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Psihiatru.ro 19

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Title: Depresia, contemporana noastra Author: Conf. dr. Catalina Tudose Introduction: Depresia a fost, este si ramane subiectul de prim rang al discutiilor psihiatrice indiferent unde si cand sunt purtate. De la deceniu la deceniu puternicele modificari socio-culturale ale lumii contemporane au facut ca subiectul depresiei sa transgreseze frontierele psihopatologiei pentru a fi pus in discutie in cele mai variate ipostaze stiintifice sau culturale care depasesc adesea domeniul medicinei. Title: Corpul - veriga lipsa Author: Prof. univ. Vintila Mihailescu Afiliation: Director Muzeul Taranului Roman, Sociolog Introduction: “Timp de secole, a existat o straduinta de a convinge oamenii ca nu aveau (un corp, n.n.) (de fapt, acestia nu au fost niciodata cu adevarat convinsi de acest lucru); astazi exista obstinarea sistematica de a-i convinge de corpul lor. O propaganda necontenita ne aminteste (…) ca nu avem decat un corp si ca trebuie sa-l salvam. (…)…totul probeaza astazi ca acest corp a devenit obiect de mantuire. Acesta s-a substituit literalmente sufletului in aceasta functie morala si ideologica” (Baudrillard, 1970: 200). Ceea ce era mai mult o premonitie in 1970, cand Jean Baudrillard scria aceste randuri, a devenit in prezent un fapt aproape cotidian. Sa privim insa mai de aproape aceasta rasturnare de perspectiva. Title: Depresia si distorsiunile proceselor cognitive Author: I. Gabos Grecu, M. Gabos Grecu, Th. Moica, A. Vesa, G. Buicu, C. Gabos Grecu Afiliation: Clinica Psihiatrie 1 Targu Mures, Romania Abstract: The purpose of the study: to evaluate disfunctional cognitive schemes in depressed patients, according to various aspects of clinical and to identify the most important and most common cognitive scheme. Methods: in the study were included 50 depressed inpatients, from Psychiatry Clinic No I Tirgu Mures, in the period July 2007 - October 2008. Clinical diagnosis was established on the basis of the DSM-IV TR. The control group was composed of 50 persons, without psychiatric history. For evaluation we used the Hamilton Scale for Depression (21 items) and The Disfunctional Attitudes Scale (DAS - Beck and Weissman) Results: DAS score and the presence of various disfunctional schemes shows a linear increase toghether with the severity of depression (Hamilton Score). DAS score results show that depressed patients may be characterized by the following disfunctionalities: the need for recognition (60% of depressed patients and 28% in the control group) need to be loved (59% to group patients and 29% in control group ), perfectionism (58% of depressed patients and 26% in the control group); expectations (55% of depressed patients and 25% in the control group). Disfunctional schemes have different characteristics depending on age, group and type of depression Conclusion: Study results show the existence of disfunctional attitudes, specific, depending on the diagnosis (bipolar disorder, major depressive disorder), gender and age group, which motivates the needing of new therapeutical methods, which integrates drugs and psychotherapy and works on disfunctional attitudes, depending on gender, age and diagnosis. Key-words: depression, cognitive schemes, disfunctional attitudes Rezumat: Scopul lucrarii consta in evaluarea schemelor disfunctionale la pacientii depresivi, in functie de diferite aspecte clinice, identificarea celor mai importante si celor mai frecvente scheme cognitive. Metode: In studiu au fost inclusi 50 pacienti cu depresie, internati in Clinica de Psihiatrie 1 Targu Mures, in perioada iulie 2007 - octombrie 2008. Diagnosticul clinic a fost stabilit pe baza criteriilor DSM IV-TR. Grupul de control a fost compus din 50 de persoane, fara antecedente psihiatrice. Pentru evaluare am folosit Scala Hamilton pentru Depresie (21 itemi) si Scala Atitudinilor Disfunctionale (DAS - Beck si Weissman). Rezultate: Scorul DAS si prezenta diferitelor scheme disfunctionale arata o crestere lineara impreuna cu severitatea depresiei (Scorul Hamilton). Rezultatele arata ca pacientii cu depresie pot fi caracterizati prin urmatoarele disfunctionalitati: nevoia de recunoastere (60% din pacientii cu depresie si 28% in grupul de control), necesitatea de a fi iubit (59% la grupul de pacienti si 29% in grupul de control), perfectionism (58% din pacientii cu depresie si 26% in grupul de control), asteptari (55% din pacientii cu depresie si 25% in grupul de control). Schemele disfunctionale au caracteristici diferite in functie de varsta, de sex si de tipul de depresie. Concluzii: Rezultatele studiului arata existenta atitudinilor disfunctionale, specifice, in functie de diagnostic (tulburare bipolara, tulburari depresive majore), de sex si grupa de varsta, care motiveaza nevoia de noi metode terapeutice, care integreaza terapia medicamentoasa si psihoterapia si actioneaza pe atitudinile disfunctionale, in functie de sex, varsta si de diagnostic. Cuvinte cheie: depresie, scheme cognitive, atitudini disfunctionale Title: De-medicalizarea depresiei – o alternativa in abordarea terapeutica a depresiei Author: Dr. Radu Vrasti , MD, PhD Afiliation: Crisis Intervention Program, Stratford General Hospital, Huron-Perth Healthcare Alliance, Ontario, Canada Introduction: O privire rapida asupra psihiatriei ca demers social releva o anumita certitudine cu privire la abordarile diagnostice si terapeutice ale marilor entitati clinice, precum depresia sau schizofrenia. Publicul larg aproape ca nu se mai indoieste de “veridicitatea” modelului psihiatric. Din pacate lucrurile nu stau totdeauna asa si profesionistii sanatatii mentale au datoria continua de a se intreba daca ceea ce cred ei ca diagnosticheaza si trateaza este un lucru adevarat si universal acceptat. Title: Psihopatologia evolutionista si depresia Author: Mircea Lazarescu Afiliation: Clinica Psihiatrica Timisoara Introduction: In textul ce urmeaza se va face o succinta prezentare a psihologiei si psihopatologiei evolutioniste actuale si un comentariu al aplicarii acesteia in depresie. Title: Problematica economica a depresiei unipolare, din perspectiva celei mai impovaratoare maladii psihice a secolului XXI Author: As. univ. dr. Enatescu Virgil – Radu Afiliation: Universitatea de MedicinA Si Farmacie „Victor Babes” Timisoara – Disciplina Psihiatrie Abstract: The present paper consist in a extensive review of international psychiatric literature which analyses the most representative epidemiological and costs related studies performed so far regarding unipolar depression. As it is well known unipolar depression represents the most prevalent psychiatric disorder existing in general population as a distinct disorder. Beside epidemiological magnitude, the more modern concept of global burden of disease raises new significant financial challenges related to unipolar depression. This new concept represents a significant achievement for psychiatry because from the financial perspective of chronic diseases, it was made equity between wellknown impoverishment somatic diseases, as coronary heart disease, and psychiatric disorder in respect to global costs of disease. The global burden of disease concept comprises particularly the years lived with disability that have a dramatic consequence on indirect costs related to unipolar depression that are considered as a unseeable part of the economical iceberg. It is not to be neglected the intangible costs due to disease so the human suffering generally and psychic’s suffering particularly can’t be quantified in a usual way. The depressive phenomena transcends beyond the geographical boundaries of continental areas so remarkable worldwide efforts are made for the development of national health policies more efficacious and more elaborated that will respond more properly and more competent to actual requirements raises by unipolar depression. Keywords: unipolar depression, global burden of disease, epidemiology Rezumat: Articolul prezent cuprinde o ampla recenzie a literaturii internationale de specialitate, in care au fost incluse cele mai importante studii de epidemiologie si de costuri ale depresiei unipolare. Asa cum este bine stiut depresia unipolara reprezinta cea mai raspandita afectiune psihica distincta in populatia generala. Pe langa magnitudinea epidemiologica, o importanta deosebita este cea legata de mai noul concept de cost global pe care il antreneaza depresia unipolara. Aparitia acestuia in problematica financiara asociata bolilor cronice, a facut o mare echitate in ceea ce semnifica estimarea ponderii depresiei alaturi de afectiuni somatice cronice semnificative, precum boala coronariana, la costurile globale legate de boala pe care societatea trebuie sa le plateasca. Acesta include in mod particular si anii de dizabilitate cauzati de boala si care au ca efect direct cresterea impresionanta a costurilor indirecte legate de boala, considerate pe buna dreptate, de catre specialistii in domeniu, ca partea nevazuta a aisbergului. Deloc de neglijat sunt costurile intangibile, astfel incat suferinta umana, in general, iar cea sufleteasca, in special, sunt aproape imposibil de cuantificat. Fenomenul depresiv transcede limtele spatiale ale continentelor astfel ca la nivel mondial se fac eforturi remarcabile pentru dezvoltarea unor politci de sanatate publica cat mai bine elaborate si mai eficiente, care sa raspunda cat mai competent cerintelor reale legate de acesta maladie. Cuvinte cheie: depresie unipolara, cost global al bolii, epidemiologie Title: Factori predictivi ai rezistentei la tratament in depresii Author: Gerarldine Stanciu Afiliation: medic primar psihiatru, doctorand in psihiatrie Abstract: Objective: Not easy to differentiate factors associated with chronic and /or resistance to treatment of those factors would be predictive for recurrence of symptoms of a new episode. For this reason it is probably advisable for individual therapy setting minimum effective dose in the absence of specific research studies, to assess cost benefit and other attributes related to optimizing quality of life for patients. Because the treatment is appropriate, that means correct and complete, it is necessary the diagnosis to be correct and complete, so when we face a potential treatment failure, before switching strategy is needed reassessment of diagnosis and determination of the comorbidities. Method: Article is to analyze relevant data from literature on the issue of treatment-resistant depression (TRD). Conclusion: It can be said that the current depressed patient therapeutic needs can be met only partially. What is studied and known to be effective, according to a randomized and placebo controlled studies cannot lead to a guide for treatment resistant depression but is essential the psychiatrists experience and their way of approach of each patient to achieve the best results. Keywords: treatment resistant depression, predictive factors Rezumat: Obiectiv: Nu sunt usor de diferentiat factorii asociati cu cronicizarea si/sau rezistenta la tratament, de acei factori care ar fi predictivi pentru reaparitia simptomelor unui nou episod. Din acest motiv este probabil recomandabila individualizarea tratamentului cu stabilirea dozelor minimale eficiente in absenta unor studii de cercetare concrete, cu evaluarea raportului cost beneficiu si a altor atribute legate de optimizarea calitatii vietii pacientului. Pentru ca tratamentul sa fie adecvat, adica corect si complet, este necesar si ca diagnosticul sa fie corect si complet, de aceea, cand ne aflam in fata unui potential esec terapeutic, inainte de a schimba strategia, este necesara reevaluarea diagnosticului si stabilirea eventualelor comorbiditati. Metoda: Articolul isi propune sa analizeze datele relevante din literatura de specialitate cu privire la problematica depresiei rezistente la tratament (DRT). Concluzii: Se poate afirma ca, nevoile terapeutice ale pacientilor depresivi actuali, pot fi acoperite numai partial. Ceea ce este studiat si cunoscut ca fiind eficace, conform studiilor clinice randomizate si placebo controlate, nu poate conduce spre un ghid de tratament in cazul depresiei rezistente, ci este esentiala in continuare experienta psihiatrului si modul propriu de abordare al fiecarui pacient, pentru obtinerea celor mai bune rezultate. Cuvinte cheie: depresie rezistenta la tratament, factori predictivi Title: Studiu privind eficacitatea superioara a clonazepamului fata de alte benzodiazepine (diazepam), in tratamentul depresiei unipolare Author: Denise Buda Afiliation: Medic primar psihiatru, Spitalul Clinic de Psihiatrie “Prof. Dr. Al. Obregia” Bucuresti Abstract: Depressive disorders are considered to be clinical entities frequently seen in medical practice, causing a very high level of disease burden and are expected to show a rising trend during the coming 20 years. Simptoms of depressive episode in both recurrent depressive disorder and bipolar affective disorder are similar. Despite of theese similarities, recent studies show that depressive episode who appears in both disorders, is different regarding etiology, course and adjacent neurochemical processes. The therapeutic plan used for the treatment of depression usually combines an antidepressant with a benzodiazepine. The current study investigates the therapeutic efficiency of clonazepam versus diazepam in association with paroxetine used to treat the depressive episode – recurrent depressive disorder. Key words: depressive episode, therapeutic efficiency, clonazepam Rezumat: Tulburarile depresive reprezinta entitati clinice frecvent intalnite in practica medicala, depresia fiind una din cauzele majore de dizabilitate pe plan mondial, avand tendinta de a creste in urmatorii 20 ani. Tabloul clinic al episodului depresiv din tulburarea depresiva recurenta si tulburarea afectiva bipolara - faza depresiva este identic, insa studiile din literatura de specialitate evidentiaza faptul ca cele doua entitati clinice difera din punct de vedere al etiologiei, al substratului neurochimic si al evolutiei. Schema terapeutica utilizata in tratamentul episodului depresiv asociaza frecvent un agent antidepresiv cu o benzodiazepina. Studiul de fata isi propune sa investigheze eficacitatea terapeutica superioara a clonazepamului fata de diazepam, in asociere cu paroxetina, in tratamentul episodului depresiv din tulburarea depresiva recurenta. Cuvinte cheie: episod depresiv, eficacitate terapeutica, clonazepam Title: Masurarea Psihizei - Partea a III-a Author: Dr. Radu Vrasti , MD, PhD Afiliation: Crisis Intervention Program, Stratford General Hospital, Huron-Perth Healthcare Alliance, Ontario, Canada Motto: “What sets worlds in motions is the interplay of differences, their attractions and repulsions. Life is plurality, death is uniformity. By suppressing differences and peculiarities, by eliminating difference civilizations and cultures, progress wakens life and favors death. The idea of a single civilization for everyone, implicit in the cult of progress and technique, impoverishes and mutilates us. Every view of the world that becomes exctinct, every culture that disappears, diminishes a possibility.” (Octavio Paz, The Labyrinth of Solitude, 1993)

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