Repositorio de la Asociación Española de Neuropsiquiatría
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Perfiles clínicos en hospitalización psiquiátrica prolongada: reflexiones para un nuevo enfoque en el abordaje del trastorno mental grave
No full textInstitutions dedicated to the care of serious mental illness (SMI) have admission criteria that determine the users who are admitted. A thorough analysis of the patients may reveal the existence of different clinical profiles with diverse therapeutic needs. In order to determine the existence of different clinical profiles in the UCPP of the Centro San Juan de Dios de Ciempozuelos (CSJD), a cross-sectional descriptive study was carried out, finding five clinical typologies by applying a two-stage cluster analysis. 413 people with SMI, admitted in different devices of the Prolonged Psychiatric Care Unit (according to their autonomy and needs), with a mean age of 53.78 years (95.4% males and 4.4% females) and high levels of institutionalization (mean 13.06 years), took part in the study. The main diagnosis found was residual schizophrenia (38.3%; n= 158), followed by paranoid schizophrenia (26.6%; n= 110). There was also a significant number of personality disorders (35 cases). The five typologies of users were named according to their most salient characteristics: Rehab (R), Rehab Behav (RB), Young Care (YC), Old Care (OC) and Young Behav (YB). A discussion on the implications of the determination of these profiles for a better use of existing resources is held. In addition, different alternatives for particularly difficult cases of SMI, such as borderline personality disorder, are proposed.El acceso de los usuarios con trastorno mental grave (TMG) a los dispositivos sociosanitarios viene determinado por unos criterios preestablecidos que pueden estar opacando la existencia de perfiles clínicos con diferentes necesidades terapéuticas. En esta línea, desde el Centro San Juan de Dios de Ciempozuelos (CSJD), se ha realizado un estudio descriptivo de tipo transversal en el que se han encontrado cinco tipologías clínicas mediante la aplicación de un análisis de conglomerados en dos fases. En el estudio participaron 413 personas con TMG ingresadas en diferentes dispositivos de la Unidad de Cuidados Psiquiátricos Prolongados -UCPP- del CSJD (en función de su autonomía y necesidades) y que presentaban una media de edad de 53.78 años (95.4% varones y 4.4% mujeres) y altos niveles de institucionalización (media de 13.06 años). El diagnóstico principal encontrado fue el de esquizofrenia residual (38.3%; n= 158), seguido de esquizofrenia paranoide (26.6%; n= 110). También había un número significativo de trastornos de la personalidad (35 casos). Las cinco tipologías de usuarios se denominaron en función de sus características más destacadas: Rehab (R), Rehab Behav (RB), Young Care (YC), Old Care (OC) y Young Behav (YB). En función de estos resultados se debate la idoneidad de los recursos existentes a la par que se proponen alternativas que maximicen la efectividad de los mismos en relación a casos de TMG complejos, como los de trastorno límite de la personalidad
Suicidio más allá del diagnóstico: un enfoque centrado en la persona y su circunstancia
No full textThere is a plurality of understanding approaches to suicide. In the scientific literature and the healthcare field, the biomedical model is hegemonic. This paper presents an alternative existential-contextual model for the study, understanding, prevention and postvention of suicide in the healthcare field. The academic paper is divided into two parts. The first part sets out the three essential elements of the existential-contextual model: the notion of personhood, the concept of life problems and the practice of caring and supportive relationships. The second one develops some of the most important differences in care between the biomedical and the existential-contextual models of suicide. It concludes with the need to overcome the traditional biomedical suicidological paradigm and to build a broad transdisciplinary space for critical suicidological reflection that is up to date with our times. This paradigm shift requires moving from a logic that prioritizes the pathological-biological-pharmacological to a socio-psycho-political logic of suicide that integrates the contributions of the biomedical model without being reduced to them.Existe una pluralidad de enfoques sobre el suicidio. En la literatura científica y en el ámbito sanitario es hegemónico el modelo biomédico. En este trabajo se presenta un modelo alternativo, existencial-contextual, de estudio, comprensión, prevención y posvención del suicidio en el ámbito sanitario. El trabajo se divide en dos partes. La primera expone los tres elementos esenciales del modelo existencial-contextual: la noción de persona, el concepto de problemas de la vida y la práctica de la relación de cuidado y acompañamiento. La segunda desarrolla algunas de las diferencias asistenciales más importantes entre el modelo biomédico y el existencial-contextual del suicidio. Se concluye en la necesidad de superar el paradigma suicidológico biomédico tradicional y construir un espacio amplio transdisciplinar de reflexión suicidológica crítica a la altura de nuestro tiempo. Este cambio de paradigma requiere pasar de una lógica que prioriza lo patológico-biológico-farmacológico a otra socio-psico-política del suicidio que integre las aportaciones del modelo biomédico sin reducirse a ellas
Las vicisitudes del self según Kohut
No full textCharles B. STROZIER, Konstantine PINTERIS, Kathleen KELLEY, Deborah CHER (2023). The New World of Self. Heinz Kohut’sTransformation of Psychoanalysis and Psychotherapy. Oxford: Oxford University Press. ISBN: 9780197535226, 272 páginas
En contra de las guerras
No full textIñaki MARKEZ (2023). Freud y Einstein no van a la guerra. Bilbao: Ediciones Beta. ISBN: 978-84-19227-30-0, 254 páginas
Does Involvement in Peer Bullying Invite Self-Injury? The Association Between Peer Bullying and Self-Injury in a Clinical Sample
No full textPrevious studies have linked peer bullying to nonsuicidal self-injury (NSSI). However, the evidence is largely limited to population-based groups. This study examined whether there is a relationship between NSSI and being a victim of peer bullying among adolescents in a clinical sample and how this may be influenced by types of bullying. The sample consisted of 96 outpatients with NSSI and 107 healthy adolescents. The Inventory of Statements About Self-Injury, Peer Bullying Scale, and Rosenberg Self-Esteem Scale were applied. Whereas the scores of each bullying type of adolescents with NSSI were significantly higher, their self-esteem scores were significantly lower. Each victimization score of bullying had a negative correlation with NSSI-onset age and self-esteem scores and a positive correlation with self-injury scores. This study demonstrated that being a victim of any type of bullying is strongly associated with self-injury. It would be advisable to screen adolescents with self-injury for exposure to bullying, and vice versa
The effect of positive psychotherapy-based psychoeducation given to individuals with mental illness on forgiveness and psychological well-being
No full textAmaç: Bu araştırma ruhsal hastalığı olan bireylere verilen pozitif psikoterapi temelli psikoeğitimin (PPPT), affetme ve psikolojik iyi oluşa etkisini belirlemek amacıyla yapıldı. Materyal ve Metot: Araştırma randomize kontrollü olarak Ekim 2021 ile Şubat 2023 tarihleri arasında yürütüldü. Araştırma Turgut Özal Tıp Merkezi (TÖTM) psikiyatri kliniğinde tedavi gören 120 ruhsal hastalık tanısı alan birey (60 deney 60 kontrol) ile tamamlandı. Araştırmada deney grubuna sekiz oturumluk PPPT eğitimi verildi. Kontol grubuna herhangi bir girişimde bulunulmadı. Araştırmada (Tanıtıcı Özellikler Formu, Heartland Affetme ve Psikolojik İyi Oluş Ölçeği) uygulandı. Verilerin analizinde, sayı, yüzde, ortalama, standart sapma, ki kare, bağımlı ve bağımsız gruplarda t testi kullanıldı. Bulgular: Deney grubu son test ölçek alt boyutlarından olan başkasını affetme alt boyutu ve affetme ölçek toplam puan ortalamalarının istatistiksel olarak anlamlı olduğu belirlendi (p<0.05). Deney grubunda son test affetme ölçek toplam puan ortalaması ve başkasını affetme ölçek alt boyut toplam puan ortalamasının kontrol grubuna göre arttığı saptandı. Deney grubu son test psikolojik iyi oluş ölçeği toplam puan ortalamasının istatistiksel olarak anlamlı olduğu belirlendi (p<0.05). Sonuç: Ruhsal hastalığı olan bireylere verilen PPTP eğitiminin affetme ve psikolojik iyi oluş düzeyini arttırmada etkili olduğu belirlendi. Bu sonuçlar psikiyatri kliniğindeki tüm hasta gruplarında PPTP eğitiminin uygulanabileceği, psikiyatri kliğinde çalışan ruh sağlığı ve psikiyatri hemşirelerine de bu eğitimlerin verilmesi önerilebilir. Anahtar Kelimeler: Affetme, pozitif psikoterapi, psikiyatri hemşireliği, psikoeğitim, psikolojik iyi oluş, ruhsal hastalıkAim: This study was conducted to determine the effect of positive psychotherapy-based psychoeducation (PPBP) given to individuals with mental illness on forgiveness and psychological well-being. Material and Method: The study was conducted between October 2021 and February 2023 in a randomized controlled manner. The study was completed with 120 individuals diagnosed with mental illness (60 experiment and 60 control) who were treated at the TOTM psychiatry clinic. Eight sessions of PPBP training were given to the experimental group in the study. No attempt was made to the control group. (Descriptive Characteristics Form, Heartland Forgiveness and Psychological Well-Being Scale) was applied in the research. In the analysis of the data, number, percentage, mean, standard deviation, chi-square, dependent and independent groups t-test was used. Results: It was determined that the mean scores of the experimental group's post-test scale sub-dimensions, forgiveness of others and forgiveness scale total score were statistically significant (p<0.05). It was determined that the post-test forgiveness scale total score average and the forgive others scale sub-dimension total score average in the experimental group increased compared to the control group. It was determined that the total mean score of the experimental group post-test psychological well-being scale was statistically significant (p<0.05). Conclusion: It was determined that PPBP training given to individuals with mental illness was effective in increasing the level of forgiveness and psychological well-being. These results suggest that PPBP training can be applied to all patient groups in the psychiatry clinic, and that these trainings should be given to mental health and psychiatry nurses working in the psychiatry clinic. Keywords: Forgiveness, positive psychotherapy, psychiatric nursing, psychoeducation, psychological well-being, mental illnesse
Evaluation of Eyelid, Angle, and Anterior Segment Parameters Using Scheimpflug Camera and Topography System in Obstructive Sleep Apnea Syndrome
No full textObjectives: The purpose of the study was to investigate the eyelid hyperlaxity, anterior segment, and corneal topographic parameters in patients with obstructive sleep apnea syndrome (OSAS) using Scheimpflug camera and topography system. Methods: In this prospective and cross-sectional clinical study, 32 eyes of 32 patients with OSAS and thirty-two eyes of 32 healthy subjects were evaluated. The participants with OSAS were selected from those with an apnea-hypopnea index ? 15. The minimum corneal thickness (ThkMin), apical corneal thickness (ACT), central corneal thickness (CCT), pupillary diameter (PD), aqueous depth (AD), aqueous volume (AV), anterior chamber angle (ACA), horizontal anterior chamber diameter (HACD), corneal volume (CV), simulated K readings (sim-K), front and back corneal keratometric values at 3 mm, RMS/A values, highest point of ectasia on the anterior and posterior corneal surface (KVf, KVb), symmetry indices and keratoconus measurements were taken by combined Scheimpflug-Placido corneal topography and compared with healthy subjects. Upper eyelid hyperlaxity (UEH) and floppy eyelid syndrome were also evaluated. Results: There were no statistically significant difference between groups in terms of age, gender, PD, ACT, CV, HACD, simK readings, front and back keratometric values, RMS/A-KVf and KVb values, symmetry indices, and keratoconus measurements (p>0.05). ThkMin, CCT, AD, AV, and ACA values were significantly higher in OSAS group compared to the control (p<0.05). UEH was detected in two cases in the control group (6.3%) and in 13 cases in the OSAS group (40.6%) and the difference was significant (p<0.001). Conclusion: The anterior chamber depth, ACA, AV, CCT, and UEH increase in OSAS. These ocular morphological changes occurring in OSAS may explain why these patients prones to normotensive glaucoma. © Issues in Information Systems.All rights reservedThis research has earned no particular grant from any state, commercial, or non-profit funding agency
Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors
No full textBackground. Cholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD). Methods. Data from 2577 LLDs who underwent living donor hepatectomy (n = 2511) or aborted living donor hepatectomy (n = 66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study. Results. A total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n = 446; 17.9%), adenomyomatosis (n = 9), and papillary hyperplasia (n = 6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n = 207; 0.4%), cholelithiasis (n = 53), cholesterol polyp (n = 31), and noncholesterol polyp (n = 19), respectively. Significant differences were detected between the male and (content) (P < .001), and lymph node around the gallbladder (P = .015). Conclusions. The results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women
Determination of maternal serum pro-inflammatory cytokine changes in intrauterine growth restriction
No full textOBJECTIVE: To evaluate ma-ternal serum inflammatory marker changes in intrauterine growth restriction (IUGR) preg-nancies.PATIENTS AND METHODS: 50 healthy preg-nant women and 50 patients diagnosed with IU-GR were enrolled. Maternal serum high sensi-tivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), tumor necrosis fac-tor-alpha (TNF-alpha), interleukin (IL)-6, and IL-10 levels were measured before delivery and neonatal outcomes were evaluated.RESULTS: Birth weight, Apgar scores, and cord blood gas pH were lower in the IUGR group (p3.2 pg/ml) had a sensi-tivity of 100%, specificity of 100%, PPV of 100% and NPV of 100%.CONCLUSIONS: While birth weight, Apgar score and cord blood pH decreased in IUGR cas-es, ESR, hsCRP, IL-6 and TNF-alpha levels increased. Combined measurement of these markers can be used for the diagnosis of IUGR
Investigation of elevated temperature resistance of lightweight geopolymer concrete
No full textPortland çimentosu (PÇ) üretiminin neden olduğu ekonomik ve çevresel sorunlar PÇ'ye alternatif bağlayıcı arayışlarını teşvik etmektedir. Bunlar arasında geopolimer bağlayıcılar çimentoya kıyasla çevre dostu olması, yüksek dayanım ve dayanıklılık özellikleri nedeniyle öne çıkmaktadır. Geopolimer bağlayıcılar, uçucu kül, yüksek fırın cürufu ve metakaolin gibi Si-Al açısından zengin hammaddelerin sodyum hidroksit ve sodyum silikat gibi yüksek alkali çözeltilerle aktivasyonu sonucu sentezlenen inorganik polimerlerdir. Geopolimer bağlayıcıların hafif betonlara uygulanarak dayanım ve dayanıklılık özelliklerinin ortaya çıkarılması uygulama alanlarının ve kullanım avantajlarının artması açısından oldukça önem arz etmektedir. Bu çalışmanın amacı laboratuvar koşullarında sertleşen taşıyıcı hafif geopolimer beton üretmek ve daha sonra yüksek sıcaklık direncini ortaya çıkarmaktır. Bu doğrultuda, ilk olarak beton bileşenleri ve oranları gibi üretim parametreleri değiştirilerek taşıyıcı hafif geopolimer betonlar üretilmiştir. Üretilen bu hafif geopolimer betonların yüksek sıcaklık (150, 300, 450, 600, 750 C) etkisi sonrasında basınç dayanımı, su emme, ağırlık değişimi, mikro yapı (SEM-XRD) özelliklleri incelenmiş ve normal ağırlıklı geopolimer beton ile mukayese edilmiştir. Sonuç olarak pomza agregalı taşıyıcı hafif geopolimer beton üretimi için optimum üretim parametreleri belirlenmiş ve bu betonların normal geopolimer betonlara kıyasla daha iyi yüksek sıcaklık direnci gösterdiği ortaya çıkarılmıştır. Anahtar Kelimeler: Hafif Geopolimer Beton, Yüksek Sıcaklık Direnci, Basınç Dayanımı, MikroyapıThe economic and environmental problems caused by the production of Portland cement (PC) encourage the search for alternative binders to PC. Among these, geopolymer binders stand out due to their environmental friendliness, high strength and durability. Geopolymer binders are inorganic polymers synthesized as a result of the activation of Si-Al rich raw materials such as fly ash, blast furnace slag and metakaolin with highly alkaline solutions such as sodium hydroxide and sodium silicate. It is very important to reveal the strength and durability properties of geopolymer binders by applying them to lightweight concrete in order tı,o increase the application fields and the advantages of usage. The aim of this study is to produce lightweight structural geopolymer concrete that hardens under laboratory conditions and then to reveal its elevated temperature resistance. In this direction, firstly, structural lightweight geopolymer concretes were produced by changing the production parameters such as concrete components and ratios. The compressive strength, water absorption, weight change, microstructure (SEM-XRD) properties of these produced lightweight geopolymer concretes after the effect of high temperature (150, 300, 450, 600, 750 C) were examined and compared with normal weight geopolymer concrete. As a result, optimum production parameters for the production of structural lightweight geopolymer concrete with pumice aggregate were determined and it was revealed that these concretes exhibited better elevated temperature resistance compared to normal geopolymer concretes. Keywords: Lightweight Geopolymer Concrete, Elevated Temperature Resistance, Compressive Strength, Microstructur