Essential Hypertension

(some psychosomatic considerations)

 

Paulo Horta *, José Amaral **, Júlio Brandão *, Rui Coelho***

 

Abstract: The authors make considerations about a psychosomatic approach on the functions of cardiovascular system, with particular incidence on essential hypertension.

 

Starting with the relationships between psyche and soma they emphasise the theories based on psychogenesis (Alexander and Ey).

 

They then refer some therapeutic aspects, namely the doctor-patient relationship. Finally a clinical case is described.

 

Keywords: essential hypertension, psychosomatic, therapeutic approach

 

* Psychiatrist, Psychiatry Department of S. Gonçalo - Amarante Hospital

** Psychiatrist, Psychiatry Department of Padre Américo - Vale de Sousa Hospital

*** Psychiatrist, Associate Professor, Faculty of Medicine Oporto University

.

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Somatization: Its Presentation and Management

 

Geoffrey G. Lloyd *

 

Abstract: Somatization refers to the presentation of psychiatric disorder with somatic symptoms. It is a common phenomenon in primary care general hospital outpatient clinics but it often leads to diagnostic difficulties and inappropriate investigations and treatment. This paper reviews the commoner patterns of symptoms and discusses the psychiatric disorders which underlie somatization. Recommendations for treatment are made with particular emphasis on the role of cognitive therapy in altering the patient’s attribution of symptoms.

 

Keywords: somatization, cognitive therapy

 

*Consultant Psychiatrist, Royal Free Hospital, London

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Mixed States of Anxiety and Depression

 

Guimarães Lopes *

 

Abstract: Mixed states of anxiety and depression are the most common psychopatological disorders in primary care and general hospital in- and out-patients. Epidemiological data obtained from primary care study in Oporto are presented, the diagnostic criteria and clinical features of this sates are reviewed, as well as its prevention and treatment.

 

Key-words: Anxiety, depression, mixed anxious -depressive, diagnostic criteria, clinics, prevention, treatment

 

*Psychiatrist, Hospital do Conde de Ferreira - Oporto

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Alcohol - Abuse: Cognitive - Behavioural Aspects of Relapse

 

Aníbal Fonte *, Piedade Vieitas **, Rogério Pastor-Fernandes **

 

Abstract: Alcohol abuse is a chronic condition, characterised by a high frequency of relapses, being usual the development of repeated cycles: treatment, recovery, relapse. For the comprehension of this phenomena it becomes necessary to consider the treatment of the alcoholic subjects, as a process of change, in which consuming alcohol, means the ability to dispose of adequate competencies to cope with life situations and, particularly, with his own emotions.

In this work, authors review the concept of relapse, exposing some of its fundamental concepts, developed according to the cognitive-behavioural theories.

 

Key-words: alcohol-abuse, relapse, cognitive-behavioural therapy

 

*Psychiatrist, Psychiatry Department of Stª Luzia Hospital, Viana do Castelo

**Clinical Psychologist, Health Sciences Institute (Oporto).

 

Address:

A. Fonte

Dep. Psiquiatria e Saúde Mental, Hospital de Stª Luzia

Estrada de Stª Luzia

4900 VIANA DO CASTELO

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The Child Psychiatrist in a Dialysis Unit

 

Paula Cristina Correia *, António C. Bastos **, Conceição Mota ***, Albino Ramos ****,

Elói Pereira *****

 

Summary: There has been a growing concern of the importance of psychological problems in children on dialysis. Children with chronic renal failure often need dialysis treatment (haemodialysis or peritoneal dialysis) while they are waiting kidney transplantation. This causes disruption to normal life, with repeated hospitalisations, diagnostic and therapeutic procedures, associated with immobilisation and restraint, keeping their dependence on dialysis to survive.

 

We would like to highlight the importance of the child psychiatrist in a dialysis unit, and the psychological aspects of children with chronic renal failure on haemodialysis and peritoneal dialysis.

 

The authors report the cases of two adolescents, one treated with haemodialysis and the other with peritoneal dialysis.

 

Key-words: pedopsychiatric liaison, psychological problems, child, dialysis

 

*Assistant of Pedopsychiatry

**Psychologist

***Nefrologist

****Pedopsychiatrist, Director of Department

*****Nefrologist, Director of Department

 

Address:

Hospital Conde de Ferreira

Paula Cristina Correia, MD

Rua da Boavista, 827

4050 OPORTO

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Self-Mutilation and Factitious Disorders:

An Overview

 

Prof. Dr. Myriam M.M.P. Van Moffaert *

 

Summary: This paper reviews self-mutilation and factitious disorders, discussing in detail their most important clinical types.

 

The psychiatric co-morbidity of those syndromes is also emphasised, as well as the proposed psychiatric therapy, according to the liaison model.

 

Key-words: Self-mutilation, factitious disorders, psychiatric co-morbidity, liaison psychiatry

 

*Psychosomatic Department University Hospital Gent, Belgium.

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SUBSCRIÇÕES

A Revista de Psiquiatria Consiliar publica dois números por ano, em Maio e Novembro, dois números formam um volume. O preço de cada volume (1997) é para instituições 1500$00, para subscritores privados 1000$00, cada número 600$00.

 

ENDEREÇO

Revista de Psiquiatria Consiliar e de Ligação

Hospital do Conde de Ferreira

R. de Costa Cabral 4200 Porto

Portugal

(attn.: Dra. Ana Maria Moreira, ou Dra. Alexandra Corte Real).

ISSN 0873-612X

 

Atypical Chest Pain

 

Richard A. Mayou *

 

Summary: Atypical chest pain is a common clinical problem in both primary and specialist care. This paper discusses its presentation, emphasis being given to the accompanying psychological symptoms. Primary care and cardiological management are taken in to account, special attention being paid, to psychological treatment and its evaluation.

Key-words: Atypical chest pain; psychosomatic symptoms; primary care; cardiological management; psychotherapy.

* Professor of Psychiatry

University of Oxford Department of Psychiatry - Warneford Hospital - Oxford - OX3 7 IX

Tels. (+44) 1865 226477 - Fax (+44) 1865 793101 - email: richard.mayou@psych.ox.ac.uk

Consultadory - Liaison Psychiatry in a General Hospital

Difficulties and advantages of is exercise *

 

Luiz Gustavi Guilherme **, Fabiana Grossi Machado ***, Fernanda Crestana ***,

Jaqueline Balestrin ***, Luciana Frantz ***

 

Summary: Administrative aspects of Psychiatric Consultation-Liaison at a General Hospital (C-L) are discussed based on the examination of an empirically verifiable fact wich occurs among us: psychiatrist have not shown any interest in this important branch of specialty and C-L has had a low "birth rate" among new practitionares and a high "mortatlity rate" among veteran practitioners. In Porto Alegre since 1980's we have been practicing psychiatry increasingly integrated with General Medicine, and we have major centers of professional training effectively functioning in general hospitals; Despite this the practice of C-L is nor greatly value, and has a very minor place in the dedication of profissionals who are already specialized. The specialized bibliography is reviewend seekink reasons to explain this situation. Severak difficulties in C-L activity that may cause burn-out among consuntants are described. On the other hand several advantage wich could be offered by C-L to its practitioneres are stressed. Suggestions are made to improve working conditions offered by C-L services to render them more attractive to professionals, and a theoretical foundation for field research on the subject is proposed.    

Key-words: Consultation-liaison psychiatry; general hospita

* Trabalho apresentado na XVIII JORNADA SUL-RIO-GRANDENSE DE PSIQUIATRIA DINÂMICA em Gramado de 10 a 12 de Outubro de 1996.

** Professor Assistente da Faculdade de Medicina de PUCRS e Coordenador da Equipa de Consultoria Psiquiátrica do Hospital São Lucas da PUCRS.

*** Doutoradas da Faculdade de Medicina de PUCRS.

Adolescence and Pregnancy - a phenomenological study

 

João Franco *, Maria Gracinda Rodrigues **, Maria José Dionísio **

 

Summary: .With the application of the phenomenological method it was possible to reach the reason why adolescents get pregnancy. Based on the studied sample we can conclude that the fact of getting pregnant is connect with the following reasons: pregnancy in adolescence is not planned, but it can be wished, information influences the use of contraceptives, expectations of greate changes associated with pregnancy, the familiar relationship can lead to the appearance of pregnancy in adolescence, the connection of pregnancy with the group of pairs.
In his turn this reasons are linked to the same number of categories, which are: the family support settles the options of the pregnant adolescent, the accptance of the pregnant adolescent by the couple with unilateral decision, pregnancy in adolescent is related to the learned cultural values, pregnancy change the maturing process, pregnancy strengthens the changes aspired by the adolescent. These reasons are influent motives, but direct reasons for the appearence of pregnancy in adolescence.

Key-words: pregnancy; adolescence; phenomenology.

* Professor-Adjunto da ESEBB.

** Enfermeira Especialista em Enfermagem de Saúde Materna e Obstétrica.

Pain: endogenous regulating mechanisms

 

Guilhermo Iglésias *, Oscar Taboada **

 

Summary: Pain, its definition and study have experienced important advances. In this article we intend to analyze  the different approaches to the sympton, its phenomenologyand adaptation behaviors related to it, as well as the endogenous systems responsible for regulating nociception, emphasizing on the importance of the hypothalamic-pituitary-adrenocortical system which makes up the analgesic response. Moreover, we have aimed at the involvement of the inmunological system (citokines, IL-1, IL-2) acting as regulators of such response.

Key-words: Pain, endogenous regulating mechanisms, Nociception, analgesic response. hypothalamic-pituitary-adrenocortical system. Inmunore gulators (endogenous opioids, citokines).

* Consultor Psiquiatra del la Unidade de Dolor coordenador de saúde nestas, Área Ferrol-La Coruña - Espanã.

** Médico Psiquiatra.

Medically Attended Procriation

the meds of psychoterapeutic support *

Orlando J. P. Von Doellinger **

 

Summary: The recent changes in the field of reproductive medicine made it even more appealing for infertile couples, but there is substancial evidence that infertility and its treatment are psychologically stressful.
In this paper, the author tries to review those psychological effects, demonstrating the need of a psychotherapeutic support to infertile couples undergoing infertility treatment. 

Key-words: Infertility; Psychologic reactions; psychotherapeutic support.

* Trabalho apresentado em reunião do Serviço de Internamento Feminino do Departamento, a 16.9.97.

** Interno Complementar de Psiquiatria do Departamento de Psiquiatria e Saúde Mental do Centro Hospitalar de Vila Nova de Gaia - Rua Conceição Fernandes - 4430 Vila Nova de Gaia.

R. Guimarães Lopes*

Summary: ls known, that the recognition of the usual conditions of life of elderly is important to permit the ealry diagnosis and efficacy of treatment.
Several studies integrated in Consultation/Liaison Psychiatry were made in Oporto (North Portugal) with old-people in the different settings where e found them:
- in the Community; - in the Primary Care; - in the General Hospital; - in the Psychiatric Hospital; - in the Ambulatory Gerontopsychiatric Service The ideal model of recognition of abnormalities must be structured in different anthropological perspectives and easy to work within the medical praxis. These perspectives may be:
- biological; - psychological; - biographical; - situative (circunstancial and social); - noological (prospective of expectations and values).
The results of these model gauged in the practice are presented and discussed.

Key-words: Elderly; Complaints; Life-problems; Health problems; Somatic conditions; Psychological conditions; Comorbility; Expectations; Dreams

*Psychiatrist, Prof. do ICBAS - University of Oporto

An Aging C/L experience in Centro Hospitalar de Coimbra

Célia Franco*

Summary: Since April 1993 there is the "Consulta de Envelhecimento Cerebral", a Liaison Consultation in General Hospital of Centro Hospitalar de Coimbra, Portugal. There are working in this consultation three neurologists, two psychiatrists and two medical doctors. With this consultation we pretend to study Alzheimer Disease and other cases of dementia and to treat them.
At the end of four years of liaison work, the author decided to evaluate the experience and to think about it.

Key-words: Consultation /Liaison Psychiatry; Aging; Dementia; Alzheimer Disease

*Assistente Hospitalar do Hospital Sobral Cid, Coimbra

Anxiety and Family Disfunction in Elderly

Anabela de Sousa dos Santos*

Summary:  With this work we pretend to connect elderly anxiety with family dysfunction, and to evaluate the psychometric qualities in the portuguesa population, by means of a questionnaire for the study of the psychological, social and health profile of the portuguesa elderly.

Key-words: Anxiety; Family Dysfunction; Elderly

*Membro do Centro de Estudos Psicobiográficos
Departamento de Psicologia
Universidade Lusófona

C/L Approach on Elderly's Sexuality

Ana Maria Moreira*
Alexandra Côrte-Real*

Summary: The authors examine the various psychological, organic and relational aspects of the elderly's sexual life. The use of this knowledge in the practice of Consultation/Liaison Psychiatry, which includes the general practioner, the patient and other specialists in wards and out-patient clinics, has made easier a better understanding of an approach to the elderly's sexuality.

Key-words: Sexuality; Elderly; Consultation/Liaison Psychiatry

*Psiquiatra do Hospital do Conde de Ferreira

Aging - Psychological Perspective

M. Fernanda Santos*

Summary: A revision of the psychological processes in old age is made. Also are commented particularities of the Consultation/Liaison Psychology. "Finding mean to life and death" is given as orientation to psychotherapy following the experience of Viktor Frankl.

Key-words: Elderiy; Psychology; Vision; Audition; Motility; Memory; Sage; Consultation/Liaison Psychology; Psychotherapy

*Psicóloga Clínica. Psicoterapeuta.

Quality of Life and Senescence

M. Fátima R. A. Campos*

Summary: The author discusses an exploratory study about quality of life in the elderly and their health conditions such as: dementia and depression. lt seeks to understand the importance of family support, to be assessed in order to a multidisciplinary therapeutical community intervention.

Key-words: Quality of Life; Elderly; Dementia; Depression; Family

*Membro do Centro de Estudos Psicobiográficos
Departamento de Psicologia
Universidade Lusófona

The Consequences of lnactivity and Hyperactivity in a Sample of Elderly ,Attending Primary Care Settings

R. Guimarães Lopes*

Summary: In Portugal, like in other countries, the demographical growth of the older population takes many problems for which the society is not prepared.
To solve them, we need a better understanding of the elderly - which features are due to the living circunstances, which is the essencial way of being an older adult.
The science of circunstances is epidemiology. lf we could know all the circunstances and if we could eliminate the prejudices then we would be nearer the essence of elderly-being and perhaps nearer of the happiness of life-accomplishment.

Key-words: Elderly, lnactivity; Hyperactivity- Primary Care

*Psychiatrist, Prof. do ICBAS - University of Oporto

Psychobiology of the Aging

Silva Martins*

Summary: In the bio-psico-social perspective of elderly, the author matter a critical review of the different accost models of illness in elderly people. After a brief reference to cientifical-instruction thinking, especialy some aspects of the modern neurotransmission, The author situates his accord in the field of elderly-ilness, elderly-family, elderly-environment, elderly-institution.
Ends with the idea that, in the presence of elderly people, only the pluridisciplinar and interinstitucionaly learn can be sucessful.

Key-words: Elderly; Illness; Familly; Institution

*Médico Psiquiatra
Director do Departamento de Psiquiatria e Saúde Mental do Hospital de S. Marcos, Braga

Manuela Cruz⁽¹⁾, Ana Sanfins⁽²⁾, Bárbara Lemos⁽²⁾, Dora Maltez⁽²⁾, Elsa Félix⁽³⁾

Summary: The subject of this work, made in the Centro de Estudos Psicobiográficos of the Departamento de Psicologia da Universidade Lusófona de Humanidades e Tecnologias, with the colaboration of the Grupo Português de Psiquiatria Consiliar/Ligação e Psicossomática, is depression in the cycles of life. The is an investigation protocol designed for the adolescentology field, which allows the determinator of the psychological, social and health profile of the portuguese adolescent. From the multiple scales and questionnaires, the authors sort out the biographical events, corporality and depression.The object of this exploratory study is to find out the correlation between these aspects and depression. The most important biographical events are often accountable for the crisis of adolescence. The corporal transformations may be experienced with displeasure, difficulting the body unit and giving occasion to depression.The results of this exploratory work were only presentated in percentage and, because our representativa sample is very smali, only tendences were found.

Key-words: Adolescence, Biography, Corporality, Depression

*Trabalho apresentado no XIV Encontro do Grupo Português de Psiquiatria Consiliar/Ligação e Psicossomática, Encontro de Outono, Outubro de 1998.
Universidade Lusófona de Humanidades e Tecnologias em Lisboa.
(1)Docente da Universidade Lusófona de Humanidades e Tecnologias, responsável no CEP do projecto da adolescentologia
Correspondência: Manuela Cruz, Calçada da Estrela, 128, 1º 1200 Lisboa
(2) Aluna 5º ano da área de Clínica da Universidade Lusófona
(3) Aluna 5º ano da área de Educacional da Universidade Lusófona

Depression in Adulthood

Celeste de Carvalho⁽¹⁾, Luísa Gonçalves⁽²⁾

Summary: The authors of the present document intend to relate the depression with the Biography and the pathologies, to help defining the comorbility of depression.

Key-words: Depression; Adult; Somatoformes disturbances; Biographic- method

(1) Psicóloga Clínica: membro do CEP (Centro de Estudos Psicobiográfcos) e docente na ULHT (Universidade Lusófona de Humanidades e Tecnologias)
(2) Aluna do curso de Psicologia da ULHT

Depression - some aspects of psycholinguistics

 A. Barbedo de Oliveira⁽¹⁾

Summary: Related to a Semantic Study concerning some expressions of the Psychiatric Glossary, the author emphasizes the results of his investigation (around the connotative meaning of the concepts "Life, Death, Past, Future, Self, World"), in order to draw up a psycholinguistic model of Depression.

Key-words: Depression; Psycholinguistics; Semantic Differetial

(1) Assistente Graduado de Psiquiatria do Hospital do Conde de Ferreira - Porto

Psychiatric Support of Pregnant and Lactent Women - CL Psychiatry Service from the Hospital Sobral Cid to Maternidade Bissaya Barreto

Ilda Murta⁽¹⁾; Célia Franco⁽¹⁾; Pitorra Monteiro⁽²⁾

Summary: The consultation of pregnant and lactant women with psychopathology is a delicate situation and usually brings uncertainty between Psychiatry, Obstetrics and Family Doctors. ln January 1995, a group of doctors began to attend to psychiatric urgent calls in the Obstetric Service of Bissaya Barreto Maternity.
Since October 1997, the connection with Bissaya Barreto Maternity was restructured, giving place to a weekly consultation integrated in the Social Risk Consultation of the Early lntervention Unit. At present, this consultation is made by two psychiatrists of Sobral Cid Hospital. The number of cases seen has increased and the pathology is very diversified.
When we concluded a year of work together, we made a revision of the observed cases, in order to reflect about our experience. As we have recorded the cases only since January 1998, we present the results abtained in this ten months.

Key-words: Pregnancy; Mternity C/L, Consultation

(1)Assistente Hospitalar de Psiquiatria do Hospital Sobral Cid
(2) Assistente Hospitalar de Obstetrícia da Maternidade Bissaya Barreto

Psychological impact of the Diagnosis of Breast Cancer

Oriando J. P. Von Doellinger⁽¹⁾

Summary: ln recent years, many articles were published on the subject of the reactions to breast cancer and its treatment.
This review summarises the results of some of those papers and gives some clues to establish the role of the mental health professional, either with the medical team or with the patients.

Key-words: Breast cancer; Mastectomy; Chemotherapy; Radiotherapy; Psychological Response

*Trabalho apresentado em reunião do Seriço de Internamento Feminino do Depârtamento, a 7.10.97
(1) Interno Complementar de Psiquiatria do Departamento de Psiquiatria e Saúde Mental do Centro Hospitalar de Vila Nova de Gaia

Psychological Consultation for Terminal Ill Patients

Piedade Vieitas^(l), Rogério Pastor-Fernandes^(l), Joana Soares^(l), Susana Correia⁽²⁾

Summary: ln this paper, the authors go into the basic issues of death and dying, the way we face them as well as the particular form the terminally ill cancer patient lives them. Palliative care and some aspects of the "taking care of" philosophy are also discussed.
Other issues are also dealt with such as the way a patient may face death, and illiness as a stress-producing cause. The psychological state of the terminaily iii patient is described as an explosion of emotions, specially fear, and the fear of death in particular. Communication, anguish and depression are other issues under dicussion. The coping mechanisms and the forms and models of psychological intervention are briefly presented.

Key-words: Psychological consultation; Cancer; Terminally ill patient;  Psychoterapies; Coping

*Trabalho apresentado nas 1 JORNADAS DE PSICOLOGIA CLINICA do ISCS-N, Porto, 5 e 6 de junho de 1997.
(1) Psicólogo(a) Clínico(a). Assistente Universitário(a) - Instituto Superior de Ciências da Saúde-Norte.
(2) Psicóloga Clínica.

Auditive Disorder and Behaviour in Classroom - a pioneer study

João Luís de Freitas^(l), Isabel Neves⁽²⁾, Correia Ferronha⁽³⁾

Summary: ln the last years the scientific community has been establishing a more effective early deafness diagnosis. However, the knowledge of the psychological development of deaf children remains poor. Literature documents a series of psychopathological problems in this group. Beginning with the hypothesis that increased attention given to the sign language in Portugal in the last years could alter the above documented situation, the authors study, in a classroom behaviour setting, a deaf children population from a special school. ln this way, they pretend to make a first approach to an eventual psychopathological state. This study also constitutes an experience of liaison psychiatry in an unusual setting: the school and the classroom.

Key-words: Deafness; Psychology; Psychopathology; Auditive reabilitation

1) Médico Psiquiatra, Hospital Conde de Ferreira, Porto
(2) Professora do Ensino Básico, CESE em Deficiência Auditiva, APECDA, Porto
(3) Chefe de Serviço do Departamento de Pedopsiquiatria do Hospital de Crianças Maria Pia, Porto