Tratamiento cognitivo-conductual en un caso de fobia a la muerte

En este artículo se describe el tratamiento cognitivo-conductual llevado a cabo en un caso de fobia a la muerte, con un seguimiento de doce meses. La paciente es una mujer de 38 años. En la evaluación se utilizó el SCL-90-R, la CL-FODS y las conductas-objetivo. El tratamiento se aplicó en 16 sesiones. Se utilizaron técnicas de control de la activación, técnicas de exposición (exposición en imaginación y en vivo e inundación en imaginación), así como técnicas de reestructuración cognitiva. Tras un año de seguimiento, se produjo una mejoría en la reducción de las conductas de evitación, en el control de los síntomas de ansiedad y de pensamientos y creencias relacionadas con la muerte, los muertos y el proceso de morir, así como en el malestar psicológico asociado a la vivencia de la muerte. Se comentan las implicaciones de este caso para la investigación y la práctica profesional.In this paper, the cognitive-behavioural treatment applied in a case of death phobia monitored during twelve months is described. The patient is a 38 year old woman. In the evaluation, the SCL-90-R, the CL-FODS and objective behaviour were used. The treatment was applied in 16 sessions. Activation control, exposure techniques (exposure in imagination and in vivo, and flooding in imagination), as well as cognitive restructuring techniques were applied. After one year of monitoring, an improvement in the reduction of avoidance behaviour, in the control of anxiety symptoms, thoughts and beliefs related to death, the dead and the process of dying, as well as the psychological discomfort associated to the experience of death took place. The implications of this case are discussed for investigation and professional practice

Relationship Between Self-Perceived Health, Vitality, and Posttraumatic Growth in Liver Transplant Recipients

Our objective was to analyze the differences in posttraumatic growth in 240 liver transplant recipients based on two factors. First, self-perceived health: better (Group 1 = G1) and worse (Group 2 = G2). Second, vitality: more (Group 3 = G3) and less (Group 4 = G4). The Posttraumatic Growth Inventory, SF-36 Health Survey (Item 2) and SF-12 Health Survey (vitality dimension) were used. Firstly, analyzing main effects recipients with better (G1) compared to worse (G2) self-perceived health, showed greater posttraumatic growth. Interaction effects were found on essential posttraumatic growth domains such as new possibilities (p = 0.040), personal strength (p = 0.027), and appreciation of life (p = 0.014). Statistically significant differences showed that among transplant recipients with worse self-perceived health (G2), those with more vitality had higher levels on abovementioned posttraumatic growth dimensions. However, in transplant recipients with better self-perceived health (G1) respective dimensions were not significantly influenced by the level of vitality. Among the recipients with less vitality (G4), those with better self-perceived health showed higher scores on abovementioned posttraumatic growth dimensions. We conclude that positive self-perceived health might compensate for a lack of vitality as well as a high level of vitality may compensate for negative self-perceived health regarding the development of crucial aspects of posttraumatic growth after liver transplantation.Ministerio de Economía y Competitividad de España PSI2014-51950-

Tratamiento cognitivo-conductual en un caso de fobia a la muerte

En este artículo se describe el tratamiento cognitivo-conductual llevado a cabo en un caso de fobia a la muerte, con un seguimiento de doce meses. La paciente es una mujer de 38 años. En la evaluación se utilizó el SCL-90-R, la CL-FODS y las conductas-objetivo. El tratamiento se aplicó en 16 sesiones. Se utilizaron técnicas de control de la activación, técnicas de exposición (exposición en imaginación y en vivo e inundación en imaginación), así como técnicas de reestructuración cognitiva. Tras un año de seguimiento, se produjo una mejoría en la reducción de las conductas de evitación, en el control de los síntomas de ansiedad y de pensamientos y creencias relacionadas con la muerte, los muertos y el proceso de morir, así como en el malestar psicológico asociado a la vivencia de la muerte. Se comentan las implicaciones de este caso para la investigación y la práctica profesional.In this paper, the cognitive-behavioural treatment applied in a case of death phobia monitored during twelve months is described. The patient is a 38 year old woman. In the evaluation, the SCL-90-R, the CL-FODS and objective behaviour were used. The treatment was applied in 16 sessions. Activation control, exposure techniques (exposure in imagination and in vivo, and flooding in imagination), as well as cognitive restructuring techniques were applied. After one year of monitoring, an improvement in the reduction of avoidance behaviour, in the control of anxiety symptoms, thoughts and beliefs related to death, the dead and the process of dying, as well as the psychological discomfort associated to the experience of death took place. The implications of this case are discussed for investigation and professional practice

Bulimia Nervosa, Borderline Personality Disorder, and Executive Functions: Treatment and Follow-up in a Case Study

This study describes the clinical case of a 20-year-old woman diagnosed with bulimia nervosa (BN), borderline personality disorder (BPD), and impaired executive functioning. The objectives were to: 1) Determine the efficacy of cognitive-behavioral therapy (CBT) and dialectic behavioral therapy (DBT) in a case of BN and BPD comorbidity, evaluating the improvement of specific parameters related to eating disorders (BN) and aspects of BPD after treatment (posttreatment) and at 1-year follow-up; and 2) Determine whether the psychological intervention of choice for BN and BPD is also of benefit for alteration of executive functions. She was assessed at three time points: pretreatment, posttreatment, and at 12-month follow-up. The instruments used were EDI-3, SCL-90-R, MCMI-III, ring test, and WCST. CBT and DBT were applied for 11 months. The results at 1-year follow-up showed a decrease in the characteristic symptomatology of BN and BPD, whereas executive functioning impairments did not show any improvement. It was concluded that a specific unit on neuropsychological rehabilitation must be included in the treatment protocol for patients with these characteristics. However, more research is still necessary to provide an answer to the open debate on whether alterations of executive functions are previous to or consequences of ED

Influencia del apego en pacientes con obesidad mórbida candidatos a cirugía bariátrica. Estudio comparativo en función del género

El objetivo de este estudio es comprobar si las variables apego y genero guardan relación alguna con personas candidatas a cirugía bariátrica con obesidad mórbida en comparación con personas que no lo son. De los 274 individuos participantes en este estudio, 162 presentaban obesidad mórbida candidatas a dicha cirugía (72,76% mujeres y 27,33% hombres) y 112 formaron el grupo control, los cuales no presentaban obesidad (75% mujeres y 25 % hombres), seleccionados por el método de conveniencia. Los instrumentos utilizados han sido: Cuestionario de Apego Adulto y unas plantillas con datos sociodemográficos y clínicos. Los datos obtenidos en este estudio ponen de manifiesto que existe una mayor prevalencia de apego preocupado en el grupo no apto para la cirugía bariátrica en comparación con los otros dos grupos comparados. Atendiendo al género, se concluye que existen diferencias significativas, siendo las mujeres las que obtienen mayores puntuaciones en apego preocupadoThe aim of this study is to see if attachment and gender variables are linked in any way to those bariatric surgery sufferenig morbid obesity candidates, in comparison with people that are not. 274 people participated in this study; 162 suffered from morbid obesity and were candidates to the surgery (72.76% were women and 27.33% were men); 112 people were included in the control group and they didn’t suffer from morbid obesity (75% were women and 25% were men). All of them were selected by the convenience method. The instruments used were: Adult Attachment Questionnaire and socio-demographic and clinical data questionnaires. The results of the study show that there is a higher preoccupied attachment prevalence in the group that is not suitable for the bariatric surgery. Regarding gender, there are significant differences: women obtained higher scores in preoccupied attachment

Personality traits and eating disorders: mediating effects of self-esteem and perfectionism

The purpose of this ex post facto study has been to test a structural model of the mediating roles of self-esteem and perfectionism in the relationship between personality traits and eating disorders (ED). The sample consisted of 155 women (from 18 to 31 years). Ninety three met the DSM-IV diagnostic criteria for some type of ED, 31 women formed the symptomatic group, with high risk of ED, and 31 women, the non-symptomatic group, without known pathology or alteration of eating behaviours. The instruments used were the MCMI-II, EDI-2, EAT-40 and BSQ. Data analysis was conducted using structural equation modelling by means of LISREL 8.71. The estimated model fi t satisfactorily. The results confi rm the relationship between schizoid, paranoid, self-destructive and borderline personality traits with ED, the role of self-esteem as the main mediating variable in the effect exerted by certain personality traits in ED, and perfectionism as a mediating variable of the effect of borderline personality traits on ED and self-esteem.El objetivo de este estudio ex post facto ha sido poner a prueba un modelo estructural sobre el papel mediador de la autoestima y el perfeccionismo en la relación entre los rasgos de personalidad y los trastornos de la conducta alimentaria (TCA). La muestra estuvo compuesta por 155 mujeres (18 a 31 años): 93 cumplían criterios diagnósticos DSM-IV para alguno de los tipos de TCA, 31 formaron el grupo sintomático, con alto riesgo de padecer un TCA y 31, grupo no sintomático, no presentaban patología conocida y sin alteraciones de la conducta alimentaria. Los instrumentos de evaluación utilizados fueron el MCMI-II, EDI-2, EAT-40 y BSQ. Para el análisis de los datos se utilizó el método de estimación de máxima verosimilitud mediante el programa LISREL 8.71. El modelo estimado se ajustó satisfactoriamente. Los resultados confi rman la relación de los rasgos de personalidad esquizoide, paranoide, autodestructiva y límite con los TCA, el papel de la autoestima como principal variable mediadora en el efecto ejercido por ciertos rasgos de personalidad sobre los TCA y del perfeccionismo como variable mediadora del efecto del rasgo de personalidad límite sobre dichos trastornos y sobre la autoestima

Diferencias de género en pacientes con obesidad mórbida candidatos a cirugía bariátrica: Influencia de ansiedad, depresión y autoestima

Debido a la gravedad actual de la obesidad mórbida, siendo causa de muerte de muchos casos en la población, la cirugía bariátrica es una buena solución para esta enfermedad. Ante dicha situación este estudio analiza las diferencias significativas que pueden darse entre un grupo de candidatos a cirugía bariátrica, un grupo no candidato a esta cirugía y una muestra control en diferentes variables, como son la ansiedad, la depresión y la autoestima, viéndose la posible influencia del género en todo ello. Se utilizó una muestra de 274 individuos a través de un método de selección de conveniencia. El diseño realizado fue ex post facto prospectivo. Una vez realizado el estudio, se concluye que existen diferencias significativas entre los tres grupos en todas las variables. Sin embargo, no existen dichas diferencias con respecto a los hombres en ninguna de las variables, excepto en autoestima.Currently, the majority of the morbid obesity patients die due to the severity levels of that disease, thus the bariatric surgery seems to be a good solution nowadays. Taking into account the actual situation, this research tries to analyse the significantly differences between a group of patients proposed to bariatric surgery, a group of patients who are not proposed to bariatric surgery and a control sample with different variables, such as anxiety, depression and self-steem, taking into account the possible gender influence among all conditions. The sample is composed of 274 individuals. The design was ex post facto prospective. The results of the research show significant differences between the 3 groups in all the variables conditions. However, there are no significant differences with the male group in any of the variables conditions, except for self-estee

Perceived parental rearing styles in eating disorders

El objetivo ha sido poner a prueba un modelo estructural para determinar cómo pueden estar afectando los estilos de crianza percibidos al desarrollo personal y emocional, así como a la aparición de conductas directamente relacionadas con los trastornos de la conducta alimentaria (TCA). La muestra estuvo formada por 168 mujeres con criterios diagnósticos para alguno de los tipos de TCA. El modelo estimado se ajustó satisfactoriamente. Los resultados muestran que la calidez emocional percibida del padre desempeña un importante papel frente a la percepción de rechazo de la madre, en el desarrollo personal y emocional, así como en la aparición de conductas relacionadas con los TCA. Además, se comprueba la relevancia de las variables personales y emocionales para el desarrollo de los TCA, en especial de la baja autoestima, más allá de la influencia directa de los estilos de crianza parentales, percibidos como disfuncionales.The aim of this study was to test a structural model designed to determine how perceived parenting styles may, in women with eating disorders (ED), affect their personal development and the emotional disturbances they experience, and also to explore how these styles may influence the emergence of behaviors directly related to ED. EMBU, BSQ, EAT-40, EDI-2, BDI, STAI, and BITE were administered to 168 women with some type of ED. The estimated model showed a satisfactory fit. The results show that perceived emotional warmth in the father plays an important role in mitigating perceived rejection by the mother. The analysis also highlights the relevance of personal and emotional variables, particularly low self-esteem, in the development of ED, above and beyond the direct influence of parental rearing styles that are perceived as dysfunctional

Handling of lipemic samples in the clinical laboratory

Interferences in the clinical laboratory may lead physicians misinterpret results for some biological analytes. The most common analytical interferences in the clinical laboratory include hemolysis, icterus and lipemia. Lipemia is defined as turbidity in a sample caused by the accumulation of lipoproteins, mainly very-low density lipoproteins (VLDL) and chylomicrons. Several methods are available for the detection of lipemic samples, including the lipemic index, or triglyceride quantification in serum or plasma samples, or mean corpuscular hemoglobin (MCHC) concentration in blood samples. According to the European Directive 98/79/CE, it is the responsibility of clinical laboratories to monitor the presence of interfering substances that may affect the measurement of an analyte. There is an urgent need to standardize interference studies and the way interferences are reported by manufacturers. Several methods are currently available to remove interference from lipemia and enable accurate measurement of biological quantities. The clinical laboratory should establish a protocol for the handling of lipemic samples according to the biological quantity to be tested