Ramón Florenzano

Somatización: aspectos teóricos, epidemiológicos y clínicos

Objetivo. Este articulo tiene como objetivo hacer una revision del concepto de somatizacion para contrastar esta teoria con datos clinicos y epidemiologicos actuales. Metodo. Revision bibliografica comparada con los resultados de estudios empiricos de los autores. Resultado. Se concluye sobre la necesidad de re-pensar las clasificaciones para este trastorno, abriendose interrogantes para futuras investigaciones que exploren la comorbilidad con cuadros depresivos, ansiosos y trastornos medicos cronicos, como asi tambien la asociacion con trauma infantil, maltrato y abuso sexual, antecedentes frecuentes en pacientes limitrofes y somatizadores. Conclusiones. Los pacientes somatizadores tendrian dificultades con la organizacion intencional de sus deseos; la somatizacion seria expresion de un conflicto psicosocial por via somatica. Por ello es necesaria la capacitacion de profesionales medicos, a traves de metodologias docentes que se centren en la conflictiva psico-social de base. El estudio y manejo de estos pacientes es un excelente campo para equipos de trabajo interdisciplinarios y multiprofesionales en el diseno de intervenciones efectivas y aproximaciones preventivas

Psicopatología en pacientes hospitalizados en un hospital general

Existen escasos estudios que evaluan la prevalencia de alteraciones psicopatologicas en pacientes hospitalizados por causas medicas, a pesar de la importancia de estos sobre el diagnostico, tratamiento, evolucion y costos de atencion. El presente estudio pretende detectar la presencia de alteraciones psicopatologicas en pacientes internados en el Hospital del Salvador de Santiago, utilizando como instrumento de deteccion el Cuestionario General de Salud de Goldberg, en su version de 12 preguntas (GHQ-12). Un equipo de entrevistadores evaluo las consecuencias psicologicas del trauma infantil y recolecto los antecedentes sociodemograficos de los pacientes hospitalizados en los servicios de Medicina Interna, Cirugia, Oftalmologia, Otorrinolaringologia, Neurologia, Urologia, Traumatologia y Ginecologia durante el periodo comprendido durante un fin de semana de agosto de 2001. La muestra considero a 362 pacientes, incorporandose en el estudio 297, mayoritariamente mujeres (61,5%). El promedio de edad en los hombres fue de 57,8 anos y de 52,7 anos en las mujeres. La prevalencia de alteraciones psicopatologicas (GHQ-12 con 5 puntos o mas) fue de 46,4%. No se encontro una correlacion entre el mayor puntaje en el GHQ-12 con variables tales como estado civil, ocupacion o tipo de servicio (medico o quirurgico). La alta prevalencia de comorbilidad encontrada confirma la importancia de la deteccion y adecuado manejo de los trastornos emocionales en pacientes con patologias fisicas.

Treatment of paroxysmal atrial arrhythmias with acetyl-strophanthidin∗

Abstract Nine patients with ten episodes of paroxysmal atrial arrhythmias (supraventricular tachycardias and paroxysmal atrial flutter), most of them prolonged and resistant to other therapies, have been treated with acetyl-strophanthidin. Small divided doses by slow intravenous injection, not exceeding a total amount of 1 mg., have been used. The procedure was carried out under careful clinical and electrocardiographic control. Patients in whom the drug is contraindicated were carefully excluded. In nine cases conversion to normal rhythm was obtained. This occurred with great promptness during the administration of the drug or immediately after its completion. Clinical symptoms or electrocardiographic signs of digitalis intoxication were not observed in this group of patients. Acetyl-strophanthidin is a useful drug. It is potentially dangerous, as are all digitalis and related substances, but when properly administered it appears reasonably safe. With slow intravenous administration its promptness of action permits an accurate regulation of dosage.

Harm to others from alcohol: the role of socio-cultural variables

This paper describes the changes in alcohol research, from a traditional individual focus on individual bodily and mental effects, to a broader focus on harm to others. This shift has coincided with broader sequential definitions of the progression from normal through harmful alcohol dependence, both in the specialized epidemiological and also in the newer classificatory systems (DSM 5 and CIE 11 draft). After presenting updated global, regional and chilean data, an international collaborative Project (Alcohol Harm to Others, ATOH) is described, with the participating institutions: the local study and the chilean components of the research team, the conceptual framework of harm to others (families, children, women; neighbors, friends, co-workers; society at large). Ethical aspects and institutional approval are presented and the principal results outlined: socio-demographic data (with special focus on the role of gender, socio-economic level and religiosity/spirituality). The data is presented for the chilean sample, with examples from other participating countries. The complexity of the link between alcohol harm to others and religious and spiritual factors is studied comparing data from several of the participating countries, and the impact upon vulnerable populations, especially women and children. The discussion reviews some of the confounding and intervening factors that could influence the results. The conclusion about prevention and policy development closes the paper.

Harm to children and their families due to alcohol abuse: results of a population survey in Chile

INTRODUCTION Alcohol is widely used among young families, and leisure time is frequently family time. Heavy alcohol consumption can adversely affect children. The objective of this work is to measure the harm to others in Chile. SUBJECTS AND METHOD This descriptive and probabilistic study forms part of a collaborative research funded by Thai Health and WHO. The survey was adapted by co-researchers and applied to a nationally representative sample of 1500 Chileans over 18years of age. RESULTS A total of 408 respondents (27.2%) lived with children at home. Of this total, 10.5% felt that the use of alcohol by any member of the family had adversely affected a child. The most common adverse effects were verbal violence (29.7%), domestic violence (23.1%), unsupervised homes (18.7%), lack of money to provide basic needs of the child (14.3%), and physical violence (7.7%). Furthermore, in 6.6% of the cases child or family services agencies became involved. In almost half of the cases (46.3%), the drinker was the father, mother or step-parents. This was followed by other relatives (24.4%) and brothers (4.9%), or guardian of the child (2.4%). CONCLUSION These data support the clinical observation that alcohol is common in Chilean homes. Its consumption not only damages the physical and mental health of the drinker but also those around him. Verbal violence and witnessing serious physical violence are frequent issues, as well as economic problems that end up with the inability to provide the child with its basic needs.INTRODUCTION: Alcohol is widely used among young families, and leisure time is frequently family time. Heavy alcohol consumption can adversely affect children. The objective of this work is to measure the harm to others in Chile. MATERIAL AND METHOD: This descriptive and probabilistic study forms part of a collaborative research funded by Thai Health and WHO. The survey was adapted by co-researchers and applied to a nationally representative sample of 1500 Chileans over 18years of age. RESULTS: A total of 408 respondents (27.2%) lived with children at home. Of this total, 10.5% felt that the use of alcohol by any member of the family had adversely affected a child. The most common adverse effects were verbal violence (29.7%), domestic violence (23.1%), unsupervised homes (18.7%), lack of money to provide basic needs of the child (14.3%), and physical violence (7.7%). Furthermore, in 6.6% of the cases child or family services agencies became involved. In almost half of the cases (46.3%), the drinker was the father, mother or step-parents. This was followed by other relatives (24.4%) and brothers (4.9%), or guardian of the child (2.4%). CONCLUSION: These data support the clinical observation that alcohol is common in Chilean homes. Its consumption not only damages the physical and mental health of the drinker but also those around him. Verbal violence and witnessing serious physical violence are frequent issues, as well as economic problems that end up with the inability to provide the child with its basic needs. Language: es