Indicação e concordância em iniciar tratamento durante avaliação inicial para psicoterapia psicodinâmica

This naturalistic and longitudinal study, following 557 outpatients who sought psychodynamic psychotherapy, aimed to verify factors associated with non-indication for psychodynamic psychotherapy and to establish predictors of non-agreement to initiate treatment for patients indicated for this treatment. It found that patients consulting for somatic or att ention problems and/or with a low educational level were less likely to be indicated for psychodynamic psychotherapy; patients perceiving their symptoms as intense were more likely to be indicated for this treatment. The following were the predictors of non-agreement to initiate psychodynamic psychotherapy: low educational level, low family income, diagnosis of schizophrenia, schizotypal or delusional disorders, depressive problems and/or never experiencing psychotherapy. Psychodynamic psychotherapy, as every other treatment, appears to be suitable for a specific group of patients. Unless the technique performed by psychotherapists during psychodynamic psychotherapy’s initial stages is improved, the relevance of referring a non-concordant profi le to this psychotherapeutic modality is herein discussed.Keywords: treatment indication, treatment compliance, suitability, premature discontinuation, psychodynamic psychotherapy.Este estudo naturalístico e longitudinal, seguindo 557 pacientes ambulatoriais que buscaram psicoterapia psicodinâmica, teve por objetivo verificar fatores associados com não indicação para psicoterapia psicodinâmica, bem como estabelecer preditores de não concordância em iniciar tratamento entre pacientes que receberam indicação para esta modalidade terapêutica. A investigação encontrou que pacientes com queixas de problemas somáticos ou problemas de atenção e/ou com baixa escolaridade tiveram menor probabilidade de receberem indicação para psicoterapia psicodinâmica; pacientes que percebiam seus sintomas como intensos tiveram maior probabilidade de receberem indicação para este tratamento. Foram preditores de não concordância em iniciar psicoterapia psicodinâmica: baixa escolaridade, baixa renda familiar, diagnóstico de esquizofrenia, transtorno esquizotípico ou delirante, problemas depressivos e/ou estar buscando psicoterapia pela primeira vez. A psicoterapia psicodinâmica, como todas as formas de tratamento, parece ser adequada para um grupo específico de pacientes. A menos que as técnicas utilizadas pelos terapeutas durante as fases iniciais da psicoterapia psicodinâmica sejam aperfeiçoadas, a relevância de indicar o perfil de pacientes não concordantes para esta modalidade terapêutica é aqui discutida.Palavras-chave: indicação para tratamento, aderência ao tratamento, contraindicação, abandono precoce, psicoterapia psicodinâmica

Stress and coping in a sample of medical students in Brazil

Background Medical training is a stressing situation, making medical students vulnerable to psychiatric disorders, such as depression and anxiety. Objective The study aimed to assess the prevalence of stress and coping in students of a public medical school in Brazil, comparing the groups from the first and sixth years of training. Methods Through a cross-sectional, observational study, a sample of 232 first and sixth-year regularly registered medical students has been evaluated. Students filled a socio-demographic questionnaire, the Lipp Inventory of Stress Symptoms (ISSL), and the Coping Strategies Inventory (CSI). Results From the total sample of 232 students, 110 were first-year students and 122 sixth-year students. Stress symptoms were significantly higher in first-year students (49.1%) than in the sixth-year group (33.6%; p = 0.018). Variables significantly associated with stress were: year of the training (1st year >; 6th year), income (lower >; higher income), satisfaction with the training (dissatisfied >; satisfied) and the use of escape/avoidance copying strategy (positive association). Discussion Considering the higher stress symptoms among first-year medical students and the positive association of the escape/avoidance copying strategy with stress, strategies must be developed to enable students starting medical school to be better at coping with this stressful situations