Psychosomatic Unit Research Articles

THE IMAGE OF GOD IN THE HUMAN BEING OR THE IDENTITY OF MAN AS A PERSON

Man by his being is par excellence a dynamic organism, towards the eternal. Man is fundamentally penetrated by the mystery of love that pushes people from the inside towards a natural communion, which reveals the personal and conscious existence in time and space, incorporated in an indissociable psychosomatic unit, with immeasurable psychic depth; free, master, rational, creator of holiness (man sanctifies the place), knower, etc. These are the attributes that eloquently reveal the true constitution of man. The eternal value of the human person, the uniqueness of his being realized through the unity of contrasts that man represents as body and soul, shows that the person is not brought into the world by God in isolation, as a uniform abstract achievement, separated from nature, from being. The person presents himself in the complex context of the bonds of love and care manifested towards himself and towards other persons different from him, but who share the same common nature in which the divine presence mysteriously dwells

Advocating Values through Meaningful Participation: Introducing a Method to Elicit and Analyze Values for Enriching Data Donation Practices in Healthcare

The secondary use of routinely collected patient data made possible by the broad consent form is seen as a prerequisite for developing data-driven health technologies. In Germany, relevant stakeholder groups (e.g., ethics committees and data protection authorities) specified the broad consent form; however, only one group of patient representatives was consulted, which may indicate asymmetries in engagement. This situation informed our research on medical data donation and emphasized foregrounding patient values. Drawing on participatory design, value sensitive design, and emerging research on value-led participation, we propose a method consisting of (1) a workshop concept for participatory value elicitation composed of four carefully coordinated phases and (2) an analysis procedure to examine the empirical data collected. This analysis allowed us to derive design requirements for medical data donation user interfaces. We conducted three workshops with patient advocates of vulnerable groups and patients in residential care of a psychosomatic unit. Our findings provide new directions to improve user interfaces for medical data donation: First, user interfaces need to enhance patients' reflective thinking about the potential consequences of their data donation; second, a decision facilitator supporting patients' value-based decision-making (e.g., by providing simple language or tailoring descriptions to patient needs); and finally, a data intermediary relieving patients' decision-making and giving them control over their data after donation. Moreover, we emphasize the need to increase the use of participatory approaches in health technology development.

Differences in life attitudes between general population and hospitalized psychosomatic patients: a comparative cross-sectional study

ABSTRACT To compare the extent to which value-based life attitudes measured by means of the Life Attitude Profile (LAP-R) could differ between the general population and people suffering from mental disorders hospitalized in a psychosomatic ward. Cross-sectional comparative study between a sample of general population (n = 409) and a sample of unselected patients (n = 147) at admission in a psychosomatic ward. Comparisons were carried out by means of Cronbach’s alpha, correlation matrix, t-tests, robust multivariate linear regression models (MLRM), and using propensity scores. The internal consistency of LAP-R is good (alpha = 0.90). Divergent validity with BFI dimensions is widely given. In MLRM general population scored higher for the indexes ‘personal meaning’ and ‘existential transcendence’, whereas psychosomatic patients for the dimensions ‘responsibleness’, ‘death acceptance’, ‘goal seeking’ and especially ‘existential vacuum’. Sex, partnership and schooling display few associations. Neuroticism is negatively and agreeableness positively associated with life attitudes considered as protective. Norm values and differences were stratified by age ranges. This study demonstrates that basic human attitudes like personal transcendence, personal meaning, having a biographically supported mission in life, and belief in a reason for existence are so fundamental for individuals that they are to some degree given independently of having a mental disorder or not. Neuroticism is a risk trait and agreeableness a protective trait facing life attitudes. The findings of this study indicate that people suffering from mental disorders treated in a specialized psychosomatic unit in a general hospital have important value-based resources and simultaneously higher levels of existential vacuum that have to be considered in treatment planning but should also be embedded in a therapeutic alliance. The existential vacuum deserves special consideration in the treatment of patients, especially facing risk of suicide.

FIRST STEPS OF EDUCATION IN THE FAMILY – THE POSSIBILITIES OF EARLY CHILDHOOD PREVENTION AND INTERVENTION AT THE DEPARTMENT OF PEDIATRICS OF THE UNIVERSITY OF DEBRECEN

In Hungary, preterm birth is a common issue; approximately 8.000 infants are born preterm each year. At the Department of Pediatrics of the University of Debrecen, our Pediatric Psychology and Psychosomatic Unit work to minimize the risk of neurodevelopmental delay in children born prematurely or in other risk groups. In favour of it, we help families at both the prevention and the intervention levels. Parent education, organization of parent groups, and counselling provide us an opportunity to acquaint parents with the possibilities of using help. The chapter briefly describes the possibilities of prevention (screening tests, diagnostics) and intervention (parent group, music therapy, animal-assisted therapy, sensory integration therapy), the family implications of the COVID-19 pandemic, and the Bayley-III diagnostic and screening test, which is one of the most advanced developmental tools for early prevention. Our approach is that, in favour of healthy and balanced development, the whole family needs to get the appropriate support and care. Supporting and strengthening parental efficiency is an important step by which the parent is able to implement a method of education that takes into account the individual characteristics of the child, by which the child's adaptability, carrying capacity, and social skills develop and strengthen.

OXTR-Related Markers in Clinical Depression: a Longitudinal Case\u2013Control Psychotherapy Study

We investigated stability and change of plasma and urinary oxytocin as well as OXTR DNA methylation patterns through psychotherapy. Furthermore, we explored the potential impact of inpatient psychotherapy on oxytocin-related biomarkers and vice versa by differentiating patients who remitted from depression versus non-remitters. Blood and urine samples were taken from 85 premenopausal women (aged 19–52), 43 clinically depressed patients from a psychosomatic inpatient unit, and 42 healthy control subjects matched for age and education at two points of time. Serum and urine oxytocin were measured using standard ELISA, and DNA methylation of the OXTR gene was assessed using bisulfite sequencing at the time of admission (baseline) and at discharge and from controls at matched time points. Oxytocin plasma levels were not associated with depression and were influenced by neither time in healthy controls nor psychotherapy in patients. Non-remitting depressed patients had significantly lower oxytocin urine levels before and after psychotherapy treatment. We found significantly lower exon 1 OTXR methylation in depressed patients over time and these differences were driven by patients remitting due to psychotherapy. A reverse pattern — higher levels of methylation in remitters — was found for exon 2 OXTR DNA methylation. Plasma oxytocin, urinary oxytocin, and OXTR DNA methylation patterns were intrapersonally relatively stable. OXTR-related factors were seemingly unaffected by inpatient psychotherapeutic treatment, but we found significant differences between remitting and non-remitting patients in urinary oxytocin and OXTR DNA methylation. If replicated, this suggests that OXTR-related markers may predict inpatient treatment outcomes of clinically depressed patients.

The application of technoscience to man: ethical discernment in relation to the transhumanist-posthumanist proposal

Transhumanism-posthumanism is a current of thought that appears closely linked to the development of technoscience and its application to man. At the same time that this current must be subject to criticism, an anthropological and ethical paradigm must be illuminated that allows accepting or not the new technoscientific advances, making a discernment between them. Such discernment should lead us to weigh the goodness of these advances, rejecting only those that represent a degradation of the human being, and accepting those that help man to be more fully man. To do this, the article proposes starting the discernment from an ethical principle such as respect for the integrity of man. Together with him, it is necessary to act with caution regarding human health, considered in relation to his psychosomatic unity. It will also be necessary to avoid deriving the ethics of the advances from the same technoscience. Finally, discernment requires, ultimately, starting from an idea about what man is, proposing the need to do so from a dual rather than dualistic conception of the human person. Based on all of the above, various ethical criteria are indicated in the work that complete the principle of respect for human integrity indicated above: respect and promote human life in all its dimensions, use of technology at the service of human beings in a controlled manner and that report social benefit or value by each technique, not only from a therapeutic perspective, but also from the improvement of the human psychosomatic unit. In conclusion, it is necessary to recognize in man the uniqueness of him as he is a bodily being who knows and loves in freedom, whose ends are not limited to material or sensible things, but which are only achievable in and from his own material condition. Consequently, any techno-scientific intervention that substantially alters his body condition is inhuman, not instead when it repairs or enhances -without abolishing them- his own qualities.

“Our difficult job is to take a unified view of the patient … ” (Winnicott) Psychosomatic work in a children’s hospital

ABSTRACT We present our work as psychoanalysts in the interdisciplinary psychosomatic unit of a paediatric hospital. As the starting point for our work we use Winnicott’s understanding of the psychosomatic dilemma delineated in his paper on psychosomatic illness in its positive and negative aspects. The central hypothesis is that splitting the medical field into many highly specialized fields can be understood as a display of the psychosomatic patients’ inner need for splitting and their defence against integration. Based on four case examples from different developmental periods, we demonstrate the interconnectedness of the relational environment, developmental processes, and psychic and biological conditions, and show how early experiences of threat and deprivation can cause the soma–psyche unit to fragment. Drawing on several psychoanalytic psychosomatic schools, we delineate treatment principles of the psychoanalytic contribution to the interdisciplinary work and of the individual psychoanalytic treatment.

Clinical courses of depressive and anxiety disorders over 1 year : Direct comparison of four treatment settings in psychiatry and psychosomatic medicine-results of the PfAD study

Inpatient care for patients with depressive and anxiety disorders (ICD-10 F3/F4 diagnoses) is provided in Germany in different settings of psychiatry and psychosomatic medicine. Apart from the question of the effectiveness of treatment, it is of interest whether the course of the disease differs between four different settings up to aperiod of 1 year after discharge. A total of 320 patients with main clinical diagnoses from the ICD-10 F3/F4 spectrum were recruited and interviewed consecutively in four treatment settings (psychiatric depression unit, psychiatric crisis intervention unit, psychiatric day hospital, psychosomatic acute hospital). The interviews were conducted after admission, before discharge and 6and 12months after discharge. Overall, treatment in all four settings was shown to be highly effective. The slight increase in symptoms in the postinpatient phase described in the literature was observed across all settings. In terms of treatment intensity, those treated in the crisis intervention unit received the most services after index treatment; however, this group was also the one with the most pronounced symptom burden at admission. Patients treated in the psychosomatic department had the lowest symptom burden at admission and overall received the least inpatient services over the observation period; however, outpatient follow-up treatment was apparently used most by those patients. The treatments proved to be effective in the long-term in both psychiatric and psychosomatic units. The different settings seem to be successful in adapting the treatments to the respective patient groups.

Results from the first inpatient alcohol withdrawal management program in Iran: An observational study.

The consumption of alcohol is prohibited in Iran; however, concerns regarding alcohol-related harm have led to the development of national policies supporting the establishment of officially endorsed alcohol treatment settings. As a part of these policies, the Iranian Ministry of Health supported the establishment of the first alcohol withdrawal management unit in the psychosomatic unit of Taleghani Hospital in 2015. The purpose of this study is to report on this pilot project. This was an observational and descriptive study, conducted on 83 patients with alcohol use disorder based on DSM 5 who were consecutively admitted to the unit for alcohol withdrawal management, from March 2017 to March 2018. The demographic data, alcohol use history, comorbid physical and psychiatric conditions, completion of inpatient treatment, length of hospital stay, and adverse events were extracted from the patients' records using a checklist developed by the authors. 95.2% of the patients were male. The mean age was 45.3 (±12.2) years. Study participants reported using 38.7 (±29.6) standard drinks in a drinking day during the last year. Mean length of stay was 9.01 (±6.8) days. 81.7% of patients completed the inpatient treatment episode. Six patients (7.2%) had a complicated withdrawal (delirium), and no incidents of a withdrawal seizure were reported during the period of this study. This is the first study providing preliminary results on the safety and effectiveness of symptom-triggered alcohol withdrawal management in Iran. The clinical and policy level implications of these findings have been discussed.

Using clonidine in the treatment of tizanidine abuse and withdrawal: a case report of a patient with somatoform pain disorder

ABSTRACT Tizanidine is a noradrenergic alpha-2 receptor agonist approved in the treatment of muscle spasticity. Limited data on abuse and withdrawal of Tizanidine are available. We present a case of severe withdrawal and symptoms of psychological and physiological dependence: A 52-year-old woman who was transferred to the psychosomatic unit because of pain and anxiety. She presented with a long history of inpatient treatment due to symptoms of pain. After multiple treatment options had been tried without much efficacy, the patient was prescribed Tizanidine for her symptoms of pain. As symptoms were diminished, treatment was upheld. Soon, abuse, and later, dependence of Tizanidine had established. At time of admission, the patient had been on a self-escalated daily administration scheme of 40 mg of Tizanidine. As dose tapering proved unsuccessful, dose reduction with Lorazepam to reduce withdrawal symptoms was attempted. As also the additive treatment with Lorazepam showed no satisfying results, another treatment option was needed. After establishing Clonidine, the off tapering of Tizanidine was much better tolerated by the patient and finally proved successful. This case report draws attention to possible severe abuse of Tizanidine and the major clinical aspects and challenges in the treatment of Tizanidine withdrawal.

The Body That Is Not One: Overclothing as Bodily Transformation in Topographia Hibernica

The Body That Is Not One:Overclothing as Bodily Transformation in Topographia Hibernica Andrea Whitacre In Topographia Hibernica, Gerald of Wales narrates one of the most striking werewolf depictions in the medieval canon, one that has been interpreted in scholarship of the past two decades as an example of the rejection of belief in bodily change in the twelfth and thirteenth centuries. A priest traveling from Ulster to Meath encounters a talking wolf. The wolf explains that he and his mate were human beings who were cursed by a saint to live as wolves for seven years. The priest fears the speaking wolf, which seems to present a specter of body-hopping or metempsychosis, the human soul displaced within an animal body. The werewolf asks the priest to give the last rites to the dying female werewolf, but at the moment of administering the eucharist, the priest hesitates. To answer his doubts, the male werewolf peels back his partner's skin, rolling it down from her head to her waist and revealing the body of an elderly human woman underneath. This revelation of the real body under the false skin seems to reclassify this tale of transformation: this is not a story of change, but one of stability. Yet the spectacle of the overlaid animal and human bodies gestures at other underlying anxieties about bodily change, ones that might reshape the way the body and animal/human identity are conceptualized in this period. In this paper, I would like to reconsider the conventional reading of these werewolves as representing a stable human identity, as well as the ideas of the body that underwrite this reading. I argue instead that overclothing presents a conception of body and identity worth paying attention to, and that doing so reveals a new way in which medieval writers conceptualize identity and body. Overclothing in Bynum's Twelfth Century In what is still the definitive reading on bodily change in the twelfth century, Caroline Walker Bynum establishes that Topographia refutes the possibility of real [End Page 99] change. In her reading, the moment when the wolf peels the skin from his mate reveals the wolf form as a false exterior, covering the real interior body. The ease of its removal and the appearance of the human form beneath it imply that the wolf body is as inconsequential as clothing, not a real body at all. It is Bynum who uses the term "overclothing" to describe this kind of non-change: "Gerald's werewolves are not souls trapped in alien bodies, cases of metempsychosis. A human being with a body and soul, a psychosomatic entity, a person, is underneath. . . . The wolf worn by this werewolf is a skin or garment overclothing the human; it is not an essence, not even a body, unless one can (like the angels) assume several. The body is with the soul in the person underneath. Unlike the werewolves of European tradition before and after, Gerald's story—the fullest werewolf story of the twelfth-century revival—is not a case of metempsychosis at all."1 Bynum argues that medieval anthropology understood the self as a psychosomatic unit, a conception that is linked to the development of a newly exclusive transnational Christian identity.2 Her project identifies an unwillingness to depict separation of soul from body (metempsychosis) as a consistent principle of the high to late Middle Ages. The impulse toward overclothing is thus for Bynum a conservative move on the part of the text, substituting a reassuring stable body for the threat of metempsychosis. She shows that this figure is fundamentally different from the monstrous hybrid, in which two natures are intermingled within the boundaries of the body, and also different from the transformation of one body into another. Instead, overclothing presents a body that remains unchanged beneath a false outer skin: a human in wolf's clothing. This theological imperative against true animal/human metamorphosis serves as a limit for the period's intellectual and social fascination with change: appearance can change or seem to change, but the true body and identity within must remain stable. This has led to critical disinterest in Topographia as an example of metamorphosis or human...

Соматопсихиатрическое гериатрическое отделение в многопрофильном стационаре: особенности контингента больных

Background : due to the high risk of development of multiple somatic and mental comorbidities in elderly and senile inpatients, — search and development of resultative and cost-efficient organizational forms of specialized medical care for this patient population takes on great importance in the context of healthcare reform. The aim : was to investigate the characteristics of the patient population of psychosomatic geriatric unit in multi-specialty hospital as a background for development and adoption of organizational form model of hospital care. Material and methods : material of the study was the data from healthcare records of 463 patients, admitted to geriatric psychosomatic unit in multi-specialty hospital. Obtained data were analyzed with the use of clinical epidemiological method and further statistical processing with the purpose of unification. Results : during hospitalization period clinical signs of confusion were presented in 92,3% patients (427 patients) of all age groups. The incidence of confusion showed statistically significant association with patient age: patients aged 50–59 years presented confusion in 78,6% cases, patients aged 60–74 years — in 81,1% cases, patients aged 75 and older — in 96,5%. Correlation between age and average daily dosage of 4 medications: chlorprothixene, risperidone, «Phenazepam» and «Mexidol» was defined. Data integration revealing multiple somatic and mental comorbidities was held. Conclusion : patients of tertiallypsychosomanic geriatric unit is a unique patient population determined with old age and a combination of somatic and mental comorbid disorders, requiring multidisciplinary approach in delivering specialized health care.

Psychoanalytic inpatient psychotherapy of depression – Two naturalistic samples throughout the course of a decade

Background: While the general effectiveness of psychodynamic inpatient psychotherapy has been established, very few studies have specifically investigated the effectiveness of psychodynamic inpatient treatment of depression, though depressed patients represent the largest group of inpatients.Method : This study investigated two naturalistic samples of depressed patients regarding treatment outcome as well as clinical and treatment characteristics. Patients were treated in a psychoanalytical psychosomatic hospital unit. Data was collected from 2000 to 2002 (N=234) and from 2008 to 2010 (N=514). Data was acquired at admission and discharge.Results: The findings reveal high pre-post effect sizes for symptom reduction (SCL-90-R), general functioning (GAF) and medium changes of interpersonal problems (IIP). The improvement on the IIP was significantly higher for patients with comorbid personality disorder. Based on therapist ratings, the sample treated from 2008-2010 showed higher levels of impairment on several levels: chronic, complex, functional (GAF) and structural (OPD).Conclusion: Findings indicate that patients show substantial short-term benefit following psychoanalytic inpatient psychotherapy, as practiced under naturalistic conditions. Open questions remain regarding the long-term nature of these benefits and the possible influence of placebo-effects.

Promoting Self-Care Instead of Resistance Orientation: Therapeutic or Side Effect in Regard to Work?

In rehabilitation medicine an important goal is to restore the ability to work by improving resistance to stress. We observed the development of resistance orientation on one hand and the tendency of self-care, stress avoidance, and regeneration orientation on the other, in the course of a 5 week psychosomatic inpatient rehabilitation. A convenience sample of 121 inpatients of a psychosomatic rehabilitation unit filled in the ReRe-Scale (Resistance-Regeneration-Scale) at the beginning and end of a 5 week inpatient treatment. Also patients rated their ability to work before discharge from the hospital. There was a decline in resistance orientation and a clear increase in regeneration orientation. Regeneration orientation, in contrast to resistance orientation, was associated with a greater ability to work. The reduction in resistance and increase in regeneration orientation was unexpected and could be seen as an unwanted effect of inpatient rehabilitation. When taking into account the disposition to go back to work, promotion of regeneration seems to be the better way. This raises questions in respect to treatment strategies for stress tolerance, and occupational rehabilitation but also for the definition of positive or negative treatment effects in psychotherapy.

Analysis of the main activities of the city center of Alexander's psychosomatic hospital of St. Petersburg, focused on the choice of priorities in perfection of treatment and prophylaxis

The authors have analyzed the results of the City Psychosomatic Centre (CPSC) activity in 2009-2011 ys in order to find out the most important trends in the clinical work that may be helpful in planning of management and prophylaxis. The methods applied were statistical and clinico-statistical analyses of the results of of the Center work in 2009-2011 ys. There were changes in the structure by increasing the incidence of diseases associated with stress and organic damage brain with mental disorders, showed an increase in the flow of male patients. Found that the average length of stay in bed in the center of psychosomatic inpatient unit was 9.2-9.7 days, which creates barriers to good practice the use of antidepressants. Overcoming of these challenges can be achieved through the formation of new forms of continuity between the departments of the psychosomatic center, the health center and the offices of St. Petersburg SHCI «Alexander's Hospital,» and other medical institutions of the city.

Motivation for Psychotherapy in Patients With Functional Gastrointestinal Disorders

The motivation of patients with functional gastrointestinal disorders to accept psychotherapy (PT) as a treatment option is not known. The authors investigated motivation for patients' refusal to participate and dropout from PT/medical management programs. Consecutive patients with symptoms suggestive of functional bowel disorders, seen at the outpatient clinic of a tertiary gastrointestinal (GI) center were evaluated for their motivation to undergo PT. Data from 85 patients were evaluated in two phases: In Phase 1, patients were asked about willingness to participate in PT if it were offered; in Phase 2, patients were offered PT. In both samples, PT motivation was also measured by standardized psychometric scales. Age, gender, social status, and clinical symptom severity did not predict willingness to participate in or accept PT. Motivation was higher when patients were directly recruited in a GI setting than a psychosomatic outpatient unit. Quantitative assessment of PT motivation also did not correlate with declared PT motivation or participation. Assessment of interpersonal problems were among the few variables that were related to participation in PT. Motivation for PT in patients with functional gastrointestinal disorders is low and is not determined by clinical, but, rather, by interpersonal problems that may exist beyond and independent of GI symptoms.

Die waarde van menswaardigheid in die bioetiek

The worth of human dignity in bioethics Bioethicists and jurists put forward that the notion of “human dignity” adds nothing to the field of bioethics and is essentially a meaningless term. Against this presupposition the view is put forward that the notion of “human dignity” belongs to the heart of the Bible and can therefore be used as a valuable notion in bioethics. Human dignity is founded in the fact that man is created in the image of God. The fact that man is created in God’s image, and therefore has human dignity, undoubtedly has implications for bioethics. Human dignity by and towards man in bioethics has the meaning that one must strive for the healing of disease; that man must act and be treated as a psychosomatic unit; that reproduction may occur exclusively within marriage; and that all human life has to be maximally protected. Where the aforementioned does not occur, God- given human dignity is impinged upon.

Physical, sexual, and psychological violence in a gynaecological–psychosomatic outpatient sample: Prevalence and implications for mental health

Objective The main objective was to assess the prevalence of physical, sexual, or psychological violence in a cohort of patients with gynaecological symptoms who presented at a psychosomatic outpatient clinic. We assessed differences in prevalence rates of gynaecological symptoms and mental health problems in women with and without a history of experiencing violence. Study design We performed a cohort study of women ( n = 424) who attended a psychosomatic–gynaecological outpatient clinic during a 6-year-period of time. Information about lifetime victimization, mental health status, and socio-demographic characteristics were systematically obtained through semi-structured interviews. Psychiatric diagnoses were made using questions adapted to the structured interview for DSM-IV. Results Some form of violence was reported by 39.9%. Of the total sample, physical violence was reported in 25.2%, sexual violence in 13.0%, and psychological violence in 23.8%. Of those with a history of experiencing violence, 26.1% experienced two different kinds of violence, and 14.8% were victims of all three kinds of violence. Perpetrators of physical and psychological violence were, predominantly, the partner or the father. With respect to sexual violence, perpetrators were exclusively male, including family members or friends in more than 80% of all cases. Women with a history of experiencing violence suffered significantly more often from major depressive disorders (29.6%) than those without a history of experiencing violence (16.5%) ( p < .002). Post-traumatic stress disorder (PTSD) was significantly more frequent in women with a history of experiencing violence (7.1%) ( p < .001). Conclusions We found a high lifetime prevalence of different forms of violence toward women in our sample. Perpetrators were most often male family members, highlighting the impact of domestic violence. Our study provides evidence that women who attend a psychosomatic unit should be cautiously screened for a potential history of traumatic violent experiences.

Die Bedeutung von Missbrauch und Abhängigkeit von psychotropen Substanzen bei der Behandlung von Patienten in der psychosomatischen Rehabilitation

The objective of this study is to investigate the influence of substance abuse and addiction as comorbid disorders on the treatment results of patients of a psychosomatic unit one year after their release. In a prospective, non-randomized field study patients were asked by mail one year after finishing their treatment as part of a quality management endeavour. After one year patients with comorbid substance addiction did not improve in psychological tests whereas those with comorbid substance abuse or without any of these comorbidities showed significant improvements. Due to reasons to be studied further comorbid substance addiction seems to influence treatment outcome at least in psychological tests.

Estrés, ansiedad y depressión en gestantes controladas en la Unidad de Ginecología Psicosomática del Hospital Materno-Infantil de Málaga

ObjectivesTo understand perinatal depression, identify risk factors for depression during pregnancy, recognize depression during pregnancy, describe the possible links between depression and pregnancy, discover whether this disease affects the newborn, pregnancy or childbirth, and analyze treatment for depression during pregnancy. Material and methodsWe performed an observational, descriptive, prospective study of 118 pregnant women followed-up in the Obstetrics and Gynecology Psychosomatic Unit of the Maternity Hospital of Malaga for anxiety, depression or psychopharmacological treatment. ResultsA history of depression was found in 30% of the patients and a history of anxiety disorder in 9%. Among the patients treated, 63 had depression, 106 had anxiety (56 with depression), and nine had stress (five with anxiety and four with anxiety and depression). Sixty percent had one previous delivery and 40% had had one or more abortions (32% were voluntary). Pregnancy terminated in vaginal delivery in 66%, cesarean section in 28%, miscarriage in 4%, abortion in 2%, and preterm delivery in 16% (a frequency higher than in the general population, corroborating the literature on the subject). Of preterm deliveries, 5% were vaginal deliveries and 11% were cesarean sections. Treatment for depression consisted of antidepressant drugs in 63% (51% with paroxetine, 9% with fluoxetine and 3% with sertraline). Among patients treated for anxiety, 91% received an anxiolytic agent during the pregnancy. Only 11% rejected their newborns: 31% due to preterm delivery, 31% due to maternal depression, 15% due to severe cardiac defects, 7.5% due to the death of the husband, 7.5% due to death of the second twin, and 7.5% due to major problems with the partner. ConclusionsThe factors associated with a greater risk of anxiety or depression in pregnancy were as follows: age more than 30 years old, being a secundipara and having a prior abortion, a history of depression, difficulties in the relationship with the partner, being a housewife or working in the catering trade or hotel industry, undergoing an invasive technique during pregnancy, and hospital stay due to hyperemesis. The effects of anxiety and depression are more negative for the fetus than those of drug treatment for these disorders.