Neurologia-Neurocirugia Psiquiatria最新文献

At the ISSSTE, a community psychiatry program was created and is being developed in two areas: the population of beneficiaries who attend two clinics and groups of employees of those same clinics at their respective places of work. The main purpose is to carry out prevention in mental health. In this report only the work in the first session of eight employee operative groups is reported. The method, the difficulties and the characteristics of the groupings are explained. Some theoretical aspects are shown. Results showed: 1. Little correspondence between the internal reality of the beneficiaries. 2. Difficulties in communication which produce differences of criteria with the clinic. 3. Difficulties in the internal distribution of power. 4. Unnecessary expenditure of energy. 5. Suggestions to solve the problems handled in the group. 6. Resistance against responsibilities.

It is of great emotional impact to lose upper or lower limbs; adequate psychological handling of such a loss is described. Mourning will bary if amputation was programmed or carried out without warning. In the group, individual conflict, depression and the problem of function loss are handled, more than problems of the patient vis-a-vis the institution. Characteristics of the group are described.

Since most of the patients who attend for psychiatric consultation at a clinic are little motivated for psychotherapy, analytic group therapy was attempted, with basis on studies on psychological genetics, on groups management, and on the theories of Freud, Klein and Bion. Several open groups were handled, with the following achievements: 1. A decrease in anxiety, and increase in the objective vision of reality and in increase in the ability to see past and present conflicts. 2. A greater tolerance to agressive and sexual instincts and to frustration. 3. A greater personal acceptance, ability to sublimate productively and elimination of clinical symptoms. Varying degrees of improvement, and lesser need for psychiatric medication and hospitalization were obtained. Several problems were encountered: a) Desertion of 30% of patients from the sessions, due to the disapearance of symptoms buth with no character changes (resistances). b) Temporary absence or habit of arriving late to the sessions (resistances). c) Overwhelming passivity. The groups were handled in cotherapy and the work was supervised with experienced therapists. To attempt solving the above mentioned problems a better selection of patients was made, complete clinical histories were elaborated, a battery of psychological tests was made, and diagnosis, dynamics and prognosis of each case were outlined; this allowed the evaluation of middle and long term treatment. It was suggested to change the technique to that of operative groups.

Child psychotherapy has limited use in an institution. Through play one can appreciate the conflicts and suggest solutions, either verbally or through the play itself. As a framework one can use a dynamic concept of development and learning, and an educational approach. First one must elaborate a clinical history, do a physical examination and apply psychological tests in order to make a good diagnosis. The approach and treatment should be interdisciplinary. The institutional difficulties for this type of work are mentioned.

In a social security system that includes prepaid, integral medical care, psychiatric services function in prevention, treatment and rehabilitation in a close relationship with the rest of medical care, the psychotherapies are part of an eclectic system of psychiatric attention, but also of the psychological aspects of institution-patients, institution-beneficiaries and institution-staff relationships. Within diverse psychotherapeutic schools, common denominators of the therapeutic process are outlined, as well as the background philosophy of the system.

In 1972, prepaid medical care for government employees provided by their social security institute, ISSSTE, was reorganized. A division of planning and technical standards was established, within which a Department of Psychiatry was included. Psychiatric care was restructured at three levels: psychiatric hospital, psychiatric OPD at clinic and hospital level and a pilot program in community psychiatry. A three-year psychiatric residency program was established, in addition to participation in other postgraduate, in-service training and monographic courses. Systematic research was started, as well as a publications program, working relationship with other institutions and societies were enhanced. A descriptive example is Child Psychiatry. Most frequent diagnoses are reviewed, and development of services is followed in relation to pediatric departments.

In a warm desertic and irrigated region, with population 250 000 Northwest of Mexico, in Hermosillo, Sonora, along 8 weeks, 51 patients showed the following clinical data: fever, vomiting, neck rigidity, drowsiness and increase of cells and proteins in the CSF. In 12 patients good correlations were found between positive serologic results using SLE antigen by means of HI, CF and NT. Four paired sera showed fourfold increases in titers to SLE by means of HI or CF. With VEE antigen no such increases were found. The cases were scattered geographically, most of them occurred within an urban area, and affected people in 13 localities. The outbreak developed from August to September, 1974, the attack rate was 22/100 000, 69% of the patients being children under 15 years of age. The case fatality rate was 20%. A prosperous chicken industry existed in the region and epizootics were not reported in either domestic or wild animals at that time.

Recent advances in the understanding of the asymmetrical functions of the cerebral hemispheres provide new insight to the mechanisms underlying the developmental language disorders. It is probable that learning to read depends in part upon the ability to establish an association between a seen object (customarily perceived within the right hemisphere) and a verbal symbol (mediated by the left). It is possible that as the reading skill develops, verbal symbol recognition may also become a left hemisphere function. A complex interaction between the two developing hemispheres is involved. A clue to the nature of this problem is that developmental dyslexia is six times more common in boys than in girls. Studies defining differences in cerebral dominance in boys and girls will be reviewed in this context.

The study of two groups of right handed aphasics, group A and group B, is presented. Each group was formed by four subjects, both groups showed an aphasic syndrome craracterized by alteration in the efferent sphere of oral and written language, principally in the latter. There was almost no alteration in the sensory interchange sphere, except for a right hypoesthesia and astereognosis in two subjects of each group. The aspect in which both groups differed profoundly was the efferent sphere of written language. Group B patients could not write with the dominant hand because of a right hemiplegia. Nevertheless, they could do it with the left, nondominant hand. Group A patients were unable to write with either hand in spite of the absence of motor deficit or incoordination which could explain this inability. The different possible topographical localizations responsible for the deficit are analyzed. It is concluded that there are three main possibilities that could explain the writing difficulty found in group B patients: a) a lesion located in the white frontal matter of the left hemisphere just underneath the kinesthetic area; b) a lesion in the kinesthetic dominant area itself; c) a lesion in the dominant cerebral hemisphere white matter underlying the primary receptor somesthetic and the primary effector areas, but without directly involving them, and extending also in depth toward the anterior third of the corpus callosum. Any one of these lesions could impair the transmission of information from the dominant kinesthetic hand area to the primary effector motor area of both cerebral hemispheres.