Elem de Psihosomatica

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\ul0\nosupersub\cf5\f6\fs36 Sub redactia I. B. lamandescu\par\pard\ql
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\ul0\nosupersub\cf7\f8\fs32 Editura IMFIe^\par\pard\ql \li2736\sb0\sl-
144\slmult0 \up0 \expndtw0\charscalex127 \ul0\nosupersub\cf3\f4\fs18 c<�*
\par\pard\sect\sectd\fs24\paperw9500\paperh12940{\bkmkstart Pg2}{\bkmkend
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\ul0\nosupersub\cf8\f9\fs22 sub redactia \par\pard\ql \li2601\sb127\sl-
253\slmult0 \up0 \expndtw0\charscalex164 v'onn Jgradu Jtmnndpscu \par\pard\ql
\li1968\sb0\sl-230\slmult0 \par\pard\ql\li1968\sb0\sl-230\slmult0
\par\pard\ql\li1968\sb146\sl-230\slmult0 \up0 \expndtw0\charscalex119
\ul0\nosupersub\cf9\f10\fs20 Grigore Bu$oi, Carmen Ciolu Lilians Diaconescu,
\par\pard\ql \li1747\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex119 Corneliu
Oragomirescu, Ina lonescu, lolanda Mitrofan, \par\pard\ql \li935\ri1314\sb2\sl-
240\slmult0\tx3571 \up0 \expndtw0\charscalex118 Coralia M?r$u Paun. Cristian Sever
Oana, Fraga Paveliu, Sorin Paveliu, \line\tab \up0 \expndtw0\charscalex115 Ovidiu
Popa Velea \par\pard\ql \li2899\ri910\sb429\sl-980\slmult0\fi830 \up0
\expndtw0\charscalex138 \ul0\nosupersub\cf10\f11\fs62 �lemeitte dc \line \up0
\expndtw0\charscalex133 psibosomnticA \par\pard\ql \li926\sb164\sl-782\slmult0 \up0
\expndtw0\charscalex128 \ul0\nosupersub\cf11\f12\fs68 qenevaln si aplicnta
\par\pard\ql \li3720\sb0\sl-644\slmult0 \par\pard\ql\li3720\sb0\sl-644\slmult0
\par\pard\ql\li3720\sb0\sl-644\slmult0 \par\pard\ql\li3720\sb0\sl-644\slmult0
\up0 \expndtw0\charscalex93 \ul0\nosupersub\cf12\f13\fs56 INF \par\pard\ql
\li4036\ri4162\sb1\sl-300\slmult0\tx4320 \up0 \expndtw0\charscalex129
\ul0\nosupersub\cf8\f9\fs22 Bucuresti \line\tab \up0 \expndtw0\charscalex130
1999 \par\pard\sect\sectd\fs24\paperw8460\paperh13040{\bkmkstart Pg3}{\bkmkend
Pg3}\par\pard\qj \li1939\sb0\sl-200\slmult0 \par\pard\qj\li1939\sb0\sl-
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\par\pard\qj\li1939\ri3440\sb154\sl-200\slmult0 \up0 \expndtw0\charscalex115
\ul0\nosupersub\cf13\f14\fs16 Doscneroa CIP a Bibliotecii Nationalo \up0 \expndtw-
1\charscalex100 IAMANOESCU, BRAOU IOAN \par\pard\qj \li1934\ri2255\sb17\sl-
180\slmult0\fi9 \up0 \expndtw0\charscalex119 Elemente do psihosomatica generala si
aplicata/loan \up0 \expndtw0\charscalex120 Bradu lamandescu \par\pard\ql
\li1934\sb17\sl-184\slmult0 \up0 \expndtw0\charscalex111 Bucuesti: Infomedica. 1999
\par\pard\ql \li1929\sb7\sl-196\slmult0 \up0 \expndtw-4\charscalex100
\ul0\nosupersub\cf3\f4\fs18 341 p; 24 cm \par\pard\ql \li1929\sb1\sl-176\slmult0
\up0 \expndtw0\charscalex103 \ul0\nosupersub\cf13\f14\fs16 Bibliogr \par\pard\ql
\li1934\sb18\sl-184\slmult0 \up0 \expndtw0\charscalex103 ISBN: 973-9394 14 0
\ul0\nosupersub\cf3\f4\fs18 61689:616 \par\pard\ql \li1891\sb0\sl-207\slmult0
\par\pard\ql\li1891\sb0\sl-207\slmult0 \par\pard\ql\li1891\sb13\sl-207\slmult0 \up0
\expndtw0\charscalex106 �1999 - INFOMEDICA s.r.l. \par\pard\qj
\li1900\ri2195\sb206\sl-240\slmult0 \up0 \expndtw0\charscalex119 Elemente de
psihosomatica generala si aplicata \up0 \expndtw0\charscalex105 loan Bradu
IAMANDESCU \par\pard\ql \li1896\sb0\sl-230\slmult0 \par\pard\ql\li1896\sb39\sl-
230\slmult0 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs20 ISBN: 973-
9394-14-0 \par\pard\qj \li1891\sb0\sl-210\slmult0
\par\pard\qj\li1891\ri2031\sb117\sl-210\slmult0\fi4 \up0 \expndtw0\charscalex115
\ul0\nosupersub\cf3\f4\fs18 Toate drepturile rezervate Edituni INFOMEDICA. \up0
\expndtw0\charscalex121 Nici o parte din acest volum nu poate fi copiata \up0
\expndtw0\charscalex116 fdrd permisiunea scrisa a Edituni INFOMEDICA.
\par\pard\qj \li1896\sb0\sl-220\slmult0 \par\pard\qj\li1896\ri3038\sb122\sl-
220\slmult0\fi4 \up0 \expndtw0\charscalex119 Drepturile de distribute Tn
strSinatate \up0 \expndtw0\charscalex114 aparjin Tn exclusivitate edituni
220\slmult0 \up0 \expndtw0\charscalex114 Copyright �1999 by INFOMEDICA s.r.l.
\up0 \expndtw0\charscalex115 All rights reserved. \par\pard\ql \li1900\sb0\sl-
Aparut 1999 \par\pard\li1900\sb0\sl-207\slmult0\par\pard\li1900\sb18\sl-
207\slmult0\fi0\tx4195 \up0 \expndtw0\charscalex106 Editura INFOMEDICA\tab \up0
\expndtw0\charscalex110 Bucuresti\par\pard\li1900\sb4\sl-
207\slmult0\fi2294\tx6614\tx6849\tx7190 \up0 \expndtw0\charscalex114 Sos. Panduri
35, Bl. P1, Sc.\tab \up0 \expndtw-5\charscalex100 B.\tab \up0 \expndtw-
5\charscalex100 Ap.\tab \up0 \expndtw0\charscalex111 34\par\pard\li1900\sb1\sl-
223\slmult0\fi2289\tx4617 \up0 \expndtw-9\charscalex95 \ul0\nosupersub\cf9\f10\fs20
Tel.:\tab \up0 \expndtw0\charscalex102 781 42 98;\par\pard\ql \li4190\sb1\sl-
190\slmult0 \up0 \expndtw0\charscalex116 \ul0\nosupersub\cf3\f4\fs18 Fax:
78134.28 \par\pard\ql \li1920\sb0\sl-253\slmult0 \par\pard\ql\li1920\sb0\sl-
253\slmult0 \par\pard\ql\li1920\sb0\sl-253\slmult0 \par\pard\ql\li1920\sb0\sl-
253\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf8\f9\fs22 Redactor:
Luminita Butnaru \par\pard\ql \li1915\sb1\sl-237\slmult0 \up0 \expndtw-
3\charscalex100 Tehnoredactor: Lorena Colisniuc
Pg4}\par\pard\ql \li4257\sb0\sl-253\slmult0 \par\pard\ql\li4257\sb77\sl-253\slmult0
\up0 \expndtw0\charscalex137 \ul0\nosupersub\cf8\f9\fs22 sub redactia
\par\pard\ql \li3115\sb127\sl-253\slmult0 \up0 \expndtw0\charscalex145 v'/omi
Jgrndu vVnmnndcscu \par\pard\ql \li4473\sb0\sl-276\slmult0
\ul0\nosupersub\cf14\f15\fs24 <?4utoei: \par\pard\ql \li2486\sb1\sl-208\slmult0
\up0 \expndtw0\charscalex109 \ul0\nosupersub\cf8\f9\fs22 Grigore Busoi, Carmen
Ciofu, Liliana Diaconescu, \par\pard\ql \li2265\sb13\sl-232\slmult0 \up0
\expndtw0\charscalex110 Corneliu Dragomirescu, Ina ionescu, lolanda Mitrofan,
\par\pard\ql \li1449\ri929\sb2\sl-240\slmult0\tx4089 \up0 \expndtw0\charscalex110
Coraiia Mirsu Paun, Cristian Sever Oana, Fraga Paveliu, Sorin Paveliu, \line\tab
\up0 \expndtw0\charscalex106 Ovidiu Popa Velea \par\pard\ql \li3427\ri548\sb849\sl-
980\slmult0\fi830 \up0 \expndtw0\charscalex131 \ul0\nosupersub\cf15\f16\fs60
<�lemente de \line \up0 \expndtw0\charscalex132 psihosomatica \par\pard\ql
\li1444\sb280\sl-690\slmult0 \up0 \expndtw0\charscalex153 generala si aplicata
Pg5}\par\pard\ql \li4684\sb0\sl-391\slmult0 \par\pard\ql\li4684\sb0\sl-
391\slmult0 \par\pard\ql\li4684\sb234\sl-391\slmult0
\up0 \expndtw0\charscalex141 \ul0\nosupersub\cf16\f17\fs34 cûtori \par\pard\ql
\ul0\nosupersub\cf13\f14\fs16 Q DP. GRIGORE BUSOI \par\pard\ql \li1924\sb36\sl-
184\slmult0 \up0 \expndtw0\charscalex107 \u8226? medic prlmar MG/MF \par\pard\ql
\li1929\sb36\sl-184\slmult0 \up0 \expndtw0\charscalex110 - Dispensarul Apusului
\par\pard\ql \li2030\sb16\sl-184\slmult0 \up0 \expndtw0\charscalex113 Policlinica
Sector 6, Bucuresti \par\pard\ql \li6777\sb136\sl-184\slmult0 \up0
\expndtw0\charscalex118 Q DR CARMEN CIOFU \par\pard\ql \li7036\sb16\sl-184\slmult0
\up0 \expndtw0\charscalex114 - medic prlmar pediatru \par\pard\ql
\li5486\ri1182\sb0\sl-240\slmult0\tx6215 \up0 \expndtw0\charscalex112 Set Sec(ie
Institutul pentru Ocrotirea Mamei \line\tab \up0 \expndtw0\charscalex113 si
Copilului .Prot. Altred Rusescu" \par\pard\qj \li1934\ri4485\sb87\sl-220\slmult0
\up0 \expndtw0\charscalex118 \u9633? AS. UNIV DR. LILIANA DIACONESCU \up0
\expndtw0\charscalex110 \u9632? Catedra de Psihologie Medicald, \par\pard\ql
\li2088\sb10\sl-184\slmult0 \up0 \expndtw0\charscalex110 UMF .Carol Davila"
Bucuresti \par\pard\ql \li5035\ri1167\sb115\sl-210\slmult0\tx6604 \up0
\expndtw0\charscalex120 \u9633? PROF. DR CORNELIU DRAGOMIRESCU \up0
\expndtw0\charscalex114 Cllnica de Chirurgie, Spitalul "St loan" Bucuresti
\line\tab \up0 \expndtw0\charscalex110 UMF "Carol Davila" Bucuesti \par\pard\ql
\li1939\sb0\sl-184\slmult0 \par\pard\ql\li1939\sb168\sl-184\slmult0 \up0
\expndtw0\charscalex116 \u9633? CONF DR IOAN BRADU IAMANDESCU \par\pard\ql
\li1934\sb16\sl-184\slmult0 \up0 \expndtw0\charscalex113 - Catedra de Psihologie
Medicals. UMF 'Carol Davila' Bucuresti \par\pard\ql \li1948\sb36\sl-184\slmult0
\up0 \expndtw0\charscalex109 - Spitalul Clinic "N.Gh. Lupu" Bucuresti - Alergologie
\par\pard\ql \li6561\sb136\sl-184\slmult0 \up0 \expndtw0\charscalex123 \u9633?
PSIHOL INA IONESCU \par\pard\ql \li6264\ri1169\sb7\sl-220\slmult0\tx6600 \up0
\expndtw0\charscalex113 - Catedra de Psihologie Medicald, \line\tab \up0
\expndtw0\charscalex107 UMF "Carol Davila" Bucuresti \par\pard\ql \li1948\sb130\sl-
184\slmult0 \up0 \expndtw0\charscalex118 \u9633? PROF DR. IOLANDA MITROFAN
\par\pard\ql \li1943\sb36\sl-184\slmult0 \up0 \expndtw0\charscalex114 - Catedra de
Psihologie, \par\pard\qj \li2049\ri3618\sb23\sl-200\slmult0 \up0
\expndtw0\charscalex115 Departamentul Master in Psihoterapie si Psihodiagnostic
\up0 \expndtw0\charscalex112 Univorsiiatea Bucuresti \par\pard\ql \li1953\sb34\sl-
184\slmult0 \up0 \expndtw0\charscalex113 - Pre$edinte al Socmta(u Humane de
Psihoterapie Experien\{iala \par\pard\ql \li4847\sb136\sl-184\slmult0 \up0
\expndtw0\charscalex122 \u9633? PSIHOL PRINCIP CORALIA MIRSU PAUN \par\pard\ql
\li6609\sb16\sl-184\slmult0 \up0 \expndtw0\charscalex112 - Cercetator stunjitic
gradul II \par\pard\ql \li6460\sb36\sl-184\slmult0 \up0 \expndtw0\charscalex108
\u9632? Institutul Oncologic Bucuresti, \par\pard\ql \li5270\sb36\sl-184\slmult0
\up0 \expndtw0\charscalex114 Departamentul de Recuperare Psihoiuncfionaia
\par\pard\qj \li1953\ri5295\sb107\sl-220\slmult0 \up0 \expndtw0\charscalex118 Q DR
CRISTIAN SEVER OANA \up0 \expndtw0\charscalex107 medic prlmar MG/MF \par\pard\ql
\li1958\sb30\sl-184\slmult0 \up0 \expndtw0\charscalex110 - Dispensarul Apusului
\par\pard\ql \li1963\sb16\sl-184\slmult0 \up0 \expndtw0\charscalex113 - Policlinica
Sector 6, Bucuresti \par\pard\ql \li5150\sb79\sl-253\slmult0 \up0 \expndtw-
10\charscalex93 \ul0\nosupersub\cf8\f9\fs22 D SEF DE LUCRARI DR. FRAGA PAVELIU
\par\pard\ql \li4780\sb44\sl-184\slmult0 \up0 \expndtw0\charscalex111
\ul0\nosupersub\cf13\f14\fs16 - Catedra de Biochimie, UMF "Carol Davila'
Bucuresti \par\pard\ql \li3897\sb16\sl-184\slmult0 \up0 \expndtw0\charscalex112 -
medic primar endocrinolog, Spitalul Clinic Universitar Bucuresti \par\pard\ql
\li1972\sb136\sl-184\slmult0 \up0 \expndtw0\charscalex119 \u9633? DR. SORIN PAVELIU
\par\pard\ql \li2068\sb36\sl-184\slmult0 \up0 \expndtw0\charscalex109 medic
specialist medic ma interna \par\pard\ql \li1972\sb36\sl-184\slmult0 \up0
\expndtw0\charscalex110 - Centrul Medical .Carol Davila" \par\pard\ql
\li5438\sb36\sl-184\slmult0 \up0 \expndtw0\charscalex117 D AS. UNIV DR OVIDIU
POPA-VELEA \par\pard\ql \li4003\sb36\sl-184\slmult0 \up0 \expndtw0\charscalex111 -
Catedra de Psihologie Medicald, UMF "Carol Davila' Bucuresti \par\pard\ql
\li4823\sb16\sl-184\slmult0 \up0 \expndtw0\charscalex112 - Institutul de
Pneumoftiziologie "M. Nasta' Bucuresti
\ul0\nosupersub\cf5\f6\fs36 PtQfotC* \par\pard\qj \li1881\sb0\sl-236\slmult0
\par\pard\qj\li1881\sb0\sl-236\slmult0 \par\pard\qj\li1881\ri876\sb182\sl-
236\slmult0\fi292 \up0 \expndtw0\charscalex110 \ul0\nosupersub\cf9\f10\fs20 De la
Hipocrat. adevSrat parinte al medtcinii psihosomatice. si pans in zile\up0
\expndtw0\charscalex113 le noastre observahile clinice au reusit sa aduca in
centrul dezbaterilor medi� \up0 \expndtw0\charscalex116 cate o seie de factori de
ordin psihologie ce participa, direct sau indirect, la \up0 \expndtw0\charscalex116
debutul si ntmarea evolufiei bolii (mergand pans la complicafii sau deces). \up0
\expndtw0\charscalex125 constituted adesea factori de rezisteni la tratament sau,
dimpotrivd, de \up0 \expndtw0\charscalex113 potenfare a acestuia. \par\pard\qj
\li1876\ri870\sb7\sl-233\slmult0\fi321 \up0 \expndtw0\charscalex112 Treptat s-au
acumulat date convingatoare privind comportamentefe nocive \up0
\expndtw0\charscalex118 pentru sanitate (dar si cele utile pentru sanogenezS),
toate avand vehtabile \up0 \expndtw0\charscalex110 \u8222?radacini psihologice",
formula prin care am incercat sa evidenpez legdtura lor \up0
\expndtw0\charscalex110 cu psihoiogia medicala. \par\pard\qj \li1886\ri866\sb7\sl-
233\slmult0\fi307 \up0 \expndtw0\charscalex117 Un moment fundamental in istona
psihosomaticii l-a constituit aparilia \up0 \expndtw0\charscalex113 conceptului de
stres psihic, legal de numele lui Hans Selye, a carui via\\d \u9632? ca \up0
\expndtw0\charscalex118 si cariera sa medicald - a fost asociatd cu cea a unui
arhitect al catedralei -\line \up0 \expndtw0\charscalex107 incSt netinisatH \up0
\expndtw0\charscalex124 - reprezentatd de aceasta veritabila ptaca turnanta
intre \par\pard\qj \li1886\ri871\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex112
acfiunea stimulilor psihici si raspunsul maximal dat de organismut individului \up0
\expndtw0\charscalex112 san;)tos sau deja bolnav. \par\pard\qj
\li1886\ri866\sb5\sl-235\slmult0\fi278 \up0 \expndtw0\charscalex112 As aduce, in
acest moment al unui istoric extrem de sumar al psihosomati� \up0
\expndtw0\charscalex112 cii un oinagiu unui mare precursor, Cannon, care \u9632?
descriind reacfiife funda\up0 \expndtw0\charscalex119 mertae ale stresului psihic
(..fight" sau Jlight") a pierdut posibilitatea de a \up0 \expndtw0\charscalex107
ajunge la voncluzii siinilare dr.loriln rvvefuful ir.\u8222?<) precar at
cunosiin\\e!or de fi \up0 \expndtw0\charscalex107 jiclogie din vremea sa.
\par\pard\qj \li1896\ri830\sb1\sl-240\slmult0\fi307 \up0 \expndtw0\charscalex112
"'teen nd oeste lorn.ularoa principalelor concepte ale psihnsomatic", ce vor
\up0 \expndtw0\charscalex115 fi abordate in dcud capitole ale acestei lucrari, este
suficient doar sd detinim \up0 \expndtw0\charscalex102 intr-un mnd oxtrei. I de
SoCCfnt ce i\up0 \expndtw0\charscalex111 *'.e psihosomatica si ce reprezinta ea
pentru \par\pard\qj \li1886\ri856\sb5\sl-235\slmult0 \up0 \expndtw0\charscalex114
practica si cercetjrea medicala. in primul randea este o concepfic intetjra/icts
\up0 \expndtw0\charscalex113 a i' edicmii, prin aceea ca ia in considerare nu numai
tactorii fizico-chimici si \up0 \expndtw0\charscalex109 biologici ce intervin in
etiologia bolii (modeiui bio-psiho-social al lui Engel). ci \up0
\expndtw0\charscalex125 si pe cei psthologici. Spre deosebire de psihoiogia
medicala, care si ea \up0 \expndtw0\charscalex114 studiazd acesti factori psihici
(cu o extensie asupra sorgmtei lor sociale, deci \up0 \expndtw0\charscalex110
factori i psiho-sociati). psihosomatica se apleaca in mod prioritar asupra meca\up0
\expndtw0\charscalex111 nismelor psiho-fiziopatotogice prin care excitafta psihica
este convertitS intr-o \up0 \expndtw0\charscalex112 activitate somatica (de la
modificdri de tonus muscular sau de vasomotneitate \up0 \expndtw0\charscalex110
cutanatci si pand la perturbarea activitdfii viscerate) \par\pard\qj
\li1896\ri843\sb4\sl-237\slmult0\fi283 \up0 \expndtw0\charscalex111 Aceste procese
psihosomatice, legate de acti vitalize sistemului limbic si de \up0
\expndtw0\charscalex117 medierea complex^ neuro-endocrinovegetativa si imunologica,
ancoreazS \up0 \expndtw0\charscalex117 adesea - in ciuda unei axiomatice
reversibilitAti \u9632? intr-un proces patologic \up0 \expndtw0\charscalex119
favorizat de o meiopragie de organ preexistenta, fie datoritd unei inducfii \up0
\expndtw0\charscalex115 genetice, fie edificata in cursul interacfiunii subiectului
afectat cu tactorii de \up0 \expndtw0\charscalex120 mediu natural si social. Mai
pu(in se vorboste despre tulburarile somato\up0 \expndtw0\charscalex115 psihice
care inchid un cere vicios cu tulburarile psihesomatice. dar prezenfa \up0
\expndtw0\charscalex112 lor este reflectata in mod pregnant in deprecierea calitahi
vie(ii omului bolnav \up0 \expndtw0\charscalex112 si in relafia acestuia cu medicul
si echipa de ingrijire. \par\pard\sect\sectd\fs24\paperw9480\paperh13220{\bkmkstart
Pg7}{\bkmkend Pg7}\par\pard\qj \li1080\sb0\sl-237\slmult0
\par\pard\qj\li1080\sb0\sl-237\slmult0 \par\pard\qj\li1080\sb0\sl-237\slmult0
\par\pard\qj\li1080\ri1002\sb219\sl-237\slmult0\fi302 \up0
\expndtw0\charscalex118 \ul0\nosupersub\cf9\f10\fs20 O astfel de viziune personala
asupra bolilor p: ihosomatice. edificata in \up0 \expndtw0\charscalex117 peste doua
decenti (1974-1999), mi a fost sugarata de practica medicald de \up0
\expndtw0\charscalex113 internist si alergolog pe care am potenfato prin noua
optica. cea de psiholog -\line \up0 \expndtw0\charscalex109 edificatd in mod
progresiv - de cunostinfele obfinute prin frecventarea facultafn \up0
\expndtw0\charscalex114 de Psihologie intre anii 1970-1974. in aceastd direcfie,
inclusiv in elaborarea \up0 \expndtw0\charscalex111 tezei de doctoral cu tematica
de Psihosomaticd, am beneficial - ca si in prezent \up0 \expndtw0\charscalex111
\u9632? de indrumarea plina de substanfd intelectuala si bundvoinfd a D-lui Prof
dr. \up0 \expndtw0\charscalex112 Radu Paun. un entuziast sprijinitor al
introducerii psihotogiei in invafdmantul \up0 \expndtw0\charscalex109 medical
romanesc, inclusiv in clinicile medicate. \par\pard\qj \li1080\ri1002\sb1\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex115 Avand prilejul sd cunosc la fata
locului cateva fief-uri ate Psihosomaticii \up0 \expndtw0\charscalex115 europene
(Elve(ia si Germania), am constatat cd, dincoto de sechelele de tip \up0
\expndtw0\charscalex118 psihanalitic ale Psihosomaticii clasice, apare tot mai
frecvent desprinderea \up0 \expndtw0\charscalex123 psihosomaticii actuate de
cordonul ombilical care o Icaga de psihiatrie, \up0 \expndtw0\charscalex118
accentul abordarii medicate psihosomatice punandu-se pe elementele unei \up0
\expndtw0\charscalex121 psihologii actuate. ..hie et nunc". dar bazatd pe nofiuni
recente de psiho\up0 \expndtw0\charscalex107 neurofiziologie. endocrinologie si
imunologie. \par\pard\qj \li1089\ri990\sb3\sl-237\slmult0\fi297 \up0
\expndtw0\charscalex109 Legitimitatea inctuderii unor elemente ale psihotogiei in
componenfa actului \up0 \expndtw0\charscalex119 medical (..perspectiva psihologica
a acesteia") poate fi acceptatd de cdtre \up0 \expndtw0\charscalex116 medici numai
dacd o astfel de abordare integrativd a omului bolnav nu face \up0
\expndtw0\charscalex122 abstracUe de faptul cd majoritatea acuzetor somatice cu
care un bolnav \up0 \expndtw0\charscalex112 ..nepsihiatric" seprezinta la
consultalia medicald - este indusa, in primul rand. \up0 \expndtw0\charscalex115 de
cauze \u8222?materiale" (fizico-chimice. biologice), asociate sau precedate insd
\up0 \expndtw0\charscalex124 de acfiunea unor factori psihici al cdror efect
ulterior poate sd imbrace \up0 \expndtw0\charscalex110 caracterele unui veritabil
trigger nespecific. \par\pard\qj \li1084\ri983\sb1\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex114 Revenind la modelele occidentale in privinfa asistentei
medicate a bolilor \up0 \expndtw0\charscalex114 psihosomatice. am constatat ca
existd clinici cu acest profit in care terapeufii \up0 \expndtw0\charscalex118
chemafi sa rezolve problemele pacien\\ilor cu o astfel de patologie, lucrand
\up0 \expndtw0\charscalex113 obligatoriu ..in echipd", fie posedd specialitatea
medicald de ..psihoterapeuf, \up0 \expndtw0\charscalex126 fie sunt psihologi.
fiziokinetoterapeufi sau chiar internisti cu studii de \up0 \expndtw0\charscalex108
psihologie. \par\pard\qj \li1099\ri988\sb0\sl-240\slmult0\fi278 \up0
\expndtw0\charscalex111 Aceste unitdfl cltnice de psihosomaticd (existd in
institute cu acest profit in \up0 \expndtw0\charscalex112 cadrul Universitdfitor do
Medicind!) colaboreazd constant cu un psihiatru \u8222?de \up0
\expndtw0\charscalex109 legdturd" care le viziteazd periodic. \par\pard\qj
\li1113\ri989\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex113 Faptul ca in
aceste (ari mentionate s-au conturat o serie de ramuri aplicati\up0
\expndtw0\charscalex116 ve ale psihosomaticii, precum psihosomatica ginecologicd.
reumatologicd, \up0 \expndtw0\charscalex125 etc.. a inspirat includerea in cartea
de fa(d. ca si in tittul ei. de altfel, a \up0 \expndtw0\charscalex111 sintagmei de
..psihosomatica aplicatd". \par\pard\ql \li1391\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex111 Acest volum. ilustrand \u9632? fie si incomplet - un
domeniu asteptat de peste un \par\pard\ql \li1108\sb9\sl-
230\slmult0\tx7300\tx7473 \up0 \expndtw0\charscalex120 deceniu spre a fi ilustrat
printr-o aparifie editoriald, incearcd \tab \up0 \expndtw0\charscalex80 \u9632?
\tab \up0 \expndtw0\charscalex125 odata cu \par\pard\qj \li1108\ri979\sb6\sl-
235\slmult0 \up0 \expndtw0\charscalex113 problematica pe care o infafiseazd \u9632?
sd acrediteze ideea ca un astfel de camp \up0 \expndtw0\charscalex123 de
interferenfd dintre medicind si psihologie incepe sd-si creeze o baza \up0
\expndtw0\charscalex115 teoretica romaneasca si o arie de aplicafii in sdnul unei
populatii afectate de \up0 \expndtw0\charscalex115 lipsa unor mi/loace elementare
diagnostice si terapeutice (remarcd valabild. \up0 \expndtw0\charscalex112 desigur.
pentru cei mulfi. dependent de ..compensate") \par\pard\qj \li1118\ri970\sb1\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex116 Din fericire, aceste aplicafii ate
psihosomaticii nu necesitd medicamente \up0 \expndtw0\charscalex116 sau explordri
costisitoare. desi ele amplified in mod consistent efectut
\ul0\nosupersub\cf9\f10\fs20 medica(iei. ci doar o \u8222?particicd de suftet" din
partea fiecdrui medic angrenat in \up0 \expndtw0\charscalex111 actul terapeutic si.
ceva mai mult, o nguroasd activitate a psihologului. chemat \up0
\expndtw0\charscalex117 si iiitregeascd - cu armete si bagajele meseriei sale -
tratarea pacienfilor cu \up0 \expndtw0\charscalex110 bolt severe sau cu evolufie
cronicd, descurajantd. \par\pard\qj \li1473\ri619\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex117 Poate cd destinul carfii de fata este mai pufin acela de a
aduce precizdri \up0 \expndtw0\charscalex114 conceptuate si date noi din domeniut
psihosomaticii. cat o lentativd menitd a \up0 \expndtw0\charscalex113 demonstra
faptul cd psihosomatica a inceput sd se Jacd~ si in Romania, chiar \up0
\expndtw0\charscalex121 dacd incd sporadic si lipsitd de un sprijin consistent la
mvel institutional \up0 \expndtw0\charscalex111 (psihosomatica hind absenta dm
nomenclatorul specialitd(ilor medicate, si din \up0 \expndtw0\charscalex111
invafamantul superior medical) \par\pard\qj \li1473\ri609\sb0\sl-
243\slmult0\fi302 \up0 \expndtw0\charscalex112 Faptul cd la elaborarea aeestei cdr\
{i au acceptat sd particioe distinsi colegi \up0 \expndtw0\charscalex111 cu
preocupari sustinute in domeniulpsihosomaticii. jumatate dintre dansii fima \up0
\expndtw0\charscalex110 psihologi - absolvenfi sau in de venire - constituie un
argument pentru mine, ca \up0 \expndtw0\charscalex111 editor al lucrdrn \u9632? si,
ani de zile, un ..alergdtor de cursd lungd" pe acest traseu \up0
\expndtw0\charscalex113 al psihosomaticii - sd consider cd ..nurnai impteuna vom
reusi" sd canalizdm \up0 \expndtw0\charscalex115 un curent de opmie deja existent
in favoarea psihosomaticii. pe fdgasul unei \up0 \expndtw0\charscalex108 oiganizdri
institufionale. \par\pard\qj \li1488\ri609\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex113 Un optimism incurabil ne indeamnd sd sperdm cd se va putea
gasi. in cele \up0 \expndtw0\charscalex113 din urmd, un ..algoritm functional' (nu
politic!) adaptat la realitdfile medicate \up0 \expndtw0\charscalex113 din fara
noastra. inclusiv interlocutori avizafi in randul factoritor decizionali, \up0
\expndtw0\charscalex111 academic/ sau institutional!, cu tofii capabili sa ofe'e un
cadru legal, organizat. \up0 \expndtw0\charscalex117 de dezvoltare a psihosomaticii
O astfel de perspectiva ar putea conduce, in \up0 \expndtw0\charscalex113 mod
sigur, la optimizarea actului medical si la o mai demnd posturd a omului \up0
\expndtw0\charscalex113 sufermd. \par\pard\qj \li1488\ri604\sb0\sl-
250\slmult0\fi288 \up0 \expndtw0\charscalex115 Aduc mul(umirile noastre
colectivului redacfional al Editurii Infomedica \up0 \expndtw0\charscalex125 pentru
realizarea in condi(ii optime si in limp record a tehnoredactdrii \up0
\expndtw0\charscalex105 volumuhii de fata. \par\pard\qj \li1492\ri588\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex115 in ceea ce priveste destinul
lucrdrii noastre. asteptdm cu interes verdictul \up0 \expndtw0\charscalex112 unui
public de cititori interesafi de psihosomaticd pe care ni-i dorim a fi critic
\up0 \expndtw0\charscalex121 constructivi. manafi de aceleasi bune intenfii precum
acelea ate autonlor \up0 \expndtw0\charscalex112 aeestei carfi. \par\pard\ql
\li5510\sb198\sl-230\slmult0 \up0 \expndtw0\charscalex117 Cont. dr. loan Bradu
lamandescu \par\pard\sect\sectd\fs24\paperw9480\paperh13220{\bkmkstart Pg9}
{\bkmkend Pg9}\par\pard\ql \li1646\sb0\sl-805\slmult0 \par\pard\ql\li1646\sb0\sl-
805\slmult0 \par\pard\ql\li1646\sb164\sl-805\slmult0 \up0
\expndtw0\charscalex190 \ul0\nosupersub\cf17\f18\fs70 ûoar
\par\pard\li1636\sb0\sl-414\slmult0\par\pard\li1636\sb0\sl-
414\slmult0\par\pard\li1636\sb219\sl-414\slmult0\fi0\tx1953 \up0
\expndtw0\charscalex86 \ul0\nosupersub\cf5\f6\fs36 I.\tab \up0
\expndtw0\charscalex131 /psihosomatica generala\par\pard\li1636\sb0\sl-
\expndtw0\charscalex108 \ul0\nosupersub\cf8\f9\fs22 1.\tab \up0
\expndtw0\charscalex115 Introducere. Spre o psihosomaticd modernu
MM,\par\pard\li1636\sb59\sl-253\slmult0\fi336 \up0 \expndtw0\charscalex106 loan
Bradu lamandescu\par\pard\li1636\sb188\sl-253\slmult0\fi9\tldot\tx8168\tx8217
\up0 \expndtw0\charscalex122 2. Concepte clinice fundamentale in
psihosomatica\expndtw0\charscalex100\tab \tab \up0 \expndtw0\charscalex101
15\par\pard\ql \li1963\sb47\sl-253\slmult0 \up0 \expndtw-1\charscalex100 Grigore
Bu$oi \par\pard\ql \li1646\sb187\sl-253\slmult0 \up0 \expndtw0\charscalex121 3.
Tulburari si boli psihosomatice. Tentative! de reformulare
\par\pard\li1934\sb30\sl-253\slmult0\fi0\tldot\tx8168 \up0 \expndtw0\charscalex121
a unor <on<epte generate ale psihosomaticii\expndtw0\charscalex100\tab \t \up0
\expndtw0\charscalex121 25\par\pard\ql \li1977\sb44\sl-253\slmult0 \up0
\expndtw0\charscalex106 loan Bradu lamandescu \par\pard\ql \li1631\sb187\sl-
253\slmult0 \up0 \expndtw0\charscalex122 4. Stresui psihic - concept fundamental
ancorat in \par\pard\li1934\sb27\sl-253\slmult0\fi0\tx4943\tx5515\tx8169 \up0
\expndtw0\charscalex105 psihosomatica \u9632?\u9632?\u9632?\tab \up0
\expndtw0\charscalex105 ,\tab \up0 \expndtw0\charscalex105 ,\tab \up0
\expndtw0\charscalex104 loan Bradu lamandescu \par\pard\ql \li1641\sb187\sl-
253\slmult0 \up0 \expndtw0\charscalex122 5. Mecanisme adaptative de ajustare
(coping) in stresui \par\pard\li1939\sb44\sl-253\slmult0\fi0\tx8193 \up0
\expndtw0\charscalex118 psihic. Impiicatii in practice medicala\tab \up0
\expndtw0\charscalex100 Ovidiu Popa Velea \par\pard\li1646\sb179\sl-
253\slmult0\fi0\tx1943\tldot\tx8168 \up0 \expndtw0\charscalex116 o.\tab \up0
\expndtw0\charscalex116 Mormon ii de stres\expndtw0\charscalex100\tab \t \up0
\expndtw0\charscalex102 Fraga Paveliu, Sorin Paveliu \par\pard\ql \li1641\sb187\sl-
253\slmult0 \up0 \expndtw0\charscalex121 7. Abordarea psihosomatica a bolnavilor
\par\pard\li1910\sb60\sl-253\slmult0\fi0\tx6964\tx8246 \up0 \expndtw0\charscalex101
a. Principii general* de abordare psihosomatica\tab \up0 \expndtw0\charscalex101
M\tab \up0 \expndtw0\charscalex101 89\par\pard\ql \li2179\sb34\sl-253\slmult0
\up0 \expndtw0\charscalex104 loan Bradu lamandescu \par\pard\li1915\sb17\sl-
253\slmult0\fi0\tx7569\tx8246 \up0 \expndtw0\charscalex103 b. Algorita de abordar*
a bolnavilor psihosonatici\tab \up0 \expndtw0\charscalex103 M\tab \up0
253\slmult0\fi0\tx8131 \up0 \expndtw0\charscalex101 c. Relatia do comunicaro in
nodicina do lamilio\tab \up0 \expndtw0\charscalex101 113\par\pard\ql
\li2097\sb5\sl-253\slmult0 \up0 \expndtw0\charscalex105 Crislian Sever Oana
\expndtw0\charscalex124 \ul0\nosupersub\cf8\f9\fs22 8. Elemente de psihoterapie a
bolnavilor psihosomatici \par\pard\li1694\sb146\sl-
253\slmult0\fi0\tldot\tx7092\tx7920 \up0 \expndtw0\charscalex102 a. Psihotorapia
oxporiontiald in bolii* psihosomatice\expndtw0\charscalex100\tab \tab \up0
\expndtw0\charscalex102 127\par\pard\li1694\sb30\sl-253\slmult0\fi201 \up0
\expndtw0\charscalex102 lolanda Mitrofan\par\pard\li1694\sb16\sl-
253\slmult0\fi9\tldot\tx7878\tx7929 \up0 \expndtw0\charscalex102 b. ImpcKtuI
psihosomatic al moxicii \u8226? pronisi a muzi<olerapiei\expndtw0\charscalex100\tab
\tab \up0 \expndtw0\charscalex102 143\par\pard\li1694\sb25\sl-253\slmult0\fi201
\up0 \expndtw0\charscalex102 loan Bradu lamandescu\par\pard\ql \li1440\sb178\sl-
253\slmult0 \up0 \expndtw0\charscalex121 9. De la grupurile Balint la modelul Monte
Verita - elemente \par\pard\li1732\sb27\sl-253\slmult0\fi0\tldot\tx7819 \up0
\expndtw0\charscalex119 concrete de formare psihosomaticd a
medicului\expndtw0\charscalex100\tab \t \up0 \expndtw0\charscalex119
159\par\pard\li1732\sb59\sl-253\slmult0\fi43 \up0 \expndtw0\charscalex119 Ina
lonescu\par\pard\ql \li1440\sb0\sl-414\slmult0 \par\pard\ql\li1440\sb188\sl-
414\slmult0\tx1876 \up0 \expndtw0\charscalex86 \ul0\nosupersub\cf5\f6\fs36 II. \tab
\up0 \expndtw0\charscalex131 /psihosomatica aplicata \par\pard\li1468\sb0\sl-
253\slmult0\par\pard\li1468\sb0\sl-253\slmult0\par\pard\li1468\sb130\sl-
253\slmult0\fi0\tldot\tx7823 \up0 \expndtw0\charscalex118
\ul0\nosupersub\cf8\f9\fs22 1. Psihosomaticd cardiovascular
a\expndtw0\charscalex100\tab \t \up0 \expndtw0\charscalex118 167\par\pard\ql
\li1780\sb50\sl-253\slmult0 \up0 \expndtw0\charscalex104 loan Bradu lamandescu
\par\pard\li1449\sb193\sl-253\slmult0\fi0\tx7847 \up0 \expndtw0\charscalex123 2.
Psihosomaticd reumatologicd\tab \up0 \expndtw0\charscalex123 1f3\par\pard\ql
\li1780\sb41\sl-253\slmult0 \up0 \expndtw0\charscalex104 loan Bradu lamandescu
\par\pard\li1454\sb207\sl-253\slmult0\fi0\tx5457\tx6321\tx7843 \up0 \expndtw-
7\charscalex100 3. Psihosomatica alergologicd\tab \up0 \expndtw0\charscalex50
\u9632?\u9632?\u9632?\u9632?\u9632?\u9632?\u9632?\tab \up0 \expndtw-7\charscalex100
\u9632?\u9632?\u9632?\u9632?\u9632?\u9632?\u9632?\u9632?\tab \up0 \expndtw-
7\charscalex100 sQS\par\pard\ql \li1790\sb47\sl-253\slmult0 \up0
\expndtw0\charscalex104 loan Bradu lamandescu \par\pard\li1454\sb195\sl-
253\slmult0\fi0\tldot\tx7828 \up0 \expndtw0\charscalex119 4. Psihosomaticd
endocrinologicd\expndtw0\charscalex100\tab \t \up0 \expndtw0\charscalex119
255\par\pard\ql \li1785\sb39\sl-253\slmult0 \up0 \expndtw0\charscalex102 Fraga
Paveliu, Sorin Paveliu \par\pard\li1463\sb204\sl-253\slmult0\fi0\tx7843 \up0
\expndtw0\charscalex120 5. Psihosomaticd chirurgicala\tab \up0
\expndtw0\charscalex120 271\par\pard\qj \li1708\ri2968\sb28\sl-280\slmult0 \up0
\expndtw0\charscalex103 Corneliu Dragomirescu, loan Bradu lamandescu, \up0
253\slmult0\fi0\tldot\tx7843 \up0 \expndtw0\charscalex118 6. Psihosomaticd
oncologicd\expndtw0\charscalex100\tab \t \up0 \expndtw0\charscalex118
285\par\pard\ql \li1785\sb43\sl-253\slmult0 \up0 \expndtw0\charscalex101 Coralia
Mirsu Paun \par\pard\ql \li1468\sb187\sl-253\slmult0 \up0 \expndtw0\charscalex121
7. Particuloritdti ale aborddrii psihosomatice in cadrul \par\pard\li1473\sb29\sl-
253\slmult0\fi288\tx7867 \up0 \expndtw0\charscalex116 medicinei de famihe\tab
\up0 \expndtw0\charscalex116 313\par\pard\li1473\sb69\sl-253\slmult0\fi316 \up0
\expndtw0\charscalex116 Grigore Busoi\par\pard\li1473\sb169\sl-
253\slmult0\fi0\tldot\tx7837 \up0 \expndtw0\charscalex116 8. Algoritm de
investigate psihosomaticd in pediatrie\expndtw0\charscalex100\tab \t \up0
\expndtw0\charscalex116 Carmen Ciolu. Liliana
Diaconescu\par\pard\sect\sectd\fs24\paperw9480\paperh13220{\bkmkstart Pg11}
{\bkmkend Pg11}\par\pard\qr \li3772\sb0\sl-900\slmult0 \par\pard\qr\li3772\sb0\sl-
900\slmult0 \par\pard\qr\li3772\sb0\sl-900\slmult0 \par\pard\qr\li3772\sb0\sl-
900\slmult0 \par\pard\qr\li2492\ri475\sb376\sl-900\slmult0 \up0
\expndtw0\charscalex120 \ul0\nosupersub\cf4\f5\fs64 I. Psihosomatica \line \up0
\expndtw0\charscalex121 generala
Pg12}\par\pard\li1713\sb0\sl-253\slmult0\par\pard\li1713\sb0\sl-
253\slmult0\fi0\tx2807 \up0 \expndtw0\charscalex115 \ul0\nosupersub\cf8\f9\fs22
Capitolul\tab \up0 \expndtw0\charscalex115 1\par\pard\ql \li1718\sb0\sl-253\slmult0
INTRODUCERE. \par\pard\qj \li1713\ri701\sb0\sl-360\slmult0 \up0
\expndtw0\charscalex106 SPRE 0 PSIHOSOMATICA MODERNA, APLICATA, ANCORATA \up0
\expndtw0\charscalex107 IN COMPLEXITATEA NOILOR COORDONATE \par\pard\ql
\li1708\sb108\sl-253\slmult0 \up0 \expndtw0\charscalex104 ALE ACTULUI MEDICAL
\ul0\nosupersub\cf9\f10\fs20 loan Bradu lamandescu \par\pard\qj \li1430\sb0\sl-
Concept psihosomatica in medicina sta la baza diagnosticului �i trata-\line \up0
\expndtw0\charscalex118 mentului omului bolnav, analizat in mod global, adica prin
prisma datelor \up0 \expndtw0\charscalex114 \u8222?medicale" lurnizate de examenul
climco-anamnestic ?i de investigatiile pa-\line \up0 \expndtw0\charscalex117
raclinice. dar �i din perspectiva psihologica a trairilor sale, generate de
su-\line \up0 \expndtw0\charscalex120 ferinta sa patologica si de catre echipa
terapeutica. Aceasta conceptie de-\line \up0 \expndtw0\charscalex118 vine o
adevarata mentalitate de abordare a pacientului de catre medicii zl-\line \up0
\expndtw0\charscalex118 lelor noastre (vezi caracterele generale ale aeestei
concept in tabelul 1). \par\pard\ql \li2692\sb211\sl-230\slmult0 \up0
\expndtw0\charscalex115 Tabelul 1. Concepfia psihosomatica fn medicind.
\par\pard\ql \li4118\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex116 Caractere
generale.\par\pard\sect\sectd\sbknone\cols2\colno1\colw5019\colsr160\colno2\colw416
1\colsr160\qj \li1656\ri36\sb240\sl-244\slmult0\fi76 \up0 \expndtw0\charscalex112
1. Conceptie holisticd (integrativa) \line \up0 \expndtw0\charscalex106 \u9632?
unitatea dintre SOMA si PSIHIC\par\pard\qj \li1646\ri41\sb0\sl-243\slmult0\fi48
\up0 \expndtw0\charscalex109 2. Bazata pe observafii clinice (con-\line \up0
\expndtw0\charscalex107 firmate
de cercetdri epidemioiogice), \up0 \expndtw0\charscalex107 date experimentale
psiho-fiziologice, \up0 \expndtw0\charscalex111 neuroendocrinologice
etc.\par\pard\qj \li1651\ri21\sb0\sl-241\slmult0\fi48 \up0 \expndtw0\charscalex120
3. Includerea influenfei mediului \line \up0 \expndtw0\charscalex112 social
(mediatd prin psihicut bolna-\line \up0 \expndtw0\charscalex100 vului) asupra bolii
(VON UEXKUELL: \line \up0 \expndtw0\charscalex106 def. BPS).\par\pard\column \qj
\li20\ri794\sb235\sl-244\slmult0\fi62 \up0 \expndtw0\charscalex119 4. Reliefarea la
bolnavii psihoso-\line \up0 \expndtw0\charscalex120 matici a unei duble
vulnerabllitati \line \up0 \expndtw0\charscalex116 la stres:\par\pard\qj
\li754\ri2423\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex112 - psihicd \line
\up0 \expndtw0\charscalex105 \u9632? de organ\par\pard\qj \li39\ri805\sb4\sl-
240\slmult0\fi43 \up0 \expndtw0\charscalex107 5. Impunerea stresului psihic ca fac�
\line \up0 \expndtw0\charscalex121 tor de rise major in patogeneza:\par\pard\qj
\li759\ri1722\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex108 \u9632? aparent
exctusiv \up0 \expndtw0\charscalex107 \u8226? sumativ. \par\pard\sect\sectd\sbknone
\qj \li1435\sb0\sl-220\slmult0 \par\pard\qj\li1435\ri640\sb75\sl-
220\slmult0\fi292 \up0 \expndtw0\charscalex120 Inainte de a se decanta elementele
conceptiei psihosomatice, a$a cum \up0 \expndtw0\charscalex115 este ea vazuta
astazi ca stand la baza a$a numitei medicine integrative \up0 \expndtw-
4\charscalex100 (,.ho-\par\pard\qj \li1435\ri642\sb0\sl-230\slmult0\fi14 \up0
\expndtw0\charscalex112 listice", ..Ganzheitmedizin"), s-a utilizat termenul de
\u8222?boli psihosomatice", iar \up0 \expndtw0\charscalex112 in ultimele decenii,
eel de \u8222?medicina psihosomatica", analiza lor liind efectua-\line \up0
\expndtw0\charscalex118 ta pu|m mai departe (capitolul 2). Indiferent de adecvarea
terminologiei \up0 \expndtw-3\charscalex100 ?i \par\pard\qj \li1440\ri643\sb0\sl-
225\slmult0\fi9 \up0 \expndtw0\charscalex120 rnai ales de sfera de cuprindere a
bolilor psihosomatice (intrucat Intreaga \up0 \expndtw0\charscalex113 medicina
este. mai mult sau mai pujin psihosomatica), pentru practica medi� \up0
\expndtw0\charscalex118 cala prezinta o imensa important faptul ca circa o treime
din tulburarile cu \up0 \expndtw0\charscalex124 care se prezinta pacientii la
consultatii au exclusiv o cauza psihologica \up0 \expndtw0\charscalex116 Iar intr-o
serie de boli \up0 \expndtw0\charscalex115 (psihosomatice). ca de exemplu infarctul
miocardic, \par\pard\ql \li1444\sb2\sl-226\slmult0 \up0 \expndtw0\charscalex115
lactorul psihic a tost statuat ca veritabil factor de rise (vezi tabelul 2).
230\slmult0\par\pard\li1209\sb54\sl-230\slmult0\fi0\tx1507\tx4257 \up0
\expndtw0\charscalex104 \ul0\nosupersub\cf9\f10\fs20 ?\tab \up0
\expndtw0\charscalex104 \u8226?:\u8226?\tab \up0 \expndtw0\charscalex104 Elemente
de psihosomatica generala si aplicata\par\pard\li1416\sb0\sl-
230\slmult0\par\pard\li1416\sb207\sl-230\slmult0\fi657 \up0 \expndtw0\charscalex114
Tabelul 2. Premise ale apiicarii conceptlet psihosomatice
in\par\pard\li1416\sb15\sl-230\slmult0\fi2558 \up0 \expndtw0\charscalex114 practice
medicala\par\pard\li1416\sb0\sl-230\slmult0\par\pard\li1416\sb30\sl-
230\slmult0\fi163\tx1862\tx4972 \up0 \expndtw0\charscalex114 1.\tab \up0
\expndtw0\charscalex114 Simptomele acuzate de cca.\tab \up0 \expndtw0\charscalex114
3. Factorul psihic\par\pard\li1416\sb72\sl-230\slmult0\fi9\tx5332 \up0
\expndtw0\charscalex114 30% bolnavi = expresia unui stres\tab \up0
\expndtw0\charscalex114 \u8226? agraveazd evolufia bolilor\par\pard\li1416\sb39\sl-
230\slmult0\fi0\tx5342 \up0 \expndtw0\charscalex114 psihic\tab \up0
\expndtw0\charscalex114 \u9632? factor de rezistenfd la
tratament\par\pard\li1416\sb48\sl-230\slmult0\fi3921 \up0
\expndtw0\charscalex114 \u9632? factor de rise in apart(ia unor
bo\par\pard\sect\sectd\sbknone\cols2\colno1\colw4812\colsr160\colno2\colw4068\colsr
160\qj \li1795\ri2267\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex111 - crontc
\line \up0 \expndtw0\charscalex101 \u9632? acut\par\pard\ql \li1536\sb130\sl-
230\slmult0 \up0 \expndtw0\charscalex117 2. Boata insasi = sursa de
stres\par\pard\column \ql \li491\sb49\sl-230\slmult0 \up0 \expndtw0\charscalex100
li (infarct miocardic. HTA. etc.).\par\pard\qj \li20\ri702\sb14\sl-278\slmult0 \up0
\expndtw0\charscalex119 4. Psihoterapia potenfeazd efectul \up0
\expndtw0\charscalex111 terapeutic al medicafiei. \par\pard\sect\sectd\sbknone
\ql \li1540\sb0\sl-230\slmult0 \par\pard\ql\li1540\sb156\sl-230\slmult0 \up0
\expndtw0\charscalex132 1. Conceptul de abordare psihosomaticd \par\pard\qj
\li1214\ri565\sb126\sl-236\slmult0\fi292 \up0 \expndtw0\charscalex116 Abordarea
psihosomatica a oricarui bolnav tinde sa devina o modahtate \up0
\expndtw0\charscalex117 curenta in conducerea demersurilor diagnostice $i
terapeutice din perspec\up0 \expndtw0\charscalex116 tiva holistica (integrativa) a
actului medical. Acest mod de evaluare a situa\up0 \expndtw0\charscalex123 tici
concrete a bolnavului, inserata intr-un context biologic si psiho-so-\line \up0
\expndtw0\charscalex120 cial, are in vedere atat datele de patologie propriu-zisa,
cat ?i pe cele pri\up0 \expndtw0\charscalex115 vind comportamentul, dar $i trairile
neexteriorizate ale omului suferind (pa\up0 \expndtw0\charscalex118 cientul \up0
\expndtw0\charscalex121 = bolnavul real sau inchipuit) \par\pard\qj
\li1219\ri554\sb1\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex117 Afirmam ca, in
prezent, exista deja aceasta tendinta pozitiva. referindu\up0
\expndtw0\charscalex116 ne. in primul rand, la medicu unor tari dezvoltate, in care
grija pentru fiinta \up0 \expndtw0\charscalex118 umana extinde investigatiile
diagnostice - suplimentate cu investigatn psi \up0 \expndtw0\charscalex121 hologice
- pana in domeniul aprecierii indicilor de calitate a vietii modi \up0
\expndtw0\charscalex118 ficati de discontortul psihic $i somatic caracteristic
bolii. nu rareori acesta \up0 \expndtw0\charscalex117 fiind indus de catre inse$i
mijloacele terapeutice. O preocupare in devenire \up0 \expndtw0\charscalex124 este
s> aceea consacrata evaluarii factorilor psiho-sociali si socio-eco� \up0
\expndtw0\charscalex124 nomic! ai comphantei terapeutice. \par\pard\qj
\li1214\ri559\sb0\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex114 Aceasta
"tendinta" a fost prezenta, de la Hipocrat $i pana in zilele noastre \up0
\expndtw0\charscalex111 (vezi tabelul \up0 \expndtw0\charscalex118 3 - istoricul
Psihosomaticii), la toti acei clinicieni cu trasatun \up0 \expndtw0\charscalex120
relationale, naturale sau cultivate prin lecturi cu continut psihologie, aju\up0
\expndtw0\charscalex115 tandui pe medicii respectivi sa triumfe intr-un mod mai
convingator (dar $1 \up0 \expndtw0\charscalex115 mai rapid) asupra bolii.
\par\pard\ql \li3259\sb209\sl-230\slmult0 \up0 \expndtw0\charscalex120 Tabelul 3.
Istoricul Psihosomaticii' \par\pard\ql \li1497\sb0\sl-230\slmult0
\par\pard\ql\li1497\sb80\sl-230\slmult0 \up0 \expndtw0\charscalex109 Unitatea
psyche-soma- subliniatd incd din Antichitate (Hipocrat) \par\pard\qj
\li1483\ri740\sb2\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex113 Filozofii dm sec.
XVII - Descartes. Spinoza, Leibniz \u9632? re/alia mintecorp \up0
\expndtw0\charscalex113 (dualism) \par\pard\li1483\sb9\sl-
230\slmult0\fi0\tx4348\tx5092\tx5755\tx5961 \up0 \expndtw0\charscalex116 Johann
Christian Heinroth\tab \up0 \expndtw0\charscalex116 (1773,\tab \up0
\expndtw0\charscalex116 1843)\tab \up0 \expndtw0\charscalex116 -\tab \up0
\expndtw0\charscalex116 inventatorul termenului\par\pard\ql \li1511\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex110 "psihosomatic'' \par\pard\qj
\li1440\ri736\sb2\sl-240\slmult0\fi86 \up0 \expndtw0\charscalex120 1885 Freud
\u9632? Instanfele personatitdfii. nivele de constientizare ale \up0
\expndtw0\charscalex113 proceselor psihtce. etapele dezvoltdrit mstmctuale.
transfer, psihanaliza \up0 \expndtw0\charscalex114 1899 Pavlov - Influenfa emo(iei
asupra proceselor tiziologice. reflexele \up0 \expndtw0\charscalex114
condi(ionate \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg14}
{\bkmkend Pg14}\par\pard\li1084\sb0\sl-230\slmult0\par\pard\li1084\sb121\sl-
Psihosomatica generala\tab \up0 \expndtw0\charscalex117 \u9830? 3\par\pard\qj
\li1401\sb0\sl-240\slmult0 \par\pard\qj\li1401\ri4048\sb120\sl-240\slmult0 \up0
\expndtw0\charscalex108 1912 Adler - Locus minoris resistentiae \up0
\expndtw0\charscalex105 1922 Deutsch \u9632? Nevroze de organ \par\pard\qj
\li1406\ri1009\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex109 1943 FI. Dunbar
\u9632? Profiluri de personalitate specilice pentru liecare BPS \up0
\expndtw0\charscalex109 1946 Selye - Sindromul general de adaptare (SGA)
\par\pard\ql \li1406\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex106 1950 Alexander
- Specificitatea conf/ictului \par\pard\ql \li1401\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex106 1957 Hinkle. Wolff - Factori de mediu = rot determinant
\par\pard\qj \li1406\ri2172\sb0\sl-260\slmult0 \up0 \expndtw0\charscalex106 1963
von Uexkull - Diferenfierea tulburdrilor de conversiune \up0
\expndtw0\charscalex107 1963 Marty, de M'Uzan - Gandire operatorie \par\pard\ql
\li1406\sb1\sl-218\slmult0 \up0 \expndtw0\charscalex109 1966 Schafer -
Sociopsihosomatica \par\pard\ql \li1401\sb13\sl-230\slmult0 \up0
\expndtw0\charscalex104 1973 Sifneos. Nemiah - Alexitimia \par\pard\ql
\li1396\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex107 1974 Bateson \u9632?
Teoria generald a sistemelor \par\pard\li1368\sb21\sl-230\slmult0\fi28\tx1948
\up0 \expndtw-8\charscalex100 1981.\tab \up0 \expndtw0\charscalex109 1985 Locke.
Besedovsky - Implicarea SP in functionarea
sistemului\par\pard\li1368\sb19\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex109
imunitar (psihoneuroimunologie).\par\pard\ql \li1363\sb30\sl-230\slmult0 \up0
\expndtw-1\charscalex100 ' reprodus dupd Dr. Liliana Diaconescu \par\pard\ql
\expndtw0\charscalex114 in ultimele 2 decenii, procesul de instruire a for\up0
\expndtw0\charscalex113 t,ei medicate din tarile oc \par\pard\qj
\li1094\ri691\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex119 cidentale include o
serioasa educate psihologica, concretizata prin "aloca\up0 \expndtw0\charscalex115
rea", in Elvetia de ex., a 6 semestre pentru studierea psihologiei medicate �i \up0
\expndtw0\charscalex115 psihosomaticii. \par\pard\qj \li1108\ri676\sb20\sl-
240\slmult0\fi278 \up0 \expndtw0\charscalex112 intrucat vom acorda un alt capitol,
mai amplu, conceptelor de baza ale psi� \up0 \expndtw0\charscalex118 hosomaticii,
vom incerca in acest capitol introductiv sa prezentam succint \up0
\expndtw0\charscalex116 sub forma de tabele. perspectivele $i obiectivele aeestei
conceptii \up0 \expndtw0\charscalex109 (inclusiv \par\pard\qj \li1094\ri684\sb0\sl-
240\slmult0\fi9 \up0 \expndtw0\charscalex116 problemele pe care ea Ie ridica)
(tabelele 4 si 5). (Toate aceste tabele cu ex-\line \up0 \expndtw0\charscalex116
ceptia tabelului 5, sunt reproduse din Psihoiogia Medicala, I.B.lamandescu,
\par\pard\li1108\sb26\sl-230\slmult0\fi0\tx2702\tx3897\tx4516 \up0
\expndtw0\charscalex112 Ed. Infomedica,\tab \up0 \expndtw0\charscalex105 1996.
p.107,\tab \up0 \expndtw0\charscalex103 108 si\tab \up0 \expndtw0\charscalex116
122).\par\pard\li1108\sb0\sl-230\slmult0\par\pard\li1108\sb39\sl-
230\slmult0\fi864 \up0 \expndtw0\charscalex116 "abetu14. Conceptia psihosomatica -
perspective actuate, cu\par\pard\li1108\sb15\sl-230\slmult0\fi2102 \up0
\expndtw0\charscalex116 implicatil in gandirea
medicald\par\pard\sect\sectd\sbknone\cols2\colno1\colw4687\colsr160\colno2\colw4193
\colsr160\qj \li1310\ri9\sb243\sl-262\slmult0\fi86 \up0 \expndtw0\charscalex114 1.
Remodelarea comportamentelor \up0 \expndtw0\charscalex114 nocive pentru sdnatate.
generatoare \up0 \expndtw0\charscalex109 de boli psihosomatice (fumat.
seden-\line \up0 \expndtw0\charscalex108 tarism, afimentafie etc.)\par\pard\qj
\li1320\ri16\sb70\sl-256\slmult0\fi43 \up0 \expndtw0\charscalex112 2. Stabilirea
precisd a ponderii par-\line \up0 \expndtw0\charscalex118 ticipdrii SP in geneza si
agravarea \up0 \expndtw0\charscalex101 imbolndvirilor.\par\pard\qj
\li1315\ri14\sb59\sl-264\slmult0\fi48 \up0 \expndtw0\charscalex116 3. Studierea
detaliatd a corelatelor \up0 \expndtw0\charscalex106 fiziologice ale
emofiilor.\par\pard\column \qj \li30\ri827\sb218\sl-292\slmult0\fi57 \up0
\expndtw0\charscalex117 4. Descifrarea mecanismelor con-\line \up0
\expndtw0\charscalex110 vertirii tulburdrilor psihice in proce-\line \up0
\expndtw0\charscalex112 se patologice.\par\pard\qj \li40\ri812\sb50\sl-
297\slmult0\fi52 \up0 \expndtw0\charscalex115 5. Elaborarea de conduite
antistres \up0 \expndtw0\charscalex109 individuate si colective.\par\pard\qj
\li20\ri828\sb58\sl-287\slmult0\fi76 \up0 \expndtw0\charscalex115 6. Reumanizarea
R.I.P. \up0 \expndtw0\charscalex111 \u9632? medic -\line \up0
\expndtw0\charscalex111 pacient. \par\pard\sect\sectd\sbknone \qj \li1099\sb0\sl-
245\slmult0 \par\pard\qj\li1099\ri660\sb70\sl-245\slmult0\fi283 \up0
\expndtw0\charscalex122 in ceea ce priveste obiectivele abordarii psihosomatice,
ele trebuie sa \up0 \expndtw0\charscalex119 fie acceptate de catre oricare medic,
intrucat bolnavul prezentat la consul-\line \up0 \expndtw0\charscalex118 tatie nu
este un simplu obiect ce necesita reparatii. El reac(ioneaza In mod \up0
\expndtw0\charscalex114 inevitabil, si m plan psihologie (dupa Piaget, in planul
intelectual, eel afectiv \up0 \expndtw0\charscalex114 Si eel moral) in cadrul
relatiei sale cu medicul, dar si acesta din urma nu
230\slmult0\fi0\tx1555\tx4310 \up0 \expndtw0\charscalex107
\ul0\nosupersub\cf9\f10\fs20 4\tab \up0 \expndtw0\charscalex107 \u9830?\tab \up0
\expndtw0\charscalex107 Elemente de psihosomaticd generala si
aplicata\par\pard\qj \li1271\sb0\sl-256\slmult0 \par\pard\qj\li1271\sb0\sl-
\expndtw0\charscalex118 poate si nu trebuie sa ramana indiferent, ca participant la
o relate duala in\up0 \expndtw0\charscalex117 carcata masiv cu elemente
psihologice. Avand in vedere natura dubla a re� \up0 \expndtw0\charscalex114 label
(\u8222?medicala si psihologica") dintre medic ?i pacient dar $1 Influenta
bl\up0 \expndtw0\charscalex115 univoca dintre psyche s* soma, abordarea
psihosomatica a bolnavului devi\up0 \expndtw0\charscalex119 ne nu numai inerenta ci
necesita, in plus, o structurare a unor obiective pe \up0 \expndtw0\charscalex119
care le-am infatisat in tabelul 5 (modificat dupa lamandescu 1998). \par\pard\ql
\expndtw0\charscalex116 Tabelul 5. Obiectivele abordarii psihosomatice \par\pard\ql
\expndtw0\charscalex117 1. Stabilirea ponderii factorutui psihic \par\pard\ql
\li1891\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex109 \u9632? in aparifia BPS
(factor de rise asociat) \par\pard\ql \li1891\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex107 - in ritmarea evolufiet BPS (trigger \u9632? declansant)
\par\pard\qj \li1891\ri683\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex112 \u9632?
ierarhizarea participdrii sale etiologice in contextul plurifactorial al \up0
\expndtw0\charscalex112 BPS \par\pard\ql \li1540\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex118 2. Impactul BPS asupra psihicului bolnavului
\par\pard\ql \li1886\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex111 - recutul
somatopsihic general de disconfortul simptomelor; \par\pard\ql \li1886\sb30\sl-
230\slmult0 \up0 \expndtw0\charscalex111 - afectarea indicilor de calitale a viefii
si a inser/iei socio-profestonale \par\pard\ql \li1881\sb1\sl-217\slmult0 \up0
\expndtw0\charscalex111 - asteptarea anxioasa a recidtvelor bolii \par\pard\ql
\li1545\sb13\sl-230\slmult0 \up0 \expndtw0\charscalex115 3. Persona Iitatea
bolnavului \par\pard\qj \li1891\ri697\sb39\sl-220\slmult0 \up0
\expndtw0\charscalex110 - premorbidd (..primara")�- (factor genetic + factori de
rise biografici) \up0 \expndtw0\charscalex110 \u9632? secundara bolii
\par\pard\li1483\sb35\sl-230\slmult0\fi62\tx1886 \up0 \expndtw0\charscalex128
4.\tab \up0 \expndtw0\charscalex128 Tulburari neuro-psihice induse de BPS (sau
coexistente ori\par\pard\li1483\sb10\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex128 precedand BPS)\par\pard\ql \li1550\sb1\sl-214\slmult0
\up0 \expndtw0\charscalex119 5 Psihoterapla BPS - obiective \par\pard\ql
\li1886\sb33\sl-230\slmult0 \up0 \expndtw0\charscalex111 \u9632? strategia de
preventre sau atenuare a stresului psihic (SP) \par\pard\ql \li1891\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex111 - moda/itdti de antrenament pentru
confruntare cu SP \par\pard\ql \li1881\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex110 - influenfarea efectiva a simptomelor BPS \par\pard\ql
\li1886\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex110 - prioritatea pentru
formule de relaxare si participare in grup \par\pard\ql \li1545\sb10\sl-230\slmult0
\up0 \expndtw0\charscalex118 6. Asigurarea unei bune compllanfe terapeutice
\par\pard\qj \li1881\ri2152\sb2\sl-240\slmult0\tx2241 \up0 \expndtw0\charscalex112
- parteneriatul pentru sdnatate dintre medic si pacient \line\tab \up0
\expndtw0\charscalex108 \u9632? asigurarea monitorizdrii tratamentului \par\pard\ql
\li2241\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex108 \u9632? combaterea
factoritor psihici perturbanti \par\pard\qj \li1497\ri698\sb2\sl-
240\slmult0\fi388 \up0 \expndtw0\charscalex111 \u9632? implicarea familiei �
personalului medico-sanitar auxiliar in echipa \up0 \expndtw0\charscalex112
terapeuticd (Luban Plozza) \par\pard\qj \li1492\ri699\sb0\sl-240\slmult0\fi67
\up0 \expndtw0\charscalex122 7 Programe educafionate si initiative organizatorice
pentru diverse \up0 \expndtw0\charscalex123 categoril de pacienfl (diabetlci.
cardiaci, reumatici etc.) \par\pard\ql \li1574\sb0\sl-230\slmult0
\par\pard\ql\li1574\sb179\sl-230\slmult0 \up0 \expndtw0\charscalex134 2. Argumente
privind editarea lucrdrii \par\pard\qj \li1286\ri511\sb177\sl-246\slmult0\fi288
\up0 \expndtw0\charscalex116 O data cu "expedierea" problemelor generale ale
psihosomaticii in tabe-\line \up0 \expndtw0\charscalex117 lele de mai sus, precum
si cu asigurarea unei reveniri asupra lor in urmato-\line \up0
\expndtw0\charscalex118 rul capitol al aeestei carti, vom insista in aceasta
introducere asupra Inten-\line \up0 \expndtw0\charscalex118 tillorlucrarii de fata.
Ea aditioneaza o serie de probleme ale psihosomaticii,
\ul0\nosupersub\cf3\f4\fs18 Psihosomaticd generala\tab \up0
\expndtw0\charscalex57 \u8226?:\u8226?\tab \up0 \expndtw0\charscalex118
5\par\pard\qj \li1401\sb0\sl-235\slmult0 \par\pard\qj\li1401\sb0\sl-235\slmult0
\ul0\nosupersub\cf9\f10\fs20 vazute de catre editor, ca �i de catre distinsil sai
colaboratori, dintr o pers� \up0 \expndtw0\charscalex116 pective, personala (ce
guverneaza si aplicarea conceptelor respective in do\up0 \expndtw0\charscalex118
meniile de activitate ale autorilor). $i totusi, cartea nu este o simpla
juxta\up0 \expndtw0\charscalex118
punere a unor tratari (in mare majoritate de catre editor) a unor importante
\up0 \expndtw0\charscalex118 aspecte generale si particulare ale psihosomaticii.
\par\pard\qj \li1396\ri372\sb0\sl-238\slmult0\fi302 \up0 \expndtw0\charscalex122 In
intentia princeps a asamblarii acestor "elemente de psihosomaticd \up0
\expndtw0\charscalex118 generala si aplicatS" a stat o mai veche viziune asupra
acestui domeniu pe \up0 \expndtw0\charscalex120 care editorul �i-a format-o in anii
'70, o data cu elaborarea primei teze de \up0 \expndtw0\charscalex115 doctorat din
tara noastra in domeniul psihosomaticii ("Corelatil psihosoma� \up0
\expndtw0\charscalex118 tice Tn astmul bron�ic") sub conducerea $i cu sprijinul
autoritatii Prof.Dr. \up0 \expndtw0\charscalex117 Radu Paun. Elaborarea aeestei
teze a beneficiat ?i de o "deschidere Ideolo\up0 \expndtw0\charscalex113 gica" (o
veritabila bre$a) realizata de Prof. Dr. V. Predescu (un articol defini\up0
\expndtw0\charscalex112 toriu pentru obiectivele psihosomaticii, in revista
"Medicinistul" din 1971), ca \up0 \expndtw0\charscalex117 Si de aportul
informational cu tenta exhaustive, adus de prima monografie, \up0
\expndtw0\charscalex118 "Psihosomatica" (1973). realizata de Prof. Dr. G. lonescu,
eel care avea sa \up0 \expndtw0\charscalex115 adauge ulterior cateva noi si ample
capitole consacrate psihosomaticii intr-o \up0 \expndtw0\charscalex115 lucrare mai
recenta a domniei sale, "Psihoterapia" (1990). \par\pard\qj \li1401\ri382\sb0\sl-
230\slmult0\fi297 \up0 \expndtw0\charscalex120 Nu trebuie uitate contributiile
deosebite, desi mai mult "subterane", la \up0 \expndtw0\charscalex116 dezvoltarea
unei conceptii psihosomatice inca din anii'70 datorate celor doi \up0
\expndtw0\charscalex113 marl disparu(i in anul \up0 \expndtw0\charscalex111 1997,
academicienii $t.M.Milcu si Victor Sahleanu. \par\pard\ql \li1694\sb22\sl-
230\slmult0\tx8472 \up0 \expndtw0\charscalex122 Revenind la acea viziune propusa de
editor asupra Psihosomaticii \tab \up0 \expndtw-5\charscalex100 �i \par\pard\qj
\li1396\ri382\sb0\sl-236\slmult0 \up0 \expndtw0\charscalex118 construita prin
asimilarea unor date din literatura, in special de scoala ger-\line \up0
\expndtw0\charscalex125 mana, ea s-ar putea defini prin considerarea psihosomaticii
ca fiind un \up0 \expndtw0\charscalex122 domeniu interdisciplinar - axat pe relatia
dintre medicina si psihologie -\line \up0 \expndtw0\charscalex126 ce acorda o
importanta speciala, prin definite, rolului tactorului psihic \up0
\expndtw0\charscalex122 in aparitia dar si in vindecarea (sau ameliorarea
evolu(iei) bolilor. Acest \up0 \expndtw0\charscalex118 domeniu are la baza o
conceptie generala, aceea a abordarii psihosomatice \up0 \expndtw0\charscalex113 a
tuturor bolnavilor - indiferent de agentul etiologic principal \up0 \expndtw-
2\charscalex100 -\up0 \expndtw0\charscalex116 �i, in acelasi \par\pard\qj
\li1396\ri378\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex120 timp, poseda un camp
de aplicatii intr-o serie de domenii ale medicinii In \up0 \expndtw0\charscalex123
cadrul carora unele boh \up0 \expndtw0\charscalex121 (cele denumite psihosomatice)
sunt influen'ate \par\pard\ql \li1396\sb1\sl-224\slmult0 \up0
\expndtw0\charscalex113 constant �i precumpamtor de catre factorul psihic
(lamandescu 1993). \par\pard\qj \li1396\ri372\sb9\sl-233\slmult0\fi288 \up0
\expndtw0\charscalex123 Cartea de fata intentioneaza sa acorde o prioritate tocmai
aeestei din \up0 \expndtw0\charscalex121 urma laturi a psihosomaticii pentru care
consideram potrivit termenul de \up0 \expndtw0\charscalex125 Psihosomatica
Aplicata, pornind de la ideea ca deja in numeroase tari \up0
\expndtw0\charscalex117 occidentale (in Elvejia. de ex., cum se va vedea mai
departe). exista ramuri \up0 \expndtw0\charscalex132 ale psihosomaticii in cadrul
principalelor specialitati ale medicinii \up0 \expndtw0\charscalex127
(psihosomatica reumatologica, ginecologica, etc.). Aceasta intentie a \up0
\expndtw0\charscalex116 cdrfii se bazeaza s> pe realitatea unor incercari ale
subsemnatului \up0 \expndtw0\charscalex109 - in aler-\par\pard\qj
\li1391\ri367\sb7\sl-233\slmult0 \up0 \expndtw0\charscalex117 gologie - ca si ale
unor valorosi colegi. medici sau psihologi, de a aplica in \up0
\expndtw0\charscalex116 mod constant si, la nlvel de competenta calificata, - in
domeniile lor de ac� \up0 \expndtw0\charscalex112 tivitate \up0
\expndtw0\charscalex118 - pnncipiile ca S' metodele diagnostice $\u8226? nial ales
terapeutice, ale \up0 \expndtw0\charscalex119 psihosomaticii. \par\pard\qj
\li1391\ri368\sb6\sl-235\slmult0\fi302 \up0 \expndtw0\charscalex122 De asemenea, au
contribuit la aparitia lucrarii $i o serie de medici de \up0
\expndtw0\charscalex115 diverse specialitati, o mare parte dintre dansii fiind
cadre didactice ale UMF \up0 \expndtw0\charscalex118 "'Carol Davila" Bucure$ti.
care promoveaza In activitatea lor profesionala \up0 \expndtw0\charscalex116
conceptia psihosomatica. recunoscand ?i tratand in mod adecvat interventia \up0
\expndtw0\charscalex116 factorului psihic in dinamica bolilor din cadrul
specialitatilor respective.
\ul0\nosupersub\cf18\f19\fs20\ul 6\ul0\tab \up0 \expndtw0\charscalex107
\ul0\nosupersub\cf18\f19\fs20\ul \u9830?\ul0\tab \up0 \expndtw0\charscalex107
\ul0\nosupersub\cf9\f10\fs20 Elemente de psihosomatica generala si
\expndtw0\charscalex117 intrucat nu avem inca in (ara noastra o desfasurare
uniforma de forte ale \up0 \expndtw0\charscalex114 psihosomaticii in cadrul tuturor
specialita\{ilor clinice medicale sau chirurgi-\line \up0 \expndtw0\charscalex122
cale (nici pe plan mondial nu exista inca asa ceval), am considerat utila, \up0
\expndtw0\charscalex117 pentru medicii s' studentii in medicina �i psihologie,
interesati de psihoso� \up0 \expndtw0\charscalex118 matica, atingerea \up0
\expndtw0\charscalex121 \u8226? de catre cartea de fata - a unor obiective -
definitorii \par\pard\ql \li1185\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115
pentru acest domeniu - ce vor fi prezentate mai jos. \par\pard\qj
\li1175\ri603\sb6\sl-235\slmult0\fi302 \up0 \expndtw0\charscalex118 Lucrarea nostra
nu este un tratat, nici macar un manual. Ea reuneste, in \up0
\expndtw0\charscalex119 primul rand.o serie de capitole -unele bazate pe lucrari
publicate anterior, \up0 \expndtw0\charscalex122 altele concepute ad hoc - care
ilustreaza o directie generala. de abordare \up0 \expndtw0\charscalex124
psihosomatica a bolnavilor \u8226? cu implicatii diagnostice s\\ terapeutice Ea
\up0 \expndtw0\charscalex123 prezinta o serie de domenii \up0
\expndtw0\charscalex121 (psihosomatica speciala, "aplicata") in care
abordarea psihosomatica a unor boll cuprinse in specialitatile medicale \up0
\expndtw0\charscalex117 respective este completata de mtervenjia psihoterapeutica a
unor psihologi \up0 \expndtw0\charscalex121 avizati in procedurile respective si
activand in planul asistentei medicale \up0 \expndtw0\charscalex115 alaturi de
medicii specialist! (oncologi, reumatologi, nutritionist etc.). Desi-\line \up0
\expndtw0\charscalex116 gur, asa cum si titlul. "Elemente de Psihosomatica
aplicata" o arata, nu sunt \up0 \expndtw0\charscalex117 prezentate toate domeniile
in care psihosomatica zilelor noastre "$i-a creat \up0 \expndtw0\charscalex114
ambasade". Editorul a avut in vedere s< alte proiecte personate, ca de
exem-\line \up0 \expndtw0\charscalex120 plu faptul ca psihosomatica ginecologica va
fi tratata cu ocazia reeditarii \up0 \expndtw0\charscalex115 lucrSrii
"Psihosomatica feminina" \up0 \expndtw0\charscalex112 (de Valeanu \up0
\expndtw0\charscalex119 ?i Daniel), psihosomatica \par\pard\qj
\li1171\ri608\sb7\sl-233\slmult0\fi4 \up0 \expndtw0\charscalex112 digestiva s<
imunologica vor fi tratate in volumul II al unei lucrari incepute in \up0
\expndtw0\charscalex115 1993 "Stresui psihic $i bolile interne" s.a.m.d.. dar mai
ales faptul ca - dupa \up0 \expndtw0\charscalex114 aparitia prezentei lucrari - va
incerca, intr-un viitor apropiat, elaborarea unui \up0 \expndtw0\charscalex114
tratat de Psihosomatica. \par\pard\qj \li1171\ri612\sb5\sl-236\slmult0\fi307
\up0 \expndtw0\charscalex119 Importanta apare concep(ia de baza a car(ii potrivit
careia - dupa reali\up0 \expndtw0\charscalex128 zarea elementelor de baza ale
abordaril psihosomatice a bolnavilor -\line \up0 \expndtw0\charscalex126 este
necesara o punere in practica (psihosomatica) a aeestei conceptii \up0
\expndtw0\charscalex125 Tn diversele sectoare ale asistentei medicale. in acest
caz, va trebui sa \up0 \expndtw0\charscalex116 existe posibilitatea pentru medic de
a apela la competenta psihologului care \up0 \expndtw0\charscalex115 este de dorit
sa fie prezent in cadrul echipei medicale, fie in ambulator, fie -\line \up0
\expndtw0\charscalex115 mai ales - in unita(ile spitalicesti. \par\pard\ql
\li1463\sb210\sl-253\slmult0 \up0 \expndtw0\charscalex117
\ul0\nosupersub\cf8\f9\fs22 3. Obiectivele lucrdrii \par\pard\qj
\li1171\ri607\sb162\sl-236\slmult0\fi302 \up0 \expndtw0\charscalex114
\ul0\nosupersub\cf9\f10\fs20 in zilele noastre patologia psihosomatica afecteaza
80% din bolnavii care \up0 \expndtw0\charscalex119 solicits consult medical iar o
serie de boli ce contribuie prioritar la morta\up0 \expndtw0\charscalex126 lltate.
in frunte cu infarctul miocardic, recunosc in diversele etape ale \up0
\expndtw0\charscalex119 evolufiei lor o importanta participare a factorului psihic.
Aceasta optica a \up0 \expndtw0\charscalex126 unei abordari psihosomatice generale.
realizata intr-un cadru specific \up0 \expndtw0\charscalex129 de patologie se
constituie intr-un obiectiv major al lucrarii, ale carei \up0
\expndtw0\charscalex114 componente sunt urmatoarele: \par\pard\qj
\li1171\ri607\sb7\sl-233\slmult0\fi307 \up0 \expndtw0\charscalex123 1. Conturarea
campului de definire al psihosomaticii, ca si reformu\up0 \expndtw0\charscalex120
larea unor concepte de baza (tulburari si boli psihosomatice, personalita\up0
\expndtw0\charscalex118 tea bolnavului psihosomatic. etc.), in acord cu datele de
observa(ie clinica \up0 \expndtw0\charscalex118 dar $i cu mutatiile survenite in
psihosomatica contemporana. \par\pard\qj \li1180\ri618\sb2\sl-240\slmult0\fi278
\up0 \expndtw0\charscalex112 Acest capitol (nr.3) poarta amprenta unor opinii
personale s< asteptam de-\line \up0 \expndtw0\charscalex112 ja reactia unor
psihosomaticieni strain! care au primit versiunea in engleza
Psihosomatica generala\tab \up0 \expndtw0\charscalex130 \u9830? 7\par\pard\ql
\par\pard\ql\li1132\sb149\sl-230\slmult0\tx3892 \up0 \expndtw0\charscalex118
\ul0\nosupersub\cf9\f10\fs20 a unui studiu (lamandescu, \tab \up0
\expndtw0\charscalex115 1998) ce contesta multe dintre fetisurile vechii
\par\pard\qj \li1132\ri671\sb19\sl-220\slmult0 \up0 \expndtw0\charscalex118
conceptii psihosomatice Pentru a nu fi acuzati de o viziune prea personala \up0
\expndtw0\charscalex114 Si continand posibile afirmalii \up0
\expndtw0\charscalex112 \u8222?discutabile", capitolul \up0 \expndtw0\charscalex116
2 al lucrarii prezinta \par\pard\ql \li1128\sb12\sl-230\slmult0 \up0
\expndtw0\charscalex115 conceptele de baza ale psihosomaticii \u8222?oficiale".
\par\pard\qj \li1123\ri656\sb4\sl-238\slmult0\fi292 \up0 \expndtw0\charscalex117 2.
Accentuarea faptului ca - pe langa conceptia psihosomatica, devenita \up0
\expndtw0\charscalex120 obltgatorie, ca metoda de abordare a oricarui bolnav, data
fiind reactia in \up0 \expndtw0\charscalex118 plan psihologie a acestuia fata de
propria boala - devine tot mai stringenta \up0 \expndtw0\charscalex124 delimitarea
unor zone de "prioritate psihosomatica" in cadrul special' \up0
\expndtw0\charscalex124 tatilor clinice ale medicinii, zone de "psihosomatica
aplicata". Acestea \up0 \expndtw0\charscalex118 vor putea care sa absoarba in
desfa?urarea actului lerapeutic o serie de noi \up0 \expndtw0\charscalex115 forte
aflate de multa vreme pe orbita profesiunii medicale dar - pana in pre\up0
\expndtw0\charscalex109 zent \up0 \expndtw-2\charscalex100 \u8226? \up0
\expndtw0\charscalex117 subsolicitate sau chiar respinse datorita unei viziuni
anacronice, ex\up0 \expndtw0\charscalex116 clusiv medicale. asupra bolilor somatice
sau chiar psihosomatice. Este vor\up0 \expndtw0\charscalex121 ba, in primul rand,
de psihologi, sociologi si cadre pregatite in domeniul \up0 \expndtw0\charscalex121
asistentei sociale. \par\pard\qj \li1128\ri650\sb1\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex116 intrucat Prof. Luban Plozza a creat la Ascona modelul Monte
Verita, eel \up0 \expndtw0\charscalex118 mai complet sistem de abordare
psihosomatica a bolnavilor (in special cei \up0 \expndtw0\charscalex124 cu boli
cronice, generatoare de disconfort psihic si somatic), editorul a \up0
\expndtw0\charscalex116 incercat in ultimii ani sa realizeze. in alergologie. o
strategie asemandtoare, \up0 \expndtw0\charscalex121 incluzand si elemente de
psihoterapie cu Implicatii de tip placebo sau de \up0 \expndtw0\charscalex124
psihoterapie suportiva simpla, vizand cresterea compliantei terapeuti� \up0
\expndtw0\charscalex118 ce. De asemenea, a inceput sa fie utilizata muzicoterapia
ca adjuvant, inca \up0 \expndtw0\charscalex118 insuficient explorat in alergologie,
al medica(iei specifice bolilor respective. \par\pard\qj \li1128\ri645\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex128 Rezultatele mult superioare si Pe
deplin cuantificabile, au obtinut \up0 \expndtw0\charscalex113 "psihologi de
meserie" precum Prof.Dr. lolanda Mitrofan (promotoare in tara \up0
\expndtw0\charscalex119 noastra a "Psihoterapiei Experientiale"), sau Psih. Coralia
Popovici-Paun, \up0 \expndtw0\charscalex121 aceasta din urma psihooncolog pe cale
sa dezvolte o adevarata scoala de \up0 \expndtw0\charscalex119 Psihooncologie
romaneasca. De asemenea in Clinica de boli de Nutritie a \up0
\expndtw0\charscalex120 Institutului N. Paulescu, Prof Dr. C. lonescu-Targoviste,
in colaborare cu \up0 \expndtw0\charscalex122 Psihol. Mariana Costea, investigheaza
constant bolnavii din perspectiva \up0 \expndtw0\charscalex113 unei conceptii
psihosomatice si au realizat lucrari originale cu privire la rolul \up0
\expndtw0\charscalex113 stresului psihic in aparitia si agravarea diabetului
zaharat. \par\pard\qj \li1128\ri641\sb0\sl-248\slmult0\fi283 \up0
\expndtw0\charscalex120 intrucat, pana in ultima clipa. cartea de fata fusese
proiectata ca avand \up0 \expndtw0\charscalex125 un singur autor (editorul), o
evaluare a tuturor for(elor din tara noastra \up0 \expndtw0\charscalex116 angajate
in mod competent si consecvent in campul psihosomaticii aplicate \up0
\expndtw0\charscalex121 nu a constituit un obiectiv al lucrarii. asa incat selectia
care a stat la baza \up0 \expndtw0\charscalex115 invitani distinsilor colaboratori
ai aeestei editii a inclus numai reprezentanti \up0 \expndtw0\charscalex117 ai
Capitalei. iar \up0 \expndtw0\charscalex119 - dintre acestia - pe cei care au
elaborat lucrari, in primul \par\pard\ql \li1132\sb1\sl-206\slmult0\tx8207 \up0
\expndtw0\charscalex116 rand carti, ce Ie reflecta un punct de vedere personal (nu
"carti din carti") \tab \up0 \expndtw-4\charscalex100 $i \par\pard\qj
\li1128\ri646\sb6\sl-240\slmult0 \up0 \expndtw0\charscalex120 o aclivitate angajata
pe taramul psihosomaticii. Fara indoiala ca in centre \up0 \expndtw0\charscalex115
universitare de traditie - precum las'. Timi�oara. Cluj, Craiova si. desigur, ?i
\up0 \expndtw0\charscalex122 in alte parti \up0 \expndtw-2\charscalex100 -\up0
\expndtw0\charscalex121 exista preocupari importante pentru psihosomatica dar ne
\par\pard\qj \li1128\ri661\sb20\sl-240\slmult0 \up0 \expndtw0\charscalex116 temen
ca. in multe cazuri, optica acestor abordari psihosomatice este tribu� \up0
\expndtw0\charscalex115 tary unei mentalitati psihiatrice. indusa de catre
psihosomatica "clasica" oc� \up0 \expndtw0\charscalex119 cidentals si putand fi
concentrata in formula "Psihoiogia \up0 \expndtw0\charscalex118 - ancilla
Psihia-\par\pard\ql \li1132\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex113 triae"
(parafrazand raportul dintre filozofie si teologie).
\expndtw0\charscalex107 Elemente de psihosomatica generala si
\expndtw0\charscalex116 3. Atingand involuntar - in paragraful precedent - raportul
dintre Psihia\up0 \expndtw0\charscalex123 trie si Psihosomatica, apare ca deosebit
de actuala o delimitare a dome \up0 \expndtw0\charscalex115 niilor de competenta
ale difentelor specialitati medicale (inclusiv Psihiatria) \up0
\expndtw0\charscalex120 in cazul unor pacien(i cu tulburari sau, mai ales, boli
psihosomatice. Asa \up0 \expndtw0\charscalex117 cum am opinat si cu alta ocazie,
atunci cand simptomatologia somatica are \up0 \expndtw0\charscalex123 o incadrare
certa intr-o boala de baza psihiatrica si poate fi abordata, in \up0
\expndtw0\charscalex129 primul rand, printr-o medicare psihotropa, este evidenta
implicarea \up0 \expndtw0\charscalex116 responsabilitatii medicale a psihiatrului.
Un-exemplu ce mi se pare evident \up0 \expndtw0\charscalex119 este eel furnizat de
anorexia nervoasa care este una din bolile considerate \up0 \expndtw0\charscalex128
eminamente psihosomatica si care este tratata prin mijloace aproape \up0
\expndtw0\charscalex120 exclusiv psihologice in unele clinici de psihosomatica,
desi adesea exista \up0 \expndtw0\charscalex127 un teren de baza cu tulburari
psihiatrice majore al acestor bolnavi, ce \up0 \expndtw0\charscalex117 beneficiazS
s' de medicare psihotropa. \par\pard\qj \li1281\ri512\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex119 in schimb. o serie de boli psihosomatice, precum ulcerul
duodenal sau \up0 \expndtw0\charscalex118 astmul bronsic. trebuie sa ramana in
grija internistului sau a specialitafilor \up0 \expndtw0\charscalex119
corespunzatoare derivate din medicina interna desi, in marea majoritate a \up0
\expndtw0\charscalex117 cazurilor, consullatia psihologica \up0
\expndtw0\charscalex116 (implicit tratamentul psihologie) nu mai \par\pard\qj
\li1291\ri517\sb19\sl-240\slmult0 \up0 \expndtw0\charscalex128 trebuie ignorate, la
fel ca si apelul la psihiatru in cazurile ce reclama \up0 \expndtw0\charscalex121
aceasta. \par\pard\ql \li1583\sb29\sl-230\slmult0\tx3383 \up0
\expndtw0\charscalex126 Un element util \tab \up0 \expndtw0\charscalex128 (desi nu
infailibil) in diagnosticul unor tulburari \par\pard\qj \li1281\ri510\sb0\sl-
244\slmult0\fi9 \up0 \expndtw0\charscalex115 psihosomatice il constituie accentul
simptomatologiei pe soma. neinfluentat \up0 \expndtw0\charscalex115 de psihoterapie
dar. in schimb. cu raspuns favorabil la medicatia simptoma-\line \up0
\expndtw0\charscalex110 tica \up0 \expndtw0\charscalex118 (aten(ie la efectul
pseudoplacebo), situate in care medicul nepsihiatru \up0 \expndtw0\charscalex120
apare mai indicat sa preia bolnavul respectiv. in schimb, persistenta unor \up0
\expndtw0\charscalex118 simplome somatice, coexistand cu tulburari psihice, in
ciuda administrarii \up0 \expndtw0\charscalex122 unei medicatii simptomatice sau
chiar agravate de catre aceasta \up0 \expndtw0\charscalex113 (de ex.
miofilinul in "nevroza respiratorie"), indica necesitatea consultului \up0
\expndtw0\charscalex117 psihiatne. \par\pard\qj \li1286\ri507\sb0\sl-
245\slmult0\fi297 \up0 \expndtw0\charscalex120 Desigur. tulburarile functionate
"sine materia", eel mai adesea psiho� \up0 \expndtw0\charscalex115 somatice, nu pot
fi. de la primul consult, incredin\{ate unui anume specialist \up0
\expndtw0\charscalex116 (medicul de familie, internist sau psihiatru) si. cu atat
mai putin psihologu\up0 \expndtw0\charscalex125 lui, pana ce nu se exclud cauze
organice. pasibile adesea de o evolu(ie \up0 \expndtw0\charscalex115 severa.
\par\pard\ql \li1574\sb24\sl-230\slmult0 \up0 \expndtw0\charscalex122 Cei mai
firesc ar fi ca sa existe urmatoarea secventa: \par\pard\qj \li1291\ri528\sb2\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex120 - consult efectuat de catre medicul
de familie. urmat de doua variante. \up0 \expndtw0\charscalex120 avand ca rezultat
posibil: \par\pard\qj \li1286\ri514\sb20\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex121 a) Clarificarea diagnostica, urmata de psihoterapie simpla
suportiva t \up0 \expndtw0\charscalex122 apelul la psiholog sau. direct, consult
psihiatric, daca "este cazul"; \par\pard\ql \li1583\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex118 b) Solicitarea de investiga(ii. inclusiv consulturi de
specialitate, urmate \par\pard\ql \li1300\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex118 - si ele - de aceeasi strategie i apel la psiholog sau la
psihiatru. \par\pard\qj \li1296\ri502\sb18\sl-245\slmult0\fi287 \up0
\expndtw0\charscalex116 Nu este decat in favoarea bolnavului o delimitare a sferei
de competenta \up0 \expndtw0\charscalex118 a diverselor specialitati care sa-l
"preia in sarcina" sub cele mai bune aus-\line \up0 \expndtw0\charscalex119 picii
terapeutice. Din pacate. in timp ce psihiatrul are clar definite obiec� \up0
\expndtw0\charscalex116 tivele sale - bolnavul cu acuze psihice dominante �
tulburari psihosomatice \up0 \expndtw0\charscalex116 (secundare traumei psihice
cauzale ori unor modifican psihice "idiopatice"
\li1180\sb0\sl-240\slmult0 \par\pard\qj\li1180\sb0\sl-240\slmult0
\par\pard\qj\li1180\ri618\sb122\sl-240\slmult0 \up0 \expndtw0\charscalex117 sau din
cauze greu detectabile, ca in psihozele endogene) - medicul genra-\line \up0
\expndtw0\charscalex122 list sau internist ori de alte specialitati \up0
\expndtw0\charscalex117 (endocrinolog sau nutritionist, de \par\pard\qj
\li1175\ri623\sb16\sl-246\slmult0 \up0 \expndtw0\charscalex114 ex.), pus in fata
unui bolnav cu tulburari functionate ce par legate de un stres \up0
\expndtw0\charscalex117 psihic anterior sau cronic persistent, are inca o serie de
dificultdti in relafia \up0 \expndtw0\charscalex119 sa terapeutica, cele de ordin
diagnostic fiind. adesea. depasite. Asa de ex. \up0 \expndtw0\charscalex121 un
hipertensiv care, intr-un context existential stresant \up0 \expndtw0\charscalex119
(concedierea. de \par\pard\qj \li1175\ri613\sb9\sl-253\slmult0 \up0
\expndtw0\charscalex119 ex.), prezentand valori tensionale crescute pe o durata
prelungita, nu pune \up0 \expndtw0\charscalex115 probleme diagnostice (referitor la
trigger-ul psihogen), ci terapeutice, deoa\up0 \expndtw0\charscalex115 rece medicul
"somatician" nu are disponibilitati psihoterapeutice "speciale", \up0
\expndtw0\charscalex115 iar psihiatrul este complexat de doua circumstante:
\par\pard\qj \li1175\ri623\sb0\sl-260\slmult0\fi297 \up0 \expndtw0\charscalex118 -
nemultumirea, mergand pana la revolta, a bolnavului pentru ca a fost \up0
\expndtw0\charscalex116 trimis la psihiatru \up0 \expndtw0\charscalex115 ("Ce,
domnule doctor, ma considerati dezechilibrat min-\par\pard\ql \li1175\sb0\sl-
214\slmult0 \up0 \expndtw0\charscalex105 tal?"); \par\pard\qj
\li1171\ri622\sb20\sl-246\slmult0\fi302 \up0 \expndtw0\charscalex116 -
dificulta(ile reale. implicate de modificarea schemei terapeutice antihi\up0
\expndtw0\charscalex119 pertensive prin adaugarea unei medicatn psihotrope care,
fie ca nu garan\up0 \expndtw0\charscalex116 teaza scaderea cifrelor tensionale, fie
ca ameninta (in cazul anumitor medi\up0 \expndtw0\charscalex116 camente) sa Ie
creasca, pe calea efectelor secundare. \par\pard\qj \li1171\ri622\sb11\sl-
250\slmult0\fi292 \up0 \expndtw0\charscalex114 Solu(ia este numai una singura intr-
un viitor apropiat (in prezent, chiar I), \up0 \expndtw0\charscalex124 integrarea
psihologului in echipa terapeutica, eel pu(in la niveiele si in \up0
\expndtw0\charscalex118 cazurile cu o patologie generatoare de disconfort psihic si
somatic impor� \up0 \expndtw0\charscalex124 tant, ca si elaborarea unor criterii
care sa permita alegerea momentului \up0 \expndtw0\charscalex124 in care este
solicitat medicul psihiatru. \par\pard\qj \li1171\ri612\sb14\sl-
246\slmult0\fi292 \up0 \expndtw0\charscalex117 De asemenea, subscriem la ideea -
deja pusa in practica in Romania - a \up0 \expndtw0\charscalex116 dotarii marilor
unitati spitalicesti cu un psihiatru "de legatura" care sa poata \up0
\expndtw0\charscalex119 decela s> prelua in sarcina, in mod operativ, pacientii cu
tulburari psihice \up0 \expndtw0\charscalex119 asociate diverselor maladii.
Urmatoarele doua obiective ale cartil reprezinta elemente cu caracter de \up0
\expndtw0\charscalex127 baza teoretica pentru in(elegerea etiopatogeniei
tulburarilor si bolilor \up0 \expndtw0\charscalex115 psihosomatice. \par\pard\ql
\li1463\ri1531\sb123\sl-330\slmult0\tx1766\tx1761 \up0 \expndtw0\charscalex134 4.
Stresui psihic - concept inerent definirii tulburdrilor \line\tab \up0
\expndtw0\charscalex135 psihosomatice ca domeniu de interferentd \line \tab \up0
\expndtw0\charscalex136 intre normal si patologie \par\pard\qj
\li1175\ri609\sb176\sl-251\slmult0\fi292 \up0 \expndtw0\charscalex116 Un element de
maxima importanta in stabilirea volumului dar si calitatii \up0
\expndtw0\charscalex119 solicitarii unui medic de familie intr-un cabinet de
consultatii il constituie \up0 \expndtw0\charscalex122 constatarile cvasiunanime
ale diversilor autori in ceea ce priveste natura \up0 \expndtw0\charscalex112
suferintelor \up0 \expndtw0\charscalex120 (acuzelor subiective sau obiective)
pentru care se prezinta la \up0 \expndtw0\charscalex125 consult pacientii intr-o zi
obisnuita de consultatii. Toate statisticile Tn \up0 \expndtw0\charscalex117
aceasta pnvinta variaza "in jurul valorilor de 30%-40% - pacientii acuzand \up0
\expndtw0\charscalex118 tulburari functional eel mai adesea psihosomatice (ca
expresie a unui stres \up0 \expndtw0\charscalex118 acut sau cronic) \par\pard\qj
\li1185\ri623\sb0\sl-280\slmult0\fi278 \up0 \expndtw0\charscalex115 O astfel de
cifra nu trebuie sa ne faca indiferenti asupra urmatoarelor im\up0
\expndtw0\charscalex108 plicatii:
\ul0\nosupersub\cf9\f10\fs20 10\tab \up0 \expndtw0\charscalex106 \u9830?\tab
\up0 \expndtw0\charscalex106 Elemente de psihosomatica generala si
\expndtw0\charscalex115 - stresui psihic, responsabil - alaturi de conditionarea
reflexa - de aparitia \up0 \expndtw0\charscalex115 tulburarilor psihosomatice
(lamandescu \up0 \expndtw0\charscalex117 1993), necesita - in calitatea sa de
\par\pard\qj \li1080\ri718\sb0\sl-260\slmult0 \up0 \expndtw0\charscalex118 agent
etiologic - atat o evaluare a conditiilor de aparitie (la nivel de colec\up0
\expndtw0\charscalex124 tivitate sau de individ), cat s1 de prevenire ori atenuare
a efectelor sale \up0 \expndtw0\charscalex114 (principii de conduitd antistres);
mterpretarea eronata a contextului etiopatogenic al unor astfel de tulbu� \up0
\expndtw0\charscalex120 rari. poate sa aiba urmatoarele consecinte contrastante:
atribuirea facila a \up0 \expndtw0\charscalex118 unor tulburari. considerate ca
functionate, stresului psihic si caderea intr-o \up0 \expndtw0\charscalex116
capcana a ignorarii unor cauze organice ale tulburarilor respective, cu con�
\up0 \expndtw0\charscalex114 secinte grave privind pierderea unui "tempo"
terapeutic; - ignorarea factoru\up0 \expndtw0\charscalex120 lui psihic (de regula
stresui psihic) si consumul excesiv de asistenta me� \up0 \expndtw0\charscalex119
dicala (in special analize si explorari extrem de costisitoare) creeaza ven\up0
\expndtw0\charscalex118 tabile probleme de ordin economic atat pentru pacient, cat
si pentru unita\up0 \expndtw0\charscalex118 tile sanitare \par\pard\qj
\li1070\ri718\sb0\sl-262\slmult0\fi307 \up0 \expndtw0\charscalex117 Din aceste
motive, apare extrem de necesar ca, inca de la acest nivel in\up0
\expndtw0\charscalex116 troductiv al unei carti consacrate psihosomaticii. sa
adresam un apel tuturor \up0 \expndtw0\charscalex114 forunlor (nu numai celor
medico-sanitare) - implicate in cultivarea si pastra\up0 \expndtw0\charscalex117
rea starii de sanatate - pentru
a se informa opinia publica (inclusiv, inca pe \up0 \expndtw0\charscalex116
parcursul educa(iei scolare, cum sugera Prof Dr Radu Paun) asupra proble\up0
\expndtw0\charscalex115 melor privind conditiile de aparitie ale stresului psihic,
ca si de prevenire on \up0 \expndtw0\charscalex120 atenuare a urmarilor sale
(adesea nefaste pentru sanatate dar si - a$a cum \up0 \expndtw0\charscalex113
afirma Selye - generand "nefericirea"). \par\pard\qj \li1070\ri728\sb0\sl-
260\slmult0\fi307 \up0 \expndtw0\charscalex123 Pentru patologie. stresui psihic
poate fi, in aceeasi masura, $i cauza \up0 \expndtw0\charscalex127 (vezi aparitia
unui infarct miocardic in cursul unui conflict major), si \up0
\expndtw0\charscalex117 efect \up0 \expndtw0\charscalex124 (vezi stresui secundar
oricarei boli care afecteaza individul, prin \up0 \expndtw0\charscalex121
disconfort somato-psihic sau prin implicatiile sale asupra insertiei socio\up0
\expndtw0\charscalex121 prolesionale a acesteia) \par\pard\qj \li1070\ri729\sb0\sl-
260\slmult0\fi292 \up0 \expndtw0\charscalex122 De aceea consideram ca orice lucrare
de sinteza in psihosomatica nu \up0 \expndtw0\charscalex115 trebuie sa ignore
problematica stresului psihic. \par\pard\qj \li1368\ri1167\sb128\sl-
340\slmult0\tx1656 \up0 \expndtw0\charscalex136 5. Antrenarea verigii neuro-
endocrine si imune in aparitia \line\tab \up0 \expndtw0\charscalex134 tulburdrilor
psihosomatice \par\pard\qj \li1070\ri727\sb155\sl-250\slmult0\fi292 \up0
\expndtw0\charscalex120 Nu se poate vorbi de psihosomatica fara analiza implicarii
sistemelor \up0 \expndtw0\charscalex121 de transmisie a informafiei de la cortex la
soma ("sensul" psiho-somatic \up0 \expndtw0\charscalex109 propriu-zis) \up0
\expndtw0\charscalex130 �i de la soma la cortex \up0 \expndtw0\charscalex124
(somato-psihic). in cadrul acestor \par\pard\qj \li1075\ri734\sb10\sl-
250\slmult0 \up0 \expndtw0\charscalex119 sisteme de transmisie un loc, de mult
statuat, este eel al sistemului neuro-\line \up0 \expndtw0\charscalex121 vegetativ-
endocrin, considerat ca tot unitar, incepand de la Gr.T.Popa si \up0
\expndtw0\charscalex121 pana in zilele noastre, cand putem sa vorbim mai degraba de
un veritabil \par\pard\qj \li1075\ri734\sb0\sl-250\slmult0\fi43 \up0
\expndtw0\charscalex116 'terminal", constand intr-o veritabila "supa de mediatori"
ce transmit infor-\line \up0 \expndtw0\charscalex123 matia vehiculata de
terminatiile nervoase sau ajunsa pe calea toreniului \up0 \expndtw0\charscalex114
circulator sub forma hormonilor \up0 \expndtw0\charscalex117 (multi dintre ei
secretati de catre neuroni, \par\pard\ql \li1075\sb17\sl-230\slmult0 \up0
\expndtw0\charscalex111 etc.).
\par\pard\ql\li1497\sb140\sl-230\slmult0\tx8390 \up0 \expndtw0\charscalex123 Ceea
ce ne intereseaza in acest stadiu al dezvoltarii psihosomaticii \tab \up0 \expndtw-
2\charscalex100 -\par\pard\qj \li1204\ri580\sb22\sl-240\slmult0 \up0
\expndtw0\charscalex116 care analizeaza intimitatea celulara si subcelulara a
legaturilor dintre psihic \up0 \expndtw0\charscalex119 Si soma \up0
\expndtw0\charscalex124 - este in primul rand participarea endocrina in
determinismul \up0 \expndtw0\charscalex114 tulburdrilor $i bolilor psihosomatice.
si aceasta din doua motive: \par\pard\ql \li1800\sb9\sl-230\slmult0\tx5894 \up0
\expndtw0\charscalex130 \u8226? rezultatele cercetarilor din ultimele \tab \up0
\expndtw0\charscalex140 2 decenii au adus date \par\pard\qj \li1209\ri564\sb19\sl-
244\slmult0\fi14 \up0 \expndtw0\charscalex117 interesante si relativ cuantificabile
despre hormonii de stres (este mult mai \up0 \expndtw0\charscalex113 greu sa urmanm
si sa cuantificam - Tn stadiul actual - procesele de la nivelul \up0
\expndtw0\charscalex111 cortical si al centrilor subcorticali, ori la diverse
niveluri ale nevraxului intr-un \up0 \expndtw0\charscalex117 stres psihic produs
intr-un anumit context (ex. emotia care apare sub lorma \up0
\expndtw0\charscalex122 de furie sau ru$ine, etc.) in timp ce dozarile hormonale
(nici ele u�or de \up0 \expndtw0\charscalex122 efectuat si de interpretat) par a ne
fi, totusi, mai la indemana; \par\pard\qj \li1209\ri574\sb16\sl-
245\slmult0\fi590 \up0 \expndtw0\charscalex117 \u8226? exista o patologie
endocrina, in mare parte indusa de stres (eel mai \up0 \expndtw0\charscalex121
elocvent exemplu Boala Basedow, dar si alte sindroame endocrine) care \up0
\expndtw0\charscalex116 evidentiaza o trasatura mai putin dlscutata Tn literatura:
imbolnavirea - sub \up0 \expndtw0\charscalex123 efectul stresului psihic - a msesi
organelor cu rol de reglare a activitatii \up0 \expndtw0\charscalex123 somato-
viscerale. \par\pard\qj \li1209\ri575\sb0\sl-250\slmult0\fi302 \up0
\expndtw0\charscalex124 Din aceste motive putem rezuma interventia glandelor
endocrine in \up0 \expndtw0\charscalex127 geneza sau ritmarea unor tulburari sau
boli psihosomatice sub forma \up0 \expndtw0\charscalex111 urmatoarelor
modalitati: \par\pard\qj \li1214\ri575\sb0\sl-260\slmult0\fi595 \up0
\expndtw0\charscalex122 1. eliberarea constanta - prin definite - a "hormonilor de
stres". in \up0 \expndtw0\charscalex121 cursul actiunii diver$ilor agenti
stresori \up0 \expndtw0\charscalex128 �i intr-un mod departe de a fi
nespecific (daca ar fi sa ne gandim numai la "constelatia hormonala" din \up0
\expndtw0\charscalex121 eustress Tn raport cu cea din distress). \par\pard\qj
\li1224\ri575\sb0\sl-250\slmult0\fi571 \up0 \expndtw0\charscalex134 2. actiunca
diferentiata a unui pattern al secretiei hormonale \up0 \expndtw0\charscalex119
(aproximativ constant pentru o situate stresanta data), in functie de starea
\up0 \expndtw0\charscalex118 receptorilor hormonali s1 momentul functional \up0
\expndtw0\charscalex119 (inclusiv anumite leziuni \par\pard\ql \li1219\sb1\sl-
216\slmult0 \up0 \expndtw0\charscalex114 preexistente) ale organului \\inta;
\par\pard\qj \li1219\ri559\sb1\sl-245\slmult0\fi576 \up0 \expndtw0\charscalex119 3
predominanta unui anume raspuns "de stres" (reactie catecolami\up0
\expndtw0\charscalex117 nica sau cortizolica) in cursul situatiilor variate dar si
in functie de tipul de \up0 \expndtw0\charscalex118 personalitate si, rnai ales,
comportamental al unui individ (de ex. tipul A -\line \up0 \expndtw0\charscalex121
mai "permeabil" la actiunea catecolaminelor, tipul C, supus actiunii unei \up0
\expndtw0\charscalex109 hipercortizolemii); \par\pard\qj \li1209\ri560\sb15\sl-
245\slmult0\fi580 \up0 \expndtw0\charscalex124 4. activitatea crescuta sau scazuta
fiziologic a unei glande endo� \up0 \expndtw0\charscalex121 crine (hipertonie sau
hipotonie), inca in limitele normalului, dar mai ales \up0 \expndtw0\charscalex127
afectarile, leziunile endocrine, insotite de exces sau deficit hormonal \up0
\expndtw0\charscalex125 favorizeaza sau antreneaza o serie de boli psihosomatice
(de exemplu \up0 \expndtw0\charscalex116 diabetul zaharat sau hipertensiunea
arteriaia - in sindromul Cushing). \par\pard\qj \li1209\ri565\sb15\sl-
245\slmult0\fi287 \up0 \expndtw0\charscalex119 Cat despre antrenarea sistemului
imun in aparitia si evolutia patologiei \up0 \expndtw0\charscalex127 este suficient
doar sa amintim ca acest sistem este considerat ca unui \up0
\expndtw0\charscalex119 dintre cele mai importante (daca nu eel mai important)
sistem de reglare a \up0 \expndtw0\charscalex116 activitatii organelor si
aparatelor iar legatura lui cu psihosomatica a devenit \up0 \expndtw0\charscalex126
o veritabila subspecialitate a acesteia \up0 \expndtw0\charscalex119 (vezi tratatul
de Psihoneuroimu-\par\pard\ql \li1219\sb8\sl-230\slmult0 \up0
\expndtw0\charscalex113 nologie al lui R Ader). \par\pard\qj \li1214\ri574\sb0\sl-
260\slmult0\fi297 \up0 \expndtw0\charscalex113 In lucrarea de fata, un paragraf
cuprins in capitolul despre psihoneuroaler-\line \up0 \expndtw0\charscalex113
gologie va analiza unele implicatii ale sistemului imun in patologia
psihoso-\par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg23}{\bkmkend
aplicata\par\pard\li1147\sb0\sl-230\slmult0\par\pard\li1147\sb0\sl-
\expndtw0\charscalex123 matica, fara a se omite legatura sa intlma\tab \up0
\expndtw0\charscalex123 �i bidirectionala cu sistemul\par\pard\li1147\sb10\sl-
230\slmult0\fi0 \up0 \expndtw0\charscalex123 neuro-endocrin.\par\pard\qj
Reflectand evolutla generala a patologiei, cu diferentierile ei inerente \up0
\expndtw0\charscalex113 progresului cunoasterii medicale - mai intai clinice
(aparitia "specialitatilor") \up0 \expndtw0\charscalex110 Si apoi teoretice
(fiziopatologia. anatomo-patologia si histologia, etc.) - psiho� \up0
\expndtw0\charscalex126 somatica, nascuta din observatia clinlca, dobandeste astazi
\up0 \expndtw0\charscalex124 - sub exi-\par\pard\qj \li1137\ri651\sb13\sl-
248\slmult0\fi14 \up0 \expndtw0\charscalex123 gentele justlficate de necesitatea
unor dovezi obiective - un caracter tot \up0 \expndtw0\charscalex124 mai stiintific
prin descifrarea unor mecanisme pslhofiziologice cuplate \up0
\expndtw0\charscalex121 de complexele mecanisme de reglare cortico-viscerala,
antrenand vengi \up0 \expndtw0\charscalex108 "clasice" \up0
\expndtw0\charscalex114 (sistemul neuro-vegetativ-endocrin) si moderne (sistemul
imun) al \up0 \expndtw0\charscalex112 caror "terminal" nu mai este exprimat doar de
catre organele-\{inta. ci de catre \up0 \expndtw0\charscalex112 receptorii celulari
sau lumea pestrita a citokinelor. \par\pard\qj \li1142\ri656\sb0\sl-
260\slmult0\fi297 \up0 \expndtw0\charscalex121 In acelasi tlmp. la celalalt pol al
psihosomaticii (eminamente practic) \up0 \expndtw0\charscalex130 al psihotogiei
clinice \up0 \expndtw0\charscalex128 (o ramura a acesteia. inca in formare,
datorita \par\pard\qj \li1137\ri656\sb0\sl-250\slmult0 \up0 \expndtw0\charscalex117
dirijarii aproape exclusiviste a posibililor clinicieni spre asistenfa
psihiatri\up0 \expndtw0\charscalex122 ca). se acumuleaza tot mai multe forte si.
mai ales, mijloace capabile sa \up0 \expndtw0\charscalex126 ofere un suport
psihologie solid actului terapeutic atat sub forma unei \up0
\expndtw0\charscalex119 asociori benefice la efectele medicatiei, cat ?i sub forma
remodelarii unor \up0 \expndtw0\charscalex119 comportamente nocive pentru sanatate,
generatoare de recidive \par\pard\qj \li1137\ri659\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex114 incercand sa fie o reflectare a acestor veritabile
"framantari" ale terenului \up0 \expndtw0\charscalex120 actual al psihosomaticii,
lucrarea de fata - purtand pecetea conceptiiior si \up0 \expndtw0\charscalex114
activitatii autorilor ei \up0 \expndtw0\charscalex123 - aspira la familiarlzarea
medicilor $i psihologilor \par\pard\qj \li1137\ri651\sb7\sl-246\slmult0\fi4 \up0
\expndtw0\charscalex123 cu un domeniu de care va trebui sa se tma seama, in
mileniul ce ne a?\up0 \expndtw0\charscalex114 teapta cu nerdbdare. fie doar s<
pentru faptul ca una dintre aspiratiile majore \up0 \expndtw0\charscalex121 ale
urmatorului secol este constituita de ameliorarea calitatii vietii, atat a \up0
\expndtw0\charscalex121 omului sanatos cat si a celui bolnav \par\pard\ql
\expndtw0\charscalex107 Bibliografie \par\pard\ql \li1473\sb230\sl-
230\slmult0\tx6801 \up0 \expndtw0\charscalex100 I Alexander F. - Psychosomatic
medicine. Norton. New York. \tab \up0 \expndtw-9\charscalex90 1950. \par\pard\ql
\li1430\sb1\sl-217\slmult0 \up0 \expndtw-2\charscalex100 2. Ader R. (red.).
Psychoimmunotogy - Academic Press \u9632? London. New York. 1981. \par\pard\ql
\li1430\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex103 3 Brouchon Schweitzer
Marilou. Dantzer R - Introduction dans la psychologie de \par\pard\li1435\sb17\sl-
230\slmult0\fi220\tx5697 \up0 \expndtw0\charscalex104 la santd pp. 13-42, Presso
Univ France. Paris,\tab \up0 \expndtw0\charscalex104 1994.\par\pard\li1435\sb1\sl-
213\slmult0\fi4\tx3710 \up0 \expndtw0\charscalex104 4 Buddeberg C, Willi J.\tab
\up0 \expndtw0\charscalex104 \u9632? Psychosoziale Medizin. 2 Auflage. Springer
Heidel�\par\pard\li1435\sb1\sl-228\slmult0\fi215\tx2193 \up0
\expndtw0\charscalex104 berg,\tab \up0 \expndtw0\charscalex104
1998\par\pard\li1435\sb1\sl-219\slmult0\fi0\tx3187 \up0 \expndtw0\charscalex104 5.
Coculescu M\tab \up0 \expndtw0\charscalex104 Psychoendocrine stress induced
syndromes. Rev. Roum.\par\pard\li1435\sb1\sl-226\slmult0\fi220\tx2481 \up0
\expndtw0\charscalex104 Physioi.\tab \up0 \expndtw0\charscalex104 1989. 26. 233-
250\par\pard\li1435\sb1\sl-219\slmult0\fi0 \up0 \expndtw0\charscalex105 6.
lamandescu t. 8. Corela(ii psihosomatice in astmul bronsic - TezA de
Doctoral.\par\pard\li1435\sb1\sl-221\slmult0\fi220\tx3004 \up0 \expndtw-
2\charscalex100 IMF Bucuresti.\tab \up0 \expndtw0\charscalex104
lamandescu IB. \u9632? Stresui psihic si bolile interne. Ed. ALL. Bucuresti,\tab
\up0 \expndtw0\charscalex104 1993.\par\pard\li1435\sb1\sl-230\slmult0\fi4\tx6527
\up0 \expndtw0\charscalex103 8 lamandescu t.B. \u9632? Psihologie Medicald. Ed.
Infomedica,\tab \up0 \expndtw0\charscalex104 1996.\par\pard\li1435\sb1\sl-
223\slmult0\fi4\tx3192 \up0 \expndtw0\charscalex104 9. lamandescu IB.\tab \up0
\expndtw0\charscalex104 - Mecanisme psihoendoenne invocate in evolufia
astmutui\par\pard\li1435\sb3\sl-230\slmult0\fi230 \up0 \expndtw0\charscalex105
bronsic cu trigger psihogen. Cong. Naf. I de Psihoneurologie. Acad.
Rom..\par\pard\li1435\sb1\sl-223\slmult0\fi230 \up0 \expndtw0\charscalex104
Bucuresti 1996.\par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg24}
\par\pard\ql\li1574\sb188\sl-207\slmult0\tx7464 \up0 \expndtw0\charscalex113 10
lamandescu IB. - Phsychoatlergology - Romcartexim. Bucuresti, \tab \up0 \expndtw-
3\charscalex100 1998 \par\pard\ql \li1574\sb33\sl-207\slmult0\tx7127 \up0
\expndtw0\charscalex112 11. lonescu G. - Psihosomatica, Ed. Stiin(ificd si
Enciclopedicd. \tab \up0 \expndtw-8\charscalex95 1973. \par\pard\ql
\li1579\sb13\sl-207\slmult0\tx6974 \up0 \expndtw0\charscalex113 12. lonescu G.
\u9632? Psihoterapia. Ed Stiintificd si Enciclopedicd, \tab \up0 \expndtw-
5\charscalex100 1990. \par\pard\ql \li1579\ri557\sb3\sl-
220\slmult0\tx1848\tx1881 \up0 \expndtw0\charscalex117 13 lonescu Targoviste C,
Prund S., Costea Mariana si colab. - The signification \line\tab \up0
\expndtw0\charscalex118 of stress in the aetiopathology of type 2 diabetes
mellitus. Stress Medicine, \line\tab \up0 \expndtw0\charscalex104 1987, 3. 277-284.
\par\pard\ql \li1574\sb11\sl-207\slmult0\tx7982 \up0 \expndtw0\charscalex112 14.
Mitrofan lotanda - Psihoiogia experien\{iata. Ed. tnfomedica. Bucuresti, \tab
\up0 \expndtw-5\charscalex100 1998. \par\pard\ql \li1579\sb13\sl-207\slmult0
\up0 \expndtw0\charscalex113 15 Popovici-Mir$u Coralia si Nicotau S. \u9632?
Psihologie si Cancer. Via(a Medicald. \par\pard\li1843\sb30\sl-
207\slmult0\fi0\tx2635 \up0 \expndtw0\charscalex108 26 sept.\tab \up0
\expndtw0\charscalex107 16. Predescu V. - Conceptia psihosomaticd in medicind.
Medicinistul, 1971, 1, 17-21. \par\pard\ql \li1579\sb13\sl-207\slmult0\tx7920
\up0 \expndtw0\charscalex113 17 Vdleanu si Daniel \u9632? Psihosomatica teminind.
Ed. Medicald. Bucuresti, \tab \up0 \expndtw-7\charscalex100 1976.
\expndtw0\charscalex119 \ul0\nosupersub\cf8\f9\fs22 Capitolul 2 \par\pard\ql
\li1363\sb0\sl-276\slmult0 \par\pard\ql\li1363\sb132\sl-276\slmult0 \up0 \expndtw-
10\charscalex100 \ul0\nosupersub\cf14\f15\fs24 CONCEPT! CLINICE FUNDAMENTALE IN
PSIHOSOMATICA \par\pard\ql \li1382\sb222\sl-230\slmult0 \up0
\expndtw0\charscalex131 \ul0\nosupersub\cf9\f10\fs20 Grigore Busoi \par\pard\qj
240\slmult0\fi278 \up0 \expndtw0\charscalex125 Psihosomatica este o conceptie
medicald integratoare (are in vedere \up0 \expndtw0\charscalex120 interrelatia
Psyche-Soma), care permite abordarea unor atectiuni somatice \up0
\expndtw0\charscalex123 induse psihic, ca reactie a unor trairi emotiv
tensionale \up0 \expndtw0\charscalex119 (factori stresanti \par\pard\qj
\li1070\ri718\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex117 conflicte, pierderi),
sau a unor manifestari psihice secundare unor boli orga\up0 \expndtw0\charscalex121
nice, inclusiv a unor suferinte psihocorporale produse prin mecanisme de \up0
\expndtw0\charscalex113 "reintrare circulare". \par\pard\qj \li1070\ri718\sb0\sl-
246\slmult0\fi297 \up0 \expndtw0\charscalex120 Medicina psihosomatica (MPS) este o
cale integrativa a aspiratiei spre \up0 \expndtw0\charscalex122 cuprinderea globala
s* holista cu care se confrunta medicul practician, in \up0 \expndtw0\charscalex123
speta medicul de medicina generaia/medicina de familie. Pentru a fi mai \up0
\expndtw0\charscalex120 aproape de un adevdr profesional, asa cum rezulta el de pe
platforma spe\up0 \expndtw0\charscalex117 cialitatii de MG/MF, ar trebui sa vorbim
de o medicina bio-psiho-socio-eco \up0 \expndtw0\charscalex118 logico-somatica in
care contextul plurietiologic al afectlunilor este prezent. \up0
\expndtw0\charscalex120 Trebuie spus ca MPS este o continuare a psihanalizei, care
a adus si a im\up0 \expndtw0\charscalex123 pus perspectiva dinamica si globalista.
Dupa H.Ey, psihanaliza a permis \up0 \expndtw0\charscalex118 descoperirea
importantei patogene a frustratiilor precoce si a corelatiel pro\up0
\expndtw0\charscalex118 funde dintre boala si caracter. \par\pard\qj
\li1070\ri718\sb0\sl-246\slmult0\fi302 \up0 \expndtw0\charscalex126 Deschiderea
moderna a MPS are ca elemente de reper conceptul de \up0 \expndtw0\charscalex124
stres si o multime de studii psihosociologice si transculturale. in acela$i \up0
\expndtw0\charscalex123 timp trebuie spus ca exista o serie de cercetari
experimentale care pun in \up0 \expndtw0\charscalex120 ecuatie tactorii
psihosociali, verigile neuroendocrine si neuroimunologice. \up0
\expndtw0\charscalex117 inclusiv patologia aferenta, de o larga distributie de la
cefalee pana la dishi\up0 \expndtw0\charscalex119 droza, de la astm, ulcer ?i
cancer pana la psoriazis $i tulburari de dinamica \up0 \expndtw0\charscalex119
sexuaia. \par\pard\qj \li1065\ri713\sb0\sl-242\slmult0\fi302
\up0 \expndtw0\charscalex118 Ne face piacere sa reiteram ideea ca medicina geto-
dacica a fost prima \up0 \expndtw0\charscalex127 medicina de factura psihosomatica
mentionata in documente. lata ce \up0 \expndtw0\charscalex120 spune Platon in
Charmides despre terapeutii geto-daci: Zamolxis, zice un \up0
\expndtw0\charscalex113 terapeut, ne invaja ca "dupa cum nu trebuie sa Tncercam a
vindeca ochii fara \up0 \expndtw0\charscalex123 sa vindecam capul. ori capul fara
sa tinem seama de trup. tot astfel nici \up0 \expndtw0\charscalex120 trupul nu
poate fi Tnsanatosit fara suflet". Pentru asta, adauga terapeutul, \up0
\expndtw0\charscalex113 "remediul multor boli este necunoscut medicilor greci
pentru ca ei neglijeaza \up0 \expndtw0\charscalex113 ansamblul". \par\pard\qj
\li1070\ri718\sb0\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex116 intr-o derulare
istorica, vrem sa amintim o serie de autori romani care au \up0
\expndtw0\charscalex117 avut in preocuparile lor $i MPS. Dintre acestia citam pe V.
Sahleanu $i A. \up0 \expndtw0\charscalex117 Athanasiu, G lonescu (Psihosomatica,
1975), V. Valeanu si C Daniel
(Psiho-\par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg26}{\bkmkend
\expndtw0\charscalex115 somatica feminma. 1977), I. Cucu (Medicina
psihosomatica,\tab \up0 \expndtw0\charscalex116 1981). P.
Dere-\par\pard\li1291\sb1\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex117 venco. I.
Anghel $i Adriana Baban (Stresui in sanitate $i boala 1993). IB.
la�\par\pard\li1291\sb5\sl-230\slmult0\fi0\tx5625\tx5817 \up0
\expndtw0\charscalex116 mandescu (Stresui psihic s* bolile interne\tab \up0
\expndtw0\charscalex116 -\tab \up0 \expndtw0\charscalex116 1993 s' Psihologie
medica�\par\pard\li1291\sb15\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex116
la,1996) si alfll.\par\pard\qj \li1291\ri522\sb3\sl-220\slmult0\fi292 \up0
\expndtw0\charscalex114 Plecand de la unitatea psihosomatica a organismului, MPS
releva patolo-\line \up0 \expndtw0\charscalex120 gia in relate directa cu via|a
psihica. Astfel, expresii psihologice \up0 \expndtw0\charscalex105 (emotii,
\par\pard\ql \li1296\sb12\sl-230\slmult0\tx6499 \up0 \expndtw0\charscalex119 stres)
i$i gasesc corespondent Tn expresii somatice \tab \up0 \expndtw0\charscalex113
(simptome, tulburari. \par\pard\qj \li1296\ri521\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex114 boli) Medicul trebuie sa stabileasca corelatiile intre
evenimentele vietii, des-\line \up0 \expndtw0\charscalex114 prinse din biografie si
istoricul bolii pacientilor si familiilor. cu faptele pato-\line \up0
\expndtw0\charscalex114 logice. Exista si un model de fisa psihosomatica pe care il
lanseaza Delay. \par\pard\ql \li1612\sb90\sl-230\slmult0 \up0
\expndtw0\charscalex133 1. Etiopatogenia tulburdrilor si bolilor psihosomatice
Dimensiunea etiopatogenica a tulburarilor si bolilor psihosomatice Tn \up0
\expndtw0\charscalex117 articulare - factori psihici patogeni, personalitate
premorbida si teren reac\up0 \expndtw0\charscalex114 tiv. patogenia - permite
medicuiui de familie sa abordeze ptilntlflc procesele \up0 \expndtw0\charscalex114
psihosomatice, iar actele medicale sa capete consistenta necesara. \par\pard\ql
\li1593\sb50\sl-230\slmult0 \up0 \expndtw0\charscalex112 Factori osihici
oatoaeni \par\pard\qj \li1296\ri512\sb70\sl-230\slmult0\fi283 \up0
\expndtw0\charscalex117 Orice realitate exterioara sau interioara pe care o
percepem, cu atat mai \up0 \expndtw0\charscalex120 mult un factor stresant, are o
tonalltate afectivd. care poate fi placuta sau \up0 \expndtw0\charscalex116
neplacuta. in psihoiogia patologica, procesele afective, dupa cum afirma E \up0
\expndtw0\charscalex122 Bleuler. au un rol capital Cunoasterea afectivitatli
devine un prim ele� \up0 \expndtw0\charscalex122 ment esential in mtelegerea
tulburarilor psihosomatice \par\pard\qj \li1281\ri512\sb7\sl-234\slmult0\fi307 \up0
\expndtw0\charscalex118 Pentru S. Freud, anxietatea apare ca un simt intern ce
previne Eul des� \up0 \expndtw0\charscalex113 pre existenta unui conflict intre
doua tendinte afectiv opuse (de exemplu dra\up0 \expndtw0\charscalex118 goste si
ura). Anxietatea, ca si angoasa, sunt recunoscute ca elemente ini� \up0
\expndtw0\charscalex114 tiate ce stau la baza mecanismelor fiziopatologice ale
simptomelor psihoso� \up0 \expndtw0\charscalex114 matice. Angoasa, ne spune Freud,
aduce doua elemente: pericolul si reflexul \up0 \expndtw0\charscalex119 de
autoaparare. Un alt factor psihogen este frustrarea. De fapt. dacd avem \up0
\expndtw0\charscalex118 in vedere psihanaliza clasica, si alte elemente cauzale pot
fi luate in discu\up0 \expndtw0\charscalex118 tie, spre exemplu: dependenta si
culpabilitatea. \par\pard\qj \li1291\ri506\sb10\sl-230\slmult0\fi283 \up0
\expndtw0\charscalex117 in cadrul relajiei bine-rau, trebuie spus ca omul este
bombardat cotidian \up0 \expndtw0\charscalex120 de o multime de agenti stresorl,
care stimuleaza, antreneaza si cresc vita \up0 \expndtw0\charscalex119 litatea,
rezistenta \up0 \expndtw0\charscalex117 �1 performantele organismului, agresiuni
care, odata ce \par\pard\qj \li1286\ri502\sb9\sl-232\slmult0 \up0
\expndtw0\charscalex116 depasesc norma individuals sau vin brutal, pot conduce la
reactii patologice \up0 \expndtw0\charscalex120 psihosomatice. si in observatia
populara se spune Tn acest sens: "tot ce-i \up0 \expndtw0\charscalex124 mult
strica" si "prea rnult pe capul bietului om". Se are astfel in vedere \up0
\expndtw0\charscalex119 cantitatea $i intensitatea, continuitatea si
repetabilitatea agentilor stresori, \up0 \expndtw0\charscalex120 dar mai ales
celeritatea agresiunii, bruschetea ei, napasta cazuta sau seria \up0
\expndtw0\charscalex120 neagra de evenimente. \par\pard\qj \li1281\ri502\sb7\sl-
234\slmult0\fi302 \up0 \expndtw0\charscalex120 Daca in celebra scala Holmes si Rahe
se tree Tn revista evenimentele \up0 \expndtw0\charscalex116 generatoare de stres,
cu impact asupra individului, in Romania Tn perioade \up0 \expndtw0\charscalex114
de tranzitie, prin politica adoptata. de "strangerea curelei" S' Pîn
"posturile" \up0 \expndtw0\charscalex120 sociale induse de "goana pentru asigurarea
zilei de maine", se ajunge la o \up0 \expndtw0\charscalex114 situare in stres
colectiv, mai ales in plan familial, se realizeaza un eveniment \up0
\expndtw0\charscalex117 stresant la scara nationals, ce trebuie sa sesizeze pe
medicii de MG/MF. in \up0 \expndtw0\charscalex117 calitatea lor de gate-keepers ai
sistemului sanitar. dar si de aparatori perso\up0 \expndtw0\charscalex117 nali ai
sanatatii indivizilor, in context familial sau comunitar.
Psihosomatica aplicata\tab \up0 \expndtw0\charscalex123 \u9830? 17\par\pard\ql
\ul0\nosupersub\cf18\f19\fs20\ul Evidentierea oersona\ul0\nosupersub\cf9\f10\fs20
titdtii oremorbide si a terenului reactiv \par\pard\qj \li1296\ri496\sb142\sl-
240\slmult0\fi278 \up0 \expndtw0\charscalex130 Tulburarile psihosomatice apar mai
frecvent la anumite tipuri de \up0 \expndtw0\charscalex116 personalitate
caracterizate prin: \par\pard\qj \li1588\ri4071\sb0\sl-260\slmult0 \up0
\expndtw0\charscalex117 T reactivitate emotionala crescuta, \up0
\expndtw0\charscalex118 T susceptibilitate exagerata, \par\pard\qj
\li1583\ri3111\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex114 \u9660? rigiditate
in derularea proceselor corticale, \up0 \expndtw0\charscalex115 T agresivitatea
externa blocata. \par\pard\qj \li1296\ri513\sb0\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex117 Ar fi mteresant de cunoscut de ce unii pacienti fac
nevroze, iar aljii boli \up0 \expndtw0\charscalex117 psihosomatice sj 'n ce masura
personalitatile accentuate, in formularea lui \par\pard\ql \li1300\sb0\sl-
217\slmult0 \up0 \expndtw0\charscalex115 K. Leonhard, sunt predispuse la boh
psihosomatice. \par\pard\qj \li1291\ri496\sb0\sl-246\slmult0\fi292 \up0
\expndtw0\charscalex123 Sunt cunoscute de asemenea tipurile comportamentale de tip
A si B \up0 \expndtw0\charscalex118 descrise de Friedman si Rosenman (1959). Tipul
psihologie A este definlt \up0 \expndtw0\charscalex115 prin ambitie,
competitivitate si combativitate crescuta. Acest tip este predis\up0
\expndtw0\charscalex115 pus clasic la coronaropatie. \par\pard\qj
\li1300\ri502\sb0\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex113 R. Kourilsky
descrie un tip de personalitate caracterizat printr-o "vulnera\up0
\expndtw0\charscalex113 bilitate la stres". \par\pard\qj \li1291\ri492\sb0\sl-
246\slmult0\fi297 \up0 \expndtw0\charscalex116 Engel s< colaboratorii considers ca
subiecfii au o mai mare probabilitate \up0 \expndtw0\charscalex122 de a deveni
bolnavi somatici daca dezvolta un complex de renuntare s* \up0
\expndtw0\charscalex113 cedare ("giving-up. given-up complex") ca raspuns la o
pierdere sau amenin-\line \up0 \expndtw0\charscalex117 tare. Pacientii par
neajutorati \up0 \expndtw0\charscalex115 �i isi dezvolta sentimentul de
inutilitate, desi \par\pard\ql \li1296\sb3\sl-230\slmult0 \up0
\expndtw0\charscalex116 se simt raspunzatori pentru cele intamplate.
Nemiah $i
Sifneos au sugerat ca o cauza a suferintei psihosomatice ar \up0
\expndtw0\charscalex120 putea fi alexitimia (incapacitatea de a recunoaste si a
descrie sentimente, \up0 \expndtw0\charscalex122 dificultatea de a diferentia
starile emotionale de senzatii corporale, ca ?i \up0 \expndtw0\charscalex115
incapacitatea imaginative) \par\pard\qj \li1296\ri508\sb0\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex115 Opinii asupra existenjei unui anumit tip de personalitate,
propriu fiecarei \up0 \expndtw0\charscalex115 boli psihosomatice, nu au rezistat
probei timpului. \par\pard\qj \li1291\ri492\sb0\sl-246\slmult0\fi297 \up0
\expndtw0\charscalex117 Existenta unui anumit teren reactiv (de exemplu diateza
atopica), a unei \up0 \expndtw0\charscalex114 predispozitii de organ este mai mult
sau mai putin acceptata. Fiecare individ \up0 \expndtw0\charscalex114 are un anumit
"defect fundamental" ce apare in relatia neuroendoenna-vege-\line \up0
\expndtw0\charscalex115 tativa s> in fixarea patogena, care scoate in evidenta
predispozitia de organ. \up0 \expndtw0\charscalex117 Aceasta predispozitie este
denumita de unii autori ca "loc de minora rezis\up0 \expndtw0\charscalex113 tenta".
Adler emite ipoteza "inferioritatil de organ". Se poate admite, de ase� \up0
\expndtw0\charscalex118 menea, ca anumite tentorii de manifestare ale agresiunilor
sunt reperate si \up0 \expndtw0\charscalex120 sensibilizate anterior prin difente
procese patogene (de exemplu procesul \up0 \expndtw0\charscalex114 de metaplazie la
nivelul mucoaselor). Bogatia de receptori ale anumitor teri\up0
\expndtw0\charscalex117 torii permite cuplarea cu diferiti mediatori biochimici
eliberati in procesele \up0 \expndtw0\charscalex117 fiziopatologice amorsate.
explicate generala propusa este considerate a fi imaturitatea subiecti-\line
\up0 \expndtw0\charscalex115 lor actuali de a face fata vietii Tn civilizatia
contemporana. Organismul lace \up0 \expndtw0\charscalex114 apel la reactii arhaice
cu finahzare motorie (lupta sau fuga). Astazi, la un om \up0
\expndtw0\charscalex116 ajuns fiinta sedentara, exprimarile sale reactive in plan
fizic sunt reprimate, \up0 \expndtw0\charscalex114 el fiind obligat organic si
comportamental "sa arda in sue propriu". De aici o \up0 \expndtw0\charscalex114
buna parte din bolile afiliate psihosomaticii (hipertensiunea artenala,
cardio-\line \up0 \expndtw0\charscalex114 patia ischemicS, cancerul) au devenit
boli ale civilizatiei moderne. Stresui,
\expndtw0\charscalex113 situatiile conflictuale, spune Alexander, apar atat in faza
"pregStirii de lupta" \up0 \expndtw0\charscalex119 Si sunt mediate simpatico-tonic,
cat $i in "faza de retragere" cand se aso\up0 \expndtw0\charscalex117 ciaza de
regula parasimpaticotonia. Bolile circulatorii sunt legate mai mult \up0
\expndtw0\charscalex125 de tipul de reacfie simpatica, pe cand cele digestive si
respiratorii sunt \up0 \expndtw0\charscalex115 legate predominant de reactia
parasimpaticS. \par\pard\ql \li1454\sb49\sl-230\slmult0 \up0
\expndtw0\charscalex115 Patoaenie \par\pard\qj \li1156\ri652\sb82\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex113 in explicarea mecanismelor
fiziopatologice implicate Tn producerea boli� \up0 \expndtw0\charscalex114 lor
psihosomatice, remarcam contribu|nle lui Cannon si Selye, ale lui Pavlov \up0
\expndtw0\charscalex118 Si Bacov, ale lui Alexander si ale scolii sale de la
Chicago, cat si ale aitor \up0 \expndtw0\charscalex116 autorl, multi dintre ei
adepti ai unei medicini psihanalitice remnoite doctri\up0 \expndtw0\charscalex117
nar, sau a altor curente moderne cum sunt fenomenologia clinica, socioge\up0
\expndtw0\charscalex117 netica sau biopersonalismul. \par\pard\qj
\li1147\ri661\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex114 Simtim nevoia,
pentru a lumina mai bine problema discutata, sa preluSm \up0
\expndtw0\charscalex117 unele definitii ale termenilor vehicular, cum sunt: stres,
reactivitate, reactii \up0 \expndtw0\charscalex114 de "coping". Astfel. pentru M.
Golu stresui psihic reprezinta "o stare de ten-\line \up0 \expndtw0\charscalex117
siune, incordare si disconfort determinate de agen(i afectogeni cu semnifl-\line
\up0 \expndtw0\charscalex115 ca(ie negative, de frustrarea sau reprlmarea unor
stari de motivatie (trebuin-\line \up0 \expndtw0\charscalex116 te, dorinte.
aspiratii), de dificultatea sau imposibilitatea rezolvani unor pro-\line \up0
\expndtw0\charscalex107 bleme". \par\pard\qj \li1147\ri650\sb0\sl-240\slmult0\fi302
\up0 \expndtw0\charscalex119 R. Williams defineste reactlvitatea ca pe un proces,
modulat de factori \up0 \expndtw0\charscalex121 genetlci si de personalitate, prin
care creierul interpreteaze evenimentele \up0 \expndtw0\charscalex117 cei parvin si
trimite mesaje somatomotorii, vegetative si neuroendocrine la \up0
\expndtw0\charscalex117 organele tints. \par\pard\qj \li1147\ri670\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex120 in ceea ce pnveste react!lie de
coping se au in vedere strategiile adap\up0 \expndtw0\charscalex117 tative
utilizate. adesea mconstiente, de a face fata situatiei.de a invinge di\up0
\expndtw0\charscalex104 ficultStile. \par\pard\qj \li1142\ri654\sb4\sl-
236\slmult0\fi297 \up0 \expndtw0\charscalex118 H. Selye concepe stresui ca pe un
factor agresiv, dar si ca pe un proces \up0 \expndtw0\charscalex124 de adaptare al
organismului, un rSspuns nespecific general la actiunea \up0
\expndtw0\charscalex121 agentilor stresori. RSspunsul la stres se deruleazS prin
reactii adaptative \up0 \expndtw0\charscalex116 fiziologice. mediate de verigi
neurovegetativ-endocrine. in cadrul reactiilor \up0 \expndtw0\charscalex118 de
stres pot apSrea leziuni histochimice sau chiar histologice, dupS model \up0
\expndtw0\charscalex111 von Bergmann. \par\pard\qj \li1142\ri656\sb24\sl-
237\slmult0\fi302 \up0 \expndtw0\charscalex115 Mecanismele psiho-fiziopatologice
implicate in MPS, desi nu sunt per� \up0 \expndtw0\charscalex117 fect ISmurite,
presupun o activare a sistemului nervos central, o prelucrare \up0
\expndtw0\charscalex115 corticosubcorticalS, cu relee importante la nivelul
hipotalamusului $i siste� \up0 \expndtw0\charscalex113 mului limbic $i verigi
descendente neurovegetative si endocrine diferen(iate \up0 \expndtw0\charscalex121
Procesul psihosomatlc se deruleaza in sapte secvente: provocarea (agre\up0
\expndtw0\charscalex113 siunea psihicS), receptare (personalitSti sensibile),
prelucrare (la nivelul sis� \up0 \expndtw0\charscalex116 temului nervos central),
amorsare (neuro-endocrino-metabolicS S' imunita\up0 \expndtw0\charscalex118 rS),
detectarea (structuri reactive, organe sau aparate tints), afectare (de la \up0
\expndtw0\charscalex117 tulburari functionate la boli organice) si relevare
(diagnosticarea. stabilirea \up0 \expndtw0\charscalex117 corelatiilor. a
cauzalitStii si adecvarea terapeuticS). \par\pard\ql \li1444\sb90\sl-253\slmult0
\up0 \expndtw0\charscalex118 \ul0\nosupersub\cf8\f9\fs22 2. Clinicd si nosografie
psihosomaticd \par\pard\qj \li1156\ri647\sb42\sl-260\slmult0\fi283 \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 Tabloul manifestSrilor clinice
psihosomatice propnu-zise este destul de \up0 \expndtw0\charscalex117 bogat. Unii
autori sus(m cS intreaga patologie medicals ar putea intra sau
\ul0\nosupersub\cf9\f10\fs20 intrS sub o incidents psihosomaticS. in ceea ce mS
prive�te, mS voi referl \up0 \expndtw0\charscalex121 strict la manifestSrile
clinice unde raportul factor psihic-rSsunet somatic \up0 \expndtw0\charscalex121
este evident. \par\pard\qj \li1046\ri752\sb0\sl-250\slmult0\fi283 \up0
\expndtw0\charscalex113 Aceasta realitate psihosomatica o reprezentSm intr-o suits
de tablouri cli� \up0 \expndtw0\charscalex115 nice si o inscriem intr-o gramaticS a
sensurilor (formulare personals - Busoi \up0 \expndtw0\charscalex115 1997) ce
permite ordonarea. Astfel, avem: \par\pard\li1334\sb18\sl-230\slmult0\fi0\tx5222
\up0 \expndtw0\charscalex121 \u9830? simptome si semne psihosomatice\tab \up0
\expndtw0\charscalex121 = prepozifii psihosomatice, ca\par\pard\li1334\sb5\sl-
230\slmult0\fi273 \up0 \expndtw0\charscalex121 reactii normale la tensiuni
psihice,\par\pard\li1334\sb20\sl-230\slmult0\fi0\tx4099 \up0
\expndtw0\charscalex121 \u9830? tulburari psihosomatice\tab \up0
\expndtw0\charscalex121 = propozitii psihosomatice. ca
dezvoltSri\par\pard\li1334\sb20\sl-230\slmult0\fi278 \up0 \expndtw0\charscalex121
psihofunctionale,\par\pard\qj \li1339\ri746\sb6\sl-240\slmult0\tx1608 \up0
\expndtw0\charscalex118 \u9830? boli psihosomatice = fraze psihosomatice, ca
organizSri psihosoma� \line\tab \up0 \expndtw0\charscalex109 tice. \par\pard\qj
\li1036\ri737\sb16\sl-245\slmult0\fi307 \up0 \expndtw0\charscalex124 Simptome si
semne psihosomatice (prepozifii psihosomatice). Sunt \up0 \expndtw0\charscalex115
reprezentate de manifestSri clinice, componente normale asociate emotiilor, \up0
\expndtw0\charscalex118
care dureaza putin si sunt rapid reversibile. Termenul de prepozitie ne este
\up0 \expndtw0\charscalex121 necesar pentru cS el exprimS raportul simplu de
legSturS intre emotie si \up0 \expndtw0\charscalex114 simptom. ManifestSrile
clinice din aceasts categorie sunt: palpitatii (tahicar-\line \up0
\expndtw0\charscalex115 die), tremor. modificSri ale vocii. paloare sau roseatS
tegumentarS etc. Sunt \up0 \expndtw0\charscalex117 de uz curent manifestSrile
psihosomatice conexe vorbitului Tn public, care \up0 \expndtw0\charscalex118 apar
la sustinerea examenelor sau, dupS cum cunoastem, la prezentarea la \up0
\expndtw0\charscalex108 medic. \par\pard\qj \li1046\ri727\sb0\sl-
253\slmult0\fi316 \up0 \expndtw0\charscalex122 Tulburarile psihosomatice
(propozitii psihosomatice). Conceptul de. \up0 \expndtw0\charscalex120 propozitie
psihosomaticS ne este folositor pentru cS el pune Tntr-o relate \up0
\expndtw0\charscalex118 directs subiectul (pacientul agresat), invesmantat in
atrlbute, cu predicatul \up0 \expndtw0\charscalex118 (actiunea de somatizare),
insotit de complemente \par\pard\qj \li1041\ri723\sb0\sl-246\slmult0\fi292 \up0
\expndtw0\charscalex121 in acest caz modificSrile clinice survenite depSsesc
firescul. sunt mai \up0 \expndtw0\charscalex117 ample ca intensitate si duratS si
sunt mai bine structurate. Se simte schema \up0 \expndtw0\charscalex120
circuitului. iar organul reactiv se individualizezS. RSspunsul la agresiuni \up0
\expndtw0\charscalex119 psihice brutale poate fi diferit dupS particularitati
constitutionale $i cana\up0 \expndtw0\charscalex117 lizarea tipului de reactie De
exemplu, in spaimS unii pacienti rSspund prin \up0 \expndtw0\charscalex118 blocaj
verbal, al(ii prin relaxare muscularS. iar frica intensS poate sa ducS \up0
\expndtw0\charscalex118 fie la un debaclu diareic, fie la o contracturS muscularS
rigidS. \par\pard\qj \li1046\ri727\sb0\sl-250\slmult0\fi292 \up0
\expndtw0\charscalex126 La tensiuni psihice intercurente, raspunsul somatic tinde
sa devina \up0 \expndtw0\charscalex117 stereotip (aceeasi zonS de reactie si
aceleasi simptome). Exemple: cefalee. \up0 \expndtw0\charscalex133 salve de
strSnuturi, cascade de tuse faringianS. crize de tahicardie \up0
\expndtw0\charscalex115 paroxisticS supraventricularS, scaune diareice, tulburari
de dinamicS sexua\up0 \expndtw0\charscalex115 IS, prurit etc. \par\pard\qj
\li1036\ri723\sb0\sl-250\slmult0\fi302 \up0 \expndtw0\charscalex121 Persoanele cu
un anumit teren reactiv pot prezenta crize de tetanie (la \up0
\expndtw0\charscalex118 spasmofili). lipotimii etc. Ce este caracteristic la
tulburarile psihosomatice \up0 \expndtw0\charscalex118 este faptul cS la ele nu se
gSseste un substrat organic. \par\pard\qj \li1041\ri723\sb0\sl-240\slmult0\fi302
\up0 \expndtw0\charscalex120 Boli psihosomatice (fraze psihosomatice). Introducerea
termenului de \up0 \expndtw0\charscalex115 frazS psihosomatica permite intelegerea
raporturilor de coordonare si subor-\line \up0 \expndtw0\charscalex118 donare a
elementelor \up0 \expndtw0\charscalex118 (subansamblelor) constitutive ale bolii:
agentul psi-\par\pard\qj \li1046\ri728\sb0\sl-260\slmult0\fi4 \up0
\expndtw0\charscalex115 hosomatogen, personalitatea premorbidS, predispozitia de
organ, amorsarea \up0 \expndtw0\charscalex115 patogenS, imprimarea
morfofunctionalS, relevantS clinics, evolutia, terapia.
\expndtw0\charscalex112 In fraza psihosomaticS propozitia-cheie este datS de
agresiunea psihicS S' \up0 \expndtw0\charscalex110 semnificatia ei in perceptia
persoanei agresate, conform celor trei "V": victims, \up0 \expndtw0\charscalex108
vinovStie proprie \up0 \expndtw0\charscalex116 (\u8222?ce-si face omul cu mana
lui") sau vitregia sorjii \up0 \expndtw0\charscalex111 (destin \par\pard\ql
\li1137\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex110 genetic). Cei trei "V"
constituie cheia ce manipuleazS zSvorul terapeutic. \par\pard\qj
\li1142\ri670\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex122 Ceea ce pune
eticheta de boala psihosomatica este evidentierea sub\up0 \expndtw0\charscalex131
stratului organic si strangerea manifestarilor clinice in entitati bine \up0
\expndtw0\charscalex122 conturate. \par\pard\qj \li1137\ri661\sb9\sl-
230\slmult0\fi297 \up0 \expndtw0\charscalex118 in discutarea asocierilor posibile
intre tulburarile psihice si somatice ne \up0 \expndtw0\charscalex118 oprim la
tipul de legSturS in care se TncadreazS si bolile psihosomatice si \up0
\expndtw0\charscalex118 anume la: factori psihici drept cauze ale bolii
somatice. \par\pard\qj \li1137\ri676\sb22\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex117 Tulburarile psihice ce se prezinta cu simptome fizice sunt
heterogene si \up0 \expndtw0\charscalex117 dificil de clasificat. \par\pard\qj
\li1142\ri656\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex121 Un termen de
refennta care permite clasilicarea este somatizarea Din \up0
\expndtw0\charscalex118 nefericire el este utilizat in mai multe acceptii: ca un
mecanism psihologie \up0 \expndtw0\charscalex117 subiacent formarii simptomelor
somatice si ca o subcategorie a DSM III si \up0 \expndtw0\charscalex117 apoi a DSM
IV, ca si In ICD 10, aceea a tulburarilor somatoforme. \par\pard\qj
\li1147\ri680\sb0\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex121 Redam intr-o
acceptie clasica, dupa H.I.Kaplan, tulburarile psihoso� \up0
\expndtw0\charscalex122 matice. \par\pard\qj \li1132\ri671\sb0\sl-240\slmult0\fi302
\up0 \expndtw0\charscalex117 EntitStile prezentate de el in ordine alfabeticS Ie
ordonSm si noi. dar in \up0 \expndtw0\charscalex117 versiune
romSneasce:\par\pard\sect\sectd\sbknone\cols2\colno1\colw4803\colsr160\colno2\colw4
077\colsr160\ql \li1751\sb60\sl-230\slmult0 \up0 \expndtw0\charscalex121
acnee\par\pard\qj \li1751\ri1409\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex114
alergie (reac(ii) \line \up0 \expndtw0\charscalex118 angine pectoraie \line \up0
\expndtw0\charscalex109 aritmii\par\pard\ql \li1751\ri1788\sb5\sl-235\slmult0
\up0 \expndtw0\charscalex116 astm bronsic \line \up0 \expndtw0\charscalex111 boli
imune \line \up0 \expndtw0\charscalex113 boala Crohn \line \up0
\expndtw0\charscalex118 cardiospasm\par\pard\qj \li1751\ri887\sb66\sl-
249\slmult0 \up0 \expndtw0\charscalex119 cardiopatie ischemica \up0
\expndtw0\charscalex119 cefalee\par\pard\qj \li1751\ri1630\sb65\sl-235\slmult0 \up0
\expndtw0\charscalex120 diabet zaharat \up0 \expndtw0\charscalex116
dismenoree\par\pard\qj \li1751\ri1126\sb0\sl-236\slmult0 \up0
\expndtw0\charscalex115 durere sacroiliacS \line \up0 \expndtw0\charscalex116 edem
angioneurotic \line \up0 \expndtw0\charscalex122 greats\par\pard\ql
\li1756\ri837\sb8\sl-235\slmult0 \up0 \expndtw0\charscalex118 herpes \line \up0
\expndtw0\charscalex116 hipertensiune arterialS\par\pard\column \qj
\li29\ri2633\sb51\sl-240\slmult0 \up0 \expndtw0\charscalex113 hipoinsulinism
\line \up0 \expndtw0\charscalex112 hipertiroidism \line \up0
\expndtw0\charscalex111 hipoglicemie \line \up0 \expndtw0\charscalex112
migrene\par\pard\qj \li20\ri2766\sb0\sl-243\slmult0\fi9 \up0
\expndtw0\charscalex115 neurodermits \up0 \expndtw0\charscalex117
obezitate\par\pard\ql \li29\sb1\sl-227\slmult0 \up0 \expndtw0\charscalex114
pilorospasm\par\pard\qj \li34\ri1970\sb29\sl-196\slmult0 \up0
\expndtw0\charscalex113 poliartrits reumatoidS \up0 \expndtw0\charscalex112 prurit
anal\par\pard\ql \li29\sb11\sl-230\slmult0 \up0 \expndtw0\charscalex118
psoriazis\par\pard\ql \li24\ri1491\sb6\sl-219\slmult0\fi4 \up0
\expndtw0\charscalex113 rectocolitS ulceroasS \line \up0 \expndtw0\charscalex111
sindromul colonului iritabil \up0 \expndtw0\charscalex114 sindromul dureros
cronic \up0 \expndtw0\charscalex111 tuberculozS\par\pard\qj \li20\ri1352\sb22\sl-
235\slmult0\fi14 \up0 \expndtw0\charscalex116 ulcerul gastric si ulcerul \up0
\expndtw0\charscalex113 duodenal\par\pard\qj \li24\ri2508\sb10\sl-235\slmult0
\up0 \expndtw0\charscalex113 verucile vulgare \up0 \expndtw0\charscalex111
vSrsStura \par\pard\sect\sectd\sbknone \qj \li1147\sb0\sl-240\slmult0
\par\pard\qj\li1147\ri660\sb40\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex119 La
aceste entitati se mai pot adauga eczema, pelada, cSderea difuza a \up0
\expndtw0\charscalex113 parului, vitiligo. impotenta si altele. \par\pard\qj
\li1147\ri661\sb5\sl-235\slmult0\fi292 \up0 \expndtw0\charscalex120 in DSM III nu
mai apare clasa de tulburari psihosomatice. Se pare ca \up0 \expndtw0\charscalex122
se contureaza urmatoarea diferentiere: termenul de psihosomatic are in \up0
\expndtw0\charscalex123 vedere etiologia, cauza bolii si situa(ia clinica, pe cand
termenul de so \up0 \expndtw0\charscalex125 matizare apare ca o exprimare a bolii
si o traire a bolii (comportament \up0 \expndtw0\charscalex118 de boala).
\ul0\nosupersub\cf9\f10\fs20 late acum clasificarea tulburarilor somatoforme:
\ul0\nosupersub\cf18\f19\fs20\ul Tulburdri somatotorme in DSM IV \par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 \u9632? Tulburare de somatizare (se refers la isterie
sau sindromul Briquet) \par\pard\ql \li1540\sb10\sl-230\slmult0\tx5625 \up0
\expndtw0\charscalex120 - Tulburare somatoforma nediferentiata \tab \up0
\expndtw0\charscalex113 (suferintS fizicS inexplicabilS \par\pard\ql
\li1670\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 care dureazS eel putin 6
luni) \par\pard\qj \li1545\ri559\sb19\sl-220\slmult0 \up0 \expndtw0\charscalex115 -
Tulbursri de conversie (simptome sau deficite care afecteazS motricita\up0
\expndtw0\charscalex115 tea voluntarS sau lunctia senzorialS) \par\pard\ql
\li1545\sb12\sl-230\slmult0 \up0 \expndtw0\charscalex114 - TulburSri somatoforme de
tip algic \par\pard\ql \li1545\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex117 -
Hipocondrie \par\pard\qj \li1540\ri565\sb19\sl-220\slmult0 \up0
\expndtw0\charscalex118 - Tutburarea dismorfica (preocuparea pentru un defect
corporal imagi\up0 \expndtw0\charscalex119 nar sau exagerarea unuia existent).
intr-o perioadS de 30 de luni, intr-un serviciu de psihiatrie de legSturS, \up0
\expndtw0\charscalex124 Fl.Tudose recunoaste 297 de cazuri de tulburari
somatoforme. ceea ce \up0 \expndtw0\charscalex113 reprezintS 9,52% din totalul
diagnosticelor inregistrate. \par\pard\li1248\sb13\sl-230\slmult0\fi292 \up0
\expndtw0\charscalex120 Iar in ceea ce priveste ICD-10 la capitolul TulburSri
nevrotice legate de\par\pard\li1248\sb10\sl-230\slmult0\fi0\tx5020\tx8313 \up0
\expndtw0\charscalex119 factori de stres s* tulburari somatice\tab \up0
\expndtw0\charscalex119 (F40-F48), nota(ia F45 se refers\tab \up0
\expndtw0\charscalex119 la\par\pard\li1248\sb10\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex119 tulburdri somatice.\par\pard\ql \li1540\sb0\sl-
180\slmult0 \up0 \expndtw0\charscalex113 In cadrul punctului F45 avem subpunctele
(expuse in tabelul 1): \par\pard\qj \li1703\sb0\sl-240\slmult0
\par\pard\qj\li1703\ri820\sb159\sl-240\slmult0\tx2303 \up0 \expndtw0\charscalex115
F45.0 Somatizarea (simptome fizice multiple, recurente �i variabile \line\tab
\up0 \expndtw0\charscalex116 in timp, persistand eel putin 2 ani) \par\pard\qj
\li1703\ri815\sb0\sl-240\slmult0\tx2294 \up0 \expndtw0\charscalex117 F45.1
Tulburare somatice nediferentiata (se refera la tulburarile cu \line\tab \up0
\expndtw0\charscalex114 extindere sub 2 ani) \par\pard\ql \li1699\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex111 F45.2 Tulburare hipocondrlce
\par\pard\ql \li1703\ri815\sb0\sl-245\slmult0\tx2299\tx2299\tx2299\tx2294 \up0
\expndtw0\charscalex114 F45 3 Disfunctie neurovegetative somatoforme. Aici isi
gasesc locul \line\tab \up0 \expndtw0\charscalex121 formele psihogene de:
aerofagie, colon iritabil, diaree, dls-\line\tab \up0 \expndtw0\charscalex115
pepsie, disurie, flatulenta. sughit, hiperventilatie. urinari frec-\line\tab
\up0 \expndtw0\charscalex114 vente, tuse. spasmele pilorului. Tot aici se
incadreaze nevroza \line\tab \up0 \expndtw0\charscalex115 cardiacs (sindromul Da
Costa) \par\pard\qj \li1699\ri818\sb0\sl-240\slmult0\tx2303 \up0
\expndtw0\charscalex116 F45.4 Sindromul dureros somatoform persistent (cefaleea
psihoge� \line\tab \up0 \expndtw0\charscalex117 ne. lombalgia psihogene etc.)
F45.8 Alte tulburari somatoforme (in relate cu evenimente stresante, \line\tab \up0
\expndtw0\charscalex125 deci psihogene): dismenoreea, disfagia \up0
\expndtw0\charscalex116 ("globul isterie"), \par\pard\ql \li2303\sb1\sl-213\slmult0
\up0 \expndtw0\charscalex112 prunt. torticolis, bruxism. \par\pard\ql
\li1703\sb13\sl-230\slmult0 \up0 \expndtw0\charscalex113 F45.9 Tulburari
somatoforme fere precizare \par\pard\qj \li1262\sb0\sl-240\slmult0
\par\pard\qj\li1262\ri546\sb202\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex112 O
sarcine de prima importanta pentru medicul de MG/MF este codificarea \up0
\expndtw0\charscalex113 Si raportarea afectiunilor Tntalnite. \par\pard\qj
\li1257\ri536\sb0\sl-244\slmult0\fi302 \up0 \expndtw0\charscalex127 Incadrarea
simptomelor, tulburarilor si bolilor psihosomatice inca \up0
\expndtw0\charscalex119 nu este bine pusa la punct. in schimb. in ICPC,
clasificarea internationaia \up0 \expndtw0\charscalex115 a morbiditetil in ingri|
irile pnmare ("primary care"), este facilitate inscrierea \up0
\expndtw0\charscalex114 Si urmarirea patologiei din practice de MG/MF, punandu-se
accentul pe mo\up0 \expndtw0\charscalex117 tivele solicitarii medicului si
constituirea episodului de rezolvare a proble\up0 \expndtw0\charscalex117 mei
initiate \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg32}{\bkmkend
\ul0\nosupersub\cf18\f19\fs20\ul Elemente de psihosomatica generala si
aplicata\par\pard\ql \li1444\sb0\sl-230\slmult0 \par\pard\ql\li1444\sb0\sl-
\expndtw0\charscalex134 \ul0\nosupersub\cf9\f10\fs20 3. Demersuri terapeutice in
patologia psihosomaticd \par\pard\qj \li1142\ri641\sb100\sl-243\slmult0\fi307
\up0 \expndtw0\charscalex118 Medicul de MG/MF ca si de diverse specialitati
nepsihiatrice in cadrul \up0 \expndtw0\charscalex120 unui invatamant modern
postuniversitar poate soluliona o buna parte din \up0 \expndtw0\charscalex114
problemele psihopatologice ale pacientilor sai. inteinirea Tntre medic $i pa�
\up0 \expndtw0\charscalex116 cient este primul moment al terapiei, iar
comportamentul $i rebdarea medi\up0 \expndtw0\charscalex119 cului constituie
condifii propice deschiderii terapeutice. Fluxul terapeutic \up0
\expndtw0\charscalex120 este realizat de comunicarea stabihts, iar aici medicina
devine arts Orl de \up0 \expndtw0\charscalex116 cate ori este cazul se recurge, in
cadrul muncii Tn echipa, la ajutorul psiho\up0 \expndtw0\charscalex117 logului sau
psihiatrului. Este important sa se retina faptul ca pentru pacient \up0
\expndtw0\charscalex115 conversia psihosomaticS este un mijloc de apSrare Tn fata
agresiunilor psi� \up0 \expndtw0\charscalex121 hice. iar reca$tigarea statutului de
luptator se se face cu grija pentru a nu \up0 \expndtw0\charscalex116 adanci
somatizarea sau pentru a evita raptusurile psihotice. A demonta cau\up0
\expndtw0\charscalex116 zahtatea, a cunoaste terenul reactiv si mediul familial
posibil viciat, consti� \up0 \expndtw0\charscalex117 tuie premise care conduc la un
tratament psihoterapie adecvat, individuali\up0 \expndtw0\charscalex117 zat sau
extins la nivelul grupului. \par\pard\ql \li1151\ri653\sb0\sl-
245\slmult0\fi292\tx1440 \up0 \expndtw0\charscalex117 in cadrul dialogului medic-
pacient, bolnavul transfers asupra medicului \up0 \expndtw0\charscalex116 temerile
sale $i medicul trebuie se she se dozeze transferul. \line \tab \up0
\expndtw0\charscalex118 in ceea ce prive$te psihoterapia, ea trebuie realizata de
catre terapeutul \up0 \expndtw0\charscalex115 avizat, intr-un cadru proteiat si o
atmosferd de permeabilizare ?i Tncredere. \up0 \expndtw0\charscalex115 Se cultiva
prin mijloace potrivite speranta. \par\pard\qj \li1151\ri638\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex124 Procesul psihoterapie! in familie
are ca punct de plecare postulated \up0 \expndtw0\charscalex119 fundamental ale
psihosociologiei grupului familial, din care refinem doua \up0
\expndtw0\charscalex111 (in formularea Aureliei lonescu): \par\pard\qj
\li1147\ri657\sb16\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex115 \u8226?
mentinerea unitetii grupului familial cere ca fiecare membru al familiei \up0
\expndtw0\charscalex128 se acorde oarecare priontate nevoilor grupului, dincolo de
dorintele. \up0 \expndtw0\charscalex112 atitudinile si opiniile proprii;
\u8226? pentru a-$i indeplini functiile esentiale fate de societate, grupul
familial \up0 \expndtw0\charscalex117 trebuie se posede obiective unitare si o
conducere unitare pentru realizarea \up0 \expndtw0\charscalex117 acestor obiective.
Metodele psihologice de tratament nu pot fi insusite fere o indrumare \up0
\expndtw0\charscalex121 practice din partea unei persoane abilitate.
Medicul de MG/MF exercita o influents psihoterapeutica sau el chiar face \up0
\expndtw0\charscalex123 o psihoterapie embnonarS. Prin locul si rolul sSu in
asistenfa medicals, \up0 \expndtw0\charscalex122 medicul de MG/MF este chemat sS
facS psihoterapie si in acest sens el \up0 \expndtw0\charscalex114 trebuie sa-si
dezvolte capacitetile la maximum. \par\pard\ql \li1142\ri631\sb0\sl-
242\slmult0\fi297\tx1444\tx1444\tx1454 \up0 \expndtw0\charscalex121 Iar cand vorbim
despre psihoterapie ea se defineste in functie de cine \up0 \expndtw0\charscalex115
este implicat in sedin(ele terapeutice si dupa continutul si metodele folosite.
\line\tab \up0 \expndtw0\charscalex116 Psihoterapia individuals, a cuplului sau a
familiei va fi aleasa Tn functie \up0 \expndtw0\charscalex115 de problemele
specifice cu care se confruntS terapeutul. \line \tab \up0 \expndtw0\charscalex115
E bine sS fie spus cS problema centrals a psihoterapiei este comunicarea \up0
\expndtw0\charscalex123 Si cS ea vizeazS schimbarea. Primul pas spre deschiderea
canalului de \up0 \expndtw0\charscalex115 comunicare este reprezentat de ascultare.
Terapeutul nu oferS solutii, ci el ii \up0 \expndtw0\charscalex114 ajuts pe eel Tn
cauzS sS gSseascS solutii pentru rezolvarea problemelor lor. \line\tab \up0
\expndtw0\charscalex114 In terapia
maritalS, spre exemplu, i se cere cuplului sS identifice proble� \up0
\expndtw0\charscalex114 mele pe care cei doi doresc sS Ie solutioneze.
\expndtw0\charscalex123 \ul0\nosupersub\cf9\f10\fs20 Manuchian vorbeste despre
terapeut ca despre un regizor, care pune \up0 \expndtw0\charscalex119 accentul pe
diferite actiuni. Cand este vizate interactiunea dintre membrii \up0
\expndtw0\charscalex119 familiei avem psihoterapie familiala structuraie; cand se
stabilesc scopuri \up0 \expndtw0\charscalex120 vorbim de terapie familiala
strategice. cand se urmereste sporirea sponta\up0 \expndtw0\charscalex123 neitat'i
si mdependentei membrilor familiei, terapia capata atribulul "de \up0
\expndtw0\charscalex115 crestere" �.a.m.d. \par\pard\qj \li1219\ri559\sb1\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex119 Exists o bogats hteratura de
specialitate privind tratamentul psihologie \up0 \expndtw0\charscalex120 din care
reamintim doar patru proceduri: terapii comportamentale, terapii \up0
\expndtw0\charscalex117 cognitive, antrenamentul autogen (autorelaxarea prin
concentrare, Schultz) \up0 \expndtw0\charscalex117 Si tehnici de meditatie.
\par\pard\ql \li1224\ri565\sb0\sl-240\slmult0\fi287\tx1507 \up0
\expndtw0\charscalex115 PosibilitS(ile suplimentare de ajutare a pacientilor
individuali sau grupati \up0 \expndtw0\charscalex116 se pot realiza prin terapie
fizicS, climatoterapie, muzicoterapie etc. \line \tab \up0 \expndtw0\charscalex120
Ca medicare se dau de regulS sedative si tranchilizante. Dintre neuro-\up0
\expndtw0\charscalex114 leptice se folosesc Tiondazina si Haloperidolul.
Vrem sa prezentSm in continuare cateva probleme din perimetrul \up0
\expndtw0\charscalex120 stiintei si artei MPS: \par\pard\ql \li1516\sb1\sl-
215\slmult0 \up0 \expndtw0\charscalex117 \u8226? abordarea unilateral, via MPS, a
pacientului poate deveni periculoasS, \par\pard\ql \li1228\ri540\sb5\sl-
240\slmult0\fi287\tx1516 \up0 \expndtw0\charscalex121 \u8226? medicul trebuie sa
aibS in vedere fazele de fragilitale psihosomatice \up0 \expndtw0\charscalex115
legate de restructurSrile hormonale (pubertate. sarcinS, climacteriu), \line
\tab \up0 \expndtw0\charscalex134 e trebuie de asemenea sS aibe in vedere efectul
placebo, dar \up0 \expndtw-5\charscalex100 $i \par\pard\ql \li1228\sb29\sl-
230\slmult0 \up0 \expndtw0\charscalex113 latrogenia. \par\pard\li1219\sb9\sl-
230\slmult0\fi292\tx5472 \up0 \expndtw0\charscalex123 e adecvarea reciproca medic-
pacient\tab \up0 \expndtw0\charscalex123 (uneori schimbarea
medicului\par\pard\li1219\sb15\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex123
amelioreaze suferinta),\par\pard\ql \li1516\sb1\sl-213\slmult0\tx8179 \up0
\expndtw0\charscalex121 \u8226? folosirea unor procedee ce permit detensionarea
inconstientului \tab \up0 \expndtw0\charscalex113 (de \par\pard\qj
\li1214\ri540\sb5\sl-240\slmult0 \up0 \expndtw0\charscalex122 exemplu eliberarea
agresivitStii prin mi$cari, jocuri, competitii sportive \up0
\expndtw0\charscalex113 amicale, drumetii) \par\pard\qj \li1214\ri556\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex121 Vindecarea se realizeazS atunci cand
dependenja de medic inceteaza, \up0 \expndtw0\charscalex122 cand pacientul isi
recastigS autonomia. \par\pard\qj \li1214\ri531\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex115 Credem cS edificarea unei psiho-socio-fizico-chimioterapii
familiale este \up0 \expndtw0\charscalex126 rnetoda de tratament a viitorului in
tulburarile sSnStatii individului s* \up0 \expndtw0\charscalex128 familiei. Psiho-
socio-fizico-chimioterapia cuprinde o paletS larga de \up0 \expndtw0\charscalex115
mijloace care "invelesc" cuvantul �i se asambleaze penetrant pentru
influen-\line \up0 \expndtw0\charscalex116 tarea pozitiva a comportamentelor si
relatiilor membrilor familiei, inducand \up0 \expndtw0\charscalex116 acea stare de
bine in libortate a intregului multiplu articulat si nedivizat. \par\pard\ql
\expndtw0\charscalex120 Bibliografie \par\pard\ql \li1545\sb170\sl-230\slmult0 \up0
\expndtw0\charscalex109 1. Alexander F Psychosomatic Medicine. Its principles and
application. New \par\pard\li1756\sb8\sl-230\slmult0\fi0\tx2260 \up0 \expndtw-
9\charscalex88 York.\tab \up0 \expndtw-9\charscalex88 1950.\par\pard\ql
\li1507\sb1\sl-196\slmult0\tx8092 \up0 \expndtw0\charscalex103 2. Athanasiti A.
Elemente de psihologie medicald. Ed. Medicald. Bucuresti. \tab \up0 \expndtw-
9\charscalex94 1973 \par\pard\ql \li1507\sb10\sl-214\slmult0\tx7905 \up0
\expndtw0\charscalex103 3. Fernandoz-Zodla A Freud si psihanalizele, Ed. Humamtas,
Bucuresti, \tab \up0 \expndtw-9\charscalex91 1996. \par\pard\ql
Gedler M., Gath D.. Mayou R. Tratat de psihiatrie Oxford (editia a tt-a), Editat
\line\tab \up0 \expndtw0\charscalex100 de Asociafia Psihiatrilor Libert din Romdnia
$i Geneva Initiative on Psychiatry, \line\tab \up0 \expndtw0\charscalex100
Bucuresti Amsterdam, \up0 \expndtw-9\charscalex91 1994. \par\pard\li1507\sb1\sl-
209\slmult0\fi0\tx7459 \up0 \expndtw0\charscalex104 5 lamandescu LB. Psihologie
medicald, Ed. Infomodica. Bucuresti.\tab \up0 \expndtw0\charscalex104
1995.\par\pard\li1507\sb1\sl-223\slmult0\fi4\tx7867 \up0 \expndtw0\charscalex105 6.
lonescu G. Psihosomatica Ed. Stiinfificd si Enciclopedicd. Bucuresti.\tab \up0
1975.\par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg34}{\bkmkend
220\slmult0 \par\pard\qj\li1420\ri696\sb183\sl-220\slmult0\tx1622 \up0
\expndtw0\charscalex115 7. Kaplan HI.. Sadock B.J. Comprehensive textbook of
PsychialryA/ (vol.2, fifth \line\tab \up0 \expndtw0\charscalex109 edition).
Williams and Wilkms, Baltimore. Hong Kong. London. Sydney, \up0 \expndtw-
6\charscalex100 1989. \par\pard\qj \li1406\ri701\sb0\sl-220\slmult0\tx1617 \up0
\expndtw0\charscalex121 8. Luban-Plozza B.. Poldinger W. Krdger F. Boli
psihosomatice in practica \line\tab \up0 \expndtw0\charscalex113 medicald, Ed
Medicald, Bucuresti, 1996. \par\pard\li1411\sb5\sl-207\slmult0\fi0\tx7872 \up0
\expndtw0\charscalex114 9. Restian A Patologia mformationald, Ed. Academiei Romdne,
Bucuresti.\tab \up0 \expndtw0\charscalex114 1997.\par\pard\li1411\sb14\sl-
207\slmult0\fi28 \up0 \expndtw0\charscalex115 10. Sahteanu V, Popescu-Sibiu I.
Introducere criticd in psihanalizd, Ed. Dacia.\par\pard\li1411\sb9\sl-
207\slmult0\fi302\tx2923 \up0 \expndtw0\charscalex109 Cluj-Napoca.\tab \up0
\expndtw0\charscalex114 1972\par\pard\li1411\sb9\sl-207\slmult0\fi28\tx7872 \up0
\expndtw0\charscalex115 II Sdhleanu V. Eseu do biologie informa(ionald, Ed.
Stiin(ilicd, Bucuresti.\tab \up0 \expndtw0\charscalex114
1973.\par\pard\li1411\sb9\sl-207\slmult0\fi28 \up0 \expndtw0\charscalex115 12.
Sdhleanu V. Conceptii despre om in medicina conlemporana. Ed. Dacia,
Cluj-\par\pard\li1411\sb13\sl-207\slmult0\fi316\tx2529 \up0 \expndtw0\charscalex108
N.ipoca.\tab \up0 \expndtw0\charscalex114 1976\par\pard\li1411\sb5\sl-
207\slmult0\fi28 \up0 \expndtw0\charscalex115 13 Vdleanu V.. Daniel C.
Psihosomatica leminind. Ed. medicald, Bucuresti, 1977.\par\pard\li1411\sb9\sl-
207\slmult0\fi33 \up0 \expndtw0\charscalex115 13 XXX - Health promotion research -
Towards a new social epidemiology (edited\par\pard\li1411\sb9\sl-
207\slmult0\fi292 \up0 \expndtw0\charscalex114 by B.Badura and llona Kickbusch),
WHO Regional Publications European\par\pard\li1411\sb18\sl-207\slmult0\fi297\tx2956
\up0 \expndtw0\charscalex114 Series No.37.\tab \up0 \expndtw0\charscalex114
\ul0\nosupersub\cf14\f15\fs24 Capitolul 3 \par\pard\ql \li1531\sb0\sl-
CADRUL ACTUAL DE DEFINIRE AL PSIHOSOMATICII. \par\pard\ql \li1526\ri774\sb15\sl-
360\slmult0 \up0 \expndtw0\charscalex100 TENTATIVE DE REFORMULARE A UNOR CONCEPT!
ALE \up0 \expndtw0\charscalex100 PSIHOSOMATICII (TULBURARI $1 BOLI
PSIHOSOMATICE) \par\pard\ql \li1550\sb208\sl-230\slmult0 \up0
\expndtw0\charscalex138 \ul0\nosupersub\cf9\f10\fs20 loan Bradu lamandescu
\par\pard\qj \li1238\sb0\sl-240\slmult0 \par\pard\qj\li1238\sb0\sl-240\slmult0
240\slmult0\fi297 \up0 \expndtw0\charscalex117 Unui dintre paradoxurile stiintelor
contemporane (vezi cazul Psihologiei, \up0 \expndtw0\charscalex118 al cSrei obiect
de studiu este incS nesatisfScStor definit) - este acela de a se \up0
\expndtw0\charscalex122 opera in plan teoretic si practic (inclusiv terapeutic
pentru medicina) \up0 \expndtw0\charscalex118 - cu \par\pard\qj
\li1233\ri551\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex118 concepte
insuficient
clarificate din punct de vedere al notelor de definite si, \up0
\expndtw0\charscalex118 desigur, s< al sferei notionale. \par\pard\qj
\li1233\ri534\sb3\sl-237\slmult0\fi297 \up0 \expndtw0\charscalex116 In ceea ce
pnveste definirea bolilor psihosomatice (BPS), eel care doreste \up0
\expndtw0\charscalex123 se obtine un reper - inductor al unor actiuni elective de
asistenta sau cer-\line \up0 \expndtw0\charscalex120 cetare medicala - remene
dezorientat prin absenta unor definitii (ocolite de \up0 \expndtw0\charscalex120
majoritatea psihosomaticienilor) a acestui grup de boli, cu o pondere con� \up0
\expndtw0\charscalex131 siderable ca frecventa a morbiditatii si reprezentand o
majore cauza \up0 \expndtw0\charscalex117 invalidante sau de deces. Nici DSM-IV nu
aduce lumine suficiente in aceas-\line \up0 \expndtw0\charscalex116 te privinte,
vehiculand termeni ce provoace conluzie, date fiind destinatia lor \up0
\expndtw0\charscalex115 stricte pentru medicii psihiatri (nici acestia nu sunt
total satisfacuti). DSM-IV \up0 \expndtw0\charscalex121 prezinte obsesia incadrerii
tulburarilor somatice in sindroame cu etiologie \up0 \expndtw0\charscalex116
psihice exclusive, fSre a tine cont ce tulburarea somatoforme (de ex. palpita-\line
\up0 \expndtw0\charscalex117 tiile) poate avea un substrat lezional (coronarian de
ex.) sau poate fi produse \up0 \expndtw0\charscalex130 alternativ de cetre stimuli
psihogeni sau de cetre factori nepsihogeni \up0 \expndtw0\charscalex120 (cafeaua de
ex.) Esen(a tulburarilor PS ar trebui sa fie in dubla lor nature -\line \up0
\expndtw0\charscalex117 tulburari functional reversibile sau tulburari patologice
(lezionale) induse de \up0 \expndtw0\charscalex117 fiecare data (la omul sSnStos
sau la eel bolnav) de factori psihici. \par\pard\qj \li1228\ri546\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex123 Considerand in plan general
carentele existente in domeniul definirii \up0 \expndtw0\charscalex120 bolilor
psihosomatice, ele isi au douS explica|n majore: confuzia ce se fa� \up0
\expndtw0\charscalex124 ce intre termenul de "conceptie psihosomatica" si eel de
boala psihoso� \up0 \expndtw0\charscalex125 matica (BPS) pe de o parte. si intre
notiunea de tulburari psihosomatice \up0 \expndtw0\charscalex125 (TPS) si boli
psihosomatice (BPS) pe de alta parte. \par\pard\qj \li1233\ri536\sb0\sl-
236\slmult0\fi288 \up0 \expndtw0\charscalex124 incercand sS propunem o serie de
reformulSri asupra conceptului de \up0 \expndtw0\charscalex118 BPS, va trebui sS
separSm "ab initio" aceasts problems de impas (definirea \up0
\expndtw0\charscalex123 BPS) de cea a definirii conceptiei psihosomatice, cu o
sfera eminamente \up0 \expndtw0\charscalex119 teoretica AceastS conceptie, este
mult mai bine definitS de cStre majorita� \up0 \expndtw0\charscalex117 tea
autorilor contemporani. dintre care am cita pe Von Uexkull: "interrelatia \up0
\expndtw0\charscalex117 dintre corpul, psihicul individului s< mediul sau social",
sau pe Duret: \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg36}
\ul0\nosupersub\cf18\f19\fs20\ul �\ul0\tab \up0 \expndtw0\charscalex106
\ul0\nosupersub\cf18\f19\fs20\ul Elemente de psihosomatica generala si
aplicata\par\pard\li1286\sb0\sl-230\slmult0\par\pard\li1286\sb83\sl-230\slmult0\fi9
\up0 \expndtw0\charscalex119 \ul0\nosupersub\cf9\f10\fs20 "orientare holistica a
medicinii pluricauzale care studiazS nu boala izolate.\par\pard\li1286\sb15\sl-
230\slmult0\fi0 \up0 \expndtw0\charscalex121 ci omul bolnav - adice bolnavul, in
perspectiva sa nosologice si ecologice\par\pard\li1286\sb5\sl-
230\slmult0\fi0\tx4387 \up0 \expndtw0\charscalex115 cea mai complete" (vezi
tabelul\tab \up0 \expndtw-9\charscalex91 1).\par\pard\li1286\sb1\sl-
398\slmult0\fi139 \up0 \expndtw0\charscalex195 \ul0\nosupersub\cf5\f6\fs36 \u9632?
i\par\pard\li1286\sb0\sl-180\slmult0\fi1555 \up0 \expndtw0\charscalex121
\ul0\nosupersub\cf9\f10\fs20 etui 1. Apticafii ale concept'ei
psihosomatice\par\pard\li1526\sb0\sl-230\slmult0\par\pard\li1526\sb5\sl-
230\slmult0\fi9\tx1761 \up0 \expndtw-9\charscalex87 1.\tab \up0
\expndtw0\charscalex107 ill PRACTICA MEDICALA\par\pard\li1526\sb10\sl-
230\slmult0\fi0\tx1771 \up0 \expndtw0\charscalex100 (J\tab \up0
\expndtw0\charscalex107 In diagnostic\par\pard\ql \li1751\sb1\sl-222\slmult0
\up0 \expndtw0\charscalex111 Metoda generald de investigare \par\pard\ql
\li1742\sb12\sl-230\slmult0 \up0 \expndtw0\charscalex111 Anamneza psihosomaticd:
\par\pard\ql \li2256\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex110 evidenfiazd
triggerii psihogeni \par\pard\qj \li1756\ri2988\sb2\sl-240\slmult0\fi499 \up0
\expndtw0\charscalex110 stabileste un modus Vivendi cu pacientul \up0
\expndtw0\charscalex111 Decelarea unor simptome psihosomatice \par\pard\qj
\li1751\ri804\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex110 Evidenfiazd
implicafiile bolii si mijloacelor terapeutice asupra calitdfii \up0
\expndtw0\charscalex104 viefii individului \par\pard\qj \li1516\ri3737\sb0\sl-
240\slmult0\fi240 \up0 \expndtw0\charscalex111 Reumanizarea re/aftei medic -
pacient \up0 \expndtw0\charscalex112 \u9633? in tratament \par\pard\qj
\li1751\ri2139\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex111 Remodelarea
comportamentelor nocive pentru sdndtate \up0 \expndtw0\charscalex112 Optimizarea
comp/ianfei terapeutice \par\pard\ql \li1751\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex113 Elaborarea de conduite antistres \par\pard\ql
\li2260\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex107 - individuale \par\pard\ql
\li2270\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex107 - colective
\expndtw0\charscalex110 Psihoterapia \u9632? favorizeazd verbalizarea trairilor
anxioase legate de \up0 \expndtw0\charscalex111 discomfortul simptomelor si
nesiguranfa cauzata de boald \line \tab \up0 \expndtw0\charscalex110 \u9632?
adjuvant al terapiei medicamentoase \par\pard\ql \li2270\sb11\sl-230\slmult0
\up0 \expndtw0\charscalex108 \u9632? ameliorarea suferinfei psihotogice
\par\pard\ql \li2265\sb1\sl-217\slmult0 \up0 \expndtw0\charscalex111 - suport moral
in lupta cu boala si problemele ei adiacente \par\pard\qj \li2380\ri809\sb4\sl-
240\slmult0 \up0 \expndtw0\charscalex110 apel la procedeele de grup cu roluri
multiple (inclusiv cresterea \up0 \expndtw0\charscalex111 complianfei
terapeutice) \par\pard\ql \li2270\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex109 -
cuplatd uneori cu medicafia psihotropd. \par\pard\li1516\sb17\sl-
230\slmult0\fi0\tx1756 \up0 \expndtw0\charscalex101 2\tab \up0
\expndtw0\charscalex101 JN CERCETARE\par\pard\ql \li1751\sb3\sl-230\slmult0 \up0
\expndtw0\charscalex111 Stabilirea \par\pard\ql \li2260\sb1\sl-217\slmult0 \up0
\expndtw0\charscalex111 - ponderii SP in patogenezd \par\pard\qj
mecanisme/or psihoneuroendocrine implicate \up0 \expndtw0\charscalex110 Permite
\par\pard\qj \li2265\ri1365\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex110 -
evaluarea afectdrii indicilor de calitate a viefii (in special \up0
\expndtw0\charscalex111 lestarea noilor medicamente) \par\pard\qj
\li2270\ri981\sb0\sl-260\slmult0 \up0 \expndtw0\charscalex110 \u9632? introducerea
unor metode de realizare a unei anume educafii \up0 \expndtw0\charscalex111
medicale a bolnavului \par\pard\ql \li1761\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex112 Clasificarea si omogenizarea unor concepte psihosomatice
Stabileste valoarea si limitele diferitelor procedee psihoterapeutice in \up0
\expndtw0\charscalex112 raport cu tratamentul medicamentos \par\pard\qj
\li1291\sb0\sl-240\slmult0 \par\pard\qj\li1291\ri499\sb7\sl-240\slmult0\fi288
\up0 \expndtw0\charscalex116 in interiorul aeestei "sfere" se cuprind intr-un mod
consistent BPS dar si \up0 \expndtw0\charscalex117 o parte componente - mai mice
sau mai mare - din celelalte boli ferS parti-\line \up0 \expndtw0\charscalex121
cipare etiologies majors a stresului psihic \up0 \expndtw0\charscalex117 (practic
sinonimS cu termenul \par\pard\ql \li1310\sb29\sl-230\slmult0 \up0
\expndtw0\charscalex112 "factor de rise-rise").
\expndtw0\charscalex126 \ul0\nosupersub\cf3\f4\fs18 Psihosomatica generala\tab \up0
\expndtw0\charscalex126 \u9830? 27\par\pard\qj \li1195\sb0\sl-240\slmult0
\ul0\nosupersub\cf9\f10\fs20 in cele ce urmeaza vom incerca se punctSm locul s<
semnificatia \up0 \expndtw0\charscalex114 principalilor termeni ce poartS
atributele psihosomaticii \par\pard\ql \li1502\sb209\sl-230\slmult0 \up0
\expndtw0\charscalex131 1. Conceptia psihosomatica si medicina psihosomatica
Conceptia psihosomaticS are drept corespondent in practica medicals o \up0
\expndtw0\charscalex123 "atitudine teoretica si terapeutica" (Buddeberg si colab.)
de considerare \up0 \expndtw0\charscalex117 a bolnavului nu numai din punct de
vedere somatic ci si psihic. Cu alte cu \up0 \expndtw0\charscalex123 vinte.
abordarea bolnavului se face global, cu ajutorul mijloacelor 'ten-\line \up0
\expndtw0\charscalex126 nice" deprinse de catre medic in cursul formarii sale
profesionale, dar \up0 \expndtw0\charscalex113 Si utilizand date ob(inute in cadrul
relatiei psihologice inerente actului medi� \up0 \expndtw0\charscalex120 cal, si
stratificatS, dupS modelul general stabilit de J. Piaget, pentru
orice \up0 \expndtw0\charscalex119 relate interpersonal, Tn cele 3 planuri.
cognitiv, afectiv $i relational. Desi \up0 \expndtw0\charscalex121 termenul de
"Medicina psihosomatica" (MPS) este un termen cu o sfera \up0
\expndtw0\charscalex126 de maxima generalitate, care include practic toatS
patologia \up0 \expndtw0\charscalex109 (datoritS \par\pard\ql \li1195\ri583\sb4\sl-
236\slmult0\fi14\tx1488 \up0 \expndtw0\charscalex115 implicSrii chiar s< mmimaie, a
factorului psihic in patogenezS si sanogene\up0 \expndtw0\charscalex115 zd) -
considerSm utila mentinerea acestui termen intr-un sens mai restrictiv.
\line\tab \up0 \expndtw0\charscalex122 Sustinem astfel, definirea MPS de catre
Buddeberg si colab., ca pe o \up0 \expndtw0\charscalex123 "disciplina stiintif ica
ce are ca obiect studierea relatiilor ce exista intre \up0 \expndtw0\charscalex123
factorii biologici. psihotogiei si sociali care intervin in explicarea sana-\up0
\expndtw0\charscalex123 tatn si bolii". avand drept corolar diagnostic si
terapeutic acea abordare \up0 \expndtw0\charscalex123 holistica (globala) a
bolnavului, mai sus amintita \par\pard\qj \li1195\ri583\sb8\sl-232\slmult0\fi292
\up0 \expndtw0\charscalex115 Aceaste definitie se bazeaze pe modelul bio-psiho-
social al bolii creat de \up0 \expndtw0\charscalex116 cetre Engel care "infatiseaze
intr-o maniera holistica ipotezele psihogeneti-\line \up0 \expndtw0\charscalex118
ce si biologice" (E. Heim) despre aparitia si evolutia bolii. Cunoscand im-\line
\up0 \expndtw0\charscalex123 plicatiile factorilor bio-psihosociali in aparitia
bolii . putem ob(me date \up0 \expndtw0\charscalex128 extrem de utile despre
sanogeneza care ar putea fi definite ca un an \up0 \expndtw0\charscalex117 samblu
de masun vizand pastrarea. redobandirea sau cultivarea sanata(n \par\pard\qj
\li1195\ri584\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex122 Acest model
bio-psihosocial al lui Engel a fost completat in anii din \up0
\expndtw0\charscalex122 urma de catre Ikemi printr-o noua dimensiune, "existentiala
sau ecolo� \up0 \expndtw0\charscalex118 gies", a funtei umane cereia i se
recunoaste dreptul la libertatea deciziei in \up0 \expndtw0\charscalex117 cadrul
unei autocunoasteri �i a perceperii de cetre individ a sensului vietii, \up0
\expndtw0\charscalex117 ca $i a asumeni responsabilitetil actelor sale.
\par\pard\qj \li1200\ri578\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex115 Un
astfel de model quadridimensional, propus de Ikemi. apare ca o ade-\line \up0
\expndtw0\charscalex122 verate "integrare a medicinii psihosomatice estice si
vestice" \up0 \expndtw0\charscalex124 (care este \par\pard\ql \li1200\sb1\sl-
215\slmult0 \up0 \expndtw0\charscalex116 dealtfel si titlul unei recente carti a
aceluiasi autor). \par\pard\ql \li1492\sb213\sl-230\slmult0 \up0
\expndtw0\charscalex126 2. Tulburari psihosomatice (TPS) \par\pard\qj
\li1195\ri598\sb186\sl-236\slmult0\fi297 \up0 \expndtw0\charscalex118 Revenind la
definirea TPS s' BPS, trebuie atrasa atentia asupra faptului \up0
\expndtw0\charscalex119 ca elementele def initiei mai largi a MPS cltate mai sus
vor trebui eel mai \up0 \expndtw0\charscalex125 adesea circumscrise bolilor
somatice, nepsihiatrice, deoarece in cazul \up0 \expndtw0\charscalex124 bolilor
psihice relatia dintre factorii psihosociali existential! si psihicul \up0
\expndtw0\charscalex122 bolnavului nu are nevoie de nici o demonstrate, fiind
evidenta si accep\up0 \expndtw0\charscalex122 tarea ca atare. \par\pard\qj
\li1200\ri583\sb0\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex117 Totusi. unele
tulburari psihosomatice persistente insotite si de un intens \up0
\expndtw0\charscalex118 disconfort psihic \up0 \expndtw0\charscalex121 ?i
somatic \up0 \expndtw0\charscalex123 (precum tinnitusul) pot ocupa o pozitie de
asociere. de comorbiditate, cu o tulburare psihiatrica (de exemplu: depresia)
\up0 \expndtw0\charscalex115 chiar dace aceasta a precedat-o, ambele avand o
origine psihicS. \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg38}
\expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs20 28\tab \up0
\expndtw0\charscalex106 \u9830?\tab \up0 \expndtw0\charscalex106 Elemente de
psihosomatica generala si aplicata\par\pard\qj \li1555\sb0\sl-240\slmult0
240\slmult0\fi297 \up0 \expndtw0\charscalex114 Din acest motiv vom incerca in cele
ce urmeazS sa propunem o defini(ie \up0 \expndtw0\charscalex122 a BPS menita sS
focalizeze atentia corpului medical nepsihiatric care Ie \up0
\expndtw0\charscalex119 trateaza, asupra factorufui psihic atat Tn aparitia, cat si
in ameliorarea lor \up0 \expndtw0\charscalex119 (rol terapeutic eel mai adesea
adjuvant). \par\pard\qj \li1550\ri226\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex122 inainte insa de prezentarea elementelor aeestei definitii
este necesara \up0 \expndtw0\charscalex114 delinirea tulburarilor psihosomatice
(TPS). ConsiderSm cS se poate porni de \up0 \expndtw0\charscalex126 la o definite
potrivita in acest sens, data de Huber, desi ea inglobeaza \up0
\expndtw0\charscalex127 atat tulburarile psihosomatice cat s< bolile psihosomatice:
"tulburdri \up0 \expndtw0\charscalex114 fizice (corporate) in a caror origine,
dezvoltare si persistenfd intervin factorii \up0 \expndtw0\charscalex120
psiho/ogici". Autorul men(ionat opereazS apoi in cadrul aeestei notiuni o \up0
\expndtw0\charscalex120 distinctie intre: \par\pard\qj \li1555\ri247\sb0\sl-
240\slmult0\fi408 \up0 \expndtw0\charscalex118 tulburari fara corespondents
organica demonstratS (de exemplu unele \up0 \expndtw0\charscalex119 dureri sau
vaginismul) - acestea fiind, in opinia noastrS, TPS -\up0 \expndtw0\charscalex116
�i boli cu \par\pard\qj \li1555\ri258\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex116 tulburari functionate stabile (exemplificand prin migrene
dar si prin astmul \up0 \expndtw0\charscalex116 bronsic, ce are inse o baze
organice demonstrate): \par\pard\ql \li2025\sb9\sl-230\slmult0\tx8481 \up0
\expndtw0\charscalex126 bolile psihogene insofite de degradari morfologice
obiective \tab \up0 \expndtw0\charscalex107 (de \par\pard\qj \li1550\ri262\sb2\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex113 exemplu: ulcerul, hipertensiunea
arteriaie si artrita reumatoide). N.B. Aceas� \up0 \expndtw0\charscalex116 ta a
doua categorie o considerem ca reprezentand bolile psihosomatice pro\up0
\expndtw0\charscalex116 priu-zise (in care se include si astmul bronsic in prima
ca^gorie). \par\pard\qj \li1550\ri258\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex122 in ceea ce ne priveste. considerem ce TPS pot fi definite
ca tulburari \up0 \expndtw0\charscalex124 ample si durabile ale unor procese
fiziologice ca urmare a unei stari de \up0 \expndtw0\charscalex122 oxcitatie
psihica anormala cu atributele unui stres psihic, sau reprezinta \up0
\expndtw0\charscalex120 o conditionare refiexa la o situatie anterior stresanta
(lamandescu. 1993) \up0 \expndtw0\charscalex123 Weiss mentioneaze drept o treseture
specifice a TPS faptul ce, s' la alti \up0 \expndtw0\charscalex116 indivizi, in
afara bolnavului cu TPS analizate, stresui psihic poate declansa \up0
\expndtw0\charscalex116 Si influenta in mod apreciabil evolutia unor TPS
asemanatoare. \par\pard\qj \li1545\ri248\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex119 Credem ca este extrem de importanta incadrarea TPS in sfera
cea mai \up0 \expndtw0\charscalex123 larga a tulburarilor functionale Acestea sunt
definite de cetre Gamier si \up0 \expndtw0\charscalex125 Delamare cit. de Gay
astfel: "tulburSri morbide. in general benigne si \up0 \expndtw0\charscalex114
reversibile. care par sS fie datorate unei simple perturbari ale activitatii
unui \up0 \expndtw0\charscalex118 organ, fere se existe la acest nivel o leziune
decelabiie (cu posibilita(ile de \up0 \expndtw0\charscalex118 investigare ale
momentului respectiv)". \par\pard\qj \li1545\ri252\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex118 Tulburerile functionale somatice (se exemplificem doar cu
doue dmtre \up0 \expndtw0\charscalex119 ele. extrem de rSspandite: dispneea si
palpita(iile) pot se apare in condi|ii \up0 \expndtw0\charscalex114 variate. efort
fizic, graviditate, introducerea in organism a unor alimente sau \up0
\expndtw0\charscalex119 substanje farmacologice (cafea, alcool, medicamente) dar si
in cazul unor \up0 \expndtw0\charscalex121 excitaf'i psihice. in acest dm urmS caz,
"tulburarile somatice functionale \up0 \expndtw0\charscalex122 cu declansare
psihogena" - formulare pe care o presupunem ca definite \up0
\expndtw0\charscalex123 concentrate a TPS - mai trebuie delimitate de asa numitele
"concomi-\par\pard\li1550\sb17\sl-230\slmult0\fi0\tx8097\tx8294 \up0
\expndtw0\charscalex124 tente emotionale" corelatele fiziologice ale emotiilor,
sau\tab \up0 \expndtw0\charscalex120 -\tab \up0 \expndtw0\charscalex124
dupa\par\pard\li1550\sb10\sl-230\slmult0\fi9\tx3633\tx3782\tx7545 \up0
\expndtw0\charscalex116 lormularea lui Freud\tab \up0 \expndtw0\charscalex120 -\tab
\up0 \expndtw0\charscalex114 "manifestSrile expresive ale emotiilor"\tab \up0
\expndtw0\charscalex124 (cu toate cS.\par\pard\qj \li1555\ri247\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex116 ceea ce Freud desemna - ca exprimare
clinice a acestor manifestSri - repre\up0 \expndtw0\charscalex119 zenta, de
asemenea, o largS categorie de tulburSri psihosomatice). Se cu\up0
\expndtw0\charscalex119 noaste faptul cS orice proces psihic se insoteste de
modilicSn lunctionale \up0 \expndtw0\charscalex115 somatice de diverse amplitudinl
in virtutea corelatiilor dintre cortex si orga\up0 \expndtw0\charscalex115 nele
interne, aparatul locomotor plus organele
de sim,. \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg39}
\ul0\nosupersub\cf3\f4\fs18 Psihosomatica generala\tab \up0 \expndtw-8\charscalex76
\u8226?>\tab \up0 \expndtw0\charscalex119 29\par\pard\qj \li1132\sb0\sl-233\slmult0
Expresia clinics a acestor modifican este foarte variats insS ea apare cei \up0
\expndtw0\charscalex119 mai pregnant in cadrul stSrilor afective (de unde s1
denumirile anterioare \up0 \expndtw0\charscalex114 men(ionate) cu toate cS si
procesele cognitive (de exemplu transpiratia frun \up0 \expndtw0\charscalex116 tii
in cursul unor exercitii de calcul mintal) sau mai ales cele volitionale ge\up0
\expndtw0\charscalex112 nereazS. si ele. modificSri perceptibile mai ales la nivel
cutanat (de exemplu: \up0 \expndtw0\charscalex117 vasodilatatia) sau muscular
(variatii ale tonusului muscular, unele ml^cSri \up0 \expndtw0\charscalex110
Involuntare, etc.). \par\pard\qj \li1132\ri671\sb7\sl-233\slmult0\fi292 \up0
\expndtw0\charscalex121 incercand sS definim aceste modificSri somatice sincrone
sau conse \up0 \expndtw0\charscalex118 cutive proceselor psihice (in special
alective), corespunzand unei "activan \up0 \expndtw0\charscalex115 fiziologice"
dupS expresia lui Huber, propunem termenul de "concomitente \up0
\expndtw0\charscalex115 somato-viscerale ale proceselor psihice". (CSVP) inclusiv
ale emotiilor. \par\pard\qj \li1132\ri662\sb10\sl-230\slmult0\fi288 \up0
\expndtw0\charscalex114 Cu ajutorul unui astfel de termen (CSVP), vom putea
diferen|ia - asa cum \up0 \expndtw0\charscalex118 o fac unii autorl - precum
Dongier, in cadrul simptomelor somatice gene� \up0 \expndtw0\charscalex118 rale
nespecifice aparute in cursul emotiilor \u8226? doua etape succesive:
cea deja mentionatS, a corelatelor somato-viscerale (componente psiho\up0
\expndtw0\charscalex114 fiziologice ale reactiei emotionale) cu tendinta de
revenire rapida la normal; \par\pard\qj \li1132\ri667\sb6\sl-233\slmult0\fi288 \up0
\expndtw0\charscalex120 - tulburarile psihosomatice. pe care Ie consideram ca fiind
CSVP mai \up0 \expndtw0\charscalex130 ample si mai persistente ce se pot organiza
intr-un adevSrat pattern \up0 \expndtw0\charscalex119 psihosomatic, specific
fiecSrui individ, ce apare cu ocazia stresului psihic \up0 \expndtw0\charscalex119
(de exemplu unii acuza crampe epigastrice, altii opresiune toracica. etc.)
\par\pard\qj \li1128\ri665\sb7\sl-233\slmult0\fi297 \up0 \expndtw0\charscalex119 De
regulS - si aici cvasiunanimitatea autorilor o recunoaste - repetarea \up0
\expndtw0\charscalex125 sau mentinerea in regim constant (stres cronic) a TPS
(considerate de \up0 \expndtw0\charscalex123 noi ca eminamente functionale) conduce
in cele din urma la "organici-\line \up0 \expndtw0\charscalex131 zarea" lor, cu
aparitia bolilor psihosomatice \up0 \expndtw0\charscalex124 (BPS), caracterizate in
\par\pard\ql \li1123\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex116 esenta lor
prin existenta unui substrat lezional anatomo-hislopatologic. \par\pard\qj
\li1128\ri674\sb2\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex121 Mecanismele
prin care TPS conduc in cele din urmS la apari(ia unor \up0 \expndtw0\charscalex114
leziuni de organ au la bazS: \par\pard\qj \li1118\ri666\sb0\sl-240\slmult0\fi302
\up0 \expndtw0\charscalex131 - persistenta sau repetarea actiunii unor factori
stresanfi al cSror \up0 \expndtw0\charscalex118 efect devine in interiorul
organismului extrem de agresiv, in cazul emotiei \up0 \expndtw0\charscalex124
blocate la exterior \up0 \expndtw0\charscalex117 (Sivadon) prin dereglSrile neuro-
vegetativ-endocrine \par\pard\qj \li1123\ri681\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex114 frecvente (Delay) inerente oricSrei reactii de stres (a se
vedea si rolul variat, \up0 \expndtw0\charscalex114 polimorf si fluctuant al
hormonilor de stres - M. Coculescu): \par\pard\ql \li1416\sb1\sl-191\slmult0\tx6388
\up0 \expndtw0\charscalex130 - suprasolicitarea functionala a unor structuri
\tab \up0 \expndtw0\charscalex135 - eel mai adesea -\par\pard\qj
\li1118\ri677\sb9\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex118 grevate de
anumite "defecte" (induse genetic de cStre alti factori specific" \up0
\expndtw0\charscalex118 organului respectiv) \par\pard\ql \li1411\sb9\sl-
230\slmult0\tx3340 \up0 \expndtw0\charscalex118 Conceptul de TPS \tab \up0
\expndtw0\charscalex122 - ca fiind tulburSri somatice functionale de cauza
psihice - facend parte - eel mai adesea din tabloul clinic al stresului - este \up0
\expndtw0\charscalex129 eminamente clinic, bazandu-se pe autoobservatia bolnavului
sau pe \up0 \expndtw0\charscalex130 observatia clinice a medicului. in aceasta din
urma categorie putem \up0 \expndtw0\charscalex117 exempllfica: cresierea tensiunn
artenale in cursul unui interviu stresant sau \up0 \expndtw0\charscalex129 aparitia
unui eritem al fetei. ignorat uneori de catre bolnav Trasarea \up0
\expndtw0\charscalex130 iimitelor dincolo de care corelatele somato-viscerale ale
proceselor \up0 \expndtw0\charscalex123 psihice devin tulburarPpsihosomaticc este
arbitrara, ea corespunzand \u8226? \up0 \expndtw0\charscalex125 Si fiind la fel de
greu de trasat - cu cea care separa o emotic minimala \up0 \expndtw0\charscalex128
sau moderata de instalarea unui stres psihic in cadrul caruia latura sa \up0
\expndtw0\charscalex117 emotionaia este deosebit de ampla s1 se prelungeste
adeseori cu mult dupa \up0 \expndtw0\charscalex117 incetarea actiunii agentului
stresor. \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg40}{\bkmkend
\up0 \expndtw0\charscalex106 Elemente de psihosomaticd generala si
\expndtw0\charscalex122 Intrucat autorii care au utilizat termenul de TPS au avut
in vedere tot \up0 \expndtw0\charscalex114 criteriul clinic de evaluare. considerem
ce in diferentierea TPS de CSVP, un \up0 \expndtw0\charscalex133 element ajutator
ii poate constitui disconfortul pe care il relateaza \up0 \expndtw0\charscalex116
bolnavul (de aici termenul de "trouble"), ca si producerea unor TPS Tn fata \up0
\expndtw0\charscalex116 medicului. confirmate de acesta \par\pard\qj
\li1689\ri140\sb19\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex120 Cadrul de
aparitie al TPS, apreciate Tn special cu ajutorul mijloacelor \up0
\expndtw0\charscalex120 clinice - este constituit de prezenta lor la:
omul sanatos aflat sub actlunea unui stres psihic (TPS constituie o \up0
\expndtw0\charscalex113 exprimare somato-viscerale a stresului, de exemplu:
Tncordarea musculaturii \up0 \expndtw0\charscalex113 cetei, tahicardie,
hiperventilatie, paloare sau eritem al fetei, etc.); \par\pard\qj
\li1694\ri136\sb0\sl-252\slmult0\fi292 \up0 \expndtw0\charscalex123 - bolnavul cu
tulburari nevrotice. a carui vulnerabilitate fata de stres \up0
\expndtw0\charscalex123 sporesle frecventa apantiei TPS care devin asociate extrem
de frecvent \up0 \expndtw0\charscalex116 tulburarilor psihice propriu-zise ale
bolnavului nevrotic. Vulnerabilitatea la \up0 \expndtw0\charscalex118 stres a
acestuia este mult crescuta in raport cu cea a subiectului sSnStos si \up0
\expndtw0\charscalex119 semnificativ mai mare fats de cea a unui individ cu o BPS
fSrS asocierea \up0 \expndtw0\charscalex111 unor tulburSri nevrotice (lamandescu,
1980, 1987) \par\pard\qj \li1699\ri130\sb0\sl-253\slmult0\fi288 \up0
\expndtw0\charscalex134 La bolnavii nevrotici persists adesea o serie de stresuri
psihice \up0 \expndtw0\charscalex113 "atenuate" deci TPS apar in mod Irecvent, ceea
ce justifies Tn parte afirmatia \up0 \expndtw0\charscalex114 lui Mayer-Gross cS TPS
sunt in marea lor majoritate tulburSri somatice care \up0 \expndtw0\charscalex114
apar la nevrotici. \par\pard\ql \li1991\sb1\sl-199\slmult0 \up0
\expndtw0\charscalex123 - bolnavii cu BPS. la care un caracter particular al TPS
(de exemplu \par\pard\qj \li1694\ri133\sb18\sl-252\slmult0 \up0
\expndtw0\charscalex121 dispneea la astmatic sau la hipertensiv) este dat de
reaparitia acestora cu \up0 \expndtw0\charscalex114 ocazia stresului, Tn conditiile
coexistentei unor leziuni organice pe care TPS \up0 \expndtw0\charscalex114 Ie
agraveazS prin intensitatea s< mai ales repetarea lor frecvents. In plus, un
\up0 \expndtw0\charscalex117 bolnav cu o BPS cantonatS la nivelul unui organ (de
exemplu un astmatic) \up0 \expndtw0\charscalex119 poate sS prezinte TPS afectand
reversibil alte organe (palpitatii, tulburSri \up0 \expndtw0\charscalex111
sexuale); \par\pard\qj \li1694\ri128\sb0\sl-251\slmult0\fi297 \up0
\expndtw0\charscalex117 - bolnavii cu psihoze, la care existenta TPS (sS amintim
doar tahicardia \up0 \expndtw0\charscalex125 Si cresterile tensionale, ca si
faciesul vultuos al unor bolnavi in cadrul \up0 \expndtw0\charscalex129 puseelor de
excitatie maniacaie) este certS dar adesea estompata de \up0
\expndtw0\charscalex126 gravitatea tulburarilor psihice. in once caz nu este rara
asocierea unei \up0 \expndtw0\charscalex124 psihoze cu BPS (in cazulstica noastra
am
urmarit 2 bolnavi cu schizo\up0 \expndtw0\charscalex124 frenie suferind de ulcer
duodenal si respectiv, astm alergic la polen, un \up0 \expndtw0\charscalex114 caz
recent: tatSI cu astm bron$ic s> tulburSri nevrotice, iar fiul, cu astm ato\up0
\expndtw0\charscalex114 pic omonim $i schizofrenie). \par\pard\ql \li1991\sb1\sl-
200\slmult0 \up0 \expndtw0\charscalex118 Asa cum se observS in cazul clasificSrii
de fata, TPS apar nu numai la \par\pard\qj \li1708\ri123\sb23\sl-245\slmult0
\up0 \expndtw0\charscalex123 nevrotici ci s< 'a subiectii normali psihic sau la
indivizii cu tulburari de \up0 \expndtw0\charscalex113 personalitate (psihopatii in
vechea clasificare a bolilor psihice) ori la bolnavi \up0 \expndtw0\charscalex124
cu psihoze exogene sau endogene. Este adevarata, dar nu in totalitate, \up0
\expndtw0\charscalex125 opinia unor autori psihanalistl referitoare la roal TPS de
"paratraznet" \up0 \expndtw0\charscalex123 sau de focalizarea interesului
bolnavilor spre organele afectate. ceea ce \up0 \expndtw0\charscalex117 diminua
intr-o oarecare masure tensiunea lor psihice extrem de crescute in \up0
\expndtw0\charscalex118 cadrul bolii lor de baze, dar in BPS acest rol este doar
"consolator" fate de \up0 \expndtw0\charscalex118 substratul lezional activat de o
multime de agenti etiologici.
\par\pard\ql\li1416\sb188\sl-230\slmult0 \up0 \expndtw0\charscalex131 3. Bolile
psihosomatice \par\pard\qj \li1118\ri676\sb202\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex117 Bolile psihosomatice (BPS). adesea insuficient detasate de
catre diversi \up0 \expndtw0\charscalex126 auton psihosomaticieni, de tulburarile
psihosomatice \up0 \expndtw0\charscalex129 (care in opinia \par\pard\qj
\li1123\ri670\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex115 noastrS, sunt incluse
Tn sfera BPS si/sau Ie preced), au fost nominalizate de \up0
\expndtw0\charscalex115 Scoala lui Alexander la mijlocul acestui secol, dupS cum
urmeazS: \par\pard\ql \li1857\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex112 -
ulcerul duodenal \par\pard\ql \li1862\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex113 - colita ulceroasS \par\pard\ql \li1862\sb10\sl-230\slmult0
\up0 \expndtw0\charscalex114 - neurodermita (dermatita atopies) \par\pard\ql
\li1867\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex111 - astmul bron�ic
\par\pard\ql \li1871\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex112 - artrita
reumatoidS \par\pard\ql \li1857\sb1\sl-217\slmult0 \up0 \expndtw0\charscalex118 -
hipertensiunea artenala \par\pard\ql \li1857\sb13\sl-230\slmult0 \up0
\expndtw0\charscalex110 - tireotoxicoza \par\pard\qj \li1118\ri660\sb0\sl-
243\slmult0\fi297 \up0 \expndtw0\charscalex127 in zilele noastre, acest capitol de
patologie s-a extins considerabil \up0 \expndtw0\charscalex125 (numai in
cardiologie am putea cita: infarctul miocardic, prolapsul de \up0
\expndtw0\charscalex119 valvS mitrala, sindromul Da Costa, sindromul X \u8226?
Likoff, etc.), si limitele \up0 \expndtw0\charscalex117 sale nu mai pot fi
stabilite decat cu o dozS de arbitrar, fapt ce ne-a fScut sa \up0
\expndtw0\charscalex114 considerSm extrem de necesarS o tentativS de a defini
bolile psihosomatice, \up0 \expndtw0\charscalex127 atat pe baza criteriilor
utilizate divers si adesea exclusivist, de autorii \up0 \expndtw0\charscalex114
acestor definitii \up0 \expndtw0\charscalex115 (de regulS, psihosomaticieni de
sorginte psihanaliticS), cat \par\pard\qj \li1123\ri665\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex114 Si pe baza unei experiente (bazatS pe o dubIS formatie, de
medic internist �i \up0 \expndtw0\charscalex118 psiholog) Tn domemul unei patologii
psihosomatice tipice, aceea a bolilor \up0 \expndtw0\charscalex118 alergice (cu
astmul bronsic cap de lists). \par\pard\qj \li1123\ri650\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex121 Pornind de la o definite care dilata
nepermis de mult sfera notiunii de \up0 \expndtw0\charscalex116 BPS. "toate bolile
somatice ce prezinta componente psihologice" (Karasu -\line \up0
\expndtw0\charscalex118 1980) s-ar putea justifies opinia lui Hinkle. care afirma
ca, din moment ce \up0 \expndtw0\charscalex130 toate bolile au implica(ii
psihosomatice, ar fi inutila separarea unui \up0 \expndtw0\charscalex121 grup de
BPS (de exemplu, am putea include aici si fracturile generate de \up0
\expndtw0\charscalex121 neatentia unui om puternic stresat, care calcS intr-o
groape). \par\pard\qj \li1123\ri651\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex115 Din aceste motive, legate de justificarea unei noi
patologii psihosomatice \up0 \expndtw0\charscalex119 dar si de extensia maxima a
sferei notionale a BPS - considerem necesara \up0 \expndtw0\charscalex117 imtierea
unei argumentatii care se restrangS acest domeniu al BPS la acele \up0
\expndtw0\charscalex114 boli care - pe langS interventia factorului psihic in
etiopatogenia lor, unanim \up0 \expndtw0\charscalex123 recunoscute ca element de
definite - prezinta si alte trasaturi definitorii, \up0 \expndtw0\charscalex114
usor de recunoscut (vezi tabelul 2). \par\pard\qj \li1123\ri651\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex123 1. Rolul factorilor psihici in
etiopatogeneza BPS trebuie - Tn opinia \up0 \expndtw0\charscalex118 noastre mult
mai clar precizat si nuantat deoarece la o aceeasi boala. ca de \up0
\expndtw0\charscalex116 exemplu ulcerul duodenal, unii autori \up0
\expndtw0\charscalex121 (Weiss) considere ce este vorba de \par\pard\qj
\li1128\ri655\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex113 BPS numai Tn
acele cazuri in care este evidenta interventia factorului psihic, \up0
\expndtw0\charscalex114 desi \up0 \expndtw0\charscalex118 \u8226? in opinia noastra
- acelasi bolnav poate sS-$i reactiveze ulcerul, fie \up0 \expndtw0\charscalex118
dupS un stres psihic. fie dupS utilizarea aspirinei. \par\pard\qj
\li1132\ri651\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex133 La aceasta notS
a definitiei BPS, putem sistematiza interventia \up0 \expndtw0\charscalex122
factorului psihic in etiopatogenia BPS, astfel: \par\pard\qj \li1128\ri646\sb0\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex122 - participa alternatlv sau sumativ
cu ceilalti factori etiologici organo\up0 \expndtw0\charscalex116 specifici
(fizici, chimici, biologici, etc.) la aparitia si evolutia BPS (inclusiv \up0
\expndtw0\charscalex116 complicatii sau deces).
\expndtw0\charscalex106 \ul0\nosupersub\cf18\f19\fs20\ul 32\ul0\tab \up0
\expndtw0\charscalex106 \ul0\nosupersub\cf18\f19\fs20\ul \u9830?\ul0\tab \up0
\expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs20 Elemente de psihosomatica
generala $i aplicata\par\pard\li1502\sb0\sl-230\slmult0\par\pard\li1502\sb0\sl-
\expndtw0\charscalex126 - multi dintre acesti factori\tab \up0
\expndtw0\charscalex126 ..organo-specifici" sunt rezultatul
unor\par\pard\li1502\sb15\sl-230\slmult0\fi0\tx5779\tx8630 \up0
\expndtw0\charscalex126 comportamente nocive pentru sanatate\tab \up0
\expndtw0\charscalex121 (studiul Alameda stabileste\tab \up0
\expndtw0\charscalex126 5\par\pard\qj \li1507\ri292\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex116 factori majori de rise pentru bolile contemporane cu maxims
morbiditate $i \up0 \expndtw0\charscalex115 mortalitate: fumatul. consumul excesiv
de alcool, lipsa miscSril, supragreu\up0 \expndtw0\charscalex115 tatea $i somnul
redus < 7-8 ore). Aceste comportamente au la bazS. eel mai \up0
\expndtw0\charscalex115 adesea, factori de ordin psihologie. \par\pard\qj
\li1497\ri282\sb0\sl-240\slmult0\fi494 \up0 \expndtw0\charscalex128 poate crea
aparenta exclusivitatii etiologice, atunci cSnd ceilal|i \up0
\expndtw0\charscalex113 agenji etiologici specifici bolii nu sunt implicabili in
momentul respectiv (dar \up0 \expndtw0\charscalex120 isi pastreazS potentialul lor
patogen Tn orice alt moment). Cand factorul \up0 \expndtw0\charscalex120 psihic
intervine aparent exclusiv, se creaza premisele izolSrii unor forme \up0
\expndtw0\charscalex118 cllnico-etiologice desemnate ca "psihogene", dar nevalidate
de cercetSrile \up0 \expndtw0\charscalex123 ultimelor decenii. De exemplu, astmul
bronsic psihogen a fost negat in \up0 \expndtw0\charscalex116 lucrSrile noastre
incS din \up0 \expndtw0\charscalex120 1980. sustinandu-se ideea cS declansarea unor
\par\pard\qj \li1502\ri277\sb0\sl-246\slmult0 \up0 \expndtw0\charscalex116 crize de
astm de cStre stresui psihic necesitS in mod obligatoriu un teren al \up0
\expndtw0\charscalex123 cSrui substrat este reprezentat de o hiperreactivitate
bronsicS indusS de \up0 \expndtw0\charscalex125 factori genetici sau dobandlti,
alergici si nealergici, diferiti de factorul \up0 \expndtw0\charscalex112
psihic. \par\pard\ql \li1800\sb0\sl-180\slmult0 \up0 \expndtw0\charscalex119 Chiar
dacS exists sindroame cu declansare constants psihogenS, ca de \par\pard\qj
\li1507\ri282\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex119 exemplu urticaria
cohnergica. mecanismul de Interventie al stresului psi� \up0
\expndtw0\charscalex121 hic se cupleaza la un mecanism mai general, numitor comun
pentru cel-\line \up0 \expndtw0\charscalex128 lalti agenfi etiologici
nepsihogeni \up0 \expndtw0\charscalex120 (efortul fizic, sursele de cSldurS-in
\par\pard\qj \li1507\ri288\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex117 cazul
respectiv) Astfel, in ultima instants, lactorul
psihogen rSmane numai \up0 \expndtw0\charscalex118 unui dintre agentii etiologici
ai sindromului urticarian Tn cadrul eliologiei \up0 \expndtw0\charscalex118
pluricauzale a tuturor bolilor psihosomatice. \par\pard\qj \li1502\ri267\sb4\sl-
245\slmult0\fi307 \up0 \expndtw0\charscalex131 Exists numeroase cazuri de bolnavi
cu BPS Tn care medicul are \up0 \expndtw0\charscalex122 posibilitatea sS constate,
de fats cu bolnavii respectivi, cS nici stresurile \up0 \expndtw0\charscalex136
psihice majore survenite brusc la acestia nu declanseaza imediat \up0
\expndtw0\charscalex117 manifestSrile clinice de BPS (neaparitia crizelor la unii
astmatici observati \up0 \expndtw0\charscalex116 de noi in cursul unor stresuri
psihice situationale apSrute intempestiv sau al \up0 \expndtw0\charscalex114 unor
stresuri provocate printr-un test propriu de inducere a stresului (laman� \up0
\expndtw0\charscalex114 descu, 1980, \up0 \expndtw0\charscalex115 1991). Analizand
acesti bolnavi care tolereaze, lere simptome \up0 \expndtw0\charscalex119 clinice
de BPS. unele stresuri psihice, am considerat posibile urmetoarele \up0
\expndtw0\charscalex108 explicatii: \par\pard\qj \li1516\ri262\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex118 \u8226? stresui "perceput" de
subiect nu a fost identic cu eel anticipat de cetre \up0 \expndtw0\charscalex114
observator. Existe observatii clinice \up0 \expndtw0\charscalex116 (precum cele
raportate de Klumbies si \par\pard\qj \li1516\ri258\sb0\sl-244\slmult0 \up0
\expndtw0\charscalex111 colab. la bolnavii coronarieni urmeriti prin sugestia sub
hipnozS a unor traume \up0 \expndtw0\charscalex136 psihice anterioare. din
biografia acestora) care atesta importanta \up0 \expndtw0\charscalex130
semnificatiei elective pentru subiectii respectivi a situatiei stresante \up0
\expndtw0\charscalex111 evocate. A$adar nu poate fi exclusS in cazurile relatate de
noi (bolnavi aparent \up0 \expndtw0\charscalex122 "rezistenti" la stres)
eventualitatea aparitiei unor crize de astm la aceiasi \up0 \expndtw0\charscalex112
bolnavi. in cursul altor stresuri cu un impact afectiv mai mare asupra lor.
\u8226? Bolnavii tineri. cu o vulnerabiiitate la stres mai redusa dar si cu \up0
\expndtw0\charscalex121 forme incipiente sau usoarc de boala (9 din cazurile
urmSrite de noi ast-\line \up0 \expndtw0\charscalex121 maticii si urticarienii cu
evolutie discontinuS) declanseaza mai greu pusee \par\pard\qj \li1545\ri269\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex125 - sub actiunea stresului psihic - decat
bolnavii varstnici sau cei cronici \up0 \expndtw0\charscalex119 Si cei cu probleme
severe ale BPS respective A$a de exemplu. astmaticii
corticodependenti declanseazS in peste \tab \up0 \expndtw0\charscalex128 86% din
cazuri, crize chiar la \par\pard\ql \li1003\sb10\sl-230\slmult0\tx3734\tx5169
\up0 \expndtw0\charscalex124 stresuri psihice moderate \tab \up0
\expndtw0\charscalex114 (lamandescu, \tab \up0 \expndtw0\charscalex123 1996) iar
bolnavii cu urticarie \par\pard\qj \li998\ri801\sb19\sl-220\slmult0 \up0
\expndtw0\charscalex114 cronica idiopatica si evolutie indelungatS acuzS in
aceleasi conditii eel putin \up0 \expndtw0\charscalex115 prurit dacS nu aparitia
eruptiei intr-o proportie de 90% (lamandescu, \up0 \expndtw-3\charscalex100
1997). \par\pard\qj \li998\ri795\sb0\sl-250\slmult0\fi283 \up0
\expndtw0\charscalex122 2. Terenul de aparitie este reprezentat, Tn opinia noastrS,
de o dubla \up0 \expndtw0\charscalex126 vulnerabilitate a bolnavului la stresui
psihic: vulnerabilitate psihica si \up0 \expndtw0\charscalex115 vulnerabihtate de
organ (locus minoris resistentiae). \par\pard\qj \li1003\ri785\sb0\sl-
244\slmult0\fi297 \up0 \expndtw0\charscalex125 J Personalitatea vulnerabila la
stresui psihic - mlocuieste, in opinia \up0 \expndtw0\charscalex116 noastra \up0
\expndtw0\charscalex121 (argumentata de studiul tipurilor de personalitate ale
bolnavilor \up0 \expndtw0\charscalex119 psihosomatici astmatici, urticarieni.
hipertensivi si ulcerosi) asa-nurnitele \up0 \expndtw0\charscalex122 "tipuri de
personalitate specifice diverselor BPS", postulate de Flanders \up0
\expndtw0\charscalex117 Dunbar si neconfirmate de majoritatea autorilor din
ultimele decenii (citati \up0 \expndtw0\charscalex113 in lucrSrile de sintezS
elaborate de G. lonescu 1975 si 1990). \par\pard\qj \li993\ri774\sb0\sl-
242\slmult0\fi297 \up0 \expndtw0\charscalex149 Ea are o sfera mai larga ce
depaseste asa-numitul "tip de \up0 \expndtw0\charscalex124 personalitate specific
BPS in general", care includea si alexitimia, des-\line \up0
\expndtw0\charscalex125 crisa de Nemiah si Siffneous, sau alexisomia, de care
vorbeste Ikemi, \up0 \expndtw0\charscalex122 trSsStun care sunt de neimaginat la
subiectii cu una sau mai multe BPS \up0 \expndtw0\charscalex136 provenind din lumea
artisticS. Bolnavii psihosomatici sunt marl \up0 \expndtw0\charscalex116
colectionari de stres fiind reprezentati in planul comportamental (indiferent
\up0 \expndtw0\charscalex129 de structura ceiorialte compartimente ale
personalitstii) de subiectii \up0 \expndtw0\charscalex125 apartinand tipurilor
psiho-comportamentale A sau C dar si de cei care \up0 \expndtw0\charscalex133
prezinta o intensitate crescuta a unor trasaturi de personalitate \up0
\expndtw0\charscalex107 (de \par\pard\ql \li1003\sb1\sl-202\slmult0\tx7502 \up0
\expndtw0\charscalex113 exemplu, cote crescute la chestionarul MMPI) (lamandescu
1980 si \tab \up0 \expndtw-4\charscalex100 1993). \par\pard\qj
\li1003\ri785\sb7\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex118 Din datele
ob(inute de noi, rezulta cS vulnerabilitatea la stres a celor cu \up0
\expndtw0\charscalex125 BPS este intermediara (ca amplitudine a unor trasaturi
dezadaptative) \up0 \expndtw0\charscalex128 fata de cea a bolnavilor neurotlci \up0
\expndtw0\charscalex128 (maxima) si a subiectilor sanatosi \par\pard\ql
\li1003\sb9\sl-230\slmult0\tx3892 \up0 \expndtw0\charscalex115 (minima) (lamandescu
1980, \tab \up0 \expndtw0\charscalex115 1985). Este posibil ca sS existe
particulariteti \par\pard\ql \li998\ri771\sb0\sl-243\slmult0\fi9\tx1286 \up0
\expndtw0\charscalex124 la nivel hipotalamic facilitatoare pentru o rezonan'S
crescutS la stresui \up0 \expndtw0\charscalex114 psihic, avand implicatii si asupra
sferei somato-viscerale (Von Eiff-1978). \line\tab \up0 \expndtw0\charscalex125
Vulnerabilitatea la stres a bolnavilor cu BPS consta deci, in primul \up0
\expndtw0\charscalex127 rand, intr-o predispozitie a acestora de a "intra" mai usor
Tn stres. La \up0 \expndtw0\charscalex125 tipul psihocomportamental A, stresurile
devin inerente prin ambitia si \up0 \expndtw0\charscalex131 exigentele crescute ale
bolnavilor respectivi care prin modul lor de \up0 \expndtw0\charscalex120
comportament intra deseori in situatii conflictuale externe \up0
\expndtw0\charscalex113 (competitii) si \par\pard\qj \li1003\ri787\sb16\sl-
220\slmult0\fi19\tx1766 \up0 \expndtw0\charscalex108 Interne \tab \up0
\expndtw0\charscalex115 (reprimarea unor motivatii cu tente relaxante) iar in plan
fiziologic, \up0 \expndtw0\charscalex128 reactivitatea lor vasculare la
catecolamine \up0 \expndtw0\charscalex123 (inclusiv nivelul eliberani
\par\pard\ql \li1003\sb32\sl-230\slmult0 \up0 \expndtw0\charscalex116 acestora)
este mai intense si prelungitS decat la tipul B. \par\pard\qj \li998\ri766\sb0\sl-
242\slmult0\fi302 \up0 \expndtw0\charscalex127 In schimb la tipul C. llpsa de
centrare pe problems, cu punerea Tn \up0 \expndtw0\charscalex117 "parantezS" a
situatiei stresante, inclusiv amSnarea prezentSrli la medic in \up0
\expndtw0\charscalex118 cazul apantiei unei probleme de sSnState, care ar putea
reprezenta o boalS \up0 \expndtw0\charscalex107 gravS, \up0 \expndtw0\charscalex120
(Marilou Bruchon-Schweitzer), constituie factori de cronicizare a \up0
\expndtw0\charscalex128 stresului psihic ce acjioneaza la nivel subconstient in
ciuda refuzului \up0 \expndtw0\charscalex134 bolnavei de a se gSndi la problema
stresanta ramasa nerezolvate. \up0 \expndtw0\charscalex133 Corespondentul hormonal
al acestui tip de comportament evltant, \up0 \expndtw0\charscalex127 disimulant al
stresului (inclusiv refuzul unei comunicari ce ar fi putut \up0
\expndtw0\charscalex127 permite obfinerea unui suport social), este constituit de
cresterea de \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg44}
generala si aplicata\par\pard\ql \li1449\sb0\sl-230\slmult0
\par\pard\ql\li1449\sb0\sl-230\slmult0 \par\pard\ql\li1449\sb163\sl-
230\slmult0\tx8452 \up0 \expndtw0\charscalex126 cortizol plasmatic, responsabila de
diminuarea imumtatn celulare \tab \up0 \expndtw-9\charscalex83 (Tn \par\pard\ql
\li1454\ri330\sb0\sl-245\slmult0\fi4\tx1747 \up0 \expndtw0\charscalex116 special
celulele NK) (Khansari, Dantzer-1994) ?i consecutiv - aparitia unor \up0
\expndtw0\charscalex116 infectii cronice ori a unor cancere (in special cancerul de
san). \line \tab \up0 \expndtw0\charscalex117 \u9633? Terenul de organ meiopragic
(morfofunctional) constituie nota prin� \up0 \expndtw0\charscalex119
cipal de definite a BPS ce indicS "un tropism" pentru propagarea actiunii \up0
\expndtw0\charscalex118 nocive a stimulilor psihici. Organul "fragil" \up0
\expndtw0\charscalex121 (prin "defecte genetice" sau \par\pard\qj
\li1454\ri325\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex121 dobandite)
constituie o "cutie de rezonan(S" pentru stres dar si un loc de \up0
\expndtw0\charscalex116 fixare a unor reflexe conditionate elaborate la o serie de
stimuli psihici fara \up0 \expndtw0\charscalex119 valoare de stres Autori ca Bauer
(incS din \up0 \expndtw0\charscalex114 1942) sau Wolf, ambii citati de \par\pard\qj
\li1454\ri319\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex114 VSIeanu si Daniel, au
sustinut $i ei acest element definitonu pentru BPS, iar \up0
\expndtw0\charscalex122 noi accentuSm ideea caracterului lezional al BPS, spre a Ie
diferentia de \up0 \expndtw0\charscalex116 tulburarile psiho-somatice, desi o nets
delimitare intre organic s* functional \up0 \expndtw0\charscalex116 nu poate fi
totdeauna efectuats. \par\pard\qj \li1454\ri314\sb0\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex123 Referitor la caracterul lezional al BPS. noi considerem cS
o serie de \up0 \expndtw0\charscalex123 entitSti psihosomatice, din care
exemplificSm tinnitus-ul psihogen sau \up0 \expndtw0\charscalex117 anorexia
nervoasa, sunt veritabile TPS care insotesc, intr-o pozitie de prim \up0
\expndtw0\charscalex119 plan, o serie de tulburSri psihice complexe, persistente.
Acestea din urmS \up0 \expndtw0\charscalex117 sunt agravate prin recul somato-
psihic de cStre disconfortul somatic sau de \up0 \expndtw0\charscalex118 cStre
consecintele existentiale generate de TPS respective. Mai mult, dacS \up0
\expndtw0\charscalex127 nu ar fi Tn prim plan tulburarea somaticS \up0
\expndtw0\charscalex124 (in cazul tlnnitus-ului) sau \par\pard\qj
\li1454\ri321\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex120 consecintele in plan
somatic (ca de exemplu scSderea ponderalS in cazul \up0 \expndtw0\charscalex121
anorexiei nervoase), aceste douS entitSti patologice revendicate de cetre \up0
\expndtw0\charscalex121 psihosomatice ar putea fi revendicate de cetre
psihiatrie. \par\pard\qj \li1459\ri329\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex118 3. Mecanismele aparitiei BPS pot fi considerate intr-o
dubie perspecti� \up0 \expndtw0\charscalex100 ve: \par\pard\ql \li1766\sb7\sl-
230\slmult0\tx8327\tx8539 \up0 \expndtw0\charscalex133 J Producerea unei tulburari
la nivelul psihicului, smonima \tab \up0 \expndtw-2\charscalex100 -\tab \up0
\expndtw-4\charscalex100 in \par\pard\qj \li1459\ri321\sb2\sl-240\slmult0\fi4
\up0 \expndtw0\charscalex118 maioritatea cazurilor - cu aparitia unui stres psihic,
cu caracter nespecific. \up0 \expndtw0\charscalex118 Nespecificitatea acestui
sindrom este justificata de faptul cS in orice stres, \up0 \expndtw0\charscalex115
are loc o reactie de stimulare neuro-endocrino-vegetativS cu eliberarea
a$a-\line \up0 \expndtw0\charscalex123 numitilor hormoni de stres care actioneazS
intr-un mod relativ constant \up0 \expndtw0\charscalex123 asupra tuturor tesutunlor
si organelor \up0 \expndtw0\charscalex118 (in acord \up0 \expndtw0\charscalex120 $i
cu modelul "teoretic \par\pard\qj \li1459\ri300\sb4\sl-236\slmult0\fi4 \up0
\expndtw0\charscalex116 nespecific" al lui Mahl). In esenta, primum movens in
geneza BPS il cons� \up0 \expndtw0\charscalex130 tituie exacerbarea corelatelor
somato-viscerale ale emotiilor. carac\up0 \expndtw0\charscalex123 teristica
oricarui stres psihic (lamandescu - 1993) si sinonima cu apari� \up0
\expndtw0\charscalex118 tia TPS (in acord si cu Jaspers - interpunerea tulburarilor
neuro-vegetative \up0 \expndtw0\charscalex123 intre emotie si reactia de organ - si
cu Kaplan - "alerta este transmisS la \up0 \expndtw0\charscalex117 sistemele
somatice). \par\pard\qj \li1468\ri301\sb1\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex124 Fara Tndoiala ce aceasta "nespecificitate" a reactiei de
stres are, a$a \up0 \expndtw0\charscalex115 cum insusi Selye a dovedit-o (ca si
alti autori in zilele noastre), o importanta \up0 \expndtw0\charscalex124 limite,
constituind doar un cadru de apreciere a unor reactii "generale" \up0
\expndtw0\charscalex117 Existe desigur o serie de particularitSti \up0
\expndtw0\charscalex113 - induse de "compozitia" diver$ilor \par\pard\ql
\li1488\sb9\sl-230\slmult0\tx3379 \up0 \expndtw0\charscalex125 hormoni de stres
\tab \up0 \expndtw0\charscalex124 - care oglindesc specificul s* intensitatea
diferitelor \par\pard\qj \li1483\ri296\sb2\sl-240\slmult0 \up0
\expndtw0\charscalex119 categorii dar si "specii" de agen(i streson, ca si
specificul modalitStilor de \up0 \expndtw0\charscalex119 rSspuns ale organismului
afectat de stres. \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg45}
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sr160\colno3\colw1794\colsr160\colno4\colw1279\colsr160\ql \li1099\sb0\sl-
207\slmult0 \par\pard\ql \li1099\sb134\sl-207\slmult0 \up0
\expndtw0\charscalex126 \ul0\nosupersub\cf3\f4\fs18 Psihosomatica
generala\par\pard\ql \li3619\sb0\sl-207\slmult0 \par\pard\ql \li3619\sb0\sl-
207\slmult0 \up0 \expndtw0\charscalex63 cu\par\pard\ql \li3619\sb66\sl-
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\qj \li6854\sb0\sl-144\slmult0 \par\pard\qj \li6854\sb0\sl-144\slmult0 \par\pard\qj
\li6854\sb0\sl-144\slmult0 \par\pard\qj \li6854\sb0\sl-144\slmult0 \par\pard\qj
\li6854\sb0\sl-144\slmult0 \par\pard\qj \li1057\ri588\sb25\sl-144\slmult0\fi19 \up0
\expndtw-2\charscalex100 u \line \up0 \expndtw0\charscalex106 S\par\pard\ql
\li39\sb121\sl-126\slmult0\tx1072 \up0 \expndtw0\charscalex128
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\ul0\nosupersub\cf23\f24\fs14 cC\par\pard\ql \li1071\sb57\sl-92\slmult0 \up0
\expndtw-1\charscalex100 \ul0\nosupersub\cf22\f23\fs8 3\par\pard\ql \li44\sb0\sl-
129\slmult0\tx1072 \up0 \expndtw0\charscalex121 \ul0\nosupersub\cf19\f20\fs12 u> E
33\tab \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf22\f23\fs8 CO\par\pard\ql
\li39\sb0\sl-90\slmult0 \up0 \expndtw0\charscalex172 \ul0\nosupersub\cf24\f25\fs10
a> \u9632?= c ~\par\pard\ql \li44\sb10\sl-139\slmult0\tx1072 \up0
\expndtw0\charscalex138 \ul0\nosupersub\cf23\f24\fs14 e o \u9632?� y\tab \up0
\expndtw-7\charscalex80 \ul0\nosupersub\cf3\f4\fs18 m\par\pard\ql \li20\sb0\sl-
90\slmult0\tx1052 \up0 \expndtw0\charscalex140 \ul0\nosupersub\cf24\f25\fs10
\u8212? Y I/) \up0 \expndtw0\charscalex116 \ul0\nosupersub\cf19\f20\fs12 ai\tab
\up0 \expndtw0\charscalex124 \ul0\nosupersub\cf24\f25\fs10 \u9830?^\par\pard\column
\ql \li7809\sb0\sl-207\slmult0 \par\pard\ql \li68\sb139\sl-207\slmult0 \up0
\expndtw0\charscalex129 \ul0\nosupersub\cf3\f4\fs18 \u9830? 35\par\pard\qj
\li2040\sb0\sl-144\slmult0 \par\pard\qj \li30\ri1111\sb43\sl-144\slmult0\tx107 \up0
\expndtw-2\charscalex100 a \line\tab \up0 \expndtw-2\charscalex100
\u8226?\par\pard\qj \li20\ri1105\sb0\sl-182\slmult0 \up0 \expndtw-2\charscalex100 s
\line \up0 \expndtw-2\charscalex100
s\par\pard\sect\sectd\sbknone\cols2\colno1\colw5139\colsr160\colno2\colw3741\colsr1
60\ql \li2231\sb0\sl-108\slmult0\tx3633\tx4751 \up0 \expndtw-5\charscalex89
\ul0\nosupersub\cf19\f20\fs12 -II\tab \up0 \expndtw0\charscalex114
\ul0\nosupersub\cf24\f25\fs10 -I\tab \up0 \expndtw-5\charscalex81
\ul0\nosupersub\cf3\f4\fs18 m\par\pard\ql \li2040\sb0\sl-126\slmult0 \up0 \expndtw-
6\charscalex100 \ul0\nosupersub\cf23\f24\fs14 cr\par\pard\ql \li2040\sb0\sl-
135\slmult0\tx4747 \up0 \expndtw0\charscalex178 c 2\tab \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf3\f4\fs18 3\par\pard\ql \li2049\sb0\sl-
90\slmult0\tx4761 \up0 \expndtw0\charscalex127 \ul0\nosupersub\cf24\f25\fs10 3
COQ.\tab \up0 \expndtw0\charscalex172 n,\par\pard\ql \li4761\sb0\sl-98\slmult0 \up0
\expndtw0\charscalex120 B\par\pard\column \ql \li567\sb0\sl-90\slmult0 \up0
\expndtw0\charscalex167 O o\par\pard\ql \li538\sb0\sl-120\slmult0\tx1594\tx2492
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144\slmult0\tx1594\tx2521 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf3\f4\fs18
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\expndtw0\charscalex189 \ul0\nosupersub\cf23\f24\fs14 - cm c\par\pard\column \ql
\li202\sb0\sl-180\slmult0\tx754\tx1474\tx2305\tx3188 \up0
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2\charscalex100 \ul0\nosupersub\cf23\f24\fs14 a\tab \up0 \expndtw-6\charscalex85
\ul0\nosupersub\cf19\f20\fs12 -2\par\pard\ql \li2736\sb19\sl-126\slmult0\tx4108
\up0 \expndtw0\charscalex60 \ul0\nosupersub\cf24\f25\fs10 Itw\tab \up0 \expndtw-
1\charscalex100 \ul0\nosupersub\cf23\f24\fs14 j\par\pard\ql \li2736\sb0\sl-
108\slmult0\tx4098 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf19\f20\fs12
n\tab \up0 \expndtw0\charscalex112 \ul0\nosupersub\cf23\f24\fs14 in
J*\par\pard\ql \li2702\sb1\sl-121\slmult0\tx4122 \up0 \expndtw0\charscalex120
\ul0\nosupersub\cf19\f20\fs12 O\tab \up0 \expndtw-1\charscalex100
\ul0\nosupersub\cf23\f24\fs14 c\par\pard\column \ql \li49\sb0\sl-180\slmult0
\up0 \expndtw0\charscalex157 \ul0\nosupersub\cf9\f10\fs20 o%o,S\par\pard\ql
i � > \u9632?Sv'C\par\pard\ql \li49\sb0\sl-144\slmult0 \up0 \expndtw0\charscalex110
\ul0\nosupersub\cf3\f4\fs18 B 6S \u8226? g\\n\par\pard\ql \li49\sb0\sl-
108\slmult0 \up0 \expndtw0\charscalex158 \ul0\nosupersub\cf19\f20\fs12 D-OCD-
ga\par\pard\qj \li44\ri1069\sb0\sl-153\slmult0\tx241 \up0
\expndtw0\charscalex113 \ul0\nosupersub\cf3\f4\fs18 o o _ = \u8226?= \line\tab \up0
\expndtw0\charscalex121 S u\par\pard\ql \li20\sb0\sl-198\slmult0 \up0
\expndtw0\charscalex125 \ul0\nosupersub\cf8\f9\fs22 S 2 - - -\par\pard\column
\ql \li20\sb1\sl-131\slmult0\tx553 \up0 \expndtw-5\charscalex100
\ul0\nosupersub\cf23\f24\fs14 4)\tab \up0 \expndtw0\charscalex128 .2\par\pard\ql
\li35\sb13\sl-161\slmult0 \up0 \expndtw0\charscalex104 C 3 E\par\pard\ql
\ul0\nosupersub\cf24\f25\fs10 � I- T U)\tab \up0 \expndtw-
4\charscalex90 \ul0\nosupersub\cf22\f23\fs8 CO\tab \up0 \expndtw0\charscalex136
10\par\pard\ql \li25\sb0\sl-134\slmult0\tx904 \up0 \expndtw0\charscalex147
\ul0\nosupersub\cf23\f24\fs14 E c o.Q.\tab \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf3\f4\fs18 ||\par\pard\ql \li25\sb0\sl-86\slmult0\tx481 \up0
\expndtw0\charscalex125 \ul0\nosupersub\cf22\f23\fs8 C0 CD\tab \up0
\expndtw0\charscalex199 -\u9632?-\par\pard\ql \li20\sb0\sl-
J\tab \up0 \expndtw0\charscalex158 4j! \up0 \expndtw0\charscalex126 ,c\tab \up0
\expndtw-5\charscalex100 \ul0\nosupersub\cf19\f20\fs12 Jo <7>\par\pard\ql
\ul0\nosupersub\cf24\f25\fs10 2 CD CO CJ\tab \up0 \expndtw-5\charscalex94
\ul0\nosupersub\cf19\f20\fs12 Q> "O\par\pard\ql \li25\sb0\sl-95\slmult0\tx222
\up0 \expndtw0\charscalex143 \ul0\nosupersub\cf24\f25\fs10 c;\tab \up0
\expndtw0\charscalex146 - 'CO .q\par\pard\ql \li903\sb143\sl-161\slmult0 \up0
\expndtw0\charscalex233 \ul0\nosupersub\cf23\f24\fs14 >?
\expndtw0\charscalex125 J Somatizarea, (alegerea organului) este legatS in primul
rand de o \up0 \expndtw0\charscalex116 serie de defecte induse genetic (ix : dubla
capacitate acido-secretorie a mu\up0 \expndtw0\charscalex117 coasei antrale - a
ulcerosului, fata de subiectii normali) sau dobandite (ex.. \up0
\expndtw0\charscalex112 aparitia HTA dupa o glomerulonefrita cronica, cu ritmare
psihogenS ulterioa\up0 \expndtw0\charscalex112 ra a puseelor hipertensive).
Totodata este implicate si o conditionare intre stimulii psihici negativi si
\up0 \expndtw0\charscalex116 o serie de momente fiziologice sau patologice ale
functiei difentelor organe \up0 \expndtw0\charscalex116 (v Hendrik) (cit. de
VSIeanu si Daniel). \par\pard\ql \li1468\sb10\sl-230\slmult0\tx7483 \up0
\expndtw0\charscalex113 Teoriile fanteziste, in genul "limbajului simbolic ai
organelor" \tab \up0 \expndtw0\charscalex105 (Groddek) \par\pard\qj
\li1175\ri607\sb9\sl-232\slmult0\fi4 \up0 \expndtw0\charscalex115 sunt depSsite in
acest domeniu al BPS, rSmanand posibile doar in domeniul \up0
\expndtw0\charscalex116 nevrozelor. De fapt. insusi Freud a trasat o diferentS
clara intre simptomele \up0 \expndtw0\charscalex117 somatice de conversie ("emotii
exagerate. traduse prin mijloace insollte") -\line \up0 \expndtw0\charscalex114 ce
pot li decodificate prin mijloacele psihanalizei - $i "manifestSrile expresi\up0
\expndtw0\charscalex116 ve ale emotiilor" care traduc "excitatia noastrS corporals"
intr-un rezultat al \up0 \expndtw0\charscalex116 utilizani energiei noastre
afective". \par\pard\qj \li1171\ri602\sb5\sl-236\slmult0\fi297 \up0
\expndtw0\charscalex121 Considerem cS in prezent. simptomele psihosomatice
reprezentand o \up0 \expndtw0\charscalex124 veritabila transformare a unor conf
licte intrapsihice in manifestari so� \up0 \expndtw0\charscalex124 matice trebuie
privite ca fiind legate in mod obiectiv de natura s' canti\up0
\expndtw0\charscalex127 tatea neuromediatorilor ajunsl la celulele tints, Inclusiv
"hormoni! de \up0 \expndtw0\charscalex122 stres" - pe de o parte \u8226? si de acel
"locus minoris resistentiae" reprezentat \up0 \expndtw0\charscalex125 de organele
si aparatele la nivelul carora preexists disfunctii bazate pe \up0
\expndtw0\charscalex125 existenta unor "slabiciuni" structurale sau biochlmice
\par\pard\qj \li1175\ri588\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex118 O
exceptie de la aceasta explicare a TPS - pe baza "activSrii fiziologice \up0
\expndtw0\charscalex117 care acompaniazS sentimentele si emotiile
noastre"(Huber) \up0 \expndtw0\charscalex118 - o reprezinte \par\pard\qj
\li1180\ri594\sb0\sl-236\slmult0\fi9 \up0 \expndtw0\charscalex128 manifestable
somatice din cadrul accidentelor isterice. Definirea lor \up0
\expndtw0\charscalex121 pastreaza in intregime caracteristicile formulate de Freud:
"ele afecteaza \up0 \expndtw0\charscalex117 strict organele de simt (de exemplu
anesteziile isterice, capricioase, cecita-\line \up0 \expndtw0\charscalex115 tea
isterice) sau aparatul locomotor (parezele isterice) iar natura tulburarilor
\up0 \expndtw0\charscalex122 aperute prin mecanismul de conversie pestreaze un
caracter simbolic, a \up0 \expndtw0\charscalex122 carui decodilicare de cetre
terapeut \up0 \expndtw0\charscalex121 (de ex prin mijloacele psihanalizei)
\par\pard\qj \li1180\ri589\sb0\sl-233\slmult0 \up0 \expndtw0\charscalex129 poate
conduce la disparitia lor. Greseala adeptilor teoriei limbajului \up0
\expndtw0\charscalex126 simbolic al organelor (Groddeck) consta tocmai in
extinderea acestor \up0 \expndtw0\charscalex127 procese de conversie la organele cu
musculature neteda, care asculta \up0 \expndtw0\charscalex127 de alte legi. ele
fiind afectate - in cursul unui stres psihic-
Tn virtutea \up0 \expndtw0\charscalex120 manifestarilor expresive "ale emotiilor"
(Freud), analizate mai sus si co� \up0 \expndtw0\charscalex134 respunzand
actiunilor specifice de organ a diversilor mediator! ai \up0
\expndtw0\charscalex126 reactiei de stres \par\pard\ql \li1483\sb1\sl-
183\slmult0 \up0 \expndtw0\charscalex121 4. Evolutia clinica, in pusee, a BPS - o
considerem, ca si Haliiday, un \par\pard\qj \li1190\ri574\sb16\sl-233\slmult0
\up0 \expndtw0\charscalex117 element de baza al BPS, menit se atragS atentia asupra
posibilitatii declan\up0 \expndtw0\charscalex114 SSrii psihogene a acestor pusee $i
posibilitStii combaterii lor pe calea psiho\up0 \expndtw0\charscalex121 terapiei (a
se vedea puseele de ulcer aperute vara la studenti, in sesiunile \up0
\expndtw0\charscalex113 de examene). \par\pard\qj \li1219\ri573\sb7\sl-
233\slmult0\fi273 \up0 \expndtw0\charscalex128 5. Asocierea facultativa dar
destul de frecvents, a unor tulburari \up0 \expndtw0\charscalex125 psihice izolate
sau sistematizate in veritabile nevroze pledeazS pentru \up0
\expndtw0\charscalex120 fragilitatea psihica mai mare a unor bolnavi psihosomatici,
confentS de o \up0 \expndtw0\charscalex120 vulnerabilitate la stres^ considerats
majors la bolnavii neurotici \up0 \expndtw0\charscalex114 (laman \par\pard\ql
\li1219\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex105 descu. 19B0 s< 1985).
Psihosomatica generala\tab \dn2 \expndtw0\charscalex116 \u9830? 37\par\pard\ql
\par\pard\ql\li1339\sb135\sl-230\slmult0 \up0 \expndtw0\charscalex121 6 Efectul
favorabil al psihoterapiei \par\pard\qj \li1046\ri756\sb22\sl-240\slmult0\fi288
\up0 \expndtw0\charscalex116 Chiar fSrS asocierea la BPS a unor trasaturi
neurotice, practica medicals \up0 \expndtw0\charscalex114 a demonstrat utilitatea
diverselor tipuri de psihoterapie in BPS, cu precSdere \up0 \expndtw0\charscalex111
a celor de relaxare de tipul T. A. Schultz, terapiei familiala (Petzold).
antrena-\line \up0 \expndtw0\charscalex113 mentului psihosomatic (Luban Plozza) dar
si a unor forme mai complexe. ac-\line \up0 \expndtw0\charscalex117 cesibile numai
psihoterapeutilor calificatl \up0 \expndtw0\charscalex116 (ex. psihoterapia
experientialS, \par\pard\ql \li1041\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex116
comportamentalS, etc) \par\pard\qj \li1046\ri742\sb2\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex119 insa cea mai importanta, in planul psihoterapiei de
sustinere - valabilS \up0 \expndtw0\charscalex115 pentru toate cele 5 trasaturi ale
BPS, infafisate de noi ca putand circumscrie \up0 \expndtw0\charscalex114 sfera
notiunii acestor boli \up0 \expndtw0\charscalex113 - o constituie abordarea
psihosomatice a bolnavi� \par\pard\qj \li1041\ri747\sb0\sl-240\slmult0\fi14 \up0
\expndtw0\charscalex124 lor, constand in acordarea unei atentii sporite factorilor
care genereaza \up0 \expndtw0\charscalex125 ecologia relatnlor interumane, in
scopul individualizarii tratamentului \up0 \expndtw0\charscalex125 omului
(persoana-unicat) aflat in sufennta \par\pard\ql \li1046\ri737\sb20\sl-
240\slmult0\fi292\tx1334 \up0 \expndtw0\charscalex123 Ea se incadreaze in
orientarea moderns bio-psiho-socialS pe care se \up0 \expndtw0\charscalex114
centreazS in prezent medicina psihosocialS (Figura 1). \line \tab \up0
\expndtw0\charscalex120 AceastS abordare sus(me utilitatea unor variate tipuri de
psihoterapie, \up0 \expndtw0\charscalex120 mai ales cele bazate pe relaxare
initiate de T A. Schultz. terapie familiala \up0 \expndtw0\charscalex114 (Petzold)
si antrenament psihosomatic (Luban-Plozza). in vindecarea bolilor \up0
\expndtw0\charscalex114 psihosomatice. \par\pard\qj \li1051\ri737\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex115 Pentru medicul practician, un
important element al psihoterapiei suporti-\line \up0 \expndtw0\charscalex122 ve
simple de sustinere. este abordarea psihosomatice a pacientului. ce il \up0
\expndtw0\charscalex117 permite focalizarea atentiei asupra factorilor ce genereaza
ecologia relatiei \up0 \expndtw0\charscalex117 interumane ?i individualizarea
tratamentului. Aceaste abordare moderns se \up0 \expndtw0\charscalex117 inscrie in
orientarea bio-psiho-soclalS a medicinii psihosociale de astSzi. \par\pard\ql
\expndtw0\charscalex123 Figura 1. Princlpaiii agenfl etiologici in bolile
psihosomatice \par\pard\ql \li1334\sb0\sl-230\slmult0 \par\pard\ql\li1334\sb200\sl-
230\slmult0 \up0 \expndtw0\charscalex135
-I\par\pard\sect\sectd\sbknone\cols2\colno1\colw5244\colsr160\colno2\colw3636\colsr
160\ql \li1329\sb3\sl-206\slmult0\tx1790\tx3642 \up0 \expndtw0\charscalex120
<\tab \up0 \expndtw0\charscalex120 \ul0\nosupersub\cf13\f14\fs16 Agent!
strosori\tab \up0 \expndtw-1\charscalex100 CORTEX\par\pard\column \ql
\li20\ri992\sb41\sl-230\slmult0\tx2413 \up0 \expndtw0\charscalex114 Nevroze
\line \up0 \expndtw0\charscalex122 Psihoze reactive \tab \up0 \expndtw-
7\charscalex72 \ul0\nosupersub\cf9\f10\fs20
CO\par\pard\sect\sectd\sbknone\cols4\colno1\colw1640\colsr160\colno2\colw3464\colsr
160\colno3\colw2226\colsr160\colno4\colw1250\colsr160\ql \li1320\sb0\sl-230\slmult0
\up0 \expndtw0\charscalex120 <\par\pard\qj \li1324\ri0\sb28\sl-272\slmult0 \up0
\expndtw0\charscalex97 \ul0\nosupersub\cf16\f17\fs34 o \line \up0
\expndtw0\charscalex97 o\par\pard\ql \li1320\sb0\sl-198\slmult0 \up0
\expndtw0\charscalex124 \ul0\nosupersub\cf8\f9\fs22 (0\par\pard\column \ql
\ul0\nosupersub\cf30\f31\fs46 I\par\pard\ql \li1863\sb0\sl-144\slmult0 \up0
\expndtw0\charscalex120 \ul0\nosupersub\cf13\f14\fs16 Sistem\par\pard\qj
\li1872\ri171\sb0\sl-145\slmult0\fi4 \up0 \expndtw0\charscalex121 neuro-
endocrino-\line \up0 \expndtw0\charscalex120 vegetativ fi Imun\par\pard\qj
Factor!\tab \up0 \expndtw0\charscalex102 SOMA \up0 \expndtw0\charscalex120
comportamentali\par\pard\column \ql \li5414\sb0\sl-184\slmult0 \par\pard\ql
\li20\sb22\sl-184\slmult0\tx1609 \up0 \expndtw0\charscalex119 Boli org. rogl\tab
\up0 \expndtw0\charscalex112 \u9632?=v>\par\pard\qj \li150\ri1036\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex133 \u8226? endocine \line \up0
\expndtw0\charscalex122 \u8226? metabollce\par\pard\ql \li145\sb52\sl-
184\slmult0 \up0 \expndtw0\charscalex119 - imunologlce\par\pard\qj \li5414\sb0\sl-
237\slmult0 \par\pard\qj \li20\ri752\sb98\sl-237\slmult0\fi4 \up0
\expndtw0\charscalex121 Boll degenerative \line \up0 \expndtw0\charscalex114 Boll
intlamatorll \line \up0 \expndtw0\charscalex118 Infoctil cronlce\par\pard\ql
\ul0\nosupersub\cf31\f32\fs16\ul Neoplazll\par\pard\column \ql \li25\sb0\sl-
306\slmult0 \up0 \expndtw0\charscalex97 \ul0\nosupersub\cf16\f17\fs34 o\par\pard\ql
r\par\pard\ql \li20\sb199\sl-253\slmult0 \up0 \expndtw0\charscalex110
\ul0\nosupersub\cf8\f9\fs22 W\par\pard\qj \li30\ri822\sb20\sl-272\slmult0 \up0
\expndtw0\charscalex97 \ul0\nosupersub\cf16\f17\fs34 E \line \up0
5\par\pard\sect\sectd\sbknone\cols2\colno1\colw7640\colsr160\colno2\colw1240\colsr1
60\qj \li1334\ri4445\sb97\sl-235\slmult0\tx1804 \up0 \expndtw0\charscalex125
\ul0\nosupersub\cf13\f14\fs16 Q Factori etiologici \line \tab \up0
\expndtw0\charscalex129 organo-specilcl\par\pard\column \qj \li20\ri842\sb0\sl-
256\slmult0 \up0 \expndtw0\charscalex97 \ul0\nosupersub\cf7\f8\fs32 o \line \up0
\expndtw0\charscalex80 m
de psihosomaticS generals si aplicata\par\pard\ql \li1881\sb0\sl-230\slmult0
\up0 \expndtw0\charscalex133 4. Abordarea medicala a bolii psihosomatice
in acest punct final al discutiei, se poate pune problema asupra celor \up0
\expndtw0\charscalex117 chemati sa ingrijeascS bolnavii cu BPS. In ceea ce ne
priveste, consideram \up0 \expndtw0\charscalex116 ca eel putin in momentele de
acutizare (de exemplu astmul bronsic cu crize \up0 \expndtw0\charscalex115
trecvente, neurodermita agravata, un angioedem recurent cu manifested se� \up0
\expndtw0\charscalex116 vere, un puseu hipertensiv, etc.) este necesare tratarea
bolnavilor respectivi \up0 \expndtw0\charscalex117 de cetre un medic somatician:
generalise internist sau specialist (cardiolog. \up0 \expndtw0\charscalex117
alergolog, etc.). \par\pard\ql \li1896\sb8\sl-230\slmult0\tx3220\tx8592 \up0
\expndtw0\charscalex129 intre pusee \tab \up0 \expndtw0\charscalex124 (faze acute),
este necesare interventia psihologului \tab \up0 \expndtw0\charscalex100 (in
\par\pard\qj \li1583\ri186\sb2\sl-240\slmult0
\up0 \expndtw0\charscalex123 colaborare cu medicul curant) pentru a consollda prin
metode si lehnici \up0 \expndtw0\charscalex133 psihoterapeutice remlsiunea
terapeutica obtinute de cetre medicul \up0 \expndtw0\charscalex117 "somatician" cu
ajutorul mijloacelor farmacologice. Asocierea unor tulbu� \up0
\expndtw0\charscalex128 rari psihice severe impune apelul la psihiatru, fie ince
din momentul \up0 \expndtw0\charscalex123 manifestarllor fazei acute a BPS, fie
dupe trecerea acesteia. Desigur, in \up0 \expndtw0\charscalex118 cazul unui bolnav
psihic cu BPS asociata (de exemplu un puseu hiperten� \up0 \expndtw0\charscalex120
siv la un bolnav cu psihoza maniacalS) el va rSmSne in responsabilitatea \up0
\expndtw0\charscalex116 medicului psihiatru care apeleaze la internist numai pentru
etapa terapeuti� \up0 \expndtw0\charscalex116 ce respective si ob(inerea unui plan
terapeutic al BPS respective aplicabil la \up0 \expndtw0\charscalex116 bolnavul in
cauzS. \par\pard\qj \li1583\ri176\sb0\sl-240\slmult0\fi307 \up0
\expndtw0\charscalex118 Refentor la alegerea - de catre medicul "somatician" (medic
de familie \up0 \expndtw0\charscalex118 sau de specialitati nepsihiatrice) a
psihoterapeutului care se incerce, in fa� \up0 \expndtw0\charscalex115 za de
acalmie clinice, prevenirea reactualizerii BPS prin mljloace psihologi\up0
\expndtw0\charscalex119 ce, crlterille folosite difera de la o tare la alta, uneort
chiar in aceeasi tare, \up0 \expndtw0\charscalex119 iar stabilirea lor nu
constituie obiectul lucrarii de fate \par\pard\qj \li1588\ri185\sb0\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex118 in ceea ce ne priveste. considerem
cS epuizarea mijloacelor psihotera� \up0 \expndtw0\charscalex121 peutice "pure",
fere un rezultat pentru bolnav oblige psihologul se incre\up0
\expndtw0\charscalex116 dinteze bolnavul medicului psihiatru care va apela cu
sigurantS la arma te� \up0 \expndtw0\charscalex116 rapeutice sigurS, cea
farmacologicS. \par\pard\qj \li1593\sb0\sl-237\slmult0
Aceste tentative de reformulare a conceptelor de TPS si BPS contin in \up0
\expndtw0\charscalex128 ultima instants o perspectiva diagnostics, abordarea
psihosomatice a \up0 \expndtw0\charscalex118 bolilor somatice si una terapeutica:
utilizarea diverselor lorme de psihote� \up0 \expndtw0\charscalex120 rapie ca
element adjuvant, recuperator si profilactic al recidivelor in toate \up0
\expndtw0\charscalex118 cazurile de sindroame clinice avand o tegeiure eel putin
partialS cu stresui \up0 \expndtw0\charscalex117 psihic Eventualele discutii asupra
vaiabilitstit propunerilor si argumentelor \up0 \expndtw0\charscalex119 prezentate
de noi vor contrlbui desigur la clasiflcSri si adSugiri ce ne apar \up0
\expndtw0\charscalex119 extrem de necesare. \par\pard\ql \li1900\sb229\sl-
230\slmult0 \up0 \expndtw0\charscalex108 Bibliografie \par\pard\ql
\li1939\sb210\sl-230\slmult0\tx7281 \up0 \expndtw0\charscalex100 1 Alexander F.
Psychosomatic medicmo. Norton. New York, \tab \up0 \expndtw-8\charscalex100 1950
\par\pard\ql \li1900\sb1\sl-217\slmult0 \up0 \expndtw0\charscalex105 2 Brouchon-
Schweitzer Marilou et Dantzor E., Introduction dans la Psychologie
\par\pard\li1905\sb1\sl-221\slmult0\fi220\tx4276 \up0 \expndtw0\charscalex107 de la
Sante. PDF, Pans\tab \up0 \expndtw0\charscalex107 1994. pp 13-
42.\par\pard\li1905\sb1\sl-208\slmult0\fi0 \up0 \expndtw0\charscalex107 3 Buddeberg
CL, Radovila A . Kaufmann P., Was ist Psychosomatische und\par\pard\li1905\sb1\sl-
223\slmult0\fi220 \up0 \expndtw0\charscalex107 Psychosoziale Medizm. In: Modecme
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Psihosomatica feminind. Ed. Medicald, Bucuresti, \tab \up0 \expndtw-7\charscalex100
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J.. Hetm E.Hrsg.. Psychosoziate Medizin. Bd I Grundlagen,
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\expndtw0\charscalex111 Berlin. Heidelberg. NY., Tokyo,\tab \up0
\up0 \expndtw0\charscalex120 \ul0\nosupersub\cf8\f9\fs22 Capitolul 4
360\slmult0 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf14\f15\fs24 STRESUI
PSIHIC - CONCEPT OPERATIONAL CU ROL DE \up0 \expndtw0\charscalex101 PLACA TURNATA
IN ETIOPATOGENEZA PSIHOGENA A \up0 \expndtw-1\charscalex100 BOLILOR
PSIHOSOMATICE \par\pard\ql \li1320\sb208\sl-230\slmult0 \up0
\expndtw0\charscalex138 \ul0\nosupersub\cf9\f10\fs20 loan Bradu lamandescu
\up0 \expndtw0\charscalex107 \ul0\nosupersub\cf14\f15\fs24 1. Definitie
\par\pard\qj \li998\ri761\sb194\sl-240\slmult0\fi307 \up0
\expndtw0\charscalex118 \ul0\nosupersub\cf9\f10\fs20 DatorSm lui Selye introducerea
conceptului general de stres, definit cu o \up0 \expndtw0\charscalex126 reactie
generals nespecificS a organismului la ac(iunea externS a unor \up0
\expndtw0\charscalex110 factori \up0 \expndtw0\charscalex116 -agenti stresori - de
naturS variatS fizicS, chimicS, biologies si psihi-\line \up0
\expndtw0\charscalex118 cS. in ultimele decenii accentul definitiei acestui
veritabil sindrom sa mutat \up0 \expndtw0\charscalex119 pe caracterizarea
ansamblului manifestSrilor ce compun aceastS reactie. in \up0
\expndtw0\charscalex118 scopul analizSrii impactului sSu cu activitatea unor organe
si aparate "dota-\line \up0 \expndtw0\charscalex119 te" cu disfuncfii potentiate
sau actuate dar si asupra unor indivizi cu o anu-\line \up0 \expndtw0\charscalex121
mitS constitute psihicS. predispusS (ereditar sau prin traume psihice ante-\line
\up0 \expndtw0\charscalex117 rioare) aparitiei unor tulburSri cu implicatii
disadaptative comportamentale. \par\pard\qj \li998\ri756\sb0\sl-
241\slmult0\fi292 \up0 \expndtw0\charscalex117 O definitie sinteticS actuals a
"stresului general" este cea dats de A. von \up0 \expndtw0\charscalex124 Eiff:
"reactie psiho-fizica a organismului generate de agenti stresori ce \up0
\expndtw0\charscalex124 actioneaza pe calea organelor de simt asupra creierului,
punandu-se in \up0 \expndtw0\charscalex127 miscarc - datorita legaturilor cortico-
limbice cu hipotalamusul un sir \up0 \expndtw0\charscalex125 intreg de reactii
neuro-vegetative si endocrine, cu rasunet asupra intre\up0 \expndtw0\charscalex115
gului organism". Mai recent, Derevenco prezintS o definitie psiho-biologicS \up0
\expndtw0\charscalex119 a stresului, inspiratS de teoria cognitiva a stresului
elaboratS de scoaia lui \up0 \expndtw0\charscalex115 Lazarus. Astfel, in aceastS
definitie accentul este pus pe "dezechilibrul bio� \up0 \expndtw0\charscalex116
logic, psihic si comportamental dintre cerintele (prorocirile) mediului fizic, \up0
\expndtw0\charscalex120 ambiental sau social si dintre resursele \u8226? reale sau
percepute ca atare - ale \up0 \expndtw0\charscalex118 omului, de a face fata (prin
ajustare sau adaptare) acestor cerinte si situatii \up0 \expndtw0\charscalex110
conflictuale" \up0 \expndtw0\charscalex108 (Derevenco, 1998) \par\pard\qj
\li998\ri771\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex123 Referitor la
definirea stresului psihic, se cuvine sa mentionSm cS el \up0
\expndtw0\charscalex120 reprezinte un caz particular de stres, inscris in sfera
notionaie a "stresului \up0 \expndtw0\charscalex116 general", fiind declansat de
anumiti agenti stresori: cei psihici. Acestia sunt \up0 \expndtw0\charscalex114
dotati cu semnificatie negative (distres) sau pozitivS (eustres) pentru indivizi
\up0 \expndtw0\charscalex117 Si opereazS in planul constiintei numai dupS
decodiiicarea lor si evaluarea \up0 \expndtw0\charscalex114 "sarclnii" pe care ei o
pun in fata individului \up0 \expndtw0\charscalex113 (lamandescu, \up0
\expndtw0\charscalex106 1997). Dintre de-\par\pard\ql \li998\sb9\sl-230\slmult0
\up0 \expndtw0\charscalex116 finitiile existente in literature asupra stresului
psihic ni se pare mai potrivita
207\slmult0\par\pard\li1368\sb129\sl-207\slmult0\fi0\tx1771\tx4425
\up0 \expndtw0\charscalex117 \ul0\nosupersub\cf3\f4\fs18 42\tab \up0
psihosomatica gonorala si aplicata\par\pard\qj \li1391\sb0\sl-245\slmult0
\ul0\nosupersub\cf9\f10\fs20 definitia oarecum descriptive - dar incluzand
majoritatea circumstantelor de \up0 \expndtw0\charscalex117 declansare a stresului
- data de M. Golu: "stare de tensiune, incordare, dis-\line \up0
\expndtw0\charscalex123 confort. determinata de agenti afectogeni cu semnificatie
negativa (sau \up0 \expndtw0\charscalex119 pozitiva, am adauga noi, in cazul
eustres-ului), de frustrare sau reprimare \up0 \expndtw0\charscalex123 a unor
motivatil \up0 \expndtw0\charscalex122 (trebuinte. dorinte. aspiratii \up0
\expndtw0\charscalex125 - inclusiv subsolicltarea, \par\pard\ql \li1391\sb8\sl-
230\slmult0\tx1915 \up0 \expndtw0\charscalex115 n.n.) \tab \up0
\expndtw0\charscalex119 , de dificultatea sau imposibiiitatea rezolvarii unor
probleme" \par\pard\qj \li1382\ri410\sb1\sl-242\slmult0\fi297 \up0
\expndtw0\charscalex117 CompletSrile noastre la aceastS definitie, in afara
sublinierii dihotomiei \up0 \expndtw0\charscalex114 semnificatiei puternice pentru
organism a agenjilor stresori negativi (distres) \up0 \expndtw0\charscalex105 Si
pozitivi \up0 \expndtw0\charscalex115 (eustres), sunt reprezentate de includerea in
randul situatiilor ge\up0 \expndtw0\charscalex115 neratoare de stres a
suprasohcitarii cognitive-afective si volitionale (chiar in \up0
\expndtw0\charscalex115 cursul unei activitsti pasionante pentru subiect!) si a
efectelor, insidios pro� \up0 \expndtw0\charscalex117 pagate la scoarta cerebrals,
a unor agenti fizici (zgomotul, adesea avSnd si \up0 \expndtw0\charscalex114 o
rezonantS afectivS negativa) himici (noxele ambientale) si biologic* (boa\up0
\expndtw0\charscalex114 ia, ca sursS a unor reflexe aferonte viscero-corticale).
Revenind la definitive bazate pe evaluarea in plan cognitiv (dar cu ecou \up0
\expndtw0\charscalex114 afectiv) a discrepantei percepute (eronat sau nu) de cStre
subiect intre cerin-\line \up0 \expndtw0\charscalex118 teie sarcinii si
posibilitStite sale de a Ie face fata, definitii ce postuleaza si \up0
\expndtw0\charscalex115 caracterul anticipativ al reactiei de stres - se cuvine sS
exprimSm cateva re-\line \up0 \expndtw0\charscalex120 zerve asupra capacitStii lor
de cuprindere in totalitate a sferei notiunii de \up0 \expndtw0\charscalex120
stres. Astfel. o imagine cu impact afectiv major (revederea unei persoane \up0
\expndtw0\charscalex113 foarte dragi sau, din contra, imaginea unui accident cu
victime masacrate, ori \up0 \expndtw0\charscalex119 un vis de cosmar) dar mai ales
instalarea insidioasa a unui stres de supra-\line \up0 \expndtw0\charscalex121
solicitare intr-un climat afectiv pozitiv dar si eustres-ul in general, nu au
\up0 \expndtw0\charscalex112 aproapedeloc de-a face cu anticiparea unui
"dezechilibru de for(e" in fata unei \up0 \expndtw0\charscalex108 amenintSri.
\up0 \expndtw0\charscalex123 (Se poate specula totusi asupra "amenintSrii"
momentane a \up0 \expndtw0\charscalex112 echiiibrului sufletesc dar asa ceva se
intSmpIS si in timpul unui film "horror", \up0 \expndtw0\charscalex112 "gustat" de
cStre spectator si inclus, de regulS. in randul eustres-ului). \par\pard\qj
\li1382\ri401\sb0\sl-242\slmult0\fi287 \up0 \expndtw0\charscalex118 in alta ordine
de idei, toate definitiile de pans acum ale stresului psihic. \up0
\expndtw0\charscalex115 inclusiv cele mentionate, accentueazS latura
constientizSrii de cStre individ \up0 \expndtw0\charscalex116 (inclusiv
anticiparea, realizats la nivelul evaluSrii cognitive) a potentialului \up0
\expndtw0\charscalex115 nociv al agentilor stresori avandu-se. deci, in vedere
distress-ul. Prin aceas� \up0 \expndtw0\charscalex117 ta se omite, cum am Tncercat
sS sugerSm mai sus. includerea in definitie a \up0 \expndtw0\charscalex123
eustress-ului. concept similar din punct de vedere al intensitatii starilor \up0
\expndtw0\charscalex125 afective (insa cu polaritate opusa) si al reactiilor
psihosomatice aparu-\line \up0 \expndtw0\charscalex129 te, inclusiv impiicatiile
sale in patologia acuta \up0 \expndtw0\charscalex121 (de exemplu, criza de
astm), dar total diferit in perspectiva repetSrii sale pe termen lung \up0
\expndtw0\charscalex120 (imp icatii pozitive privind longevitatea). \par\pard\qj
\li1387\ri401\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex119 In plus, fata
de delimitarea sferei notiunii de stres psihic - prezents sub \up0
\expndtw0\charscalex114 formele mentionate. cu mici diferen|e de nuantS in intreaga
literaturS a stre� \up0 \expndtw0\charscalex107 sului \up0 \expndtw0\charscalex118
(Selye. Lazarus, Kaplan. French, von Eiff, Sells, Floru, Derevenco, \up0
\expndtw0\charscalex113 Pichot. Bruchon-Schweitzer, Mc Grath, Appley S1 Trumbull) -
am incercat o \up0 \expndtw0\charscalex123 largire a aeestei sfere, introducSnd
conceptul de "stres psihic secundar" \up0 \expndtw0\charscalex112 (lamandescu,
\expndtw0\charscalex124 DacS ceea ce se defmeste. in mod obisnuit. prin stres
psihic. repre-\line \up0 \expndtw0\charscalex124 zinta, in opinia noastra, stresui
psihic primar (cu agenti stresori psihici \up0 \expndtw0\charscalex112 posesori ai
unei semnifica(il, ca de ex. cuvantul 'cutremur". capabil sa declan-\line \up0
\expndtw0\charscalex112 seze instantaneu reactia de stres), in cazul "stresului
pilhlc secundar" \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg53}
\expndtw0\charscalex125 \ul0\nosupersub\cf3\f4\fs18 Psihosomatica gonerala\tab \up0
\expndtw0\charscalex125 * 43\par\pard\qj \li1104\sb0\sl-240\slmult0
\ul0\nosupersub\cf9\f10\fs20 este vorba tot de o reactie de stres psiMc dar care
survine in continuare (sau \up0 \expndtw0\charscalex118 aproape instantaneu) a unui
stres primar, declansat de agenti stresori nepsi-\line \up0 \expndtw0\charscalex118
hogeni (ex. cazurile de insolatie, o senzatie dureroasS, sau o stare febrilS)
Cei mai elocvent exemplu il constituie stresui psihic secundar repre-\line \up0
\expndtw0\charscalex120 zentat de boala. in cadrul careia simptomele somatice
genereaza stres psi� \up0 \expndtw0\charscalex121 hic secundar prin recul somato-
psihic \up0 \expndtw0\charscalex125 (dar si un stres psihic primar prin
semnificatia de pericol pentru viate sau integritatea individului on pentru
in\up0 \expndtw0\charscalex116 sertia lui socio-profesionala). \par\pard\qj
\li1104\ri699\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex116 incercand o
unificare a diferltelor definitii ale stresului psihic date de au� \up0
\expndtw0\charscalex114 tori ca: Selye , von Eiff, Pichot, M.Golu, \up0
\expndtw0\charscalex113 $i Bruchon-Schweitzer, putem con-\par\pard\qj
\li1104\ri674\sb0\sl-240\slmult0\fi9 \up0 \expndtw0\charscalex116 sidera ce stresui
psihic (SP), in ipostaza sa eel mai frecvent invocate de dis� \up0
\expndtw0\charscalex118 tress, reprezinte o reactie a iniregului organism la unui
sau mai multi exci� \up0 \expndtw0\charscalex122 tant corespunzand asa-numitului
"eel de-al doilea sistem de semnalizare" \up0 \expndtw0\charscalex120 descris de
cetre Pavlov (limbajul), dar si la stimuli nonverbali ce posede o \up0
\expndtw0\charscalex116 semmficatie cu o large rezonantS afectivS pentru subiectul
in cauza. Reac;ia \up0 \expndtw0\charscalex122 de stres psihic se manifests sub
forma unui sindrom "nespecific", in Unii \up0 \expndtw0\charscalex117 generale - ce
include manifestari psihice (predominant cognitive si elective, \up0
\expndtw0\charscalex120 cu exprimare comportamentalS) si tulburSri functionale -
psihosomatice -\line \up0 \expndtw0\charscalex121 care pot afecta sau nu sSnStatea
unui Individ. Nespecificitatea reac(iei de \up0 \expndtw0\charscalex123 stres, in
zilele noastre nu mai este acceptate decat conventional, existand \up0
\expndtw0\charscalex119 diferente - uneori considerabile \up0
\expndtw0\charscalex122 - intre stresunle psihice la diversii agenti
\par\pard\ql \li1108\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex120 stresori (ex.
stresui de examen si stresui de detente, etc.). \par\pard\qj \li1104\ri673\sb2\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex125 Conform unei definitii personale
prezentate intr-o lucrare anterioare \up0 \expndtw0\charscalex119 (lamandescu.
1993), stresui psihic (in ipostaza sa eel mai frecvent invocate \up0
\expndtw0\charscalex127 de "distress") reprezinta un sindrom constituit de
exacerbarea dincolo \up0 \expndtw0\charscalex127 de nivelul unor simple ajustari
homeostatice, a unor reactii psihice si a \up0 \expndtw0\charscalex132 corelatelor
lor somatice \up0 \expndtw0\charscalex128 (afectand cvasitotalltatea
compartimentelor \par\pard\qj \li1104\ri665\sb0\sl-242\slmult0\fi4 \up0
\expndtw0\charscalex127 organismului) in legatura cu agresiunea externa sau interns
exercitata \up0 \expndtw0\charscalex130 de o configurate de factori dedansanti
(agenti stresori) ce actioneaza \up0 \expndtw0\charscalex139 intens. surprinzator,
brusc si/sau persistent si avand adeseori un \up0 \expndtw0\charscalex128 caracter
simbolic "de amenlntare" (perceputi sau anticipati ca atare de \up0
\expndtw0\charscalex142 subiect). Alteori, agentii stresori reprezinta excitant)
psihici
cu \up0 \expndtw0\charscalex130 rezonanta afectlva majors (pozitiva - eustress sau
negative - distress) \up0 \expndtw0\charscalex123 sau surse de suprasolicitare a
proceselor cognitive (atentie, gandire, etc.) \up0 \expndtw0\charscalex120 Si
volitionale, cu mentiunea cS SP are la bazS in primul rand o participare \up0
\expndtw0\charscalex118 afectiva pregnants. O schematizare a interreactiilor
generate in cursul SP la \up0 \expndtw0\charscalex116 nivelul divorselor
"compartimente" ale psihicului este redats in Figura \up0 \expndtw-9\charscalex86
1. \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg54}{\bkmkend
\expndtw0\charscalex114 \ul0\nosupersub\cf13\f14\fs16 44\tab \up0 \expndtw-
7\charscalex75 \u8226?:\u8226?\tab \dn2 \expndtw0\charscalex104
\ul0\nosupersub\cf9\f10\fs20 Elemente de psihosomaticd generala s<
\ul0\nosupersub\cf8\f9\fs22 Figura 1. Prlnclpalele mecanisme psiho-nauro-
endocrlno-\par\pard\li2131\sb1\sl-243\slmult0\fi0 \up0 \expndtw0\charscalex113
vegetatlve si manifestable lor din cursul stresului psihic\par\pard\li2025\sb0\sl-
Stimuli\tab \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf3\f4\fs18
Stimuli\par\pard\li2025\sb0\sl-144\slmult0\fi0\tx6225 \dn0
\expndtw0\charscalex120 \ul0\nosupersub\cf13\f14\fs16 H Interni\tab \up0
externi\par\pard\sect\sectd\sbknone\cols2\colno1\colw5945\colsr160\colno2\colw2935\
colsr160\ql \li3614\sb0\sl-172\slmult0 \up0 \expndtw0\charscalex111
\ul0\nosupersub\cf9\f10\fs20 AGENTI STRESORI\par\pard\ql \li2054\sb73\sl-
_( Aierenfe\tab \up0 \expndtw-10\charscalex89 \ul0\nosupersub\cf33\f34\fs30
T\par\pard\ql \li2256\sb0\sl-128\slmult0 \up0 \expndtw0\charscalex121
\ul0\nosupersub\cf13\f14\fs16 nteroceptlve\par\pard\qj \li2572\sb0\sl-
158\slmult0 \par\pard\qj \li2572\ri2690\sb146\sl-158\slmult0 \up0
\expndtw0\charscalex117 Evocare \line \up0 \expndtw0\charscalex109 "In
srtu"\par\pard\column \qj \li1230\ri848\sb0\sl-144\slmult0\fi67 \up0
\expndtw0\charscalex116 Perceptll \line \up0 \expndtw0\charscalex123
senzoriale\par\pard\qj \li20\ri2052\sb31\sl-158\slmult0\fi81 \up0
\expndtw0\charscalex124 Atoento \line \up0 \expndtw0\charscalex124
senzoriale\par\pard\ql \li846\sb38\sl-369\slmult0 \up0 \expndtw0\charscalex109
\ul0\nosupersub\cf5\f6\fs36 <4\ul0\nosupersub\cf3\f4\fs18 Stimuli\par\pard\ql
verbali\par\pard\sect\sectd\sbknone\cols3\colno1\colw3125\colsr110\colno2\colw2245\
colsr160\colno3\colw3410\colsr160\ql \li2273\sb0\sl-320\slmult0 \up0
\expndtw0\charscalex80 \ul0\nosupersub\cf32\f33\fs40 Q\par\pard\ql \li2587\sb0\sl-
Boala\par\pard\column \ql \li1167\sb0\sl-162\slmult0 \up0
\expndtw0\charscalex115 \ul0\nosupersub\cf3\f4\fs18 Cotex\par\pard\ql
\ul0\nosupersub\cf34\f35\fs22\ul ^TTXT-\ul0\nosupersub\cf8\f9\fs22 n\par\pard\ql
\expndtw0\charscalex120 \ul0\nosupersub\cf13\f14\fs16 Sistem limbic\par\pard\ql
\expndtw0\charscalex115 \ul0\nosupersub\cf3\f4\fs18 Subcotex\par\pard\ql
Neurotransmijatori\par\pard\ql \li3475\sb0\sl-184\slmult0 \par\pard\ql
Stimulare\par\pard\column \ql \li6484\sb0\sl-184\slmult0 \par\pard\ql
\li874\sb99\sl-184\slmult0 \up0 \expndtw0\charscalex117 Tulburirl\par\pard\ql
comportamentale\par\pard\ql \li1665\sb0\sl-207\slmult0 \par\pard\ql \li1665\sb0\sl-
\ul0\nosupersub\cf3\f4\fs18 Stimulare \par\pard\sect\sectd\sbknone \li1665\sb0\sl-
162\slmult0\fi1569\tx5385 \up0 \expndtw0\charscalex123
\ul0\nosupersub\cf13\f14\fs16 neuroendocrina\tab \dn3 \expndtw0\charscalex107
\ul0\nosupersub\cf3\f4\fs18 neurovegetativa\par\pard\sect\sectd\sbknone
\li1665\sb137\sl-414\slmult0\fi2140\tx6086 \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf13\f14\fs16 \\\tab \up0 \expndtw0\charscalex97
\ul0\nosupersub\cf5\f6\fs36 1\par\pard\sect\sectd\sbknone \li1665\sb0\sl-
Hormoni Catecolamine Acetllcolina
Neuropeptide\par\pard\sect\sectd\sbknone\cols2\colno1\colw4702\colsr160\colno2\colw
4178\colsr160\ql \li1675\sb0\sl-144\slmult0\tx3537 \up0 \expndtw0\charscalex120
Disprotectie\tab \up0 \expndtw0\charscalex128 de stres\par\pard\column \ql
\ul0\nosupersub\cf35\f36\fs50\ul I\ul0\tab \up0 \expndtw0\charscalex97
\ul0\nosupersub\cf35\f36\fs50\ul I\ul0\tab \up0 \expndtw0\charscalex97
\ul0\nosupersub\cf35\f36\fs50\ul
\colno3\colw5709\colsr160\qj \li1665\ri522\sb0\sl-144\slmult0\tx1809 \up0
\expndtw0\charscalex112 \ul0\nosupersub\cf13\f14\fs16 Adapt am \line\tab \up0
\expndtw0\charscalex125 "llni"\par\pard\column \ql \li3120\sb0\sl-230\slmult0
\par\pard\ql \li3120\sb0\sl-230\slmult0 \par\pard\ql \li20\sb47\sl-230\slmult0 \up0
\expndtw-2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 \\\par\pard\column \ql
\ul0\nosupersub\cf13\f14\fs16 Modificiri la nivel de tesuturl si organe\par\pard\ql
\li3331\sb0\sl-230\slmult0 \par\pard\ql \li20\sb85\sl-230\slmult0\tx3375 \up0
\expndtw-3\charscalex100 \ul0\nosupersub\cf9\f10\fs20 TULBURARI FUNCTIONALE\tab
\up0 \expndtw-4\charscalex100 TULBURARI\par\pard\ql \li495\sb25\sl-
201\slmult0\tx3558 \up0 \expndtw0\charscalex112 (exprimate clinic)\tab \up0
\expndtw0\charscalex101 PSIHICE \par\pard\sect\sectd\sbknone \li4996\sb1\sl-
t\tab \dn2 \expndtw0\charscalex113 \ul0\nosupersub\cf32\f33\fs40 zzr\t \dn2
\expndtw0\charscalex80 ~\par\pard\ql \li1675\sb0\sl-230\slmult0
\ul0\nosupersub\cf9\f10\fs20 2. Caractere generale \par\pard\qj
\li1382\ri406\sb214\sl-250\slmult0\fi283 \up0 \expndtw0\charscalex117 in cazul
stresului psihic, agentul stresor reprezentat de o largS paletS de \up0
\expndtw0\charscalex118 stimuli dotati cu o semnificatie de regulS nocivS (dar si
intens favorabilS, \up0 \expndtw0\charscalex118 in "oustress") \up0
\expndtw0\charscalex126 - actioneazS intotdeauna pe calea organelor de simt, cu
proiectie corticalS. in urma interventiei sale, apar influxuri nervoase
cortico-\line \up0 \expndtw0\charscalex115 subcorticale. cu activarea centrilor
neuro-vegetativi superiori \up0 \expndtw0\charscalex116 $i punerea in
functiune a sistemului simpato-adrenergic si a axului hipotalamo-hipofizo-\line
\up0 \expndtw0\charscalex119 suprarenal, cu eliberarea consecutivS a unei game
polimorfe de hormoni \up0 \expndtw0\charscalex111 (catecolamine, ACTH, cortizol,
STH, vasopresinS etc.). \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart
Pg55}{\bkmkend Pg55}\par\pard\li1123\sb0\sl-207\slmult0\par\pard\li1123\sb0\sl-
\expndtw0\charscalex120 \ul0\nosupersub\cf9\f10\fs20 In final, rezults o eliberare
crescuts de mediatori ai transmiteni neuro\up0 \expndtw0\charscalex118 vegetative
si de asa-numitii "hormoni de stres" Toti acesti veritabili "me� \up0
\expndtw0\charscalex124 diator!" ai SP au receptori specifici la nivelul celulelor
diferitelor tesu \up0 \expndtw0\charscalex118 turi si organe, prin intermediul
cSrora produc variate tulburSri functionale \up0 \expndtw0\charscalex116
concretizate prin amenintarea pasagera a homeostaziei mediului intern, dar \up0
\expndtw0\charscalex113 care este urmatS de revenirea la valorile compatibile cu
functionarea norma� \up0 \expndtw0\charscalex115 ls a organismului (aceasta in
marea majoritate a SP care
nu lasS in urma lor \up0 \expndtw0\charscalex115 disfunc(ii la diferite niveluri,
generatoare de boalS). \par\pard\qj \li1132\ri665\sb6\sl-235\slmult0\fi292 \up0
\expndtw0\charscalex111 in ultimii ani (dar, incS de la Selye) capStS o utilizare
tot mai frecvents ter \up0 \expndtw0\charscalex118 menul de eustress, ..stresui
pozitiv'. cu efecte benefice asupra organismu� \up0 \expndtw0\charscalex119 lui
uman si care apare - cu atribute generale ale reactiei de stres - in cazul \up0
\expndtw0\charscalex118 in care agentii stresori au o semnificatie favorabilS
pentru individ declan\up0 \expndtw0\charscalex115 sand veritabile afecte pozitive
(bucurie intensS, extaz, triumf, rasul in hoho\up0 \expndtw0\charscalex120 te),
fapt ce se repercuteazS asupra tuturor organelor si aparatelor eel mai \up0
\expndtw0\charscalex118 adesea in mod pozitiv (de ex. efectele sanogenetice ale
rasului) desi exists \up0 \expndtw0\charscalex117 exceptii furnizate de aparitia
unor manifest,in clinice (ex. criza de astm) si \up0 \expndtw0\charscalex121 chiar
la decese (la bolnavii cu cardiopatii severe, in cursul unui hohot de \up0
\expndtw0\charscalex117 ras). Eustress-ul mai apare in cursul unor stSri emotionale
pozitive cuplate \up0 \expndtw0\charscalex117 sau nu cu un efort fizic moderat (ex.
jogging sau actul sexual). Eustress-ul \up0 \expndtw0\charscalex131 este prin
excelenta un stres psihic acut. ..lericirea" atunci cand este \up0
\expndtw0\charscalex115 cronicS. nu are amplitudinea paroxisticS a stresului dar
constituie un fundal \up0 \expndtw0\charscalex115 afectiv (cu numeroase conotatii
cognitive si emotionale), cu un rol favorabil \up0 \expndtw0\charscalex115 asupra
Individului. in plan psihic si somatic. \par\pard\li1128\sb13\sl-
230\slmult0\fi292 \up0 \expndtw0\charscalex120 Ceea ce, insS. constituie o
apreciere relativ cvasiunanimS, este aceea cS\par\pard\li1128\sb5\sl-
230\slmult0\fi9\tx6047\tx7041 \up0 \expndtw0\charscalex119 repetarea frecvents a
eustress-urilor constituie\tab \up0 \expndtw0\charscalex119 \u8222?per se"\tab \up0
\expndtw0\charscalex119 (mai ales cS\par\pard\li1128\sb15\sl-230\slmult0\fi4
\up0 \expndtw0\charscalex120 produce o crestere a imunitStii antiinfectioase si
antitumorale) o premiss a\par\pard\li1128\sb5\sl-
230\slmult0\fi14\tx2284\tx3369\tx3686\tx6144 \up0 \expndtw0\charscalex107
longevitStii\tab \up0 \expndtw0\charscalex108 (v. Tabelul\tab \up0
\expndtw0\charscalex119 1)\tab \up0 \expndtw0\charscalex118 Prin contrast,
distress-ul\tab \up0 \expndtw0\charscalex119 (stresui psihic
negativ)\par\pard\li1128\sb5\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex120
cumuleazS calitstile de factor de rise pentru sSnState si el rSmSne
incS\par\pard\li1128\sb5\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex120
superpozabil cu termenul de stres psihic (SP) atunci cSnd nu se face
preci-\par\pard\li1128\sb6\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex119
zarea ..distress" sau ..eustress".\par\pard\ql \li1128\ri665\sb0\sl-
240\slmult0\fi297\tx1435 \up0 \expndtw0\charscalex109 Si noi vom pSstra aceastS
..sechelS terminologies" (stres psihic in loc de di� \up0 \expndtw0\charscalex112
stress). utilizSnd in mod special termenul de eustress, atunci cand va fi cazul.
\line\tab \up0 \expndtw0\charscalex126 In SP perturbarea homeostaziei somatice este
precedatS si cauzata \up0 \expndtw0\charscalex122 de perturbarea homeostaziei
psihice de catre AS. Asadar SP are in toate \up0 \expndtw0\charscalex117 cazurile
repercusiuni asupra tuturor organelor \up0 \expndtw0\charscalex116 $i aparatelor in
primul rand \par\pard\qj \li1123\ri660\sb0\sl-236\slmult0 \up0
\expndtw0\charscalex114 cele cu rol reglator (sistem neuro-endocrino-vegetativ,
aparat cardio-circula-\line \up0 \expndtw0\charscalex117 tor �i sistemul imun),
dintre care unele - grevate de o patologie anterioarS, \up0 \expndtw0\charscalex117
pe fond sau nu de meiopragie dobandite sau constitutionaie - vor respunde \up0
\expndtw0\charscalex126 prin manifested patologice. Nota obisnuite a SP acute,
cotidiene, este \up0 \expndtw0\charscalex120 "reactia de alarma", continuate sau
nu, de cea "de rezistente", descrise de \up0 \expndtw0\charscalex125 Selye, cu
modificeri generale sj locale reversibile, in conditiile in care \up0
\expndtw0\charscalex124 agentii stresori nu-si prelungesc actiunea. Mijloacele de
contracarare a \up0 \expndtw0\charscalex115 acestora de cetre subiectul afectat (de
regulS prin conduite comportamenta\up0 \expndtw0\charscalex120 le antistres. active
dar si involuntare) sunt capabile sS restabileascS para \up0
\expndtw0\charscalex115 metrii anteriori SP sau sS impiedice chiar din "start"
antrenarea unei verita� \up0 \expndtw0\charscalex115 bile reactii de stres,
inlocuite - atunci cand SP lipseste - doar cu oscilatii ho\up0
\expndtw0\charscalex115 meostatice aflate in zona normalului.
psihosomaticd generals si aplicata\par\pard\li1449\sb0\sl-
Tabelul 1. Distress si Eustress\par\pard\li1449\sb216\sl-
230\slmult0\fi1939\tx6019 \up0 \expndtw0\charscalex110 Distress\tab \up0
\expndtw0\charscalex110 Eustress\par\pard\li1449\sb92\sl-230\slmult0\fi19 \up0
\expndtw0\charscalex110 Calitatea\par\pard\li1449\sb24\sl-
230\slmult0\fi14\tx3383\tx6024 \up0 \expndtw0\charscalex110 agenfilor
stresori\tab \up0 \expndtw0\charscalex110 Neplacufl. ameninfdtori\tab \up0
\expndtw0\charscalex110 Placufi. solicitare\par\pard\li1449\sb29\sl-
230\slmult0\fi1934\tx6014 \up0 \expndtw0\charscalex110 suprasolicitanfi\tab \up0
\expndtw0\charscalex110 moderatd intr-un climat\par\pard\li1449\sb34\sl-
230\slmult0\fi4564 \up0 \expndtw0\charscalex110 afectiv
pozitiv\par\pard\li1449\sb87\sl-230\slmult0\fi38\tx3388\tx6014 \up0
\expndtw0\charscalex110 Tipuri de reactii\tab \up0 \expndtw0\charscalex110
..Active": furie. rusine\tab \up0 \expndtw0\charscalex110 Bucurie. trimf,
extaz,\par\pard\li1449\sb29\sl-230\slmult0\fi1919\tx6019 \up0
\expndtw0\charscalex110 groazd. etc.\tab \up0 \expndtw0\charscalex110 \u8222?
senzafii tari". rdsul in\par\pard\li1449\sb25\sl-230\slmult0\fi1943\tx6019 \up0
\expndtw0\charscalex110 ..Pasive": trtstefe adancd\tab \dn2 \expndtw0\charscalex110
cascade, excitafie\par\pard\li1449\sb29\sl-230\slmult0\fi1929\tx6019 \up0
\expndtw0\charscalex110 neajutorare, nestguranfd\tab \dn2 \expndtw0\charscalex110
sexua/d, dragoste, etc.\par\pard\li1449\sb29\sl-230\slmult0\fi1934\tx6019 \up0
\expndtw0\charscalex110 lipsa de speranfd\tab \up0 \expndtw0\charscalex110 Efort
fizic moderat\par\pard\li1449\sb87\sl-230\slmult0\fi38\tx3388\tx6024 \up0
\expndtw0\charscalex110 Tipuri de situafii\tab \up0 \expndtw0\charscalex110
Conflict, suprasolicitare\tab \up0 \expndtw0\charscalex110 Castiguri financiare
si\par\pard\li1449\sb24\sl-230\slmult0\fi1934\tx4329\tx6009 \up0
\expndtw0\charscalex110 frustrare\tab \up0 \expndtw0\charscalex110 \u8222?
examen".\tab \up0 \expndtw0\charscalex110 morale, contemplare
ex-\par\pard\li1449\sb35\sl-230\slmult0\fi1924\tx6024 \up0 \expndtw0\charscalex110
pierderi n tiore (ex. deces\tab \up0 \expndtw0\charscalex110 taticd (opere de arts,
in\par\pard\li1449\sb33\sl-230\slmult0\fi1929\tx6014 \up0 \expndtw0\charscalex110
divorf. concediere. etc.)\tab \up0 \expndtw0\charscalex110 special muzica,
peisaje\par\pard\li1449\sb25\sl-230\slmult0\fi1929\tx6019 \up0
\expndtw0\charscalex110 N.B. Buddeberg si Wil/i\tab \up0 \expndtw0\charscalex110
naturale), surse de ras\par\pard\li1449\sb34\sl-230\slmult0\fi1929\tx6019 \up0
\expndtw0\charscalex110 considers:\tab \up0 \expndtw0\charscalex110 (lecturi.
spectacote etc.)\par\pard\li1449\sb29\sl-230\slmult0\fi1929\tx6014 \up0
\expndtw0\charscalex110 a) sit. de distress activ\tab \up0 \expndtw0\charscalex110
N.B. Situafii de provocare\par\pard\li1449\sb29\sl-230\slmult0\fi1934\tx6019
\up0 \expndtw0\charscalex110 (implicare activd pre-\tab \up0
\expndtw0\charscalex110 directs (ex. jogging-ul sau\par\pard\li1449\sb30\sl-
230\slmult0\fi1934\tx6000 \up0 \expndtw0\charscalex110 lungitd dar cu
posibilitate\tab \up0 \expndtw0\charscalex110 jocuri de noroc)
sau\par\pard\li1449\sb24\sl-230\slmult0\fi1929\tx6019 \up0 \expndtw0\charscalex110
de control redus\tab \up0 \expndtw0\charscalex110 indirectd (ex. filme
polifiste)\par\pard\li1449\sb29\sl-230\slmult0\fi1934\tx6024 \up0
\expndtw0\charscalex110 b) sit. de distress pasiv\tab \up0 \expndtw0\charscalex110
in care subiectul este solid-\par\pard\li1449\sb34\sl-230\slmult0\fi1939\tx6019
\up0 \expndtw0\charscalex104 (..pierderi". fdrdposibilitatea\tab \up0
\expndtw0\charscalex110 tat. daractivarea fizioiogicd\par\pard\li1449\sb29\sl-
230\slmult0\fi1924\tx6014 \up0 \expndtw0\charscalex110 oricarut control, cu
caracter\tab \up0 \expndtw0\charscalex110 rezultatd are loc pe
fondul\par\pard\li1449\sb34\sl-230\slmult0\fi1929\tx6019 \up0
\expndtw0\charscalex110 de tipsd de perspective\tab \up0 \expndtw0\charscalex110
siguranfei asupra contro/ului\par\pard\li1449\sb30\sl-230\slmult0\fi1929\tx6014
\up0 \expndtw0\charscalex110 si ..neajutorare"\tab \up0 \expndtw0\charscalex110
..provocdrii"\par\pard\li1449\sb86\sl-230\slmult0\fi14\tx3383\tx6019 \up0
\expndtw0\charscalex110 Reactie endocrind\tab \up0 \expndtw-2\charscalex100 a)
catecolamine 1T + cortizol T\tab \up0 \expndtw0\charscalex110 catecolamine +
endorfine\par\pard\li1449\sb25\sl-230\slmult0\fi1934\tx6009 \up0 \expndtw-
4\charscalex100 b) catecolamine 1 + cortizoirTT\tab \up0 \expndtw0\charscalex110
prolactivd + CRF\par\pard\li1449\sb0\sl-230\slmult0\par\pard\li1449\sb111\sl-
230\slmult0\fi9\tx3388\tx6024
\up0 \expndtw0\charscalex110 Sistem imun\tab \up0 \expndtw0\charscalex110
inhibifie (cei. NK)\tab \up0 \expndtw0\charscalex110 imunostimutare (eel. NK de
ex)\par\pard\li1449\sb91\sl-230\slmult0\fi0\tx3383\tx6019 \up0
\expndtw0\charscalex110 Ap. \ul0\nosupersub\cf18\f19\fs20\ul cardiovascular\ul0\tab
\up0 \expndtw0\charscalex110 \ul0\nosupersub\cf18\f19\fs20\ul
Predomind\ul0\nosupersub\cf9\f10\fs20 cresterea TA\tab \up0
\expndtw0\charscalex110 Predommd cresterea AV\par\pard\qj \li1396\sb0\sl-
\par\pard\qj\li1396\ri411\sb82\sl-256\slmult0\fi283 \up0 \expndtw0\charscalex120 SP
cuprinde in tabloul manifestarilor sale, in primul rand simptomele \up0
\expndtw0\charscalex118 ptihice, inclusiv manifested comportamentale. in acela$i
timp, orice feno-\line \up0 \expndtw0\charscalex114 men psihic, exteriorizat sau nu
- de la procesele cognitive (atentie, memorie, \up0 \expndtw0\charscalex115 gandire
etc.) sj pane la procesele volltionale si afective (acestea din urme in \up0
\expndtw0\charscalex114 modul eel mai pregnant) - se insoteste de fenomene
fiziologice de hiper- sau \up0 \expndtw0\charscalex117 hipofunctie a organelor
interne, mediate neuroumoral si avand in genere o \up0 \expndtw0\charscalex117
intensitate moderate, sub cea a unui SP. intre simptomele psihice afective
\par\pard\ql\li1104\ri704\sb134\sl-233\slmult0\fi4\tx1396 \up0
\expndtw0\charscalex119 frecvente in distres mentionem: anxietatea, iritabilitatea,
luria (in formele \up0 \expndtw0\charscalex115 acute), fatigabilitatea, apatia,
depresia (in formele cronice). \line \tab \up0 \expndtw0\charscalex120 Referitor la
comportamentul individului in cursul unui SP - cronic, in \up0
\expndtw0\charscalex114 special - remarcam excesele referitoare la substitutul
drogului (fumat, cafea. \up0 \expndtw0\charscalex117 alcool). scederea
randamentului profesional. refuzul muncii si al accepteni \up0
\expndtw0\charscalex115 responsabilitetilor, inchiderea in sine, neglijarea
aspectului fizic ca si a unor \up0 \expndtw0\charscalex115 norme sociale (Luban
Plozza si colab). \par\pard\qj \li1099\ri699\sb9\sl-231\slmult0\fi288 \up0
\expndtw0\charscalex121 Cele mai cunoscute modificeri somatice induse de
desfe$urarea unor \up0 \expndtw0\charscalex120 procese psihice sunt asa-numitele
"corelate fiziologice (somato-viscera� \up0 \expndtw0\charscalex118 le) ale
emotiilor" (tahicardie, tulburari de tonus muscular, reajusteri vaso\up0
\expndtw0\charscalex122 motorii, tulburari secretorii etc.) care pot imbreca in
cazul SP o serie de \up0 \expndtw0\charscalex116 manifestari sesizate chiar de
persoane din afara domeniului medical si con\up0 \expndtw0\charscalex117 cretizate
in expresii ca: "imi bate inima" sau "mi-a stat inima in loc". ori "a \up0
\expndtw0\charscalex117 albit de spaime" sau "s-a inrosit toate de rusine", "am
simjit o usceciune in \up0 \expndtw0\charscalex117 gat", "mi s-a pus un nod in get"
etc. \par\pard\qj \li1094\ri699\sb9\sl-232\slmult0\fi288 \up0
\expndtw0\charscalex119 Aceste corelate somatice ale proceselor psihice amplificate
dincolo de \up0 \expndtw0\charscalex119 granitele normalului in cadrul stresului
psihic s1 repetate in timp. solicita \up0 \expndtw0\charscalex124 anumite organe si
aparate cu disfunctii latente ori deja manifeste si pot \up0
\expndtw0\charscalex114 se conduce la aparitia unor tulburari patologice
psihosomatice a ceror rever\up0 \expndtw0\charscalex116 sibilitate poate sa
dispare, o date cu aparitia leziunilor de organ, moment in \up0
\expndtw0\charscalex116 care se poate vorbi de boli psihosomatice. \par\pard\ql
\li1391\sb230\sl-230\slmult0 \up0 \expndtw0\charscalex135 3. Stresui psihic $i
adaptarea \par\pard\qj \li1084\ri699\sb190\sl-230\slmult0\fi297 \up0
\expndtw0\charscalex118 in ceea ce priveste relatia dintre SP s' adaptarea
organismului la mediul \up0 \expndtw0\charscalex114 complex al epocii contemporane
(natural-poluat si artificial-suprasolicitant). \up0 \expndtw0\charscalex124
trebuie subliniat ce insusi SP este o reactie a organismului "in intense-' \up0
\expndtw0\charscalex116 adaptatlve, numai ce ea se realizeaza cu pretul unor
eforturi mult mai mari. \up0 \expndtw0\charscalex126 capabile sS lase in urmS
procese de uzurS sau chiar leziuni la diferite \up0 \expndtw0\charscalex122 nivele
SP este decl o reactie de adaptare "stridentS", "zgomotoasS" la o \up0
\expndtw0\charscalex119 constelatie de factori, configurand o situatie care
solicits structurile regla-\line \up0 \expndtw0\charscalex113 toare cele mai inalte
ale organismului (psihicul), "amenintand" sS Ie deregle-\line \up0
\expndtw0\charscalex115 ze activitatea, fapt cu consecinte inevitabile. potential
nocive, asupra tuturor \up0 \expndtw0\charscalex115 compartimentelor din subordine.
Luban Plozza si colab. considers stresui ca \up0 \expndtw0\charscalex123 pe o
reactie la stimulii ambientali care implies semnale de aparare si de \up0
\expndtw0\charscalex117 adaptare Aceiasi autori, mergand pe linia nespecificitetii
stresului \up0 \expndtw0\charscalex100 - postu� \par\pard\qj \li1094\ri713\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex118 late de cetre Selye - il considere ca pe
un sistem de protectie care este per\up0 \expndtw0\charscalex118 maneni pentru
orice tip de stimuli. \par\pard\qj \li1089\ri709\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex127 Rezistenta impresionante a psihicului. ca si a celorlalte
tesuturi si \up0 \expndtw0\charscalex121 aparate ale organismului la stres Tn
general \up0 \expndtw0\charscalex128 $i la SP in special face ca \par\pard\ql
\li1094\sb0\sl-180\slmult0 \up0 \expndtw0\charscalex118 raspunsul adaptativ - chiar
dace este dat "cu consum sporit de energie" ($i \par\pard\ql \li1099\sb11\sl-
230\slmult0\tx3772 \up0 \expndtw0\charscalex113 la propriu, dar $i la figurat) \tab
\up0 \expndtw0\charscalex114 - se nu lase "urme vizibile" decat intr-un numSr
\par\pard\qj \li1094\ri719\sb12\sl-228\slmult0 \up0 \expndtw0\charscalex119 minim
de cazun, adeseori previzibile de cetre medic (scederea rezisten(ei \up0
\expndtw0\charscalex116 biologice si psihice a organismului este previzibilS in caz
de intensitate sau \up0 \expndtw0\charscalex116 durats neobisnuite ale actiunii
agentilor stresori - v. scala Holmes si Rahe) \up0 \expndtw0\charscalex113
Indiferent de "pretul" adaptarii in plan somatic ori psihic, SP lase in urma lui
\up0 \expndtw0\charscalex125 doue posibile modificeri ale "steril sistemului"
reprezentat de intregul \up0 \expndtw0\charscalex111 organism:
\expndtw0\charscalex126 \u8226? cresterea rezistentei fata de solicitari ulterioare
identice sau simi\up0 \expndtw0\charscalex120 lare cu aceea care l-a general, in
caz ce subiectul a dominat, desi stresat, \up0 \expndtw0\charscalex121 situatia
inductoare a SP (se realizeaze un veritabil "antrenament" fate de \up0
\expndtw0\charscalex121 suprasoliciteri psihice in circumstante stresante
potentiale similare); \par\pard\qj \li1387\ri430\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex122 - aparitia unei adevarate "vulnerabilitati fats de stres"
ce reprezintS o \up0 \expndtw0\charscalex121 "capacitate" a subiectului de a "intra
in stres" mult mai usor, la actiunea \up0 \expndtw0\charscalex119 acelorasi agenti
stresori care i-au produs SP initial, in cazul in care acesta \up0
\expndtw0\charscalex120 s-a soldat cu un esec adaptativ (subiectul nu a reusit sS
gSseascS eel mai \up0 \expndtw0\charscalex120 potrivit rSspuns fa(S de situate ori
consecintele ei au fost nocive). \par\pard\qj \li1391\ri431\sb0\sl-
230\slmult0\fi278 \up0 \expndtw0\charscalex117 Vulnerabilitatea la stres constituie
o importantS premise pentru aparitia \up0 \expndtw0\charscalex115 nevrozelor,
psihozelor reactive si a bolilor psihosomatice (acestea din urma \up0
\expndtw0\charscalex115 necesitand s* coexisten(a unui teren organic predispozant).
\par\pard\qj \li1377\ri425\sb0\sl-233\slmult0\fi307 \up0 \expndtw0\charscalex121 in
concluzie. SP reprezinta deci un moment de solicitare a intregului \up0
\expndtw0\charscalex129 organism, chiar dace agresiunea agentului stresor se
exercitS initial \up0 \expndtw0\charscalex128 asupra psihicului. deoarece aceasta
influenteaza. prin relee multiple \up0 \expndtw0\charscalex122 psihosomatice,
activitatea tuturor compartimentelor organismului. \par\pard\qj
\li1382\ri425\sb0\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex113 Dm acest motiv
orice SP reprezintS un examen dat, nu numai de psihicul \up0
\expndtw0\charscalex126 individului solicitat ci si de fiecare organ, in special de
cele solicitate \up0 \expndtw0\charscalex116 preferential \up0
\expndtw0\charscalex131 $i anume: glandele endocrine, sistemul imun, aparatul
\up0 \expndtw0\charscalex115 cardiovascular, aparatul respirator precum $i organele
cu o bogatS inervatie \up0 \expndtw0\charscalex115 cum sunt cele ale aparatului
digestiv \par\pard\ql \li1670\sb1\sl-190\slmult0 \up0 \expndtw0\charscalex116 Acest
examen este trecut cu succes in marea majoritate a situatiilor, fapt
ce explicS rezistenta aparent miraculoasS a organismului la avalansa zilnics
\up0 \expndtw0\charscalex117 de SP sau chiar SP prelungite cu majore implicatii in
existenta individului, \up0 \expndtw0\charscalex117 Si dotate cu o rezonantS
extremS. \par\pard\qj \li1372\ri436\sb0\sl-244\slmult0\fi302 \up0
\expndtw0\charscalex126 Istoria naturals a multor boli demonstreazS o evolutle
indelungata \up0 \expndtw0\charscalex120 preclinica \up0 \expndtw0\charscalex129
(latentS) a proceselor patologice induse de variati agenti \up0
\expndtw0\charscalex115 etiologici si aflate intr-un echilibru fragil cu forjele de
apSrare ale organis� \up0 \expndtw0\charscalex125 mului ce actioneazS in sens
regiator homeostazic. De regulS, exista o \up0 \expndtw0\charscalex121 actiune
sumativa a mai multor agenti etiologici intre care s> un SP ma� \up0
\expndtw0\charscalex121 jor, ori SP minore dar repetate (sau cvasicontinue).
DacS ac(iunea SP a fost inregistrate ca impact asupra psihicului subiec� \up0
\expndtw0\charscalex113 tului afectat \up0 \expndtw0\charscalex113 (a se vedea
exemplele privind efectele cutremurului din Roma� \up0 \expndtw0\charscalex111 nia
in \up0 \expndtw0\charscalex117 1977) \u8226? fere urmeri imediate asupra sanatatii
psihice si somatice - o \up0 \expndtw0\charscalex110 evaluare a efectului lor
tardiv (vezi St. M. Milcu -\up0 \expndtw0\charscalex110 1994) dezveiuie, nu rareori
aparitia - la distanfa fata de un SP major - unor sindroame psiho-pato-\line
\up0 \expndtw0\charscalex119 logice, endocrine, psihosomatice sau chiar a unor boli
din domeniul me� \up0 \expndtw0\charscalex115 dicinii interne in a ceror
etiopatogenie factorul psihogen ocupe de obicei un \up0 \expndtw0\charscalex127 loc
mai modest \up0 \expndtw0\charscalex128 (vezi pneumonia pneumococice in a cerei
etiologie \par\pard\qj \li1372\ri431\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex113 expunerea la frig, de exemplu, ocupe un rol mai important
dar, cuplate cu un \up0 \expndtw0\charscalex125 stres prelungit. o poate declansa
la cateva zile de la o expunere relativ \up0 \expndtw0\charscalex114 moderate la
temperaturi scSzute) \par\pard\qj \li1391\ri437\sb0\sl-246\slmult0\fi292 \up0
\expndtw0\charscalex118 Pornind de la aceste constaten, la indemena medicului
practician, vom \up0 \expndtw0\charscalex118 prezenta in cele ce urmeaze o serie de
afectiuni patologice din variate do\up0 \expndtw0\charscalex115 menii ale
medicinii, in care SP are o participare "prioritare" adice. in raport \up0
\expndtw0\charscalex115 cu alti agenti etiologici. ocupS un rol dominant.
\ul0\nosupersub\cf9\f10\fs20 Psihosomatica generals\tab \up0 \expndtw-
9\charscalex74 <\u8226?\tab \up0 \expndtw0\charscalex108 49\par\pard\qj
Nu trebuie omis din aceastS "demonstrate" nici rolul jucat de "eel de-al \up0
\expndtw0\charscalex118 doilea pol" al interactiunii stresante: terenul "de organ"
(indus genetic sau \up0 \expndtw0\charscalex113 dobandit) pe "matricea" ceruia SP
si-a "gravat amprenta" uneori chiar la dis� \up0 \expndtw0\charscalex120 tant de
actiunea agentului stresant care a declansat explozia. Tot la capi� \up0
\expndtw0\charscalex114 tolul "teren" se inscriu si irasaturile psihice ale
individului, inclusiv baza lor \up0 \expndtw0\charscalex114 neurofiziologice,
dezvoltate in cursul cnstalizarii personalita|n \par\pard\ql \li1387\sb29\sl-
230\slmult0\tx5222 \up0 \expndtw0\charscalex124 Un subiect cu antecedente familiale
\tab \up0 \expndtw0\charscalex118 (AHC) pozitive pentru anumite \par\pard\qj
\li1089\ri718\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex120 afectiuni psihice
(parinti nevrotici de exemplu) va dezvolta mai usor sub \up0
\expndtw0\charscalex116 actiunea SP nevroze decet boli somatice. iar in caz de AHC
pozitive pentru \up0 \expndtw0\charscalex116 boli somatice, va fi afectat priontar
de boli psihosomatice. \par\pard\qj \li1094\ri713\sb20\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex125 Existenta unui "locus minoris resistentiae". postulat de
A.Adler, la \up0 \expndtw0\charscalex121 modul general - si pe care, in prezent, il
considerem a fi situat la diferite \up0 \expndtw0\charscalex123 nivele, inclusiv in
structura sistemului nervos. va oferi locul de actiune \up0 \expndtw0\charscalex115
patogene prioritare a SP (IB. lamandescu - 1993). \par\pard\ql \li1377\sb229\sl-
230\slmult0 \up0 \expndtw0\charscalex135 4. Sfera actiunii prioritare a SP
Participarea SP poate fi considerate ca factor de rise in urmetoarele \up0
\expndtw0\charscalex110 tipuri de boli \par\pard\qj \li1089\ri713\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex122 a. boli psihice, in primul rand
psihogeniile (unde exista o declansare \up0 \expndtw0\charscalex113 exogene prin
SP, aproape exclusive a bolii); \par\pard\qj \li1094\ri713\sb3\sl-233\slmult0\fi297
\up0 \expndtw0\charscalex126 b. unele boli endocrine: boala Basedow. in primul
rand, dar si alte \up0 \expndtw0\charscalex115 afectiuni endocrine, ca de exemplu:
amenoreea de stres, disfunctiile sexuale \up0 \expndtw0\charscalex126 la berbat,
sindromul eutiroidian, hipercorticismul reactiv si nanismul \up0
\expndtw0\charscalex128 psihosocial. "hipocorticismul central" la cei cu SP
cronic \up0 \expndtw0\charscalex123 (in cadrul \par\pard\qj \li1099\ri723\sb18\sl-
220\slmult0 \up0 \expndtw0\charscalex118 "sindromului de disprotectie", constand in
blocarea respunsului endocrin) \up0 \expndtw0\charscalex109 (Coculescu - 1986);
\par\pard\ql \li1377\sb12\sl-230\slmult0\tx3921 \up0 \expndtw0\charscalex127 c.
bolile psihosomatice \tab \up0 \expndtw0\charscalex122 (termen ce include atat
ponderea crescute a \par\pard\qj \li1094\ri708\sb19\sl-220\slmult0 \up0
\expndtw0\charscalex116 etiologiei psihogene, cat s' existenta unui teren de organ
ca si a unui anume \up0 \expndtw0\charscalex116 tip de personalitate a bolnavului,
receptiv la SP); \par\pard\qj \li1094\ri740\sb4\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex120 d. unele boli infectioase cu componenta psihogena
importanta: de ex. \up0 \expndtw0\charscalex113 tuberculoza, hepatite virala A.
\par\pard\ql \li1382\sb1\sl-215\slmult0\tx5827 \up0 \expndtw0\charscalex126 e.
unele boli metabolice: diabetul zaharat \tab \up0 \expndtw0\charscalex119
(ecloziunea si modularea \par\pard\ql \li1094\sb13\sl-230\slmult0 \up0
\expndtw0\charscalex115 evolutiei sale), obezitatea, anorexia nervoase etc;
f. in anumite cazuri de neoplasm exista argumente convmgatoare in \up0
\expndtw0\charscalex121 favoarea implicarii unui SP major in aparitia brusce a
fazei clinice ori in \up0 \expndtw0\charscalex121 diseminare metastatice
fulgeretoare. \par\pard\ql \li1387\sb10\sl-230\slmult0\tx7108 \up0
\expndtw0\charscalex130 Desigur ce in orice boala, chiar cu o etiologie unica
\tab \up0 \expndtw0\charscalex115 (de exemplu \par\pard\qj \li1094\ri718\sb0\sl-
235\slmult0 \up0 \expndtw0\charscalex113 afectiunile patologice din domeniul
ortopediei), poate fi implicat SP, atat din \up0 \expndtw0\charscalex114 punct de
vedere al circumstantelor de producere (o fracturS la un om stresat. \up0
\expndtw0\charscalex119 un accident rutier in cazul unei stSri de enervare
accentuats etc.) cat, mai \up0 \expndtw0\charscalex124 ales, din punctul de vedere
al evolutiei bolii. a cSrei vindecare poate fi \up0 \expndtw0\charscalex115
intarziate de SP ulterioare. \par\pard\qj \li1094\ri713\sb0\sl-233\slmult0\fi297
\up0 \expndtw0\charscalex116 Evantaiul larg de afectiuni in care este implicat SP
ne face se ne gandim \up0 \expndtw0\charscalex116 la o apreciere fecute de Balzac
cu mult inainte de Selye, refenndu-se la una \up0 \expndtw0\charscalex118 dintre
cele mai evidente emotii. capabiie se traduce un SP intens: "spaima \up0
\expndtw0\charscalex118 este un sentiment care te imbolneveste pe jumetate, care
atace atat de \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg60}
233\slmult0 \up0 \expndtw0\charscalex116 violent masina omeneasce incat facultetile
acesteia sunt dintr-o date impin-\line \up0 \expndtw0\charscalex117 se, fie la eel
mai inalt grad al for\{ei lor, fie la ultimul grad al destrSmSrii' \up0
\expndtw0\charscalex125 Spaima nu este altceva decat un fel de tresnet interior
dar, ca toate ac-\line \up0 \expndtw0\charscalex114 cidentele electrice. bizar $i
capricios in manifestSrile sale (Cesar Birotteau). \par\pard\qj
\li1521\ri286\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex132 intr adevar, SP
solicits violent organismul uman. dar caracterul \up0 \expndtw0\charscalex130
"bizar si capricios" al efectelor sale poate fi prevazut prin studierea \up0
\expndtw0\charscalex125 "punctelor slabe" ale organismului, situate, asa cum s-a
mentionat. la \up0 \expndtw0\charscalex119 diferite nivele (reglator sau organo-
efector) (Poenaru -\up0 \expndtw-3\charscalex100 1986) \par\pard\qj
intre actiunea SP $i aparitia manifestSrilor de boalS exists adesea o \up0
\expndtw0\charscalex122 perioadS mai mult sau mai putin indelungatS de "latentS" a
bolii sau de \up0 \expndtw0\charscalex122 lupts, incununatS de succes. pentru
lichidarea urmSrilor SP dacS nu in \up0 \expndtw0\charscalex114 totalitate (in
special ecoul sSu asupra viefii psihice a individului) eel putin la \up0
\expndtw0\charscalex114 nivelul sistemelor de reglare ?i organelor interne,
solicifate pe parcurs \par\pard\qj \li1814\ri1139\sb166\sl-300\slmult0\tx2107
\up0 \expndtw0\charscalex131 5. Modificarile psihosomatice premorbide induse de
SP \line\tab \up0 \expndtw0\charscalex132 prelungit \par\pard\qj
\li1511\ri296\sb170\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex122 in afara
reactiilor psiho-comportamentale induse de SP, unele dintre \up0
\expndtw0\charscalex118 ele atingand granita dintre fiziologic \up0
\expndtw0\charscalex112 $i patologie \up0 \expndtw0\charscalex118 (cum este, de
exemplu, \par\pard\qj \li1511\ri291\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex123
oboseala extremS), exists o serie de modificSri ale intregului organism \up0
\expndtw0\charscalex117 (Inclusiv in sfera reglatorie: psihicS. neuro-endocrins ?i
imunitara) pe care \up0 \expndtw0\charscalex117 Ie putem sistematiza astfel:
a) modificSri functionale somato-viscerale ample si prelungite \up0
\expndtw0\charscalex117 (veritabile tulburSri psihosomatice) care, pe un teren
patologie. predispus, \up0 \expndtw0\charscalex130 pot declansa procese patologice
reversibile \up0 \expndtw0\charscalex132 (de exemplu un puseu \par\pard\ql
\li1511\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex115 hipertensiv), sau
ireversibile (un accident vascular cerebral), \par\pard\qj \li1507\ri300\sb0\sl-
260\slmult0\fi302 \up0 \expndtw0\charscalex126 De regulS, solicitSrile somato-
viscerale induse de SP declanseaza \up0 \expndtw0\charscalex113 tulburSri
functionale reversibile la putin timp dupS incetarea SP. \par\pard\qj
\li1502\ri291\sb0\sl-254\slmult0\fi297 \up0 \expndtw0\charscalex124 b) in cazuri
mai rare, dar insumand cifre apreciabile la nivelul unei \up0
\expndtw0\charscalex124 colectivltSti numeroase expuse la SP obisnuite, tulburarile
functionale \up0 \expndtw0\charscalex121 "amorsate" de SP participa la edificarea
unor procese morfologice stand \up0 \expndtw0\charscalex129 la baza aparmei unor
boli organlce. De asemenea SP poate accelera \up0 \expndtw0\charscalex126 evolu|ia
unor procese patologice cu aparenja de tulburSri functionale \up0
\expndtw0\charscalex122 datoritS unui substrat lezional greu evidentiabil cu
mijloace diagnostice \up0 \expndtw0\charscalex118 uzualc. Cei mai adesea astfel de
procese patologice "generate" de SP apar \up0 \expndtw0\charscalex125 la un
interval "liber" sau ocupat de "tulburSri functionale" \up0 \expndtw0\charscalex115
(ex.: boala \par\pard\qj \li1507\ri293\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex115 ulceroasS) sau chiar pe parcursul desfSsurSrii unui SP
prelungit sau al unor \up0 \expndtw0\charscalex115 SP repetitive \par\pard\qj
\li1516\ri300\sb0\sl-253\slmult0\fi288 \up0 \expndtw0\charscalex122 Nu trebuie omis
si faptul cS realitatea zilnica ofera exemplul tipic de \up0
\expndtw0\charscalex127 SP aparut pe fondul unui SP anterior, la putin timp dupS
"iesirea din \up0 \expndtw0\charscalex121 stres" \up0 \expndtw0\charscalex124 (cand
subiectul este mai receptiv fata de solicitSri care, in mod \up0
\expndtw0\charscalex117 obisnuit, nu-i produc SP) si mai frecvent sumatja mai
multor SP. \par\pard\qj \li1536\ri301\sb9\sl-250\slmult0\fi278 \up0
\expndtw0\charscalex115 in acest context, nuantarea rSspunsului psiho-
neurovegetativ endoenn in \up0 \expndtw0\charscalex117 functie de natura SP
contribuie la conturarea unor tablourl clinice al cSror \up0
\expndtw0\charscalex123 polimorfism este accentuat si de faptul cS tulburSrile
functionale \up0 \expndtw0\charscalex121 (sau
Psihosomatica generals\tab \up0 \expndtw0\charscalex113 \u9830? 51\par\pard\qj
patologice) apar rareori pe un fond 'bazar de repaus. al unei anumite \up0
\expndtw0\charscalex119 activitati fiziologice. Ele apar in cursul desfasurSrii
unor functii legate de \up0 \expndtw0\charscalex118 diterite momente fiziologice
(efort, digestie. de exemplu), inclusiv al unor \up0 \expndtw0\charscalex116
ritmuri biologice hormonale (exemplu secrejie de cortizol, de insulins etc.)
\up0 \expndtw0\charscalex115 sau pe fondul unui tonus crescut neuro-vegetativ
simpatic sau parasimpatic. \par\pard\qj \li1031\ri786\sb0\sl-260\slmult0\fi288 \up0
\expndtw0\charscalex113 Exists insS, chiar Selye a recunoscut-o, diferen(e
calitative intre diferitele \up0 \expndtw0\charscalex113 forme de stres - si intr-o
forms nets, intre stresui fizic (SF) si eel psihic (SP) \par\pard\qj
\li1031\ri777\sb0\sl-240\slmult0\fi4\tx1238 \up0 \expndtw-2\charscalex100 -\tab
\up0 \expndtw0\charscalex128 fapt probat si de observatia curenta asupra unor
bolnavi cu infarct \up0 \expndtw0\charscalex127 miocardic la care declansarea
acestuia este indusS de un stres psihic \up0 \expndtw0\charscalex127 (uneori
repetitiv), desi toleran(a lor anterioara la efort a fost eel putin \up0
\expndtw0\charscalex112 normals (cazul multor fosti sportivi, de exemplu).
ConsiderSm cS este foarte probabil ca in SP sS existe o alts configurate \up0
\expndtw0\charscalex114 a mediatorilor (inclusiv a hormonilor) reactiei de stres
fata de celelalte tipuri \up0 \expndtw0\charscalex113 de stres: fizic, biologic,
etc. \up0 \expndtw0\charscalex112 - in special sub raportul cantitativ al
participSrii \par\pard\qj \li1031\ri771\sb19\sl-240\slmult0\tx1977 \up0
\expndtw0\charscalex110 fiecSruia \tab \up0 \expndtw0\charscalex120 - de unde si
rSspunsurile calitative diferite ale acelorasi organe \up0 \expndtw0\charscalex114
solicitate in SP asa cum sunt analizate de M. Coculescu (1992). \par\pard\qj
\li1027\ri776\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex119 De asemenea un
SP i$i prelungeste actiunea (efect recunoscut) adesea \up0 \expndtw0\charscalex114
cu mult timp dupS incetarea agentului stresor fa(S de stresui fizic.
\par\pard\ql \li1324\sb229\sl-230\slmult0 \up0 \expndtw0\charscalex136 6.
Vulnerabilitatea psihica la stres \par\pard\qj \li1031\ri766\sb174\sl-
250\slmult0\fi292 \up0 \expndtw0\charscalex118 Referitor la terenul psihic asupra
cSruia actioneazS agentii stresori este \up0 \expndtw0\charscalex117 dovedit cS in
asa-numitele boli psihosomatice exists o serie de trasaturi de \up0
\expndtw0\charscalex114 personalitate cu rol "permisiv" fate de stresui psihic.
Dupe cum am aretat in lucrari anterioare (1980, 1984). opinam impotriva \up0
\expndtw0\charscalex122 existentei unor profiluri psihosomatice proprii fiecSrei
boli psihosoma� \up0 \expndtw0\charscalex115 tice (BPS), postulate de cStre FI.
Dunbar. Opinia noastrS rezultS, nu numai \up0 \expndtw0\charscalex115 din datele
obtinute la aplicarea testelor de personalitate, dar poate fi dedusS \up0
\expndtw0\charscalex117 Si din coexistenta la acela$i bolnav. a unor BPS diverse -
de exemplu astm \up0 \expndtw0\charscalex113 bronsic + urticarie + ulcer duodenal +
hipertensiune arterialS - cum am intal-\line \up0 \expndtw0\charscalex113 nit la
sase dintre bolnavii nostri \up0 \expndtw0\charscalex112 (lamandescu. \up0
\expndtw0\charscalex113 1980). Mai recent, G lonescu \par\pard\qj
\li1027\ri770\sb0\sl-252\slmult0\fi9\tx1315 \up0 \expndtw0\charscalex112 (1990)
observS aceeasi perimare a acestor tipologii specif ice diferitelor BPS.
\line\tab \up0 \expndtw0\charscalex114 ConsiderSm ce existe un "profil general" de
bolnav psihosomatic s* vom \up0 \expndtw0\charscalex117 ceuta se demonstrem acest
lucru la locul potrivit. Credem ce la acest nivel. \up0 \expndtw0\charscalex114 al
personalitetii bolnavului. se realizeazS impactul factorului stresant psihic.
\up0 \expndtw0\charscalex123 in legSturS cu care ConsiderSm necesar sS accentuSm
rolul traumelor \up0 \expndtw0\charscalex112 minime, dar cu actiune indelungatS sau
a "situaliilor ISrS iesire" (Kourilsky) \par\pard\qj \li1027\ri787\sb7\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex114 Un rol important in privin(a
receptionSrii intensitStii si duratei unui SP il \up0 \expndtw0\charscalex128
joacS, atat mecanismele de ajustare \up0 \expndtw0\charscalex131 (coping) fata de
SP cat si tipul \par\pard\ql \li1046\sb29\sl-230\slmult0 \up0
\expndtw0\charscalex116 locului de control. Ele vor fi analizate in paragraful
7. \par\pard\qj \li1031\ri767\sb14\sl-250\slmult0\fi288 \up0
\expndtw0\charscalex116 Vulnerabilitatea fata de stres reprezintS nu atSt o sums
algebricS a unor \up0 \expndtw0\charscalex118 date de personalitate facilitSnd. mai
mult sau mai putin, "intrarea in stres" \up0 \expndtw0\charscalex121 ori
amplltudinea reactiei la stres a unui individ. Ea este constituits de un \up0
\expndtw0\charscalex117 pattern dinamic, de interactiune, al acestor trasaturi
stabile de personalitate \up0 \expndtw0\charscalex117 dar. adeseori. solicitate ca
per(i componente ale unui comportament relativ
\expndtw0\charscalex104 <\u8226?\tab \up0 \expndtw0\charscalex104 Elemente de
250\slmult0 \up0 \expndtw0\charscalex122 stereotip (ca de ex tipul A).
Vulnerabilitatea psihice la stres apare ca un \up0 \expndtw0\charscalex123 element
favorizant pentru bolile psihice, dar si pentru cele psihosoma� \up0
\expndtw0\charscalex123 tice (BPS) in cadrul carora ea se asoclaza cu o
vulnerabilitate de organ. \par\pard\qj \li1488\ri319\sb12\sl-248\slmult0\fi292 \up0
\expndtw0\charscalex117 in BPS, aperute ca urmare a unui SP mai intens receptionat
de cetre un \up0 \expndtw0\charscalex121 subiect cu un tip de personalitate
vulnerabiie fate de actiunea AS. putem \up0 \expndtw0\charscalex118 considera ce
mai exists un agent de "rezonante" pentru SP. Acesta inchide \up0
\expndtw0\charscalex123 un cere vicios si este reprezentat de tulburarile somato-
psihice inerente \up0 \expndtw0\charscalex122 oricarei boli psihosomatice, dar
amplificate si ele de un tip de persona� \up0 \expndtw0\charscalex122 litate cu o
vulnerabilitate crescuta. in special, in sfera afectiv-emotiona-\line \up0
\expndtw0\charscalex114 la (de exemplu. reactia unui bolnav cardiac la
extrasistolele sale ventriculare \up0 \expndtw0\charscalex114 apSrute in cursul
unor emotii) (lamandescu -\up0 \expndtw-3\charscalex100 1993). \par\pard\qj
\li1483\ri319\sb10\sl-251\slmult0\fi287 \up0 \expndtw0\charscalex120 Actualmente
castigS teren ideea cS tipul de personalitate (postulat de \up0
\expndtw0\charscalex130 catre primii psihosomaticieni ca fiind specific pentru
fiecare dintre \up0 \expndtw0\charscalex119 afectiunile psihosomatice, ca de
exemplu tipologia nespecificS a astmati-\line \up0 \expndtw0\charscalex118 cufui,
ulcorosului, coronarianului etc.), nu mai reprezinte decat o compo� \up0
\expndtw0\charscalex123 nents intr-un complex de factori nespecific! care moduleaza
rSspunsul \up0 \expndtw0\charscalex120 individual al organismului la agentii
etiologici. Acest complex multifac-\line \up0 \expndtw0\charscalex128 torial
include in mod necesar trasSturi de personalitate formate pe o \up0
\expndtw0\charscalex130 matrice constitutional si dobandite in cursul
experientei \up0 \expndtw0\charscalex118 (biografia) \par\pard\qj
\li1483\ri320\sb0\sl-253\slmult0\fi14 \up0 \expndtw0\charscalex124 individului. in
planul insertiei si interactiunilor sale cu "reteaua socia� \up0
\expndtw0\charscalex118 ls" (Malchair). ca si al situatiilor concrete (evenimente
cu rol stresor) care \up0 \expndtw0\charscalex121 pot juca un rol trigger psihogen
in patologia clinics, indiferent de natura \up0 \expndtw0\charscalex121
acesteia. \par\pard\qj \li1483\ri330\sb0\sl-260\slmult0\fi278 \up0
\expndtw0\charscalex121 Avand o exprimare in actele de comportament, cu inevitable
ajustSri \up0 \expndtw0\charscalex118 conjuncture impuse de acestea, ConsiderSm cS
- in cazul unei hipetrofieri \up0 \expndtw0\charscalex118 a trasSturiior componente
("personalitSti accentuate" descrise de Leonhard) \par\pard\qj
\li1473\ri325\sb0\sl-246\slmult0\fi14 \up0 \expndtw0\charscalex126 - diferitele
tipuri de personalitate pot sS conflueze intr-un tip general, \up0
\expndtw0\charscalex128 caracterizat printr-o "vulnerabilitate fata de stres",
termen utihzat de \up0 \expndtw0\charscalex110 Kourilsky. avand o sfera mai large
decat cea a tipului psihocomportamental A. \up0 \expndtw0\charscalex110 desens de
Friedman ?i R. Rosenman. \par\pard\ql \li1761\sb10\sl-230\slmult0\tx8232 \up0
\expndtw0\charscalex119 Astfel, pe baza unor studii si observatil personate
(lamandescu -\tab \up0 \expndtw-3\charscalex100 1977, \par\pard\qj
\li1483\ri316\sb12\sl-252\slmult0\fi23\tx2078 \up0 \expndtw-3\charscalex100
1980. \tab \up0 \expndtw0\charscalex116 1984) considerem ce o vulnerabilitate fa(S
de stres poate fi Tntalnita \up0 \expndtw0\charscalex118 atat la indivizi cu
trSsSturi de personalitate accentuate dincolo de limitele \up0
\expndtw0\charscalex120 unei adaptabilitati sociale normale ($i contribuind la
edificarea unor acte \up0 \expndtw0\charscalex117 comportamentale adeseori
"ineficiente"). cat si 'a indivizi cu diverse tipuri \up0 \expndtw0\charscalex126
de personalitate "neaccentuate", dar inclinati cStre un comportament \up0
\expndtw0\charscalex116 generator facil de stres psihic. \par\pard\qj
\li1492\ri320\sb0\sl-260\slmult0\fi288 \up0 \expndtw0\charscalex110 Un astfel de
comportament este prezent la indivizi cu diferite tipuri de per� \up0
\expndtw0\charscalex117 sonalitate (psihastemc. isterie, paranoid etc.), unificati
prin posedarea unor \up0 \expndtw0\charscalex115 insusiri comportamentale
asemSnStoare. fata de realizarea unei sarcini \up0 \expndtw0\charscalex109 (de
obicei profesionale) si de raportare la cei din fur, tipul comportamental A \up0
\expndtw0\charscalex109 type A behaviour pattern - (TABP), descris de Friedman,
Rosenman si Jenkins. \line\tab \up0 \expndtw0\charscalex113 Analiza acestui tip de
comportament - dominat de sentimentul urgenjei S' \up0 \expndtw0\charscalex113 eel
al competitiei, acesta din urmS dublat de ostilitate, va fi fecute in
\ul0\nosupersub\cf9\f10\fs20 Psihosomatica generala\tab \up0 \expndtw0\charscalex51
\u8226?:\u8226?\tab \up0 \expndtw0\charscalex106 53\par\pard\ql \li1012\sb0\sl-
\par\pard\ql\li1012\ri808\sb84\sl-250\slmult0\tx1296 \up0 \expndtw0\charscalex122
capitolul consacrat PS cardiovasculare. in acest paragral vom nota doar \up0
\expndtw0\charscalex112 impactul comportamentului A asupra unor parametri
fiziologici. \line \tab \up0 \expndtw0\charscalex127 Astfel, posesoni tipului
comportamental A, fie numai cu ostilitate \up0 \expndtw0\charscalex119 crescuts
\up0 \expndtw0\charscalex120 (Haynes) fie cu tot ansamblul trSsSturilor TABP, vor
"rezona" \up0 \expndtw0\charscalex124 dispropor(ional, de exemplu prin secretie
excesivS de catecolamine \up0 \expndtw0\charscalex80 � \par\pard\qj
\li1008\ri799\sb8\sl-253\slmult0 \up0 \expndtw0\charscalex130 cortizol, la o arie
extrem de largS de stimuli psihici negativi. Tipul \up0 \expndtw0\charscalex123
comportamental A reprezintS - in opinia noastrS - un tip "ideal" pentru \up0
\expndtw0\charscalex126 "crearea". de catre insusi individul apartenent, a unor
premise pentru \up0 \expndtw0\charscalex129 "coiectionarea" facila a numeroase si
variate stresuri psihice si prin \up0 \expndtw0\charscalex114 aceasta, el devine un
important factor de rise pentru o serie mai larga de boli \up0
\expndtw0\charscalex118 decat bolile cardio-vasculare cu raspandire larga dar si a
altor boli cronice \up0 \expndtw0\charscalex109 degenerative (lamandescu - 1993,
confirmat si de BSban $i colab. -1995). \par\pard\qj \li1012\ri810\sb0\sl-
260\slmult0\fi288 \up0 \expndtw0\charscalex117 Pornmd de la aspectele vizSnd rolul
tipurilor psihocomportamentale in \up0 \expndtw0\charscalex117 favoarea instalSrii
unor boli \up0 \expndtw0\charscalex125 (in special psihosomatice dar si a celor
cu \par\pard\qj \li1008\ri794\sb0\sl-260\slmult0 \up0 \expndtw0\charscalex113
evolutie cronic degenerative), cu o componenta etiologies psihogenS - initial
\up0 \expndtw0\charscalex123 mai "stearsS", dar ulterior tot mai accentuats \up0
\expndtw0\charscalex129 - nu se poate concepe o \par\pard\ql \li1012\sb1\sl-
189\slmult0 \up0 \expndtw0\charscalex115 tentativS a msertiei acestor factori
etiologici in patogenezS decat apeland la \par\pard\qj \li1008\ri804\sb13\sl-
260\slmult0 \up0 \expndtw0\charscalex124 conceptul de stres psihic fara a uita insS
si rolul conditionarii reflexe a \up0 \expndtw0\charscalex129 reactiei de stres la
unii stimuli indiferenti \up0 \expndtw0\charscalex111 (Caroline Koblenzer \up0
\expndtw-2\charscalex100 -\up0 \expndtw-4\charscalex100 1987, \par\pard\ql
\li1012\sb25\sl-230\slmult0 \up0 \expndtw0\charscalex112 lamandescu - 1995).
\expndtw0\charscalex137 7. Stresui perceput - rezultanta a interactiunii
agentilor \line\tab \up0 \expndtw0\charscalex133 stresori cu factori si mecanismele
componente \line \tab \up0 \expndtw0\charscalex134 ale filtrelor antistres
\par\pard\ql \li1305\sb178\sl-230\slmult0 \up0 \expndtw0\charscalex121 J Agenfi
stresori. scale de evaluare \par\pard\qj \li993\sb0\sl-251\slmult0
\par\pard\qj\li993\ri799\sb22\sl-251\slmult0\fi292\tx2198 \up0
\expndtw0\charscalex113 incS din \tab \up0 \expndtw0\charscalex116 1967, Holmes �i
Rahe au cercetat corelatia dintre schimbSrile \up0 \expndtw0\charscalex118 recente
de via'S (afectand cSminul si familia. munca si relatiile sociale ale \up0
\expndtw0\charscalex112 subiectului) si aparitia unor boli (infectiile in general,
tuberculoza s* infarctul \up0 \expndtw0\charscalex118 miocardic). constatand cS
astfel de evenimente - cauzatoare de SP, uneori \up0 \expndtw0\charscalex115 trecut
cu vederea - pot avea o influents certs in patogenezS la marea maior-\line \up0
\expndtw0\charscalex118 itate a indivizilor. De exemplu, frecventa deceselor
..imprevizibile" ca s' a \up0 \expndtw0\charscalex113 infarctului miocardic este
net crecuts la un grup de subiec(i din Finlanda care \up0 \expndtw0\charscalex114
au inregistrat schimbSri \u8222?de viata" (concediere. divort, chiar si mutarea
intr-\line \up0 \expndtw0\charscalex116 o noua locuinja) in ultimele 6 luni in
raport cu o populate martor fere astfel \up0 \expndtw0\charscalex125 de schimberi
s* cu caracteristici demografice asemenatoare \up0 \expndtw0\charscalex127 (Rahe s'
\par\pard\ql \li993\sb27\sl-230\slmult0\tx2265 \up0
\expndtw0\charscalex110 colaboratorii \tab \up0 \expndtw0\charscalex105 - citat de
Yuwiller). \par\pard\ql \li1296\sb30\sl-230\slmult0\tx6139 \up0
\expndtw0\charscalex127 lerarhizand situatiile stresante cu caracter de \tab
\up0 \expndtw0\charscalex120 \u8222?schimbareu in viata \par\pard\ql
\li993\sb10\sl-230\slmult0\tx7752 \up0 \expndtw0\charscalex116 diferitilor indivizi
corelate cu posibilitatea crescute de aparitie a bolii \tab \up0
\expndtw0\charscalex105 (deci \par\pard\qj \li993\ri816\sb6\sl-260\slmult0\fi9 \up0
\expndtw0\charscalex116 sugerand un raport de cauzalitate). Rahe a evaluat
principalele evenimente, \up0 \expndtw0\charscalex119 grupate in patru categorii
(\u8222?starea sanatatii". ..munca", \up0 \expndtw0\charscalex123 \u8222?casa s'
familia", \par\pard\qj \li1003\ri825\sb0\sl-260\slmult0\fi9 \up0
\expndtw0\charscalex117 ..personal ?i social"), acordand fieceruia un punctaj care
indice potentialul \up0 \expndtw0\charscalex115 patogen al evenimentelor
respective, intr-un \up0 \expndtw0\charscalex112 \u8222?clasament" conform
acestui \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg64}{\bkmkend
\expndtw0\charscalex105 \u9830?\tab \up0 \expndtw0\charscalex105
\ul0\nosupersub\cf18\f19\fs20\ul Elemente de psihosomatica generala ?i
\expndtw0\charscalex112 \ul0\nosupersub\cf9\f10\fs20 punctaj primul loc il ocupe
mortea unuia dintre soti (100), ..urmate" de divort \par\pard\ql \li1257\sb10\sl-
230\slmult0\tx3321\tx5020 \up0 \expndtw0\charscalex120 (80), starea de arest
\tab \up0 \expndtw0\charscalex113 (64), spitalizarea \tab \up0
\expndtw0\charscalex113 (62). imbolnavirea unui membru din \par\pard\qj
\li1248\ri554\sb17\sl-246\slmult0\fi4 \up0 \expndtw0\charscalex116 familie (54) si
situatii profesionale, echivalente ca punctaj: pensionarea sau \up0
\expndtw0\charscalex119 concedierea recente si situatia de recent cesetorit (50
puncte). Pe ultimele \up0 \expndtw0\charscalex112 locuri: schimberi ale
obiceiurilor personale (12). petrecerea unei vacanfe (11) \up0
\expndtw0\charscalex112 Si ..incSlcSri minore ale legii". \par\pard\qj
\li1243\ri559\sb13\sl-248\slmult0\fi287 \up0 \expndtw0\charscalex115 Valoarea unor
astfel de scale este incontestabilS, mai ales pentru studiile \up0
\expndtw0\charscalex115 de epidemiologie a diferitelor boli somatice si psihice,
dar trebuie totdeauna \up0 \expndtw0\charscalex114 analizata in cadrul
anamnezei, ..validarea prin S.P.". de cStre fiecare individ \up0
\expndtw0\charscalex121 a unor astfel de evenimente. in plus, chiar in conditiile
in care acele .life \up0 \expndtw0\charscalex118 changes" postulate de Holmes si
Rahe declansau reale SP majore, aparitia \up0 \expndtw0\charscalex113 bolilor
..prezise" de ScalS a fost departe de proportia prevSzutS datorits unor \up0
\expndtw0\charscalex118 factori de rezistentS care tin de personalitatea
individului dar si de terenul \up0 \expndtw0\charscalex117 sSu de organ. Cohen $i
Williamson \up0 \expndtw-5\charscalex100 (in \up0 \expndtw0\charscalex118 1989) au
considerat riscul pentru \par\pard\qj \li1248\ri560\sb0\sl-246\slmult0\fi4 \up0
\expndtw0\charscalex113 imbolnSvire de numai 9% pentru cazurile cu punctaj crescut
la aceastS seals. \up0 \expndtw0\charscalex123 S-a subliniat si de cStre alti
autori importanta stresurilor minore zilnice \up0 \expndtw0\charscalex112 cumulate
in timp dar si modul in care este perceput de catre indivizi propiului \up0
\expndtw0\charscalex112 stres psihic (v. Scala stresului perceput de Cohen si
Williamson). \par\pard\qj \li1252\ri555\sb13\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex116 Va trebui sS prezentSm o mult mai noua seals a
evenimentelor de viata \up0 \expndtw0\charscalex129 cu rol de agenti stresori,
elaborata de Lindemann si colab. \up0 \expndtw0\charscalex115 (valabilS
pentru Germania anului 1994) pe un numSr de 251 de subiec(i si care indicS \up0
\expndtw0\charscalex127 un punctaj si " ordine destul de diferite fata de scala
Holmes si Rahe, \up0 \expndtw0\charscalex112 apSrutS in urmS cu circa 30 de ani.
\par\pard\ql \li1550\sb7\sl-230\slmult0\tx5068 \up0 \expndtw0\charscalex111 In
privinta evenimentelor "Casnice", \tab \up0 \expndtw0\charscalex116 - decesul
partenerului de viatS este \par\pard\qj \li1248\ri554\sb22\sl-240\slmult0\fi4
\up0 \expndtw0\charscalex113 punctat cu 86 p.. iar divor(ul (tot 70 p.) este
"devansat" de decesul unei fnnte \up0 \expndtw0\charscalex109 apropiate (73 p.)
\up0 \expndtw0\charscalex111 $i o boalS severs sau accident (72 p.). De asemenea,
in jurul \par\pard\qj \li1248\ri569\sb20\sl-240\slmult0\tx2030 \up0
\expndtw0\charscalex118 a 50 p. \tab \up0 \expndtw0\charscalex115 (cSsStoria in
scala Holmes si Rahe) figureazS evenimente precum: \up0 \expndtw0\charscalex114
conflicte cu legea (60 p.), incendiu al locuintei \up0 \expndtw0\charscalex111 (60
p.). zgomot ambiant (51) \par\pard\ql \li1248\sb29\sl-230\slmult0 \up0
\expndtw0\charscalex111 sau penalitSti financiare s> tulburSri de somn (ambele 50
p.). \par\pard\qj \li1257\ri560\sb2\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex112 Un loc important in aceastS seals recents a lui Lindemann
il ocupS stresui \up0 \expndtw0\charscalex118 profesional declansat eel mai
frecvent de "conditiile proaste de lucru" \up0 \expndtw0\charscalex103 (62
\par\pard\qj \li1252\ri560\sb0\sl-260\slmult0 \up0 \expndtw0\charscalex113 p.),
sohcitSri profesionale extrem de crescute (61 p.), munca in acord sau sub \up0
\expndtw0\charscalex113 presiunea timpului (60 p.) sau conflictele cu seful (55
p.). \par\pard\qj \li1248\ri560\sb0\sl-250\slmult0\fi297 \up0
\expndtw0\charscalex113 De altfel cercetSrile lui Thorell $i Karasek, completate
ulterior de Siegrist \up0 \expndtw0\charscalex132 au evidential ca un model de
stres profesional acel stres in care se \up0 \expndtw0\charscalex109 conf igureazS
un complex situa(ional tridimensional alcStuit din: \par\pard\qj
\li2020\ri550\sb0\sl-240\slmult0\tx2299 \up0 \expndtw0\charscalex126 / -
amplitudinea si calitatea (continuitate, placute-nepiacute) a \line\tab \up0
\expndtw0\charscalex127 solicitation \par\pard\ql \li1267\ri560\sb4\sl-
250\slmult0\fi720\tx1540 \up0 \expndtw0\charscalex114 2 \u9632? postbilitatea de
control $1 decizle (activ-pasiv) asupra sarcinil. \line\tab \up0
\expndtw0\charscalex115 Ambele dimensiuni reprezentate pe axe perpendiculare prin
combinarea \up0 \expndtw0\charscalex114 valorilor lor extreme binare \up0
\expndtw0\charscalex110 (inalts \up0 \expndtw0\charscalex117 ?i scSzutS),
delimiteazS patru cadrane \par\pard\qj \li1267\ri550\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex123 dintre care contrastul eel mai mare il reprezintS
distressul maxim pasiv \up0 \expndtw0\charscalex114 (solicitare crescuta sj control
decizional minim) \up0 \expndtw0\charscalex124 ?i distressul minim activ
\par\pard\ql \li1271\sb28\sl-230\slmult0 \up0 \expndtw0\charscalex110 (solicitare
redusS. control decizional maxim).
Psihosomatica generala\tab \dn2 \expndtw0\charscalex113 \u9830? 55\par\pard\qj
200\slmult0 \up0 \expndtw0\charscalex119 Figura 2 Modificatd dupa Siegrist \up0
\expndtw0\charscalex120 preluat din Buddeberg si Will! \par\pard\ql
\ul0\nosupersub\cf23\f24\fs14 Minim (acllv) \par\pard\ql \li4814\sb0\sl-161\slmult0
\par\pard\ql\li4814\sb152\sl-161\slmult0 \up0 \expndtw0\charscalex118 Sollcltan
\par\pard\li2750\sb0\sl-126\slmult0\fi0\tx6187 \up0 \expndtw0\charscalex113 Minim .
4-\tab \up0 \expndtw0\charscalex144 \ul0\nosupersub\cf19\f20\fs12
Umm\par\pard\qj \li5846\sb0\sl-160\slmult0 \par\pard\qj\li5846\sb0\sl-
160\slmult0 \par\pard\qj\li5846\ri2311\sb34\sl-160\slmult0 \up0
\expndtw0\charscalex108 \ul0\nosupersub\cf23\f24\fs14 Dime* maxim \up0
\expndtw0\charscalex109 p�lv \par\pard\ql \li4219\sb0\sl-161\slmult0
\expndtw0\charscalex106 Multn <p�ilv) \par\pard\ql \li1708\sb0\sl-230\slmult0
\ul0\nosupersub\cf9\f10\fs20 3 - suportul social ca factor cu rol de filtru in
calea stresului si care \par\pard\qj \li2016\ri823\sb0\sl-210\slmult0\fi14 \up0
\expndtw0\charscalex115 - adSugat ca 0 a treia dimensiune la primele doua -
contribuie la \up0 \expndtw0\charscalex122 conturarea unui model spatial
tridimensional in care maxima \up0 \expndtw0\charscalex117 morbiditate este plasats
intr-un "cub" ale cSrei dimensiunl sunt \up0 \expndtw0\charscalex118 reprezentate
de: solicitare crescuta, control decizional si suport \up0 \expndtw0\charscalex113
social scSzute (date preluate de Buddeberg si Willi). \par\pard\ql \li1267\sb0\sl-
183\slmult0\tx5447 \up0 \expndtw0\charscalex127 \u9633? Factorii de rise biografici
reprezintS \tab \up0 \expndtw0\charscalex127 0 serie de caracteristici de
\par\pard\qj \li964\ri834\sb15\sl-210\slmult0\fi4
\up0 \expndtw0\charscalex114 mediu, psihologice si sociale, care isi pun amprenta
asupra individului, fiind \up0 \expndtw0\charscalex119 considerate de cStre
Hoffmann si Eggle ca veritabili factori de rise pentru \up0 \expndtw0\charscalex114
bolile psihice si psihosomatice. RedSm acesti factori in Tabelul 2. \par\pard\qj
\li1713\ri952\sb209\sl-260\slmult0\tx1924 \up0 \expndtw0\charscalex121 Tabelul 2.
Factori de rise biografici pentru patologia pslhlca $1 \line\tab \up0
\expndtw0\charscalex122 psihosomaticd. Sistematizarea dupa Hoffmann fi Eggle
Circumstanfe socio-profeslonale ale parlnfllor \par\pard\ql \li1608\sb30\sl-
230\slmult0 \up0 \expndtw0\charscalex115 - status socio-economic scSzut
\par\pard\ql \li1603\sb1\sl-193\slmult0 \up0 \expndtw0\charscalex112 \u8226? nivel
scoiar scSzut al pSrintilor \par\pard\ql \li1598\sb7\sl-193\slmult0 \up0
\expndtw0\charscalex113 - activitatea profesionalS a mamei in primul an de viafa al
copilului \par\pard\ql \li1598\sb37\sl-230\slmult0 \up0 \expndtw0\charscalex122 2.
Climatul psihic indus de parinfi \par\pard\ql \li1603\sb30\sl-230\slmult0 \up0
\expndtw0\charscalex112 \u9632? tulburSri psihice ale mamei sau ale tatSlui
\par\pard\ql \li1732\sb1\sl-193\slmult0 \up0 \expndtw0\charscalex112 neinjelegeri
cronice in familie (patologie relationalS) \par\pard\ql \li1603\sb0\sl-
180\slmult0 \up0 \expndtw0\charscalex114 - criminalitate sau disocialitate a unuia
dintre paring (sau a ambilor) \par\pard\ql \li1598\sb37\sl-230\slmult0 \up0
\expndtw0\charscalex121 3. Carenfe afective potentiate ale copilului
\par\pard\ql \li1603\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex111 - copll
nedorit (inclusiv nSscut "nelegitim") \par\pard\ql \li1603\sb1\sl-193\slmult0
\up0 \expndtw0\charscalex120 - educatia unilateral a mamei \par\pard\ql
\li1598\sb7\sl-193\slmult0 \up0 \expndtw0\charscalex112 - tatS autoritar
\par\pard\ql \li1603\sb17\sl-230\slmult0 \up0 \expndtw0\charscalex123 4. Contacte
sociale \par\pard\ql \li1608\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex112
\u9632? frecvent schimbate (nu sunt trainice) \par\pard\ql \li1598\sb1\sl-
217\slmult0 \up0 \expndtw0\charscalex116 - reduse (cu copii de aceeasi varstS)
\par\pard\ql \li1598\sb0\sl-180\slmult0 \up0 \expndtw0\charscalex112 - interval mai
mic de 18 luni intre frati \par\pard\ql \li1608\sb10\sl-185\slmult0 \up0
\expndtw0\charscalex120 5. Abuz sexual sau viol
\expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs20 Elemente de psihosomaticS
generals si aplicata\par\pard\li1324\sb0\sl-230\slmult0\par\pard\li1324\sb0\sl-
\u9633? Factorii cu rol de filtru in calea agentilor stresori pot fi
rezumatl\par\pard\li1324\sb10\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex119 (dupS
Bruchon-Schneider ?i Danzer) astfel:\par\pard\li1324\sb10\sl-230\slmult0\fi292 \up0
\expndtw0\charscalex119 - expenenta personals pozitivs
(..antrenament")\par\pard\li1324\sb19\sl-230\slmult0\fi297\tx1823\tx6614 \up0
\expndtw0\charscalex119 -\tab \up0 \expndtw0\charscalex119 trSsStun imunogene de
personalitate pozitive\tab \up0 \expndtw0\charscalex119 (robustete. sens
al\par\pard\li1324\sb15\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex119 coerentei,
optimism si simt al umorului, loc de control intern)\par\pard\li1324\sb10\sl-
230\slmult0\fi292\tx3225 \up0 \expndtw0\charscalex114 - suportul social\tab \up0
\expndtw0\charscalex119 (inclusiv posibilitSti de
comunicare)\par\pard\li1324\sb20\sl-230\slmult0\fi292 \up0 \expndtw0\charscalex120
- factori demografici (vSrste tanere, statut socio-prolesional
ridicat)\par\pard\li1324\sb53\sl-230\slmult0\fi292 \up0 \expndtw0\charscalex119 -
teren psihic patologie minim sau absolut.\par\pard\qj \li1612\ri1097\sb166\sl-
320\slmult0\tx1905 \up0 \expndtw0\charscalex136 8. Modul de participare si
ierarhizare a actiunii stresului \line\tab \up0 \expndtw0\charscalex133 psihic
intre ceilalti agenti etiologici \par\pard\qj \li1315\ri487\sb158\sl-
250\slmult0\fi292 \up0 \expndtw0\charscalex118 in patogeneza aparitiei bolilor
psihosomatice trebuie avute in vedere si \up0 \expndtw0\charscalex116
obligativitatea coexistentei unui teren organic meiopragic, in care SP poate
\up0 \expndtw0\charscalex116 se-$i graveze o amprente de diferite grade, culminSnd
cu aparitia bolii. \par\pard\qj \li1310\ri502\sb0\sl-245\slmult0\fi292 \up0
\expndtw0\charscalex133 inainte de a analiza insertia stresului psihic intre
ceilalti factori \up0 \expndtw0\charscalex119 etiopatogenetici ai bolilor interne,
se cuvine sS subliniem ca actiunea sa -\line \up0 \expndtw0\charscalex121 mediate
prin stimulare neurovegetativS si reactia de eliberare a "hormo-\line \up0
\expndtw0\charscalex125 nilor de stres" - se exercita prioritar asupra acelor
aparate si organe cu \up0 \expndtw0\charscalex130 o bogatS inervatie vegetativa
\up0 \expndtw0\charscalex121 (cardiovascular, respirator, digestiv) si \par\pard\ql
\li1320\sb23\sl-230\slmult0\tx4454 \up0 \expndtw0\charscalex128 asupra unor functli
generate \tab \up0 \expndtw0\charscalex126 (metabolice, imunitare) cu rol major
in \par\pard\ql \li1315\sb1\sl-217\slmult0 \up0 \expndtw0\charscalex114 pSstrarea
parametrilor homeostatici ai intregului organism. \par\pard\qj
\li1310\ri493\sb24\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex112 O ierarhizare.
cu tents exhaustivS, a participSrii SP si intricSrii lui cu a Hi \up0
\expndtw0\charscalex114 factori etiopatogenici - in aparitia si evolutia diverselor
boli (nu numai SP) a \up0 \expndtw0\charscalex114 fost intrepnnsS la noi in \up0
\expndtw-4\charscalex100 1985. \par\pard\qj \li1320\ri495\sb0\sl-
260\slmult0\fi278 \up0 \expndtw0\charscalex124 Asadar. sistematizand participarea
stresului psihic la geneza bolilor \up0 \expndtw0\charscalex112 interne, putem
delimita urmStoarele situafii: \par\pard\ql \li1593\sb229\sl-230\slmult0\tx2025
\up0 \expndtw0\charscalex105 8.1. \tab \up0 \expndtw0\charscalex122 - participa la
constituirea bolii \par\pard\qj \li1300\ri493\sb22\sl-240\slmult0\fi307 \up0
\expndtw0\charscalex114 Un exemplu ilustrativ il pot oferi unii subiecti predispusi
la hipertensiune \up0 \expndtw0\charscalex117 arteriala \up0
\expndtw0\charscalex120 (HTA) la care stresurile psihice repetate pot conduce la
aparitia \up0 \expndtw0\charscalex130 bolii, uneori la vSrste mai tinere decet la
ascendentii hipertensivi ai \up0 \expndtw0\charscalex115 bolnavilor respectivi \up0
\expndtw0\charscalex128 (Klumbies). Pornind de la acest exemplu se pot \par\pard\ql
\li1305\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex115 intrevedea doua variante
posibile: \par\pard\qj \li1305\ri493\sb22\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex119 a) boala este declansats aparent exclusiv de factorul
psihogen asa cum \up0 \expndtw0\charscalex119 sunt unele debuturi bruste ale
hipertensiunii arteriale dupS un stres major \up0 \expndtw0\charscalex118 (divort.
conflicte profesionale soldate cu retrogradSri sau sanctionSri etc.) \up0
\expndtw0\charscalex117 cazurile intalmte si de noi \up0 \expndtw0\charscalex114
(lamandescu, \up0 \expndtw0\charscalex111 1991). Din instructivele observatii
\par\pard\qj \li1310\ri488\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex115 ale lui
Klumbies am putea mentiona la acest paragraf cazurile cu "pusee" de \up0
\expndtw0\charscalex114 HTA, durand circa \up0 \expndtw0\charscalex123 6-12 luni,
aperute la tinerii cu stari conflictuale, dar \par\pard\qj \li1315\ri497\sb20\sl-
240\slmult0 \up0 \expndtw0\charscalex122 pasibile se intre in acalmie in urma unor
proceduri psihoterapeutice sau \up0 \expndtw0\charscalex122 odate cu disparitia
sursei stresante. \par\pard\qj \li1320\ri508\sb0\sl-250\slmult0\fi297 \up0
\expndtw0\charscalex119 b) boala este produsa si declansata de un complex de
factori etiologici \up0 \expndtw0\charscalex121 care actioneaze sumativ cu stresui
psihic (excesul de sare in alimentatie, \up0 \expndtw0\charscalex114 instalarea
obezitetii etc.). \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg67}
\ul0\nosupersub\cf9\f10\fs20 8.2.\tab \up0 \expndtw0\charscalex120 -\tab \up0
\expndtw0\charscalex136 participa la ritmarea puseelor evolutive ale bolii
odata\par\pard\li1008\sb20\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex136
constituite.\par\pard\ql \li1291\sb122\sl-230\slmult0 \up0 \expndtw0\charscalex113
Si aici existe "variante": \par\pard\ql \li1296\sb10\sl-230\slmult0\tx5342 \up0
\expndtw0\charscalex136 a) de participare aparent exclusiva \tab \up0
\expndtw0\charscalex123 (ex. reactualizarea ulcerului \par\pard\qj
\li998\ri800\sb0\sl-250\slmult0 \up0 \expndtw0\charscalex129 duodenal in sesiunile
de examene de vara si de iarna, la studenfi, in \up0 \expndtw0\charscalex117
contrast cu ritmarea clasice a bolii - specifica la majoritatea bolnavilor dar \up0
\expndtw0\charscalex115 tot pe un teren predispus (lamandescu, 1980).
\par\pard\qj \li1008\ri809\sb0\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex121 b)
se adauge posibilitatea unei declansari alternative de cStre unii din \up0
\expndtw0\charscalex126 factorii etiologici specifici bolii \up0
(revenind la ulcer, reintrarea in puseu \par\pard\qj \li998\ri800\sb0\sl-
246\slmult0\fi9 \up0 \expndtw0\charscalex115 poate fi datorats, intr-un an, unei
conduite alimentare defectuoase. in alt an, \up0 \expndtw0\charscalex118 datoritS
unei medicatii agreslve inclusiv acidosecretoare, etc.) Referitor la \up0
\expndtw0\charscalex116 ulcerul duodenal, privind relevarea importantului rol
etiopatogenic jucat de \up0 \expndtw0\charscalex120 Helicobacter Pylori, opinSm cS
actiunea aeestei bacterii se supune, s' ea. \up0 \expndtw0\charscalex114 efectelor
stresului asupra imunitatii. stiut fiind efectul nociv asupra celulelor \up0
\expndtw0\charscalex115 NK jucat de cresterea cortizolului plasmatic in stSrile de
distres cronic, fapt \up0 \expndtw0\charscalex115 ce scade apSrarea locals fata de
agentul patogen mentionat. \par\pard\qj \li1008\ri814\sb108\sl-
240\slmult0\fi278\tx1718 \up0 \expndtw0\charscalex105 8.3. \tab \up0
\expndtw0\charscalex123 - participa la intretinerea evolutiei prelungite sau
cronice a unei \up0 \expndtw0\charscalex122 boli si inducerea aparitie) unor
complicatii \par\pard\qj \li993\ri795\sb117\sl-244\slmult0\fi302 \up0
\expndtw0\charscalex113 Exemplificand tot cu ulcerul duodenal, prelungirea unui
puseu, dincolo de \up0 \expndtw0\charscalex116 limitele temporale. cu caracter
obisnuit, boala poate fi consecinta unui stres \up0 \expndtw0\charscalex114 psihic
conjugat sau nu si cu alti factori etiologici. Astfel am observat In vara \up0
\expndtw0\charscalex107 anului \up0 \expndtw0\charscalex116 1976. la un lot de 26
de student cu ulcer duodenal, aparitia la 12 din \up0 \expndtw0\charscalex116 ei a
unor complicatii majore (8 cazuri cu hematemeze si/sau melene si 4 cu \up0
\expndtw0\charscalex116 perforate gastrice). \par\pard\qj \li988\ri800\sb20\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex126 La 9 dintre acesti bolnavi a fost
inregistratS prezenta unor stresuri \up0 \expndtw0\charscalex118 psihice importante
(6 din ei au pierdut anul universitar, iar la 3 bolnavi lea \up0
\expndtw0\charscalex112 decedat unui din pSrintO \par\pard\qj \li988\ri795\sb9\sl-
230\slmult0\fi297 \up0 \expndtw0\charscalex120 La fel ne apare si cronicizarea unei
urticarii aperute acut la un alergen \up0 \expndtw0\charscalex119 (alimentar de
exemplu) si prelungite (uneori cronicizare) prin coexistenta \up0
\expndtw0\charscalex118 ulterioarS a unui stres psihic. AceastS adSugare a SP face
adesea posibilS \up0 \expndtw0\charscalex125 o conditional reflexa si preluarea
etiologiei de cStre factorul psihogen \up0 \expndtw0\charscalex111 (lamandescu -
1996 si 1997). \par\pard\qj \li984\ri794\sb110\sl-
230\slmult0\fi297\tx1800\tx2011 \up0 \expndtw0\charscalex106 8 4 \tab \up0
\expndtw-2\charscalex100 -\tab \up0 \expndtw0\charscalex136 participa ca factor
declansant direct al decesului Tntr-o \up0 \expndtw0\charscalex129 afectiune ajunsa
in stadiul final evolutiv si in care o gama de agenti \up0 \expndtw0\charscalex123
etiologici pot precipita sfarsitul letal al bolii. \par\pard\qj
\li984\ri789\sb133\sl-227\slmult0\fi292 \up0 \expndtw0\charscalex119 Cei mai
elocvent exemplu este oferit de cazurile in care un stres psihic \up0
\expndtw0\charscalex120 intens poate genera un edem pulmonar acut la un vechi
cardiac (eventual \up0 \expndtw0\charscalex122 hipertensiv) sau. mai ales, un
infarct miocardic cu evolutie rapid letalS. \up0 \expndtw0\charscalex122 Chiar
eustress-ul poate, in aceste conditii de boalS preexistents, sS aibS \up0
\expndtw0\charscalex117 drept elect decesul bolnavului, fiind cunoscuts o serie de
cazuri anecdotice \up0 \expndtw0\charscalex123 de decese apSrute la unii spectatorl
in urma emotiei violente cauzate de \up0 \expndtw0\charscalex124 marcarea unui gol
de cStre echipa favorits. AceastS modalitate, relativ \up0 \expndtw0\charscalex127
facilS. de a constitui o cauzS fatalS este rareori un atribut exclusiv al \up0
\expndtw0\charscalex113 stresului.
psihosomaticS generals si aplicata\par\pard\qj \li1320\sb0\sl-240\slmult0
240\slmult0\fi292 \up0 \expndtw0\charscalex115 SS nu uitam ca eustress-ul, chiar
declan$and aceleasi furtuni neurovege-\line \up0 \expndtw0\charscalex129 tative si
hormonale ca si distressul \up0 \expndtw0\charscalex124 (analizat ca factor
etiopatogen in \par\pard\qj \li1310\ri488\sb12\sl-226\slmult0\fi14 \up0
\expndtw0\charscalex115 prezentarea de fata) este reputat ca avSnd virtuti
terapeutice. in primul rand \up0 \expndtw0\charscalex128 de regenerare nervoase.
Rasul este considerat astezi ca avand efecte \up0 \expndtw0\charscalex115 benefice
asupra a multiple functii ale organismului, analizate scrupulos prin \up0
\expndtw0\charscalex116 variate metode de laborator Totusi. atunci cand se
analizeaze de ex. nivelul \up0 \expndtw0\charscalex115 hormonilor de stres in cazul
unui subiect supus unui examen, comparativ cu \up0 \expndtw0\charscalex120 unui
care are o explozie de bucurie (din alte motive), in ambele cazuri se \up0
\expndtw0\charscalex120 evidentiaze o reactie catecolaminica. \par\pard\qj
\li1310\ri481\sb13\sl-228\slmult0\fi302 \up0 \expndtw0\charscalex115 Desigur. mai
existe nuante. unele insesizabile, in special de ordin neuro\up0
\expndtw0\charscalex119 secretor, care pot in viitor explica de ce intr-un caz.
rolul jucat de distress \up0 \expndtw0\charscalex128 este nociv iar eel de eustress
benefic. Se pot da si raspunsun privind \up0 \expndtw0\charscalex115 pattern-ul
diferit al emotiei la nivelul structurilor corticae si subcorticale, cu \up0
\expndtw0\charscalex123 corelate somatice diferite, dar persiste ince multe
necunoscute ce se cer \up0 \expndtw0\charscalex115 studiate pe viitor
Revenind la inserjia sa in randul celorlaHi agenti etiologici ai bolilor \up0
\expndtw0\charscalex119 interne, trebuie amintit ca eel mai adesea factorul
psihogen - actionand in \up0 \expndtw0\charscalex118 exclusivitate sau asociat cu
ceilalti factori etiopatologici \up0 \expndtw0\charscalex122 - declanseaza la
nivelul general al organismului, sau local de organ, tulburari functionale \up0
\expndtw0\charscalex120 pasibile de o reversibilitate complete, mai ales cSnd ele
se produc asupra \up0 \expndtw0\charscalex131 unor structuri morfo-biochimice ince
nealterate sau fare fragilitate \up0 \expndtw0\charscalex115 constitutionaie. Din
acest motiv. de reguie, stresui psihic nu antreneazS atat \up0
\expndtw0\charscalex114 de frecvent tulburarile patologice organice, desi - in
cazul preexistentei unor \up0 \expndtw0\charscalex120 meiopragii de organ sau tesut
(ori numai biochimice) sau repetSrilor sale \up0 \expndtw0\charscalex120 frecvente
- se poate ancora sj in organicitate. \par\pard\qj \li1305\ri478\sb19\sl-
220\slmult0\fi292 \up0 \expndtw0\charscalex127 Ceea ce trebuie retinut, este
intrarea factorului psihogen in "elita" \up0 \expndtw0\charscalex120 factorilor
etiopatogenici ai bolilor interne, pozitie in care se cere tratat cu \up0
\expndtw0\charscalex120 considerate de practicieni si descifrat in intimitatea
mecanismelor sale de \up0 \expndtw0\charscalex120 cStre cercetstori.
\par\pard\ql \li1612\sb0\sl-230\slmult0 \par\pard\ql\li1612\sb2\sl-230\slmult0 \up0
\expndtw0\charscalex118 Bibliograffe \par\pard\ql \li1631\sb190\sl-230\slmult0 \up0
\expndtw0\charscalex100 1. Appley MH, Trumbull R Psychological stress \u9632? New
York, Apple ton Century-\par\pard\li1593\sb1\sl-226\slmult0\fi235\tx2448 \up0
\expndtw-7\charscalex100 Drifts,\tab \up0 \expndtw0\charscalex102
Brouchon-Schwettzer Marilou, Dantzer R. Introduction dans la psychologie
de\par\pard\li1593\sb1\sl-227\slmult0\fi230\tx2932\tx5927 \up0
\expndtw0\charscalex102 la sante pp.\tab \up0 \expndtw0\charscalex102 13-42. Presse
Univ. France. Paris.\tab \up0 \expndtw0\charscalex102 1994.\par\pard\li1593\sb1\sl-
225\slmult0\fi0\tx7775 \up0 \expndtw0\charscalex102 3 Coculescu M
Neuroendocrinologie clinicd. Ed. Medicald, Bucuresti.\tab \up0
\expndtw0\charscalex103 4. Derevenco P. Anghel I. Baban Adriana. Stresui in
sdndtate �i boala. Ed. Dacia,\par\pard\li1593\sb1\sl-213\slmult0\fi263 \up0
\expndtw0\charscalex100 5. Dunbar Flanders, Synopsis of psychosomatic medicine,
Mosby, St. Louis, 1948. \par\pard\ql \li1603\sb1\sl-195\slmult0\tx7118 \up0
\expndtw0\charscalex102 6. Floru R. Stresui psihic. Ed. $tiin(ificd Encicloped
Bucuresti. \tab \up0 \expndtw-9\charscalex84 1974. \par\pard\qj
\li1612\ri536\sb5\sl-220\slmult0\tx1819 \up0 \expndtw0\charscalex105 7. French
TM, and Alexander, F. Psychogenic factors in bronchial asthma \line\tab
\up0 \expndtw0\charscalex105 Psychosom. Med Monogr. 1941, 4:2. \par\pard\qj
\li1608\ri492\sb20\sl-220\slmult0\tx1819 \up0 \expndtw0\charscalex102 8 Golu M. in:
Dicfionar de psihologie sociald, Ed. Enciclopedicd Bucuresti, 1981 \line\tab
\up0 \expndtw0\charscalex102 pp. 235 236. \par\pard\qj \li1617\ri499\sb0\sl-
220\slmult0\tx1838 \up0 \expndtw0\charscalex105 9. lamandescu IB. Corela/ii
psihosomatice in astmul bronsic. Tezd de Doctoral, \line\tab \up0 \expndtw-
3\charscalex100 IMF Bucuresti 1980. \par\pard\qj \li1651\ri483\sb0\sl-
220\slmult0\tx1924 \up0 \expndtw0\charscalex106 10. lamandescu IB. Rolul factorilor
psihoemofionali
in etiopatogenia astmului \line\tab \up0 \expndtw0\charscalex100 bron$ic. Viata
Medicald 1985. I. 34 \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart
\expndtw0\charscalex126 \u9830? 59\par\pard\ql \li1233\sb0\sl-210\slmult0
\par\pard\ql\li1233\sb0\sl-210\slmult0 \par\pard\ql\li1233\ri898\sb192\sl-
210\slmult0\tx1492\tx1492 \up0 \expndtw0\charscalex114 11. lamandescu IB. The study
ot personality type on patients with allergic asthma \line\tab \up0
\expndtw0\charscalex114 using MMPl, vot.4'h Cong. "Bronchitis and emphysema" -
Abstrade, Giornale \line\tab \up0 \expndtw0\charscalex109 italiano detle ma la t
tie di torace, p. A78, sept. 23-28, \up0 \expndtw-6\charscalex100 1985.
12. lamandescu IB Stresui psihic si bolile interne. Ed. All. Bucuresti. 1993, p.
172-\line \tab \up0 \expndtw0\charscalex100 213. \par\pard\qj
\li1233\ri912\sb20\sl-200\slmult0\tx1507 \up0 \expndtw0\charscalex118 13.
lamandescu IB Principles of psychosomatic approach to allergic patients \u9632?
\line\tab \up0 \expndtw0\charscalex111 Rev Roum Psychologie, 1993, 37, Nr. 1, p.
79-89. \par\pard\ql \li1233\sb15\sl-207\slmult0 \up0 \expndtw0\charscalex128 14.
lamandescu IB. Stresui psihic la interferenfa Psihotogiei Medicate cu
\par\pard\li1233\sb16\sl-207\slmult0\fi273\tx3676\tx4401 \up0
\expndtw0\charscalex110 Psihosomatica. J. Med..\tab \up0 \expndtw0\charscalex100
1993, 2.\tab \up0 \expndtw0\charscalex110 17-19.\par\pard\li1233\sb0\sl-
207\slmult0\fi0\tx7200\tx7704\tx7920 \up0 \expndtw0\charscalex110 15. lamandescu
IB. Abordare psihosomaticd in alergii. J. Med. Rom.,\tab \up0 \expndtw-
6\charscalex100 1993,\tab \up0 \expndtw-8\charscalex78 1,\tab \up0
\expndtw0\charscalex110 19-\par\pard\ql \li1502\sb3\sl-207\slmult0 \up0
\expndtw0\charscalex100 20. \par\pard\ql \li1228\sb1\sl-198\slmult0 \up0
\expndtw0\charscalex111 16. lamandescu IB. Psihologie Medicald, Ed. Infomedica,
1996. \par\pard\qj \li1228\ri892\sb4\sl-220\slmult0\tx1497 \up0
\expndtw0\charscalex129 17. Kaplan AP. The pathogenia basis ot urticaria and
angioedemarecent \line\tab \up0 \expndtw0\charscalex113 advanced Amer. J. Med.
1981, 70, 755. \par\pard\li1190\sb0\sl-162\slmult0\fi38\tx7204 \up0
\expndtw0\charscalex113 18. Kaplan HB. Psychosociat stress. Acad. Press. New York,
London,\tab \up0 \expndtw0\charscalex116 1983.\par\pard\li1190\sb17\sl-
207\slmult0\fi38\tx7718 \up0 \expndtw0\charscalex116 19. Klumbies G. Psychotherapie
innerer Erkrankungen, Jena, G. Fischer,\tab \up0 \expndtw0\charscalex116
1983.\par\pard\li1190\sb9\sl-207\slmult0\fi302 \up0 \expndtw0\charscalex116 pp. 459
462\par\pard\li1190\sb9\sl-207\slmult0\fi0 \up0 \expndtw0\charscalex117 20 Klumbies
G, Psychotherapie und Allgemeine Medizin, Hirsel Verlag,
Leipzig.\par\pard\li1190\sb14\sl-207\slmult0\fi364 \up0 \expndtw0\charscalex116
Koblenzer Caroline. Psychocutaneous Disease. Grune and Straton
Inc.,\par\pard\li1190\sb9\sl-207\slmult0\fi335\tx3076 \up0 \expndtw0\charscalex112
Orlando. Florida.\tab \up0 \expndtw0\charscalex116 1987.\par\pard\qj
\li1190\ri868\sb0\sl-220\slmult0\tx1555 \up0 \expndtw0\charscalex113 22. Lazarus
RS. Psychological stress and coping process. New York McGraw-Hill \line\tab \up0
\expndtw-5\charscalex100 1966. \par\pard\qj \li1190\ri892\sb0\sl-220\slmult0\tx1521
\up0 \expndtw0\charscalex120 23 Leonhard K Personalitdfi accentuate in viafd si
literaturd. Ed. Stiinfificd si \line\tab \up0 \expndtw0\charscalex110 Enciclopedicd
Bucuresti 1979. \par\pard\qj \li1195\ri883\sb0\sl-220\slmult0\tx1545 \up0
\expndtw0\charscalex113 24. Lindemann H. Das erofotgretche Ant/stress Programm
Orbis Verlag, Munchen \line\tab \up0 \expndtw-3\charscalex100 1994. \par\pard\ql
\li1190\sb1\sl-183\slmult0 \up0 \expndtw0\charscalex115 25. Luban Plozza 8.,
LaederachHoffmann K., Knaak L.. Dickhaut H. H. Der Ariz \par\pard\ql
\li1516\sb18\sl-207\slmult0\tx4948 \up0 \expndtw0\charscalex109 als Arznei. Deutche
Artze Verlag, Kdln, \tab \up0 \expndtw-5\charscalex100 1996. \par\pard\qj
\li1190\ri913\sb0\sl-220\slmult0\tx1516 \up0 \expndtw0\charscalex112 26. MilcuSt.
M. Sindromul psihosomatic al bdtranului valid. Viafa Medicald 1984, \line\tab
\up0 \expndtw0\charscalex100 XXXI. 277-280. \par\pard\li1190\sb3\sl-
207\slmult0\fi0\tx7113 \up0 \expndtw0\charscalex117 27. Poenaru S.
Neurolransmission et stress (2), Eutherapie 1984. 2.\tab \up0
\expndtw0\charscalex120 1-6.\par\pard\li1190\sb9\sl-207\slmult0\fi0\tx6667 \up0
\expndtw0\charscalex120 28. Sells SB. On the nature of stress. In: McGrath
JE.\tab \up0 \expndtw0\charscalex120 (ed) Social and\par\pard\li1190\sb9\sl-
207\slmult0\fi316\tx7747 \up0 \expndtw0\charscalex116 psychological factors in
stress. New York. Holt. Rinehart and Winston,\tab \up0 \expndtw0\charscalex120
1970.\par\pard\li1190\sb14\sl-207\slmult0\fi312 \up0 \expndtw0\charscalex120 p.
134-139.\par\pard\ql \li1185\sb1\sl-196\slmult0\tx6331 \up0 \expndtw0\charscalex116
29. Selye H. The stress ot life, Longman, Green. London, \tab \up0
\expndtw0\charscalex108 1957. Von Eiff A, Zur \par\pard\ql \li1516\sb15\sl-
207\slmult0 \up0 \expndtw0\charscalex111 Psychology und Klinik des Stress.
Terapiewoche. 1984.34, 7192-7196.
\expndtw0\charscalex117 \ul0\nosupersub\cf14\f15\fs24 Capitolul 5 \par\pard\qj
\li1368\sb0\sl-360\slmult0 \par\pard\qj\li1368\ri2973\sb55\sl-360\slmult0 \up0
\expndtw0\charscalex100 MECANISME ADAPTATIVE (DE COPING) \up0
\expndtw0\charscalex100 IN STRESUL PSIHIC. \par\pard\ql \li1377\sb90\sl-276\slmult0
\up0 \expndtw0\charscalex102 IMPUCATII IN PRACTICA MEDICALA \par\pard\ql
\ul0\nosupersub\cf8\f9\fs22 Ovidiu Popa Velea \par\pard\qj \li1080\sb0\sl-
\expndtw0\charscalex108 Termenul de "stres" a cepetat in ultimele decenii o
extensie semnificati\up0 \expndtw0\charscalex111 va, chiar spectaculare, ajungand a
explica aparitia/agravarea a o serie ?n\up0 \expndtw0\charscalex111 treage de
afectiuni psihice sau somatice. izolate sau congruente. \par\pard\qj
\li1075\ri706\sb20\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex106 Acest fapt. de
altfel cu radacim in realitatea imediats, trimite cercetetorul \up0
\expndtw0\charscalex109 sau chiar pe eel profan in materie - la intrebarea
legitima: existe mecanis� \up0 \expndtw0\charscalex106 me, tehnici de a face fata
stresului, si daca da. cum anume functioneazS ele, \up0 \expndtw0\charscalex107 cum
pot fi optimizate. in asa fel incit agentii stresori \up0 \expndtw0\charscalex108 -
in mare parte inevi-\par\pard\ql \li1075\sb3\sl-237\slmult0\tx1622 \up0 \expndtw-
1\charscalex100 tabili \tab \up0 \expndtw0\charscalex108 - sS nu actioneze
necontrolat, haotic asupra noastrS? \par\pard\qj \li1070\ri707\sb0\sl-
250\slmult0\fi302 \up0 \expndtw0\charscalex108 RSspunsul la aceastS Tntrebare a
fost dat in principal de douS categorii \up0 \expndtw0\charscalex106 de
cercetStori. unii care vSd aceste lucruri prin perspectiva psihotogiei cog� \up0
\expndtw0\charscalex100 nitive, altii \up0 \expndtw0\charscalex107 - discipoli ai
diverselor curente psihanalitice. \par\pard\ql \li1358\sb262\sl-276\slmult0 \up0
\expndtw-7\charscalex100 \ul0\nosupersub\cf14\f15\fs24 A. PERSPECTIVA
COGNITIVISTA \par\pard\qj \li1080\ri697\sb234\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex104 \ul0\nosupersub\cf8\f9\fs22 DupS Lazarus ?i Folkman (1984),
termenul de stres desemneazS o "relate \up0 \expndtw0\charscalex106 particulars
intre persoanS \up0 \expndtw0\charscalex108 $i mediu, in care persoana evaiueazS
mediul ca \par\pard\qj \li1065\ri702\sb0\sl-240\slmult0\fi14 \up0
\expndtw0\charscalex103 impunand solicitSri care exced resursele proprii si
amenintS starea sa de bine, \up0 \expndtw0\charscalex111 evaluare ce determine
declansarea unor procese de coping, respectiv rSs\up0 \expndtw0\charscalex103
punsuri cognitive, afective $i comportamentale la feed-back-urile primite".
AceastS definitie aduce in prim-plan cateva atribute definitorii pentru re\up0
\expndtw0\charscalex109 latia persoanS-agent stresor, acesta din urme vezut ca
"factor fizic, chimic \up0 \expndtw0\charscalex109 sau emotional, ($i biologic,
n.n.), ce produce tensiune corporae sau minta\up0 \expndtw0\charscalex104 e"
(Webster New Collegiate Dictionary, 1989), din care eel mai reprezentaliv \up0
\expndtw0\charscalex104 este termenul de "coping". \par\pard\ql \li1377\sb90\sl-
253\slmult0 \up0 \expndtw0\charscalex122 1. Coping: caracteristici generale
\ul0\nosupersub\cf3\f4\fs18 /. 1. Definitie. structura \par\pard\qj
\ul0\nosupersub\cf8\f9\fs22 Copingul desemneaze un "efort cognitiv $i
comportamental de a reduce, \up0 \expndtw0\charscalex113 stapam sau tolera
solicitanle interne sau externe care depasesc resursele \up0
\expndtw0\charscalex106 personae" (Lazarus si Folkman, ibid., pg.141).
\ul0\nosupersub\cf9\f10\fs20 Analiza aeestei definitii pune in evidente o
caracteristice esentiae: co\up0 \expndtw0\charscalex115 pingul este ilustrarea
faptului ce stresui emerge numai din relatia dintre su� \up0
\expndtw0\charscalex118 biect si situatie. fiind de neconceput in afara triadei
actiune-cognitie-com-\line \up0 \expndtw0\charscalex118 portament dizadaptativ.
Definitia de mai sus este oarecum restrictive, in raport cu notiunea mai \up0
\expndtw0\charscalex117 large de "strategii adaptative", care ar include si
mecanismele defensive de \up0 \expndtw0\charscalex117 sorginte inconstiente,
nesupuse controlului voluntar. \par\pard\qj \li1276\ri531\sb20\sl-240\slmult0\fi287
\up0 \expndtw0\charscalex116 in ce priveste caracteristlcile copmgului, paradigma
cognitivistS clasicS \up0 \expndtw0\charscalex116 porneste de la eel putin douS
premise esentiae ; \par\pard\qj \li1271\ri531\sb60\sl-240\slmult0\fi316\tx1684 \up0
\expndtw-2\charscalex100 1 \tab \up0 \expndtw0\charscalex117 ) copingul presupune
efort constient. indreptat asupra modului in care \up0 \expndtw0\charscalex118
situatia stresants este perceputS. prelucratS, stocatS; \par\pard\qj
\li1267\ri530\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex130 2) copingul
presupune o anumitS procesualitate, etapizare, ce se \up0 \expndtw0\charscalex113
concretlzeazS in: \par\pard\li2011\sb22\sl-230\slmult0\fi4\tx4367 \up0
\expndtw0\charscalex117 - a) anticiparea situatiei\tab \up0 \expndtw0\charscalex118
(evaluarea costului confruntSrii);\par\pard\li2011\sb24\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex118 \u8226? b) confruntarea propriu-zisS si redefinirea
situatiei prin prisma\par\pard\li2011\sb10\sl-230\slmult0\fi384 \up0
\expndtw0\charscalex118 confruntSrii;\par\pard\ql \li2011\sb3\sl-230\slmult0
\up0 \expndtw0\charscalex117 - c) analiza semniticatiei personae a situatiei post-
confruntare. \par\pard\qj \li1267\ri521\sb82\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex116 Exists o anumitS lerarhie la nivelul structurii copingului:
copingul de tip \up0 \expndtw0\charscalex115 cognitiv intervine atunci cind
strategiile comportamentale uzuale devin ine\up0 \expndtw0\charscalex119 ficiente,
prea costisitoare, atunci cind posibilitstile de interventie concrets \up0
\expndtw0\charscalex119 in mediu sunt limitate, sau cand timpul necesar unei
asemenea interventii \up0 \expndtw0\charscalex119 este prea scurt. \par\pard\qj
\li1267\ri520\sb0\sl-245\slmult0\fi302 \up0 \expndtw0\charscalex117 Distorsiunile
in prelucrarea mformatiei, redefinirea situatiei stresante in \up0
\expndtw0\charscalex126 termeni convenabili, capStS, in viziune cognitivistS, o
inaltS valoare \up0 \expndtw0\charscalex121 adaptative, desi se poate intampla ca,
uneori, se existe un dezacord intre \up0 \expndtw0\charscalex120 ceea ce stabileste
subiectul "amenintat" in forul sau interior si exigentele \up0
\expndtw0\charscalex113 sarcmii. \par\pard\qj \li1271\ri522\sb16\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex117 Percepute din afare uneori ca
mecanisme de "autoinselare", tehnicile de \up0 \expndtw0\charscalex129 coping de
acest tip sunt frecvent intalnite in clinics. Supraestimarea \up0
\expndtw0\charscalex115 sanselor de vindecare si minimalizarea simptomelor ce
anuntS un prognos� \up0 \expndtw0\charscalex112 tic prost \up0
\expndtw0\charscalex118 (ex. scSderea accentuats in greutate la un bolnav
neoplazic, etc.) \up0 \expndtw0\charscalex119 sau optimismul nejustificat, denumite
generic "iluzii pozitive" \up0 \expndtw-2\charscalex100 (Taylor \up0 \expndtw-
5\charscalex100 $i \par\pard\qj \li1271\ri538\sb0\sl-260\slmult0\fi4\tx2040 \up0
\expndtw0\charscalex100 Brown. \tab \up0 \expndtw0\charscalex119 1994) ar avea o
certs contributie modulatoare in relatia cu stresui \up0 \expndtw0\charscalex120
produs de boais. \par\pard\qj \li1267\ri516\sb0\sl-245\slmult0\fi307 \up0
\expndtw0\charscalex116 Nu de putine ori, un sir de evaluSri/distorsiuni de acest
tip, pot fi urmate \up0 \expndtw0\charscalex121 de reevaluSri ce nu se mai
adreseazS situatiei initiae, ci celei imaginate, \up0 \expndtw0\charscalex124
construite mental de bolnav. Acest fenomen atinge un apogeu in cazul \up0
\expndtw0\charscalex119 constituirii anumitor boli psihice, si explicS depSrtarea
tot mai accentuats \up0 \expndtw0\charscalex122 de realitate a acestor pacienti
\up0 \expndtw0\charscalex117 (ex. mecanisme defensive de tip proiectiv,
\par\pard\qj \li1281\ri517\sb0\sl-246\slmult0 \up0 \expndtw0\charscalex120 apllcate
neselectiv, mai ales pe un tip de personalitate dizarmonic. ca eel \up0
\expndtw0\charscalex115 paranoid) ; il intalnim insS �i in diverse boli somatice.
cu impact psihologie \up0 \expndtw0\charscalex129 real, situatie in care se poate
ajunge la hipocompliantS si agravarea \up0 \expndtw0\charscalex110 prognosticului
initial \par\pard\qj \li1291\ri511\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex123 in practicS, chiar si aphcarea exclusive si neselectivS a
unei singure \up0 \expndtw0\charscalex127 tehnici adaptative, duce in mod
inevitabil la dizadaptare si rupere de \up0 \expndtw0\charscalex128 realitate.
Atribute esentiae ale mecanismelor cognitive de coping la o
\ul0\nosupersub\cf18\f19\fs20\ul Psihosomatica generala\ul0\tab \up0
\expndtw0\charscalex116 \ul0\nosupersub\cf18\f19\fs20\ul \u9830? 63\par\pard\qj
\li1041\sb0\sl-260\slmult0 \par\pard\qj\li1041\ri776\sb9\sl-260\slmult0\fi4 \up0
\expndtw0\charscalex124 \ul0\nosupersub\cf9\f10\fs20 persoanS senStoasS le-ar
reprezenta asadar flexibilitatea si adecvarea. \up0 \expndtw0\charscalex117
Orientarea teleologies (spre scop) a mecanismelor de coping nu trebuie sS \up0
\expndtw0\charscalex112 prevaleze in principiu asupra flexibilitStii.
\par\pard\ql \li1670\sb65\sl-230\slmult0 \up0 \expndtw0\charscalex121 / 2. Natura
copingulul \par\pard\qj \li1060\ri772\sb126\sl-260\slmult0\fi278 \up0
\expndtw0\charscalex120 in legSturS cu natura copingului. acest aspect rSmane
controversat in \up0 \expndtw0\charscalex108 literaturS. \par\pard\ql
\li1339\sb25\sl-230\slmult0\tx2423\tx3148\tx5361 \up0 \expndtw0\charscalex108 Unii
autori \tab \up0 \expndtw-3\charscalex100 (Miller, \tab \up0
\expndtw0\charscalex108 1987, Carver s> colab., \tab \up0 \expndtw0\charscalex113
1989, etc.) concep copingul ca \par\pard\qj \li1041\ri751\sb11\sl-
253\slmult0\fi4 \up0 \expndtw0\charscalex125 pe o predispozitie stabilS, sau ca pe
o trSsStura de personalitate. Alfii \up0 \expndtw0\charscalex110 (Lazarus si
Folkman, 1984, Miclea, 1997, BSban, 1998) il vSd ca pe un proces \up0
\expndtw0\charscalex121 evolutiv, inclusiv in plan ontogenetic Cea de-a 2-a
variants este cea care \up0 \expndtw0\charscalex113 castigS vizibil teren astSzl,
Inclusiv pentru cS susfine mai bine flexibilitatea. \par\pard\ql \li1660\sb146\sl-
230\slmult0 \up0 \expndtw0\charscalex122 13. Forme de coping \par\pard\ql
\li1339\sb150\sl-230\slmult0\tx6921\tx7507 \up0 \expndtw0\charscalex119 Se
delimiteaza o ciasificare clasicS (Lazarus s< colab., \tab \up0 \expndtw-
4\charscalex100 1984, \tab \up0 \expndtw0\charscalex107 1987) in \par\pard\ql
\li1051\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex122 coping centrat pe problems
si coping central pe emotie \par\pard\qj \li1051\ri757\sb11\sl-253\slmult0\fi292
\up0 \expndtw0\charscalex123 Pnma variants, numita si coping direct, este
directionatS pe analiza, \up0 \expndtw0\charscalex119 rezolvarea, sau, daca nu este
posibil, minimaiizarea situatiei stresante. Ea \up0 \expndtw0\charscalex118 ar
cuprinde, in principal, strategiile de acceptare a confruntSrii cu agentul \up0
\expndtw0\charscalex118 stresor \par\pard\qj \li1041\ri747\sb2\sl-260\slmult0\fi297
\up0 \expndtw0\charscalex117 Cea de-a 2-a (coping indirect) se centreazS pe
persoanS, pe (incapaci� \up0 \expndtw0\charscalex116 tatea ei de a face fata
stresului, si cuprinde inclusiv modalitSti paliative sau \up0
\expndtw0\charscalex123 de autoinselare, prin care o confruntare decisivS cu
agentul stresor este \up0 \expndtw0\charscalex117 adesea amSnatS 'sine die'" sau
chiar nu are loc \par\pard\qj \li1051\ri742\sb17\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex112 Aitl autori concep copingul intr-o manierS mult mai
neomogenS, in esentS \up0 \expndtw0\charscalex127 multitactonala. Spre exemplu,
Stone si Neale \up0 \expndtw0\charscalex128 (1984) il vSd ca fiind \par\pard\qj
\li1046\ri746\sb7\sl-256\slmult0 \up0 \expndtw0\charscalex118 determinat de 8
factori (catharsis, suport social, acceptare, actiune directs, \up0
\expndtw0\charscalex121 distragere, redefinirea situatiei, relaxare. sentimente
religioase), si in$isi \up0 \expndtw0\charscalex112 Folkman s' Lazarus procedeazS,
in 1985, la o diversificare a structurii copin� \up0 \expndtw0\charscalex105
gului \up0 \expndtw0\charscalex114 (8 factori: confruntare. distantare.
autocontrol, cSutarea suportului so� \up0 \expndtw0\charscalex115 cial, asumarea
resoonsabllitStii. evadare-evitare, planilicarea rezolvSni pro\up0
\expndtw0\charscalex115 blemei. reevaluare pozitiva). \par\pard\qj
\li1046\ri737\sb4\sl-256\slmult0\fi297 \up0 \expndtw0\charscalex115 Revenind la
clasificarea initials, sS remarcSm interrelatia intre cele douS \up0
\expndtw0\charscalex124 tipuri de coping, ele sustinSndu-se si
potentSndu-se reciproc: copingul \up0 \expndtw0\charscalex116 centrat pe emotie
creazS conditiile pentru solutionarea in conditii mai bune \up0
\expndtw0\charscalex114 a problemoi \up0 \expndtw0\charscalex123 (tensiunea ergicS
scade), iar copingul centrat pe problems \up0 \expndtw0\charscalex120 reduce
distress-ul emotional, printr-o evaluare mai realists. decentratS de \up0
\expndtw0\charscalex120 sentimentul neputintei. \par\pard\qj \li1060\ri732\sb1\sl-
260\slmult0\fi292 \up0 \expndtw0\charscalex124 Exista o legaturS, atSt de filiatie
conceptualS, cat si obiectivS, intre \up0 \expndtw0\charscalex124 strategiile de
coping \up0 \expndtw0\charscalex122 (vSzute din perspectivS cognitivistS) si
diversele \par\pard\qj \li1060\ri733\sb17\sl-240\slmult0 \up0
\expndtw0\charscalex126 scheme cognitive mai generale ale persoanei. care reflects
"modul de \up0 \expndtw0\charscalex121 selectie. pSstrare, interpretare a
informatei, din \up0 \expndtw0\charscalex124 $i in experience trSite"
\par\pard\ql \li1060\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex114 (BSban.
1998), chiar $i independent de prezenta stresului. \par\pard\qj
\li1060\ri758\sb6\sl-260\slmult0\fi297 \up0 \expndtw0\charscalex117 Mai
representative ne apar aceste legSturi in cazul locusului de control, \up0
\expndtw0\charscalex117 autoeficacitStii, robustetei.
\expndtw0\charscalex106 \ul0\nosupersub\cf18\f19\fs20\ul Elemente de psihosomatica
\up0 \expndtw0\charscalex134 \ul0\nosupersub\cf9\f10\fs20 2. Trasaturi imunogene de
personalitate, implicate in coping \par\pard\ql \li2337\sb0\sl-230\slmult0
\par\pard\ql\li2337\sb100\sl-230\slmult0 \up0 \expndtw0\charscalex124 2 1 Locus de
control \par\pard\ql \li2035\sb0\sl-230\slmult0 \par\pard\ql\li2035\sb160\sl-
230\slmult0\tx8064 \up0 \expndtw0\charscalex131 Termenul de "locus de control" a
fost lansal de Rotter \tab \up0 \expndtw0\charscalex118 (1966) si \par\pard\ql
\li1737\ri169\sb0\sl-247\slmult0\fi4\tx2040\tx2040 \up0 \expndtw0\charscalex115
desemneaza "modul in care o persoanS i$i explicS succesul sau esecul. prin \up0
\expndtw0\charscalex116 cauze de tip intern sau extern, controlabile sau
necontrolabile"(ibld.) \line \tab \up0 \expndtw0\charscalex116 Locusul de control
intern (LCI) reprezintS convingerea cS responsabili-\line \up0
\expndtw0\charscalex118 tatea pentru esec, respectiv mentul pentru succes stau in
defectele, erorile. \up0 \expndtw0\charscalex115 respectiv in aplitudmile s�
calitStile persoanei respective, s* au o prea micS \up0 \expndtw0\charscalex115
legeturS cu intSmplarea sau factor: de presiune din afara, in timp ce locusul
\up0 \expndtw0\charscalex122 de control extern (LCE) se refers la convingerea ca
sursa evenimentelor \up0 \expndtw0\charscalex118 (pozitive sau negative) se gSseste
in soarta. destin sau puterea altora. \line \tab \up0 \expndtw0\charscalex114
Dincolo de apropierea evidenta care se poate face intre categorii ca LCE-\line \up0
\expndtw0\charscalex116 proiec(ie, sau LCI-strategu do tip combativ ("lupta"), unii
autori incearcS a \up0 \expndtw0\charscalex116 stabili o legaturS intre tipul de LC
s< eficienta copingulul. Astfel, LCI ar fi \up0 \expndtw0\charscalex123 protector
in stresui psihic acut si cronic \up0 \expndtw0\charscalex114 (Cohen. Edwards, \up0
\expndtw0\charscalex106 1989; Rotter, \par\pard\qj \li1747\ri166\sb15\sl-
240\slmult0\fi23 \up0 \expndtw0\charscalex118 1966) prin receptivitatea crescuts a
persoanei la informatnle din mediu cu \up0 \expndtw0\charscalex121 valoare
adaptative, prin rezistenta la presiunile externe, ca si Prm gradul \up0
\expndtw0\charscalex115 crescut de angajare in situatie. Antonovsky (cit. de BSban.
\up0 \expndtw0\charscalex113 1998) considers \par\pard\ql \li1747\sb9\sl-
230\slmult0\tx5961 \up0 \expndtw0\charscalex124 cS LCI manifestat prin
responsabllitate \tab \up0 \expndtw0\charscalex123 (asumarea rSspunderii pentru
\par\pard\qj \li1751\ri161\sb17\sl-246\slmult0 \up0 \expndtw0\charscalex130 succes,
dar si pentru esec) ar reprezenta un factor favorizant pentru \up0
\expndtw0\charscalex128 sanogenezS. Al(i autori sus(in, in consens, cS LCE ar fi
asociat cu o \up0 \expndtw0\charscalex117 proportie mai mare de insatisfactii. si
cu o predispozitle nets spre anxietate \up0 \expndtw0\charscalex116 Si depresie
(Sarason si colab . \up0 \expndtw-5\charscalex100 1978). \par\pard\qj
\li1747\ri166\sb0\sl-260\slmult0\fi297 \up0 \expndtw0\charscalex121 Totusi aceste
concluzil au un anumit grad de relativitate, in masura in \up0
\expndtw0\charscalex121 care : \par\pard\qj \li2486\ri172\sb0\sl-240\slmult0\tx2740
\up0 \expndtw0\charscalex114 a) LC are totusi o evolutie individuae cu varsta (in
general de la LCI \line\tab \up0 \expndtw0\charscalex106 spre LCE); \par\pard\ql
\li2486\ri167\sb0\sl-240\slmult0\tx2755\tx2745 \up0 \expndtw0\charscalex118 b)
uneori LCI este asociat cu sentimente crescute de culpabilitate, \line\tab \up0
\expndtw0\charscalex114 Iar LCE \up0 \expndtw0\charscalex133 - cu o anurnita
detasare de consecintele situatiei \line\tab \up0 \expndtw0\charscalex117 slresante
("externalitate defensiva j \par\pard\ql \li2491\ri155\sb0\sl-
246\slmult0\tx2745\tx2740\tx2740\tx2750\tx2745\tx2750 \up0 \expndtw0\charscalex114
c) exists o variabilitate transculturalS a LC, care vine din normele de
\line\tab \up0 \expndtw0\charscalex114 presiune culturalS si sociale specifice unui
anumit tip de societate \line\tab \up0 \expndtw0\charscalex111 (ex. LCI -
exprimabil in autonomie timpurie, independents, respon \line\tab \up0
\expndtw0\charscalex115 sabilitate \up0 \expndtw0\charscalex122 - s< strategiile
agresive de coping sunt incurajate in \line\tab \up0 \expndtw0\charscalex127
societetile moderne de tip occidental, iar LCE s* strategiile \line\tab \up0
\expndtw0\charscalex117 pasive. de tip "Capul plecat sabia nu-l tale" sau "Ce li-e
scris, in \line\tab \up0 \expndtw0\charscalex118 frunte ti-e pus", in societetile
de tip traditional). \par\pard\ql \li2356\sb124\sl-230\slmult0 \up0
\expndtw0\charscalex121 2.2. Autoeficacitatea si robustefca \par\pard\ql
Autoeficacitatea \tab \up0 \expndtw0\charscalex131 (AE) reprezinta "convingerea
unei persoane in \par\pard\ql \li1790\sb30\sl-230\slmult0\tx7348 \up0
\expndtw0\charscalex129 capacitate sale de a-si mobiliza resursele cognitive
\tab \up0 \expndtw0\charscalex115 $i motivationale. \par\pard\ql \li1790\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex117 necesare pentru indeplinirea cu succes a
sarcinilor date" (Beban, 1998)
\expndtw0\charscalex118 \u8226? AE crescute este asociatS cu o motivate mai inalts
$i cu o centrare pe \up0 \expndtw0\charscalex123 problems mai accentuata si rnai
productive \up0 \expndtw0\charscalex119 (subiectul i$i concentreaze \par\pard\ql
\li1219\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex116 atentia pe analiza si
gSsirea de soiutn). \par\pard\qj \li1214\ri1309\sb2\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex120 \u8226? AE scazute este, in contrast, asociaie cu
atribuirea insucceselor unor \up0 \expndtw0\charscalex119 cauze ce tin de propna
incompetente, teama de insucces, iar in plan clinic \up0 \expndtw0\charscalex115
pnn predispozitia nete la: \par\pard\li1219\sb23\sl-230\slmult0\fi427 \up0
\expndtw0\charscalex121 anxietate (pnn perceperea inelicientei resurselor do
coping);\par\pard\li1219\sb15\sl-230\slmult0\fi302\tx1689\tx2635 \up0
\expndtw0\charscalex120 \u8226?\tab \up0 \expndtw0\charscalex121 depresie\tab
\up0 \expndtw0\charscalex121 (rezulte din autocritica exagerate, fixarea de scopuri
prea\par\pard\li1219\sb14\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex121
inalte).\par\pard\li1219\sb10\sl-230\slmult0\fi297 \up0 \expndtw0\charscalex121
Este documentata. de asemenea, o relate de directe
proportionalitate\par\pard\li1219\sb10\sl-230\slmult0\fi14 \up0
\expndtw0\charscalex122 intre AE si func(ionarea optlme a sistemului imun, in
special a celulelor T,\par\pard\li1219\sb15\sl-230\slmult0\fi9 \up0
\expndtw0\charscalex121 subpopulatia NK (lamandescu,
1996).\par\pard\li1219\sb15\sl-230\slmult0\fi297\tx2827\tx4012\tx6120 \up0
\expndtw0\charscalex121 Robustetea\tab \up0 \expndtw0\charscalex121
(hardiness\tab \up0 \expndtw0\charscalex121 - engl.. andurance\tab \up0
\expndtw0\charscalex121 - fr.) este o variabie\par\pard\li1219\sb10\sl-
230\slmult0\fi24 \up0 \expndtw0\charscalex122 individuae llustrativa pentru
rezistenta la stresui psihic, sau, altfel spus.\par\pard\li1219\sb15\sl-
230\slmult0\fi4 \up0 \expndtw0\charscalex121 pentru elicienla mecanismelor de
coping.\par\pard\li1219\sb15\sl-230\slmult0\fi297 \up0 \expndtw0\charscalex121 Trei
components defmesc aceasta dispozitie de personalitate:\par\pard\li1219\sb19\sl-
230\slmult0\fi302\tx1723\tx2183 \up0 \expndtw0\charscalex120 -\tab \up0 \expndtw-
9\charscalex97 LCI\tab \up0 \expndtw0\charscalex121 (convingerea ce evenimentele
pot fi controlate si influentate,\par\pard\li1219\sb5\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex121 datorita capacitatiior si aptitudinilor
subiectulul);\par\pard\ql \li1651\sb3\sl-230\slmult0 \up0 \expndtw0\charscalex117
angajarea si persistenta in scopul propus; \par\pard\qj \li1228\ri1275\sb2\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex117 \u8226? perceptia schimberilor de
viata, ca fiind normale (sau chiar ca pe niste \up0 \expndtw0\charscalex114
provocSri (\u8226? challenges"), si nu ca pe niste fatalitsti. \par\pard\ql
\li1521\sb229\sl-230\slmult0 \up0 \expndtw0\charscalex132 3. Limitele teoriilor
cognitive asupra copingului \par\pard\ql \li1526\sb210\sl-230\slmult0\tx7219
\up0 \expndtw0\charscalex128 in principal, cei care sustin limitele teonei
cognitive \tab \up0 \expndtw0\charscalex114 (psihanalistl. \par\pard\qj
\li1228\ri1280\sb0\sl-244\slmult0 \up0 \expndtw0\charscalex121 psihiatri, dar si
unii medici somaticieni) se prevaleazS de incompatibili-\line \up0
\expndtw0\charscalex124 latea intre notiuni ca prelucrare informationalS,
restructurare cognitive \up0 \expndtw0\charscalex119 constiente. etc.. si posiblla
evolutie subterane a unui agent stresor (uneori \up0 \expndtw0\charscalex130 strict
la nivel inconstient). sau de evolutia sa brutae. ce nu lase timp \up0
\expndtw0\charscalex124 :-utir;ient mecanismelor de filtrare si adaptare constiente
sS actioneze. \up0 \expndtw0\charscalex118 lamandescu \up0 \expndtw0\charscalex127
(1993) consldere ce tot,i agentii stresori \up0 \expndtw0\charscalex118 (fizici,
chimici. \par\pard\qj \li1233\ri1280\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex117 biologici) indue, in ultime instante, un stres psihic
"secundar". Este evocat \up0 \expndtw0\charscalex119 efectul stresor jucat de
stimuli afectogeni putermci \up0 \expndtw0\charscalex115 (ex. dezgustul violent
\par\pard\qj \li1224\ri1275\sb0\sl-240\slmult0\fi9 \up0 \expndtw0\charscalex120 sau
emotia brutae la vederea unui accident), ca $i stresui psihic instaet in \up0
\expndtw0\charscalex117 cursul efectuSrii unei actiuni cu rezonan(S afectivS
pIScuta pentru subiect, \up0 \expndtw0\charscalex121 ce genereaza Insidios o "stare
de oboseaie. cu atributele stresului" (ibid) \up0 \expndtw0\charscalex120 Dupa
Shaller \up0 \expndtw0\charscalex122 (1982). citat de L. Alexandrescu \up0
\expndtw0\charscalex119 (1997). agen(ii stresori \par\pard\ql \li1243\sb8\sl-
230\slmult0\tx5174 \up0 \expndtw0\charscalex118 silentiosl. msidiosi "pot declan?a
SGA \tab \up0 \expndtw0\charscalex121 (sindromul general de adaptare
-\par\pard\qj \li1233\ri1286\sb0\sl-250\slmult0 \up0 \expndtw0\charscalex134 n.n.)
direct, fere o evaluare cognitive constientizabilS", iar agenti \up0
\expndtw0\charscalex104 "inevitablli" \up0 \expndtw0\charscalex115 (ca poluarea
atmosferlca. zgomotul stradal continuu, etc ) sunt \up0 \expndtw0\charscalex116
procesa(i automat, fera implicarea proceselor cognitive superioare. \par\pard\ql
\li1521\sb1\sl-230\slmult0 \up0 \expndtw0\charscalex117 Acestor puncte de vedere li
se opun altl autori, care, spri|inmdu-se si pe \par\pard\li1233\sb14\sl-
230\slmult0\fi0\tx3446 \up0 \expndtw0\charscalex124 cerceten antenoare\tab \up0
\expndtw0\charscalex124 (studiul subcept'ei. analiza apararn
perceptive,\par\pard\li1233\sb14\sl-230\slmult0\fi14\tx3196\tx4670 \up0
\expndtw0\charscalex118 invatarea implicite\tab \up0 \expndtw0\charscalex124 -
inconstients\tab \up0 \expndtw0\charscalex124 - a gramaticilor artificiale)
postuleazS\par\pard\li1233\sb6\sl-230\slmult0\fi19\tx4785\tx5664 \up0
\expndtw0\charscalex120 imaginea unui inconstient cognitiv\tab \up0
\expndtw0\charscalex105 (Miclea,\tab \up0 \expndtw0\charscalex124 1997), ce
depSseste cu mult\par\pard\ql \li1238\sb6\sl-230\slmult0 \up0
\expndtw0\charscalex114 clasicul contmut 'cald , umed , primitiv ?i irational"
(ibid.) al inconslientului
230\slmult0\par\pard\li1497\sb112\sl-230\slmult0\fi0\tx1886\tx4531 \dn2
\expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs20 66\tab \dn2
240\slmult0 \up0 \expndtw0\charscalex118 freudian. lncons*ientul cognitiv ar avea
certe proprieteti informatlonale si \up0 \expndtw0\charscalex118 adaptative.
Aceasta controversa, intre punctul de vedere psihiatric - psihanalltic, si \up0
\expndtw0\charscalex118 eel al psihotogiei cognitive, este inca departe de a fi
rezolvate. \par\pard\ql \li1809\sb0\sl-253\slmult0 \par\pard\ql\li1809\sb37\sl-
253\slmult0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf8\f9\fs22 B. PERSPECTIVA
PSIHANALITICA \par\pard\qj \li1507\sb0\sl-240\slmult0
\ul0\nosupersub\cf9\f10\fs20 Traditia psihanalitice asupra mecanismelor de aparare
situeazS \up0 \expndtw0\charscalex131 conflictul id(sine)-ego, ca tip de conflict
primar, sursS a majoritstii \up0 \expndtw0\charscalex115 mecanismelor defensive.
Ego-ul. supus "principiuiui realitatii", incearcS compromisul optim, \up0
\expndtw0\charscalex120 reconcilierea intre tendintele de sens contrar ae sinelui
si supra-ego-ului. \up0 \expndtw0\charscalex120 supuse exclusiv "principiuiui
pIScerii', respectiv 'datoriei'. \par\pard\ql \li1507\ri406\sb0\sl-
243\slmult0\fi292\tx1809 \up0 \expndtw0\charscalex111 Aceasta reconciliere se poate
realiza intr-o manierS mai mult sau mai putin \up0 \expndtw0\charscalex113
adaptative. func(iu s1 de gradul de maturizare a mecanismelor defensive.
\line\tab \up0 \expndtw0\charscalex122 lerarhizarea mecanismelor defensive este.
din punctul de vedere psi-\line \up0 \expndtw0\charscalex112 hanalitic. un (apt
real, la un pol situandu-se mecanismele cu un potential inalt \up0
\expndtw0\charscalex117 patogen, "imature", ce blocheazS energia instinctuala,
creSnd implicit pre-\line \up0 \expndtw0\charscalex116 misele pentru acumularea
tensiunii interne (ca de ex. negarea, represia), iar \up0 \expndtw-3\charscalex100
la \up0 \expndtw0\charscalex113 celSlalt pol, cele mature, "superioare", ca
intelectualizarea ?i sublimarea. \par\pard\ql \li2270\sb0\sl-230\slmult0
\par\pard\ql\li2270\sb196\sl-230\slmult0 \up0 \expndtw0\charscalex117 Tabel 1.
Cateva importanta mecanisme defensive lncon$tiente \par\pard\li1766\sb0\sl-
\expndtw0\charscalex106 MECANISM\tab \dn2 \expndtw0\charscalex106 CONTINUTUL
MECANISMULUI\par\pard\li1766\sb111\sl-230\slmult0\fi0\tx1977\tx3667 \up0 \expndtw-
9\charscalex78 1.\tab \up0 \expndtw0\charscalex106 Negarea\tab \up0
\expndtw0\charscalex106 Desprlnderea, din caracteristicile potential nocive
ale\par\pard\qj \li3662\ri612\sb0\sl-220\slmult0\fi9 \up0 \expndtw0\charscalex110
unor agenti stresori, a celor acceptabile sau mai usor \up0 \expndtw0\charscalex111
contracarabile. Unei dorinte inconstiente i se refuza. \up0 \expndtw0\charscalex118
cu ajutorul negSrii, intrarea in campul constiintei \up0 \expndtw0\charscalex105
subiectului \up0 \expndtw0\charscalex114 (nu o recunoaste ca apartinandu-i, sau
o \par\pard\ql \li3672\sb2\sl-217\slmult0 \up0 \expndtw0\charscalex108
\ul0\nosupersub\cf18\f19\fs20\ul recunoa$te intr-o forms deghlzata)
\ul0\nosupersub\cf9\f10\fs20 2 Proiectia\tab \up0 \expndtw0\charscalex112 Subiectul
atribuie altcuiva - dorinte . tendinte pe care\par\pard\qj \li3667\ri617\sb0\sl-
226\slmult0\fi4 \up0 \expndtw0\charscalex107 nu Ie recunoaste ca fiind ale sale.
Alte forme de mani\up0 \expndtw0\charscalex114 festare: asimilarea de cStre subiect
a unei porsoane \up0 \expndtw0\charscalex108 cu o alta (ex. transferul din
psihanallzS), identificarea \up0 \expndtw0\charscalex109 subiectului cu alt�
persoane sau cu creatia sa. \par\pard\li1742\sb12\sl-230\slmult0\fi0\tx3672 \up0
\expndtw0\charscalex117 3 Comutarea\tab \up0 \expndtw0\charscalex117 Energia
subiectului este deturnats de la scopuri in\par\pard\ql \li3681\sb1\sl-
211\slmult0 \up0 \expndtw0\charscalex111 tangibile, reprobabile. antisociale - spre
scopuri tan \par\pard\ql \li3667\sb5\sl-216\slmult0 \up0 \expndtw0\charscalex107
\ul0\nosupersub\cf18\f19\fs20\ul gibile (in cazul sublimSrii, ele au $i utllitate
socialS). \par\pard\li1751\sb29\sl-230\slmult0\fi0\tx3672 \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 4 Refularea\tab \up0
\expndtw0\charscalex117 Trimiterea si mentmerea in inconstient de
ginduri,\par\pard\qj \li3676\ri609\sb0\sl-224\slmult0\fi4 \up0
\expndtw0\charscalex110 imagini, amintiri, train reprobabile, penibile, antiso�
\up0 \expndtw0\charscalex106 ciale. psihotraumatizante. Are caracter de aparare
tem-\line \up0 \expndtw0\charscalex109 porarS, deoarece con|inuturile refulate
exercita o pre \up0 \expndtw0\charscalex105 siune permanentS asupra constiintei,
tinzand sS iasS la \up0 \expndtw0\charscalex108 suprafaJS intr-o manierS simbolicS
(vise , acte ratate, \up0 \expndtw0\charscalex109 lapsusuri, sau (oatologic) - ca
simptome psihice). \par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart
Psihosomatica generals\tab \up0 \expndtw0\charscalex114 \u9830?
67\par\pard\li1099\sb0\sl-230\slmult0\par\pard\li1099\sb0\sl-
\expndtw0\charscalex111 MECANISM\tab \up0 \expndtw0\charscalex111 CONTINUTUL
MECANISMULUI\par\pard\li1099\sb115\sl-230\slmult0\fi4\tx3023 \up0
\expndtw0\charscalex111 5. Regresia\tab \up0 \expndtw0\charscalex111 Reintoarcerea
la etape anterioare ale dezvoltSrii su�\par\pard\li1099\sb1\sl-
219\slmult0\fi1924\tx3859 \up0 \expndtw0\charscalex102 biectului\tab \up0
\expndtw0\charscalex111 (etape legate de experien(e mai agreabile
si\par\pard\li1099\sb1\sl-221\slmult0\fi1929 \up0 \expndtw0\charscalex111
satisfactii mai mari). produsS mai ales in condifii de\par\pard\li1099\sb1\sl-
227\slmult0\fi1920 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf18\f19\fs20\ul
frustrare reals sau imaginarS\par\pard\li1099\sb20\sl-230\slmult0\fi0\tx3028
\up0 \expndtw0\charscalex111 \ul0\nosupersub\cf9\f10\fs20 6. Formatia\tab \up0
\expndtw0\charscalex111 Investirea in diferite obiecte - de sentimente de
sens\par\pard\li1099\sb1\sl-213\slmult0\fi254\tx3023 \up0 \expndtw0\charscalex111
reacjionae\tab \up0 \expndtw0\charscalex111 opus unei dorinte refulate si
comportamente inverse\par\pard\ql \li3019\sb3\sl-213\slmult0 \up0
\expndtw0\charscalex108 \ul0\nosupersub\cf18\f19\fs20\ul celor care corespund
donntei refulate. \par\pard\ql \li1099\ri1357\sb5\sl-240\slmult0\tx3019 \up0
\expndtw0\charscalex115 \ul0\nosupersub\cf9\f10\fs20 7. IntelectualizareaEpuizarea
in procesul analitic, al continutului psiho \line\tab \up0 \expndtw0\charscalex108
traumatizant al unei situatii de viatS. \par\pard\qj \li873\ri1054\sb77\sl-
220\slmult0\fi288 \up0 \expndtw0\charscalex118 Criticii paradigmei psihanalitice
subliniazS insuficienta operabihtate si \up0 \expndtw0\charscalex127 putere de
generaiizare a acesteia: mecanismele defensive, in viziune \up0
\expndtw0\charscalex121 psihanaliticS, ar fi indreptate majoritar spre blocarea
pulsiunilor instinc-\line \up0 \expndtw0\charscalex119 tuale interne (si mai putin
inspre afarS), ca moment de aparitie sunt post \up0 \expndtw0\charscalex117
afective (se declanseazS doar dupS ce a intervenit "anxietatea de semnai" \up0
\expndtw0\charscalex115 cind "pulsiunile instinctuale amenintS sS inunde Ego-ul"
\up0 \expndtw0\charscalex107 (Miclea,1997)). in \par\pard\qj \li868\ri1055\sb0\sl-
220\slmult0\fi4 \up0 \expndtw0\charscalex135 viziunea acestor autori, demersul
acestor mecanisme este adesea \up0 \expndtw0\charscalex115 distorsionant in
finalitate (nu faciliteazS uneori decat adaptarea de moment, \up0
\expndtw0\charscalex115 iar alteori este chiar generator de simptome). \par\pard\qj
\li873\ri1064\sb0\sl-210\slmult0\fi288 \up0 \expndtw0\charscalex117 in plus.se aduc
critici care (in de insasi esenja teonei psihanalitice: ope\up0
\expndtw0\charscalex121 rarea implicits cu constelatii si mecanisme psihice
inconstiente, deci ne\up0 \expndtw0\charscalex114 demonstrabile. \par\pard\qj
\li883\ri1049\sb0\sl-220\slmult0\fi288 \up0 \expndtw0\charscalex119 Retinem, la
acest punct (in ce priveste mecanismele adaptative in fata \up0
\expndtw0\charscalex116 stresului psihic) \up0 \expndtw0\charscalex119 -
predilectia pentru folosirea termenului de "coping", de \par\pard\ql \li873\sb1\sl-
209\slmult0 \up0 \expndtw0\charscalex116 cStre cognitivisti, fa\up0
\expndtw0\charscalex119 t,S de termenul "mecanisme defensive", mai uzitat de
orientarea psihanaliticS. care corespund tendmtei de a alStura termenul de \up0
\expndtw0\charscalex115 "coping" mecanismelor con$tientizate, iar pe eel de
"mecanisme defensive" \par\pard\ql \li888\sb1\sl-198\slmult0 \up0
\expndtw0\charscalex116 - celor subconstiente sau inconstiente. \par\pard\qj
\li878\ri1064\sb41\sl-200\slmult0\fi288 \up0 \expndtw0\charscalex114 Principalele
deosebiri intre cele douS curente. in ce priveste mecanisme� \up0
\expndtw0\charscalex114 le adaptative fata de stres, sunt sintetizate in tabelul 2.
\par\pard\ql \li1574\sb0\sl-240\slmult0 \par\pard\ql\li1574\ri1409\sb67\sl-
240\slmult0\tx3777 \up0 \expndtw0\charscalex117 Tabel 2 Compararea mecanismelor de
coping cu cale defensive \line\tab \up0 \expndtw0\charscalex102 (A.Baban.
1998)\par\pard\sect\sectd\sbknone\cols2\colno1\colw4457\colsr160\colno2\colw4543\co
lsr160\qj \li1151\sb0\sl-230\slmult0 \par\pard\qj \li1156\ri634\sb8\sl-
230\slmult0\fi244 \up0 \expndtw0\charscalex100 MECANISME DE COPING \up0
\expndtw0\charscalex108 \u8226? procese (sub)constiente;\par\pard\ql
\li1151\ri56\sb0\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex107 \u8226? produse in
contact cu realitatea. \line \up0 \expndtw0\charscalex106 \u8226? permit
confruntarea cu realitatea; \line \up0 \expndtw0\charscalex113 \u8226? implies scop
si perspectivS \up0 \expndtw0\charscalex101 (sunt\par\pard\qj \li1151\ri68\sb0\sl-
231\slmult0\fi182 \up0 \expndtw0\charscalex104 orientate spre prezent si'sau
viitor); \up0 \expndtw0\charscalex104 \u8226? au (necesitS)
flexibilitate;\par\pard\ql \li1151\ri47\sb0\sl-228\slmult0 \up0
\expndtw0\charscalex104 \u8226? permit exprimarea afectivS; \line \up0
\expndtw0\charscalex119 \u8226? preced sau succed reactiei de\par\pard\ql
\li1339\sb1\sl-223\slmult0 \up0 \expndtw0\charscalex103 stres;\par\pard\qj
\li1151\ri47\sb6\sl-220\slmult0\tx1339 \up0 \expndtw0\charscalex122 e sunt
orientate spre Interior sau \line\tab \up0 \expndtw0\charscalex100
exterior;\par\pard\ql \li1156\sb2\sl-230\slmult0 \up0 \expndtw0\charscalex107
\u8226? au eficienta situationaie.\par\pard\column \qj \li4617\sb0\sl-
230\slmult0 \par\pard\qj \li20\ri1672\sb8\sl-230\slmult0\fi427 \up0 \expndtw-
1\charscalex100 MECANISME DEFENSIVE \up0 \expndtw0\charscalex110 \u8226? procese
inconstiente;\par\pard\ql \li20\ri1268\sb0\sl-228\slmult0\fi4 \up0
\expndtw0\charscalex108 \u8226? produse la interfata ego-id: \line \up0
\expndtw0\charscalex108 \u8226? distorsioneaze (mai mult decit cele\par\pard\ql
\li207\sb1\sl-230\slmult0 \up0 \expndtw0\charscalex106 de coping)
realitatea;\par\pard\ql \li20\ri1338\sb0\sl-229\slmult0 \up0
\expndtw0\charscalex108 e orientate predominant spre trecut; \up0
\expndtw0\charscalex109 \u8226? imphca automatisme, sunt rigide; \up0
\expndtw0\charscalex107 \u8226? blocheaze exprimarea afectivS; \up0
\expndtw0\charscalex110 \u8226? sunt procese post-afective;\par\pard\ql
\li20\sb1\sl-218\slmult0 \up0 \expndtw0\charscalex109 \u8226? orientate spre
blocarea pulsiunilor\par\pard\ql \li222\sb8\sl-230\slmult0 \up0
\expndtw0\charscalex105 instinctuale interne;\par\pard\qj \li20\ri1274\sb0\sl-
229\slmult0\tx217 \up0 \expndtw0\charscalex118 \u8226? au organizare ierarhica
mature \line\tab \up0 \expndtw0\charscalex105 vs. imature.
\expndtw0\charscalex102 \u8226?>\tab \up0 \expndtw0\charscalex102 Elemonte de
psihosomaticd generala $i aplicata\par\pard\qj \li1838\sb0\sl-340\slmult0
\par\pard\qj\li1838\ri800\sb252\sl-340\slmult0\tx2136 \up0 \expndtw-4\charscalex100
\ul0\nosupersub\cf8\f9\fs22 C. UTILITATEA CU NO ASTER II MECANISMELOR ADAPTATIVE
\line\tab \up0 \expndtw-4\charscalex100 IN PRACTICA MEDICALA. \par\pard\qj
\li2126\ri2102\sb17\sl-320\slmult0 \up0 \expndtw0\charscalex100 TIPURI
PSIHOCOMPORTAMENTALE CU RISC. \up0 \expndtw-4\charscalex100 ALTERNATIVE TERAPEUTICE
240\slmult0\fi292 \up0 \expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 Pentru
medicul curant, ca si pentru psiholog, cunoasterea pattern-urilor \up0
\expndtw0\charscalex118 adaptative favorite ale pacientului reprezintS un important
avantaj, atat in \up0 \expndtw0\charscalex122 (re)evaluarea prognosticului prin
prisma grilei comportamentale, dar s* \up0 \expndtw0\charscalex122 pentru
aprecierea corects a compliantel terapeutice. \par\pard\qj \li1536\ri391\sb0\sl-
250\slmult0\fi302 \up0 \expndtw0\charscalex115 Uneori se pot identifica la unii
pacien(i adevSrate tipuri de personalitate. \up0 \expndtw0\charscalex115 cu vocatie
pentru incorporarea stresului. cum ar fi tipul A, C sau o tulburare \up0
\expndtw0\charscalex115 precum alexitimia. \par\pard\qj \li1536\ri391\sb0\sl-
242\slmult0\fi297 \up0 \expndtw0\charscalex120 Primul dintre acestea, tipul
psihocomportamental A. a fost descris de \up0 \expndtw0\charscalex117 Friedman si
Rosenman , inca din anii '60, in legSturS cu predispozitia spre \up0
\expndtw0\charscalex114 boli cardiovasculare. Ulterior, s-a dovedit faptul cS
trSsSturile caracteristice \up0 \expndtw0\charscalex116 tipului A predispun la
boala psihosomatice in general, prin suprasolicitarea \up0 \expndtw0\charscalex115
compartimentelor psihic motivational, volitional, afectiv, cognitiv, mai ales
\up0 \expndtw0\charscalex133 daca aceasta este coroborate cu nerespectarea unui
regim de viate \up0 \expndtw0\charscalex120 sanogenetic, sau cu o vulnerabilitate
innascute de organ (meiopragie). Ei \up0 \expndtw0\charscalex116 sunt adevara(i
"colectionan de stresuri", si posede mecanisme de convertire \up0
\expndtw0\charscalex116 la nivel metabolic a factorului psihogen in tulburSri sau
boli psihosomatice \up0 \expndtw0\charscalex116 (lamandescu, 1996). \par\pard\qj
\li1531\ri396\sb0\sl-244\slmult0\fi302 \up0 \expndtw0\charscalex116 Principalele
trasaturi ale acestui tip de personalitate ar fi reprezentate de \up0
\expndtw0\charscalex117 sentimentul urgen(ei si de ostilitate, dar lor li se
asociazS mai intotdeauna, \up0 \expndtw0\charscalex125 Si consecinte in planul
relatiei medic-pacienf. care pericliteazS relatia \up0 \expndtw0\charscalex121
terapeuticS. o mare parte din acesti bolnavi fiind hipocomplianti. avSnd \up0
\expndtw0\charscalex122 adesea expectatii nereahste de la institue medicae,
neangajandu-se activ \up0 \expndtw0\charscalex122 in recuperarea/pSstrarea starii
de senetate (au "alte prioriteti"), etc. \par\pard\qj \li1536\ri396\sb0\sl-
244\slmult0\fi292 \up0 \expndtw0\charscalex119 Restructurarea tipului A reprezinte
o probleme spinoasS, in conditiile \up0 \expndtw0\charscalex130 lipsei
de motivate a pacientului pentru schimbarea conduitelor sale \up0
\expndtw0\charscalex129 "standard" de a face fate stresului. intre modalitstile
terapeutice mai \up0 \expndtw0\charscalex126 frecvent folosite, s-ar situa
psihoterapiile cognitiv-comportamentale, \up0 \expndtw0\charscalex122 training ui
autogen si chiar psihoterapia de grup (cu analiza predilects a \up0
\expndtw0\charscalex112 factorilor de rise incrimina(i). \par\pard\qj
\li1531\ri396\sb0\sl-244\slmult0\fi288 \up0 \expndtw0\charscalex118 Tipul C, pus in
rela(ie cu bolile neoplazice. a fost descris de Temoshok \up0
\expndtw0\charscalex123 (1990), pe baza dimensiunii reprimare-vigilentS El ar fi
caracterizat de \up0 \expndtw0\charscalex122 asocierea unor mecanisme represive
puternice (pinS la incapacitatea de \up0 \expndtw0\charscalex119 verbalizare si
chiar de recunoastere a emotiilor), cu un complex de reactii \up0
\expndtw0\charscalex117 secundare, precum autodeprecierea, sentimente de neputintS
si de pierdere \up0 \expndtw0\charscalex110 a controlulul. \par\pard\qj
\li1540\ri397\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex121 Tipul C,
denumit de unii autori si "anger-in"(pentru cS o dimensiune \up0
\expndtw0\charscalex117 esentiae a sa o reprezintS reprimarea sentimentelor
negative, de ostilitate), \up0 \expndtw0\charscalex115 constituie in plan
comportamental, o ilustrare fidelS a copingului centrat pe \up0
\expndtw0\charscalex123 emotie, asociat din punct de vedere neuro-hormonal \up0
\expndtw0\charscalex106 ?i imunitar \up0 \expndtw0\charscalex131 - cu
diminuarea secretiei de catecolamine si a activitatii celulelor NK, si cu \up0
\expndtw0\charscalex121 hiperfunctia axei hipotalamo-corticotrope, ceea ce
accentueaza inhibitia \up0 \expndtw0\charscalex106 celulelor NK. \par\pard\qj
\li964\ri977\sb0\sl-250\slmult0\fi278 \up0 \expndtw0\charscalex114 Contrada, cit.
de Brouchon-Schweitzer si Danzer (1994) elaboreaze chiar \up0
\expndtw0\charscalex120 un model etiopatogenic complex, ce argumenteaze pentru
legStura intre \up0 \expndtw0\charscalex118 atitudinea "rationae" \up0
\expndtw0\charscalex117 (antiemotionae) a acestor subiecji, $i dezvoltarea de
\par\pard\ql \li969\sb1\sl-230\slmult0 \up0 \expndtw0\charscalex112 infectii
cronice $i neoplazii. \par\pard\qj \li964\ri973\sb2\sl-240\slmult0\fi273 \up0
\expndtw0\charscalex118 Alexitimia, descrisS pentru prima data de J.C.Nemiah si
rnai ales de P. \up0 \expndtw0\charscalex110 Sifneos \up0 \expndtw0\charscalex121
(citati de G. lonescu, \up0 \expndtw0\charscalex122 1990) ar fi caracterizate in
principal de o \par\pard\ql \li974\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex116
incapacitate de autocunoastere si expresie, manifeste clinic prin: \par\pard\ql
\li1699\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 - saracirea viefii
imaginative; \par\pard\ql \li1699\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113
- inabilitate de autoexaminare; \par\pard\ql \li1694\sb10\sl-230\slmult0\tx2990
\up0 \expndtw0\charscalex112 - rigidizarea. \tab \up0 \expndtw0\charscalex112
-constrlctia" viefii emotionale; \par\pard\qj \li1694\ri977\sb19\sl-220\slmult0
\up0 \expndtw0\charscalex124 - Incapacitatea de exprimare adecvate si nuan(ate.
in vederea \up0 \expndtw0\charscalex113 comunicani dispozifiei. \par\pard\qj
\li964\ri982\sb24\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex118 lamandescu
(1998) considere ce principalul mecanism care ar putea fi \up0
\expndtw0\charscalex129 invocat in aprecierea alexitimiei drept factor patogen, l-
ar constitui \up0 \expndtw0\charscalex124 posibilitatea reduse de extenorizare \up0
\expndtw0\charscalex125 (pnn verbalizare) a suferinfei lor \par\pard\qj
\li960\ri993\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex114 psihice sau
somatice. Ikemi (1995) lanseaze chiar termenul de "alexisomie", \up0
\expndtw0\charscalex115 aceasta reprezentand incapacitatea de exprimare. la
bolnavii psihosomatici. \up0 \expndtw0\charscalex115 a sufennlei lor corporae.
cazul alexitimicilor, se aduce in discutie ceea ce unii autori inteleg prin \up0
\expndtw0\charscalex110 "hiposimbolism ", uneori dobSndit. alteori innSscut. DacS
in cazul alexitimiei \up0 \expndtw0\charscalex134 primare. etiologia rSmane neclars
\up0 \expndtw0\charscalex128 (componenta ereditarS nefiind \par\pard\ql
\li960\ri972\sb0\sl-240\slmult0\fi9\tx1320 \up0 \expndtw0\charscalex114 incriminatS
exclusiv), alexitimia secundarS rezulta din modificSri la nivelul \up0
\expndtw0\charscalex114 stilului de coping, constitute prin intermediul invS(Srii
sociale. \line \tab \up0 \expndtw0\charscalex113 Se noteazS (C. Tudose, \up0
\expndtw0\charscalex114 1987), respunsul bun la psihoterapiile suportive
\par\pard\ql \li955\ri962\sb0\sl-240\slmult0\tx1252 \up0 \expndtw0\charscalex121 Si
educationale, la unele terapii de grup, iar in tulburarile psihosomatice \up0
\expndtw0\charscalex115 asociate - utilitatea biofeedback-ului si a terapiilor de
relaxare. \line \tab \up0 \expndtw0\charscalex116 Desi pattern-urile descrise pot
explica o parte din dificultetile pe care Ie \up0 \expndtw0\charscalex117 intampinS
o serie de pacienfi, atat in raportul cu propria lor boala. cat si in \up0
\expndtw0\charscalex123 relatia cu medicul, renene deschise problema acelor
pacienti care nu se \up0 \expndtw0\charscalex128 incadreaze in categornle
mentionate, si care, fSrS a avea, de altfel, o \up0 \expndtw0\charscalex122
afectare psihicS gravS, cu potential de ireversibilitate, se cantoneazS in \up0
\expndtw0\charscalex115 mecanisme dizadaptative de coping. \par\pard\qj
\li955\ri972\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex130 In aceste
cazuri, cele mai numeroase de altfel, se pune problema \up0 \expndtw0\charscalex117
educSrii pacientului in directia insusirii unui nou stil de viata, si inarmarea
\up0 \expndtw0\charscalex117 sa cu mijloacele necesare pentru a accede si a se
menfine la acest palier. \par\pard\qj \li950\ri973\sb0\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex116 Pentru realizarea acestui obiectiv, consecutiv
identificarii mecanismelor \up0 \expndtw0\charscalex120 dizadaptative (inclusiv a
dinamicii acestora), se poate trece la o forme de \up0 \expndtw0\charscalex115
psihoterapie adecvate necesitatilor si posibilitatilor pacientului. \par\pard\qj
\li984\ri981\sb0\sl-240\slmult0\fi259 \up0 \expndtw0\charscalex114 Cateva orienten
in aceasta direcfie ar merita mentionate (dupe Holdevici, \up0 \expndtw-
3\charscalex100 1996): \par\pard\ql \li1248\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex124 - psihoterapia experientiala considere omul ca pe o
entitate active, \par\pard\qj \li950\ri977\sb0\sl-260\slmult0\fi9 \up0
\expndtw0\charscalex119 autoafirmative, cu un potential latent cert. Nu se
urmereste neaperat strict \up0 \expndtw0\charscalex119 vindecarea simptomelor
actuae, ci perfeclionarea. atingerea unui nivel
psihosomaticS generala $i aplicata\par\pard\qj \li1751\sb0\sl-240\slmult0
240\slmult0\fi4 \up0 \expndtw0\charscalex118 superior de consents, accentuandu-se
pe contextul de viatS in care are loc \up0 \expndtw0\charscalex115 psihoterapia. pe
raportul de simetrie (egalitate) intre psihoterapeut si client. \up0
\expndtw0\charscalex116 Prin tehnici de exprimare libera a Eu-lui (dramatice. de
imaginatie dirijate. \up0 \expndtw0\charscalex121 etc.) se creaza premisele pentru
saltul de la folosirea exhaustive, stabile. \up0 \expndtw0\charscalex124 rigida a
catorva strategii \up0 \expndtw0\charscalex123 - la multiplicarea acestora si la
flexibilizarea \par\pard\ql \li1751\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex107
utilizdrii lor: \par\pard\qj \li1751\ri180\sb2\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex117 - psihoterapia cognitiv-comportamentalS: pune accentul pe
formularea \up0 \expndtw0\charscalex117 problemei in termeni clan, si pe elaborarea
unor strategii comportamentale \up0 \expndtw0\charscalex116 la indemSna
pacientului. de a face fats situatiei. Accentul se deplaseazS de \up0
\expndtw0\charscalex117 la insurmontabilitatea aparents a problemei, spre
rationalizare, experimen\up0 \expndtw0\charscalex114 tare (inclusiv mentalS),
relaxare. fiind extrem de eficientS in tulburSri de tip \up0
\expndtw0\charscalex114 anxios sau obsesivo-tobic; \par\pard\qj
-\tab \up0 \expndtw0\charscalex135 psihoterapia scurta, centrata pe obiectiv
vizeazS clarificarea \up0 \expndtw0\charscalex117 scopurilor pacientului,
deplasarea centrului de greutate al discutiei dinspre \up0 \expndtw0\charscalex119
problems spre solutie (pornindu-se de la asa-zisele "exceptii pozitive' din \up0
\expndtw0\charscalex117 viata pacientului), evidentierea progreselor (chiar minime)
ale pacientului. \up0 \expndtw0\charscalex126 incuraiarea acestuia in directia
asumSrii de responsabililSti si acfiuni \up0 \expndtw0\charscalex114
independente; \par\pard\qj \li1747\ri180\sb0\sl-242\slmult0\fi302 \up0
\expndtw0\charscalex116 - analiza tranzactionala: se porneste de
la premisa multiplicitStii stSrilor \up0 \expndtw0\charscalex124 Ego-ului, in
fiecare persoanS coexistind serile de "pSrinte". "adult" s* \up0
\expndtw0\charscalex115 "copil", fie in latentS, fie activ. Trecerea la terapie
este precedats de analiza \up0 \expndtw0\charscalex132 stSrilor Ego-ului si de
alcStuirea unei egograme Analiza relatiilor \up0 \expndtw0\charscalex116
interpersonale si tentativa de restructurare comportamentae implies analiza \up0
\expndtw0\charscalex117 dlnamicii stSrilor Eu-lui si modificarea scenariilor de
viatS. Acest obiectiv \up0 \expndtw0\charscalex122 poate fi realizat si cu ajutorul
hipnozei. in vederea obtinerii regresiei de \up0 \expndtw0\charscalex122 varste,
necesare acestor schimbSri. \par\pard\ql \li2040\sb1\sl-209\slmult0\tx5961 \up0
\expndtw0\charscalex134 - psihoterapia de grup: faciliteazS \tab \up0
\expndtw0\charscalex129 (functie si de dezirabilitatea \par\pard\qj
\li1751\ri181\sb6\sl-240\slmult0 \up0 \expndtw0\charscalex122 subiectului in grup),
aparitia sentlmentelor de acceptare si de cre$tere a \up0 \expndtw0\charscalex116
increderii in sine, deplasarea comportamentului de la orientarea spre trecut
\expndtw0\charscalex123 - la cea spre viitor, deplasarea gandirii de la orientarea
spre simptom la \up0 \expndtw0\charscalex115 orientarea spre Eu. perceperea mai
finS si rnai diferentiatS a realitStii. \line \tab \up0 \expndtw0\charscalex137
Toate aceste forme de psihoterapie. alSturi de psihanalizS, si \up0
\expndtw0\charscalex116 fSrS a epuiza paleta extrem de largS de psihoterapii, au
vocatie adaptativS, \up0 \expndtw0\charscalex124 in primul rand prin restructurarea
mecanismelor de coping, dar si prin \up0 \expndtw0\charscalex128 cresterea
disponibilitStii generale a subiectului la autocunoastere \up0 \expndtw-
7\charscalex100 $i \par\pard\qj \li1751\ri185\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex121 autoformare. Utllizarea lor la bolnavii psihosomatici
reprezintS un aport \up0 \expndtw0\charscalex125 extrem de valoros in remodelarea
unor comportamente nocive pentru \up0 \expndtw0\charscalex132 sSnState, ele
valorizand suplimentar colaborarea cu psihologul, s' \up0 \expndtw0\charscalex113
optimizand interventia terapeuticS.
\up0 \expndtw0\charscalex119 Bibliografie \par\pard\qj \li1214\ri1061\sb179\sl-
200\slmult0\tx1401 \up0 \expndtw0\charscalex113 1. Alexandrescu L. - (1997)
"Stresui psihic - conceple generate" in: Rev Rom&nd \line\tab \up0
\expndtw0\charscalex113 de Sdnatate Mintald, 6. 6-10. \par\pard\qj
\li1180\ri1082\sb0\sl-200\slmult0\tx1401 \up0 \expndtw0\charscalex113 2. Bdban
Adriana \u9632? (1998) "Stress si personalitate", Presa Universitard Clujeand.
\line\tab \up0 \expndtw0\charscalex111 43-70, 89-98 \par\pard\li1180\sb0\sl-
162\slmult0\fi0\tx4747 \up0 \expndtw0\charscalex114 3 Brouchon-Schweitzer M..
Dantzer R. -\tab \up0 \expndtw0\charscalex116 (1994) "Introduction ,\\ la
psychologie de\par\pard\li1180\sb1\sl-203\slmult0\fi225 \up0
\expndtw0\charscalex116 la santd". Presse Univ. de France,
Paris.\par\pard\li1180\sb1\sl-184\slmult0\fi9\tx4641\tx4761 \up0
\expndtw0\charscalex116 4. Carver S., Scheier M.. Weintraub J.\tab \up0 \expndtw-
4\charscalex100 \u9632?\tab \up0 \expndtw0\charscalex116 (1989) "Assessing coping
strategies a\par\pard\li1180\sb1\sl-198\slmult0\fi230 \up0 \expndtw0\charscalex117
theoretically based approach. Journal ot Personality and Social Psychology,
t,\par\pard\li1180\sb1\sl-185\slmult0\fi254 \up0 \expndtw0\charscalex116 184-
195.\par\pard\ql \li1185\ri1035\sb0\sl-190\slmult0\tx1416\tx1416 \up0
\expndtw0\charscalex116 5. Cohen S.. Edwards JR. \u9632? (1989) "Personality
characteristics as moderators of \line\tab \up0 \expndtw0\charscalex114 the
relationship between stress and disorder", in R.W.Neufetd (ed.) "Advances \line\tab
\up0 \expndtw0\charscalex114 in the investigation of psychological stiess". J.Wiley
& Sons, Chicester. \par\pard\ql \li1185\sb0\sl-172\slmult0\tx3767 \up0
\expndtw0\charscalex113 6. Folkman S.. Lazarus R S \tab \up0
\expndtw0\charscalex114 (1985) "If it changes, it must be a process; study of
emotion and coping, during three stage of college examination" , Journal of \up0
\expndtw0\charscalex111 Personality and Social Psychology. 48. \up0 \expndtw-
5\charscalex100 150-170. \par\pard\ql \li1204\ri1022\sb10\sl-
193\slmult0\tx1396\tx1406\tx1406 \up0 \expndtw0\charscalex114 7. Friedman M.,
Rosenman R.H. \u9632? (1959) "Association of specttic overt behavior \line\tab \up0
\expndtw0\charscalex114 patterns, with blood and cardiovascular findings: blood
cholesterol level, blood \line\tab \up0 \expndtw0\charscalex123 clotting time,
incidence ot arcus senilis. and clinically coronary disease", \line\tab \up0
\expndtw-1\charscalex100 JAMA, 169. \up0 \expndtw0\charscalex102 1286-1296.
8. Friedman M.. Rosenman R.H - (1974) "Type A behavior and your heart", Knopf,
\line\tab \up0 \expndtw-2\charscalex100 New York. \par\pard\ql \li1190\sb0\sl-
162\slmult0 \up0 \expndtw0\charscalex112 9. Holdevici Irina - (1996) "Elemente de
psihoterapie". Ed. Alt, Bucuresti \par\pard\ql \li1228\sb13\sl-186\slmult0 \up0
\expndtw0\charscalex113 10. lamandescu IB. - (1993) ..Stresui psihic si bolile
interne", Ed. All, Bucuresti \par\pard\li1200\sb1\sl-198\slmult0\fi28\tx3072
\up0 \expndtw0\charscalex116 11 lamandescu I B\tab \up0 \expndtw0\charscalex116
(1998) \u8222?Psychoneuroallorgology". Romcartexim,
Bucuresti.\par\pard\li1200\sb1\sl-185\slmult0\fi33\tx3000\tx3100 \up0
\expndtw0\charscalex116 12 l.imandescu IB.\tab \up0 \expndtw-4\charscalex100
\u9632?\tab \up0 \expndtw0\charscalex116 (1993) ^Stresuipsihic si bolile interne",
Ed All. Bucuresti\par\pard\li1200\sb1\sl-187\slmult0\fi28\tx3081 \up0
\expndtw0\charscalex116 13. lamandescu I B.\tab \up0 \expndtw0\charscalex116 (1998)
\u8222?Psychoneuroatlergotogy", Romcartexim. Bucuresti\par\pard\li1200\sb1\sl-
193\slmult0\fi28\tx3067\tx3220 \up0 \expndtw0\charscalex116 14. lamandescu l.B.\tab
\up0 \expndtw0\charscalex116 -\tab \up0 \expndtw0\charscalex116 (1996) "Psihologie
Medicald", ed.a 2-a, Ed.lnfomedica,\par\pard\li1200\sb2\sl-207\slmult0\fi302
\up0 \expndtw0\charscalex116 Bucuresti\par\pard\li1200\sb1\sl-
165\slmult0\fi33\tx2620 \up0 \expndtw0\charscalex116 15. Ikemi Y.\tab \up0
\expndtw0\charscalex116 (1995) ..Integration of Eastern and Western
Psychosomatic\par\pard\li1200\sb1\sl-197\slmult0\fi307 \up0 \expndtw0\charscalex116
Medicine", Kyushu Univ. Press. Tokyo\par\pard\li1200\sb1\sl-184\slmult0\fi33
\up0 \expndtw0\charscalex116 16. lonescu G. - (1990) "Psihoterapie". Ed.
$tiintificd. Bucuresti.\par\pard\li1200\sb1\sl-193\slmult0\fi33\tx3926 \up0
\expndtw0\charscalex116 17. Lazarus R.S. Folkman S.\tab \up0
\expndtw0\charscalex116 (1984) "Stress, Appraisal and Coping".
Springer\par\pard\li1200\sb1\sl-197\slmult0\fi307 \up0 \expndtw0\charscalex116
Publishing Company, New York\par\pard\li1200\sb1\sl-
184\slmult0\fi33\tx3887\tx4036 \up0 \expndtw0\charscalex116 18 Lazarus R.S, Folkman
S.\tab \up0 \expndtw-4\charscalex100 -\tab \up0 \expndtw0\charscalex116 (1987)
Transadional Theory and Research on\par\pard\li1200\sb1\sl-
193\slmult0\fi321\tx6379\tx6595 \up0 \expndtw0\charscalex115 emotions and coping",
European Journal ol Personality.\tab \up0 \expndtw0\charscalex116 1,\tab \up0
\expndtw0\charscalex116 141-169.\par\pard\li1200\sb1\sl-197\slmult0\fi38 \up0
\expndtw0\charscalex117 19 Miciea M. \u9632? (1997) "Stress si apdrarepsthtcd".
Presa Universitard Clu/eand, 4-\par\pard\li1200\sb0\sl-197\slmult0\fi307 \up0
\expndtw0\charscalex116 43\par\pard\li1200\sb1\sl-166\slmult0\fi0\tx2361\tx2496
\up0 \expndtw0\charscalex116 20 Millet S\tab \up0 \expndtw-4\charscalex100 -\tab
\up0 \expndtw0\charscalex116 (1987) "Monitoring and blunting- validation ol a
questionnaire to\par\pard\li1200\sb1\sl-197\slmult0\fi638 \up0
\expndtw0\charscalex117 l ss styles of information seeking under threat". Jounal ot
Personality and\par\pard\li1200\sb0\sl-197\slmult0\fi331 \up0
\expndtw0\charscalex116 Social Psychology, 52. 345 353\par\pard\ql \li1204\sb1\sl-
171\slmult0\tx2587\tx2731 \up0 \expndtw0\charscalex117 21. Rotter J.B \tab \up0
\expndtw0\charscalex80 \u9632? \tab \up0 \expndtw0\charscalex118 (1966)
"Generalized expectancies lor internal versus external \par\pard\ql
\li1526\sb11\sl-193\slmult0 \up0 \expndtw0\charscalex112 control of reinforcement".
Psychological Monographs, 80 i 128. \par\pard\ql \li1204\sb1\sl-177\slmult0\tx4992
\up0 \expndtw0\charscalex124 22. Sarason I G . Johnson J.. Siegel S. \tab \up0
\expndtw0\charscalex116 (1978) "Assessing the impact of life \par\pard\qj
\li1536\ri1011\sb0\sl-200\slmult0 \up0 \expndtw0\charscalex112 changes :
development of the Life Experiences Survey". Journal of Consultii \\g \up0
\expndtw0\charscalex112 and Clinical Psychology, 46. 932-946. \par\pard\ql
\li1204\sb0\sl-162\slmult0 \up0 \expndtw0\charscalex110 23. Shaffer M \u9632?
(1982) "Life after Stress", Plenum Press, New York. \par\pard\li1204\sb6\sl-
207\slmult0\fi0\tx3235\tx3374 \up0 \expndtw0\charscalex116 24. Stone A., Neale
J\tab \up0 \expndtw-2\charscalex100 \u9632?\tab \up0 \expndtw0\charscalex116 (1984)
"New measure of daily coping.developmem .md\par\pard\li1204\sb1\sl-
188\slmult0\fi316 \up0 \expndtw0\charscalex117 preliminary results". Journal of
Personality and
Social Psychology. 46, 892-\par\pard\li1204\sb1\sl-204\slmult0\fi331 \up0
\expndtw0\charscalex116 906\par\pard\li1204\sb1\sl-171\slmult0\fi4\tx3667\tx3801
\up0 \expndtw0\charscalex113 25 Taylor S.E.. Brown J.D.\tab \up0 \expndtw-
2\charscalex100 \u9632?\tab \up0 \expndtw0\charscalex116 (1994) "Positive illusions
and well-being revised\par\pard\li1204\sb1\sl-196\slmult0\fi331\tx6192\tx6374
\up0 \expndtw0\charscalex113 Separating facts from fiction". Psychological
Bulletin.\tab \up0 \expndtw-8\charscalex79 1,\tab \up0 \expndtw0\charscalex116 21-
Temoshok L.\tab \up0 \expndtw0\charscalex116 (1990) "Type C and cancur", Random
House, New York.\par\pard\li1204\sb1\sl-169\slmult0\fi9\tx3211\tx3398\tx6566
\up0 \expndtw0\charscalex116 27. Tudose Cdtdltna\tab \up0
\expndtw0\charscalex116 \u9632?\tab \up0 \expndtw0\charscalex116 (1987)
"Alexitimia", in C.Gorgos\tab \up0 \expndtw0\charscalex116 (red.)-
"Diclionar\par\pard\ql \li1540\sb8\sl-207\slmult0 \up0 \expndtw0\charscalex112
enciclopodic de psihiatrie". vol.1 (AD), Ed.Medicald, Bucuresti.
\up0 \expndtw0\charscalex117 \ul0\nosupersub\cf14\f15\fs24 Capitolul 6 \par\pard\ql
\expndtw0\charscalex102 HORMONII DE STRES \par\pard\ql \li1291\sb183\sl-253\slmult0
\up0 \expndtw0\charscalex117 \ul0\nosupersub\cf8\f9\fs22 Fraga Paveliu, Sorin
Paveliu \par\pard\ql \li1300\sb0\sl-253\slmult0 \par\pard\ql\li1300\sb0\sl-
253\slmult0 \up0 \expndtw0\charscalex125 1. Considerate generale \par\pard\qj
\li988\ri928\sb46\sl-230\slmult0\fi297 \up0 \expndtw0\charscalex107 Hormonii
reprezintS chemiteri umorali, substanfe capabile sS transmits \up0
\expndtw0\charscalex106 informafia pe cale umorae, la distante, la nivelul
receptorllor celulari speci\up0 \expndtw0\charscalex106 fici existenti in diverse
(esutun \par\pard\qj \li988\ri934\sb0\sl-233\slmult0\fi292 \up0
\expndtw0\charscalex108 Glandele endocrine, in functie de natura agentului stresor,
determine un \up0 \expndtw0\charscalex112 respuns, eliberand catecolamine, hormoni
glucocortlcoizi, vasopresinS, \up0 \expndtw0\charscalex107 prolactinS, opioide
endogene si inhlbandeliberarea de testosteron, hormoni \up0 \expndtw0\charscalex102
gonadotropi. \par\pard\qj \li988\ri923\sb0\sl-235\slmult0\fi302 \up0
\expndtw0\charscalex106 Implicarea hormonilor in reactia de stres psihic sau fizic
nu se poate des\up0 \expndtw0\charscalex105 prinde in mod net de cea a sistemului
nervos central si autonom, datoritS in\up0 \expndtw0\charscalex111 tricSrn si
interdependentei activitatii celor trei slsteme. Acest aspect este \up0
\expndtw0\charscalex108 valabil si referitor la sistemul imun, cu care sistemul
neuroendocrln are le\up0 \expndtw0\charscalex108 geturi strSnse demonstrate recent.
Rezultanta globala a secretiei dlferitelor glande endocrine in stres, \up0
\expndtw0\charscalex114 contureazS un tablou umoral specific diverselor situafii
generatoare de \up0 \expndtw0\charscalex107 stres. Intricarea sa cu ceilalfi
medlatorl al reactiei de stres (de neurosecretie \up0 \expndtw0\charscalex106 a
celulelor nervoase sau flbrelor nervoase de diverse categorii: adrenergice, \up0
\expndtw0\charscalex107 collnergice. peptldergice, etc.) realizeazS o rezultanta
umorae complexS cu \up0 \expndtw0\charscalex106 efecte ..nuanfate" asupra
receptorilor celulari specificl hormonilor si media\up0 \expndtw0\charscalex112
toriior respectivi, deciansand rSspunsuri somato-viscerale caracterlstice \up0
\expndtw0\charscalex107 pentru subtlpul de stres psihic (de ex. reactie violentS
sau blocaj emotional \up0 \expndtw0\charscalex107 in cadrul unui conflict sau
asteptare anxioasS sau depresie, etc). \par\pard\ql \li1296\sb0\sl-198\slmult0 \up0
\expndtw0\charscalex105 Fondul activitatii secretorii a glandelor endocrine, ca si
starea functiona� \par\pard\qj \li1003\ri917\sb0\sl-230\slmult0\fi9 \up0
\expndtw0\charscalex110 e bazalS a sistemului endocrln, la care se adaugS terenul
genetic si even\up0 \expndtw0\charscalex111 tuaiele antecedente patologice,
conditioneazS amplitudinea si durata ras \up0 \expndtw0\charscalex107 punsului; nu
trebuie ignorate corelafiile cu centrii nervosi: cortico-limblco-\line \up0
\expndtw0\charscalex107 hipotalamici. in special factorii eiiberatori sau factorii
inhibitori ai hormo� \up0 \expndtw0\charscalex104 nilor adenohlpofizarl, etc.
Referitor la natura agenfiior stresori care determine eliberarea de \up0
\expndtw0\charscalex103 CRF (corticotrophine-releasing factor), menfionem:
\par\pard\ql \li1296\sb8\sl-228\slmult0 \up0 \expndtw0\charscalex103 - disconfortul
fizic si probabil psihic; \par\pard\li1296\sb1\sl-247\slmult0\fi0\tx7363 \up0
\expndtw0\charscalex112 - sterile de abandonare a luptei, generatoare de reactii
de\tab \up0 \expndtw0\charscalex112 \u8222?ajustare\par\pard\li1296\sb1\sl-
226\slmult0\fi134 \up0 \expndtw0\charscalex112 pasive" in cursul stresului
psihic;\par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart Pg82}{\bkmkend
\ul0\nosupersub\cf3\f4\fs18 Element* Jo ;..-iliOSom.itica yonwrala si aplicata
\expndtw0\charscalex119 \ul0\nosupersub\cf9\f10\fs20 - starile de ..suspense"
inaintea unei interventii chirurgicale sau de anti\up0 \expndtw0\charscalex117
cipare a unui act care implies durerea fizicS $i un efort intens. \line \tab
\up0 \expndtw0\charscalex121 Eustresul produce, de asemenea. o reactie cortizolicS,
dar aceasta este \up0 \expndtw0\charscalex121 depSsitS de reacfia
catecolaminica. \par\pard\qj \li1425\ri531\sb20\sl-220\slmult0\fi283 \up0
\expndtw0\charscalex117 Este de mentionat cS pot exista stresuri psihice fSra
modificSri ale nive\up0 \expndtw0\charscalex117 lunlor serice ale cortizolului.
Clasic, se cunosc doua tipuri de respuns endocrin global la stresui \up0
\expndtw0\charscalex118 psihic, dupe predominanta uneia din cele doue reactii
fundamentale postu� \up0 \expndtw0\charscalex115 late de Selye: catecolaminica si
cortizolice. in prezent, tahloul umoral neuro\up0 \expndtw0\charscalex115 endocrin
este mult mai complex. \par\pard\qj \li1425\ri518\sb20\sl-220\slmult0\fi283 \up0
\expndtw0\charscalex131 3. Principalii efectori biologici ai raspunsului
generalizat la stres \up0 \expndtw0\charscalex116 (sindromul general de adaptare)
sunt reprezentati de CRH - hormonul elibe\up0 \expndtw0\charscalex116 rator de
corticotropinS - si sistemele norepinefnne - locus ceruleus. \par\pard\ql
\li2764\sb172\sl-230\slmult0 \up0 \expndtw0\charscalex123 Figura 1. Medierea
stresului de catre efectorii \par\pard\qj \li2788\ri1810\sb0\sl-220\slmult0\fi28
\up0 \expndtw0\charscalex121 central! prin Intermediul CRH - corticotropin \up0
\expndtw0\charscalex122 releasing hormone si al SNC (dupa Gold WP) \par\pard\ql
\expndtw0\charscalex139 \ul0\nosupersub\cf3\f4\fs18 Agenti stresori \par\pard\ql
\expndtw0\charscalex132 Efectori SNC \par\pard\li3134\sb0\sl-
207\slmult0\fi43\tx5611 \up0 \expndtw0\charscalex119 Neuron! CRH\tab \up0
\expndtw0\charscalex126 Locus Ceruleus\par\pard\li3134\sb1\sl-
188\slmult0\fi355\tx5592 \up0 \expndtw0\charscalex117 (CRH)\tab \up0
\expndtw0\charscalex120 ( Noradrenalind)\par\pard\li3134\sb96\sl-
I\par\pard\li3134\sb0\sl-162\slmult0\fi345\tx6052 \up0 \expndtw0\charscalex123
\ul0\nosupersub\cf3\f4\fs18 Cortex\tab \up0 \expndtw0\charscalex123
Cortex\par\pard\li3134\sb1\sl-181\slmult0\fi0\tx5788 \up0 \expndtw0\charscalex122
Sistem Limbic\tab \up0 \expndtw0\charscalex123 Hipotalamus\par\pard\li3134\sb1\sl-
194\slmult0\fi86\tx6000 \up0 \expndtw0\charscalex122 Hipotalamus\tab \up0
\expndtw0\charscalex110 HipofizS\par\pard\li3398\sb0\sl-
207\slmult0\fi0\tx5668 \up0 \expndtw0\charscalex122 Impulsuri\tab \up0
\expndtw0\charscalex122 Glococorticoizi\par\pard\li3398\sb1\sl-
182\slmult0\fi0\tx5726 \up0 \expndtw0\charscalex122 nervoase\tab \up0
\expndtw0\charscalex122 Catecolamine\par\pard\li3009\sb0\sl-
207\slmult0\fi398\tx5932 \up0 \expndtw0\charscalex127 Adaptare\tab \dn2
\expndtw0\charscalex127 Adaptare\par\pard\li3009\sb1\sl-177\slmult0\fi0\tx5927 \up0
\expndtw0\charscalex127 \ul0\nosupersub\cf37\f38\fs18\ul comportamontaia\ul0\tab
\dn2 \expndtw0\charscalex127 \ul0\nosupersub\cf37\f38\fs18\ul
perlferlci\par\pard\qj \li1449\sb0\sl-240\slmult0
\ul0\nosupersub\cf9\f10\fs20 Cand homeostazia este amenintate, ace$ti efectori,
pusi in miscare, ac-\line \up0 \expndtw0\charscalex120
tioneaze direct asupra sistemului nervos central \up0 \expndtw0\charscalex119
(figura l), facilitand caile \par\pard\qj \li1454\ri487\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex122 nervoase adaptative. care promoveaze atentia, vigilenta,
agresivitatea. in \up0 \expndtw0\charscalex120 timp ce Ie inhibe pe cele non-
adaptative ce promoveaze functil vegetative \up0 \expndtw0\charscalex115 precum:
comportamentul alimentar $i sexual, functia reproductive, in perife\up0
\expndtw0\charscalex117 rie, ele actioneaze prin intermediul catecolaminelor $i al
hormonilor gluco\up0 \expndtw0\charscalex118 corticoizi pentru a redirecfiona
fluxul sanguin cetre sistemul nervos central \up0 \expndtw0\charscalex118 $i a
mobiliza energia pentru acfiune imediate.
252\slmult0\fi287 \up0 \expndtw0\charscalex122 \ul0\nosupersub\cf9\f10\fs20 4.
Exista o functie foarte importanta a hormonilor glucocorticoizi in \up0
\expndtw0\charscalex130 timpul stresului, ce necesite o atenfie speciae. Secrefia
de hormoni \up0 \expndtw0\charscalex123 glucocorticoizi este necesare pentru a
restrange sau contracara efectele \up0 \expndtw0\charscalex121 respunsului la
stres. prevenind consecintele activarii prelungite excesiv. \up0
\expndtw0\charscalex122 Astfel, hormonii glucocorticoizi antagonizeaza hormonul
eliberator de \up0 \expndtw0\charscalex123 corticotropina si sistemul
noradrenalina - locus ceruleus. \par\pard\ql \li1195\sb27\sl-230\slmult0 \up0
\expndtw0\charscalex115 Electul ce urmeaze se poate produce: \par\pard\qj
direct, pnn stimularea activitatii enzimatice a tirozinhidroxilazei la ni� \up0
\expndtw0\charscalex116 velul locus ceruleus, mediae prin intermediul receptorului
glucocorticoid; \par\pard\qj \li907\ri1059\sb20\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex120 \u8226? indirect prin inhibifia efectului hormonulul
eliberator de corticotro� \up0 \expndtw0\charscalex120 pina asupra locus
ceruleus. \par\pard\ql \li1195\sb29\sl-230\slmult0\tx8044 \up0
\expndtw0\charscalex125 Hormonii glucocorticoizi mediaze, de asemenea,
imunosupresia \tab \up0 \expndtw-2\charscalex100 -\par\pard\qj
\li902\ri1045\sb10\sl-255\slmult0\fi4 \up0 \expndtw0\charscalex116 mecanism in care
intervine respunsul inflamator implicat in clasica situatie \up0
\expndtw0\charscalex116 "fight-or-flight". in traumatisme. Desi poate oferi un
avantaj in timpul unei \up0 \expndtw0\charscalex121 situafii acute, un astfel de
efect devine problematic in timpul distresului \up0 \expndtw0\charscalex115
emotional, care rar se rezolve rapid �i definitiv, precum pericolul asociat cu \up0
\expndtw0\charscalex115 combativitatea tizica directs. \par\pard\qj
\li902\ri1044\sb18\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex122 Oncare stres,
inclusiv eel psihic, implies activarea sistemului neuro\up0 \expndtw0\charscalex115
endocrin central care presupune interventia: \par\pard\ql \li1200\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex112 - axei hipotalamo-hipofizo-
corticosuprarenaliene; \par\pard\ql \li1200\sb30\sl-230\slmult0 \up0
\expndtw0\charscalex110 - catecolaminelor. \par\pard\qj \li907\ri1030\sb0\sl-
260\slmult0\fi292 \up0 \expndtw0\charscalex120 Studii clinice si experimental
recente au aratat ce niveluri crescute ale \up0 \expndtw0\charscalex107
cortizolului \up0 \expndtw0\charscalex115 (de tipul celor din stresui psihic
cronic) putand produce leziuni \par\pard\li907\sb23\sl-
230\slmult0\fi0\tx3383\tx4756\tx4982 \up0 \expndtw0\charscalex127 ale sistemului
nervos\tab \up0 \expndtw0\charscalex114 (hipocampul\tab \up0
\expndtw0\charscalex120 -\tab \up0 \expndtw0\charscalex127 veche formafiune
filcgenetice\par\pard\li907\sb24\sl-230\slmult0\fi0\tx6072\tx6264 \up0
\expndtw0\charscalex127 anatomice, implicate in unele forme de memorie\tab \up0
\expndtw0\charscalex120 -\tab \up0 \expndtw0\charscalex127 are o
sensibilitate\par\pard\ql \li902\sb24\sl-230\slmult0 \up0 \expndtw0\charscalex113
crescutS la acfiunea cortizolului). \par\pard\qj \li911\ri1040\sb0\sl-
260\slmult0\fi283 \up0 \expndtw0\charscalex135 in cursul unui stres acut,
concentrafii crescute ale cortizolului \up0 \expndtw0\charscalex127 determina
distrugerea neuronilor de la nivelul hipocampului, putand \up0
\expndtw0\charscalex116 afecta memoria care, mai departe. determina distuncfii
cognitive \par\pard\ql \li907\ri1035\sb0\sl-255\slmult0\fi292\tx1204 \up0
\expndtw0\charscalex122 in cursul procesului de imbStrSnire. hipercorticismul este
asociat cu \up0 \expndtw0\charscalex114 afectarea performantei - in sindromul
Cushing. boala Alzheimer, depresie. \line\tab \up0 \expndtw0\charscalex114
Dehidroepiandrosteronul (DHEA) reprezintS un antagonist al cortizolu� \up0
\expndtw0\charscalex117 lui. S-a constatat cS nivelul de DHEA scade, si este invers
proportional cu \up0 \expndtw0\charscalex111 eel al cortizolului \par\pard\qj
\li911\ri1039\sb0\sl-253\slmult0\fi288 \up0 \expndtw0\charscalex119 5.
Testosteronul scade in stresui psihic, in cursul cSruia subiectul per-\line \up0
\expndtw0\charscalex114 cepe un control redus asupra evenimentelor (Henry) De
regulS existe un ra� \up0 \expndtw0\charscalex121 port invers intre nivelurile
cortizolului si cele ale testosteronului in cur� \up0 \expndtw0\charscalex116 sul
distresului, mai ales in faza anticiparii esecului (Rabin si colab.. \up0 \expndtw-
3\charscalex100 1968). \par\pard\qj \li916\ri1036\sb0\sl-252\slmult0\fi288 \up0
\expndtw0\charscalex127 Diferentierea secrefiei hormonale este in functie de
intensitatea s' \up0 \expndtw0\charscalex125 importanfa psihologica pe care Ie
atribuie individul agentului stresant \up0 \expndtw0\charscalex115 (Coculescu Ml
Spre exemplu, secrefia de cortizol apare la stimuli mai putin \up0
\expndtw0\charscalex119 intensi comparativ cu cea de hormon de crestere (Ling s'
colab.). Reac(ia \up0 \expndtw0\charscalex118 corticosuprarenalianS poate fi
determinats numai de caracterul de noutate \up0 \expndtw0\charscalex116 sau de
bruschefea unui stresor fizic.
253\slmult0\fi0\tx2203\tx4843 \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf8\f9\fs22 76\tab \up0 \expndtw-3\charscalex100 *\tab \up0
\expndtw-3\charscalex100 Elemente de psihosomatica generae si
253\slmult0\fi0 \up0 \expndtw0\charscalex111 Figura 2. tntervenfla cortizolului in
condtfll de\par\pard\li3383\sb1\sl-231\slmult0\fi513 \up0 \expndtw0\charscalex111
stres (dupd Croes si colab., 1993)\par\pard\li3153\sb0\sl-
138\slmult0\fi3748 \up0 \expndtw0\charscalex113 \ul0\nosupersub\cf19\f20\fs12 Tn
condemn\par\pard\sect\sectd\sbknone\cols3\colno1\colw4318\colsr160\colno2\colw2269\
colsr160\colno3\colw2263\colsr160\ql \li3153\sb0\sl-161\slmult0 \par\pard\ql
\expndtw0\charscalex143 \ul0\nosupersub\cf23\f24\fs14 Cot
li/olul\par\pard\column \qj \li1254\ri312\sb0\sl-108\slmult0\tx1326 \up0
\expndtw0\charscalex111 \ul0\nosupersub\cf19\f20\fs12 .Ktili rftmul \line\tab
\up0 \expndtw0\charscalex117 clrcjwtcan\par\pard\qj \li20\ri1387\sb2\sl-
La .'.llh:.>i.Jil \line\tab \up0 \expndtw0\charscalex130 sandtosl\par\pard\ql
1\charscalex100 \ul0\nosupersub\cf19\f20\fs12 t C<��tt>\par\pard\column \ql
\li467\sb1\sl-127\slmult0 \up0 \expndtw0\charscalex101 ulul\par\pard\qj
\li20\ri1439\sb48\sl-133\slmult0\tx654 \up0 \expndtw-5\charscalex100
\ul0\nosupersub\cf23\f24\fs14 Tn cuz\tab \up0 \expndtw-4\charscalex100 \u8212?
\line \up0 \expndtw0\charscalex117 d�e�oc\par\pard\qj \li7320\sb0\sl-124\slmult0
\par\pard\qj \li7320\sb0\sl-124\slmult0 \par\pard\qj \li7320\sb0\sl-124\slmult0
\par\pard\qj \li7320\sb0\sl-124\slmult0 \par\pard\qj \li443\ri1069\sb70\sl-
Tntnphnirnn \line \up0 \expndtw0\charscalex115 unei etucln*\par\pard\ql
\ul0\nosupersub\cf24\f25\fs10 <\tab \up0 \expndtw0\charscalex142 .|*-i.'in-
i,i,ii. \par\pard\sect\sectd\sbknone \qj \li5779\ri1134\sb138\sl-140\slmult0\fi4
\up0 \expndtw0\charscalex123 \ul0\nosupersub\cf19\f20\fs12 o tdevlrail
~are*c1rvttate" a eocrepoi \up0 \expndtw0\charscalex124 da coti/ol ca rlmlna mutt
acJUutl \par\pard\qj \li5784\ri1721\sb0\sl-140\slmult0 \up0 \expndtw0\charscalex121
\u8226?tat Tn �e�c o�t |i In eoooes \up0 \expndtw0\charscalex108 l"nodi�crlmrru�rn
') \par\pard\ql \li2131\sb0\sl-253\slmult0 \par\pard\ql\li2131\sb94\sl-
253\slmult0 \up0 \expndtw0\charscalex119 \ul0\nosupersub\cf8\f9\fs22 2. Axa
hipotalamo-hipofixo-corticosuprarenaliana \par\pard\qj \li1833\ri141\sb198\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex102 Hormonii glucocorticoizi joacS un
rol important in adaptarea organismu� \up0 \expndtw0\charscalex102 lui la stres \
{figura 2). \par\pard\qj \li1823\ri138\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex114 in condifii de stres.
se constatS. la cateva minute de la producerea \up0 \expndtw0\charscalex104
acestuia, o crestere a sintezei de ACTH prin mecanism nervos (figura 3).
\ul0\nosupersub\cf19\f20\fs12 HITMURI CIRCAOIENE \par\pard\li2376\sb79\sl-
287\slmult0\fi1852\tx4766 \dn4 \expndtw-3\charscalex100 \ul0\nosupersub\cf8\f9\fs22
-.\tab \up0 \expndtw-10\charscalex94 STRES\par\pard\li2376\sb0\sl-630\slmult0\fi153
\up0 \expndtw0\charscalex120 \ul0\nosupersub\cf17\f18\fs70 s\t \up0
\expndtw0\charscalex115 <Fn\par\pard\li2376\sb0\sl-342\slmult0\fi2145 \up0
\expndtw0\charscalex120 \ul0\nosupersub\cf28\f29\fs38 P\par\pard\li2376\sb1\sl-
395\slmult0\fi964 \up0 \expndtw0\charscalex96 \ul0\nosupersub\cf32\f33\fs40 \\
t\par\pard\sect\sectd\sbknone\cols2\colno1\colw6104\colsr160\colno2\colw2896\colsr1
60\qj \li2376\sb0\sl-187\slmult0 \par\pard\qj \li2529\ri1571\sb31\sl-
L/sEROTONINA \line \up0 \expndtw-5\charscalex100 NEURONl \up0
\expndtw0\charscalex207 _l/ A.\par\pard\ql \li2376\sb60\sl-161\slmult0 \up0
\expndtw0\charscalex100 PEPTIOERQIC.. _*T\par\pard\ql \li2976\sb0\sl-253\slmult0
\ul0\nosupersub\cf8\f9\fs22 Ei/ w \up0 \expndtw-6\charscalex100
\ul0\nosupersub\cf3\f4\fs18 cm\par\pard\ql \li3614\sb97\sl-191\slmult0 \up0
\expndtw-2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 \\\par\pard\ql
\expndtw-3\charscalex100 \ul0\nosupersub\cf19\f20\fs12 ACTH\tab \up0
\expndtw0\charscalex100 CORTIZOL\par\pard\ql \li3417\sb301\sl-345\slmult0 \up0
\expndtw0\charscalex59 \ul0\nosupersub\cf33\f34\fs30 \u9632?x\par\pard\column
\ql \li720\sb112\sl-253\slmult0 \up0 \expndtw0\charscalex109
\ul0\nosupersub\cf8\f9\fs22 Figura 3\par\pard\ql \li461\sb1\sl-237\slmult0 \up0
\expndtw0\charscalex111 fteprezentarea\par\pard\ql \li68\ri567\sb3\sl-
237\slmult0\fi52\tx270 \up0 \expndtw0\charscalex114 schamailca a reglani
\line\tab \up0 \expndtw0\charscalex102 secrefiei de ACTH. \line \up0
\expndtw0\charscalex105 Secrefia de ACTH este\par\pard\ql \li20\ri508\sb0\sl-
239\slmult0\fi297\tx236 \up0 \expndtw0\charscalex111 stlmulsta de CRF \line\tab
\up0 \expndtw0\charscalex114 hlpotalamlc si este \line \up0 \expndtw0\charscalex112
inhibata prin feedback'\par\pard\qj \li68\ri556\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex113 ul negativ exercftatde \line \up0 \expndtw0\charscalex106
cottlzol (dupd Martin.\par\pard\qj \li116\ri650\sb4\sl-240\slmult0\fi105 \up0
\expndtw0\charscalex114 J.B.. etal., Clinical \line \up0 \expndtw0\charscalex106
Neuroendocrinology, \line \up0 \expndtw0\charscalex101 \u9632?Sf" Ed. Philadelphia,
\par\pard\sect\sectd\sbknone \li2976\sb0\sl-108\slmult0\fi0\tx6614 \up0
\expndtw0\charscalex101 \ul0\nosupersub\cf19\f20\fs12 OLANOASU\t \up0 \expndtw-
1\charscalex100 \u8226?RAHENAL\tab \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf8\f9\fs22 F.A. Davis.
1997\}\par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart Pg85}{\bkmkend
Pg85}\par\pard\sect\sectd\sbknone\cols2\colno1\colw3872\colsr160\colno2\colw5128\co
lsr160\ql \li1046\sb0\sl-230\slmult0 \par\pard\ql \li1046\sb0\sl-230\slmult0
\ul0\nosupersub\cf9\f10\fs20 Psihosomatica generala\par\pard\ql \li2049\sb0\sl-
\expndtw0\charscalex114 \ul0\nosupersub\cf19\f20\fs12 HllMllHl
CIRCADIENE\par\pard\ql \li2366\sb0\sl-506\slmult0 \par\pard\ql \li2366\sb0\sl-
\expndtw0\charscalex100 \ul0\nosupersub\cf29\f30\fs44 \u8226?IMM\par\pard\ql
\ul0\nosupersub\cf16\f17\fs34 s\\\par\pard\ql \li2577\sb0\sl-160\slmult0 \up0
\expndtw0\charscalex42 \ul0\nosupersub\cf9\f10\fs20 >.\par\pard\ql \li2520\sb81\sl-
138\slmult0 \up0 \expndtw0\charscalex110 \ul0\nosupersub\cf19\f20\fs12 CRH T T
\up0 \expndtw0\charscalex104 VP\par\pard\qj \li1502\ri490\sb152\sl-
182\slmult0\fi1142 \up0 \expndtw0\charscalex115 UlPOM7A^ \up0
\expndtw0\charscalex112 EPINEKJINA\par\pard\column \ql \li7704\sb0\sl-
230\slmult0 \up0 \expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 \u9830?
77\par\pard\ql \li4296\sb0\sl-230\slmult0 \par\pard\ql \li4296\sb0\sl-
STRES\par\pard\ql \li20\sb59\sl-414\slmult0 \up0 \expndtw0\charscalex80
\ul0\nosupersub\cf5\f6\fs36 P>\par\pard\ql \li6215\sb0\sl-230\slmult0
\up0 \expndtw0\charscalex118 \ul0\nosupersub\cf9\f10\fs20 Figura 4.\par\pard\ql
Reprezentarea\par\pard\qj \li1483\ri1281\sb2\sl-240\slmult0\fi96\tx1724\tx1570 \up0
\expndtw0\charscalex120 schematic a a funcfiol \line\tab \up0
\expndtw0\charscalex121 axului htpotalamo-\line \tab \up0 \expndtw0\charscalex122
hipofizo-adrenalian in \line \up0 \expndtw0\charscalex120 stres (dupd Martin
J.B
,\par\pard\sect\sectd\sbknone\cols3\colno1\colw2297\colsr160\colno2\colw3100\colsr1
60\colno3\colw3453\colsr160\ql \li1689\sb0\sl-198\slmult0 \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf8\f9\fs22 /\par\pard\column \ql \li20\sb0\sl-
r\par\pard\column \ql \li20\sb0\sl-180\slmult0 \up0 \expndtw0\charscalex121
\ul0\nosupersub\cf9\f10\fs20 Relchlln S.
Clinical\par\pard\sect\sectd\sbknone\cols2\colno1\colw5475\colsr160\colno2\colw3525
\colsr160\ql \li2299\sb0\sl-108\slmult0\tx3196 \up0 \expndtw-1\charscalex100
\ul0\nosupersub\cf19\f20\fs12 ACTH\tab \up0 \expndtw0\charscalex114
CORTIZOI\par\pard\ql \li2438\sb0\sl-522\slmult0 \up0 \expndtw0\charscalex66
\ul0\nosupersub\cf26\f27\fs58 V J.\par\pard\column \ql \li29\sb0\sl-
Neuroendocrinology\par\pard\ql \li20\sb0\sl-198\slmult0 \up0
\expndtw0\charscalex111 \ul0\nosupersub\cf8\f9\fs22 2* Ed.
Philadelphia,\par\pard\ql \li212\sb0\sl-180\slmult0 \up0 \expndtw0\charscalex111
\ul0\nosupersub\cf9\f10\fs20 F.A. Davis, 1997) \par\pard\sect\sectd\sbknone \ql
\ul0\nosupersub\cf19\f20\fs12 (1LANUA SIJHP.An.FNAI A \par\pard\ql \li1401\sb0\sl-
\ul0\nosupersub\cf9\f10\fs20 1. Condifli secretorii pentru ACTH si cortizoi
ACTH stimuleaza cortexul adrenal pentru a elibera cortizoi, care la randul \up0
\expndtw0\charscalex122 lui exercite un feedback negativ asupra hipoflzei
anterioare. Secrefia de \up0 \expndtw0\charscalex115 ACTH este stimulate de CRH
care acfioneaze concomitent cu argininvaso-\line \up0 \expndtw0\charscalex115
presina (AVP) (VP in figura 4). Eliberarea de eplnefrina in sange indusS de \up0
\expndtw0\charscalex136 stres potenfeaza efectele AVP si CRH. Efectele de feedback
ale \up0 \expndtw0\charscalex114 glucocorticoizilor sunt exercitate direct asupra
hipofizei $i asupra sintezei �i \up0 \expndtw0\charscalex114 secretiei de CRH si
AVP. in hipotalamus, secrefia de CRH s* AVP
este\par\pard\sect\sectd\sbknone\cols2\colno1\colw5848\colsr60\colno2\colw3252\cols
r160\ql \li1075\sb18\sl-220\slmult0 \up0 \expndtw0\charscalex116 reglatS printr-o
multitudine de neurotransmitetori\par\pard\column \ql \li20\sb10\sl-230\slmult0
\up0 \expndtw0\charscalex119 $i neuropeptide. cei mai
\par\pard\sect\sectd\sbknone \qj \li1075\ri873\sb0\sl-220\slmult0\fi14 \up0
\expndtw0\charscalex119 important fiind reprezentafi in figura 4 Dintre
neurotransmitetorii clasici, \up0 \expndtw0\charscalex112 efectele excitatoni sunt
exercitate de acetllcoline (ACH) \up0 \expndtw0\charscalex108 $i serotonine
(5TH), \par\pard\ql \li1084\sb0\sl-197\slmult0\tx5361 \up0 \expndtw0\charscalex130
iar efectele inhibitorli de cetre GABA \tab \up0 \expndtw0\charscalex125 (acid
gammaamino butiric). \par\pard\qj \li1080\ri856\sb0\sl-225\slmult0\fi4 \up0
\expndtw0\charscalex124 Catecolaminele pot avea atat etecte inrtibitorii, cat si
excitatorii. intr-o \up0 \expndtw0\charscalex117 reprezentare mai veche a acestui
sistem de control, se credea ce serotonina \up0 \expndtw0\charscalex119 acfioneaze
prin intermediul acetilcolinei. Studii mai recente sugereaze ce \up0
\expndtw0\charscalex123 serotonina acfioneaze direct asupra neuronului CRH, NE
(norepinefrl\up0 \expndtw0\charscalex108 na), IL 1 \up0 \expndtw0\charscalex118
(interleuklna 1). \par\pard\qj \li1080\ri847\sb0\sl-220\slmult0\fi288 \up0
\expndtw0\charscalex115 ACTH-ul plasmatic si secretia de cortizoi respund la
stresui fizic in mod \up0 \expndtw0\charscalex125 caracteristic. Astfel, ACTH-ul si
cortizolul plasmatic sunt secretate in \up0 \expndtw0\charscalex125 minutele
urmStoare debutului unui stres de tipul celui chirurgical sau \up0
\expndtw0\charscalex120 hipoglicemic, iar aceste rSspunsuri abolesc rltmul
circadian dacS stresui \up0 \expndtw0\charscalex115 este prelungit. RSspunsul la
stres i$i are originea in sistemul
nervos central, \up0 \expndtw0\charscalex117 cu o secrefie crescute hlpotalamlce
de CRH $i. astfel, o secrete crescute de \up0 \expndtw0\charscalex111 ACTH
hipotizar. Responsivitatea la stres a ACTH-ului plasmatic $i a cortizo� \up0
\expndtw0\charscalex126 lului este abolite printr-o administraro anterioarS a unei
doze mari de \up0 \expndtw0\charscalex115 glucocorticoid, iar in sindromul Cushing-
spontan; din contrS, responsivita� \up0 \expndtw0\charscalex115 tea secrefiei de
ACTH este intensificatS dupS adrenalectomie
\expndtw0\charscalex111 \ul0\nosupersub\cf3\f4\fs18 78 v\tab \up0
generala si aplicata\par\pard\qj \li1713\sb0\sl-220\slmult0
220\slmult0\fi283 \up0 \expndtw0\charscalex118 Cresterea secrefiei de ACTH $i. prin
urmare, a cortizolemiei se face da\up0 \expndtw0\charscalex120 torits difenfilor
stimuli nervosi care sporesc productia de CRH in celulele \up0
\expndtw0\charscalex120 neurosecretorii din hipotalamus. \par\pard\qj
\li1703\ri227\sb0\sl-226\slmult0\fi302 \up0 \expndtw0\charscalex119 CRH
(corticotrophin-releasing-hormone) ajunge prin sistemul vascular \up0
\expndtw0\charscalex122 port hipotalamo-hipofizar in hipofiza anterioarS, stimuland
eliberarea de \up0 \expndtw0\charscalex116 ACTH care va actiona la nivelul
corticosuprarenalelor determinand elibera� \up0 \expndtw0\charscalex116 rea
cortizolului. \par\pard\ql \li1713\ri223\sb0\sl-224\slmult0\fi292\tx2001 \up0
\expndtw0\charscalex113 Cortizolul poate stimula conversia noradrenalinei si a
adrenalinei la nivelul \up0 \expndtw0\charscalex113 medulosuprarenalei prin
activarea enzimei fenoximetil-N-metil transferaza. \line\tab \up0
\expndtw0\charscalex117 in stresui acut cresterea nivelelor cortizolului determine
cresteri de 20 de \up0 \expndtw0\charscalex114 ori ale secrefiei de ACTH. Secrefia
de ACTH in aceste proporfii este inhibate \up0 \expndtw0\charscalex120 rapid de
cresterea cortizolemiei prin mecanism feedback (dispare dupe 30 \up0
\expndtw0\charscalex120 de minute). NeurotransmitStorii implicafi sunt acetilcolina
si serotonina. \par\pard\qj \li1353\ri229\sb0\sl-220\slmult0\tx2011 \up0 \expndtw-
2\charscalex100 | \tab \up0 \expndtw0\charscalex129 Noradrenalina intracerebrala
exercits o inhibifie tonica in ceea ce \up0 \expndtw0\charscalex111 L, \up0
\expndtw0\charscalex125 priveste raspunsul secretor al hormonului adrenocorticotrop
la stres. \par\pard\qj \li1723\ri229\sb0\sl-220\slmult0\fi278 \up0
\expndtw0\charscalex119 Axul hipotalamo-hipofizo-adrenalian joacS un rol esenfial
in fiziopato\up0 \expndtw0\charscalex120 logia stresului. Mult timp s-a considerat
cS stresui precipits episoadele de \up0 \expndtw0\charscalex120 tulburari afective
la indivizii cu susceptibilitate genetice. \par\pard\qj \li1713\ri224\sb12\sl-
220\slmult0\fi297 \up0 \expndtw0\charscalex116 O lunga penoadS s-a considerat ce
ACTH este singurul agent reglator al \up0 \expndtw0\charscalex122 descSrcerii de
cortizoi din cortexul adrenal. Dovezi recente sugereaze ce \up0
\expndtw0\charscalex125 existe perioade in care apare o disociere intre
concentrafiile plasmatice \up0 \expndtw0\charscalex119 de ACTH si cele de cortizoi
(de ex. dupe masa de pranz, dupe administra-\line \up0 \expndtw0\charscalex122 rea
de de metamfetamine, in cursul primelor ore ale diminefii), cand pot \up0
\expndtw0\charscalex120 exista cresteri ae cortizolemiei fere o modificare
precedents sau concomi-\line \up0 \expndtw0\charscalex115 tente a concentrafiei
plasmatice de ACTH. Recent s-a observat ca aproxima-\line \up0
\expndtw0\charscalex116 liv o jumState din timp nu existe o relafie directe intre
secretia de cortizoi $i \up0 \expndtw0\charscalex126 de ACTH. Sunt implicate
mecanisme ACTH-independente, incluzand \up0 \expndtw0\charscalex119 activarea
simpatice a cortexului adrenal, activarea prin mecanism paracrin \par\pard\ql
\li1737\sb12\sl-230\slmult0\tx1910\tx6940\tx7123 \up0 \expndtw-2\charscalex100
-\tab \up0 \expndtw0\charscalex120 mesagerii chimici produsi in
medulosuprareanalS \tab \up0 \expndtw-2\charscalex100 -\tab \up0
\expndtw0\charscalex129 $i alte peptide ce \par\pard\ql \li1723\sb1\sl-
193\slmult0 \up0 \expndtw0\charscalex114 stimuleaza direct cortexul adrenal - de
ex. y-MSH, GH. interferoni, etc. \par\pard\ql \li2011\sb97\sl-230\slmult0 \up0
\expndtw0\charscalex115 2. Reglarea secrefiei de ACTH \par\pard\qj
\li1728\ri228\sb59\sl-220\slmult0\fi283 \up0 \expndtw0\charscalex119 Secrefia de
ACTH este reglatS de o serie de factori: CRF, vasopresina, \up0
\expndtw0\charscalex121 somatostatina, pollpeptidul intestinal vasoactiv,
catecolamine \up0 \expndtw0\charscalex124 (atat prin \par\pard\ql \li1728\sb12\sl-
230\slmult0 \up0 \expndtw0\charscalex116 mecanisme �- cat si p-adrenergice),
angiotensinS. glucocorticoizi. \par\pard\qj \li1728\ri224\sb0\sl-
220\slmult0\fi288 \up0 \expndtw0\charscalex114 CRF si vasopresina regleazS secrefia
de ACTH in cazul actiunii diferifilor \up0 \expndtw0\charscalex118 agenfi cu efect
stresor CRF este principalul factor ce moduleazS rSspunsul \up0
\expndtw0\charscalex118 ACTH la stres. vasopresina jucand un rol adjuvant.
RSspunsul la stresui \par\pard\li1728\sb1\sl-227\slmult0\fi0\tx2985\tx4176 \up0
\expndtw0\charscalex110 hipovolemic\tab \up0 \expndtw0\charscalex113 (hemoragie\tab
\up0 \expndtw0\charscalex119 - stres cu rSsunet hemodinamlc) este medial
in\par\pard\li1728\sb1\sl-219\slmult0\fi4 \up0 \expndtw0\charscalex119 principal de
vasopresina.\par\pard\li1728\sb1\sl-221\slmult0\fi302 \up0 \expndtw0\charscalex119
Noradrenalina. pe calea mecanismului o, adrenergic, este implicats
in\par\pard\li1728\sb0\sl-221\slmult0\fi4 \up0 \expndtw0\charscalex119 reglarea
axului hipotalamo-hipofizo-adrenalian.\par\pard\li1728\sb1\sl-
225\slmult0\fi302\tx7526 \up0 \expndtw0\charscalex119 Dopamina si serotonina au
influenfe stimulatorii\tab \up0 \expndtw0\charscalex119 asupra
axului\par\pard\li1728\sb1\sl-220\slmult0\fi14\tx6979\tx7780 \up0
\expndtw0\charscalex114 hipotalamo-hipofizo-adrenalian; acidul y-
aminobutiric\tab \up0 \expndtw-6\charscalex100 (GABA)\tab \up0
\expndtw0\charscalex119 $i peptidele\par\pard\ql \li1742\sb3\sl-222\slmult0 \up0
\expndtw0\charscalex114 opioide inhibS activitatea axei. \par\pard\ql
\li2040\sb72\sl-230\slmult0 \up0 \expndtw0\charscalex118 3. Efectele psihice $1
somatice ale cortizolului \par\pard\qj \li1747\ri219\sb59\sl-220\slmult0\fi292 \up0
\expndtw0\charscalex125 Pacientii cu tulburari afective, in cursul fazei depresive,
manifests o \up0 \expndtw0\charscalex121 secrefie crescue de cortizoi, apreciats
prin determinarea cortizolului liber \up0 \expndtw0\charscalex121 urinar pe 24 de
ore. Pacientii cu depresie au concentrafii plasmatice
\expndtw0\charscalex124 \ul0\nosupersub\cf3\f4\fs18 PsihosomaticS generala\tab \dn2
crescute de corticosteroizi. concentrafii cu atat mai man cu cSt depresia \up0
\expndtw0\charscalex116 este mai severe (Gibbons). Nivelurile glococorticoizilor
plasmatici revin la \up0 \expndtw0\charscalex117 normal dupe tratamentul
antidepresiv. Existe o corelatie pozitive intre rata \up0 \expndtw0\charscalex113
producerii de cortizoi s> anumite simptome de depresie s* anxietate.
\par\pard\ql \li1353\sb12\sl-230\slmult0\tx2788 \up0 \expndtw0\charscalex115 intr-
un studiu \tab \up0 \expndtw0\charscalex121 (Carpenter si Bunney) s-a constatat o
similaritate intre \par\pard\qj \li1060\ri882\sb0\sl-220\slmult0 \up0
\expndtw0\charscalex130 concentrafule de cortizoi la pacientii cu afectiuni
psihiatrice s1 cae \up0 \expndtw0\charscalex118 observate la cei cu boae
Cushing. \par\pard\qj \li1065\ri885\sb15\sl-226\slmult0\fi288 \up0
\expndtw0\charscalex119 Concentratiile serice de cortizoi sunt crescute la
pacienfii cu depresie. \up0 \expndtw0\charscalex130 existSnd atat cresterea
numaruiui cat s> a amplitudinii episoadelor \up0 \expndtw0\charscalex118
secretorii. Nu se constate un paralelism intre gradul si extinderea cre$terii
\up0 \expndtw0\charscalex110 nivelului de ACTH si variatia observatS in valorile
cortizolului \up0 \expndtw0\charscalex102 (Linkowski). \par\pard\qj
\li1065\ri871\sb0\sl-230\slmult0\fi297 \up0 \expndtw0\charscalex129 Rezultatele
studiilor sugereazS cS la subiectii deprimafi exists o \up0 \expndtw0\charscalex119
crestere a sensibilitafii cortexulul adrenal la ACTH, pacienfii cu depresie \up0
\expndtw0\charscalex113 prezinta un raspuns cortizolic la ACTH superior fata de
subiectii normali din \up0 \expndtw0\charscalex118 lotul de control, in concordats
cu cresterea responsivitSfii adrenocorticale \up0 \expndtw0\charscalex110 la ACTH
in cursul depresiei \par\pard\ql \li1353\sb1\sl-230\slmult0\tx4219 \up0
\expndtw0\charscalex124 in plus, CRH este implicat \tab \up0
\expndtw0\charscalex128 - prin intermediul secrefiei de cortizoi \par\pard\qj
\li1060\ri872\sb0\sl-224\slmult0\fi14\tx2164 \up0 \expndtw0\charscalex122 plasmatic
\tab \up0 \expndtw0\charscalex127 - in scaderea imunitafii in stSrile depresive.
prin afectarea \up0 \expndtw0\charscalex114 celulelor NK. Foarte posibil, CRH se
elibereazS in cursul stresului psihic de \up0 \expndtw0\charscalex116 duratS, iar
cand stresui psihic se mentine intens $i prelungit pe fondul unei \up0
stari depresive, apare initial o crestere a cortizolemiei cu efecte negative
\up0 \expndtw0\charscalex120 asupra imunitafii, corelate cu aparitia unor boli
infecfioase si accelerarea \up0 \expndtw0\charscalex113 dezvolteni tumorale.
\par\pard\qj \li1324\ri1078\sb198\sl-240\slmult0\tx1718 \up0
\expndtw0\charscalex121 Tabelul 1. Efectele cortizolului asupra dfferitelor
fesuturi si organe \line\tab \up0 \expndtw0\charscalex122 (adaptat dupa I B.
lamandescu- 1993. I.G Totoianu- 1992) \par\pard\ql \li3110\sb0\sl-207\slmult0
\ul0\nosupersub\cf3\f4\fs18 Acfiuni metabolice ale cortizolului
Metabolism\tab \up0 \expndtw0\charscalex120 Efecte
fiziologice\par\pard\li1271\sb72\sl-207\slmult0\fi0\tx3715 \dn2
\expndtw0\charscalex120 Ifetabbl isnTprotidic\tab \up0 \expndtw0\charscalex120 -
Reducerea sintezelor proteice\par\pard\ql \li3710\sb1\sl-194\slmult0 \up0
\expndtw0\charscalex114 - Bilanf azotat negativ \par\pard\ql \li3715\sb4\sl-
197\slmult0 \up0 \expndtw0\charscalex114 - Catabolism protidic crescut
Metabolism glucidic\tab \dn2 \expndtw0\charscalex117 Stimularea activitatii
enzimelor implicate in\par\pard\li1348\sb4\sl-207\slmult0\fi2520 \up0
\expndtw0\charscalex117 gluconeogeneza\par\pard\li1348\sb1\sl-
205\slmult0\fi2524\tx7329 \up0 \expndtw0\charscalex116 ScSderea utilizSrii
penterice a glucozei\tab \up0 \expndtw0\charscalex117 (in
fesuiui\par\pard\li1348\sb6\sl-207\slmult0\fi2524 \up0 \expndtw0\charscalex117
muscular, adipos, limfatic)\par\pard\qj \li3859\ri970\sb0\sl-220\slmult0 \up0
\expndtw0\charscalex118 Actiune hiperglicemianta si pnn efectul permisiv \up0
\expndtw0\charscalex119 asupra glicogenolizei hepatice exercitate de
\ul0\nosupersub\cf37\f38\fs18\ul adrenalins si glucagon \par\pard\li1339\sb81\sl-
207\slmult0\fi9\tx3878 \dn2 \expndtw0\charscalex119 \ul0\nosupersub\cf3\f4\fs18
Metabolism lipidic\tab \up0 \expndtw0\charscalex119 Mobilizarea grasimilor din
depozite. cu redis\par\pard\li1339\sb4\sl-207\slmult0\fi2534 \up0
\expndtw0\charscalex119 tnbuirea lor in anumite zone caractenstice
(fata,\par\pard\li1339\sb0\sl-207\slmult0\fi2534 \up0 \expndtw0\charscalex119 ceae,
lose supraclaviculare. trunchi, abdomen)\par\pard\li1339\sb4\sl-
207\slmult0\fi2539 \up0 \expndtw0\charscalex119 Potenfaroa efectelor (in special
efectului lipolitic)\par\pard\li1339\sb4\sl-207\slmult0\fi2534\tx6350 \up0
\expndtw0\charscalex119 glucagonului, adrenahnei\tab \up0 \expndtw0\charscalex119
$i STH-ului asupra\par\pard\li1339\sb1\sl-200\slmult0\fi2539 \up0
\expndtw0\charscalex119 lipidalor (acest elect este contracarat de
insuhna)\par\pard\li1339\sb44\sl-207\slmult0\fi14\tx3873 \up0
\expndtw0\charscalex119 Metabolism hidro-\tab \up0 \expndtw0\charscalex119
Cresterea elimindrii de K si reabsorbfioi do Na la\par\pard\li1339\sb1\sl-
194\slmult0\fi0\tx3883 \up0 \expndtw0\charscalex119 electrolitic\tab \up0
\expndtw0\charscalex119 nivelul tubilor renali\par\pard\qj \li3868\ri994\sb0\sl-
200\slmult0\fi4 \up0 \expndtw0\charscalex120 Cresterea filtram glomerulare. avSnd
un discret \up0 \expndtw0\charscalex114 elect diuretic
Pg88}\par\pard\sect\sectd\sbknone\cols2\colno1\colw3910\colsr40\colno2\colw5210\col
sr160\ql \li1473\sb0\sl-207\slmult0 \par\pard\ql \li1473\sb0\sl-207\slmult0
\par\pard\ql \li1473\sb129\sl-207\slmult0\tx1866 \up0 \expndtw0\charscalex109
\ul0\nosupersub\cf3\f4\fs18 80\tab \up0 \expndtw-8\charscalex84 \u8226?
>\par\pard\ql \li1804\sb0\sl-207\slmult0 \par\pard\ql \li1804\sb0\sl-207\slmult0
\ul0\nosupersub\cf37\f38\fs18\ul Tesut sau organ\par\pard\ql \li1814\sb48\sl-
207\slmult0 \up0 \expndtw0\charscalex122 \ul0\nosupersub\cf3\f4\fs18 Tegumente si
mucoase\par\pard\ql \li1809\sb0\sl-207\slmult0 \par\pard\ql \li1809\sb0\sl-
Tesut conjunctiv\par\pard\ql \li1814\sb0\sl-207\slmult0 \par\pard\ql
\expndtw0\charscalex125 Sistem muscular\par\pard\ql \li1814\sb0\sl-207\slmult0
\up0 \expndtw0\charscalex126 Sistem osteo-articular\par\pard\ql \li1814\sb0\sl-
207\slmult0 \up0 \expndtw0\charscalex124 Aparat respirator\par\pard\ql
2\charscalex100 _\par\pard\ql \li1814\sb0\sl-144\slmult0 \up0
\expndtw0\charscalex123 Aparat cardiovascular\par\pard\ql \li2663\sb258\sl-
552\slmult0 \up0 \expndtw0\charscalex97 \ul0\nosupersub\cf21\f22\fs48 f\par\pard\ql
\ul0\nosupersub\cf3\f4\fs18 Sange\par\pard\ql \li1819\sb0\sl-207\slmult0
\par\pard\ql \li1819\sb0\sl-207\slmult0 \par\pard\ql \li1819\sb193\sl-
207\slmult0 \up0 \expndtw0\charscalex122 Aparat digestiv\par\pard\ql
\expndtw0\charscalex123 Aparat uro-genital\par\pard\ql \li1843\sb0\sl-
Sistem nervos\par\pard\column \ql \li4516\sb0\sl-207\slmult0 \par\pard\ql
aplicata\par\pard\ql \li3950\sb0\sl-207\slmult0 \par\pard\ql \li3950\sb0\sl-
207\slmult0 \up0 \expndtw0\charscalex122 Alte acfiuni ale
cortizolului\par\pard\ql \li250\sb57\sl-207\slmult0 \up0 \expndtw0\charscalex119
\ul0\nosupersub\cf37\f38\fs18\ul Efecte fiziologice\par\pard\ql
\li413\ri2110\sb47\sl-201\slmult0 \up0 \expndtw0\charscalex118
\ul0\nosupersub\cf3\f4\fs18 Cresterea secretiei sudoralo \line \up0
\expndtw0\charscalex116 Diminuarea secrefiei seboreice\par\pard\ql \li413\sb1\sl-
196\slmult0 \up0 \expndtw0\charscalex117 Scdderea sintezei fibrelor
elastice\par\pard\ql \li418\sb1\sl-201\slmult0 \up0 \expndtw0\charscalex109
Scdderea numdrului de celule conjunctive si a fibre\par\pard\ql \li418\sb1\sl-
196\slmult0 \up0 \expndtw0\charscalex115 \ul0\nosupersub\cf37\f38\fs18\ul lor
elastice la nivelul vaselor sanguine din piele\par\pard\qj \li409\ri554\sb70\sl-
194\slmult0\fi9 \up0 \expndtw0\charscalex125 \ul0\nosupersub\cf3\f4\fs18 Excesul de
glucocorticoizi inhiba tibroblastii, \line \up0 \expndtw0\charscalex119 ceea ce
conduce la pierderea de colagen si fesut \up0 \expndtw0\charscalex111
conjunctiv\par\pard\qj \li409\ri1937\sb59\sl-196\slmult0 \up0
\expndtw0\charscalex115 Cresterea catabolismului protidic \up0
\expndtw0\charscalex114 Scaderea utilizSrii glucozei\par\pard\ql \li413\sb1\sl-
196\slmult0 \up0 \expndtw0\charscalex116 \ul0\nosupersub\cf37\f38\fs18\ul Scaderea
sintozei fibrelor colageno\par\pard\qj \li413\ri1379\sb62\sl-192\slmult0 \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf3\f4\fs18 Reducerea sintezei matricei
colagenice \up0 \expndtw0\charscalex115 Stimularea activitatii
osteoclastelor\par\pard\qj \li418\ri550\sb7\sl-196\slmult0 \up0
\expndtw0\charscalex121 Inhibarea osteoblastelor, cu osteolizi si secretie \up0
\expndtw0\charscalex114 unnard croscuta de hidroxiprolind\par\pard\ql
\li423\sb1\sl-196\slmult0 \up0 \expndtw0\charscalex116 Scaderea fixarii Ca'" la
nivel osos\par\pard\qj \li418\ri852\sb63\sl-196\slmult0\fi4 \up0
\expndtw0\charscalex116 Efecte beta-stimulatoare pe bronhii (relaxare) \up0
\expndtw0\charscalex118 Scaderea secrefiei de mucus\par\pard\qj
Jnhi\ul0\nosupersub\cf37\f38\fs18\ul barea migrarii macrofagelor; inhibarea
fagocitozei \line\ul0\tab \up0 \expndtw0\charscalex116 \ul0\nosupersub\cf3\f4\fs18
Cresterea debitului cardiac\par\pard\qj \li413\ri545\sb0\sl-194\slmult0 \up0
\expndtw0\charscalex121 Sensibilizarea peretelui arterial la catecolamine \up0
\expndtw0\charscalex116 (cresterea tonusului vascular periferic)\par\pard\ql
\li418\sb2\sl-196\slmult0 \up0 \expndtw0\charscalex117 Cresterea volemiei (roteniie
de Na' si apa)\par\pard\ql \li423\sb0\sl-196\slmult0 \up0
\expndtw0\charscalex114 \ul0\nosupersub\cf37\f38\fs18\ul Reglarea microcirculafiei
capilare\par\pard\qj \li423\ri1600\sb46\sl-206\slmult0 \up0 \expndtw0\charscalex113
\ul0\nosupersub\cf3\f4\fs18 Stimularea eritropoiezei (policitemie) \up0
\expndtw0\charscalex113 Hipercoagulabilitate\par\pard\qj \li413\ri540\sb0\sl-
194\slmult0\fi9 \up0 \expndtw0\charscalex120 Leucocitozd cu neutrofitie; scaderea
numarului \line \up0 \expndtw0\charscalex115 de bazohle; limfopenie si reducerea
numdrului de \line \up0 \expndtw0\charscalex124 eozinofile prin sechestrare la
nivelul splinei si \line \up0 \expndtw0\charscalex110 plamanilor\par\pard\ql
\li433\sb1\sl-206\slmult0
\up0 \expndtw0\charscalex113 Redistribufia leucocitelor\par\pard\ql \li433\sb1\sl-
201\slmult0 \up0 \expndtw0\charscalex116 \ul0\nosupersub\cf37\f38\fs18\ul Reducerea
migrarii leucocitare si a fagocitozei\par\pard\qj \li418\ri556\sb59\sl-
196\slmult0 \up0 \expndtw0\charscalex125 \ul0\nosupersub\cf3\f4\fs18 Cresterea
secrefiei gastrice de pnpsina si HCI \line \up0 \expndtw0\charscalex114
(favorizarea aparifiei ulcerului gastric)\par\pard\qj \li423\ri540\sb1\sl-
196\slmult0 \up0 \expndtw0\charscalex118 Scdderea absorbfiei digestive a Ca"
(diminuarea \up0 \expndtw0\charscalex114 rezervelor de calciu ale
organismului)\par\pard\ql \li437\sb1\sl-196\slmult0 \up0 \expndtw0\charscalex116
Inhibarea secrefiei de mucus\par\pard\qj \li428\ri555\sb0\sl-196\slmult0 \up0
\expndtw0\charscalex126 La nivel hepatic: producere crescuta de corpi \line \up0
\expndtw0\charscalex110 cetonici\par\pard\qj \li433\ri2057\sb59\sl-196\slmult0 \up0
\expndtw0\charscalex118 Relenfie tubulara de Na' si apa \up0
\expndtw0\charscalex114 Hipertonie arteriolara renalS\par\pard\ql
\li428\ri535\sb6\sl-196\slmult0\fi4 \up0 \expndtw0\charscalex117 Elimmare urinarS
crescuta de Ca" si fosfaii \line \up0 \expndtw0\charscalex120 Rata crescuta a
filtrarii glomerulare \up0 \expndtw0\charscalex120 (datonta \line \up0
\expndtw0\charscalex120 cresterii debitului cardiac sau a unui efect
renal\par\pard\ql \li423\sb1\sl-201\slmult0 \up0 \expndtw0\charscalex111
\ul0\nosupersub\cf37\f38\fs18\ul direct)\par\pard\qj \li428\ri550\sb57\sl-
198\slmult0\fi9 \up0 \expndtw0\charscalex116 \ul0\nosupersub\cf3\f4\fs18 Efoct
excitator; in stres secrefia de hormoni glu� \line \up0 \expndtw0\charscalex122
cocorticoizi este mult crescuta \up0 \expndtw0\charscalex111 (glucocorticoizii
\line \up0 \expndtw0\charscalex116 ioaca un rol important in adaptarea organismului
\line \up0 \expndtw0\charscalex117 la stres)
\ul0\nosupersub\cf3\f4\fs18 Psihosomatica generae\par\pard\ql \li1281\sb0\sl-
Glande endocrine\par\pard\ql \li1286\sb0\sl-207\slmult0 \par\pard\ql
\li1286\sb24\sl-207\slmult0 \up0 \expndtw0\charscalex122 Sistem imun\par\pard\ql
\expndtw0\charscalex132 \ul0\nosupersub\cf9\f10\fs20 3.
Catecolaminele\par\pard\column \ql \li7607\sb0\sl-207\slmult0 \par\pard\ql
\li3796\sb0\sl-211\slmult0 \par\pard\qj \li20\ri1102\sb69\sl-211\slmult0 \up0
\expndtw0\charscalex112 Cresterea consumului de glucoza la nivel neuronal \up0
\expndtw0\charscalex117 Cresterea sintezei neuronale de glutamina\par\pard\qj
\li30\ri1106\sb0\sl-204\slmult0\fi9 \up0 \expndtw0\charscalex118 Modilicarea
concentratiei de serotonina ?i cate� \up0 \expndtw0\charscalex113
colamine\par\pard\qj \li35\ri2685\sb53\sl-201\slmult0 \up0 \expndtw0\charscalex112
Inhibifia hipoialamo-hipofizard \up0 \expndtw0\charscalex112 Inhibifia funcfiei
tiroidiene\par\pard\ql \li44\sb1\sl-201\slmult0 \up0 \expndtw0\charscalex113
Inhibifia luncfiei gonadale\par\pard\qj \li35\ri1082\sb5\sl-201\slmult0\fi4 \up0
\expndtw0\charscalex123 Potontarea electului presor al catecolaminelor \line
\up0 \expndtw0\charscalex117 (menfin reactivitatea normaia a vaselor sanguine
\up0 \expndtw0\charscalex115 la acfiunea catecolaminelor)\par\pard\qj
\li30\ri1087\sb0\sl-220\slmult0\fi4 \up0 \expndtw0\charscalex125 Elect permisiv
in ceea ce priveste actiunea \line \up0 \expndtw0\charscalex115
bronhodilatatoare a adrenalinei �i noradrenalinei \up0 \expndtw0\charscalex114
Scaderea numarului limfocitelor T. prin diminua� \up0 \expndtw0\charscalex116 rea
producerii interleukinei-2\par\pard\qj \li35\ri1081\sb0\sl-200\slmult0 \up0
\expndtw0\charscalex116 Diminuarea volumului ganglionitor hmfatici s> a \up0
\expndtw0\charscalex108 timusului\par\pard\qj \li35\ri1086\sb8\sl-203\slmult0
\up0 \expndtw0\charscalex117 ScSderea sau suprimarea producerii de anticorpi
\up0 \expndtw0\charscalex121 (inhibarea mecanismelor do aparare a organis� \up0
\expndtw0\charscalex110 mului fafa de infecfn'i\par\pard\ql \li44\sb1\sl-
201\slmult0 \up0 \expndtw0\charscalex110 Inhibifia activitatii celulelor NK
\expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 Medulosuprarenalele reprezintS
un traductor neuroendocrin periferic. asa \up0 \expndtw0\charscalex116 cum
hipotalamusul este traductorul neuroendocrin central (de tip neuro-se-\line \up0
\expndtw0\charscalex107 cretor). \par\pard\qj \li969\ri982\sb0\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex113 Medulosuprarenala secree atat hormoni catecolaminici
(adrenalins, nora� \up0 \expndtw0\charscalex111 drenalina. dopammS), cat si hormoni
peptidici opioizi (enkefaline. endorfine), \up0 \expndtw0\charscalex111 acestea din
urmS cu rol neuromodulator local asupra celulelor care Ie secrets. \par\pard\qj
\li974\ri962\sb0\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex117 Adrenalina este
sintetizatS si depozitatS in meduiosuprarenale. de unde \up0
\expndtw0\charscalex120 este eliberate in circuitul sanguin. Noradrenalina provine
din doue surse, \up0 \expndtw0\charscalex114 avand o dube ipostaze funcfionae:
hormon secretat de meduiosuprarenale $i \up0 \expndtw0\charscalex112 mediator
simpatic ehberat in circulafia sanguine. \par\pard\ql \li1315\sb89\sl-
230\slmult0 \up0 \expndtw0\charscalex117 1 Acfiunile fiziologice ale hormonilor
medulosuprarenali \par\pard\qj \li984\ri972\sb62\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex114 ModificSrile fiziologice induse de catecolamine sunt
mediate de recepto-\line \up0 \expndtw0\charscalex114 rii adrenergici.
Interactiunea catecolamine-receptori are loc la nivelul mem-\line \up0
\expndtw0\charscalex112 branei celulare. progreseazS la nivelul celulei �i
determinS rSspunsul celular. \par\pard\ql \li984\ri962\sb0\sl-
240\slmult0\fi287\tx1267 \up0 \expndtw0\charscalex122 RSspunsurile fiziologice au
fost caracterizate drept fi sau a, pe baza \up0 \expndtw0\charscalex113 seriei de
activitate farmacologicS selectivS a agonistilor. \line \tab \up0
\expndtw0\charscalex119 Ambele catecolamine determinS efecte tip alfa; adrenalina
determinS \up0 \expndtw0\charscalex135 efecte de tip beta \up0
\expndtw0\charscalex123 (in general metabolice) mult mai pronunfate decat
\par\pard\ql \li988\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex113 noradrenalina.
\par\pard\ql \li1281\sb130\sl-230\slmult0 \up0 \expndtw0\charscalex117 2. Mecanisme
de reglare a secrefiei de catecolamine \par\pard\qj \li984\ri963\sb165\sl-
213\slmult0\fi297 \up0 \expndtw0\charscalex115 in condifii fiziologice eliberarea
catecolaminelor din meduiosuprarenale \up0 \expndtw0\charscalex115 se face sub
controlul direct si exclusiv al sistemului nervos. Influxul nervos \up0
\expndtw0\charscalex123 este un inductor enzimatic pentru tirozinhidroxilaza,
enzima cheie care \up0 \expndtw0\charscalex123 controieaza rata sintezei
catecolaminelor. \par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart Pg90}
8\charscalex77 <\u8226?\tab \up0 \expndtw0\charscalex104
\ul0\nosupersub\cf9\f10\fs20 Llbmeme de psihosomaticS generala $i
230\slmult0\fi623 \up0 \expndtw0\charscalex116 Tabelul 2 Raspunsurile adrenergice
ate fesuturifor selectate\par\pard\li1814\sb216\sl-230\slmult0\fi9\tx4540\tx6172
\up0 \expndtw0\charscalex116 ORGAN SAU TESUT\tab \up0 \expndtw0\charscalex116
RECEPTOR\tab \up0 \expndtw0\charscalex116
EFECT\par\pard\sect\sectd\sbknone\cols2\colno1\colw5619\colsr160\colno2\colw3381\co
lsr160\ql \li1833\sb68\sl-264\slmult0\tx4871 \up0 \expndtw0\charscalex109 InimS
(miocard)\tab \up0 \expndtw-11\charscalex79 \ul0\nosupersub\cf25\f26\fs28
a,\par\pard\ql \li1828\sb197\sl-264\slmult0\tx4919 \up0 \expndtw0\charscalex107
\ul0\nosupersub\cf9\f10\fs20 Rinichi\tab \up0 \expndtw0\charscalex80
\ul0\nosupersub\cf25\f26\fs28 B\par\pard\ql \li1814\sb80\sl-168\slmult0\tx4900 \up0
\expndtw0\charscalex118 \ul0\nosupersub\cf18\f19\fs20\ul Vase sanguine\ul0\tab \up0
\expndtw-2\charscalex100 \ul0\nosupersub\cf24\f25\fs10 i'\par\pard\ql
\ul0\nosupersub\cf14\f15\fs24 P\par\pard\ql \li1833\sb1\sl-203\slmult0 \up0
\expndtw0\charscalex112 \ul0\nosupersub\cf9\f10\fs20 Intestm\par\pard\ql
\li1819\sb0\sl-230\slmult0 \par\pard\ql \li1828\sb6\sl-230\slmult0\tx4900
\up0 \expndtw0\charscalex120 Pancreas\tab \up0 \expndtw-8\charscalex92
\ul0\nosupersub\cf3\f4\fs18 D\par\pard\ql \li1819\sb0\sl-241\slmult0
Ficat\tab \up0 \expndtw-10\charscalex81 \ul0\nosupersub\cf14\f15\fs24 </,
P\par\pard\ql \li1819\sb28\sl-230\slmult0 \up0 \expndtw0\charscalex116
\ul0\nosupersub\cf9\f10\fs20 Tesut adipos\par\pard\ql \li1819\ri550\sb39\sl-
230\slmult0\fi14\tx4901 \up0 \expndtw0\charscalex114 Majoritatea fesuturilor
\line \up0 \expndtw0\charscalex110 Tegument (glandele apocrine \line \up0
\expndtw0\charscalex120 de pe maini, axie etc) \tab \up0 \expndtw0\charscalex161
\ul0\nosupersub\cf19\f20\fs12 i/\par\pard\ql \li1828\sb34\sl-230\slmult0\tx4809
\up0 \expndtw0\charscalex110 \ul0\nosupersub\cf9\f10\fs20 Bronsiole\tab \up0
\expndtw-9\charscalex94 \ul0\nosupersub\cf8\f9\fs22 "pT\par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 Uter\tab \up0 \expndtw0\charscalex138
\ul0\nosupersub\cf23\f24\fs14 i/\par\pard\ql \li4886\sb81\sl-184\slmult0 \up0
\expndtw0\charscalex106 \ul0\nosupersub\cf13\f14\fs16 P2\par\pard\column \ql
Creste forta de contracfie\par\pard\ql \li20\sb1\sl-190\slmult0 \up0
\expndtw0\charscalex114 \ul0\nosupersub\cf18\f19\fs20\ul Cre$te frecventa
contracfiilor\par\pard\qj \li25\ri625\sb27\sl-259\slmult0\fi9 \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 Eliberare crescute de
renina \up0 \expndtw0\charscalex114 Vasoconstrictie\par\pard\ql \li25\sb19\sl-
230\slmult0 \up0 \expndtw0\charscalex112 Vasodilatafie\par\pard\qj
Motilitate scSzuta\tab \up0 \expndtw-9\charscalex90 Si\tab \up0
\expndtw0\charscalex114 (onus \up0 \expndtw0\charscalex117 sfincterian
crescut\par\pard\qj \li25\ri357\sb36\sl-230\slmult0\fi4 \up0
\expndtw0\charscalex118 Eliberare scazuta de insuima \up0 \expndtw0\charscalex117
Eliberare crescuts de glucagon \up0 \expndtw0\charscalex119 Eliberare crescuts de
insulins \up0 \expndtw0\charscalex115 Eliberare scSzutS de glucagon \up0
\expndtw0\charscalex115 GlicogenolizS crescuts\par\pard\ql \li39\sb34\sl-
230\slmult0 \up0 \expndtw0\charscalex112 LipolizS crescuts\par\pard\ql
\li29\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex114 TermogenezS
crescute\par\pard\qj \li34\ri1528\sb208\sl-259\slmult0 \up0 \expndtw0\charscalex117
Sudorafie crescute \up0 \expndtw0\charscalex108 Dilatafie\par\pard\qj
\li29\ri2329\sb48\sl-201\slmult0 \up0 \expndtw0\charscalex114 Contracfie \line \up0
\expndtw0\charscalex111 Relaxare \par\pard\sect\sectd\sbknone \li1833\sb0\sl-
Tabelul 3. Receptorii adrenerglci $1 efectele exercitirfi
tor\par\pard\sect\sectd\sbknone\cols2\colno1\colw6401\colsr160\colno2\colw2599\cols
r160\ql \li1838\sb221\sl-230\slmult0\tx3335 \up0 \expndtw0\charscalex112
Tipul\tab \up0 \expndtw0\charscalex122 iMecanismul de acfiune\par\pard\ql
\ul0\nosupersub\cf18\f19\fs20\ul prin mesagerul secund\par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 Recepton alfa Ca-2 activeaze fosfodiesteraza
\line \up0 \expndtw-1\charscalex100 Alfa \up0 \expndtw-2\charscalex100 1 \tab
\up0 \expndtw0\charscalex113 care transforma AMPc in AMP\par\pard\ql
\li3398\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex119 Prin proteina Gi este
inhibata\par\pard\qj \li1833\ri469\sb0\sl-218\slmult0\tx3378 \up0
\expndtw0\charscalex108 Alfa 2\tab \up0 \expndtw0\charscalex119 activitatea
adenilciclazei \up0 \expndtw0\charscalex122 Recepton beta \up0
\expndtw0\charscalex118 Sunt cuplafi adenilciclaza\par\pard\qj
\li1848\ri180\sb0\sl-197\slmult0\tx3388\tx3383 \up0 \expndtw0\charscalex108 Beta
1\tab \up0 \expndtw0\charscalex119 prin proteina Gs'- stimulante \line \up0
\expndtw0\charscalex117 Beta 2 \tab \up0 \expndtw0\charscalex115 Determine sinteza
de AMPc\par\pard\column \ql \li34\sb226\sl-230\slmult0 \up0 \expndtw0\charscalex122
Efecte fiziologice\par\pard\ql \li20\ri784\sb207\sl-225\slmult0 \up0
\expndtw0\charscalex117 Vasoconstrictie \up0 \expndtw0\charscalex118 Contracfie
uterine \up0 \expndtw0\charscalex113 Hipertonia\par\pard\ql \li25\sb1\sl-
185\slmult0 \up0 \expndtw0\charscalex116 muschilor netezi\par\pard\qj
\li30\ri381\sb42\sl-201\slmult0 \up0 \expndtw0\charscalex119 Stimuleaze activitatea
\up0 \expndtw0\charscalex112 miocardului\par\pard\ql \li30\sb0\sl-201\slmult0
\up0 \expndtw0\charscalex116 Stimuleaze lipoliza \par\pard\sect\sectd\sbknone
\li1838\sb0\sl-138\slmult0\par\pard\li1838\sb83\sl-138\slmult0\fi4444 \up0
\expndtw0\charscalex108 \ul0\nosupersub\cf19\f20\fs12 MMMJ BM
MM\par\pard\sect\sectd\sbknone \li1838\sb1\sl-209\slmult0\fi1392 \up0
\expndtw0\charscalex122 \ul0\nosupersub\cf9\f10\fs20 Tabelul 4. Reglarea secrefiei
de catecolamine\par\pard\sect\sectd\sbknone \li1838\sb182\sl-
230\slmult0\fi201\tx3628 \up0 \expndtw0\charscalex110 nervos\tab \dn2
\expndtw0\charscalex110 stresui, frigul, emofiile, efortul fizic intensifies
activitatea\par\pard\sect\sectd\sbknone \li1838\sb1\sl-213\slmult0\fi1790 \up0
\expndtw0\charscalex110 tirozinhidroxilazei, deci determinS cresterea
adrenaline!\par\pard\sect\sectd\sbknone \li1838\sb1\sl-204\slmult0\fi1780 \up0
\expndtw0\charscalex104 \ul0\nosupersub\cf18\f19\fs20\ul ?i
noradrenalinei.\par\pard\sect\sectd\sbknone \li1838\sb5\sl-
\u8226? feed-back\tab \up0 \expndtw0\charscalex102 excesul de catecolamine inhibS
activitatea tirozinhidroxilazei,\par\pard\sect\sectd\sbknone \li1838\sb1\sl-
190\slmult0\fi4\tx3628 \up0 \expndtw0\charscalex109 local mtracelular\tab \up0
\expndtw0\charscalex113 deci determina scederea adrenalinei $i
noradrenalinei.\par\pard\sect\sectd\sbknone \li1838\sb22\sl-230\slmult0\fi14\tx3638
\up0 \expndtw0\charscalex113 \u8226? control\tab \up0 \expndtw0\charscalex109 prin
cortizoi, cu rol de stimulare (activeaza PNMT)\par\pard\sect\sectd\sbknone
\li1838\sb1\sl-202\slmult0\fi254\tx3638 \dn0 \expndtw0\charscalex103
\ul0\nosupersub\cf18\f19\fs20\ul umoral\ul0\tab \up0 \expndtw0\charscalex111
\ul0\nosupersub\cf18\f19\fs20\ul pnn prostaglandinele E. cu rol de
stimulare.\par\pard\sect\sectd\sbknone \li1838\sb5\sl-230\slmult0\fi9\tx3513
\up0 \expndtw0\charscalex116 \ul0\nosupersub\cf9\f10\fs20 \u8226? la nivel\tab \up0
\expndtw0\charscalex106 - prin nivelul glicemiei\par\pard\ql \li2020\sb1\sl-
181\slmult0 \up0 \expndtw0\charscalex111 de receptor
\par\pard\ql\li1238\sb150\sl-230\slmult0 \up0 \expndtw0\charscalex115 a) Controlul
neurogen \par\pard\qj \li955\ri1001\sb59\sl-220\slmult0\fi278 \up0
\expndtw0\charscalex119 in stres existe un control nervos cu arcuri reflexe
gigante, catenare, cu \up0 \expndtw0\charscalex118 alerente multiple nervoase si
umorale la o zone centrae catecolaminergice \up0 \expndtw0\charscalex119
rnezencefalo diencefalice in legStura cu sistemul limbic \up0
\expndtw0\charscalex108 ("creierul visce� \par\pard\qj \li955\ri1006\sb0\sl-
230\slmult0 \up0 \expndtw0\charscalex114 ral"). Unele reflexe aie regerii viscerae
se pot inchide direct in trunchiul ce� \up0 \expndtw0\charscalex118 rebral si
mSduva spinarii. Nu toate stresurile realizeaza activarea medulo-\line \up0
\expndtw0\charscalex118 suprarenalel prin reflexe supraspinale. Unii stresori
\up0 \expndtw0\charscalex111 (imobilizarea prelun-\par\pard\qj \li945\ri998\sb0\sl-
220\slmult0 \up0 \expndtw0\charscalex118 gitS) pot actlva sistemul simpato-adrenal
prin arcuri reflexe care se inchid \up0 \expndtw0\charscalex112 la nivelul mSduvei
spinarii (dupd Teodorescu Exarcu, Fiziologia si fiziopato\up0
\expndtw0\charscalex112 logia sistemului endocrin). \par\pard\ql \li1233\sb1\sl-
209\slmult0\tx3244 \up0 \expndtw0\charscalex119 Aifi agenti stresori \tab \up0
\expndtw0\charscalex117 (intervenfule chirurgicale) parcurg obligatoriu cSi
supraspinale, secfionarea maduvei spinSrii impiedicand rSspunsul en� \up0
\expndtw0\charscalex123 docrin la stres. \par\pard\ql \li1248\sb72\sl-
230\slmult0 \up0 \expndtw0\charscalex115 b) Controlul local, intracelular, prin
feedback \par\pard\qj \li955\ri988\sb50\sl-230\slmult0\fi288 \up0
\expndtw0\charscalex118 Catecoiaminele isi autoregleazS producfia pnn mecanism de
feedback \up0 \expndtw0\charscalex117 negativ intre noradrenalina, adrenalina.
dopamina intracelulare si activita� \up0 \expndtw0\charscalex110 tea
tirozinhidroxilazei. \par\pard\ql \li1248\sb70\sl-230\slmult0 \up0
\expndtw0\charscalex114 c) Controlul umoral \par\pard\qj \li955\ri992\sb59\sl-
220\slmult0\fi283 \up0 \expndtw0\charscalex115 in reglarea producerii de adrenaline
intervine cortizolul, activand enzima \up0 \expndtw0\charscalex121 PNMT. Din acest
motiv, hlpofizectomia scade sinteza de adrenalins; in \up0 \expndtw0\charscalex113
absenfa cortizolului. enzima PNMT este degradatS rapid. \par\pard\ql
\li1248\sb92\sl-230\slmult0 \up0 \expndtw0\charscalex115 d) Reglarea la nivel de
receptor! \par\pard\qj \li955\ri992\sb54\sl-226\slmult0\fi297 \up0
\expndtw0\charscalex115 Receptorii adrenergici au un rol major in reglarea
rSspunsurilor fesutun\up0 \expndtw0\charscalex112 lor periferice la actiunea
catecolaminelor. NumSrul de recepton
disponibili si \up0 \expndtw0\charscalex124 afinitatea lor sunt influenfate de
cantitatea de catecolamine, de factorii \up0 \expndtw0\charscalex112 locali fizico-
chimici si hormonali. \par\pard\qj \li960\ri987\sb0\sl-220\slmult0\fi283 \up0
\expndtw0\charscalex123 Conform legii lui Cannon, sensibilitatea unui organ la
catecolamine \up0 \expndtw0\charscalex124 crests dupa denervare. \par\pard\qj
\li960\ri991\sb36\sl-200\slmult0\fi292 \up0 \expndtw0\charscalex114 Modificanle
fiziologice Induse de catecolamine sunt mediate prin recep� \up0
\expndtw0\charscalex114 torii adrenergici existenfi la suprafata celulelor
efectoare\par\pard\sect\sectd\sbknone\cols2\colno1\colw2964\colsr40\colno2\colw6156
\colsr160\ql \li2534\sb72\sl-115\slmult0\tx2711 \up0 \expndtw-4\charscalex75
\ul0\nosupersub\cf24\f25\fs10 '\u8226? \tab \up0 \expndtw-4\charscalex83 * *
-\par\pard\ql \li1823\sb14\sl-192\slmult0 \up0 \expndtw0\charscalex108
\ul0\nosupersub\cf8\f9\fs22 Figura 5. *\par\pard\ql \li2011\sb0\sl-138\slmult0
\ul0\nosupersub\cf19\f20\fs12 Lfmcl cronic\par\pard\ql \li2011\sb0\sl-
tm,Hj)M\par\pard\column \ql \li20\sb72\sl-
115\slmult0\tx630\tx731\tx1134\tx1235\tx1537\tx1619\tx1907\tx2013\tx2310\tx2430\tx2
718\tx3006\tx3121\tx3222 \up0 \expndtw-4\charscalex75 � -\u9632? t 1\tab
\up0 \expndtw-4\charscalex80 >\tab \up0 \expndtw0\charscalex62 - \u9632? \tab
\up0 \expndtw-1\charscalex100 -\tab \up0 \expndtw0\charscalex45
\u9632?\u9632?\u9632? j\tab \up0 \expndtw0\charscalex40 \u9632?\u9632? \tab
\up0 \expndtw-1\charscalex100 \u8226? \tab \up0 \expndtw0\charscalex40
\u9632?\u9632? \tab \up0 \expndtw-4\charscalex76 .:\tab \up0 \expndtw-
1\charscalex100 .,\tab \up0 \expndtw0\charscalex80 <\tab \up0
\expndtw0\charscalex80 K\tab \up0 \expndtw0\charscalex40 <.\tab \up0 \expndtw-
1\charscalex100 1\tab \up0 \expndtw0\charscalex100 ,\u8226? ,\par\pard\ql
\ul0\nosupersub\cf8\f9\fs22 tecolamiiw\par\pard\ql \li2553\sb0\sl-161\slmult0
\ul0\nosupersub\cf23\f24\fs14 aciivitate BiummcA\par\pard\ql \li2553\sb0\sl-
138\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf19\f20\fs12 mc .
1\par\pard\ql \li2553\sb0\sl-114\slmult0 \par\pard\ql \li2553\sb0\sl-114\slmult0
FtOCHOUOClt (Cl I Ut-A CHOUAflMAf \line\tab \up0 \expndtw-1\charscalex100
Imfuilm\par\pard\ql \li1230\sb127\sl-184\slmult0\tx1960 \up0
\expndtw0\charscalex107 \ul0\nosupersub\cf13\f14\fs16 tmozm\tab \up0 \expndtw-
2\charscalex100 ,\par\pard\ql \li1043\sb0\sl-108\slmult0 \up0
HIOHOXIL*ZA\par\pard\sect\sectd\sbknone\cols2\colno1\colw5091\colsr160\colno2\colw3
909\colsr160\qj \li2553\ri1237\sb0\sl-113\slmult0\fi364 \up0 \expndtw-
1\charscalex100 %i+cl*lcj> "" \line \up0 \expndtw0\charscalex103 (invtucjlm
enximmtKm)\par\pard\column \ql \li20\ri2726\sb21\sl-114\slmult0\fi4 \up0
\expndtw0\charscalex101 r-cttVf>l9*rr*airf \line \up0 \expndtw0\charscalex107 ; m
catecofmrtlnmtor \par\pard\sect\sectd\sbknone \ql \li3566\ri3724\sb95\sl-
160\slmult0\tx3902 \up0 \expndtw0\charscalex100 WMTWJA CAT*COi AJdiHt I OR V
\line\tab \up0 \expndtw0\charscalex100 grenulm &m ot^poz/r \par\pard\ql
\li4075\sb59\sl-138\slmult0 \up0 \expndtw0\charscalex105 Cstmeaimtnine \par\pard\ql
\li4247\sb82\sl-138\slmult0 \up0 \expndtw-3\charscalex100 Op4oiOm \par\pard\ql
\ul0\nosupersub\cf7\f8\fs32 7
2\charscalex100 *\tab \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf9\f10\fs20
Elemente de psihosomatica generaid �' aplicata\par\pard\ql \li1896\sb0\sl-
230\slmult0 \up0 \expndtw0\charscalex121 3. Interventia catecolaminelor in stresui
psihic \par\pard\qj \li1603\ri359\sb42\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex116 Catecolaminele detin un rol important in adaptarea
organismului la stres, \up0 \expndtw0\charscalex116 atat din punct de vedere
metabolic, hemodinamic cat ?i psihocomportamental. \par\pard\ql \li3374\sb125\sl-
olrr�i)Mln, \par\pard\ql \li3374\sb1\sl-116\slmult0 \up0 \expndtw0\charscalex127
hfpogllcamlo \par\pard\ql \li3364\sb6\sl-138\slmult0 \up0 \expndtw0\charscalex133
actlvttata
Uric*\par\pard\sect\sectd\sbknone\cols3\colno1\colw4414\colsr160\colno2\colw1501\co
lsr160\colno3\colw2935\colsr160\ql \li3412\sb1\sl-115\slmult0 \up0
\expndtw0\charscalex140 \ul0\nosupersub\cf24\f25\fs10 nan Jr.\par\pard\qj
\expndtw0\charscalex135 \ul0\nosupersub\cf19\f20\fs12 hlpovoomla \line \up0
\expndtw0\charscalex135 hlpotrrmla\par\pard\ql \li2116\sb0\sl-138\slmult0
\up0 \expndtw0\charscalex111 HIPOTALAMUS\par\pard\ql \li2663\sb0\sl-230\slmult0
\ul0\nosupersub\cf9\f10\fs20 0\par\pard\ql \li3249\sb0\sl-138\slmult0
\ul0\nosupersub\cf19\f20\fs12 r,.\par\pard\column \ql \li92\sb1\sl-134\slmult0 \up0
\expndtw0\charscalex122 stres fiztc\par\pard\ql \li20\sb0\sl-129\slmult0 \up0
\expndtw0\charscalex133 ' uu biologic\par\pard\ql \li4694\sb0\sl-184\slmult0
\up0 \expndtw0\charscalex100 \ul0\nosupersub\cf13\f14\fs16 NA ^\par\pard\ql
\ul0\nosupersub\cf19\f20\fs12 actiuna\par\pard\column \ql \li7017\sb0\sl-
\ul0\nosupersub\cf8\f9\fs22 Figura 6.\par\pard\ql \li20\ri364\sb0\sl-
236\slmult0\tx237 \up0 \expndtw0\charscalex112 Rolul catecolaminelor in
\line\tab \up0 \expndtw0\charscalex118 adaptarea la stres si \line \up0
\expndtw0\charscalex113 pregatlrea organismului \line \up0 \expndtw0\charscalex112
pentru activitatea fizica.\par\pard\ql \li68\sb1\sl-238\slmult0 \up0
\expndtw0\charscalex113 Gs a ganglion simpatic;\par\pard\ql \li486\sb19\sl-
230\slmult0 \up0 \expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 A �
adrenalina";\par\pard\sect\sectd\sbknone\cols3\colno1\colw4985\colsr40\colno2\colw1
170\colsr160\colno3\colw2815\colsr160\ql \li4564\sb0\sl-288\slmult0 \up0
\expndtw0\charscalex111 \ul0\nosupersub\cf5\f6\fs36 �\par\pard\ql
\ul0\nosupersub\cf19\f20\fs12 Art, \line\tab \up0 \expndtw0\charscalex106
NA\par\pard\ql \li3643\sb0\sl-138\slmult0 \par\pard\ql \li3643\sb74\sl-
138\slmult0 \up0 \expndtw0\charscalex113 MSR\par\pard\ql \li3235\sb15\sl-
216\slmult0 \up0 \expndtw0\charscalex120 \ul0\nosupersub\cf9\f10\fs20 <\par\pard\ql
\ul0\nosupersub\cf38\f39\fs54 ?\par\pard\qj \li2241\ri1748\sb0\sl-
5IMPATICUL \line\tab \up0 \expndtw0\charscalex109 TORACIC\par\pard\column \ql
\li164\sb1\sl-108\slmult0 \up0 \expndtw0\charscalex126 local*\par\pard\ql
\li20\ri286\sb131\sl-134\slmult0\fi47 \up0 \expndtw0\charscalex150 - 'actluno \line
\up0 \expndtw0\charscalex146 fla dla\\an,a'\par\pard\column \qj
\ul0\nosupersub\cf9\f10\fs20 NA t* noradrenalina, \line\tab \up0
\expndtw0\charscalex121 Ach * acetltcolind:\par\pard\ql \li20\sb1\sl-249\slmult0
\up0 \expndtw0\charscalex110 \ul0\nosupersub\cf8\f9\fs22 Oe � organe
efectoare;\par\pard\ql \li102\sb0\sl-226\slmult0 \up0 \expndtw0\charscalex114
\ul0\nosupersub\cf9\f10\fs20 MRS m medulosupra-\par\pard\ql \li836\sb5\sl-
renafa\par\pard\qj \li145\ri614\sb5\sl-240\slmult0\tx942 \up0
\expndtw0\charscalex106 (dupd Totolanu I.G.-\line \tab \up0 \expndtw-
10\charscalex95 1992) \par\pard\sect\sectd\sbknone \ql \li1612\ri335\sb0\sl-
Adaptarea psihocomportamentaie la stres se realizeaze atat prin \up0
\expndtw0\charscalex117 intermediul sistemului catecolaminergic central, cat si
prin eel periferic \line\tab
\up0 \expndtw0\charscalex123 Catecolaminele intervm in stres prin "ajustarea"
rezistenfei perilerice \up0 \expndtw0\charscalex124 prin vasoconstrictie mediate de
receptorii a si prin vasodietafie mediate \up0 \expndtw0\charscalex119 prin
receptorii p\\ Un factor important pentru aparitia infarctului miocardic \up0
\expndtw0\charscalex121 este reprezentat de spasmul coronarian prelungit, Indus
atat de hipercate-\line \up0 \expndtw0\charscalex124 colammemie, cat s* de deplefia
magnezlului. ambele produse in cursul \up0 \expndtw0\charscalex117 stresului psihic
(exemplul recent al unui caz relatat de ZeanS O, \up0 \expndtw-2\charscalex100
1999). \par\pard\ql \li1622\ri325\sb0\sl-215\slmult0\fi287\tx1915 \up0
\expndtw0\charscalex115 Adaptarea metabolice la stres are rol in menfinerea
constante a glicemiei. \line\tab \up0 \expndtw0\charscalex124 Reactia
catecolaminice din cursul stresului psihic are loc prioritar in \up0
\expndtw0\charscalex119 cursul unor stan de vigilenfa si incordare a atenfiei
(inclusiv starea de start \up0 \expndtw0\charscalex118 on de activitate mentae
intense), ca si in sterile afective explozive, inclusiv \up0
\expndtw0\charscalex122 cele cu valoare de eustress. Diferentele secretorii intre
adrenaline \up0 \expndtw-9\charscalex94 (A) \up0 \expndtw-1\charscalex100 ?i
noradrenaline (NA) apar - in sinteza executate de cetre lamandescu, \tab \up0
\expndtw0\charscalex101 1993 -\par\pard\ql \li1622\sb1\sl-197\slmult0 \up0
\expndtw0\charscalex113 astfel: \par\pard\qj \li1627\ri324\sb10\sl-
213\slmult0\fi292 \up0 \expndtw0\charscalex119 - A - predomina in SP insofit de
anxietate, incertitudine, schimbare, as\up0 \expndtw0\charscalex118 teptare Ea
creste semnificativ in sterile de concentrare a atenfiei in condifii \up0
\expndtw0\charscalex120 perturbatoare ca si in sterile de fricS (producand
hiperventilatie, cresterea \up0 \expndtw0\charscalex120 tensiunii arteriale);
NA - cre$te impreunS cu A, in stSrile de fune exteriorizatS si. singurS, \up0
\expndtw0\charscalex117 in furia interiorizata, dar si in siatuafille care provoace
rSspunsurl agresive, \up0 \expndtw0\charscalex117 in expuneriie prelungite la efort
si la frig. \par\pard\qj \li1636\ri320\sb14\sl-230\slmult0\fi297 \up0
\expndtw0\charscalex136 Sistemul noradrenergic reprezinte un mediator de baze
pentru \up0 \expndtw0\charscalex128 comportamentul deficitar de tipul helplessness
si depresiel, aparut in \up0 \expndtw0\charscalex114 cadrul hipofuncfiei
adrenergice (Janke si Wolfgramm).
\expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs20 Psihosomatica generala\tab
\dn2 \expndtw0\charscalex63 \u8226?>\tab \dn2 \expndtw0\charscalex107
Weiss, citat de Janke si Wolfgramm demonstreazS rolul stresului psihic \up0
\expndtw0\charscalex122 cronic de a reduce disponibilitatea noradrenalinei
(favorizand, deci, de \up0 \expndtw0\charscalex119 presia, care este legate de
aceasta). \par\pard\qj \li1113\ri855\sb0\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex129 Sistemul dopaminergic este decisiv implicat in medierea
stSrilor \up0 \expndtw0\charscalex119 afective pozitive ce apar dupa stres (Willner
si Schell-Kruger -\up0 \expndtw0\charscalex103 1991, cit. \par\pard\ql
\li1104\sb1\sl-193\slmult0 \up0 \expndtw0\charscalex110 de Janke s> Wolfgramm -
1996) \par\pard\ql \li1401\sb97\sl-230\slmult0 \up0 \expndtw0\charscalex117 4.
Implicafii tarmacologice \par\pard\qj \li1104\ri847\sb59\sl-220\slmult0\fi297
\up0 \expndtw0\charscalex120 Beta-blocantele ce pot sS combats excesul de
catecolamine (Antal si \up0 \expndtw0\charscalex120 colab.) pot fi utile chiar
trSgStorilor \up0 \expndtw0\charscalex126 (de tir) deoarece nu scad precizia
(performanta): dispare tremonul datorat catecolaminelor. in studiul
anterior\par\pard\sect\sectd\sbknone\cols2\colno1\colw5776\colsr60\colno2\colw3324\
colsr160\qj \li1113\ri0\sb1\sl-230\slmult0 \up0 \expndtw0\charscalex120 menfionat
s-a utilizat Metoprolol; actualmente \up0 \expndtw0\charscalex118 sunt cu atat mai
eliciente.\par\pard\ql \li1300\sb0\sl-148\slmult0 \par\pard\ql
\li1300\ri976\sb103\sl-148\slmult0\fi191\tx4078 \up0 \expndtw0\charscalex106
\ul0\nosupersub\cf24\f25\fs10 FWfM \line \up0 \expndtw0\charscalex117 CIRCAIVAN
\tab \up0 \expndtw0\charscalex113 \ul0\nosupersub\cf13\f14\fs16
STHES\par\pard\column \ql \li20\sb1\sl-230\slmult0 \up0 \expndtw0\charscalex122
\ul0\nosupersub\cf9\f10\fs20 beta-blocantele selective\par\pard\ql \li1689\sb0\sl-
Figura 7.
Reglarea\par\pard\sect\sectd\sbknone\cols4\colno1\colw2904\colsr110\colno2\colw1285
\colsr40\colno3\colw1463\colsr160\colno4\colw3218\colsr160\qj \li2001\ri466\sb0\sl-
180\slmult0\fi143 \up0 \expndtw-5\charscalex100 *� \line \up0 \expndtw-
9\charscalex87 ;.\par\pard\ql \li1689\sb1\sl-218\slmult0 \up0
\expndtw0\charscalex48 .-\up0 \expndtw-2\charscalex100 -\par\pard\ql
\expndtw0\charscalex104 \ul0\nosupersub\cf24\f25\fs10 MrUKMT\par\pard\ql
\ul0\nosupersub\cf13\f14\fs16 ttturnrohicptin\par\pard\column \ql \li3014\sb0\sl-
230\slmult0 \par\pard\ql \li500\sb197\sl-230\slmult0 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 \u8226?\par\pard\qj
\ul0\nosupersub\cf23\f24\fs14 0 mUMMIC -\line \tab \up0 \expndtw0\charscalex149
\u8226?. uukhki \u9830?\par\pard\ql \li3110\sb0\sl-230\slmult0 \par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 /\par\pard\ql \li293\ri0\sb37\sl-158\slmult0\fi408
\up0 \expndtw0\charscalex152 \ul0\nosupersub\cf19\f20\fs12 �i�o.: \line \up0
\expndtw0\charscalex135 S/ tfr-:of��ici\par\pard\column \ql \li4329\sb0\sl-
2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 �\par\pard\qj \li4329\sb0\sl-
220\slmult0 \par\pard\qj \li20\ri505\sb121\sl-220\slmult0\tx232 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf13\f14\fs16 EXEKCTTJU \line\tab \up0
\expndtw0\charscalex121 FIZIC\par\pard\column \ql \li226\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs20 secrefiei de GH
esta\par\pard\ql \li260\sb0\sl-196\slmult0 \up0 \expndtw0\charscalex100
\ul0\nosupersub\cf8\f9\fs22 legate in special de\par\pard\qj \li20\ri944\sb0\sl-
factorul eliberator de GH \line\tab \up0 \expndtw0\charscalex107 (GRF) si
somatostatina\par\pard\qj \li97\ri1028\sb0\sl-180\slmult0\tx582 \up0
\expndtw0\charscalex112 hipoiafamici Inttuenfe \line\tab \up0
\expndtw0\charscalex107 adrenergice,\par\pard\qj \li346\ri1292\sb0\sl-
180\slmult0\tx438 \up0 \expndtw0\charscalex110 dopaminergice fi \line\tab \up0
\expndtw0\charscalex111 seroteninergice\par\pard\qj \li145\ri1080\sb1\sl-
192\slmult0\tx495 \up0 \expndtw0\charscalex110 exercitate de eittemut \line\tab
\up0 \expndtw0\charscalex110 nervos central\par\pard\ql \li260\sb0\sl-
192\slmult0 \up0 \expndtw0\charscalex109 moduleaza
secretm\par\pard\sect\sectd\sbknone\cols3\colno1\colw2701\colsr20\colno2\colw3061\c
olsr160\colno3\colw3228\colsr160\ql \li1948\sb1\sl-86\slmult0 \up0
\expndtw0\charscalex188 \ul0\nosupersub\cf22\f23\fs8 r ...|.l�ll\par\pard\ql
\expndtw0\charscalex106 \ul0\nosupersub\cf19\f20\fs12 v�.-<-��f-lsi \up0 \expndtw-
2\charscalex100 /\par\pard\column \ql \li308\sb0\sl-216\slmult0 \up0 \expndtw-
1\charscalex100 \ul0\nosupersub\cf14\f15\fs24 s\\\par\pard\ql \li140\sb55\sl-
*m�h|\tab \up0 \expndtw0\charscalex160 |�a*-0\par\pard\ql \li2721\sb0\sl-
138\slmult0 \up0 \expndtw0\charscalex126 HIPQFItAj\par\pard\column \qj
\ul0\nosupersub\cf9\f10\fs20 hipotalamica de GRF ei \line\tab \up0
\expndtw0\charscalex102 SRIF, can deferm'nM\par\pard\ql \li371\sb2\sl-
201\slmult0 \up0 \expndtw0\charscalex106 secrefia de GH in\par\pard\qj
\li20\ri942\sb6\sl-196\slmult0\tx88 \up0 \expndtw0\charscalex110 hlpoftza
anterioart (dupe \line\tab \up0 \expndtw0\charscalex102 Reichlln Si, In
Williams.\par\pard\qj \li145\ri1074\sb0\sl-199\slmult0\fi14 \up0
\expndtw0\charscalex109 R.H. fed.) Texttookof \line \up0 \expndtw0\charscalex104
Endocrinology, 6th ed.\par\pard\qj \li275\ri1189\sb0\sl-195\slmult0\fi52 \up0
\expndtw0\charscalex109 Philadelphia, WP \line \up0 \expndtw-2\charscalex100 Sun
riders Co., 1981) \par\pard\sect\sectd\sbknone \ql \li1401\sb0\sl-230\slmult0
\par\pard\ql\li1401\sb86\sl-230\slmult0 \up0 \expndtw0\charscalex129 4. Hormonal de
crestere (GH) \par\pard\ql \li1406\sb50\sl-230\slmult0\tx5956 \up0
\expndtw0\charscalex124 Secrefia GH este reglats prin interacfiunea \tab \up0
\expndtw0\charscalex116 complexS a influenfelor \par\pard\qj \li1118\ri827\sb15\sl-
225\slmult0\fi9 \up0 \expndtw0\charscalex121 nervoase si endocrine, atat
stimulatoare
cSt ?i inhibitoare. Acest control \up0 \expndtw0\charscalex115 este realizat prin
acfiunea a eel putin doi hormoni: GRF (hormon eliberator \up0
\expndtw0\charscalex116 al GH) \up0 \expndtw0\charscalex122 $i somatostatina,
hormoni sintetizafi si descSrcati din neuronii \up0 \expndtw0\charscalex113
hipotalamici. Existe, in plus, dovezl ca monoaminele, in principal dopamina,
\up0 \expndtw0\charscalex113 noradrenalina \up0 \expndtw0\charscalex120 $i
serotonina acfioneaze prin modularea eliberarii acestor \par\pard\ql
\li1128\sb11\sl-230\slmult0 \up0 \expndtw0\charscalex110 hormoni hipotalamici cu
tropism hipofizar. \par\pard\qj \li1123\ri834\sb0\sl-230\slmult0\fi283 \up0
\expndtw0\charscalex122 GRF stimuleaze atat sinteza cat s' eliberarea GH la nivelul
celulelor \up0 \expndtw0\charscalex116 somatotrope aie hipotize' antenoare, in timp
de somatostatina inhibe num3i \up0 \expndtw0\charscalex116 descercarea de GH de la
acest nivel. \par\pard\qj \li1123\ri844\sb0\sl-233\slmult0\fi287 \up0
\expndtw0\charscalex114 in condifii bazale GH este secretat ritmic, cantitatea de
hormon fiind mai \up0 \expndtw0\charscalex120 mare in primele ore ale nopfii.
Varsta constituie un determinant major al \up0 \expndtw0\charscalex114 secrefiei de
GH: secrefia de GH scade cu inaintarea in varste (Finkelstein si \up0
\expndtw0\charscalex114 colab).
\ul0\nosupersub\cf9\f10\fs20 Elemente de psihosomatica generae �i
aplicatS\par\pard\qj \li1636\sb0\sl-220\slmult0 \par\pard\qj\li1636\sb0\sl-
\expndtw0\charscalex126 Pacienfii cu depresie (uni- sau bipolarS) secrets o
cantitate de GH \up0 \expndtw0\charscalex136 superioara fafa de subiectii
sanatosi \up0 \expndtw0\charscalex106 (Mendlewiez \up0 \expndtw0\charscalex121 $i
colab., \up0 \expndtw-1\charscalex100 1985), \par\pard\qj \li1631\ri291\sb0\sl-
222\slmult0 \up0 \expndtw0\charscalex114 aceastS secrefie avand loc mai mult in
cursul stSrii de veghe decat in timpul \up0 \expndtw0\charscalex116 somnului. S-a
observat o crestere a nivelului secrefiei de aproximativ 6 ori \up0
\expndtw0\charscalex121 in depresia unipolarS si de circa patru ori in cadrul
depresiei bipolare. in \up0 \expndtw0\charscalex116 acest studiu nu a putut fi
constatatS o relafie intre secrefia nocturnS de GH \up0 \expndtw0\charscalex117 Si
depresie. Un studiu anterior (Schilkrut si colab.) a sugerat ca secrefia de \up0
\expndtw0\charscalex121 GH este afectate in cursul nopfii la pacienfii cu depresie,
acesti pacienfi \up0 \expndtw0\charscalex117 avand o secretie nocturne de GH
diminuata (anomalia fiind puse pe seama \up0 \expndtw0\charscalex113 alterarii
structurii somnului \up0 \expndtw0\charscalex112 \u8226? somnul cu unde lente).
Prolactina \par\pard\qj \li1636\ri292\sb202\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex117 in stresui psihic. secrefia de prolactine creste numai in
situafii acute, nu \up0 \expndtw0\charscalex128 Si in cele de acfiune cronica ale
agenfilor stresori. Pe ISnga efectele \up0 \expndtw0\charscalex119 menfionate,
referitoare la comportamentul sexual, amenoree si galactoree \up0
\expndtw0\charscalex118 de stres este menfionat si comportamentul matern de aeptare
care poate fi \up0 \expndtw0\charscalex118 perturbat in stres (lamandescu I.B.).
Principalul factor inhibitor al secretiei de prolactine (PRL) este dopamina \up0
\expndtw0\charscalex123 provenite din neuronii dopaminergici de la nivelul
eminenfei mediane. \up0 \expndtw0\charscalex122 Dopamina mhibe atat sinteza de
prolactine \up0 \expndtw0\charscalex118 (prin inhibarea transcripfiei
\par\pard\ql \li1641\sb29\sl-230\slmult0\tx3283\tx6072 \up0 \expndtw0\charscalex120
ADN-ului) cet \tab \up0 \expndtw0\charscalex128 $i eliberarea prolactinei \tab \up0
\expndtw0\charscalex127 Dopamina actioneaze prin \par\pard\qj \li1636\ri292\sb0\sl-
240\slmult0\fi14 \up0 \expndtw0\charscalex125 intermediul receptorilor specifici.
Compusii care au ca efect blocarea \up0 \expndtw0\charscalex113 receptorilor
dopaminergici (metoclopramid, haloperidol, fenotiazine) sau cei \up0
\expndtw0\charscalex124 care produc deplefia continutului hipotalamic de PRL
\up0 \expndtw0\charscalex114 (alfa-metildopa, \par\pard\ql \li1646\ri282\sb0\sl-
237\slmult0\tx1929\tx1934 \up0 \expndtw0\charscalex116 rezerpine) determine
cresterea secrefiei de PRL. Este in curs de investigare \up0
\expndtw0\charscalex114 $i importanta altor factori hipotalamici in inhibarea
secretiei de PRL. \line \tab \up0 \expndtw0\charscalex134 Serotonina are ca efect
descSrcarea de PRL, blocanfii acesteia \up0 \expndtw0\charscalex115 (metisergin,
ciproheptadinS) putand inhiba aceaste acfiune. \line \tab \up0
\expndtw0\charscalex122 Alfi neurotransmifetori de la nivelul sistemului nervos
central pot fi \up0 \expndtw0\charscalex112 implicafi in modificarea secrefiei PRL:
opioidele endogene, acidul gamaami-\up0 \expndtw0\charscalex110 nobutiric \up0
\expndtw0\charscalex118 (GABA) si analogii sai, antagonistii receptorilor H1,
cimetidina \up0 \expndtw0\charscalex119 (blocant al receptorilor H2), polipeptidul
intestinal vasoactiv \par\pard\qj \li1646\sb0\sl-228\slmult0
Am schifat in capitolul de fafa o punte din datele existente despre \up0
\expndtw0\charscalex113 implicarea principalilor hormoni in reacfia complexe psiho-
neuro-endocrino-\line \up0 \expndtw0\charscalex113 vegetative \up0
\expndtw0\charscalex125 �i imune constituite de insusl stresui psihic Am incercat
se \up0 \expndtw0\charscalex130 legem datele prezentate de circumstantele
psihologlce de aparitie a \up0 \expndtw0\charscalex129 stresului psihic. Despre
ceilalfi hormoni de stres, existand ince date \up0 \expndtw0\charscalex115
contradictorii s* insuficient probate, vom incerca se publicSm intr-un viitor
\up0 \expndtw0\charscalex119 apropiat un capitol sau chiar o monografie avand
coordonate cu mult mai \up0 \expndtw0\charscalex109 ample.
\par\pard\ql\li1286\sb9\sl-207\slmult0 \up0 \expndtw0\charscalex135 Blbliografie
selectiva \par\pard\qj \li998\ri981\sb119\sl-200\slmult0\fi321 \up0
\expndtw0\charscalex117 I J.D. Baxter, LA Frohman Endocrinology and Metabolism.
Third Edition. Ed. \up0 \expndtw0\charscalex109 Philip Feting. \par\pard\ql
\li1276\sb2\sl-198\slmult0 \up0 \expndtw0\charscalex117 2. Coculescu M.
Neuroendocrmologie Clmicd. Ed. Stiinfificd si Enciclopedicd,
Bucuresti.\tab \up0 \expndtw0\charscalex109 1986\par\pard\qj \li1031\ri957\sb5\sl-
200\slmult0\fi249 \up0 \expndtw0\charscalex116 3. Coculescu M Endocrinologie
clinicd \u9632? note de curs, ed. a lll-a, Ed. Medicald. \up0 \expndtw-
5\charscalex100 1996. \par\pard\qj \li998\ri941\sb0\sl-200\slmult0\fi292 \up0
\expndtw0\charscalex115 4. Croes S., Merz P. and Netter P. (1993) Cortisol reaction
in success and failure \up0 \expndtw0\charscalex115 condition in endogenous
depressed patients and controls. Psychoneuroendocrinolo-\par\pard\li998\sb11\sl-
207\slmult0\fi0\tx1334\tx1656 \up0 \expndtw-7\charscalex100 gy.\tab \up0 \expndtw-
8\charscalex94 18.\tab \up0 \expndtw0\charscalex112 100-113.\par\pard\li998\sb1\sl-
200\slmult0\fi288 \up0 \expndtw0\charscalex113 5. De Groot L.Y , Larson PR.,
Hennemann G. The Thyroid and its diseases. Sixth\par\pard\li998\sb1\sl-
207\slmult0\fi9\tx1766 \up0 \expndtw0\charscalex112 Edition\tab \up0
\expndtw0\charscalex113 6. Dumitrac.he C, lonescu B., Ranetti A., Endocrinologie.
Elemente de diagnostic\par\pard\li998\sb1\sl-205\slmult0\fi4\tx3700 \up0
\expndtw0\charscalex112 Si tratament. Editura National,\tab \up0
\expndtw0\charscalex112 1997.\par\pard\qj \li1041\ri932\sb0\sl-200\slmult0\fi263
\up0 \expndtw0\charscalex118 7 Francis S. Greenspan. Basic and Clinical
Endocrinology. Third Edition. Ed.. \up0 \expndtw-8\charscalex95 1991
\par\pard\ql \li1296\sb2\sl-196\slmult0 \up0 \expndtw0\charscalex113 8 Greabu M.,
Paveliu F. Biochimie Medicald. Ed. Infomedica, Bucuresti, 1997. \par\pard\ql
\li1296\sb3\sl-198\slmult0\tx7228 \up0 \expndtw0\charscalex113 9. lamandescu I.B.
Stresui psihic $i bolile interne. Ed-All. Bucuresti, \tab \up0 \expndtw-
\expndtw0\charscalex112 10. lamandescu I.B. Psihologie medicald, Ed. Infomedica,
\tab \up0 \expndtw-5\charscalex100 1995. \par\pard\qj \li1008\ri979\sb0\sl-
220\slmult0\fi321 \up0 \expndtw0\charscalex112 11. Kollermann (Hrsg.). Emotion:
Theory, Research, and Experience. Vol 3( S.37 \up0 \expndtw0\charscalex112 60). San
Diego Academic Press. \par\pard\li1012\sb1\sl-181\slmult0\fi311\tx5822 \up0
\expndtw0\charscalex113 12. Martin J.8. et al Clinical Neuroendocrinology,\tab \up0
\expndtw0\charscalex113 2nd Ed. Philadelphia. FA.,\par\pard\li1012\sb5\sl-
207\slmult0\fi0\tx1656 \up0 \expndtw-2\charscalex100 DAvis.\tab \up0
\expndtw0\charscalex113 1997.\par\pard\li1012\sb1\sl-199\slmult0\fi316
\up0 \expndtw0\charscalex114 13. Milcu M Tratat de endocrinologie dinted, vol. I,
Editura Acadennei Romano.\par\pard\li1012\sb16\sl-207\slmult0\fi0\tx1972 \up0
\expndtw0\charscalex113 Bucuresti.\tab \up0 \expndtw0\charscalex113
Rose R.M. - Psychoendocrinology. Wilson J., Foster D., Ed. Williams
Textbook\par\pard\li1012\sb8\sl-207\slmult0\fi0\tx4583 \up0 \expndtw0\charscalex113
of Endocrinology, Saunder. Philadelphia.\tab \up0 \expndtw0\charscalex113
1985\par\pard\qj \li1012\ri916\sb0\sl-220\slmult0\fi321 \up0
\expndtw0\charscalex122 15. LH. Smith Jr., S.O.Thter. Pathophysiology. The
Biological Principles of \up0 \expndtw0\charscalex116 Disease 2'" Ed. A. H Samiy,
L.H.Smith, J.B. Wyngaarden. (Ed.fl985 \par\pard\ql \li1329\sb0\sl-
162\slmult0\tx7809 \up0 \expndtw0\charscalex116 16. Teodorescu Exarcu \u9632?
Fiziologia si ttziopatologia sistemului endocrm. \tab \up0 \expndtw-5\charscalex100
1989, \par\pard\ql \li1008\sb13\sl-187\slmult0 \up0 \expndtw0\charscalex110 254
350. \par\pard\li1017\sb11\sl-207\slmult0\fi321 \up0 \expndtw0\charscalex116 17.
Totoianu I.G. Introducere in fiziologia clinicd a sistemului endocrin. Ed S
C.\par\pard\li1017\sb4\sl-207\slmult0\fi14\tx4127 \up0 \expndtw0\charscalex108
"Cromatic Tipo" SRL. Tdrgu-Mures,\tab \up0 \expndtw0\charscalex115
Williams Textbook of Endocrinology 8* Ed. J D. Wilson and D W. Foster
(Ed.)\par\pard\li1017\sb1\sl-203\slmult0\fi312 \up0 \expndtw0\charscalex115 19. Von
Eiff A. Stress in der Pathogenese von Funktionsstdrungen
und\par\pard\li1017\sb5\sl-207\slmult0\fi0 \up0 \expndtw0\charscalex115
Erkrankungen. iheraptewoche, 1981, 31. 1, 9-16.\par\pard\li1017\sb13\sl-
207\slmult0\fi283\tx7478\tx7972 \up0 \expndtw0\charscalex115 20. Von Eiff A Zur
Physiologie und Klinik dos Stress. Therapiewsche,\tab \up0 \expndtw-4\charscalex100
1984.\tab \up0 \expndtw0\charscalex115 34.\par\pard\li1017\sb33\sl-
207\slmult0\fi0 \up0 \expndtw0\charscalex115 52, 7192-
7196.\par\pard\li1017\sb29\sl-207\slmult0\fi283\tx3902 \up0 \expndtw0\charscalex111
21. Zeana C. Vi,i\{a Medicald.\tab \up0 \expndtw0\charscalex115 1999, 9,
p.3\par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart Pg96}{\bkmkend
\up0 \expndtw0\charscalex120 \ul0\nosupersub\cf8\f9\fs22 Capitolul 7
\up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf14\f15\fs24 PRINCIMI $1 MODALITATI
DE ABORDARE PSIHOSOMATICA \par\pard\ql \li1703\sb0\sl-276\slmult0
\par\pard\ql\li1703\sb128\sl-276\slmult0 \up0 \expndtw-2\charscalex100 A. CONCEPTUL
DE ABORDARE PSIHOSOMATICA \par\pard\ql \li1723\sb0\sl-230\slmult0
\ul0\nosupersub\cf9\f10\fs20 loan Bradu lamandescu \par\pard\ql \li1286\sb0\sl-
230\slmult0 \up0 \expndtw0\charscalex137 1. Consideratii generale \par\pard\qj
\li974\ri953\sb186\sl-260\slmult0\fi278 \up0 \expndtw0\charscalex116 Abordarea
psihosomatice (APS) a bolnavului de cStre medic presupune, \up0
\expndtw0\charscalex117 din start, o viziune integrativS (holisticS) asupra actului
medical, considerat \par\pard\qj \li974\ri949\sb0\sl-260\slmult0 \up0
\expndtw0\charscalex118 - potrivit concepfiei psihosomatice-dintr-o dubIS
perspectivS: cea medicae \up0 \expndtw0\charscalex114 propnu-zisS \up0
\expndtw0\charscalex120 $i cea psihologicS \up0 \expndtw0\charscalex118 (specifics
oricSrei relafH interpersonale) \par\pard\qj \li964\ri939\sb0\sl-253\slmult0
\up0 \expndtw0\charscalex120 AceastS abordare globae a bolnavului presupune doi-S
obiective, conform \up0 \expndtw0\charscalex118 opiniei lui van Es: centra ea
demersurilor medicului pe pacient (pornind de \up0 \expndtw0\charscalex116 la
precizarea, impreunS cu acesta, a obiectului cererii sale) s> stabilirea, im\up0
\expndtw0\charscalex116 preunS cu pacientul, a planului terapeutic. \par\pard\qj
\li979\ri948\sb0\sl-248\slmult0\fi288 \up0 \expndtw0\charscalex123 APS consta in
esenfS, din Introducerea Tn cadrul examenului clinic, \up0 \expndtw0\charscalex126
in special la nivelul anamnezei, a unor elemente de t.vostigane asupra \up0
\expndtw0\charscalex122 rolulul factorilor psihici in dinamica bolii (alaturi de
ceilalfi agenfi etio� \up0 \expndtw0\charscalex130 logici) dar si dintr-o
considerate atents a elementelor psihologice ale \up0 \expndtw0\charscalex121
dialogului cu bolnavul, unele dintre ele constituind veritabile premise sau \up0
\expndtw0\charscalex118 chiar modalitsti de debut ale psihoterapiei de
sustinere. \par\pard\ql \li1281\sb1\sl-187\slmult0 \up0 \expndtw0\charscalex114
DacS intr-o relafie de tip client-mecanic de masinS, elementele psihologi�
\par\pard\qj \li984\ri943\sb21\sl-250\slmult0 \up0 \expndtw0\charscalex118 ce
nSscute inerent in cursul comunicSrii dintre cei doi, nu au cum sS se re-\line \up0
\expndtw0\charscalex119 percuteze in nici un fel asupra defecflunilor masinii (eel
mult, sub aspectul \up0 \expndtw0\charscalex116 seriozitafii cu care mecanicul va
electua reparatia) - in cadrul relafiei medic-\line \up0 \expndtw0\charscalex118
pacient elementele psihologice pot Influenta covar$itor reacfia organismu� \up0
\expndtw0\charscalex120 lui, inclusiv rSspunsul terapeutic. in plus, abordarea
psihosomaticS \up0 \expndtw0\charscalex101 (APS) \par\pard\qj \li984\ri938\sb0\sl-
246\slmult0\fi4 \up0 \expndtw0\charscalex119 presupune, in primul rand, o adevarata
"prejudecatS" din partea medicului \up0 \expndtw0\charscalex116 de a cauta. in
contextul plurifactorial al principaielor boli ale epocii contem\up0
\expndtw0\charscalex118 porane, participarea complexe (factor predispozant sau
trigger) a stimulilor \up0 \expndtw0\charscalex118 psihici, eel mai adesea sub
forma stresului psihic. \par\pard\qj \li984\ri930\sb0\sl-250\slmult0\fi302 \up0
\expndtw0\charscalex117 Desi nu este atat de utle ca in cadrul bolnavilor
psihosomatici si mai ales \up0 \expndtw0\charscalex118 psihosomatici, abordarea
psihosomaticS de cStre medicii psihiatri este mai \up0 \expndtw0\charscalex118
frecvent TntSlnitS datorits pregStirii s' practicil acestora in direcfia unei
\expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs20 90 v\tab \up0
\expndtw0\charscalex106 Elemente de pbihosomt'ticS generae si
aplicata\par\pard\qj \li1608\sb0\sl-240\slmult0 \par\pard\qj\li1608\ri319\sb47\sl-
240\slmult0 \up0 \expndtw0\charscalex116 abordSri psihologice a bolnavilor psihici
pe care ii au in sarcinS profesiona\up0 \expndtw0\charscalex114 IS. in schimb,
tulburarile psihosomatice ale acestor bolnavi pot ridica proble� \up0
\expndtw0\charscalex121 ma unui substrat lezional, cSnd ele nu apar coerent legate
si justificate de \up0 \expndtw0\charscalex121 simptomele psihice care dominS scena
clinicS. \par\pard\qj \li1608\ri325\sb0\sl-244\slmult0\fi297 \up0
\expndtw0\charscalex120 Pentru medicii somaticieni, nepsihiatri. APS constituie
adesea un ele� \up0 \expndtw0\charscalex120 ment acceptat formal si utilizat intr-
un mod accidental sau cu totul insufi\up0 \expndtw0\charscalex117 cient. fapt ce
"se rSzbunS" ulterior sub forma unui diagnostic incomplet (cu \up0
\expndtw0\charscalex120 omiterea trigger-ului' psihogen) dar mai ales a unei
rezistenfe terapeutice. \up0 \expndtw0\charscalex122 chiar atunci cSnd s-au
prescris medicamente adecvate simptomatologiei \up0 \expndtw0\charscalex116
prezentate de bolnav. \par\pard\qj \li1612\ri320\sb17\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex122 Un lucru este sigur, APS trebuie sa devinS un modus
operand), intrat \up0 \expndtw0\charscalex127 in constimfa profesionale a oricarui
medic, atat din rafiuni pragmatice \up0 \expndtw0\charscalex126 (optimizarea
actului medical) cat si din respect pentru omul bolnav al \up0
\expndtw0\charscalex129 carui contort psihic trebuie asigurat prin toate mijloacele
posibile dar \up0 \expndtw0\charscalex129 Si accesibile medicului care il
ingrijeste. \par\pard\qj \li1622\ri310\sb0\sl-250\slmult0\fi287 \up0
\expndtw0\charscalex123 in cele ce urmeazS vom incerca se prezenem o linie generae
a APS a \up0 \expndtw0\charscalex120 bolnavilor somatici, valable in special pentru
bolnavii cronici. deoarece in \up0 \expndtw0\charscalex117 bolile acute APS remSne
doar un cadru general, limitat la primele segmente \up0 \expndtw0\charscalex119
(evaluare psihologica rapidS-"tehnica flash" de care vorbesc Luban Plozza \up0
\expndtw0\charscalex109 Si colab. \up0 \expndtw-3\charscalex100 1996). \par\pard\qj
\li1617\ri305\sb0\sl-242\slmult0\fi302 \up0 \expndtw0\charscalex123 in urgenfele
medicale si chirurgicale APS se rezumS doar la un anu-\line \up0
\expndtw0\charscalex125 me tip de atitudine din partea medicului. eel mai adesea
legata de sigu-\line \up0 \expndtw0\charscalex122 ranfa profesionalS si optimism,
cu o tenta de compasiune "reglata" con� \up0 \expndtw0\charscalex127 form
severitafii simptomelor si cerinfelor extreme de ajutor din partea \up0
\expndtw0\charscalex120 bolnavului. Pe mSsurS ce boala regreseazS, totusi
problemele psihologice \up0 \expndtw0\charscalex119 ale bolnavului se inmulfesc-
legate de perspectivele vindecSrii sau cronici \up0 \expndtw0\charscalex117 zSrii
dar mai ales de acele mai vechi confllcte sau frustrSri, care, o datS de-\line \up0
\expndtw0\charscalex115 pasita pnmejdia reprezentatS de boalS, revin cu
brutalitate in constimfa bol� \up0 \expndtw0\charscalex109 navului. \par\pard\qj
\li1631\ri306\sb0\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex129 Acestea, doar
cateva modalitSfi de prezentare a bolnavului in fata \up0 \expndtw0\charscalex115
medicului - la care se adaugS si diferenfele dintre locul si momentul indepli-\line
\up0 \expndtw0\charscalex115 nirii actului medical \up0 \expndtw0\charscalex115 (la
domiciliu bolnavului, la locul accidentului, in spital \par\pard\qj
\li1622\ri301\sb9\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex122 salon sau camera
de gardS) sau in cabinetul medicului - justifies intenfia \up0
\expndtw0\charscalex114 noastrS de a prezenta un set de minime conduite de APS ale
medicului in ca� \up0 \expndtw0\charscalex115 drul efectuSrii actului medical, ele
putand constitui doar un model, cu varia� \up0 \expndtw0\charscalex126 ble aphcafii
si mai ales completsh. potrivit ecuatiei sale terapeutice \up0 \expndtw-
8\charscalex100 $i \par\pard\ql \li1627\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex114 condifiilor concrete in care are loc dialogul cu
bolnavul. \par\pard\qj \li1631\ri296\sb19\sl-244\slmult0\fi288 \up0
\expndtw0\charscalex119 in contmuarea capitolului vor fi detaliate elemente
speclfice anamnezei \up0 \expndtw0\charscalex115 bolnavilor adulfi sau copiilor ca
$i o serie de elemente - distincte de alte spe\up0 \expndtw0\charscalex114
cialita.fi medicale - ale comunicSrii dintre medicul de familie $l pacienfii
sSi, \up0 \expndtw0\charscalex116 aflafi intr-un grup cu caractoristici inrudite,
nu numai genetic ci si din punct \up0 \expndtw0\charscalex119 de vedere al
relafiilor de comunicare, adesea insS-distorsionate sau orien� \up0
\expndtw0\charscalex119 tate spre veritabile conflicte. \par\pard\ql
\li1948\sb108\sl-230\slmult0 \up0 \expndtw0\charscalex133 2. Elemente de baza ale
APS \par\pard\ql \li1943\sb90\sl-230\slmult0\tx8121 \up0 \expndtw0\charscalex122 O
punere la punct asupra APS a bolnavilor a fost realizata in \tab \up0
\expndtw0\charscalex111 1996 de \par\pard\ql \li1651\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex120 cStre Luban Plozza, Laederach-Hofmann, Knaak si Dickhaut,
in lucrarea \par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart Pg98}
\ul0\nosupersub\cf9\f10\fs20 "Der Artz als Arznei" ("Medicul ca medicament"), ca si
in noua versiune a \up0 \expndtw0\charscalex113 Medicinii Psihosociale realizats de
Buddeberg $i Willi in \up0 \expndtw0\charscalex112 1998. incercand o
reorganizare si o schematizare a datelor expuse in aceste lucrari, filtrate \up0
\expndtw0\charscalex122 prin experienfa personals, ca si prin datele altor autori
psihosomaticieni \up0 \expndtw0\charscalex114 (Stocksmeier, Petzold, etc.), am
conceput urmStoarea strategie de APS apli\up0 \expndtw0\charscalex113 cabie tuturor
bolnavilor examinafi dar valabie in special pentru bolnavii cro� \up0
\expndtw0\charscalex117 nici cu afectiuni patologice psihosomatice ca si pentru
pacienfii cu proble\up0 \expndtw0\charscalex122 me de ordin psihologie care se
considers bolnavi $i asteaptS vindecarea \up0 \expndtw0\charscalex113 unor
tulburSri somatice "sine materia". \par\pard\qj \li945\ri958\sb109\sl-
253\slmult0\fi297 \up0 \expndtw0\charscalex118 a) Evaluarea psihologica a
bolnavului "la prime vedere" (prima impre\up0 \expndtw0\charscalex116 sie) -
reprezintS desigur, un atribut cu valoare maxims pentru un medic so� \up0
\expndtw0\charscalex118 matician expenmentat. cu calitSfi relational deosebite,
amplificate printr-o \up0 \expndtw0\charscalex115 culturS psihologicS sau eel putin
psihiatricS. deosebits. \par\pard\ql \li1238\sb6\sl-230\slmult0 \up0
\expndtw0\charscalex115 Se au in vedere: \par\pard\qj \li1248\ri967\sb22\sl-
240\slmult0\tx1459 \up0 \expndtw0\charscalex121 \u8226? stabilirea contactului
vizual cu bolnavul, Inclusiv considerarea lim� \line\tab \up0
\expndtw0\charscalex111 bajului. mimicS, gesturi, inflexiunile vocii \up0
\expndtw0\charscalex113 (comunicarea non verbals). \par\pard\qj
\li1248\ri958\sb20\sl-240\slmult0\tx1454 \up0 \expndtw0\charscalex117 \u8226?
faptul cS este marcat sau nu la exterior de boalS (dispnee, infepenit de
\line\tab \up0 \expndtw0\charscalex117 durere, etc.) \par\pard\qj
\li1243\ri967\sb20\sl-240\slmult0\tx1459 \up0 \expndtw0\charscalex120 e evaluarea
stSrii emotionale a acestuia ("blocat" sau euforic dar mas-\line\tab \up0
\expndtw0\charscalex116 cand anxietatea. teatral. agresiv. disimulant, etc.)
\expndtw0\charscalex119 e trSsSturile dominante de personalitate obiectivate in
comportament: \line\tab \up0 \expndtw0\charscalex113 anxio$ii, timizii, impulsivii,
agresivii, flegmaticii, depresivii-acestia pot \line\tab \up0
\expndtw0\charscalex113 avea un sindrom depresiv pasager, introvertifii, etc.
\par\pard\ql \li1248\sb29\sl-230\slmult0\tx5971 \up0 \expndtw0\charscalex123 Pentru
medic au o mare importanfS eel putin \tab \up0 \expndtw0\charscalex121 5 categorii
de bolnavi \par\pard\ql \li955\sb30\sl-230\slmult0\tx3263 \up0
\expndtw0\charscalex112 (Luban Plozza $l colab \tab \up0 \expndtw0\charscalex111
1996): dependenfii, inhibafii (timizii), agresivii, apa-\par\pard\qj
\li950\ri958\sb22\sl-240\slmult0\tx1368 \up0 \expndtw0\charscalex101 ticii \tab
\up0 \expndtw0\charscalex117 $i psihastenicii (hiperscrupulosO Pentru liecare din
aceste categorii se \up0 \expndtw0\charscalex115 poate adopta un anume tip de
comportamenl "de Intampinare" $i de relafio\up0 \expndtw0\charscalex112 nare
ulterioarS. \par\pard\ql \li1243\sb29\sl-230\slmult0\tx7487 \up0
\expndtw0\charscalex124 e modul de prezentare a simptomelor, impregnat de emofie
\tab \up0 \expndtw0\charscalex120 (de ex. \par\pard\qj \li945\ri973\sb0\sl-
260\slmult0 \up0 \expndtw0\charscalex118 teatral. dramatizant la isterici sau,
abStut, descurajat la depresivi) si even� \up0 \expndtw0\charscalex115 tual
disproporfionat fafa de severitatea tulburSril (la nevrotici in general).
\expndtw0\charscalex119 b) Evaluarea caracterului functional sau organic al
acuzelor \line\tab \up0 \expndtw0\charscalex117 bolnavului \par\pard\qj
\li950\ri947\sb170\sl-248\slmult0\fi283 \up0 \expndtw0\charscalex119 Chiar daca
adesea, se poate face la prima vedere, aceaste evaluare im\up0
\expndtw0\charscalex114 piica responsabilitatea unui act medical complet efectuat
(ex.obiectiv, inves\up0 \expndtw0\charscalex121 tigafii) la cea mai mice indoiae
asupra naturii functionale a simptomelor \up0 \expndtw0\charscalex106 bolnavului
\up0 \expndtw0\charscalex115 (v. cazul unor boli grave al cSror stres secundar
genereazS sim� \up0 \expndtw0\charscalex116 ptome functionale ce mascheazs
severitatea si. mai ales, perspectivele evo� \up0 \expndtw0\charscalex113 lutive
ale acestor boli). \par\pard\ql \li1243\sb27\sl-230\slmult0 \up0
\expndtw0\charscalex120 Natura tulburarilor functionale se poate sistematiza
astfel: \par\pard\qj \li945\ri963\sb0\sl-253\slmult0\fi292 \up0
\expndtw0\charscalex124 \u9633? TulburSri functionale apSrute in cadrul unui stres
psihic acut sau \up0 \expndtw0\charscalex111 cronic \up0 \expndtw0\charscalex121
(acesta din urmS acompaniat de excese-fumat, alcool, cafea, \up0
\expndtw0\charscalex119 medicamente tranchilizante sau antialgice - ce pot, prin
ele insele, induce \up0 \expndtw0\charscalex110 tulburSri functionale.
230\slmult0\fi297 \up0 \expndtw0\charscalex116 \u9633? TulburSri functionale
somato-psihice (deci tulburSri psihice de cauzS \up0 \expndtw0\charscalex116
somaticS) secundare unei boli ale cSrei acuze subiective sau obiective sunt \up0
\expndtw0\charscalex111 ignorate \up0 \expndtw0\charscalex120 (ex apneea pasagere
nocturne la bolnavii cu rinita \up0 \expndtw0\charscalex120 $i urmate in
\par\pard\ql \li1593\sb10\sl-230\slmult0\tx4406 \up0 \expndtw0\charscalex122 cursul
zilei de somnolente \tab \up0 \expndtw0\charscalex128 ?i tulburari de concentrare a
atenfiei si de \par\pard\qj \li1603\ri330\sb22\sl-240\slmult0\tx1891 \up0
\expndtw0\charscalex116 memone, prezentate de bolnav ca acuze de baze ale
consultafiei solicitate) \line\tab \up0 \expndtw0\charscalex121 (J TulburSri
functionale coexistand cu tulburSri organice ale bolii de \up0
\expndtw0\charscalex124 bazS si apSrute datorits stresului psihic secundar, produs
de acesta din \up0 \expndtw0\charscalex112 urma (de ex. in cadrul aparifiei si
constientlzSril de cStre bolnav a unei HTA) \par\pard\ql \li1896\sb169\sl-
230\slmult0 \up0 \expndtw0\charscalex118 c) Analiza sistematizata a psihologiel
bolnavului \par\pard\qj \li1598\ri325\sb182\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex115 Cunoasterea situatiei socio-familiale a bolnavului ca $i a
aspirafiilor sale \up0 \expndtw0\charscalex117 intime (atentie la nevoile sale
psihologice de "prims urgenfS" si pe termen \up0 \expndtw0\charscalex103 lung.
\par\pard\ql \li1943\sb229\sl-230\slmult0
\up0 \expndtw0\charscalex117 Tabel 1 Abordarea bolnavului prin prisma concepfiei
psihosomatice \par\pard\ql \li1929\sb0\sl-230\slmult0 \par\pard\ql\li1929\sb100\sl-
230\slmult0 \up0 \expndtw0\charscalex122 1. Conduita de intamplare anti stres
\par\pard\ql \li1920\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 - climat
relaxare (ineturarea factorilor perturbatori) \par\pard\ql \li1924\sb10\sl-
230\slmult0\tx2980 \up0 \expndtw0\charscalex113 - asigurari \tab \up0
\expndtw0\charscalex112 (incurajSri): verbale, non-verbale \par\pard\ql
\li1920\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 - anamneze libere,
ulterior centrate pe simptome relevante \par\pard\ql \li1915\sb10\sl-230\slmult0
\up0 \expndtw0\charscalex125 2. Este un pacient stresat? \par\pard\qj
\li1910\ri595\sb2\sl-240\slmult0\fi249 \up0 \expndtw0\charscalex114 - acut -
stresui reprezinte chiar cauza consultafiei (consult \u8222?la cald", \up0
\expndtw0\charscalex114 centrat pe linistirea pacientului) \par\pard\qj
\li1910\ri584\sb0\sl-240\slmult0\fi240 \up0 \expndtw0\charscalex114 - cronic -
simptomele acuzate sunt expresia unui stres psihic cronic \up0
\expndtw0\charscalex115 (consult obisnuit. consult \u8222?la rece") \par\pard\ql
\li1905\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex121 3. Evaluarea psihologica a
bolnavului \par\pard\ql \li2136\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex119 A.
Nivel intelectual si statut socio-economic** \par\pard\qj \li1910\ri600\sb2\sl-
240\slmult0\fi230 \up0 \expndtw0\charscalex122 B. Trasaturi de personalitate
afective dommante": labil. anxios, \up0 \expndtw0\charscalex114
depresiv/hipomaniacal, optimist-pesimist \par\pard\ql \li2145\sb9\sl-230\slmult0
\up0 \expndtw0\charscalex118 C. Comportament/atitudini* \par\pard\li2687\sb34\sl-
230\slmult0\fi0\tx5702\tx7022 \up0 \expndtw0\charscalex120 a) Fafe de doctor:
cooperant\tab \up0 \expndtw0\charscalex120 + permeabil\tab \up0
\expndtw0\charscalex120 (la argumentele\par\pard\li2687\sb10\sl-
230\slmult0\fi259 \up0 \expndtw0\charscalex120 medicului)\par\pard\ql
\li2687\sb6\sl-230\slmult0 \up0 \expndtw0\charscalex114 b) Fate de profesie: tip A
sau B \par\pard\qj \li1924\ri609\sb2\sl-240\slmult0\fi763 \up0
\expndtw0\charscalex113 c) Tip relational: rigid/flexibll, obsesional, histrionic,
schizoid \up0 \expndtw0\charscalex114 *A, B, C = pe parcursul anamnezei
\par\pard\ql \li2145\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex118 D. Schifa
biografica + viata mtima" ' \par\pard\ql \li1929\sb1\sl-217\slmult0 \up0
\expndtw0\charscalex111 1. comportament/atitudini: \par\pard\ql \li1915\sb33\sl-
230\slmult0 \up0 \expndtw0\charscalex117 - copierie: fericits, obisnuita. traume
marcante \par\pard\ql \li1920\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 -
evenimente majore (\u8222?life changes") \par\pard\ql \li1920\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex112 - esecuri in viafa intimS (sentimentalS,
sexualS) \par\pard\ql \li1924\sb10\sl-230\slmult0\tx2932 \up0
\expndtw0\charscalex107 - internSri \tab \up0 \expndtw0\charscalex113 (consulturi)
pentru boli psihice \par\pard\li1920\sb28\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex118 2. Nivel de aspirafii si de posibilitSti (+ raportul intre
ele)\par\pard\li1920\sb5\sl-230\slmult0\fi0\tx4622\tx6830\tx7737 \up0
\expndtw0\charscalex118 3. Sunt satisfScute cele\tab \up0 \expndtw0\charscalex118
3 nevoi psihologice\tab \up0 \expndtw0\charscalex118 (Linton)\tab \up0
\expndtw0\charscalex118 (afiliere,\par\pard\li1920\sb10\sl-230\slmult0\fi9 \up0
\expndtw0\charscalex118 securitate pe termen lung,
noutate)?\par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart Pg100}
\ul0\nosupersub\cf9\f10\fs20 4. DominS motivele biologice sau sociale? \par\pard\ql
\li1401\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 5. Viata sexualS (inclusiv
calitatea ei). \par\pard\qj \li1406\ri1118\sb2\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex121 E. Factori de rise psihocomportamentali**:
fumat, alcool, \up0 \expndtw0\charscalex115 sedentarism, supraalimentafie,
drogurl \par\pard\ql \li1411\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex111 **D+E
= la starsitul anamnezei \par\pard\ql \li1401\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex121 4. Context existenfial stresant \par\pard\qj
\li1406\ri1088\sb2\sl-240\slmult0\fi14\tx1660 \up0 \expndtw-9\charscalex90 1.
\tab \up0 \expndtw0\charscalex117 Actual: relevat direct de pacient sau desprins
din reculul inserfiei \up0 \expndtw0\charscalex112 familiale s< profesionale
stabilitate. conflicte \par\pard\ql \li1401\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex119 2 Antecedente (in ultimele 6 luni) sau momente relevante
legate de \par\pard\ql \li1401\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex104
imbolnSvirl \par\pard\qj \li1396\ri1166\sb2\sl-240\slmult0 \up0
\expndtw0\charscalex120 3. lerarhizarea intervenfiei factorului psihic in
declan$area mam \up0 \expndtw0\charscalex115 festanior clinice subiective si
obiective: \par\pard\ql \li1411\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex114 -
exclusive: - aparente (locus minoris resistentiae) \u9632? forme
psihogene-\par\pard\ql \li2515\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 -
frecvenfa in antecedente? \par\pard\ql \li1406\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex112 - alternativ cu ceilalfi factori specific! bolii
\par\pard\ql \li1401\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 - sumativ
(eel mai des). \par\pard\qj \li1396\ri1104\sb2\sl-240\slmult0 \up0
\expndtw0\charscalex123 4 Ponderea participarii stresului psihic: minime,
moderate, \up0 \expndtw0\charscalex110 importante. \par\pard\ql \li1406\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex124 5 Rolul psihoterapiei + apelul la psiholog
\par\pard\ql \li1636\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex112 - pentru
problemele psihologice ale bolnavului \par\pard\ql \li1636\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex118 - pentru modificarea comportamentelor subiective, nocive
pentru \par\pard\ql \li1766\sb6\sl-236\slmult0 \up0 \expndtw0\charscalex101
\ul0\nosupersub\cf8\f9\fs22 san&tate \par\pard\ql \li1636\sb9\sl-230\slmult0
\up0 \expndtw0\charscalex116 \ul0\nosupersub\cf9\f10\fs20 - programe antistres
\par\pard\ql \li1641\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 - terapii de
relaxare \par\pard\ql \li1387\sb0\sl-250\slmult0
\expndtw0\charscalex118 d) Reiafionarea simptomatologiei (sau a unei parti din
simptome) cu \line\tab \up0 \expndtw0\charscalex120 stresui psihic si lerarhizarea
intervenfiei acestuia in contextul \line\tab \up0 \expndtw0\charscalex121
pturietiologic al bolii \par\pard\qj \li1084\ri838\sb179\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex122 in legeture cu aparitia unor simptome ale BPS datorita
stresului psi� \up0 \expndtw0\charscalex116 hic s-au prezentat criteriile de
stabilire a etiologiei psihice (vezi lamandes� \up0 \expndtw0\charscalex107 cu
1993) \par\pard\qj \li1089\ri824\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex119 Referitor la tulburarile functionale "sine materia" se pot
avea in vedere \up0 \expndtw0\charscalex116 urmetoarele criterii de stabilire a
etiologiei psihice a unor simptome (modi\up0 \expndtw0\charscalex111 licat dupe
Luban Plozza si colab. 1996): \par\pard\qj \li1084\ri829\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex115 \u8226? autoobservafiile pacientului
sau observafiile medicului privind concor-\line \up0 \expndtw0\charscalex117 danfa
dintre aparitia simptomelor \up0 \expndtw0\charscalex119 $i evenimentele stresante
(vezi metoda \par\pard\ql \li1084\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex110
cronologice a lui Kourilsky); \par\pard\ql \li1382\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex115 e caracterul fluctuant al simptomelor; \par\pard\ql
\li1387\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex116 e discrepanta dintre
severitatea simptomelor si acuzele bolnavului; \par\pard\ql \li1382\sb10\sl-
230\slmult0\tx4703 \up0 \expndtw0\charscalex126 e rezonanfa psihice accentuate \tab
\up0 \expndtw0\charscalex123 (adesea extrem de "zgomotoase") a \par\pard\ql
\li1089\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 simptomelor acuzate;
\u8226? diagnosticul "ex non juvantibus"\tab \up0 \expndtw0\charscalex121 (lipsa
efectelor terapeutice ale\par\pard\li1099\sb15\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex121 medicafiei somatice simptomatice);\par\pard\li1099\sb5\sl-
230\slmult0\fi283\tx6014 \up0 \expndtw0\charscalex115 e efectul favorabil al
psihotropelor (inconstient)\tab \up0 \expndtw0\charscalex121 $i
psihoterapiei.\par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart Pg101}
psihosomatica generala si aplicata\par\pard\ql \li1886\sb0\sl-230\slmult0
\up0 \expndtw0\charscalex119 e) Inifierea unor elemente de psihoterapie de
sustinere \par\pard\ql \li1881\sb170\sl-230\slmult0\tx7276 \up0
\expndtw0\charscalex118 Se poate vorbi mai degrabe, de un "ajutor psihologie"
\tab \up0 \expndtw0\charscalex117 (Huber) pe care \par\pard\qj
medicul il acorda bolnavului pe tot parcursul dialogului sau cu bolnavul si
\up0 \expndtw0\charscalex118 care este concretizat prin atitudinea sa plinS de
infelegere s* de incurajare \up0 \expndtw0\charscalex118 a bolnavului. inclusiv pnn
urmStoarele elemente: \par\pard\qj \li1593\ri349\sb22\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex118 \u8226? formula "urechi mari si limba scurta" (conform
principiilor psihana� \up0 \expndtw0\charscalex106 lizei) \par\pard\ql
\li1886\ri340\sb0\sl-240\slmult0\tx2097\tx2102 \up0 \expndtw0\charscalex121 \u8226?
intrebSri deschise sau sugestive de tipul "ce vS face sS avefi o viata \line\tab
\up0 \expndtw0\charscalex117 grea ?". "ce va deranjeazS ?" - pentru situafii
confhctuale, "ce vS lip-\line\tab \up0 \expndtw0\charscalex117 seste ?" - pentru
carenfe afective, pierderi. \par\pard\qj \li1588\ri340\sb0\sl-240\slmult0\fi297
\up0 \expndtw0\charscalex117 \u8226? explicafii referitoare la cauzele bolii,
obiectivele tratamentului, evolu\up0 \expndtw0\charscalex116 fia bolii, mecanismul
de acfiune al medicamentelor si posibilitatea aparifiei \up0
\expndtw0\charscalex116 unor efecte secundare, modalitstile de ineturare sau
prevenire a unor facto� \up0 \expndtw0\charscalex119 ri cauzali sau tnggen si, mai
ales, natura modului de viafS pe care trebuie \up0 \expndtw0\charscalex112 sS il
adopte bolnavul. \par\pard\qj \li1583\ri335\sb20\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex115 Cea mai importantS contributie de ordin psihoterapeutic a
medicului so� \up0 \expndtw0\charscalex119 matician in cadrul relafiei sale cu
pacientul este instituirea si promovarea \up0 \expndtw0\charscalex116 asa-numitului
"parteneriat pentru sSnState" bazat pe drepturile pacientului: \up0
\expndtw0\charscalex115 dreptul la informarea totals asupra bolii sale si dreptul
asupra propriilor sale \up0 \expndtw0\charscalex118 decizii (de aderare totals sau
parfiae ori de refuz la tratamentu! prescris de \up0 \expndtw0\charscalex112 cStre
medic)(Edith Rameckers). \par\pard\qj \li1588\ri325\sb0\sl-243\slmult0\fi292
\up0 \expndtw0\charscalex119 Dincolo de aceste douS elemente componente ae
psihoterapiei simple \up0 \expndtw0\charscalex116 de susfinere, medicul somatician
trebuie sS aibS in vedere s1 apelul la psi� \up0 \expndtw0\charscalex116 holog in
cadrul echipei de ingrijire a bolnavilor psihosomatici iar in ceea ce \up0
\expndtw0\charscalex133 priveste relatia sa cu psihiatrul ea poate sS inceapS, fie
inainte de \up0 \expndtw0\charscalex117 consultul psihologic-in cazul unei
simptomatologii psihiatrice patente-, fie \up0 \expndtw0\charscalex122 dupS ce
insusi psihologul a decelat tulburSri psihice care fin de resortul \up0
\expndtw0\charscalex122 asistenfei psihiatrice (de ex depresia atipicS).
paragraiul anterior figureazS o serie de propuneri personae privind si \up0
\expndtw0\charscalex113 tuafiile care impun participarea activS a psihologului in
cadrul echipei de in� \up0 \expndtw0\charscalex113 grijire a bolnavilor
somatici. \par\pard\ql \li1886\ri438\sb177\sl-290\slmult0\tx2179\tx2183 \up0
\expndtw0\charscalex135 3. Indicatii si oportutiitati pentru participarea
psihologului in \line\tab \up0 \expndtw0\charscalex132 cadrul echipei medicale de
ingrijire a bolnavilor cu \line \tab \up0 \expndtw0\charscalex133 patologie
somatica $i psihosomatica \par\pard\qj \li1588\ri336\sb169\sl-243\slmult0\fi292
\up0 \expndtw0\charscalex117 in afara participSrii. deja consacrate-aeturi de
medicii psihiatri-in trata\up0 \expndtw0\charscalex114 mentul bolilor psihice,
psihologii pot dobandi o ImportantS pozifie in cadrul \up0 \expndtw0\charscalex118
echipei terapeutice din domeniul asistenfei medicale a bolnavilor somatici \up0
\expndtw0\charscalex118 (in special chirurgicall sau cu o patologie fortuitS: boli
infectioase, arsuri, \up0 \expndtw0\charscalex109 etc.) \up0
\expndtw0\charscalex112 $*\u8226? mai ales psihosomatici (cu boli de maxims
frecvenfS si implicafii in \up0 \expndtw0\charscalex125 mortaiitate boala
coronananS si \u9632?\u8226?'sau hipertensivS. diabetul zaharat, \up0
\expndtw0\charscalex115 obezitatea. etc.). \par\pard\qj \li1603\ri324\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex123 intr-o succints tentativS de
circumscriere a indicafiilor si mai ales, a \up0 \expndtw0\charscalex106
oportunitSfilor \up0 \expndtw0\charscalex117 (adesea sugerate de cetre medicul
curant) pentru solicitarea
\expndtw0\charscalex129 \ul0\nosupersub\cf3\f4\fs18 Psihosomatica generae\tab
\up0 \expndtw0\charscalex129 \u9830? 95\par\pard\li1051\sb0\sl-
ajutorului psihologului, aeturi de medic si ceilalfi membrii ai echipei
tera�\par\pard\li1051\sb5\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex116 peutice,
consideram urmetoarele:\par\pard\li1051\sb5\sl-230\slmult0\fi312\tx1583 \up0
\expndtw0\charscalex116 1\tab \up0 \expndtw0\charscalex117 Tulburarile
psihosomatice ince reversibile dar frecvent prezente la
pa�\par\pard\li1051\sb10\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex116 cienfii
aflafi sub efectele unui stres cronic,\par\pard\qj \li1055\ri877\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex121 2 Bolile psihosomatice, mai ales in
afara puseelor, in care se incearce \up0 \expndtw0\charscalex113 modificarea unor
comportamente nocive pentru senState (tipurile comporta� \up0
\expndtw0\charscalex117 mentale A sau C, fumatul, sedentarismul, consumul de alcool
in exces, su\up0 \expndtw0\charscalex117 praahmentafia, etc). \par\pard\qj
\li1060\ri882\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex111 3. Bolnavii
cronici cu disconfort important psihic si somatic si/sau cu pers\up0
\expndtw0\charscalex111 pectiva agravSrii inexorabile, cu sau farS depresie
secundarS. \par\pard\qj \li1060\ri884\sb0\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex115 4 Bolnavii somatici cu probleme psihologice "stabile" sau
coniuncturale, \up0 \expndtw0\charscalex115 sesizabile chiar de cStre medicul
curant. \par\pard\qj \li1060\ri868\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex117 5. Bolnavii chirurgicali cu probleme psihologice deosebite,
implicate in \up0 \expndtw0\charscalex118 anxietatea si/sau depresia anterioare
actului operator sau in etapa postope\up0 \expndtw0\charscalex118 ratorie de
refacere si recuperare. \par\pard\qj \li1055\ri867\sb0\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex115 6. Bolnavii somatici avand asociate tulburSri psihice
nesistematizate sau \up0 \expndtw0\charscalex118 incadrabile nosografic in
sindroame psihiatrice (acestea din urmS in cola\up0 \expndtw0\charscalex118 borare
cu psihiatru care pot prelua cazul pentru un tratament axat prioritar \up0
\expndtw0\charscalex113 pe psihotrope). \par\pard\qj \li1060\ri852\sb0\sl-
233\slmult0\fi292 \up0 \expndtw0\charscalex114 7. Instltuirea-in cadrul programului
de reabilitare-a unor forme de psiho� \up0 \expndtw0\charscalex120 terapie cu rol
relaxant si de a creste rezistenfa bolnavului somatic fafa de \up0
\expndtw0\charscalex114 stresui psihic (training autogen Schultz, antrenamentul
psihosomatic Luban-\line \up0 \expndtw0\charscalex114 Plozza) sau de modificare a
unor comportamente cu rol de factori de rise. \par\pard\ql \li1339\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex114 8. Extinderea psihoterapiei asupra
familiei bolnavului. \par\pard\qj \li1060\ri852\sb2\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex120 9 Atragerea in terapia de grup a unor bolnavi cu aceleasi
boli, inclusiv \up0 \expndtw0\charscalex121 aceleasi probleme legate de bolile
respective, cu incurajarea impartasirn \up0 \expndtw0\charscalex127 experienfei lor
emotionale colegilor de suferinfa \up0 \expndtw0\charscalex126 (vezi "cluburile
de \par\pard\ql \li1060\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex112 reumatici"-
Stocksmeier) \par\pard\qj \li1065\ri848\sb2\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex118 10. Formarea unor centre pilot de asistenfS psihologicS in
echips (mai \up0 \expndtw0\charscalex114 mulfi psihologi fiecare aplicand o anume
metodS psihoterapeuticS)(Mihaela \up0 \expndtw0\charscalex119 Minulescu), a
bolnavilor psihosomatici, cu diminuarea corespunzStoare a \up0
\expndtw0\charscalex116 nevoii de medicamente a acestora. \par\pard\ql
\li1363\sb109\sl-230\slmult0 \up0 \expndtw0\charscalex118 Blbliografie:
\ul0\nosupersub\cf3\f4\fs18 1 Buddenberg C. With J. Psychosoztale Mediztn. Springer
Berlin. Heidelberg. \line\tab \up0 \expndtw-4\charscalex100 1998. \par\pard\ql
\li1348\sb15\sl-207\slmult0 \up0 \expndtw0\charscalex118 2. Huber W. Psihoterapnle.
Terapia potrivitd (iocdrui pacient Stnnld si tehnicd, \par\pard\li1579\sb28\sl-
207\slmult0\fi0\tx2543 \up0 \expndtw0\charscalex105 Bucuresti.\tab \up0
\expndtw0\charscalex105 1997.\par\pard\ql \li1353\sb0\sl-205\slmult0 \up0
\expndtw0\charscalex117 3 lamandescu IB. Psihologie medicald, ed. II. Ed.
Infomedica. Bucuresti 1997 \par\pard\ql \li1363\sb0\sl-199\slmult0 \up0
\expndtw0\charscalex117 4. Kourilsky R. Les mechanismespsychophysiologiquesdans
lasthme. Bordeaux \par\pard\li1574\sb23\sl-207\slmult0\fi0\tx2404\tx2918 \up0
\expndtw0\charscalex100 mddical.\tab \up0 \expndtw-5\charscalex100 1969.\tab
\up0 \expndtw0\charscalex100 1120-1126.\par\pard\qj \li1348\ri840\sb0\sl-
240\slmult0\tx1603 \up0 \expndtw0\charscalex117 5. Luban Plozza B, Laederach-
Hoffmann K.. Knaak L., Dickhaul H. H Der Artz \line\tab \up0
\expndtw0\charscalex109 als Arznei, Deutche Arize Verlag. Kotn. \up0 \expndtw-
7\charscalex100 1996. \par\pard\qj \li1358\ri851\sb0\sl-220\slmult0\tx1574
\up0 \expndtw0\charscalex116 6. Rameckers Edith. Patient emprovement - a threat or
a help? EFA Symposium \line\tab \up0 \expndtw0\charscalex111 at ICACI94 Conference.
Stockholm, June, 29th 1994. \par\pard\ql \li1368\sb1\sl-189\slmult0\tx7358 \up0
\expndtw0\charscalex113 7. Van Es J. C. Medicul de familie si pacientul sdu. Libra,
Bucuresti, \tab \up0 \expndtw-7\charscalex100 1997.
\expndtw0\charscalex100 \ul0\nosupersub\cf14\f15\fs24 B. ALGORITM DE ABORDARE A
BOLNAVILOR \line\tab \up0 \expndtw-1\charscalex100 PSIHOSOMATICI \par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 Ovidiu Popa-Velea \par\pard\qj \li1036\sb0\sl-
Practica medicala demonstreazS adesea nu numai clasi\up0 \expndtw0\charscalex108
cul adagio "nu existe boli, ci bolnavi". ci si o ingrijoretoare de\up0
\expndtw0\charscalex113 ficienfa in "abordarea psihosomatice" a unor cazuri cu
etio\up0 \expndtw0\charscalex111 patogenie multiple, Intricate \par\pard\qj
\li1036\ri2528\sb0\sl-226\slmult0\fi297 \up0 \expndtw0\charscalex119 intre cauzele
de care depinde un parametru esenfial al \up0 \expndtw0\charscalex110 relafiei
inter-personale medic-pacient (nivelul complianfei), -\line \up0
\expndtw0\charscalex116 calitatea comunicerii remene un factor constant si mai ales
\up0 \expndtw0\charscalex111 controlabil de catre medic. \par\pard\qj
\li1046\ri2528\sb215\sl-220\slmult0\fi292 \up0 \expndtw0\charscalex127 Factori ce
produc scaderea complianfei terapeutice \up0 \expndtw0\charscalex111 (lamandescu.
1995) \par\pard\ql \li1348\sb2\sl-218\slmult0 \up0 \expndtw0\charscalex111 -
Nivelul scazut at dtsconfortului produs de boala \par\pard\ql \li1353\sb3\sl-
217\slmult0 \up0 \expndtw0\charscalex112 - Tendinta unor bolnavi de a nega boala
\par\pard\ql \li1353\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex109 -
Complexitatea excesivd a regimului terapeutic \par\pard\ql \li1358\sb3\sl-
217\slmult0 \up0 \expndtw0\charscalex109 \u9632? Tratamentul este perceput ca
stanjenitor sau umilitor \par\pard\qj \li1358\ri2518\sb21\sl-220\slmult0 \up0
\expndtw0\charscalex108 - Factori extern! (exigenfele profesiei. presiunile
anturaju\up0 \expndtw0\charscalex109 lui) ce vin in contradictie cu desfdsurarea
terapiei \par\pard\qj \li1353\ri2524\sb0\sl-220\slmult0 \up0
\expndtw0\charscalex108 - Evaziunea in cadrul bolii (pacientul beneiiciazd de
avan\up0 \expndtw0\charscalex109 taje de pe urma starii de boala) \par\pard\ql
\li1353\sb2\sl-218\slmult0 \up0 \expndtw0\charscalex112 - Etecte adverse ale
medicafiei \par\pard\ql \li1478\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex117 O
comunicare deficitara medic-pacient \par\pard\qj \li1041\ri2523\sb218\sl-
224\slmult0\fi297 \up0 \expndtw0\charscalex108 Momentul de inceput, eel anamnestic.
are de reguie o im� \up0 \expndtw0\charscalex117 portanta particular in economia
desfesurerii relafiei tera� \up0 \expndtw0\charscalex114 peutice. in cele ce
urmeaza dorim a incerca creionarea - in \up0 \expndtw0\charscalex104 linii mari
\up0 \expndtw0\charscalex114 - a unor pas> obligator^ de ecut, pa$i de nature a
\up0 \expndtw0\charscalex112 optimiza atat eficienta actului medical, cat si
calitatea rela� \up0 \expndtw0\charscalex109 fiei medic-pacient. \par\pard\qj
\li1041\ri2533\sb0\sl-230\slmult0\fi302 \up0 \expndtw0\charscalex108 Interviul
clinic (discufia initiae cu pacientul) implies aso� \up0 \expndtw0\charscalex115
cierea unor multiple elemente cu vocafie comunicafionae, \up0
\expndtw0\charscalex118 impletirea unor aspecte ce fin de centrarea pe pacient \up0
\expndtw-3\charscalex100 (si \par\pard\qj \li1046\ri2519\sb0\sl-220\slmult0\fi4
\up0 \expndtw0\charscalex112 simptomele acestua). cu altele ce fin de medic (in
special in \up0 \expndtw0\charscalex111 partea finale a consultafiei, cand medicul
preia de regue po\up0 \expndtw0\charscalex109 zifia dominante, conduce interviul.
explice, recomande). \par\pard\li1353\sb54\sl-
241\slmult0\fi0\tx1579\tx6792\tx7507 \dn3 \expndtw-1\charscalex100 1\tab \dn3
\expndtw-1\charscalex100 CADRUL AMBIENTAL, INITIEREA COMUNICARII\tab \up0 \expndtw-
5\charscalex100 PASUL\tab \up0 \expndtw-1\charscalex100 1\par\pard\qj
\li1046\ri2518\sb37\sl-220\slmult0\fi292 \up0 \expndtw0\charscalex109 In special la
prima intalnire medic-pacient, atmosfera, lo� \up0 \expndtw0\charscalex110 cul
consultafiei pot juca un rol determinant. Ele pot permite
\expndtw0\charscalex109 \u9830?\tab \dn2 \expndtw0\charscalex109 Elemente de
psihosomatica generae si aplicata\par\pard\li1828\sb0\sl-
230\slmult0\fi57 \up0 \expndtw0\charscalex109 af irmarea identitetii celor doi
(prevenind confuzia,
amestecul\par\pard\sect\sectd\sbknone\cols2\colno1\colw7562\colsr60\colno2\colw1538
\colsr160\ql \li1886\ri0\sb0\sl-229\slmult0\fi4\tx2179 \up0 \expndtw0\charscalex112
rolurilor) si pot pune bazelc unei relafii de lunga durats. \line\tab \up0
\expndtw0\charscalex113 Pentru crearea unei stari de contort si relaxare se pot
uti-\line \up0 \expndtw0\charscalex113 liza tehnici verbale s* non-verbale. precum
formule ca "bun \line \up0 \expndtw0\charscalex112 venit in clinica noastre" etc..
dublate de o strSngere de mSne \line \up0 \expndtw0\charscalex116 sincere, cordials
(nu traumatizante, sau, din centre nesigu-\line \up0 \expndtw0\charscalex113 ra,
ezitanta).\par\pard\qj \li1886\ri0\sb0\sl-229\slmult0\fi288 \up0
\expndtw0\charscalex118 Gesturile de deschidere. atitudmea prietenoasS sincera
\line \up0 \expndtw0\charscalex111 (nu contrafScutS. "profesionale") favorizeaze
comunicarea.\par\pard\qj \li1891\ri0\sb4\sl-225\slmult0\fi283 \up0
\expndtw0\charscalex110 Desfasurarea consultafiei trebuie se nu se face sub
semnul \line \up0 \expndtw0\charscalex109 improvizafiei: pe culoar. in lift, gata
de urcarea in masina, etc\par\pard\qj \li1886\ri23\sb1\sl-225\slmult0\fi288 \up0
\expndtw0\charscalex118 Cablnetul medical, loc predestmat aeestei intSlniri ini
\line \up0 \expndtw0\charscalex111 tiaie. joacS un rol supllmentar in clarificarea
initiae de roluri\par\pard\qj \li1881\ri0\sb4\sl-221\slmult0\fi297 \up0
\expndtw0\charscalex113 Medicul trebuie sa-si asume identitatea, evltand extreme
\up0 \expndtw0\charscalex113 Ie: nu se recomandSca fiind 'asistentdr. X. doctor in
medici \up0 \expndtw0\charscalex111 nS". dar nici ca fiind un oarecare "X". cea mai
rezonabilS so \up0 \expndtw0\charscalex110 lufie fiind utilizarea simpla a
titulaturil de "doctor" ("Sunt dr. \up0 \expndtw0\charscalex113 X"), iar pentru
studenfii la medicina, formule de genul "sun \up0 \expndtw0\charscalex115 stud. Y,
si ec parte din echipa care va avea grije de dvs., pe \up0 \expndtw0\charscalex113
parcursul sederii la noi'\par\pard\qj \li1881\ri0\sb17\sl-235\slmult0\fi302 \up0
\expndtw0\charscalex117 Foiosirea numelui pacientului este recomandabie la in-\line
\up0 \expndtw0\charscalex119 talnirea imfiaie. putandu-se trece la foiosirea
prenumelui \up0 \expndtw0\charscalex121 atunci cand relafla s-a mai consolidat sau
cand pacientul \up0 \expndtw0\charscalex117 solicits explicit acest
lucru\par\pard\qj \li1886\ri0\sb0\sl-235\slmult0\fi292 \up0 \expndtw0\charscalex116
Dace pacientul are un nume greu de pronuntat, medicul \up0 \expndtw0\charscalex119
poate intreba care este pronunfia corects\par\pard\qj \li1876\ri0\sb0\sl-
236\slmult0\fi288 \up0 \expndtw0\charscalex113 in general, pentru foiosirea unui
anumit apelativ (in spe� \up0 \expndtw0\charscalex115 cial a prenumelui) se cere
consimfSmSntuI pacientului.\par\pard\qj \li1876\ri0\sb0\sl-237\slmult0\fi292
\up0 \expndtw0\charscalex119 A tine seama de sentirnentele pacientului presupune si
\line \up0 \expndtw0\charscalex119 ca desfSsurarea consultafiei sa se desfSsoare
intr-un mo� \line \up0 \expndtw0\charscalex123 ment convenabil pentru pacient (dupS
ce rudele sale au \line \up0 \expndtw0\charscalex115 plecat, dupS ce a luat masa.
dupS somnul de dupS-amiazS, \line \up0 \expndtw0\charscalex116 sau in general,
atunci cand un simptom neplacut (ex. grea-\line \up0 \expndtw0\charscalex120 fa)
este pe moment absent). Desigur, aceastS regue nu se \line \up0
\expndtw0\charscalex119 aplica in situafiile de urgenfs, sau atunci cand
simptomul \line \up0 \expndtw0\charscalex117 este presant, pacientul (anxios)
doreste intsimrea imediatS \line \up0 \expndtw0\charscalex117 cu un medic,
etc.\par\pard\qj \li1881\ri0\sb0\sl-231\slmult0\fi302 \up0 \expndtw0\charscalex117
Respectarea intimitafii se concretizeazS s< in exclucle-\line \up0
\expndtw0\charscalex116 rea "musalirilor nepoftifi" \up0 \expndtw0\charscalex126 (a
unui alt pacient, sau a unei \line \up0 \expndtw0\charscalex123 asistente cunoase.
etc.)\par\pard\qj \li1809\ri0\sb4\sl-
236\slmult0\fi374\tx1896\tx1896\tx1900\tx1900\tx1900 \up0 \expndtw0\charscalex119
in cabinet, medicul nu trebuie se abuzeze de factori de \line\tab \up0
\expndtw0\charscalex117 natura ai creste artificial (pane la ridicol) prestigiul:
abun-\line \tab \up0 \expndtw0\charscalex120 denfa de diplome, telefonui care sunS
neincotat, scaunul \line \tab \up0 \expndtw0\charscalex115 rotativ (cu mai multe
grade de libertate decat eel al pacion-\line \tab \up0 \expndtw0\charscalex121
tului. etc.) Fere a se autodeprecia, \up0 \expndtw0\charscalex116 $i mergand pe
princi-\line \tab \up0 \expndtw0\charscalex116 piul "exists o mesure in toate",
medicul poato doza, cu bun \line \up0 \expndtw0\charscalex115 I gust, elementele
care (in de decor.\par\pard\column \ql \li25\sb1\sl-190\slmult0 \up0 \expndtw-
9\charscalex90 1. \up0 \expndtw0\charscalex112 Formule de\par\pard\ql
\li241\sb17\sl-230\slmult0 \up0 \expndtw0\charscalex115 intampinare\par\pard\ql
\li20\sb104\sl-230\slmult0 \up0 \expndtw-6\charscalex100 2. \up0
\expndtw0\charscalex111 Formule de\par\pard\ql \li250\sb5\sl-230\slmult0 \up0
\expndtw0\charscalex119 adresare\par\pard\qj \li7857\sb0\sl-238\slmult0
238\slmult0 \up0 \expndtw0\charscalex114 Asigurarea \line \up0
\expndtw0\charscalex113 intimitafii si \line \up0 \expndtw0\charscalex112
confortului \line \up0 \expndtw0\charscalex114 pacientului\par\pard\qj
\li7862\sb0\sl-240\slmult0 \par\pard\qj \li250\ri75\sb202\sl-240\slmult0\fi9
\up0 \expndtw0\charscalex119 Ineturarea \line \up0 \expndtw0\charscalex112
barierelor de \line \up0 \expndtw0\charscalex111 comunicare
\up0 \expndtw0\charscalex115 \ul0\nosupersub\cf9\f10\fs20 PsihosomaticS
generae\par\pard\qj \li1041\sb0\sl-217\slmult0 \par\pard\qj \li1041\sb0\sl-
217\slmult0 \par\pard\qj \li1041\sb0\sl-217\slmult0 \par\pard\qj
\li1036\ri0\sb13\sl-217\slmult0\fi297 \up0 \expndtw0\charscalex122 De altfel, o
bunS parte din pacienfi vin la medic deja \line \up0 \expndtw0\charscalex120
pregatifi pentru a-i urma indicaftite \up0 \expndtw0\charscalex120 ("sugestie de
presti-\line \up0 \expndtw0\charscalex122 giu'), astfel incat nu este necesarS
plusarea cu elemente \line \up0 \expndtw0\charscalex108 nelalocul
lor.\par\pard\qj \li1036\ri0\sb1\sl-215\slmult0\fi292 \up0 \expndtw0\charscalex118
O precaufie importante se impune in cazul cabinetelor \line \up0
\expndtw0\charscalex121 de psihoterapie (psihanahza), in care cadrul, desi
priete-\line \up0 \expndtw0\charscalex117 nos, este necesar a fi oarecum auster,
pentru a nu influen-\line \up0 \expndtw0\charscalex116 fa in chip determinant
ideafia pacientului, piansele (even� \line \up0 \expndtw0\charscalex123 tual
confinand teste psihologice) nu sunt la vedere \up0 \expndtw0\charscalex104 (pot
\line \up0 \expndtw0\charscalex116 compromite evaluarea ulterioare), plasarea
mobilierului se \line \up0 \expndtw0\charscalex118 face ca pentru o sedinfe de
lucru (cei doi, medicul s* pa� \line \up0 \expndtw0\charscalex116 cientul
colaboreaze, sunt aliafi. in rezolvarea unei proble� \line \up0
\expndtw0\charscalex119 me. care "se intampe se fie cea a
pacientului").\par\pard\qj \li1041\ri0\sb5\sl-211\slmult0\fi292 \up0
\expndtw0\charscalex119 In sedinfele de psihoterapie de grup, cea mai eficiente
\line \up0 \expndtw0\charscalex120 grupare a pacientilor se face in asa fel incSt
se nu se evi-\line \up0 \expndtw0\charscalex113 denfieze In mod necesar un lider
(in nici un caz terapeutul).\par\pard\qj \li1046\ri0\sb14\sl-213\slmult0\fi283 \up0
\expndtw0\charscalex120 Acesta remane simplu membru al grupului, \up0
\expndtw0\charscalex118 �i in pro-\line \up0 \expndtw0\charscalex118 cesul
psihoterapeutic intervine doar atunci cand este nea-\line \up0
\expndtw0\charscalex119 parat necesar.\par\pard\qj \li1046\ri0\sb12\sl-
214\slmult0\fi283 \up0 \expndtw0\charscalex115 Asigurarea confortulul pacientului,
dincolo de aspectele \line \up0 \expndtw0\charscalex114 de ambient, implies si
intrarea intr-o maniera delicate, ptina \line \up0 \expndtw0\charscalex116 de tacl
- in miezul problemei, intrefinerea unei conversafii \line \up0
\expndtw0\charscalex117 "usoare", pane ce pacientul este pregatit se se
confeseze.\par\pard\ql \li1339\sb94\sl-230\slmult0 \up0 \expndtw0\charscalex106 2.
AGENDA DE PROBLEME\par\pard\qj \li1041\ri0\sb6\sl-213\slmult0\fi292 \up0
\expndtw0\charscalex121 Odate clarificate rolurile celor doi, este utie
stabilirea \line \up0 \expndtw0\charscalex117 unei liste de obiective, si un timp
alocat acestora. Aceasta \line \up0 \expndtw0\charscalex121 previne atat explicable
nerealiste (din ambele parfi), dar \line \up0 \expndtw0\charscalex121 contribuie si
la conturarea unui grafic eficient de acfiuni \line \up0 \expndtw0\charscalex114
comune.\par\pard\qj \li1041\ri0\sb7\sl-215\slmult0\fi288 \up0
\expndtw0\charscalex141 in principal, in aceasta etape medicul aduce la \line
\up0 \expndtw0\charscalex121 cunostinfa pacientului timpul de care dispune, il pune
la \up0 \expndtw0\charscalex118 curent cu modalitatea de lucru, obfine o enumerare
a pro-\line \up0 \expndtw0\charscalex120 blemelor ce vor fi discutate cu pacientul,
rezume si chiar \up0 \expndtw0\charscalex115 negociaze unele aspecte de detaliu
(ex. unele probleme pot \up0 \expndtw0\charscalex116 fi, intr-o prime instanfe,
amenate).\par\pard\qj \li1046\ri0\sb0\sl-216\slmult0\fi292 \up0
\expndtw0\charscalex119 Aceaste etape nu este atat de usor de indeplinit, pe cat
\line \up0 \expndtw0\charscalex117 pare la prima vedere. Uneori din grabe, alteori
din dorinta \line \up0 \expndtw0\charscalex117 de a perea vesnic disponibil pentru
pacient, poate fi negli-\line \up0 \expndtw0\charscalex120 jate ciarificarea
agendei de lucru, si aceasta induce anu� \line \up0 \expndtw0\charscalex117 mite
blocaje ulterioare (de ex., pacientul nu infelege de ce \line \up0
\expndtw0\charscalex117 i se pun anumite intreban. sau de ce anumite probleme,
pe \line \up0 \expndtw0\charscalex122 care el le considere presante, nu fac
obiectul interesului \line \up0 \expndtw0\charscalex111 medicului).\par\pard\qj
\li1051\ri0\sb0\sl-213\slmult0\fi292 \up0 \expndtw0\charscalex117 De aceea, este
util a alia in primul rSnd \ul0\nosupersub\cf18\f19\fs20\ul ce este impor� \line
\up0 \expndtw0\charscalex116 tant pentru oacient\ul0\nosupersub\cf9\f10\fs20 .
chiar dace lucrul respectiv poate sS nu \line \up0 \expndtw0\charscalex117 fie, in
mod necesar si o problems demnS de atenfie pentru \line \up0
\expndtw0\charscalex110 medic.\par\pard\qj \li1051\ri0\sb0\sl-235\slmult0\fi287
\up0 \expndtw0\charscalex118 in aceastS etapS, medicul nu intre in detalii
nesemnifi-\line \up0 \expndtw0\charscalex117 cative El doar clarified problemele,
le enunfe pacientului, \up0 \expndtw0\charscalex117 il asigure ce va reveni in
detaliu asupra lor.\par\pard\column \ql \li7655\sb0\sl-230\slmult0 \par\pard\ql
\li917\sb203\sl-230\slmult0 \up0 \expndtw0\charscalex115 \u9830? 99\par\pard\qj
\li222\ri1063\sb135\sl-235\slmult0\fi4 \up0 \expndtw0\charscalex111 Delimitarea
\up0 \expndtw0\charscalex112 rolurilor\par\pard\ql \li6767\sb0\sl-253\slmult0
\ul0\nosupersub\cf8\f9\fs22 PASUL \up0 \expndtw-3\charscalex100 2\par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 V preclzarea \line\tab \up0 \expndtw0\charscalex112
duratei\par\pard\qj \li20\ri1169\sb0\sl-240\slmult0\fi230 \up0
\expndtw0\charscalex106 Intorvlulul \line \up0 \expndtw-9\charscalex94 2. \up0
\expndtw0\charscalex113 preclzarea\par\pard\qj \li241\ri1135\sb0\sl-240\slmult0
\up0 \expndtw0\charscalex100 modal ItSfii \up0 \expndtw0\charscalex113 de
lucru\par\pard\ql \li6758\sb0\sl-230\slmult0 \par\pard\ql \li6758\sb0\sl-
230\slmult0 \up0 \expndtw-8\charscalex100 3. \up0 \expndtw0\charscalex114
ciarificarea\par\pard\ql \li255\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115
listei de\par\pard\qj \li250\ri1251\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex111
probleme \line \up0 \expndtw0\charscalex109 ale\par\pard\ql \li246\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex111 pacientului
\par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart
psihosomatica generala si aplicata\par\pard\li1627\sb0\sl-
241\slmult0\fi297\tx7344 \dn3 \expndtw0\charscalex114 De la aceasta regue face
excepfie notabie situafia in care\tab \up0 \expndtw0\charscalex114 4
finalizarea\par\pard\sect\sectd\sbknone\cols2\colno1\colw7303\colsr60\colno2\colw17
97\colsr160\qj \li1627\ri0\sb31\sl-214\slmult0 \up0 \expndtw0\charscalex108 o
anumite probleme (simptom) are o semnificative incerceture \up0
\expndtw0\charscalex111 emotionale. in acest caz, descSrcarea emotionale a
pacientu� \up0 \expndtw0\charscalex108 lui este mai importanta decat respectarea
"ad litteram" (rigida) \up0 \expndtw0\charscalex111 a algoritmului. si este permise
intrarea in anumite anrenunte, \up0 \expndtw0\charscalex110 relevante pentru
pacient, legate de simptom\par\pard\qj \li1641\ri0\sb12\sl-214\slmult0\fi283
\up0 \expndtw0\charscalex123 in ansamblu. pasul \up0 \expndtw0\charscalex122 2
permite. dincolo de negocierea \line \up0 \expndtw0\charscalex117 modalitafii de
lucru si ciarificarea primare a problemelor. \line \up0 \expndtw0\charscalex116
mitierea unei veritabile relafii de parteneriat intre medic si \line \up0
\expndtw0\charscalex114 pacient.\par\pard\ql \li1920\ri1878\sb130\sl-211\slmult0
\up0 \expndtw0\charscalex104 3. INTERVIUL PROPRIU-ZIS \line \up0
\expndtw0\charscalex114 Al necentrat oe problema. "deschis"\par\pard\qj
\li1636\ri0\sb11\sl-216\slmult0\fi288 \up0 \expndtw0\charscalex110 in preambulul
interviului propnu-zis, se prefere intrebarilo \up0 \expndtw0\charscalex113
"deschise" (care il provoace pe pacient se se exprime liber). \up0
\expndtw0\charscalex111 Si nu neaparat legate de problema nr. 1 a sa. Se prefere
incu-\line \up0 \expndtw0\charscalex115 rajarile non-verbale \up0
\expndtw0\charscalex117 (persistenta contactului ocular, ecoul \up0
\expndtw0\charscalex117 postural, gesturi de evaluare-decizie si interes), pentru a
il \up0 \expndtw0\charscalex118 stimula pe pacient se continue, dar se pot folosl
si mesaje \up0 \expndtw0\charscalex120 verbale de tipul rezumem intr-o frazS
concise a spuselor \up0 \expndtw0\charscalex113 pacientului (aceasta ii permite
celui aflat in suferinfS a avea \up0 \expndtw0\charscalex111 un adevarat feed-back
al mesajului receptat (si eventual infe-\line \up0 \expndtw0\charscalex114 les) de
medic, clarificSrilor ("ce vrefi sS spuneti?'), ecoului \up0
\expndtw0\charscalex108 (se repeta, in altS forma, afirmafiile pacientului).
incurajSrilor \up0 \expndtw0\charscalex109 mSrunte ("Interesant".
''Continuafr').\par\pard\qj \li1641\ri0\sb5\sl-216\slmult0\fi283 \up0
\expndtw0\charscalex118 in aceastS etape, chiar daca medicul adopte o atitudine
\line \up0 \expndtw0\charscalex111 relativ pasive, existe o serie intreagS de
elemente, care fin de \line \up0 \expndtw0\charscalex118 pacient, ce pot furnlza
Informafii utile: elemente ce tin de \line \up0 \expndtw0\charscalex114 facies,
habitus, culoarea pielii \up0 \expndtw0\charscalex104 $i pSrului. dlformitSfi.
tempe� \line \up0 \expndtw0\charscalex113 rature (de ex.. la simpla strSngere a
malnil). mobilitatea pu-\line \up0 \expndtw0\charscalex113 pllara (crescute, cu
tendinta la midriaza - la un pacient exci-\line \up0 \expndtw0\charscalex117 tat
emotional), accesoni \up0 \expndtw0\charscalex114 (ochelari, machiaj,
vestimentatie, \line \up0 \expndtw0\charscalex108 bijuterii), modul de organizare a
ambientului (la un bolnav in� \line \up0 \expndtw0\charscalex113 ternal),
etc.\par\pard\ql \li1939\sb3\sl-225\slmult0 \up0 \expndtw0\charscalex110
B)QcaMzai\par\pard\qj \li1641\ri0\sb0\sl-214\slmult0\fi292 \up0
\expndtw0\charscalex117 Se tau in discutie problemele principale de senetate ale
\up0 \expndtw0\charscalex116 bolnavului. preferandu-se foiosirea de Tntrebari
"inchise", \up0 \expndtw0\charscalex111 mult mai precis direcfionate, in cadrul
unei atitudini generale \up0 \expndtw0\charscalex111 a medicului mai
participative.\par\pard\ql \li1934\sb2\sl-220\slmult0 \up0 \expndtw0\charscalex113
Aceaste etape implica mai multe subetape:\par\pard\ql \li1943\sb1\sl-209\slmult0
\up0 \expndtw0\charscalex131 - obfinerea unei descrieri dm partea pacientului
a\par\pard\ql \li2068\ri0\sb6\sl-217\slmult0 \up0 \expndtw0\charscalex110
simptomelor principale (continue etapa 3A); \line \up0 \expndtw0\charscalex124
plasarea simptomelor in contextul mai larg al bolii \line \up0
\expndtw0\charscalex109 pacientului \up0 \expndtw0\charscalex118 (Adesea neglijata.
aceasta subetapS poate \line \up0 \expndtw0\charscalex117 facilita
\ul0\nosupersub\cf18\f19\fs20\ul inteleqerea\ul0\nosupersub\cf9\f10\fs20 bolii de
cStre medic, chiar dacS in \line \up0 \expndtw0\charscalex131 aparenfS are mai
pufinS valoare diagnostice. Se \line \up0 \expndtw0\charscalex127 investigheaze
inclusiv aspecte legate de dinamica \line \up0 \expndtw0\charscalex109 relafiilor
familiale/profesionale, functie de boala. prezen-\line \up0 \expndtw0\charscalex116
fa/evolutia diversilor factori psihocomportamentah de \line \up0
\expndtw0\charscalex110 rise \up0 \expndtw0\charscalex113 (fumat, alcool), cu
implicafii ulterioare in evolufia \line \up0 \expndtw0\charscalex106 bolii,
etc.);\par\pard\column \qj \li231\ri511\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex115 agendei de \up0 \expndtw0\charscalex106
lucru;\par\pard\qj \li236\ri505\sb8\sl-230\slmult0 \up0 \expndtw0\charscalex114
negocierea \line \up0 \expndtw0\charscalex111 unor\par\pard\qj \li231\ri367\sb7\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex117 aspecte de \line \up0
\expndtw0\charscalex117 detaliu sau \line \up0 \expndtw0\charscalex114 de
prioritnte\par\pard\ql \li7363\sb0\sl-253\slmult0 \par\pard\ql \li20\sb130\sl-
253\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf8\f9\fs22 PASUL
3\par\pard\qj \li29\ri757\sb0\sl-220\slmult0\tx246 \up0 \expndtw0\charscalex107
\ul0\nosupersub\cf9\f10\fs20 1. Interviu \line\tab \up0 \expndtw0\charscalex116
deschis:\par\pard\ql \li29\sb14\sl-230\slmult0 \up0 \expndtw0\charscalex106 -
relaxarea\par\pard\ql \li135\sb15\sl-230\slmult0 \up0 \expndtw0\charscalex106
pacientului:\par\pard\ql \li39\sb14\sl-230\slmult0 \up0 \expndtw0\charscalex110 -
descrierea\par\pard\qj \li144\ri523\sb0\sl-239\slmult0 \up0 \expndtw0\charscalex105
simptomelor \up0 \expndtw0\charscalex110 de cdtre\par\pard\ql \li135\sb1\sl-
226\slmult0 \up0 \expndtw0\charscalex105 pacient (liber);\par\pard\ql
\li29\sb21\sl-230\slmult0 \up0 \expndtw-2\charscalex100 -\up0
\expndtw0\charscalex110 1 descdrcarea\par\pard\qj \li140\ri481\sb0\sl-
244\slmult0 \up0 \expndtw0\charscalex106 emofionala a \line \up0
\expndtw0\charscalex107 pacientului\par\pard\qj \li7367\sb0\sl-240\slmult0
\par\pard\qj \li24\ri681\sb177\sl-240\slmult0\tx251 \up0 \expndtw0\charscalex116 2
Interviu \line\tab \up0 \expndtw0\charscalex109 focalizat:\par\pard\ql
\li44\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex109 - descriere\par\pard\qj
\li154\ri457\sb4\sl-244\slmult0 \up0 \expndtw0\charscalex108 suplimentara \up0
\expndtw0\charscalex106 simptome\par\pard\ql \li49\ri332\sb4\sl-
235\slmult0\fi110 \up0 \expndtw0\charscalex102 (controlatd); \line \up0
\expndtw0\charscalex103 \u9632? plasarea lor in\par\pard\qj \li144\ri721\sb0\sl-
242\slmult0\fi9 \up0 \expndtw0\charscalex105 contextul \line \up0
\expndtw0\charscalex111 general al \line \up0 \expndtw-2\charscalex100
bolii;\par\pard\qj \li44\ri779\sb4\sl-230\slmult0\tx174 \up0
\expndtw0\charscalex110 - testarea \line\tab \up0 \expndtw0\charscalex100
implicdrit\par\pard\qj \li144\ri457\sb16\sl-240\slmult0\fi19 \up0
\expndtw0\charscalex108 emotionale a \line \up0 \expndtw0\charscalex109 pacientului
230\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf9\f10\fs20 - testarea
implicarii emotionale a pacientului (dace nu a ape-\line \up0
\expndtw0\charscalex104 rut ca fiind deja evidente in etapa 2): se face intr-o
maniere \up0 \expndtw0\charscalex102 indirecte sau directs, functie de
disponibilitSfile de expresie \par\pard\qj \li1473\ri2524\sb0\sl-220\slmult0
\up0 \expndtw0\charscalex108 ale acestuia (de ex. se poate lolosi "autodezvSluirea"
("si \up0 \expndtw0\charscalex106 medicul a trait candva o situatie similars") sau
din contrS, \up0 \expndtw0\charscalex106 o intrebare directs, chiar provocatoare
("cum vS simflfi in \up0 \expndtw0\charscalex107 legaturS cu asta (acest
simptom) ?'. \par\pard\qj \li1070\ri2506\sb0\sl-220\slmult0\fi283 \up0
\expndtw0\charscalex120 OdatS expresia emofionae a pacientului verbalizate
\up0 \expndtw0\charscalex112 (mScar in parte), este necesar ca medicul se respecte
cateva \up0 \expndtw0\charscalex109 reguli, denumite sugestiv de Robert C. Smith
(1996) - NURS \up0 \expndtw0\charscalex113 (Naming Understanding, Respecting,
Supporting). Aceasta \up0 \expndtw0\charscalex110 ar insemna, in ordine: a)
recunoa?terea emofiei si precizarea \up0 \expndtw0\charscalex116 numelui ei; b)
streduinfa medicului de a arata pacientului \up0 \expndtw0\charscalex108 faptul
cS o infelege; c) cS o respects; d) cS este disponibil de \up0
\expndtw0\charscalex109 a acorda ajutorul, in orice forms posibilS. \par\pard\qj
\li1075\ri2483\sb211\sl-230\slmult0\fi297 \up0 \expndtw0\charscalex115 Fragment de
interviu destasurat. respectand NURS la o \up0 \expndtw0\charscalex114 pacientd la
care simptomele (durerile de cap) sunt asociate \up0 \expndtw0\charscalex115 cu
relafii deteriorate cu seful ierarhic (dupd R. C. Smith. \par\pard\ql
\li1123\sb1\sl-217\slmult0 \up0 \expndtw-5\charscalex100 1996):
\expndtw0\charscalex124 ( .)Dr.:\tab \up0 \expndtw0\charscalex124 Povestifi-mi
despre seful dvs.\tab \up0 \expndtw0\charscalex124 (medicul\par\pard\li1075\sb0\sl-
225\slmult0\fi0 \up0 \expndtw0\charscalex124 incurajeaza pacienta in direcfla
discutSrii unei probleme\par\pard\li1075\sb1\sl-214\slmult0\fi9 \up0
\expndtw0\charscalex124 personae aparent importante)\par\pard\qj
\li1084\ri2468\sb0\sl-217\slmult0\fi297 \up0 \expndtw0\charscalex107 P- Ei bine, a
lipsit pentru mai mult timp si eu l-am fnlocuit \up0 \expndtw0\charscalex115 in
aproape toate sarcinile de serviciu. A rdmas set doar cu \up0
\expndtw0\charscalex109 numele. Se plange de toatd lumea. Nimeni nu il place, si
nici \up0 \expndtw0\charscalex111 nu face mare lucru. De asta m-au si adus acolo.
Consiliul de \up0 \expndtw0\charscalex111 Administrate, ca sd redresez cumva
situafia. Durerile de cap \up0 \expndtw0\charscalex112 au inceput chiar atunci.
(Evident, pacienta pune in legStura \up0 \expndtw0\charscalex118 simptomele cu
situafla sa profesionala; in plus. oferS li� \up0 \expndtw0\charscalex115 ber
anumite intormafii suplimentare, eel vor ajuta pe me� \up0 \expndtw0\charscalex116
dic sa infeleaga mai bine aceasta legSturS). \par\pard\qj \li1084\ri2469\sb0\sl-
215\slmult0\fi297 \up0 \expndtw0\charscalex118 Dr.: Stall pufini Spunefi cd esto in
functie. dar de fapt \up0 \expndtw0\charscalex118 dumneavoastrd conducefi? (Medicul
rezuma din dorinfa \up0 \expndtw0\charscalex121 de a reconcentra atenfia pacientel
asupra situatiei, si nu \up0 \expndtw0\charscalex118 asupra simptomelor, ce au fost
deja descrise intr-un timp \up0 \expndtw0\charscalex116 anterior). \par\pard\qj
\li1099\ri2470\sb0\sl-220\slmult0\fi288 \up0 \expndtw0\charscalex120 P. intocmai.
Cine stie cat va dura asta... Numai de-as \up0 \expndtw0\charscalex112 rezista!
\up0 \expndtw0\charscalex126 (Pacienta revine la tonul personal, permifund \up0
\expndtw0\charscalex117 precizarea unor nuanfe foarte utile pentru medic).
\expndtw0\charscalex125 Dr. Sd rezistafi? (Ecou care va menfine discufla in \up0
\expndtw0\charscalex118 aceeasi arie. provocand-o pe pacients sS continue).
\line \tab \up0 \expndtw0\charscalex113 P: Nu stiu cat voi putea sd mai suport.
Spuneau ca no sd \up0 \expndtw0\charscalex109 am nici o problemd cu el, si cd o sd
fie cooperant. De fapt, la \up0 \expndtw0\charscalex110 inceput l-am pldcut. dar
mai apoi... \par\pard\ql \li1396\sb2\sl-207\slmult0\tx4876 \up0
\expndtw0\charscalex127 Dr.: "Spuneau"? Cine spuneau? \tab \up0
\expndtw0\charscalex129 (intreruperea are \par\pard\ql \li1108\sb6\sl-
216\slmult0 \up0 \expndtw0\charscalex119 menirea de a clarifica spusele
pacientel) \par\pard\qj \li1108\ri2455\sb9\sl-210\slmult0\fi292 \up0
\expndtw0\charscalex109 P: Consiliul. el conduce de fapt compania. Pozifia mea
nu \up0 \expndtw0\charscalex119 e mare lucru. dar la varsta mea funcfla care mi s-a
oferit \up0 \expndtw0\charscalex120 reprezinta o sansd buna do a mai acumula
experienfd, si \par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart Pg108}
230\slmult0\par\pard\li1771\sb73\sl-230\slmult0\fi0\tx2251\tx4790 \up0 \expndtw-
8\charscalex100 \ul0\nosupersub\cf9\f10\fs20 102\tab \up0
\ul0\nosupersub\cf3\f4\fs18 Elemente de psihosomaticS generae si
\ul0\nosupersub\cf9\f10\fs20 de a lucra intr-o Urma de prestigiu. (Pacienta
furnizeaza o \up0 \expndtw0\charscalex124 alts suma de date ce pot ajuta la
infelegerea mai bunS \up0 \expndtw0\charscalex119 a contextului). \par\pard\qj
\li1828\ri1745\sb17\sl-200\slmult0\fi287 \up0 \expndtw0\charscalex118 Dr. Se pare.
Consiliul v-a spus ceva la inceput, si mai \up0 \expndtw0\charscalex131 apoi v-a
lasat singura cu problema pe cap \up0 \expndtw0\charscalex109 (Medicul \par\pard\qj
\li1819\ri1770\sb40\sl-200\slmult0\fi9 \up0 \expndtw0\charscalex127 rezuma spusele
pacientel. pregStindu-se sS treacS la \up0 \expndtw0\charscalex122 etapa urmatoare)
\par\pard\ql \li2116\sb9\sl-214\slmult0 \up0 \expndtw0\charscalex116 P: Da. destul
de urat din partea lor. nu-i asa? \par\pard\qj \li1823\ri1775\sb22\sl-
220\slmult0\fi288 \up0 \expndtw0\charscalex116 Dr. Cum va simttfi in legdturd cu
asta?(Testare direc� \up0 \expndtw0\charscalex117 ts a implicarii emotionale).
\par\pard\ql \li2121\sb2\sl-218\slmult0 \up0 \expndtw0\charscalex114 P: Oh, nu
stiu. Eu am probleme cu capul. \par\pard\qj \li1828\ri1761\sb1\sl-220\slmult0\fi287
\up0 \expndtw0\charscalex113 Dr.: Bine, dar cum vd simfifi personal, afectiv,
emotio� \up0 \expndtw0\charscalex120 nal? (Retestare directa. monitorizand
permanent reactia \up0 \expndtw0\charscalex121 pacientel). \par\pard\qj
\li1843\ri1744\sb37\sl-200\slmult0\fi278 \up0 \expndtw0\charscalex113 P- Oh. nu ma
deranjeaza prea mult. Am fost invdfata sa \up0 \expndtw0\charscalex112 intorc si
celdtalt obraz. \par\pard\qj \li1833\ri1745\sb24\sl-220\slmult0\fi288 \up0
\expndtw0\charscalex120 Dr.: Stifi. un fost $ef de-al meu obisnuia sd se poarte
\up0 \expndtw0\charscalex121 cam in acelasi fel cu mine. Mi-a trebuit ceva timp sd-
mi\par\pard\sect\sectd\sbknone\cols2\colno1\colw7464\colsr110\colno2\colw1586\colsr
160\qj \li1828\ri0\sb1\sl-220\slmult0\fi4 \up0 \expndtw0\charscalex118 dau seama
cat de tare md deran/a de fapt comportamentul \up0 \expndtw0\charscalex121 Un
(Schimbarc de strategie. cu "autodezvaluire"; pentru \up0 \expndtw0\charscalex124 a
fi eficienta, trebuie sS fie scurta si precisS).\par\pard\qj \li2121\ri149\sb0\sl-
218\slmult0\fi4 \up0 \expndtw0\charscalex119 P: Ei bine, cred cd si eu sunt cam in
aceeasi situatie. \up0 \expndtw0\charscalex112 Dr.: Ce sim(i(i?\par\pard\qj
\li1823\ri0\sb5\sl-221\slmult0\fi297 \up0 \expndtw0\charscalex115 P: imi vine sd
arunc cu ceva in ei Md iniurie atat de ta� \up0 \expndtw0\charscalex115 re! Nu i-am
facut ntmic rdu. Muncesc cu adevdrat mult, iar \up0 \expndtw0\charscalex116
lucrurtle au inceput sa meargd mai bine, de cand sunt aco-\line \up0
\expndtw0\charscalex118 lo. Atunci cand ma infurii, apar si durerile de cap. Uneori
\up0 \expndtw0\charscalex117 am si greafd, si mi se pune o ceafd pe ochi. (Pacienta
face \up0 \expndtw0\charscalex120 acum o legStura mai precisa intre durerile de
cap, situa� \up0 \expndtw0\charscalex124 fia stresants si o anume stare
emofionala).\par\pard\ql \li1843\ri0\sb0\sl-217\slmult0\fi287\tx2126 \up0
\expndtw0\charscalex112 Dr.: Deci in principal simfifi furie. (Naming).
\line\tab \up0 \expndtw0\charscalex113 P: Da. md infurii cu adevdrat. Uneori ma
enervez atdt de \line \up0 \expndtw0\charscalex117 tare, cd-mi vine sd urlu.
(Strange pumnil).\par\pard\qj \li1833\ri0\sb8\sl-219\slmult0\fi292 \up0
\expndtw0\charscalex123 Dr.: E normal. Se pare ca aft incercat atat de mult sd
\line \up0 \expndtw0\charscalex115 ajutafi. ?i avefi parte doar de necazuri. E de
apreciat cd pu-\line \up0 \expndtw0\charscalex124 tefi vorbi atat de deschis despre
aceste lucrurt \up0 \expndtw0\charscalex104 (Under� \line \up0
\expndtw0\charscalex124 standing, Respecting)\par\pard\qj \li1828\ri0\sb16\sl-
219\slmult0\fi297 \up0 \expndtw0\charscalex124 P: Si acum. cand vorbesc despre
toate astea. simt cd \line \up0 \expndtw0\charscalex120 ma infurii. Pared md doare
deja capul (incS o data apare \up0 \expndtw0\charscalex123 evidentS relatia de
cauzalitate. chiar condlfionare. intre \line \up0 \expndtw0\charscalex125 situatie
si simptom).\par\pard\qj \li1852\ri0\sb8\sl-211\slmult0\fi278 \up0
\expndtw0\charscalex116 Dr.: Pot sd-mi imaginez. Afi trecut prin multe in ultima
\up0 \expndtw0\charscalex120 vreme. (Understanding, Respecting).\par\pard\qj
\li1843\ri0\sb8\sl-220\slmult0\fi292 \up0 \expndtw0\charscalex118 P: Stiff, de (apt
sunt mai supdrata pe nenomcitul dcela \line \up0 \expndtw0\charscalex116 de
Consiliu. decdt pe el. Nu mi-au spus nimic despre asta, \line \up0
\expndtw0\charscalex121 din contra, mi-au spus cd totui e in reguid. (Ca urmare
a \line \up0 \expndtw0\charscalex129 tehnicii adecvate de interviu, pacienta
prezinta acum \line \up0 \expndtw0\charscalex127 din proprie inifiatlva elemente cu
valoare emofionala \line \up0 \expndtw0\charscalex124 care intregesc tabloul
initial) \up0 \expndtw0\charscalex117 (...)\par\pard\column \ql
\li20\ri456\sb119\sl-235\slmult0\tx145 \up0 \expndtw-2\charscalex100 - \up0
\expndtw0\charscalex109 rezumat \line\tab \up0 \expndtw0\charscalex112
preliminar\par\pard\ql \li7579\sb0\sl-230\slmult0 \par\pard\ql \li7579\sb0\sl-
PASUL4 \par\pard\sect\sectd\fs24\paperw9300\paperh13220{\bkmkstart Pg109}{\bkmkend
Psihosomatica generala\tab \up0 \expndtw-7\charscalex100
\ul0\nosupersub\cf8\f9\fs22 \u9830? 103\par\pard\qj \li1200\sb0\sl-220\slmult0
220\slmult0\fi292 \up0 \expndtw0\charscalex120 \ul0\nosupersub\cf9\f10\fs20 De cele
mai multe ori, exprimarea de catre medic, in \up0 \expndtw0\charscalex124 plan
comportamental. a celor \up0 \expndtw0\charscalex129 4 reguli NURS se face
selectiv. neintruziv. in caz contrar putandu-se contura in \up0
\expndtw0\charscalex116 mintea pacientului ideea de manipulare sau de amestec in
\up0 \expndtw0\charscalex122 viata private. Dintre greselile cele mai frecvente,
pot fi \up0 \expndtw0\charscalex113 menfionate. pentru importanfa lor, tendinta
unor medici de \up0 \expndtw0\charscalex120 a "san' etapele, exprimand de ex..
simpatie si intelegere \up0 \expndtw0\charscalex124 fate de o situafie de viata pe
care nici nu au ascultat-o \up0 \expndtw0\charscalex124 pane la capSt ('). sau a
altora - de a amana la nesfarsit \up0 \expndtw0\charscalex121 atingerea aspectelor
emofionale. motivand aceasta prin \up0 \expndtw0\charscalex123 faptul ce nu au
calitafile necesare, pentru desfesurarea \up0 \expndtw0\charscalex119 intr-o
maniera mai personae, mai apropiate de bolnav. a \up0 \expndtw0\charscalex106
interviuiui \par\pard\qj \li1200\ri2379\sb0\sl-222\slmult0\fi297 \up0
\expndtw0\charscalex111 Realitatea este cS aceste cahtafi, dacS exists, se pot dez�
\up0 \expndtw0\charscalex111 volta numai prin antrenament. $\u8226? prin observarea
beneficiu-\line \up0 \expndtw0\charscalex121 lui pentru pacient. a descSrcSrii sale
emofionale. Nu in \up0 \expndtw0\charscalex111 ultimul rSnd. investigarea
statusului emofional al pacientu� \up0 \expndtw0\charscalex112 lui, legat de boala
sa. constituie o etapS prehminara obliga \up0 \expndtw0\charscalex111 torie in
instituirea oricSrei forme de psihoterapie (pe termen \up0 \expndtw0\charscalex113
scurt. eel mai reprezentativ caz este al psihoterapiei supor-\line \up0
\expndtw0\charscalex100 tive). \par\pard\qj \li1209\ri2379\sb0\sl-216\slmult0\fi292
\up0 \expndtw0\charscalex117 inainte de trecerea la faza anamnezei 'centrata pe me�
\up0 \expndtw0\charscalex102 dic" \up0 \expndtw0\charscalex116 (in care
desfasurarea interviuiui. distribufia de roluri \up0 \expndtw0\charscalex117 sunt
mult mai bine controlate do acesta). se face un scurt \up0 \expndtw0\charscalex114
rezumat preiiminar al celor atete, se venfica acuratefea da-\line \up0
\expndtw0\charscalex113 telor, se previne interlocutorul asupra schimberii de
regis� \up0 \expndtw0\charscalex114 try \par\pard\qj \li1507\ri2373\sb121\sl-
220\slmult0\tx1747 \up0 \expndtw0\charscalex121 4 OBTINEREA DE DATE PRECISE.
CONCRETE \line\tab \up0 \expndtw0\charscalex103 ASUPRA FIECARUI SIMPTOM
in aceastS faze, pornindu-se si de la relaxarea \up0 \expndtw0\charscalex136
emofionala induse prin descarcarea unei parfl din \up0 \expndtw0\charscalex121
tensiunea interioare a pacientului, se trece la analiza de \up0
\expndtw0\charscalex122 detaliu, profesionale, a fiecarui simptom, in ordinea de
\up0 \expndtw0\charscalex118 prioritefi alease de comun acord cu pacientul, in
etapa 2. \up0 \expndtw0\charscalex120 Se investigheaza, mai ales prin intreberi
inchise. o serie \up0 \expndtw0\charscalex118 intreaga de simptome somatice, care,
in contextul dat, se \up0 \expndtw0\charscalex114 pot incadra in categoriile de
tulburari/boli psihosomatice. \par\pard\qj \li1224\ri2349\sb183\sl-
240\slmult0\fi321 \up0 \expndtw0\charscalex136 Tulburari fiziopatologice dcclansate
de stimuli \up0 \expndtw0\charscalex116 psihici (dupa lamandescu. 1995)
\par\pard\ql \li1555\sb209\sl-230\slmult0 \up0 \expndtw0\charscalex130 ;
Respiratorii \par\pard\ql \li1963\sb1\sl-217\slmult0 \up0 \expndtw0\charscalex116 -
blocaj nazal sau salve de stranuturi \par\pard\ql \li1968\sb3\sl-217\slmult0
\up0 \expndtw0\charscalex115 - crize de tuse, dispnee � wheezing (astm)
hiperventilafie - crize tetaniforme \par\pard\ql \li1521\sb213\sl-230\slmult0
\up0 \expndtw0\charscalex125 2 Cardiovasculare: \par\pard\qj \li1968\ri2345\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex119 \u9632? tahicardie "emofionalS" z accese
de tahicardie \up0 \expndtw0\charscalex110 paroxisticS
\ul0\nosupersub\cf3\f4\fs18 104\tab \up0 \expndtw-2\charscalex100 \u9830?\tab
\up0 \expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs20 Elemente de psihosomaticS
generae si aplicata\par\pard\qj \li2625\sb0\sl-220\slmult0
\par\pard\qj\li2625\ri1708\sb2\sl-220\slmult0 \up0 \expndtw0\charscalex119 -
creseri tranzitorii ale TA, ocazionate de stimuli \up0 \expndtw0\charscalex109
psihici \par\pard\qj \li2625\ri2649\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex117
- hipotensiune artenala j stsri lipotimice \up0 \expndtw0\charscalex118 crize
anginoase \par\pard\qj \li2625\ri1708\sb0\sl-220\slmult0 \up0
\expndtw0\charscalex113 - tulburari de ritm (extrasistole supraventriculare ?i \up0
\expndtw0\charscalex110 ventriculare) \par\pard\ql \li2630\sb0\sl-180\slmult0
\up0 \expndtw0\charscalex109 - spasme coronariene "functionale" (sindrom Likotf)
\par\pard\li2198\sb4\sl-230\slmult0\fi0\tx2443 \up0 \expndtw-8\charscalex100 3.\tab
\up0 \expndtw0\charscalex114 Digestive:\par\pard\ql \li2635\sb1\sl-205\slmult0 \up0
\expndtw0\charscalex115 - cardiospasm, pilorospasm \par\pard\ql \li2635\sb7\sl-
215\slmult0 \up0 \expndtw0\charscalex115 - hipersecretie \par\pard\ql
\li2635\sb4\sl-217\slmult0 \up0 \expndtw0\charscalex113 - tulburSri de tranzit
(constipafie. diaree) \par\pard\ql \li2635\sb3\sl-217\slmult0 \up0
\expndtw0\charscalex113 - diskinezii (esofagiene, biliare) \par\pard\li2198\sb2\sl-
\expndtw0\charscalex114 Urogenitale:\par\pard\ql \li2625\sb0\sl-207\slmult0 \up0
\expndtw0\charscalex117 - disune, poliune. oligune \par\pard\ql
\li2203\ri3540\sb3\sl-220\slmult0\fi436\tx2635 \up0 \expndtw0\charscalex115 -
tulburSri de dinamicS sexuae \up0 \expndtw-8\charscalex100 5. \up0
\expndtw0\charscalex119 Endocrino-metabolice: \line \tab \up0
\expndtw0\charscalex107 \u9632? anorexie, bulimie \par\pard\ql \li2760\sb2\sl-
218\slmult0 \up0 \expndtw0\charscalex115 diabet zaharat (latent/manifest)
\par\pard\ql \li2635\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex114 - obezitate
\par\pard\ql \li2208\sb0\sl-197\slmult0\tx2448 \up0 \expndtw-2\charscalex100 6 \tab
\up0 \expndtw0\charscalex118 Dermatologlce \par\pard\ql \li2635\sb9\sl-
214\slmult0 \up0 \expndtw0\charscalex112 - tulburari vasomotorii (eritem,
paloare) \par\pard\ql \li2635\sb4\sl-217\slmult0 \up0 \expndtw0\charscalex115 -
erupfie urticariana sau angioedem \par\pard\ql \li2640\sb13\sl-
230\slmult0\tx3355 \up0 \expndtw0\charscalex106 - prurit \tab \up0
\expndtw0\charscalex116 (aparifie sau accentuare) \par\pard\ql \li2630\sb1\sl-
193\slmult0 \up0 \expndtw0\charscalex125 -tlush \par\pard\ql \li2208\sb17\sl-
230\slmult0\tx2452 \up0 \expndtw-9\charscalex90 7. \tab \up0
\expndtw0\charscalex118 Imunologice: \par\pard\ql \li2640\sb1\sl-193\slmult0
\up0 \expndtw0\charscalex112 - scSderea numarului de llmfocite T \par\pard\qj
\li2774\ri2453\sb5\sl-220\slmult0 \up0 \expndtw0\charscalex113 imunocompetente
(scaderea numSrului si \up0 \expndtw0\charscalex106 activitSfii celulelor NK)
\par\pard\ql \li2635\sb2\sl-218\slmult0 \up0 \expndtw0\charscalex114 - scSderea IgA
secretor \par\pard\ql \li2640\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex111 -
lazy leukocyte syndrome \par\pard\li2649\sb1\sl-226\slmult0\fi0\tx6897 \up0
\expndtw0\charscalex117 - vulnerabilitate crescuts la boll infecfioase\tab \up0
\expndtw0\charscalex117 si/sau\par\pard\li2649\sb1\sl-213\slmult0\fi115 \up0
\expndtw0\charscalex117 oncogenezS\par\pard\qj \li1905\ri1668\sb201\sl-
220\slmult0\fi292 \up0 \expndtw0\charscalex113 intrebanle "inchise", mult mai
abundente acum, vizeaze \up0 \expndtw0\charscalex116 aspecte precum: debutul
simptomului \up0 \expndtw0\charscalex123 (la ce date, brusc/ \par\pard\qj
\li1900\ri1669\sb24\sl-216\slmult0 \up0 \expndtw0\charscalex115 treptat), condifii
de apanfie/ameliorare/ agravare, caracte\up0 \expndtw0\charscalex113 rele
simptomului (loc de aparitie. intensitate (eventual pe o \up0
\expndtw0\charscalex115 scare de la 1 la 10), mobilitate. situare corporae (in
supra\up0 \expndtw0\charscalex114 fafa/profunzime), senzafle subiective (durere,
arsurS, infe\up0 \expndtw0\charscalex114 paturS, etc.), durate, frecvente. evolufie
in timp, concomi\up0 \expndtw0\charscalex122 tenfa altor simptome, gradul de
invaliditate/disabilitate \up0 \expndtw0\charscalex119 asociate, etc.
\par\pard\li1920\sb215\sl-230\slmult0\fi292\tx7617\tx7838 \dn2
\expndtw0\charscalex117 Cei 7 descriptor! ai simptomului (R. C. Smith, dupd\tab
\up0 \expndtw-9\charscalex88 1.\tab \up0 \expndtw0\charscalex117
Caracteris-\par\pard\li1920\sb1\sl-219\slmult0\fi4\tx4574\tx7838 \up0
\expndtw0\charscalex113 Morgan W.L.. Engel C. /..,\tab \up0 \expndtw0\charscalex117
1969 si Billings A. J., Stoeckle\tab \up0 \expndtw0\charscalex117 ticile
simp�\par\pard\li1920\sb1\sl-215\slmult0\fi0\tx2471\tx7843 \up0
\expndtw0\charscalex117 J.D.\tab \up0 \expndtw0\charscalex117 1989)\tab \dn4
\expndtw0\charscalex117 tomului\par\pard\li1920\sb1\sl-222\slmult0\fi331\tx7843
\up1 \expndtw0\charscalex117 i. localizare si inttndere\tab \dn3
\expndtw0\charscalex117 (localizare/\par\pard\li1920\sb1\sl-
219\slmult0\fi734\tx7847 \up0 \expndtw0\charscalex117 - precise/imprecise\tab
\dn4 \expndtw0\charscalex117
iradlere),\par\pard\li1920\sb1\sl-215\slmult0\fi739 \up0 \expndtw0\charscalex117 -
specifice/difuza\par\pard\li1920\sb0\sl-180\slmult0\fi5918 \up0
\expndtw0\charscalex117 calitate.\par\pard\ql \li2649\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex116 - profunde/superficiae
Pg111}\par\pard\sect\sectd\sbknone\cols2\colno1\colw6800\colsr160\colno2\colw2200\c
olsr160\ql \li993\sb0\sl-230\slmult0 \par\pard\ql \li993\sb217\sl-230\slmult0
\up0 \expndtw0\charscalex116 \ul0\nosupersub\cf9\f10\fs20 Psihosomatica
generae\par\pard\ql \li1343\sb0\sl-230\slmult0 \par\pard\ql \li1343\sb0\sl-
2. calitate:\par\pard\ql \li1790\sb0\sl-230\slmult0 \up0 \expndtw0\charscalex114
\u8226? foiosirea de termeni uzuali\par\pard\ql \li1795\sb1\sl-225\slmult0 \up0
\expndtw0\charscalex114 - foiosirea de termeni neobisnuifi\par\pard\ql
\li1353\sb1\sl-225\slmult0 \up0 \expndtw0\charscalex120 3. cantdate:\par\pard\ql
\li1785\sb1\sl-230\slmult0 \up0 \expndtw0\charscalex111 - tipul
debutului\par\pard\ql \li1785\sb0\sl-230\slmult0 \up0 \expndtw0\charscalex118 -
intensitate/severitate\par\pard\qj \li1795\ri2052\sb15\sl-220\slmult0 \up0
\expndtw0\charscalex116 \u8226? grad de invaliditate/handicap \up0
\expndtw0\charscalex115 \u8226? descriere numerice.\par\pard\ql \li2520\sb1\sl-
225\slmult0 \up0 \expndtw0\charscalex115 - numer de evenimente\par\pard\ql
\li2515\sb2\sl-230\slmult0 \up0 \expndtw0\charscalex113 - amploare\par\pard\ql
\li2510\sb1\sl-217\slmult0 \up0 \expndtw0\charscalex108 - volum\par\pard\ql
\li1348\sb4\sl-230\slmult0 \up0 \expndtw0\charscalex114 4.
cronologie:\par\pard\ql \li1800\sb0\sl-225\slmult0 \up0 \expndtw0\charscalex110 -
debutul \up0 \expndtw0\charscalex113 (data debutului)\par\pard\ql \li1790\sb2\sl-
230\slmult0 \up0 \expndtw0\charscalex113 - durata simptomului\par\pard\ql
\li1790\sb0\sl-230\slmult0 \up0 \expndtw0\charscalex112 - frecvenfe\par\pard\ql
\li1348\sb1\sl-225\slmult0 \up0 \expndtw0\charscalex117 5. condifii
asociate:\par\pard\ql \li1804\sb0\sl-225\slmult0 \up0 \expndtw0\charscalex115 -
pentru agravare\par\pard\ql \li1795\sb2\sl-230\slmult0 \up0 \expndtw0\charscalex115
- pentru ameliorare\par\pard\ql \li1353\sb0\sl-225\slmult0 \up0
\expndtw0\charscalex120 6. context de aparifie (la lucru. acase, la scoae,
etc.)\par\pard\ql \li1363\sb2\sl-230\slmult0 \up0 \expndtw0\charscalex117 7. alte
simptome asociate.\par\pard\qj \li1060\ri138\sb111\sl-224\slmult0\fi288 \up0
\expndtw0\charscalex112 Beneficiul Tntrebarilor "inchise" (abundenfa de
informa-\line \up0 \expndtw0\charscalex122 fu utile pentru medic) nu trebuie se
exclude eventualele \up0 \expndtw0\charscalex119 "rupen de ntm", in care pacientul
poate adeuga unele co-\line \up0 \expndtw0\charscalex117 mentarii, semniticative
din punctul sau de vedere.\par\pard\qj \li1055\ri138\sb4\sl-227\slmult0\fi297
\up0 \expndtw0\charscalex116 De asemenea. remarcile suportive ale medicului, fecute
\line \up0 \expndtw0\charscalex116 periodic, atmosfera generae de infelegere si
ceidurS emo� \line \up0 \expndtw0\charscalex113 fionala pot "umaniza"' o astfel de
fazS a interviuiui, care, in \line \up0 \expndtw0\charscalex116 alte condifii. ar
fi susceptibilS de a polariza relafia medic-\line \up0 \expndtw0\charscalex117
pacient (pans e aceea ca medicul sS joace rolul dominant, \line \up0
\expndtw0\charscalex120 iar pacientul sS se cantonoze intr-o perpetuS si
precautS \line \up0 \expndtw0\charscalex114 defensive).\par\pard\qj
\li1060\ri143\sb9\sl-220\slmult0\fi292 \up0 \expndtw0\charscalex113 In formularea
intreberilor (mai ales a celor inchise), tre� \line \up0 \expndtw0\charscalex119
buie se se finS seama si de o serie de exigente suplimen-\line \up0
\expndtw0\charscalex111 tare:\par\pard\qj \li1353\ri143\sb0\sl-
229\slmult0\tx1483 \up0 \expndtw0\charscalex114 - a se porni de la general spre
particular (ex. de e un sls-\line \tab \up0 \expndtw0\charscalex113 tem/aparat,
spre o anumitS arie somaticS, si nu invers).\par\pard\ql \li1353\sb1\sl-225\slmult0
\up0 \expndtw0\charscalex119 - a se lolosi intrebSri precise, nu confuze sau
excesive\par\pard\qj \li1478\ri128\sb0\sl-225\slmult0\fi9 \up0
\expndtw0\charscalex118 pnn complexitateintindere \up0 \expndtw0\charscalex112
(contraexemplu: "Afi avut \up0 \expndtw0\charscalex113 vreodatS dureri de cap,
amnezie, pierderea temporarS a \up0 \expndtw0\charscalex112 vederii sau
lesin?"):\par\pard\qj \li1363\ri128\sb1\sl-230\slmult0\tx1483 \up0
\expndtw0\charscalex116 - a se evita intrebSrile ce pot sugera raspunsul (de
tipul \line\tab \up0 \expndtw0\charscalex116 "Nu-i asa ce. .?" sau cele mai
subtile, care favorizeaze\par\pard\qj \li1473\ri134\sb0\sl-228\slmult0\fi4 \up0
\expndtw0\charscalex112 (nu neaparat impun) un anumit respuns (ex. "A fost mai \up0
\expndtw0\charscalex114 intai febra, sau frisonul?") (recomandae: 'Ce a fost mai
\up0 \expndtw0\charscalex110 intSi, febra sau frisonul?");\par\pard\qj
\li1368\ri127\sb0\sl-222\slmult0\tx1478\tx1488 \up0 \expndtw0\charscalex118 - a nu
se interpreta neselectiv spusele pacientului \up0 \expndtw0\charscalex101 (unii
\line\tab \up0 \expndtw0\charscalex111 pacienfi vin cu diagnostice prefabricate,
rod al propriilor \line \tab \up0 \expndtw0\charscalex114
interpreeri);\par\pard\column \ql \li7550\sb0\sl-230\slmult0 \par\pard\ql
242\slmult0\fi4 \up0 \expndtw0\charscalex115 cantitate, \line \up0
\expndtw0\charscalex113 cronologie. \line \up0 \expndtw0\charscalex111
condifii\par\pard\qj \li29\ri1159\sb0\sl-243\slmult0 \up0 \expndtw0\charscalex118
asociate, \line \up0 \expndtw0\charscalex115 context de \line \up0
\expndtw0\charscalex111 aparifie,\par\pard\qj \li34\ri1020\sb0\sl-243\slmult0
\up0 \expndtw0\charscalex108 alte simpto� \line \up0 \expndtw0\charscalex108
me)\par\pard\ql \li7046\sb0\sl-240\slmult0 \par\pard\ql \li7046\sb0\sl-
240\slmult0 \par\pard\ql \li92\ri966\sb152\sl-240\slmult0\fi14 \up0
\expndtw0\charscalex119 Deplasarea \line \up0 \expndtw0\charscalex119 centrului
\line \up0 \expndtw0\charscalex122 de greutate \line \up0 \expndtw0\charscalex110
al interviu� \line \up0 \expndtw0\charscalex120 iui spre\par\pard\ql \li96\sb13\sl-
230\slmult0 \up0 \expndtw0\charscalex116 medic\par\pard\ql \li7036\sb0\sl-
235\slmult0 \par\pard\ql \li7036\sb0\sl-235\slmult0 \par\pard\ql
\li96\ri1102\sb36\sl-235\slmult0 \up0 \expndtw0\charscalex115 Tehnica \line \up0
\expndtw0\charscalex116 formularii\par\pard\qj \li96\ri950\sb0\sl-
238\slmult0\fi9 \up0 \expndtw0\charscalex120 intreberilor \line \up0
\expndtw0\charscalex123 (mai ales a \line \up0 \expndtw0\charscalex120
celor\par\pard\ql \li101\sb16\sl-230\slmult0 \up0 \expndtw0\charscalex121
inchise) \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg112}
\up0 \expndtw0\charscalex107 Elomente de psihosomatica generae si
\par\pard\qj\li1977\ri1795\sb1\sl-220\slmult0 \up0 \expndtw0\charscalex123 - a nu
se interpreta datele cu voce tare, pe parcursul \up0 \expndtw0\charscalex105
recoltSrii lor \up0 \expndtw0\charscalex109 ("Ar putea fi apendicitS. Afi avut
cumva si \up0 \expndtw0\charscalex110 greats ?"); \par\pard\qj
\li1977\ri1774\sb9\sl-210\slmult0 \up0 \expndtw0\charscalex122 - a se acorda
atenfie tuturor simptomelor evocate de \up0 \expndtw0\charscalex110 pacient, intr-o
maniere echilibrate (si nu doar problemei \up0 \expndtw0\charscalex105 nr. 1 a
acestuia): \par\pard\qj \li1982\ri1794\sb2\sl-220\slmult0 \up0
\expndtw0\charscalex113 - a nu se formula intrebari care vizeaza aspecte
tehnice, \up0 \expndtw0\charscalex111 inaccesibile pacientului ("Ce v-au gasit e
ecografie?"); \par\pard\qj \li1972\ri1780\sb0\sl-220\slmult0 \up0
\expndtw0\charscalex113 - a nu abdica de la empatie ?i de la necesarul tact si
bun \up0 \expndtw0\charscalex111 simf, nici pe parcursul acestui gen de inlrebari
(eel mai \up0 \expndtw0\charscalex112 simplu este a ne intreba "Oare ce simte
pacientul, chiar \par\pard\ql \li2102\sb1\sl-195\slmult0 \up0
\expndtw0\charscalex110 in acest moment ?''). \par\pard\qj \li1684\ri1780\sb25\sl-
220\slmult0\fi283 \up0 \expndtw0\charscalex121 O anamneza mtehgent condusa poate
crea in aceasta \up0 \expndtw0\charscalex124 faze premisele pentru un diagnostic
fidel. si pentru un \up0 \expndtw0\charscalex111 tratament eficace. \up0
\expndtw0\charscalex115 0 regula de baza o constituie aceea de a \par\pard\ql
\li1689\sb2\sl-218\slmult0\tx7089 \up0 \expndtw0\charscalex113 fine seama, in
timpul interviuiui de raspunsunle primite, \tab \up0 \expndtw-7\charscalex100 ?i
\par\pard\qj \li1684\ri1780\sb21\sl-220\slmult0 \up0 \expndtw0\charscalex109 de a
modula fluxul intrebarilor functie de acestea (a se inves\up0
\expndtw0\charscalex113 tiga, de exemplu. pane la capat 'raspantule' in care un
sim� \up0 \expndtw0\charscalex110 ptom poate avea reievanfa pentru mai multe boli
(diagnostic \up0 \expndtw0\charscalex115
dilerenfial), sau a se tine seama nu numai de prezenfa, dar \up0
\expndtw0\charscalex110 Si de absenfa unui (sir de) simptom(e),
etc.\par\pard\sect\sectd\sbknone\cols2\colno1\colw7339\colsr110\colno2\colw1591\col
sr160\qj \li1684\ri0\sb16\sl-223\slmult0\fi292 \up0 \expndtw0\charscalex110 In
context psihosomatic, problema simptomului capate re-\line \up0
\expndtw0\charscalex117 levanta si prin necesara delimitare intre simptom veritabil
\line \up0 \expndtw0\charscalex110 (de precizat etiologia
exciusiv.'alternativ/sumativ psihogene), \line \up0 \expndtw0\charscalex112 Si
pseudosimptom (expresie de ex.. a conversiei isterice).\par\pard\qj
\li1680\ri0\sb1\sl-220\slmult0\fi297 \up0 \expndtw0\charscalex116 Investigand in
maniera amintita aspectele enunfate, dar \up0 \expndtw0\charscalex115 Si
manifestarea simptomului, chiar pe parcursul interviuiui \up0
\expndtw0\charscalex116 (ex. dispneea/falsa dispnee. durerea-falsa durere) \up0
\expndtw0\charscalex122 - aceste \line \up0 \expndtw0\charscalex113 diferenfe pot
fi sesizate.\par\pard\qj \li1680\ri3\sb6\sl-220\slmult0\fi292 \up0
\expndtw0\charscalex116 in ansamblu, apare mai ales necesare stabilirea unei
co-\line \up0 \expndtw0\charscalex112 relatn logice intre psihic $i somatic, cu
precizarea fine a sec-\line \up0 \expndtw0\charscalex115 venfelor temporale si a
dommantelor psihice sau somatice, \up0 \expndtw0\charscalex120 adiacente
lor\par\pard\qj \li1680\ri0\sb5\sl-222\slmult0\fi297 \up0 \expndtw0\charscalex126
De exemplu. depresia primare este susceptibie de a \line \up0
\expndtw0\charscalex119 genera un grad de imunodepresie (inclusiv prin asocierea
\line \up0 \expndtw0\charscalex111 unor factori psihocomportamentali de rise
(fumat, consum de \line \up0 \expndtw0\charscalex122 alcool. etc.)), dar s< direct,
fapt ce poate genera o boae/ \line \up0 \expndtw0\charscalex113 tulburare somatice
(vorbim in acest caz de o boala'tulburare \line \up0 \expndtw0\charscalex114
psihosomatica): aceasta, la randul ei, poate genera o reactie \line \up0
\expndtw0\charscalex113 secundare (de tip tulburare sornatopsihice). apta de a
agrava \line \up0 \expndtw0\charscalex108 situafia inifialS.\par\pard\qj
\li1689\ri0\sb5\sl-220\slmult0\fi278 \up0 \expndtw0\charscalex123 Jocul psihic-
somatic-psihic. agravarea prin feedback \line \up0 \expndtw0\charscalex117 pozitiv
a unor simptome psihice si.'sau somatice in cadrul \line \up0
\expndtw0\charscalex114 mai general al afectiunilor psihosomatice apar drept extrem
\line \up0 \expndtw0\charscalex121 de tipice. iar elucidarea, in mSsura
posibilului. a acestor \line \up0 \expndtw0\charscalex112 aspecte. in aceastS
etapS, apare drept extrem de importantS\par\pard\column \qj \li20\ri555\sb0\sl-
202\slmult0\tx179 \up0 \expndtw0\charscalex101 4 Distincfia \line\tab \up0
\expndtw-2\charscalex100 simptom-\par\pard\qj \li164\ri204\sb1\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex100 pseudosimp-\line \up0
\expndtw0\charscalex105 tom (cenesto-\line \up0 \expndtw0\charscalex102
patii,\par\pard\qj \li169\ri231\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex107
conversiune \line \up0 \expndtw0\charscalex109 isterica. etc.)\par\pard\ql
\li30\sb5\sl-230\slmult0 \up0 \expndtw0\charscalex113 5 Ipoteze cu\par\pard\qj
\li246\ri497\sb6\sl-235\slmult0 \up0 \expndtw0\charscalex108 privire la \up0
\expndtw0\charscalex108 relafia\par\pard\ql \li246\sb14\sl-207\slmult0 \up0
\expndtw0\charscalex124 \ul0\nosupersub\cf3\f4\fs18 psihic\par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 somatic\par\pard\qj \li7617\sb0\sl-231\slmult0
Formularea \line \up0 \expndtw0\charscalex107 unui model \line \up0
\expndtw0\charscalex106 etiopatogenic \line \up0 \expndtw0\charscalex111
specific\par\pard\qj \li193\ri531\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex107
cazului \line \up0 \expndtw0\charscalex110 respectiv
lsr160\ql \li1175\sb0\sl-230\slmult0 \par\pard\ql \li1175\sb154\sl-230\slmult0 \up0
\expndtw0\charscalex113 \ul0\nosupersub\cf9\f10\fs20 Psihosomatica
generala\par\pard\qj \li1233\sb0\sl-220\slmult0 \par\pard\qj \li1233\sb0\sl-
220\slmult0 \par\pard\qj \li1233\ri0\sb218\sl-220\slmult0\fi297 \up0
\expndtw0\charscalex111 5 PROBLEME LEGATE DE SANOGENEZA (STIL DE \up0 \expndtw-
2\charscalex100 VIATA. ATITUDINI FATA DE BOALA)\par\pard\qj \li1238\ri0\sb9\sl-
216\slmult0\fi288 \up0 \expndtw0\charscalex127 Adesea neglijate, aceste elemente
isi pun amprenta \line \up0 \expndtw0\charscalex110 asupra bolii. putand avea un
rol fundamental in etiopatogenie \up0 \expndtw0\charscalex112 (a opera asupra lor
echivaleaze cu o profilaxie primare). Dar \up0 \expndtw0\charscalex134 Si dace
boala s-a declansat, cunoasterea lor nu este \line \up0 \expndtw0\charscalex118
derizone. in masura in care medicul poate tenta profilaxia \up0
\expndtw0\charscalex109 recSderilor/recidivelor (profilaxie secundara).\par\pard\qj
\li1243\ri0\sb10\sl-216\slmult0\fi297 \up0 \expndtw0\charscalex114 Interviul clinic
trebuie sS stabileascS existenfa anumitor \line \up0 \expndtw0\charscalex110
practici \up0 \expndtw0\charscalex120 (obiceiun, vicii) cu rol potential daunator
asupra \line \up0 \expndtw0\charscalex110 demersului terapeutic; sa clarifice modul
in care pacientul i$i \line \up0 \expndtw0\charscalex110 verities \up0
\expndtw0\charscalex115 (daca o face) sanatatea. S" raportul pe care il are in
\line \up0 \expndtw0\charscalex126 general cu institufia medicae; sa evidenfieze
existenfa \line \up0 \expndtw0\charscalex121 practicilor terapeutice alternative,
sau apelul simultan la \line \up0 \expndtw0\charscalex122 medicina alopate si
neconvenfionae, se precizeze \up0 \expndtw0\charscalex109 (chiar \line \up0
\expndtw0\charscalex113 printr-o intrebare deschise, simple, de genul: "Spuneti-mi
ce \line \up0 \expndtw0\charscalex117 lacefi in general pentru a va menfine
sanatatea") existenta \line \up0 \expndtw0\charscalex115 conduitelor
prosanogenetice; sa aduce informafii utile. mai \line \up0 \expndtw0\charscalex118
ales in perspectiva unui tratament de lungS durata, despre \line \up0
\expndtw0\charscalex121 gradul in care pacientul ar respecta \up0
\expndtw0\charscalex122 (si cum ar respecta) \line \up0 \expndtw0\charscalex111
indicafiiie terapeutice.\par\pard\ql \li1540\sb186\sl-253\slmult0 \up0 \expndtw-
7\charscalex100 \ul0\nosupersub\cf8\f9\fs22 6. ANTECEDENTE\par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 Desi unele date care tin de antecedentele
semnificative in \line \up0 \expndtw0\charscalex117 contextul bolii pot fi obtmute
incS din etapele precedente, \line \up0 \expndtw0\charscalex129 alocarea unui timp
special pentru ciarificarea tuturor \line \up0 \expndtw0\charscalex114
aniecedentelor \up0 \expndtw0\charscalex115 (fiziologice, patologice, heredo-
colaterale) \line \up0 \expndtw0\charscalex119 ale bolnavului este in continuare, o
etapS indispensabilS. \line \up0 \expndtw0\charscalex118 Unele puncte trebuie
neapSrat atinse, si notate in foaia de \line \up0 \expndtw0\charscalex116
observatie:\par\pard\qj \li1555\ri0\sb0\sl-216\slmult0\tx1675 \up0
\expndtw0\charscalex110 - spitalizari \up0 \expndtw0\charscalex114 (tipul de
mternaro: pentru o problema acute/ \line\tab \up0 \expndtw0\charscalex120 cromce.
chirurgicae \up0 \expndtw0\charscalex114 (inclusiv obstetricalS)/nu.
pentru\par\pard\qj \li1684\ri0\sb0\sl-219\slmult0 \up0 \expndtw0\charscalex112
recuperare, etc.); imbolnaviri. accidonte, incidente, pro-\line \up0
\expndtw0\charscalex117 cedun terapeuiice (inclusiv psihoterapie);\par\pard\ql
\li1555\sb0\sl-215\slmult0 \up0 \expndtw0\charscalex117 - noli semnificative ca
afectiuni cardiovasculare, ulcer,\par\pard\qj \li1684\ri0\sb0\sl-216\slmult0
\up0 \expndtw0\charscalex120 reumatism, TBC. cancer, hipertensiune arteriae,
dia-\line \up0 \expndtw0\charscalex114 bet zaharat, etc , eventual amanunte legate
de evolufie, \line \up0 \expndtw0\charscalex115 tratamente urmate, controale (mai
ales in ultimul an);\par\pard\ql \li1555\sb0\sl-211\slmult0 \up0
\expndtw0\charscalex118 - insusirea sau renunfarea la unii factori
psihocompor-\par\pard\qj \li1684\ri0\sb5\sl-211\slmult0 \up0
\expndtw0\charscalex120 tamentali de rise (consumul de alcool, fumat, etc.) si \up0
\expndtw0\charscalex117 motivele aeestei decizh.\par\pard\qj \li1560\ri0\sb7\sl-
215\slmult0\tx1684 \up0 \expndtw0\charscalex121 - alergii s> reacfii toxice la
medicamenle \up0 \expndtw0\charscalex117 (inclusiv in \line\tab \up0
\expndtw0\charscalex116 cadrul tentativelor de sinucidere);\par\pard\qj
\li1555\ri0\sb0\sl-219\slmult0\tx1694 \up0 \expndtw0\charscalex112 - medicamente
"anodine", "de uz curent" gen anticoncep-\line \tab \up0 \expndtw0\charscalex125
fionale. vitamme, tonice. antialgice, tranchilizante\par\pard\ql \li1694\sb0\sl-
215\slmult0 \up0 \expndtw0\charscalex117 minore (r dependenfa fizica.'psihica de
acestea):\par\pard\ql \li1569\sb1\sl-215\slmult0 \up0 \expndtw-2\charscalex100 -
\up0 \expndtw0\charscalex123 (pentru femei): menarha, durata ciclului
menstrual.\par\pard\qj \li1694\ri0\sb0\sl-216\slmult0\fi4 \up0
\expndtw0\charscalex121 tulDureri legate de acesta, nr. de sarcini, de avorturi
\up0 \expndtw0\charscalex115 spontane/provocate, evolufia eventualelor
sarcini.\par\pard\column \ql \li7761\sb0\sl-230\slmult0 \par\pard\ql
\li831\sb154\sl-230\slmult0 \up0 \expndtw0\charscalex112 \u9830?
107\par\pard\ql \li6950\sb0\sl-253\slmult0 \par\pard\ql \li6950\sb0\sl-253\slmult0
\ul0\nosupersub\cf8\f9\fs22 PASUL 5\par\pard\qj \li30\ri813\sb9\sl-
244\slmult0\tx241 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf9\f10\fs20 1
conduite sa-\line \tab \up0 \expndtw0\charscalex107 nogenetice\par\pard\qj
\li231\ri661\sb0\sl-245\slmult0 \up0 \expndtw0\charscalex106 cu vocafie de \up0
\expndtw0\charscalex102 profilaxie:\par\pard\ql \li370\sb3\sl-230\slmult0 \up0
\expndtw0\charscalex103 - primara;\par\pard\ql \li370\sb15\sl-230\slmult0 \up0
\expndtw0\charscalex101 - secundara.\par\pard\ql \li20\sb19\sl-230\slmult0 \up0
\expndtw0\charscalex113 2 raportul cu\par\pard\ql \li231\ri983\sb6\sl-
235\slmult0\fi9 \up0 \expndtw0\charscalex108 instufia \line \up0
\expndtw0\charscalex105 medicala:\par\pard\qj \li25\ri742\sb0\sl-
243\slmult0\tx246 \up0 \expndtw0\charscalex110 3 pozifia fafa \line\tab \up0
\expndtw0\charscalex107 de medicina\par\pard\qj \li231\ri725\sb4\sl-235\slmult0
\up0 \expndtw0\charscalex109 tradifionala/ \line \up0 \expndtw0\charscalex107
alternative,\par\pard\ql \li30\sb14\sl-230\slmult0 \up0 \expndtw0\charscalex114 4
apelul la\par\pard\ql \li236\ri730\sb6\sl-242\slmult0 \up0 \expndtw0\charscalex108
medicina \line \up0 \expndtw0\charscalex107 tradifionala/ \line \up0
\expndtw0\charscalex105 alternative;\par\pard\ql \li39\sb8\sl-230\slmult0 \up0
\expndtw0\charscalex106 5. evaluarea\par\pard\qj \li236\ri727\sb5\sl-237\slmult0
\up0 \expndtw0\charscalex110 estimative a \line \up0 \expndtw0\charscalex105
complianfei \line \up0 \expndtw0\charscalex108 terapeutice.\par\pard\ql
\expndtw0\charscalex101 \ul0\nosupersub\cf8\f9\fs22 PASUL 6\par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 1 ciarificarea \line \up0 \expndtw0\charscalex106
antecedentelor \line \up0 \expndtw0\charscalex104 semnificative \line \up0
\expndtw-1\charscalex100 (fiziologice, pa� \line \up0 \expndtw0\charscalex103
tologice. here-\line \up0 \expndtw0\charscalex106 docolaterale)\par\pard\ql
\li44\sb4\sl-230\slmult0 \up0 \expndtw0\charscalex113 2 analiza\par\pard\ql
\li54\sb5\sl-230\slmult0 \up0 \expndtw0\charscalex105 calitative a\par\pard\qj
\li49\ri679\sb0\sl-242\slmult0 \up0 \expndtw0\charscalex106 antecedentelor \line
\up0 \expndtw0\charscalex104 (spitalizari tra� \line \up0 \expndtw0\charscalex104
tamente, reactii \line \up0 \expndtw0\charscalex104 alergice/toxice, \line \up0
\expndtw0\charscalex104 accidente.\par\pard\qj \li58\ri717\sb0\sl-238\slmult0
\up0 \expndtw0\charscalex101 proceduri tera� \up0 \expndtw0\charscalex105
peutice \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg114}{\bkmkend
\dn2 \expndtw0\charscalex107 \ul0\nosupersub\cf18\f19\fs20\ul Elemente de
psihosomatica generae si aplicata\par\pard\li1281\sb0\sl-
In context psihosomatic, in aceaste etapa putem obfine\tab \dn2
neconventionale\par\pard\sect\sectd\sbknone\cols2\colno1\colw6909\colsr60\colno2\co
lw2071\colsr160\qj \li1281\ri0\sb0\sl-220\slmult0\fi4 \up0 \expndtw0\charscalex115
acele "verigi hpsa" care umplu golul de mformafie necesar \up0
\expndtw0\charscalex116 pentru a contura un model etiopatogonic viabil al bolii. Se
\up0 \expndtw0\charscalex120 insiste asupra factorului psihic (dace el exists) in
geneza \up0 \expndtw0\charscalex112 anumitor boli din trecut sau in motivarea
anumitor compor� \up0 \expndtw0\charscalex120 tamente (ex. evitarea prezentSrn la
medic, administrarea \up0 \expndtw0\charscalex115 de
anticoncepfionale).\par\pard\qj \li1281\ri0\sb0\sl-222\slmult0\fi292 \up0
\expndtw0\charscalex113 Deoarece cercul vicios de tipul factor etiologic psihic
(� \line \up0 \expndtw0\charscalex113 al(i triggeri) \up0 \expndtw0\charscalex115
-> boala psihosomaticS -\u9830? agravarea simpto� \line \up0
\expndtw0\charscalex113 mului psihic (+ aparifia altor simptome noi) se constituie
in \line \up0 \expndtw0\charscalex118 timp. in etapa 6 putem alia o serie intreagS
de evenimen-\line \up0 \expndtw0\charscalex116 te/circumstanfe din trecut care
pledeazS pentru boala psi� \line \up0 \expndtw0\charscalex118 hosomatica actuae, $i
ofera s1 explicafii pentru aceasta\par\pard\qj \li1569\sb0\sl-215\slmult0
\par\pard\qj \li1569\ri0\sb5\sl-215\slmult0\tx1819 \up0 \expndtw0\charscalex105 7.
RELATII SOCIALE $1 FAMILIALE ALE PACIENTU� \line\tab \up0 \expndtw0\charscalex106
LUI. SUPORT SOCIAL\par\pard\qj \li1281\ri0\sb0\sl-224\slmult0\fi292 \up0
\expndtw0\charscalex126 in evolufia difentelor tulburan.'boll psihosomatice.
\line \up0 \expndtw0\charscalex118 aceasta dimensiune poate avea o dubie
importantS:\par\pard\qj \li1579\ri0\sb5\sl-215\slmult0\tx1708 \up0
\expndtw0\charscalex115 - poate crea climatui propice pentru aparitia lor (intra in
\line\tab \up0 \expndtw0\charscalex120 categona factorilor pe care n denumim
generic "me-\par\pard\qj \li1699\ri0\sb10\sl-216\slmult0 \up0
\expndtw0\charscalex116 diu", si ii opunem. nu intotdeauna justificat. la
dimen-\line \up0 \expndtw0\charscalex118 siunea genetica,
ereditara).\par\pard\qj \li1569\ri0\sb11\sl-215\slmult0\tx1703 \up0
\expndtw0\charscalex119 - poate permanentiza evolufia acestor entitSfl nosolo-\line
\tab \up0 \expndtw0\charscalex116 gice. pnn fenomer.e ca lipsa de suport social,
presiuni\par\pard\qj \li1699\ri0\sb3\sl-213\slmult0\fi264 \up0
\expndtw0\charscalex117 sensul reducerii complianfei terapeutice, susfinerii
\up0 \expndtw0\charscalex118 anumitor lacton psihocomportamentali de rise penlru
\up0 \expndtw0\charscalex118 pacient, etc.\par\pard\qj \li1271\ri0\sb13\sl-
214\slmult0\fi292 \up0 \expndtw0\charscalex124 a) in ce priveste relafnie
pacientului cu microgrupul \line \up0 \expndtw0\charscalex119 familial, dincolo de
investigarea prezenfei anumitor boh. \up0 \expndtw0\charscalex127 cu determinism
genetic important sau cu rise mare de \line \up0 \expndtw0\charscalex115
transmitere (ex. boli cardiovascular^, diabet. cancer, TBC. \up0
\expndtw0\charscalex117 astm bron$ic, unele boli psihice. in special psihoze), si
de \up0 \expndtw0\charscalex122 incercarea de a structure un arbore genealogic,
medicul \line \up0 \expndtw0\charscalex126 trebuie sa se concentreze asupra
anumitor vanabile de \line \up0 \expndtw0\charscalex116 ordin psihologie.
importante in acest context:\par\pard\qj \li1574\ri0\sb7\sl-215\slmult0\tx1703 \up0
\expndtw0\charscalex115 - struclura mteracfiunilor familiale (competifie.
coeziu-\line \tab \up0 \expndtw0\charscalex118 ne, dependents, conflicte,
etc.),\par\pard\qj \li1569\ri0\sb18\sl-206\slmult0\tx1713 \up0
\expndtw0\charscalex110 - climat familial \up0 \expndtw0\charscalex113 (dominat de
afectiune, ostilitate. Indife-\line \tab \up0 \expndtw0\charscalex118 renfa. s a
\up0 \expndtw-9\charscalex83 ),\par\pard\qj \li1574\ri0\sb8\sl-
215\slmult0\tx1713 \up0 \expndtw0\charscalex119 - existenfa/Sbsenta suportului
social \up0 \expndtw0\charscalex121 (de tip material, \line\tab \up0
\expndtw0\charscalex115 informational, afectiv) (cf. lamandescu, \up0 \expndtw-
4\charscalex100 1995);\par\pard\ql \li1579\sb1\sl-215\slmult0 \up0
\expndtw0\charscalex114 - raportul memonior familiei cu boala pacientului,
odata\par\pard\ql \li1703\sb1\sl-215\slmult0 \up0 \expndtw0\charscalex117 apSrute
(spnjin. margmalizare. sancfionare);\par\pard\ql \li1579\sb0\sl-211\slmult0 \up0
\expndtw0\charscalex114 - presiuni in direcfia cresterii.scSderli complianfei
tera�\par\pard\ql \li1718\sb0\sl-211\slmult0 \up0 \expndtw0\charscalex116
peutice\par\pard\qj \li1291\ri0\sb0\sl-219\slmult0\fi292 \up0
\expndtw0\charscalex119 in decursul anamnezei, ponderea acordate investigaril \line
\up0 \expndtw0\charscalex120 acestor aspecte variaza, funcfie si de stilul cognitiv
$i de \line \up0 \expndtw0\charscalex114 tipul de coping predominant al
pacientului. De exemplu. se \line \up0 \expndtw0\charscalex116 poate presupune ca
pacienfii cu loc de control intern (care \line \up0 \expndtw0\charscalex128 afirme
si cred ca "sta in puterea lor" sa face fate unei\par\pard\column \ql
\li20\sb19\sl-230\slmult0 \up0 \expndtw0\charscalex120 etc)\par\pard\ql
\li20\ri660\sb10\sl-237\slmult0 \up0 \expndtw0\charscalex112 3 contribute \up0
\expndtw0\charscalex106 suplimentare la \up0 \expndtw0\charscalex107
elaborarea\par\pard\ql \li25\sb4\sl-230\slmult0 \up0 \expndtw0\charscalex102
modelului\par\pard\ql \li30\sb20\sl-230\slmult0 \up0 \expndtw0\charscalex106
etiopatogenic\par\pard\ql \li6988\sb0\sl-253\slmult0 \par\pard\ql \li6988\sb0\sl-
253\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf8\f9\fs22 PASUL
7\par\pard\qj \li7055\sb0\sl-240\slmult0 \par\pard\qj \li7055\sb0\sl-240\slmult0
\expndtw0\charscalex102 \ul0\nosupersub\cf9\f10\fs20 1. context \line\tab \up0
\expndtw0\charscalex102 familial\par\pard\ql \li97\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex104 - boll cu\par\pard\qj
\li198\ri823\sb10\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex109 transmitere
\line \up0 \expndtw0\charscalex107 ereditara,\par\pard\ql \li92\sb14\sl-230\slmult0
\up0 \expndtw0\charscalex104 - arbore\par\pard\ql \li203\sb15\sl-230\slmult0
\up0 \expndtw0\charscalex114 genealogic\par\pard\ql \li87\sb10\sl-230\slmult0
\up0 \expndtw0\charscalex102 - dinamica\par\pard\qj \li198\ri625\sb0\sl-
244\slmult0\fi9 \up0 \expndtw-1\charscalex100 relafiilor intra-\line \up0 \expndtw-
1\charscalex100 tamiliale;\par\pard\ql \li97\ri1122\sb0\sl-240\slmult0\tx212
\up0 \expndtw0\charscalex112 -climat \line\tab \up0 \expndtw0\charscalex101
familial:\par\pard\ql \li97\sb3\sl-230\slmult0 \up0 \expndtw0\charscalex108 \u8226?
suport social,\par\pard\ql \li97\sb15\sl-230\slmult0 \up0 \expndtw0\charscalex107 -
raportul cu\par\pard\ql \li212\sb5\sl-230\slmult0 \up0 \expndtw0\charscalex102
boala;\par\pard\qj \li97\ri781\sb15\sl-230\slmult0\tx217 \up0
\expndtw0\charscalex114 - contribute \line\tab \up0 \expndtw0\charscalex104
diferenfiata,\par\pard\qj \li207\ri954\sb6\sl-240\slmult0 \up0
\expndtw0\charscalex105 funcfie de \line \up0 \expndtw0\charscalex108 tipul de
\line \up0 \expndtw0\charscalex104 boala.\par\pard\ql \li212\sb19\sl-230\slmult0
\up0 \expndtw0\charscalex107 prognostic.
generae\par\pard\qj \li984\sb0\sl-215\slmult0 \par\pard\qj \li984\sb0\sl-
215\slmult0 \par\pard\qj \li984\sb0\sl-215\slmult0 \par\pard\qj \li984\ri0\sb21\sl-
215\slmult0 \up0 \expndtw0\charscalex121 situafii stresante ca boala) au un grad de
autonomie mai \up0 \expndtw0\charscalex114 mare in raport cu mediul familial, si
anumite intervenfii ale \up0 \expndtw0\charscalex118 familiei pot fi percepute ca
agresionante, agasante.\par\pard\qj \li988\ri0\sb2\sl-221\slmult0\fi292 \up0
\expndtw0\charscalex116 Invers. cei cu 'loc de control extern", care tind in
gene� \line \up0 \expndtw0\charscalex116 ral sS proiecteze in afara cauza
suferinfei lor. si sS a$tepte \line \up0 \expndtw0\charscalex114 rezolvari. mai
degrabS decat sS le caute, vor fi mai suscep-\line \up0 \expndtw0\charscalex118
tibtll la interventia factorului familial, si 'a dependenta de \line \up0
\expndtw0\charscalex108 familie.\par\pard\qj \li984\ri0\sb2\sl-225\slmult0\fi292
\up0 \expndtw0\charscalex106 in acest context particular, o intervenfie
neindemanaticS din \up0 \expndtw0\charscalex108 partea membrilor familiei poate
avea consecinfe importante.\par\pard\qj \li979\ri0\sb0\sl-218\slmult0\fi297 \up0
\expndtw0\charscalex128 Desigur, se poate pune problema mecanismului de \line
\up0 \expndtw0\charscalex130 reintarire pozitiva/negative. care poate
crea/diminua \line \up0 \expndtw0\charscalex126 dependenta de familie. Sesizarea
acestor feedback-uri \line \up0 \expndtw0\charscalex123 pozitive trebuie exploatatS
inteligent de catre medic, in \line \up0 \expndtw0\charscalex121 sensul favorizem
unei tendmfe sau alteia. in raport �i de \line \up0 \expndtw0\charscalex114 tipul
de boala a pacientului $' de prognostici.il acesteia (ox. \line \up0
\expndtw0\charscalex117 la un alcoolic cirotic, un relativ control din partea
familiei \line \up0 \expndtw0\charscalex117 (chiar daca perceput ca dependenta de
cetre bolnav) poate \line \up0 \expndtw0\charscalex119 fi benefic pentru evolufia
bolii, evident daca bolnavul nu \line \up0 \expndtw0\charscalex114 provme dmtr-o
familie de alcoolici: in caz contrar, medicul \line \up0 \expndtw0\charscalex117 va
favonza. atat cat este posibil tendinfele spre autonomie \line \up0
\expndtw0\charscalex119 ale pacientului. va intan relatia transferenfiae,
etc.).\par\pard\qj \li988\ri0\sb7\sl-216\slmult0\fi288 \up0 \expndtw0\charscalex127
Judecarea liecarui caz este nuanfats. punandu-se in \line \up0
\expndtw0\charscalex128 balanta tofi acesti factori, urmSrindu-se beneficiul pe
\line \up0 \expndtw0\charscalex116 termen lung al pacientului. in general,
foiosirea familiei ca \up0 \expndtw0\charscalex115 aliat terapeutic constituie un
factor important in restabilire. \up0 \expndtw0\charscalex136 Si-1 poate degreva pe
medic de o serie intreaga de \line \up0 \expndtw0\charscalex116 responsabiiitati
suplimentare.\par\pard\qj \li984\ri0\sb0\sl-218\slmult0\fi302 \up0
\expndtw0\charscalex123 b'l Dinamica relafiilor sociale poate Ii importantS in
\line \up0 \expndtw0\charscalex115 etiopatogenia anumitor boli (cu o menfiune
specials pentru \line \up0 \expndtw0\charscalex120 cele la care anumifi lacton
psihocornportamentali de rise \line \up0 \expndtw0\charscalex131 a'j o contnhufie
importanta) Grupul de apartenenfS, \line \up0 \expndtw0\charscalex116 ai.Hirajul
pacientului pot favonza (sau nu) comportamente \line \up0 \expndtw0\charscalex126
de tip regresiv. pot se aibe inlluente divergente asupra \line \up0
\expndtw0\charscalex118 complianfei terapeutice, pot fi responsabile de o parte din
\line \up0 \expndtw0\charscalex116 recaderi/recidive (un ex sugestiv - bolnavul
toxicoman)\par\pard\qj \li993\ri0\sb0\sl-219\slmult0\fi288 \up0
\expndtw0\charscalex127 in stranse relatie cu problematica relafiilor sociale.
\line \up0 \expndtw0\charscalex119 mdicii de calitate a viefii otere o imagine
asupra inserfiei \up0 \expndtw0\charscalex124 individului la nivel micro si
macrogrupal, cat si asupra \line \up0 \expndtw0\charscalex116 coniortului seu
biologic si psihologie\par\pard\qj \li993\ri0\sb0\sl-204\slmult0\fi297 \up0
\expndtw0\charscalex118 Desi concentrarea asupra acestor elemente poate parea \line
\up0 \expndtw0\charscalex119 prezumfioasa la primul contact cu bolnavul. ea trebuie
se \line \up0 \expndtw0\charscalex127 ramane o preocupare a medicului. Fie sub
forma unui \line \up0 \expndtw0\charscalex126 chestionar scurt. de \up0
\expndtw0\charscalex121 10-12 intrebari. fie sub forma unor \line \up0
\expndtw0\charscalex118 intrebari deschise, formulate in a$a fel incat se
favorizeze \line \up0 \expndtw0\charscalex119 desteinuinle pacientului, atingerea
acestor aspecte (inclu-\line \up0 \expndtw0\charscalex114 zanrl aici s> nivelul de
trai. venitul. raportul aspirafii/ posi-\line \up0 \expndtw0\charscalex118
bilitafi. lerarhia motivafionaia, gradul de satisfacere a ne-\line \up0
\expndtw0\charscalex122 voilor psihologice fundamentae \up0 \expndtw0\charscalex120
(securitate emotionale, \line \up0 \expndtw0\charscalex120 afiliere. noutate) apare
drept extrem de necesarS. cu atSt\par\pard\column \ql \li7492\sb0\sl-230\slmult0
\u8226?:\u8226? \tab \up0 \expndtw-6\charscalex100 109\par\pard\ql \li6854\sb0\sl-
242\slmult0 \par\pard\ql \li6854\sb0\sl-242\slmult0 \par\pard\ql
\li169\ri833\sb169\sl-242\slmult0 \up0 \expndtw0\charscalex110 stilul cognitiv'
\line \up0 \expndtw0\charscalex100 al pacientu� \line \up0 \expndtw-6\charscalex100
lui;\par\pard\ql \li174\sb3\sl-230\slmult0 \up0 \expndtw0\charscalex105
obiectiv\par\pard\qj \li169\ri919\sb4\sl-244\slmult0 \up0 \expndtw0\charscalex100
general: fami� \up0 \expndtw0\charscalex108 lia, ca aliat \up0
\expndtw0\charscalex108 terapeutic\par\pard\ql \li6705\sb0\sl-230\slmult0
\par\pard\ql \li25\sb47\sl-230\slmult0\tx246 \up0 \expndtw-2\charscalex100 2\tab
\up0 \expndtw0\charscalex110 context\par\pard\ql \li250\sb6\sl-230\slmult0 \up0
\expndtw0\charscalex111 socia.\par\pard\ql \li20\ri1036\sb10\sl-
235\slmult0\tx160 \up0 \expndtw0\charscalex111 - grupul de \line\tab \up0
\expndtw0\charscalex110 apartenenfa,\par\pard\ql \li150\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex108 anturaj:\par\pard\ql \li35\sb15\sl-230\slmult0 \up0
\expndtw0\charscalex111 - calitatea\par\pard\qj \li155\ri881\sb0\sl-242\slmult0\fi4
\up0 \expndtw0\charscalex100 viefii \up0 \expndtw0\charscalex103 (venit. \line \up0
\expndtw0\charscalex110 raport aspira-\line \up0 \expndtw0\charscalex106
fii/posibilltafi, \line \up0 \expndtw0\charscalex109 ierarhie\par\pard\qj
\li155\ri905\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex119 motivational \line
\up0 \expndtw0\charscalex118 etc);
\dn2 \expndtw0\charscalex105 lente de psihosomatica gunerala si
230\slmult0\par\pard\li1660\sb203\sl-230\slmult0\fi9\tx7329 \dn2
\expndtw0\charscalex121 mai niuit cu cat o intreaga strategie terapeutica poate
fi\tab \up0 \expndtw0\charscalex121 - tip
particular\par\pard\sect\sectd\sbknone\cols2\colno1\colw7289\colsr40\colno2\colw171
1\colsr160\ql
\li1660\sb1\sl-194\slmult0 \up0 \expndtw0\charscalex119 astfel pusa in miscare
(sau anula\par\pard\qj \li1660\ri0\sb1\sl-209\slmult0\fi292 \up0
\expndtw0\charscalex120 Relevant ramane de ex., cazul tipului
psihocomporta-\line \up0 \expndtw0\charscalex117 mental A. in general domic de
vindecare, dar putin dispus \line \up0 \expndtw0\charscalex119 la restructurare
comportamentale (mai ales in ce priveste \line \up0 \expndtw0\charscalex115
moriuiarea raporturilor cu ceflalft in direcfia unei lolerante \line \up0
\expndtw0\charscalex116 S' llexibilitafi crescute. \up0 \expndtw0\charscalex122 $i
scaderii ostilita|ii), ca si cazul \line \up0 \expndtw0\charscalex119 tipului C.
predispus la reprimarea sentimentelor negative \line \up0 \expndtw0\charscalex114
(agresivitate. nemuifumire. Irustrare) fata de ceilalt*\par\pard\qj
\li1651\ri0\sb2\sl-205\slmult0\fi307 \up0 \expndtw0\charscalex122 Dinamica
refafinor sociale poate fi \up0 \expndtw0\charscalex132 (si este eel mai \line
\up0 \expndtw0\charscalex119 adesea) supusa factoriior de presiune (normare)
culturae, \up0 \expndtw0\charscalex120 anumite obiceiuri, atitudini in legatura cu
boala \up0 \expndtw0\charscalex110 (inclusiv \up0 \expndtw0\charscalex122
explicafii asupra originii s1 prognosticului ei) cSpStand \up0
\expndtw0\charscalex127 semnificafn particuiare in anumite areale cuiturale, si
\line \up0 \expndtw0\charscalex119 fund total ignorate in altele. Acesta este inca
un determi� \up0 \expndtw0\charscalex122 nant de care medicul trebuie sa fina
seama, in evaluarea \up0 \expndtw0\charscalex116 bolii prin gnla perspectivei
psihosomatice.\par\pard\ql \li1939\sb0\sl-207\slmult0 \par\pard\ql
\li1651\ri0\sb4\sl-207\slmult0\fi288\tx1939 \up0 \expndtw0\charscalex105 8
DIAGNOSTICUL PSIHOLOGIC/PSIHOSOMATIC \line\tab \up0 \expndtw0\charscalex118 Scopul
final al acestui algoritm il constituie precizarea \line \up0
\expndtw0\charscalex115 diapnosticiilui, intr-o viziune mai largS. smcreticS.
psihic-\line \up0 \expndtw0\charscalex134 somatic. Datele culese pana in aceastS
etapS pot fi \line \up0 \expndtw0\charscalex118 acoperitoare, in masura in care
fiecare pas este parcurs cu \up0 \expndtw0\charscalex118 responsabiiitate $i cu
nuanfarea necesarS.\par\pard\qj \li1641\ri0\sb5\sl-206\slmult0\fi297 \up0
\expndtw0\charscalex120 O situatie speciala o reprezinta aceea in care bolnavul
\line \up0 \expndtw0\charscalex117 prezinta tulburari de comportament ce nu pot fi
puse strict \line \up0 \expndtw0\charscalex119 in legatura cu simptomele bolii
somatice Dincolo de ine-\line \up0 \expndtw0\charscalex120 renta anxietate. sau de
depresie. uneori regresie in cadrul \line \up0 \expndtw0\charscalex118 bolii. pot
fi decelate uneori semnele unei afectiuni psihice \line \up0
\expndtw0\charscalex118 palente sau unei tulburari dt: personalitate care reclamS o
\line \up0 \expndtw0\charscalex117 prudenja sporita in evaluare s> in demersul
terapeutic. Ti-\line \up0 \expndtw0\charscalex119 punle de personalitate
dizarmonicS paranoid, isterie, psi-\line \up0 \expndtw0\charscalex123 hastenic,
schizoid, impuisiv. pot ridica probleme atat in \line \up0 \expndtw0\charscalex117
vindecama propriei afecfiuni. cat $i la nivel de comunitate \line \up0
\expndtw0\charscalex119 spitai.ceascS, sau de mediu social in general. Comphanfa
\line \up0 \expndtw0\charscalex116 acestor bolnavi este nu in putine cazuri
deficitarS. sustine-\line \up0 \expndtw0\charscalex122 rea terapiei dificiia. do
aceea se recumandS tehnici spe-\par\pard\qj \li1631\ri0\sb0\sl-208\slmult0\fi614
\up0 \expndtw0\charscalex117 oaiticulare. de abordare in cadrul modelului
general \up0 \expndtw0\charscalex115 descr-s. ca de exemplu gratificarea dorinfei
de dezirabilita-\line \up0 \expndtw0\charscalex116 te la icteric, ceutarea. intr-o
masura mai mare, a suportului \up0 \expndtw0\charscalex117 iamihal la deprosiv,
incurajarea verbalizarii emofionale la \up0 \expndtw0\charscalex107 \u8226?
^chiôid, etc.\par\pard\qj \li1636\ri0\sb0\sl-200\slmult0\fi297 \up0
\expndtw0\charscalex138 in cazul bolilor psihice nete, este utila ceutarea \line
\up0 \expndtw0\charscalex121 spripnului terapeutic al psihologului/psihiatrului,
intr-un \up0 \expndtw0\charscalex113 vontabil '"lucru in echipa".\par\pard\qj
\li1646\ri0\sb4\sl-207\slmult0\fi288 \up0 \expndtw0\charscalex118 La poiul opus,
cei mai mulfi oameni afectafi de o boae \line \up0 \expndtw0\charscalex115
psihosomatica ranren totusi, dm punct de vedere al norma-\line \up0
\expndtw0\charscalex119 litatn psihice \up0 \expndtw-2\charscalex100 -\up0
\expndtw0\charscalex121 integri, Iar posibila afectare, reversibile. \line \up0
\expndtw0\charscalex120 este pnemuite de impasul existential in care se
gSsesc.\par\pard\qj \li1656\ri0\sb5\sl-200\slmult0\fi278 \up0
\expndtw0\charscalex123 Acestora Ii se adreseaze algoritmul de mai sus, care, \line
\up0 \expndtw0\charscalex118 fSre a avea pretentia de exhaustivitate, poate
reprezenta o \line \up0 \expndtw0\charscalex125 baza utila in abordarea IncununatS
de succes a acestor \line \up0 \expndtw0\charscalex108 bolnavi.\par\pard\column \qj
\li131\ri184\sb0\sl-224\slmult0 \up0 \expndtw0\charscalex107 de personalita�
\line \up0 \expndtw-9\charscalex96 te;\par\pard\ql \li25\sb13\sl-230\slmult0
\up0 \expndtw0\charscalex103 - norme cuiturale\par\pard\ql \li7334\sb0\sl-
\ul0\nosupersub\cf8\f9\fs22 PASUL 8\par\pard\ql \li30\sb35\sl-230\slmult0 \up0
\expndtw-9\charscalex80 \ul0\nosupersub\cf9\f10\fs20 1. \up0
\expndtw0\charscalex113 diagnostic\par\pard\ql \li241\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex112 psihologie\par\pard\qj \li231\ri583\sb0\sl-244\slmult0 \up0
\expndtw0\charscalex109 (afectiuni \line \up0 \expndtw0\charscalex113
psihice\par\pard\qj \li231\ri238\sb0\sl-239\slmult0\fi14 \up0
\expndtw0\charscalex109 intercurente. \line \up0 \expndtw0\charscalex110 tulburSri
de \line \up0 \expndtw0\charscalex114 personalitate \line \up0
\expndtw0\charscalex105 etc.).\par\pard\ql \li20\sb1\sl-226\slmult0 \up0 \expndtw-
9\charscalex94 2. \up0 \expndtw0\charscalex110 modalitafi de\par\pard\ql
\li241\sb16\sl-230\slmult0 \up0 \expndtw0\charscalex111 abordare\par\pard\qj
\li20\ri189\sb10\sl-242\slmult0\fi225\tx241 \up0 \expndtw0\charscalex113
particulars in \line\tab \up0 \expndtw0\charscalex114 aceste cazuri \line \up0
\expndtw-9\charscalex90 3. \up0 \expndtw0\charscalex112 colaborare
cu\par\pard\qj \li236\ri252\sb0\sl-242\slmult0\fi4 \up0 \expndtw0\charscalex110
psihologul \line \up0 \expndtw0\charscalex114 sau/$i psihia \line \up0
\expndtw0\charscalex104 trul;\par\pard\ql \li20\sb1\sl-223\slmult0 \up0 \expndtw-
9\charscalex90 4. \up0 \expndtw0\charscalex113 diagnostic\par\pard\ql
\li236\sb12\sl-230\slmult0 \up0 \expndtw0\charscalex114 psihosomatic
\expndtw0\charscalex127 \ul0\nosupersub\cf3\f4\fs18 PsihosomaticS generae\tab
\up0 \expndtw0\charscalex127 \u9830? 111\par\pard\ql \li1387\sb0\sl-207\slmult0
\up0 \expndtw0\charscalex120 Bibliografie \par\pard\qj \li1416\sb0\sl-
220\slmult0 \par\pard\qj\li1416\ri714\sb3\sl-220\slmult0\tx1612\tx1603 \up0
\expndtw0\charscalex118 1. Barrows H.S.. Pickell G.C "Developing Clinical Problem-
Solving Skills - A \line\tab \up0 \expndtw0\charscalex112 Guide to More Effective
Diagnosis and Treatment", New York, Norton Medical \line\tab \up0
\expndtw0\charscalex112 Books. 1991: \par\pard\li1377\sb18\sl-207\slmult0\fi0
\up0 \expndtw0\charscalex116 2. Bates B. "A guide to Physical Examination and
History Taking" (5lh Ed.),\par\pard\li1377\sb18\sl-207\slmult0\fi225\tx3792 \up0
\expndtw0\charscalex113 Philadelphia, Lippincott,\tab \up0 \expndtw0\charscalex115
1991:\par\pard\li1377\sb9\sl-207\slmult0\fi9 \up0 \expndtw0\charscalex116 3.
Billings A.J.. Stoeckle J.D. "The Clinical Encounter \u9632? A Guide to the
Medical\par\pard\li1377\sb14\sl-207\slmult0\fi235\tx6417 \up0
\expndtw0\charscalex114 Interview and Case Presentation", Chicago, Year
Book.\tab \up0 \expndtw0\charscalex115 1989;\par\pard\li1377\sb14\sl-
207\slmult0\fi9 \up0 \expndtw0\charscalex116 4. Elstein A.S. 'Psychological
Research on Diagnostic Reasoning" in: Lipkin M.,\par\pard\li1377\sb19\sl-
207\slmult0\fi230\tx3792 \up0 \expndtw0\charscalex115 Putnam S.M., Lazare A.\tab
\up0 \expndtw0\charscalex115 (eds.) "The Medical Interview". New York,
Springer-\par\pard\li1377\sb18\sl-207\slmult0\fi254\tx2299 \up0
\expndtw0\charscalex100 Verlag.\tab \up0 \expndtw0\charscalex115 1995, pg.504-
510;\par\pard\ql \li1391\sb12\sl-207\slmult0 \up0 \expndtw0\charscalex114 5.
lamandescu I.B. 'Psihologie Medicald", Ed. Infomedica. Bucuresti, 1995;
6. Johnson T.M.. Hardt E.J., Kleinman A. "Cultural Factors in the Medical \line\tab
\up0 \expndtw0\charscalex123 Interview". In: Lipkin M., Putnam S.M.. Lazare A. \up0
\expndtw0\charscalex123 (eds.) "The Medical \par\pard\ql \li1617\sb1\sl-174\slmult0
\up0 \expndtw0\charscalex107 Interview". New York. Springer-Verlag, 1995. pg. 153-
162; \par\pard\ql \li1411\sb19\sl-207\slmult0\tx7862 \up0 \expndtw0\charscalex112
7. Levinson D. "A Guide to the Clinical Interview", Philadelphia, Saunders, \tab
\up0 \expndtw-4\charscalex100 1987; \par\pard\qj
\li1396\ri696\sb3\sl-220\slmult0\tx1603 \up0 \expndtw0\charscalex111 8. Lipkin
J.M. etal. "Performing the Interview". in: Lipkin M., Putnam S.M., Lazare \line\tab
\up0 \expndtw0\charscalex110 A (eds.) "The Medical Interview". New York. Springer
Verlag, \up0 \expndtw0\charscalex108 1995, pg. 65 82; \par\pard\qj
\li1387\ri720\sb0\sl-220\slmult0\tx1617 \up0 \expndtw0\charscalex115 9 Morgan W.L..
Engel G.L "The Clinical Approach to the Patient". Philadelphia, \line\tab \up0
\expndtw0\charscalex115 Saunders, 1969: \par\pard\qj \li1425\ri726\sb0\sl-
220\slmult0\tx1699 \up0 \expndtw0\charscalex122 10. Smith R.C. "The patient's
story: integrated patient-doctor interviewing", \line\tab \up0
\expndtw0\charscalex107 Boston, New York, London, Toronto: Little, Brown and
Company. \up0 \expndtw-2\charscalex100 1996; \par\pard\qj \li1435\ri686\sb0\sl-
220\slmult0\tx1675 \up0 \expndtw0\charscalex124 11. Smith R.C, Hoppe R.B. "The
patient's story; integrating the patient-and \line\tab \up0 \expndtw0\charscalex121
physician-centered approaches in interviewing", Ann. Intern.Med., \up0 \expndtw-
8\charscalex95 1991, \par\pard\ql \li1718\sb31\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 115:470-477.
\expndtw0\charscalex101 \ul0\nosupersub\cf14\f15\fs24 C. COMUNICAREA MEDIC-PACIENT
IN \line\tab \up0 \expndtw-1\charscalex100 MEDICINA DE FAMILIE \par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 Cristian Sever Oana \par\pard\ql \li4396\sb0\sl-
240\slmult0 \par\pard\ql\li4396\ri631\sb182\sl-240\slmult0\tx5236 \up0
\expndtw0\charscalex115 Motto: "Medicina este un echilibru delicat \line\tab
\up0 \expndtw0\charscalex116 intre arid, ?tiin(a si comunicare", \par\pard\ql
\li6844\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex113 Carole Guzman. \par\pard\ql
\li3556\sb10\sl-230\slmult0\tx8001 \up0 \expndtw0\charscalex116 Presedinte at
Asociafiet Medicale Canadiene, \tab \up0 \expndtw-9\charscalex95 1991
Se considere ce existe doua tipuri de stiinfe: stiinfe naturale si stiinfe \up0
\expndtw0\charscalex120 sociale (umane). Stnnfele naturale se ocupe de fenomenele
din natura care \up0 \expndtw0\charscalex122 trebuie explicate prin demonstrarea
cauzelor acestora. S'iinfele sociale se \up0 \expndtw0\charscalex123 ocupe de
fenomenele umane care trebuie infelese in funcfie de atitudlni, \up0
\expndtw0\charscalex116 sentimente. norme $i motive ale persoanelor implicate.
Medicina este o profesie care imbine in egae nresure elemente ale s'iin\up0
\expndtw0\charscalex116 felor naturale cat si ale stiinfelor sociale. Modelul
medical contemporan este \up0 \expndtw0\charscalex118 unui eclectic, modelul bio-
psiho-social, care foloseste elemente din trei sis\up0 \expndtw0\charscalex116 teme
teoretice. Acest model este bun din punctul de vedere al practicii clini� \up0
\expndtw0\charscalex116 ce dar este nesatisecetor din punct de vedere filosofic $i
Stiinfific. \par\pard\qj \li1156\ri637\sb0\sl-233\slmult0\fi292 \up0
\expndtw0\charscalex125 Dupe cum subliniaza Kuhn, un concept stiinfific dobandeste
sens si \up0 \expndtw0\charscalex116 semnificafie doar in contextul paradigmei
cereia ii aparfine si deci un model \up0 \expndtw0\charscalex117 al bolii care
imprumue concepte din trei paradigme diferite este un punct de \up0
\expndtw0\charscalex117 pornire nesatistecetor pentru formularea unor teorii
fertile. \par\pard\ql \li1440\sb217\sl-230\slmult0 \up0 \expndtw0\charscalex127 I.
Conceptii ecologice \par\pard\qj \li1156\ri627\sb168\sl-233\slmult0\fi287 \up0
\expndtw0\charscalex116 Modelul medical bio-psiho-social asa cum a fost pus la
punct de Engel nu \up0 \expndtw0\charscalex118 poate fi aplicat intotdeauna cu
usurinfe in practica medicinei de familie. De \up0 \expndtw0\charscalex124 aceea s-
a dezvoltat un model ecologic care integreaza perfect elemente \up0
\expndtw0\charscalex122 de antropologie medicae. Cadrul conceptual folosit de
autori ca Jansen si \up0 \expndtw0\charscalex126 Bronfenbrenner are patru nivole
majore, liecare cu caracteristicile sale \up0 \expndtw0\charscalex116 unice.
Terminologia folosita pentru a defini trei dintre aceste nivele apeleaza \up0
\expndtw0\charscalex116 1a cuvantul "sistem" pentru a accentua interacfiunile
dintre ele (Figura 1). \par\pard\qj \li1151\ri628\sb9\sl-231\slmult0\fi302 \up0
\expndtw0\charscalex124 Primul nivel este eel individual. Importanta acestui nivel
este usor de \up0 \expndtw0\charscalex119 infeles, deoarece reprezinte pacientul in
sensul individualitSfii sale biome\up0 \expndtw0\charscalex116 dicale, intelectuale
s> emofionale. al funcfionalitafii sensori-motoril. abilite\up0
\expndtw0\charscalex122 filor cognitive si al tariei ego-ului in relafia pritejuie
de intalnirea climca \up0 \expndtw0\charscalex117 Conceptele antropologice 1a acest
nivel cuprind modelul explicativ al bolii, \up0 \expndtw0\charscalex118
evidenfierea cererilor pacientului, negocierea medic-pacient si impactul et\up0
\expndtw0\charscalex116 nicitefii asupra relafiei medic-pacient si asupra
comportamentului de bolnav \up0 \expndtw0\charscalex116 sau senetos.
9\charscalex94 \ul0\nosupersub\cf9\f10\fs20 114\tab \up0 \expndtw0\charscalex120
\u9830?\tab \dn2 \expndtw0\charscalex106 Elemente de psihosomatica generala si
230\slmult0\fi3350 \up0 \expndtw0\charscalex118 Figura 1\par\pard\li1262\sb0\sl-
207\slmult0\par\pard\li1262\sb148\sl-207\slmult0\fi2784 \up0
\expndtw0\charscalex166 \ul0\nosupersub\cf3\f4\fs18 ^CBO-
SIST^\par\pard\li4204\sb0\sl-241\slmult0\par\pard\li4204\sb0\sl-
\expndtw0\charscalex128 \ul0\nosupersub\cf9\f10\fs20 *o\tab \up0
\expndtw0\charscalex153 s'�;\par\pard\li4204\sb8\sl-230\slmult0\fi0\tx5246 \up0
\expndtw0\charscalex120 #\tab \dn2 \expndtw0\charscalex120 %\par\pard\ql
\li4468\sb0\sl-207\slmult0 \par\pard\ql\li4468\sb43\sl-207\slmult0 \up0 \expndtw-
8\charscalex100 \ul0\nosupersub\cf3\f4\fs18 INDIVIDUL \par\pard\qj \li1252\sb0\sl-
\ul0\nosupersub\cf9\f10\fs20 Al doilea nivel este microsistemul constituit de
mediul fizic si social \up0 \expndtw0\charscalex117 din imediata proximitate in
care funcfioneaza individul. Mediul social este \up0 \expndtw0\charscalex113 format
din oamenii semnilicativi din viafa subiectului precum perinfii, soful. \up0
\expndtw0\charscalex115 prietenii. colegii de serviciu. Individul este expus
presiunii sociale ca rezul\up0 \expndtw0\charscalex118 tat al apartenenfei sale la
n grup. Tot aici sunt induse fenomene ca presiu\up0 \expndtw0\charscalex112 nea de
grup. normele sock.19 active in mediul imediat de viafS al individului, \up0
\expndtw0\charscalex115 viafa profesionale si religioasS. in afara de mediul social
microsistemul cu� \up0 \expndtw0\charscalex112 prinde s< mediul fizic natural ?i
artificial construit. Dimensiunile fizice si so� \up0 \expndtw0\charscalex114 ciale
ale microsistemului afecteaze credinfele si comportamentul individului \up0
\expndtw0\charscalex114 fafe de starea sanatafii sale. \par\pard\qj
\li1252\ri546\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex122 Al treilea
nivel, exosistemul, cuprinde comunitatea locale, vecinata\up0
\expndtw0\charscalex114 tea. Conceptul de comunitate poate fi infeles din eel putin
trei puncte de ve� \up0 \expndtw0\charscalex114 dere diferite: \par\pard\ql
\li1564\sb9\sl-230\slmult0\tx1790 \up0 \expndtw-9\charscalex87 1. \tab \up0
\expndtw0\charscalex115 Ca o arie sau teritoriu bine definit; \par\pard\qj
\li1545\ri525\sb2\sl-240\slmult0\tx1785 \up0 \expndtw0\charscalex119 2. Ca o
multime de institufii cu componente fizice, personale si sociale \line\tab \up0
\expndtw0\charscalex119 care asigurS servicii de intrefinere ?i implinire a viefii
indivizilor; \par\pard\ql \li1550\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex116
3. in sens psihologie ca o apartenenfS, sentimentul de grup. \par\pard\qj
\up0 \expndtw0\charscalex116 Vecinstatea sau mediul comunitar este de importantS
majors pentru sS\up0 \expndtw0\charscalex118 nStatea individului. Ea este o sursS
de satisfacere a nevoilor fundamental, \up0 \expndtw0\charscalex117 servicii.
securitate fizicS, interacfiune socials, distracfii si mulfi alfl factori \up0
\expndtw0\charscalex117 legafi de nevoile, cerinfele si presiunile umane.
\par\pard\qj \li1271\ri531\sb0\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex121 Al
patrulea nivel este macrosistemul sau contextul global al cadrului \up0
\expndtw0\charscalex115 ecologic si cuprinde procesele politice, forfele economice
$i sociale si eve� \up0 \expndtw0\charscalex114 nimentele ce opereazS intr-un mediu
politico-economic particular
pentru so-\line \up0 \expndtw0\charscalex112 cializarea bolii \up0
\expndtw0\charscalex112 $' suferinfei. DupS cum sugereazS Young lactorii ce operea�
\par\pard\qj \li1271\ri537\sb0\sl-260\slmult0\fi4 \up0 \expndtw0\charscalex115 zS
la acest nivel influenfeaza direct sau indirect aproape orice aspect al vie\up0
\expndtw0\charscalex115 tii. Acesti factori determinS:
240\slmult0\fi297 \up0 \expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 1. cine
ce boalS va face, la ce servicii medicale are acces si de ce ingn\up0
\expndtw0\charscalex117 jiri beneticiaza, \par\pard\qj \li1099\ri723\sb20\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex115 2. cum indivizi cu acelasi set de
simptome si semne sunt incadrafi la boli \up0 \expndtw0\charscalex114 diferite $i
tratamente diferite in functie de pozifia sociale s' economice a su\up0
\expndtw0\charscalex114 fenndului. \par\pard\qj \li1094\ri734\sb0\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex113 Cadrul conceptual ecologic
facihteaze integrarea principiilor antropologi\up0 \expndtw0\charscalex113 ce in
practica clinice a medicului de familie. \par\pard\ql \li1401\sb229\sl-
230\slmult0 \up0 \expndtw0\charscalex130 2. Conceptia antropologico \par\pard\qj
\li1099\ri708\sb182\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex118 in
continuarea capitolului ne vom ocupa de nivelul individual care este \up0
\expndtw0\charscalex116 nucleul intregului sistem si la care se concentreaze toate
relafiile si mlluen \up0 \expndtw0\charscalex117 tele. La acest nivel se desfasoara
interacfiunea clinics medic-pacient baza\up0 \expndtw0\charscalex117 tS pe
comunicare. \par\pard\qj \li1104\ri688\sb20\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex118 Nivelul individual include fesatura Una si complicata a
relafiilor dintre \up0 \expndtw0\charscalex119 cererile pacientului. modelul sau
explicativ pentru boala $i abordarea ne\up0 \expndtw0\charscalex119 gociata a
ingrijirii cazului. \par\pard\qj \li1094\ri699\sb0\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex113 a. Modelul explicativ este reprezentat de percepfiile si
opiniile individului \up0 \expndtw0\charscalex119 despre boalS in esenfS aceste
opinii confin elemente de cauzalitate. fizio\up0 \expndtw0\charscalex114 patologie,
prognozS si percepfiile pacientului asupra mijloacelor terapeutice \up0
\expndtw0\charscalex131 eficiente. Modelul explicativ al pacientului reflects
preocuparea sa \up0 \expndtw0\charscalex121 pentru boala pe care o are si este un
amestec de nofiuni comune. biome\up0 \expndtw0\charscalex121 dicale si
folclorice. \par\pard\ql \li1104\ri709\sb0\sl-246\slmult0\fi292\tx1396 \up0
\expndtw0\charscalex111 Modelul explicativ al pacientului poate fi evidenfiat in
timpul interviuiui ?i \up0 \expndtw0\charscalex112 poate fi un element important in
alcetuirea strategiei de ingrijire a bolnavului. \line\tab \up0
\expndtw0\charscalex113 Lazare si colaboratorii au conceptualizat inteinirea
clinica dintre medic $\u8226? \up0 \expndtw0\charscalex113 pacient ca incepand cu o
cerere specifics de servicii din partea pacientului. \par\pard\qj
\li1104\ri718\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex118 b. Dezvoltand
ideea, Good si Good au clasificat solicitarile pacientului \up0
\expndtw0\charscalex118 din asistenfa medicals primarS in trei mari grupe:
\par\pard\ql \li1406\sb4\sl-230\slmult0 \up0 \expndtw0\charscalex111 1) solicitSri
biomedicale; \par\pard\ql \li1391\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113
2) solicitSri psihosociale; \par\pard\ql \li1391\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex114 3) solicitSri legate specific de interacfiunea medic-
pacient. \par\pard\qj \li1104\ri694\sb22\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex118 Aceste solicitSri includ informafii medicale, asistenfa
psihosociale, as\up0 \expndtw0\charscalex127 cultarea terapeuticS. tratament
biomedical s' legitimarea statutului de \up0 \expndtw0\charscalex106 bolnav.
Evidenfierea solicitSrilor pacientului se concentreazS pe nevoile \tab \up0
\expndtw-4\charscalex100 $i \par\pard\ql \li1104\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex121 dorinfele acestuia in cadrul interacfiunil clinice.
\par\pard\qj \li1108\ri695\sb2\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex121 c.
infelegerea cennfelor pacientului este extrem de utie in procesul de \up0
\expndtw0\charscalex124 negociere dintre medic si pacient a asteptarilor $l
rezultatelor intalnirii \up0 \expndtw0\charscalex113 clinice. Medicul poate
evidenfia solicitarile reale ale bolnavului in cursul in� \up0
\expndtw0\charscalex113 terviuiui s* vom reveni asupra acestui aspect ceva mai
tarziu (Figura 2). \par\pard\qj \li1104\ri689\sb0\sl-245\slmult0\fi297 \up0
\expndtw0\charscalex117 Evidenfierea modelului explicativ al pacientului si a
solicitSrilor sale in \up0 \expndtw0\charscalex115 cursul intalnirii clinice este
doar pasul initial care permite medicului sS ob� \up0 \expndtw0\charscalex121 serve
diferenfele dintre modelul explicativ biomedical s< eel laic al pa� \up0
\expndtw0\charscalex120 cientului infelegerea asemSnarilor $' deosebirilor intre
cele douS modele \up0 \expndtw0\charscalex120 este si primul pas in negocierea
reconcilierii dintre ele. Negocierea implica
230\slmult0 \up0 \expndtw0\charscalex119 ciarificarea modelului explicativ al
pacientului si pornind de la asemSna \up0 \expndtw0\charscalex113 rea cu eel al
medicului se poate ajunge la un plan de ingrijiri medicale agreat \up0
\expndtw0\charscalex113 de ambele parfi \par\pard\ql \li4699\sb0\sl-230\slmult0
\par\pard\ql\li4699\sb40\sl-230\slmult0 \up0 \expndtw0\charscalex119 Figura
0\ql \li3816\sb0\sl-207\slmult0 \par\pard\ql \li3816\sb0\sl-207\slmult0
\ul0\nosupersub\cf3\f4\fs18 EvahanM\par\pard\ql \li3816\sb8\sl-161\slmult0 \up0
\expndtw0\charscalex137 \ul0\nosupersub\cf23\f24\fs14 wueteior\par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 /\par\pard\ql \li2088\sb0\sl-161\slmult0
\ul0\nosupersub\cf23\f24\fs14 Fomruarea\par\pard\ql \li2083\sb12\sl-161\slmult0
\up0 \expndtw-6\charscalex97 planuluj do Ingrijiri\par\pard\ql \li2611\sb0\sl-
2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 /\par\pard\ql \li1929\sb0\sl-
\ul0\nosupersub\cf23\f24\fs14 Kegooeea si reconaiierea\par\pard\ql \li1929\sb12\sl-
161\slmult0\tx3924 \up0 \expndtw-2\charscalex100 difomiiolur dVfro mooole \tab \up0
\expndtw0\charscalex117 DOCTOR\par\pard\ql \li3974\sb60\sl-161\slmult0 \up0
\expndtw0\charscalex112 \u8226?PACIEN\par\pard\ql \li2577\sb146\sl-230\slmult0 \up0
\expndtw-2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 \\\par\pard\ql
\ul0\nosupersub\cf23\f24\fs14 Transir.iteiea modelului \line \up0
\expndtw0\charscalex113 explicativ caire pacierd''\par\pard\ql \li2491\sb126\sl-
"A\par\pard\ql \li2812\sb0\sl-126\slmult0 \up0 \expndtw0\charscalex123
\ul0\nosupersub\cf23\f24\fs14 PormanMi\par\pard\column \ql \li5241\sb0\sl-
Seni-atie\par\pard\ql \li1325\sb0\sl-288\slmult0 \up0 \expndtw0\charscalex120
\ul0\nosupersub\cf5\f6\fs36 X\par\pard\ql \li1747\sb85\sl-161\slmult0 \up0
\expndtw0\charscalex124 \ul0\nosupersub\cf23\f24\fs14 Consltrtizate\par\pard\ql
2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 \\\par\pard\qj \li1925\ri1237\sb0\sl-
Fonnam) modelului \line\tab \up0 \expndtw-2\charscalex100 cxplicabv\par\pard\ql
\li725\sb137\sl-184\slmult0\tx2410 \up0 \expndtw0\charscalex110 PACIENT\tab \up0
\expndtw-2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 \\\par\pard\qj
\ul0\nosupersub\cf23\f24\fs14 psaenimui \up0 \expndtw0\charscalex108 OCH
TOR\par\pard\qj \li6695\sb0\sl-139\slmult0 \par\pard\qj \li2035\ri1169\sb79\sl-
139\slmult0\tx2405 \up0 \expndtw0\charscalex117 ConsUonturorco \line\tab \up0
\expndtw0\charscalex116 carerll\par\pard\ql \li2707\sb0\sl-230\slmult0 \par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 /\par\pard\ql \li1632\sb0\sl-126\slmult0 \up0
\expndtw0\charscalex106 \ul0\nosupersub\cf23\f24\fs14 AHaroa
nodclului\par\pard\sect\sectd\sbknone\cols2\colno1\colw4376\colsr160\colno2\colw450
4\colsr160\ql
\ul0\nosupersub\cf24\f25\fs10 \u8226? �'. m1..Ii \up0 \expndtw0\charscalex142 |
Iiii\par\pard\ql \li2807\sb0\sl-126\slmult0 \up0 \expndtw0\charscalex100
\ul0\nosupersub\cf23\f24\fs14 \u8226?MpMOMIv\par\pard\ql \li2707\sb0\sl-
90\slmult0\tx3436 \up0 \expndtw0\charscalex123 \ul0\nosupersub\cf24\f25\fs10 mI i t
\up0 \expndtw0\charscalex100 \u8226?\u8226?\u9632? ii\tab \up0 \expndtw-
1\charscalex100 ,'\par\pard\column \ql \li20\sb0\sl-126\slmult0 \up0
\expndtw0\charscalex135 \ul0\nosupersub\cf23\f24\fs14 Obtlnora\par\pard\qj
\li72\ri1233\sb0\sl-126\slmult0\tx1781\tx135 \up0 \expndtw0\charscalex132
dntolor\tab \up0 \expndtw0\charscalex109 explicaiiv a' paocntului \line \tab
\up0 \expndtw0\charscalex122 dlnlcM \par\pard\sect\sectd\sbknone \qj
\expndtw0\charscalex119 \ul0\nosupersub\cf9\f10\fs20 Succesul tratamentului depinde
de succesul aeestei negocieri pnn care \up0 \expndtw0\charscalex119 se \up0
\expndtw0\charscalex120 asigurS participarea voluntare a bolnavului la ingrijirea
sanatafii sale. \up0 \expndtw0\charscalex117 Impunerea modelului explicativ al
medicului cu neglijarea si m detriments \up0 \expndtw0\charscalex114 modelului
explicativ al bolnavului este primul pas spre esecul tratamentului, \up0
\expndtw0\charscalex115 iar acest lucru se datoreaza intotdeauna proastei
comunicSri dintre medic si \up0 \expndtw0\charscalex115 pacient. \par\pard\ql
\li1660\sb228\sl-230\slmult0 \up0 \expndtw0\charscalex131 II. Modele de consultotie
Modelul medical incS prevalent, considers consultafia un simplu decor in \up0
\expndtw0\charscalex115 care doctorul i?i desfSsoare munca de diagnostic si
tratament. Noul val care \up0 \expndtw0\charscalex121 tinde sa schimbe paradigme.
fine cont din ce in ce mai mull de faptul cS \up0 \expndtw0\charscalex119 pacientul
nu funcfioneazS ca o masinS, ci are sentimente, iar doctorul nu \up0
\expndtw0\charscalex123 este o rnasmS de pus diagnostice si are e randul lui
sentimente. AstSzi, \up0 \expndtw0\charscalex117 acordam o atenfie din ce in ce mai
mare la ceea ce se intamplS. dincolo de \up0 \expndtw0\charscalex116 aspectul pur
clinic al consultatiei. Una dintre primele teorii care descrie eel \up0
\expndtw0\charscalex116 mai bine modelul medical actual este teoria rolurilor.
\expndtw-8\charscalex71 \u8226?:\u8226?\tab \up0 \expndtw0\charscalex117
117\par\pard\ql \li1511\sb0\sl-230\slmult0 \par\pard\ql\li1511\sb0\sl-
\expndtw0\charscalex113 \ul0\nosupersub\cf9\f10\fs20 A Teoria rolurilor
Descrie asteptarile pe care fiecare le are de la rolul de pacient, respectiv
\up0 \expndtw0\charscalex115 de doctor si regulile dupS care se desfasoarS
mteracfiunea dintre cei doi. in \up0 \expndtw0\charscalex114 mod traditional, cand
pacientul intra in rolul de bolnav, el renunfS temporar \up0
\expndtw0\charscalex123 la o parte din responsabilitatea sa asupra propriei
bunSstSri. El accepta \up0 \expndtw0\charscalex118 unele restncfii asupra
capacitetn sale de libera alegere in probleme de sa� \up0 \expndtw0\charscalex117
natate si ii acorda medicului puteri de judecetor. Pacientul trebuie se-S'
re\up0 \expndtw0\charscalex115 cunoasca vulnerabilitatea, dar si autoritatea
medicului. Adoptand rolul bol� \up0 \expndtw0\charscalex119 navului el poate iesi
din alte roluri, de exemplu eel de susfinetor al fami� \up0 \expndtw0\charscalex118
liei, si ii legitlmeaze un comportament regresiv, dependent (sta la pat, este
\up0 \expndtw0\charscalex120 servit. etc.) Totusi. acest rol implica si obligafia
pacientului de a ceuta sa \up0 \expndtw0\charscalex120 se vindece. lucru pe care
dace nu-l face, isi pierde avantajele \par\pard\qj \li1224\ri578\sb0\sl-
243\slmult0\fi297 \up0 \expndtw0\charscalex119 Fiecare societate acorde anumitor
indivizi responsabilitatea de a usura \up0 \expndtw0\charscalex118 suferinta fizice
si spintuaie. endemics in omenire. in acest sens, societatea \up0
\expndtw0\charscalex118 creeaza doctori pe care ii inzestreaza cu putere si
autoritate pentru a u$ura \up0 \expndtw0\charscalex116 sau, eel putin, a izola
suferinta (Michael Focault). in schimbul stimei, doc� \up0 \expndtw0\charscalex114
torul este dator se-s' dedice competenta si atenfia oriceror probleme prezen�
\up0 \expndtw0\charscalex115 tate de pacient si se acfioneze in interesul
pacientului $i. uneori, in interesul \up0 \expndtw0\charscalex115 societafii
\par\pard\ql \li1516\sb6\sl-230\slmult0 \up0 \expndtw0\charscalex118 Accesul e
medic implica executarea unor ritualuri: \par\pard\ql \li1526\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex114 - umilinfa pacientului care trebuie sa-si
afirme neajutorarea; \par\pard\ql \li1531\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex114 - etalarea suferinfei intr-un mod standardizat sub forme de
simptome; \par\pard\ql \li1526\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex117 -
programarea la consultafie sau inscrierea pe o lists de asteptare; \par\pard\qj
\li1238\ri585\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex115 - imblanzirea
spiritelor care il inconjoara pe doctor (asistente, infirmiere, \up0
\expndtw0\charscalex115 secretare. portan); \par\pard\qj \li1233\ri560\sb0\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex125 - pacientul trebuie sa-si sacrifice
pSrfi din corpul sSu ca sS castige \up0 \expndtw0\charscalex115 atenfia medicului:
sange, urinS, fesutun pentru analize; \par\pard\qj \li1243\ri570\sb0\sl-
240\slmult0\fi278 \up0 \expndtw0\charscalex122 - doctorul este imbracat intr-o
uniforms simbolica. intronat in spatele \up0 \expndtw0\charscalex114 unui birou si
tacut ca un sfinx, \par\pard\qj \li1243\ri565\sb29\sl-230\slmult0\fi292 \up0
\expndtw0\charscalex124 - pacientul, dm contra, sta gol pe un scaun sau pe o
canapea, si asta \up0 \expndtw0\charscalex116 numai pentru ca s-a pierdut bunul
obicei al ingenuncherii, corpul �i spmtul \up0 \expndtw0\charscalex116 lui fiind
accesibile doctorului. \par\pard\ql \li1243\ri559\sb2\sl-
240\slmult0\fi283\tx1531 \up0 \expndtw0\charscalex116 - mormeielile doctorului, ca
si prezicerlle Pylhiei la oracolul din Delphi, \up0 \expndtw0\charscalex116 sunt
ambigue si. de obicei. intr-o limbe inaccesibie pacientului. \line \tab \up0
\expndtw0\charscalex118 Acest model de consultafie, traditional si comod pentru
doctor, este tot \up0 \expndtw0\charscalex115 mai puternic contestat. Pe creasta
noului val plutesc concepte noi "holistic", \up0 \expndtw0\charscalex118
"deprofesionalizarea medicinei". "medicalizarea excesivS a viefii'. "drep� \up0
\expndtw0\charscalex118 turile pacientului" etc Spre onoarea proteslunii. valul
schimbSril este con-\line \up0 \expndtw0\charscalex120 dus de medici, care au
renunfat la piedestal ?i se indepSrteazS de stereo-\line \up0
\expndtw0\charscalex123 tipul autocratic Accentul se deplaseaza de pe doctor pe
pacient si de pe \up0 \expndtw0\charscalex123 sarcina pe comportament. Modelele
curente de consultafie pot fi astfel \up0 \expndtw0\charscalex118 clasificale dupe
doue axe de coordonate: axa centrat pe doctor sau pe pa� \up0
\expndtw0\charscalex118 cient $i axa orientat spre sarcinS sau spre comportament
(Figura 3) \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg123}
207\slmult0\par\pard\li1324\sb105\sl-207\slmult0\fi0\tx1430\tx1800\tx4339 \up0
\expndtw-2\charscalex100 \ul0\nosupersub\cf3\f4\fs18 1\tab \up0 \expndtw-
8\charscalex95 18\tab \up0 \expndtw-2\charscalex100 \u9830?\tab \dn2
230\slmult0\fi3335 \up0 \expndtw0\charscalex121 \ul0\nosupersub\cf9\f10\fs20 Figura
3\par\pard\li1324\sb0\sl-230\slmult0\par\pard\li1324\sb25\sl-230\slmult0\fi2587
\up0 \expndtw0\charscalex134 CentratS pe pacient\par\pard\li1324\sb159\sl-
Modelul concnpjiei\tab \up0 \expndtw0\charscalex104
Consilierea\par\pard\li1324\sb0\sl-162\slmult0\fi1464\tx5971 \up0
\expndtw0\charscalex115 despre sanatate\tab \dn2 \expndtw0\charscalex100 (Balint,
Bendix)\par\pard\li1324\sb1\sl-168\slmult0\fi1473 \up0 \expndtw0\charscalex100
(Helmen)\par\pard\li2788\sb0\sl-230\slmult0\par\pard\li2788\sb0\sl-
Orientate spre\tab \up0 \expndtw0\charscalex134 Orientate
spre\par\pard\li2788\sb81\sl-207\slmult0\fi67\tx5894 \up0
\expndtw0\charscalex122 \ul0\nosupersub\cf3\f4\fs18 sarcina\tab \up0
\expndtw0\charscalex121 comportament\par\pard\li2788\sb0\sl-
\expndtw0\charscalex104 Bio-psiho-social\tab \up0 \expndtw0\charscalex103 Analiza
tranzactionala\par\pard\li2788\sb1\sl-165\slmult0\fi4\tx6590 \up0
\expndtw0\charscalex109 (Pendleton, Statt\tab \up0 \expndtw0\charscalex104
(Berne)\par\pard\li2788\sb1\sl-173\slmult0\fi0\tx5697 \dn0 \expndtw0\charscalex101
si Davies)\tab \up0 \expndtw0\charscalex105 Analiza categonala\par\pard\ql
\li5975\sb0\sl-162\slmult0 \up0 \expndtw-1\charscalex100 (Byrno si Long)
\ul0\nosupersub\cf9\f10\fs20 CentratS pe doctor \par\pard\ql \li1603\sb0\sl-
230\slmult0 \par\pard\ql\li1603\sb200\sl-230\slmult0 \up0 \expndtw0\charscalex120 B
Etapele si conffnutul consultafiei \par\pard\qj \li1300\ri502\sb114\sl-
250\slmult0\fi297 \up0 \expndtw0\charscalex114 Indiferent de modelul de consultafie
adoptat. comunicarea medic-pacient \up0 \expndtw0\charscalex115 este esenfialS, iar
diferenfee dintre modele sunt date mai degrabS de rapor� \up0
\expndtw0\charscalex115 tul de putere si de calitatea comunicSrii, decat de absenfa
sau prezenfa ei. \par\pard\qj \li1300\ri493\sb0\sl-244\slmult0\fi292 \up0
\expndtw0\charscalex116 Consultafia in sine are doua etape principale, ambele
bazate pe comuni \up0 \expndtw0\charscalex118 care. Prima etapS este interviul, in
care doctorul incearcS sS descopere de \up0 \expndtw0\charscalex114 ce a venit
pacientul sS-l cearS ajutorul. A doua etapS este expunerea, in care \up0
\expndtw0\charscalex119 doctorul il informeazS pe pacient despre concluziile sale
privind diagnos\up0 \expndtw0\charscalex119 ticul, tratamentul si recomandSrile
sale. Din punct de vedere strict al co� \up0 \expndtw0\charscalex119 municSrii,
sunt patru etape bazate pe tot atatea talente: \par\pard\ql \li1598\sb23\sl-
230\slmult0 \up0 \expndtw0\charscalex110 - de a pune Tntrebari \par\pard\ql
\li1598\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex119 - de a asculta
\par\pard\ql \li1603\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex118 - de a
respunde \par\pard\ql \li1593\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 - de
a explica \par\pard\qj \li1305\ri498\sb22\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex124 Din fericire, chiar si cei lipsiti de ele le pot dobandi
prin invSfare si \up0 \expndtw0\charscalex115 exersare zilnice. \par\pard\ql
\li1612\sb129\sl-230\slmult0 \up0 \expndtw0\charscalex109 Interviul \par\pard\qj
\li1310\ri482\sb120\sl-243\slmult0\fi297 \up0 \expndtw0\charscalex114 Pacienfii
sunt de cele mat multe on anxiosi cand trebuie se vine la medic. \up0
\expndtw0\charscalex121 Aceaste anxietate poate fi diminuata printr-un comportament
prletenesc \up0 \expndtw0\charscalex127 din partea doctorului. De altfel, acest
lucru se coreleazS cu gradul de \up0 \expndtw0\charscalex115 satisfacfie al
pacientului. Medicul isi poate manifesta prietenia salutand pa� \up0
\expndtw0\charscalex118 cientul, adresandu-i-se pe nume si dand mana cu el,
rugSndu-l sS ia loc si \up0 \expndtw0\charscalex116 inifiind o discutie amicais pe
o tema nemedicalS. Aceste mesaje verbale �i \up0 \expndtw0\charscalex116 non-
verbale eliminS in general anxietatea pacientului. Regia consultatiei
\up0 \expndtw0\charscalex127 \u9830? 119\par\pard\qj \li1046\sb0\sl-
\ul0\nosupersub\cf8\f9\fs22 este aranjate de medic si poate intluenfa decisiv
comunicarea Uniforma \up0 \expndtw0\charscalex112 medicae inhibe, pe cand finuta de
strade reiaxeaza pacientul. pozifia in \up0 \expndtw0\charscalex104 jurul biroului
este si ea parte importante (Figura 4). \par\pard\ql \li4411\sb0\sl-253\slmult0
\par\pard\ql\li4411\sb57\sl-253\slmult0 \up0 \expndtw0\charscalex108 Figura 4
\expndtw0\charscalex113 \ul0\nosupersub\cf3\f4\fs18 Cooooro'e \par\pard\ql
\up0 \expndtw0\charscalex107 Contu-'itaie \par\pard\ql \li4041\sb0\sl-
Conveisoie \par\pard\qj \li1065\sb0\sl-244\slmult0 \par\pard\qj\li1065\sb0\sl-
\expndtw0\charscalex110 \ul0\nosupersub\cf8\f9\fs22 Medicul poate manipula situafia
in a?a fel incat sa-l aseze pe pacient \up0 \expndtw0\charscalex106 unde vrea. fara
sa-i dea posibilitatea se aleage. Dace vrea sS afle mai multe \up0
\expndtw0\charscalex106 despre personalitatea pacientului, medicul ii va permite
acestuia sS-si alea\up0 \expndtw0\charscalex105 gs locul unde vrea sS stea
Pacientul timid va incerca sS-si asigure un spatiu \up0 \expndtw0\charscalex106
personal cSt mai izolat si va sta cat mai departe de medic Aspectul exterior
\up0 \expndtw0\charscalex108 al medicului este hotSrator pentru buna comunicare;
dacS medicul cores\up0 \expndtw0\charscalex105 punde ca aspect asteptSrilor
bolnavului, acesta se va destsinui mai usor. De \up0 \expndtw0\charscalex104
asemenea. postura care exprimS interesul, putin aplecat in fafa, contactul
vi\up0 \expndtw0\charscalex107 zual. este de naturS sS incurajeze pacientul.
Uneori. atingerea pacientului, \up0 \expndtw0\charscalex108 de exemplu o mane pusS
pe umSr, poate fi esenfiae pentru usurarea unui \up0 \expndtw0\charscalex109
pacient foarte stresat. \par\pard\qj \li1075\ri678\sb0\sl-243\slmult0\fi297 \up0
\expndtw0\charscalex110 Prima intrebare trebuie sS fie deschise. de qenul: "ei
bine" sau "cu ce \up0 \expndtw0\charscalex107 va pot ajuta?". Medicul trebuie se
asculte in liniste. fere sa intrerupa, mar-\line \up0 \expndtw0\charscalex105
tunsirea initiae a bolnavului. Ulterior, va trebui se rezume spusele bolnavu�
\up0 \expndtw0\charscalex106 lui cu scopul de a i se confirma ca a inteles exact
mesajul. Apoi poate con-\line \up0 \expndtw0\charscalex106 tinua cu intreberi de
tip inchis, care implice respunsuri scurte, pentru a pu� \up0
\expndtw0\charscalex107 tea sonda in profunzime ceea ce il intereseaze in mod
special (ce tempera-\line \up0 \expndtw0\charscalex107 tura afi avut?. cate
kllograme afi slabit?. etc.) Trebuie evitate cu orice
\expndtw0\charscalex108 *\tab \up0 \expndtw0\charscalex108 Elemente de
psihosomaticS generae si aplicae\par\pard\qj \li1108\sb0\sl-240\slmult0
240\slmult0\fi9 \up0 \expndtw0\charscalex125 pre( intrebarile care ar putea sugera
un raspuns (nu credefl cS de teamS \up0 \expndtw0\charscalex125 facefi
palpitafii? \up0 \expndtw0\charscalex121 - aceastS intrebare ar putea fi formulatS
astfel: "ce mai \par\pard\qj \li1108\ri670\sb0\sl-246\slmult0\fi9 \up0
\expndtw0\charscalex125 simfifi cand va este teama" sau "ce mai simfifi cand avefi
palpitafii?"). \up0 \expndtw0\charscalex122 inainte si dupa intrebarea cea mai
importantS este bine sS facefi o pauzS \up0 \expndtw0\charscalex121 pentru a fi
siguri cS pacientul a infeles implicafiile acesteia Ascultarea in \up0
\expndtw0\charscalex116 sine cere din partea medicului sS fie atat relaxat, cat ?i
vigilant, intreruperile \up0 \expndtw0\charscalex125 de orice naturS. telefon,
asistentS etc., pot bloca comunicarea. Medicul \up0 \expndtw0\charscalex120 trebuie
sS fie atent in timpul interviuiui si 'a mesajele non-verbale, care de \up0
\expndtw0\charscalex125 multe ori pot fi mai importante decat cuvintele. Ori de
cate ori medicul \up0 \expndtw0\charscalex124 primeste un semnal emotional de la
bolnav, va trebui se confirme acest \up0 \expndtw0\charscalex121 lucru, fie din
privin, inclinend capul. sau mormeind o aprobare pentru a-l \up0
\expndtw0\charscalex121 incuraja sS-si continue povestirea. \par\pard\ql
\li1411\sb4\sl-230\slmult0 \up0 \expndtw0\charscalex116 Interviul poate esua din
numeroase motive: \par\pard\ql \li1416\sb10\sl-230\slmult0\tx4516 \up0
\expndtw0\charscalex117 - lipsa de relaxare a pacientului \tab \up0
\expndtw0\charscalex115 - nu-l agresafi din start cu intrebSril; \par\pard\ql
\li1416\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex120 - scSparea discufiei din
mana - nu-l esafi so ia razna!; \par\pard\qj \li1118\ri665\sb0\sl-260\slmult0\fi292
\up0 \expndtw0\charscalex117 - limitarea premature a discufiei la o singure
probleme - pacientul incepe \up0 \expndtw0\charscalex117 cu o probleme minora:
\par\pard\ql \li1416\sb1\sl-194\slmult0 \up0 \expndtw0\charscalex117 - lipsa unor
intrebari sistematice; \par\pard\ql \li1411\sb37\sl-230\slmult0 \up0
\expndtw0\charscalex113 - absenfa clarif icarilor ulterioare; \par\pard\ql
\li1416\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex119 - lipsa de respuns a
medicului la mesajele non-verbale ale pacientului; \par\pard\ql \li1416\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex116 - lipsa concentrarii din partea medicului.
Contactul fizic cu pacientul in timpul examenului clinic poate stimula o \up0
\expndtw0\charscalex120 comunicare mult mai intimS, care de multe ori completeaza
in mod fericit \up0 \expndtw0\charscalex107 interviul. \par\pard\ql
\up0 \expndtw0\charscalex118 Expunerea \par\pard\qj \li1108\ri656\sb179\sl-
244\slmult0\fi307 \up0 \expndtw0\charscalex118 Explicable bune, ca si o pereche de
bikini, trebuie sS fie minuscule, sti� \up0 \expndtw0\charscalex125 mulative si
totusi sS acopere lucrurile esenfiale. in tinerefe, majoritatea \up0
\expndtw0\charscalex117 medicilor sunt tentafi sS explice prea mult si prea
devreme. Consecinfa este \up0 \expndtw0\charscalex120 cS foarte repede ajung sS se
contrazicS si nu mai au pe unde scoate cSma-\line \up0 \expndtw0\charscalex123 sa.
Indiferent cat de exact s* complet este diagnosticul, dacS medicul nu \up0
\expndtw0\charscalex118 este capabil sS explice semnificafia acestuia in termeni
accesibili pacientu� \up0 \expndtw0\charscalex116 lui, rezultatul este un pacient
nemultumit, derutat, care de cele mai multe ori \up0 \expndtw0\charscalex116 nu va
respecta indicafiile medicului. Pacienfii i$i amintesc eel mai bine ceea \up0
\expndtw0\charscalex117 ce Ii se spune in primul minut dupS terminarea examinSrii
clinice De aceea, \up0 \expndtw0\charscalex117 este esenfial ca atunci sS i se
transmits informafia cea mai importantS. \par\pard\qj \li1123\ri651\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex118 Transmiterea vestilor proaste
necesitS cea mai mare mSiestrie. Empatia \up0 \expndtw0\charscalex120 Si llmbajul
clar sunt conditiile sine qua non in acest scop. Principlile dupS \up0
\expndtw0\charscalex120 care se face transmiterea unei vesti rele sunt urmStoarele:
\par\pard\ql \li1425\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex113 - alege
momentul potrivit: \par\pard\ql \li1430\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex113 - rezervS suficient timp; \par\pard\ql \li1425\sb30\sl-
230\slmult0 \up0 \expndtw0\charscalex115 - progreseazS in ritmul infelegerii $i
acceptSrii pacientului; \par\pard\ql \li1425\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex117 \u8226? evalueazS cat stie si cat vrea de fapt sS stie;
\par\pard\ql \li1425\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 - Identifies
preocuparea principals a pacientului. \par\pard\ql \li1430\sb30\sl-230\slmult0 \up0
\expndtw0\charscalex112 - asigurS-l de tot sprijinul tSu
\up0 \expndtw0\charscalex129 \u9830? 121\par\pard\qj \li1031\sb0\sl-235\slmult0
235\slmult0\fi288 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf8\f9\fs22 In
final, consultafia trebuie sS se termine intr-o notS de relaxare. Pacien� \up0
\expndtw0\charscalex107 tul este satisfScut, se pregSteste sS se ridice, zambeste
si 'Si ia e revedere. \up0 \expndtw0\charscalex107 Dace pacientul vorbe�te cu
ezitari, evite contactul vizual cu doctorul si nu \up0 \expndtw0\charscalex110 este
gata se se ridice. este evident esecul comunicerii si procesul trebuie \up0
\expndtw0\charscalex103 reluat, eventual la o noue vizite. \par\pard\qj
\li1031\ri735\sb1\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex110 in concluzie
comunicarea medic-pacient este esenfiae ?i poate afecta \up0
\expndtw0\charscalex102 profund ingrijirea bolnavului. Din fericire, tehnica
comunicerii poate fi invS\up0 \expndtw0\charscalex102 fata s* exersate e fel de
bine ca si tehnica examinerii clinice. \par\pard\qj \li1031\ri742\sb0\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex108 Una dintre cele mai eliciente
tehnici de comunicare la indemSna me� \up0 \expndtw0\charscalex105 dicului de
familie este derivata din tehnica psihanaliticS bazatS pe modelul \up0
\expndtw0\charscalex105 tranzactional al lui Berne, in continuare vom expune
modelul tranzactional. \par\pard\ql \li1334\sb150\sl-253\slmult0 \up0 \expndtw-
8\charscalex100 MODELUL TRANZACTIONAL AL LUI BERNE \par\pard\ql \li1324\sb147\sl-
253\slmult0\tx2577 \up0 \expndtw0\charscalex110 Eric Berne \tab \up0
\expndtw0\charscalex116 (1961), pornind de la concepte din psihanalizS, teoria
comunicSrii si teoria jocurilor, a reusit sS puns la punct un sistem de analizS
\up0 \expndtw0\charscalex114 tranzacfionala care defmeste procesele ce opereazS in
relafiile inter� \up0 \expndtw0\charscalex107 personal in termeni simpll usor de
folosit in practica medicinei de lamilie. \par\pard\qj \li1036\ri717\sb0\sl-
233\slmult0\fi350 \up0 \expndtw0\charscalex103 RestrSngand si concentrand
operafiile tranzacfionale asupra unui numSr \up0 \expndtw0\charscalex109 limitat de
grupe mai frecvente este posibil cu ajutorul aeestei tehnici sS-l \up0
\expndtw0\charscalex109 faci pe pacient sS infeleagS anumite defecte
caracterologice fundamental \up0 \expndtw0\charscalex109 atat ale lui, cat si ale
altora. \par\pard\qj \li1041\ri726\sb0\sl-230\slmult0\fi350 \up0
\expndtw0\charscalex104 Deoarece tranzacfiile dintre oameni sunt descrise ca
"distractii", "jocuri" \up0 \expndtw0\charscalex113 Si "scenarii" si sunt tratate
cu umor, pacientul i$i formeazS o atitudine \up0 \expndtw0\charscalex107
intelegStoare fafS de sebiciunile altor oameni \up0 \expndtw0\charscalex108 �i
dobandeste o infelegere \par\pard\qj \li1041\ri711\sb6\sl-233\slmult0 \up0
\expndtw0\charscalex106 critica a propriel sale relafii histrionice cu ceilalfi
oameni. (Tranzacfia este \up0 \expndtw0\charscalex108 unitatea interacfiunii
sociale. Cand doi sau mai mulfi oameni se IntSlnesc \up0 \expndtw0\charscalex113
intr-o agregare sociale, unui din ei va vorbi sau va da un alt semn care \up0
\expndtw0\charscalex104 indice recunoasterea prezenfei celorlalfi. Acesta este
stimulul tranzactional. \up0 \expndtw0\charscalex111 Altcineva va spune sau va face
ceva ca respuns la acest stimul s* acesta \up0 \expndtw0\charscalex106 este
respunsul tranzacfional). Atitudinile ego-sintonice, de obicei dificil de \up0
\expndtw0\charscalex111 admis. sunt izolate ca fiind absurde \up0
\expndtw0\charscalex108 �i aducand un beneficiu indoielnic. \par\pard\qj
\li1051\ri716\sb0\sl-220\slmult0\fi4 \up0 \expndtw0\charscalex106 Pacientul invafe
se radS de sine insu$i S' sS-�l inhlbe anumite inclinafii ca \up0
\expndtw0\charscalex106 strSme de ego (ego alien). \par\pard\qj
\li1046\ri711\sb2\sl-240\slmult0\fi383 \up0 \expndtw0\charscalex107 Berne concepe
relafiile umane ca seturi repetitive de manevre sociale \up0
\expndtw0\charscalex112 care au rol defensiv si aduc importante gratificafii.
Aceste manevre iau \up0 \expndtw0\charscalex105 forme de "distractii" \up0
\expndtw0\charscalex110 $i "jocuri" pe care le joacS oamenii. Acestea pot fi
simple trucuri sau pot lua forma unor exercifii elaborate care urmeazS un \up0
\expndtw0\charscalex108 plan inconstient sau scenariu. \par\pard\ql \li1406\sb8\sl-
231\slmult0 \up0 \expndtw0\charscalex104 La orice persoanS se manifests trei stSri
ale ego-ului: \par\pard\qj \li1051\ri712\sb2\sl-240\slmult0\fi297\tx1540 \up0
\expndtw-3\charscalex100 -\tab \up0 \expndtw0\charscalex115 prima este copilul din
interiorul persoanei, o relicvS regresivS a \up0 \expndtw0\charscalex105 trecutului
arhaic al individului, deci un aspect al arheopslhicului sou, \par\pard\qj
\li1051\ri717\sb17\sl-220\slmult0\fi292 \up0 \expndtw0\charscalex115 - a doua este
parintele. agentul parental extern, pe care persoana il \up0
\expndtw0\charscalex103 incorporeazS prin identificare, sau exteropsihicul;
\par\pard\ql \li1348\sb9\sl-234\slmult0 \up0 \expndtw0\charscalex105 - a treia,
adultul. matur, rational, prelucrand date, sau neopsihicul. \par\pard\qj
\li1055\ri722\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex116 Fiecare dintre
aceste componente ale persoanei percepe realitatea \up0 \expndtw0\charscalex107
diferit: partea de copil percepe prelogic \up0 \expndtw0\charscalex108 �i
distorsionat; partea de pSrinte \par\pard\ql \li1055\sb3\sl-237\slmult0 \up0
\expndtw0\charscalex105 sentenfios; partea de adult, comprehensiv pe baza
experienfei trecute. \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart
\up0 \expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs20 Elemente de psihosomatica
generae �i aplicata\par\pard\ql \li4492\sb0\sl-230\slmult0
\par\pard\ql\li4492\sb15\sl-230\slmult0 \up0 \expndtw0\charscalex121 Figura $
\par\pard\ql \li3028\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex120 Diagrama
structured a personal itafl I \par\pard\ql \li5107\sb0\sl-161\slmult0
\expndtw0\charscalex104 \ul0\nosupersub\cf23\f24\fs14 Ego \par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 Damt \par\pard\ql \li4766\sb0\sl-230\slmult0
\par\pard\ql\li4766\sb109\sl-230\slmult0 \up0 \expndtw-9\charscalex75 Eon
\ul0\nosupersub\cf24\f25\fs10 CWU It \par\pard\ql \li4420\sb0\sl-184\slmult0
\expndtw0\charscalex111 \ul0\nosupersub\cf13\f14\fs16 I a, \par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 cow \par\pard\qj \li1271\sb0\sl-230\slmult0
Cele trei stSn acfioneaza ca rSspuns la nevoile persoanei si 'a tipurile de \up0
\expndtw0\charscalex114 "jocuri" pe care le practicS la un moment dat. De exemplu,
in cazul unei po-\line \up0 \expndtw0\charscalex116 vesti despre delapidare
pSrintele acfioneaze moratizator \up0 \expndtw0\charscalex114 (joace jocul
"con-\par\pard\ql \li1271\sb10\sl-230\slmult0\tx7406 \up0 \expndtw0\charscalex120
damnare"), adultul este interesat cum s-a produs delapidarea \tab \up0
\expndtw0\charscalex113 (joace jocul \par\pard\qj \li1271\ri503\sb22\sl-
240\slmult0\fi9 \up0 \expndtw0\charscalex113 "contabilul"), copllul acfioneaze naiv
si se gandeste ce distractiv este se con� \up0 \expndtw0\charscalex115 tinue
delapidarea (joace jocul "hofn si vardistti"). Cele trei stari ale ego-ului \up0
\expndtw0\charscalex129 pot intra in conflict intre ele, simptomele fiind
consecinfa relicvelor \up0 \expndtw0\charscalex125 copilului care se lupta cu
relicvele parintelul, amandoua contaminand \up0 \expndtw0\charscalex126 adultul.
In timpul interviuiui medicul de familie trebuie se-si dea seama in funcfie \up0
\expndtw0\charscalex119 de aspectul si prezentarea pacientului, gesturi. vocabular
si intonafia vocii \up0 \expndtw0\charscalex118 care stare a ego-ului a produs
simptomul sau tulburarea echillbrului perso-\line \up0 \expndtw0\charscalex103
nalitSfii \up0 \expndtw0\charscalex119 Psihopatologia poate fi reformulate in
termenii trilogiei pShnte-\line \up0 \expndtw0\charscalex113 adult-copil pentru
uzul medicului de familie. Astfel halucinafiile reprezintS o \up0
\expndtw0\charscalex116 manifestare a parintelui ce foloseste audienfa copilului si
uneori a adultului \up0 \expndtw0\charscalex123 contaminat. Iluziile sunt in
general manifesteri ale copilului care conta-\line \up0 \expndtw0\charscalex117
mineaze adultul. Depersonalizarea este o manifestare a stimulilor somatici. \up0
\expndtw0\charscalex120 distorsionafi de un copil derutat care sunt de neinfeles
pentru adult. DacS \up0 \expndtw0\charscalex116 stimulii sunt ego-sintonici pentru
adult, sunt transformafi in iluzie de modi \up0 \expndtw0\charscalex114 ficare a
corpului. In hipomanie copilul exclude penntele cu ajutorul adultului \up0
\expndtw0\charscalex127 contaminat Dace se transforme in rnanie adultul ca si
perintele devin \up0 \expndtw0\charscalex128 excesiv de puternici cu ajutorul
copilului care \up0 \expndtw0\charscalex128 \\s\\ Investeste energia
\par\pard\ql \li1286\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex114 libidinalS in
acea acfiune. \par\pard\qj \li1286\ri473\sb2\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex120 Isteria de conversie este o manifestare a copilului care
exclude adultul \up0 \expndtw0\charscalex120 prin refulare. TulburSrile de caracter
si psihopatiile sunt manifestSri ale
\expndtw0\charscalex115 \ul0\nosupersub\cf9\f10\fs20 Psihosomatica generae\tab \up0
210\slmult0\tx1416 \up0 \expndtw0\charscalex114 copilului care conviefuie�te in
armonie cu adultul. Nevrozele impulsive sunt \up0 \expndtw0\charscalex112 izbucniri
ale copilului fara controlul adultului sau pSrintelui. \line \tab \up0
\expndtw0\charscalex113 Medicul acfioneaze la randul lui cu parinteie. adultul sau
copilul din \par\pard\qj \li1123\ri675\sb0\sl-260\slmult0\fi4 \up0
\expndtw0\charscalex132 structura personalitafii sale. Presupunerea este cS acest
act este in \up0 \expndtw0\charscalex113 beneficiul pacientului. \par\pard\qj
\li1128\ri666\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex116 Deseori copilul
din medic va percepe intuitiv si subconstient copilul sau \up0
\expndtw0\charscalex116 perintele din pacient \par\pard\ql \li1123\ri660\sb3\sl-
244\slmult0\fi287\tx1411 \up0 \expndtw0\charscalex115 Analiza tranzacfionalS simple
trebuie sa diagnosticheze care stare a ego\up0 \expndtw0\charscalex116 ului
inifiaza stimulul tranzactional si care inifiaza respunsul tranzactional. \line\tab
\up0 \expndtw0\charscalex127 Cele mai simple tranzacfii sunt cele in care atat
stimulentul, cat si \up0 \expndtw0\charscalex115 respunsul provin de e adulfii
medicului, respectiv pacientului. La intrebarea \up0 \expndtw0\charscalex117
medicului "ce v-a suparat?" pacientul "adult" respunde "m-a durut capul si \up0
\expndtw0\charscalex117 am avut febra" \par\pard\qj \li1123\ri650\sb0\sl-
246\slmult0\fi287 \up0 \expndtw0\charscalex116 A doua ca simplitate este tranzacfia
copil-perinte. De exemplu pacientul \up0 \expndtw0\charscalex129 spune: "mi-e reu,
tremur. daca o sa mor singur noaptea in casa?" La \up0 \expndtw0\charscalex122
acest stimul tranzacfional inifiat de pacientul "copil", medicul "pSrinte" \up0
\expndtw0\charscalex128 rSspunde: "linlstifi-va. este doar un guturai si va rog sa
bcfi acum un \up0 \expndtw0\charscalex119 pahar de apa si o aspirins." Ambele
aceste tranzacfii sunt complementare. \up0 \expndtw0\charscalex128 adicS rSspunsul
este adecvat si asteptat si respecta ordinea naturals a \up0
\expndtw0\charscalex114 relafiilor umane sanStoase. \par\pard\ql \li1420\sb3\sl-
230\slmult0 \up0 \expndtw0\charscalex114 Ele pot Ii schematizate astfel (vezi
figura 6). \par\pard\qj \li1123\ri645\sb18\sl-245\slmult0\fi297 \up0
\expndtw0\charscalex123 Prima regue a comunicani este cS aceasta este de bunS
calitate si se \up0 \expndtw0\charscalex121 desfasoarS cu usurintS dacS
tranzacfiile sunt complementare. Corolarul \up0 \expndtw0\charscalex127 aeestei
reguli este cS atata timp cSt tranzacfiile sunt complementare, \up0
\expndtw0\charscalex123 comunicarea poate in pnncipiu sS continue la infinit.
Aceste reguli sunt \up0 \expndtw0\charscalex129 independente de natura si
confinutul tranzacliilor; ele se bazeazS in \up0 \expndtw0\charscalex120 intregime
pe direcfia vectorilor implicafi. Atata timp cat tranzacfiile sunt \up0
\expndtw0\charscalex117 complementare, este irelevant din punctul de vedere al
regulii dacS cei doi \up0 \expndtw0\charscalex129 sunt angajafi intr-o barfS
critics \up0 \expndtw0\charscalex123 (parinte-pSrinte), in rezolvarea unei
\par\pard\ql \li1137\sb8\sl-230\slmult0 \up0 \expndtw0\charscalex113 probleme
(adult-adult) sau intr-un |oc (copil-copil sau pSrinte-copil) \par\pard\qj
\li1128\ri635\sb0\sl-245\slmult0\fi288 \up0 \expndtw0\charscalex131 A doua regue a
comunicSrii este cS aceasta se intrerupe cand se \up0 \expndtw0\charscalex114
produce o tranzacfie incruci$atS. Cea mai frecvents tranzactie incrucisatS s>
\up0 \expndtw0\charscalex128 care creeazS cele mai multe dificultSfi sociale in
relafiile de munca, \up0 \expndtw0\charscalex132 cSsatorie, prietenie, iubire. este
cea in care la un stimul adult-adult \up0 \expndtw0\charscalex116 respunsul este
copil-perinte. \par\pard\qj \li1128\ri621\sb0\sl-246\slmult0\fi288 \up0
\expndtw0\charscalex121 Acest tip de tranzacfie nu este altc9va decat reacfia
clasice de transfer \up0 \expndtw0\charscalex118 din psihanalize. La intrebarea
simple "nu stil unde este ziarul de azi"? pofi \up0 \expndtw0\charscalex123
rSspunde "pe birou" sau "intotdeauna dai vina pe mine cSnd nu gesesti \up0
\expndtw0\charscalex119 ceva!". Acest al doilea respuns este o tranzacfie
incrucisata. De asemenea \up0 \expndtw0\charscalex118 la remarca doctorului
"analizele sunt destul de proaste; cred ca ar trebui s3 \up0
\expndtw0\charscalex120 gesim o solufie ca se befi mai putin", respunsul adultului
intr-o tranzacfie \up0 \expndtw0\charscalex120 complementare ar fi "cred ce ar
trebui se me abfin un timp". \par\pard\qj \li1132\ri627\sb0\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex120 RSspunsul intr-o tranzacfie incruci$ate va fi "tot
timpul mS critical de \up0 \expndtw0\charscalex120 pares afi fi maice-mea!"
2\charscalex100 \u9830?\tab \dn2 \expndtw0\charscalex107
\ul0\nosupersub\cf9\f10\fs20 Elemente de psihosomatica generala si
230\slmult0 \up0 \expndtw0\charscalex115 F/ptrra 6 \par\pard\ql \li2567\sb0\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf3\f4\fs18 /'
\ul0\nosupersub\cf23\f24\fs14 S-
stimul\par\pard\sect\sectd\sbknone\cols2\colno1\colw4607\colsr20\colno2\colw4413\co
lsr160\ql \li2558\sb189\sl-230\slmult0 \up0 \expndtw0\charscalex221
\ul0\nosupersub\cf9\f10\fs20 7^\\\par\pard\ql \li2558\sb77\sl-207\slmult0 \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf3\f4\fs18 V \up0 \expndtw0\charscalex105
A\par\pard\ql \li4017\sb1\sl-148\slmult0 \up0 \expndtw0\charscalex147
\ul0\nosupersub\cf13\f14\fs16 r v\par\pard\ql \li2567\sb11\sl-
211\slmult0\tx4079 \up0 \expndtw0\charscalex113 \ul0\nosupersub\cf9\f10\fs20 f C
'\tab \up0 \expndtw0\charscalex118 \ul0\nosupersub\cf33\f34\fs30 c )\par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 Doctor \tab \up0 \expndtw0\charscalex127
Pacient\par\pard\column \ql \li2328\sb0\sl-378\slmult0 \up0 \expndtw0\charscalex138
\ul0\nosupersub\cf27\f28\fs42 si/\par\pard\ql \li20\sb0\sl-126\slmult0 \up0
\expndtw0\charscalex107 \ul0\nosupersub\cf23\f24\fs14 � \u9632? lOsouns\par\pard\ql
K-S\par\pard\ql \li1738\sb35\sl-207\slmult0 \up0 \expndtw-8\charscalex90
\ul0\nosupersub\cf3\f4\fs18 '<\par\pard\ql \li1177\sb0\sl-208\slmult0\tx2333\tx2525
\up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf8\f9\fs22 c\tab \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf25\f26\fs28 :\tab \up0 \expndtw-3\charscalex100
c\par\pard\ql \li865\sb81\sl-230\slmult0\tx2295 \up0 \expndtw0\charscalex123
\ul0\nosupersub\cf9\f10\fs20 Doctor\tab \up0 \expndtw0\charscalex127 Pacient
\par\pard\sect\sectd\sbknone \qj \li1459\sb0\sl-240\slmult0
Un alt tip de tranzacfie este eel in care la stimulul tranzactional adult\up0
\expndtw0\charscalex115 adull rSspunsul este pSrinte-copil. La intrebarea de mai
inainte "nu stii unde \up0 \expndtw0\charscalex126 este ziarul de azi?" rSspunsul
poate fi "niciodatS nu ai grijS unde la$i \up0 \expndtw0\charscalex105 lucrurile!".
relafia medic pacient acest lucru se intampIS de pildS cand la \up0
\expndtw0\charscalex124 intrebarea pacientului "si ce se poate face ca sa mS
vindec?" rSspunsul \up0 \expndtw0\charscalex115 medicului este "totdeauna venifi in
ultima clips si plini de pretenfii!". Acest \up0 \expndtw0\charscalex115 tip de
tranzactii poate fi schematizat dupe cum urmeazS: \par\pard\ql \li4680\sb0\sl-
Figure
60\ql \li2875\sb0\sl-207\slmult0 \par\pard\ql \li2875\sb205\sl-207\slmult0 \up0
\expndtw0\charscalex118 \ul0\nosupersub\cf3\f4\fs18 R\par\pard\column \ql
\ul0\nosupersub\cf11\f12\fs68 c \up0 \expndtw0\charscalex110
\ul0\nosupersub\cf33\f34\fs30 PJ s=\ul0\nosupersub\cf13\f14\fs16 stimul\tab
\up0 \expndtw0\charscalex97 \ul0\nosupersub\cf20\f21\fs26 J\par\pard\ql
\ul0\nosupersub\cf8\f9\fs22 N\tab \up0 \expndtw-4\charscalex100
\ul0\nosupersub\cf16\f17\fs34 r \par\pard\sect\sectd\sbknone \li2251\sb1\sl-
162\slmult0\fi0\tx3892\tx4564\tx6033\tx7665 \dn1 \expndtw0\charscalex120
\ul0\nosupersub\cf3\f4\fs18 A\tab \dn3 \expndtw0\charscalex120 A\tab \up3
\expndtw0\charscalex109 \ul0\nosupersub\cf23\f24\fs14 R \u8212? r<Sspuns\tab
\dn3 \expndtw0\charscalex120 \ul0\nosupersub\cf3\f4\fs18 A\tab \dn2
\expndtw0\charscalex120 A\par\pard\ql \li7992\sb0\sl-162\slmult0 \up0 \expndtw-
2\charscalex100 ' \par\pard\li1982\sb1\sl-347\slmult0\fi0\tx2521\tx3892\tx5985 \dn3
\expndtw0\charscalex174 \ul0\nosupersub\cf7\f8\fs32 (c\tab \up6 \expndtw-
2\charscalex100 \ul0\nosupersub\cf3\f4\fs18 ^\tab \dn4 \expndtw0\charscalex120
\ul0\nosupersub\cf7\f8\fs32 c\tab \up0 \expndtw0\charscalex120 c\par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 > \par\pard\li1972\sb1\sl-
200\slmult0\fi0\tx3585\tx5620\tx7377 \up0 \expndtw0\charscalex134
\ul0\nosupersub\cf8\f9\fs22 Doctor\tab \dn2 \expndtw0\charscalex134 Paciont\tab
\dn3 \expndtw0\charscalex134 Dcxrloi\tab \dn2 \expndtw0\charscalex134
Pacient\par\pard\qj \li1454\sb0\sl-240\slmult0 \par\pard\qj\li1454\sb0\sl-
\expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 Un grad mare de complexitate
au tranzacfiile ulterioare care implice acti� \up0 \expndtw0\charscalex116 vitatea
simultana a mai mult de doua stari ale ego-ului Aceasta categorie de \up0
\expndtw0\charscalex116 tranzacfii sta la baza "jocurilor". \par\pard\qj
\li1463\ri311\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex123 Exemplul clasic
este tranzacfia angulare practicata de vanzatori. De \up0 \expndtw0\charscalex107
exemplu: \par\pard\qj \li1756\ri1073\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex115 VSnzetorul: "Aceasta este mai buna, dar este mult mai
scumpe." \up0 \expndtw0\charscalex116 Ciientul: "Ei bine, pe asta am s-o iau'"
Analiza aeestei tranzacfii ne arate ce vanzatorul in calitate de adult \up0
\expndtw0\charscalex117 afirme doue lucrurl obiective: ce aceaste marfe este mai
bunS si cS aceastS \up0 \expndtw0\charscalex129 marfs este mult mai scumpS. La
nivel de interactiune socials aceste \up0 \expndtw0\charscalex117 afirmafii se
adreseazS adultului din client Replica de adult a clientului ar fi
250\slmult0\fi4 \up0 \expndtw0\charscalex104 \ul0\nosupersub\cf8\f9\fs22 "aveai
dreptate cu ambele afirmafii." Totu$i vectorul ulterior sau psihologie \up0
\expndtw0\charscalex103 este indreptat de vanzStorul adult experimental cStre
copilul din client: "este \up0 \expndtw0\charscalex103 mult mai scumpS si deci nu
fi-o pofi permite!" \par\pard\ql \li1372\sb0\sl-198\slmult0 \up0
\expndtw0\charscalex109 Corectitudinea judecSfii vanzStorului este conlirmata de
rSspunsul \par\pard\qj \li1075\ri692\sb0\sl-253\slmult0\fi4 \up0
\expndtw0\charscalex104 copilului din client: "indiferent de pref o sS-i arSt
infumuratului Sstuia cS si \up0 \expndtw0\charscalex106 eu pot sS mi-o cumpar" - la
ambele niveluri tranzactia este complementare \up0 \expndtw0\charscalex117 deoarece
replica este exceptatS la nivel de adult ca un contract de \up0
\expndtw0\charscalex101 cumpSrare. \par\pard\ql \li4300\sb0\sl-253\slmult0
\par\pard\ql\li4300\sb64\sl-253\slmult0 \up0 \expndtw0\charscalex109 Figura
\colno3\colw1792\colsr110\colno4\colw1367\colsr20\colno5\colw1519\colsr160\ql
\ul0\nosupersub\cf9\f10\fs20 S\par\pard\ql \li1516\sb51\sl-
518\slmult0\tx1818\tx2815 \up0 \expndtw0\charscalex97 \ul0\nosupersub\cf38\f39\fs54
f\tab \up0 \expndtw0\charscalex78 A 1 \tab \up0 \expndtw0\charscalex97
,\par\pard\column \ql \li1511\sb0\sl-299\slmult0 \par\pard\ql \li1511\sb0\sl-
ft\ul0\nosupersub\cf40\f41\fs26\ul A\par\pard\column \ql \li1511\sb0\sl-
207\slmult0 \par\pard\ql \li68\sb102\sl-207\slmult0\tx289 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf3\f4\fs18 ,\tab \up0 \expndtw0\charscalex131
stmu\par\pard\ql \li1511\sb0\sl-207\slmult0 \par\pard\ql \li20\sb66\sl-
207\slmult0 \up0 \expndtw0\charscalex112 R rdspuns\par\pard\ql \li1511\sb0\sl-
\expndtw0\charscalex120 \ul0\nosupersub\cf8\f9\fs22 C\par\pard\column \ql
\expndtw0\charscalex164 J< \tab \up0 \expndtw-3\charscalex100 v\par\pard\column \ql
\li20\sb128\sl-253\slmult0 \up0 \expndtw0\charscalex120 A\par\pard\qj
\li30\ri1009\sb35\sl-176\slmult0\tx294 \up0 \expndtw0\charscalex120 c: \line\tab
\up0 \expndtw0\charscalex120 > \par\pard\sect\sectd\sbknone \li1511\sb25\sl-
\ul0\nosupersub\cf14\f15\fs24 Vanzator\tab \up0 \expndtw0\charscalex133
Client\tab \up0 \expndtw0\charscalex133 Baiat\tab \up0 \expndtw0\charscalex133
Fata\par\pard\ql \li1387\sb0\sl-253\slmult0 \par\pard\ql\li1387\sb249\sl-
253\slmult0 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf8\f9\fs22 Acee�i tip de
tranzacfie se poate desfS$ura intre medic si pacient. \par\pard\qj
\li1104\ri672\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex107 Medicul: Pentru
simptomele dumneavoastrS luafi doar aceste medica\up0 \expndtw0\charscalex108 mente
Sunt comod de administrat. \par\pard\ql \li1396\sb3\sl-235\slmult0 \up0
\expndtw0\charscalex105 Pacientul: Exists si alta metodS de tratament? \par\pard\qj
\li1104\ri663\sb0\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex110 Medicul: Desigur. dar este prea complicat pentru
dumneavoastrS Va \up0 \expndtw0\charscalex107 trebui sS finefi regim, sS facefi
miscare. sS vS schimbafi stilul de viafS $i \up0 \expndtw0\charscalex107 personal
nu cred ca avefi vointa necesare. \par\pard\ql \li1391\sb0\sl-198\slmult0 \up0
\expndtw0\charscalex104 Pacientul: Ei bine, renunf la medicamente s'-mi schimb
stilul de viafS! \par\pard\qj \li1104\ri648\sb4\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex112 Un alt tip de tranzacfie ulterioarS foarte frecvent este
duplexul care \up0 \expndtw0\charscalex111 implica patru stSri ale ego-ului. Acest
gen de tranzacfii este eel mai des \up0 \expndtw0\charscalex104 intalnit in flirt
si locun amoroase. \par\pard\ql \li1401\sb1\sl-215\slmult0 \up0
\expndtw0\charscalex101 BSiatuI: Vino in pod sa-fi arSt observatorul meu astronomic
\par\pard\ql \li1401\sb11\sl-233\slmult0 \up0 \expndtw0\charscalex107 Fata: Mia
pecul sS privesc steiele incS de cand eram micS. \par\pard\ql \li1406\sb2\sl-
216\slmult0 \up0 \expndtw0\charscalex104 La nivel social este o conversafie intre
doi adulfi despre astronomle. \par\pard\qj \li1113\ri655\sb5\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex103 La nivel psihologie este conversafie
intre doi copii despre jocul sexual, in \up0 \expndtw0\charscalex105 aparenfS
adultul are inifiativa. dar ca in majoritatea jocurilor rezultatul este \up0
\expndtw0\charscalex105 decis de copil, ceea ce este perceput ca o surprlzS.
\par\pard\ql \li1396\sb0\sl-198\slmult0 \up0 \expndtw0\charscalex117 Analiza
tranzactionae nu este o cheie universae cu care sS putem \par\pard\qj
\li1113\ri650\sb0\sl-253\slmult0 \up0 \expndtw0\charscalex106 deschide toate usile
ce blocheaze comunicarea medic-pacient, dar este fere \up0 \expndtw0\charscalex111
indoiae utte in majoritatea situaftilor intalnite in cabinetul medicului de \up0
\expndtw0\charscalex109 familie mai ales dace este dublate de empatia doctorului
fafa de suferinta \up0 \expndtw-3\charscalex100 bolnavului.
Bibliografie\par\pard\li1305\sb0\sl-207\slmult0\par\pard\li1305\sb62\sl-
207\slmult0\fi331 \up0 \expndtw0\charscalex120 1. Engel G.L. The need tor a new
medical model: A chalenge for biomedicme.\par\pard\li1305\sb4\sl-
207\slmult0\fi14 \up0 \expndtw0\charscalex119 Science 1977; 196: 129-
136\par\pard\li1305\sb9\sl-207\slmult0\fi292 \up0 \expndtw0\charscalex120 2. Jansen
J.M. The comparative study of medical systems as changing
social\par\pard\li1305\sb9\sl-207\slmult0\fi9\tx3484 \up0 \expndtw0\charscalex119
systems. Soc. Sci. Med\tab \up0 \expndtw0\charscalex119 1978; 12: 121-
129.\par\pard\qj \li1324\ri465\sb17\sl-200\slmult0\fi278 \up0
\expndtw0\charscalex114 3. Bronienbrenner U The Echology of Human Development.
Cambridge, Harvard \up0 \expndtw0\charscalex114 University Press, 1979.
Lazare A., Eisenthat S.. Wasserman L.. Hartford T.C Patient Requests in a \up0
\expndtw0\charscalex108 Walk-m Clinic. Compr. Psych. \up0 \expndtw0\charscalex100
1975; 16: 467-477. \par\pard\li1310\sb23\sl-207\slmult0\fi292 \up0
\expndtw0\charscalex117 5. Good M.D., Good B.J. Patients requests in primary Care
Clinics, Clinically\par\pard\li1310\sb8\sl-207\slmult0\fi0\tx6686 \up0
\expndtw0\charscalex112 Applied Anthropology. Dordrecht. The Netherlands. D.
Reidel,\tab \up0 \expndtw0\charscalex116 1982\par\pard\li1310\sb14\sl-
207\slmult0\fi297 \up0 \expndtw0\charscalex117 6. Young A. The antropologies of
illness and sickness. In Annual Review ot\par\pard\li1310\sb9\sl-
207\slmult0\fi0\tx6278 \up0 \expndtw0\charscalex111 Anthropology. Palo Alto,
California. Annual Reviews, Inc.\tab \up0 \expndtw0\charscalex116
7. Wultt H.R., Pedersen S.A., Rosenberg R. Philosophy of Medicine, 2"1* Ed.\tab
\up0 \expndtw0\charscalex116 -\par\pard\li1310\sb14\sl-207\slmult0\fi14\tx4185 \up0
\expndtw0\charscalex113 Blakweli Scientific Publications,\tab \up0
\expndtw0\charscalex116 1990.\par\pard\ql \li1612\sb1\sl-191\slmult0 \up0
\expndtw0\charscalex111 8. Eraser R.C: Clinical Method, 2nd Ed.. Butterworth-
Heinemann. \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg132}
276\slmult0 \up0 \expndtw0\charscalex110 \ul0\nosupersub\cf14\f15\fs24 Capitolul
8 \par\pard\ql \li1185\sb0\sl-276\slmult0 \par\pard\ql\li1185\sb168\sl-
276\slmult0 \up0 \expndtw-10\charscalex100 ELEMENTE DE PSIHOTERAPIE A BOLNAVILOR
PSIHOSOMATICI \par\pard\ql \li1622\sb184\sl-276\slmult0 \up0 \expndtw-
8\charscalex100 A. PSIHOTERAPIA EXPERIENtlALA IN BOLILE \par\pard\ql
\li1939\sb84\sl-276\slmult0 \up0 \expndtw-11\charscalex96 PSIHOSOMATICE
\ul0\nosupersub\cf8\f9\fs22 lolanda Mitrofan \par\pard\ql \li1209\sb0\sl-
1. Principille psihoterapiei experientiale \par\pard\qj \li892\ri861\sb174\sl-
245\slmult0\fi292 \up0 \expndtw0\charscalex102 Obisnuim sS spunem cS, in mod
natural, cunoasterea incepe cu exponen� \up0 \expndtw0\charscalex109 ts. \up0
\expndtw0\charscalex104 \u8222?A fl in situatie" sau ..a fi prezent" este
atitudinea prin care percepem lu\up0 \expndtw0\charscalex103 mea, ne dezvoltSm si
mijlocul obiectiv prin care stablllm relafia personae cu \up0
\expndtw0\charscalex106 ceilalfi si cu lumea. AceastS atitudine naturals, spontane.
de a experimenta \up0 \expndtw0\charscalex103 realul este ..poluatS" de o mulfime
de prejudecafi. scheme aperceptive invS\up0 \expndtw0\charscalex108 fate,
stereotipii si obisnuinte socio-culturale. supozlfii si dorinfe. dar ceea \up0
\expndtw0\charscalex104 ce conteaze in primul rSnd este percepfia realulul si
treirea afective asociatS \up0 \expndtw0\charscalex115 ei. Reflexia si evaluarea.
rafionalizarea $i pastrarea cunostinfelor si a \up0 \expndtw0\charscalex104
atitudinilor ce ne definesc, dupS criterii de o mare diversltate, (in funcfie de
\up0 \expndtw0\charscalex105 dinamica fenomenelor constient-inconstiente, de nevoi
$i de posibilltSfi. de \up0 \expndtw0\charscalex109 interese s' de speranfe, de
frici si de neputlnfe) - toate acestea devin si se \up0 \expndtw0\charscalex106
construiesc pe sistemul nostru natural, direct, de a experimenta lumea, atat
\up0 \expndtw0\charscalex106 cea interne, cat si cea externe. \par\pard\ql
\li1195\sb0\sl-198\slmult0 \up0 \expndtw0\charscalex108 Acfiunea este princlpiul de
baza al dezvoltSril, atat la nivel mental, cat \par\pard\qj \li907\ri865\sb0\sl-
248\slmult0 \up0 \expndtw0\charscalex100 Si comportamental Noi experimentSm
(acfionem in plan intern) ori de cate ori \up0 \expndtw0\charscalex106 proiectem
(gandim si concepem strategii, operSm, analizem si comparem, \up0
\expndtw0\charscalex100 abstragem si generallzSm, elaborSm solufii $i rezolvSm.
imaginam, ne repre-\line \up0 \expndtw0\charscalex100 zentSm, visam si cream). Apoi
transpunem ..proiectul nostru mental'" in reali� \up0 \expndtw0\charscalex102 tate,
verificSm, modificSm. restructurSm ceea ce am proiectat, in contact di� \up0
\expndtw0\charscalex103 rect cu obiectul. relafiile si strategiile rezultate sau
puse in aplicare. Proiectul \up0 \expndtw0\charscalex104 nostru mental se refers s*
la propria imagine, la Eul sau Sinele nostru. auto-\line \up0
\expndtw0\charscalex104 perceput, real sau ideal, la ceea ce stim sau nu stim cS
suntem, la ceea ce \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart
9\charscalex96 \ul0\nosupersub\cf18\f19\fs20\ul 128\ul0\tab \up0
\expndtw0\charscalex105 \ul0\nosupersub\cf18\f19\fs20\ul Elemento do psihosomatica
generala S' aplicata\par\pard\qj \li1200\sb0\sl-240\slmult0
\ul0\nosupersub\cf9\f10\fs20 dorim sau respingem la noi insine. Devenim persoane si
ne actualizSm \up0 \expndtw0\charscalex116 Sinele, dupS expresia lui Maslow,
restructurand continuu realitatea externS \up0 \expndtw0\charscalex113 Si simultan
pe noi insine. precum $i raporturile dintre liinfa noastra ISuntnca \up0
\expndtw0\charscalex113 Si realitatea externa. \par\pard\qj \li1204\ri594\sb19\sl-
242\slmult0\fi292 \up0 \expndtw0\charscalex119 invSfam astfel. intreaga viafS sa
participem la marea create, ca parte a \up0 \expndtw0\charscalex115 acesteia si
bucurandu-ne de privilegiul creativitefii si al translormarii. Pute\up0
\expndtw0\charscalex119 rea transformativa se expnma inse in egae masure, in
creafie. ca ?i in dis\up0 \expndtw0\charscalex117
trucfie. Creativitatea, ca si distructivitatea se resfrang nu doar asupra exte\up0
\expndtw0\charscalex113 norului (mediului). ci si asupra intcriorului nostru.
Astfel. ne putem autocrea, \up0 \expndtw0\charscalex114 pastrandu-ne si sporindu-ne
sanatatea. intrSnd intr-un acord firesc cu mediul \up0 \expndtw0\charscalex117
psihosocial si fizic. cu ecosistemul, sau neo putem submina si distruge, fie
\up0 \expndtw0\charscalex119 din ignoranfa, fie din iresponsabilitate, fie din
uitare de Sine, fie din pier\up0 \expndtw0\charscalex119 derea, pervertirea sau
reecirea valorilor moral-spirituale. \par\pard\qj \li1204\ri580\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex118 Cu cat suntem mai pufin constienfi
de noi insine, cu atat ne indepartam \up0 \expndtw0\charscalex121 de la natura
noastrS senetoasa. pozitive, deschise, potential creatoare, cu \up0
\expndtw0\charscalex121 resurse aproape nelimitate in a se adapta, evolua,
iransforma. \par\pard\qj \li1209\ri588\sb0\sl-245\slmult0\fi335 \up0
\expndtw0\charscalex117 .Natura, din intamplare sau din necesitate l-a fecut pe om.
Omul a con\up0 \expndtw0\charscalex117 struit ulterior, ca Mints libera si capabie
de premeditare, propria sa umani\up0 \expndtw0\charscalex114 tate. A fi om inseamne
a dori sa fii liber. DacS eu cunosc pe dinSuntru liber\up0 \expndtw0\charscalex117
tatea mea posibils, inteligenta imi aratS limitele ei". este de pSrere Jaquard \up0
\expndtw0\charscalex104 Albert (1988) \par\pard\qj \li1214\ri574\sb0\sl-
241\slmult0\fi292 \up0 \expndtw0\charscalex124 Psihoterapia experienfiala, prin
accesul la natura transformarilor de \up0 \expndtw0\charscalex123 sine si a
relafiilor interumane, prin valorile ei pozitive care stau la baza \up0
\expndtw0\charscalex125 infelegerii, explorarii si asistarii fiinfei umane, se
constituie intr-o pa-\line \up0 \expndtw0\charscalex125 radigma a restructurarii si
dezvoltarii persoanei, ca o cale de rcdoban \up0 \expndtw0\charscalex124 dire si
pastrare a sanatafii somato-psiho-sociale, de prevenire a alienS-\line \up0
\expndtw0\charscalex115 rii. in mSsura in care persoana ?si deblocheazS, foloseste
creativ si dezvolta \up0 \expndtw0\charscalex117 propriile resurse, facand fats
stresurilor si provocarilor existenfei, pnntr-un \up0 \expndtw0\charscalex118
proces de evolutie constient, autocontrolat, bazat pe libertatea alegerllor si \up0
\expndtw0\charscalex120 pe asumarea responsabilitafii, putem vorbi do adaptare
creative, adice de \up0 \expndtw0\charscalex117 senatate in sens larg -
somatopsihic, socio-moral, interpersonal si spiritual. \up0 \expndtw0\charscalex120
Aceasta presupune angajarea persoanei intr-un proces de autovindecarc. \up0
\expndtw0\charscalex123 provocarea si activarea resurselor ei compensatorii
naturale, potenfarea \up0 \expndtw0\charscalex117 acestora prin regasirea
semnilicafulor si sensurilor reale ale existenfei. \par\pard\qj
\li1219\ri564\sb11\sl-245\slmult0\fi302 \up0 \expndtw0\charscalex118 Procesul de
insanatos're este pentru experienfialist \u8226? o redescoperire de \up0
\expndtw0\charscalex116 sine, o reintoarcere la izvoarele proprii, spontane si
pozitive. o reintegrare a \up0 \expndtw0\charscalex121 experientei impasului sj a
bolii pe o alte treapte a cunoasterii si pe un alt \up0 \expndtw0\charscalex113
nivel al constiinfei. o armonizare a tendinfelor contrarii pnntr-o clarificare
de \up0 \expndtw0\charscalex113 sine si invefarea strategiei de .,a lucra asupra
siesi" S* de a te autoschimba. \par\pard\qj \li1238\ri554\sb0\sl-
240\slmult0\fi278 \up0 \expndtw0\charscalex116 Acest proces este indestructibii
legat de coevoiufia spirituale, a terapeu\up0 \expndtw0\charscalex117 tului si
pacientului, de dubla responsabilitate a pastrarii igienei psihologice \up0
\expndtw0\charscalex114 Si relafionale de cetre ambii. in cadrul unui proces de
devenire. ..crestere" $i \up0 \expndtw0\charscalex114 implinire mutuae. bazat pe
respectul libertefn valorilor si opfiunilor. \par\pard\qj \li1243\ri560\sb0\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex133 Pentru expenentialist, senetatea
individuae nu poate fi rupte de \up0 \expndtw0\charscalex131 senetatea sociala si
de cea a mediului natural, adice de respectarea \up0 \expndtw0\charscalex121
ntmurilor si legilor naturale ale cosmosului. Conceptia si modalitatea de \up0
\expndtw0\charscalex121 abordare este holiste. Calea este armonizarea cu sine, cu
alfil si cu \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg134}
\up0 \expndtw0\charscalex129 * 129\par\pard\qj \li1142\sb0\sl-240\slmult0
\ul0\nosupersub\cf9\f10\fs20 lumea. obiectivul este autodezvoltarea,
autotransformarea sanogena si \up0 \expndtw0\charscalex131 autocreafia iar finta
este inaintarea intru cunoastere. transcunoastcre \up0 \expndtw0\charscalex124 Si
transpersonalizare. \par\pard\ql \li1430\sb9\sl-230\slmult0\tx7915 \up0
\expndtw0\charscalex122 Psihoterapia expenentiae are ,.redacini" in filosofia
existenfialS \tab \up0 \expndtw0\charscalex124 ?i in \par\pard\qj
\li1132\ri661\sb0\sl-250\slmult0 \up0 \expndtw0\charscalex121 gindirea
fenomenologicS, de aceea ea pune accent pe trSirea si devenirea \up0
\expndtw0\charscalex124 fiinfei umane, care este libera. s> prin urmare,
responsabilS de propriul \up0 \expndtw0\charscalex115 destin. \par\pard\qj
\li1137\ri646\sb0\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex119 Devenirea
personae este un proces de autocreafie in care omul trebuie \up0
\expndtw0\charscalex120 sa se implice con?tienl Terapeufii experienfialisti
considers cS lucrul eel \up0 \expndtw0\charscalex117 mai important care trebuie
protejat e om este unicitatea sa. Fiecare dispune \up0 \expndtw0\charscalex117 de
un potential latent ce se cere valorificat. Acest potential este cea mai
si-\line \up0 \expndtw0\charscalex121 gurS garanfie in lupta cu alienarea, cu
\up0 \expndtw0\charscalex118 \u8222?instrSinarea omului de sine", cu
pierderea sau blocarea spontaneitafii. autenticitSfii si capacitSfilor creative.
\up0 \expndtw0\charscalex117 Boala psihicS poate Ii considerae, dm aceasta
perspective, drept o expresie \up0 \expndtw0\charscalex119 a scederii potenfialului
uman prin blocarea posibiliefilor de manifestare a \up0 \expndtw0\charscalex106 eu-
lui. \par\pard\qj \li1151\ri632\sb0\sl-244\slmult0\fi292 \up0
\expndtw0\charscalex120 Psihoterapeutul experienfialist pune in prim-planul
preocuparilor sale \up0 \expndtw0\charscalex120 trairea emofiei si exprimarea
experienfei prezente Pnncipiul sSu de bazS \up0 \expndtw0\charscalex119 este
expenenfa ..aici si acum", ceea ce ii permite subiectului constientiza-\line
\up0 \expndtw0\charscalex116 rea propnilor perceptii, emotii, ganduri s* trSiri.
Dobandind con�tiinfa pro-\line \up0 \expndtw0\charscalex123 priului eu, persoana va
fi capabilS sa se puna in acord cu semnificafiile \up0 \expndtw0\charscalex118
lumii sale interne si externe si sS se perfectioneze pnn autorestructurare.
Relafia terapeuticS poarts s* ea ..amprenta" valorizahi omului ca entitate \up0
\expndtw0\charscalex128 active, auto-afirmativa. Astfel, rolul terapeutului nu este
acela de a-l \up0 \expndtw0\charscalex120 modifica pe pacient, ci de ai crea
situafii experienfiale prin care acesta se \up0 \expndtw0\charscalex122 devina con?
tient de proprnle disponibilitafi. pe care, apoi, sS le punS in \up0
\expndtw0\charscalex114 acfiune in scopul dezvolerii personalitSfii.
Terapeutul experienfialist se manifests ca o liinfS omeneasca disponibi\up0
\expndtw0\charscalex117 la pentru o reiafie echllibrata. de la adult-la adult - in
care cei doi sunt par\up0 \expndtw0\charscalex121 teneri in procesul terapeutic.
Acceptarea necondifionatS a experienfei si \up0 \expndtw0\charscalex121 valorilor
clientului, incarcatura alectivs, sinceritatea si deschiderea catre \up0
\expndtw0\charscalex120 comunicarea verbals ?i non-verbalS, sunt cateva dintre
caracteristicile de \up0 \expndtw0\charscalex120 baza in aceastS orientare
terapeutice. \par\pard\qj \li1161\ri616\sb0\sl-242\slmult0\fi297 \up0
\expndtw0\charscalex124 Scopul procesului terapeutic este ca pacientul sa obfine
autonomia. \up0 \expndtw0\charscalex125 apeland inifial la un spnjin. Terapeutul il
ajue pe pacient sa obfina noi \up0 \expndtw0\charscalex119 intormafn atunci cand
isi stabileste not scopuri. in acest demers complex, \up0 \expndtw0\charscalex117
exista trepte. urcusuri $i coborasun pe care relafia terapeutice le face se fie
\up0 \expndtw0\charscalex115 depasiie mai usor. in cadrul noilor experienfe cu
sine, cu ceilalfi $1 cu tera� \up0 \expndtw0\charscalex118 peutul, apar noi
posibilitefi pentru pacient de a se ..vedea" pe sine mai dar \up0
\expndtw0\charscalex121 Si de a beneficia de avantajele insight-urilor pe care le
treieste in timpul \up0 \expndtw0\charscalex117 terapiei. Acestea devin castiguri
experienfiale ale pacientului, ajutandu-l in \up0 \expndtw0\charscalex117
autoacceptare \par\pard\qj \li1171\ri627\sb0\sl-245\slmult0\fi287 \up0
\expndtw0\charscalex124 Conceptele de baza in terapiile experienfiale sunt
spontaneitatea s1 \up0 \expndtw0\charscalex124 autenticitatea, iar mstrumentul
preferat este autodezveiuirea ca o fiinfe \up0 \expndtw0\charscalex119 omeneasce
autentice si afirmarea identitafii unice in confruntarea cu altii. \up0
\expndtw0\charscalex121 cu familia. cu grupul Atat in terapia individuae, cat si in
cea de grup sau \up0 \expndtw0\charscalex121 de familie, terapeutul
promoveaze comunicarea libera in expenmentarea
\expndtw0\charscalex105 \ul0\nosupersub\cf18\f19\fs20\ul Elements de
psihosomaticS\ul0\nosupersub\cf9\f10\fs20 generala ?i aplicata\par\pard\qj
interacfiunii, interesele lui fiind cenfrate pe stimularea comportamentului \up0
\expndtw0\charscalex117 spontan si pe trairea sentimentelor. El este preocupat de
ce simte si cum se \up0 \expndtw0\charscalex113 comports pacientul in cadrul
familiei. in situafiile legate de serviciu sau con� \up0 \expndtw0\charscalex124
tact comunitar, de relafiile sale cu cei apropiafi si mai putin de cauzele \up0
\expndtw0\charscalex115 acestui comportament, evitand interogafiile de tip \u8222?
de ce?', precum $i inter\up0 \expndtw0\charscalex116 pretarile. In felul acesta
experienfialistii se diferenfiazS atat de psihanaiistl, \up0
\expndtw0\charscalex122 cat si de comportamentalisti, dezavuand punctul de vedere
determinist. \up0 \expndtw0\charscalex113 precum si abordarea mampulativS a omului.
Experienfa permite manifestarea creativitafii personate si interperso\up0
\expndtw0\charscalex122 nale, in stransa legSturS cu funcfionarea optimS a
personalitafii umane \up0 \expndtw0\charscalex121 Procesul autocreatiei implies,
dupS Schutz \up0 \expndtw-2\charscalex100 ( \up0 \expndtw-4\charscalex100 1969)
\up0 \expndtw0\charscalex127 5 etape sau condifii \par\pard\ql \li998\sb29\sl-
230\slmult0 \up0 \expndtw0\charscalex117 psihologice: achizifia. asociafia,
expresia, evaluarea si perseverenfa. \par\pard\qj \li993\ri805\sb2\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex120 \u8226? Achizifia. Procesul
autocreativ presupune ca punct de plecare exis� \up0 \expndtw0\charscalex116 tenta
elementelor experienfiale. Acumularea lor necesitS deschiderea cStre \up0
\expndtw0\charscalex116 noi experienfe, capacitatea de a percepe mediul exterior si
de a-fi con?tien-\line \up0 \expndtw0\charscalex117 tiza propriile sentimente.
Elementele experienfiale inseamnS informafia si \up0 \expndtw0\charscalex121
experienfa Internalizate de Individ. Persoana deschisS cStre experientS, \up0
\expndtw0\charscalex120 capabila de simfire, acumuleazS mai multe elemente
experienfiale decat \up0 \expndtw0\charscalex115 persoana ngida. care nu-si pormite
manifestarea propriilor sentimente. \par\pard\qj \li998\ri790\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex121 Atat deschiderea cStre experientS,
cat si inhibifia. se pot manifesta la \up0 \expndtw0\charscalex118 niveluri
diferite de constiinfa. La nivel constient, capacitatea de a invSfa a \up0
\expndtw0\charscalex121 unei persoane este relationats cu dezvoltarea sa emofionae.
Exists multe \up0 \expndtw0\charscalex117 blocaje emotionale in ceea ce priveste
invSfarea. Anxietatea, temerile acu-\line \up0 \expndtw0\charscalex122 mulate in
copierie, conflictele nerezolvate, distorsioneaza percepfia. De \up0
\expndtw0\charscalex116 exemplu. unele persoane evita implicarea emotionalS intr-o
relafie, datorita \up0 \expndtw0\charscalex116 temerii de respingere. A ajuta o
persoanS sS-si invingS inhibifia, sS devinS \up0 \expndtw0\charscalex116 mai
deschisS cStre experientS, inseamnS deblocare emotionalS $1 extensia \up0
\expndtw0\charscalex137 constiinfei de sine \up0 \expndtw0\charscalex133 (ceea ce
presupune constientizarea propriilor \par\pard\ql \li1003\sb29\sl-230\slmult0
\up0 \expndtw0\charscalex114 sentimente) \par\pard\qj \li1008\ri790\sb5\sl-
237\slmult0\fi288 \up0 \expndtw0\charscalex118 \u8226? Asociafia. Aceasta este o
etapS a procesului autocreativ care se refers \up0 \expndtw0\charscalex118 la
combinarea elementelor experienfiale in diferite modalitafi: informafii, \up0
\expndtw0\charscalex116 senzafii si emofii. toate extrem de importante pentru
activitatea creativS. Si \up0 \expndtw0\charscalex117 combinarea elementelor
experientiale poate fi blocatS la nivel inconstient. \up0 \expndtw0\charscalex120
Multor oameni le este teams de ceea ce tear putea releva inconstientul cu \up0
\expndtw0\charscalex118 pnvire la ei in$isi Pentru acestia. jocul asociativ
reprezinte o mare dificul\up0 \expndtw0\charscalex115 tate. A restricfiona
manifestarea inconstientulul inseamne a-fi limlta posibl\up0
\expndtw0\charscalex112 titSfile de crestere. \par\pard\qj \li1022\ri775\sb7\sl-
233\slmult0\fi287 \up0 \expndtw0\charscalex114 Esenfa asociafiei consta in
realizarea de conexiuni intre elementele ce nu \up0 \expndtw0\charscalex115 sunt
conectate in mod evident. Asadar. dezvoltarea depinde de poslbilitSfile \up0
\expndtw0\charscalex119 persoanei de a-si explora gandurile si emotille trSite,
astlel putand desco\up0 \expndtw0\charscalex113 peri relafiile dintre ele
\u8226? Expresivitatea Atat la nivel constient, cat si la nivel inconstient, exists
\up0 \expndtw0\charscalex120 limite privind expresivitatea unei persoane. Schutz
considers cS educatia \up0 \expndtw0\charscalex114 tradifionala este un factor
foarte important care, acfionand la nivel constient, \up0 \expndtw0\charscalex118
limiteazS expresivitatea unei persoane. Exists norme speciale care trebuie \up0
\expndtw0\charscalex123 respectate, devierea de \up0 \expndtw0\charscalex123 1a
aceste norme putSnd fi interpretats ca
anor-\par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg136}{\bkmkend
malitate. Factorii socio-culturali actioneazS insS �i e nivel inconstient. De
\up0 \expndtw0\charscalex106 exemplu asocierea unor manifesteri artistice cu
comportamente exhibitive. \up0 \expndtw0\charscalex115 imorale sau iresponsabile,
este un factor care blocheaze constient \up0 \expndtw-10\charscalex89 �l
inconstient \tab \up0 \expndtw0\charscalex108 - expresivitatea umane. Un pas pe
calea dezinhibifiei poate fi \up0 \expndtw0\charscalex104 facut prin crearea in
cadrul grupului experiential, a unei atmosfere de explo\up0 \expndtw0\charscalex104
rare reciprocS a laturii expresive a fiecSrui membru al grupului. \par\pard\qj
Evaluarea. Acest aspect se refers la relevanta unui anumit comporta� \up0
\expndtw0\charscalex104 ment pentru o situatie datS. Comportamentul rezultat in
urma asocierii anu� \up0 \expndtw0\charscalex102 mitor elemente experienfiale
trebuie sS fie nu numai creativ, cl s' Utll. Bloca-\line \up0
\expndtw0\charscalex103 jele emofionale impledicS evaluarea reals. Teama de a nu
dezamSgl pe aifn, \up0 \expndtw0\charscalex108 de a nu se autodezamSgi, nesiguranta
privind propria competenfS sau un \up0 \expndtw0\charscalex103 perfecflonism
compulslv, reprezintS piedlci Tn calea unei evaluSri corecte a \up0
\expndtw0\charscalex113 propriilor rezultate. Pe de alts parte, dorinta de a te
Impune, tendinfele \up0 \expndtw0\charscalex104 competitive, reprezintS piedicl in
evaluarea corectS a rezultatelor altora. \par\pard\ql \li1300\sb1\sl-
215\slmult0\tx4497 \up0 \expndtw0\charscalex112 \u8226? Perseverenfa. Ideile
creative \tab \up0 \expndtw0\charscalex109 ?i comportamentul creativ nu sunt de
\par\pard\qj \li1008\ri763\sb5\sl-240\slmult0 \up0 \expndtw0\charscalex112 ajuns
pentru o autotransformare reals. Aceasta implies $i o atltudine de \up0
\expndtw0\charscalex105 perseverenfa. Ideea creative trebuie ..maturae", trebuie
\u8222?trSitS", Tnalnte de \up0 \expndtw0\charscalex104 a fl exprlmatS. Lipsa de
perseverenfa poate insemna plerderea unei Idel va\up0 \expndtw0\charscalex104
loroase. Atitudlnea ostie fafa de autorltate poate constltul unui din blocajele
\up0 \expndtw0\charscalex102 privind perseverenfa. \par\pard\qj
\li1012\ri760\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex105 Unii oameni se
confrunta permanent cu autorltatea negatlvS internallza\up0 \expndtw0\charscalex104
ts, ceea ce ii impledicS sa tlnalizeze un act creativ, Inclusiv eel de a se
auto\up0 \expndtw0\charscalex102 transforma. \up0 \expndtw0\charscalex108 \u8222?
Pot face ceva mai bun decdt ceea ce au facut specialism din \up0
\expndtw0\charscalex117 acest domeniu", spun eel care nu si-au rezolvat conflicted
legate de \up0 \expndtw0\charscalex102 autorltate. \par\pard\qj
\li1012\ri764\sb0\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex106 Pslhoterapllle
experienfiale deschld o poarta catre un mod mai sSnatos \up0
\expndtw0\charscalex103 de a fl si de a acflona al fllnfel umane aflate Tn
dlflcultate psihologica, Inter-\line \up0 \expndtw0\charscalex103 personaia, dar si
Tn Impas pslhopatologlc. Pe de alts parte, ele constitute cai \up0
\expndtw0\charscalex108 vailde In optlmizarea comportamentului si performanfelor
umane, avdnd \up0 \expndtw0\charscalex102 valenfe formative recunoscute Tn special
Tn Instrulrea academics a profeslo-\line \up0 \expndtw0\charscalex103 nlstllor
pslhoterapeufi, conslllerk educational! si de familie, a tuturor specia-\line
\up0 \expndtw0\charscalex104 listllor Tn relafll umane \up0 \expndtw0\charscalex113
$1 dezvoltare
personae. De aceea incercam sS \par\pard\qj \li1012\ri755\sb0\sl-
240\slmult0\fi14 \up0 \expndtw0\charscalex103 compiementSm pufinele resurse
Informational romSnesti Tn acest domeniu, \up0 \expndtw0\charscalex103 precum si
numSrui redus al traducerilor care s-au facut dupS 1990, dominate \up0
\expndtw0\charscalex107 de lucrSnie fundamentale ale psihanalizei. in completarea
acestora, avdnd \up0 \expndtw0\charscalex106 Tn vedere unele Izvoare psihanalitice
si analltlce prefioase (Tn special cele \up0 \expndtw0\charscalex114 identlficate
Tn operele lui C. Q. Jung fl W. Relon), pe care orientarea \up0
\expndtw0\charscalex106 expenenfiaiista le recunoaste, aslmilSndu-le II
diferenfMldu-ie totodata de \up0 \expndtw0\charscalex110 ele, prin infuzia gSndirlt
fenomenologice \up0 \expndtw0\charscalex107 |l umanigt-exiBtenfiali9te, ne
propunem sS umplem o lacuna inlormafionali, reftntoir* la un domeniu \up0
\expndtw0\charscalex102 inca incomplet cunoscut si exploatat*. \par\pard\ql
253\slmult0\tx7420 \up0 \expndtw-3\charscalex100 v I Mitrofan si colab.
..Psihoterapia experiential*'. Editura Infomedica, \tab \up0 \expndtw-
10\charscalex89 1997 \par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart
240\slmult0\fi292 \up0 \expndtw0\charscalex118 SperSm sS oferim in continuare o
mostrS de realitate pslhoterapeutica \up0 \expndtw0\charscalex113 vie, decupatS din
experienfa nostrS clinics.* \par\pard\ql \li1560\ri664\sb183\sl-
310\slmult0\tx1843\tx1838 \up0 \expndtw0\charscalex137 2. Rezultatele unui model
recuperator experiential, bazat pe \line\tab \up0 \expndtw0\charscalex136 analiza
bioenergetica si gestalt-terapie in cazurile cu \line \tab \up0
\expndtw0\charscalex137 torticolis de etiologie $i expresie psihogena
Osciend intre tulburare neurologies s" pseudoneuroiogicS, asimilabil \up0
\expndtw0\charscalex114 adesea nevrozelor motorii sau tulburarilor conversive cu
simptom motor sau \up0 \expndtw0\charscalex108 deficit \up0 \expndtw0\charscalex106
(D.S.M. IV. cod \up0 \expndtw0\charscalex114 300.11, American Psychiatric
Association. \up0 \expndtw0\charscalex110 1994, p \par\pard\qj
\li1262\ri526\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex115 221), atat prin
complexul etiologie psihogen, cat si prin absenfa substratului \up0
\expndtw0\charscalex117 organic decelabil \up0 \expndtw0\charscalex120 -
torticolisul spasmodic ridicS semnificative si dificile \par\pard\qj
\li1262\ri536\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex117 probleme de evaluare
si recuparare, avand in vedere slaba responsivitate in \up0 \expndtw0\charscalex119
tratamentul farmacologic, lizio- s' chinetoterapeutic, in sensul recidivelor
\up0 \expndtw0\charscalex119 sau slabelor ameliorSri. \par\pard\qj
\li1257\ri531\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex119 Pornind de la
aceasta realitate, abordarea noastrS este neconvenfionae \up0
\expndtw0\charscalex122 $i reflects principiile psihoterapiei holiste si
reconstructive, de orientare \up0 \expndtw0\charscalex121 experienfialS. incluzand
douS dintre principalele metode terapeutice ale \up0 \expndtw0\charscalex117
domeniului: analiza bioenergeticS (A. Lowen) si gestalt terapia (F. Perls si
\up0 \expndtw0\charscalex117 continuatorii). \par\pard\qj \li1267\ri525\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex116 Ea i?i propune sS dinamizeze creativ
si sS restructureze resursele psiho \up0 \expndtw0\charscalex128 fiziologice si
postural kinestezice ale personaliefii pacientului, intr-o \up0
\expndtw0\charscalex115 tentative de restructurare a gestaltului functional.
Tulburarea psihogene care \up0 \expndtw0\charscalex121 se reveleaze sub forma
dramatlcului s1 spectaculosului torticolis \up0 \expndtw0\charscalex117 (fie in
varianta spasmului de torsiune, fie in cea hipotonS \tab \up0
\expndtw0\charscalex118 - rigidizarea gatului \par\pard\qj \li1262\ri530\sb9\sl-
240\slmult0 \up0 \expndtw0\charscalex123 orientat antero-lateral) constituie un
eveniment clinic rar, dar cu marcat \up0 \expndtw0\charscalex112 potential
invalidant. \par\pard\qj \li1271\ri523\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex117 Penduland intre cabmetul de neurologie - cu sau, de cele
mai multe on. \up0 \expndtw0\charscalex119 fSrS indicafie operatone, \up0
\expndtw0\charscalex129 $' cabmetul de psihiatrie, dupa ce a parcurs
inevitabil tratamente larmacologice paleative $i fizioterapie, fSrS ameliorSn
\up0 \expndtw0\charscalex121 semnificative sau stabile, dupS ce si-a investit
speranfele in acupunctura \up0 \expndtw0\charscalex123 sau in masaiul bioenergetic
miraculos al vreunuia dintre vindecStorii la \up0 \expndtw0\charscalex124 moda,
bolnavul cu torticolis ajunge intampeior si e u$a cabinetului de \up0
\expndtw0\charscalex119 psihoterapie. La capStuI unui drum sinuos de cea. \up0
\expndtw0\charscalex121 1-2 ani de la debut si \par\pard\qj \li1271\ri517\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex117 chiar 4-5 ani de evolufie, acest bolnav
aflat in cautarea vindecSrii, lipsit de \up0 \expndtw0\charscalex120 speranfS.
demisiv, cu atitudini sociofobe \up0 \expndtw0\charscalex121 $i depresat \up0
\expndtw0\charscalex125 - se confruntS cu \par\pard\ql \li1276\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex114 alternative pensionSrii de
invaliditate. \par\pard\qj \li1281\ri511\sb2\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex117 Ceea ce la inceput parea doar o incomodS contractura a
gatului, devme \up0 \expndtw0\charscalex122 treptat o adevSratS \up0
\expndtw0\charscalex122 \u8222?teroare psiho-corporae"- un simptom rezistent
\up0 \expndtw-9\charscalex95 $i \par\pard\qj \li1286\ri517\sb6\sl-
233\slmult0\fi19 \up0 \expndtw0\charscalex119 invalidant, pentru cS el se complies
s* se structureazS postural si mental \up0 \expndtw0\charscalex125 Torticolisul
conduce la un ventabil deficit de deplasare. coordonare si \up0
\expndtw0\charscalex125 integrare sociae. Bolnavul se deplaseazS cu mare
dificultate. coloana \up0 \expndtw0\charscalex124 vertebrae \up0
\expndtw0\charscalex115 (\u8222?axul viefii") comports prefaceri de mecanicS
si implicit. \par\pard\ql \li1324\sb0\sl-230\slmult0 \par\pard\ql\li1324\sb20\sl-
230\slmult0 \up0 \expndtw0\charscalex103 ' /. Mitrofan. Rev. de Expertiza Medicala
si Recuperare a Capacildtn de Munca. \par\pard\li1296\sb1\sl-
211\slmult0\fi0\tx2188\tx2404\tx3134 \up0 \expndtw-5\charscalex100 nr. 2.
vol\tab \up0 \expndtw-5\charscalex100 1.\tab \up0 \expndtw-5\charscalex100 1995.
p.\tab \up0 \expndtw-5\charscalex100
\ul0\nosupersub\cf9\f10\fs20 Psihosomatica generate\tab \up0 \expndtw0\charscalex57
\u8226?:\u8226?\tab \up0 \expndtw0\charscalex106 133\par\pard\qj \li1094\sb0\sl-
functionale: el nu mai are siguranta deplasSrii pe direcfia autopropusS, apar
\up0 \expndtw0\charscalex115 tulburSri de echilibru si senzatia de \u8222?mers
deviat". Obosit. bolnavul i?i sim \up0 \expndtw0\charscalex117 te umerii $i ceafa
crispafi ca intr-o ..carcasS", muschii sternocleidomastoi \up0
\expndtw0\charscalex117 dieni prezintS contracturi penibile, dureroase si sunt
perceputi ca pe \u8222?niste \up0 \expndtw0\charscalex123 coarde prea scurte sau
rigide", capul alunecS Involuntar, se torsioneaza \up0 \expndtw0\charscalex116
spastic in pozifii dintre cele mai spectaculoase. \par\pard\qj
\li1104\ri723\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex116 Situafia este
trSitS dramatic $i jenant de cStre bolnav. Ritmul respirator \up0
\expndtw0\charscalex124 este perturbal, dispneea insofeste orice efort minimal,
\up0 \expndtw0\charscalex122 $i uneori, chiai \par\pard\ql \li1104\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex114 simpla conversafie. \par\pard\qj
\li1099\ri704\sb2\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex126 Bolnavul de
torticolis, a cSrui organicitate este InfirmatS total sau \up0
\expndtw0\charscalex121 partial de neurolog si al cSrui caracter nevrotic este
confirmat de psihia \up0 \expndtw0\charscalex115 tru - devine repede un invalid
pentru cS tendinta la cronicizare si fixare este \up0 \expndtw0\charscalex116
importantS in aceastS afecfiune. Anxietatea s< depresia uneori preced, dar \up0
\expndtw0\charscalex118 aproape intotdeauna insofesc simptomul de bazS,
dezvoltandu-se insidios \up0 \expndtw0\charscalex118 cu tendints la inlegrSri
antropotobe si claustrare la domiciliu, consecutive \par\pard\ql \li1440\sb169\sl-
230\slmult0 \up0 \expndtw0\charscalex120 /. Cine si cum este bolnavul de torticolis
psihogen? \par\pard\ql \li1646\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115
Profilul personatitafll. \par\pard\qj \li1108\ri695\sb162\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex124 Personalitatea premorbidS a pacientului
de torticolis, a$a cum se \up0 \expndtw0\charscalex119 developeaza ea prin
analiza efectuatS de-a lungul a 15 ani pe o cazuistica \up0 \expndtw0\charscalex109
incluzand \up0 \expndtw0\charscalex122 25 de cazuri selectate si tratate in
psihoterapie \up0 \expndtw0\charscalex110 (v. I. Mitrofan \par\pard\ql
\li1128\sb9\sl-230\slmult0\tx1948 \up0 \expndtw0\charscalex104 1995, p. \tab
\up0 \expndtw0\charscalex111 137-143) circumscrie urmStoarele aspecte: \par\pard\qj
-\tab \up0 \expndtw0\charscalex127 Fondul structural: introversie, anxietate bazae,
scrupulozilate S' \up0 \expndtw0\charscalex117 pedantene. sentimente de
autoinsuficienfS, spirit critic excesiv, cu efort de \up0 \expndtw0\charscalex117
autorepnmare. super-ego de tip ..sadic". \par\pard\qj \li1118\ri702\sb5\sl-
235\slmult0\fi297\tx1612 \up0 \expndtw-2\charscalex100 -\tab \up0
\expndtw0\charscalex124 in planul manifestSrilor constiente: crispare si rigiditate
ideativa \up0 \expndtw0\charscalex116 afectivS si posturalS. condtfionate
educational, hiperexactitate, senzitivisni \up0 \expndtw0\charscalex117 relational
reprimat, sentimente de jene si Inadecvare, disconfort psihic, au \up0
\expndtw0\charscalex127 topunitiune. tendinfa la ruminatii obsesive pe nucleu
complexual df \up0 \expndtw0\charscalex119 inferioritate. in copierie \up0
\expndtw0\charscalex119 - tata hiperautoritar, rigid, mame rejective. rece
conjunctura generatoare de complexe de autorltate $i castrafie. Dificultat \up0
\expndtw0\charscalex126 de decizie, insecuritate dupe luarea oncSrei decizii cu
grad crescut di \up0 \expndtw0\charscalex117 resposabilitate TrSiri de panics in
situafii de pencol iminent, \up0 \expndtw0\charscalex112 (in special Ii
\par\pard\ql \li1123\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex111 cazul
femeilor) \par\pard\qj \li1123\ri680\sb5\sl-237\slmult0\fi292 \up0
\expndtw0\charscalex114 - in planul mecanismelor profunde, inconstiente:
dificultafi de integrare a \up0 \expndtw0\charscalex119 schemei corporae. avSnd
drept consecintS slaba constientizare a acesteui \up0 \expndtw0\charscalex122 prin
mecanism de autonegare, tendinfa la rejecfia propriului corp cu \up0
\expndtw0\charscalex124 proiectie senzitiva in anturaj si eventual in partenerui
sexual, coniugai \up0 \expndtw0\charscalex122 Dificultafi in acceptarea laentnafii
psihosexuale, cu reflexe negative ii \up0 \expndtw0\charscalex116 asumarea si
exercitarea rolului sexual in general. Complexe de masculinits \up0
\expndtw0\charscalex115 te/femmitate, anxietate. tulburari de dinamice sexuala la
barbafi $i trlgldlta \up0 \expndtw0\charscalex118 te la temei, decepfii erotice la
ambele sexe, corelate subiectiv cu perioadi \up0 \expndtw0\charscalex118 de
surmenai sau suprasolicitare. \par\pard\qj \li1142\ri748\sb1\sl-
240\slmult0\fi264 \up0 \expndtw0\charscalex118 Toate acestea susfm ideea cS
instalarea bolii angajaza. pe fondul urn. \up0 \expndtw0\charscalex125
personaliteti fragile, cu o istorie de viafa similara in anumite secvenv \up0
\expndtw0\charscalex116 importante - mecanisme conversive dintre cele mai
sofisticate. cu prole'-'
\up0 \expndtw-4\charscalex100 Elemente de psihosomaticS generala si
\expndtw0\charscalex110 in sfera funcfionalitafii si a expresivitSfii corporae, cu
tendintS e fixare. \up0 \expndtw0\charscalex104 ..Metafora corporae"
simptomatologicS traduce fidel \up0 \expndtw0\charscalex103 �i rezonant
interiorul \par\pard\qj \li1320\ri462\sb0\sl-240\slmult0\fi14 \up0
\expndtw0\charscalex106 ideo-afectiv si atitudinile fundamentale fafa de sine si
'afS de ceilalfi. CSci \up0 \expndtw0\charscalex110 ce altceva poate exprima
simbolic spasmul de torsiune decat evitarea de \up0 \expndtw0\charscalex118 sine
sau a altora, fuga de sine s' de alfii. intr-un efort inconstient de \up0
\expndtw0\charscalex110 autoaparare patologlca. dintr-un impuls primar de evadare
din ..capcana \up0 \expndtw0\charscalex127 inconfortablla a propriei fiinfe"
corodate cronic de un profund \up0 \expndtw0\charscalex110 sentiment de
inadecvare?! \par\pard\qj \li1320\ri452\sb7\sl-232\slmult0\fi288 \up0
\expndtw0\charscalex108 Asistand la ..spectacolul " propriei corporalitSfi scspate
de sub control \up0 \expndtw0\charscalex103 voluntar, pacientii dezvoltS consecutiv
tendinfe antropofobe, de?l, compen� \up0 \expndtw0\charscalex103 sator, ego-ul se
exacerbeazS, orgoliul excesiv si jena de a se expune se com\up0
\expndtw0\charscalex110 binS, toleranfa la frustrate scade, iar nevoia de
recunoastere s* sustinere \up0 \expndtw0\charscalex106 creste, eel pufin Tn
familie. Totul conduce Inevitabil, spre o supratensiune \up0
\expndtw0\charscalex100 psIhicS tradusS morfo-funcfional. \par\pard\qj
Simptomul-flnta din perspectlva oblectlvelor si modelului \line\tab \up0
\expndtw0\charscalex107 terapeutic apl/cat \par\pard\qj \li1324\ri453\sb189\sl-
230\slmult0\fi297 \up0 \expndtw0\charscalex109 Simptomul-fintS: Torticolisul este
abordat ca modalltate deturnata de \up0 \expndtw0\charscalex102 ..rezolvare
patologlca" a confllctelor Intrapslhice multiple si de blocare a flu\up0
\expndtw0\charscalex102 xului energetic la nivelul zonei cervlco-humerale.
Obiectivele psihoterapiei decurg din necesitSfiie de reechlllbrare a \up0
\expndtw0\charscalex105 raporturilor cognitiv-emofionale ale Insulul cu sine si
apol, cu ceilalfi, si in \up0 \expndtw0\charscalex113 primul rand, din cele de
acceptare si evaluare corecta a identltSfii sale \up0 \expndtw0\charscalex111
psihocorporale, precum si de crestere a autoregiajuiui voluntar. Aceasta \up0
\expndtw0\charscalex108 presupune o constientizare si o infelegere a
semnlflcafillor manlfestarilor \up0 \expndtw0\charscalex105 corporale
simptomatologice, precum si o mobiilzare a resurselor energetice \up0
\expndtw0\charscalex114 de autoreglare in sensul depaslrll impasuiui si creerll
unui nou gestalt \up0 \expndtw-1\charscalex100 functional optlm. \par\pard\ql
\li1631\sb0\sl-198\slmult0 \up0 \expndtw0\charscalex112 Lucrul cu corpul este o
modalltate terapeutica integrate unui proces \par\pard\qj \li1334\ri448\sb4\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex106 analltlc si este extrem de apreclata
actualmente de numerosl specialist! din \up0 \expndtw0\charscalex106 domeniu. Este
cunoscuta sub numele de ..analiza bioenergetice", fiind \par\pard\li1334\sb5\sl-
253\slmult0\fi0\tx3883\tx6873 \up0 \expndtw0\charscalex107 dezvoltatd conceptual
Tn\tab \up0 \expndtw0\charscalex107 1953 de cdtre Wilheim Reich\tab \up0
\expndtw0\charscalex107 (eel care i-a fost\par\pard\li1334\sb1\sl-
237\slmult0\fi9\tx3086\tx7459 \up0 \expndtw0\charscalex107 anallst lui
Perls)\tab \up0 \expndtw0\charscalex107 $i structurata terapeutic de elevul
acestuia\tab \up0 \expndtw0\charscalex107 - Alexander\par\pard\li1334\sb1\sl-
246\slmult0\fi14\tx2702\tx3268\tx3816 \up0 \expndtw-3\charscalex100 Lowen
(1958,\tab \up0 \expndtw-10\charscalex92 1972,\tab \up0 \expndtw-10\charscalex91
1975,\tab \up0 \expndtw0\charscalex107 1984). Tehnica anaiizei bioenergetice se
bazeaze\par\pard\qj \li1343\ri448\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex116
pe Ideea corespondenfelor dintre Idee, emofle si miscare, a?a Tncat \up0
\expndtw0\charscalex107 resursele energetice de care dlspune omul sd poate fl
reactivate si redlrec-\line \up0 \expndtw0\charscalex115 flonate terapeutic. Calea
sau vehlculul prin Intermediul cdrula pot fi \up0 \expndtw0\charscalex117
modlficate procesele energetice o constitue resplrafla \up0 \expndtw0\charscalex115
$l ml$carea, \par\pard\qj \li1353\ri443\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex107 asociate constient, intr-un pattern armonlos, sinergic,
adaptatlv. Din acest \up0 \expndtw0\charscalex106 punct de vedere. gestalt-terapia
se TntSlneste s' se completeazS benefic cu \up0 \expndtw0\charscalex115 analiza
bioenergetice. ele putand fi asociate Tn cadrul unei aborddri \up0
\expndtw0\charscalex104 terapeutice holiste. \par\pard\qj \li1358\ri433\sb0\sl-
246\slmult0\fi297 \up0 \expndtw0\charscalex107 Tehnlclle active, sub forma
exercifiilor corporale si respiratorii sunt de \up0 \expndtw0\charscalex116 nature
se activeze sentimentele blocate si se le repolarizeze pozitiv. \up0
\expndtw0\charscalex103 Legatura existente Tntre emofiile reprimate, respirafie si
miscarea spontana, \up0 \expndtw0\charscalex110 este chela Tnfelegerii simptomelor
corporale ca \up0 \expndtw0\charscalex102 \u8222?traductori" ai stSrilor
\par\pard\qj\li950\ri853\sb122\sl-240\slmult0 \up0 \expndtw0\charscalex114 mental-
emofionale experimentate de subiect. Oamenii invafe de timpunu, ce \up0
\expndtw0\charscalex121 sentimentele dureroase sau amenmfetoare pot fi suportate
mai bine prin \up0 \expndtw0\charscalex116 refinerea respiratiei \up0
\expndtw0\charscalex122 (reflex de autoaperare care le reduce intensitatea si
uneori, le supnmS), ca si prin blocarea miscSni sponiane - manifestats prin
\up0 \expndtw0\charscalex125 tensiuni sau riglditSfi musculare. Lowen considers cS
fiecare muschi \up0 \expndtw0\charscalex113 tensionat cronic reflecta un conflict
interior intre impuls sau sentiment si ex� \up0 \expndtw0\charscalex121 primarea
acestora. De exemplu, o mandibulS inclestatS poate semnifica \up0
\expndtw0\charscalex126 strSdania subiectului de a-si ascunde, masca sau refine
impulsul de a \up0 \expndtw0\charscalex122 ..nusca' \up0 \expndtw0\charscalex119
(concordant cu orientarea agresive a acestuia fafa de cineva sau \up0
\expndtw0\charscalex130 ceva), dar persoana nu va constientiza semnificafia acestui
impuls. \up0 \expndtw0\charscalex117 deoarece inhibifia miscarii spontane.
blocheaze percepfia sentlmentului. in \up0 \expndtw0\charscalex118 acelasi mod. un
gat rigid, intepenit, poate ascunde impulsurile de a plange \up0
\expndtw0\charscalex119 sau de a fipa (supararea si mania sunt astfel reprimate),
iar un gat spastic, \up0 \expndtw0\charscalex116 fera etiologie organice poate
..traduce" teama sau nevoia de evitare, negare \up0 \expndtw0\charscalex124 a ceva
sau a cuiva. in aceeasi ordine de idei, umerii tensionafi exprime \up0
\expndtw0\charscalex121 impulsurile retinute de a lovi sau de a lua ceva, etc Toate
aceste tensiuni \up0 \expndtw0\charscalex120 musculare cu mecanism inconstient
acfioneaze, de asemenea si pentru a \up0 \expndtw0\charscalex112 reduce respirafia
- corelate direct cu nivelul negativ al emofionalitSfil. Un gat \up0
\expndtw0\charscalex130 \u8222?rigid" contribuie e reducerea cantitSfil de aer care
intrS si iese din \up0 \expndtw0\charscalex117 plamam, dupS cum un abdomen ..rigid"
limiteaze profunzimea respiratiei, \up0 \expndtw0\charscalex114 desi, in acelasi
timp, reduce emofiile negative Astfel, expresii ca \u8222?a rade din \up0
\expndtw0\charscalex124 rSrunchi" acoperS o realitate psihofiziologica. aceste
manifestSri fiind \up0 \expndtw0\charscalex118 imposibile in sterile de crispare
mental-muscularS, specifice si bolnavului \up0 \expndtw0\charscalex112 de
torticolis. \par\pard\ql \li1252\sb9\sl-230\slmult0\tx6830 \up0
\expndtw0\charscalex119 Tensiunea muscularS cronies imobilizeaza corpul carp
\tab \up0 \expndtw0\charscalex116 \u8222?se mortifies" \par\pard\qj
\li964\ri814\sb0\sl-242\slmult0\fi9 \up0 \expndtw0\charscalex117 treptat. traducand
contractura ideo-alectiva dureroasS, iar aceasta produce, \up0
\expndtw0\charscalex117 in continuare, recurent, tensiune muscularS (ca fenomen
de ..autoprotectie \up0 \expndtw0\charscalex115 patologicS''). O persoana ngidS
mental este s' rigidS corporal, iar rigiditatea \up0 \expndtw0\charscalex125
corporae mortifies emofionalitatea in terapia bioenergeticS. pacientul \up0
\expndtw0\charscalex115 experimenteazS si constientizeazS, \u8222?aici si acum",
rigiditatea ca ..mortifica-\line \up0 \expndtw0\charscalex121 re" personae si
relaxarea, miscarea si respirafia, ca posibilitSfi autocrea-\line \up0
\expndtw0\charscalex117 tive, de reconfigurare a complexului mental-corporal.
Aceasta necesitS, pe \up0 \expndtw0\charscalex114 langa exercifiile propriu-zise si
analiza sentimentelor si integrarea polaritafu \up0 \expndtw0\charscalex114 lor
printr-un dialog gestaltist, bazat pe intrebSrile de bazS: \up0
\expndtw0\charscalex110 \u8222?ce simfi? "; \up0 \expndtw0\charscalex104 ,.ce
\par\pard\qj \li969\ri814\sb0\sl-240\slmult0\fi4\tx2035 \up0
\expndtw0\charscalex116 traiesti?". \tab \up0 \expndtw0\charscalex121 \u8222?ce
experimentezi. acum s* aici? ". Scopul declarat al acestui \up0
\expndtw0\charscalex116 dialog este de a-l ajuta pe client sa constientizeze chiar
modul in care poate \up0 \expndtw0\charscalex120 constientiza. pentru ca apol sS se
poatS autodepa$i, dezvolta, operand cu \up0 \expndtw0\charscalex116 resursele
energetice si creative ale intregului organism. \par\pard\qj \li984\ri803\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex120 Din motivele conceptuale dezvoltate
mai sus si raportat la obiectivele \up0 \expndtw0\charscalex117 recuperatorii pe
care ni le-am propus, am optat pentru un model psihotera\up0
\expndtw0\charscalex122 peutic neconventional. bazat pe tehnicile asociate ale
gestalt-teraplei s* \up0 \expndtw0\charscalex120 analizei bioenergetice. cu
integrarea unor procedee de inspirafie orientae \up0 \expndtw0\charscalex115
(preluate din Yoga si Q> Gong). Premisele de la care am pornit. postuleazS \up0
\expndtw0\charscalex119 ideea cS simptomul-fints cu tot cortegiul sSu de
dificultafi diskinetice s< \up0 \expndtw0\charscalex117 afective devine \u8222?un
limbaj corporal" cu dramatics expresivitate, traducand \up0 \expndtw0\charscalex115
..mesajul" personalitSfii in dificultate. Acest mesaj se refers e:
240\slmult0\fi297 \up0 \expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 -
negarea surselor de conflict intra- si interpsihic. prin reprimarea maniei \up0
\expndtw0\charscalex124 cu expresie corporae in spasmul de torsiune sau in
rgidizarea gatului cu \up0 \expndtw0\charscalex118 orientarea capului antero-
lateral. Cu alte cuvinte, pacientul se opune, isi ex \up0 \expndtw0\charscalex120
primS dezacordul printr-un NU corporal, refuza sau evitS ceva cu valoare \up0
\expndtw0\charscalex120 psihotraumatizanta: \par\pard\qj \li1420\ri372\sb0\sl-
240\slmult0\fi480 \up0 \expndtw0\charscalex128 Inca de propria idontitate
psihosomaticS s' de modul in care este \up0 \expndtw0\charscalex116 perceput si
evaluat de catre altii. Acesta este nuceul complexului senzitiv de \up0
\expndtw0\charscalex117 inferioritate, frica de rejectie, tradusa simbolic prin
posturS incordatS. invo \up0 \expndtw0\charscalex120 luntar rigidS, supracontrolata
gestual, in atitudine de apSrare. Pacientul se \up0 \expndtw0\charscalex124
comports de pares s-ar astepta sS fie agresat. El are o atitudine corporae \up0
\expndtw0\charscalex119 de fugS din fata unui pericol imaginar (cand gatul este
antrenat in spasmul \up0 \expndtw0\charscalex121 de torsiune) \up0
\expndtw0\charscalex125 - fie o atitudine de impietrire, de imobilitate, de
rezistenfe \up0 \expndtw0\charscalex122 pasiva in fata aceluiasi pericol iminent,
in forms hipotonS. cu rigidizarea \up0 \expndtw0\charscalex122 gatului si
inclinarea sa spre partea stanga sau dreaptS. Aceasa lateralitate \up0
\expndtw0\charscalex120 nu este nici ea intampetoare De cele mai multe on, am
observat cS ea este \up0 \expndtw0\charscalex119 declansata si fixae ca depnndere
posturalS de cStre un stimul sau o situatie \up0 \expndtw0\charscalex122
psihotraumatizanta de care bolnavul \up0 \expndtw0\charscalex122 ,.s-a ferit", prin
inclinarea capului, \par\pard\qj \li1416\ri372\sb0\sl-240\slmult0\fi14 \up0
\expndtw0\charscalex126 spontan, in partea opuse acfiunii stimulului implicat.
Modelul miscarii \up0 \expndtw0\charscalex119 initiae asociate puternicei tensiuni
emofionale negative, din istona de viafa \up0 \expndtw0\charscalex135 particulars a
pacientului are tendinfa e a se relua circular si 'ixa ca \up0
\expndtw0\charscalex124 depnndere posturala patologica. De exemplu, in cazul unui
pacient, am \up0 \expndtw0\charscalex122 reconstituit prin tehnica focalizani prin
imaginare ghidatS scenariul unei \up0 \expndtw0\charscalex121 situafii de pericol
iminent, la care asistase in momentul producerii pentru \up0
\expndtw0\charscalex135 prima date a spasmului de torsiune \up0
\expndtw0\charscalex130 (subiectul asistase la iminenfa \par\pard\qj
\li1420\ri363\sb0\sl-237\slmult0 \up0 \expndtw0\charscalex116 accidentarii unui
copil, intr-o intersecfie. de cStre un vehicul care se apropia \up0
\expndtw0\charscalex128 in vitezS, dinspre partea stanga a subiectului si Pe care
nu putuse sa-l \up0 \expndtw0\charscalex120 impiedice. fiind ..fintuit locului' din
cauza fneii). Gestul lui spontan care a \up0 \expndtw0\charscalex132 insofit
tensiunea negativa deosebite a fost de a-si onenta capul spre \up0
\expndtw0\charscalex115 dreapta. gest mvoluntar, pe care l-a repetat ulterior, din
ce in ce mai frecvent, \up0 \expndtw0\charscalex138 in special in situafiile de
stres, grip, luarea unor decizii cu rise si \up0 \expndtw0\charscalex120
responsabilitate. Pacientul traia intr-o situafie de conliict Intern, pe fondul
\up0 \expndtw0\charscalex129 careia se declansase o crescuta susceptlbiiitate in a
se simfi agresat si \up0 \expndtw0\charscalex128 punitionat moral. El isi repnma
astlel tot mai profund. sentimentul de \up0 \expndtw0\charscalex114
cuipabilitate. \par\pard\qj \li1430\ri348\sb0\sl-238\slmult0\fi288 \up0
\expndtw0\charscalex133 0 pacienta care prezenta dm mica ei copierie o zona cu
alopecie \up0 \expndtw0\charscalex120 (chelie), situate in dreptul lobului temporal
drept. se obisnuise, pentru a-si \up0 \expndtw0\charscalex117 masca detectul sa-si
incline usor capul antero-lateral, spre dreapta, a$a incat \up0
\expndtw0\charscalex124 se-i ofere interlocutorului doar imaginea sa acceptabiie.
Torticolisul s-a \up0 \expndtw0\charscalex125 declansat insa pnn intarirea
sentimentului de autorespingere pe care l-a \up0 \expndtw0\charscalex120 retrait si
reprimat, in contextul unui manai incarcat de violenfe. Sotul sau, \up0
\expndtw0\charscalex120 sub intluenfa alcoolulul, o agresa frecvent, peimuindu-i de
prefennfa chiar \up0 \expndtw0\charscalex129 obrazul slang, mai expus bataii. prin
pozifia defectuoase a pacientei. \up0 \expndtw0\charscalex123 Peimuirea, antrena
inse si miscarea de rotafie mvoluntara a capului, care \up0
\expndtw0\charscalex129 conlinua se se miste spasmodic s1 dupa incetarea
agresiunii. Fixarea \up0 \expndtw0\charscalex117 gestului s-a produs pnn reprimarea
plansului si fipetelor. in efortul constient \up0 \expndtw0\charscalex117 al
pacientei de a nu Ii auzita de veclni si respinsS afectiv de acesiia
137\par\pard\qj \li1060\sb0\sl-240\slmult0 \par\pard\qj\li1060\sb0\sl-
\expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 Sentimentul de jena se
amplifica astfel pe fondul temerii de respingere, iar \up0 \expndtw0\charscalex116
tensiunea emofionala perturbe controlul voluntar al miscSrilor capului si se
\up0 \expndtw0\charscalex116 convertesc simbolic in spasmul mvoluntar de
torsiune. \par\pard\ql \li1363\sb129\sl-230\slmult0 \up0 \expndtw0\charscalex119 3.
Desfasurarea procesulul terapeutic \par\pard\ql \li1358\sb170\sl-230\slmult0\tx2894
\up0 \expndtw0\charscalex116 Decodificarea \tab \up0 \expndtw0\charscalex130
..mesajului" patologie si a imprejurarilor care l-au \par\pard\qj
\li1065\ri737\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex123 exacerbat s> tixat in
simptom, prin intermediul etapei de constientizare \up0 \expndtw0\charscalex119
focalizata gestaltist, asociate ca analiza, a permis conceperea s' nuanfarea
\up0 \expndtw0\charscalex119 ..scenanului terapeutic" din punct de vedere al
tehnicilor utilizate. \par\pard\qj \li1065\ri727\sb6\sl-
233\slmult0\fi297\tx2068\tx2351 \up0 \expndtw0\charscalex117 Etapa \tab \up0
\expndtw-9\charscalex87 1. \tab \up0 \expndtw0\charscalex123 Initial, pe parcursul
a trei-patru sedinfe. am cuplat tehnica \up0 \expndtw0\charscalex116 analitice
orientate asupra trecutului cu o tehnicS gestaltista de readucere s� \up0
\expndtw0\charscalex123 retraire in prezent a elementelor implicate in modificSrile
expresive ale \up0 \expndtw0\charscalex126 poslurn. Am focalizat apoi
constientizarea asupra perceptiei schemei \up0 \expndtw0\charscalex123 corporale si
tonusului muscular, lucrand pe integrarea poeritSfilor. Am \up0
\expndtw0\charscalex116 insistat in constientizarea prin descopenre a corelafiilor
dintre emofii, gand \up0 \expndtw0\charscalex115 Si mi$care \up0
\expndtw0\charscalex117 $i pozitie \up0 \expndtw0\charscalex121 (lucrul cu corpul),
a raporturilor de consonants \up0 \expndtw-9\charscalex95 $i \par\pard\qj
\li1070\ri722\sb7\sl-233\slmult0 \up0 \expndtw0\charscalex126 respectiv disonanfS
intre mental si corporal, in acelasi scop am inifiat \up0 \expndtw0\charscalex119
pacientii in cateva tehnici de respirafie constiene, controlats, incepand cu
\up0 \expndtw0\charscalex121 ciclul respirafiei abdominale S' apoi, exersand ciclul
respirator complet. \up0 \expndtw0\charscalex118 Concentrarea asupra ntmului
respirator ca si praclica egalizSrii constiente \up0 \expndtw0\charscalex116 a
limpului de inspir si expir, intr-un ntm natural, propriu subiectului (3 cu 3
\up0 \expndtw0\charscalex117 timpi, sau 4 cu 4 timpi), in coreefie directs cu
starea de calm si deconecta\up0 \expndtw0\charscalex117 re a constituit un obiectiv
important al aeestei prime etape. \par\pard\qj \li1070\ri704\sb3\sl-
238\slmult0\fi307 \up0 \expndtw0\charscalex118 Etapa 2. Dupa cateva sedinte de
familiarizare si de motivare adecvatS. \up0 \expndtw0\charscalex125 am introdus in
programul terapeutic o tehnicS hipnoterapeutica de tip \up0 \expndtw0\charscalex116
sophromc. constand in inducfie lent-progresivS a relaxarii psihomuscularo. \up0
\expndtw0\charscalex122 cu accent pe activarea circuetorie S1 energizarea uniforme,
cvasitotae a \up0 \expndtw0\charscalex120 corpului, incepand din zona membrelor
inlenoare. Dupe declansarea ca-\line \up0 \expndtw0\charscalex118 talepsiei
pleoapelor. lie pnn tehnica focatizarii punctului dintre sprancene, \up0
\expndtw0\charscalex128 fie pnn concentrare pe linistirea ntmului respirator, am
procedat la o \up0 \expndtw0\charscalex119 relaxare corporae globalS, incepand cu
degetele picioarelor, taipi, glezne, \up0 \expndtw0\charscalex123 muschii infenori
ai picioarelor, genunchi, coapse, abdomen, plex solar, \up0 \expndtw0\charscalex127
torace, baza gatului. umen. brate. palme. degete. in aceleasi ordini de \up0
\expndtw0\charscalex124 focalizare, am provocat ulterior subiectul sa lucreze prin
constientizare \up0 \expndtw0\charscalex137 focalizata. menfinandu-se si
experimentand constient senzafiile \up0 \expndtw0\charscalex141 corporale si
alternanfa tensiunilor cu relaxarea. completand si \up0 \expndtw0\charscalex115
aprofundand la nivelul integrSrii constiente ceea ce initial a fost practicat pe
\up0 \expndtw0\charscalex117 fondul transei lejere. deci cu o mai redusS
parlicipare constiene. in aceasta \up0 \expndtw0\charscalex127 consta si caracterul
neconvenfional in care am complementat tehnici \up0 \expndtw0\charscalex122
terapeutice aparflnand unor abordSri relativ diferite. Pentru noi. impor� \up0
\expndtw0\charscalex117 tanta este conexiunea pe care aceste tehnici o pot crea in
relacerea pSrfilor \up0 \expndtw0\charscalex125 interne aflate in conflict, in
scopul unirii eu-lui \up0 \expndtw0\charscalex117 $i completSrii ciclulut
gestaltului Am aprofundat exercifiile pe fond de relaxare si de supravigilitate
\up0 \expndtw0\charscalex124 consecutiva. practicand si tehnica inducfiei
focalizate a lui Zlocker, cu \up0 \expndtw0\charscalex120 integrarea muncii de
constientizare si experimental a senzafiilor, ceea ce \up0 \expndtw0\charscalex120
a a condus treptat la dobandirea capacitSfii de autoinductie si control
241\slmult0\fi4 \up0 \expndtw0\charscalex119 asupra senzatiilor de cSldurS
concentrae si dispersatS in zonele corporale \up0 \expndtw0\charscalex128 de
interes \up0 \expndtw0\charscalex123 (cervico-dorso-iombarS, numerae, brafe, palme,
degete, cu \up0 \expndtw0\charscalex121 revenire in zona gatului). Am pus accent si
pe amplificarea progresivS a \up0 \expndtw0\charscalex126 suportului verbal
imagistic, plastic, evocator al senzatiilor de cSldurS \up0 \expndtw0\charscalex113
profundS, invadants, inmuiere, flexibilizare, topire, usurare. eliberare. Lucrul
\up0 \expndtw0\charscalex125 cu corpul s-a folosit astfel s> de tehnica
vizualizSrii ghidate. ceea ce a \up0 \expndtw0\charscalex122 crescut controlul
subiectului in procesul de autorestructurare. Scenariul \up0
\expndtw0\charscalex117 imagistic de restructurare mentala a schemei corporale a
fost particularizat \up0 \expndtw0\charscalex118 de la caz la caz si conceput in
colaborare cu pacientul, el descoperind cele \up0 \expndtw0\charscalex125 mai
reprezentative metafore personae utilizate in restructurare. Acolo \up0
\expndtw0\charscalex122 unde clientul s-a dovedit mai putin imaginativ, terapeutul
a gltidat activ \up0 \expndtw0\charscalex124 metaforizarea cu scop de
restructurare. propunSnd exercifii cum ar fi: \up0 \expndtw0\charscalex127
imaginarea schemei corporale in miscare transformativS constand in \up0
\expndtw0\charscalex112 flexibllizarea corpului s* lungirea sa intre \u8222?cer si
pSmSnt", progresiv, urmatS \up0 \expndtw0\charscalex122 de revenirea autocontrolatS
intr-o dimensiune optimS \up0 \expndtw0\charscalex136 $i la o posture
echilibrats, simetrics, in conformitate cu modelul mental pozitiv, dezirabil.
\up0 \expndtw0\charscalex116 autoproiectat. Sena exercifulor mentale se incheie cu
un exercifiu cefalic si \up0 \expndtw0\charscalex125 de reintegrare armonioasS a
intregil scheme corporale restructurate in \up0 \expndtw0\charscalex125 mediu.
Variabil s-a asociat \up0 \expndtw0\charscalex131 $' tehnica orientae Rey Qi
\up0 \expndtw0\charscalex114 (constand Tn \par\pard\qj \li1147\ri635\sb0\sl-
240\slmult0\fi9 \up0 \expndtw0\charscalex120 aplicarea palmelor terapeutului,
direct sau in zona de contact a cSmpului \up0 \expndtw0\charscalex121 bioenergetic
al persoanei), tinand cont de polarizarea diferitS a palmelor \up0
\expndtw0\charscalex114 terapeutului (stSnga negativ, dreapta - pozitiv, in
corelare directa cu orele de \up0 \expndtw0\charscalex124 maximum bioenergetic,
respectiv in cazul nostru, orele \up0 \expndtw0\charscalex106 9-11 s* \up0
\expndtw-4\charscalex100 15-17). \par\pard\qj \li1147\ri616\sb0\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex124 Conform studiilor in domeniu, palma
stangS acfioneaze ca absorbant, \up0 \expndtw0\charscalex123 dispersator, iar palma
dreape ca emifator, corector al fluxului energetic \up0 \expndtw0\charscalex123
diminuat sau blocat. In funcfie de particularitefile subiecfilor nostri am \up0
\expndtw0\charscalex121 observat ce utilitatea paselor bioenergetice palmare este
diferitS. Astfel. \up0 \expndtw0\charscalex131 barbafii au beneficial mai mult de
contactul palmei stangi. ceea ce \up0 \expndtw0\charscalex114 sugereazS Indirect
existenfa unui posibil exces energetic de tip Yang in zona \up0
\expndtw0\charscalex115 superioara a corpului
(aceasta se coreleazS, de altfel $i cu tulburarile de di� \up0
\expndtw0\charscalex128 namica sexuae semnalate), torticolisul manifestandu-se in
contextul \up0 \expndtw0\charscalex131 acestui dezechilibru energetic Femeile au
beneliciat mai curand de \up0 \expndtw0\charscalex121 aplicafiile palmei drepte.
ceea ce near putea sugera prezenfa unui deficit \up0 \expndtw0\charscalex118
energetic sau a unui blocaj, implicat in perturbarea respective. Menfionam \up0
\expndtw0\charscalex130 insa ce, in faza initiae a terapiei. majoritatea
pacientilor prezentau o \up0 \expndtw0\charscalex126 necesitate crescuta de
absobfie bioenergetice, adesea constientlzate si \up0 \expndtw0\charscalex123
comunicata din proprie initiative de cetre subiect. Aceasta sustine posi\up0
\expndtw0\charscalex141 bilitatea mai curand a unui blocaj sau deficit energetic in
zona \up0 \expndtw0\charscalex129 simptomaticS, in special in formele de torticolis
hipoton in formele \up0 \expndtw0\charscalex130 spastice. e de presupus un exces
energetic de tip Yang, care se cere \up0 \expndtw0\charscalex119 \u8222?drenaf pnn
pase corespunzStoare. \par\pard\ql \li1468\sb9\sl-230\slmult0\tx7939 \up0
\expndtw0\charscalex123 Etapa 3. Pe mSsura inaintarii in procesul terapeutic. dupa
cea. \tab \up0 \expndtw-4\charscalex100 10-15 \par\pard\qj \li1166\ri623\sb2\sl-
240\slmult0\fi9 \up0 \expndtw0\charscalex120 sedinfe de relaxare si constientizare
a unui nou gestalt integrativ mental-\line \up0 \expndtw0\charscalex116 corporal,
am introdus exercifii de modificare a posturn vicioase, a coloanei \up0
\expndtw0\charscalex116 vertebrae, a gatului si a modalitSfii de orientare a
privirii in mediu, precum \up0 \expndtw0\charscalex116 $i de experimened a
mersului ritmic, armonios. conectat la ritmul
\ul0\nosupersub\cf9\f10\fs20 respirator constientizat. S-a lucrat si asupra
deblocSrii miscSrilor de balans \up0 \expndtw0\charscalex114 ritmic al bratelor,
insistandu-se asupra constientizarii si exprimSrn emofiilor \up0
\expndtw0\charscalex118 asociate si acelasi lucru, pentru picioare Asocierea unor
pattern-uri speci\up0 \expndtw0\charscalex118 fice de miscare corporae si
respirafie controlats. a constituit paradigma de \up0 \expndtw0\charscalex115 bazS
a acestui antrenament al constientizarii s< autoreglarii. MenfionSm cS \up0
\expndtw0\charscalex123 nu am practicat o kinetoterapie de facturS uzuais. ci un
model mental\up0 \expndtw0\charscalex119 corporal de autorestructurare prin
experimentare sj constientizare activS. \up0 \expndtw0\charscalex115 creativa.
Activarea resurselor s-a bazat pe irepiedul: \par\pard\ql \li1329\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex114 \u8226? model mental, imagistic;
onentare verbals a miscSrij euritmice; \par\pard\qj \li1329\ri970\sb2\sl-
240\slmult0 \up0 \expndtw0\charscalex116 \u8226? acfiune creatoare constiente
(exercifiu), cu feed-back-urile necesare. \up0 \expndtw0\charscalex116
RestructurSrile (castigurite) terapeutice s-au bazat pe: \par\pard\ql
\li1329\sb9\sl-230\slmult0\tx3921 \up0 \expndtw0\charscalex131 \u8226? simetnzare
posturala \tab \up0 \expndtw0\charscalex135 (atat in plan ideativ. cat si motor),
prin \par\pard\ql \li1041\sb10\sl-230\slmult0\tx3023 \up0 \expndtw0\charscalex113
urmStoarele tehnici \tab \up0 \expndtw0\charscalex123 (care au acfionat ca niste
cSi de reperizare in expe-\par\pard\ql \li1041\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex114 rimentarea deplasSrn). \par\pard\qj \li1036\ri776\sb10\sl-
230\slmult0\fi292 \up0 \expndtw0\charscalex121 \u8226? orientarea pnvirii simultan
cu miscarea lentS, constiene, voluntara a \up0 \expndtw0\charscalex118 capului. pe
lima imaginarS a unor largi sermcercuri. situate la distanfe din \up0
\expndtw0\charscalex116 ce in ce mai mari de corp; \par\pard\qj
\li1041\ri776\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex120 \u8226? fixarea
privirii pe obiecte situate la distanfa mare, cu constientizarea \up0
\expndtw0\charscalex113 detaliilor din ce in ce mai fine (focalizarea atenfiei pe
obiect extern - tehnicS \up0 \expndtw0\charscalex108 preluatS din Yoga);
\u8226? parcurgerea constiene, mentals, a drumului pane e obiectul \up0
\expndtw0\charscalex116 concentrSrii si indSrSt, cu reluarea ciclului si
complicarea lui. progresiv cu \up0 \expndtw0\charscalex113 alte exercifii de
urmSrire (trasee orizontale. verticale. cercuri. diferite forme\up0
\expndtw0\charscalex122 exercifiu pe care l-am denumit ..plimbarea privirii"
sau ..mangSierea cu \up0 \expndtw0\charscalex116 privirea" simultan cu respiratia
calme, egae, complete. \par\pard\qj \li1041\ri766\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex120 \u8226? mersul constient-ritmic, cadentat si flexibil
elegant, cu sprijin verbal \up0 \expndtw0\charscalex118 de concentrare pe
nunreretoare. asociat cu o ritmare calme a respiratiei de \up0
\expndtw0\charscalex120 tip abdominal, apoi cu nrenrea treptatS a timpului de expir
intr-un raport \up0 \expndtw0\charscalex123 dublu fats de timpul de inspir \up0
\expndtw0\charscalex117 (3/6 sau \up0 \expndtw-1\charscalex100 4/8) \up0
\expndtw0\charscalex121 - exercifiu preluat din sena \par\pard\ql \li1046\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex112 pranayamelor (Yoga) cu scop de
..dezintoxicare". \par\pard\ql \li1339\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex116 \u8226? asocierea unui numSr variabil de exercifii
respiratorii, dupS caz, de tip \par\pard\qj \li1041\ri762\sb3\sl-240\slmult0
\up0 \expndtw0\charscalex132 dezanxietare, purificare. calmare. etc. Din seria
celor mai utilizate \up0 \expndtw0\charscalex116 menfionam exercifiul respiratiei
alternative \up0 \expndtw0\charscalex119 (pe Ida s* Pingala). in cicluri
repetate de \tab \up0 \expndtw0\charscalex135 3 on pe zi, cate \tab \up0
\expndtw0\charscalex117 5-6 exercifii. exercifiul de expir prelungit,
\par\pard\ql \li1046\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex112 eliberator
\u8222?Han. exercifiul celor 5 silabe emise pe expir din practica Qi Gong;
\u8226? corecfia simetrizSrii pozifiei umerilor. initial cu sprijin subaxilar
\tab \up0 \expndtw0\charscalex104 (o \par\pard\qj \li1041\ri752\sb2\sl-
240\slmult0 \up0 \expndtw0\charscalex117 carte) pentru umSrul denivelat, ulterior
prin fixarea voluntarS a brafelor la \up0 \expndtw0\charscalex114 spate, in timpul
mersului ritmic. De un real folos a fost practicarea unor pos \up0
\expndtw0\charscalex100 turi \up0 \expndtw0\charscalex116 (asane) din Hatha Yoga,
axate in special pe constientizarea $i activarea \up0 \expndtw0\charscalex126
coloanei vertebrate s> a simfului echilibrului. Corecfia mersului pnn \up0
\expndtw0\charscalex130 flexibilizarea miscarilor s-a fScut in trepte, parcurgandu-
se in mod \up0 \expndtw0\charscalex114 experimental un mers pendulator intenfional.
cu proiectarea toracelui in fafa \up0 \expndtw0\charscalex126 Si vizualizarea
miscarilor capului ca si cum ar fi acfionat de un resort \up0
\expndtw0\charscalex124 elastic. Aceste exercifii se transformau treptat intr-o
forma de expresie \up0 \expndtw0\charscalex124 corporale estetica, un adeverat
\u8222?model de dans personal", bazat pe
mis-\par\pard\sect\sectd\fs24\paperw9180\paperh13220{\bkmkstart Pg145}{\bkmkend
240\slmult0 \up0 \expndtw0\charscalex122 ceri din ce in ce mai ample, mai libere.
Astfel, crisparea, ca si torsiunea \up0 \expndtw0\charscalex115 mvoluntara a
gatului au putut fi progresiv autoreglate, subiectii invSfand si \up0
\expndtw0\charscalex114 exersand ulterior o ritmice armonioase, bazate pe
sincronicitatea proiectului \up0 \expndtw0\charscalex126 imaginativ-ideativ cu
respirafia adecvate si miscarea liber-reglabilS. \up0 \expndtw0\charscalex131
Pacientii au experimental cum pot sS si creeze o imagine corporae \up0
\expndtw0\charscalex116 acceptate, care se elibereze miscSrile optim. cSpStSnd din
interior modelul \up0 \expndtw0\charscalex116 posturii simetrice si eliberate.
siguranta necesarS restructurSrii \up0 \expndtw0\charscalex109 �i preluarii
controlului postural. Exersarea constiene a dus la rezultate stabile. dupS \up0
\expndtw0\charscalex116 cea 8-12 luni de tratament intensiv, reluat Tn cicluri,
intre care subiectii i$l \up0 \expndtw0\charscalex120 continuau pe conl propriu
programul Pe masurS ce s-a produs ..cresterea \up0 \expndtw0\charscalex119
psihologicS", extinderea constientizarii de sine si integrarea polantSfilor,
\up0 \expndtw0\charscalex118 corecfia si depS$irea simptomului s-a produs in grade
variabile, finand de \up0 \expndtw0\charscalex119 durata si perseverenfa
tratamentului, de calitatea contactulul terapeutic si \up0 \expndtw0\charscalex128
de susfinerea proterapeuticS a mediului familial si a personalului
de \up0 \expndtw0\charscalex118 ingrijire, pe perioada spitalizSrilor. in unele
cazuri, s-a practicat progresiv \up0 \expndtw0\charscalex111 tratamentul Tn regim
semiambulator si apoi ambulator. \par\pard\qj \li1180\ri632\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex116 Esentiae a fost pe parcursul
intregii psihoterapii, facihtarea si cultivarea \up0 \expndtw0\charscalex121
sentimentului de autoacceptare si. mai ales, dobandirea atitudinii de a fi \up0
\expndtw0\charscalex122 liber interior. Libertatea mtenoare a constituit baza pe
care s-a creat pas \up0 \expndtw0\charscalex126 cu pas si libertatea in planul
miscarilor si actiunii, fluidizarea posturii \up0 \expndtw0\charscalex114
expresive, comumcante \par\pard\qj \li1185\ri627\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex118 Exprimarea unui caz ni se pare relevante pentru experienfa
terapeutica \up0 \expndtw0\charscalex110 traita: \up0 \expndtw0\charscalex124
\u8222?Am scepat din capcane" Colaborarea cu pacienfii a stimulat s' \up0
\expndtw0\charscalex118 propria lor creativitate in planul miscarilor si posturii,
unii dovedind reale \up0 \expndtw0\charscalex120 disponibilitefi de inventare a
unor jocuri de miscare ritmice. armonioase. \up0 \expndtw0\charscalex116
corespunzetoare dobandirii unei dezinvolturi posturale. Astfel, un exercitiu
\up0 \expndtw0\charscalex118 de balans corporal lateral, gandlt si trait ca o
miscare line de plutire a unei \up0 \expndtw0\charscalex118 berci pe valuri. sau a
unui leagan sau a unui pendul, practicat ca o tehnica \up0 \expndtw0\charscalex125
meditative a ajutat mult la diminuarea contracturii gatului, capul fiind \up0
\expndtw0\charscalex115 imagmat ca susfinut de un resort elastic, liber.
Modelul mental adecvat, \tab \up0 \expndtw0\charscalex118 (trait ca imagine
plastice). cuvantul sugestiv, \par\pard\qj \li1180\ri627\sb2\sl-240\slmult0\fi9
\up0 \expndtw0\charscalex115 acfiunea propnu-zise experimentata in realitate
(privire. miscare, deplasare) \up0 \expndtw0\charscalex114 Si respirafia
controlata, calme, au constituit cei 4 piloni ai reconstrucfiei pnn \up0
\expndtw0\charscalex114 constientizare a unui nou model psihocorporal, care a
rezolvat sau ameliorat \up0 \expndtw0\charscalex114 pans la suportabil simptomul de
bazS. \par\pard\qj \li1195\ri622\sb0\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex128 0 consecinfS importanta a terapiei a fost o reslructurare
spiritual\up0 \expndtw0\charscalex117 atitudinalS a pacienfilor. care au inteles cS
suferinta poate deveni un prilej \up0 \expndtw0\charscalex121 de autodezvoltare a
resurselor. de autodepSsire, regSsire si acceptare de \up0 \expndtw0\charscalex119
sine, precum si de transformare beneficS. Reinnodarea speranfei a deblo\up0
\expndtw0\charscalex119 cat. incS o dats ..performanfa".
\ul0\nosupersub\cf3\f4\fs18 Psihosomatica generae\tab \up0 \expndtw-8\charscalex79
<\u8226?\tab \up0 \expndtw0\charscalex121 141\par\pard\ql \li1353\sb0\sl-
Blbttografie \par\pard\ql \li1387\sb0\sl-207\slmult0 \par\pard\ql\li1387\sb46\sl-
207\slmult0 \up0 \expndtw0\charscalex108 1 Lowen A. The Language of the Body. Now
York. Macmillan, 1967 \par\pard\ql \li1343\sb13\sl-207\slmult0\tx6907 \up0
\expndtw0\charscalex115 2. Mitrolan tolanda Psihoterapia Exponentiald. Ed
Infomedica, \tab \up0 \expndtw0\charscalex102 1997, 53-59. \par\pard\ql
\li1348\sb1\sl-198\slmult0 \up0 \expndtw0\charscalex118 3. Mitrofan lolanda
Psihoterapia Exponent/aid \u9632? O Provocare la Crestere. Rev
\par\pard\li1348\sb34\sl-207\slmult0\fi225\tx4003\tx4507\tx4718 \up0
\expndtw0\charscalex115 Psihoterapia Experiential*.\tab \up0 \expndtw-
7\charscalex100 1998,\tab \up0 \expndtw0\charscalex117 1,\tab \up0
\expndtw0\charscalex117 1-3.\par\pard\li1348\sb4\sl-207\slmult0\fi0 \up0
\expndtw0\charscalex118 4. Perls F.S. The Rules and Games of Gestalt Therapy. In:
Levitsky A. Gestalt\par\pard\li1348\sb9\sl-207\slmult0\fi240 \up0
\expndtw0\charscalex117 Therapy Now Theory, Tehniques. Applications. Penguin Books
Ltd..\par\pard\li1348\sb14\sl-207\slmult0\fi220 \up0 \expndtw0\charscalex117
Harmonworth, Midllesex, England. 1970.\par\pard\li1348\sb9\sl-
207\slmult0\fi4\tx6801 \up0 \expndtw0\charscalex115 5. Reich W. "La fonction de
t'orgasme". LArche Editeur, Pans.\tab \up0 \expndtw0\charscalex117
1972\par\pard\li1348\sb9\sl-207\slmult0\fi4 \up0 \expndtw0\charscalex118 6. Schutz
W. Joy Expanding Human Awarness. New York, Ever Green Black
Hat.\par\pard\li1348\sb14\sl-207\slmult0\fi254 \up0 \expndtw0\charscalex117
\par\pard\qj\li1708\ri1589\sb232\sl-300\slmult0\tx2001 \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf8\f9\fs22 B. IMPACTUL PSIHOSOMATIC AL MUZICII
\u8226? PREMISA A \line\tab \up0 \expndtw-6\charscalex100 MUZICOTERAPIEI
\par\pard\ql \li1953\sb219\sl-253\slmult0 \up0 \expndtw0\charscalex119 loan Bradu
lamandescu \par\pard\ql \li1267\sb0\sl-253\slmult0 \par\pard\ql\li1267\sb0\sl-
253\slmult0 \par\pard\ql\li1267\sb195\sl-253\slmult0 \up0 \expndtw-5\charscalex100
A. IMPACTUL NEUROFIZIOLOGIC SI PSIHOLOGIC \par\pard\ql \li1324\sb0\sl-
\expndtw0\charscalex108 /. Conslderafll neuroflzlologlce asupra efectelor blologlce
ale muzlcll \par\pard\qj \li984\ri788\sb172\sl-248\slmult0\fi292 \up0
\expndtw0\charscalex107 Pentru medlcinS - interesatS in aplicarea muzicii in
scopuri terapeutice \up0 \expndtw0\charscalex102 (muzicoterapia) dar si ca un
element Tncadrat intr-o conduits complexS anti\up0 \expndtw0\charscalex105 stres -
este Importanta analiza etectului pe care Tl are muzlca asupra orga� \up0
\expndtw0\charscalex106 nismului uman, sistematizat de Raoul Rousseau, ca fiind
exercitat asupra a \up0 \expndtw0\charscalex105 trei "compartimente" fundamentale.
cu rol de receptor al muzicii: senzorlal, \up0 \expndtw0\charscalex105 afectiv si
intelectual. \par\pard\qj \li993\ri779\sb0\sl-250\slmult0\fi288 \up0
\expndtw0\charscalex109 SI Beethoven denumea muzlca drept "inelul de cSsStorle
Tntre viafa \up0 \expndtw0\charscalex102 spirituals si cea a simfurilor". Pentru
psihosomatlcian, format Tn spiritul apll-\line \up0 \expndtw0\charscalex106 cSrii
in practica medicald, diagnostics si terapeutica a unltdfii dintre psihic \up0
\expndtw0\charscalex110 Si somatic, prezints un interes deosebit, nu atat
fascinanta lume a inter� \up0 \expndtw0\charscalex106 preed mesajulul muzical si
nici chiar Infinltele posibilitSfi de ameliorare a \up0 \expndtw0\charscalex103
suferinfelor psihice prin muzicS, ci in primul rand. rSsunetuI acesteia asupra \up0
\expndtw-3\charscalex100 activitSfii Some! \up0 \expndtw0\charscalex103 (viafa
somato-viscerald). InsS el va trebui sd nu omits nici \par\pard\qj
\li998\ri783\sb0\sl-250\slmult0 \up0 \expndtw0\charscalex100 un moment faptul cS
rSsunetuI psihosomatic al muzicii deplnde Tntr-un mod -\line \up0
\expndtw0\charscalex107 direct sau indirect, analog sau aleator - de ceea ce "se
intampia" la nivelul \up0 \expndtw0\charscalex100 experienfei intelectual afective
a subiectului, Tn timpul audiflei muzicale. \par\pard\qj \li1003\ri769\sb0\sl-
246\slmult0\fi287 \up0 \expndtw0\charscalex103 ConsiderSm ca, Tn primul rand, este
necesar sS mentlonam cele doua ni\up0 \expndtw0\charscalex105 veiuri de comunicare
pe care le oferS muzlca: eel non-verbal (sau infraver\up0 \expndtw0\charscalex105
bal) \u8226? muzica "pur" instrumentalS si eel verbal - muzica vocals
(amplificare \up0 \expndtw0\charscalex105 explicate prin llmbaj verbal, a mesajelor
transmise de muzica "pura"). \par\pard\qj \li1003\ri764\sb0\sl-247\slmult0\fi292
\up0 \expndtw0\charscalex103 in fiecare din cele douS niveluri de comunicare,
faptul cS muzica - lipsitS \up0 \expndtw0\charscalex106 de cuvinte \u8226? are
"Tnfelesurile" ei (subtile, adesea), obllga 1a o decodiflcare \up0
\expndtw0\charscalex105 grevata de multe "riscurl" in corectitudlnea recepfionarll
mesajului Ele sunt \up0 \expndtw0\charscalex105 legate de caracteristicile muzicii
(inclusiv ae autorulul ei), dar si de cele ale \up0 \expndtw0\charscalex105
ascultstorului, precum s' de o serie de factori conjuncturali extrem de
varia\up0 \expndtw0\charscalex104 fi. "Riscurile" de care am pomenlt pot constitui
sursa unor intersante si pline \up0 \expndtw0\charscalex105 de farmec excursii Tn
imaginar, din partea ascultetorilor (sporite si de fac� \up0
\expndtw0\charscalex105 torii conjuncturali, precum si de lipsa unui Tnfeles pe
care muzlca vocals si \up0 \expndtw0\charscalex105 cea instrumentalS "cu program"
il dau In operele respective).
psihosomatica generae si aplicata\par\pard\qj \li1243\sb0\sl-247\slmult0
247\slmult0\fi292 \up0 \expndtw0\charscalex118 Cu sau ISrS "aventurS in imaginar",
muzica prezints douS categorii de \up0 \expndtw0\charscalex114
mesaje: apollinic (inducand o stare de relaxare) si dlonisiac (caracter stimu�
\up0 \expndtw0\charscalex121 lant, mergand pans la angrenarea unor expresii
corporale, culminand cu \up0 \expndtw0\charscalex117 dansul) Toate aceste stSri
emofionale, ca s* ideile sugerate de muzicS sunt \up0 \expndtw0\charscalex114
trSite la nivelul experienfei psihice a subiectului si repercutate prin interme�
\up0 \expndtw0\charscalex116 diul relafiilor cortico-somato viscerae, asupra
activitSfii aparatului locomo\up0 \expndtw0\charscalex116 tor si a organelor
interne (pnn antrenarea sistemelor reglatorli psiho-neuro-\line \up0
\expndtw0\charscalex117 endocrino-vegetative si. incS insultcient precizatS in
domemul muzicii si a \up0 \expndtw0\charscalex117 sistemului imun). \par\pard\qj
\li1248\ri556\sb0\sl-250\slmult0\fi292 \up0 \expndtw0\charscalex112 Sistemul
limDic, constitute - dupS Ruch - sediul integrant experienfei psi� \up0
\expndtw0\charscalex113 hice "transmise organelor interne prin conexiunile sale cu
lobul frontal, rela� \up0 \expndtw0\charscalex112 fiile cu lolamusul \up0
\expndtw0\charscalex117 (considerat ca "sediu al trSirii subiective") si cu hipotae
\par\pard\qj \li1252\ri540\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex117 musui
(considerat "creierul vegetativ". deci reglator al activitafii organelor \up0
\expndtw0\charscalex109 interne). \par\pard\qj \li1243\ri531\sb0\sl-
245\slmult0\fi302 \up0 \expndtw0\charscalex116 Referitor la emofiile care
acompaniazS. de regue, perceperea muzicii, se \up0 \expndtw0\charscalex117 cuvine
sa mentionam cateva teoni referitoare la mecanismele lor de forma\up0
\expndtw0\charscalex117 re teoria "cortico-talamica' a lui Papez, care indicS
sediul cortical - ce pre\up0 \expndtw0\charscalex115 lucreazS informatia intr-o
vanetate de forme - si talamic, al trSirilor subiec� \up0 \expndtw0\charscalex118
tive, si teoria "activatoare" a lui Arnold, ce se bazeazS pe indicarea Siste�
\up0 \expndtw0\charscalex112 mului Reticulat Activator Ascendent (SRAA). ca sediu
al amplificarii, ca intr\up0 \expndtw0\charscalex118 o avaensa, a emofiilor, pe
baza particularitSfilor morfologice ale SRAA si \up0 \expndtw0\charscalex118 anume
existenta unui circuit neuronal inchis. \par\pard\qj \li1248\ri540\sb0\sl-
246\slmult0\fi302 \up0 \expndtw0\charscalex115 Nu trebuie uitat met faptul.
demonstrat de Bindra, cS structunle neurona\up0 \expndtw0\charscalex113 le cu rol
in emotii sunt "utilizate" $i de procesele motivafionale. asa incat re� \up0
\expndtw0\charscalex111 latia de influenfS reciprocS intre emofie $t motivafie in
cadrul proceselor psi� \up0 \expndtw0\charscalex113 hice umane este reflectata si
in planul ascultSrii, infelegerii $i indrSgirii mu� \up0 \expndtw0\charscalex114
zicii de catre orice meloman. Acest aspect de ordin neurofiziologic s' psiho�
\up0 \expndtw0\charscalex117 logie poate constitui o explicate si pentru efectul
analog drogului pe care il \up0 \expndtw0\charscalex117 are muzica pentru unii
dintre iubitorii ei. \par\pard\ql \li1545\sb149\sl-230\slmult0 \up0
\expndtw0\charscalex119 2. Caracterizare generala a efectelor psihologice ale
muzicii \par\pard\qj \li1252\ri538\sb174\sl-250\slmult0\fi288 \up0
\expndtw0\charscalex117 Pentru a injelege efectele muzicii asupra activitSfii
corporale este nece\up0 \expndtw0\charscalex116 sarS o trecere in revists sumarS a
celor mai generale aspecte ale impactului \up0 \expndtw0\charscalex116 muzicii
asupra psihicului ascultatorului \par\pard\qj \li1257\ri517\sb0\sl-
243\slmult0\fi283 \up0 \expndtw0\charscalex113 Vom omite in mod intenfionat efectul
muzicii asupra celui care o interpre\up0 \expndtw0\charscalex116 teazs (in
ansamblu. mai benefic decat la ascultstorul pasiv) deoarece obiec\up0
\expndtw0\charscalex115 tivul final al intregii prezentSri a impactului
psihosomatic este acela al utili\up0 \expndtw0\charscalex115 zaru tuturor
particularitafilor in care are loc acest impact, in folosul aplicarii \up0
\expndtw0\charscalex114 unei muzicoterapii optime - dar de reguia pasive - si fara
adaosul unor efec� \up0 \expndtw0\charscalex115 te adifionale "secundare"
(neindicate sau contraindlcate la unii subiecfi si in \up0 \expndtw0\charscalex115
unele stadii). \par\pard\qj \li1271\ri523\sb0\sl-250\slmult0\fi283 \up0
\expndtw0\charscalex115 Asadar, la o primS apreciere a ansamblului de idei S'
sentimente pe care, \up0 \expndtw0\charscalex120 in mod evident, le produce muzica
asupra ascultstorului este suficient sS \up0 \expndtw0\charscalex111 amintim
remarca lui Ribot (cit. de Verdeau-PaillSs s< colab. \up0 \expndtw0\charscalex102
1995, p. \up0 \expndtw0\charscalex108 97) "Ea \par\pard\ql \li1267\sb1\sl-
223\slmult0 \up0 \expndtw0\charscalex117 creeazS dispozifii, ce depind de starea
organicS a activitSfii nervoase si pe
\par\pard\qj\li1190\ri594\sb120\sl-245\slmult0 \up0 \expndtw0\charscalex114 care
noi le traducem In termeni vagi ca bucurie, tristefe, tandrefe, seninatate, \up0
\expndtw0\charscalex112 neliniste. Pe aceastS canava inteligenfa brodeazS in
funcfie de natura diferifi-\line \up0 \expndtw0\charscalex111 lor indivizi." Noi am
adauga, referitor la aspectul de ordin intelectual al muzi� \up0
\expndtw0\charscalex112 cii, faptul ce omul are tendinfa de a decodifica sensurile
muzicii (sugerate sau \up0 \expndtw0\charscalex113 nu de compozitor) acfionand pe
baza unui izomorfism al elementelor muzicii \up0 \expndtw0\charscalex110 ascultate.
Asa de exemplu, cunoscutul Andante din Simfoma a V-a de Beetho� \up0
\expndtw0\charscalex114 ven, prin tempoul sSu asemSnStor mersului llnistit, ca s*
prin "ascensiunea" \up0 \expndtw0\charscalex115 melodies, poate sS ne sugereze un
urcus, Incununat - prin acordurile in for� \up0 \expndtw0\charscalex115 tissimo ale
orchestrei \up0 \expndtw0\charscalex116 - cu biruinfa ajungerii pe culme (umbrits
din cand in \par\pard\ql \li1200\sb8\sl-230\slmult0 \up0 \expndtw0\charscalex113
cand de indoiala strecuratS de un motiv in tonalitate minors). \par\pard\qj
\li1200\ri583\sb18\sl-245\slmult0\fi292 \up0 \expndtw0\charscalex118 EvaluSnle in
plan intelectual (cSutate atent \u8226? in cadrul ascultSrii de "tip \up0
\expndtw0\charscalex119 Intelectual" a muzicii sau "fluctuant" intr-o liberS s'
multiple asociafie de \up0 \expndtw0\charscalex101 idei \up0 \expndtw-
2\charscalex100 -\up0 \expndtw0\charscalex125 in cadrul asaleni "evocatoare") au
intotdeauna un corespondent \up0 \expndtw0\charscalex114 afectiv pregnant exprimat
si constientizat de ascultetor, inducand stSri emo� \up0 \expndtw0\charscalex114
fionale persistente, $' dupa Incetarea audierii muzicii. \par\pard\ql
\li1502\sb8\sl-230\slmult0\tx4780\tx6643 \up0 \expndtw0\charscalex119 Dupe autori
ca Spingte si Droh, \tab \up0 \expndtw0\charscalex110 (1992), Segenwald \tab
\up0 \expndtw0\charscalex113 (1995) si Verdeau-\par\pard\qj \li1204\ri585\sb0\sl-
250\slmult0\fi4 \up0 \expndtw0\charscalex113 Pailles si col. (1995), putem grupa
efectele psihologice globale ale muzicii in \up0 \expndtw0\charscalex116
urmetoarele categorii (cu Interferente frecvente). detaliind - prin exemplifi
\up0 \expndtw0\charscalex116 ceri - clasificarea efectelor muzicii din capitolul
precedent. \par\pard\qj \li1507\ri593\sb0\sl-240\slmult0\tx1737 \up0
\expndtw0\charscalex116 1. Relaxare psihica, avand urmetoarele variante cu
implicafii comporta� \line\tab \up0 \expndtw0\charscalex116 mentale:
\par\pard\qj \li1943\ri579\sb0\sl-260\slmult0\tx3081 \up0 \expndtw0\charscalex117 -
catharsis \tab \up0 \expndtw0\charscalex120 (scederea marcatS a tensiunii
emofionale). incluzSnd \up0 \expndtw0\charscalex121 defularea si posibila aparifie
a extazului; \par\pard\ql \li1939\sb1\sl-207\slmult0 \up0 \expndtw0\charscalex115 -
sedare (favonzand instalarea somnului, in unele cazuri); \par\pard\qj
\li1943\ri575\sb6\sl-240\slmult0 \up0 \expndtw0\charscalex119 - eufone (generate,
uneori compensator fafa de disparifia rapida a \up0 \expndtw0\charscalex111
continutului afectiv negativ). \par\pard\ql \li1492\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex127 2 Stimulare psihica \par\pard\ql \li1943\sb30\sl-
230\slmult0 \up0 \expndtw0\charscalex114 - cresterea randamentului cogmtiv (memorie
s' ideafie); \par\pard\ql \li1953\sb10\sl-230\slmult0\tx2841\tx4814 \up0
\expndtw0\charscalex109 - euforie \tab \up0 \expndtw0\charscalex121 (aici se
incadreaza \tab \up0 \expndtw0\charscalex119 $\u8226? muzica rock si
corespondentele ei \par\pard\qj \li2073\ri574\sb0\sl-250\slmult0 \up0
\expndtw0\charscalex117 creatoare de euforie in mod facil, prin dezinhibifia
produse de rit \up0 \expndtw0\charscalex120 mica pregnanta. intensitatea soncre
brutae si asperitatea timbru\up0 \expndtw0\charscalex113 lui mstrumentelor
"electrice" sau "electronice" loiosite); \par\pard\ql \li1948\sb1\sl-230\slmult0
\up0 \expndtw0\charscalex116 - cresterea increderii in sine, \par\pard\ql
\li1948\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex112 - stimularea voinfei si
inifiativei. \par\pard\qj \li1214\ri559\sb0\sl-244\slmult0\fi283 \up0
\expndtw0\charscalex116 3. Comunicare interumane, avSnd un caracter infraverbal,
bogat in ele� \up0 \expndtw0\charscalex122 mente sugestive, fapt constatat in
special in cazul executiilor colective a \up0 \expndtw0\charscalex117 unor piese
muzicale (exemplu In cvartet), dar si un caracter verbal (muzica \up0
\expndtw0\charscalex117 vocalS) ce explice sau accentueaze, cu ajutorul textului,
ideile si sentimen\up0 \expndtw0\charscalex114 tele vehiculate de muzica
instrumentalS. in cazul participarii active la muzi� \up0 \expndtw0\charscalex114
ca. de exemplu cantatul
in cor, comunicarea este maxima. \par\pard\ql \li1516\sb167\sl-230\slmult0 \up0
\expndtw0\charscalex119 4. Scaderea pragului durerii si modlficarea excitabllitafii
pslhomotorli \par\pard\qj \li1219\ri564\sb182\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex121 ince din antichitate, efectul analgetic al muzicii era
utilizat in practica \up0 \expndtw0\charscalex123 medicae, existSnd mSrturii despre
un medic grec Athenaops, care trata \up0 \expndtw0\charscalex124 lombalgiile si/sau
sciatica prin utilizarea sunetului de flaut, instrument ce
\up0 \expndtw0\charscalex107 Elemente de psihosomatica generae $i
\expndtw0\charscalex115 mtona o melodie ritmice exact "deasupra locului durerii",
realizSnd ceea ce \up0 \expndtw0\charscalex115 s-ar putea numi o veritabila
"acupuncture muzicae" (Luban Plozza $i colab. \up0 \expndtw-2\charscalex100
\expndtw0\charscalex123 Mai tarziu, exista obiceiul de a se efectua extracfii
dentare in piefe \up0 \expndtw0\charscalex115 publice. in zilele "de targ", de
cetre "extractorii de dinfi" care utilizau trorn\up0 \expndtw0\charscalex117 peta
si tobele ce intonau o muzice bine ritmate si de mare intensitate sono\up0
\expndtw0\charscalex116 re. al cerui efect asupra pacientului era acela de a-i
atenua durerea din tim� \up0 \expndtw0\charscalex113 pul extractiei (posibil si un
efect "direct" asupra pragului senzorial al durerii. \up0 \expndtw0\charscalex116
sau indirect prin procesul de excitafie brutae corticae imediatS. cu inhibifia \up0
\expndtw0\charscalex116 zonelor adiacente legate $i de percepfia durerii).
in sfarsit este citat \tab \up0 \expndtw0\charscalex115 (tot in Luban Plozza si
colab. \tab \up0 \expndtw0\charscalex116 - Musik und Psyche -\par\pard\qj
\li1209\ri519\sb22\sl-240\slmult0\fi24 \up0 \expndtw0\charscalex120 1988) si
exemplul medicului John Butcher care utiliza scurte melodil, cu \up0
\expndtw0\charscalex115 cuvinte. pentru pacientele sale, in timpul travaliului
obstetrical, obtinSnd un \up0 \expndtw0\charscalex115 efect analgetic
\par\pard\ql \li1502\sb9\sl-230\slmult0\tx4872 \up0 \expndtw0\charscalex119 in
zilele noastre, Spingte si Droh \tab \up0 \expndtw0\charscalex115 (1992) citeazS
rezultatele unor studli \par\pard\qj \li1209\ri530\sb2\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex114 efectuate de cStre Schapiro si Cohen pe 500 femel supuse
curetajulul uterin, \up0 \expndtw0\charscalex119 dintre care \up0
\expndtw0\charscalex121 142 au ascultat la cases muzicS \up0
\expndtw0\charscalex118 (clasicS, disco sau country), \par\pard\qj
\li1209\ri514\sb20\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex124 afirmand in 82%
din cazuri - disparifia complee a durerilor (fapt ce s-a \up0
\expndtw0\charscalex117 realizat numai la 57% dintre cele care au primit, ca
anestezlc, Methoxyflu\up0 \expndtw0\charscalex118 ran). Toate aceste efecte
analgezice ae muzicii indreptSfesc termenul pro\up0 \expndtw0\charscalex111 pus de
Diamond (in 1981) de "muzicoanestezle". \par\pard\ql \li1511\sb189\sl-
230\slmult0 \up0 \expndtw0\charscalex117 3. Efectul de modlficare a cxcitabllitafil
psihomotorll \par\pard\ql \li1507\sb190\sl-230\slmult0\tx7967 \up0
\expndtw0\charscalex118 Este relatat tot de cetre Spingte s' Droh, cu urmetoarele
preclzari \tab \up0 \expndtw0\charscalex124 (a se \par\pard\qj
\li1209\ri520\sb2\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex117 vedea si
pragraful consacrat modificerilor musculaturll sub efectul muzicii \up0
\expndtw0\charscalex109 anxiolltice): \par\pard\ql \li1953\sb9\sl-230\slmult0
\up0 \expndtw0\charscalex114 - scederea nellnistii motorii; \par\pard\ql
\li1948\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 - scSderea tonusului
muscular; \par\pard\ql \li1948\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 -
diminuarea sau disparifia crampelor musculare. \par\pard\qj \li1219\ri515\sb22\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex128 Efectele excltante asupra tonusului
muscular, induse de o muzica \up0 \expndtw0\charscalex115 stimulants \up0
\expndtw0\charscalex123 (ritm, intensitate sonord) vor fi prezentate e acelasi
paragraf \up0 \expndtw0\charscalex109 menfionat. \par\pard\qj \li1214\ri505\sb0\sl-
246\slmult0\fi297 \up0 \expndtw0\charscalex126 Reacfiile la muzicS, descnse mai sus
si situate Tn sfera proceselor \up0 \expndtw0\charscalex125 psihice, prezinta un
Impact psihosomatic, modificand in grade variate \up0 \expndtw0\charscalex122
activitatea somato-visceralS prin Intermediul releelor integrative neuro\up0
\expndtw0\charscalex110 endocri no-vegetative. \par\pard\ql \li1521\sb224\sl-
230\slmult0 \up0 \expndtw0\charscalex129 B. Mecanisme psiho-neuro-endocrine
implicate \par\pard\ql \li1564\sb0\sl-230\slmult0 \par\pard\ql\li1564\sb140\sl-
230\slmult0 \up0 \expndtw0\charscalex115 1. Loca/fzdri cerebrate ale funcflllor
muzicii \par\pard\qj \li1228\ri500\sb182\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex122 Demn de Interes si deloc surprinzStor avand in vedere
activitatea de \up0 \expndtw0\charscalex116 cercetare a Fundatiei Muzicae
intemelate e Salzburg de cStre marele dirijor \up0 \expndtw0\charscalex112 Herbert
von Karajan - este ca acest muzician de geniu ($i. totusi. nu un medic \up0
\expndtw0\charscalex112 psihosomatician) defmeste muzica drept "o realitate
atotcuprinzStoare \par\pard\sect\sectd\fs24\paperw9120\paperh13220{\bkmkstart
\ul0\nosupersub\cf8\f9\fs22 (totae) traits, atat in plan fizic. cSt si in eel
psihic", indicand \tab \up0 \expndtw0\charscalex101 - in continua-\par\pard\qj
\li1036\ri690\sb0\sl-245\slmult0\fi4 \up0 \expndtw0\charscalex106 rea aprecierilor
sale despre muzica - faptul ce. pe engS posibilitSfiie de a o \up0
\expndtw0\charscalex107 cunoaste pnn rellecfie, mai este posibilS "studierea ei in
contextul unitSfii \up0 \expndtw0\charscalex105 psihosomatice a individului" (din
prefafa lucrarii "La troisieme oreille et la \up0 \expndtw0\charscalex103 pensee
musicale" de Jaqueline Verdeau-Pailles. B. Luban-Plozza et M. Delli \up0
\expndtw0\charscalex103 Ponti, ed. Fuzeau, Paris 1995). \par\pard\qj
\li1041\ri675\sb0\sl-244\slmult0\fi283 \up0 \expndtw0\charscalex105 in acest
context al psihosomaticii, baza neuro-morfo-fiziologicS a expli-\line \up0
\expndtw0\charscalex104 cSrii influenfei muzicii asupra activitSfii somato-
viscerale a individului, su-\line \up0 \expndtw0\charscalex104 pus audifiei
muzicii. este furnizatS de cStre celebrul neurochirurg J. Eccles, \up0
\expndtw0\charscalex105 laureat al Premiului Nobel: "Actualmente este posibil.
datoritS unor tehnici \up0 \expndtw0\charscalex105 foarte sofisticate (tomografice,
cu emisie de pozitronl*. potenfiale evocate) \up0 \expndtw0\charscalex105 sS se
demonstreze cS, pans si simplul fapt de a recunoaste un ritm muzical, \up0
\expndtw0\charscalex110 antreneazS o crestere a activitSfii emisferei cerebrae
drepte*', la nivelul \up0 \expndtw0\charscalex105 ariei simetrice fafa de cea in
care isi au sediul, in emisfera stSngS, funcfiile \up0 \expndtw0\charscalex106
limbajului. Din aceastS arie de localizare a funcfiilor muzicae Tn emisfera \up0
\expndtw0\charscalex105 dreaptS pleacS o serie de cSI nervoase ce ajung in sistemul
limbic si hipo� \up0 \expndtw0\charscalex109 talamus, la baza encefalului; ele sunt
foarte mult implicate in producerea \up0 \expndtw-1\charscalex100 "armonicelor \up0
\expndtw0\charscalex106 (in sens de rezonanfS afectivS n. trad.) emofionale"
asociate \up0 \expndtw0\charscalex107 muzicii. Dar eu emit si ipoteza cS experienfa
muzicae survine atunci cand \up0 \expndtw0\charscalex103 are loc activarea lobilor
prefrontall care stau la originea fenomenelor psiho� \up0 \expndtw0\charscalex103
somatice". \par\pard\qj \li1051\ri675\sb0\sl-245\slmult0\fi292 \up0
\expndtw0\charscalex103 Pentru infelegerea efeclelor evidente ale ritmului muzical
asupra diverse\up0 \expndtw0\charscalex102 lor funcfii somatice este suflcient sS
amintim cS la nivelul sistemului limbic, \up0 \expndtw0\charscalex105 adevSrat
"creier visceral", are loc Integrarea emotivo-instinctivo-comporta-\line \up0
\expndtw0\charscalex106 mentae cu elementele bioritmice care acompaniazS
componentele acestui \up0 \expndtw-3\charscalex100 complex. \par\pard\qj
\li1060\ri670\sb0\sl-245\slmult0\fi278 \up0 \expndtw0\charscalex111 Conexiunile
sistemului limbic cu hipotalamusul implies influenfe si \up0
\expndtw0\charscalex104 asupra unor funcfii coordonate de cStre acestea - inclusiv
prin reglarea unor \up0 \expndtw0\charscalex102 ritmuri biologice fundamentale
precum temperatura corpului, activitatea cor-\line \up0 \expndtw0\charscalex105
ticosuprarenalei, ciclul veghe-somn ca si activitatea ritmicS a centrilor res-\line
\up0 \expndtw0\charscalex106 piratori si cardiaci \up0 \expndtw0\charscalex102
(Luban-Plozza, Verdeau-PaillSs -1994). Este usor de in-\par\pard\qj
\li1055\ri661\sb0\sl-244\slmult0 \up0 \expndtw0\charscalex107 feles cum acordarea
acestui "orologiu biologic", reprezentat de ansamblul \up0 \expndtw0\charscalex100
funcfiilor biologice menfionate (dar si de altele,
neenumerate), cu ritmul mu� \up0 \expndtw0\charscalex105 zicii ascultate, poate sS
genereze o varietate de influente, in ultimS instanfa \up0 \expndtw0\charscalex103
ale ritmului muzicii. asupra activitSfii organelor interne, ca si a altor
compo-\line \up0 \expndtw0\charscalex107 nente somatice (tonusul muscular, de ex.).
In plus, a$a cum argumenteazS \up0 \expndtw0\charscalex102 Sergi (cit. la pg.
\up0 \expndtw0\charscalex100 97 - "La troisieme oreille") datoritS apropierii
localizSrii nu-\par\pard\qj \li1060\ri658\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex105 cleilor acustici si vagali. stimulii acustici muzicali pot
acfiona asupra respi \up0 \expndtw0\charscalex103 rafiei si circulafiei. fiind
implicafi in aparifia memoriei muzicale. DupS cum \up0 \expndtw0\charscalex107 se
va vedea. si alte elemente structurale de bazS ale muzicii \up0
\expndtw0\charscalex103 (Intensltatea. \par\pard\qj \li1075\sb0\sl-200\slmult0
\ul0\nosupersub\cf9\f10\fs20 ' Prin aceastd metodd se evidenfiazd zonete cerebrate
care devin active sub \up0 \expndtw0\charscalex109 .ic\\tunea diversilor excttanfi
vizuati. acustici, inclusiv cei cu confinul verbal \up0 \expndtw-9\charscalex81 (v.
\par\pard\ql \li1080\sb5\sl-194\slmult0 \up0 \expndtw-3\charscalex100 Eberhard-
Metzger) \par\pard\ql \li1511\sb11\sl-213\slmult0\tx5006 \up0
\expndtw0\charscalex104 "La japonezi. datorita particularitafilor \tab \up0
\expndtw0\charscalex105 (onetice ale limbajului si construcfiei \par\pard\ql
\li1075\sb1\sl-197\slmult0 \up0 \expndtw-1\charscalex100 muzicii lor, localtzarea
"cenlrului muzical" este in emisfera cerebral* stdngd (n. trad.)
240\slmult0\fi9 \up0 \expndtw0\charscalex119 acordurile consonante sau disonante.
melodia si- mai ales, timbrul sonor) \up0 \expndtw0\charscalex114 exercitS
influenfe directe (pnn conexiumle cSilor senzoriale acustice cu sis� \up0
\expndtw0\charscalex115 temul limbic) sau indirect \up0 \expndtw0\charscalex114 -
prin intermediul unor reactii emotionale provo-\par\pard\qj \li1339\ri395\sb20\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex116 cate de fiecare din aceste componente
(dar prin efectul de ansamblu al mu� \up0 \expndtw0\charscalex113 zicii) asupra
sistemului limbic. Nu trebuie omise nici influenfele unor factori \up0
\expndtw0\charscalex113 de "montaj" afectiv-ideativ. legate de contextul audifiei.
ca si de unele trSsS-\line \up0 \expndtw0\charscalex117 turi psihologice ale
ascultStorului \up0 \expndtw0\charscalex119 (avand Imphcafii in receptivitatea
sa \up0 \expndtw-2\charscalex100 -\par\pard\qj \li1339\ri404\sb0\sl-246\slmult0
\up0 \expndtw0\charscalex115 crescuts sau scSzutS - pentru muzica ce i se
prezinta). Toate aceste influen� \up0 \expndtw0\charscalex116 fe. prin mecanismele
reglatoare (sau dereglatoare cortico-hmbice) converg, \up0 \expndtw0\charscalex114
in ultimS instants tot la nivelul aeestei "pISci turnante a relafiei psihosoma�
\up0 \expndtw-2\charscalex100 tice'" \up0 \expndtw0\charscalex113 (Duret) care este
sistemul limbic. \par\pard\ql \li1636\sb184\sl-230\slmult0 \up0
\expndtw0\charscalex121 2. Relafli posibile cu eustresul si distresut
Exists deja date in literaturs care eticheteazS diferitele cresteri sau sce\up0
\expndtw0\charscalex112 deri ale concentrafiei diver?ilor hormoni, studiafi in
cursul unei audifn muzi� \up0 \expndtw0\charscalex112 cae, drept "hormoni de stres"
Aceaste formulare partial justificate ne oblige se analizam reacfia globa-\line
\up0 \expndtw-2\charscalex100 la \up0 \expndtw0\charscalex116 (psihosomatice) a
organismului uman, declansatS de ascultarea muzicii, \up0 \expndtw0\charscalex115
din punctul de vedere al atnbutelor stresului psihic pe care unui dintre noi
I-\line \up0 \expndtw0\charscalex115 a definit drept "o reacfie adaptative a
intregului organism constituite de exa-\line \up0 \expndtw0\charscalex114 cerbarea
- dincolo de nivelul unor simple ajusteri homeostatice - a unor pro� \up0
\expndtw0\charscalex123 cese psihice s* a corelatolor somato-viscerale ale acestora
sub acfiunea \up0 \expndtw0\charscalex113 unor stimuli declan$antl cu semnificatie
pozitive - benefice (eustres) sau ne� \up0 \expndtw0\charscalex113 gative nocive
(distres) pentru individul respectiv" (lamandescu -1996). \par\pard\qj
\li1329\ri378\sb0\sl-245\slmult0\fi307 \up0 \expndtw0\charscalex116 Dupe cum se
poate observa, existe "din start'" posibilltatea ca muzica se \up0
\expndtw0\charscalex119 declanseze doue categorii opuse de stres, in legetura cu
pecerea, mergand \up0 \expndtw0\charscalex119 pana la extaz (eustres) s' cu
plictiseala, mergand pane la agasare sau chiar \up0 \expndtw0\charscalex120
anxietate sau fune (distres). in realitate, chiar si intre aceste stari afective
\up0 \expndtw0\charscalex119 extreme, exista o gama large de trein emofionale
intermediare care - ceea \up0 \expndtw0\charscalex117 ce este eel mai important
pentru studierea efectelor psihosomatice ale mu� \up0 \expndtw0\charscalex104 zicii
\up0 \expndtw0\charscalex120 - se insofesc de variate modificeri ale funcfiilor
diverselor organe si \up0 \expndtw0\charscalex115 aparate, desemnate sub numele de
"corelate somato-viscerale ale ernofiilor" \up0 \expndtw0\charscalex115 (lamandescu
-1993) \par\pard\qj \li1334\ri370\sb0\sl-244\slmult0\fi288 \up0
\expndtw0\charscalex123 Aceste emofii pozitive sau negative pot se atinge sau nu
intensitatea \up0 \expndtw0\charscalex124 stresului, desi aspiratia oricSrui
meloman este aceea de obfinere a unui \up0 \expndtw0\charscalex116 eustres. atunci
cand ascultS o muzicS. fie cunoscutS si pentru care prezintS \up0
\expndtw0\charscalex116 o atracfie puternica. fie necunoscutS dar care sa Ii
suscite un vlu interes sau \up0 \expndtw0\charscalex119 care sa-l poatS "surprinde"
in mod "violent" prin valoarea oi deosebitS pe \up0 \expndtw0\charscalex119 care -
justificat sau nu - acest tubitor i-o confere. \par\pard\ql \li1641\sb1\sl-
223\slmult0\tx5481 \up0 \expndtw0\charscalex121 intre aceste fafete opuse ale
stresului \tab \up0 \expndtw0\charscalex117 (datorie semnificafiei stimulilor
psihici) exists asa cum s-a aratat mai sus "trSiri emofionale inlermediare".
\up0 \expndtw0\charscalex118 adicS acele emofu (mai degrabS stari de dispozifie),
de intensitate mai re-\line \up0 \expndtw0\charscalex119 dusS decat efectele, ce
inirunesc atributele stresului. in plan terapeutic ele \up0 \expndtw0\charscalex113
prezintS un interes deosebit la bolnavii care nu tolereazS oscilatii emotionale
\up0 \expndtw0\charscalex113 intense, fie ele si din categoria eustresului. Asa de
exemplu un bolnav cu \par\pard\sect\sectd\fs24\paperw9120\paperh13220{\bkmkstart
antecedente recente de inlarct miocardic relata urmetoarele. "trompeta din \up0
\expndtw0\charscalex115 muzica baroce me elibereazS. pur si simplu. de durerea din
regiunea inimii, \up0 \expndtw0\charscalex122 tonalitSfile joase si surde ale
instrumentelor de percufie. in schimb, imi \up0 \expndtw0\charscalex115 produc
fricS. mai ales daca ele au o cadents apropiatS de cea a bStSilor ini� \up0
\expndtw-4\charscalex100 mii" \up0 \expndtw0\charscalex109 (Delli Ponti si Luban
Plozza -1987). \par\pard\ql \li1339\sb169\sl-230\slmult0 \up0
\expndtw0\charscalex118 3. Reacfia endocrina in cursul ascultarii muzicii
a) Hormonii implicafi in reacfia de eustres provocata de audifia \up0
\expndtw0\charscalex121 muzicala \par\pard\qj \li1041\ri687\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex123 Referitor la datele din literaturs
care incearcS sS desemneze muzica \up0 \expndtw0\charscalex125 aleasS spre a induce
un eustres ascultatorului, se pare cS cea scrisS de \up0 \expndtw0\charscalex112
Mozart intruneste cele mai multe aprecieri Desigur, opera oricSruia dintre
ge\up0 \expndtw0\charscalex112 niile muzicii - Bach, Beethoven. Haydn, Schubert.
Brahms, Wagner s.a.m.d. -\line \up0 \expndtw0\charscalex119 poate produce, in mod
electiv, un eustres ascultstorului. avizat sau nu, iar \up0 \expndtw0\charscalex114
acesta din urmS va include ulterior pe compozitorul respectiv prinlre sursele
\up0 \expndtw0\charscalex114 sale generatoare, "in mod garantat", de eustres.
Din punct de vedere al hormonilor considerafi ca markeri ai eustresulul \up0
\expndtw0\charscalex120 (in cadrul unui model neuro-endocrin al aeestei reactii,
incS departe de o \up0 \expndtw0\charscalex117 descriere mScar aproximativa), au
lost evidenfiate cresteri ale endorllnelor \up0 \expndtw0\charscalex117 Si ale
catecolaminelor.
\ul0\nosupersub\cf18\f19\fs20\ul Endorfinele\ul0\nosupersub\cf9\f10\fs20 au lost
invocate ca "hormoni ai muzicii" datoritS actiunii lor \up0 \expndtw0\charscalex113
"morphine-like'" (efect analgezic s* eufonzant), mai ales cS, pentru multi
as\up0 \expndtw0\charscalex115 cultStori, muzica constituie o sursS de euforie,
mergand pans e extaz. Evers \up0 \expndtw0\charscalex117 a demonstrat pe o grupS de
studenfi (in 1994) blocarea efectului pecut, eu\up0 \expndtw0\charscalex115
forizant al muzicii pnn administrarea prealabie audifiei muzicae a Naloxon\up0
\expndtw0\charscalex100 ului \up0 \expndtw0\charscalex114 (cunoscut blocant al
morlinei, deci si al endorfinelor). \par\pard\qj \li1046\ri677\sb24\sl-
237\slmult0\fi283 \up0 \expndtw0\charscalex118 AceastS constatare experimentae,
fara posibilitate de tSgadS in ceea ce \up0 \expndtw0\charscalex119 priveste
implicarea endorfinelor in producerea senzafiilor pecute de cStre \up0
\expndtw0\charscalex125 audierea muzicii, vine in contradiefie cu datele din
literatura ceva mai \up0 \expndtw0\charscalex112 veche, prezentate de Spingte si
Droh in 1984. Astfel - referitor la modificSrile \up0 \expndtw0\charscalex124 unor
hormoni de stres survenite sub efectul "muzicii anxio-algolitice", \up0
\expndtw0\charscalex115 studiate la gravide in cursul travaliului - autorii au
gasit aceste valori scSzu-\line \up0 \expndtw0\charscalex116 te ale 6-endorfinelor,
ca si ale altor hormoni de stres (cortizolul, prolactina, \up0
\expndtw0\charscalex121 catecolaminele etc ) in afara unor posibile artefacte (in
urmS cu \up0 \expndtw0\charscalex108 15 ani), \par\pard\qj \li1051\ri682\sb1\sl-
240\slmult0 \up0 \expndtw0\charscalex115 exists si varianta interpretativS a unei
acliuni anxiolitice a muzicii, cu "efect \up0 \expndtw0\charscalex113 inhibitor"'
asupra secrefiei unor endorfine - crescute "solidar" cu ceilalfi hor� \up0
\expndtw0\charscalex113 moni de stres, in cursul travaliului obstetrical.
C\ul0\nosupersub\cf18\f19\fs20\ul atecolam\ul0\nosupersub\cf9\f10\fs20 inele
\par\pard\qj \li1055\ri667\sb2\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex115 La
fel ca si endorlinele. ele au fost gSsite crescute (in special adrenalina) \up0
\expndtw0\charscalex120 mai ales la ascultstorii de muzicS rock, stiut fiind cS
aceastS muzica este \up0 \expndtw0\charscalex121 bogata in elemente care
declanseaza reactii de alarms: intensitate sonorS \up0 \expndtw0\charscalex123
crescuta, ntm accelerat, zgomote cu caracter de semnal \up0 \expndtw0\charscalex115
(percufie, diso-\par\pard\li1055\sb13\sl-230\slmult0\fi0\tx3047\tx3206 \up0
\expndtw0\charscalex112 nanfe) (Verle si Bell\tab \up0 \expndtw0\charscalex117
-\tab \up0 \expndtw0\charscalex117 1993). Acesti autori considers cS una dintre
cele mai\par\pard\li1055\sb1\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex118
puternice ehberSri de adrenalins este rSspunsul de tip "fight or flight"
(atac\par\pard\li1055\sb15\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex118 sau
fugS), indus de muzica discordants in ceea ce priveste ritmul si
corzile\par\pard\li1055\sb14\sl-230\slmult0\fi0\tx1305 \up0 \expndtw0\charscalex101
ei\tab \up0 \expndtw0\charscalex117 (chitarele
electronice).\par\pard\sect\sectd\fs24\paperw9120\paperh13220{\bkmkstart Pg154}
\u9830?\tab \up0 \expndtw0\charscalex107 Elemente de psihosomatica generae $i
\expndtw0\charscalex120 b) Hormonii de distres, sub actiunea unei muzici
anxiolitice (Spingte \up0 \expndtw0\charscalex108 Si Droh -1992) \par\pard\qj
\li1492\ri265\sb0\sl-245\slmult0\fi288 \up0 \expndtw0\charscalex116 Citand datele
unor autori japonezi consacrate studierii efectelor relaxan-\line \up0
\expndtw0\charscalex120 te ale muzicii in cursul anesteziei epidurale sau la
bolnavii stomatologici \up0 \expndtw0\charscalex116 (Tanioka, Oyama. Sato etc.),
Spingte si Droh prezintS un tabel din care re-\line \up0 \expndtw0\charscalex114
zulta efectul de scSdere a unor hormoni de stres. precum: ACTH. Cortizolul \up0
\expndtw0\charscalex107 Prolactina s* \up0 \expndtw0\charscalex112 13-endorfinele
(cu rezerva noastrS asupra acestora din urmS). \par\pard\qj \li1492\ri265\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex113 Este extrem de probabil cS audifia
unei lucrSri muzicae, cu efect relaxant \up0 \expndtw0\charscalex113 in cursul unui
distres. poate contribui la scSderea nivelului plasmatic al hor� \up0
\expndtw0\charscalex113 monilor de stres mentionafi. precum si al altora.
\par\pard\qj \li1492\ri246\sb0\sl-246\slmult0\fi345 \up0 \expndtw0\charscalex113 La
subiectul normal, in momentele de liniste - indiferent de starea de dis\up0
\expndtw0\charscalex115 pozifie (buns sau "neutrS"), este foarte posibil ca muzica
sS aibS alte efecte \up0 \expndtw0\charscalex120 asupra "constelafiei endocrine",
neabordate sau neclarificate incS intr-un \up0 \expndtw0\charscalex113 cadru
experimental. \par\pard\li1492\sb13\sl-230\slmult0\fi297\tx5894 \up0
\expndtw0\charscalex116 CercetSri personale (lamandescu si colab.\tab \up0
\expndtw0\charscalex118 1994-1997) au evidential indu-\par\pard\li1492\sb15\sl-
230\slmult0\fi0\tx4401\tx5332\tx5510\tx8659 \up0 \expndtw0\charscalex118 cerea unor
ventabile efecte\tab \up0 \expndtw0\charscalex107 (pozitive\tab \up0
\expndtw0\charscalex118 -\tab \up0 \expndtw0\charscalex118 bucurie si. mai ales,
negative\tab \up0 \expndtw0\charscalex118 -\par\pard\li1492\sb10\sl-230\slmult0\fi9
\up0 \expndtw0\charscalex119 groaza) prin ascultarea unor fragmente muzicae
contrastante si Insofite de\par\pard\li1492\sb15\sl-230\slmult0\fi0\tx5884 \up0
\expndtw0\charscalex118 corelate somato-viscerale corespunzetoare\tab \up0
\expndtw0\charscalex118 (senzafie de ceidure pentru\par\pard\li1492\sb14\sl-
230\slmult0\fi4 \up0 \expndtw0\charscalex119 emofiile pozitive si de frig -
incordare + palpitafii pentru cele negative).\par\pard\li1492\sb6\sl-
230\slmult0\fi297 \up0 \expndtw0\charscalex119 Aceste train in planul afectiviefii
si al reacfiilor corporale au desigur si\par\pard\li1492\sb14\sl-230\slmult0\fi9
\up0 \expndtw0\charscalex116 o exprimare in plan hormonal, pe care lucrarile
viitoare vor incerca se o des-\par\pard\li1492\sb6\sl-230\slmult0\fi9 \up0
\expndtw0\charscalex118 cifreze.\par\pard\qj \li1502\ri246\sb0\sl-246\slmult0\fi292
\up0 \expndtw0\charscalex116 Cei mai important apare faptul ce hormonii (in
configurafia calitative si \up0 \expndtw0\charscalex117 cantitative sub care sunt
eliberafl la audierea muzicii) isi exercite influenfa \up0 \expndtw0\charscalex117
lor specifice asupra organelor si aparatelor organismului uman, a ceror ac-\line
\up0 \expndtw0\charscalex118 tivitate o modeleaze, eel mai adesea, favorabil
\up0 \expndtw0\charscalex118 (in special in eustres) dar, \par\pard\qj
\li1502\ri235\sb0\sl-243\slmult0\fi4 \up0 \expndtw0\charscalex115 uneori, si
nefavorabil (in cazul distresului produs de o muzice neagreate dar \up0
\expndtw0\charscalex117 Si al unor acfiuni excesive cu particulariefi conjuncture
nocive. Nu trebuie \up0 \expndtw0\charscalex119 omise nici situafia incere (eustres
trecand in distres) a audifiilor colective \up0 \expndtw0\charscalex126 in cadrul
concertelor de pop-rock, atunci cand reacfiile dezenfuite ale \up0
\expndtw0\charscalex109 auditorilor \up0 \expndtw0\charscalex114 - conjugate in mod
nefast cu efectul fiziologic nociv al timbrului \up0 \expndtw0\charscalex114
instrumental si numarul unas de decibeli - pot avea efecte negative in planul
\up0 \expndtw0\charscalex114 modificenlor parametrilor somatici ai organismului.
\par\pard\qj \li1795\ri312\sb205\sl-320\slmult0\tx2068 \up0 \expndtw-
5\charscalex100 \ul0\nosupersub\cf8\f9\fs22 C. MOOIFICARI SOMATO-VISCERALE INDUSE
DE MUZICA ASUPRA \line\tab \up0 \expndtw-10\charscalex93 ASCULTATORULUI
Includem astfel manifestSrile referitoare la expresia corporae a muzicii \up0
\expndtw0\charscalex112 (Verdeau-Pailles -1994) - ca element asociat. in plan
somatic, a modificSrilor \up0 \expndtw0\charscalex112 psihice induse de muzicS,
precum si rSsunetuI visceral al acesteia. \par\pard\qj \li1521\ri223\sb6\sl-
235\slmult0\fi288 \up0 \expndtw0\charscalex111 Am eliminat in mod intentionat
termenul de audiere a muzicii (implicand o \up0 \expndtw0\charscalex114 concentrare
voluntarS a atenfiei, consecventS - ca in tipul de auditie intelec-\line \up0
\expndtw0\charscalex110 tualS - sau fluctuantS. ca in tipul de auditie afectivS,
relaxantS) deoarece exis� \up0 \expndtw0\charscalex113 ts nenumSrate situafii in
care muzica poate constitui un fundal sonor cu care, \up0 \expndtw0\charscalex113
involuntar, venim in contact. A$a se intampIS, in cazul unor bune intenfii ae
Psihosomatica generala\tab \up0 \expndtw0\charscalex117 \u9830?ISI\par\pard\qj
\par\pard\qj\li787\ri955\sb132\sl-235\slmult0 \up0 \expndtw0\charscalex115 celor ce
o pun in acfiune - la locul de munce, Tn magazine, in parcurl, etc. -\line \up0
\expndtw0\charscalex114 dar si Tn situafiile cand, fortuit, suntem obligafi sa-i
suporem efectele nedo\up0 \expndtw0\charscalex116
rite (de exemplu orchestrele de restaurant in staflunile de pe lieral, ori mu�
\up0 \expndtw0\charscalex119 zica figeneasce difuzate "cu forfe si perseverente" la
petrecerile de cartier \up0 \expndtw0\charscalex114 sau in unele localuri
periferice). \par\pard\qj \li787\ri935\sb20\sl-242\slmult0\fi287 \up0
\expndtw0\charscalex119 Contactul inevitabil, chiar cu o muzica bunS si agreate.
poate avea - in \up0 \expndtw0\charscalex117 plus fafa de emotia estetice
declansate - efecte noclve, generate de depe$i\up0 \expndtw0\charscalex117 rea unor
parametri sonori cum sunt: intensitatea (peste 65 dB), disonanfele \up0
\expndtw0\charscalex114 excesive (muzica moderne), rilmul obsedant de monoton,
frecventele modi� \up0 \expndtw0\charscalex115 ficeri de ritm (se citeaze "Ragtime"
de Strawinski, cu o structure ritmice va\up0 \expndtw0\charscalex115 riabie ce
induce o stare emofionala extrem de fluctuantS - intre solitudine si \up0
\expndtw0\charscalex114 angoasS S' senzafia de pace sau bucurie) si, nu Tn ultimul
rand, de preferin\up0 \expndtw0\charscalex114 fele muzicae $i starea de moment a
ascultstorului. \par\pard\qj \li791\ri932\sb0\sl-246\slmult0\fi283 \up0
\expndtw0\charscalex126 incercand o prezentare didactics a acestor modificSri, vom
analiza \up0 \expndtw0\charscalex118 succesiv reacfiile diferitelor organe si
aparate, evaluate pe baza datelor de \up0 \expndtw0\charscalex114 observafie
\up0 \expndtw0\charscalex124 (sau de introspecfie), continuand cu determinarea
pulsului, \up0 \expndtw0\charscalex116 tensiunii arteriale si a numSrului de
respirafii, \up0 \expndtw0\charscalex117 ?i terminand cu metode din \par\pard\qj
\li791\ri948\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex119 ce in ce mai
sotisticate: retlexul psiho-galvanic, ECG, EMG, termografie, \up0
\expndtw0\charscalex114 tomografia prin emisie de pozitroni. dozSri ale hormonilor
de stres. \par\pard\ql \li1128\sb103\sl-230\slmult0 \up0 \expndtw0\charscalex111 1
Tegumentele \par\pard\ql \li1089\sb110\sl-230\slmult0 \up0 \expndtw0\charscalex116
a) ModificSri vasomotorii \par\pard\qj \li801\ri941\sb22\sl-240\slmult0\fi278
\up0 \expndtw0\charscalex121 Au fost studiate pe baza modificarilor autoanalizate
de cStre subiectii \up0 \expndtw0\charscalex110 sSnStosi \up0
\expndtw0\charscalex118 (lamandescu si colab., \up0 \expndtw0\charscalex113 1994-
1997) sau de catre bolnavii psihoso� \par\pard\qj \li796\ri941\sb0\sl-
250\slmult0\fi4 \up0 \expndtw0\charscalex112 matici (lamandescu - 1996 si Antonescu
Doina -1997) Tn cursul audieril unor \up0 \expndtw0\charscalex115 fragmente muzicae
wagneriene contrastante (Muzicotest W, elaborat de la� \up0 \expndtw0\charscalex112
mandescu 1994) \par\pard\qj \li791\ri937\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex118 Corelate cu serile afective polare produse de audierea
celor douS frag� \up0 \expndtw0\charscalex113 mente mentionate in paragraful
anterior, au fost Tnregistrate senzatii de cSl� \up0 \expndtw0\charscalex118 durS
(vasodiiatafie) si respectiv, de frig, mergand pane la "piele de geine" \up0
\expndtw0\charscalex114 (vasoconstrictie \up0 \expndtw0\charscalex115 +
piloerectie). Experimental modificSrile vasomotorii mai \par\pard\ql \li801\sb1\sl-
204\slmult0 \up0 \expndtw0\charscalex115 sunt studiate si cu ajutorul metodei
pletismografice. \par\pard\ql \li1089\sb35\sl-230\slmult0 \up0
\expndtw0\charscalex120 b) ModificSrile secrefiei sudorale \par\pard\ql
\li1099\sb0\sl-180\slmult0 \up0 \expndtw0\charscalex117 In cursul audieni unor
piese muzicae "anxiolitice" (Spingte si Droh) are \par\pard\ql
\li796\ri913\sb19\sl-245\slmult0\fi4\tx1099\tx1089 \up0 \expndtw0\charscalex120 loc
o scedere a secrefiei sudoripare, traduse printr-o scedere a intensitafii \up0
\expndtw0\charscalex115 curentutui psihogalvanometrului (micsorarea secrefiei
catecolaminelor). \line\tab \up0 \expndtw0\charscalex119 Exista, insa. analog
modificarilor vasomotorii opuse descrise mai sus, \up0 \expndtw0\charscalex124
posibilitatea unei secrefii crescute de catecolamine, in cazul muzicii cu \up0
\expndtw0\charscalex116 efect excitant (ca de exemplu muzica Disco), sau cu
elemente avand valoa-\line \up0 \expndtw0\charscalex116 rea de semnal (ritm
accentuat, obsedant, ca Tn Bolero-ul lui Ravel sau tem-\line \up0
\expndtw0\charscalex119 pouri accelerate ori acordun cu caracter disonant sau in
tonalltate minore, \up0 \expndtw0\charscalex117 sugerand o atmosfere lugubre, asa
cum este cazul cu fragmentul wagnerian \up0 \expndtw0\charscalex111 "Hagen,
Schlafst du mein Sohn" din "Amurgul Zeilor", utilizat in Muzicotest). \line\tab
\up0 \expndtw0\charscalex115 in aceste situafii are loc o crestere a secretiei
sudoripare corelate cu sen� \up0 \expndtw0\charscalex114 zafia de trig, acuzate de
unii subiecfi in cursul audifiei fragmentului menfio-\line \up0
\expndtw0\charscalex108 nat.
generala �i aplicata\par\pard\ql \li1713\sb0\sl-230\slmult0
\up0 \expndtw0\charscalex117 2. Aparatul locomotor \par\pard\qj
\li1425\ri318\sb190\sl-230\slmult0\fi350 \up0 \expndtw0\charscalex119 Se stie ca o
muzicS antrenantS sau un mars ne incie adesea e dans on \up0
\expndtw0\charscalex114 la baterea mSsurii. O muzicS excitants, "in tempo" rapid
induce o cre$tere a \up0 \expndtw0\charscalex114 tonusului muscular, in timp ce o
muzicS ents, discree, il reduce. \par\pard\ql \li1718\sb190\sl-230\slmult0 \up0
\expndtw0\charscalex118 3. Aparatul respirator \par\pard\qj \li1420\ri313\sb161\sl-
242\slmult0\fi307 \up0 \expndtw0\charscalex115 Influenfa muzicii asupra frecvenfei
si profunzimii respiratiei este extrem \up0 \expndtw0\charscalex121 de variatS.
fiind de domeniul evidenfei atat accelerarea respirafiei la as\up0
\expndtw0\charscalex117 cultarea unui mar$ on a unei piese ritmice de muzicS
usoarS, ca si 'finerea \up0 \expndtw0\charscalex119 respirafiei" in anumite momente
ale desfSsurSrii discursului muzical. ur\up0 \expndtw0\charscalex122 matS de un
suspin profund (uneori si de un cSscat involuntar de diferite \up0
\expndtw0\charscalex118 cauze. inclusiv dupa o concentrare prelungite in urmSrirea
unei piese mu \up0 \expndtw0\charscalex116 zicale interesante). inregistrarea
numSrului de respirafii constituie un para\up0 \expndtw0\charscalex117 metru
obisnuit in obiectivarea modificSrllor fiziologice induse de audierea \up0
\expndtw0\charscalex114 muzicii. Exists un acord unanim, referitor la dependenta
modificarilor respi\up0 \expndtw0\charscalex114 ratorii de calitatea muzicii.
\par\pard\ql \li1728\sb168\sl-230\slmult0 \up0 \expndtw0\charscalex118 4. Aparatul
cardiovascular \par\pard\qj \li1420\ri308\sb181\sl-242\slmult0\fi302 \up0
\expndtw0\charscalex120 Frecventa cardiacs (pulsul) reprezintS poate, eel mai
utilizat mijloc de \up0 \expndtw0\charscalex115 apreciere a influenfei asupra
funcfiilor somatice. exercitae de cStre muzicS, \up0 \expndtw0\charscalex120
existand in acest sens o premisS indubitabie, aceea ca orice proces psihic \up0
\expndtw0\charscalex116 (inclusiv cele generate de muzicS) se oglindeste in
modificSrile de ritm ale \up0 \expndtw0\charscalex120 inimii, organ ce constituie
un adevSrat seismograf al stSrilor sufletesti in \up0 \expndtw0\charscalex118 limba
romanS exists o adevSratS recunoastere etlmologicS a aeestei reali\up0
\expndtw0\charscalex113 tafi. "cordul" anatomic fiind denumit in llmbajul comun
,inima", cuvant deri\up0 \expndtw0\charscalex112 vat din latinescul anima =
suflet). Si in cazul flziologiei aparatului cardiovas� \up0 \expndtw0\charscalex112
cular, distingem efecte opuse. exercitate de ascultarea muzicii. \par\pard\ql
\li1723\sb8\sl-230\slmult0 \up0 \expndtw0\charscalex120 a) Efectele unei muzici
relaxante \par\pard\qj \li1425\ri323\sb2\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex115 DupS datele centralizate de Spingte si Droh, sub efectul
muzicii anxioll\up0 \expndtw0\charscalex115 tice au loc urmstoarele modificSri:
\par\pard\ql \li2164\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex115 - scSderea
frecventei cardiace; \par\pard\ql \li2164\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex116 - scSderea tensiunn arteriale: \par\pard\ql
\li2164\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex112 - acfiune antiaritmicS.
\par\pard\ql \li1728\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex122 b) Efectele
unei muzici dinamice, "stralucitoare" \par\pard\qj \li1430\ri298\sb2\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex113 Sunt inverse celor de mai sus.
existand inregistrSri ale TA si pulsului (in� \up0 \expndtw0\charscalex113 clusiv
sfigmograma) in timpul audifiel unei muzici cu tempo rapid sau acom\up0
\expndtw0\charscalex114 paniatS de tobe, in care - pe langS cresterea frecventei
pulsului $i a tenslunli \up0 \expndtw0\charscalex113 arteriale - are loc o
diminuare a amplitudinii pulsului (autori citafi de Spingte \up0
\expndtw0\charscalex100 Si Droh) \par\pard\ql \li1751\sb169\sl-230\slmult0 \up0
\expndtw0\charscalex117 5. Aparatul digestlv \par\pard\qj \li1459\ri298\sb182\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex112 Spingte si Droh (1992), ca si
Sengewald - 1995 - nu menfioneazS aparatul \up0 \expndtw0\charscalex112 digestiv in
tabelele referitoare la influenfa muzicii asupra funcfiilor somatice. \up0
\expndtw0\charscalex112 Totu$i, exists date experimentale mai vechi care
evidenfiaza efectul benefic
207\slmult0\par\pard\li1003\sb23\sl-207\slmult0\fi0\tx7646
generala\tab \up0 \expndtw0\charscalex125 \u9830? 153\par\pard\qj \li1017\sb0\sl-
\ul0\nosupersub\cf9\f10\fs20 al muzicii lui Mozart asupra bolnavilor cu
hiperclorhidrie gastncS (in genere \up0 \expndtw0\charscalex121 ulcerosO. carora le
normahzeaza secrefia acida \up0 \expndtw0\charscalex118 (Demleng cit. de Luban
Plozza si colab. \tab \up0 \expndtw-2\charscalex100 -\tab \up0
\expndtw0\charscalex116 1988). Fiind vorba despre "Mica SerenadS", nu se poate
\par\pard\qj \li1017\ri725\sb0\sl-246\slmult0 \up0 \expndtw0\charscalex117 totusi
afirma cS alte compozifii mozartiene, emanand o atmosferS complet \up0
\expndtw0\charscalex112 diferite (de exemplu concertele pentru pian Tn do minor $i
re minor sau unele \up0 \expndtw0\charscalex117 pasaje din Requiem) ar putea avea
un efect opus, dupS cum nu este exclus \up0 \expndtw0\charscalex118 nici faptul cS.
si muzica altor compozitori \up0 \expndtw0\charscalex117 (Schubert, Bach sau
Mendels-\par\pard\qj \li1017\ri721\sb13\sl-220\slmult0\fi4 \up0
\expndtw0\charscalex113 sohn-Bartholdy. de exemplu) ar putea avea - prin
intermediul eustresului - un \up0 \expndtw0\charscalex113 efect asemanator.
\par\pard\ql \li1320\sb192\sl-230\slmult0 \up0 \expndtw0\charscalex115 6. Aparatul
excretor \par\pard\qj \li1022\ri721\sb182\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex124 Este de asemenea sSrac reprezentat in literature, in
lucrarea de fate \up0 \expndtw0\charscalex116 neputandu-se cita rezultate
interesante. \par\pard\ql \li1334\sb189\sl-230\slmult0 \up0 \expndtw0\charscalex118
7 Modlficarlle metabollce \par\pard\qj \li1017\ri711\sb179\sl-244\slmult0\fi287
\up0 \expndtw0\charscalex118 Au fost studiate mai putin. iar aparitia lor a fost
legate pe buna dreptate \up0 \expndtw0\charscalex119 de modificenle neuro-
vegetative produse de cStre muzice. Parametrul eel \up0 \expndtw0\charscalex122 mai
usor de studiat a fost glicemia, ale carei valorl, crescute la audierea \up0
\expndtw0\charscalex119 unei muzici rapide, de intensitate crescute, au fost
interpretate ca fiind un \up0 \expndtw0\charscalex118 marker al cresterii
catecolaminelor. in timp ce o muzice lentS $i "discree" \up0
\expndtw0\charscalex118 scade nivelul glicemiei (Sengwald) \par\pard\ql
\li1315\sb0\sl-320\slmult0 \par\pard\ql\li1315\ri1222\sb14\sl-
D. VARIANTS ALE IMPACTULUI PSIHOSOMATIC AL MUZICII IN \line\tab \up0 \expndtw-
7\charscalex100 FUNCTIE DE PERSONAUTATE SI STAREA DE SANATATE A \line\tab \up0
\expndtw-10\charscalex93 ASCULTATORULUI \par\pard\qj \li1022\ri706\sb167\sl-
Referitor e intensitatoa sj polimorfismul manifestSnlor somato-viscerale \up0
\expndtw0\charscalex115 induse de ascultarea muzicii pnn aplicarea "Musicotest-ului
W" (lamandes� \up0 \expndtw0\charscalex113 cu 1994) - la subiectii normali dar si e
bolnavii psihosomatici. unui dintre noi \up0 \expndtw0\charscalex109 a obfinut \up0
\expndtw0\charscalex120 - pe baza unor studii personae (lamandescu IB si colab.
\up0 \expndtw0\charscalex104 1996 si \par\pard\ql \li1051\sb9\sl-230\slmult0
\up0 \expndtw0\charscalex114 1997) o serie de rezultate ce pot fi sistematizate
astfel: \par\pard\qj \li1027\ri675\sb1\sl-242\slmult0\fi311\tx1593 \up0 \expndtw-
9\charscalex87 1. \tab \up0 \expndtw0\charscalex119 "Somatizarea" (acuze de tip,
rSceae-cSldurS. incordare muscularS, \up0 \expndtw0\charscalex117 palpitafii. etc.)
mentionae de catre subiecfi a fost net dependents de trSirile \up0
\expndtw0\charscalex118 ideafional afective ale acestora. Astfel, e ascultarea unui
pasaj din muzica \up0 \expndtw0\charscalex115 wagneriana (Gdtterdammerung), cu
caracter sumbru, majoritatea subiecfilor \up0 \expndtw0\charscalex119 au indicat
grade diverse de anxietate ce s-au corelat cu tulburari vasomo� \up0
\expndtw0\charscalex115 torii. de tipul senzafiei de frig (pena e fnson) si cu
incordarea muscularS in-\line \up0 \expndtw0\charscalex114 tensS. Dar la ascultarea
celuilalt pasaj wagnenan - liric, visStor - aceiasi su� \up0
\expndtw0\charscalex116 biecfi au indicat aparitia unor stari afective pozitive
(llniste, visare) ce s-au \up0 \expndtw0\charscalex113 corelat cu o senzafie de
cSldurS difuzS $i de relaxare muscularS (lamandes� \up0 \expndtw0\charscalex113 cu
- 1994). \par\pard\ql \li1329\sb8\sl-230\slmult0\tx6167 \up0
\expndtw0\charscalex128 2 Aprecierea indicilor de somatizare qlobala \tab \up0
\expndtw0\charscalex110 (totalul "simptomelor" \par\pard\qj \li1036\ri711\sb2\sl-
240\slmult0 \up0 \expndtw0\charscalex114 somatice "acuzate" de subiecfi la audierea
muzicii) a condus la concluzia cS \up0 \expndtw0\charscalex114 acestia au fost mai
mult crescufi dupS ascultarea fragmentului anxiogen
240\slmult0 \up0 \expndtw0\charscalex115 desi majoritatea subiecfilor cu astfel de
acuze au apreciat favorabil calitatea \up0 \expndtw0\charscalex115 muzicii
ascultate (ibidem). \par\pard\qj \li1123\ri654\sb0\sl-260\slmult0\fi268 \up0
\expndtw0\charscalex123 3. Referitor la tipul de personalitate al ascultetorului
s\\ gradul de so-\line \up0 \expndtw0\charscalex123 matizare la audierea acelorasi
fragmente muzicae \up0 \expndtw0\charscalex120 (in colaborare cu O. \par\pard\qj
\li1108\ri649\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex115 Popa-Velea s*
Daniela Popa -1996) s-a evidential nivelul maxim al somati-\line \up0
\expndtw0\charscalex120 zSrii e subiectii cu cote inalte la scala impulsivitate"
\up0 \expndtw0\charscalex114 (testul Vitrail. de E. \par\pard\ql \li1118\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex110 Morin, varianta Caille). \par\pard\qj
\li1108\ri629\sb0\sl-246\slmult0\fi292 \up0 \expndtw0\charscalex118 4. Bolnavii
psihosomatici (astmatici. ulcerosi. hipertensivi - studiafi de \up0
\expndtw0\charscalex115 lamandescu si Doina Antonescu -1997) reactioneazS mai
intens in raport cu \up0 \expndtw0\charscalex119 subiectii sSnStosi. atat in planul
trairii ideafional-afective. cat si Tn eel al \up0 \expndtw0\charscalex119
somatizerii. Am interpretat aceste rezultate ca fiind expresia unei posibile
\up0 \expndtw0\charscalex115 corelafii intre vulnerabilitatea la stres a bolnavilor
psihosomatici si o anume \up0 \expndtw0\charscalex115 acuitate senzoriale crescute
a acestora, ca $i un nivel mai inalt al proceselor \up0 \expndtw0\charscalex115 lor
intelectuale. \par\pard\qj \li1118\ri619\sb0\sl-253\slmult0\fi292 \up0
\expndtw0\charscalex117 Desigur cS sunt necesare multe studii cu privire la
Individualitatea rSs-\line \up0 \expndtw0\charscalex119 punsului asculetorului - in
plan psihic si somatic - la audierea muzicii. Ne \up0 \expndtw0\charscalex115
gandim. in primul rand, la variantele tipurilor de personalitate "altoite" de o
\up0 \expndtw0\charscalex122 posibilS educafie muzicae dar \up0
\expndtw0\charscalex121 $i la multitudinea bolilor, intre care cele \par\pard\qj
\li1118\ri625\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex137 psihice sau
psihosomatice dominate de durere, etc. pot induce o \up0 \expndtw0\charscalex115
receptivitate particulars fafa de acfiunea muzicii. \par\pard\qj \li1416\sb0\sl-
320\slmult0 \par\pard\qj\li1416\ri725\sb78\sl-320\slmult0\tx1684 \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf8\f9\fs22 E. MODIFICARILE PRODUSE DE MUZICA
ASUPRA INTERPRETER, \line\tab \up0 \expndtw-8\charscalex100 IN CURSUL EXECUTIEI
MUZICALE \par\pard\qj \li1123\ri605\sb162\sl-245\slmult0\fi292 \up0
\expndtw0\charscalex118 \ul0\nosupersub\cf9\f10\fs20 Este lipsitS de orice indoialS
supozitia cS efectele psiho-fiziologice ale \up0 \expndtw0\charscalex119 muzicii
sunt cu mult mai puternlce in cazul participSrii active la execufia \up0
\expndtw0\charscalex120 muzicae, in cazul interprefilor, mai ales al acelora dintr-
o orchestrS, care \up0 \expndtw0\charscalex122 suferS o influenfS a muzicii mult
amplificatS de mterpretarea celorlalfi \up0 \expndtw0\charscalex112
orchestranfi. \up0 \expndtw0\charscalex111 (Fuhrmeister si Wiesenhutter - 1973).
incercand sS analizeze variafia impactului psihosomatic asupra interpre\up0
\expndtw0\charscalex117 tilor dintr-o orchestrS, functie de stilul compozitorilor
muzicii interpretate, \up0 \expndtw0\charscalex120 autorii de mai sus au studiat
254 de muzicieni, aparflnand la 3 orchestre, \up0 \expndtw0\charscalex115 care au
interpretat: A = 74% din lucrSri cu muzicS simlonicS moderne, B = \up0
\expndtw0\charscalex126 37% acelasi tip de muzice s1 C = erS interpretarea muzicii
simfonice \up0 \expndtw0\charscalex113 contemporane. \par\pard\qj
\li1142\ri605\sb0\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex115 in raport cu
aceastS din urmS orchestrS (C). la muzicienii componenfi ai \up0
\expndtw0\charscalex117 orchestrei A (ce au interpretat muzica simfonicS
contemporanS) au apSrut \up0 \expndtw0\charscalex108 mult mai frecvent:
tulburSri de somn. cefalee si otalgii, nervozitate (irascibilitate, viru\up0
\expndtw0\charscalex113 lenfa) sau stari depresive; \par\pard\ql \li1886\sb1\sl-
215\slmult0
\up0 \expndtw0\charscalex113 - epigastralgii. grefuri. diaree; \par\pard\ql
\li1886\sb13\sl-230\slmult0 \up0 \expndtw0\charscalex113 - palpitafii si alte
tulburSri cardiace. \par\pard\qj \li1161\ri617\sb22\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex130 Compozitorii eel mai frecvent interpreed de orchestra A au
fost: \up0 \expndtw0\charscalex112 Stockhausen, Boulez, Penderecki, Nilson,
Strawinski. \par\pard\sect\sectd\fs24\paperw9120\paperh13220{\bkmkstart Pg159}
240\slmult0\fi297 \up0 \expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 In
perspectivs, exists deja in desfSsurare in Romania un studiu (inifiat de \up0
\expndtw0\charscalex117 lamandescu. Dima s! colab.) referitor la patologia acuzats
de membrii unei \up0 \expndtw0\charscalex127 formatii simfonice si 'a opimile
acestor muzicieni referitoare la unele \up0 \expndtw0\charscalex116 condifii
specilice'mductoare de stres psihic profesional. \par\pard\qj
\li1228\ri2009\sb151\sl-300\slmult0\tx1468 \up0 \expndtw-6\charscalex100
\ul0\nosupersub\cf8\f9\fs22 F. FACTORI DEPENDENT! DE STRUCTURA MUZICII CARE
\line\tab \up0 \expndtw-6\charscalex100 MODELEAZA IMPACTUL El PSIHOSOMATIC
\expndtw0\charscalex124 \ul0\nosupersub\cf9\f10\fs20 S-a stabilit in mod
experimental cS diferitele variabile ale structurii \up0 \expndtw0\charscalex115
muzicii ascultate exercits o inlluenfS directs, per se, asupra funcfiilor fizio�
\up0 \expndtw0\charscalex120 logice. independent de satisfacfiile sau
insatisfacfiile estetice ale ascule� \up0 \expndtw0\charscalex104 torului \up0
\expndtw0\charscalex108 (Burckhardt Schmidt -1985). \par\pard\ql \li1267\sb109\sl-
230\slmult0 \up0 \expndtw0\charscalex117 1. Caracteristicile melodiei
\expndtw0\charscalex117 Polaritatea rSsunetului melodiei\tab \up0
\expndtw0\charscalex115 \\r\\ plan afectiv\tab \up0 \expndtw0\charscalex119
(pozitive sau negative)\par\pard\li931\sb10\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex120 este legate de proprietefile melodiei care - dupe aceste
reactii emotionale\par\pard\li931\sb14\sl-230\slmult0\fi9\tx2663 \up0
\expndtw0\charscalex115 ale ascultetorului\tab \up0 \expndtw0\charscalex119 - este
definite ca: "vesee", "trista" dar si in alte ipostaze:\par\pard\li931\sb6\sl-
230\slmult0\fi9\tx6302\tx7387 \up0 \expndtw0\charscalex119 solemne (coralurile.
imnurile, missele), mobilizatoare\tab \up0 \expndtw0\charscalex113
(marsurile\tab \up0 \expndtw0\charscalex119 - dar in\par\pard\li931\sb5\sl-
230\slmult0\fi4 \up0 \expndtw0\charscalex119 acest caz ritmul este implicat eel mai
mult), etc.\par\pard\ql \li1228\sb104\sl-230\slmult0 \up0 \expndtw0\charscalex119 2
Ritmul muzicii \par\pard\qj \li935\ri797\sb128\sl-233\slmult0\fi288 \up0
\expndtw0\charscalex124 A lost eel mai indelung studiat, datorite accesibiliefii
observarii sale \up0 \expndtw0\charscalex115 inse si datorite legaturilor pe care
le are cu diferitele bioritmuri ale asculte� \up0 \expndtw0\charscalex114 torului,
in primul rand cu cele doue frecvenfe fundamentale - cardiace si res\up0
\expndtw0\charscalex110 piratorie. \par\pard\qj \li935\ri808\sb2\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex121 incercend o sistematizare a datelor
despre Influenfa ritmului muzical \up0 \expndtw0\charscalex122 asupra activiefii
somato-viscerale \up0 \expndtw0\charscalex120 (influenfa intermediate de
activitatea \par\pard\qj \li931\ri805\sb0\sl-240\slmult0\fi9 \up0
\expndtw0\charscalex116 sistemului neuro-vegetativ, modificate, si ea, prin celule
psiho-neuro-endo-\line \up0 \expndtw0\charscalex116 crine cu transmisia integrarii
"reacfiilor" senzorial-ideational-afective e ni� \up0 \expndtw0\charscalex112 velul
centriior vegetativi superiori) - vom distinge urmatoarele: \par\pard\qj
\li1675\ri802\sb0\sl-240\slmult0\tx1920 \up0 \expndtw0\charscalex125 a. Exista o
certa corelafie intre tempoul muzicii si bioritmurile \line\tab \up0
\expndtw0\charscalex123 ascultetorului. \par\pard\qj \li940\ri802\sb0\sl-
237\slmult0\fi739 \up0 \expndtw0\charscalex120 b. Cei mai bine tolerat ritm.
concomitent cu o bunS cenestezie si \up0 \expndtw0\charscalex127 avand un efect
sedativ, este eel corespunzator tempoului andante, cu \up0 \expndtw0\charscalex117
frecvenfa egala cu cea a pulsului normal (= 72 b/minut in medie). La acest \up0
\expndtw0\charscalex116 ritm. cSntecul de leagSn, cu o mSsurS binarS, produce
aparifia somnului la \up0 \expndtw0\charscalex117 sugar. Ritmul in jur de 80
mSsuri/minut a fost si el invocat ca generator de \up0 \expndtw0\charscalex110
sigurantS, incredere, el fiind "fixat" in execufia "Odei Bucuriei" din Simfonia
a \up0 \expndtw0\charscalex108 IX-a beethovenianS DupS acest ritm ("simfit" de noi
in mod favorabil) ne putem \up0 \expndtw0\charscalex108 orienta asupra ritmului
(mai rapid sau mai lent) al unei piese muzicale. \par\pard\qj \li940\ri798\sb0\sl-
236\slmult0\fi734 \up0 \expndtw0\charscalex133 c. Orice accelerare a ritmului
produce o crestere marcatS a \up0 \expndtw0\charscalex123 valorilor impresiei
muzicale dar si o activare a frecventei respiratoril si \up0
\expndtw0\charscalex128 cardiace, ca si o crestere a tenslunil arteriale si a
rezistentei electrice \up0 \expndtw0\charscalex115 cutanate (Burckhardt Schmidt
-1985), iar atingerea unor tempouri peste 140 \up0 \expndtw0\charscalex118 mSsuri
pe minut este nocive pentru organism, avand un efect independent \up0
\expndtw0\charscalex126 de trSirea psihice pozitive a muzicii respective si de
genul de muzice \up0 \expndtw0\charscalex111 utilizate.
\u9830?\tab \up0 \expndtw0\charscalex106 Elemente de psihosomatica generala si
d. Alternanfele de ritm \par\pard\qj \li1502\ri241\sb22\sl-240\slmult0\fi287
\up0 \expndtw0\charscalex129 ReprezintS si ele stimuli psihici cu caracter
excitant, reflectafl in \up0 \expndtw0\charscalex115 modificSrile frecventelor
cardio-respiratorii. prin cresteri ale acestora, ca de \up0 \expndtw0\charscalex124
altfel si in cazul tensiunii arteriale in plus, pot apare si aritmil cardiace
\up0 \expndtw0\charscalex105 (Mernt-Ullius). \par\pard\qj \li1492\ri246\sb0\sl-
260\slmult0\fi297 \up0 \expndtw0\charscalex127 Un experiment ce pune in evidenfs
astfel de modificSri este si eel \up0 \expndtw0\charscalex123 efectuat de Desturis
care a obtmut la 60 de subiecfi \up0 \expndtw0\charscalex117 - prin introducerea
Concertului pentru oboi de Bartok dupa audierea unui program cu muzicS de \up0
\expndtw0\charscalex117 Bach - o crestere a tensiunii arteriale (valori chiar pans
la 230 mmHg) \up0 \expndtw0\charscalex114 $i a \par\pard\ql \li1492\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex113 frecvenfei a pulsului. precum $i
modificSri de tip ischemic pe ECG. \par\pard\ql \li1790\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex108 Poate fi citat si exemplul, deja prezentat, al lucrarii
"Ragtime" de Strawinski. \par\pard\ql \li1795\sb130\sl-230\slmult0 \up0
\expndtw0\charscalex118 3. Intensitatea muzicii \par\pard\ql \li1790\sb130\sl-
230\slmult0 \up0 \expndtw0\charscalex123 a. Parametrii intensltafii sonore
Intensitatea muzicii este cert implicate in generarea unor modificeri \up0
\expndtw0\charscalex119 somato-viscerale, atat printr-un efect mediat de reacfia in
plan ideaflonal\up0 \expndtw0\charscalex119 afectiv a ascultetorului. cat si
printr-un efect direct, propagat de la nivelul \up0 \expndtw0\charscalex116
analizorulul acustic - prin numeroase conexiuni - la eel al diverselor organe
\up0 \expndtw0\charscalex116 Si aparate. \par\pard\qj \li1497\ri241\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex122 Aceasta depesire a intensiefii
sonore, in cadrul audifiei sau execufiei \up0 \expndtw0\charscalex114 unei lucrari
muzicale. este intalnita in discoteci (cele din Berlin avand valori \up0
\expndtw0\charscalex117 ale intensitafii intre \up0 \expndtw0\charscalex124 92 si m
dB - cf. Ising -\up0 \expndtw0\charscalex115 1988. posibil s* mai mari, in
\expndtw0\charscalex114 prezent) dar si in cazul audierii muzicii (in special rock,
pop, techno, etc.) la \up0 \expndtw0\charscalex113 radioreceptoare cu casca
(walkman). cu valori intre 95-100 dB. \line \tab \up0 \expndtw0\charscalex130 De
asemenea unele piese de muzice contemporane \up0 \expndtw0\charscalex116
(Stockhausen \par\pard\qj \li1497\ri236\sb0\sl-260\slmult0\fi9 \up0
\expndtw0\charscalex111 Penderecki, Boulez, etc.) ating valori de 100-130 dB
(Marion Schulzke - 1995 \up0 \expndtw0\charscalex111 cit. de Sengewald)
\par\pard\ql \li1795\sb1\sl-189\slmult0 \up0 \expndtw0\charscalex122 b. Efecte
asupra organismului \par\pard\qj \li1488\ri225\sb9\sl-240\slmult0\fi307 \up0
\expndtw0\charscalex116 Cercetan efectuate asupra zgomotului la locul de munce au
evidenfiat o \up0 \expndtw0\charscalex122 disjunctie a comportamentului in plan
psihic si 'n P'an somatic, in cazul \up0 \expndtw0\charscalex115 zgomotelor cu o
intensitate
de peste 65 dB. Astlel, in timp ce in plan psihic, \up0 \expndtw0\charscalex122
survine o acomodare late de zgomot \up0 \expndtw0\charscalex118 ("obisnuirea"
auzului cu atmosfera \par\pard\qj \li1492\ri237\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex116 sonorS respective), in planul reactivitafii neuro-
vegetative aceastS acomo� \up0 \expndtw0\charscalex121 dare nu se produce.
persistSnd o stare de excitare ce se rSsfrange asupra \up0 \expndtw0\charscalex112
funcfionSrii organelor interne (Harrer, \up0 \expndtw0\charscalex115 1973) Analog,
in cazul muzicii, desi \par\pard\qj \li1502\ri227\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex116 se poate ca ascultStorul sa fie loarte multumit cu
stimularea psihlcS pe care \up0 \expndtw-2\charscalex100 i \up0
\expndtw0\charscalex116 -o produce intensitatea sonora a unei piese muzicale (sS
zicem, de muzicS \up0 \expndtw0\charscalex124 rock sau electroacusticS) efectele
nocive ale aeestei muzici se propagS \up0 \expndtw0\charscalex109 (Babisch \up0
\expndtw0\charscalex115 1985, Marion Schulzke) asupra auzului. in Germania cea \up0
\expndtw0\charscalex101 15-20% \par\pard\qj \li1507\ri226\sb0\sl-240\slmult0
\up0 \expndtw0\charscalex118 dm tineri sunt hipoacuzici, datoritS asculerii
frecvente a muzicii "cu mulfi \up0 \expndtw0\charscalex118 decibeli". in afara
atectarii auzului. muzlca "bogae in decibeli" isi exercite \up0
\expndtw0\charscalex118 acfiunea ei nociva si asupra activitSfii organelor interne,
acestea din urma \up0 \expndtw0\charscalex113 rSspunzSnd prin urmatoarele tipuri de
reactii, evidenfiate de cStre Scheidt si \up0 \expndtw0\charscalex113 colab. (1986)
\par\pard\ql \li1809\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex115 - modificari
ale frecvenfei cardiace si tensiunii arteriale (cresc); \par\pard\ql
\li1814\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 - cresterea potenfialelor
musculare, implicit a tonusului muscular:
\par\pard\qj\li1339\ri696\sb119\sl-240\slmult0 \up0 \expndtw0\charscalex117 -
tulburarea secrefiei salivare si gastrice; tulburarea perlstalticii gastrice
\up0 \expndtw0\charscalex117 Si intestinale; \par\pard\ql \li1343\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex115 - cresteri ale glicemiei alternand cu
scurte faze hipoglicemice; \par\pard\ql \li1353\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex112 - diminuarea numSrului de eritrocite $i leucocite;
\par\pard\ql \li1339\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex116 - scSderea
capacitSfii de efort . \par\pard\ql \li1348\sb110\sl-230\slmult0 \up0
\expndtw0\charscalex114 4. Tlmbrul muzicii \par\pard\qj \li1051\ri696\sb122\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex114 Desigur cS, eel mai adesea, in cazul
muzicii interpretate de orchestrS - in \up0 \expndtw0\charscalex117 afara solo-
urilor instrumentale - este vorba de o asociere a timbrului diver\up0
\expndtw0\charscalex125 selor instrumente, conferind piesei ascultate un rafinament
armonico\up0 \expndtw0\charscalex113 timbral. apreciat de ascultStor.
Din acest motiv constatSrile ce urmeazS a fi infafisate prezinta valoare \up0
\expndtw0\charscalex115 onentative, in functie de ponderea elementului tlmbral-
cromatic in structura \up0 \expndtw0\charscalex115 muzicii ascultate.
Exemplele au totusi valoarea unor posibile selecfii a diverselor fragmente \up0
\expndtw0\charscalex114 muzicale pentru o muzicoterapie individualizae.
Asttel, instrumentele de coarde (mai ales in cazul muzicii preclasice si \up0
\expndtw0\charscalex119 clasice) posede un efect linistitor asupra psihicului si
corpului auditorului \up0 \expndtw0\charscalex110 dar \up0 \expndtw-2\charscalex100
-\up0 \expndtw0\charscalex124 nu rareori, de exemplu in introducerea evocend
furtuna si Pe tot \up0 \expndtw0\charscalex115 parcursul pnmului tablou din
Walkyrya am remarcat freametul generator de \up0 \expndtw0\charscalex117 anxietate
al coardelor \up0 \expndtw0\charscalex114 - in special violoncelele \up0
\expndtw0\charscalex117 - cu impactul psihosomatic \par\pard\ql \li1060\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex117 specific aeestei stari afective.
\par\pard\ql \li1358\sb130\sl-230\slmult0 \up0 \expndtw0\charscalex117 5. Tipul de
muzica si stilul compozitorului \par\pard\qj \li1055\ri678\sb102\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex116 intrucat aceastS problema va fi
analizae pe larg intr-un alt capitol, vor fi \up0 \expndtw0\charscalex115 doar
sistematlzate cateva linii directoare, cu referire la acest "parametru" de \up0
\expndtw0\charscalex118 bazS al structurii muzicii ascultate, de care depinde eel
mai mult impactul \up0 \expndtw0\charscalex118 psihosomatic. \par\pard\qj
\li1060\ri668\sb0\sl-245\slmult0\fi292 \up0 \expndtw0\charscalex116 5.1. Impactul
psihosomatic al muzicii va fi maxim sau minim in funcfie \up0
\expndtw0\charscalex136 de afinitatea subiectului fafa de muzica respectiva
RSspunsurile \up0 \expndtw0\charscalex115 organismului variazS intre douS extreme:
eustres (maxim-benefic) s' distres \up0 \expndtw0\charscalex116 (maxim-nociv). in
punctul O alendu-se neimplicarea asculetorului in audi� \up0
\expndtw0\charscalex116 tie prin mdiferentS. \par\pard\qj \li1070\ri674\sb0\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex117 5.2. Chiar dacS nu se implies in
auditie. dar suferS involuntar si inerent \up0 \expndtw0\charscalex128 (muzica
anumitor medil comerciale. restaurante in vecinState, etc.). \up0
\expndtw0\charscalex123 subiectul este supus \up0 \expndtw0\charscalex119 (la
intesitafi peste \up0 \expndtw0\charscalex117 65 dB) acflunil zgomotului si- in
\par\pard\qj \li1070\ri673\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex131 plus,
celorlalte efecte specifice ntmului, timbrului, etc. ale muzicii. \up0
\expndtw0\charscalex114 exercitate direct asupra funcfiilor organelor interne (cu o
minors irnplicare a \up0 \expndtw0\charscalex119 unei regeri psihosomatice prin
"perceperea" involuntarS si discontinue in \up0 \expndtw0\charscalex119 plan psihic
a muzicii respective). \par\pard\ql \li1372\sb225\sl-230\slmult0 \up0
\expndtw0\charscalex119 Bib/iografie \par\pard\li1406\sb215\sl-
230\slmult0\fi0\tx7320 \up0 \expndtw0\charscalex104 l. Bader J.M. Les stress met
less neurones a mort, Science et Vie,\tab \up0 \expndtw0\charscalex104 1994, S.
59.\par\pard\qj \li1363\ri673\sb0\sl-200\slmult0\tx1588 \up0
\expndtw0\charscalex104 2 Bell Verle L., in How to conquer the addiction ol rock
music, institute in basic \line\tab \up0 \expndtw0\charscalex104 life principles.
Illinois 1993. 81-85 \par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart
psihosomatica generae �i aplicata\par\pard\qj \li844\sb0\sl-200\slmult0
\par\pard\qj\li844\ri624\sb39\sl-200\slmult0\tx1060 \up0 \expndtw0\charscalex115 3.
Eberhard-Hetzger CI.. Das puzzlespiet der nevronen, in bild dor wissonschaft.
\line\tab \up0 \expndtw0\charscalex115 nov.94. S.65. \par\pard\qj
\li844\ri598\sb0\sl-200\slmult0\tx1060 \up0 \expndtw0\charscalex113 4. Eccles Y.,
Geleitwort pp.9-11 daus "Musik und psyche" - Luban-Plazza l., Delli \line\tab
\up0 \expndtw0\charscalex113 Ponti M . Dickhaut H., Bikkhauser Verlag, Basel
\expndtw0\charscalex120 5. Harrer G., Grunolagenoer musik therapte und musik
psychilogte. Stuttgart, \line\tab \up0 \expndtw-5\charscalex100 1982.
\par\pard\ql \li844\sb2\sl-198\slmult0 \up0 \expndtw0\charscalex113 6 Harrer G..
Musik und vegetativum, ciba geigy. nasel 1973. \par\pard\qj \li859\ri603\sb1\sl-
200\slmult0\tx1089 \up0 \expndtw0\charscalex116 7. Huber G.. Esthetique de la
musique. Ed.Gustav Fischer, Stuttgart/Now York, \line\tab \up0 \expndtw-
5\charscalex100 1964. \par\pard\ql \li844\sb2\sl-198\slmult0 \up0
\expndtw0\charscalex122 8. lamandescu I.N., Impactul psihosomatic al mesajului
muzical, Infomedica \par\pard\li844\sb10\sl-207\slmult0\fi244\tx1593\tx1910 \up0
\expndtw-7\charscalex100 1997,\tab \up0 \expndtw-8\charscalex94 12.\tab \up0
\expndtw0\charscalex116 18 23.\par\pard\li844\sb1\sl-
205\slmult0\fi0\tx3772\tx3964 \up0 \expndtw0\charscalex116 9. lamandescu I.B..
Musicotest\tab \up0 \expndtw0\charscalex116 \u9632?\tab \up0
\expndtw0\charscalex116 Tentative personal* de a evalua
impactul\par\pard\li844\sb1\sl-195\slmult0\fi206\tx6072\tx6537\tx6878\tx7075
\up0 \expndtw0\charscalex115 psihosomatic al mesajului muzical, Rev.Roum..
Psychol..\tab \up0 \expndtw-8\charscalex95 1997.\tab \up0 \expndtw-5\charscalex100
41.\tab \up0 \expndtw-2\charscalex100 1,\tab \up0 \expndtw0\charscalex116 75-
84.\par\pard\ql \li873\ri587\sb3\sl-200\slmult0\tx1132\tx1147 \up0
\expndtw0\charscalex138 10. lamandescu IB.. Musicotest-Tentativd de evaluare a
impactului \line\tab \up0 \expndtw0\charscalex120 psihofiziologic al mesa/ulut
muzical Conferinfa de Psihiatrie si Ecologie a \line\tab \up0
\expndtw0\charscalex110 relatiilor interumane. APCR. sept. 1994. Bucuresti.
\par\pard\ql \li878\ri583\sb0\sl-200\slmult0\tx1137\tx1137
\up0 \expndtw0\charscalex119 11. lamandescu /.i., Popa-Daniela. Popa-Velea O..
Studiu experimental asupra \line\tab \up0 \expndtw0\charscalex144 impactului
psihosomatic al mesajului muzical, Cong.Naf. I de \line\tab \up0
\expndtw0\charscalex110 neuroendocrinologie, Bucuresti 27-28 sept. 1996.
12. lamandescu IB., Muzica \u9632? Element terapeutic antistres Simpozion VII de
\line\tab \up0 \expndtw0\charscalex113 psihoneuroendocrinologie, Brasov, 20 21
lunie. \up0 \expndtw-3\charscalex100 1997 \par\pard\qj \li878\ri583\sb0\sl-
200\slmult0\tx1151 \up0 \expndtw0\charscalex113 13. lamandescu I.B., Popa Dantela,
Antonescu Doina. Studiu experimental asupra \line\tab \up0 \expndtw0\charscalex113
impactului psihosomatic al mesajului muzical Nota III. Aspectele somatizani
mesajului muzical la astmatici\tab \up0 \expndtw0\charscalex119 in afara crizelor.
Sinops VII.\par\pard\li878\sb1\sl-200\slmult0\fi273 \up0 \expndtw0\charscalex119
Psihoneuroendocrinologie. Brasov, 20 21 iunie 1997\par\pard\li878\sb1\sl-
195\slmult0\fi4 \up0 \expndtw0\charscalex120 14. Luban-Plazza B., Delli Ponti M.,
Dickhaut H.H.. Musik und Psyche. Horen mil\par\pard\li878\sb3\sl-
207\slmult0\fi273\tx4329 \up0 \expndtw0\charscalex117 der seele. Birkhausor verlag,
Basel,\tab \up0 \expndtw0\charscalex119 1988.\par\pard\li878\sb1\sl-
199\slmult0\fi0\tx6988\tx7516 \up0 \expndtw0\charscalex117 15. Luban-Plazza l.,
Musique Art. el therapte, Rev.Med Suisse Rom..\tab \up0 \expndtw-4\charscalex100
1994.\tab \up0 \expndtw0\charscalex119 114.\par\pard\li878\sb2\sl-207\slmult0\fi268
\up0 \expndtw0\charscalex119 373-375.\par\pard\li878\sb1\sl-199\slmult0\fi4 \up0
\expndtw0\charscalex120 16. Parhon C, Asian Ana, Vrdbioscu A.. Actiunea muzicii
asupra circulafiei si\par\pard\li878\sb1\sl-202\slmult0\fi273\tx4896\tx6000 \up0
\expndtw0\charscalex119 respiratiei la om Lucr.Ses.Gen.$tiinttf\tab \up0
\expndtw0\charscalex119 2-12 iunie\tab \up0 \expndtw0\charscalex119 1950. EdAcad
RPR.\par\pard\li878\sb5\sl-207\slmult0\fi273 \up0 \expndtw0\charscalex119
Bucuresti\par\pard\ql \li883\sb1\sl-177\slmult0\tx5337 \up0 \expndtw0\charscalex118
17 Popa- Velea O. Popa Daniela, lamandescu I l. \tab \up0 \expndtw0\charscalex117 -
Corelafii intre somatizarea \par\pard\qj \li1137\ri579\sb4\sl-200\slmult0\fi9
\up0 \expndtw0\charscalex122 mesa/ulut muzical si impulsivitatea ca trdsaturd de
personalitate (studiate \up0 \expndtw0\charscalex120 pnn testul vitraliului Mann)
Primul Congres Naf. de Neuroendocrinologie, \up0 \expndtw0\charscalex108 Bucuresti
27/28 sept. 1996. \par\pard\qj \li883\ri563\sb0\sl-200\slmult0\tx1166 \up0
\expndtw0\charscalex137 18 Rotter Gunter. Elektrishe Hautwiderstanosanderungen als
abbild \line\tab \up0 \expndtw0\charscalex110 musikalischer strukturen.
musikpsychologie 11/1985, \up0 \expndtw-1\charscalex100 139-148 \par\pard\ql
Saletu, Schultes. Grunberger, Einfluss der Discoszene auf psyche und soma \line\tab
\up0 \expndtw0\charscalex134 lugendlicher: psychometrische. computer-EEq und
physiologische \line\tab \up0 \expndtw0\charscalex114 untersuchungen. wiener
medizintsche wochen schtitt. \up0 \expndtw-2\charscalex100 1982, Nr.6, \up0
\expndtw-8\charscalex91 137. \par\pard\ql \li849\ri546\sb20\sl-
200\slmult0\tx1180\tx1175 \up0 \expndtw0\charscalex122 20 Schmidt Burkhardt M..
Empirische untersucgung emotionater wirkungen \line\tab \up0
\expndtw0\charscalex122 verschiedener tempi bei Rhythmisch betonter musik. Musik
psychologie \line\tab \up0 \expndtw-4\charscalex100 11/1985. S. 157.
Scheldt. Jena \u9632? Die extraaurale wirkung von larm - eine
Itteraturubeisicht. \line\tab \up0 \expndtw0\charscalex113 zeitschntt fur
larmbekampfung, springer verlag 1986. S. \up0 \expndtw-5\charscalex100 151-159.
22. Sengewald l.. Grunduberlegung zur wirkungweise von musik, Diplomarbeit.
\line\tab \up0 \expndtw0\charscalex116 Darmstadt 1995 \par\pard\ql \li864\sb2\sl-
198\slmult0 \up0 \expndtw0\charscalex113 23 Spintge R., Droh R . Musik-Medizm.
Fischer-Verlag, Stuttgart 1992. S.6 \par\pard\qj \li868\ri599\sb0\sl-
220\slmult0\tx1195 \up0 \expndtw0\charscalex120 24. Van Deest H.. Heilen mil musik.
Deutscher Taschenbuch Verlag-Thieme, \line\tab \up0 \expndtw0\charscalex109
Munchen, Stuttgart 1997. \par\pard\li878\sb1\sl-181\slmult0\fi0\tx6575 \up0
\expndtw0\charscalex116 25. Verdeau Failles Jacquezine. Luban-Plazza B.. Delli
Ponti M.\tab \up0 \expndtw0\charscalex116 - La troisieme\par\pard\li878\sb0\sl-
207\slmult0\fi321\tx5102 \up0 \expndtw0\charscalex116 oreille et la pensee
musicale. Fuzeau. Pans,\tab \up0 \expndtw0\charscalex116
253\slmult0 \up0 \expndtw0\charscalex119 \ul0\nosupersub\cf8\f9\fs22 Capitolul 9
\par\pard\ql \li1569\sb0\sl-360\slmult0 \par\pard\ql\li1569\ri129\sb119\sl-
360\slmult0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf14\f15\fs24 DE LA
GRUPURILE BALINT LA MODELUL MONTE VERITA \up0 \expndtw0\charscalex100 ELEMENTE
CONCRETE DE FORMARE PSIHOSOMATICA \up0 \expndtw0\charscalex100 A MEDICULUI
\up0 \expndtw0\charscalex135 \ul0\nosupersub\cf9\f10\fs20 Ina lonescu
\up0 \expndtw0\charscalex128 \ul0\nosupersub\cf14\f15\fs24 Grupuri Balint
\up0 \expndtw0\charscalex135 \ul0\nosupersub\cf9\f10\fs20 I. Concepte
fundamentale \par\pard\qj \li1281\ri0\sb190\sl-230\slmult0\fi297 \up0
\expndtw0\charscalex118 Dmtotdeauna prolesiunea medicae a presupus nu numai stunfa
si expe� \up0 \expndtw0\charscalex121 rienfa ci si o reala confruntare intre cele
douS personalitSfi complexe, ale \up0 \expndtw0\charscalex114 medicului practician
si pacientului sSu. Astfel. contactul medic-bolnav gene� \up0
\expndtw0\charscalex121 reaza reactii de transfer s' contratransfer ce confers
unicitate fiecSrei ase� \up0 \expndtw0\charscalex121 menea relafn \par\pard\qj
\li1281\ri0\sb8\sl-233\slmult0\fi297 \up0 \expndtw0\charscalex117 Desi dinamica
relafiei medic-pacient implica mecanisme de protectie s1 \up0
\expndtw0\charscalex121 identificare, ce tnmit de la trecutul pacientului e
trecutul medicului, mults \up0 \expndtw0\charscalex122 vreme ceea ce asezi nummn
Psihologie Medicae, nici nu s-a predat in fa\up0 \expndtw0\charscalex114 cuitafile
de Medicina. \par\pard\qj \li1286\ri0\sb8\sl-232\slmult0\fi288 \up0
\expndtw0\charscalex118 intelegand personalitatea in totalitatea laturilor sale.
Michael Balint. psi\up0 \expndtw0\charscalex118 hanalist bntanic de ongme maghiara.
reintroduce in atenfia studierii aeestei \up0 \expndtw0\charscalex117 dinamici.
suuiectivitatea, modul particular de interpretare al fiecSruia. rezo\up0
\expndtw0\charscalex121 nanta afectivS la propnile interpretSri, reumanizand actul
medical sj cres\up0 \expndtw0\charscalex117 candu-i ef icienfa despre care mult
timp s-a crezut ca este exclusiv legatS de \up0 \expndtw0\charscalex117 medicament.
\par\pard\qj \li1291\ri0\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex116 M
Balint apllcS pentru prima oarS tehnicile psihanalitice de grup cu me� \up0
\expndtw0\charscalex120 dici generalise S' mternisti (care au contact permanent cu
bolnavul) pentru \up0 \expndtw0\charscalex121 a-i ajuta sa-si expnme problemele de
ordin psihologie intalnite in practica \up0 \expndtw0\charscalex121 de zi cu zl.
Bolnavul nu mai este considerat un caz. Pacientul are emofii, amintiri. \up0
\expndtw0\charscalex125 stabileste analogii cu situafii trecute. are dorinfe
inconstiente ce aparfin \up0 \expndtw0\charscalex120 unor retueri trecute. La
randul sSu. medicul trebuie sS identifice $' sS fina \up0 \expndtw0\charscalex120
seama de dificuitSfile sale emofionale in infelegerea atitudinii bolnavului.
\up0 \expndtw0\charscalex120 emofu care se rSsfrang direct asupra acestuia.
Ailat intr-o permanents confruntare cu boala, durerea. moartea, depresia \up0
\expndtw0\charscalex118 bolnavului, medicul i$i dezvolta propriile mecanisme de
aperare cum ar fi: \up0 \expndtw0\charscalex118 izolarea, negarea. sentimentui de
culpa. cimsmui si receala alecfiva
generae si\ul0\nosupersub\cf9\f10\fs20 aplicata\par\pard\qj \li643\sb0\sl-
265\slmult0 \par\pard\qj\li643\sb0\sl-265\slmult0 \par\pard\qj\li643\ri470\sb61\sl-
265\slmult0\fi302 \up0 \expndtw0\charscalex116 Din aceastS cauza M.Balint propune
pe lange reumanizarea relafiei me\up0 \expndtw0\charscalex114 dic-bolnav, o
abordare holista a pacientului in cadrul
medicinii psihosomati� \up0 \expndtw0\charscalex119 ce El considere drept cheie a
activiefii medicale tocmai relafia medic-pa� \up0 \expndtw0\charscalex117 cient, o
relafie analitice ce Implice atat o comunicare alectivS aparentS cSt \up0
\expndtw0\charscalex110 S> o comunicare la nivelul inconstientului. \par\pard\qj
\li648\ri461\sb0\sl-265\slmult0\fi292 \up0 \expndtw0\charscalex118 Scopul celor mai
clasice grupun Balint. precizat de Ch.Bnsset este de a \up0 \expndtw0\charscalex117
realiza o "psihoterapie profesionale" a medicului care sS-i lase acestuia in\up0
\expndtw0\charscalex116 tacte vocafia specifics si achizifille tehnice dar in
acelasi timp sS-i dezvolte \up0 \expndtw0\charscalex116 capacitatea si investirea
emotionalS, ceea ce insusi Balint numea "o schim\up0 \expndtw0\charscalex116 bare
limitatS dar considerabie". \par\pard\ql \li657\ri461\sb0\sl-
273\slmult0\fi297\tx950 \up0 \expndtw0\charscalex117 Medicul trebuie sS stie cine
este si sa-$i cunoasca foarte bine limitele. \line\tab \up0 \expndtw0\charscalex120
Metoda Balint clasicS reprezintS o deschidere spre ceea ce se petrece \up0
\expndtw0\charscalex117 inconstient in relafia medic-bolnav Cei care expune un caz
i$i asums astfel \up0 \expndtw0\charscalex117 riscul de a se confrunta cu amintirea
refulae \par\pard\qj \li652\ri456\sb0\sl-264\slmult0\fi302 \up0
\expndtw0\charscalex123 Metoda Balint combina dec) reconsiderarea atitudinii
medicale cu o \up0 \expndtw0\charscalex126 incursiune psihanalitica asupra
inconstientului relafiei medic-pacient. \up0 \expndtw0\charscalex116 Ceea ce se
afla in centrul atenfiei este transferul si mai ales contratransferul \up0
\expndtw0\charscalex116 specific relafiei, definit de M Balint ca suma reacfiilor
inconstiente ale ana\up0 \expndtw0\charscalex119 listului fafS de eel analizat si
in special tafa de transferul acestuia, de fapt \up0 \expndtw0\charscalex119
"interpretarea expresiei inconstientului celui analizat". \par\pard\qj
\li648\ri461\sb0\sl-265\slmult0\fi307 \up0 \expndtw0\charscalex118 Succesul de care
se bucure metoda Balint a venit in primul rand din in\up0 \expndtw0\charscalex118
deplinirea nevoil si dorinfei unor medici generalise de a-si creste eficienfa
\up0 \expndtw0\charscalex117 terapeutice M.Balint introduce astfel, pentru prima
date, termenul de "me� \up0 \expndtw0\charscalex115 dicul ca medicament" referindu-
se la efectul terapeutic exercitat de persona\up0 \expndtw0\charscalex115 litatea
medicului. \par\pard\qj \li657\ri452\sb0\sl-266\slmult0\fi292 \up0
\expndtw0\charscalex117 intre medic si bolnav ar trebui se existe o atmoslere a
armoniei primare, \up0 \expndtw0\charscalex124 favorabie situatiei de a fi
acceptafi si iubifi asa cum suntem, ceea ce va \up0 \expndtw0\charscalex115 genera
securitate, va diminua refularea si va induce "regresia pozitiva". acel \up0
\expndtw0\charscalex115 punct al unor dezvolteri ulterioare, o 'regresie pentru
progresle". \par\pard\qj \li662\ri447\sb0\sl-268\slmult0\fi288 \up0
\expndtw0\charscalex116 O relafie ideae ar presupune simpatia s> empatia medic-
bolnav. mtuifia \up0 \expndtw0\charscalex118 medicului fafa de boae s' bolnav.
Schimbarea impusa de abordarea psiho� \up0 \expndtw0\charscalex117 somatica
presupune pentru medic invefarea unui nou mod de a trata (trece\up0
\expndtw0\charscalex124 rea de la medicina centrae pe boae la medicina centrate pe
bolnav) si o \up0 \expndtw0\charscalex122 maturizare traita in cadrul grupului
printr-o succesiune de constientizeri \up0 \expndtw0\charscalex112 colective
\par\pard\ql \li974\sb1\sl-189\slmult0 \up0 \expndtw0\charscalex116 M Balint
considere 3 categorii de schimben survenite e medici: \par\pard\qj
\li1411\ri437\sb33\sl-260\slmult0\tx1627 \up0 \expndtw0\charscalex118 \u8226?
schimbare minine: infelegerea mai bune a cazurilor si o toleranta \line\tab \up0
\expndtw0\charscalex119 crescute dar fere modificSri esenfiale ale atitudinii
\expndtw0\charscalex116 \u8226? schimbare definitive medicul invatS, devine mai
flexlbil, dezvolts \line\tab \up0 \expndtw0\charscalex117 noi aptitudim
\expndtw0\charscalex116 \u8226? schimbare definitiva ealitativS: isi dS seama de
greseli si le poate \line\tab \up0 \expndtw0\charscalex110 controla singur.
Psihosomatica generae\tab \up0 \expndtw0\charscalex112 \u9830? 161\par\pard\ql
\par\pard\ql\li1353\sb187\sl-230\slmult0 \up0 \expndtw0\charscalex131 II.
Descrierea metodei Balint clasice \par\pard\qj \li1060\ri115\sb182\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex115 Sub conducerea unui psihanalist sau
unui alt medic (psihoterapeut) ce va \up0 \expndtw0\charscalex113 coordona
activitatea, se formeazS un grup de 10-15 persoane format din me� \up0
\expndtw0\charscalex114 dici generali$ti evitSndu-se cuplurile sof-sofie pentru a
nu transforma sedin\up0 \expndtw0\charscalex114 tele intr-o terapie de cuplu.
Grupul se va intSIni de 2-3 ori pe lunS pentru a relae pe rand o problems \up0
\expndtw0\charscalex117 din cazuistica proprie fiecSruia. Identitatea persoanei al
cSrei caz este pre\up0 \expndtw0\charscalex118 zentat nu se desconspirS iar cea a
medicului care expune va rSmane necu\up0 \expndtw0\charscalex118 noscutS celor din
afara grupului Balint. \par\pard\ql \li1060\ri106\sb0\sl-
240\slmult0\fi297\tx1358\tx1363\tx1363 \up0 \expndtw0\charscalex122 Membrii
grupului se aseazS in cere, fara a esa locuri libere intre ei si \up0
\expndtw0\charscalex118 este preferabil ca la inceput se se poarte ecusoane cu
numele mic. \line \tab \up0 \expndtw0\charscalex117 Liderul grupului poate ramane
in cercul membrilor sau se poate piasa in \up0 \expndtw0\charscalex123 afara
acestuia avSnd rol de observator si de anallze critica, constructiv-\up0
\expndtw0\charscalex117 educativa a desfesurerii sedmfei (dinamice, calitate,
etc.). \line \tab \up0 \expndtw0\charscalex120 Liderul realizeaza sinteza sedinfei
fere insa a avea voie se intervine in \up0 \expndtw0\charscalex119 desfesurarea
discufiei. se dea sugestii sau sS pune intrebari. \line \tab \up0
\expndtw0\charscalex118 La prima sedinfe membrii se prezinta fiecare pe scurt
(nume, profesie. \up0 \expndtw0\charscalex118 loc de munce, eventual o scurte
caracterizare) fiind preferabil ca liJerul se \up0 \expndtw0\charscalex118 inceape
prezentarea. \par\pard\qj \li1065\ri103\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex113 Dupe prezentarea membrilor. compozifia grupului nu se va
mai schimba, \up0 \expndtw0\charscalex124 nu se mai permit noi intran in grup in
cazul in care mai mulfi membrii \up0 \expndtw0\charscalex115 doresc se prezinte un
caz intr-o sedinfe, se acorde unuia prioritate in funcfie \up0
\expndtw0\charscalex116 de timpul avut la dispozifie si gravitatea cazului. Dace nu
existe nici un caz \up0 \expndtw0\charscalex128 spre a fi prezentat, liderul va
solicita unuia dintre membrii se descrie \up0 \expndtw0\charscalex117 activitefile
sau internarile la care a asistat in ziua respective. \par\pard\ql \li1363\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex116 De regue. modalitatea relatam indlce
stilul de lucru al medicului. \par\pard\ql \li1065\ri106\sb2\sl-
240\slmult0\fi288\tx1358 \up0 \expndtw0\charscalex116 intrebariie puse de grup se
vor centra asupra relafiei medic-pacient si nu \up0 \expndtw0\charscalex117 asupra
diagnosticului sau tratamentului evitand eventuae controverse. \line \tab \up0
\expndtw0\charscalex115 Se pune accent pe personalitatea bolnavului. pe problema de
fond a celui \up0 \expndtw0\charscalex117 ce prezinta cazul incercSnd a se obfine
atat o imagine corecta a relafiei cSt \up0 \expndtw0\charscalex117 Si o imagine de
sine \par\pard\ql \li1358\sb9\sl-230\slmult0\tx5040 \up0 \expndtw0\charscalex122 O
sedinfS dureazS in mod obisnuit \tab \up0 \expndtw0\charscalex125 60-90 minute, in
prima parte se \par\pard\ql \li1075\sb10\sl-230\slmult0\tx4392 \up0
\expndtw0\charscalex115 prezintS cazul concret (ideal ar fi \tab \up0
\expndtw0\charscalex113 1/3 din sedintS), urmeazS intrebariie (1/3 \par\pard\qj
\li1070\ri103\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex119 din sedinfS).
dezbaterea (un fel de 'brain-storming") si evaluarea realizats \up0
\expndtw0\charscalex119 de conducstorul grupului \par\pard\qj \li1075\ri119\sb0\sl-
260\slmult0\fi292 \up0 \expndtw0\charscalex116 M Balint subllmazS nu in ultimul
rand, dinamica bolnavului, a simpto� \up0 \expndtw0\charscalex117 mului si a
ooin. \par\pard\qj \li1075\ri108\sb0\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex115 Cand medicul evoca o problems relafionala el regaseste
practic dinamica \up0 \expndtw0\charscalex115 acelei relafii. \par\pard\ql
\li1382\sb130\sl-230\slmult0 \up0 \expndtw0\charscalex118 //. / Disponibllltafi ale
medicului pentru psihoterapia suportiva \par\pard\qj \li1080\ri111\sb182\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex117 in cadrul unei astfel de
psihoterapii de sustinere, medicul devine pentru \up0 \expndtw0\charscalex124
pacient un adevSra: medicament uneori avand efecte similare acestuia \up0
\expndtw0\charscalex117 asupra simptomelor Acest efect se datoreazS in cea mai mare
masurS unei \up0 \expndtw0\charscalex117 bune reiationSri medic-pacient.
\expndtw0\charscalex106 \ul0\nosupersub\cf18\f19\fs20\ul
�\ul0\tab \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs20 Elemente de
247\slmult0\fi302 \up0 \expndtw0\charscalex120 Pe langa pregatirea si experienfa sa
profesionale (axata pe stradania lui \up0 \expndtw0\charscalex135 de a vedea
dincolo oe caz), un medic trebuie se posede abilitefi in \up0
\expndtw0\charscalex118 comunicare s< relatmnare, disponibilitafi naturale precum
empatia, ceidura \up0 \expndtw0\charscalex126 sufleteasca si "cea de-a treia
ureche"("urechea sufletului". termen ce ar \up0 \expndtw0\charscalex123 desemna
capacitatea de a descoperi semnificafn ascunse in verbalizarea \up0
\expndtw0\charscalex118 pacienfilor) si desigur timp pentru pacientul sSu
('investind minute, econo-\line \up0 \expndtw0\charscalex118 misesti ore"- B.Luban
Plozza) . El trebuie sa perrmta in cea mai mare parte \up0 \expndtw0\charscalex122
din cazuri descSrcarea emotionala diminuand astfel anxietatea, eliberand \up0
\expndtw0\charscalex122 bolnavul de tensiunea psihica creata de noua situafie in
care se afla. \par\pard\qj \li758\ri355\sb11\sl-250\slmult0\fi297 \up0
\expndtw0\charscalex121 De cele mai multe on bolnavul nu stie sau nu poate exprima
o serie de \up0 \expndtw0\charscalex116 probleme psihologice, (apt ce creaza o
stare de frustrare medicului care vrea \up0 \expndtw0\charscalex126 sa-l ajute \up0
\expndtw0\charscalex128 $i intuieste existenfa unor astfel de probleme. El trebuie
sa \up0 \expndtw0\charscalex132 identifice daca anxietatea si depresia sunt cauzate
de boae sau sunt \up0 \expndtw0\charscalex125 trasaturi ale porsonalitafii
pacientului seu, se combae anumite conduite \up0 \expndtw0\charscalex119
maladaptive, se sesizeze esenfialul unei probleme medicale si apanfia unei \up0
\expndtw0\charscalex119 probleme psihice (tehnica "Flash").
Printre greselile medicului in planul relafiei sale cu pacientul\tab \up0
\expndtw0\charscalex120 (dupe\par\pard\li768\sb10\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex120 Bmswanger si Luban-Plozza) amintim:\par\pard\qj
\li763\ri372\sb5\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex127 - timpul prea
scurt acordat pacientului se razbuna sub aparitia allei \up0
\expndtw0\charscalex123 tulburari sau boli psihosomatice, ce pot apare dupe
amendarea primelor \up0 \expndtw0\charscalex116 simptome \par\pard\qj
\li763\ri370\sb4\sl-260\slmult0\fi292 \up0 \expndtw0\charscalex122 - ignorarea unui
complex sau probleme psihice ce reclame un consult \up0 \expndtw0\charscalex123
psihologie. si care nesolufionate vor accentua acuzele somatice \par\pard\qj
\li768\ri356\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex124 - relafia
impersonate, bolnavul fie ii este indiferent medicului fie i se \up0
\expndtw0\charscalex117 spune ca nu are niciun motiv pentru un consult \par\pard\qj
\li763\ri356\sb17\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex119 -
neatenfionarea pacientului asupra unor efecte secundare moderate ale \up0
\expndtw0\charscalex120 rnedicaflei. acesta putand se le dramatizeze
\up0 \expndtw0\charscalex134 III. Psihodrama Balint \par\pard\qj
\li758\ri361\sb166\sl-260\slmult0\fi297 \up0 \expndtw0\charscalex125 O alternative
la grupunle Balint de tip clasic este psihodrama Balint \up0
\expndtw0\charscalex118 intemeiata de psihanahsta franceze Anne Cain, \up0
246\slmult0\fi283 \up0 \expndtw0\charscalex120 Ca $i metoda clasice. psihodrama cu
medici se limiteaza la problemele \up0 \expndtw0\charscalex122 ivite in practica
medicae dar spre deosebire de prima, presupune "rejuca\up0 \expndtw0\charscalex132
rea' scenelor din viafa profesionale. in esenta, inlocuirea relatarii cu \up0
\expndtw0\charscalex123 actiunea. \par\pard\qj \li772\ri346\sb5\sl-
248\slmult0\fi292 \up0 \expndtw0\charscalex123 Coridunetorul grupului nu so mat
numese lider ci animator, confrun-\line \up0 \expndtw0\charscalex126 tandu-se cu
grupul la un moment dat al actiunii El este eel care alege o \up0
\expndtw0\charscalex119 anumita situatie. un anumit punct care necesitS a fi mai
bine definit pentru \up0 \expndtw0\charscalex117 a Ii pus in scenS, urmand ca
medicul ce expune cazul sS aleaga "actorn" 51 \up0 \expndtw0\charscalex133 sS
distribute rolurile. sa realizeze discursurile si scenariul. Specific \up0
\expndtw0\charscalex119 psihodramei Balint este si acea "voce off", o replies pe
care 0 va da fiecare \up0 \expndtw0\charscalex126 participant la grup plasandu-se
in spatele protagonistului sau celorlaifi \up0 \expndtw0\charscalex118 "actori".
AceastS replies este o reflecfie proprie ce apare in mintea par1 \par\pard\ql
\li796\sb7\sl-230\slmult0 \up0 \expndtw0\charscalex115 pantilor in timpul jucSrn
unei scene. \par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart Pg167}
Psihosomatica generae\tab \up0 \expndtw0\charscalex105 \u9830? 163\par\pard\qj
Ideea de a "'introduce corpul in discursul terapeutic" inseamnS de fapt a \up0
\expndtw0\charscalex104 acorda importanta cuvenite comunicerii non-verbale. Prin
recrearea intregii \up0 \expndtw0\charscalex108 atmosfere se evidenfiaze cu usunnfa
atitudinea, diferitele semnificafii ale \up0 \expndtw0\charscalex113 gesturilor,
adeveratele intenfii, impactul pe care il are o reactie asupra \up0
\expndtw0\charscalex112 celullalt. indicafii sugerate comportamental, retrairea
unei situafii la un \up0 \expndtw0\charscalex103 nivel emofional initial trecut
neobservat, etc \par\pard\qj \li1075\ri108\sb19\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex108 Prin povestire $i apoi prin joe, ecoul unor astfel de
situafii stabileste o \up0 \expndtw0\charscalex118 multiple relafie transferenfiae
intre tofi participant determinSnd ca \up0 \expndtw0\charscalex114 Intensitatea
participarii emofionale, mai mare decSt in metoda Balint \up0
\expndtw0\charscalex104 clasice, sS producS o adevSrata revelatle. \par\pard\ql
\expndtw0\charscalex112 \ul0\nosupersub\cf20\f21\fs26 Modetele Monte Verita $1
Ascona \par\pard\qj \li1075\sb0\sl-246\slmult0 \par\pard\qj\li1075\ri105\sb219\sl-
246\slmult0\fi307 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf8\f9\fs22 DupS
exemplul modelului Balint claslc, B. Luban-Plozza a incercat sS lar\up0
\expndtw0\charscalex109 geascS sfera personalulul aflat in pozijia de ingrijire a
bolnavului, intro� \up0 \expndtw0\charscalex110 duced in grupele sale de lucru pe
langa medici si psihologi si studenfl la \up0 \expndtw0\charscalex110 medicina
precum si aslstente medicale. \par\pard\qj \li1080\ri103\sb19\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex115 Modelul Monte Verita se constituie
astfel intr-o nouS si complete \up0 \expndtw0\charscalex104 abordare a pacientului
permifSnd atat o analizS responsabllS a bolii cSt si o \up0 \expndtw0\charscalex104
securlzare emotionalS supllmentarS (suport social). \par\pard\qj
\li1075\ri101\sb0\sl-250\slmult0\fi302 \up0 \expndtw0\charscalex111 Echipa
terapeutica Include alSturl de cllnlcienl, aslstentele medicale \up0
\expndtw0\charscalex103 precum s' familia bolnavului care ajutS 1a o mai bund
Identiflcare a cauzelor \up0 \expndtw0\charscalex104 bolii si a condiflilor de
aparifie a crizelor. Discufia cu medicul este decisive \up0 \expndtw0\charscalex108
dar prezenfa unui alt membru al echipei poate fl de asemenea deoseblt de \up0
\expndtw0\charscalex105 importantS. Identificarea factorilor declansatori, uneori
mai usor de realizat \up0 \expndtw0\charscalex102 de cStre o persoanS din exterior,
va dlminua anxietatea bolnavului s1 va per� \up0 \expndtw0\charscalex102 mite
stabiiirea legaturli intre stresui psihic si o criza sau un atac de panics.
Astfel, prin cooperarea familiei cu medicul se poate prevent aparlfla unei \up0
\expndtw0\charscalex104 crize. \par\pard\qj \li1084\ri101\sb7\sl-
245\slmult0\fi292 \up0 \expndtw0\charscalex106 De asemenea, compllanfa terapeutice
va cre$te datoratS inerim Indlca\up0 \expndtw0\charscalex104 fiilor date de medic
de cStre aslstente s> famine. Pacientul va beneflcla de o \up0
\expndtw0\charscalex107 atmosferS caidS si optimists, de ajutorul intregii echlpe
terapeutice. Rolul \up0 \expndtw0\charscalex106 echipei de terapeufl se evidenflazS
s< in corectarea unor atitudlnl negative \up0 \expndtw0\charscalex100 cum ar fl:
hlpercompllanfa \par\pard\ql \li1828\sb1\sl-237\slmult0 \up0
\expndtw0\charscalex108 \u8226? abuzul de medicamente \par\pard\ql \li1823\sb10\sl-
253\slmult0 \up0 \expndtw0\charscalex108 \u8226? cortlcodependenfa \par\pard\ql
\li1833\sb7\sl-253\slmult0 \up0 \expndtw0\charscalex105 \u8226? hipocompllanfa
refuzul medicafiei (efecte secunda e, intoleranfa) \par\pard\qj
\li1084\ri108\sb1\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex104 Biografla
pacientului este completatS cu date furnizate de familie sau de \up0
\expndtw0\charscalex107 colegii de munca \up0 \expndtw0\charscalex106 (in cazul
unor conflicte profesionale), deseon furnizand \par\pard\qj \li1094\ri116\sb20\sl-
240\slmult0 \up0 \expndtw0\charscalex114 sursa stresului psihic si Informafil cu
prlvire e tipul de personalitae al \up0 \expndtw0\charscalex102 pacientului.
psihosomatica generala �i aplicata\par\pard\qj \li720\sb0\sl-240\slmult0
240\slmult0\fi288 \up0 \expndtw0\charscalex119 Pentru bolnavul cu tratament de
durae sau cu restricfii severe, modelul \up0 \expndtw0\charscalex119 Monte Verita
contribuie atat la vindecare cSt \up0 \expndtw0\charscalex119 $1 la constituirea
unui bun \par\pard\qj \li710\ri409\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex119
echilibru psihic. El se constituie astfel ca o strategie medicae moderne. cu
\up0 \expndtw0\charscalex119 scopul de reumanizare a actului medical, cu accent
deosebit pe psihoiogia \up0 \expndtw0\charscalex112 pacientului. \par\pard\qj
\li715\ri408\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex113 in ultimele trei
decenii, conceptele lui M.Balint au fost dezvoltate de cetre \up0
\expndtw0\charscalex118 B Luban-Plozza \\n cadrul activitafilor desesurate la
Centrul de Documen\up0 \expndtw0\charscalex115 tare Balint, cu sediul la Ascona
(Elvetia) care coordoneaza intalniri si seml\up0 \expndtw0\charscalex115 narli
dedicate prevenirii s' tratamentului stres-ului. \par\pard\qj \li715\ri418\sb0\sl-
244\slmult0\fi292 \up0 \expndtw0\charscalex120 incepand cu 1968. e Ascona se
reunesc sub egida Secretariatului Ge� \up0 \expndtw0\charscalex114 neral al
Consiliului Europei, medici clinicieni. psihologi, psihiatru, studenfi, \up0
\expndtw0\charscalex123 .isistenfi sociali, incercand sS defineascS o metodS de
abordare care sS \up0 \expndtw0\charscalex119 amelloreze relafia medic-pacient prin
cre$terea disponibilitSfii spre auto\up0 \expndtw0\charscalex108 reflecfie \up0
\expndtw0\charscalex121 (asumandu-fi propria realitate) atSt in cazul medicului cSt
si al \up0 \expndtw0\charscalex112 pacientului \par\pard\qj \li715\ri412\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex114 ConservSnd esen|a si finalitatea
grupurilor Balint clasice, Modelul Asco� \up0 \expndtw0\charscalex124 na, propune o
nouS forma de invafare. cea a artel comuncSrii, gSsirea \up0
\expndtw0\charscalex115 tonului adecvat fiecSrui pacient, precum si identificarea
mesajelor non-ver� \up0 \expndtw0\charscalex115 bale $l a celor somatice. Fiecare
bolnav devine in planul relafiei cu medicul \up0 \expndtw0\charscalex114 sSu o
experienfS in sine, unicS si complexS, participand impreune cu mem� \up0
\expndtw0\charscalex114 brii familiei sale la o terapie de grup. \par\pard\qj
\li710\ri408\sb0\sl-245\slmult0\fi297 \up0 \expndtw0\charscalex120 Printre
subiectele abordate in grup se regesesc depresia, angoasa, difi\up0
\expndtw0\charscalex115 cultSfi relafionale, alcoolismul. tabagismul.
corticodependenfa, drogul. can \up0 \expndtw0\charscalex117 cerul de san precum si
bolile psihosomatice. Se practice jocul de rol, astfel \up0 \expndtw0\charscalex121
incat pe parcursul sadlnfei, in funcfie de tema evocata, diferenfele dintre \up0
\expndtw0\charscalex121 specialist si eel analizat dispar. \par\pard\ql
\ul0\nosupersub\cf8\f9\fs22 Btbliografie \par\pard\ql \li1041\sb226\sl-
230\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf9\f10\fs20 1. Cain Anne
- Psihodrama Balint. Ed. Tret Bucuresti 1996 \par\pard\ql \li1003\sb1\sl-
217\slmult0 \up0 \expndtw0\charscalex104 2. lamanoescu I B Psihologie medicald. Ed.
Infomedica, Bucuresti, 1997 \par\pard\ql \li1008\sb3\sl-217\slmult0 \up0
\expndtw0\charscalex104 3. lamandescu I l. Psychoneuroallergology, Ed. Romcartezim,
Bucuresti. 1998. \par\pard\qj \li1012\ri372\sb1\sl-220\slmult0\tx1219 \up0
\expndtw0\charscalex105 4. Luban-Plozza Borris. Laererach-Hoffmann K., Knaak L..
Dickhaut H. H. Der \line\tab \up0 \expndtw-1\charscalex100 Arzt als Arznei,
Deutscher. Arzte-Verlag. \up0 \expndtw-9\charscalex92 1996. \par\pard\qj
\li1017\ri385\sb0\sl-220\slmult0\tx1228 \up0 \expndtw0\charscalex108 5 Moldovan
Csila, Beta Trif almos. Ziolmski Robert-lndrumdlor metodologic \line\tab \up0
\expndtw0\charscalex100 pentru grupul Balint. Botosam 1997. \par\pard\qj
\li1022\ri384\sb0\sl-220\slmult0\tx1228 \up0 \expndtw0\charscalex114 6 Schneider
Pierre-Beernard-A propos de la formation psychologique et \line\tab \up0
\expndtw0\charscalex100 psychodynamique des medecins. Rev.Med., 117. 721-725, 1997.
Pg169}\par\pard\qr \li3033\sb0\sl-900\slmult0 \par\pard\qr\li3033\sb0\sl-
900\slmult0 \par\pard\qr\li1753\ri24\sb416\sl-900\slmult0 \up0
\expndtw0\charscalex120 \ul0\nosupersub\cf4\f5\fs64 II. Psihosomatica \line \up0
\expndtw0\charscalex121 aplicata
Capitolul\tab \up0 \expndtw0\charscalex114 1\par\pard\ql \li1142\sb0\sl-276\slmult0
\ul0\nosupersub\cf14\f15\fs24 ELEMENTE DE PSIHOSOMATICA CARDIOVASCULAR!
\up0 \expndtw0\charscalex122 \ul0\nosupersub\cf8\f9\fs22 loan Bradu lamandescu
300\slmult0\tx1372 \up0 \expndtw0\charscalex126 I. Interrolafii bidirectional intre
factorii psihici si \line\tab \up0 \expndtw0\charscalex121 bolile
cardiovasculare \par\pard\qj \li844\ri263\sb190\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex106 Sfera actuate de preocupan a psihosomaticii include la loc
de frunte doue \up0 \expndtw0\charscalex106 categorii de probleme: \par\pard\qj
impactul factorilor psiho-sociali asupra sanatafli individului (in vir\up0
\expndtw0\charscalex110 tutea unor particulariefi psiho-fiziologice,
permeabilizante pentru stress, \up0 \expndtw0\charscalex107 ale acestuia) si
capacitatea lor de a genera lenomene patologice, ca si me� \up0
\expndtw0\charscalex107 canismele prin care ei actioneaze; \par\pard\qj
\li840\ri263\sb110\sl-250\slmult0\fi316 \up0 \expndtw0\charscalex106 J rezonanfa
organicS (neurologica) si psihologica fafa de tulburarile din \up0 \expndtw-
1\charscalex100 cadrul bolilor somatice, inclusiv fafS de situafia (statutul) de
bolnav, ambele ti� \up0 \expndtw-1\charscalex100 puri de rezonanfS constituind
reculul somato-psihic al patologiei de organ. \par\pard\qj \li840\ri267\sb10\sl-
250\slmult0\fi288 \up0 \expndtw0\charscalex105 in bolile cardiovasculare (BCV),
participarea factorului psihogen (repre-\line \up0 \expndtw0\charscalex107 zentat
cu precSdere de stress-ul psihic) la constituirea si modularea evoiu-\line \up0
\expndtw-1\charscalex100 fiei lor \up0 \expndtw0\charscalex104 - in raport cu
ceilalfi factori etiopatogenici \up0 \expndtw0\charscalex110 - este inegae, pe
primul \par\pard\ql \li844\sb8\sl-253\slmult0\tx6374 \up0 \expndtw0\charscalex104
plan situSndu-se HTA $1 cardiopatia ischemicS (v tabel \tab \up0
\expndtw0\charscalex101 1), ca boll emina� \par\pard\qj \li844\ri264\sb10\sl-
250\slmult0\fi4 \up0 \expndtw0\charscalex106 mente psihosomatice de largS
rSspandire, alSturi de tahicardia paroxisticS \up0 \expndtw0\charscalex108
supraventricularS, hipotensiunea arteriale, Boala Raynaud, astenia neuro\up0
\expndtw0\charscalex101 circulatorie \up0 \expndtw0\charscalex107 (..neuroza
cardiacs") si alte sindroame psihosomatice cardio� \up0 \expndtw0\charscalex102
vasculare mai rar intalnite (Sindromul X-Likoff, Sindromul hiperkinetic car�
\up0 \expndtw0\charscalex102 diac primitiv). \par\pard\qj \li840\ri258\sb106\sl-
256\slmult0\fi288 \up0 \expndtw0\charscalex106 Actualmente se poate afirma cS in
orice boae exists o components psi� \up0 \expndtw0\charscalex104 hosomatica (11.
16). eticheta de boae psihosomaticS continuand sS fie apli� \up0
\expndtw0\charscalex108 cata doar acelor boll sau sindroame (precum cele de mai
sus) in care pon\up0 \expndtw0\charscalex107 derea etiologies a factorului psihogen
este importantS si. uneori, decisivS, \up0 \expndtw0\charscalex106 ea fiind
apreciats si institufionalizatS ca factor de rise pentru boala respec\up0 \expndtw-
4\charscalex100 tivS (8).
psihosomatica generae si aplicatS\par\pard\qj \li1204\sb0\sl-280\slmult0
280\slmult0\tx1588 \up0 \expndtw0\charscalex133 A. Tulburarile psihosomatice
cardiovasculare induse de \line\tab \up0 \expndtw0\charscalex131 stress-ul
psihic \par\pard\ql \li1252\sb222\sl-230\slmult0 \up0 \expndtw0\charscalex112 /
Modal I tafI de In serfie a SP in patogeneza BCV \par\pard\qj
\li916\ri217\sb199\sl-220\slmult0\fi288 \up0 \expndtw0\charscalex112 Activitatea
psihicS - inclusiv desfSsurarea relativ \u8222?lini$titS" a unor proce� \up0
\expndtw0\charscalex116 se cognitive ca atenfia, operafiile gandirii etc. \up0
\expndtw0\charscalex115 - exercitS o influents asupra \par\pard\qj
\li911\ri212\sb7\sl-236\slmult0\fi4 \up0 \expndtw0\charscalex115 unor organe cu o
bogats Inervafie cum sunt si cele ale aparatului cardiovas� \up0
\expndtw0\charscalex111 cular \up0 \expndtw0\charscalex118 (ACV) (a se vedea. de
exemplu, modificanle ECG aperute in cursul \up0 \expndtw0\charscalex120 unor teste
de calcul mental). Se poate atinge un maxim de amplitudine si \up0
\expndtw0\charscalex114 persistenfe a modificerilor induse psihogen ale activitafit
ACV in cazul unor \up0 \expndtw0\charscalex116 emofii violente sau al unor stari de
tensiune emotionale prelungite, cupnnse \up0 \expndtw0\charscalex116 in mod curent
in sfera notiunii de stres psihic (SP). \par\pard\qj \li911\ri217\sb4\sl-
236\slmult0\fi292 \up0 \expndtw0\charscalex112 in conditiile unei functioned
normale a ACV, SP provoaca doar respunsuri \up0 \expndtw0\charscalex113 fiziologice
emofionale (de fapt, corelatele fiziologice, somato-viscerale, car� \up0
\expndtw0\charscalex115 diovasculare ale emotiilor) a ceror lixare in pattern-
uri ..psiho-cardio-vascu-\line \up0 \expndtw0\charscalex114 lare" poate antrena. in
decursul timpului si prin repetarea ori brutalitatea SP, \up0
\expndtw0\charscalex127 \u8222?asternerea patului" unor boll organice (marea lor
majoritate aperute \up0 \expndtw0\charscalex120 prin intermediul aterogenezei sau
al instalarii HTA). \par\pard\qj \li916\ri228\sb1\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex115 in aceaste privinfa, studierea efectelor pe termen lung ale
SP implica di� \up0 \expndtw0\charscalex117 ficultafi metodologice, ISsand loc
adesea unor estimSn axate, in principal, \up0 \expndtw0\charscalex117 pe
deducfie. \par\pard\qj \li911\ri213\sb0\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex116 Pe fondul aterosclerozei coronariene, cerebrae dar si in
alte teritorii vas-\line \up0 \expndtw0\charscalex117 culare, mai putin studiate -
si care, cu toate reprezine studii latente de boae \up0 \expndtw0\charscalex113
vascularS \up0 \expndtw0\charscalex133 - stresui psihic poate acflona ca trigger al
manlfestSrilor \up0 \expndtw0\charscalex117 clinice (crize de amor sau
hipertensive, infarct miocardic sau cerebral etc.) \par\pard\qj
\li907\ri187\sb0\sl-234\slmult0\fi297 \up0 \expndtw0\charscalex113 La indivizii cu
predispozifie genetics pentru BCV si in cazul preexistenfei \up0
\expndtw0\charscalex124 unor tulburSri cardiovasculare functionale sau organice,
interventia SP \up0 \expndtw0\charscalex117 poate genera modificSri importante,
prin supraadSugarea la tulburarile an\up0 \expndtw0\charscalex116 tenoare, a
efectelor descSrcSrii de catecolamine si a altor mediatori ai reac\up0
\expndtw0\charscalex55 f11 \up0 \expndtw0\charscalex119 lor de stress. Se poate
afirma cu certitudine cS SP grabeste (scade vars\up0 \expndtw0\charscalex116 ta
debutului) aparitia unor BCV ..programate" genetic pentru varsta maturi\up0
\expndtw0\charscalex100 tStii \up0 \expndtw0\charscalex111 (lamandescu, 1993)
(exemplul eel mai relevant fiind dat de HTA esentia� \up0 \expndtw0\charscalex111 e
si infarctul miocardic apSrute la tineri). \par\pard\qj \li907\ri212\sb0\sl-
233\slmult0\fi302 \up0 \expndtw0\charscalex122 Indiferent de actiunea, imediatS sau
in timp, exercitatS de SP asupra \up0 \expndtw0\charscalex125 ACV. ea se intrica
eel mai adesea cu cea a unui complex de factori de \up0 \expndtw0\charscalex116
rise cu components ..voluntarS". deci evitabil. cum sunt fumatul, consumul \up0
\expndtw0\charscalex117 de grSslmi si/sau supragreutatea, excesul de alcool,
sedentarismul, somnul \up0 \expndtw0\charscalex114 redus. Acesti factori de rise
(studiul Alameda cit. de Heim evidentiazS o du-\line \up0 \expndtw0\charscalex114
blare a mortalitSfii in cazul in care sunt cumulati 4 sau tofi cei 5 factori enu
\up0 \expndtw0\charscalex117 merati) sunt la randul lor. de asemenea, generafi de
factori psihosociali di-\line \up0 \expndtw0\charscalex118 versi. dar in special de
stresui psihic.Alteori, exists o disfuncfie la nivel de \up0
\expndtw0\charscalex113 inervafie a ACV (Malliani -12) sau de recepton, ca in
sindromul hiperkinetic \up0 \expndtw0\charscalex120 primitiv, creand premisele unei
actiunl \up0 \expndtw0\charscalex119 ..zgomotoase a SP asupra ACV, \par\pard\ql
\li931\sb2\sl-230\slmult0 \up0 \expndtw0\charscalex115 capabie sS realizeze
aparenfa unor veritabile BCV organice \par\pard\qj \li935\ri213\sb2\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex112 Interventia SP in patogeneza BCV
exercitatS intr-un context plurietiologic \up0 \expndtw0\charscalex114 Si adesea
pluripatogenic. are loc in urmStoarele modalitSfi (vezi tabelul \up0 \expndtw-
9\charscalex94 1): \par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart
\expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 Psihosomatica aplicata\tab
\dn2 \expndtw0\charscalex111 \u9830? 169\par\pard\li1612\sb0\sl-
253\slmult0\fi311 \up0 \expndtw0\charscalex108 \ul0\nosupersub\cf8\f9\fs22 Tabelul
1. Factori etlo-patologict impllcafl in evolufia bolilor
car-\par\pard\li1612\sb1\sl-243\slmult0\fi0 \up0 \expndtw0\charscalex108 dlo-
vascutare (sinteza dupi von Eiff 1980, lamandescu 1993,
McEven\par\pard\li1612\sb1\sl-239\slmult0\fi33 \up0 \expndtw0\charscalex108 1998.
Musefoiu
1998).\par\pard\sect\sectd\sbknone\cols2\colno1\colw7524\colsr40\colno2\colw936\col
sr40\ql \li2155\sb0\sl-230\slmult0 \par\pard\ql \li2155\sb28\sl-
230\slmult0\tx4665 \up0 \expndtw0\charscalex123 \ul0\nosupersub\cf9\f10\fs20 I.
Biologic!\tab \up0 \expndtw0\charscalex134 Psiho sociali\par\pard\ql
\expndtw0\charscalex140 \ul0\nosupersub\cf19\f20\fs12 traaaturi palhka\tab \up0
\expndtw0\charscalex131 lofloanta aoclala\par\pard\ql \li2016\sb0\sl-138\slmult0
138\slmult0\tx3758\tx5601 \up0 \expndtw0\charscalex128 > raactlvltata vascular*\tab
\up0 \expndtw0\charscalex133 \u8226? nival Intalactual madlu\tab \up0
\expndtw0\charscalex139 \u8226? alatut social\par\pard\ql \li2107\sb20\sl-
138\slmult0\tx3758\tx6009 \up0 \expndtw0\charscalex132 cataoolarnlnlca\tab \up0
\expndtw0\charscalex135 \u8226? agraalvltala natlva\tab \up0
\expndtw0\charscalex103 \ul0\nosupersub\cf23\f24\fs14 \u9632? acaurl\par\pard\ql
\ul0\nosupersub\cf19\f20\fs12 > cojiiioi T\tab \up0 \expndtw0\charscalex134
(\u9830? angarIn)\tab \up0 \expndtw0\charscalex134 - loan. Inalt
\u9830?\par\pard\ql \li2016\sb40\sl-138\slmult0\tx3758\tx5745 \up0
\expndtw0\charscalex138 > aatoganl I\tab \up0 \expndtw0\charscalex126 a
damorallzara lac I la\tab \up0 \expndtw0\charscalex132 raaponaabllltatl
majors,\par\pard\ql \li2020\sb34\sl-138\slmult0\tx5745 \up0 \expndtw0\charscalex124
> HDl colaat.rol *\tab \up0 \expndtw0\charscalex142 con.lrangalo.ni\par\pard\ql
\li2020\sb30\sl-138\slmult0\tx5601 \up0 \expndtw0\charscalex121 > ribrlnogan
*\tab \up0 \expndtw0\charscalex137 \u8226? protaala cu sducsfls
madia\par\pard\qj \li2020\ri354\sb13\sl-153\slmult0\tx5745 \up0
\expndtw0\charscalex118 > dlaoat\tab \up0 \expndtw0\charscalex131 (\u8226? carlnâ
craacula) \line \up0 \expndtw0\charscalex122 I ot>.7rt.tr.\par\pard\qj
\ul0\nosupersub\cf23\f24\fs14 Conxmclnf Itrvoriimntm \line\tab \up0
\expndtw0\charscalex115 (Imctorl if rite)\par\pard\ql \li1972\sb122\sl-
\u8226? craataraa praalunll\tab \up0 \expndtw0\charscalex132 \u8226? Ins-labllltata
social*\par\pard\qj \li1972\ri115\sb14\sl-158\slmult0\fi148\tx5606\tx6339 \up0
\expndtw0\charscalex133 aangulna\tab \up0 \expndtw0\charscalex134 \u8226? conrilcta
- profaalonala \line \up0 \expndtw0\charscalex138 \u8226? craataraa adailvttatii
\tab \up0 \expndtw0\charscalex135 -familiala\par\pard\column \ql \li7564\sb0\sl-
control\par\pard\qj \li35\ri39\sb8\sl-124\slmult0 \up0 \expndtw0\charscalex138
potaalonal \line \up0 \expndtw0\charscalex129 scazut\par\pard\ql \li111\ri1\sb7\sl-
134\slmult0\tx179 \up0 \expndtw0\charscalex123 \u8226? aarclnl \line \tab \up0
\expndtw0\charscalex146 apadllva\par\pard\ql \li102\sb0\sl-129\slmult0 \up0
\expndtw0\charscalex121 \u9632? praalunaa\par\pard\ql \li169\sb3\sl-138\slmult0
\up0 \expndtw0\charscalex127 tlmpulul\par\pard\qj \li107\ri0\sb0\sl-
133\slmult0\tx189\tx222 \up0 \expndtw0\charscalex128 - poslbllltiU \line \tab
\up0 \expndtw0\charscalex156 d.clnon.l. \line \tab \up0 \expndtw0\charscalex128
raduaa \par\pard\sect\sectd\sbknone \li2121\sb0\sl-108\slmult0\fi2251 \up0
\expndtw0\charscalex135 tpuusr.\par\pard\sect\sectd\sbknone \li2121\sb0\sl-
108\slmult0\fi0\tx4137\tx5611 \up0 \expndtw0\charscalex135 placrtatar.\tab \dn2
\expndtw0\charscalex135 vit.i sahaustlon\tab \up0 \expndtw0\charscalex135 a
aupraaollcltara protaslonal*\par\pard\sect\sectd\sbknone \li2121\sb1\sl-
117\slmult0\fi110\tx5611 \up0 \expndtw0\charscalex135 - dapunaraa llpWalof\tab \up0
\expndtw0\charscalex135 \u8226? aarclnl tamlllala \u9830?
profaalonala\par\pard\sect\sectd\sbknone \li2121\sb25\sl-
138\slmult0\fi115\tx5755 \up0 \expndtw0\charscalex135 - complicatii
trombollc.\tab \up0 \expndtw0\charscalex135 (la lamal 'munca dubli")\par\pard\ql
\li1972\sb11\sl-138\slmult0 \up0 \expndtw0\charscalex135 a railatanta la
Inaullna \par\pard\ql \li2635\sb0\sl-161\slmult0 \par\pard\ql\li2635\sb0\sl-
161\slmult0 \up0 \expndtw0\charscalex135 \ul0\nosupersub\cf23\f24\fs14 Comportament
fevorlzant pentru bolile cardto vaaculmre \par\pard\ql \li2630\sb18\sl-
138\slmult0 \up0 \expndtw0\charscalex143 \ul0\nosupersub\cf19\f20\fs12 �tipul A
\par\pard\ql \li2625\sb42\sl-138\slmult0 \up0 \expndtw0\charscalex123 >\u9632?
conaum craacut \par\pard\ql \li2803\sb22\sl-138\slmult0 \up0
\expndtw0\charscalex123 \u8226? fumat \par\pard\ql \li2807\sb22\sl-138\slmult0 \up0
\expndtw0\charscalex122 - alcool \par\pard\qj \li2625\ri4179\sb41\sl-
140\slmult0\fi182 \up0 \expndtw0\charscalex129 - alimantar (\u8226? graalml)
\up0 \expndtw0\charscalex130 J- saOantarl.m \par\pard\li2620\sb39\sl-
138\slmult0\fi4\tx5150 \up0 \expndtw0\charscalex131 >\u8226? aomn radua\tab \up0
\expndtw0\charscalex131 .cognltlv*\par\pard\li2620\sb35\sl-138\slmult0\fi0 \up0
\expndtw0\charscalex131 > agraalvltata sacundar* -
daacarcaia/\par\pard\li2620\sb1\sl-138\slmult0\fi2563 \up0 \expndtw0\charscalex131
comporlsmsnt.li (vlol.nl*)\par\pard\li2620\sb30\sl-138\slmult0\fi2928 \up0
\expndtw0\charscalex131 \u9632? varbalt\par\pard\li2620\sb20\sl-
138\slmult0\fi2923 \up0 \expndtw0\charscalex131 \u9632?
title*\par\pard\li1391\sb0\sl-230\slmult0\par\pard\li1391\sb229\sl-
230\slmult0\fi292 \up0 \expndtw0\charscalex124 \ul0\nosupersub\cf9\f10\fs20 a) In
planul declansant direct al tulburarilor
CV\par\pard\sect\sectd\sbknone\cols2\colno1\colw4197\colsr60\colno2\colw4263\colsr2
0\ql \li1694\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex120 - alternativ cu alfi
factori\par\pard\column \ql \li10\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex116
(de exemplu, un SP poate precipita un pusei \par\pard\sect\sectd\sbknone
\li1391\sb14\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex119 hipertensiv sau - in
caz extrem - constituie chiar o cauzS de deces);\par\pard\sect\sectd\sbknone
\li1391\sb10\sl-230\slmult0\fi302\tx2870\tx7582 \up0 \expndtw0\charscalex119 -
sumativs\tab \up0 \expndtw0\charscalex119 (in asociere) cu alfi factori, de
exemplu, un SP\tab \up0 \expndtw0\charscalex116 + un
efort\par\pard\sect\sectd\sbknone \li1391\sb15\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex119 declanseazS o crizS de angor sau chiar un infarct
miocardic;\par\pard\sect\sectd\sbknone \li1391\sb10\sl-230\slmult0\fi292 \up0
\expndtw0\charscalex119 b) in planul evolufiei bolll:\par\pard\qj
\li1387\ri0\sb0\sl-260\slmult0\fi297 \up0 \expndtw0\charscalex114 - participS la
edificarea bolilor psihosomatice CV, favorizand \u8222?scSdere� \up0
\expndtw0\charscalex114 varstei" debutului; \par\pard\ql \li1694\sb0\sl-180\slmult0
\up0 \expndtw0\charscalex118 - agraveazS evolufia acestor boli, favorizand aparitia
complicafiilor si \par\pard\ql \li1396\sb15\sl-230\slmult0 \up0
\expndtw0\charscalex116 uneori, a decesului.
240\slmult0\tx955 \up0 \expndtw0\charscalex118 2. Mecanisme generale demonstrate
sau posibile privind relafia dintre \line\tab \up0 \expndtw0\charscalex119 SP si
bolile cardiovasculare \par\pard\qj \li417\ri720\sb80\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex117 in cursul stresului psihic SP se produc constant modificSri
de tipul unei \up0 \expndtw0\charscalex114 hiperactivitsti simpato-adrenergice cu
implicafii hemodinamice si metaboll-\line \up0 \expndtw0\charscalex113 ce avand
influenfe asupra activitatii inimii (debit bataie si frecvenfa). a circu-\line \up0
\expndtw0\charscalex116 lafiei sistemice \up0 \expndtw0\charscalex116 (cresterea
rezistenfei vasculare periferice, cu HTA conse� \par\pard\qj \li417\ri716\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex114 cutive), generand modificeri potential
patologice, de regue, direct proporfio \up0 \expndtw0\charscalex113 nale cu
gravitatea leziunilor deja instalate 1a nivelul ACV. Astfel, din studiul \up0
\expndtw0\charscalex113 argumentelor \up0 \expndtw0\charscalex118 (epidemiologice
si de laborator) in favoarea existenfei unei \up0 \expndtw0\charscalex115 relafii
de cauzalitate intre SP si cardiopatia ischemice cronice (CIC). rezulte \up0
\expndtw0\charscalex121 ce ar putea fi invocae posibilitatea ca SP, majore sau
preungite pe durate \up0 \expndtw0\charscalex119 de ordinul a catorva decenn, se
poate contribui \up0 \expndtw0\charscalex115 1a aparitia precoce a bolii
coronanene. Taylor considere ce, - daca SP este un factor de rise minor \up0
\expndtw0\charscalex123 pentru CIC la subiectul sSnatos - el capata un caracter din
ce in ce mai \up0 \expndtw0\charscalex123 serios. odata ce boala este constituitS
(12) \par\pard\qj \li412\ri716\sb20\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex115 Desi mecanismele psiho-fiziologice prin care SP se inserS
la nivelul fie� \up0 \expndtw0\charscalex115 care! verigi a ACV diferS. ele apar pe
fondul unei reacfii totusi generale, de \up0 \expndtw0\charscalex115 antrenare a
cordului si vaselor. ca un tot organo-funcfional. \par\pard\qj
\li628\ri842\sb200\sl-240\slmult0\fi307 \up0 \expndtw0\charscalex125 Tabelul 2.
Inserfia factorilor psihosociall in contextul factorilor \up0
\expndtw0\charscalex130 biologici implicafi in etiopatogeneza fnfarctului \up0
\expndtw0\charscalex124 (sfstematlzarea \par\pard\ql \li619\sb1\sl-215\slmult0 \up0
\expndtw0\charscalex120 personate dupe autorii X (n). \par\pard\ql \li926\sb213\sl-
230\slmult0 \up0 \expndtw0\charscalex101 FACTORI GENETICI \par\pard\ql
\li931\sb1\sl-217\slmult0 \up0 \expndtw0\charscalex113 - hiperreclivitate vasculare
(Moga) \par\pard\ql \li931\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex114 -
persisten(a TA crescute dupe un test aritmic (1) \par\pard\ql \li926\sb3\sl-
217\slmult0 \up0 \expndtw0\charscalex111 - hiperreactivitate vasculare la
catecolamine (TAB) (19) \par\pard\qj \li931\ri879\sb1\sl-220\slmult0 \up0
\expndtw0\charscalex116 - modificeri structurale in hipotalamus poster favorizand
amploarea \up0 \expndtw0\charscalex106 SP (von Eiff) \par\pard\ql \li926\sb0\sl-
230\slmult0 \par\pard\ql\li926\sb2\sl-230\slmult0 \up0 \expndtw-1\charscalex100
FACTORI HORMONALI \par\pard\ql \li916\sb1\sl-217\slmult0 \up0
\expndtw0\charscalex113 - testosteron T \par\pard\ql \li921\sb3\sl-217\slmult0 \up0
\expndtw0\charscalex117 - estrogen i - menopauzS precoce \u8222?de stres"
\par\pard\ql \li916\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex117 - catecolamine
1 *- stresui psihic acut de orice fel \par\pard\qj \li916\ri880\sb29\sl-
210\slmult0\tx2289 \up0 \expndtw0\charscalex112 - cortizoiul T \tab \up0
\expndtw0\charscalex122 �-? stresui psihic cronic cu reacfii c!e abandon, sau
\up0 \expndtw0\charscalex112 situafii de ..plerdere"; e feme! cu ..incSrcare
alostatlca1' excesivS (2) \up0 \expndtw0\charscalex112 stSrlie depresive
\up0 \expndtw-1\charscalex100 FACTORI METABOLICI \par\pard\ql \li926\sb1\sl-
217\slmult0 \up0 \expndtw0\charscalex112 - colesterolul <- stresui psihic acul
(catecolamine) \par\pard\qj \li2212\ri884\sb1\sl-220\slmult0\tx2467 \up0
\expndtw0\charscalex113 4- stresui psihic profesional cu recompense mici asociat
\line\tab \up0 \expndtw0\charscalex111 cu fumatul, exces ponderal si de exces de
alcool (3, 4) \par\pard\ql \li931\sb2\sl-218\slmult0\tx1694 \up0
\expndtw0\charscalex100 - LDL i \tab \up0 \expndtw0\charscalex112 �- SP la femei
\par\pard\ql \li940\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex111 - HDL T <-
incercare alostatice la femei (2) \par\pard\ql \li955\sb3\sl-217\slmult0\tx2155
\up0 \expndtw0\charscalex107 - Acizi grasi \tab \up0 \expndtw0\charscalex116 �-
stresui psihic acut de orice fel \par\pard\li950\sb1\sl-
224\slmult0\fi0\tx2236\tx4598 \up0 \expndtw0\charscalex108 \u8226? Trigliceride\tab
\up0 \expndtw0\charscalex117 �- stresui psihic cronic\tab \up0
\expndtw0\charscalex117 \u9830? lumat \u9830? contraceptive
orale\par\pard\li950\sb1\sl-220\slmult0\fi129 \up0 \expndtw0\charscalex117 (femei)
(5)\par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart Pg174}{\bkmkend
\up0 \expndtw0\charscalex100 FACTORII COAGULARII \par\pard\ql \li1531\sb1\sl-
217\slmult0 \up0 \expndtw0\charscalex109 - Flbrinogenul T - fumStori (*- creste Tn
SP) \par\pard\ql \li3134\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex112
- nefumStori - calilicare redusS \par\pard\ql \li3153\sb13\sl-230\slmult0 \up0
\expndtw0\charscalex114 \u8226? aglomerare familiala si izotare sociae (6)
intabilitate, epuizare, demorallzare (3, 4) \par\pard\ql \li1526\sb3\sl-217\slmult0
\up0 \expndtw0\charscalex114 - adezivitatea plachetarS (betatromboaglutinina
plasmatica) \par\pard\ql \li3129\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex112 -
stresuri acute; ostUitateaexprimata (agresiviate) (8) \par\pard\ql \li1536\sb3\sl-
217\slmult0 \up0 \expndtw0\charscalex113 - inactivare plasminogen tisular
<- SP profesionale cronice si oboseae exeeslvS \line\tab \up0
\expndtw0\charscalex106 (vital exhaution) (9,10) \par\pard\ql \li1545\sb212\sl-
230\slmult0 \up0 \expndtw-1\charscalex100 FACTORI VASCULARI \par\pard\qj
\li1545\ri261\sb0\sl-220\slmult0\tx2395 \up0 \expndtw0\charscalex118 - HTA <- SP
profesionale cu sarcini crescute s* control redus \line\tab \up0
\expndtw0\charscalex119 decizional (1) in condifii de suport social redus
microcirculafie\par\pard\sect\sectd\sbknone\cols2\colno1\colw3617\colsr160\colno2\c
olw4603\colsr160\ql \li1814\sb5\sl-220\slmult0 \up0 \expndtw0\charscalex113 e
tromboze\par\pard\ql \li1814\ri75\sb0\sl-220\slmult0\tx2006 \up0
\expndtw0\charscalex119 \u8226? rupturS placS \line\tab \up0
\expndtw0\charscalex116 ateromatoasS \line \up0 \expndtw0\charscalex118 e i NO
(vasodila-\par\pard\qj \li2068\ri23\sb0\sl-221\slmult0\fi9 \up0
\expndtw0\charscalex115 tafie sintetizatS \up0 \expndtw0\charscalex114 de
endoteliu)\par\pard\qj \li1550\ri882\sb0\sl-214\slmult0\fi4 \up0
\expndtw0\charscalex113 - modificarl \line \up0 \expndtw0\charscalex119
bioelectrice\par\pard\column \qj \li20\ri241\sb5\sl-220\slmult0 \up0
\expndtw0\charscalex108 <- Indirect prin cresterea adezivitSfii plachetare, \up0
\expndtw0\charscalex117 ischemia relative (ambele prin catecolamine \up0
\expndtw0\charscalex110 Si ceilalfi factori)\par\pard\qj \li20\ri215\sb0\sl-
218\slmult0\fi4 \up0 \expndtw0\charscalex109 <- este scSzut indirect in cursul
cresterii TA $l a \up0 \expndtw0\charscalex115 colesterolului plasmatic\par\pard\ql
\li30\sb2\sl-220\slmult0 \up0 \expndtw0\charscalex109 <- scade in stresui mental
(11)\par\pard\qj \li1262\sb0\sl-213\slmult0 \par\pard\qj \li265\ri215\sb10\sl-
213\slmult0\fi9 \up0 \expndtw0\charscalex112 prolilul lipidic generat de
combinafia: exces \up0 \expndtw0\charscalex127 de catecolamine pe fondul excesului
de \line \up0 \expndtw0\charscalex108 cortizoi din depresive (35)
\par\pard\sect\sectd\sbknone \li1262\sb0\sl-230\slmult0\par\pard\li1262\sb13\sl-
230\slmult0\fi0\tx2577 \up0 \expndtw0\charscalex101 Autori! citati.\tab \up0
\expndtw0\charscalex101 1. McEven; 2. Gold: 3. Stegnst: 4.Cleophos; 5.
Smaek;\par\pard\sect\sectd\sbknone \li1262\sb1\sl-213\slmult0\fi9\tx5812\tx6552
\up0 \expndtw0\charscalex101 6. Roshegren: 7 Fukunishi; 8. Markovitz; 9.
Appets,\tab \up0 \expndtw-9\charscalex95 10. Kov;\tab \up0 \expndtw0\charscalex101
11. Cannon,\par\pard\sect\sectd\sbknone \li1262\sb1\sl-222\slmult0\fi47 \up0
\expndtw0\charscalex101 12. Pringlo\par\pard\qj \li1113\sb0\sl-249\slmult0
\par\pard\qj\li1113\ri84\sb93\sl-249\slmult0\fi292 \up0 \expndtw0\charscalex116 in
reacfia de stress, eel pufin pe durata SP, exists e nivelul ACV efectele \up0
\expndtw0\charscalex122 unei hiperactivitSfi neuro-vegetative simpatice si ale
eliberSrii de cate� \up0 \expndtw0\charscalex118 colamine s! a celorlalfl hormoni
de stres (ACTH, cortizolul. hormonul so \up0 \expndtw0\charscalex117 matotrop,
prolactina, vasopresina, substanfe opioide etc.). in plus, modifi� \up0
\expndtw0\charscalex121 cSrile metabolice induse in primul rand de modificenle
dlslipidemice de \up0 \expndtw0\charscalex120 stres creeazS premisele unei stSri de
hipercoagulabilitate (cresterea ade� \up0 \expndtw0\charscalex114 zivitSfii
plachetare, conjugatS cu scSderea activitSfii fibrinolitice) cu rise de \up0
\expndtw0\charscalex116 trombozS $\u8226? embolizSrl secundare ale refelel
areriolare coronariene. loziu\up0 \expndtw0\charscalex117 nile putand genera
aritmii grave, inclusiv fibrilafia ventricularS si moartea \up0
\expndtw0\charscalex118 subitS (ABE). De asemenea. actiunea aritmogena a aclzilor
gras� liberi se \up0 \expndtw0\charscalex127 conjuga cu cea a catecolaminelor si
hipoxiei, fiind agravatS de cStre \up0 \expndtw0\charscalex118 acestea din urma
Hiperfuncfla simpaticS, prezents in cele mai multe cazuri de SP. mascheazS \up0
\expndtw0\charscalex113 efectele acestuia mediate vagal. Ele pol fi evidenfiate
(\u8222?demascate") in unele \up0 \expndtw0\charscalex115 situafii, de exemplu
rSrlrea bStSilor mimii in cazul vizionSrii unor scene de \up0
\expndtw0\charscalex114 violenfS filmate. cand nivelul catecolaminelor subiectului
este, totusi. foarte \up0 \expndtw0\charscalex114 crescut (Carruthers) (4).
generala $i aplicata\par\pard\qj \li552\sb0\sl-240\slmult0
240\slmult0\fi292 \up0 \expndtw0\charscalex116 Este posibil ca exprimarea cu
precSdere la nivelul aparatului cardiovas� \up0 \expndtw0\charscalex119 cular a
reacfiilor generate de SP sS aibS o baza genetics modelatS de ex� \up0
\expndtw0\charscalex119 perienfa individului. \par\pard\ql \li835\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex110 Aceste pattern un psiho-fIziologlce,
declansatoare de reacfii cardiovasculare \par\pard\ql \li552\sb30\sl-230\slmult0
\up0 \expndtw0\charscalex109 - prezente la majoritatea indivizilor, dar cu nuanfe
adesea subtile diferentiatoare \par\pard\qj \li552\ri591\sb0\sl-243\slmult0 \up0
\expndtw0\charscalex125 - se pot constitui, de-a lungul unei existente presSrate cu
numeroase s' \up0 \expndtw0\charscalex114 importante SP, in posibill agenfi
etiologici ai unor afectiuni cardiovasculare. \up0 \expndtw0\charscalex119 Astfel.
analiza unor expresii emofionale negative ca: anxietatea. mania si \up0
\expndtw0\charscalex106 depresia, relevS atSt modificSri ale frecvenfei si
regularitSfii ritmului cardiac, cat \up0 \expndtw0\charscalex111 $i existenta unor
tulburSri vasomotorii (de regue, vasoconstrictie, cu cresterea \up0
\expndtw0\charscalex116 tensiunii arteriale). percepute prin mSsurStori obiective,
dar eel mai adesea \up0 \expndtw0\charscalex110 subiectiv \up0
\expndtw0\charscalex113 (palpitafii, uneori neregulate \up0 \expndtw0\charscalex112
- extrasistole, rSceala extremitSfilor. \par\pard\qj \li552\ri576\sb16\sl-
245\slmult0 \up0 \expndtw0\charscalex117 celalee etc.). Dispneea. ca semn al
tulburarilor psihosomatice (TPS) induse \up0 \expndtw0\charscalex116 de SP la
nivelul aparatului respirator, poate sS aparS insS si ca efect al unei \up0
\expndtw0\charscalex120 HTA de stress, in limp ce durerea coronarianS de naturS
ischemicS este \up0 \expndtw0\charscalex121 induse de SP aproape constant pe un pat
coronarian ateromatos, mai rar \up0 \expndtw0\charscalex112 puend fi consecinta
unui vasospasm la un subiect normal (13, 14. 16) \par\pard\qj \li561\ri580\sb0\sl-
245\slmult0\fi292 \up0 \expndtw0\charscalex126 In condifiile existenfei unei boli
cardiace cu evolufie severe, chiar \up0 \expndtw0\charscalex113 \u8222?eustress-ul"
\up0 \expndtw0\charscalex118 - reprezentat de unele stari de intense bucurie, de
exemplu -\line \up0 \expndtw0\charscalex121 poate antrena. prin aceleasi modificeri
de tip simpaticoton, aparitia unor \up0 \expndtw0\charscalex121 complicafii grave,
fiind cunoscute morfi subite la unii suporteri, bolnavi \up0
\expndtw0\charscalex121 coronarieni. dupe marcarea unui gol de cetre echipa
favorite \par\pard\qj \li859\ri1939\sb175\sl-240\slmult0\tx1094 \up0
\expndtw0\charscalex119 3. Gradul de reversibilitate al tulburarilor
psihosomatice \line\tab \up0 \expndtw0\charscalex120 cardiovasculare
Cu toate ce marea majoritate a SP genereaze tulburari functionale rever� \up0
\expndtw0\charscalex119 sibile de-a lungul unor decenii. existe situafii in care
reacfia ACV la stres \up0 \expndtw0\charscalex116 poate avertiza asupra Instaerii
ulterioare a unei anumite boli (cazul crestem \up0 \expndtw0\charscalex119
disproportionate in SP a valorilor tensionale la tinerii hiperreactivi vascu\up0
\expndtw0\charscalex112 lari, cu antecedente familiale de HTA) (Moga). Nu tot a$a
se intampia cu ca� \up0 \expndtw0\charscalex119 zurile in care ..reversibilitatea"
unor tahicardii paroxistice prelungite, In� \up0 \expndtw0\charscalex123 duse
psihogen la un coronarian, nu mai poate evita, la un moment dat, \up0
\expndtw0\charscalex116 aparitia unui IM (prin scSderea debitului coronarian, in
condifii de crestere \up0 \expndtw0\charscalex116 a consumului de oxigen).
\par\pard\ql \li864\sb8\sl-230\slmult0\tx7747 \up0 \expndtw0\charscalex119 in
sfarsit, exists situafii cand tablouri patologice relativ sistematizate \tab
\up0 \expndtw-2\charscalex100 -\par\pard\qj \li575\ri568\sb0\sl-250\slmult0 \up0
\expndtw0\charscalex116 fSrS afectare cardiacs, dar cu sensibilitate extremS a ACV
fafS de SP, cum \up0 \expndtw0\charscalex120 este sindromul DaCosta - isi menfin
reversibilitatea si nu evolueazS spre \up0 \expndtw0\charscalex113 organicitate
nici dupS
30 de ani de evolufie (12). \par\pard\ql \li892\sb221\sl-230\slmult0 \up0
\expndtw0\charscalex134 B. Rasunetul cerebral al tulburarilor aparatului
cardiovascular \par\pard\qj \li609\ri557\sb197\sl-246\slmult0\fi283 \up0
\expndtw0\charscalex114 Atat tulburarile psihosomatice cardio-vasculare fiziologice
- in marea lor \up0 \expndtw0\charscalex114 majoritate reversibile - din cursul SP,
cSt mai ales cele fiziopatologice, pre� \up0 \expndtw0\charscalex118 zente
cvasiconstant (de exemplu, insuficienfa cardiacS) sau incidental (de \up0
\expndtw0\charscalex118 exemplu. sindromul Adams-Stokes, unele scSderi ale
debitului vascular \par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart
\expndtw0\charscalex109 \ul0\nosupersub\cf9\f10\fs20 PsihosomaticS aplicata\tab
\par\pard\qj\li1080\ri115\sb99\sl-240\slmult0 \up0 \expndtw0\charscalex112 cerebral
in insuficienfS aorticS, sindromul ortostatic etc.) exercitS o influents \up0
\expndtw0\charscalex116 1a nivel cerebral. atSt pe plan neurologic (organic), cat
si psihologie, fie ca \up0 \expndtw0\charscalex126 perceptie senzoriae a unor
disfuncfii, fie ca o observare cu rezonantS \up0 \expndtw0\charscalex111 afectivS
negativS a propriei boll. \par\pard\qj \li1084\ri108\sb3\sl-237\slmult0\fi331
\up0 \expndtw0\charscalex116 7. Tulburarile neurologiceia bolnavii cardio-vasculari
sunt adesea igno\up0 \expndtw0\charscalex113 rate chiar la bolnavii cu o hipoxie
cerebrae cronicS, la care concurs atat pro� \up0 \expndtw0\charscalex121 cesul de
aterosclerozS cat si scSderea debitului cerebral de cauza hemo\up0
\expndtw0\charscalex124 dinamica (insuficienfa cardiacs, in primul rand).
Simptomele cele mai \up0 \expndtw0\charscalex127 frecvent intalnite in aceste
condifii sunt: cefaleea, astenia. Insomnia, \up0 \expndtw0\charscalex117 adesea
grupate intr-un sindrom neurastenitorm si favorizand alte tulburSri \up0
\expndtw0\charscalex123 ca: scaderea atenfiei si memoriei. uneori chiar a fluxului
ideafional. De \up0 \expndtw0\charscalex118 regue. apare o fatigabilitate
intelectuae pronunfatS. Toate aceste tulburSri \up0 \expndtw0\charscalex120 conduc
si la modificSri dispozifionale ale bolnavului. care devine anxios \up0
\expndtw0\charscalex120 Si/sau depresiv. \par\pard\qj \li1084\ri113\sb1\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex116 TulburSri neurologice. de gravitate
variabie, apar in sindromul Adams\up0 \expndtw0\charscalex119 Stokes si in
tulburarile de irigafie cerebrae date de cStre salvele de extra\up0
\expndtw0\charscalex120 sistole ventneuere, ca si de tahiaritmiile cu frecvents
foarte ridicatS (mai \up0 \expndtw0\charscalex120 ales adSugate pe un pat vascular
ingustat prin ateromatozS). \par\pard\qj \li1080\ri108\sb0\sl-240\slmult0\fi307
\up0 \expndtw0\charscalex120 In acest cadru intra si encefaloptia hipertensivS.
sindrom neuro-psihic \up0 \expndtw0\charscalex113 complex ce exprimS impactul
neuro-psihic al unor crize hipertensive severe. \par\pard\qj
\li1377\ri250\sb160\sl-240\slmult0\tx1622 \up0 \expndtw0\charscalex117 2. Tulburari
somato-psihice inductoare de SP la bolnavii cu afectiuni \line\tab \up0
\expndtw0\charscalex118 cardlo vasculare \par\pard\ql \li1387\sb169\sl-
230\slmult0\tx7785 \up0 \expndtw0\charscalex115 Inima a devenit de-a lungul
timpului sinonimS cu sufletul omului \tab \up0 \expndtw0\charscalex105 (\u8222?
ani-\par\pard\qj \li1089\ri103\sb4\sl-238\slmult0\fi4 \up0 \expndtw0\charscalex119
ma"), in ceea ce priveste oglindirea nuantata a viefii afective umane, prin \up0
\expndtw0\charscalex115 tulburSri prompt instalate si percepute de subiect, in
conditiile aparifiei orl-\line \up0 \expndtw0\charscalex114 cSrei emofii sau
persistenfei a variate sentimente. Este cunoscui s< faptul cS \up0
\expndtw0\charscalex126 adesea. orice variafie de frecvents cardiacs sau
tensionale. sesizatS in \up0 \expndtw0\charscalex117 plan subiectlv de cStre un
subiect sSnStos (cu atat mai mult dacS este car-\line \up0 \expndtw0\charscalex109
diopat) \up0 \expndtw0\charscalex115 - genereazS o anxietate de intensitSfi
variate. Un real SP este indus \up0 \expndtw0\charscalex123 de aparitia unor
palpitafii la un* bolnav care se stie suferind de aritmie \up0
\expndtw0\charscalex115 extrasistolicS - in special cu ES ventriculare, percepute
si subiectiv, mai pe-\line \up0 \expndtw0\charscalex100 nibil \up0
\expndtw0\charscalex115 - au un prognostic mai rezervat decat cele
supraventriculare. SP este si \up0 \expndtw0\charscalex117 mai intens dacS bolnavul
a aflat din diverse surse cS extrasistolele pot fi o \up0 \expndtw0\charscalex118
expresie a unui infarct miocardic sau a altor boli cardiace ori pot fi urinate \up0
\expndtw0\charscalex122 de tulburari grave (inclusiv moartea subitS). Tulburarile
somato-psihice \up0 \expndtw0\charscalex117 (TSP) se definesc. ca in aceste
exemple. drept tulburSri psihice apSrute ca \up0 \expndtw0\charscalex118 ecou al
unor suferinfe somatice cardio-vasculare. in situafiile menfionate, \up0
\expndtw0\charscalex120 se inchide adesea un cere vicios intre TSP si amplificarea
tulburarilor de \up0 \expndtw0\charscalex114 ritm prin descSrcSrile de catecolamine
si celelalte modificSri neuro-umorale \up0 \expndtw0\charscalex120 caracteristice
SP. Acelasi lucru este vaebil $i pentru crizele de tahicardie \up0
\expndtw0\charscalex120 paroxisticS (cele supraventriculare avand o legStura mai
nets cu SP, mai \up0 \expndtw0\charscalex120 ales cand survin la hipertiroidieni,
care au si un psihic mai labil). \par\pard\qj \li1104\ri113\sb1\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex117 O pozifie particulars o ocupS
durerea coronariana anginoasS si cea din \up0 \expndtw-9\charscalex86 IM \up0
\expndtw0\charscalex124 (stresants, ce necesite adesea apelul la medicafia
opiacee), ambele \up0 \expndtw0\charscalex113 tipuri de coronaralgii beneficiind si
de medicatia anxiolitica (17).
\expndtw0\charscalex105 <\u9632?\tab \up0 \expndtw0\charscalex105 tlomente de
psmosomaticd generae si aplicata\par\pard\qj \li580\sb0\sl-246\slmult0
246\slmult0\fi278 \up0 \expndtw0\charscalex115 in sfarsit. cea mai mare incSrcSturS
psihicS survenitS ca reactie somato\up0 \expndtw0\charscalex110 psihicS \up0
\expndtw0\charscalex121 - o constituie durerea socogenS, generatoare a unei extreme
an\up0 \expndtw0\charscalex100 xietSfi \up0 \expndtw0\charscalex115 (in unele
infarcte miocardlce, sau pulmonare, in sindromul de ische\up0
\expndtw0\charscalex116 mie penfericS acutS, etc.). \par\pard\ql \li878\sb168\sl-
230\slmult0 \up0 \expndtw0\charscalex118 3. Impactul psihic negativ al starii de
bolnav cardiac. \par\pard\qj \li575\ri548\sb202\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex120 PurtStorii bolilor cardiovasculare cu evolufie cronicS sunt
adesea de-\line \up0 \expndtw0\charscalex117 numifi ..cardiaci". Sub aceastS
etichetS. in mod inevitabil. bolnavii doban-\line \up0 \expndtw0\charscalex118 desc
un statut social aparte, legat de necesitatea menajSrii lor de la o serie \up0
\expndtw0\charscalex125 de stress-uri fizice \up0 \expndtw0\charscalex123 (mai
pufin SP, exigenfa respectivS nefiind u$or de \par\pard\ql \li590\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex116 respectat de catre cei din jur).
Situafia aceasta implies o serie de restricfii, in special legate de efort \up0
\expndtw0\charscalex116 fizic (uneori cu limitarea si a activitSfii sexuale), dar
si de o serie de activi-\line \up0 \expndtw0\charscalex119 tSfi cu importante
efecte antistresante \up0 \expndtw0\charscalex115 (drumefii, sporturi, activitSfi
fizice \par\pard\ql \li580\ri542\sb0\sl-246\slmult0\tx878 \up0
\expndtw0\charscalex127 deosebite etc.). La acestea se adaugS si efectul afectiv
determinat de \up0 \expndtw0\charscalex116 oprirea fumatului si restricfiile e
consumul de alcool si cafea. \line \tab \up0 \expndtw0\charscalex122 La toate
aceste surse de SP se adaugS, de obicei nemSrtunsite, pers-\line \up0
\expndtw0\charscalex119 pectivele morfli subite (in special la cei cu antecedente
de infarct) sau ale \up0 \expndtw0\charscalex119 unor complicafii redutabile
(accidente vasculare cerebrate generatoare de \up0 \expndtw0\charscalex116 pareze
si paralizii. edeme pulmonare la hipertensivi ori valvulari etc.). Cele \up0
\expndtw0\charscalex125 mai stresante sunt situafiile concrete ale unor bolnavi
operafi \up0 \expndtw0\charscalex111 (proteze \par\pard\qj \li585\ri538\sb0\sl-
247\slmult0 \up0 \expndtw0\charscalex114 valvulare. pace-makeri etc.), la care, pe
ISngS riscul chirurgical propriu-zis -\line \up0 \expndtw0\charscalex114 mtervine
s< teama suplimentarS intrefinuts de posibilitatea unor defecte ten\up0
\expndtw0\charscalex121 nice legate de aparatura respectivS. De asemenea,
ameninfarea recidivei \up0 \expndtw0\charscalex119 de infarct sau a complicafnlor
acestuia si rnai ales prezenfa lor, creeazS o \up0 \expndtw0\charscalex131 stare de
teams permanentS, expresie a unui SP de dilerite grade de \up0
\expndtw0\charscalex122 miensitate, cu rol negativ in evolufia insasi a bolii de
bazS coronariene \up0 \expndtw0\charscalex124 Aceasta limiteazS mult inifiativele
bolnavului, fiind necesarS adesea o \up0 \expndtw0\charscalex115 reinserfie socio-
profesionalS condusS de un psiholog experimental, colabo\up0
\expndtw0\charscalex115 rand insa
strSns cu medicul cardiolog sao internist. \par\pard\qj \li604\ri539\sb0\sl-
240\slmult0\fi278 \up0 \expndtw0\charscalex121 in acelasi mod, bolnavul hipertensiv
- care isi cunoaste, din senzafiile \up0 \expndtw0\charscalex121 subiective ce
insofesc crestenie tensionale. aparifia unui puseu hipertensiv \par\pard\qj
\li604\ri548\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex114 - amplifies uneori
severitatea acestuia prin SP in care intrS odats cu evalua� \up0
\expndtw0\charscalex115 rea ameninfarii complicatiilor (desigur, alStun de trSirea
disconfortului so� \up0 \expndtw0\charscalex115 matic legat de puseul respectiv)
\expndtw0\charscalex133 II. Argumente epidemiologice si experimentale privind
\line\tab \up0 \expndtw0\charscalex134 implicafiile stresului psihic in
etiopatogeneza bolilor \line\tab \up0 \expndtw0\charscalex130 cardiovasculare
\up0 \expndtw0\charscalex133 A. Situafii cu valoare de SP pentru majoritatea
indivizilor \par\pard\ql \li926\sb150\sl-230\slmult0\tx5784 \up0
\expndtw0\charscalex125 Pornind de e observafiile clinice curente care \tab \up0
\expndtw0\charscalex124 \u8222?au relevat o relafie \par\pard\ql \li633\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex117 empirics intre unele evenimente din cursul
viefii si consecintele lor asupra
\up0 \expndtw0\charscalex63 \u8226?>\tab \up0 \expndtw0\charscalex107
sSnStSfii fizice si mentale" (9), au fost initiate o serie de cercetSri
epidemio\up0 \expndtw0\charscalex119 logice uzand de anchete sj chestionare
referitoare la situafiile existenfiale \up0 \expndtw0\charscalex118 stresante sau
analizand o serie de parametri fiziologici (mai ales hormonii \up0
\expndtw0\charscalex127 .,de stress") la subiectii avand profesiunl cu inalte
responsabilitafi, in \up0 \expndtw0\charscalex128 contextul unor sarcini care
reclame vigilenfa. neprevSzut si luare de \up0 \expndtw0\charscalex116 decizii
\u8222?in criza de timp" (Rose). Scala elaborate de Holmes si Rahe (1967) \up0
\expndtw0\charscalex117 ierarhizeaze asa-numitele \u8222?life changes"
(..cantitatea de schimberi necesa� \up0 \expndtw0\charscalex114 re individului spre
a face fafa diferitelor evenimente din cursul viefii"), per� \up0
\expndtw0\charscalex118 mite elaborarea unui prognostic privind ..riscul" de
imbolnavire de o boae \up0 \expndtw0\charscalex113 somatice (infarctul de miocard,
de exemplu, la un individ, in luncfie de \u8222?acu\up0 \expndtw0\charscalex113
mularea trimestriae a stresurilor'). \par\pard\qj \li897\ri218\sb0\sl-
242\slmult0\fi297 \up0 \expndtw0\charscalex119 in acelasi timp, a fost studiat
rolul unor factori ambientali in aparifia si \up0 \expndtw0\charscalex111 agravarea
evolufiei unor BCV (ca in studiul lui von Eiff referitor la rolul nociv \up0
\expndtw0\charscalex114 al zgomotului aeroportului din Bonn, favorizand cresterea
incidenfel HTA la \up0 \expndtw0\charscalex114 lotul de persoane locuind in zona
limitrofe). De asemenea, au fost imaginate \up0 \expndtw0\charscalex118
ventabile \u8222?teste de stress ' (filme cu scene de violenfe, accidente de
munce \up0 \expndtw0\charscalex116 etc.) spre a se urmeri variafia diferifilor
parametri functionali din cursul SP \up0 \expndtw0\charscalex119 (inclusiv ai ACV).
Un test recent de stress, lipsit de nocivitate si utilizat e \up0
\expndtw0\charscalex119 bolnavii hipertensivi, este eel in care \u8222?sarcina"
este reprezentate de jocuri \up0 \expndtw0\charscalex111 la calculator (Sime)
(3). \par\pard\qj \li1190\ri1795\sb132\sl-320\slmult0\tx1492 \up0
\expndtw0\charscalex132 B. Factori psihocomportamentali de rise in bolile \line\tab
\up0 \expndtw0\charscalex133 cardiovasculare \par\pard\qj \li897\ri197\sb187\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex122 O atenfie deosebite se acorda (de
cetre psihologi, in special) studieril \up0 \expndtw0\charscalex118 unor treseturi
de personalitate cu rise crescut de a contracta BCV, mai ales \up0
\expndtw0\charscalex119 cele psihosomatice, azi fiind induse (11) in aceaste
categorie: hipertensiu\up0 \expndtw0\charscalex121 nea arteriale, cardiopatia
ischemice coronariane, tahicardiile paroxistice, \up0 \expndtw0\charscalex123
ateroscleroza si Boala Raynaud. Chiar dace existenfa unei personalltefl \up0
\expndtw0\charscalex119 strict specifice anumitor boli psihosomatice este
cvasiunanim contestate -\line \up0 \expndtw0\charscalex115 in ultimii ani, s-a
schematizat pentru boala coronariane un veritabil sindrom \up0
\expndtw0\charscalex118 comportamental compus dintr-o serie de factori pslho-
comportamentali de \up0 \expndtw0\charscalex123 rise pentru aceaste boae. Acest
tip, denumit .Type A behaviour pattern" \up0 \expndtw0\charscalex116 (TABP), este
prezent la subiecfi cu diferite tipuri de personalitate (psihaste\up0
\expndtw0\charscalex117 nic, isterie, paranoid etc.), unificafi prin posedarea unor
insusiri comporta� \up0 \expndtw0\charscalex116 mentale asemenetoare (fata de
realizarea unei sarcini, de obicei profesiona� \up0 \expndtw0\charscalex116 le) si
de raportare la cei din jur (8). \par\pard\qj \li907\ri197\sb0\sl-246\slmult0\fi297
\up0 \expndtw0\charscalex117 El este actualmente considerat un faclor de rise
pentru aparifia IM. Cer\up0 \expndtw0\charscalex117 ceterile din ultimul deceniu au
evidential imphcarea tipului A S' in aparifia \up0 \expndtw0\charscalex113 altor
boli psihosomatice cardiovasculare (HTA) sau de alte nature (ulcer gas� \up0
\expndtw0\charscalex113 tric si duodenal). \par\pard\ql \li1204\sb1\sl-
209\slmult0\tx6235 \up0 \expndtw0\charscalex126 Subiectii cu tip comportamental A
prezintS de \tab \up0 \expndtw0\charscalex130 2 ori mat frecvent \par\pard\qj
\li916\ri187\sb1\sl-246\slmult0 \up0 \expndtw0\charscalex116 cardiopatie
coronariana decSt cei cu tip comportamental B (12). Tipul A, in \up0
\expndtw0\charscalex119 raport cu tipul B, pare sa fie corelat s' cu o tendinta de
crestere mai rapidS \up0 \expndtw0\charscalex120 Si mai marcats a secretiei de
catecolamine sau a nivelului senc al acizilor \up0 \expndtw0\charscalex120 grasi si
colesterolului la aparifia unui SP prolesional (3, 20).
240\slmult0\fi292 \up0 \expndtw0\charscalex115 Contestarea de catre mulfi autori a
rolului negativ jucat de TABP in boala \up0 \expndtw0\charscalex123 coronarianS au
impulsionat studil care au analizat diversele componente \up0
\expndtw0\charscalex116 (factorii A. S, H si J) ale acestui comportament (v.
tabelul 3, pag. \up0 \expndtw-9\charscalex96 13) \par\pard\qj \li436\ri687\sb0\sl-
241\slmult0\fi297 \up0 \expndtw0\charscalex120 O serie de date sugereaze ce
subiectii cu tipul comportamental A - care \up0 \expndtw0\charscalex119 ii
propulseaze spre sferele superioare ale ierarhiei profesionale - pietesc un \up0
\expndtw0\charscalex120 tribut mai mare stress-ului profesional decat subalternii
lor (2), justificand \up0 \expndtw0\charscalex121 aparifia. in literature medicae,
a notiunii de ..Managers' Diseases", in care \up0 \expndtw0\charscalex121
cardiopatia coronariane s1 HTA ocupe un loc de frunte (v Stockmeyer si \up0
\expndtw0\charscalex120 colab. care evidenfiaza factorul, presiunea sarcinii si a
timpului. ca factori \up0 \expndtw0\charscalex121 de rise pentru aparifia stresului
psihic si nu pentru coronare, la personalul \up0 \expndtw0\charscalex122 de
conducere Jormen" din Industrie.Ei considere ce acesti sefi reusesc se \up0
\expndtw0\charscalex117 se adapteze (..desensitization') la stresui profesional
prin mecanisme de co� \up0 \expndtw0\charscalex121 ping adecvate. Cerceeri mai
recente releve si impactul coronarian negativ \up0 \expndtw0\charscalex121 al
suprasolicitarii profesionale. in crize de timp (lucrul la bande rulane) in \up0
\expndtw0\charscalex122 conditiile unui control decizional redus la muncitorii cu o
calificare joase \up0 \expndtw0\charscalex112 (..blue collars") \par\pard\ql
\li729\sb229\sl-230\slmult0 \up0 \expndtw0\charscalex133 III. Tulburari functionale
cardiovasculare psihogene \par\pard\qj \li441\ri692\sb162\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex130 Tulburarile psihosomatice cardiovasculare funcfionale
reprezinte \up0 \expndtw0\charscalex122 modificari fiziologice brutale, dar
reversibile - pe un cord adesea indemn \par\pard\qj \li436\ri687\sb0\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex119 - ale parametrilor esenfiah
cardiovascular!, aperute adesea ca simptome de \up0 \expndtw0\charscalex122
..rezonanfe afective" la o serie de stimului stresori si afectand principalii
\up0 \expndtw0\charscalex120 parametrii hemodinamici \up0 \expndtw0\charscalex127
(volum sistolic. frecvenfe cardiace, tensiune \par\pard\qj \li436\ri696\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex129 arteriale, tonus vasomotor etc.). Gradul
de reversibilitate fl, mai ales, \up0 \expndtw0\charscalex126 constanta
reversibilitafu in timp sunt tot mai reduse la subiectii cu pre \up0
\expndtw0\charscalex122 dispozifii genetice
pentru boli cardiovasculare, al caror debut este prece\up0 \expndtw0\charscalex127
dat sau se manifeste printr-o amploare sj persistente crescute a acestor \up0
\expndtw0\charscalex115 tulburari cardiovasculare funcfionale. \par\pard\ql
\li768\sb189\sl-230\slmult0 \up0 \expndtw0\charscalex119 /. Tulburari de ritm
a) Tahicardiile si bradlcardiile regulate induse psihogen au la baza \up0
\expndtw0\charscalex120 corelarea frecventei cardiace cu reflexele de aparare sau
de orientare cetre \up0 \expndtw0\charscalex116 un stimul. Astfel. in cazul unui
stimul intens (sonor. de exemplu), resimtit ca \up0 \expndtw0\charscalex119 nociv
de cetre un subiect, apare o accelerare a frecvenfei cardiace (reflexul \up0
\expndtw0\charscalex120 de ..aparare". ..defensiv") in timp ce - la o intensitate
reduse a aceluiasi tip \up0 \expndtw0\charscalex117 de stimul - intre in acfiune
reflexul de orientare, corelat cu o rerire a beteilor \up0 \expndtw0\charscalex117
cardiace (Lader) \up0 \expndtw0\charscalex120 (3). Master a realizat un experiment
in care \up0 \expndtw-2\charscalex100 \u8226? \up0 \expndtw0\charscalex114
prezentand \par\pard\qj \li441\ri703\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex115 diapozitive cu confinut \u8222?pecut" capabile sa reduce
frecvenfa cardiace la tofi \up0 \expndtw0\charscalex119 subiectii lotului
cercetat \up0 \expndtw0\charscalex127 - a provocat inversarea acestui respuns, deci
tahicardie. la o parte din bolnavii fobici mclusi in acest experiment Acestora \up0
\expndtw0\charscalex124 le-a prezentat, \u8226?anterior expunerii acestor imagini.
stimuli Jobici" \up0 \expndtw0\charscalex105 (cu \par\pard\qj \li455\ri688\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex116 continut stresant legat de fobiile
acestora) (3). Efectul generator de tahicar\up0 \expndtw0\charscalex116 dn al SP se
mamleste atat prin accentuarea unei tahicardii sinusale preexis\up0
\expndtw0\charscalex120 tente intr-o serie de sindroame psihosomatice
cardiovasculare, cat si prin \up0 \expndtw0\charscalex120 declansarea de tahicardii
paroxistice supraventriculare.
\par\pard\qj\li1190\ri51\sb121\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex120 Un
fapt cu o semnificafie aparte pentru mecanismele psihotiztologice \up0
\expndtw0\charscalex116 generale ale SP il constituie discrepanfa dintre nivelul
crescut de catecola� \up0 \expndtw0\charscalex119 mine si frecventa joase cardiace
e subiecfii asezafi pe scaunul stomatolo\up0 \expndtw0\charscalex117 gului in
asteptarea unui tratament dentar. Pentru astfel de situafii a tost su\up0
\expndtw0\charscalex117 gerat un mecanism vagal de contracarare a raspur.sului
tahicardie indus de \up0 \expndtw0\charscalex115 catecolamine in SP. dar pare
posibilS si o excitare a zonei reflexogene sino\up0 \expndtw0\charscalex115
carotidiene (19). \par\pard\qj \li1200\ri51\sb20\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex117 b) Extrasistolele reprezintS cea mai frecvents tulburare de
ritm apSrutS \up0 \expndtw0\charscalex117 in cursul SP. \par\pard\qj
\li1200\ri53\sb0\sl-250\slmult0\fi283 \up0 \expndtw0\charscalex112 Analiza - pe
baza unor inregistrSri prelungite (Holter) - a proporfiei de ex-\line \up0
\expndtw0\charscalex117 trasistole apSrute sub Influenfa unor emofii, in raport cu
numSrul de bStSi \up0 \expndtw0\charscalex114 normale. a pus in evidenfS cresteri
ale numSrului variind intre 3-30% (4). \par\pard\qj \li1190\ri46\sb0\sl-
242\slmult0\fi302 \up0 \expndtw0\charscalex115 Extrasistolele (ES), induse
psihogen. sunt mai frecvent ventnculare decat \up0 \expndtw0\charscalex114 atnale
(13) s> apar prin medierea influxului nervos declan$at de stimuli psi� \up0
\expndtw0\charscalex102 hici \up0 \expndtw0\charscalex116 $i transmis pe cale vagae
sau simpaticS. Klumbies deosebeste ES psi� \up0 \expndtw0\charscalex116 hogene la
individul normal de cele din nevroze, opinand cS in diverse stSri \up0
\expndtw0\charscalex115 afective. pot surveni ES. fSrS ca la baza lor sS se afle
obligatoriu o nevrozs. \up0 \expndtw0\charscalex113 Adesea, astfel de ES pot
dispare prin simpla reajustare a activitSfii profesio� \up0 \expndtw0\charscalex115
nale, cu ocohrea unor situafii generatoare de SP, ca de exemplu, schimbarea \up0
\expndtw0\charscalex115 unui loc de muncS stresant. \par\pard\qj
\li1185\ri43\sb0\sl-246\slmult0\fi297 \up0 \expndtw0\charscalex119 La bolnavii
cardiaci. cu cat emotivitatea lor este mai mare, cu atat apar \up0
\expndtw0\charscalex117 mai multe ES, induse nu numai de SP, ci si de efortul
fizic. Spre deosebire \up0 \expndtw0\charscalex116 de subiecfii fara afecfiuni
cardiace, ES apSrute la bolnavii cardiaci indue la \up0 \expndtw0\charscalex117
acestia din urma un veritabil recul somato-psihic, prin semnificafia pe care
\up0 \expndtw0\charscalex118 le-o acorde bolnavul, aflat intr-o stare de ..mereu la
pandS". Se pot instae, \up0 \expndtw0\charscalex116 din acest motiv. adeverate
cercuri vicioase. Existe in atari situafii - mai ales \up0 \expndtw0\charscalex116
in cazul ES ventnculare - pericolul unei fixari iatrogene si cronicizSri Mij�
\up0 \expndtw0\charscalex119 loacele terapeutice medicamentoase. axate pe
simptomele somatice, sunt \up0 \expndtw0\charscalex118 capabile se lichideze
aceaste lixare intr-o mai mare mesure decat psihote� \up0 \expndtw0\charscalex118
rapia centrate pe simptom. \par\pard\ql \li1185\ri45\sb0\sl-
244\slmult0\fi288\tx1483\tx1468 \up0 \expndtw0\charscalex120 c) Fibrilafia atriala.
Episoadele tranzitorii de fibrilafie atriae paroxisti\up0 \expndtw0\charscalex117
ce. aperute in cadrul unui SP. sunt estimate 1a circa 3% (17). \line \tab \up0
\expndtw0\charscalex122 Faptul ca fibrilafia atriae mai apare si reflex, asa cum s-
a demonstrat \up0 \expndtw0\charscalex122 dupS traumatisme craniene sau dupa
indepartarea unui dop de cerumen \up0 \expndtw0\charscalex119 auricular, dovedeste
posibilitatea ca SP sS poatS acfiona pe calea nervilor \up0 \expndtw0\charscalex118
vag si accelerans asupra nodului sino-atnal. TotodatS, se poate infelege s* \up0
\expndtw0\charscalex130 de ce unii indivizi prezintS accese de fibrilafie atriala
paroxisticS la \up0 \expndtw0\charscalex117 mirosuri neplacute sau la atmosfera
supraincSlzitS (14). \line \tab \up0 \expndtw0\charscalex123 Au fost semnalate si
cazuri cand la acelasi subiect, de regula stresat. \up0 \expndtw0\charscalex123
apar tulburari de ritm diferite in funcfie de starea de somn sau de veghe \up0
\expndtw0\charscalex115 (ES. fibrilafie atriae, tahicardie sinusalS ori
paroxisticS) \par\pard\ql \li1478\sb168\sl-230\slmult0 \up0 \expndtw0\charscalex118
2. Tulburarile de conducere induse de SP \par\pard\qj \li1185\ri55\sb182\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex118 Au fost mai pufin studiate si sunt
reprezentate de ISrgirea complexului \up0 \expndtw0\charscalex116 QRS si scurtarea
amplltudmii acestuia. DupS Klumbies, aceste valori ating
\expndtw0\charscalex103 \u9830?\tab \up0 \expndtw0\charscalex103 EiiMiionto do
psihosomaticS generala $i aplicae\par\pard\li758\sb0\sl-
230\slmult0\fi0 \up0 \expndtw0\charscalex120 in cursul unei excitafii provocatoare
de spaimS, 0,07 secunde si. respectiv\par\pard\li758\sb10\sl-
230\slmult0\fi19\tx7454\tx7944 \up0 \expndtw0\charscalex119 1.38 mV. comparativ cu
traseul de bazS (0,01 secunde si respectiv\tab \up0 \expndtw0\charscalex105
1,68\tab \up0 \expndtw0\charscalex119 -\par\pard\li758\sb10\sl-
230\slmult0\fi28\tx883\tx7003 \up0 \expndtw-5\charscalex100 t\tab \up0
\expndtw0\charscalex119 .83 mV) O observafie deosebits este relatatS de Koch (cit.
de\tab \up0 \expndtw0\charscalex119 17), care a\par\pard\ql \li763\sb1\sl-
217\slmult0\tx2856 \up0 \expndtw0\charscalex125 reusit in decursul a \tab \up0
\expndtw0\charscalex126 3 sSptSmSni de tratament zilnic prin hipnozS, sS
\par\pard\ql \li753\sb33\sl-230\slmult0\tx6158 \up0 \expndtw0\charscalex118 creascS
alura AV la un bolnav cu bloc AV total, de la \tab \up0 \expndtw0\charscalex121 12
bSei/min. la 40 \par\pard\qj \li758\ri365\sb2\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex117 bStSi/min., facand sa dispare (in aceaste perioade !)
cnzele zilnice Adams\up0 \expndtw0\charscalex117 Stokes de dinaintea acestui
tratament. \par\pard\ql \li1055\sb169\sl-230\slmult0 \up0 \expndtw0\charscalex121 3
Dureri precordiale. retrosternale sau cu un alt sediu toracic \par\pard\qj
\li758\ri356\sb178\sl-245\slmult0\fi297 \up0 \expndtw0\charscalex118 La bolnavul
cardiac, aparifia lor poate fi expresia unei stari de tensiune \up0
\expndtw0\charscalex116 psihice, care se exprime in plan somatic - in cazuri de
cardiopatii, pe un pat \up0 \expndtw0\charscalex123 coronarian eel mai adesea
afectat de ateromatoze - prin generarea unui \up0 \expndtw0\charscalex126 spasm (9,
\up0 \expndtw0\charscalex122 13) ori a unei cresteri a consumului miocardic de
oxigen Tn \up0 \expndtw0\charscalex123 condifiile unei irigafii coronariene
deficitare. \par\pard\qj \li753\ri357\sb0\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex116 La subiectul indemn de o afecfiune organice a ACV. durerea
precordiae \up0 \expndtw0\charscalex132
apare prin excitarea intense a terminafiilor senzitive simpatice din \up0
\expndtw0\charscalex128 perefii coronarelor, excitate de distensia aortica \up0
\expndtw0\charscalex103 (Malliani) \up0 \expndtw0\charscalex114 (12). Acest
mecanism ar putea explica mai bine numeroasele situafii in care bolnavii \up0
\expndtw0\charscalex122 nevrotici. cei cu sindrom DaCosta sau chiar unii subiecfi
normali, acuze \up0 \expndtw0\charscalex111 precordialgii \up0
\expndtw0\charscalex123 (fere caractere de durere coronariane) in stari de
anxietate \up0 \expndtw0\charscalex121 care - in plus - se insotesc de
hiperventilafie inconstiente, generatoare de \up0 \expndtw0\charscalex117 dispnee,
dar si de un posibil spasm al musculaturii pectorale. Pentru psiho-\line \up0
\expndtw0\charscalex124 logul clinician este utila cunoasterea caracterelor durerii
precordiale de \up0 \expndtw0\charscalex124 cauze coronariane, fie pentru a sesiza
la bolnavul investigat implicarea \up0 \expndtw0\charscalex120 stresului psihic in
generarea acestuia, lie pentru a o exclude in cazul unor \up0
\expndtw0\charscalex117 dureri ..sine materia" pur psihogene sau, in eel mai reu
caz, de cauze extra-\line \up0 \expndtw0\charscalex119 cardiaca (eel mai adesea
nevralgice, intercostale). Pentru lucrarea de fafa. \up0 \expndtw0\charscalex117 ne
limiem la a infafisa - dupe Braun Wald - caracterele generale ale durerii \up0
\expndtw0\charscalex120 coronariene (din angina sau infarct): apasare retrosternae
constrictive, cu \up0 \expndtw0\charscalex117 iradiere in umerul s* antebratul
stang \up0 \expndtw0\charscalex120 (iradieri atipice in mandibue sau in
\par\pard\qj \li763\ri351\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex117 ambii
umeri. etc.) si aparifie la efort (in special dupe mese) sau stres psihic \up0
\expndtw0\charscalex122 Lexcitare emotionale") Disparifia accesului anginos are loc
\up0 \expndtw0\charscalex118 (criteriu de \par\pard\ql \li772\sb9\sl-
230\slmult0\tx6767\tx7790 \up0 \expndtw0\charscalex126 patognomie) dupe
nitroglicerina sau la oprirea efortului \tab \up0 \expndtw0\charscalex114 (repaus).
\tab \up0 \expndtw0\charscalex101 (O \par\pard\qj \li772\ri367\sb0\sl-
260\slmult0 \up0 \expndtw0\charscalex123 nevralgie intercostale, foarte frecvent
conlundabie cu angina pectorala, \up0 \expndtw0\charscalex123 persists $i in
repaus.) \par\pard\ql \li1070\sb151\sl-230\slmult0 \up0 \expndtw0\charscalex119 4.
Dispneea ..cardiace'' in cursul SP \par\pard\qj \li777\ri342\sb182\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex131 in afara dispneei aperute la
subiectul normal, supus unor emofii \up0 \expndtw0\charscalex127 putermce. exista o
serie de afectiuni cardiace, in special cele cu staza \up0 \expndtw0\charscalex121
pulmonare (insuficienfa cardiace congestive, valvulopatii mitrale etc.) la \up0
\expndtw0\charscalex125 care SP genereaza agravarea dispneei preexistente.
Mecanismele care \up0 \expndtw0\charscalex122 intervin sunt reprezentate de
accelerarea reflexe a ritmului respirator, in \up0 \expndtw0\charscalex119 cursul
SP, impreuna cu soltcitarea unor parametri hemodinamici situafi la \up0
\expndtw0\charscalex115 limita eficienfei, instalandu-se un cere vicios intre SP $i
agravarea dispneei, \up0 \expndtw0\charscalex115 capabil se conduce in cazuri
extreme la aparitia unui edem pulmonar acut.
\up0 \expndtw0\charscalex110 *\tab \up0 \expndtw0\charscalex110 179\par\pard\ql
\expndtw0\charscalex121 De altfel, anxietatea este reputata ca generand
hiperventilafie (13. 20). \line\tab \up0 \expndtw0\charscalex129 Pentru medic este
suficient sS observe accentuarea dispneei la un \up0 \expndtw0\charscalex120
cardiac in cursul unui SP si legatura cauzae devine plauzibils inainte ca el
\up0 \expndtw0\charscalex119 sa mediteze la faptul cS morfina. intr-un edem
pulmonar acut intervine \up0 \expndtw-2\charscalex100 $i \par\pard\ql
\li1036\sb9\sl-230\slmult0\tx3422 \up0 \expndtw0\charscalex113 prin linistirea
bolnavului \tab \up0 \expndtw0\charscalex116 (pe langS mecanismele cunoscute).
\par\pard\ql \li1334\sb190\sl-230\slmult0 \up0 \expndtw0\charscalex119 5. Variafii
ale tensiunii arteriale \par\pard\qj \li1031\ri127\sb182\sl-240\slmult0\fi302
\up0 \expndtw0\charscalex118 Reacfia catecolaminicS de stres genereazS rSspunsuri
hipertensive chiar \up0 \expndtw0\charscalex116 la subiectul normal, insS la
bolnavii cu HTA exists, atat un nivel mai crescut \up0 \expndtw0\charscalex118 al
aeestei secrefil fafa de indivizii sanatosi supusi unui SP similar, cat si un
\up0 \expndtw0\charscalex136 nivel mai redus al excrefiei urinare de kalicrema \up0
\expndtw0\charscalex131 (generatoare de \par\pard\ql \li1041\sb9\sl-230\slmult0
\up0 \expndtw0\charscalex115 bradikinine. mediator cu rol intens vasodilatator)
(4). \par\pard\qj \li1046\ri127\sb39\sl-220\slmult0\fi283 \up0
\expndtw0\charscalex121 Referitor la cresterea TA, la subiectii senetosi, sub
efectul SP, Elliot si \up0 \expndtw0\charscalex117 Morales - Ballejo, au reu�it
\up0 \expndtw0\charscalex123 - cu ajutorul unui test de stres reprezentat de
concentrarea subiecfilor asupra unui joe video (ca o sarcina mediae beta \up0
\expndtw0\charscalex121 adrenergic) - sa diferenfieze trei categorii de reacfii:
.output reactors", la \up0 \expndtw0\charscalex113 care TA creste exclusiv pe seama
debitului cardiac (volum sistolic x frecven-\line \up0 \expndtw0\charscalex118 fa),
fere modificarea rezistenfei vasculare totale, \up0 \expndtw0\charscalex119 \u8222?
vasoconstrictive reac� \par\pard\ql \li1036\sb9\sl-230\slmult0\tx7406 \up0
\expndtw0\charscalex120 tors", la care TA creste exclusiv prin vasoconstrictie
periferice \tab \up0 \expndtw0\charscalex107 $i ..com� \par\pard\qj
\li1031\ri130\sb2\sl-240\slmult0\fi14 \up0 \expndtw0\charscalex117 bined reactors",
la care TA creste prin ambele mecanisme. Aceaste clasifi-\line \up0
\expndtw0\charscalex120 care a pattern-urilor celor \up0 \expndtw0\charscalex122 3
parametri are implicafii terapeutice dare, in \par\pard\qj \li1036\ri135\sb0\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex116 sensul prescrieril de betablocante
pentru ..output reactors" si de vasodilata\up0 \expndtw0\charscalex116 toare pentru
..vasoconstrictive reactors". \par\pard\qj \li1031\ri120\sb0\sl-
242\slmult0\fi302 \up0 \expndtw0\charscalex120 Dilerit se exercite rolul SP, pe un
teren cu miopragie funcfionale vas� \up0 \expndtw0\charscalex118 culare, in
aparifia sindromului hipotensiv. De ce hipotensiune si nu hiper-\line \up0
\expndtw0\charscalex118 tensiune? Considerem ce este posibil ca, pe lange o serie
de particularitafi \up0 \expndtw0\charscalex117 enzimatice la nivelul receptorilor
peretelui vascular, se existe si o faza Ina-\line \up0 \expndtw0\charscalex120
parente, premorbide cu valori normale tensionale. in cursul cerora s-ar fi \up0
\expndtw0\charscalex119 putut epuiza. sub acfiunea unui SP cronic sau repetitiv,
mijloacele uzuale \up0 \expndtw0\charscalex116 endocrine (respunsul secretor al
ACTH, de exemplu) de respuns la agresiu-\line \up0 \expndtw0\charscalex122 nea unor
agen(i stresori persistenfi. ..consumativi". Ne referim la fazele \up0
\expndtw0\charscalex120 unui SP prelungit Tnfafisate de Mills (4): cresterea
inifialS a secrefiei de \up0 \expndtw0\charscalex114 cortizoi, diminuarea ei in
cazul persistenfei SP (ca urmare a revenirii la nor� \up0 \expndtw0\charscalex116
mal a serotoninei hipotalamice $i a diminuSrii descSrcSrii de ACTH) si. in \up0
\expndtw0\charscalex117 sfarsit, scSderea secretiei cortizolice 1a un nivel
apropiat de eel intalnit Tn \up0 \expndtw0\charscalex117 boala Addison (analog cu
hipocorticismul de disprotecfie descris de Cocu \up0 \expndtw0\charscalex118
lescu). Interesant este cS astfel de sindroame adisoniene \u8222?de epuizare"
sub \up0 \expndtw0\charscalex120 efectul SP cronic, sunt amendate dupS circa A
sapemani de tratament cu \up0 \expndtw0\charscalex114 antidepresive.
Modiflcarlle vasomotorii in diverse teritoril. aparute sub efectul SP
Ele pot fi apreciate direct prin observafie (eritemul pudic. paloarea din \up0
\expndtw0\charscalex115 sterile de spaime. groaza, sau din crizele vasospastice de
tip Raynaud, opu� \up0 \expndtw0\charscalex118 se expresiei fizionomice de \u8222?
rosu la manie"), ca si indirect, prin pletlsmo\up0 \expndtw0\charscalex112
grafie. \par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart Pg183}{\bkmkend
240\slmult0\fi302 \up0 \expndtw0\charscalex131 Importante apar startle lipotimice
produse de ischemia cerebrae \up0 \expndtw0\charscalex123 aperute in cursul unui
SP, soldat fie cu un respuns hipotensor (Inhiblfie \up0 \expndtw0\charscalex120
vaso-vagala). fie cu diferite tulburari cardiovasculare menite se scada m-\line
\up0 \expndtw0\charscalex119 gafia cerebrae (tulburari paroxistice de ritm. de
exemplu) Klumbies
citea-\line \up0 \expndtw0\charscalex120 ze cazul imperatului Tiberius, care, la
auzul despre urcarea sa pe tron, nu \up0 \expndtw0\charscalex118 Si-a mai putut
inceifa o cizme. dar nici pe cealalte - de|a inceifate - nu s'-a \up0
\expndtw0\charscalex118 mai putut-o scoate, datorite venodilatafiei provocate de
acel eustress. \par\pard\ql \li945\sb109\sl-230\slmult0 \up0
\expndtw0\charscalex115 7. ECG in cursul SP \par\pard\qj \li628\ri495\sb122\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex119 Reprezinta un mijloc ideal de a
obiectiva un SP. La un subiect normal \up0 \expndtw0\charscalex122 nu se pot
evidenfia modificeri ischemice coronariene de tip vasospastic \up0
\expndtw0\charscalex118 in perioada examinaril, in timp ce bolnavii coronarieni -
care pot prezenta \up0 \expndtw0\charscalex117 crize de angor induse psihogen -
exteriorizeazS mai usor pe ECG influenfa \up0 \expndtw0\charscalex124 SP
(generatoare nu numai de vasospasm, ci si de un dezechilibru intre \up0
\expndtw0\charscalex140 consumul de oxlgen crescut de descarcarea de catecolamine
si \up0 \expndtw0\charscalex123 posibilitafile scazute ale irigafiei coronariene
afectate de boala). \par\pard\qj \li633\ri489\sb17\sl-220\slmult0\fi292 \up0
\expndtw0\charscalex131 ECG poate prezenta toate modificerile de ritm sau de
conducere \up0 \expndtw0\charscalex118 discutate anterior \up0
\expndtw0\charscalex116 (multe nefiind percepute subiectiv), dar \up0
\expndtw0\charscalex121 $i alte aspecte, \par\pard\qj \li628\ri485\sb11\sl-
232\slmult0\fi4 \up0 \expndtw0\charscalex120 diferite de acestea. Cei mai mult
intereseaze subdenivelarea segmentului \up0 \expndtw0\charscalex114 ST (cu peste 1
mm), studiate sistematic de cetre Klumbies si Kleinsorge (cit. \up0
\expndtw0\charscalex118 de 17) mai ales pnn metoda sugererii bolnavului, aflat sub
hipnoze, a unor \up0 \expndtw0\charscalex121 situafii psihotraumatizante din
biografia acestuia, unele dintre ele avand \up0 \expndtw0\charscalex117 valoare
stresanta maxima (elective, nefiind valabile si pentru alfi subiecfi). \up0
\expndtw0\charscalex126 Lapccirella a observat subdenivelarea ST la subiecfi fare
cardiopatii, \up0 \expndtw0\charscalex119 inaintea unei intervenfii chirurgicale
(cit. de Taylor 19). Interesant estecS \up0 \expndtw0\charscalex122 la acesti din
urmS bolnavi a fost surprinsS aparifia subdenivelSrii ST in \up0
\expndtw0\charscalex123 condifii exclusive de SP. bolnavii respectivi avand
rezultate normale la \up0 \expndtw0\charscalex114 proba de efort, iar studierea lor
amSnunfitS - prin metode de laborator minu\up0 \expndtw0\charscalex116 fioase.
inclusiv coronarogralii - nu a decelat un substrat organic, permifand \up0
\expndtw0\charscalex127 astfel sS se tragS concluzia naturil vasospastice
funcfionale a aeestei \up0 \expndtw0\charscalex114 modificSri a ECG, in contextul
unor modificSri minime ale funcfiei cardiace \up0 \expndtw0\charscalex114 Si
tensiunii arteriale in aceleasi condifii de stress. \par\pard\qj
\li633\ri491\sb8\sl-232\slmult0\fi297 \up0 \expndtw0\charscalex116 Desigur ca va
trebui urmarit dacS astfel de subiecti devin coronarieni cu \up0
\expndtw0\charscalex116 varsta ori daca ei au pattern individual de somatizare
(cardiace) a emotiilor \up0 \expndtw0\charscalex124 Trebuie, totusi. menfionat ce
subdenivelarea ST in cursul SP nu apare \up0 \expndtw0\charscalex123 decat la o
mica parte din subiecfii indemni de cardiopatie coronariane \up0
\expndtw0\charscalex124 Majoritatea persoanelor senetoase isi menfin si in cursul
SP traseul lor \up0 \expndtw0\charscalex115 normal de repaus. \par\pard\ql
\ul0\nosupersub\cf8\f9\fs22 IV. Boli si sindroame cardio-vasculare psihosomatice
\ul0\nosupersub\cf9\f10\fs20 / Hipertensiunea arterial a \par\pard\qj
\li671\ri491\sb55\sl-225\slmult0\fi278 \up0 \expndtw0\charscalex119 Cum printre
parametrii starii de SP se inscrie si cresterea mai mult sau \up0
\expndtw0\charscalex113 mai putin exprimate a tensiunii arteriale (TA), ca urmare a
activarti simpato\up0 \expndtw0\charscalex130 adrenale de stres, este de a$teptat
ca in decursul viefii unui Individ, \up0 \expndtw0\charscalex137 acumularea a
numeroase SP sd creeze condifii favorable pentru \up0 \expndtw0\charscalex118
aparifia hipertensiunii arteriale (HTA).
\ul0\nosupersub\cf9\f10\fs20 Psihosomatica aplicata\tab \up0 \expndtw0\charscalex56
\u8226?:\u8226?\tab \up0 \expndtw0\charscalex105 181\par\pard\qj \li1075\sb0\sl-
Existe dovezi in favoarea unui teren genetic la anumite animae, care \up0
\expndtw0\charscalex113 dezvolta usor HTA printr-o hiperactivitate vasculare fafa
de SP, dupe cum la \up0 \expndtw0\charscalex122 anumifi subiecti din populatia
umane, eel putin in momentul in care au \up0 \expndtw0\charscalex120 devenit
hipertensivi, s-a demonstrat un raspuns catecolaminic la SP mult \up0
\expndtw0\charscalex120 mai crescut decat la normotensivi. \par\pard\qj
\li1084\ri106\sb1\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex115 Actualmente.
este admis ce SP este implicat, in primul rand, in aparifia -\line \up0
\expndtw0\charscalex114 la tinerii hiperreactivi - a unei HTA juvenile
..tranzitorii" (Klumbies) s< rnai \up0 \expndtw0\charscalex131 ales a unei cresteri
tensionale disproportionate la efort \up0 \expndtw0\charscalex110 (Kulawick le
\par\pard\ql \li1084\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex113 denumeste
..labile hypertone Regulationsstorungen"). \par\pard\qj \li1084\ri102\sb2\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex119 Asemenea subiecti hiperreactivi
vasculari. studiafi la noi de Moga, au \up0 \expndtw0\charscalex114 fost incadrafi,
in \up0 \expndtw0\charscalex112 1975. de cetre o comisie de experti OMS in
categoria HTA \par\pard\ql \li1080\sb1\sl-215\slmult0 \up0 \expndtw0\charscalex118
de limite sau labile (..borderline hypertension"). \par\pard\qj
\li1084\ri105\sb5\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex114 in ultimii ani
s-a demonstrat ce 1/5 din subiecfii aparent seneto$i prezinte \up0
\expndtw0\charscalex118 o reactivitate cardio-vasculare crescute (\u8222?hot
reactors"), evidenfiabie chiar \up0 \expndtw0\charscalex120 printr-un simplu test
de calcul mental. Ei sunt mai predispusi se dezvolte \up0 \expndtw0\charscalex118
valori hipertensive in timpul difentelor SP profesionale sau familiale. Mai \up0
\expndtw0\charscalex118 tarziu, o mare parte din acesti bolnavi vor deveni
hipertensivi permanenti. \up0 \expndtw0\charscalex118 intrand in randul bolnavilor
cu HTA esenfiae. \par\pard\qj \li1084\ri103\sb9\sl-230\slmult0\fi297 \up0
\expndtw0\charscalex111 Referitor 1a interventia SP in aparifia $i evolufia HTA,
vom distinge, dupS \up0 \expndtw0\charscalex121 ce am analizat si categoriile de
bolnavi mai sus menfionate, urmStoarele \up0 \expndtw0\charscalex111 grupe:
a) Bolnavi tinerl hiperreactivi vasculari care vor dezvolta o HTA \up0
\expndtw0\charscalex121 tranzitorie juvenila cauzatS de o configurate existenflae
stresantS si care \up0 \expndtw0\charscalex118 vor putea fi chiar vindecafi odatS
cu disparifia sursei stresante ori printr-o \up0 \expndtw0\charscalex117
psihoterapie dirijatS (cuplatS sau nu cu training autogen) (cf. Klumbies ori
\up0 \expndtw0\charscalex101 Kulawick). \par\pard\qj \li1104\ri110\sb39\sl-
220\slmult0\fi273 \up0 \expndtw0\charscalex125 b) Bolnavi de peste 40-45 ani.
varsta la care apare in mod obi$nuit \up0 \expndtw0\charscalex118 HTAE. avand intre
factorii precipitant! ai debutului bolii, SP; \par\pard\qj \li1084\ri102\sb4\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex115 c) Bolnavii hipertensivi vechi (cu
HTAE sau HTA - secundarS), aflafi in \up0 \expndtw0\charscalex123 cursul evolufiei
bolii si la care SP poate produce paroxisme tensionale, \up0
\expndtw0\charscalex124 soldate sau nu cu complicatii, dintre care edemul pulmonar
acut, ca sj \up0 \expndtw0\charscalex120 accidentele vasculare cerebrae. reprezintS
situafii in care SP acfioneazS, \up0 \expndtw0\charscalex131 prin intermediul
acestor cresteri ale tensiunii arteriale. Un element \up0 \expndtw0\charscalex116
psihogen, fSrS atributele stresului psihic \up0 \expndtw0\charscalex117 (poate doar
o condifionare cu un \par\pard\ql \li1094\sb9\sl-230\slmult0\tx6024 \up0
\expndtw0\charscalex117 SP inifial) il constituie ..sindromul halatului alb'"
\tab \up0 \expndtw0\charscalex109 (Weisskittelhypertomle), \par\pard\qj
\li1089\ri103\sb8\sl-233\slmult0\fi9 \up0 \expndtw0\charscalex122 reprezentat de TA
cu ocazia controlulul medical decat cele mSsurate la \up0 \expndtw0\charscalex119
domiciliu. Buddenberg si Laederach propun ca solute procurarea de cStre \up0
\expndtw0\charscalex115 astfel de paclenfl hipertensivi a unor aparate cu baterii
pentru mssurarea TA \up0 \expndtw0\charscalex108 la domiciliu. \par\pard\qj
\li1099\ri113\sb2\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex127 in plus, HTA,
agravatS de SP, contribute e accelerarea procesului \up0 \expndtw0\charscalex114
aterosclerotic, cSt si la aparitia bolii coronariene, alStun si de ceilalfi factori
\up0 \expndtw0\charscalex114 de rise. \par\pard\ql \li1387\sb109\sl-230\slmult0
\up0 \expndtw0\charscalex121 2 Cardiopatia ischemica coronarlana \par\pard\qj
\li1104\ri118\sb62\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex121 a) in angina
pectorals (AP), legStura dintre SP si declansarea cvasisi-\line \up0
\expndtw0\charscalex119 multanS a accesulul anginos, este mult mai usor de stabilit
decSt in cazul \up0 \expndtw0\charscalex112
intarctului miocardic, unde se intSmpIS sS treacS cateva ore pSnS la aparifia
250\slmult0\fi4 \up0 \expndtw0\charscalex111 simptomelor ..de debut". In privinfa
Intervenfiei SP e debutul AP, exists studii \up0 \expndtw0\charscalex129
epidemiologice capabile sS llustreze ponderea incarcSrii stresante a \up0
\expndtw0\charscalex115 bolnavilor anginosi, in raport cu lotul martor \up0
\expndtw0\charscalex117 (subiecfi sSnStosi). Russek a \par\pard\qj
\li499\ri650\sb0\sl-260\slmult0 \up0 \expndtw0\charscalex121 stabilit existenfa
unei stSri de tensiune emofionala IntensS si prelungite. \up0
\expndtw0\charscalex123 inainte de aparifia primei crize de angor, la 91% din
cei \up0 \expndtw0\charscalex110 100 de bolnavi \par\pard\ql \li489\sb0\sl-
214\slmult0\tx2448 \up0 \expndtw0\charscalex114 coronarieni studiafi \tab \up0
\expndtw0\charscalex118 (12). SP care stS la baza acestor tulburSri acfioneaza.
datoritS ..hormonilor de stres", prin mecanisme multiple hemodlnamice, in� \up0
\expndtw0\charscalex125 cepand cu cresterea exagerata a nevoilor de oxigen
(raportate la o per\up0 \expndtw0\charscalex124 fuzie miocardica redusa prin
ateromatoza) ca si prin inducerea unei hi\up0 \expndtw0\charscalex124
percoagulabilitafi sanguine (v. tabelul 2). \par\pard\qj \li504\ri639\sb19\sl-
240\slmult0\fi278 \up0 \expndtw0\charscalex118 Totodate. existenfa unor simptome
nevrotice (depresie. iritabilitate, in\up0 \expndtw0\charscalex125 somnie.
anxietate) a fost gasita de doua ori mai frecvent la bolnavii cu \up0
\expndtw0\charscalex115 angme pectoraie decat la martori (12). \par\pard\qj
\li499\ri633\sb16\sl-246\slmult0\fi292 \up0 \expndtw0\charscalex124 Existe, de
asemenea, dovezi certe si in favoarea celuilalt mecanism \up0
\expndtw0\charscalex119 ischemiant, spasmul coronarian. observat chiar pe artere
indemne (Klein\up0 \expndtw0\charscalex114 sorge) si care - in conditiile unor
anomalii constitutionale, ca in sindromul X \up0 \expndtw-2\charscalex100
(Likotf) \up0 \expndtw0\charscalex112 - este exclusiv implicat. \par\pard\qj
\li494\ri625\sb0\sl-246\slmult0\fi297 \up0 \expndtw0\charscalex117 b) in infarctul
miocardic, rezuitatele unor studii clinice si experimentale \up0
\expndtw0\charscalex117 pledeaze, de asemenea. pentru posibilitatea participarii SP
in lavorizarea si \up0 \expndtw0\charscalex115 producerea infarctului Exemplilicam
cu cresterea incidenfei IM in profesiu-\line \up0 \expndtw0\charscalex119 nile cu
responsabilitate crescuts. frecvenfS semnificativ mai mare a IM la \up0
\expndtw0\charscalex126 lucratorii manuali supusi unor SP fafa de un lot de martori
nestresafi, \up0 \expndtw0\charscalex123 constituirea unui IM dupS SP brutae (12)
toate acestea fiind corelate cu \up0 \expndtw0\charscalex117 postbilitSfi reduse de
control decizional pe care le au bolnavii cu unele SP \up0 \expndtw0\charscalex118
profesionale ce favorizeaza aparifia IM (Siegrist). Referitor la aceste lipsa
\up0 \expndtw0\charscalex124 de control, cuplata cu proiecfia sublecfilor Tntr-o
situatie percepute ca \up0 \expndtw0\charscalex118 extrem de amenintetoare ciem un
experiment soldat cu aparifia cu o frec� \up0 \expndtw0\charscalex122 venfS de 25%
a unei necroze miocardice focale la sobolanii obligafi sa \up0
\expndtw0\charscalex116 asculte timp de 30 minute inregistrarea pe bands a
zgomotului luptei intre o \up0 \expndtw0\charscalex126 plsicS si un sobolan \up0
\expndtw0\charscalex128 (Raab) etc. S-a stabilit, totodae, cS subiecfii cu
reactivitate cardiovasculare crescute (\u8222?hot reactors ') au un rise dublu
de \up0 \expndtw0\charscalex113 recidiva a IM (3). \par\pard\qj
\li513\ri625\sb0\sl-248\slmult0\fi297 \up0 \expndtw0\charscalex114 Interventia SP
in reinfarctizare este si mai importante, in special la cei cu \up0
\expndtw0\charscalex114 tulburari de ritm restante (indeosebi extrasistole
ventriculare)(10), date fiind \up0 \expndtw0\charscalex114 instabilitatea
electronice a miocardului - mult crescuta dupe infarct (Lown) -\line \up0
\expndtw0\charscalex117 Si descercarea de catecolamine Tn cursul SP (atenuate
considerabil doar la \up0 \expndtw0\charscalex134 beta-blocante), care, de altfel,
administrate dupe infarct scad rata \up0 \expndtw0\charscalex113 reinfarctizehl.
Studiile psihologice - axate pe legatura dintre apartenenfa subiecfilor la \up0
\expndtw0\charscalex123 tipul comportamental A si mcidenfa crescuta a IM, care este
dube - au \up0 \expndtw0\charscalex117 evidenfiat un fenomen si rnai concludent:
cresterea exponentiae a inciden-\line \up0 \expndtw0\charscalex114 fei IM in cazul
asocierii tipului comportamental A (TABP) cu alfi factori de \up0
\expndtw0\charscalex112 rise (HTA, hipercolesterolemie, fumat, etc.)(Haynes). in
acelasi timp, modifi-\line \up0 \expndtw0\charscalex115 carea TABP. reglementata
intr-un program psihoterapeutic adecvat - a con-\line \up0 \expndtw0\charscalex115
tribuit la scederea semnificative a reinfarctizarii si mortalitafii la bolnavii
cu \par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart Pg186}{\bkmkend
\par\pard\qj\li830\sb0\sl-240\slmult0 \par\pard\qj\li830\ri319\sb116\sl-240\slmult0
\up0 \expndtw0\charscalex114 sechele de IM studiafi (Rahe). Se impune considerarea
ca factor de rise psi� \up0 \expndtw0\charscalex115 hic major, asocierea unor
evenimente stresante la tipul A. intrucat au existat \up0 \expndtw0\charscalex115
numeroase studii care au contestat legetura dintre comportamentul de tip A, \up0
\expndtw0\charscalex118 luat ca un ansamblu de trasaturi psihice exteriorizate in
acfiune, In ultimii \up0 \expndtw0\charscalex118 ani s-a Tncercat clivarea acestui
tip in cafiva factori componenfi de baze (A. \par\pard\qj \li830\ri298\sb0\sl-
250\slmult0 \up0 \expndtw0\charscalex123 S. H s' J) stiindu-se corelafia fiecaruia
dintre ei cu diverse circumstanfe \up0 \expndtw0\charscalex113 psihosociale, dar si
cu alfi factori de rise biologici (in special profilul lipidic) \up0
\expndtw0\charscalex113 Si comportamentall (de exemplu fumatul) de rise pentru IM.
Redam in tabelul \par\pard\ql \li830\sb1\sl-228\slmult0 \up0
\expndtw0\charscalex113 3 rezultatele obtinute si corelarea lor cu factorii
componenfi ai TAPB. \par\pard\ql \li2640\sb0\sl-230\slmult0
\par\pard\ql\li2640\sb141\sl-230\slmult0 \up0 \expndtw0\charscalex118 Tabelul 3.
Tipul pslhocomportamental A \par\pard\ql \li3662\sb1\sl-217\slmult0 \up0
\expndtw0\charscalex119 Factori
componenfi\par\pard\sect\sectd\sbknone\cols2\colno1\colw3974\colsr110\colno2\colw42
96\colsr160\ql \li1051\sb0\sl-230\slmult0 \par\pard\ql \li1065\sb19\sl-
230\slmult0 \up0 \expndtw0\charscalex123 Factori componenfi\par\pard\ql
\expndtw-9\charscalex94 A\tab \up0 \expndtw0\charscalex120 = ambifie
maxima\par\pard\qj \li1055\ri775\sb0\sl-254\slmult0\fi360\tx1391 \up0
\expndtw0\charscalex122 = nevoia de timp \line \up0 \expndtw0\charscalex105 S
\tab \up0 \expndtw0\charscalex124 = nelinlste\par\pard\ql \li1425\sb11\sl-
230\slmult0 \up0 \expndtw0\charscalex123 = nerabdare\par\pard\qj
\li1065\ri785\sb9\sl-249\slmult0\tx1425 \up0 \expndtw0\charscalex116 H** =
competitiviate \line\tab \up0 \expndtw0\charscalex123 = ostilitate:\par\pard\ql
\li1656\ri47\sb0\sl-247\slmult0\tx1790 \up0 \expndtw0\charscalex120 - cognitiva
(gandun \line\tab \up0 \expndtw0\charscalex122 dusnenoase, dispref.\par\pard\ql
\li1790\sb21\sl-230\slmult0 \up0 \expndtw0\charscalex119 superare)\par\pard\qj
\li1665\ri0\sb0\sl-249\slmult0\tx1800 \up0 \expndtw0\charscalex114 -
comportamentala (**') \line\tab \up0 \expndtw0\charscalex121 (agresivitate
verbae\par\pard\ql \li1795\sb12\sl-230\slmult0 \up0 \expndtw0\charscalex116 sau
fizice)\par\pard\ql \li1372\sb0\sl-252\slmult0 \par\pard\ql \li1372\sb0\sl-
252\slmult0 \par\pard\ql \li1372\ri32\sb236\sl-252\slmult0\fi4\tx1569 \up0
\expndtw0\charscalex123 = implicare profesionala \line \tab \up0
\expndtw0\charscalex113 majors (..workaholic") \line \up0 \expndtw0\charscalex123 =
modul de indeplinire a\par\pard\ql \li1569\sb17\sl-230\slmult0 \up0
\expndtw0\charscalex125 sarcinilor\par\pard\ql \li988\sb0\sl-230\slmult0
Observafii:\par\pard\column \qj \li457\ri771\sb238\sl-249\slmult0\tx698 \up0
\expndtw0\charscalex125 Elemente de rise demonstrate \line \tab \up0
\expndtw0\charscalex126 pentru boala coronariana\par\pard\qj \li20\ri493\sb102\sl-
254\slmult0\fi9 \up0 \expndtw0\charscalex119 Rise mai scSzut pentru boae (in raport
\up0 \expndtw0\charscalex115 cu factorii H si J)\par\pard\qj \li25\ri456\sb1\sl-
249\slmult0\fi4 \up0 \expndtw0\charscalex113 Dintre bolnavii asimptiomatici (clinic
si \line \up0 \expndtw0\charscalex116 EKG). majoritatea posedS acesti
factori\par\pard\ql \li4084\sb0\sl-254\slmult0
\par\pard\ql \li20\ri423\sb237\sl-254\slmult0 \up0 \expndtw0\charscalex114
Asociere cu Interiorizarea supSrSrii \line \up0 \expndtw0\charscalex116 (..anger-
in"): crese riscul coronarian (5)\par\pard\ql \li20\ri518\sb245\sl-249\slmult0 \up0
\expndtw0\charscalex116 Acte agresive verbale"** sau motorii \line \up0
\expndtw0\charscalex117 ample sau prelungite = factor major de\par\pard\qj
\li35\ri418\sb0\sl-247\slmult0 \up0 \expndtw0\charscalex114 rise coronarian maxim
sub 50 de ani (7), \up0 \expndtw0\charscalex113 inclusiv pentru aritmii grave
(4).\par\pard\qj \li30\ri398\sb8\sl-247\slmult0 \up0 \expndtw0\charscalex116
Asocierea cu fumatul. scSderea funcfiei \line \up0 \expndtw0\charscalex111
pulmonare \up0 \expndtw-1\charscalex100 (7, \up0 \expndtw0\charscalex126 8),
consum crescut de \line \up0 \expndtw0\charscalex115 alcool si efort excesiv la
locul de muncS\par\pard\ql \li30\ri402\sb0\sl-248\slmult0\fi4 \up0
\expndtw0\charscalex114 (7) - maximizeazS riscul coronarian. \line \up0
\expndtw0\charscalex117 AsociatS cu depresia. reprezintS un rise \up0
\expndtw0\charscalex110 major (4)\par\pard\ql \li44\sb26\sl-230\slmult0 \up0
\expndtw0\charscalex116 \u8226? cu dificultate - rise crescut\par\pard\ql
\li49\sb15\sl-230\slmult0 \up0 \expndtw0\charscalex114 - cu usurinfS - rise
minim \par\pard\sect\sectd\sbknone \ql \li1008\sb110\sl-230\slmult0 \up0
\expndtw0\charscalex114 ' Autorii citafi in tabel sunt indicafi in anexa
bibliografiei tabe/elor. \par\pard\ql \li1008\sb10\sl-230\slmult0\tx6412 \up0
\expndtw0\charscalex119 " = ..nucleul toxic" at tipului pslhocomportamental A
\tab \up0 \expndtw0\charscalex115 - sindromul AHA \par\pard\ql \li1444\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex114 (ostilitate, agresivitate, iritabilitate)
+ presiunea timputui (6) \par\pard\qj \li1012\ri250\sb2\sl-240\slmult0\tx1440
\up0 \expndtw0\charscalex115 '"= Agresivitatea este un factor precipitant frecvent
al IMA, acfionand prin \line\tab \up0 \expndtw0\charscalex115 urmatoarele
mecanisme: activare simpaticd si efecte catecolaminice
240\slmult0\fi9 \up0 \expndtw0\charscalex117 ample (cresterea frecvenfei cardiace
si a tensiunii arteriale), scaderea \up0 \expndtw0\charscalex130 perfuziei
miocardice si nivel ridicat de instabilitate eiectricd \up0
\expndtw0\charscalex112 miocardicd (7) \par\pard\qj \li993\ri514\sb20\sl-
240\slmult0 \up0 \expndtw0\charscalex119 = Exteriorizarea unor stdri afective
negative (inclusiv a agresivilafii). \up0 \expndtw0\charscalex126 non violenta si
de scurtd duratd (afecte ..meteortce"). pare sd se \up0 \expndtw0\charscalex115
coreleze, din contra, cu un efect protector fafa de boald. \par\pard\qj
\li1180\ri514\sb0\sl-246\slmult0\fi28 \up0 \expndtw0\charscalex113 Tipul
psihocomportamental A reprezinta in ansamblu, \u8222?un comporta� \up0
\expndtw0\charscalex117 ment inc/inat sa streseze individul prin intrezdrirea
ameninfdrii acolo \up0 \expndtw0\charscalex116 unde tipul B nu o vede. si prin
racordarea (prin determinism genetic) \up0 \expndtw0\charscalex117 a mecanismelor
psihofiziologice la reactii organice exagerate" (2). \par\pard\qj
\li1248\ri517\sb0\sl-240\slmult0\fi28 \up0 \expndtw0\charscalex124 Tipul
psihocomportamental A reprezinta de fapt, un \up0
\expndtw0\charscalex124 comportament cu un caracter de factor de rise si pentru
alte boli \up0 \expndtw0\charscalex125 somatice. in afara infarctului miocardic (1,
3). \par\pard\qj \li604\sb0\sl-240\slmult0 \par\pard\qj\li604\sb0\sl-240\slmult0
\par\pard\qj\li604\ri529\sb35\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex123 c)
Moartea subita. Desi se cunosc cazuri de moarte subits, verificate \up0
\expndtw0\charscalex122 necroptic, Tn reproducerea carora a putut fi mcriminat un
SP violent, in \up0 \expndtw0\charscalex117 absenfa unor leziuni coronariene
(Klumbies) - eel mai adesea moartea su� \up0 \expndtw0\charscalex117 bita sub
efectul SP survine la un bolnav coronarian. \par\pard\qj \li595\ri523\sb19\sl-
242\slmult0\fi302 \up0 \expndtw0\charscalex115 Dintre numeroasele dovezi ale
relafiei dintre SP si moartea subits - unele \up0 \expndtw0\charscalex116 chiar
lurnizate de simpla anecdoticS a unor decese survenite e comunicarea \up0
\expndtw0\charscalex114 unor ve$ti tragice sau, paradoxal, in momentul unei bucurii
violente - merits \up0 \expndtw0\charscalex112 amintit studiul efectuat de Myers s'
Dewar (12) care au analizat necroptic 100 \up0 \expndtw0\charscalex115 de bolnavi
cu cardiopatie ischemicS, decedafi prin moarte subits. Autorii au \up0
\expndtw0\charscalex122 stabilit ca la \up0 \expndtw0\charscalex129 23% din acest
lot a survenit un SP cu 30 min inainte de \up0 \expndtw0\charscalex124 moartea
subita, iar la 40% un SP a fost inregistrat in cursul a 24 de ore \up0
\expndtw0\charscalex119 anterioare; deci, un total de 63%. la care legStura cu SP
poate fi apreciats \up0 \expndtw0\charscalex119 ca foarte probabie. \par\pard\ql
\li897\sb168\sl-230\slmult0 \up0 \expndtw0\charscalex118 3. Hipotensiunea arterial*
prlmara (esenfiata) \par\pard\qj \li609\ri513\sb174\sl-250\slmult0\fi288 \up0
\expndtw0\charscalex118 Pentru mulfi autori. hipotensiunea arteriala esenfiae
(hTAE) apare ca o \up0 \expndtw0\charscalex117 boae temporare cu statut de
veritabie nevroze. in care rolul stresului psihic \up0 \expndtw0\charscalex117 in
aparifia si evolufia ei este de necontestat (v si lamandescu 1991). \par\pard\qj
\li614\ri514\sb0\sl-242\slmult0\fi292 \up0 \expndtw0\charscalex117 Legetura dintre
hTAE s* SP este sugerata de caracterul de ..sindrom" al \up0
\expndtw0\charscalex116 afecfiunii in cadrul cereia TA scezue sub limitele a 100 mm
Hg pentru ten-\line \up0 \expndtw0\charscalex118 siunea sistolicS si 60 mm Hg
pentru cea diastolica, este asociata cu o serie \up0 \expndtw0\charscalex124 de
alte simptome cu substrat psihopatologic: fatigabilitate, astenie. ce-\line \up0
\expndtw0\charscalex115 falee, vertij. irascibilitate, transpirafii. labilitate
afectivS etc., fapt ce a fScut \up0 \expndtw0\charscalex116 pe unii autori sS
vorbeascS mai degrabS de un \u8222?sindrom al hlpotensivului" \up0
\expndtw0\charscalex116 (Gamier) Simptomele nevrotice menfionate nu sunt insS
legate de hipoten-\line \up0 \expndtw0\charscalex111 siune, ele persistand si in
cazul normalizerii temporare a valorilor TA prin di� \up0 \expndtw0\charscalex119
ferite preparate medicamentoase. hTAE apare deci ca un simptom - ca si \up0
\expndtw0\charscalex130 celelalte acuze subiective. dominate de astenie si
fatigabilitate \up0 \expndtw0\charscalex127 - in \par\pard\qj \li628\ri519\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex121 cadrul unei veritabie nevroze Pe acest
fond apar adesea si stari lipotimi\up0 \expndtw0\charscalex121 ce induse. de regue,
de SP. \par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart Pg188}{\bkmkend
245\slmult0\fi287 \up0 \expndtw0\charscalex117 Un alt argument care pledeaze pentru
aceasta conceptie este si faptul ce \up0 \expndtw0\charscalex124 hTAE se poate
uneori vindeca la fel ca orice nevroza. prin remedierea \up0
\expndtw0\charscalex115 unui context socio-familial psihotraumatizant. ca si prin
utilizarea unor me\up0 \expndtw0\charscalex116 tode de tratament specifice
afecfiunilor psihogene (psihoterapia centrate pe \up0 \expndtw0\charscalex116
situafia conflictuala majore, asociate cu training autogen, dupe cum susfine
\up0 \expndtw0\charscalex115 Gamier). De altfel. se considere cS hTAE nu respunde
semnificatlv la o far\up0 \expndtw0\charscalex115 macoterapie prelungite corectoare
a valorilor scezute ale TA, rezultate mult \up0 \expndtw0\charscalex121 mai bune
fiind obfinute prin diets, fizioterapie si schimbarea modului de \up0
\expndtw0\charscalex121 viafa cu accent pe identificarea si anihilarea surselor de
stres. \par\pard\ql \li1161\sb208\sl-230\slmult0 \up0 \expndtw0\charscalex114 4.
Astenla neurocircutatorie (ANC) \par\pard\qj \li864\ri269\sb154\sl-
250\slmult0\fi297 \up0 \expndtw0\charscalex116 DaCosta a descris In 1871 sub numele
de \u8222?Cord IritabU" sau ..Sindrom \up0 \expndtw0\charscalex118 de efort" un
sindrom functional neuro-cardlo-vascular, cu o serie de denu\up0
\expndtw0\charscalex115 miri ulterioare (astenie neuro-circulatorie, ..Herzneurose"
etc.) s* alcatuit in \up0 \expndtw0\charscalex130 majoritate din simptome
subiective dominate de palpitafii si dureri \up0 \expndtw0\charscalex123
precordiale - fare un substrat organic. \par\pard\qj \li868\ri274\sb0\sl-
250\slmult0\fi292 \up0 \expndtw0\charscalex113 in privinta confinutului simptomatic
al sindromului, este de subliniat frec\up0 \expndtw0\charscalex116 venfa cea mai
crescute (la peste 70% din bolnavi) a dispneii (78%), amefe\up0
\expndtw0\charscalex113 lilor \up0 \expndtw0\charscalex112 (78%) s< cefaleei (72%).
Simptomele subiective cardiovasculare si respiratoril sunt prezente. de \up0
\expndtw0\charscalex119 regue. concomltent. \par\pard\qj \li868\ri260\sb5\sl-
246\slmult0\fi297 \up0 \expndtw0\charscalex117 Dispneea imbraca. in general, doue
aspecte: apare e eforturi minime (in \up0 \expndtw0\charscalex125 contrast cu
starea normale a aparatului respirator si cardiovascular) si. \up0
\expndtw0\charscalex121 este prezente si in repaus sub forme, fie de jene la
inspirul profund (ca o \up0 \expndtw0\charscalex120 senzafie de umplere msuficiente
a plSmanilor), fie de suspin \up0 \expndtw0\charscalex116 (oftat) care \par\pard\ql
\li878\sb8\sl-230\slmult0 \up0 \expndtw0\charscalex114 apare din cand in cand.
usurSnd bolnavul. \par\pard\qj \li873\ri266\sb57\sl-246\slmult0\fi292 \up0
\expndtw0\charscalex117 Durerile precordiale sunt descrise ca JulgerSturi",
InfepSturi localizate. \up0 \expndtw0\charscalex116 iar palpitafiile sunt descrise
ca ..falfSituri". intreruperi, bubuituri in dreptul \up0 \expndtw0\charscalex115
inimu Substratul durerilor nu este coronarian, el putand fi un spasm dureros
\up0 \expndtw0\charscalex115 al muschilor intercostali (Simon). \par\pard\qj
\li888\ri249\sb59\sl-240\slmult0\fi273 \up0 \expndtw0\charscalex129 Contextul
etiologie al ANC este diminuat de multitudinea sau de \up0 \expndtw0\charscalex122
magnitudinea stresurilor psihice suferite de bolnavi \up0 \expndtw0\charscalex114
(predominS. totusi, \par\pard\qj \li883\ri254\sb12\sl-250\slmult0\fi4 \up0
\expndtw0\charscalex118 sexul feminm). DupS Kolb, acest sindrom poate sa constituie
exprimarea \up0 \expndtw0\charscalex127 unor emofii, prin intermediul aparatului
cardiovascular, la o serie de \up0 \expndtw0\charscalex128 persoane dependente si
imature. \par\pard\qj \li883\ri260\sb55\sl-245\slmult0\fi278 \up0
\expndtw0\charscalex115 Tratamentul ANC trebuie sS fie axat pe o psihoterapie
minufios aplicats, \up0 \expndtw0\charscalex115 bolnavul trebuind sa fie convins cS
nu este vorba de o afectare cardio-respi-\line \up0 \expndtw0\charscalex123
ratorie, dar fara a se nega boala si insistandu-se asupra condifillor etio-\line
\up0 \expndtw0\charscalex121 logice psihogene, toxice. abuz de excitante $i asupra
unor tulburari vis� \up0 \expndtw0\charscalex118 cerate mai mult sau mai putin
favorizante O astfel de conduite are rnerltul \up0 \expndtw0\charscalex118 de a
pestra increderea bolnavului in medic si de a-l feri de un dezechihbru \up0
\expndtw0\charscalex117 psihic sporit de sentimentul neanfelegerii suferinfelor
sale care sunt, totusi \up0 \expndtw0\charscalex117 reale. De asemenea, un rol
psihoterapeutic il are si invocarea studiilor deja \up0 \expndtw0\charscalex111
mentionate ce au arStat cS ANC nu conduce, pe viitor, la imbStrSnlrea inimil
\expndtw0\charscalex106 \ul0\nosupersub\cf18\f19\fs20\ul �\ul0\tab \up0
\up0 \expndtw0\charscalex118 5. Sindromul hiperkinetic cardiac primitlv (idiopatic)
Sindromul hiperkinetic cardiac primitiv (SHCP) sau idiopatic constituie o \up0
\expndtw0\charscalex122 stare cardio-circulatone caractenzatS printr-o reactivitate
cardiacs, mani-\line \up0 \expndtw0\charscalex126 festata prin cresterea
inotropismului \up0 \expndtw0\charscalex113 (Gorlin si Frohlich si col.) \up0
\expndtw0\charscalex111 $i a frec� \par\pard\qj \li460\ri688\sb2\sl-240\slmult0
\up0 \expndtw0\charscalex128 venfei cardiace (ambele generatoare de palpitafii) s'
prin prezenfa an\up0 \expndtw0\charscalex117 xietafii \up0 \expndtw-3\charscalex100
(13). \par\pard\ql \li763\sb9\sl-230\slmult0\tx6167 \up0 \expndtw0\charscalex137
Intrucat acest sindrom apare si in alte afectiuni \tab \up0 \expndtw0\charscalex117
(hipertiroidism, \par\pard\qj \li460\ri677\sb19\sl-220\slmult0 \up0
\expndtw0\charscalex117 miocardiopatia obstructivS prin stenozS subaortica.
sindromul DaCosta). in \up0 \expndtw0\charscalex128 patogenia sa a fost invocae o
hipersensibilitate \up0 \expndtw0\charscalex124 (reactivitate excesive)
primara a betareceptorilor cardiaci la actiunea catecolaminelor (13). Fa� \up0
\expndtw0\charscalex122 te de aceaste explicate patogenice a SCHP s-ar putea emite
ipoteza ce, in \up0 \expndtw0\charscalex116 raport cu el. sindromul DaCosta ar
surveni pe un teren mai complex, capabil \up0 \expndtw0\charscalex123 sa furnizeze
un exces de catecolamine cu punct de plecare atat la nivelul \up0
\expndtw0\charscalex119 scoarfei s1 centrilor subcorticali. cat si al terminatiilor
simpatice care iner\up0 \expndtw0\charscalex122 veaze cordul si vasele. Referitor
ia prognosticul sindromulul hiperkinetic \up0 \expndtw0\charscalex123 cardiac
primitiv este interesant de semnalat cercetarea efectuate de cetre \up0
\expndtw0\charscalex117 Guazzi si Fiorentini, care au urmerit ECG si
echocardiografia subiectilor cu \up0 \expndtw0\charscalex116 un astfel de sindrom,
in scopul verificarii Ipotezei conform cSreia o hiperac\up0 \expndtw0\charscalex125
tivitate cardiacs ar putea sS genereze, in timp. o hipertrofie cardiacs, in \up0
\expndtw0\charscalex116 decursul a 3 ani. cat a dural studiul. bolnavii nu si-au
modiflcat dimensiunile \up0 \expndtw0\charscalex116 (apreciate echografic) septului
interventricular $i nici ale peretelui posterior, \up0 \expndtw0\charscalex116 in
ciuda unei hipercontractilltSfi persistente. \par\pard\qj \li460\ri668\sb10\sl-
230\slmult0\fi297 \up0 \expndtw0\charscalex123 Importanta diagnosticSril precise a
SHCP pentru practician rezidS In \up0 \expndtw0\charscalex125 aceea cS el poate
Interveni, mai activ ca pans in prezent. In reabilitarea \up0
\expndtw0\charscalex126 acestor bolnavi, apelSnd intr-o prime faza la o medicafie
betablocanta \up0 \expndtw0\charscalex126 care inlatura prompt, atat simptomele
cardiovasculare, cat s' anxietatea \up0 \expndtw0\charscalex116 (altfel. ambele s-
ar potenfa reciproc), permifand bolnavului o viafa normale \par\pard\qj
\li470\ri663\sb8\sl-233\slmult0\fi292 \up0 \expndtw0\charscalex119 intr-o a doua
etape. considerem cS accentul trebuie pus pe o psihotera� \up0
\expndtw0\charscalex121 pie (centratS pe o terapie comportamentale anti-stres)
corelate $i cu ape� \up0 \expndtw0\charscalex125 lul e mijloace fizice de
recuperare (cultura fizice medicae, agentii flzicl \up0 \expndtw0\charscalex117
influenfand reactivitatea neurovegetative, si cea vasomotone in special etc.)
\up0 \expndtw0\charscalex123 spre a se putea inlatura dependenfa bolnavilor de o
medicare, este drept. \up0 \expndtw0\charscalex122 valoroasS, dar capabilS sS
genereze si efecte secundare. adesea destul de \up0 \expndtw0\charscalex122
serioase \par\pard\ql \li777\sb170\sl-230\slmult0 \up0 \expndtw0\charscalex112 6.
Sindromul X (Likoff) \par\pard\ql \li763\sb170\sl-230\slmult0\tx6283\tx7027 \up0
\expndtw0\charscalex123 Sindromul descris de Likoff apare la bolnavi in jur de \tab
\up0 \expndtw0\charscalex120 45 ani \tab \up0 \expndtw0\charscalex127 $i este
caracterizat prin coexistenfa unor tulburari nevrotice \tab \up0
\expndtw0\charscalex130 (dominate de \par\pard\ql \li489\sb1\sl-
217\slmult0\tx5841 \up0 \expndtw0\charscalex128 anxietate) cu aparifia unor dureri
anginoase tipice \tab \up0 \expndtw0\charscalex122 (ca sediu, iradiere.
circumstanfa de aparifie, reductibilitatea pnn efort cicloergometric si \up0
\expndtw0\charscalex120 expresie electrocardiografice). in absenfa oricarui tip de
alterare morfolo\up0 \expndtw0\charscalex120 gica coronariana. Ca mecanism
patogenic, In acesl sindrom se presupune \up0 \expndtw0\charscalex126 o limitare
.criptogenetica" a capacitSfii de dilatare a arterelor coronare \up0
\expndtw0\charscalex114 (Kubler) astfel IncSt - la testul dilatator cu Dipiridamol
- bolnavii cu sindrom \up0 \expndtw0\charscalex118 X InregistreazS o crestere a
debitului coronarian de repaus de numai 200% \up0 \expndtw0\charscalex112 fafa de
400% 1a subiectii normali (13)
240\slmult0\fi287 \up0 \expndtw0\charscalex121 Desi efortul lizic releveazS aceste
limite. rSspunzStoare de ischemia \up0 \expndtw0\charscalex115 reiativS care
genereazS dureri anginoase, in sindromul X factorul declansa\up0
\expndtw0\charscalex112 tor al tulburarilor este predominant psihogen. Bolnavii au
o serie de tulburSri \up0 \expndtw0\charscalex115 nevrotice (anxietate si astenie)
consecutive unor stresuri generate de factori \up0 \expndtw0\charscalex117 psiho-
sociali si inductoare In plan somatic, ale unei hiperventilafii cronice \up0
\expndtw0\charscalex120 (legate in special de anxietate) si prin aceasta a unor
spasme coronariene \up0 \expndtw0\charscalex120 (Evans cit. de lamandescu 8b).
Caracterul psihogen al sulenntelor acestor bolnavi este argumentat s> de \up0
\expndtw0\charscalex126 disparifia durerilor anginoase printr-o psihoterapie
capabila sS supn \up0 \expndtw0\charscalex118 me hiperpneea cronica ,.de stres"
Prognosticul este bun in 50-70% cazuri, \up0 \expndtw0\charscalex116 inregistrandu-
se
disparifia simptomelor, spontanS sau sub psihoterapie (pa-\line \up0
\expndtw0\charscalex114 sager rSspunde si la perhexilinS, nu s> 'a nitnfi). Existe
inse si cazuri la care \up0 \expndtw0\charscalex114 apare un IM. cu declansarea tot
prin spasm coronarian (Kaindl si Zllcher). \par\pard\ql \li1108\sb165\sl-
230\slmult0 \up0 \expndtw0\charscalex118 7. Tulburari psihosomatice $i
psihopatologlce la cardiacii operafi \par\pard\ql \li1089\sb190\sl-
230\slmult0\tx3292 \up0 \expndtw0\charscalex113 Kammerer aprecia (in \tab \up0
\expndtw0\charscalex119 1985) cS e 40% din bolnavii operati pe cord, in
condifiile insiituirii temporare a circulafiei extracorporale , apar marcate
tul� \up0 \expndtw0\charscalex113 burari psihopatogenice. \par\pard\qj
\li796\ri342\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex109 AdaugSnd
intervenfnle chirurgicale pe coronare, tot mai frecvent utilizate In \up0
\expndtw0\charscalex114 prezent, se contureaza o categorie de bolnavi cardiaci
supusi unui greu exa� \up0 \expndtw0\charscalex120 men emofional. data fiind
perspectiva decesului, a comphcafillor sau ne \up0 \expndtw0\charscalex119
reusitelor operatorn. in plus, stresui fizic operator diminueaza capacitatea
\up0 \expndtw0\charscalex113 psihicului acestor bolnavi de a face fafS chiar unor
stresuri psihice minore \par\pard\qj \li791\ri337\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex123 S-a constatat cS, pe langS simptomele psihosomatice ca:
tahicardia. \up0 \expndtw0\charscalex121 extrasistole, cresterea valorilor
tensionale, emofionale etc. prezente, mai \up0 \expndtw0\charscalex118 ales
preoperator apar si o serie de simptome psihice (recul somato-psihic) \up0
\expndtw0\charscalex127 dupS efectuarea intervenfiei chirurgicale. Astfel:
cefaleea, amefelile, \up0 \expndtw0\charscalex119 anxietatea. amnezia.
dezorientarea si chiar depresia, ca simptome izolate, \up0 \expndtw0\charscalex132
pot fi reversibile dupS reusita operafiei dar veritabileie sindroame \up0
\expndtw0\charscalex123 psihopatologice \up0 \expndtw0\charscalex136 (s paranoid
halucinator sau s. afectiv \up0 \expndtw0\charscalex114 - emofional,
\par\pard\ql \li801\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex116 dominat de
anxietate si depresie) ce necesita intervenfia psihiatrului \par\pard\qj
\li811\ri326\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex113 Important apare
faptul cS aparifia tulburarilor psihopatologice menfionate \up0
\expndtw0\charscalex122 poate fi prezise \up0 \expndtw0\charscalex119 (10) pe baza
unor investigafii psihologice preoperatorii. \par\pard\qj \li796\ri343\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex123 Astfel, prezinta un rise crescut
persoanole cu o structura psihica rlgida, \up0 \expndtw0\charscalex121 cu un nivel
crescut al anxictafii si cu probleme familiale si profesionale \up0
\expndtw0\charscalex120 De asemenea bolnavii anxiosi. preocupati excesiv de boala.
prezintS mai \up0 \expndtw0\charscalex113 frecvent aritmii ventnculare
postoperatorii. \par\pard\ql \li1104\sb171\sl-230\slmult0 \up0
\expndtw0\charscalex118 8. Sindromul psihic al purtatorului de pacemaker
Un capitol mai recent in psihomatica bolilor cardio-vasculare il constituie \up0
\expndtw0\charscalex118 eel consacrat purtetorilor de pace-maker (PM). Spre
deosebire de bolnavii \up0 \expndtw0\charscalex115 cu operafn pe cord, pentru care
stresui maxim il reprezinte operalia propriu \up0 \expndtw0\charscalex118 zisa.
puretorii de PM. incep o perioade noua In viafa lor, aceea de acomo-\line \up0
\expndtw0\charscalex127 dare cu un \u8222?nou organ" sau .,corp strain" Apar
fireste. sentimente de \up0 \expndtw0\charscalex123 teama. neliniste S' chiar o
usoara depresie psihica legate de perspectiva
\expndtw0\charscalex103 \u8226?>\tab \up0 \expndtw0\charscalex103 Elemente de
260\slmult0 \up0 \expndtw0\charscalex114 unei bune funcfionSri a dispozitivului,
mai ales la bolnavii instruifi superfi� \up0 \expndtw0\charscalex104 cial!.
funcfie de terenul psihic, exists la o parte din bolnavi o \up0
\expndtw0\charscalex116 simptomatologie psihopatologicS patents cu elemente fobice,
desemnats de \up0 \expndtw0\charscalex119 Schneeman ..simptomatologie
cardiofobicS". in cadrul acesteia se situea\up0 \expndtw0\charscalex119 ze pe prim
plan fobia revenirii ritmului bradicardic sau chiar a opririi ini\up0
\expndtw0\charscalex112 mii. Alfi bolnavi, ignore in aparenfe situafia lor de
purtatori de PM, dovedind \up0 \expndtw0\charscalex118 intrarea in funcfiune a unor
mecanisme inconstiente de aperare a Eu-lui In \up0 \expndtw0\charscalex118
contextul existenfei unei mari anxietafi (Payk). \par\pard\qj \li566\ri536\sb0\sl-
245\slmult0\fi302 \up0 \expndtw0\charscalex118 Datele psihodiagnostice mentionate
sugereaza medicului practician un \up0 \expndtw0\charscalex116 complex de masun
protilactice privind Instruirea atenta si amanunfitS lega-\line \up0
\expndtw0\charscalex120 ta de aspectele tehnice ale PM, precum $i mSsurile
psihoterapeutice (in� \up0 \expndtw0\charscalex116 clusiv mijloace
psihofarmacologice) legate in special de combaterea anxie-\line \up0 \expndtw-
7\charscalex100 tSfii \par\pard\qj \li864\sb0\sl-300\slmult0
V. Principii de abordare psihoterapeutica si \line\tab \up0 \expndtw0\charscalex131
psihofarmacologica a bolnavilor cardiaci \par\pard\ql \li868\sb0\sl-230\slmult0
\par\pard\ql\li868\sb128\sl-230\slmult0 \up0 \expndtw0\charscalex118 A. Principii
de abordare psihosomatica a bolnavilor cardiovascular! \par\pard\qj
\li571\ri537\sb177\sl-246\slmult0\fi302 \up0 \expndtw0\charscalex115 Dimensiunea
psihologicS a actului medical - implicand si obligativitatea \up0
\expndtw0\charscalex112 unei relafii interpersonale pe multiple planuri cu bolnavul
- variazS In funcfie \up0 \expndtw0\charscalex129 de ecuafia personae a medicului.
in cardiologie - mai mult ca in alte \up0 \expndtw0\charscalex116 specialitafi
medicale - perspectiva invaliditSfii sau chiar al morfii confers o \up0
\expndtw0\charscalex141 gravitate suplimentarS relafiei dinlre medic si pacient,
creSnd \up0 \expndtw0\charscalex122 responsabilitSfi sporite primului si accentuand
celui din urma gradul de \up0 \expndtw0\charscalex115 dependenfa $i de regresie
comportamentalS \par\pard\qj \li575\ri549\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex112 O importantS deosebita cu impact asupra prognosticului IMA
il reprezintS \up0 \expndtw0\charscalex115 solicitarea precoce a ajutorului medical
la debutul IMA. dependents si ea de \up0 \expndtw0\charscalex115 o serie de factori
psihologici (vezi tabelul 4). \par\pard\qj \li580\ri558\sb0\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex115 La primul contact dintre medic si bolnav, in cazul
urgenfelor cardio-vas-\line \up0 \expndtw0\charscalex124 culare. abordarea imediatS
exclusiv medicala (. tehnicista \up0 \expndtw0\charscalex122 ) cu un su�
\par\pard\qj \li575\ri553\sb0\sl-245\slmult0\fi4 \up0 \expndtw0\charscalex126 port
psihologhic schifat dar pregnant obligS e o prelucrare \u8222?in bloc" a \up0
\expndtw0\charscalex114 bolnavului (deci si a intregului sau cortegiu emofional
dominat de anxietate) \up0 \expndtw0\charscalex120 de cStre medic, care trebuie sS
fie si un bun psiholog. dacS nu doreste sS \up0 \expndtw0\charscalex121 agraveze
starea si a$a precarS, a bolnavului, prin veritabie gafe de ordin \up0
\expndtw0\charscalex114 verbal sau comportamental. \par\pard\qj
\li590\ri548\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex134 OdatS depasit
momentul urgenfei. medicul trebuie sa treaca la \up0 \expndtw0\charscalex126
adaptarea la personalitatea bolnavului \up0 \expndtw0\charscalex114 $i vizSnd
urmStoarele obiective: \par\pard\qj \li595\ri553\sb15\sl-240\slmult0 \up0
\expndtw0\charscalex124 acomodarea psihicS a acestuia la exigenfele de ordin fizic,
socio-fami-\line \up0 \expndtw0\charscalex122 lial si/sau profesional impuse de
boala (la cardiaci ele sunt adesea inco\up0 \expndtw0\charscalex120 mode!) si
crearea unei atitudini optimiste, dar responsabile, fafa de pers\up0
\expndtw0\charscalex114 pectivele evolutive si de inserfia socio-profesionalS,
uneori chiar familiala a \up0 \expndtw0\charscalex106 bolnavului
\up0 \expndtw0\charscalex112 \u9830? 189\par\pard\li1195\sb0\sl-
230\slmult0\fi432 \up0 \expndtw0\charscalex123 Tabelul 4. Factori de ordin
demograflc si pslhosocial Implicafl\par\pard\li1195\sb1\sl-230\slmult0\fi595
\up0 \expndtw0\charscalex123 in solicltarea precoce a ajutorulul medical la debutul
IM\par\pard\li1195\sb1\sl-219\slmult0\fi1415 \up0 \expndtw0\charscalex123 (dupa
reterinfele 54, 55 din
bibliografie)\par\pard\sect\sectd\sbknone\cols2\colno1\colw4640\colsr160\colno2\col
w3580\colsr160\ql \li1200\sb208\sl-230\slmult0 \up0 \expndtw0\charscalex103
\ul0\nosupersub\cf18\f19\fs20\ul DEMOGRAFICI/SITUATIONALI\par\pard\ql
/. varsta ridicatd;\par\pard\ql \li1195\sb6\sl-230\slmult0 \up0
\expndtw0\charscalex116 2. cdsdtorit(a);\par\pard\ql \li1195\ri560\sb5\sl-
230\slmult0\tx1396 \up0 \expndtw0\charscalex119 3. simptomele apar in atara
\line\tab \up0 \expndtw0\charscalex116 loculut de muncd si in lipsa\par\pard\ql
\li1396\sb5\sl-230\slmult0 \up0 \expndtw0\charscalex115 activitatii
fizice;\par\pard\ql \li1204\sb1\sl-230\slmult0 \up0 \expndtw0\charscalex118 4.
suport social bun;\par\pard\qj \li1200\ri302\sb15\sl-225\slmult0\tx1468 \up0
\expndtw0\charscalex118 5. prezenfa attor persoane in jur \line\tab \up0
\expndtw0\charscalex113 (inclusiv sof/sofie):\par\pard\ql \li1204\sb7\sl-
230\slmult0 \up0 \expndtw0\charscalex120 6. educafie sanitard\par\pard\column
\qj \li67\ri1499\sb193\sl-244\slmult0\fi628 \up0 \expndtw0\charscalex104
PSIHOLOGICI \up0 \expndtw-9\charscalex70 1. \up0 \expndtw0\charscalex117 atenfia
marita\par\pard\ql \li29\sb1\sl-228\slmult0 \up0 \expndtw0\charscalex117 2 accepta
dificultafi personate;\par\pard\ql \li20\sb6\sl-230\slmult0 \up0
\expndtw0\charscalex120 3. nu se resemneazd usor;\par\pard\ql \li4809\sb0\sl-
230\slmult0 \up0 \expndtw0\charscalex116 4. control intern crescut;\par\pard\ql
\li29\sb5\sl-230\slmult0 \up0 \expndtw0\charscalex116 5. anxietate extremd
insofind\par\pard\ql \li221\sb0\sl-230\slmult0 \up0 \expndtw0\charscalex113
simptomele;\par\pard\qj \li29\ri252\sb0\sl-237\slmult0\tx279 \up0
\expndtw0\charscalex131 6. raspuns endorfinic scdzut la \line \tab \up0
\expndtw0\charscalex122 stres \par\pard\sect\sectd\sbknone \qj \li1041\sb0\sl-
\expndtw0\charscalex130 In indephnirea acestor obiective. medicul pune in joe
cunostinfe \up0 \expndtw0\charscalex121 psihologice si psihiatrice a cSror insusire
anterioarS variazS sulicient de \up0 \expndtw0\charscalex123 mult pentru a putea
explica marile diferenfe dintre cardiologi. internisti \up0 \expndtw0\charscalex130
sau omnipracticieni privind implicarea lor in probleme psihologice \up0
\expndtw0\charscalex116 adiacente (uneori cu rol cauzal) suterinfei bolnavului (un
studiu nepublicat, \up0 \expndtw0\charscalex118 impreunS cu H. Nicolae llicea si
Popa-Velea, releve o mai mare implicare \up0 \expndtw0\charscalex118 psihologice a
medicilor primari generalisti). \par\pard\li1051\sb0\sl-
230\slmult0\fi278\tx5769\tx6979 \up0 \expndtw0\charscalex118 Atunci cand exists
posibilitatea unei munci\tab \up0 \expndtw0\charscalex118 \u8222?in echipS"\tab
\up0 \expndtw0\charscalex118 (presupunand\par\pard\li1051\sb14\sl-
230\slmult0\fi0 \up0 \expndtw0\charscalex118 posibilitatea unei colaborSri stranse
dintre medic, psiholog si psihiatru) - se\par\pard\li1051\sb1\sl-
230\slmult0\fi0\tx4416\tx6412 \up0 \expndtw0\charscalex118 poate schifa un algoritm
de lucru\tab \up0 \expndtw0\charscalex118 \u8226? desigur perlectibil\tab \up0
\expndtw0\charscalex118 - privind abordarea\par\pard\li1051\sb5\sl-
230\slmult0\fi0 \up0 \expndtw0\charscalex118 psihologicS a bolnavilor cardio-
vasculari\par\pard\qj \li1051\ri120\sb1\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex120 in esenfe. aceaste abordare presupune evaluarea componentei
psihice \up0 \expndtw0\charscalex124 etiopatogenice a bolii si prevenirea sau
diminuarea - pe cat posibil \up0 \expndtw0\charscalex120 - a \par\pard\qj
\li1046\ri128\sb0\sl-260\slmult0\fi4 \up0 \expndtw0\charscalex120 reculului somato-
psihic si a consecinfelor in planul psihic al pacientului, \up0
\expndtw0\charscalex114 al tulburarilor cardio-vasculare prezente. \par\pard\ql
\li1334\sb0\sl-180\slmult0 \up0 \expndtw0\charscalex129 in cadrul aeestei abordan
intre evaluarea instantanee sau in etape \par\pard\qj \li1046\ri118\sb22\sl-
240\slmult0 \up0 \expndtw0\charscalex121 (contacte ulterioare)a tipului de
personalitate a bolnavului, acordandu-se \up0 \expndtw0\charscalex121 concomitent
explfcafii minimalizatoare ale gravitafii \up0 \expndtw0\charscalex115 (atenfie la
Ipohon-\par\pard\qj \li1041\ri121\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex116 drn1). preocupare (discrete inifial, ulterior maniteste)
pentru problemele de \up0 \expndtw0\charscalex117 viafa ale bolnavului si - mai
presus de toate - optimism legat de medicafie. \up0 \expndtw0\charscalex117 de
valoarea unor explorSri sau consultant si rnai ales de prognosticul bolii. \up0
\expndtw0\charscalex112 in pnvinta aprecierii ponderii factorului psihogen Tn
aparifia si evolufia bolii, \up0 \expndtw0\charscalex121 pot exista situafii cand
este util se se apeleze la psihologi \up0 \expndtw0\charscalex121 (tulburarile
si \par\pard\qj \li1036\ri120\sb20\sl-240\slmult0\fi9 \up0 \expndtw0\charscalex129
sindroamele cardio-vasculare funcfionale, reabilitarea postinfarct si \up0
\expndtw0\charscalex119 postoperatorie ori dupS implantari de pace-maker etc s1
toate problemele \up0 \expndtw0\charscalex117 de adaptare la noi modalitsti de
existenfS legate de aparifia sau de evolufia \up0 \expndtw0\charscalex116 bolii).
in afarS de acestea, consultul psihologie poate fi util, mai ales in fafa \up0
\expndtw0\charscalex109 unor bolnavi dificili \up0 \expndtw0\charscalex117 (de
regue nevrotici) si. in caz extrem, se poate recurge \par\pard\ql \li1051\sb9\sl-
230\slmult0\tx3643 \up0 \expndtw0\charscalex130 la un consult psihiatric \tab
\up0 \expndtw0\charscalex129 (bolnavii cu stari depresive si m genere cu
psihosomatica generala S' aplicata\par\pard\qj \li777\sb0\sl-260\slmult0
260\slmult0\fi4 \up0 \expndtw0\charscalex134 afectiuni nevrotice sau chiar
psihotice. ca de exemplu cazurile de \up0 \expndtw0\charscalex119 sindroame
paranoide sau depresii grave dupa operafiile pe cord deschis \par\pard\ql
\li1099\sb1\sl-211\slmult0 \up0 \expndtw0\charscalex103 \u8226?imerer) \par\pard\qj
\li772\ri367\sb26\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex116 Aceasta
orientare a medicului depinde $i de educafia sa psihosomaticS, \up0
\expndtw0\charscalex118 dar si de qradul in care el doreste s' se simte apt sa se
imphce mtr-o ..tera-\line \up0 \expndtw0\charscalex118 pie simultana \u9632?
(Petzold) care include odata cu tratamentul medical, si difi-\par\pard\ql
\li768\ri360\sb0\sl-243\slmult0\fi830\tx1070\tx1099 \up0 \expndtw0\charscalex114 de
ordin psihologie ale bolnavului, efectuand (adesea in mod firesc \up0
\expndtw0\charscalex113 \u9632??i implicit intregului act medical) o psihoterapie
simple de sustinere. \line \tab \up0 \expndtw0\charscalex115 Psihologului ii revin
sarcini speciale de psihoterapie; in prezent, in multe \up0 \expndtw0\charscalex119
climci cardiologice se practica aplicarea de rutina a unor forme de terapie \up0
\expndtw0\charscalex121 de grup \u8226? cu avantajul ..dispersarii anxietafii
bolnavilor, bazate pe exer� \up0 \expndtw0\charscalex116 cifii adecvate (din care
trammg-ul autogen Schultz a devenit cvasiobligato-\up0 \expndtw0\charscalex113
rlu), conduse de psihologi anurne mstruifi. Sunt, de asemenea, utilizate frec� \up0
\expndtw0\charscalex123 vent tehnicile de biofeedback si de terapie comportamentale
Artterapia \line\tab \up0 \expndtw0\charscalex117 \u9632?ioiorapia sau pictura ori
sculptura, efectuata de bolnavi) practicata, de \up0 \expndtw0\charscalex115 asemc-
nea de unele servicii de cardiologie, are o valoare evidonta, mai ales, \up0
\expndtw0\charscalex119 in cazurile in care bolnavii necesits o spitalizare
indelungats sau restricfii \up0 \expndtw0\charscalex119 mai mari de efort.
Luban Plozza arats beneficiile unei psihoterapii bffazice la cardiaci, \up0
\expndtw0\charscalex118 care implica initial obfinerea relaxarn psihice. iar
ulterior practicarea unei \up0 \expndtw0\charscalex118 aclivitafi fizice dozate
progresiv. \par\pard\qj \li768\ri361\sb0\sl-248\slmult0\fi292 \up0
\expndtw0\charscalex111 Trebuie accentual rolul , formator-educativ al
psihologului, care - utilizSnd \up0 \expndtw0\charscalex121 variate tehnici de
psihodiagnostic si aiungand la o cunoastere nuanfata a \up0 \expndtw0\charscalex119
bolnavului - osie in mSsura sa corecteze o ..traiectorie defectuoasa' com� \up0
\expndtw0\charscalex124 portamentale a acestuia cu efecte nocive atat socio-
profesionale, cat si \up0 \expndtw0\charscalex120 asupra sSnStafii sale (v.
corectarea tipului comportamental A, capabie sa \up0 \expndtw0\charscalex112 provma
recidivele infarctului miocardic). \par\pard\ql \li1080\sb0\sl-230\slmult0
\par\pard\ql\li1080\sb171\sl-230\slmult0 \up0 \expndtw0\charscalex118 B Principii
generate de psihofarmacoiogie in BCV \par\pard\ql \li1075\sb190\sl-230\slmult0 \up0
\expndtw0\charscalex116 Pe langa mSsunle farmacologice adresate direct efectelor 3P
hemodina-\par\pard\ql \li1128\sb10\sl-230\slmult0\tx1305\tx4670 \up0
\expndtw0\charscalex54 \u8226?: \tab \up0 \expndtw0\charscalex113 (cu rasunet
coronarian s< sistemic) \tab \up0 \expndtw0\charscalex111 $l metabolice (in special
modificSri \par\pard\qj \li772\ri356\sb0\sl-250\slmult0\fi4 \up0
\expndtw0\charscalex117 dislipidemice) - trebuie acfionat asupra sistemului nervos.
pnn intermediul \up0 \expndtw0\charscalex123 unei medicafli cu rol sedativ si
anxiolitic, menite sa limitezc amploarea \up0 \expndtw0\charscalex123 reacfiilor.
in special cea catecolaminica, din cursul SP. \par\pard\qj \li772\ri346\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex120 Trecand la analiza pnncipalelor
grupe de medicamente ce pot preveni \up0
\expndtw0\charscalex114 sau atenua rolul SP asupra aparatului cardio-vascular, vom
aminti, in primul \up0 \expndtw0\charscalex127 rand medicafia anxiolitica. Desigur
ca benzodiazepmele, creditate in \up0 \expndtw0\charscalex113 tratamentul IM acut
s� cu acfiune antiaritmicS, constituie un prelios adjuvant \up0
\expndtw0\charscalex121 at terapiei antiangmoase, antiaritmice s' chiar a
insulicientei cardiace (de \up0 \expndtw0\charscalex119 ex. Bromaxepamul -
observafii personae la bolnavii cu tahicardii pozitive \up0 \expndtw0\charscalex119
psihogene s> extrasistole atriae. de asemenea emotionale). \par\pard\qj
\li796\ri347\sb0\sl-250\slmult0\fi297 \up0 \expndtw0\charscalex115 DatoritS
efectuiui sedativ al aeestei medicatii, incompatibll cu o serie de \up0
\expndtw0\charscalex117 profesiuni care solicits atentie maxima. incS din anii '70.
interesul cerceta \up0 \expndtw0\charscalex113 torilor dar \up0
\expndtw0\charscalex121 $i al cliniciemlor s-a deplasat cetre medicafia blocanta
beta -\par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart Pg194}{\bkmkend
\up0 \expndtw0\charscalex56 \u8226?:\u8226?\tab \up0 \expndtw0\charscalex104
adrenergica. Astfel, Hawkings a reusit sS evidenfieze, utilizand drept \up0
\expndtw0\charscalex124 criteriu de apreciere scara de anxietate Hamilton \up0
\expndtw0\charscalex121 - efectul protector al \par\pard\qj \li892\ri251\sb0\sl-
246\slmult0 \up0 \expndtw0\charscalex119 oxprenololului in variate stSri psihice.
Acest efect terapeutic se manifests \up0 \expndtw0\charscalex132 priontar prin
diminuarea simptomelor cardiovasculare de stres. in \up0 \expndtw0\charscalex116
conditiile pSstrSrii unui rSspuns normal la testele de atentie sau de abilitate
\up0 \expndtw0\charscalex108 motorie. \par\pard\qj \li902\ri260\sb3\sl-
250\slmult0\fi278 \up0 \expndtw0\charscalex119 Aceste rezultate s-au dovedit
superioare celor obfinute printr-un trata� \up0 \expndtw0\charscalex116 ment cu
benzodiazepine, care, in plus de efectul sedativ, creaza si pericolul \up0
\expndtw0\charscalex116 unei farmacodependenfe (Michael). \par\pard\qj
\li907\ri241\sb2\sl-260\slmult0\fi283 \up0 \expndtw0\charscalex117 Betablocantele
au rolul de a diminua tahicardia emofionale cu rol nociv \up0
\expndtw0\charscalex115 binecunoscut la coronarieni. Astfel. intr-un experiment
\up0 \expndtw0\charscalex124 (fisa) asupra unor \par\pard\qj \li897\ri241\sb9\sl-
250\slmult0 \up0 \expndtw0\charscalex122 chirurgi care au primit aceasta medicafie
Irecvenfa cardiace este reduse \up0 \expndtw0\charscalex119 conslderabil (de la o
medie de 127 betei pe minut la 83 batai pe minut) in \up0 \expndtw0\charscalex119
momentele suprasolicitante din cursul unei intervenfii chirurgicale.
incercand se diferenfleze o posibila aptitudine In favoarea utilizSrii in tra-\line
\up0 \expndtw0\charscalex123 tamentul tulburarilor psihosomatice cardiovasculare a
medicafiei beta-\line \up0 \expndtw0\charscalex113 blocante si a tranchilizantelor
minore de tipul benzodiazepinelor. Simon con-\line \up0 \expndtw0\charscalex117
sidera ce primele sunt de preferat cand se doreste protecfia fafa de SP
sur-\line \up0 \expndtw0\charscalex120 venit intempestiv (cu mediere principale
prin sistemul nervos vegetativ), \up0 \expndtw0\charscalex126 iar tranchilizantele
apar mai utile in cazul in care tulburarile sunt ge� \up0 \expndtw0\charscalex116
nerate de o afecfiune nevrotica (o stare depresive cu tulburSri precordiale)
Asocierea intre betablocante si tranchilizante. cu scaderea dozelor \up0
\expndtw0\charscalex119 ambelor preparate s-a dovedit a avea un avantaj deosebit.
Totusi. in insu-\line \up0 \expndtw0\charscalex117 ficienfa cardiacs prin
cardiopatie ischemicS \up0 \expndtw0\charscalex117 - date fiind acfiunea de
redu-\par\pard\qj \li911\ri237\sb0\sl-253\slmult0 \up0 \expndtw0\charscalex118 cere
a contraactivitafii ventriculare a betablocantelor - pare mai rezonabie \up0
\expndtw0\charscalex113 utilizarea benzodiazepinelor (de tipul bromazepamului, de
exemplu) care pot \up0 \expndtw0\charscalex118 avea efect favorabil atat asupra
tahicardiei s< extrasistolelor. cSt si asupra \up0 \expndtw0\charscalex118
anxieefii care le genereaze (Bianchi). \par\pard\qj \li926\ri225\sb0\sl-
240\slmult0\fi273 \up0 \expndtw0\charscalex118 in plus, bolnavii anxiosi prezinta
de reguie. o hiperventilatie cronice ce \up0 \expndtw0\charscalex121 poate antrena
vasoconstncfia coronariane \up0 \expndtw0\charscalex120 (Kaindl s* Zilcher), asa
incat \par\pard\ql \li926\sb1\sl-208\slmult0 \up0 \expndtw0\charscalex136 medicafia
anxiolitica este justificata in prlncipiu atat la bolnavii \par\pard\ql
\li931\sb34\sl-230\slmult0 \up0 \expndtw0\charscalex122 anginosi. cat si la
ceilalfi coronarieni. \par\pard\qj \li921\ri231\sb14\sl-250\slmult0\fi292 \up0
\expndtw0\charscalex121 Referitor la medicafia antidepresive. ea trebuie utihzata
cu prudente. \up0 \expndtw0\charscalex119 chiar la insistenfele psihiatnlor,
deoarece este grevae de o serie de riscuri \up0 \expndtw0\charscalex128 (In
principal prin reacfia catecolaminicS) de agravare a cardiopatiei \up0
\expndtw0\charscalex117 ischemice. Aceste efecte disritmice sunt mai reduse la
preparatele mai noi \up0 \expndtw0\charscalex117 de tipul maprotihnei \up0
\expndtw0\charscalex120 (urmSrite do noi la astmaticii corticodependenti cu
tulburSri de ritm) si mai ales Mianserin-ului, care InsS necesitS prudenfS la
\up0 \expndtw0\charscalex115 bolnavii cu insuficienfS cardiacs. \par\pard\qj
\li935\ri221\sb20\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex123 ConsiderSm cS o
medicafie betablocants s* anxiolitica cupiata cu o \up0 \expndtw0\charscalex130
psihoterapie adecvate \up0 \expndtw0\charscalex138 (de susfmere sau de un grad mai
mare de \par\pard\qj \li931\ri226\sb12\sl-250\slmult0 \up0 \expndtw0\charscalex114
complexitate, antrenand interventia psihologului), constituie un bun remediu
\up0 \expndtw0\charscalex123 la bolnavii cardiaci, inclusiv cei cu HTA esenfialS.
ea reprezentand un \up0 \expndtw0\charscalex113 tratament de elecfie la
hipertensivii tineri (HTA juvenie).
\up0 \expndtw0\charscalex120 \ul0\nosupersub\cf9\f10\fs20 Bibliografie \par\pard\ql
\ul0\nosupersub\cf3\f4\fs18 1. Cay E.L.. Psychological problem in patients after a
myocardial infarction \u9632? Adv \par\pard\li1180\sb21\sl-
207\slmult0\fi0\tx1948\tx2419\tx2779 \up0 \expndtw-1\charscalex100 Cardiot.\tab
\up0 \expndtw-7\charscalex100 1982.\tab \up0 \expndtw-1\charscalex100 29.\tab
\up0 \expndtw-1\charscalex100 108-112.\par\pard\qj \li950\ri503\sb11\sl-
200\slmult0\tx1195 \up0 \expndtw0\charscalex109 2. Von Eiff A.. Zur Phystologte und
Kltnik des stres \u9632? Therapiewoche, 1984. 34. 52, \line\tab \up0 \expndtw-
3\charscalex100 7192-7194. \par\pard\qj \li950\ri467\sb40\sl-200\slmult0\tx1166
\up0 \expndtw0\charscalex129 3. Elliot R.S. si Morales Balojo H.M.. stres and the
Heart Measuring and \line\tab \up0 \expndtw0\charscalex111 evaluating reactivity
Hospimedica 1988. 5. 6, 55-6 f. \par\pard\li950\sb28\sl-207\slmult0\fi0\tx5520 \up0
\expndtw0\charscalex118 4. Eisdon-Dew R.W., Wink CA.. Birdwood G.F.\tab \up0
\expndtw0\charscalex118 (red), The cardiovascular,\par\pard\li950\sb9\sl-
207\slmult0\fi220 \up0 \expndtw0\charscalex119 metabolic and psychological
interface \u9632? Academic Press, London, Grune and\par\pard\li950\sb0\sl-
207\slmult0\fi225\tx2918 \up0 \expndtw0\charscalex108 Stratlon, New York.\tab
\up0 \expndtw0\charscalex118 1979\par\pard\ql \li950\ri463\sb15\sl-
210\slmult0\tx1171\tx1204 \up0 \expndtw0\charscalex119 5. Gamier 8., Comment
disttnguer entre ..santee" et .maladie" dans le domame \line\tab \up0
\expndtw0\charscalex112 des troblos psychosomattques cardio-vasculaires \u9632?
Kielholtz. loc. cit. 12. 21 27, \line\tab \up0 \expndtw-5\charscalex100 1982.
\expndtw0\charscalex125 6 Haynes S.G., Feinletb M.. Type A behaviour pattern and
the incidence of \line\tab \up0 \expndtw0\charscalex112 coronary heart disease in
the Frammgham Heart Study - Adv. Cardiot. 1982, 29, \line\tab \up0
\expndtw0\charscalex105 85-95. \par\pard\ql \li969\sb1\sl-195\slmult0 \up0
\expndtw0\charscalex119 7. lamandescu IB.. Conceptia psihosomaticd in medicina
contemporand, Viata \par\pard\li955\sb29\sl-207\slmult0\fi220\tx2107 \up0
\expndtw0\charscalex108 Medical*.\tab \up0 \expndtw0\charscalex115 1979. 2, 57-
lamandescu IB.. Stresui psihic si Bolile Interne, vol.1. Ed. All,\tab \up0
\expndtw0\charscalex116 9 Kamdt F., Zilcher H.. Douleurs d allure angineuse en I
absence de maladie\par\pard\li955\sb9\sl-207\slmult0\fi216\tx3211\tx3710\tx4516
\up0
\expndtw0\charscalex113 coronanenne \u9632? loc. cit.\tab \up0 \expndtw-
3\charscalex100 12. p.\tab \up0 \expndtw0\charscalex105 231 237.\tab \up0
\expndtw0\charscalex115 1982.\par\pard\li955\sb9\sl-
207\slmult0\fi28\tx5169\tx7847 \up0 \expndtw0\charscalex115 10. Kammerer W..
Chronische Herzkrankheit\tab \up0 \expndtw0\charscalex115 - Chronische
Herzkrankheit\tab \up0 \expndtw0\charscalex115 \u9632?\par\pard\li955\sb9\sl-
207\slmult0\fi302 \up0 \expndtw0\charscalex115 Psychologische Risikofaktoren -
Therapiewoche 1985. 3. 211.\par\pard\li955\sb9\sl-207\slmult0\fi28\tx1243 \up0
\expndtw0\charscalex61 11\tab \up0 \expndtw0\charscalex116 Karasu T.B., Stemmuller
R.I.. Psychoterapeutics in medicine - Grune and\par\pard\li955\sb4\sl-
207\slmult0\fi283\tx5207 \up0 \expndtw0\charscalex111 Stratton, New York San
Francisco \u9632? London,\tab \up0 \expndtw0\charscalex115 1978.\par\pard\ql
\li984\ri482\sb6\sl-210\slmult0\tx1257\tx1271 \up0 \expndtw0\charscalex136 12
Kielholtz P.. Siegenlhaler W.. Taggart P.. Zanchetti A.. Troubles \line\tab \up0
\expndtw0\charscalex122 psychosomattque cardio vasculaires - quand el comment les
trader, Hans \line\tab \up0 \expndtw0\charscalex110 Hubor, Berne, Stuttgart.
Vienne, \up0 \expndtw-5\charscalex100 1982. \par\pard\qj \li984\ri476\sb2\sl-
220\slmult0\tx1281 \up0 \expndtw0\charscalex117 13. Klumbies G.. Psychoterapie in
Algemememedizin \u9632? Hirzet Verlag, Leipzig \line\tab \up0 \expndtw-
1\charscalex100 1980 \par\pard\ql \li979\sb11\sl-207\slmult0 \up0
\expndtw0\charscalex113 14. Lang R, Funktionelle Kreistaufregulationsstorungen
\u9632? Therapienwoche 1989. \par\pard\ql \li1248\sb13\sl-207\slmult0 \up0
\expndtw0\charscalex116 39. 33 45 \par\pard\ql \li979\sb1\sl-198\slmult0 \up0
\expndtw0\charscalex113 15. Luban Plozza 8.. Stationare von Behandlung von
psychosomalischen Kranken \par\pard\ql \li1262\sb15\sl-207\slmult0 \up0
\expndtw0\charscalex110 - Therapienwoche 1990, 40. 440-445.
\par\pard\li979\sb28\sl-207\slmult0\fi0 \up0 \expndtw0\charscalex115 16. Malchair
A.. Environment social et desordres psychosomatique -
Essentialia\par\pard\li979\sb9\sl-207\slmult0\fi273\tx2918 \up0
\expndtw0\charscalex108 (UCB) 1988. 27. 2.\tab \up0 \expndtw0\charscalex114 1-
10.\par\pard\ql \li979\sb2\sl-207\slmult0 \up0 \expndtw0\charscalex113 17. Petzold
E.. Psychoterapie bei Herzerkrankungen \u9632? Therapienwoche 1990. 40,
\par\pard\ql \li1248\sb1\sl-198\slmult0 \up0 \expndtw0\charscalex114 44 445
Rose R M. Chap. - Psychoendocrinology \u9632? 653-672. in Wilson J . Foster D.
\line\tab \up0 \expndtw0\charscalex109 William textbook of endocrinology-Saunder,
Philadelphia 1985. \par\pard\li979\sb22\sl-207\slmult0\fi0\tx7238\tx7569 \up0
\expndtw0\charscalex113 19. Taylor A.. Stress, hypertension et cardiopathie
ischemiwue, loc cit.\tab \up0 \expndtw-8\charscalex92 12.\tab \up0
\expndtw-7\charscalex100 152.\tab \up0 \expndtw0\charscalex112 1982.\par\pard\qj
\li945\ri472\sb0\sl-220\slmult0\tx1267 \up0 \expndtw0\charscalex119 20. William R
8.. Haney T.L., Lee K.L. si col Type A-beliaviour. hostility and \line\tab \up0
\expndtw0\charscalex119 coronary athorosclerosis-Psychosom med. 1980. 49. 539-
549. \par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart Pg196}{\bkmkend
\up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf14\f15\fs24 ELEMENTE DE
PSIHOSOMATICA REUMATOLOGICA \par\pard\ql \li1151\sb0\sl-230\slmult0
\ul0\nosupersub\cf9\f10\fs20 loan Bradu lamandescu \par\pard\qj \li840\sb0\sl-
\expndtw0\charscalex115 Observatnle clinicienilor, asociate cu autoobservafiile
unor pacienfi - din� \up0 \expndtw0\charscalex117 tre care celebrul chirurg
Christian Barnard a incredinfat tiparului o remarca\up0 \expndtw0\charscalex115
bilS patografie personae, "Cum sS traim mai usor cu artrita" - au relevat o
le\up0 \expndtw0\charscalex115 gSturS cvasiconstants, desi variabila de 1a un
bolnav la altul. intre puseele de \up0 \expndtw0\charscalex118 activitate
("incSlzire") ale bolii reumatismale (inflamatoare sau degenerati \up0
\expndtw0\charscalex118 ve) si factorii psihici. \par\pard\qj \li835\ri283\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex119 in cele ce urmeazS vom analiza
implicarea factorului psihic ca element \up0 \expndtw0\charscalex123 nociv in
geneza si agravarea evolufiei bolilor reumatice dar si ca un aliat \up0
\expndtw0\charscalex119 in tentativa terapeutului de a micsora disconfortul bolii
si repercuslunile ei \up0 \expndtw0\charscalex117 asupra calltatii viefii sau chiar
de a elimina - pnn intermediul medicafiei ac� \up0 \expndtw0\charscalex118 tive -
procesele patogenice reumatismale (chiar dacS. eel mai adesea, remi\up0
\expndtw0\charscalex118 siunea este efemerS). \par\pard\ql \li1132\sb229\sl-
230\slmult0 \up0 \expndtw0\charscalex134 I. Bazele psihologice si mecanismele
psihofiziologice ale \par\pard\ql \li1358\sb90\sl-230\slmult0 \up0
\expndtw0\charscalex136 implicarii stresului psihic in evolufia bolilor
reumatismale \par\pard\ql \li1166\sb0\sl-230\slmult0 \par\pard\ql\li1166\sb40\sl-
230\slmult0 \up0 \expndtw0\charscalex126 /. Premise teoretice \par\pard\qj
\li830\ri269\sb162\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex117 Va trebui avut
in vedere faptul cS, in bolile inflamatorii sau degenerative \up0
\expndtw0\charscalex120 ale articulafiilor. elementele structurale principale
afectate sunt membrana \up0 \expndtw0\charscalex119 sinovialS si musculatura
periarticularS Acfiunea factorului psihic va fi im\up0 \expndtw0\charscalex124
plicatS in modificarile inflamatorii pe care mediatorii reactiei de stres le
\up0 \expndtw0\charscalex117 pot produce la nivelul ambelor structuri mentionate
dar si in modificarile de \up0 \expndtw0\charscalex123 tonus muscular (de regulS
hipertonia afectand cu precadere musculatura \up0 \expndtw0\charscalex115 cefei si
lombo-sacralS). Traducerea in simptome clinice a unor astfel de mo� \up0
\expndtw0\charscalex121 dificSri va fi reprezentata de gama variate a durenlor si
de diversele grade \up0 \expndtw0\charscalex114 de impotenfe funcfionale.
\par\pard\qj \li830\ri279\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex121 Pe
de alte parte un comportament nociv pentru sanatate, determinat de \up0
\expndtw0\charscalex120 conduitele defectuoase adaptative fate de stres ale unor
bolnavi reumaticl, \up0 \expndtw0\charscalex129 va contribui la agravarea bolii de
baze \up0 \expndtw0\charscalex125 (de ex. consumul de alcool s> \par\pard\ql
\li840\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex117 sedentarismul, tendinfele de
cedare - lipsa de voinfS etc.). \par\pard\qj \li840\ri293\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex123 in sfarsit, reculul somato-psihic al
suferinfelor fizice ale reumatismu-\line \up0 \expndtw0\charscalex119 lui, va
conduce la o reactie psihica dominats de anxietate si mai ales de
de-\par\pard\sect\sectd\fs24\paperw8520\paperh13300{\bkmkstart Pg197}{\bkmkend
\expndtw0\charscalex106 \u9830?\tab \dn2 \expndtw0\charscalex106 Elemento de
220\slmult0\fi4 \up0 \expndtw0\charscalex119 presie - generate de disconfortui
somatic datorie durerilor cronice si afec-\line \up0 \expndtw0\charscalex115 terii
posturii sau locomotiei \up0 \expndtw0\charscalex115 - inchizSndu-se astfel un cere
vicios psiho-so-\par\pard\qj \li537\ri589\sb4\sl-240\slmult0\fi14 \up0
\expndtw0\charscalex114 mato-psihic in cadrul cSruia, la nivelul "segmentului
somatic" au o "intrare" \up0 \expndtw0\charscalex114 constants ceilalfi agenti
patologici ai bolii. \par\pard\qj \li840\ri715\sb160\sl-240\slmult0\tx1065 \up0
\expndtw0\charscalex119 2. Ipoteze privind mecanismele implicate in declansarea
psihogena a \line\tab \up0 \expndtw0\charscalex120 principalelor simptome la
bolnavii recrutafi \par\pard\qj \li552\ri581\sb163\sl-237\slmult0\fi287\tx1761 \up0
\expndtw0\charscalex112 in figura \tab \up0 \expndtw0\charscalex118 1 am Tncercat o
reprezentare a unor mecanisme ipotetice (pe \up0 \expndtw0\charscalex116 baza unor
date din literaturS referitoare la inflamafie - Rihoux si la joncfiu\up0
\expndtw0\charscalex115 nea anatomies dintre fibrele C si mastocite - Bienenstock)
ce pot fi incrimi� \up0 \expndtw0\charscalex119 nate in patogenia durerii s>
impotenfei funcfionale. aeturi de cunostinfele \up0 \expndtw0\charscalex116 mai
vechi (de ex. rolul tetamgen al hiperventilafiei Inconstiente ce caracte\up0
\expndtw0\charscalex118 nzeazS stSrile de anxietate). incercand o sistematizare a
acestor mecanis� \up0 \expndtw0\charscalex116 me, vom distinge adevSrate etape
patogenice cu posibie sanctiune terapeu\up0 \expndtw0\charscalex116 ticS
(psihoterapie sau medicafie psihotropS ori liziokinetoterapie). \par\pard\qj
\li720\sb0\sl-220\slmult0 \par\pard\qj\li720\ri765\sb118\sl-220\slmult0\tx1224 \up0
Figura 1. Ipoteze privind unele mecanisme implicate in declansarea \line\tab
\up0 \expndtw0\charscalex123 psihogena a principalelor simptome la bolnavii
reumatlci \par\pard\ql \li3297\sb12\sl-230\slmult0 \up0 \expndtw0\charscalex121
(schema proprle) \par\pard\li950\sb0\sl-138\slmult0\par\pard\li950\sb0\sl-
138\slmult0\fi1070 \up0 \expndtw0\charscalex125 \ul0\nosupersub\cf19\f20\fs12 ->.
Hip.rv.niii.ii. -aJMMeMlaiantorma\par\pard\li950\sb0\sl-108\slmult0\fi4334 \up0
\expndtw0\charscalex125 Cr.fl.raa tonuaulul\par\pard\li950\sb1\sl-
112\slmult0\fi4627 \up0 \expndtw0\charscalex125 mutcutar\par\pard\li950\sb0\sl-
108\slmult0\fi1070 \up0 \expndtw0\charscalex125 -a- Excltalk
cotlnargkca\par\pard\li950\sb0\sl-131\slmult0\fi0 \up0 \expndtw0\charscalex125
Stata pilhrc\par\pard\ql \li1046\sb9\sl-138\slmult0 \up0 \expndtw0\charscalex114
(dtairaaa)\par\pard\sect\sectd\sbknone\cols3\colno1\colw3747\colsr40\colno2\colw280
7\colsr160\colno3\colw1636\colsr160\ql \li2217\sb0\sl-129\slmult0 \up0
\expndtw0\charscalex119 FllaraC\par\pard\ql \li2078\sb114\sl-230\slmult0 \up0
\expndtw0\charscalex123 \u9658? Uatlrxll\ul0\nosupersub\cf9\f10\fs20 ,'\par\pard\ql
\li2625\sb39\sl-230\slmult0 \up0 \expndtw-2\charscalex100 \\\par\pard\ql
\ul0\nosupersub\cf19\f20\fs12 Miit.mina\par\pard\ql \li1055\sb0\sl-138\slmult0
\up0 \expndtw-1\charscalex100 a\ul0\nosupersub\cf41\f42\fs12\ul )
EMOORFI\ul0\nosupersub\cf19\f20\fs12 NE\par\pard\ql \li1055\sb0\sl-138\slmult0
\par\pard\ql \li2491\sb60\sl-138\slmult0 \up0 \expndtw0\charscalex124 -lacul tomato
p�!h\par\pard\ql \li1055\sb0\sl-138\slmult0 \par\pard\ql \li1055\sb0\sl-138\slmult0
C'.�lrrrj\par\pard\column \ql \li25\sb34\sl-115\slmult0\tx1729 \up0
\expndtw0\charscalex132 \ul0\nosupersub\cf24\f25\fs10 ^ Subcrienia f\tab \up0
\expndtw0\charscalex101 \ul0\nosupersub\cf19\f20\fs12 Crete teree\par\pard\ql
p�rm**Mlli*t<l\par\pard\ql \li20\sb1\sl-115\slmult0\tx1460 \up0
\expndtw0\charscalex136 \ul0\nosupersub\cf24\f25\fs10 4 Hauoclnlfw\tab \up0
\expndtw0\charscalex119 \ul0\nosupersub\cf19\f20\fs12 raecuUrt
elnovlale\par\pard\ql \li1954\sb33\sl-216\slmult0 \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf8\f9\fs22 t\par\pard\ql \li1767\sb1\sl-134\slmult0 \up0
\expndtw0\charscalex104 \ul0\nosupersub\cf19\f20\fs12 DURERf\par\pard\qj
\up0 \expndtw0\charscalex107 IMfOTFirjA \line \up0 \expndtw-4\charscalex100
FUMCTIOMALA\par\pard\column \qj \li20\ri961\sb77\sl-134\slmult0\fi43 \up0
\expndtw0\charscalex111 Rac.pto. l \line \up0 \expndtw0\charscalex113
noctcapllvl\par\pard\sect\sectd\sbknone\cols2\colno1\colw2983\colsr160\colno2\colw5
cortt/ol.rrit.l\par\pard\column \ql \li20\sb0\sl-144\slmult0 \up0
\expndtw0\charscalex102 \ul0\nosupersub\cf13\f14\fs16 -a|o.laoeonua
Stres -> declansare (mediata de hormonii de stres s* mediatori ai \up0
\expndtw0\charscalex123 durerii), a celor doua sindroame majore ale reumatismului
articular s* \up0 \expndtw0\charscalex119 abarticular - durerea si impotenfa
funcfionala \{cu posibie evolufie si spre \up0 \expndtw0\charscalex115 osteoporozS.
care genereaza noi dureri. ca de altfel, si distrucfia unor struc\up0
\expndtw0\charscalex115 turi artlculare si periartieulare). \par\pard\ql
\li878\sb9\sl-230\slmult0\tx4900 \up0 \expndtw0\charscalex124 2. Actiunea acestora
asupra psihicului \tab \up0 \expndtw0\charscalex111 (recul somato-psihic)
determi� \par\pard\qj \li590\ri576\sb0\sl-250\slmult0 \up0 \expndtw0\charscalex114
nae de reacfia In plan afectiv, Tn special, fafa de disconfortui general de
du\up0 \expndtw0\charscalex117 rere (agravatS s* de cStre forfarea compensators a
altor segmente incS in\up0 \expndtw0\charscalex111 demne).
240\slmult0\fi288 \up0 \expndtw0\charscalex119 3. Acest disconfort este insofit de
consecintele in planul calitafii viefii \up0 \expndtw0\charscalex119 (izolare,
abandonul unor hobby-url si, mai ales, handicapul profesional). \par\pard\qj
\li955\ri173\sb15\sl-247\slmult0\fi288 \up0 \expndtw0\charscalex113 4. Ca urmare a
acestor veritabie frustrSri - apSrute Tn bolile reumatisma� \up0
\expndtw0\charscalex114 le, ca urmare a durerilor persistente si a limitSrii
libertSfii de miscare apar o \up0 \expndtw0\charscalex123 serie de tulburari
somato-psihice (insomnii nocturne, somnolenfa diur-\line \up0
\expndtw0\charscalex119 na. anxietate, astenie. irascibilitate etc.) dintre ele cea
mai redutabie fiind \up0 \expndtw0\charscalex120 depresia psihicS. Exists. insS.
primejdia ca aceastS depresie somatogenS \up0 \expndtw0\charscalex121 (generats de
suferinta somaticS) sS fie alimentatS de alte surse exogene, \up0
\expndtw0\charscalex118 psihotraumatice, inchizSnd un alt cere vicios. capabll sS
contribuie la per-\line \up0 \expndtw0\charscalex116 sistenfa durerii chiar si in
fazele de acalmie clinics a procesului inflamator. \up0 \expndtw0\charscalex120 De
altfel, este bine cunoscuts modalitatea de exprimare clinics a unei de-\line
\up0 \expndtw0\charscalex117 presii larvate (Kielholz) sub masca unor sindroame
dureroase cu localizare \up0 \expndtw0\charscalex117 sacro-lombarS sau cervico-
dorsae (V. testul Giessen-Beschwerden) ca si a \up0 \expndtw0\charscalex118 unor
neuromialgii si artralgii nesistematizate. la unii pacienfi etichetafi cu \up0
\expndtw0\charscalex116 multS usurinfS drept reumatici, in ciuda lipsei oricSrei
evidenfe obiective a \up0 \expndtw0\charscalex117 unui substrat inflamator sau
degenerativ al acuzelor respective. DacS la un \up0 \expndtw0\charscalex118 subiect
indemn de o suferinfS lezionalS reumaticS, starea depresivS poate \up0
\expndtw0\charscalex122 induce dureri cu caracter functional, este cu atat mai
legitima agravarea \up0 \expndtw0\charscalex111 veritabilelor dureri \up0
\expndtw0\charscalex114 (cu substrat lezional) in cazul unui reumatism deja
exis� \par\pard\qj \li960\ri168\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex118
tent la care se adifioneazS o traune psihice. inclusiv stresui psihic legat de \up0
\expndtw0\charscalex112 avatarurile bolii. \par\pard\qj \li1257\ri274\sb153\sl-
320\slmult0\tx1564 \up0 \expndtw0\charscalex133 II. Dovezi clinice si de laborator
privind rolul etiopatogenic al \line\tab \up0 \expndtw0\charscalex134 factorului
psihic in bolile reumatismale \par\pard\qj \li969\ri169\sb176\sl-
253\slmult0\fi288 \up0 \expndtw0\charscalex116 in sprijinul relafiei dintre stres
si durere vin dovezile furnizate de Tnsusi \up0 \expndtw0\charscalex114 Christian
Barnard a cerui introspecfie In legeturS cu factorii psihici si relafia \up0
\expndtw0\charscalex118 lor cu artrita reumatoidS, de care suferea. poarts girul
mSrturiei omului de \up0 \expndtw-2\charscalex100 StiinfS: \par\pard\qj
\li960\ri168\sb0\sl-250\slmult0\fi302 \up0 \expndtw0\charscalex122 - "artlculaflile
picioarelor si mainilor mele se intlamau cu regularlta\up0 \expndtw0\charscalex121
tea unui ceasornic, cand discufiile noastre (cu sofia n.tr.) cSpStau un ton \up0
\expndtw0\charscalex108 arfSgos"; \par\pard\ql \li964\ri169\sb0\sl-
247\slmult0\fi297\tx1271\tx1267\tx1267 \up0 \expndtw0\charscalex120 - "Am descopent
cS exists...o legatura stransS Intre anxietatea mea s' \up0 \expndtw0\charscalex116
perceperea durerii, una o influenfa pe cealaltS" (p.69). \line \tab \up0
\expndtw0\charscalex118 In plus. Schild (cit. de 9) relateazS exacerbarea durerilor
si contracturii \up0 \expndtw0\charscalex118 musculare din hernia de disc dupS
conflicte emofionale acute, ca si agra� \up0 \expndtw0\charscalex114 varea
spondilltei anchilozante in situafii emofionale cronice. \line \tab \up0
\expndtw0\charscalex115 De fapt, studiul pragului durerii la subiecfii normal!, ca
si la pacienfii cu \up0 \expndtw0\charscalex116 dureri cronice de etiologii variate
a demonstrat influenfa nocivS a stresului \up0 \expndtw0\charscalex123 psihic. ce
contribuie la scSderea pragului de aparifie a durerii. \line \tab \up0
\expndtw0\charscalex122 Pe de alts parte stresui psihic contribuie la aparifia
contracturii mus� \up0 \expndtw0\charscalex120 culare (mai usor de instaet, la un
reumatic, atunci cand musculatura peri-\line \up0 \expndtw0\charscalex116
articularS este deja supusS la eforturi deosebite), fapt ce poate fi evidenfiat
\up0 \expndtw0\charscalex118 de observafille clinice Tn toate formele de
reumatism \up0 \expndtw0\charscalex114 (dar, Tn special, in \par\pard\ql
\li979\sb1\sl-193\slmult0 \up0 \expndtw0\charscalex115 reumatismul abarticular) si
este confirmat de rezultatele electromiogramei.
\ul0\nosupersub\cf9\f10\fs20 196\tab \up0 \expndtw0\charscalex103 \u8226?>\tab \up0
\expndtw0\charscalex103 Elemente de
240\slmult0\fi292 \up0 \expndtw0\charscalex119 Astfel, exists bolnavi care alirmS
ca - atunci cand se streseaza - ei per-\line \up0 \expndtw0\charscalex125 cep in
mod clar starea de contractura instalata chiar la locul durerii lor \up0
\expndtw0\charscalex116 cronice (Bernhard). Acestor contractuh subiective Ii se
adaugS datele obfi-\line \up0 \expndtw0\charscalex121 nute pe electromiograma.
investigand zonele musculare (in care bolna� \up0 \expndtw0\charscalex116 vul acuza
dureri) in cursul unui interviu stresant ce dezvSluie o agresivitate \up0
\expndtw0\charscalex117 crescuts a pacientului legata de anumite situafii
conflictuale ale sale (Moos \up0 \expndtw0\charscalex114 $i Engel). Invers. la
fachirn indieni \up0 \expndtw0\charscalex119 - capabih sS doarmS pe cuie sau sS
se \par\pard\qj \li638\ri490\sb0\sl-246\slmult0\fi4 \up0 \expndtw0\charscalex117
lase atinsi de flScSri - a fost evidenfiats o adevSratS "anestezie", explicata \up0
\expndtw0\charscalex120 printr-o disociafie subcorticaia Intre activitatea
sistemului nervos central \up0 \expndtw0\charscalex119 Si cea muscularS perifencS
AceastS disociere este exprimatS sub forma: \up0 \expndtw0\charscalex113 ' Creierul
doarme iar corpul vegheazS'' (Bernhard). \par\pard\ql \li931\sb204\sl-
230\slmult0 \up0 \expndtw0\charscalex135 III. Personalitatea pacientilor
reumatici \par\pard\qj \li624\ri500\sb202\sl-240\slmult0\fi307 \up0
\expndtw0\charscalex117 Nu constituie un dat primar, predispozant pentru diversele
tipuri de boli \up0 \expndtw0\charscalex120 reumatismale. deci nu face boala in mod
efectiv un anume tip de perso� \up0 \expndtw0\charscalex119 nalitate in schimb
bolnavii reumatici is' modifies secundar personalitatea, \up0
\expndtw0\charscalex127 conform statutului lor de bolnavi cronici. ca si cu unele
repercusiuni \up0 \expndtw0\charscalex117 specifice simptomelor reumatice de bazS:
durerea si impoten(a functionae. \up0 \expndtw0\charscalex123 TrSsSturile de
personalitate dobandite in cursul evolutiei cronice a ori-\line \up0
\expndtw0\charscalex114 cSrei boli, sunt \up0 \expndtw0\charscalex118 - dupS Gerber
- urmetoarele: diminuarea activitatii psiho-\par\pard\ql \li633\sb29\sl-
230\slmult0\tx6681 \up0 \expndtw0\charscalex123 motorii, excitabilitatea
(iritabilitatea) crescuta, ipohondria \tab \up0 \expndtw0\charscalex124 $i depresia
\par\pard\qj \li624\ri499\sb0\sl-246\slmult0 \up0 \expndtw0\charscalex114 Aceste
trasaturi sunt valabile si pentru bolnavul reumatic al cSrui comporta� \up0
\expndtw0\charscalex115 ment Incepe sS fie dominat de cSutarea unor beneficii
secundare bolii, con-\line \up0 \expndtw0\charscalex114 comitent cu tendinfa spre
izolare socials $i cu o complianfS terapeuticS scS-\line \up0
\expndtw0\charscalex114 zuia (in ciuda faptului cS el devine usor de manipulat de
cStre cei dm jur). \par\pard\qj \li628\ri506\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex123 in schimb exista doua tipuri de implicare in boala a
diverselor tipuri \up0 \expndtw0\charscalex124 de personalitate: \par\pard\qj
\li628\ri505\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex119 - Bolnavii cu
vulnerabilitatea la stres. inclusiv cei cu personalitSfi ipo-\line \up0
\expndtw0\charscalex119 hondrice sau isterice. vor tolera mai greu durerea (la fel
si bolnavii depre-\par\pard\ql \li633\sb4\sl-207\slmult0 \up0
\expndtw0\charscalex112 \ul0\nosupersub\cf3\f4\fs18 sivi): \par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 Reacfia ia boala va fi mai accentuata la bolnavii cu
trasaturi imuno-\line \up0 \expndtw0\charscalex127 gene negative \up0
\expndtw0\charscalex121 (anxietate, neuroticism, pesimtsm, depresie, cf. Manlou
Bruchon - Schweitzer), ca $i la cei cu loc de control extern fats de stres
(indt-\line \up0 \expndtw0\charscalex119 vizii care "asise pasiv" la ravagiile
stresului psihic, considerand ca nu de-\line \up0 \expndtw0\charscalex116 pinde de
ei posibilitatea limitSrii actiunii nocive a stresului asupra sanatafn \up0
\expndtw0\charscalex119 lor) in durerile cronice. caracterul intens si prelungit al
acestora apare le� \up0 \expndtw0\charscalex119 gat tocmai de prezenta unui loc de
control extern la bolnavii respectivi). \par\pard\qj \li628\ri481\sb0\sl-
240\slmult0\fi307 \up0 \expndtw0\charscalex123 J Referitor la modificarile
personalitafii bolnavului induse secundar \up0 \expndtw0\charscalex120 de
caracterul cronic al bolii. Hohmeister descrie intr-o primS lazS a bolii \up0
\expndtw0\charscalex116 (poliartnta reumatoidS) paciente agresive. IncapStSnate -
gata sa apeleze la \up0 \expndtw0\charscalex117 alt terapeut. in caz de esec si
aceleasi paciente, dupS cafiva ani de evolufie \up0 \expndtw0\charscalex122 a bolu.
devenite extrem de resemnate chiar rSbdetoare si cooperante cu \up0
\expndtw0\charscalex112 medicul curant. \par\pard\qj \li648\ri490\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex125 J Afectarea musculara in reumatismul
abarticular, ca de altfel si in \up0 \expndtw0\charscalex121 celelalte forme de
reumatism.(degenefativ si inflamator) este imputabila
\expndtw0\charscalex123 \ul0\nosupersub\cf3\f4\fs18 Psihosomatica aplicata\tab \up0
244\slmult0\fi4 \up0 \expndtw0\charscalex119 \ul0\nosupersub\cf9\f10\fs20 unor
factori specifici atunci cand ea are la baza o hipertonie. autosesizata \up0
\expndtw0\charscalex122 de catre bolnav ca o incordare (a cefei, in special).
Interpreter! psihana-\line \up0 \expndtw0\charscalex118 liste mai vechi susfin
ideea ce, atunci cend durerea afecteaza coloana cer-\line \up0
\expndtw0\charscalex114 vicaia. este vorba de o ' fixare incapafanata pe situafie"
a bolnavului respec� \up0 \expndtw0\charscalex112 tiv iar cand durerea i$i are
sediul in regiunea lombarS (la femei. eel mai ade� \up0 \expndtw0\charscalex118
sea), ea ar traduce nevoia de compensare - printr-o pozifie rigidS, \up0
\expndtw0\charscalex104 - senti� \par\pard\ql \li648\ri471\sb16\sl-
245\slmult0\fi19\tx945\tx960 \up0 \expndtw0\charscalex116 mente de neputinfS.
generate de greutatea de a face fafa responsabilitSfilor \up0
\expndtw0\charscalex114 casnice si profesionale (Hohmeister in Luban-Plozza si
col.). \line \tab \up0 \expndtw0\charscalex116 in ciuda acestor interpretari
speculative, rSmane totusi o urmS de adevar \up0 \expndtw0\charscalex123 in
exphcarea acestor surse psiho-comportamentale ale hipertoniei unor \up0
\expndtw0\charscalex122 segmente (regiuni) musculare: orice expresie a unor stSri
afective preg-\up0 \expndtw0\charscalex121 nante antreneaza si modificari
posturale, asa meat aparifia si apoi repri� \up0 \expndtw0\charscalex119 marea unei
agresivitafi conduce la hipertonie a musculaturii cefei dar si a \up0
\expndtw0\charscalex121 celei dorso-lombare. De altfel aceastS situafie se
Intalneste in orice stres \up0 \expndtw0\charscalex118 cronic ce se traduce prin
aceeasi incordare. in timp ce startle de descuraja \up0 \expndtw0\charscalex121 re
se pot exterioriza prin hipotonia aceleiasi regiuni musculare, afectand \up0
\expndtw0\charscalex114 postura prin supraincSrcarea altor zone 'compensatoare'".
care - in timp - pot \up0 \expndtw0\charscalex115 sa cedeze, prin aparifia - la
nivelul lor - a unor procese de uzurS. \line \tab \up0 \expndtw0\charscalex123 J La
nivelul inserfiei in cadrul familiei sale, bolnavul reumatic devi-\up0
\expndtw0\charscalex119 ne un fel de "purtator de probleme" ale acesteia.
contribuind adesea la es-\up0 \expndtw0\charscalex112 tomparea situafiilor
conflictuale intrafamiliale (mobilizarea Tn jurul sau a ce-\up0
\expndtw0\charscalex112 lorlalfi membri ai familiei). \par\pard\ql \li945\sb0\sl-
230\slmult0 \par\pard\ql\li945\sb18\sl-230\slmult0 \up0 \expndtw0\charscalex132 IV.
Medicafia psihotropa in bolile reumatismale \par\pard\ql \li945\sb0\sl-
230\slmult0 \par\pard\ql\li945\sb140\sl-230\slmult0 \up0 \expndtw0\charscalex117 A.
Indicafii generale \par\pard\qj \li648\ri481\sb166\sl-260\slmult0\fi287 \up0
\expndtw0\charscalex113 Apelul la medicamentele psihotrope este justificat la
bolnavii reumatici in \up0 \expndtw0\charscalex113 doue circumstanfe, legate de
simptomatologia bolii reumatice de baze: \par\pard\ql \li950\sb5\sl-
230\slmult0\tx7588 \up0 \expndtw0\charscalex126 - existenfa unui rasunet psihic
important al durerii. caz in care \tab \up0 \expndtw0\charscalex110 - la
acflunea antialgica a medicafiei antnnflamatorii \tab \up0 \expndtw0\charscalex128
- se poate adeuga cea a \par\pard\qj \li657\ri481\sb0\sl-246\slmult0 \up0
\expndtw0\charscalex122 unor preparate psihotrope: sedative usoare (prezente in
diverse formule, \up0 \expndtw0\charscalex117 precum Codamin. ce confine
Fenobarbital) dar mai ales antidepresivele s> \up0 \expndtw0\charscalex116
neurolepticele - Tn doze mici - ambele avand. ca efect suplimentar, creste� \up0
\expndtw0\charscalex116 rea pragului aparifiei durerii \par\pard\qj
\li652\ri468\sb16\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex120 - existenfa
unor sindroame psihiatrice asociate bolii reumatismale, si� \up0
\expndtw0\charscalex118 tuafie in care sunt posibie doue atitudini terapeutice -
din partea medicului \up0 \expndtw0\charscalex118 curant: \par\pard\ql
\li652\ri457\sb18\sl-243\slmult0\fi307\tx945 \up0 \expndtw0\charscalex120 J apelul
la medicul psihiatru dace exprimarea clinice
a simptomatolo-\line \up0 \expndtw0\charscalex120 giei este intense si polimore
sau dace natura sindromului este endogene: \line\tab \up0
\expndtw0\charscalex122 \u9633? asumarea responsabllitSfii de a trata simptomele
psihice moderate \up0 \expndtw0\charscalex118 reactive (exogene) fafa de suferinta
generats de acuzele de bazS reumatice \up0 \expndtw0\charscalex118 (durerea.
impoten(a funcfionae) si de complexul de inferioritate aparut Tn \up0
\expndtw0\charscalex115 conditiile diminuarii autonomiei sale (de miscare, de
indeplinire a unor atri-\line \up0 \expndtw0\charscalex115 bufn socio-profesionale
sau a unor hobby-uri), ca s1 al cresterii consecutive
240\slmult0 \up0 \expndtw0\charscalex117 a dependenfei sale fafa de cei din jur
(devenitS dramatics, in cazul persoa\up0 \expndtw0\charscalex117 nelor varstnice
singure). \par\pard\ql \li1320\sb189\sl-230\slmult0 \up0 \expndtw0\charscalex118 B.
Principalele tipuri de preparate psihofarmacologice utilizate \par\pard\qj
\li1012\ri431\sb178\sl-245\slmult0\fi292 \up0 \expndtw0\charscalex114 O schemS
terapeuticS cu psihotrope stabilitS de Kocher (cit. de Labhart), \up0
\expndtw0\charscalex112 inca din \up0 \expndtw0\charscalex119 1969, se menfine
actuae si in prezent. Este vorba de combinafia \up0 \expndtw0\charscalex124 dintre
antidepresive si neuroleptice. administrate in doze mici. Efectul \up0
\expndtw0\charscalex118 acestor psihotrope se exercie atSt asupra simptomatologiei
reumatice pro \up0 \expndtw0\charscalex117 priu-zise, cat s* asupra haloului psihic
al acesteia deja menfionat. Un con-\line \up0 \expndtw0\charscalex119 sens, legat
de lipsa de indicafie (chiar contraindicafie) a benzodiazepine� \up0
\expndtw0\charscalex114 lor se pSstreazS $i in prezent, foarte posibil fiind acuzat
efectul miorelaxant \up0 \expndtw0\charscalex114 excesiv al aeestei medicatii, ca
si frecventa instalare a dependenfei. \par\pard\ql \li1348\sb148\sl-230\slmult0
\up0 \expndtw0\charscalex104 1. AntkJenmslvete \par\pard\li1017\sb230\sl-
230\slmult0\fi287\tx4084\tx6984 \up0 \expndtw0\charscalex118 in afarS de
Clomipramina\tab \up0 \expndtw0\charscalex118 (Anafranil-R) si trimeprimin\tab \up0
\expndtw0\charscalex118 (Surmontil-R,\par\pard\li1017\sb19\sl-230\slmult0\fi4
\up0 \expndtw0\charscalex119 Labhart), astSzi se poate recurge si la Amltriptilina,
Mianserin sau Mapro-\par\pard\li1017\sb20\sl-230\slmult0\fi0\tx1492 \up0
\expndtw0\charscalex118 tilin\tab \up0 \expndtw0\charscalex119 (care posedS si un
efect tranchilizant), ca si la alte preparate de ultima\par\pard\li1017\sb10\sl-
230\slmult0\fi0 \up0 \expndtw0\charscalex118 orS (Tianeptin, de
ex.).\par\pard\qj \li1012\ri421\sb3\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex128 Administrarea acestor medlcamente este posibie si m dozS
unicS \up0 \expndtw0\charscalex117 vesperalS, fapt ce canalizeazS somnolen(a - ca
efect secundar des intalnit -\line \up0 \expndtw0\charscalex117 in direcfia, utie
pentru reumatic, de combatere a insomniei acestuia. \par\pard\qj
\li1017\ri421\sb0\sl-246\slmult0\fi297 \up0 \expndtw0\charscalex118 Etectul
antidepresiv, ca si de potenfare a analgeticelor. este deosebit de \up0
\expndtw0\charscalex112 util la pacientii cu dureri cronice. devenite o "a doua
naturS". in cazul Tn care \up0 \expndtw0\charscalex120 o depresie mascata imitS o
boalS reumatismale. administrarea antidepre-\line \up0 \expndtw0\charscalex122
sivelor poate constitui o veritabie probS terapeuticS \up0 \expndtw0\charscalex117
(produce disparifia \par\pard\qj \li1017\ri425\sb0\sl-260\slmult0\fi4 \up0
\expndtw0\charscalex116 simptomelor "reumatice", in absenfa asocierii medicafiei
antiinflamatoare -\line \up0 \expndtw0\charscalex116 analgetice). \par\pard\ql
\li1315\sb164\sl-230\slmult0 \up0 \expndtw0\charscalex109 2.
\ul0\nosupersub\cf18\f19\fs20\ul Neurolepticele \par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 Labhart considers cS o combinafie dintre un
neuroleptic (Levomapro-\line \up0 \expndtw0\charscalex121 mazin - in doze mici de 2
pana la 6 mg/zi) si un antidepresiv (dintre cele \up0 \expndtw0\charscalex115
menfionate) poate intrerupe cercul vicios reprezentat de anxietate - depresie
\par\pard\ql \li1031\sb7\sl-230\slmult0 \up0 \expndtw0\charscalex113 - durere -
anxietate. \par\pard\ql \li1031\ri416\sb0\sl-250\slmult0\fi288\tx1324 \up0
\expndtw0\charscalex117 Un loc aparte il ocupS s* Haloperidolul care posedS
structurS chimicS \up0 \expndtw0\charscalex112 asemSnStoare morfinei (Koher),
putand fi preferat Levomepromazinei. \line \tab \up0 \expndtw0\charscalex123 De
asemenea, preparatul Opipramol \up0 \expndtw0\charscalex114 (Insidon-R) prezintS
proprietSfi \par\pard\qj \li1036\ri432\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex119 mixte (neuroleptice si antidepresive), fiind adesea
preferat de practicienii \up0 \expndtw0\charscalex119 generalisti. \par\pard\qj
\li1051\ri405\sb0\sl-244\slmult0\fi283 \up0 \expndtw0\charscalex114 Nu trebuie
omise efectele secundare ale celor douS clase de medicamen-\line \up0
\expndtw0\charscalex114 te psihotrope, dupS cum este necesarS sublinierea cS
administrarea lor, tre� \up0 \expndtw0\charscalex120 buie fecute nu numai in doze
mici ci si pe perioade scurte, de 2-3 sSptS-\line \up0 \expndtw0\charscalex117
mSni. Desigur, torapia cu psihotrope a bolnavului reumatic constituie doar \up0
\expndtw0\charscalex121 un adjuvant, adesea extrem de eflcient, Tn cadrul terapie)
complexe an-\line \up0 \expndtw0\charscalex121 tireumatlsmale, fiind asociats cu
alte procedee terapeutice precum
\up0 \expndtw0\charscalex121 flzioterapia. medicafia antiinf lamatoare si
antialgica dar si cu o serie de \up0 \expndtw0\charscalex118 metode
psihoterapeutice \up0 \expndtw0\charscalex128 (adesea poate fi inlocuits cu succes
de cStre \par\pard\ql \li643\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex118
acestea). \par\pard\qj \li652\ri810\sb0\sl-260\slmult0\fi288 \up0
\expndtw0\charscalex125 Un caz limits II constituie tratamentul unui mare nevrotic
acuzand \up0 \expndtw0\charscalex127 simptome reumatice reale \up0
\expndtw0\charscalex122 (obiectivabile prin mijloace diagnostice de \par\pard\qj
\li633\ri804\sb0\sl-242\slmult0\fi19 \up0 \expndtw0\charscalex119 laborator).
ConsiderSm cS in tratamentul unui astfel de bolnav, cuplul de \up0
\expndtw0\charscalex112 terapeufi \up0 \expndtw0\charscalex123 - psihiatru +
reumatolog (internist sau generalist) - trebuie sS \up0 \expndtw0\charscalex115
conlucreze strans. Atunci cand dificultafi obiective si subiective fac aceastS \up0
\expndtw0\charscalex125 conlucrare imposibilS, pare mai utila luarea in sarcina a
bolnavului de \up0 \expndtw0\charscalex126 catre psihiatrul care trebuie, insS, ca
sa asocieze la tratamentul psiho\up0 \expndtw0\charscalex126 trop si medicafia
antiinflamatoare sau antialgica prescrisS e consultul \up0 \expndtw0\charscalex117
reumatologic. in cazul invers, al preluSrii bolnavului de cStre reumatolog. \up0
\expndtw0\charscalex122 sarcina acestuia poate deveni ingrats si nici bolnavul nu
pare sS aiba un \up0 \expndtw0\charscalex110 beneficiu. \par\pard\ql
\li921\sb189\sl-230\slmult0 \up0 \expndtw0\charscalex134 V. Psihoterapia in bolile
reumatismale \par\pard\qj \li638\ri795\sb202\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex115 De regue. medicul care trateazS un bolnav reumatic
intruneste - voluntar \up0 \expndtw0\charscalex117 sau nu - atribufii de psiholog
deoarece relafia pur "tehnicS" medicae dintre \up0 \expndtw0\charscalex114 medic si
bolnav este dublatS inerent de o relafie psihologicS, de comunicare \up0
\expndtw0\charscalex126 interumanS. ce porne$te de la obiectivul comun al ambllor
parteneri: \up0 \expndtw0\charscalex114 vindecarea (sau alinarea suferinfei
bolnavului) \par\pard\qj \li643\ri781\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex118 Din aceastS perspectivS, psihoterapia (PT) aplicata
bolnavului de cStre \up0 \expndtw0\charscalex120 medic este, in primul rand o
psihoterapie simpIS, suportivS, de sustinere \up0 \expndtw0\charscalex119 (PTS). in
cazuri mai dificile, relevand tulburSri marcate ale personalitafii \up0
\expndtw0\charscalex119 pacientului, este necesarS colaborarea cu psihologul care
in situafii ideae \par\pard\qj \li638\ri784\sb20\sl-240\slmult0\fi9 \up0
\expndtw0\charscalex114 - lucreazS in clinica reumatologicS. in calitate de "membru
asociat" al echi� \up0 \expndtw0\charscalex111 pei de ingrijire. Totusi. nu
rareori, bolnavul reumatic, la fel ca si orice alt bol� \up0
\expndtw0\charscalex118 nav somatic, priveste cu reticenfS (si ca pe o sustragere
parfiala de la res� \up0 \expndtw0\charscalex115 ponsabilitatea terapeuticS)
tentativa medicului curant de a-l trimite e psiho� \up0 \expndtw0\charscalex121
log. Referitor la situafia trimiterii sae la consult psihiatric \up0
\expndtw0\charscalex118 (in lipsa unor \par\pard\ql \li638\sb9\sl-230\slmult0
\up0 \expndtw0\charscalex113 antecedente Tn domeniu), bolnavul se simte chiar
lezat.
Din aceste motive, eel mai adesea - dar numai cand terapeutul nu se \up0
\expndtw0\charscalex123 simte depSsit - este suficienta aplicarea unei PTS adecvata
specificului \up0 \expndtw0\charscalex120 problematicii bolnavului reumatic iar,
atunci cand este posibil, trimiterea \up0 \expndtw0\charscalex124 sa la diferitele
proceduri cu caracter psihoterapeutic (Training-ul auto\up0 \expndtw0\charscalex120
gen sau psihosomatic. de ex.). Aceste metode - fiind incluse intr-un pro� \up0
\expndtw0\charscalex122 gram terapeutic complex (ex. gimnastica medicala. proceduri
fiziotera\up0 \expndtw0\charscalex121 peutice diverse, badterapia. etc.) - nu mai
apar ca o diluare a responsabi\up0 \expndtw-2\charscalex100 litafii \up0
\expndtw0\charscalex121 terapeutului, in plus, bolnavii beneficiaze de avantajele
terapiei in \up0 \expndtw0\charscalex118 grup (comunicare cu ceilalfi bolnavi, ca
si cu terapeufii respectivi, puterea \up0 \expndtw0\charscalex115 exemplului celor
care au reusit se domine boala, etc.). \par\pard\ql \li926\sb148\sl-230\slmult0
\up0 \expndtw0\charscalex118 A. Principii de psihoterapie suportiva la bolnavii
\expndtw0\charscalex115 PTS este implicate de desesurarea intregului act medical
dar ea se infep-\line \up0 \expndtw0\charscalex115 tuieste, aproape in totalitate,
in cursul discufiilor dintre medic s' bolnav.
psihosomaticd generala si aplicata\par\pard\qj \li1339\sb0\sl-240\slmult0
240\slmult0\fi4 \up0 \expndtw0\charscalex120 Medicul trebuie se porneascS de la
datele concrete ale situatiei bolnavului \up0 \expndtw0\charscalex114 caracterizatS
- in linii generale - prin existenfa a douS laturi cu impact psiho� \up0
\expndtw0\charscalex120 logie major: disconfortui bolnavului \up0
\expndtw0\charscalex125 (dominat de durere) si handicapul. \par\pard\ql
\li1339\sb29\sl-230\slmult0\tx7708 \up0 \expndtw0\charscalex134 fizic in primul
rand, generat de afectarea autonomie! sale \tab \up0 \expndtw0\charscalex119
(implicit \par\pard\ql \li1339\sb10\sl-230\slmult0\tx3892 \up0
\expndtw0\charscalex121 cresterea dependenfel) \u8226? \tab \up0
\expndtw0\charscalex119 $i psihologie. cauzat de situafia de inferioritate
(mergand pans la perceperea unei veritabie stigmatizSri). in Tabelul \tab \up0
\expndtw-2\charscalex100 1 \par\pard\qj \li1334\ri141\sb0\sl-260\slmult0\fi9
\up0 \expndtw0\charscalex114 figureazS cateva caracteristici de psihoterapie de
grup (dupS Csef), ce pot fi \up0 \expndtw0\charscalex114 considerate ca repere si
pentru discufia individuae cu pacientul reumatic. \par\pard\ql \li2640\sb0\sl-
Tabelul 1. Terapia de grup (TO) in bolile reumatice: \par\pard\ql \li2376\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex114 Confinut fl obiective (Felul modlficat
dupa CSEF - 1990) \par\pard\li1934\sb162\sl-230\slmult0\fi105\tx2299 \up0 \expndtw-
9\charscalex73 1.\tab \up0 \expndtw0\charscalex119 Culegerea intormaflilor despre
boald (Simptome, medicafia\par\pard\li1934\sb15\sl-230\slmult0\fi0\tx4660\tx4847
\up0 \expndtw0\charscalex119 primitd, efecte secundare\tab \up0
\expndtw0\charscalex119 \u9632?\tab \up0 \expndtw0\charscalex119 bolnavul Idsat sd-
si exprime liber\par\pard\li1934\sb5\sl-230\slmult0\fi14 \up0
\expndtw0\charscalex119 simptomele dar si propriile opinii, emofii,
etc.)\par\pard\qj \li1943\ri396\sb0\sl-240\slmult0\fi52 \up0
\expndtw0\charscalex124 2. Ciarificarea comportamentului sau. ca bolnav (Care tip
de \up0 \expndtw0\charscalex109 comportament influenfeazd boala in mod pozitiv sau
negativ) \par\pard\ql \li2006\sb1\sl-227\slmult0\tx7920 \up0
\expndtw0\charscalex129 3. Convorbire deschisa despre sentlmentele personate
\tab \up0 \expndtw0\charscalex108 (ale \par\pard\qj \li1943\ri397\sb0\sl-
260\slmult0\fi4 \up0 \expndtw0\charscalex123 fiecdrui bolnav) referitoare la
experienfa fi problemele sale in \up0 \expndtw0\charscalex112 legaturd cu boala
4. Modalitafi de ajustare (coping) in cursul stresului psihic \line\tab \up0
\expndtw0\charscalex107 \u9632? centrare pe problema \par\pard\li2683\sb1\sl-
215\slmult0\fi0\tx4958 \up0 \expndtw0\charscalex103 - centrare pe emofie\tab
\up0 \expndtw0\charscalex103 **\u8226?\par\pard\ql \li2001\sb4\sl-220\slmult0
\up0 \expndtw0\charscalex118 5. Coparticipare emofionala la ceea ce sunt ceilalfi
si invers \par\pard\ql \li2006\sb12\sl-230\slmult0 \up0 \expndtw0\charscalex113 6.
Efecte pozitive ale TG \par\pard\ql \li2687\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex104 \u9632? Idrgirea comunicdrii \par\pard\ql \li2683\sb30\sl-
230\slmult0 \up0 \expndtw0\charscalex110 - impact social din partea grupului
combaterea izoldrii, dificultdfilor de comunicare $1 anxietdfii \up0
\expndtw0\charscalex106 \u9632? cresterea siguranfei de sine \par\pard\ql
\li2016\sb1\sl-194\slmult0 \up0 \expndtw0\charscalex115 7. Asocierea altor metode
de TG \par\pard\ql \li2692\sb17\sl-230\slmult0 \up0 \expndtw0\charscalex109 -
training autogen/relaxare \par\pard\qj \li1339\sb0\sl-245\slmult0
Toate aceste considerate impun medicului practician o serie de precautii, \up0
\expndtw0\charscalex118 realizand o adevSratS regizare a relafiei sale cu bolnavul
reumatic. FSrS a \up0 \expndtw0\charscalex123 avea pretenfia de a oferi un model
perfect si permanent valabil in acest \up0 \expndtw0\charscalex113 sens, vom
prezenta cSteva sugestii (prelucrate dupS Labhart, Barnard si Lu� \up0
\expndtw0\charscalex113 ban-Plozza si col. dar $1 rezultate din unele observatii
personae). \par\pard\qj \li1348\ri129\sb0\sl-248\slmult0\fi297 \up0
\expndtw0\charscalex116 �� ascultarea atentS si rSbdStoare a bolnavului. favorizand
verbalizarea \up0 \expndtw0\charscalex125 emotiilor sale, strans legate de
simptomele adesea obsedante, ca si de \up0 \expndtw0\charscalex118 ecoul lor in
existenfa sa (a nu se manifesta, sub nici o forme, acea graba a \up0
\expndtw0\charscalex122 medicului pe care Luban Plozza o denumeste In mod sugestiv
"Angina \up0 \expndtw0\charscalex132 tempons"): aceaste verbalizare contribuie si
la scederea anxietSfii \up0 \expndtw0\charscalex119 pacientului; \par\pard\ql
\li1665\sb1\sl-181\slmult0\tx6019 \up0 \expndtw0\charscalex123 >- luarea Tn serios
a acuzelor pacientului \tab \up0 \expndtw0\charscalex128 (chiar si atunci cand
ele \par\pard\ql \li1363\sb39\sl-230\slmult0 \up0 \expndtw0\charscalex120 sunt mult
modificate in cadrul haloului psihic ce are la bazS
personalita-\par\pard\sect\sectd\fs24\paperw8820\paperh13220{\bkmkstart Pg204}
235\slmult0\fi4 \up0 \expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 tea dar
si biogratia bolnavului); o negare a autenttcitSfii sulerinfei pacientu� \up0
\expndtw0\charscalex121 lui reumatic sporeste anxietatea si ulterior, depresia
acestuia, conducand \up0 \expndtw0\charscalex119 adesea la ruperea relafiei
terapeutice (de fapt, nu conteazS dacS suferinta \up0 \expndtw0\charscalex122
bolnavului este preponderent psihica si mai putin somaticS, ea exists ca \up0
\expndtw0\charscalex112 atare s> trebuie infeleasS); \par\pard\qj
\li940\ri521\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex120 > observarea
atenta a mimicii. ca si a gesturilor bolnavului, inclusiv -\line \up0
\expndtw0\charscalex118 Si mai ales - a acelora care se insofesc de modificSri
posturale (de ex. ca-\line \up0 \expndtw0\charscalex118 muflarea agresivitSfii
printr-o pozifie incordats a cefei sau a trunchiului); \par\pard\ql \li1243\sb0\sl-
180\slmult0 \up0 \expndtw0\charscalex122 > In plus, este necesarS includerea, in
setul de intrebari adresate pa� \par\pard\qj \li935\ri512\sb0\sl-240\slmult0
\up0 \expndtw0\charscalex125 cientului, pe acelea care aduc informafii de ordin
psihologie si pe care \up0 \expndtw0\charscalex116 le-am considerat extrem de utile
In anamneza oncSrui bolnav psihosomatic \up0 \expndtw0\charscalex116 (lamandescu -
1997) ele putand sS aducS informafii cu referire la: \par\pard\qj
\li935\ri507\sb0\sl-240\slmult0\fi307 \up0 \expndtw0\charscalex126 J existenfa unor
factori psihotraumatizanfi in ultimele luni. ca si o \up0 \expndtw0\charscalex119
trecere in revists foarte sumarS a unor eventuae traume psihice majore In \up0
\expndtw0\charscalex113 cursul biografiei pacientului \par\pard\qj
\li940\ri528\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex131 J relafia dintre
stresurile psihice si acutizarile simptomatologiei \up0 \expndtw0\charscalex114
(pot fl cazuri in care aceastS relafie nu este evIdentS). \par\pard\ql
\li1224\sb1\sl-218\slmult0\tx3950 \up0 \expndtw0\charscalex142 \u9633? modul in
care boala \tab \up0 \expndtw0\charscalex134 (dar si medicafia prescrisa!)
afecteaza \par\pard\ql \li940\sb13\sl-230\slmult0\tx3758 \up0
\expndtw0\charscalex124 calitatea viefii
pacientului \tab \up0 \expndtw0\charscalex118 (pot fi utilizate, dupS terminarea
anamnezei; \par\pard\qj \li935\ri518\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex119 unele chestionare consacrate in aceasta pnvinfS, ca de ex.
SF-36 Mosby), \up0 \expndtw0\charscalex117 sunt importante detaliile cu privire
\up0 \expndtw0\charscalex116 1a dispozifia \up0 \expndtw0\charscalex124 (depresive,
anxioasa) a \par\pard\qj \li935\ri502\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex126 bolnavului, tulburarile de somn, ca si afectarea unor
activitafi uzuale, \up0 \expndtw0\charscalex120 prin impotenfa funcfionale generata
de boalS sau prin efectele secundare \up0 \expndtw0\charscalex115 ale medicafiei).
Nu trebuie omise nici tulburarile de dinamicS sexualS, des \up0
\expndtw0\charscalex116 tul de frecvente e bolnavii reumatici cu tulburSri severe
de statics sau imo\up0 \expndtw0\charscalex116 bilitate care acuzS dureri la cele
mai mici miscSri \par\pard\qj \li926\ri502\sb0\sl-243\slmult0\fi307 \up0
\expndtw0\charscalex120 > instaurarea unui climat de incredere si de optimism
terapeutic, me-\line \up0 \expndtw0\charscalex115 nit sS consolideze o relafie
terapeuticS beneficS si sa contribuie la cresterea \up0 \expndtw0\charscalex115
compllantei terapeutice, ca si la potenfarea efectului farmacologic "in sine", \up0
\expndtw0\charscalex115 obiectiv, al preparatelor administrate printr-un efect
adifional psihologie, de \up0 \expndtw0\charscalex121 tip Placebo, care depeseste
cu mult aproximativ 30% subiecfi ameliorafi \up0 \expndtw0\charscalex134 (Placebo
pozitivi) din studiile farmacologice consacrate unor noi \up0
\expndtw0\charscalex123 medicamente. in acest din urma caz, la acfiunea antialgica
a medicafiei \up0 \expndtw0\charscalex122 administrate bolnavilor reumatici se
adauga si o anume cantitate de en \up0 \expndtw0\charscalex126 dorfine. generate de
credinfa bolnavului in efectul benetic al medica-\line \up0 \expndtw0\charscalex118
mentelor pe care lea primit. Se infelege ce, in aceste cazuri - de bune
rela-\line \up0 \expndtw0\charscalex116 tionare intre medic si bolnav - se pot
utiliza doze mai mici de medicamente \up0 \expndtw0\charscalex115 antiinflamatorii
si de psihotrope datorite acestor factori psihici mobilizafi si \up0
\expndtw0\charscalex115 antrenafi - pnn mecanisme incS necunoscute - in procesul
vindecerii. \par\pard\ql \li1233\sb168\sl-230\slmult0 \up0 \expndtw0\charscalex120
B Procedee psihoterapeutice speciale utilizate in bolile reumatismale
Sunt extrem de utile in cazul asocierii cu celelalte procedee terapeu� \up0
\expndtw0\charscalex118 tice (medicamentoase, fizice. etc.) dar, de regue, sunt
efectuate numai sub \up0 \expndtw0\charscalex117 indrumarea unor psihoterapeufi
specializafi in metodele respective. Totu� \up0 \expndtw0\charscalex125 si, avand
in vedere ce majoritatea acestor procedee vizeazS relaxarea \up0
\expndtw0\charscalex126 musculaturii hipertonice, concomitent cu o relaxare
psihosomatica ge-\par\pard\sect\sectd\fs24\paperw8820\paperh13220{\bkmkstart Pg205}
psihosomatica generala $i aplicata\par\pard\qj \li1296\sb0\sl-250\slmult0
250\slmult0\fi9 \up0 \expndtw0\charscalex128 neraia. exists posibilitatea TnvSfSrii
de cStre pacient a confinutului \up0 \expndtw0\charscalex118 exercifiilor unei
metode si autoaplicarea lor ulterioarS, la domiciliu sau in \up0
\expndtw0\charscalex118 oncare loc ce permite relaxarea acestuia. \par\pard\qj
\li1300\ri153\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex118 Asa este cazul
cu "antrenamentul autogen" - Schultz (Autogenic Trai� \up0 \expndtw0\charscalex124
ning) care se bazeazS pe constientizarea de cStre pacient a cenesteziei \up0
\expndtw0\charscalex120 sale somatice prin sugestia transmisS de terapeut \up0
\expndtw0\charscalex110 - in momentul InvSfSrii \par\pard\ql \li1300\sb8\sl-
230\slmult0\tx3172 \up0 \expndtw0\charscalex112 exercifiilor in grup \tab \up0
\expndtw0\charscalex125 - si apoi pnn autosugestia pacientului, referitoare la
aceleasi senzafii de lintste si relaxare a diferitelor parti ale corpului: \up0
\expndtw0\charscalex115 membre. mime, aparat respirator, abdomen, regiune cefalice.
Pentru bolna� \up0 \expndtw0\charscalex115 vul reumatic aceaste "autorelaxare
concentrate'" are valoare prin referirea la \up0 \expndtw0\charscalex121 grupele
musculare si e sentimentul de liniste si relaxare trait atat la nivel \up0
\expndtw0\charscalex117 psihic, cat si somatic de cetre pacient. Exercifiile pot fi
insofite de muzice, \up0 \expndtw0\charscalex116 (posedS un efect musculorelaxant),
iar insu?irea lor se poate face in maxi� \up0 \expndtw0\charscalex119 mum 2
sepemem. ulterior pacientul putand se efectueze singur - acasa on \up0
\expndtw0\charscalex117 intr-o pauze de servlclu \up0 \expndtw0\charscalex114 -
unui sau doue exercifii \up0 \expndtw0\charscalex115 (cu durate de cateva mi�
\par\pard\qj \li1300\ri158\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex120 nute)
Pentru bolnavii reumatici cele mai indicate sunt primeie 3 exercifii \up0
\expndtw0\charscalex120 ("liniste", "greutate". "caldurS") \par\pard\qj
\li1296\ri145\sb3\sl-235\slmult0\fi292 \up0 \expndtw0\charscalex118 O vanante.
active, a aeestei metode o constituie "Training-ul psihoso� \up0
\expndtw0\charscalex121 matic" elaborat de Luban Plozza. constand intr-un complex
de exercifii \up0 \expndtw0\charscalex127 centrate pe respirafie si insofite de
masaj. totul pe un fundal muzical \up0 \expndtw0\charscalex117 Aceaste lorrre de
psihoterapie combinata cu miscarea si muzica pare se fie \up0
\expndtw0\charscalex117 cea mai indicate pentru bolnavii reumatici. \par\pard\qj
\li1296\ri148\sb0\sl-233\slmult0\fi297 \up0 \expndtw0\charscalex115 in esenfS.
toate aceste exercifii de relaxare. lie pasivS (ca in TA. Shultz) \up0
\expndtw0\charscalex115 fie active \up0 \expndtw0\charscalex113 (ca Tn
antrenamentul psihosomatic) conduc Tn ultimS instanfS la \up0
\expndtw0\charscalex120 concentrarea pacientului asupra senzafiilor sale organice,
ca si a imaginii \up0 \expndtw0\charscalex111 corpului sSu. \par\pard\qj
\li1296\ri143\sb0\sl-230\slmult0\fi297 \up0 \expndtw0\charscalex114 Muzicoterapia
apare ca o reals promisiune in cadrul complex al bolnavi� \up0
\expndtw0\charscalex120 lor reumatici. in afara efectului cert de relaxare. ca si a
celui de comutare \up0 \expndtw0\charscalex116 a preocupSrilor anxioase sau
"gSndurilor negre" spre o lume imaginara, in-\line \up0 \expndtw0\charscalex120
carcata de frumos - muzica are capacitatea de a induce la asculetor cres� \up0
\expndtw0\charscalex120 terea secrefiei de endorfine (Harvey cit. de Van Deest). De
altfel, de mai \up0 \expndtw0\charscalex126 bine de doue decenii, muzica a fost
utilizate ca important adjuvant in \up0 \expndtw0\charscalex135 anestezia
practicate in unele intervenfii chirurgicale \up0 \expndtw0\charscalex128 (inclusiv
in \par\pard\qj \li1291\ri142\sb0\sl-240\slmult0\fi9 \up0 \expndtw0\charscalex116
stomatologie sau ginecologie) S'. de asemenea. pentru diminuarea durerilor \up0
\expndtw0\charscalex112 din timpul travaliului obstetrical \up0
\expndtw0\charscalex109 (Springte si Droh). \par\pard\ql \li1603\sb168\sl-
230\slmult0 \up0 \expndtw0\charscalex117 C. Complianfa terapeutica la bolnavii
\expndtw0\charscalex121 incercand o privire succine a complianfei terapeutice (CT),
am putea \up0 \expndtw0\charscalex128 afirma ce ea reprezinta gradul de aderenfe a
bolnavului la indicative \up0 \expndtw0\charscalex116 medicului. referitoare la
medicafie. diee. mod de viafa, etc. \par\pard\qj \li1315\ri146\sb9\sl-
232\slmult0\fi278 \up0 \expndtw0\charscalex119 Tendinfa bolnavilor reumatici la
hipocomplianfS ar putea fi mai redu-\line \up0 \expndtw0\charscalex120 sa decat in
alte boli psihosomatice deoarece durerea reprezintS un simp� \up0
\expndtw0\charscalex117 tom pentru a cSrui combatere pacientul este gata sS
respecte cele mai dra-\line \up0 \expndtw0\charscalex117 conice prescripfii
medicale Pornindu-se de la aceste premise si in acord cu \up0
\expndtw0\charscalex115 noile principii de tratament (observate. de ex., in astmul
bronsic), ameliora-\line \up0 \expndtw0\charscalex115 rea complianfei terapeutice
se bazeazS pe instaurarea asa-numitului
"par-\par\pard\sect\sectd\fs24\paperw8820\paperh13220{\bkmkstart Pg206}{\bkmkend
233\slmult0\fi4 \up0 \expndtw0\charscalex120 \ul0\nosupersub\cf9\f10\fs20 teneriat
pentru sanatate" ce constS in libertatea (parfiae) de decizie acor-\line \up0
\expndtw0\charscalex118 dats bolnavului care - in conditiile unei bune s1
obligatoni instruiri despre \up0 \expndtw0\charscalex125 cauzele. pnncipalele
mecanisme ale bolii. ca sj despre rafiunea tuturor \up0 \expndtw0\charscalex120
mSsunlor terapeutice - poate sa-si moditice temporar medicafia \up0
\expndtw0\charscalex108 (dozele) \par\pard\qj \li643\ri785\sb6\sl-
235\slmult0\fi9 \up0 \expndtw0\charscalex117 (panS la un nou control medical) si
trebuie sa-si exprime liberul consimfa-\line \up0 \expndtw0\charscalex115 mant
asupra diferitelor
restrict ii impuse de conduita terapeuticS. Este lesne \up0
\expndtw0\charscalex121 de infeles cS o serie de factori psihologici, dependent de
medic, pacient. \up0 \expndtw0\charscalex123 anturajul acestuia dar si de natura
disconfortului, restnctiilor impuse de \up0 \expndtw0\charscalex132 boala sau de
acfiunea medicamentelor \up0 \expndtw0\charscalex129 (efecle secundare, inclusiv
agravarea unor boli asociate. etc.) concurs la ecuatia personae a bolnavului
\up0 \expndtw0\charscalex109 referitor la CT \par\pard\ql \li945\sb192\sl-
230\slmult0 \up0 \expndtw0\charscalex116 D. Asociafii ale bolnavilor reumatici
Ca si in alte boh cronice psihosomatice, ca de ex. bolile coronariene sau \up0
\expndtw0\charscalex114 diabetul zaharat $i, in ultimul timp, astmul bronsic -
bolnavii reumatici S'-au \up0 \expndtw0\charscalex118 format propriile asociafii
care au ca scop instruirea si exemplificarea unui \up0 \expndtw0\charscalex119 mod
de viafa adaptat problemelor bolilor reumatismale. ofennd si condi� \up0
\expndtw0\charscalex119 fii de participare in comun la anumite forme de terapie, in
special fizica. \par\pard\qj \li648\ri719\sb9\sl-230\slmult0\fi287 \up0
\expndtw0\charscalex116 0 astfel de organizafie este reprezentata de cStre Rheuma-
Club, infiinfat \up0 \expndtw-9\charscalex74 Tn \up0 \expndtw0\charscalex117 1979
la Munchen. Activitatea acestui club se desesoare sub forma unor \up0
\expndtw0\charscalex118 Sedinfe de terapie in grup o data pe saptamana (miercurea
intre orele 18-\par\pard\qj \li643\ri770\sb1\sl-242\slmult0\fi28 \up0
\expndtw0\charscalex116 19.30, spre a putea avea acces s1 pacienfii activi
profesional). Se incepe cu \up0 \expndtw0\charscalex119 gimnastica in bazinul cu
apa (incalzitS la 32 34 C) si. dupa 45 de minute. \up0 \expndtw0\charscalex120 se
contmua cu un program de exercifii fizice la sala de gimnastica. Ulte� \up0
\expndtw0\charscalex114 rior au loc discufii Tntre membrii grupului (maximum 10, de
regue - 6-7 pa-\line \up0 \expndtw0\charscalex115 cienfi) si cu terapeutul. prilej
pentru bolnavi de a-si impSrtSsi reciproc pro� \up0 \expndtw0\charscalex117 blemele
lor sufletesti - iesind din izolarea impusS de boae - dar si de a dis-\line \up0
\expndtw0\charscalex119 cuta despre sufennfele generate de boae. Un rol important
il au exemplele \up0 \expndtw0\charscalex119 vii ale acelor bolnavi care au reusit
sS depSseascS fazele critice ale bolii. \up0 \expndtw0\charscalex117 Efectele
favorablle asupra evolufiei bolii au fost comparate cu rezultatele -\line \up0
\expndtw0\charscalex117 mult sub asteptSn - obfinute de cStre aceiasi bolnavi intr-
o fazS anterioarS \up0 \expndtw0\charscalex122 cSnd ei au urmat acelasi tip de
program e domiciliu \up0 \expndtw0\charscalex122 (bai caide in cade,
urmate de aceleasi exercifii de gimnastica), lipsindu-le doar avantajele \up0
\expndtw0\charscalex120 comumcarii. inclusiv al verbahzarii senzafiilor generate de
boala ca si ale \up0 \expndtw0\charscalex105 emofiilor \up0 \expndtw0\charscalex111
(Stocksmeier si Pinno-Poweleit). \par\pard\ql \li950\sb90\sl-230\slmult0 \up0
\expndtw0\charscalex120 Bibliografie \par\pard\ql \li974\sb110\sl-230\slmult0
\up0 \expndtw0\charscalex107 1 Barnard C Cum sa trdim mai usor cu artrita. Rohn
Direct Impex. Bucuresti-\par\pard\ql \li1195\sb9\sl-207\slmult0\tx1900 \up0
\expndtw0\charscalex103 \ul0\nosupersub\cf3\f4\fs18 1994. p \tab \up0
\expndtw0\charscalex102 63-71. 95-101. \par\pard\qj \li935\ri769\sb3\sl-
220\slmult0\tx1166 \up0 \expndtw0\charscalex133 2 Beck D. In: Psyche und rheuma
psychomatische Shmerzzustand des \line\tab \up0 \expndtw0\charscalex115
tiewegungsapparales. Schwalbe. Eular Publ. Basel, p. \up0 \expndtw0\charscalex101
180-186. \up0 \expndtw-7\charscalex100 1975. \par\pard\ql \li935\ri768\sb0\sl-
220\slmult0\tx1161\tx1161\tx1161 \up0 \expndtw0\charscalex127 3. Buddenberg C,
Kaufmann P.. Radvila A. Introduction Qu'est-ce que la \line\tab \up0
\expndtw0\charscalex116 mddecino psychosomattque et psychosociaie 7 In Medecine
psychosomatique \line\tab \up0 \expndtw0\charscalex116 et psychosociaie en Suisse.
Babler. Bern 1993 (eds. Buddernorg C. Kaufmann \line\tab \up0
\expndtw0\charscalex116 P . Radvila A), p. 57 62 \par\pard\qj \li945\ri792\sb0\sl-
220\slmult0\tx1156 \up0 \expndtw0\charscalex123 4. Bernhard P. Chronische
funktionelle schmerzzustande des bewegungsap-\line\tab \up0 \expndtw0\charscalex114
paraies auspsychosomatischer Sicht. Ther. Woche, 1983, 33, 3837.
207\slmult0\par\pard\li1742\sb21\sl-207\slmult0\fi4 \up0 \expndtw0\charscalex117 5.
Gerber R. Cap. Chronisches kranksein. In: Psychosoziale Medizin (Hgst.
J.\par\pard\li1742\sb14\sl-207\slmult0\fi230\tx4233 \up0 \expndtw0\charscalex110
Witli und E. Helm, Berne,\tab \up0 \expndtw0\charscalex116 1995, p. 529-
538).\par\pard\li1742\sb9\sl-207\slmult0\fi4 \up0 \expndtw0\charscalex115 6.
lamandescu I. B. Psihologie medicald, p. 113-119, pf/>51-259. ed.
Infomedica,\par\pard\li1742\sb14\sl-207\slmult0\fi220\tx2927 \up0
\expndtw0\charscalex116 7 lamandescu I B. Bolile psihosomatice\tab \up0
\expndtw0\charscalex116 \u9632?\tab \up0 \expndtw0\charscalex116 argumenle pentru
roformularea\par\pard\li1742\sb10\sl-207\slmult0\fi220\tx4171\tx4665\tx4881 \up0
\expndtw0\charscalex113 conceptului. Infomedica.\tab \up0 \expndtw-7\charscalex100
1997,\tab \up0 \expndtw-8\charscalex78 1.\tab \up0 \expndtw0\charscalex116 10-
11.\par\pard\li1742\sb9\sl-207\slmult0\fi0 \up0 \expndtw0\charscalex117 8. Ikemi Y
Integration of eastern and western psychosomatic medicine, p. 1-7,
p.\par\pard\li1742\sb14\sl-207\slmult0\fi215 \up0 \expndtw0\charscalex116 26-35.
Kunshu University Press. 1996.\par\pard\li1742\sb4\sl-207\slmult0\fi4 \up0
\expndtw0\charscalex116 9. Keeol O. J. Neurosurgery 1984, t5.
935.\par\pard\li1742\sb9\sl-207\slmult0\fi28 \up0 \expndtw0\charscalex117 10
Labhardt F. Psycho und psychopharmakotherapie bet
rheumattschen\par\pard\li1742\sb9\sl-207\slmult0\fi297\tx4790\tx5611 \up0
\expndtw0\charscalex115 erkrankungen. Therapiewoche.\tab \up0
\expndtw0\charscalex101 1985, 35,\tab \up0 \expndtw0\charscalex116 1235-
\expndtw0\charscalex119 11. Luban-Plozza B.. Poldinger W.. Kroger F. Boli
psihosomatice in practica \line\tab \up0 \expndtw0\charscalex112 medicald. Ed.
Medicala. Bucuresti. \up0 \expndtw0\charscalex105 1996, p. 239-252. \par\pard\ql
\li1771\sb1\sl-207\slmult0 \up0 \expndtw0\charscalex109 12. Spingte R.. Droh R.
Musik-Medizin. G. Fischer. Stuttgart-Jena-New York. 1992, \par\pard\ql
\li2044\sb13\sl-207\slmult0 \up0 \expndtw0\charscalex110 p. 23-30. 92-94.
Van Deest. Hailen mil Musik. Thieme, Stuttgart. \tab \up0 \expndtw0\charscalex104
1997. p. 28-40. \par\pard\sect\sectd\fs24\paperw8820\paperh13220{\bkmkstart Pg208}
\up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf14\f15\fs24 ELEMENTE DE
PSIHOSOMATICA ALERGOLOGICA \par\pard\ql \li1036\sb0\sl-253\slmult0
\ul0\nosupersub\cf8\f9\fs22 loan Bradu lamandescu \par\pard\ql \li1017\sb0\sl-
\expndtw0\charscalex126 I. Psihoneuroalergologia - domeniu de interferenta intre
\line\tab \up0 \expndtw0\charscalex121 actiunea factorilor intuno-alergici si
factorii psiho-sociali, \line\tab \up0 \expndtw0\charscalex122 din perspectiva
psihosomatica si somato-psihua \par\pard\ql \li1036\sb216\sl-253\slmult0 \up0
\expndtw0\charscalex121 1. Argumente preliminare. Scurt istoric \par\pard\qj
\li715\ri672\sb190\sl-250\slmult0\fi292 \up0 \expndtw0\charscalex108 In ultima
jumState de secol, relafiile psihotogiei cu medicina au inceput \up0
\expndtw0\charscalex111 sS se emancipeze de sub tutela psihiatriei de orientare
psihanaliticS (desi \up0 \expndtw0\charscalex114 mai exists numeroase sechele).
Interventia activS a unor cercetstori din \up0 \expndtw0\charscalex108 randul
corpului medical - care au asociat numerosi psihologi si sociologi la \up0
\expndtw0\charscalex107 studierea epidemiologiei unor boli psihosomatice de larga
rSspSndire, intre \up0 \expndtw0\charscalex111 care si astmul alergic sau dermatita
atopies - a reusit sS contureze, aeturi \up0 \expndtw0\charscalex109 de factorii de
rise somatici. o serie de comportamente nocive pentru sSnS-\line \up0
\expndtw0\charscalex114 tate ca de exemplu tipul comportamental A, desemnat ca
factor de rise \up0 \expndtw0\charscalex108 pentru bolile coronariene. De asemenea.
observafiile clinicienilor \up0 \expndtw0\charscalex105 - atunci \par\pard\qj
\li710\ri684\sb14\sl-246\slmult0 \up0 \expndtw0\charscalex106 cand au cSpStat si
girul psihologilor care au utilizat diferite teste, Tn special \up0
\expndtw0\charscalex109 In domeniul trSsSturilor de personalitate - au putut
evidenfia aparifia unui \up0 \expndtw0\charscalex105 comportament regresiv al
omului bolnav, generat de suferinta sa (mai ales in \up0 \expndtw0\charscalex105
bolile cronice cu evolufie prelungitS). \par\pard\qj \li700\ri684\sb0\sl-
250\slmult0\fi302 \up0 \expndtw0\charscalex105 La bolnavii psihosomatici au mai
fost observate frecvent o intensS anxie� \up0 \expndtw0\charscalex107 tate,
TntrefinutS de perspectiva revenirii unor simptome extrem de penlbile \up0
\expndtw0\charscalex108 (durere, dispnee, etc.), ca si o stare depresivS generatS
de frecventele reel\up0 \expndtw0\charscalex109 dive, ca si de o serie de esecuri
terapeutice. Considerandu-se $i implicarea \up0 \expndtw0\charscalex105 factorilor
psihosociali Tn aparifia bolilor Tn general dar mai ales a celor psi� \up0
\expndtw0\charscalex120 hosomatice, s-a creat premiza unor modele explicative ale
aparifiei \up0 \expndtw-2\charscalex100 diverselor TmbolnSviri. \par\pard\qj
\li705\ri702\sb5\sl-246\slmult0\fi288 \up0 \expndtw0\charscalex106 Asa s-a nSscut
modelul bio-psiho-social postulat de cStre Engel $i cons� \up0
\expndtw0\charscalex109 titued o premisS teoreticS logics pentru explicarea rolului
diverselor cate� \up0 \expndtw0\charscalex104 gorii de agenti etiologici capabili
sS previnS imbolnSvirea ori agravarea unei \up0 \expndtw0\charscalex104 boli deja
existente. \par\pard\qj \li710\ri723\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex108 Este lesne de infeies cS doua dintre rSdScinile bolii
(psihicS si socials), \up0 \expndtw0\charscalex110 diferite de cea biologies
\up0 \expndtw0\charscalex107 (legae de "soma"), explicS intervenfia factorului
de psihosomatica generala 91 aplicata\par\pard\li1041\sb0\sl-
230\slmult0\fi4\tx1723 \up0 \expndtw0\charscalex113 psihic\tab \up0
\expndtw0\charscalex119 (psyche) intrevSzut incS din antichitate ca avand un rol
important,\par\pard\li1041\sb10\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex119
adesea nelipsit. in patogenezS.\par\pard\ql \li1036\ri377\sb6\sl-
240\slmult0\fi283\tx1339 \up0 \expndtw0\charscalex120 Acest model al bolii
constituie in acelasi timp si factorul de legimitate \up0 \expndtw0\charscalex117
pentru Medicina psihosomatica, concept ce desemneazS o dube entitate: \line\tab
\up0 \expndtw0\charscalex121 J teoretica, fondats pe conceptia psihosomaticS.
bazatS pe explicarea \up0 \expndtw0\charscalex115 unitSfii dintre psihic si
somatic, atat in cadrul mecanismelor patogenezei cat \up0 \expndtw0\charscalex112
Si in eel al vindecarn bolii \up0 \expndtw0\charscalex112 (Buddeberg si colab.).
\expndtw0\charscalex115 \u9633? practica, bolile psihosomatice, concepute ca boli
cu etiologie multifac\up0 \expndtw0\charscalex121 tonala dar cu o componenta
psihogene obligatorie, fie asociae cu ceilalfi \up0 \expndtw0\charscalex121 factori
specifici organului afectat. fie acfionSnd altemativ cu acestia sub \up0
\expndtw0\charscalex114 aparenfa exclusivitafii (lamandescu 1980, 1997) (de exemplu
un astm intrin\up0 \expndtw0\charscalex118 sec presupus psihogen. dotat eel pufin
cu o hiperactivitate bronsicS nespe\up0 \expndtw0\charscalex105 cificS).
Psihosomatica de esentS psihanaliticS a inceput in ultimile doua decenii \up0
\expndtw0\charscalex117 sa opereze cu concepte psiho-fiziologice, neuro-
endocrinologice si biochi\up0 \expndtw0\charscalex116 mice, iar in planul
terapeutic cu o serie de metode psihoterapeutice axate pe \up0
\expndtw0\charscalex116 modificarea comportamentelor nocive pentru senetatea
individului. \par\pard\qj \li1027\ri382\sb0\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex120 Stabihrea domeniului de inciudere a bolilor psihosomatice
din randul \up0 \expndtw0\charscalex113 diferitelor specialiefi medicale (vom mai
reveni asupra acestui subiect) cons� \up0 \expndtw0\charscalex110 tituie si Tn
prezent o tentative nu lipsite de riscuri. Totusi, acolo unde ponderea \up0
\expndtw0\charscalex121 etiologica a factorului psihic a aparut ca fiind
remarcabie. s-au constituit \up0 \expndtw0\charscalex115 chiar ventabile interramun
ale medicinii psihosomatice. Buddeberg si colab. \up0 \expndtw0\charscalex116
citeaza intr-o lucrare relativ recenta (1995) cateva astfel de domenii
aplica\up0 \expndtw0\charscalex116 tive ale psihosomaticii: psihosomatica
ginecologice, reumatologice, derma\up0 \expndtw0\charscalex116 tologica.
cardiovasculara, etc. \par\pard\qj \li1031\ri383\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex119 A sosit rnomentul ca. dupe magistrae deschidere, realizata
de Ader, in \up0 \expndtw0\charscalex115 domeniul psihoneuroimunologiei, sa putem
inaugura un alt domeniu. inrudit \up0 \expndtw0\charscalex115 cu acesta dar $i "mai
psihosomatic" - acela al Psihoneuroalergologiei. \par\pard\qj \li1027\ri372\sb0\sl-
245\slmult0\fi311 \up0 \expndtw0\charscalex122 Psihoneuroalergologia poate fi
definita ca o discipline de interferen\up0 \expndtw0\charscalex124 fa intre
alergologie si psihologie. dar eel pufin in acest moment in care \up0
\expndtw0\charscalex117 alergologia constituie inca un "tot unitar" (neexistSnd o
separare intre aler\up0 \expndtw0\charscalex122 gologia prechnicS s1 cea clinicS).
aceasta noua discipiina poate fi recta\up0 \expndtw0\charscalex122 mata de
psihosomatica ca o noua subramura a acesteia \par\pard\qj \li1031\ri377\sb0\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex116 O activitate de peste 25 am in
aceastS zonS de interferenfS intre alergo� \up0 \expndtw0\charscalex121 logie si
psihologie, mS indreptsteste, sper, sS incerc in lucrarea de fafa o \up0
\expndtw0\charscalex121 conturare a acestui nou teritoriu al Psihosomaticii
Din cercetarea literaturii consacrate relafiilor dintre alergologie si psiho�
\up0 \expndtw0\charscalex115 logie considerdm ca se pol distinge doua etape:
\expndtw0\charscalex80 \u9632? \tab \up0 \expndtw0\charscalex117 cea inifiala (la
mijlocul secolului XX). dominatS de abordarea aeestei \up0 \expndtw0\charscalex123
relafii aproape exclusiv prin prisma concepfiei psihanalitice ($coala lui \up0
\expndtw0\charscalex114 Alexander, profilurile psihosomatice elaborate de Flanders
Dunbar. etc.), dar \up0 \expndtw0\charscalex114 care a furmzat - printre altele -
metodologia actuals de investigare a ponderii \up0 \expndtw0\charscalex118
factorului psihic Tn etiopatogenia astmului bronsic. bazae pe conceptul de \up0
\expndtw0\charscalex119 boae multifactorialS a acestuia \up0
\expndtw0\charscalex115 (Freour) si stabihrea relafiilor cronologice
\par\pard\qj \li1065\ri394\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex130 intre
evenimentele psihotraumatizante si Nuctuatiile evolufiei bolii \up0
\expndtw0\charscalex103 (Kourilsky),
\u8226?>\tab \up0 \expndtw0\charscalex106 207\par\pard\qj \li830\sb0\sl-240\slmult0
240\slmult0\fi297 \up0 \expndtw0\charscalex120 - etapa ultimului deceniu,
caractenzate pnn elaborarea unor lucreri cu \up0 \expndtw0\charscalex114 pnvire e
interventia factorului psihic ca trigger suplimentar al unor sindroa� \up0
\expndtw0\charscalex122 me clinice cu etiologie predominant alergice, analizand si
mecanismele \up0 \expndtw0\charscalex118 psihoneurofizlologice implicate (Barnes,
Rihoux. Marone, Biennenstock. \up0 \expndtw0\charscalex116 Grob. Ballieux etc), sau
indicil de calltate a viefii la bolnavii alergici (E Ju \up0
\expndtw0\charscalex117 niper, Bousquet si colab. etc), ca si modul Tn care se
poate edifica un ven-\line \up0 \expndtw0\charscalex122 tabil "parteneriat pentru
sanatate" al bolnavului aslmatic \up0 \expndtw0\charscalex113 (Edith
Raame-\par\pard\ql \li835\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex116 kers),
posibil de a fi atms si la alte boli alergice \par\pard\ql \li1123\sb10\sl-
230\slmult0\tx2318 \up0 \expndtw0\charscalex113 intrucat din \tab \up0
\expndtw0\charscalex116 1970 si pene in prezent. am trait aceaste evolufie a
concep-\par\pard\qj \li835\ri613\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex117
telor de "Psihosomatice alergologica". sper ca la o eventuae revenire ulte� \up0
\expndtw0\charscalex120 rioare asupra acestui subiect se consacru un paragral mult
mai consistent \up0 \expndtw0\charscalex113 istoncului devenirii
Psihoneuroalergologiei. \par\pard\qj \li830\ri598\sb0\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex119 Ceea ce este ince un prilej de nemulfumire fata de felul
cum este privit \up0 \expndtw0\charscalex117 acest domeniu de cetre comunitatea
alergologica. este absenfa Psihoneuro \up0 \expndtw0\charscalex114 alergologiei din
"main topics' a Congreselor EAACI \up0 \expndtw0\charscalex107 (excepfie \up0
\expndtw0\charscalex111 1991) la care \par\pard\ql
\li830\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex116 am participat pans in acest
an (1998). \par\pard\qj \li835\ri597\sb2\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex118 O alts exceptie o constituie includerea unei topici
"Psychosomatic pro \up0 \expndtw0\charscalex115 blems in allergology", la primul
Congres Balcanic de Alergologie in \up0 \expndtw0\charscalex108 28-29
\par\pard\ql \li835\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex112 mai 1998
(Presedinte al Comitetului de organizare Prof. Jenny Mileva). \par\pard\qj
\li1128\ri995\sb156\sl-320\slmult0\tx1435 \up0 \expndtw0\charscalex138 2. Conceptul
de Psihoneuroalergoiogie, sfera domeniului \line\tab \up0 \expndtw0\charscalex137
$i obiectivele sale \par\pard\qj \li830\ri603\sb158\sl-250\slmult0\fi297 \up0
\expndtw0\charscalex115 Deoarece obiectivele si sfera de preocupSri a PNA sunt
aplicafii ale Psi� \up0 \expndtw0\charscalex114 hosomaticii si Medicinii
Psihosociale in domeniul alergologiei, se cuvine sS \up0 \expndtw0\charscalex114
prezentSm succint nofiunile de bazS ale acestor discipline. \par\pard\qj
\li830\ri598\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex113 De asemenea,
dupS cum am mai afirmat la Tnceputul aeestei cSrfi, psiho-\line \up0
\expndtw0\charscalex118 neuroalergologla (PNA) apare in opinia noastra ca un
domeniu de interfe-\line \up0 \expndtw0\charscalex128 renfa intre alergologie,
psihoneurotiziologie si psihologie clinicd Ea \up0 \expndtw0\charscalex116 poate fi
considerae, fie ca un domeniu particular al Alergologiei (care pSnS \up0
\expndtw0\charscalex119 acum nu-l revendica!), fie ca o subramura a Psihosomaticii
(care, chiar si \up0 \expndtw0\charscalex113 sub o forms nesistematizats, a
inregistrat preocupSri Tn acest domeniu). \par\pard\ql \li1118\sb8\sl-
230\slmult0\tx6575 \up0 \expndtw0\charscalex119 Obiectivul sSu major este studierea
reactiei biunivoce \tab \up0 \expndtw0\charscalex116 (de interdepen-\par\pard\ql
\li830\sb10\sl-230\slmult0\tx6897 \up0 \expndtw0\charscalex120 denfS) dintre viafa
psihicS a unui individ predispus genetic \tab \up0 \expndtw0\charscalex114
(atopicul, in \par\pard\qj \li825\ri609\sb2\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex114 primul rand) si evolufia alergiei sale, incepSnd cu
aparifia hipersensibilizarii \up0 \expndtw0\charscalex117 latente clinic,
continuand cu primele manilestSri patologice patente - Tn al \up0
\expndtw0\charscalex115 cSror determinism factorul alergic si eel psihic se
influenfeazS reciproc - S' \up0 \expndtw0\charscalex115 sfSrsind cu aspecte severe
legate de intricarea alergiei cu alte etiologii. \par\pard\qj \li830\ri613\sb0\sl-
250\slmult0\fi297 \up0 \expndtw0\charscalex119 De altfel, Tn mod analog cu cele
douS stiinfe generale de interferentS \up0 \expndtw0\charscalex120 dintre medicine
S' psihologie, domeniul psihoneuroalergologiei cuprinde \up0
\expndtw0\charscalex120 doue zone interdependente: \par\pard\qj
\li840\ri607\sb0\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex118 - influenfa
viefii psihice asupra constituirii Inflamafiei alergice (psiho� \up0
\expndtw0\charscalex129 neurotiziologie atergotogicd) pane la aparifia
manifesterilor clinice \up0 \expndtw0\charscalex116 percepute de cetre bolnav. zone
aflata in sfera psihosomaticii propriuzise; \par\pard\qj \li844\ri633\sb0\sl-
240\slmult0\fi278 \up0 \expndtw0\charscalex114 - reacfia bolnavului fafd de
simptomele sele, ce si fafd de comportamen� \up0 \expndtw0\charscalex114 tul
echipei medicale si a tuturor celor care il ingrijesc (fere a omite si
com-\par\pard\sect\sectd\fs24\paperw8820\paperh13220{\bkmkstart Pg211}{\bkmkend
\up0 \expndtw0\charscalex106 Elemente de psihosomatica generala �i
\expndtw0\charscalex115 ponenta psihologice a acestui colectiv de Tngrijire,
generate de contactul cu \up0 \expndtw0\charscalex116 bolnavul si problemele
acesteia) \up0 \expndtw0\charscalex117 - zona aflate in sfera medicinei psihoso�
\par\pard\ql \li998\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex114 ciale si putand
ti provizoriu definite ca Psihoalergologie clinicd. \par\pard\qj
\li988\ri440\sb0\sl-244\slmult0\fi297 \up0 \expndtw0\charscalex116 Ambele "zone"
ale PNA au un sector comun "psihosomatic" de conver\up0 \expndtw0\charscalex117
genfe, de esenfa psihologice si psihofarmacologica. dar si de esenfa mana\up0
\expndtw0\charscalex118 geriala. cu elemente psihosociale implicite (organizarea
unui cadru socio\up0 \expndtw0\charscalex121 prolesional si institutional de
abordare concertate a problemelor comune \up0 \expndtw0\charscalex116 unor
categorii de boli alergice de large raspandire. cum ar fi astmul alergic. \up0
\expndtw0\charscalex116 dermatita atopies, alergia medicamentoasS si ahmentara,
etc.). \par\pard\qj \li998\ri440\sb0\sl-233\slmult0\fi292 \up0
\expndtw0\charscalex118 Domeniile de definitie ale PNA reprezinte in acelasi timp
obiective de \up0 \expndtw0\charscalex121 interes diagnostic dar mai ales
profilactic si terapeutic deoarece evolufia \up0 \expndtw0\charscalex117 unui
proces alergic este supuse legilor actuae, privind etiologia multitacto-\line
\up0 \expndtw0\charscalex115 nala a unui sindrom. cu includerea in rSndul agenfilor
etiologici \up0 \expndtw0\charscalex113 - pe langS \par\pard\ql \li988\sb1\sl-
223\slmult0\tx3225 \up0 \expndtw0\charscalex118 cei principals alergiei \tab
\up0 \expndtw0\charscalex118 - a unei serii de factori nespecifici bolii
respective, \par\pard\qj \li998\ri450\sb3\sl-240\slmult0 \up0
\expndtw0\charscalex119 denumifi triggeri. Acestia au proprietatea de a declansa
aceleasi manifes\up0 \expndtw0\charscalex115 tari clinice. la fel ca si agentul
etiologie "de baza" \up0 \expndtw0\charscalex109 (alergenul). \par\pard\qj
\li993\ri456\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex114 in cazul unor
boli cu etiologie alergicS dominants precum astmul alergic. \up0
\expndtw0\charscalex125 dermatita atopies, etc. sau al unor boli alergice propriu-
zise \up0 \expndtw0\charscalex109 (polinoza, \par\pard\qj \li988\ri435\sb0\sl-
240\slmult0\fi9 \up0 \expndtw0\charscalex114 alergia medicamentoasS ori la veninul
de himenoptere. de ex.), triggerutpsi� \up0 \expndtw0\charscalex126 hogen poate
acfiona alternativ cu alergenul sau sumativ cu acesta Tn \up0
\expndtw0\charscalex122 declansarea sindroamelor respective dar el poate si sa
"sape" la fundafia \up0 \expndtw0\charscalex122 bolii prin mecanisme care
accentueazS inflamafia alergice sau diminua \up0 \expndtw0\charscalex119
activitatea unor componente ale sistemului imun \up0 \expndtw0\charscalex123
(acestea din urma sunt \par\pard\ql \li1003\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex116 intante in cazul psihoterapiei) \par\pard\qj
\li998\ri450\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex115 in acelasi timp,
ca toate bolile psihosomatice, alergiile cu manifeseri cli� \up0
\expndtw0\charscalex118 nice - generatoare de disconfort dar $i ale unei veritabile
anxieefi \up0 \expndtw-1\charscalex100 - referi� \par\pard\qj \li988\ri410\sb22\sl-
238\slmult0\fi4 \up0 \expndtw0\charscalex117 toare la ameninfarea adesea vitae ca
si a inserfiei individului in mediul sau \up0 \expndtw0\charscalex115 social
(familial si profesional Tn primul rSnd) - sunt considerate ca afectand \up0
\expndtw0\charscalex114 calitatea viefii bolnavilor. Ele trebuie abordate prin
pnsma conceptiei psiho� \up0 \expndtw0\charscalex116 somatice care extinde
investigafia clinics (mai ales la nivelul anamnezei) in \up0
\expndtw0\charscalex114 direcfia considerarii intervenfiei factorului psihic ca
trigger al manifestSrilor \up0 \expndtw0\charscalex119 clinice si ca element ce
poate marea evolufia boiii. in plus, factorul psihic \up0 \expndtw0\charscalex113
trebuie privit si din punctul de vedere al implicSrii sale Tn relafia bolnavului
\up0 \expndtw0\charscalex118 alergic cu medicul si cu persoanele capabile sS-i
ofere un suport moral, ca \up0 \expndtw0\charscalex119 Si din punctul de vedere al
implicdrii unor elemente psihosociale in com\up0 \expndtw0\charscalex115 plianta
terapeutica. element de bazS al actului medical si avand. la bolnavul \up0
\expndtw0\charscalex115 alergic (astmatic in special), serioase neimpliniri.
\par\pard\li1012\sb26\sl-230\slmult0\fi278 \up0 \expndtw0\charscalex114
SintetizSnd, dupS Spector $i Micklas, problemele psihologice ale
bolnavi�\par\pard\li1012\sb15\sl-230\slmult0\fi0\tx4051 \up0
\expndtw0\charscalex113 lor alergiei, le redSm in tabelul\tab \up0
\expndtw0\charscalex113 1.\par\pard\ql \li1012\ri420\sb0\sl-
240\slmult0\fi292\tx1320 \up0 \expndtw0\charscalex110 DupS aceastS conturare
inevitabil sumarS a domeniului PNA. vom incerca \up0 \expndtw0\charscalex114 sS
propunem urmetoarele obiective ale aeestei noi stiinfe interdisciplinare: \line\tab
\up0 \expndtw-9\charscalex90 1. \up0 \expndtw0\charscalex129 Stabihrea ponderii
factorului psihic \up0 \expndtw0\charscalex125 (reprezentat in special, de
\par\pard\ql \li1017\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex115 stresui psihic
sub variatele sale iafete) Tn dinamica procesului alergic. \par\pard\qj
\li1031\ri440\sb0\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex114 Este apreciatS
cu incepere de la etapa infraclimcS (edificarea hipersensi-\line \up0
\expndtw0\charscalex112 bilizSrii) si pSnS la evolufia spre etapele severe, ale
bolii alergice, intricae cu \up0 \expndtw0\charscalex112 alte etiologii. Tot in
cadrul acestui obiectiv se inscriu si preocupSrile diversilor
\ul0\nosupersub\cf9\f10\fs20 Psihosomatica aplicata\tab \up0
240\slmult0\fi9 \up0 \expndtw0\charscalex117 autori de a cerceta natura diferifilor
factori psihotraumatizanti ca si meca� \up0 \expndtw0\charscalex117 nismele
psihoneurofiziologice prin care acestia acfioneazS asupra diferite\up0
\expndtw0\charscalex114 lor verigi ale reactiei alergice, ca si asupra evolufiei
clinice a unei boli aler� \up0 \expndtw0\charscalex114 gice sau a unui sindrom cu
componenta etiologies alergica. \par\pard\qj \li1631\sb0\sl-240\slmult0
Tabelul 1. Probleme psihologice ale bolnavilor alergiei \line\tab \up0
\expndtw0\charscalex117 (modifleet dupa Spector $1 Mick/as) \par\pard\qj
\li1089\sb0\sl-240\slmult0 \par\pard\qj\li1089\ri984\sb20\sl-240\slmult0\tx1300
\up0 \expndtw0\charscalex114 1. Declan$area psihogend a puseelor (urticaria) sau a
crizelor (astm), \line\tab \up0 \expndtw0\charscalex108 etc. \par\pard\qj
\li1055\ri948\sb0\sl-240\slmult0\tx1310 \up0 \expndtw0\charscalex118 2. Perceperea
unor stdri de trustrare, supdrare sau conflicte in sdnul \line\tab \up0
\expndtw0\charscalex105 familiei. \par\pard\qj \li1051\ri968\sb0\sl-
240\slmult0\tx1300 \up0 \expndtw0\charscalex114 3. Pierderi cu impact afectiv major
(decese, divorf, concediere. schim-\line\tab \up0 \expndtw0\charscalex114 barea
locuinfei, etc.). \par\pard\qj \li1065\ri953\sb0\sl-240\slmult0\tx1310 \up0
\expndtw0\charscalex127 4. Refenri frecvente la moarte. stare de neajutorare sau
lipsa de \line\tab \up0 \expndtw0\charscalex114 speranfa. \par\pard\qj
\li1060\ri984\sb0\sl-240\slmult0\tx1300 \up0 \expndtw0\charscalex114 5. Modificdri
comportamentale. labilitate emofionaid. furnat excesiv, \line\tab \up0
\expndtw0\charscalex115 abuz de alcool \par\pard\ql \li1060\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex114 6. Evidenfa unor abuzuri fizice sau sexuale.
\par\pard\ql \li1075\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 7. Probleme
confactuate cu anturajul familial si profesional. \par\pard\ql \li1060\sb1\sl-
217\slmult0 \up0 \expndtw0\charscalex112 8. Noncomplianfa \u9632? de cercetat
cauzete. \par\pard\qj \li1055\ri953\sb4\sl-240\slmult0\tx1300 \up0
\expndtw0\charscalex120 9. Abilitafi intelectuale si motivafionale reduse pentru
indepiinirea \line\tab \up0 \expndtw0\charscalex112 monitorizdrii progresutui
terapeutic. \par\pard\qj \li763\sb0\sl-240\slmult0
\par\pard\qj\li763\ri695\sb220\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex124 2.
Cercetarea impactului bolii alergice asupra psihicului bolnavului \up0
\expndtw0\charscalex125 afectat \par\pard\ql \li1051\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex114 Implies o considerare a trei mari categorii de probleme:
\par\pard\qj \li758\ri680\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex116 a)
reculul somato-psihic. ca reactie psihicd la disconfortui specific bolii. \up0
\expndtw0\charscalex117 concretizat prin tulburarile in sfera psihicS acuzate de un
bolnav ca urmare \up0 \expndtw0\charscalex114 a simptomelor sale alergice din
cursul episoadelor acute ale bolii (de ex. in� \up0 \expndtw0\charscalex115 somnia
on somnolenfa diurnS la un astmatic cu crize nocturne, iritabilitatea \up0
\expndtw0\charscalex115 Si starea de jenS a unui bolnav cu un prurit frecvent. in
cadrul unei urticarii \up0 \expndtw0\charscalex115 sau dermatite atopice, etc.):
\par\pard\qj \li768\ri675\sb20\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex116 b)
reacfia psihicd fafd de posibilitatea repetdrii puseelor de activitate ale \up0
\expndtw0\charscalex116 bolii alergice \up0 \expndtw0\charscalex127 (de regue, o
stare de anxietate, de asteptare, ca in cazul \par\pard\qj \li753\ri690\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex118 crizelor de astm sau al puseelor de edem
glotic, cu evolufie greu controla\up0 \expndtw0\charscalex123 bie) ori o anxietate
de perspectivd sau o stare de descurajare - mergand \up0 \expndtw0\charscalex113
pane la depresie - (ca in cazul nevoiii de tratament medicamentos la bolnavii
\up0 \expndtw0\charscalex113 cu alergie medicamentoase); \par\pard\qj
\li763\ri695\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex119 c) studiul
indicatorilor de calitate a viefii (OOL), cu implicafii in viafa \up0
\expndtw0\charscalex113 psihice a bolnavului, in sfera sa motivafional-afective dar
si a randamentului \up0 \expndtw0\charscalex113 sSu fizic si intelectual vizand
inserfia sa socials (familiala si profesionae). \par\pard\ql \li1051\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex120 3. Modificarile personalitafii bolnavului
alergic \par\pard\qj \li768\ri708\sb2\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex121 Au in vedere cele doue direcfii de abordare impuse de
disputa dintre \up0 \expndtw0\charscalex114 numerosii autori care au studiat
personalitatea bolnavilor alergiei, in special
generala si aplicata\par\pard\li1281\sb0\sl-230\slmult0\par\pard\li1281\sb0\sl-
pe cea a astmaticilor. Anticipand opinia noastrS. expusS intr-un capitol
ulte�\par\pard\li1281\sb10\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex117 rior, se
pot avea in vedere:\par\pard\li1281\sb19\sl-230\slmult0\fi297 \up0
\expndtw0\charscalex118 - trasaturile de personalitate premorbide, cu rol
favorizant in aparifia mai\par\pard\li1281\sb15\sl-
230\slmult0\fi0\tx3863\tx5255\tx5851 \up0 \expndtw0\charscalex117 facie a unui
stres psihic\tab \up0 \expndtw0\charscalex117 (lamandescu,\tab \up0 \expndtw-
2\charscalex100 1980,\tab \up0 \expndtw0\charscalex117 1993) si in
comportamentul\par\pard\li1281\sb15\sl-230\slmult0\fi4\tx4137 \up0
\expndtw0\charscalex117 nociv al bolnavului alergic\tab \up0
\expndtw0\charscalex117 (complianta terapeuticS reduss,
ampliticare\par\pard\li1281\sb15\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex117
psihogenS a momentelor evolutive ale bolii, etc.)\par\pard\qj \li1271\ri157\sb3\sl-
245\slmult0\fi302 \up0 \expndtw0\charscalex117 - Irdsdturi/e de personalitate
induse secundar de evolufia cronicd a unei \up0 \expndtw0\charscalex118 boli
alergice, generatoare de disconlort psiho-fizic, ca si al unor probleme \up0
\expndtw0\charscalex119 socio-profesionale. Sunt comune tuturor bolnavilor cu boli
psihosomatice \up0 \expndtw0\charscalex116 cronice dar. in cazul alergicilor,
aceste trSsSturi de personalitate (dominate \up0 \expndtw0\charscalex116 de
depresie) capatS nuanfe particulare. \par\pard\qj \li1276\ri171\sb0\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex127 4. Tulburarile neurologice si
psihiatrice induse de sindroamele cu \up0 \expndtw0\charscalex121 etiologie
alergicS dominants. \par\pard\qj \li1271\ri161\sb0\sl-248\slmult0\fi311 \up0
\expndtw0\charscalex113 DacS tulburarile neurologice de cauzS alergicS sunt fie
insuficient cunos-\line \up0 \expndtw0\charscalex115 cute, fie controversate,
tulburarile psihiatrice sunt destul de frecvent intalni-\line \up0
\expndtw0\charscalex114 te, eel mai adesea fiind izolate dar avand uneori si o
"configurafie neurotics" \up0 \expndtw0\charscalex113 (atacuri de panics, stari
depresive) in schimb foarte mulfi bolnavi alergiei (in \up0 \expndtw0\charscalex121
urticaria cronies de ex. sau in astmul bronsic corticodependent) suferS o \up0
\expndtw0\charscalex112 veritabie "dezvoltare nevroticS" (termen abandonat de
ultimele DSM-III si IV \par\pard\qj \li1276\ri162\sb0\sl-245\slmult0 \up0
\expndtw0\charscalex119 - dar care poate desemna o "stare de fapt" clinics destul
de superpozabilS \up0 \expndtw0\charscalex123 unei modificSri secundare a
personalitSfii). Importanfa izolSrii acestui \up0 \expndtw0\charscalex115 obiectiv
de studiu al PNA consts in focalizarea interesului pentru acel esan\up0
\expndtw0\charscalex114 lion de populafie cu boli alergice care necesitd consult
psihologie $i/sau psi\up0 \expndtw0\charscalex114 hiatric. ca si \u9632? destul de
des - apelul la mijloace psihofarmacologice. \par\pard\qj \li1271\ri172\sb0\sl-
246\slmult0\fi297 \up0 \expndtw0\charscalex125 5. Introducerea unor proceduri
psihoterapeutice simple (suportive) \up0 \expndtw0\charscalex122 sau complexe, in
mod sistemic la bolnavii alergiei, in funcfie de ponde\up0 \expndtw0\charscalex123
rea in dinamica bolii a factorului psihic asociat, ca si de circumstanfeie \up0
\expndtw0\charscalex123 de instituire si de desfasurare a relafiei terapeutice.
Constituie un vast capitol, in continuS extensie a PNA. incepSnd cu \up0
\expndtw0\charscalex118 pnncipiile de abordare psihosomaticS a bolnavilor alergiei,
continuand cu \up0 \expndtw0\charscalex117 psihoterapia simpla (de susfinere) si
terminSnd cu psihoterapiile complexe \up0 \expndtw0\charscalex116 (de relaxare.
experienfiale. muzicoterapie, etc.) cu accentul pe grupul tera� \up0
\expndtw0\charscalex116 peutic. \par\pard\qj \li1276\ri177\sb0\sl-260\slmult0\fi287
\up0 \expndtw0\charscalex118 in esenfa. scopurile si posibiliefile diverselor forme
de psihoterapie pot \up0 \expndtw0\charscalex118 II rezumate astfel:
\par\pard\qj \li1286\ri172\sb0\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex114 LI
anihilarea sau atenuarea intervenfiei factorului psihic Tn evolutia boln \up0
\expndtw0\charscalex114 alergice manifesto clinic; \par\pard\qj
\li1300\ri167\sb0\sl-240\slmult0\fi278
\up0 \expndtw0\charscalex124 \u9633? ameliorarea integrdrii sociale a Individului,
paralel cu corectarea \up0 \expndtw0\charscalex122 indicilor de calitate a viefii
de nature psihologice \up0 \expndtw0\charscalex116 (inclusiv acomodarea
\par\pard\ql \li1291\sb1\sl-214\slmult0 \up0 \expndtw0\charscalex111 bolnavului in
situafiile imposibil de ameliorat); \par\pard\qj \li1296\ri182\sb8\sl-
260\slmult0\fi287 \up0 \expndtw0\charscalex114 LI influenfarea efectiva a
simptomelor bolii alergice (de ex. bioleedback, \up0 \expndtw0\charscalex114
muzicoterapie. hipnoza. etc.); \par\pard\ql \li1583\sb1\sl-211\slmult0 \up0
\expndtw0\charscalex122 6 Asigurarea unei complianfe terapeutice optime
Implice - in plan psihologie, inclusiv educational \tab \up0
\expndtw0\charscalex111 - atSt factorul cantitativ \par\pard\ql \li1310\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex116 reprezentat prin cresterea raportului
procentual dintre indicafiile urmate de
Psihosomatica aplicata\tab \up0 \expndtw0\charscalex124 \u9830? 211\par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 bolnav si cele prescrise de cetre medic cat si
factorul calitativ. reprezentat \up0 \expndtw0\charscalex114 de participarea
active. Tn cunostinfa de cauze a bolnavului alergic la propria \up0
\expndtw0\charscalex114 sa vmdecare \par\pard\qj \li787\ri655\sb0\sl-
246\slmult0\fi283 \up0 \expndtw0\charscalex119 0 importanfa crescende, in special
la bolnavii alergiei. o prezine antro\up0 \expndtw0\charscalex112 narea familiei
\up0 \expndtw0\charscalex117 (aetun de medic, studenfi, infirmiere, asistenti
sociali) la in\up0 \expndtw0\charscalex118 gnjirea bolnavului alergic, modalitate
realizabie dupe exemplul modelului \up0 \expndtw0\charscalex109 Monte Verita
(Luban-Plozza). \par\pard\qj \li791\ri641\sb0\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex122 7. Organizarea unui model de viafa al bolnavului alergic.
pornind de \up0 \expndtw0\charscalex122 la educarea alergicilor \up0
\expndtw0\charscalex128 (dar si a celor predispusO sau realizarea unor \par\pard\qj
\li782\ri646\sb13\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex117 tacilitetl
privind adresabihtatea la medic si culminSnd cu constltuirea unor \up0
\expndtw0\charscalex120 veritabie asociafii ale acestor bolnavi \up0
\expndtw0\charscalex118 (de exemplu astmaticii). menite se \par\pard\qj
\li782\ri655\sb4\sl-260\slmult0 \up0 \expndtw0\charscalex116 concentreze avantajele
aborderii complexe a bolilor alergice inclusiv oferi\up0 \expndtw0\charscalex116
rea unor mijloace variate de a depesi inconvenientele. \par\pard\qj
\li787\ri641\sb0\sl-250\slmult0\fi287 \up0 \expndtw0\charscalex115 Vom releva pe
parcursul aeestei lucrari fiecare din obiectivele Tnfefisate \up0
\expndtw0\charscalex124 mai sus. fie in cadrul aeestei parfi de PNA generae, fie in
cadrul traerii \up0 \expndtw0\charscalex115 principalelor boli alergice (astmul
bronsic, dermatita atopice de ex.). \par\pard\ql \li1089\sb77\sl-253\slmult0
\up0 \expndtw0\charscalex110 \ul0\nosupersub\cf8\f9\fs22 Bibliogratie
\ul0\nosupersub\cf3\f4\fs18 1 Adet R (red) Psychoimmunology - Academic Press-
London, New York 1981. \par\pard\qj \li1075\ri643\sb0\sl-240\slmult0\tx1315 \up0
\expndtw0\charscalex131 2 Ballioux RR. Psyche and immune response Fisons Summary
Service \line\tab \up0 \expndtw0\charscalex108 Wednesday May 22 EAACI - Congress
Zurich 1991. \par\pard\ql \li1075\ri633\sb0\sl-220\slmult0\tx1300\tx1305 \up0
\expndtw0\charscalex117 3. Barnes PJ. Neural mechanisms pp. 161-174. in asthma in
Advances in allergy \line\tab \up0 \expndtw0\charscalex126 and clinical immunology
(Ed.Godard pH.. Bousquet J. si Michel F.B.). \line\tab \up0 \expndtw0\charscalex115
Parthenon Publish Group, Lanes UK New Jersey, 1992 \par\pard\li1080\sb11\sl-
207\slmult0\fi0 \up0 \expndtw0\charscalex114 4. Bienenstock J.
Psychoneuroallergology - a reality in Conversations in
allergy\par\pard\li1080\sb19\sl-207\slmult0\fi225\tx2145\tx5985 \up0
\expndtw0\charscalex101 (IV) - pp.\tab \up0 \expndtw0\charscalex109 15 18. UCB -
Institute Allergy. Brain lAlleud.\tab \up0 \expndtw0\charscalex113 1995\par\pard\ql
Bonini Se. Bonint St, Lambtase Aet at \u9632? Immune, endocrine and neural
aspects \line\tab \up0 \expndtw0\charscalex109 ot allergic inflammation - 475-481,
vol.XVI - European Congres ot Allergol. Clui. \line\tab \up0
\expndtw0\charscalex108 Immunol. Monduzzi. Bologna. \up0 \expndtw-2\charscalex100
1996 \par\pard\ql \li1084\ri668\sb0\sl-230\slmult0\tx1300\tx1291 \up0
\expndtw0\charscalex121 6. Bousquet J How do we optimise asthma assessments ? in
Eds. Clark T H.. \line\tab \up0 \expndtw0\charscalex114 Falon I. M How do we
optimise asthma therapy ?. pp. 27-30, Excerpta Medica. \line\tab \up0
\expndtw0\charscalex114 Amsterdam 1992 \par\pard\ql \li1094\sb1\sl-170\slmult0 \up0
\expndtw0\charscalex118 7 Bousquet J, Godard Ph. Michel FB (eds) Allergologie, pp.
227-242, Ellipses. \par\pard\ql \li1300\sb20\sl-207\slmult0 \up0
\expndtw0\charscalex113 Pahs, 1993. \par\pard\ql \li1075\ri628\sb0\sl-
230\slmult0\tx1334\tx1305 \up0 \expndtw0\charscalex122 8 Bousquet J, Michel FB
Socio-economic aspects of allergic diseases p 178-\line \tab \up0
\expndtw0\charscalex110 184. in Wuthnch 8 \u9632? Highlights in allergy and
clinical Immunology. Hogrefe and \line\tab \up0 \expndtw0\charscalex106 Huoer.
Bern, \up0 \expndtw-8\charscalex96 1991. \par\pard\ql \li1080\ri627\sb0\sl-
230\slmult0\tx1300\tx1300 \up0 \expndtw0\charscalex133 9 Buddeberg CI. Radvila A.
Kaufmann P. Was ist Psychosomatik und \line\tab \up0 \expndtw0\charscalex120
Psychosoziale Modizin, in Medecme psychosomatique et psychosociaie en \line\tab
\up0 \expndtw0\charscalex112 Suisse. Verlag Babler-Bern. \up0 \expndtw-
7\charscalex100 1993. \par\pard\ql \li1118\sb1\sl-198\slmult0 \up0
\expndtw0\charscalex113 10 Dunbar F Synopsis ot psychosomatic medicine. Mosby, St.
Louis. 1948. \par\pard\ql \li1113\sb15\sl-207\slmult0 \up0 \expndtw0\charscalex121
11. Engel*GL. The need for a new medical model A change tor bioscience.
Science.\tab \up0 \expndtw-8\charscalex97 1977,\tab \up0 \expndtw0\charscalex103
196:129-136.\par\pard\ql \li1118\sb0\sl-206\slmult0 \up0 \expndtw0\charscalex109
12. Freour P. Asthme une maladie complexe. Bordeaux Mod.. 1969. 1, 11,
\expndtw0\charscalex115 13. Freour P. L'asthme - terrain d'affrontement pour les
conceptions medicates, -\line \tab \up0 \expndtw0\charscalex115 Nouv Press Med.
1979, 8. 30. 2449-2650. \par\pard\qj \li1118\ri697\sb0\sl-220\slmult0\tx1391
\up0 \expndtw0\charscalex113 14 Graham DT, Psychosomatic medicine, in red.
Greenfield M. and Stembach R. \line\tab \up0 \expndtw0\charscalex113 Handbook ol
Psychophysiology, Rmehart Winston. New York 1972.
generala si aplicata\par\pard\li1430\sb0\sl-207\slmult0\par\pard\li1430\sb0\sl-
\expndtw0\charscalex117 Graham P. Childhood asthma: A psychosomatic disorder ? Some
epidemiolo\par\pard\li1430\sb5\sl-207\slmult0\fi312\tx5558 \up0
\expndtw0\charscalex116 gical considerations. Br. J. Prev. Soc. Med.\tab \up0
\expndtw0\charscalex117 1977, 21:78.\par\pard\li1430\sb18\sl-
207\slmult0\fi48\tx1756 \up0 \expndtw-8\charscalex89 16\tab \up0
\expndtw0\charscalex118 Grob. P.Stress related disorders. Fisons Summary Service.
Wednesday. May\par\pard\li1430\sb4\sl-207\slmult0\fi312 \up0
\expndtw0\charscalex117 22 EAACI - Congress. Zurich 1991.\par\pard\li1430\sb19\sl-
207\slmult0\fi43\tx1747\tx7459\tx7670 \up0 \expndtw-8\charscalex80 17.\tab \up0
\expndtw0\charscalex117 lamandescu IB. Coretafii psihosomatice in astmul
bronsic,\tab \up0 \expndtw0\charscalex117 -\tab \up0 \expndtw0\charscalex117 Tezd
de\par\pard\li1430\sb14\sl-207\slmult0\fi316 \up0 \expndtw0\charscalex117 Doctoral.
IMF Bucuresti 1980.\par\pard\li1430\sb9\sl-207\slmult0\fi43\tx1766 \up0 \expndtw-
8\charscalex91 18.\tab \up0 \expndtw0\charscalex118 lamandescu IB. L 'insterlion
des stimuli psychiques dans les mechanismes\par\pard\li1430\sb18\sl-
207\slmult0\fi331 \up0 \expndtw0\charscalex118 etiopathogemques de I'asthme
bronchiques avec trigger psychogene. Consi�\par\pard\li1430\sb9\sl-
207\slmult0\fi331\tx6455 \up0 \expndtw0\charscalex117 derations sur certames etudes
personelles\tab \up0 \expndtw0\charscalex117 (epidemiologique
et\par\pard\li1430\sb14\sl-207\slmult0\fi312\tx6460 \up0 \expndtw0\charscalex113
psychologtque). Rev. Roum. Psychol, 1990. 27, 2. pag.\tab \up0
\expndtw0\charscalex117 121-135.\par\pard\li1430\sb14\sl-
207\slmult0\fi43\tx1747\tx7238 \up0 \expndtw-8\charscalex80 19.\tab \up0
\expndtw0\charscalex115 lamandescu IB. Stresui psihic si bolile interne, ALL,
Bucuresti,\tab \up0 \expndtw0\charscalex117 1993\par\pard\li1430\sb18\sl-
\up0 \expndtw0\charscalex117 20. lamandescu IB\tab \up0 \expndtw0\charscalex117
\u9632?\tab \up0 \expndtw0\charscalex117 Stresui psihic la interferenfa Psihotogiei
Medicale cu\par\pard\li1430\sb5\sl-207\slmult0\fi336\tx4003\tx4732 \up0
\expndtw0\charscalex117 Psihosomatica. Jmed.,\tab \up0 \expndtw0\charscalex109
1993.2.\tab \up0 \expndtw0\charscalex117 17-19.\par\pard\li1430\sb14\sl-
207\slmult0\fi4\tx1766 \up0 \expndtw0\charscalex117 21\tab \up0
\expndtw0\charscalex118 lamandescu IB. Principles of psychosomatic approach of
allergic patients -\par\pard\li1430\sb9\sl-
207\slmult0\fi336\tx3523\tx4343\tx4545 \up0 \expndtw0\charscalex113 Rev
Roum.Psychol\tab \up0 \expndtw0\charscalex100 1993. 37,\tab \up0 \expndtw-
2\charscalex100 1,\tab \up0 \expndtw0\charscalex117 79 90.\par\pard\li1430\sb13\sl-
207\slmult0\fi4 \up0 \expndtw0\charscalex118 22 Juniper Elisabeth \u9632? Measuring
health-related quality of life in rhinits J Allergy\par\pard\li1430\sb14\sl-
207\slmult0\fi336 \up0 \expndtw0\charscalex117 Cltn Immunol 1997; 99S742-
9.\par\pard\li1430\sb14\sl-207\slmult0\fi4\tx1761\tx2927 \up0 \expndtw-
2\charscalex100 23.\tab \up0 \expndtw0\charscalex109 Kourilsky R.\tab \up0
\expndtw0\charscalex117 - Le conflict de personalite chez I'asthmatique
J.Fr.med.Chir,\par\pard\li1430\sb19\sl-207\slmult0\fi355\tx2524 \up0
\expndtw0\charscalex104 1963, 2.\tab \up0 \expndtw0\charscalex117
135\par\pard\qj \li1435\ri278\sb0\sl-220\slmult0\tx1756 \up0
\expndtw0\charscalex121 24 Lubban-Ploza, B. Poldinger W. Kroger F. Boli
psihosomatice in pradica \line\tab \up0 \expndtw0\charscalex112 medicala
(trad.E.Toma). Ed.Medicala, Bucuresti, \up0 \expndtw-6\charscalex100 1996.
25. Marone G, The concept of basophil and mast cell releasabiltty \u9632? AC!
\u9632? News \line\tab \up0 \expndtw0\charscalex108 1993. 5/1. 31 32
26 Rameckers EM \u9632? Patient empowerment - a threat or a help ? \u9632? EFA
-\line \tab \up0 \expndtw0\charscalex112 Symposion at the ICACI94 Conference-
Stockholm June 29th, 1994 \par\pard\qj \li1425\ri298\sb0\sl-220\slmult0\tx1790 \up0
\expndtw0\charscalex116 27. Rihoux JP The allergic reaction. 2nd ed. UCB-Pharm.
Sect.. Braine IAlleud, \line\tab \up0 \expndtw-5\charscalex100 1993.
28 Rosenman RH. Friedeman M\tab \up0 \expndtw0\charscalex118 \u9632?\tab
\up0 \expndtw0\charscalex118 Modifying type A behaviour
pattern,\par\pard\li1430\sb28\sl-207\slmult0\fi321\tx3547 \up0
\expndtw0\charscalex118 J.Psychosom. Res .\tab \up0 \expndtw0\charscalex118 1977.
21. 323-331.\par\pard\ql \li1435\sb0\sl-310\slmult0 \par\pard\ql\li1435\sb0\sl-
310\slmult0 \par\pard\ql\li1435\ri686\sb12\sl-310\slmult0\tx1737\tx1737 \up0
\expndtw0\charscalex123 \ul0\nosupersub\cf8\f9\fs22 3. Premise teoretice
psihofiziologice si clinicopsihologice \line\tab \up0 \expndtw0\charscalex128 ale
insertiei factorului psihic in etiopatogenia unor \line\tab \up0
\expndtw0\charscalex129 "sindroame alergice" \par\pard\ql \li1430\sb0\sl-
253\slmult0 \par\pard\ql\li1430\sb85\sl-253\slmult0 \up0 \expndtw0\charscalex110 A.
Sindroame plurietiologice cu domlnanfa etiologiei alergice \par\pard\qj
\li1151\ri275\sb178\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex113 Domeniul de
delimfie al bolilor alergice este. in realitate. mult mai \up0
\expndtw0\charscalex110 restrans decat acela al asistenfei medicale prostate
actualme'nte pentru o \up0 \expndtw0\charscalex110 serie de bolnavi care sunt
etichetafi ca alergiei (6). \par\pard\qj \li1151\ri271\sb20\sl-240\slmult0\fi283
\up0 \expndtw0\charscalex103 A$a-zisele boli alergice sunt, de fapt, sindroame (de
exemplu, astm, rinite \up0 \expndtw0\charscalex105 Si urticarie etc.). a ceror
etiologie poate fi reprezentate nu numai de alerge-\line \up0
\expndtw0\charscalex104 ni, ci s* de alfi factori etiologici nealergici \up0
\expndtw0\charscalex103 (inlecfiosi. toxici. etc.), inclusiv \par\pard\ql
\li1156\sb10\sl-253\slmult0 \up0 \expndtw0\charscalex102 cei psihici.
\ul0\nosupersub\cf9\f10\fs20 Pnmele date din literature privind interventia
stimulilor psihici in aparitia \up0 \expndtw0\charscalex129 sterii de alergie au
fost axate In special pe interventia stimulatoare a \up0 \expndtw0\charscalex118
stresului psihic in sinteza reaginelor dar si pe o serie de observatii
clinico\up0 \expndtw0\charscalex118 psihologice menite se releve rolul de trigger
al factorului psihic in aparifia \up0 \expndtw0\charscalex118 unor manifesed
produse, de regue, de cetre alergeni. \par\pard\qj \li849\ri783\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex121 Cerceteri ulterioare au conlirmat s*
evidentiat mecanismele psihofi� \up0 \expndtw0\charscalex114 ziologice de
intervenfie a factorului psihic in aparifia "sindromului alergic" \par\pard\ql
\li1137\sb69\sl-230\slmult0 \up0 \expndtw0\charscalex121 Conceptul de reacfii de
tip alergic \par\pard\qj \li844\ri768\sb122\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex115 Este un termen pe care l-am propus prima oare referitor la
alergia medi� \up0 \expndtw0\charscalex120 camentoasS . ince din 1988. in prezent
il consider necesar .,ca un termen \up0 \expndtw0\charscalex115 provizoriu" in
cazurile in care mecanismul alergic sau pseudoalergic (de ex. \up0
\expndtw0\charscalex116 aspirine si alte AINS) al unui sindrom inflamator e nivelul
mucoasei respi\up0 \expndtw0\charscalex124 ratorii sau tegumentelor nu poate fi
precizat pnn verificari eminamente \up0 \expndtw0\charscalex126 clinice. dar
trebuie tratat. in situafiile de urgenfe, cu aceleasi mijloace \up0
\expndtw0\charscalex115 terapeutice (antihistammice, corticoizi. medicafie
simptomatice). \par\pard\qj \li844\ri769\sb77\sl-220\slmult0\fi297 \up0
\expndtw0\charscalex117 Important este faptul ce medicul alergolog este pus in
situafia de a trata \up0 \expndtw0\charscalex113 trei categorii de bolnavi:
\par\pard\ql \li1147\sb32\sl-230\slmult0 \up0 \expndtw0\charscalex113 e bolnavi
alergiei propriu-zisi; \par\pard\qj \li849\ri784\sb2\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex120 \u8226? bolnavi nealergici cu sindroame avand "reputafia"
de a fi "in primul \up0 \expndtw0\charscalex117 rand" alergice (astm. urticarie.
rinie etc.); \par\pard\qj \li840\ri788\sb0\sl-250\slmult0\fi302 \up0
\expndtw0\charscalex116 e bolnavi alergiei ale caror manifeseri clinice devin
polimorfe prin Intri\up0 \expndtw0\charscalex113 carea altor etiologii (uneori mai
"agresive") si mai ales prin "psihizarea" bolii \up0 \expndtw0\charscalex113 (ex. o
urticarie cronice "idiopatice" pe un teren atopic). \par\pard\qj
\li844\ri770\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex115 U Alergenii pot
reprezenta o pondere etiologicd majord (de exemplu, in \up0 \expndtw0\charscalex124
astm depesesc 50% din cazuri, sau chiar mai mult), iar acelasi alergen \up0
\expndtw0\charscalex114 poate declansa multiple sindroame. avand "organe de soc"
variate (exemplu: \up0 \expndtw0\charscalex110 rino-conjunctivite +\u9632?/\u8226?
urticarie - in polmoza, sau angioedemul fefei \up0 \expndtw0\charscalex109 +/- edem
\expndtw0\charscalex107 glotic \tab \up0 \expndtw0\charscalex119 +/- crize de astm
+/- soc anafilactic, in alergia medicamentoase ori \up0 \expndtw0\charscalex117
alergia la venin de insecte). Aceste sindroame oblige la o dirijare a bolna�
\up0 \expndtw0\charscalex114 vilor respectivi spre serviciile de alergologie, chiar
atunci cand agentul etio� \up0 \expndtw0\charscalex118 logie se dovedeste a fi
nealergic. De altfel. s-a instituit o veritabite tradifie \up0
\expndtw0\charscalex117 in practica medicae de a fi trimise e alergolog toate
cazurile in care bolna� \up0 \expndtw0\charscalex112 vii prezinta sindroamele
menfionate. pe baza predominantei etiologiilor aler� \up0 \expndtw0\charscalex118
gice. Mai mult, chiar in cazurile de sindrom urticarian (urticarie si/sau
an-\line \up0 \expndtw0\charscalex115 gioedem), In care ponderea reae a etiologiei
alergice este sub 10%, bolnavii \up0 \expndtw0\charscalex117 sunt trimisi la
alergolog (dar si la dermatolog). incercand o sistematizare a \up0
\expndtw0\charscalex115 posibilelor denumiri pentru sindroamele plurilactoriale cu
etiologie alergice \up0 \expndtw0\charscalex119 vom propune termenul de "boae cu
componenta alergice" cSnd etiologia \up0 \expndtw0\charscalex115 acestor sindroame
este partial alergice si eel de "boli alergice" pentru cazu� \up0
\expndtw0\charscalex116 rile in care etiologia sindroamelor respective este
exclusiv alergice (ex. po-\line \up0 \expndtw0\charscalex108 linoza).
\u9633? Mai existd un argument de ordin tiziopatologic, extrem de rational, \up0
\expndtw0\charscalex119 spre a se ingloba prioritar in stera alergologiei
sindroamele menfionate: e \up0 \expndtw0\charscalex119 originea lor se afe
eliberarea unor mediatori proinflamatori, fie cu acfiune \up0
\expndtw0\charscalex119 directe (vasodilatatie, edem, hipersecrefie, constricte
musculaturii netede \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart
\up0 \expndtw0\charscalex108 \ul0\nosupersub\cf9\f10\fs20 214\tab \up0
psihosomatica generala ?i aplicae\par\pard\qj \li1569\sb0\sl-250\slmult0
250\slmult0\fi9 \up0 \expndtw0\charscalex118 Si a organelor cavitare). tie
indirecte (factorii chemotactici pentru celulele \up0 \expndtw0\charscalex116
inflamafiei). Placa turnanta actionae - prin intermediul mecamsmului aler� \up0
\expndtw0\charscalex121 gic (reacfia alergenului cu anticorpii sau cu celulele
sensibilizate). dar si \up0 \expndtw0\charscalex115 pnn degranulare directe cu
eliberarea mediatorilor menfionafi ai reacfiei in� \up0 \expndtw0\charscalex118
flamatorii de cetre factorii nealergici \up0 \expndtw0\charscalex124 - este
reprezentae de degranularea \par\pard\qj \li1579\ri91\sb0\sl-252\slmult0 \up0
\expndtw0\charscalex115 mastocitelor (din fesuturi) sau a bazofilelor (din plasne)
puretoare de recep\up0 \expndtw0\charscalex115 tori de inalte alinitate (R I)
pentru antigeni; in ultimii ani s-au descris $i alte \up0 \expndtw0\charscalex113
celule (macrofage, trombocite, eozinofile etc.) posedand acelasi tip de recep� \up0
\expndtw0\charscalex116 ton, dar cu o afinitate mai reduse (R II) eliberatoare, si
ele, ale acelorasi ti� \up0 \expndtw0\charscalex113 puri de mediatori: histamina.
serotonina, SRS-A (leucotrienele LTB4, LTC4, \up0 \expndtw0\charscalex113 LTD4),
prostaglandina, lactorul de agregare plachetar (PAF) etc. \par\pard\qj
\li1579\ri82\sb0\sl-250\slmult0\fi302 \up0 \expndtw0\charscalex117 U Indiferent de
mecanismul alergic sau nealergic simptomatologia este \up0 \expndtw0\charscalex116
cvasiidentica. Putem se exemplificam cu o urticarie sau un astm, declansate \up0
\expndtw0\charscalex118 atat de cStre alergeni, cat si de agenti etiologici
nealergici \up0 \expndtw0\charscalex112 (microbieni, de \par\pard\qj
\li1579\ri81\sb18\sl-240\slmult0 \up0 \expndtw0\charscalex117 exemplu). Pnn
degranularea mastocitarS nealergica se explice unele reacfii \up0
\expndtw0\charscalex116 pseudoalergice (la agenti fizici, emotii etc.), iar alte
reacfii \up0 \expndtw0\charscalex117 - de asemenea, \par\pard\qj
\li1574\ri93\sb12\sl-250\slmult0\fi9 \up0 \expndtw0\charscalex111 pseudoalergice -
se produc pnn aparitia unor mediatori extrem de potenfi (leu-\line \up0
\expndtw0\charscalex118 cotnene, prostaglandine D2 etc.) datorite devierii
metabolismului acidului \up0 \expndtw0\charscalex112 arahidonic prin inactivarea
ciclooxigenazei (de cetre aspirine si alte AINS). \par\pard\qj \li1569\ri84\sb0\sl-
254\slmult0\fi302 \up0 \expndtw0\charscalex111 Bousquet. Godard si Michel (1993)
includ in sfera reacfiilor pseudoalergi� \up0 \expndtw0\charscalex114 ce s> alte
reacfii - fere participarea sistemului imun - ca de exemplu reacfiile \up0
\expndtw0\charscalex127 Idiosincrazice (eliberare sau aport excesiv de histamina si
alte amine \up0 \expndtw0\charscalex118 vasoactive). metabolice si toxice (ex.
formarea de endotoxine). Numitorul \up0 \expndtw0\charscalex122 comun al tuturor
acestor reactii pseudoalergice il reprezinta declansarea \up0
\expndtw0\charscalex120 sindroamelor respiratoni, cutanate, digestive etc. de cdtre
o aceeasi subs\up0 \expndtw0\charscalex117 tanfa, uttlizandu-se veriga efectoare a
reacfiei alergice dar, fdrd implicarea \up0 \expndtw0\charscalex117 reacfiei
antigen-anticorp (sau limfocit sensibilizat). \par\pard\qj \li1579\ri91\sb0\sl-
250\slmult0\fi297 \up0 \expndtw0\charscalex115 \u9633? Pentru ambele modalitefi
existe o aceeasi solufie terapeutice imediate, \up0 \expndtw0\charscalex124
constand in medicafie antihistaminica si/sau cortizonica asociae cu cea \up0
\expndtw0\charscalex113 simptomatice (bronhodilatatoare de ex.). \par\pard\qj
\li1876\ri367\sb176\sl-240\slmult0\tx2183 \up0 \expndtw0\charscalex125 B Rolul
factorului psihic in aparifia alergiei si declansarea unor \line\tab \up0
\expndtw0\charscalex126 "sindroame alergice" \par\pard\qj \li1583\ri95\sb176\sl-
246\slmult0\fi297 \up0 \expndtw0\charscalex116 Inervafia vegetative a "organelor de
soc" (inclusiv existenfa unor recep\up0 \expndtw0\charscalex116 tori colinergici pe
mastocit) (1) ofere o explicate plauzibie declanserii ace� \up0
\expndtw0\charscalex129 lorasi sindroame si sub efectul unor stimuli psihici sau de
tip reflex \up0 \expndtw0\charscalex110 necondifionat (5). \par\pard\qj
\li1593\ri91\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex122 Considerafiile
de mai sus permit se se intrevade faptul ce insinuarea \up0 \expndtw0\charscalex117
factorului etiologie psihic intre ceilalfi lactori declansatori ai sindroamelor
\up0 \expndtw0\charscalex117 "alergice" si "pseudo-alergice" poate avea loc:
\par\pard\qj \li1900\ri97\sb19\sl-240\slmult0 \up0 \expndtw0\charscalex124 - prin
sumafie cu agenfii etiologici de baza - alergiei sau nealergici \up0
\expndtw0\charscalex111 (nespecifici); \par\pard\qj \li1905\ri94\sb0\sl-260\slmult0
\up0 \expndtw0\charscalex119 - prin alternanfa cu acestia, existand uneori o
aparenfe a exclusivitSfii \up0 \expndtw0\charscalex119 asa-ziselor forme
psihogene). \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart Pg218}
Din acest din urmS motiv au lost separate in literaturS formele etiotogice \up0
\expndtw0\charscalex114 de astm bronsic psihogen (Hansen. Seropian, Kleinsorge,
Oehling), urticarie \up0 \expndtw0\charscalex112 Si angioedem \u9632? psihogene
(Criep, Rajka) etc. \par\pard\qj \li705\ri912\sb0\sl-246\slmult0\fi292 \up0
\expndtw0\charscalex111 in astmul bronsic, noi am Tncercat sS dovedim cS stimuli!
psihici joacS un \up0 \expndtw0\charscalex112 rol declansator (trigger) direct sau
indirect (5) - elementul fundamental pentru \up0 \expndtw0\charscalex119 criza
astmaticS fiind terenul bronsic astmatic indus constitutional printr-o \up0
\expndtw0\charscalex112 anomalie la nivelul receptorilor beta-adrenergici \up0
\expndtw0\charscalex105 (Szentivanyi) \up0 \expndtw0\charscalex114 $i "pus in
va-\par\pard\qj \li705\ri918\sb0\sl-240\slmult0\fi9 \up0 \expndtw0\charscalex113
loare" pnntr-o inliamafie bronsicS cu predominanfa infiltratului celular eozi-\line
\up0 \expndtw0\charscalex101 nofilic \up0 \expndtw0\charscalex110 (astmul bronsic =
"bronsita descuamativS eozinofilicS" (Reed) produsS \up0 \expndtw0\charscalex111 de
alergeni sau alfi agenti nocivi (viro-bacteheni, iritanfi fizico-chimici etc.)
Referitor la ponderea triggerului psihogen in declansarea crizelor \up0
\expndtw0\charscalex117 de astm alergic. cercetSrile noastre au evidential o
diferenfS semnificativS \up0 \expndtw0\charscalex115 intre cazurile cu astm usor,
intermitent (de regue cazuri ambulatorii) la care \up0 \expndtw0\charscalex119
frecvenfa declansSrii psihogene este de 24% din bolnavi (5), cele cu astm \up0
\expndtw0\charscalex121 persistent ce determinS intemSri repetate, cu o mai
Irecvents declansare \up0 \expndtw0\charscalex114 psihogenS a crizelor (56% cazuri)
(5") si cazurile cu astm bronsic corticode\up0 \expndtw0\charscalex122 pendent la
care frecvenfa declansSrii psihogene a crizelor este maxims, \up0
\expndtw0\charscalex112 86% dm cazuri (5). \par\pard\ql \li998\sb1\sl-
209\slmult0\tx5467 \up0 \expndtw0\charscalex121 in cazurile cu astm mtrinsec opinia
noastrS \tab \up0 \expndtw0\charscalex121 (edificata numai pe baza \par\pard\qj
\li710\ri919\sb6\sl-240\slmult0 \up0 \expndtw0\charscalex119 unor observafii si
studii clinice) este cS triggerul psihic acfioneazS si mai \up0
\expndtw0\charscalex113 Irecvent decSt in astmul alergic). \par\pard\qj
\li705\ri888\sb0\sl-243\slmult0\fi292 \up0 \expndtw0\charscalex117 in ceea ce
priveste urticaria si angioedemul, exists lorme clinico-etiolo-\line \up0
\expndtw0\charscalex117 gice, cum ar Ii urticaria cotinergicd, in care stimulii
psihici sunt cuprinsi in \up0 \expndtw0\charscalex113 definitie ca agenti
etiologici obligatorii dar, in ultimd instanfd, chiar si ei - ca \up0
\expndtw0\charscalex123 Si etortul fizic - acfioneaza tot prin incdlzirea corpului
peste o anumitS \up0 \expndtw0\charscalex118 limits, "tolerae" de chemoreceptorii
hipotalamici, ale cSror impulsuri des\up0 \expndtw0\charscalex119 cendente,
vehiculate pe cale colinergicS, produc leziunile urticariene $i o \up0
\expndtw0\charscalex116 descercare "suphmentarS" de histamine. \par\pard\qj
\li705\ri913\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex120 Toate aceste
rezerve fafa de delimitarea unor lorme clinico-etiologice \up0
\expndtw0\charscalex118 "psihogene" ale unor sindroame produse in mod predominant
de cetre alfi \up0 \expndtw0\charscalex115 factori etiologici, nu dimmueaza totusi
importanta etiopatogenicS a stimuli\up0 \expndtw0\charscalex115 lor psihici,
inclusiv a stresului psihic. \par\pard\qj \li705\ri918\sb0\sl-240\slmult0\fi288
\up0 \expndtw0\charscalex121 2. Daca, la fel ca si in astm, refuzSm delimitarea
unei forme de urti� \up0 \expndtw0\charscalex120 carie exclusiv psihogenS. studiile
noastre au evidenfiat ponderea actiunii \up0 \expndtw0\charscalex130 trigger-ului
psihogen Tn urticarie si angioedem dupS cum urmeaza \up0 \expndtw0\charscalex114
(lamandescu, 5): \par\pard\li1444\sb16\sl-230\slmult0\fi0\tx1593 \up0 \expndtw-
2\charscalex100 -\tab \up0 \expndtw0\charscalex115 100% Tn urticaria cronicS
idiopaticS\par\pard\li1444\sb15\sl-230\slmult0\fi4\tx1579 \up0 \expndtw-
5\charscalex100 -\tab \up0 \expndtw0\charscalex115 54% in urticaria cronicS de
etiologie infecfioasS\par\pard\li1444\sb10\sl-230\slmult0\fi4\tx1574 \up0
\expndtw-5\charscalex100 -\tab \up0 \expndtw0\charscalex115 62% in urticaria
fizicS\par\pard\li1444\sb10\sl-230\slmult0\fi9\tx1579 \up0 \expndtw-5\charscalex100
-\tab \up0 \expndtw0\charscalex115 48% in urticaria
ahmentara\par\pard\li1444\sb15\sl-230\slmult0\fi9\tx1579 \up0 \expndtw-
5\charscalex100 -\tab \up0 \expndtw0\charscalex115 78% in urticaria medicamentoase
(5).\par\pard\ql \li710\ri932\sb0\sl-240\slmult0\fi292\tx993 \up0
\expndtw0\charscalex112 Mai mult, existe reactii psihogene, conlundate de cetre
bolnavi - in primul \up0 \expndtw0\charscalex115 rand - dar uneori $i de cetre
medic, cu reacfiile alergice. \line \tab \up0 \expndtw0\charscalex115 Aceste
reactii nealergice constau in tulburari neurovegetative pregnante, \up0
\expndtw0\charscalex116 tdrd eliberare de mediatori ai inflamafiei alergice. Ele
sunt caracterizate de \up0 \expndtw0\charscalex116 anxietate si se manifesta prin
palpitafii, amefeli, stari lipotimice etc., fiind
\up0 \expndtw0\charscalex107 Elemente de psihosomaticS generae si ap\par\pard\qj
declansate de unele medicamente la persoane care au dezvoltat Tn mo \up0
\expndtw0\charscalex118 Soc anafilactic sau edem glotic, in situafii anterioare, la
alte medicat \up0 \expndtw0\charscalex118 (de ex. Penicilina - Seropian si
lamandescu -\up0 \expndtw0\charscalex116 1981) in experienta nc \par\pard\qj
\li2332\ri0\sb20\sl-240\slmult0 \up0 \expndtw0\charscalex123 astfel de reacfii apar
mult mai frecvent la persoane cu o vulnerab \up0 \expndtw0\charscalex128 crescuts,
constitutionals sau dobandita, fafa de stres \up0 \expndtw0\charscalex116 (adesea
b< \par\pard\ql \li2337\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex108 nevrotici)
(6). \par\pard\ql \li2644\ri0\sb182\sl-240\slmult0\tx2899 \up0
\expndtw0\charscalex122 C Mecanismele generale privind interventia factorului
psihic h \line\tab \up0 \expndtw0\charscalex123 geneza si evolufia bolilor alergice
ultimii ani, infelegerea mult ergie a aeestei probleme, ajun \up0
\expndtw0\charscalex113 nivelul cooperSrii intercelulare (celulele T si B), promite
sS situeze Tn \up0 \expndtw0\charscalex115 plan actiunea inhibitoare a stresului
psihic asupra celulelor T supresoa \up0 \expndtw0\charscalex116 care "scapd de sub
control" celulele B transformabile in plasmocite s \up0 \expndtw0\charscalex122
toare de IgE (dar si de unele clase de IgG, "precipitine", evidenfia \up0
\expndtw0\charscalex115 Pepys ca stSnd la baza alergiei semitardive, de tip
III). \par\pard\qj \li2328\ri0\sb0\sl-246\slmult0\fi302 \up0
\expndtw0\charscalex113 In plus, efectul inhibitor exercitat de stresui psihic
major asupra celt \up0 \expndtw0\charscalex119 NK (Natural Killer), soldat cu
scSderea rezistenfei generale $i loca \up0 \expndtw0\charscalex114 infecfii
determinSnd afectarea "organului de soc", a fost demonstrat in \up0
\expndtw0\charscalex114 epidemiologic (5) si. in ultimii ani, experimental (7).
Rezultatul inflamafiei "organului de soc" este acela cS se permite o pet \up0
\expndtw0\charscalex114 (ie crescuta de alergeni la nivel cutanat, cat $i la
nivelul mucoaselor ac \up0 \expndtw0\charscalex113 organe (in principal
respiratorii, digestive), acolo unde - eel mai adesea \up0 \expndtw0\charscalex113
nu totdeauna! - sunt constante manifestSrile patologice de tip alergic.
Extrem de important apare s* faptul ce inervafia eolinergied si \up0
\expndtw0\charscalex118 adrenergic - noncolinergicd (mediatd. intre a/tete fl de
cdtre substan \up0 \expndtw-3\charscalex100 (4, \up0 \expndtw-9\charscalex97 10,
\up0 \expndtw0\charscalex123 11) are ca efect aparifia unor tulburSri directe,
rapid instal \up0 \expndtw0\charscalex114 (vasomotorii sau constrictoare ale
musculaturii netede bronsice, intesti \up0 \expndtw0\charscalex113 uterine etc.).
Aceleasi modificSri pot apare si indirect, Tn cazul substan \up0
\expndtw0\charscalex115 prin eliberarea de histamina ca urmare a difuziunii acestui
mediator pr \up0 \expndtw0\charscalex115 mastocite si degranulSrii consecutive a
acestora. \par\pard\qj \li2323\ri0\sb4\sl-245\slmult0\fi297 \up0
\expndtw0\charscalex111 DacS ne gandim cS sub efectul stresului psihic apar o serie
de modif \up0 \expndtw0\charscalex111 ce produc tu/burdri vasomotorii (eritem
cutanat, congestie bron$icd - am \up0 \expndtw0\charscalex114 cu rol favorizant in
penetrafia alergenilor) sau hiperventilafie (acelasi f \up0 \expndtw0\charscalex110
men, la nivel rino-bronsic) - putem avea o imagine mai largS asupra inse \up0
\expndtw0\charscalex114 factorului psihic Tn etiopatogenezS. De aid derive si
susfinerea interve \up0 \expndtw0\charscalex115 unor mecanisme reflex condifionate
- pledate de rolul dovedit al hipn \up0 \expndtw0\charscalex112 (Black si col.,
Klumbies), ca si de numeroase observafii clinice: ex. clas \up0
\expndtw0\charscalex116 crizei de astm alergic la polen, declansae de vederea unui
buchet de I \up0 \expndtw0\charscalex113 daliri artificiali \up0
\expndtw0\charscalex112 (McKenzie) sau Tn fafa TV, cu ocazia unor scene evor
\par\pard\ql \li2342\sb8\sl-230\slmult0 \up0 \expndtw0\charscalex114 alergenii la
care bolnavul este sensibil (5). \par\pard\qj \li2347\ri0\sb0\sl-
245\slmult0\fi283 \up0 \expndtw0\charscalex125 Mecanismele mai sus-prezentate se
refers la "edificarea start, \up0 \expndtw0\charscalex117 alergie", dar $i e
eliberarea de mediatori ai reacfiei alergice (ca urma \up0 \expndtw0\charscalex119
reacfiei alergen-anticorp) care pot avea loc in absenfa unor manife: \up0
\expndtw0\charscalex110 clinice aparente (din fericire. "alergia latenlS" este mai
rSspSnditS decSt \up0 \expndtw0\charscalex110 "manifests").
Psihosomatica aplicata\tab \up0 \expndtw0\charscalex110
\ul0\nosupersub\cf9\f10\fs20 \u9830? 217\par\pard\qj \li1027\sb0\sl-220\slmult0
220\slmult0\fi297 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf8\f9\fs22 in cazul
unei eliberSri masive a acestor mediatori, posibie mat ales sub \up0
\expndtw0\charscalex104 actiunea altor triggeri \up0 \expndtw0\charscalex101
(alergic, infecfios, iritativ fizico-chimic etc.) \up0 \expndtw0\charscalex104 - la
care \par\pard\qj \li1027\ri604\sb12\sl-230\slmult0\fi4 \up0
\expndtw0\charscalex104 se asociazS in grad variabil factorul psihic - apar si
manifestSrile patente de \up0 \expndtw0\charscalex106 tipul astmului. rinitei.
urticariei si angioedemului, socuim anafilactic, bolii \up0 \expndtw0\charscalex106
serului etc. \par\pard\qj \li1027\ri599\sb2\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex110 in acest stadiu, al bolii deja manifestatd clinic, factorul
psihic (care a \up0 \expndtw0\charscalex112 putut participa s> la "deschiderea
scenei" bolii) incepe sS acfioneze ca \up0 \expndtw0\charscalex102 trigger, ritmand
evolufia sindroamelor respective. \par\pard\ql \li1315\sb3\sl-237\slmult0 \up0
\expndtw0\charscalex101 El acfioneaze (figura 1): \par\pard\ql \li1401\sb250\sl-
253\slmult0 \up0 \expndtw0\charscalex110 Figura 1 Intervenfia factorului psihic in
evolufia bolilor alergi \par\pard\li3393\sb10\sl-253\slmult0\fi0\tx7612 \dn2
\expndtw0\charscalex111 (dupi lamandescu, 1993)\tab \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf3\f4\fs18 "\par\pard\ql \li4646\sb0\sl-
207\slmult0 \par\pard\ql\li4646\sb35\sl-207\slmult0 \up0 \expndtw0\charscalex109 <
creste slnteza IgE ( i eel T supres.) \par\pard\ql \li3499\sb3\sl-196\slmult0
\up0 \expndtw-8\charscalex100 \ul0\nosupersub\cf9\f10\fs20 sisL imun
\ul0\nosupersub\cf3\f4\fs18 -scade rezistenfa la infecfn \par\pard\ql
200\slmult0\fi302\tx4881 \up0 \expndtw0\charscalex102 tulburari vasomotorii +
constrictive m n. \line\tab \up0 \expndtw0\charscalex103 eflexe necondifionate (ex
hiperventilafie) \up3 \expndtw0\charscalex104 <<eflexe condifionate (ex
hipnozd) \par\pard\li1583\sb0\sl-207\slmult0\par\pard\li1583\sb68\sl-
207\slmult0\fi1281\tx6422 \up0 \expndtw0\charscalex106 .elibeeaza direct mediatorII
R Alergice\tab \up0 \expndtw0\charscalex106 ycolinergici\par\pard\li1583\sb1\sl-
205\slmult0\fi0 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf37\f38\fs18\ul |
MECANISM|\ul0\nosupersub\cf3\f4\fs18 ^-elibeeaza direct mediatoni neuro
vegetativi^\u8212?adrenergici\par\pard\li1583\sb1\sl-
200\slmult0\fi1368\tx6024\tx6374 \dn1 \expndtw0\charscalex106 elibeea/a indirect
hormonii de stres\tab \dn2 \expndtw0\charscalex106 > i\tab \up2
\expndtw0\charscalex106 \\(U adenergicai)\par\pard\li1583\sb0\sl-162\slmult0\fi4987
\up0 \expndtw0\charscalex106 neuropeptide\par\pard\li1583\sb0\sl-162\slmult0\fi4987
\up0 \expndtw0\charscalex106 (subsL P)\par\pard\li1583\sb0\sl-
\expndtw0\charscalex106 ^ i naparen ta\tab \up0 \expndtw0\charscalex106
"N*\par\pard\sect\sectd\sbknone\cols3\colno1\colw2647\colsr160\colno2\colw2471\cols
r40\colno3\colw3552\colsr160\ql \li2342\sb0\sl-115\slmult0 \par\pard\ql
\ul0\nosupersub\cf24\f25\fs10 XX.\par\pard\qj \li1334\ri284\sb14\sl-
192\slmult0\tx1583 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf3\f4\fs18 2.
TRIGGER \line\tab \up0 \expndtw-2\charscalex100 PSIHIC\par\pard\column \qj
\li467\ri502\sb0\sl-153\slmult0\fi62 \up0 \expndtw0\charscalex103 uirea
alemenului \up0 \expndtw0\charscalex101 (arternanfa)\par\pard\ql \li2807\sb0\sl-
\ul0\nosupersub\cf8\f9\fs22 sumaliv^f16:96"1\up0 \expndtw0\charscalex109
\ul0\nosupersub\cf3\f4\fs18 ^factori nespecifici\par\pard\qj \li2807\sb0\sl-
\li20\ri585\sb100\sl-153\slmult0 \up0 \expndtw0\charscalex105 reactii
pseudoalergice \line \up0 \expndtw0\charscalex100 (cu fzomorlism
clinic)\par\pard\column \ql \li20\sb1\sl-188\slmult0\tx1744 \up0
\expndtw0\charscalex114 In aparents\tab \up0 \expndtw0\charscalex111
psihoi\par\pard\qj \li539\ri1785\sb4\sl-201\slmult0 \up0 \expndtw0\charscalex108 !
*\u9632? exclusiva^ \line \up0 \expndtw-5\charscalex100 L�� alternative\par\pard\ql
Nacebo<*MED,C \line \up0 \expndtw-8\charscalex95 \u9632?*\u8226?
Fobice\u8212?\u9658? PSIHOLOG \par\pard\sect\sectd\sbknone \li1339\sb0\sl-
207\slmult0\par\pard\li1339\sb14\sl-207\slmult0\fi43 \up0 \expndtw0\charscalex106 x
Evaluare
retrospective\par\pard\sect\sectd\sbknone\cols2\colno1\colw6065\colsr160\colno2\col
w2635\colsr160\qj \li1339\ri1468\sb65\sl-192\slmult0\fi1497 \up0
\expndtw0\charscalex107 evenimente stesante -\line \up0 \expndtw0\charscalex133
**De,nves..gat tjp de ^^3,^ .\par\pard\column \ql \li246\sb0\sl-
162\slmult0 \up0 \expndtw-8\charscalex87 MEDIC\par\pard\ql \li241\sb0\sl-
185\slmult0 \up0 \expndtw-8\charscalex92 \u9830? PSIHOLOG\par\pard\qj
\li20\ri1463\sb45\sl-187\slmult0\tx246 \up0 \expndtw-8\charscalex92 -\u9658?
PSIHOLOG � \line\tab \up0 \expndtw-8\charscalex90 + MEDIC
\par\pard\sect\sectd\sbknone \li1017\sb0\sl-253\slmult0\par\pard\li1017\sb206\sl-
\ul0\nosupersub\cf8\f9\fs22 -\tab \up0 \expndtw0\charscalex115 prin eliberarea
nespecificd a mediatorilor reactiei alergice\tab \up0 \expndtw0\charscalex115
(fere\par\pard\sect\sectd\sbknone \li1017\sb1\sl-232\slmult0\fi0 \up0
\expndtw0\charscalex115 participarea reacfiei antigen-anticorp, dar folosind calea
efectoare a\par\pard\sect\sectd\sbknone \li1017\sb1\sl-241\slmult0\fi0 \up0
\expndtw0\charscalex115 acesteia. degranularea mastocitare);\par\pard\qj
\li1017\ri599\sb0\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex107 - prin
eliberarea unor mediatori efectori ai transmisiei neuro-vegetative \up0
\expndtw0\charscalex107 (acetilcolina. substanfa P) cu rol inductor al reacfiilor
vasodilalatoare (hi-\line \up0 \expndtw0\charscalex107 peremie si edem) si
musculoconstrictoare (spasme ale musculaturii netede).
\up0 \expndtw0\charscalex105 \ul0\nosupersub\cf18\f19\fs20\ul Elemente
de\ul0\nosupersub\cf9\f10\fs20 psihosomaticd generala $i aplicata\par\pard\qj
\par\pard\qj\li1502\ri139\sb127\sl-244\slmult0\fi302\tx2006 \up0 \expndtw-
2\charscalex100 -\tab \up0 \expndtw0\charscalex131 prin intermediul hormonilor de
stres care sunt ince insuficient \up0 \expndtw0\charscalex115 cunoscufi. in cadrul
varialei lor game (nereductibile doar la catecolamine $i \up0
\expndtw0\charscalex119 cortizoi) pot exista elemente capabile se joace un rol
agravant in evolufia \up0 \expndtw0\charscalex119 sindroamelor cu etiologie partial
alergice, asa cum sugereaze observatiile \up0 \expndtw0\charscalex116 clinice
evidenfiind relafia de cauzalitate dintre unele crize de astm sau pu� \up0
\expndtw0\charscalex114 see de urticarie $i angioedem $i stresui psihic (lamandescu
1991 s> \up0 \expndtw-4\charscalex100 1996). \par\pard\qj \li1502\ri129\sb0\sl-
\expndtw0\charscalex134 prin substanfe degranulante mastocitare secretate de
celulele \up0 \expndtw0\charscalex127 sistemului nervos. Recent. Bonini deschide un
nou capitol consacrat \up0 \expndtw0\charscalex121 "aspectelor neurale" ale
inflamafiei alergice, cercetSnd rolul si prezenfa \up0 \expndtw0\charscalex111
factorului de crestere al neuronului ("nerve growth factor" = NGP) la bolnavii \up0
\expndtw0\charscalex118 cu Kerato-conjunctivie vernae s' 'a cei cu astm bronsic.
Referitor la relafia \up0 \expndtw0\charscalex115 dintre acest factor si mastocit
(descrise pe larg de Marshall s< Wasserman), \up0 \expndtw0\charscalex120 autorul
indica doua proprieefi relevante, ca de ex. cresterea numSruiui si \up0
\expndtw0\charscalex114 dimensiunilor mastocitelor, precum si inducerea de cetre
NGF a degranuerii \up0 \expndtw0\charscalex118 mastocitare si bazofilice. in plus,
acelasi autor a reusit se surprmda atat in \up0 \expndtw0\charscalex120
conjunctivita vernae (alergice), cat si in astmul bronsic, niveluri crescute
\up0 \expndtw0\charscalex120 ale substanfei respective. \par\pard\ql
\li1790\sb6\sl-230\slmult0 \up0 \expndtw0\charscalex112 - prin mecanism reflex
conditional. \par\pard\qj \li1507\ri139\sb22\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex114 Un element care intra si in competenfa psihologului il
constituie reacfiile \up0 \expndtw0\charscalex116 pseudoalergice \up0
\expndtw0\charscalex122 (urticarie, astm si angioedem) aperute printr-o
veritabie \par\pard\qj \li1502\ri134\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex115 condifionare reflexe fafa de situafii anterioare de
accidente reale. Astfel, Tn \up0 \expndtw0\charscalex128 exemplul mai sus amintit
al unei bolnave studiate de noi, alergice la \up0 \expndtw0\charscalex116
Pemciline, cu antecedente de soc anafilactic la acest medicament, ea a dez-\line
\up0 \expndtw0\charscalex116 voltat ulterior reacfii puternice neurovegetative.
mimand socul \up0 \expndtw0\charscalex122 (dar fere o \par\pard\qj
\li1507\ri145\sb20\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex123 baze reae pentru
mecanismul alergic), aperute la administrarea oricerui \up0 \expndtw0\charscalex117
medicament si avand o seventate clinics mai redusS dar suficients pentru a \up0
\expndtw0\charscalex117 pune in alerts personalul medical si. in primul rand, pe
bolnava insSsi. \par\pard\qj \li1507\ri137\sb0\sl-250\slmult0\fi288 \up0
\expndtw0\charscalex120 Sumafia SP cu alergenii si cu alfi agenfi etiologici
nespecifici rSmane \up0 \expndtw0\charscalex126 modalitatea cea mai IrecventS de
intervenfie a factorului psihogen in \up0 \expndtw0\charscalex113 etiopatogenia
bolilor alergice. \par\pard\qj \li1804\ri418\sb134\sl-260\slmult0\tx2078 \up0
\expndtw0\charscalex123 D Recuiul somatopsihic ai bolilor alergice. Modificari
secundare \line\tab \up0 \expndtw0\charscalex124 ale personalltafii bolnavilor
alergiei \par\pard\qj \li1507\ri139\sb152\sl-246\slmult0\fi297 \up0
\expndtw0\charscalex119 Manifestarile acute ale unor sindroame cu etiologie
alergicS TmbracS \up0 \expndtw0\charscalex118 adesea o alurS clinics dramatics cum
se TntampIS in socul anafilactic, Tn \up0 \expndtw0\charscalex116 edemul glotic, in
criza de astm s< chiar in sindroamele tip boala serului ori \up0
\expndtw0\charscalex125 in puseele severe de urticarie. Chiar si rinita alergicS
\up0 \expndtw0\charscalex121 (mai ales forma \par\pard\ql \li1511\sb8\sl-
230\slmult0 \up0 \expndtw0\charscalex114 obstructivS), creazS un disconlorl
important, in special in cursul nopfii. \par\pard\qj \li1511\ri123\sb0\sl-
246\slmult0\fi288 \up0 \expndtw0\charscalex115 Apare deci normal ca bolnavii cu
astfel de accidente alergice sS dezvolte \up0 \expndtw0\charscalex118 o anxietate
intensd si progresiv crescutd in raport cu repetarea episoadelor \up0
\expndtw0\charscalex124 respective. Dupe un nuner de astfel de accidente, el pot
sS-$i edifice o \up0 \expndtw0\charscalex118 adevSratS asteptare anxioasS a
crizelor \up0 \expndtw0\charscalex121 (de astm sau edem glotic atunci
\par\pard\qj \li1526\ri127\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex122 cSnd
alergenul nu a fost identificat) sau o fobie cu o centrare precisa pe \up0
\expndtw0\charscalex119 alergenul identificat (ca in cazul alergiei medicamentoase
sau la venin de \up0 \expndtw0\charscalex112 insecte).
\par\pard\ql\li1228\sb154\sl-230\slmult0\tx7195 \up0 \expndtw0\charscalex114 Toate
aceste modificSri in sfera afectivS a bolnavilor alergiei \tab \up0
\expndtw0\charscalex111 (dominate \par\pard\qj \li940\ri707\sb0\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex118 de anxietate si depresie) par sS fie
secundare instaerii si evolufiei bolii iar \up0 \expndtw0\charscalex116 cercetSrile
noastre despre personalitatea bolnavilor astmatici \up0 \expndtw0\charscalex115
(lamandescu \par\pard\ql \li960\sb1\sl-193\slmult0\tx1713\tx6950 \up0 \expndtw-
3\charscalex100 1980 s< \tab \up0 \expndtw0\charscalex113 1985) sau ale bolnavilor
urticanem (lamandescu
1982, \tab \up0 \expndtw0\charscalex101 1996) au evi� \par\pard\qj
\li940\ri687\sb17\sl-230\slmult0 \up0 \expndtw0\charscalex116 dential o
vulnerabilitate la stres a acestor bolnavi preexistentd imbolndvirii \up0
\expndtw0\charscalex114 si agravatd dupd aparifia acesteia. ocupand o pozifie
intermediarS Tntre cea \up0 \expndtw0\charscalex114 maxima a bolnavilor nevrotici
si cea minine a loturilor de subiecfi sSnStosi) \par\pard\qj \li935\ri692\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex116 In domeniul studierii problemelor
psihosomatice ale bolnavilor alergiei, \up0 \expndtw0\charscalex116 cele mai
relevante aspecte le-am inregistrat la cei cu reactii de tip alergic la \up0
\expndtw0\charscalex121 medicamente.La acestia am evidenfiat faptul ce ei posede.
Tn cvasitota-\line \up0 \expndtw0\charscalex117 litatea lor, o anxietate bazae
foarte crescute, (lamandescu, \up0 \expndtw-3\charscalex100 1983) \up0
\expndtw0\charscalex116 $i o serie \par\pard\qj \li935\ri701\sb0\sl-230\slmult0
\up0 \expndtw0\charscalex118 de trasaturi de personalitate-relevate de testul MMPI-
care ii incadreaze in \up0 \expndtw0\charscalex113 procent de 86% Tn "triada
nevrotice" a testului (Scala Hipocondria. Depresia \up0 \expndtw0\charscalex112 $i
Isteria) (lamandescu, Popa-Velea si Mazuru, 1996) Aceaste Tncadrare jus-\line
\up0 \expndtw0\charscalex117 tifice prezenfa unor simptome nevrotice la 84% dintre
alergicii la medica� \up0 \expndtw0\charscalex126 mente, dintre care \up0
\expndtw0\charscalex126 42% erau in evidenfa psihiatrilor pentru afectiuni
\expndtw0\charscalex118 nevrotice, ca \tab \up0 \expndtw0\charscalex121 $i o serie
intreage de tulburari psihosomatice coexistente. \up0 \expndtw0\charscalex118
Aceste. date pot \up0 \expndtw-9\charscalex82 (i \up0 \expndtw0\charscalex121
interpretate ca exprimand rezultatul conjugat al unei \par\pard\qj
\li931\ri695\sb0\sl-233\slmult0\fi4 \up0 \expndtw0\charscalex117 vulnerabiliteti
constitutionale fafa de stres si al unei "incercStun stresante" \up0
\expndtw0\charscalex119 concretizatS prin frecvenfa crescuts e 82% dintre bolnavii
studiafi a unor \up0 \expndtw0\charscalex115 punctaje de peste 300 la Scala Holmes
si Rahe, referitoare la evenimente cu \up0 \expndtw0\charscalex115 caracter de
schimbare, din ultimele 6 luni. \par\pard\ql \li1233\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex120 Bibliografie \par\pard\li1257\sb50\sl-
230\slmult0\fi0\tx2807 \up0 \expndtw0\charscalex100 1 Bienenstock J.\tab \up0
\expndtw0\charscalex100 - Psychoneuroallergotogy - a reality - Conversations in
allergy\par\pard\li1257\sb1\sl-202\slmult0\fi192\tx6072 \up0 \expndtw-
3\charscalex100 (IV) - pp. 15-18, UCB - Institute Allergy. Brain I'Alleud.\tab \up0
\expndtw0\charscalex100 1995.1\par\pard\ql \li1219\ri630\sb0\sl-
210\slmult0\tx1444\tx1435 \up0 \expndtw0\charscalex110 2. Bonini Se.. Bonmi St.,
Lambiase A. et al-lmmune, endocrine and neural \line\tab \up0
\expndtw0\charscalex109 aspects of allergic lnflammation-475-481, vol XVI-
European Congres of \line\tab \up0 \expndtw-2\charscalex100 Altergie. Clin.
Immunol. Monduzzi. Bologna. \up0 \expndtw-9\charscalex88 1996. \par\pard\qj
\li1219\ri712\sb0\sl-220\slmult0\tx1444 \up0 \expndtw0\charscalex100 3 Bury Th. and
Rademecker M. - "Hisfamine: from Neuron-Mast Cell to allergy". \line\tab \up0
\expndtw-1\charscalex100 Brain IAlleud. The UCB Institute. Bruxelles. \up0
\expndtw-9\charscalex95 1990 \par\pard\ql \li1219\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex103 4. Foreman J.F \u9632? "Neuropeptides and the Pathogenesis
of Allergy", Allergy 212. \par\pard\li1478\sb1\sl-195\slmult0\fi0\tx1646\tx1934
\up0 \expndtw-9\charscalex80 1\tab \up0 \expndtw0\charscalex62 11.\tab \up0
\expndtw-9\charscalex80 1987.\par\pard\ql \li1224\ri676\sb9\sl-
200\slmult0\tx1440\tx1449 \up0 \expndtw0\charscalex108 5 lamandescu IB. -
"L'insertion des stimuli psychiques dans les mechanismes \line\tab \up0
\expndtw0\charscalex111 etiopathogeniques de I asthme bronchiques avec
trigger psychogene. \line\tab \up0 \expndtw0\charscalex113 Considerations sur
certaines etudes personelles \up0 \expndtw0\charscalex108 (epidemiologique et
\par\pard\ql \li1435\sb9\sl-214\slmult0\tx4795 \up0 \expndtw-1\charscalex100
psychologique)", Rev. Roum.Psychol., \tab \up0 \expndtw-4\charscalex100 1990, 27,
2, pag. 121-135. \par\pard\qj \li1224\ri692\sb0\sl-220\slmult0\tx1444 \up0
\expndtw0\charscalex106 6. lamandescu IB - Principles ot psychosomatic approach in
allergic patients \u9632? \line\tab \up0 \expndtw-3\charscalex100 Rev Roum. Psychol
\u9632? 1993, 37. 79-89. \par\pard\ql \li1238\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex102 7. Khansari D.N, MurgoA.E.. Eath R.E \u9632? "Effects of
stress on the imuno system" \par\pard\li1224\sb2\sl-230\slmult0\fi220\tx4420
\up0 \expndtw-5\charscalex100 Immunology Today, 1990. vol.11. 5,\tab \up0
\expndtw0\charscalex102 170-175.\par\pard\li1224\sb1\sl-
194\slmult0\fi0\tx5126\tx5255 \up0 \expndtw0\charscalex102 8. Nsouli T.M., Nsouli
SM. and Bellanti J.A.\tab \up0 \expndtw0\charscalex102 \u9632?\tab \up0
\expndtw0\charscalex102 "Neuroimmunologic inflammation:\par\pard\li1224\sb1\sl-
215\slmult0\fi215 \up0 \expndtw0\charscalex102 new pathogenic concepts and feature
perspectives of immediate and late\par\pard\li1224\sb1\sl-
210\slmult0\fi215\tx5385 \up0 \expndtw0\charscalex102 allergic reactions", Part I
and II. 60. 683-697,\tab \up0 \expndtw0\charscalex102 1988.\par\pard\li1224\sb1\sl-
199\slmult0\fi0\tx7747 \up0 \expndtw0\charscalex102 9. Marshall J.S., Wasserman S.
Mast cells and nerves-Clin.Exp.Allergy,\tab \up0 \expndtw0\charscalex102
1995.\par\pard\li1224\sb1\sl-214\slmult0\fi215\tx1800 \up0 \expndtw-7\charscalex100
25.\tab \up0 \expndtw0\charscalex102 102-110\par\pard\li1224\sb1\sl-
204\slmult0\fi28 \up0 \expndtw0\charscalex103 10. Mossimann 8. \u9632? Les
neuropeptides: tine nouvelte approche de la pathogenese\par\pard\li1224\sb1\sl-
206\slmult0\fi302\tx3844\tx4310 \up0 \expndtw0\charscalex102 de I'asthe - Med et
Hyg .\tab \up0 \expndtw-9\charscalex85 1991.\tab \up0 \expndtw0\charscalex102 49.
2148-2152\par\pard\li1224\sb6\sl-230\slmult0\fi33\tx3081\tx3211 \up0 \expndtw-
1\charscalex100 11. Widdicombe J.G\tab \up0 \expndtw0\charscalex102 \u9632?\tab
\up0 \expndtw0\charscalex102 "Non adrenergic cholinergic system and neuropeptides
in\par\pard\li1224\sb0\sl-230\slmult0\fi287\tx5860 \up0 \expndtw0\charscalex100
lung". Lung and Respiration. Frankfurt IV. 2, 2-10.\tab \up0
\dn2 \expndtw-4\charscalex100 Elemente de psihosomatica generala si
\expndtw0\charscalex127 4. Modalitati de abordare psihosomatica a bolnavilor
\line\tab \up0 \expndtw0\charscalex120 alergiei \par\pard\qj
\li1401\ri1301\sb180\sl-300\slmult0\tx1713 \up0 \expndtw0\charscalex124 A.
Problemati<a abordarii psihosomatice a bolnavilor \line\tab \up0
\expndtw0\charscalex121 alergiei \par\pard\qj \li1123\ri494\sb90\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex107 Investigarea oricSrui bolnav alergic
trebuie sS aibS in vedere pe langS \up0 \expndtw0\charscalex110 urmanrea factorului
etiologie principal \up0 \expndtw0\charscalex117 (alergenul), o serie de factori
declansatori, a$a-numi(ii triggeri, intre care stresui psihic ocupe un loc \up0
\expndtw0\charscalex100 important (vezi figura 1). \par\pard\qj
\li1828\ri1186\sb144\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex109 Figura 2
Model situaflonal privind premisele abordarii \up0 \expndtw0\charscalex110
phihologlce a bolnavilor alergic/ (dupa lamandescu 1998) \par\pard\ql
\ul0\nosupersub\cf19\f20\fs12 Stimuli
psihici\par\pard\sect\sectd\sbknone\cols2\colno1\colw5172\colsr160\colno2\colw3528\
colsr160\qj \li2126\ri562\sb13\sl-158\slmult0\fi321\tx4147 \up0
\expndtw0\charscalex113 Alergeni\tab \up0 \expndtw0\charscalex112 lirini.ui \up0
\expndtw0\charscalex125 (agenti doclantantl\par\pard\ql \li2423\sb13\sl-138\slmult0
\up0 \expndtw0\charscalex117 spociflcl)\par\pard\ql \li3772\sb0\sl-138\slmult0
\up0 \expndtw0\charscalex126 Tipde persona'liale ,\par\pard\ql \li2423\sb16\sl-
138\slmult0\tx3830 \up0 \expndtw0\charscalex120 Mecanism\tab \up0
\expndtw0\charscalex117 vulnorabll la atraa \up0 \expndtw0\charscalex80
>\par\pard\ql \li2539\sb4\sl-158\slmult0 \up0 \expndtw-1\charscalex100
\ul0\nosupersub\cf23\f24\fs14 alergic\par\pard\qj \li3336\sb0\sl-163\slmult0
163\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf19\f20\fs12 MiM'.in.-.-
i \line \up0 \expndtw0\charscalex120 nealergic\par\pard\column \qj
\li145\ri2925\sb99\sl-158\slmult0 \up0 \expndtw0\charscalex111 Divorsi \line
\up0 \expndtw0\charscalex116 Iriggon\par\pard\qj \li5563\sb0\sl-153\slmult0
Vulnerabilitate la stres \line\tab \up0
\expndtw0\charscalex128 secundara\par\pard\ql \li5332\sb0\sl-138\slmult0
\par\pard\ql \li20\sb41\sl-138\slmult0 \up0 \expndtw0\charscalex143 sies
conic\par\pard\sect\sectd\sbknone\cols3\colno1\colw3713\colsr160\colno2\colw2394\co
lsr160\colno3\colw2443\colsr160\qj \li1483\sb0\sl-153\slmult0 \par\pard\qj
\up0 \expndtw0\charscalex121 Med vasooclivl \line \up0 \expndtw0\charscalex123 .
constriclori m n\par\pard\ql \li1483\sb0\sl-172\slmult0 \par\pard\ql
\li1483\sb0\sl-172\slmult0 \par\pard\ql \li1483\ri534\sb93\sl-172\slmult0\fi230
\up0 \expndtw0\charscalex121 Conduiie prod actlcc \line \up0
\expndtw0\charscalex120 Medicale Comportamentale\par\pard\ql \li2788\sb0\sl-
Romi5iune\par\pard\column \qj \li1470\ri216\sb16\sl-144\slmult0 \up0
\expndtw0\charscalex119 de presiune \line \up0 \expndtw0\charscalex134
anuelate\par\pard\ql \li2017\sb3\sl-153\slmult0 \up0 \expndtw0\charscalex120
\ul0\nosupersub\cf3\f4\fs18 T\par\pard\qj \li116\ri1209\sb92\sl-
148\slmult0\tx184 \up0 \expndtw0\charscalex128 \ul0\nosupersub\cf19\f20\fs12 Med
neuroveget \line \tab \up0 \expndtw0\charscalex122 (Ach , catecho .\par\pard\ql
\li231\sb19\sl-138\slmult0 \up0 \expndtw0\charscalex115 NeuropepNde)\par\pard\ql
\expndtw0\charscalex112 CRIZA. PUSEU.\par\pard\ql \li20\sb21\sl-138\slmult0 \up0
\expndtw0\charscalex123 RrCURrrVJt-�CHON\par\pard\ql \li4152\sb0\sl-138\slmult0
\up0 \expndtw0\charscalex125 Ameliorae\par\pard\ql \li260\sb10\sl-
138\slmult0\tx1532 \up0 \expndtw0\charscalex115 (incompleuj\tab \up0
\expndtw0\charscalex126 Etec\par\pard\ql \li323\sb30\sl-115\slmult0 \up0
\expndtw0\charscalex128 \ul0\nosupersub\cf24\f25\fs10 |..i:...l|f:i.-
i)\par\pard\column \qj \li20\ri1240\sb0\sl-114\slmult0\tx318 \up0
\expndtw0\charscalex127 \ul0\nosupersub\cf19\f20\fs12 Aslopiare aniioata \line \tab
\up0 \expndtw0\charscalex120 a crizelor \par\pard\sect\sectd\sbknone \qj
\ul0\nosupersub\cf8\f9\fs22 /. Principii generale de abordare psihosomatica a
bolnavilor \up0 \expndtw0\charscalex113 alergiei \par\pard\qj
\li1142\ri484\sb125\sl-235\slmult0\fi273 \up0 \expndtw0\charscalex100 Contextul
plurietiologic al bolilor alergice - ca de altfel in toate bolile psi� \up0
\expndtw0\charscalex103 hosomatice - presupune posibilitatea declanserii
simptomelor patologice. nu \up0 \expndtw0\charscalex107 numai de cetre factorul
etiologie principal, alergenul, ci si de cetre o serie \up0 \expndtw0\charscalex104
de triggeri nespecilici in randul cerora lactorul psihic joace un rol important
\up0 \expndtw0\charscalex104 (Figura 2).
\ul0\nosupersub\cf9\f10\fs20 Abordarea psihologice a bolnavului alergic in cadrul
relafiei interpersona\up0 \expndtw0\charscalex114 le dintre medic $\u8226? pacient
constituie una dintre latunle impiicite a aeestei re\up0 \expndtw0\charscalex113
lafii. avand o pondere variabie (uneori decisive) in atingerea obiectivului fi�
\up0 \expndtw0\charscalex116 nal, vizand recapatarea (sau eel pufin ameliorarea)
serii de sSnState a bol� \up0 \expndtw0\charscalex107 navului. \par\pard\qj
\li815\ri817\sb5\sl-235\slmult0\fi292 \up0 \expndtw0\charscalex117 in plan alecliv,
acease abordare se concretizeazS prin stabilirea unei re\up0
\expndtw0\charscalex114 lafii empalice - cu grad vanabil de participare a fiecSruia
din cei doi membn \up0 \expndtw0\charscalex112 ai relafiei \up0
\expndtw0\charscalex116 \u8226? iar in plan cogniliv ea ofers posibilitatea unui
schimb de infor\up0 \expndtw0\charscalex115 mafii. aproape exclusiv din partea
pacientului. legate de problema in cauzS: \up0 \expndtw0\charscalex115 suferinfa
(reals sau imaginara) a bolnavului. \par\pard\qj \li815\ri817\sb21\sl-
240\slmult0\fi307 \up0 \expndtw0\charscalex115 Modul de culegere a acestor
inlormafii de cStre medic este si el implicat \up0 \expndtw0\charscalex116 in
relatia afectiva menfionats, existSnd diterenfe mari intre: stilul tehnictst,
\up0 \expndtw0\charscalex114 cu limitarea expunerii bolnavului la date legate
strict de mersul bolii, si rno\up0 \expndtw0\charscalex116 delul psihanalitic, axat
pe ISsarea libertSfii de exprimare a bolnavului a tot \up0 \expndtw0\charscalex114
ce el simte nevoia sS comunice medicului. \par\pard\qj \li820\ri817\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex114 Desigur ca acest din urmS model este
capabil sS imbogSfeascS relafia in \up0 \expndtw0\charscalex117 plan afectiv dintre
medic s' pacient chiar dacS ea "bruiazS" adeseori inlor\up0 \expndtw0\charscalex113
mafia utila in plan medical. \par\pard\qj \li815\ri797\sb0\sl-240\slmult0\fi288
\up0 \expndtw0\charscalex116 Abordarea psihosomaticS. izvoratS din necesitatea
evidentS de a se fine \up0 \expndtw0\charscalex121 cont de relafia de
interdependent dintre psihic si soma, a fost conceputS \up0 \expndtw0\charscalex115
intre alfn de catre Kourilsky, s> ea urmeaza o linie lerne, inse discrel
contu\up0 \expndtw0\charscalex115 rae. \par\pard\qj \li815\ri807\sb0\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex116 Astfel, se urnrereste pe cat posibil
ere a "hmita" libera exprimare a bol� \up0 \expndtw0\charscalex115 navului.
relafionarea unor momente evolutive ale bolii (inclusiv debutul) de \up0
\expndtw0\charscalex117 evenimente ("life changes" in terminologia scalelor
stabilite de Holmes s> \up0 \expndtw0\charscalex114 Rahe) cu confinul
psihotraumalizant din viafa bolnavului. Inevitabil, aceaste \up0
\expndtw0\charscalex115 modalitate implice o cunoastere a biografiei bolnavului dar
si tipului sau de \up0 \expndtw0\charscalex120 personalitate ceea ce permite o
apropiere intre medic si pacient \up0 \expndtw0\charscalex114 (cu grije
\par\pard\qj \li820\ri818\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex117 pentru
discrefie si rebdare din partea pnmului). O astlel de abordare gene� \up0
\expndtw0\charscalex121 rae a bolnavilor psihosomatici, indilerent de natura
bolilor este redate in \up0 \expndtw0\charscalex115 tabelul t de la Capitolul 7 din
Psihosomatica generala. \par\pard\ql \li1104\sb9\sl-230\slmult0\tx7723 \up0
\expndtw0\charscalex127 in cazul in care momentele de debut sau recidive ori
agravare \tab \up0 \expndtw-4\charscalex100 (+/-\par\pard\qj \li815\ri811\sb2\sl-
240\slmult0 \up0 \expndtw0\charscalex121 complicatii) ale bolii coincid cu stresuri
psihice majore ori pur si simplu \up0 \expndtw0\charscalex115 sugereaze o
declansare rellex-conditionate, sunlem obligafi sa formuem eel \up0
\expndtw0\charscalex116 pufin ipoteza unei relafii de cauzatitale %\\ se considerem
posibilitatea unor \up0 \expndtw0\charscalex114 tulbureri psihosomatice.
\par\pard\qj \li811\ri797\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex116 Asa
cum am aretat si intr-o ale lucrare ("Stresui psihic si bolile interne". \up0
\expndtw0\charscalex110 Ed. All. Buc, \up0 \expndtw0\charscalex116 1993), existe in
(iecare boae o serie de simptome clinice care \up0 \expndtw0\charscalex115 au
valoare de marker pentru boala respective si care pot fi corelate cu situa\up0
\expndtw0\charscalex116 fiile de stres psihic (in planul cerceerii ar mai putea fi
utltiza.fl si o serie de \up0 \expndtw0\charscalex115 parametri de laborator: EEG,
explorare pletismografice resplratorie, nivelul \up0 \expndtw0\charscalex118 unor
constante sence etc.). in bolile alergice ele sunt reprezentate de disp\up0
\expndtw0\charscalex124 neea (sau tusea) insofite de wheezing, de aparifia
pruritului sau a unor \up0 \expndtw0\charscalex116 erupfii cu caracter urticarian
ori a unor angioedeme etc. \par\pard\li820\sb14\sl-230\slmult0\fi292 \up0
\expndtw0\charscalex127 Din acest motiv, ca s1 din cele prezentate in lucrSri
anterioare\par\pard\li820\sb15\sl-230\slmult0\fi0\tx2183\tx2788 \up0
\expndtw0\charscalex117 (lamandescu\tab \up0 \expndtw-2\charscalex100 1996.\tab
\up0 \expndtw0\charscalex127 1998) releritor la modahefile de intricare a
factorilor\par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart Pg225}
\dn2 \expndtw0\charscalex108 Elemente de psihosomatica generae si
\expndtw0\charscalex118 psihici cu factorul alergic si alti lactorl nespecifici in
etiopatogenia bolilor \up0 \expndtw0\charscalex121 alergice - considerem ce modul
de abordare psihosomaticS a bolnavilor \up0 \expndtw0\charscalex123 alergiei sufera
unele nuanfari \up0 \expndtw0\charscalex110 (vezi figura 2) diferind adesea Tn mod
con� \par\pard\qj \li1449\ri178\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex116
sistent fate de modelul general prezentat
anterior, ca si fafa de cele utilizate \up0 \expndtw0\charscalex103 1a alfi
bolnavi \up0 \expndtw0\charscalex113 (fie psihosomatici. fie cu boli incidentale.
cu participate mini \up0 \expndtw0\charscalex114 me sau nue a stimulilor
psihici). \par\pard\qj \li1449\ri192\sb22\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex123 Desi modelul psihosomatic a fost utilizat de Kourilsky si
alfi autori \up0 \expndtw0\charscalex116 rreour, de ex.) tocmai la studierea
bolnavilor astmatici, faptul ce s-au acu-\line \up0 \expndtw0\charscalex116 mulat o
serie de date noi in acease boae dar mai ales existenfa altor boli \par\pard\qj
\li1435\ri188\sb0\sl-240\slmult0\fi14 \up0 \expndtw0\charscalex126 -ilergice
asociate sau nu cu astmul bronsic s\\. in sfarsit, interferentele \up0
\expndtw0\charscalex115 i.uneori generatoare de confuzii) cu alfi factori
etiologici nealergici fac ne� \up0 \expndtw0\charscalex115 cesare elaborarea unei
strategii mai complexe in acease privinfa. \par\pard\qj \li1440\ri192\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex117 Din acest motiv considerem ce
trebuie avute in vedere intervenfia fac� \up0 \expndtw0\charscalex112 torilor
psihogeni in doue tipuri evolutive ale bolilor alergice: cu evolufia dis� \up0
\expndtw0\charscalex112 continue (in pusee recidivante) si cu evolufie cronice.
\up0 \expndtw0\charscalex123 Figura 3. Problematics abordarii psihologice in bolile
alergice \par\pard\ql \li6129\sb0\sl-161\slmult0 \par\pard\ql\li6129\sb0\sl-
\ul0\nosupersub\cf23\f24\fs14 AE ereditar \par\pard\li1852\sb0\sl-
180\slmult0\fi2558\tx5836 \up0 \expndtw-5\charscalex100
\ul0\nosupersub\cf13\f14\fs16 r-AkfBon nacunoscut\tab \dn4
\expndtw0\charscalex120 \ul0\nosupersub\cf9\f10\fs20 <\t \dn2
\expndtw0\charscalex120 \ul0\nosupersub\cf23\f24\fs14 AE glotic
\\\par\pard\li1852\sb11\sl-172\slmult0\fi0\tx4727\tx6100\tx6729 \dn2
\expndtw0\charscalex115 A. Boll cu avolutla discontinue\tab \dn2
\expndtw0\charscalex131 b MEDIC\tab \up0 \expndtw-6\charscalex100 AB-U-\tab \up0
/rocuronto\par\pard\sect\sectd\sbknone\cols2\colno1\colw5792\colsr40\colno2\colw302
8\colsr160\ql \li2078\sb22\sl-161\slmult0\tx5039 \up0 \expndtw0\charscalex118
(poblematics, specifics)\tab \up0 \expndtw-1\charscalex100 PSIHOLOG\par\pard\ql
7\charscalex94 \ul0\nosupersub\cf13\f14\fs16 VAI organ cunoacul\par\pard\ql
\ul0\nosupersub\cf23\f24\fs14 h MEDIC \line \tab \up0 \expndtw-1\charscalex100
PSIHOLOG\par\pard\qj \li2543\sb0\sl-133\slmult0 \par\pard\qj \li2543\sb0\sl-
133\slmult0 \par\pard\qj \li2543\ri1705\sb126\sl-133\slmult0\tx2616 \up0
\expndtw0\charscalex120 evitaraa sau losuaaa \line\tab \up0 \expndtw0\charscalex109
accidenluiui alergic\par\pard\ql \li2543\ri0\sb51\sl-172\slmult0\fi763 \up0
\expndtw0\charscalex120 ^supraestimeiii ag deciansator \line \up0
\expndtw0\charscalex113 comDaiarBa^ oxtlnderli toblca a ag
declansaior\par\pard\column \ql \li5832\sb0\sl-161\slmult0 \par\pard\ql
\li20\sb130\sl-161\slmult0\tx1368 \up0 \expndtw0\charscalex146 ^K Mm)\tab \up0
\expndtw0\charscalex126 \}Alergen\par\pard\ql \li20\ri508\sb0\sl-
156\slmult0\tx1575\tx159 \up0 \expndtw0\charscalex118 ^^\u8226?A venin
insecte\tab \up0 \expndtw-2\charscalex100 evnlabll \line\tab \up0
\expndtw0\charscalex103 X AB. HA, U, - inevilabll (pral,
polon)\par\pard\sect\sectd\sbknone\cols2\colno1\colw5364\colsr60\colno2\colw3436\co
\up0 \expndtw0\charscalex104 /Urticaria (�AE) cronic*\par\pard\qj
\li1862\ri246\sb123\sl-144\slmult0\fi14 \up0 \expndtw0\charscalex122 B. Boll cu
avolutla cronlca/^tTcodepencf * \line \up0 \expndtw0\charscalex122 (poblematic*
n*�Declfle*)V.09fme.lla aîcj\par\pard\ql \li3796\sb96\sl-161\slmult0 \up0
\expndtw0\charscalex110 'Urticaria colmergica\par\pard\qj \li2236\sb0\sl-
\li2236\ri1292\sb119\sl-230\slmult0\tx2543 \up0 \expndtw0\charscalex128 <intirirea
personalit*|ii \line \tab \up0 \expndtw0\charscalex113 educatie
anlistres\par\pard\column \ql \li5424\sb0\sl-161\slmult0 \par\pard\ql
\li312\sb53\sl-161\slmult0 \up0 \expndtw0\charscalex118 siiuatiade\par\pard\ql
\li250\sb0\sl-126\slmult0 \up0 \expndtw0\charscalex107 /bolnav
cronic\par\pard\qj \li20\ri2382\sb50\sl-133\slmult0\tx173 \up0
\expndtw0\charscalex128 ^/.Farmacode \line \tab \up0 \expndtw0\charscalex121 r
pendenia\par\pard\ql \li207\ri2085\sb64\sl-133\slmult0\tx317 \up0
\expndtw0\charscalex108 \\ Agravarea \line\tab \up0 \expndtw0\charscalex112 pnn
stres psihic \par\pard\sect\sectd\sbknone \ql \li2543\sb88\sl-161\slmult0 \up0
\expndtw0\charscalex108 susjinarea psihologica a lentallvelor de sevraj
260\slmult0\tx2001 \up0 \expndtw0\charscalex122 \ul0\nosupersub\cf9\f10\fs20 2.
Abordarea psihosomatica in bolile alergice cu evolufie \line\tab \up0
\expndtw0\charscalex123 discontinue (pusee acute recidivante) \par\pard\qj
\li1468\ri153\sb157\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex116 Este
importane severitatea si Irecvenfa puseelor in stabihrea gradului de \up0
\expndtw0\charscalex116 preocupare fafd de boala al pacientului.
Psihosomaticd aplicata\tab \up0 \expndtw0\charscalex124 \u9830? 223\par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 Cei mai redutabil reprezentant al aeestei clase este
angioedemul ereditar. \up0 \expndtw0\charscalex113 aproape imprevizibil ca
declansare $i loarte greu de tratat, uneori chiar mor� \up0 \expndtw-
1\charscalex100 tal \up0 \expndtw0\charscalex113 $i ingrozind pacientul pnn
exemplul rudelor sale decedate prin edem glo� \up0 \expndtw0\charscalex120 tic. De
asemenea, accidentele acute alergice (sau de tip alergic, anafilac-\line \up0
\expndtw0\charscalex103 toid) \up0 \expndtw0\charscalex119 - cu manifeseh de edem
glotic sau s�c analilactic - la medicamente. \up0 \expndtw0\charscalex115 TntepStuh
de insecte, alimente sau aditivi alimentari - sau crizele severe de \up0
\expndtw0\charscalex115 astm sunt si ele redutabile generand o asteptare anxioase a
recidivelor. \par\pard\qj \li892\ri725\sb19\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex114 Mai sunt desigur anxiogene - si. "prin epuizare", putSnd
genera o verita� \up0 \expndtw0\charscalex124 bie stare depresive \up0
\expndtw0\charscalex124 - acele pusee de urticarie si angiodem sau crize de
\par\pard\qj \li888\ri749\sb20\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex115 astm
ori chiar socuri anatilactice, a ceror etiologie (posibil alergice) ince nu \up0
\expndtw0\charscalex127 a lost stabilite si bolnavul nu stie de ce anume trebuie sa
se fereasca. \up0 \expndtw0\charscalex130 Este generate o veritabie stare de panica
proportionae cu scurtimea \up0 \expndtw0\charscalex112 Intervalului dintre
pusee. \par\pard\ql \li1171\sb9\sl-230\slmult0\tx6489 \up0 \expndtw0\charscalex121
Adesea apar doar schifate. alteori cu caracter patent \tab \up0
\expndtw0\charscalex127 - manifeseh ale \par\pard\ql \li892\sb30\sl-
230\slmult0\tx6527 \up0 \expndtw0\charscalex126 sindroamelor astmatice,
urticariene, de "immenfe de \tab \up0 \expndtw0\charscalex119 $oc anafilactic"
(Seropian), prin mecanism reflex conditional, cum se intampe cu reacfiile \up0
\expndtw0\charscalex118 neuro-vegetative pregnant exprimate (tahicardie, amefeli,
stari lipotimice, \up0 \expndtw0\charscalex116 parestezii) declansate de
administrarea "oricerui" medicament (lamandescu \up0 \expndtw0\charscalex116 1995),
aparifia strenuturilor $i pruritului oculo-nazal sau a crizelor de astm \up0
\expndtw0\charscalex121 la bolnavii cu alergie respiratorie, induse de vederea unor
imaginl la TV \up0 \expndtw0\charscalex114 (expozitie de pisici - betaie cu perne
de fulgi \up0 \expndtw-2\charscalex100 -\up0 \expndtw0\charscalex110 7,22) etc.
\par\pard\ql \li1180\sb59\sl-230\slmult0 \up0 \expndtw0\charscalex122 3. Abordarea
psihosomatica in bolile elergice cu evolufie cronica \par\pard\qj
\li883\ri734\sb57\sl-246\slmult0\fi288 \up0 \expndtw0\charscalex118 Cei mai
trecvent Tntalnite sunt astmul bronsic, rinita alergicS, urticaria \up0
\expndtw0\charscalex121 cronicS (numai unele lorme sunt alergice) si dermatita
atopicS. in aceste \up0 \expndtw0\charscalex120 boli cronicizarea este determinatS
de posibilitatea ignorarii unei etiologli \up0 \expndtw0\charscalex126 alergice,
imposibilitatea evicfiunil totale a alergenului cauzal si \up0
\expndtw0\charscalex115 - eel \par\pard\qj \li883\ri760\sb19\sl-240\slmult0\fi9
\up0 \expndtw0\charscalex119 mai adesea - de asocierea unor factori nespecifici
infecfiosi, iritativi, me\up0 \expndtw0\charscalex113 teorologici. endoenni $i, nu
in ulttmul rand psihici. \par\pard\qj \li883\ri739\sb16\sl-246\slmult0\fi297
\up0 \expndtw0\charscalex116 Exists forme clinico-etiologice in care comanda
(trigger-ul)psihogenS a \up0 \expndtw0\charscalex116 evolufiei bolii devine
dominants, ca de exemplu in unele cazuri de urticarie \up0 \expndtw0\charscalex117
cronicS alergicS la debut, apoi intricats cu alfi triggeri: digestiv, infecfios,
\up0 \expndtw0\charscalex120 medicamentos si mai ales psihogen sau multe cazuri de
astm bronsic ale \up0 \expndtw0\charscalex115 cSrui principale componente
etiologice (alergicS, infecfioasS supraadSuga\up0 \expndtw0\charscalex122 tS) au
fost corect tratate, dar ale caror manilesen apar zilnic, necesitand \up0
\expndtw0\charscalex115 tratament simptomatic, adesea nerSspunzSnd nici la
corticoterapie. \par\pard\qj \li892\ri740\sb0\sl-260\slmult0\fi302 \up0
\expndtw0\charscalex116 Intervenfia factorului psihogen Tn etiopatogeneza
manifestSrilor clinice \up0 \expndtw0\charscalex119 ale acestor bolnavi poate fi:
continuS \up0 \expndtw0\charscalex115 (predominant prin mecanism reflex
conditional. Tnsasi teama obsesivS, "asteptarea anxioasS", fiind capabile sS
\up0 \expndtw0\charscalex116 declanseze reaparitia simptomelor) sau discontinuS
(producand exacerbSri \up0 \expndtw0\charscalex114 ale bolii. cum se intSmpIS in
cazul unor stresuri psihice evidente \par\pard\qj \li892\ri764\sb0\sl-
246\slmult0\fi283 \up0 \expndtw0\charscalex119 ConsiderSm ca elemente capabile sS
sugereze o dominants etiologies \up0 \expndtw0\charscalex117 psihogena a unor
manifeseh de urticarie s* astm cu evolufie cronice (dupe \up0
\expndtw0\charscalex121 excluderea unor perlurbSri imunologice sau a altor triggeri
nespecifici), \up0 \expndtw0\charscalex111 urmStoarele (vezi si tabelul 2):
240\slmult0\tx2553 \up0 \expndtw0\charscalex120 Tabel 2. Criterff de stabilire a
Intervenfiei trlgger-ulut psihogen tn \line\tab \up0 \expndtw0\charscalex121 bolile
alergice (dupa lamandescu 1996, 1998) \par\pard\ql \li1440\sb189\sl-
230\slmult0\tx1660 \up0 \expndtw-2\charscalex100 1 \tab \up0
\expndtw0\charscalex115 dovada unor declansSn prin stress psihic, eel putin. a
cStorva pusee; \par\pard\qj \li1377\ri626\sb0\sl-240\slmult0\fi43 \up0
\expndtw0\charscalex116 2. reversibilitatea prompts e medicafia simptomatlcS
(antihistaminice, \up0 \expndtw0\charscalex117 bronhodilatatoare) si - mai putin
sau deloc - la corticoterapie, \par\pard\qj \li1372\ri631\sb0\sl-
240\slmult0\fi52 \up0 \expndtw0\charscalex118 3. existenfa unor circumstanfe
stresante evidente Tn viafa bolnavului \up0 \expndtw0\charscalex111 preexistente si
coexistente aparifiei bolii (chiar dacS bolnavul le ignorS !), \par\pard\qj
\li1372\ri626\sb0\sl-220\slmult0\fi48 \up0 \expndtw0\charscalex129 4. structure
intens vulnerabie la stres a bolnavului respectiv sau \up0 \expndtw0\charscalex118
eventuae asociere a unei nevroze; \par\pard\li1368\sb1\sl-228\slmult0\fi57 \up0
\expndtw0\charscalex123 5. proba terapeuticS concludents la: psihoterapie,
psihotrope sau la\par\pard\li1368\sb2\sl-230\slmult0\fi0\tx3547\tx8049 \up0
\expndtw0\charscalex123 unele medicamente\tab \up0 \expndtw0\charscalex123
(Hidroxizin sau Claritine pentru urticarie\tab \up0 \expndtw0\charscalex123
�i\par\pard\li1368\sb5\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex123 Cromoglicat
pentru AB).\par\pard\qj \li1195\ri422\sb228\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex114 Relentor la problemele not, in afara declansSrii psihogene
a manifestSri-\line \up0 \expndtw0\charscalex111 lor clinice si de "fixarea" - prin
variate reflexe condifionate - a repetSrii aces� \up0 \expndtw0\charscalex120 tora.
in bolile alergice cu tulburdri cronice. sunt demne de menfionat alte \up0
\expndtw0\charscalex114 doud elemente cu implicafii de ordin psihosomatic dar si
somatopsihic (14): \par\pard\qj \li1200\ri436\sb17\sl-220\slmult0\fi283 \up0
\expndtw0\charscalex113 - situafia de bolnav cronic pentru pacientii cu urticarie
si astm cu evolufie \up0 \expndtw0\charscalex113 prelungitS, cu modificSrile de
statut si de rol implicite: \par\pard\qj \li1195\ri441\sb10\sl-233\slmult0\fi288
\up0 \expndtw0\charscalex116 - tarmacodependenfa in grade variate, fie fats de o
medicafie simptoma\up0 \expndtw0\charscalex103 ticS \up0 \expndtw0\charscalex114
(bronhodilatatoare in aerosoli, antihistaminice etc.). fie fafa de cortico� \up0
\expndtw0\charscalex120 terapie (aceasta din urmS grevata de complicatii, uneori
mai grave decat \up0 \expndtw0\charscalex120 insasi tulburarile pentru tratarea
cerora ea a fost instituita) \par\pard\qj \li1195\ri442\sb18\sl-
220\slmult0\fi288 \up0 \expndtw0\charscalex118 Ambele circumstanfe pot genera o
anxietate suplimentare si ancoreaze \up0 \expndtw0\charscalex119 Irecvenl in
veritabie stari depresive. \par\pard\qj \li1195\ri448\sb12\sl-230\slmult0\fi288
\up0 \expndtw0\charscalex116 in plus, tentativele de sevraj cortizonic se
acompaniaze de simptomato� \up0 \expndtw0\charscalex119 logie psihice dominate de
astenie. agitafie psihomotorie. depresie, uneori \up0 \expndtw0\charscalex119
mergand pane la impulsuri suicidale. \par\pard\ql \li1488\sb210\sl-230\slmult0 \up0
\expndtw0\charscalex138 B. Algoritm do abordare psihosomatica a bolnavilor alergiei
\par\pard\ql \li1488\sb130\sl-230\slmult0\tx3931\tx5265 \up0
\expndtw0\charscalex117 intr-o lucrare anterioare \tab \up0 \expndtw0\charscalex113
(lamandescu \tab \up0 \expndtw0\charscalex120 1993) am considerat ca necesar
\par\pard\qj \li1195\ri448\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex116 pentru
abordarea psihosomatice a bolnavilor alergiei, urmetoarele intrebSri \up0
\expndtw0\charscalex115 (variabile si pentru evaluarea unor parametri clinico-
evolutivi si situafionali \up0 \expndtw0\charscalex115 cu implicatii
psihosomatice): \par\pard\ql \li1540\sb31\sl-230\slmult0 \up0
\expndtw0\charscalex124 /. Evolufia bold este contlnua sau discontinua ?
\par\pard\ql \li1497\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex123 2. Alergenul
este identificat sau nu ? \par\pard\qj \li1204\ri433\sb48\sl-233\slmult0\fi297 \up0
\expndtw0\charscalex116 Este evident faptul cS necunoasterea cauzelor unor simptome
- ce pot fi \up0 \expndtw0\charscalex117 atat de dramatice (precum socul
anatilactic, astmul sau edemul glotic) sau, \up0 \expndtw0\charscalex118 eel pufin,
supSrStoare si afectand calitatea viefii (rinita alergicS. urticaria \up0
\expndtw0\charscalex115 Si/sau angioedemul, dermatita atopicS) \up0
\expndtw0\charscalex116 - dezvollS la pacienfii respectivi o \par\pard\qj
\li1219\ri444\sb0\sl-240\slmult0\fi9 \up0 \expndtw0\charscalex127 stare de
anxietate ce poate deveni extremS in cazul in care bolnavul \up0
\expndtw0\charscalex114 cunoaste cazuri similare cu un deznodSmant fatal.
\expndtw0\charscalex123 3. Exista o evident* a declansarii de catre stresui psihic
a unor \line\tab \up0 \expndtw0\charscalex123 manifestari clinice Identice sau
similare cu cele declansate de \line\tab \up0 \expndtw0\charscalex124 catre
alergeni ? \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart Pg228}
\par\pard\qj\li844\ri783\sb116\sl-236\slmult0\fi297 \up0 \expndtw0\charscalex117 Un
rSspuns lavorabil necesie considerarea unei etiologii - suplimentare \up0
\expndtw0\charscalex126 fafa de cea alergica - a sindromului clinic, ceea ce
implies o abordare \up0 \expndtw0\charscalex123 psihosomatica atentS a bolnavului,
centratS pe tipul de personalitate al \up0 \expndtw0\charscalex130 acestuia dar si
pe problemele sale de viafa facilitSnd sau generSnd \up0 \expndtw0\charscalex120
frecvente stresun psihice. O dats obfinut acest rSspuns alergologul poate \up0
\expndtw0\charscalex118 sa-$i punS intrebarea dace va trebui. sau nu, se apeleze e
psiholog ? \par\pard\ql \li1142\sb69\sl-230\slmult0 \up0 \expndtw0\charscalex122 4.
Se poate evidenf/a un anume tip de situafii stresante (cu \par\pard\ql
\li1387\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex122 semnificafie elective
pentru bolnav) capabile sa declansezc \par\pard\qj \li1387\ri1090\sb2\sl-
240\slmult0 \up0 \expndtw0\charscalex123 manifestarile clinice "alergice" sau orice
tip de stres major (ca \up0 \expndtw0\charscalex124 Intensitate) declanseaza
nespecific simptomele respective ? \par\pard\qj \li840\ri792\sb40\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex130 Aceaste diferenfiere. avand drept
beneliciu terapeutic orientarea \up0 \expndtw0\charscalex119 pacientului spre
evitarea unor agenti stresori cunoscufi sau previzibill. se \up0
\expndtw0\charscalex120 poate edifica, atSt pe chestionarea bolnavului asupra unor
"schimbSri de \up0 \expndtw0\charscalex112 viafS'1 - evenimente cu potential
psihotraumatizant general, conform scalelor \up0 \expndtw0\charscalex112 initiate
de Holmes si Rahe - cat $i pe cunoasterea biografiel pacientului. \par\pard\qj
\li844\ri808\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex116 Este posibil.
asa cum am putut evidenfia in lucrSrile noastre din 1980 si \up0
\expndtw0\charscalex112 1984, ca stresui psihic sS f i contribuit la debulul clinic
al bolii e acei bolnavi \up0 \expndtw0\charscalex117 alergiei la care simptomele s-
au instae! dupS o perioadS Tn care au suferit \up0 \expndtw0\charscalex117 stresuri
majore (punctaj crescut pe scala Holmes $i Rahe). \par\pard\ql
Exista o farmacodependenfa a pacientului (in primul rand, fafa de \line\tab \up0
\expndtw0\charscalex119 cortizonice dar si fafa de beta-2 adrenerglce
sau chiar \line \tab \up0 \expndtw0\charscalex120 antihistaminice) ?
cazul unui rSspuns pozitiv. unele probleme psihologice suplimentare \up0
\expndtw0\charscalex113 sunt generate de sevrajul medicamentului respectiv,
atingSnd, in cazul corti-\line \up0 \expndtw0\charscalex120 zonicelor severitatea
unor tulburSri psihice \up0 \expndtw0\charscalex123 (anxietate, depresie) ce pot
\par\pard\qj \li840\ri787\sb2\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex115 merge
pans la paroxisme de tip psihotic (confuzii halucinatorit sau tentative \up0
\expndtw0\charscalex120 de suicid). O ale problems este aceea a inlocuirii
medicamentului "indis-\line \up0 \expndtw0\charscalex124 pensabit" cu un altul
"inofensiv" dar dotat cu proprietdfi active fafa de \up0 \expndtw0\charscalex116
substratui inflamator nespecific al sindromului respectiv \up0
\expndtw0\charscalex114 (eel mai frecvent \par\pard\ql \li840\sb9\sl-230\slmult0
\up0 \expndtw0\charscalex115 este vorba de astmul corticodependent).
6. Ce tip de personalitate are pacientul alergic investigat si care \line\tab
\up0 \expndtw0\charscalex124 sunt zonele de vulnerabilitate la impactul agenfilor
stresori ? \par\pard\qj \li840\ri786\sb66\sl-233\slmult0\fi297 \up0
\expndtw0\charscalex113 Dupa cum s-a menfionat anterior, noi am evidenfiat la
majoritatea bolna� \up0 \expndtw0\charscalex117 vilor astmatici si urticaheni o
vulnerabilitate la stres intermediard intre su� \up0 \expndtw0\charscalex126
biecfii sanato?i si bolnavii cu simptome nevrotice iar la cei cu alergie \up0
\expndtw0\charscalex114 medicamentoasS (lamandescu 1996. Mazuru, lamandescu si
colab \up0 \expndtw0\charscalex103 1997) ea \par\pard\ql \li840\sb10\sl-230\slmult0
\up0 \expndtw0\charscalex115 este foarte apropiats de cea a bolnavilor
neurotici. \par\pard\qj \li844\ri814\sb2\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex112 De fapt, existd o "subpopuldfie nevroticd"$\\ in cazul
bolnavilor urticaneni \up0 \expndtw0\charscalex117 Si astmatici, la acestia din
urmS corticodependenfii fiind de regue bolnavi \up0 \expndtw0\charscalex114 cu
simptome nevrotice patente. \par\pard\qj \li844\ri808\sb0\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex129 Abordarea bolnavului in funcfie de tipul de personalitate
ca si al \up0 \expndtw0\charscalex126 vulnerabilttsfii lor fafa de stresui psihic
poate avea cateva consecinfe \up0 \expndtw0\charscalex115 benefice \par\pard\qj
\li854\ri833\sb0\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex123 - optimizarea
desfasurehi relafiei medic-pacient in plan psihologie, \up0 \expndtw0\charscalex114
inclusiv lavohzarea unui proces psihoterapeutic suportiv eficient;
240\slmult0\fi297 \up0 \expndtw0\charscalex141 - instruirea concrete a bolnavului
asupra unor modaliefi de a evita \up0 \expndtw0\charscalex128 anumite situafii cu
semnificafie elective stresante pentru el. \par\pard\ql \li1675\sb28\sl-207\slmult0
\up0 \expndtw0\charscalex130 - considerarea eventualiefii unui consult psihologie
sau chiar psihiatric. \par\pard\ql \li1684\sb153\sl-207\slmult0 \up0
\expndtw0\charscalex132 Blbliografie \par\pard\li1713\sb131\sl-207\slmult0\fi0 \up0
\expndtw0\charscalex114 1 Ashutosh K, Haldipur C and Boudur M \u9632? Clinical and
personality profiles and\par\pard\li1713\sb14\sl-207\slmult0\fi172\tx5774\tx6086
\up0 \expndtw0\charscalex113 survival in patients with COPD. Chest, 1997,\tab
\up0 \expndtw-8\charscalex72 111,\tab \up0 \expndtw0\charscalex113 95-
98.\par\pard\ql \li1665\sb1\sl-199\slmult0 \up0 \expndtw0\charscalex112 2. Dunbar
Flanders, Synopsis of psychosomatic medicine, Mosby. St. Louis. 1948
\par\pard\ql \li1665\ri256\sb10\sl-213\slmult0\tx1876\tx1886\tx1886 \up0
\expndtw0\charscalex112 3. Haida et al Haida M. Nomura Y. Ho K, Makino S, Miyamoto
T \u9632? Psychological \line\tab \up0 \expndtw0\charscalex114 profiles of patients
with bronchial asthma (II) Analysis according to the modes \line\tab \up0
\expndtw0\charscalex119 ot attack in severe asthmatics and in those with fatal
asthma Arerugi Japan. \line\tab \up0 \expndtw0\charscalex107 Journal of Allergology
1995 Mar.. 44, \up0 \expndtw-2\charscalex100 143-159 \par\pard\ql \li1670\sb12\sl-
207\slmult0 \up0 \expndtw0\charscalex116 4. Holmes TH, Rahe RH The social
readjunstement rating scale \u9632? J Psychosom, \par\pard\li1675\sb24\sl-
207\slmult0\fi215\tx2875\tx3120 \up0 \expndtw0\charscalex110 Res. 1967.\tab \up0
\expndtw-8\charscalex73 11,\tab \up0 \expndtw0\charscalex113 213-
lamandescu IB. Corelafii psihosomatice in astmul bronsic. Tezd de
doctoral.\par\pard\li1675\sb18\sl-207\slmult0\fi215\tx3240 \up0
\expndtw0\charscalex108 IMF Bucuresti.\tab \up0 \expndtw0\charscalex113
\expndtw0\charscalex126 6. lamandescu IB. Contributn la studiul particularildfilor
de teren psihic si \line\tab \up0 \expndtw0\charscalex116 somatic la bolnavii cu
astm bronsic cu trigger psihogen \u9632? But. Acad. St Med.
(1989).\tab \up0 \expndtw0\charscalex102 1-4. 58.\par\pard\qj \li1684\ri261\sb1\sl-
200\slmult0\tx1876 \up0 \expndtw0\charscalex116 7. lamandescu IB \u9632? L 'asthme
bronchique avec trigger psychogene. Incidence et \line\tab \up0
\expndtw0\charscalex112 particularites du terain \u9632? Rev. Roum. Physio! \up0
\expndtw0\charscalex103 1990. 27, 2. \up0 \expndtw-3\charscalex100 121-135.
8. lamandescu IB - Contribution to the study of the etiopathogenic and back
\line\tab \up0 \expndtw0\charscalex116 ground peculiarities in patients with
corticodependent bronchial asthma. Note \par\pard\qj \li1891\ri297\sb0\sl-
220\slmult0\tx2145 \up0 \expndtw-8\charscalex81 I. \tab \up0
\expndtw0\charscalex126 Concepts of corticodependence and pseudocorticodependence.
Rev. \up0 \expndtw0\charscalex108 Roum.Med. Int. 1991. 29. p. 39-47.
\expndtw0\charscalex121 9 lamandescu IB Principles ot psychosomatic approach in
allergic patients \u9632? \line\tab \up0 \expndtw0\charscalex115 Rev. Roum. Psychol
- 1993. 37, 79-89 Psycholher, Psychosom. med. Psycho! \line\tab \up0
\expndtw0\charscalex107 1996, 46, 423 429. \par\pard\ql \li1699\ri261\sb0\sl-
220\slmult0\tx1982\tx1977\tx1963 \up0 \expndtw0\charscalex118 10. lamandescu IB -
Mecanisme psihoendoenne implicate in astmul bronsic cu \line\tab \up0
\expndtw0\charscalex120 trigger psihogen pe baza unor studii asupra asmaticilor
corticodependenti. \line\tab \up0 \expndtw0\charscalex113 Cong. I National de
Psihoneuroendocrinologie, Bucuresti. Academia Romana, \line\tab \up0
\expndtw0\charscalex112 27-28 sept. \up0 \expndtw-7\charscalex100 1996.
11. Klumbies G, Psychotherapie und Allgemeine Medizin. Hirsel Verlag, Leipzig.
\line\tab \up0 \expndtw-4\charscalex100 1980. \par\pard\ql \li1708\sb12\sl-
207\slmult0 \up0 \expndtw0\charscalex121 12 Kourilsky R - Les mechanismes
psychologiques dans I'asthme. Bordeaux \par\pard\li1699\sb16\sl-
207\slmult0\fi292\tx2812\tx3321 \up0 \expndtw0\charscalex113 medical.\tab \up0
\expndtw-5\charscalex100 1969.\tab \up0 \expndtw0\charscalex113 1120-
Richtor R. Dahme 8 - High risk asthmatics: psychological aspects, pp. 198,
8.\par\pard\li1699\sb13\sl-207\slmult0\fi283 \up0 \expndtw0\charscalex114
Wuthrich \u9632? Highlights in Allergy and Clinical Immunology. Hografe und
Huber.\par\pard\li1699\sb9\sl-207\slmult0\fi278 \up0 \expndtw0\charscalex113 Bern
14. Schultz JH. Le training autogene PUF. Paris.\tab \up0 \expndtw0\charscalex113
15. Seropian E.\tab \up0 \expndtw0\charscalex113 (red). Terapia antialergicd
nespecificd. Ed.Medicald Bucuresti.\par\pard\li1699\sb14\sl-207\slmult0\fi307
\up0 \expndtw0\charscalex113 1980.\par\pard\li1699\sb4\sl-207\slmult0\fi9 \up0
\expndtw0\charscalex114 16. Seropian E, lamandescu IB. False reacfii alergice la
medicamente induse de\par\pard\li1699\sb9\sl-207\slmult0\fi273 \up0
\expndtw0\charscalex114 experien(a psihotraumatizanta a unor socuri anafilactice la
Pemcilind, Viata\par\pard\li1699\sb14\sl-207\slmult0\fi288 \up0
\expndtw0\charscalex113 Medicald. 9. 41, (1980).\par\pard\li1699\sb19\sl-
207\slmult0\fi14\tx6753 \up0 \expndtw0\charscalex111 17. Zeand C. - Imunologte
clinicd. Ed. Medicald, Bucuresti.\tab \up0 \expndtw0\charscalex113
II. Modalitdti do abordare psihosomatica specified in cateva \line\tab
\up0 \expndtw0\charscalex139 boli alergice cu larga raspdndire (astm bronsic,
\line \tab \up0 \expndtw0\charscalex140 dermatita atopica, alergia medicamentoasa)*
\up0 \expndtw0\charscalex132 A. Astmul bronsic alergic \par\pard\qj
\li811\ri816\sb202\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex119 Referitor la
acease boae eminamente psihosomatice, considerem utile \up0 \expndtw0\charscalex118
prezentarea succine a unor principii generale de abordare psihosomatice a \up0
\expndtw0\charscalex116 astmaticilor, in functie de lorma clinico-evolutive a
bolii, urmate de analiza \up0 \expndtw0\charscalex113 indicilor de calitate a
viefii bolnavului astmatic si. in final, evaluarea princi� \up0
\expndtw0\charscalex112 palelor forme de psihoterapie utilizate in cadrul
programului terapeutic com� \up0 \expndtw0\charscalex114 plex al astmaticilor
\up0 \expndtw0\charscalex112 (completand programul monitorizerii astmaticului. pro�
\par\pard\qj \li811\ri816\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex116 gram ce
include si el o serie de elemente de ordin psihologie). Toate aceste \up0
\expndtw0\charscalex126 elemente de ordin psihologie trebuie apreciate in raport cu
patogenia \up0 \expndtw0\charscalex113 astmului bronsic (Figura 4). \par\pard\ql
\expndtw0\charscalex122 Figura 4. Patogenia astmului bronsic \par\pard\ql
\par\pard\ql\li1055\sb75\sl-207\slmult0 \up0 \expndtw-3\charscalex100
Alergetii\par\pard\sect\sectd\sbknone\cols3\colno1\colw4390\colsr160\colno2\colw201
0\colsr160\colno3\colw2150\colsr160\ql \li1060\sb0\sl-207\slmult0 \par\pard\ql
\expndtw0\charscalex103 Factori\tab \up0 \expndtw0\charscalex105
Degranulare\par\pard\ql \li1060\sb38\sl-207\slmult0\tx2711 \up0
\expndtw0\charscalex107 nespecifici\tab \up0 \expndtw0\charscalex109
mastocitara\par\pard\ql \li2500\sb0\sl-207\slmult0 \par\pard\ql \li2500\sb56\sl-
207\slmult0 \up0 \expndtw-8\charscalex96 collncrgici\par\pard\ql \li969\sb0\sl-
rô^\par\pard\qj \li2001\sb0\sl-242\slmult0 \par\pard\qj \li1800\ri677\sb141\sl-
\ul0\nosupersub\cf3\f4\fs18 / HlpervwnilafJe \up0 \expndtw-8\charscalex80 >
\line \up0 \expndtw0\charscalex107 *\u8226? f (irttarsa rccaptoilor \line\tab
\up0 \expndtw0\charscalex111 \\ bronaicl) \tab \up0 \expndtw-2\charscalex100
\\\par\pard\column \qj \li140\ri882\sb34\sl-249\slmult0 \up0
\expndtw0\charscalex109 \u8226? Histamina \line \up0 \expndtw0\charscalex107
\u8226? PAF\par\pard\ql \li140\ri479\sb0\sl-248\slmult0 \up0
\expndtw0\charscalex110 \u8226? Leucotrlene \line \up0 \expndtw0\charscalex111
\u8226? Prostaglandina \line \up0 \expndtw0\charscalex119 \u8226? 2 a,
D,\par\pard\qj \li4550\sb0\sl-240\slmult0 \par\pard\qj \li4550\sb0\sl-
\li20\ri982\sb27\sl-240\slmult0 \up0 \expndtw0\charscalex106 Subctafrta P \line
\up0 \expndtw0\charscalex101 Naurokinlne\par\pard\ql \li4862\sb0\sl-253\slmult0
\ul0\nosupersub\cf8\f9\fs22 9M\par\pard\ql \li332\sb116\sl-207\slmult0 \up0
\expndtw-8\charscalex93 \ul0\nosupersub\cf3\f4\fs18 ACTH\par\pard\column \ql
\li20\sb64\sl-207\slmult0 \up0 \expndtw-8\charscalex97 *\u9632?
Edem\par\pard\qj \li6988\sb0\sl-244\slmult0 \par\pard\qj \li6988\sb0\sl-244\slmult0
Secrefie \line \up0 \expndtw0\charscalex103 (mucus)\par\pard\ql \li4185\sb0\sl-
>(Spasm\par\pard\sect\sectd\sbknone\cols2\colno1\colw5552\colsr160\colno2\colw3148\
colsr160\ql \li4185\sb0\sl-496\slmult0 \up0 \expndtw0\charscalex68
\ul0\nosupersub\cf10\f11\fs62 \u8226?C\par\pard\ql \li3537\sb196\sl-
207\slmult0\tx3931 \up0 \expndtw0\charscalex40 \ul0\nosupersub\cf3\f4\fs18 *\u9632?
\tab \up0 \expndtw0\charscalex112 Noradrenatni\par\pard\column \ql \li168\sb1\sl-
0P**\par\pard\ql \li5712\sb0\sl-207\slmult0 \par\pard\ql \li5712\sb0\sl-207\slmult0
\par\pard\ql \li5712\sb0\sl-207\slmult0 \par\pard\ql \li20\sb29\sl-207\slmult0 \up0
\expndtw0\charscalex111 \ul0\nosupersub\cf3\f4\fs18 �aA
\par\pard\qj\li825\ri827\sb61\sl-220\slmult0\fi307 \up0 \expndtw0\charscalex126 'O
tratare mai pe larg a problematicii psihosomatice a aeestei boli alergice \up0
\expndtw0\charscalex118 (incluzdnd, in plus, rinila alergicd si sindromul
urttcarian) este realizatd in recenta \up0 \expndtw0\charscalex112 monografie
..Psychoneuroallergology" a autorului
\expndtw0\charscalex123 /. Principii de abordare psihologica a bolnavilor astmatici
\expndtw0\charscalex121 a. Probleme generale ale abordarii psihologice a bolnavului
astmatic \line\tab \up0 \expndtw0\charscalex118 Abordarea psihosomatica a
bolnavilor astmatici trebuie sa fine cont de \up0 \expndtw0\charscalex111 forma
clinice si modalitefile evolutive ale bolii, ref lectate - pe plan psihologie
\u8226? in calitatea viefii acestor bolnavi, ca si in nivelul lor de complianfe
terapeu� \up0 \expndtw0\charscalex117 tice. Acest din urnre aspect capete noi
valente Tn conditiile actuae Tn care \up0 \expndtw0\charscalex118 astmaticul este
phvit ca un adeverat partener al medicului Tn acfiunea co\up0
\expndtw0\charscalex117 mune (adesea atregand chiar o intrage echipe terapeuticejde
vindecare cli� \up0 \expndtw0\charscalex117 nice a astmului. \par\pard\qj
\li1555\ri874\sb51\sl-240\slmult0\tx1809 \up0 \expndtw0\charscalex124 b Astmul
bronsic intermitent si forma usoara persistenta - fara \line\tab \up0
\expndtw0\charscalex125 dispnee de efort intre accese \par\pard\qj
\li1252\ri356\sb56\sl-245\slmult0\fi302 \up0 \expndtw0\charscalex114 Bolnavii cu
aceste forme de astm paroxistic intermitent cunosc adesea cu \up0
\expndtw0\charscalex122 precizie condifiile de aparifie a crizelor si reu$esc in
mod Irecvent se le \up0 \expndtw0\charscalex116 evite. Accentul psihoterapiei
suportive exercitate de cetre medicul care tra-\line \up0 \expndtw0\charscalex115
teaze astmul (medic de familie sau alergolog) trebuie pus nu numai pe incu-\line
\up0 \expndtw0\charscalex118 rajarea referitoare la existenfa posibilitdfii
prevenirii acestor crize, ci si pe \up0 \expndtw0\charscalex117 caracterul lor
treedtor - in cazul in care totusi se produc - si rnai ales pe in-\line \up0
\expndtw0\charscalex116 struirea detaliatd asupra modului in care trebuie se se
comporte bolnavul in \up0 \expndtw0\charscalex116 timpul crizei, inclusiv gesturile
terapeutice (vizend auto-administrarea me-\line \up0 \expndtw0\charscalex116
dicamentelor necesare). Majoritatea acestor bolnavi trebuie lemurifi asupra \up0
\expndtw0\charscalex116 faptului ce o crize astmatice nu poate fi letala
(explicandu-se decesele altor \up0 \expndtw0\charscalex114 bolnavi astmatici pnn
alte cauze - de exemplu cardiace) Medicul trebuie to� \up0 \expndtw0\charscalex117
tusi se aiba Tn vedere si o eventuae subestimare a pericolului de cetre pa� \up0
\expndtw0\charscalex118 cient, conducSnd la un comportament mai putin compliant al
acestuia. Un \up0 \expndtw0\charscalex113 real succes il inregistreazS pacienfii
care practicS, Tn afara crizelor, exercifii \up0 \expndtw0\charscalex116 de bio-
feedback \up0 \expndtw-2\charscalex100 -\up0 \expndtw0\charscalex117 de exemplu
inregistrarea relaxSrii musculaturii faciale, \par\pard\ql \li1262\sb8\sl-
230\slmult0\tx5390 \up0 \expndtw0\charscalex121 sincronS cu cea a musculaturii
bronsice \tab \up0 \expndtw0\charscalex119 - precum si training-ul autogen
\par\pard\qj \li1262\ri374\sb0\sl-245\slmult0 \up0 \expndtw0\charscalex122 Schultz
sau antrenamentul psihosomatic axat pe exercifii respiratorii s1 \up0
\expndtw0\charscalex116 insofit de muzica preconizat de Luban Plozza. Este
obligatonu ca pacientul \up0 \expndtw0\charscalex114 sa fie invafat sa utilizeze
medicafia bronhodilatatoare de la primele "avertis\up0 \expndtw0\charscalex115
mente" referitoare la chzS ("aura astmaticS") sau in cursul unor crize de tu\up0
\expndtw0\charscalex115 se spasticS sau la aparifia wheezing-ului. \par\pard\qj
\li1267\ri360\sb0\sl-246\slmult0\fi288 \up0 \expndtw0\charscalex119 Un rol
important il are si evaluarea de cStre pacient a posibilitSfii ca o \up0
\expndtw0\charscalex121 parte din crizele sale sS fie declansate de cStre stresui
psihic sau pe cale \up0 \expndtw0\charscalex112 reflex condifionatS (tabelul 1).
Medicul si/sau psihologul pot sS il instruiascS \up0 \expndtw0\charscalex112 in
acest sens
\par\pard\ql \li1555\sb61\sl-230\slmult0 \up0 \expndtw0\charscalex123 c. Astmul
bronsic persistent moderat/sever \par\pard\qj \li1281\ri366\sb62\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex116 Bolnavii prezintS adesea o dispnee
de efort care le limiteaza capacitatea \up0 \expndtw0\charscalex117 fizice si de
efort, dar constituie si un factor de favorizare a trigger-ilor ast\up0
\expndtw0\charscalex114 mogem nespecifici (mirosuri, expunere la frig sau e
"curent", etc). Atat me� \up0 \expndtw0\charscalex114 dicul cat si psihologul
trebuie se aibe in vedere urmetoarele probleme: \par\pard\qj \li1291\ri365\sb0\sl-
260\slmult0\fi288 \up0 \expndtw0\charscalex117 - se abordeze astmaticul la fel ca
si pe oricare alt bolnav cronic (deci cu \up0 \expndtw0\charscalex110 perspective
de evolufie prelungite Tn timp a bolii);
Psihosomatica aplicata\tab \up0 \expndtw0\charscalex109 \u9830?
\par\pard\qj\li998\ri657\sb119\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex119 -
se convtnge pe bolnav asupra riscului major pe care Iar avea oprirea \up0
\expndtw0\charscalex122 brusca a corticoterapiei. din exces de zel \up0
\expndtw0\charscalex115 (atenfionare obligatorie pentru \par\pard\ql
\li988\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex113 astmaticii
corticodependenti); \par\pard\ql \li1276\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex113 - sd identifice trigger-ii psihotogiei ai crizelor de astm;
se studieze posibilele condifii cu atribute de agenfi stresori capabile sa \up0
\expndtw0\charscalex116 confere uneori o rezistenfS paradoxalS la agentii
terapeutici uzuali; \par\pard\qj \li988\ri659\sb16\sl-246\slmult0\fi288 \up0
\expndtw0\charscalex117 - sS utilizeze, intre crize. proceduri psihoterapeutice
(Schultz, bio-feed \up0 \expndtw0\charscalex119 back, muzicoterapie) pasibile de a
fi insusite de cStre pacienfii spitalizafi \up0 \expndtw0\charscalex115 (sau grupe
de bolnavi ambulalori) si aplicate ulterior de cStre acestia la do� \up0
\expndtw0\charscalex123 miciliu, in penoada de acalmie a astmului \up0
\expndtw0\charscalex122 (iar in cursul crizelor, acele \par\pard\ql \li979\sb8\sl-
230\slmult0 \up0 \expndtw0\charscalex113 exercifii respiratorii cu accent pe
expir): \par\pard\qj \li979\ri653\sb0\sl-260\slmult0\fi292 \up0
\expndtw0\charscalex119 - abordarea optimista a bolii , promifSndu-i-se bolnavului
o vindecare \up0 \expndtw0\charscalex114 clinics \up0 \expndtw0\charscalex128
(absenfa cizelor), chiar dace nu totals \up0 \expndtw0\charscalex118 (persistenta
inflamatiei \par\pard\qj \li979\ri668\sb0\sl-240\slmult0\fi14 \up0
\expndtw0\charscalex114 imunologice. capabile se menfine treaze atenfia bolnavului
fafa de trigger-ii \up0 \expndtw0\charscalex114 astmului). \par\pard\ql
\li1271\sb12\sl-230\slmult0\tx2880 \up0 \expndtw0\charscalex123 in acele cazuri
\tab \up0 \expndtw0\charscalex121 (de exemplu astm vechi complicat cu BPOC) in care
absenfa crizelor este contrabalansate de dispneea de efort ireversibie, bol�
\up0 \expndtw0\charscalex114 navul trebuie indrumat cStre obfinerea unui grad
sporit de tolerantS la efort, \up0 \expndtw0\charscalex114 ca obiectiv major dupS
reusita retrocedSrii crizelor. \par\pard\ql \li1262\sb89\sl-230\slmult0 \up0
\expndtw0\charscalex121 d. Astmul corticodependent \par\pard\qj
\li969\ri639\sb56\sl-247\slmult0\fi288 \up0 \expndtw0\charscalex116 AceastS forms
severs de astm grupeazS acele cazuri in care corticotera\up0
\expndtw0\charscalex118 pia devine atat un remediu contra crizelor de astm, cSt $i
pentru pSstrarea \up0 \expndtw0\charscalex112 capacitSfii de eiort a bolnavilor
respectivi necesarS unei viefi profesionale s> \up0 \expndtw0\charscalex117
familiale normale. intre astmaticii corticodependenfi ajung atat bolnavii cu
\up0 \expndtw0\charscalex117 forme severe ale bolii (justilicare obiectivS. de
forfS majors) cat. mai ales, \up0 \expndtw0\charscalex118 acei bolnavi care
abuzeazd nepermis (ori la indicafia. faciia si lipsita ade� \up0
\expndtw0\charscalex120 sea de responsabilitate, a medicului anxios sau domic de
succese specta\up0 \expndtw0\charscalex115 culare). Balanfa intre efectele
lavorabile certe ale medicamentului s' efecte� \up0 \expndtw0\charscalex119 le
secundare . adesea depSsind beneficiul terapeutic, este acfionae adesea \up0
\expndtw0\charscalex115 de cStre factori subiectivi, finSnd de medic sau de bolnav,
cu toate cS noile \up0 \expndtw0\charscalex116 reglementSri cuprinse in Consensus
Asthma Report si apoi GINA ar trebui \up0 \expndtw0\charscalex113 sS prevaleze
asupra oricaror initiative "originae". Analizand in anul 1995, pe \up0
\expndtw0\charscalex119 baza unor chestionare si a unor teste psihologice, cauzele
de ordin psiho\up0 \expndtw0\charscalex115 social care favorizeazS instalarea
corticodependentei. am ajuns la concluzia \up0 \expndtw0\charscalex120 cS factorii
psiho-sociali dependenfi de bolnav au lost legafi in special de \up0
\expndtw0\charscalex117 personalitatea acestora, dar si de circumstante, existand
astfel urmStoarele \up0 \expndtw0\charscalex117 tipologii predilecte pentru
corticodependenfS : \par\pard\ql \li1267\sb188\sl-230\slmult0 \up0
\expndtw0\charscalex121 Q Cauzele corticodependentei (CD) dependente de bolnav
CD apare mai frecvent la anumifi bolnavi pe care - in urma observatiei \up0
\expndtw0\charscalex120 clinice si a aplicarii unor teste psihologice (lamandescu
-\up0 \expndtw0\charscalex111 1995) le putem \par\pard\ql \li979\sb29\sl-
230\slmult0 \up0 \expndtw0\charscalex116 sistematiza astfel: \par\pard\qj
\li974\ri687\sb0\sl-260\slmult0\fi302 \up0 \expndtw0\charscalex118 - bolnavii
anxiosi, speriafi de gravitatea crizelor antehoare si asteptand \up0
\expndtw0\charscalex118 obsesiv repetarea acestora.
psihosomaticd generae si aplicata\par\pard\qj \li1238\sb0\sl-240\slmult0
240\slmult0\fi302 \up0 \expndtw0\charscalex117 - bolnavii timizi, neincrezetori in
alte medicamente (mai slabe, desigur, \up0 \expndtw0\charscalex114 decat
cortizonicele) si neavSnd curajul de a reveni la medic dupS insuccesul \up0
\expndtw0\charscalex114 sevrajului; \par\pard\qj \li1248\ri384\sb0\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex114 - bolnavii dependenfi de anturaj,
incusiv de medic, Tn momentele in care \up0 \expndtw0\charscalex117 nu reu$esc sS
efectueze sevrajul cortizonic reiau singuri corticoterapia din \up0
\expndtw0\charscalex120 jena de a nu fi, din nou, o povars pentru cei din jur,
stiind cS vor putea fi \up0 \expndtw0\charscalex120 Jertafi" de medic; \par\pard\qj
\li1238\ri390\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex115 - structurile
de personalitate rigide, impenetrabile la argumentafia medi� \up0
\expndtw0\charscalex121 cului referitoare la riscurile corticoterapiei s* convinse
de superioritatea \up0 \expndtw0\charscalex121 aeestei medicafii, \par\pard\qj
\li1248\ri384\sb0\sl-226\slmult0\fi288 \up0 \expndtw0\charscalex112 - bolnavii
"descurcarefi", cu un Ego puternic, ancorati in sarcini profesio� \up0
\expndtw0\charscalex113 nale ce nu le permit momente de "cSdere" (crizele de astm)
si care i$i asumS \up0 \expndtw0\charscalex123 riscurile efectelor secundare
conform dictonului "dupS mine potopul", \up0 \expndtw0\charscalex124 sperand ca, pe
parcurs, sS aparS alte sanse terapeutice; \par\pard\qj \li1243\ri380\sb0\sl-
230\slmult0\fi302 \up0 \expndtw0\charscalex115 - bolnavii lipsifi de voinfd (deci,
la polul opus celor de mai sus) care ac� \up0 \expndtw0\charscalex122 cepts
riscurile acelorasi efecte secundare conform aceleiasi formule "de \up0
\expndtw0\charscalex114 amanare" dar - din nou diferit de ceilalfi - cu
resemnare. \par\pard\qj \li1248\ri364\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex113 De regula. bolnavii cu CD "comit" singuri greseala retudrii
corticoterapiei \up0 \expndtw0\charscalex113 (CT), iar "tehnicile" lor de dozaj
sunt, fie o repetare a celor prescrise de cetre \up0 \expndtw0\charscalex121 medic
in etapele anterioare ale bolii, fie copierea \up0 \expndtw0\charscalex126 (+
adaper! personae) \par\pard\ql \li1243\sb1\sl-221\slmult0 \up0
\expndtw0\charscalex113 celor utilizate de cetre alfi bolnavi. \par\pard\ql
\li1536\sb2\sl-218\slmult0\tx7766 \up0 \expndtw0\charscalex124 Teama si.'sau jena
de a reveni ulterior la medicul lor curant \tab \up0 \expndtw0\charscalex127 (sau
la \par\pard\qj \li1243\ri400\sb4\sl-240\slmult0 \up0 \expndtw0\charscalex120
specialists care ii tratea/a) ii lac se persiste pe acest drum al automedica\up0
\expndtw0\charscalex120 tiei. ori se mearga ia alt medic. \par\pard\ql
\li1540\sb9\sl-230\slmult0\tx7603 \up0 \expndtw0\charscalex117 De altfel, testele
psihologice utilizate de noi la acesti bolnavi \tab \up0 \expndtw0\charscalex103
(MMPI si \par\pard\qj \li1248\ri375\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex116 Rorschach) evidenfiaze ca trasaturi de personalitate:
hiperemotivitatea, an� \up0 \expndtw0\charscalex120 xietatea si - ceea ce
considerem ca element secundar bolii - depresia (la� \up0 \expndtw0\charscalex112
mandescu
- 1994 b). \par\pard\qj \li1252\ri380\sb0\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex118 Cerceeri personae mai recente evidenfiaze depresia ca fiind
prezente la \up0 \expndtw0\charscalex131 86% dintre astmaticii corticodependenfi si
corelate cu declansarea \up0 \expndtw0\charscalex119 psihogene \up0
\expndtw0\charscalex133 (suplimentare) a crizelor la \up0 \expndtw0\charscalex133
84% dintre acesti bolnavi \par\pard\ql \li1243\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex113 corticodependenfi (lamandescu 1996). \par\pard\ql
\expndtw0\charscalex121 \u9633? Cauzele CD dependente de medic \par\pard\qj
\expndtw0\charscalex112 Din analiza bolnavilor corticodependenfi indrumati la
consult alergologie, \up0 \expndtw0\charscalex115 dupe aparifia corticodependentei,
am putut distinge doue principale catego� \up0 \expndtw0\charscalex115 rii de
medici care contribuie la instalarea CD: \par\pard\qj \li1262\ri369\sb8\sl-
\expndtw0\charscalex134 Amatorii de succes medical, de rezultate spectaculare, fere
o \up0 \expndtw0\charscalex113 preocupare pentru viitorul indepertat al bolnavului
care continue se adminis-\line \up0 \expndtw0\charscalex116 treze CT pane e
aparifia unor complicatii ce o fac impracticabie, recurgand \up0
\expndtw0\charscalex108 atunci \up0 \expndtw0\charscalex112 - pentru acoperire - 1a
medicul specialist (alergolog, reumatolog, etc); \par\pard\qj \li1276\ri371\sb6\sl-
235\slmult0\fi278 \up0 \expndtw0\charscalex117 - Anxiosii, acestia fiind de regue
speciatistii dotafi cu bune intenfie si o \up0 \expndtw0\charscalex119 bune
pregetire profesionale care, la primele simptome de recidive a bolii. \up0
\expndtw0\charscalex127 recurg cu usuhnfe din nou la CT, inducand aceeasi stare de
alerta S" \up0 \expndtw0\charscalex116 pacientului; ulterior, chiar dace prescriu
medicafii cu rol de suplinire a CT. \up0 \expndtw0\charscalex116 nu au suficiente
rabdare se astepte instalarea efectulul terapeutic.
Momentul realizarii cu succes a sevrajului cortizonic este foarte dificil \up0
\expndtw0\charscalex120 pentru psihicul bolnavului, apSrSnd cu regularitate o
tnadS: astenie, an� \up0 \expndtw0\charscalex117 xietate, depresie (lamandescu
-\up0 \expndtw0\charscalex112 1993) datoratS disparifiei efectelor
"stimu-\par\pard\qj \li883\ri759\sb20\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex120 lante" ale CT antenoare asupra cortexului cerebral sj
aceste simptome de \up0 \expndtw0\charscalex116 "carentS cortizonicS" reclamS
ingrijiri speciale, adesea chiar apelul la me� \up0 \expndtw0\charscalex112 dicul
psihiatru. \par\pard\qj \li1171\ri2102\sb224\sl-260\slmult0\tx1425 \up0
\expndtw0\charscalex123 \u9633? Modalitafi psihologice de diminuare sau inlaturare
a \line\tab \up0 \expndtw0\charscalex124 corticodependentei \par\pard\qj
\li883\ri749\sb237\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex124 Desi se mtricS
in mod inerent cu mSsurile de ordin medical, aceste \up0 \expndtw0\charscalex114
modaliefi pot fi dilerenfiate astfel (lamandescu - 1993): \par\pard\qj
\li888\ri739\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex114 - asigurarea
pacientului cS inlocuirea CT va fi fScutS "dandu-i-se ceva in \up0
\expndtw0\charscalex120 schimb". adicS o medicare capabie sa preia acflunea
favorabie a cortizo-\line \up0 \expndtw0\charscalex120 nului, in acelasi timp
tnsisendu-se asupra nociviefii pe termen lung a CT; \par\pard\ql \li1166\sb29\sl-
230\slmult0 \up0 \expndtw0\charscalex115 - recurgerea la o schemd de tratament cu
inlocuirea treptate a CT; \par\pard\qj \li873\ri744\sb0\sl-244\slmult0\fi297
\up0 \expndtw0\charscalex117 - monitorizarea principalelor funcfii afectate de boae
(de exemplu inre\up0 \expndtw0\charscalex118 gistrarea valorilor respiratorii in
spital si la domiciliu de cetre astmatic. cu \up0 \expndtw0\charscalex115 ajutorul
unor aparate portabile usor de manevrat). Aceaste monitorizare asi\up0
\expndtw0\charscalex122 gura pacientul asupra posibihtafn anticipant unor momente
de recidivS \up0 \expndtw0\charscalex114 (putand recurge, in timp, la ajutorul
medicului, sau liindu-i permisS de cStre \up0 \expndtw0\charscalex114 acesta
ajustarea dozelor de medicamente); \par\pard\qj \li888\ri734\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex117 - identificarea surselor de stres si
a punctelor slabe, de vulnerabilitate la \up0 \expndtw0\charscalex116 stres, Tn
structura personaliefii bolnavului \up0 \expndtw0\charscalex118 (cooperarea cu
psihologul este \par\pard\qj \li878\ri760\sb0\sl-260\slmult0 \up0
\expndtw0\charscalex121 extrem de utila!), fiind cunoscut rolul agravant, generator
de recidive, al \up0 \expndtw0\charscalex114 stresului psihic; \par\pard\qj
\li873\ri750\sb0\sl-246\slmult0\fi292 \up0 \expndtw0\charscalex116 - aplicarea unor
metode de relaxare psihice. incluzSnd - in primul rand \u8226? \up0
\expndtw0\charscalex116 training-ul autogen Schultz (in special exercifiile
centrate pe respiratie) dar \up0 \expndtw0\charscalex115 Si bio-feedback sau
muzicoterapia (lamandescu \u8226? 1994 c), acolo unde exists \up0
\expndtw0\charscalex107 condifii; \par\pard\qj \li878\ri739\sb0\sl-
260\slmult0\fi292 \up0 \expndtw0\charscalex115 - colaborarea cu psihiatrul mai ales
in momentul apanfiei sindromului de \up0 \expndtw0\charscalex115 sevraj.
\par\pard\ql \li1175\sb123\sl-230\slmult0 \up0 \expndtw0\charscalex121 2. Calitatea
viefii bolnavului astmatic \par\pard\qj \li878\ri739\sb179\sl-244\slmult0\fi297
\up0 \expndtw0\charscalex117 Unui dintre avantajele pe care le prezintS medicina
allopats in raport cu \up0 \expndtw0\charscalex123 tot mai ofensiva medicinS
alternativS este acela al asigurSrii unei bune \up0 \expndtw0\charscalex122
calitSfi a viefii omului bolnav. Desi arms de bazS a medicinei allopate, \up0
\expndtw0\charscalex120 medicamentul este responsabil de multe dintre electele
secundare ce gre\up0 \expndtw0\charscalex113 veazS calitatea viefii bolnavului. Din
acest motiv, industria de medicamente, \up0 \expndtw0\charscalex122 racordats tot
mai mult la exigence clinice, reuseste an de an sS producS \up0
\expndtw0\charscalex112 preparate care alecteazS tot mai pufin indicii de calitate
a viefii (QOL), astfel \up0 \expndtw0\charscalex116 incat centrul de greutate al
unor cerceeri psihologice vizSnd aceastS laturS \up0 \expndtw0\charscalex116 cu
implicafii bio-psiho-sociale a actului medical se mue In zona percepfiei \up0
\expndtw0\charscalex125 disconfortului general de simptomele bolii dar si de
restricfiile la care \up0 \expndtw0\charscalex118 este supus pacientul (uneori in
mod excesiv si nejustificat).
generala ?i aplicata\par\pard\qj \li1151\sb0\sl-230\slmult0
230\slmult0\fi297 \up0 \expndtw0\charscalex131 \ul0\nosupersub\cf9\f10\fs20 Existe
un mod aparte, propriu fieceruia dintre noi. de a surptinde \up0
\expndtw0\charscalex117 semnele bolii, de a le interprets si de a reacfiona
specific la aceste interpre� \up0 \expndtw0\charscalex110 ter! propril.
Atitudinea fate de boae, modul in care aceasta este acceptae sau nu \up0
\expndtw0\charscalex114 (intrarea in rolul de bolnav), rela(ia medic-pacient cat si
stilul de viafe al bol� \up0 \expndtw0\charscalex118 navului au rol deosebit de
important in adaptarea la noua situatie de bolnav \up0 \expndtw0\charscalex118 Si
depa$irea acestui impas existential. \par\pard\qj \li1137\ri486\sb5\sl-
235\slmult0\fi292 \up0 \expndtw0\charscalex115 Astfel, stilul de viafa al
bolnavului cronic sufere numeroase modificeri le \up0 \expndtw0\charscalex119 gate
de disconfortui somatic s' psihic cauzat de boala Tn sine, de nolle exi\up0
\expndtw0\charscalex117 genfe (restric(ii) la care este supus (dieta. suprimarea
unor activitafi. renun\up0 \expndtw0\charscalex121 farea la anumite
responsabiliefi, pierderea unei anumite autontafi, etc) ca \up0
\expndtw0\charscalex121 Si de efectele secundare ale medicafiei administrate.
cazul bolnavului astmatic, calitatea viefii este determinate de \up0
\expndtw0\charscalex119 realitatea unor handicapuri propni bolii legate de
dificultatea realizani ma\up0 \expndtw0\charscalex117 suri/or de profilaxie (vezi
educafia bolnavului) si de tratament (efectele se� \up0 \expndtw0\charscalex117
cundare ale medicafiei). \par\pard\qj \li1137\ri491\sb0\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex116 Toleranfa bolnavului fafa de toate aceste modificeri
depinde si de puterea \up0 \expndtw0\charscalex121 de convingere a medicului
\up0 \expndtw0\charscalex125 (scezue in cazul medicilor pregatifi dar fere
\par\pard\qj \li1137\ri496\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex129 calitefi
pedagogice. empatice si disponibilitate de a stabili un contaci
\up0 \expndtw0\charscalex114 autentic cu bolnavul) \par\pard\qj
\li1137\ri484\sb6\sl-233\slmult0\fi297 \up0 \expndtw0\charscalex123 Evaluarea
calitafn viefii bolnavului astmatic se bazeaza pe nesurarea \up0
\expndtw0\charscalex121 unor indicator/ ai sandtdfii (fizici. de inserfie sociala,
percepfia sandtafii. \up0 \expndtw0\charscalex121 energie/fatigabilitate, prezenfa
durerii, etc) si a unor probleme variate dar \up0 \expndtw0\charscalex121 specifice
astmului. \par\pard\qj \li1137\ri491\sb2\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex122 in esenfa. evaluarea calitefi! viefii bolnavului astmatic
tinde se reduce \up0 \expndtw0\charscalex115 subiectivitatea aprecierilor
bolnavului. \par\pard\qj \li1128\ri465\sb3\sl-237\slmult0\fi302 \up0
\expndtw0\charscalex116 in ultimul decemu o serie de autori au incercat se evalueze
calitatea viefii \up0 \expndtw0\charscalex117 la bolnavul astmatic. Prmtre acestia,
Bousquet si colab. au avut meritul de a \up0 \expndtw0\charscalex115 aplica in \up0
\expndtw0\charscalex116 1992 o scala de mesurare a caliefii viefii (SF-36-MOS Short
Form \up0 \expndtw0\charscalex123 General Health Survey,pe un grup de 74 de
pacienfi astmatici, coreland \up0 \expndtw0\charscalex127 alterarea indicilor de
calitate a viefii cu gradul de sevehtate a astmului \up0 \expndtw0\charscalex120
(evaluat e rendul seu prmtr-o scale elaborate de Van Aas ce surprinde atat \up0
\expndtw0\charscalex121 aspecte clinice referitoare la numSrul si durata
simptomelor, durata bolii. \up0 \expndtw0\charscalex129 prezenfa sau absenfa
inlervalelor de calm dintre crize cat s' aspectele \up0 \expndtw0\charscalex119
terapeutice legate de nunerul zilelor de tratament necesare). \par\pard\qj
\li1137\ri476\sb1\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex125 Autorii
incearce de asemenea se introduce date referitoare la electul \up0
\expndtw0\charscalex125 terapiei bronhodilatatoare, parametrii investigafi
incluzand s* cresterea \up0 \expndtw0\charscalex114 VEMS odate cu modificeri ale
fluidului bronho-alveolar (numar de eozmofile \up0 \expndtw0\charscalex120 Si ECP)
in final, studiul evidenfiaze o corelafie semnificativd a severitdfii \up0
\expndtw0\charscalex121 astmului cu majoritatea indicilor de calitate a viefii
inclusi in scala SF-36 \up0 \expndtw0\charscalex121 exceptand pe cei referitori la
senetatea mentae si energie/fatigabilitate. \par\pard\qj \li1161\ri490\sb0\sl-
240\slmult0\fi273 \up0 \expndtw0\charscalex120 Chestionarul "Living with asthma"
prezinta avantajul unui nunrer mai \up0 \expndtw0\charscalex120 redus al itemilor
la \up0 \expndtw0\charscalex124 68 si al concentrarii acestora pe probleme
specifice \par\pard\ql \li1161\sb9\sl-230\slmult0\tx3657 \up0
\expndtw0\charscalex125 astmului repartizale pe \tab \up0 \expndtw0\charscalex127
11 subscale: somn, munca. activitafi diverse, \par\pard\qj \li1171\ri470\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex125 mobilitate, activitate sociata,
inactivitate, sport, sdrbatori. etecte asupra \up0 \expndtw0\charscalex116 celor
din jur, utilizarea medicamentelor, probleme sexuate si stari distorice.
<\u9632?\tab \up0 \expndtw0\charscalex116 233\par\pard\qj \li820\sb0\sl-233\slmult0
233\slmult0\fi297 \up0 \expndtw0\charscalex119 \ul0\nosupersub\cf9\f10\fs20 Recent.
Juniper E., in studiile sale asupra calitSfii viefii la bolnavii cu \up0
\expndtw0\charscalex122 astm si rinita, evidenfiazS aspecte diferite ale astmului
la adulfi lafS de \up0 \expndtw0\charscalex112 COpll Adulfii ar suleri mat mult de
insomnii si somnolenta ziua, fiind mai re-\line \up0 \expndtw0\charscalex119
ticenfi fafa de activitSfile fizice \up0 \expndtw0\charscalex118 (sport,
cumpSrSturi) sau obisnuitele lor \par\pard\qj \li820\ri827\sb2\sl-
240\slmult0\fi9 \up0 \expndtw0\charscalex115 hobby-url (grSdinSnt, ingrijirea
animalelor de casS, etc). Ei prezinta o tole\up0 \expndtw0\charscalex111 ranfS mai
scSzutS la schimbSrile de vreme. la mirosuri puternice (de exemplu \up0
\expndtw0\charscalex111 fumul de figara) iar boala le afecteazS prolund calitatea
vietii \par\pard\qj \li820\ri812\sb0\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex116 Copiii ar ft insS mai afectafi de dificultafile de mtegrare
sociae decat de \up0 \expndtw0\charscalex123 simptomele proprlu-zise. Izolarea
Impuse de boae duce la tulburari ale \up0 \expndtw0\charscalex117 afectivitafh
ajungandu-se la Irustrare tnstete, fune. \par\pard\qj \li815\ri823\sb6\sl-
233\slmult0\fi297 \up0 \expndtw0\charscalex121 Restrictive terapeutice si
profilactice au condus adesea la sustragerea \up0 \expndtw0\charscalex118
neiustilicate a tinerilor astmatici late de tentafiile varstei lor. mai ales
fafa \up0 \expndtw0\charscalex117 de practicarea unor sporturl mult indrSgite a
cSror interdicfie (adesea abu\up0 \expndtw0\charscalex114 zivai le crea adevSrate
complexe de inferioritate \par\pard\qj \li1108\ri2118\sb182\sl-
240\slmult0\tx1363 \up0 \expndtw0\charscalex122 3. Principalele forme de
psihoterapie si mijloace psiho-\line\tab \up0 \expndtw0\charscalex123 farmacologice
utilizate in astmul bronsic \par\pard\ql \li1104\sb169\sl-230\slmult0 \up0
\expndtw0\charscalex121 A. Implicafiile profilactice si terapeutice
\par\pard\li815\sb18\sl-230\slmult0\fi283 \up0 \expndtw0\charscalex117 Cunoasterea
rolului SP in aparitia. desfSsurarea crizelor de astm
precum\par\pard\li815\sb15\sl-230\slmult0\fi0\tx2380\tx3287 \up0
\expndtw0\charscalex110 Si evolufia bolii\tab \up0 \expndtw0\charscalex109
(referitor\tab \up0 \expndtw0\charscalex116 1a frecvenfa s> severitatea crizelor
sau la simpto-\par\pard\li815\sb5\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex117
matologia intercriticS) are desigur implicafii in primul rand de ordin
profi-\par\pard\li815\sb10\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex116
lactic.\par\pard\qj \li811\ri826\sb0\sl-238\slmult0\fi302 \up0
\expndtw0\charscalex116 Bolnavul astmatic, informal asupra riscului pe care il
prezinta SP pentru \up0 \expndtw0\charscalex118 boala sa. poate - in unele cazuri -
sS previnS anumite situafii stresante sau \up0 \expndtw0\charscalex114 sS le reducS
intensitatea. intre cele mai frecvente si severe SP este chiar pa\up0
\expndtw0\charscalex115 mea resimfits de bolnavi in momentul instaerii crizei si.
desigur, in momen \up0 \expndtw0\charscalex117 tele ei de varf. Din acest motiv
Creer si colab., referindu-sela efectele mo\up0 \expndtw0\charscalex118 deste
bronhodilatatoare ale diverselor tehnici psihoterapeutice de relaxare \up0
\expndtw0\charscalex116 (demonstrate de catre Alexander), apara totusi utilitatea
acestora prin aceea \up0 \expndtw0\charscalex113 cS ele reprezintS veritabie
procedee de autocalmare (inclusiv in timpul zilei) \up0 \expndtw0\charscalex115 Si
il feresc pe bolnav de o serie de inconveniente ale medicamentelor, ince\up0
\expndtw0\charscalex121 pSnd cu utilizarea lor defectuasS s' terminSnd cu efectele
lor secundare \up0 \expndtw0\charscalex120 Prin urmare. un antidot nemedicamentos
impotriva SP il constituie me� \up0 \expndtw0\charscalex121 todele psihoterapeutice
de relaxare \par\pard\qj \li811\ri801\sb0\sl-236\slmult0\fi292 \up0
\expndtw0\charscalex131 a) Inaintea lor se cuvine sS evidentiem rolul major
indeplinit de \up0 \expndtw0\charscalex119 psihoterapia simpla de sustinere
("suportiva") care in mainile unui medic \up0 \expndtw0\charscalex120 "cu har" dar
si bine instruit poate conduce la o nets ameliorare a cursului \up0
\expndtw0\charscalex100 bolii \up0 \expndtw0\charscalex114 (Criep). Rolul medicului
este acela de a capta increderea bolnavului ale \up0 \expndtw0\charscalex116 carui
conlesiuni, diminuandu-i acestuia din urmS starea de tensiune, pot sa \up0
\expndtw0\charscalex112 modifice in sens favorabil evolufia astmului (Gendrot).
intre pnncipiile de bazS ae psihoterapiei simple postulate de cStre Lask \up0
\expndtw0\charscalex125 ConsiderSm cS absolut necesare sunt mdividualizarea
tratamentului. \up0 \expndtw0\charscalex119 anticiparea de cStre medic a ceea ce
bolnavul asteapts de la el. incercarea \up0 \expndtw0\charscalex118 de a veded "cu
ochii bolnavului'' si relafionarea problemelor "actuate" ale \up0
\expndtw0\charscalex115 bolnavului in acord cu dezvoltarea sa emofionala, inclusiv
cu evenimentele \up0 \expndtw0\charscalex115 din copildne
\ul0\nosupersub\cf9\f10\fs20 234\tab \up0 \expndtw0\charscalex104 <>\tab \up0
\expndtw0\charscalex104 Elemente de psihosomaticd generae si
230\slmult0 \par\pard\ql\li1560\sb151\sl-230\slmult0\tx3177 \up0
\expndtw0\charscalex121 Ca s' alfi autori \tab \up0 \expndtw0\charscalex118 (Edith
Raameckers. Spector si colab.), noi considerSm \par\pard\qj \li1267\ri355\sb9\sl-
232\slmult0\fi4 \up0 \expndtw0\charscalex127 bolnavul astmatic, si in genere orice
bolnav, ca pe un partener activ al \up0 \expndtw0\charscalex128 demersului
terapeutic, punSndu-i-se la dispozifie, aieturi de nofiunile \up0
\expndtw0\charscalex117 principale despre boae (explicate intr-un limbaj adecvat al
Tnfelegerii sale), \up0 \expndtw0\charscalex130 o serie de mesuri de autotratament
al crizei, mergend de la actele de \up0 \expndtw0\charscalex122 "dirijare" a
expirului activ si pane la medicafia simptomatica capabile se \up0
\expndtw0\charscalex122 puna capet accesului. \par\pard\qj
\li1267\ri340\sb13\sl-226\slmult0\fi283 \up0 \expndtw0\charscalex117 Aceaste
apropiere a bolnavului de problemele bolii si punerea Tn fafa sa \up0
\expndtw0\charscalex120 a unor sarcini pe care se si la poate rezolva singur -
avand Tn permanenfe \up0 \expndtw0\charscalex125 perspectiva unei evolufii ades
favorabile dar si accesul facil la medicul \up0 \expndtw0\charscalex131 curant in
cazurile de impas \up0 \expndtw-2\charscalex100 -\up0 \expndtw0\charscalex127
constituie premisele unei psihopatii de \par\pard\qj \li1276\ri346\sb19\sl-
220\slmult0 \up0 \expndtw0\charscalex121 sus(inere eficace, in primul rand in
combaterea SP impus de ameninfarea \up0 \expndtw0\charscalex121 reapanfiei crizelor
astmatice (lamandescu 1993 b). \par\pard\qj \li1267\ri366\sb8\sl-
235\slmult0\fi302 \up0 \expndtw0\charscalex130 In acest context securizant fata de
SP reprezentat de ameninfarea \up0 \expndtw0\charscalex117 crizelor se inscrie S'
monitohzarea reaparifiei la domiciliu - cu ajutorul unui \up0
\expndtw0\charscalex116 aparat portabil de tip Vitalograph - care-i permite
bolnavului se sesizeze din \up0 \expndtw0\charscalex134 timp apropierea crizelor de
astm si se poate astfel anunfa medicul \up0 \expndtw0\charscalex114 (lamandescu
1992 b). \par\pard\ql \li1915\sb210\sl-230\slmult0 \up0 \expndtw0\charscalex112
Tabelul 3. \par\pard\ql \li1670\sb210\sl-230\slmult0\tx1905 \up0 \expndtw-
2\charscalex100 1 \tab \up0 \expndtw0\charscalex123 Rolul factorului psihic la
debutul bolii \par\pard\ql \li1651\sb1\sl-193\slmult0 \up0 \expndtw0\charscalex116
a) "Stare de fond" (stres cronic) \par\pard\ql \li3105\sb7\sl-193\slmult0 \up0
\expndtw0\charscalex120 - situafia general valabie \par\pard\ql \li3105\sb7\sl-
193\slmult0 \up0 \expndtw0\charscalex116 - situafia cu semnilicafie electivS
\par\pard\ql \li1651\sb7\sl-193\slmult0 \up0 \expndtw0\charscalex111 b) Trigger
initial \par\pard\ql \li3110\sb11\sl-213\slmult0 \up0 \expndtw0\charscalex110 -
exclusiv \par\pard\ql \li3110\sb1\sl-197\slmult0 \up0 \expndtw0\charscalex115 -
asociat - rol major \par\pard\ql \li4027\sb6\sl-194\slmult0 \up0
\expndtw0\charscalex109 - rol minor \par\pard\ql \li1651\sb7\sl-193\slmult0 \up0
\expndtw0\charscalex124 2. Rolul actual al fact, psihic \par\pard\ql
\li1651\sb11\sl-213\slmult0 \up0 \expndtw0\charscalex121 a) declanseaza crizele
\par\pard\li1656\sb1\sl-205\slmult0\fi1454\tx5284 \up0 \expndtw0\charscalex112 -
evidenfe: declansare\tab \up0 \expndtw0\charscalex112 - aparent exclusive
(AB.psihogen)\par\pard\li1656\sb1\sl-212\slmult0\fi3623 \up0
\expndtw0\charscalex112 - alternative\par\pard\li1656\sb1\sl-199\slmult0\fi1449
\up0 \expndtw0\charscalex112 - supozifie: fere evidente dar\par\pard\li1656\sb1\sl-
201\slmult0\fi3623 \up0 \expndtw0\charscalex112 - lipsa alfi
triggeri\par\pard\li1656\sb1\sl-202\slmult0\fi3623 \up0 \expndtw0\charscalex112 -
"Tncercare stresane"\par\pard\li1656\sb1\sl-206\slmult0\fi3633 \up0
\expndtw0\charscalex112 - tip personalitate (observatie)\par\pard\li1656\sb1\sl-
201\slmult0\fi0 \up0 \expndtw0\charscalex112 b) nu declanseaze
crizele\par\pard\li1656\sb1\sl-213\slmult0\fi1449\tx4560 \up0
\expndtw0\charscalex112 - supozifie\tab \up0 \expndtw0\charscalex112 - biografic
Normal\par\pard\ql \li4560\sb0\sl-195\slmult0 \up0 \expndtw0\charscalex113 - tip
pers. Normal \par\pard\li3110\sb1\sl-207\slmult0\fi0\tx4560\tx6729 \up0
\expndtw0\charscalex115 - evidenfe\tab \up0 \expndtw0\charscalex115 - toleranfe
bune la SP\tab \up0 \expndtw0\charscalex115 (anamneze,\par\pard\ql \li4684\sb2\sl-
191\slmult0 \up0 \expndtw0\charscalex114 observafie) \par\pard\ql \li1651\sb8\sl-
193\slmult0\tx4564 \up0 \expndtw0\charscalex115 c) intretine evolufia cronice? \tab
\up0 \expndtw0\charscalex111 - idem a) \par\pard\qj \li1300\sb0\sl-240\slmult0
Psihoterapia de susflnere (suportivd) este accesibild si necesard oricdrui \up0
\expndtw0\charscalex115 medic in tratamentul cSrora se afIS un bolnav astmatic.in
situafiile cand im-\line \up0 \expndtw0\charscalex115 plicafiile SP sunt decisive
Tn evolufia bolii, ca si ori de cate ori cadrul de or-\line \up0
\expndtw0\charscalex113 ganizare al asistenfei medicale o permite (de exemplu Tn
clinici medicale, in-\line \up0 \expndtw0\charscalex117 cadrate cu psihologi), se
poate recurge la proceduri diferentiate de psihote� \up0 \expndtw0\charscalex117
rapie. \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart Pg238}{\bkmkend
\ul0\nosupersub\cf9\f10\fs20 b) Un loc aparte in cadrul acestor proceduri revine
celor de psihoterapie \up0 \expndtw0\charscalex114 sugestivS Dintre ele hipnoza
aplicats Initial de Luparello si colab. , si-a do� \up0 \expndtw0\charscalex115
vedit de mule vreme utilitatea cu conditia existenfei unor indicafii elective: \up0
\expndtw0\charscalex117 crize de astm declansate de factori psihogen/ la bolnavi cu
manifestdri ne� \up0 \expndtw0\charscalex113 vrotice obsesive (inclusiv asteptarea
anxioasS a crizelor). De men(ionat pru\up0 \expndtw0\charscalex117 denta ce trebuie
sS pnmeze la indicarea aeestei metode de tratament adju� \up0
\expndtw0\charscalex116 vant al crizelor de astm. in caz contrar, aplicarea
hipnozei poate conduce la \up0 \expndtw0\charscalex128 agravarea astmului sau chiar
la aparifia altor simptome supSrStoare \up0 \expndtw0\charscalex112 (exemplu: un
sughif rebel sau cefalee (VI. Gheorghiu). Succesul eel mai ma� \up0
\expndtw0\charscalex116 re al utilizarii hipnozei in tratamentul astmului apare la
acei bolnavi la care \up0 \expndtw0\charscalex116 nu s-a produs obisnuinfa cu
tratamentul medicamentos. \par\pard\qj \li729\ri892\sb16\sl-245\slmult0\fi307
\up0 \expndtw0\charscalex113 LI O variants a hipnozei. menits sS prelungeascS
actiunea acesteia in ab� \up0 \expndtw0\charscalex117 senfa hipnotizatorului, este
cea utilizae de Klumbies si Kleinsorge sub nu-\line \up0 \expndtw0\charscalex120
mele de "hipnoza prin ablafie" Efectul hipnozei este asociat cu un stimul \up0
\expndtw0\charscalex112 conditional (exemplu o imagine vizualS a unor cercuri
concentrice) si ulterior \up0 \expndtw0\charscalex112 prin simpla prezentare a
imaginii, se reproduce efectul hipnotic (Klumbies). \par\pard\qj
\li729\ri883\sb0\sl-240\slmult0\fi408 \up0 \expndtw0\charscalex125 LI O ale terapie
sugestivS aplicats tot mai larg in ultima vreme, o \up0 \expndtw0\charscalex118
constituie antrenamentul autogen descris de Schultz si practicat in diverse \up0
\expndtw0\charscalex122 variante individuae sau de grup. Metoda constS in
constientizarea \up0 \expndtw0\charscalex128 - pe \par\pard\ql \li734\sb9\sl-
230\slmult0\tx2721 \up0 \expndtw0\charscalex119 calea autosugestiei \tab \up0
\expndtw0\charscalex120 - a unor cenestezii, capabile sS indues bolnavului un
\par\pard\qj \li729\ri894\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex116 contort
psihic generat de ideea cS funcfille organismului sSu se desfSsoarS \up0
\expndtw0\charscalex118 Tntr-un ritm optim. FolositS pentru inducerea unei relaxSri
psihice, opuse \up0 \expndtw0\charscalex122 incordSrii musculare produse Ce
anxietate. aceastS metodS \up0 \expndtw0\charscalex126 \u8226? cu largS
\expndtw0\charscalex113 aplicafie in tratarea BSP - a fost uTttizatS si in astmul
bronsic, mai cu seamS \up0 \expndtw0\charscalex115 "alegerea" exercifiilor cu
concentrarea atenfiei asupra funcfiunii respirafiei. \line\tab \up0
\expndtw0\charscalex122 De altfel Creer si Kotses considers important de subliniat,
"cresterea \up0 \expndtw0\charscalex116 abilitSfii de a se relaxa... eliminS unele
condifii capabile sS indues bronho-\up0 \expndtw0\charscalex118 constricfie ... iar
relaxarea este efecliv in competifie cu rSspunsul bronho-\up0
\expndtw0\charscalex113 constrictor la SP". \par\pard\qj \li724\ri895\sb0\sl-
246\slmult0\fi360 \up0 \expndtw0\charscalex118 U Pe aceeasi linie a autoreglShi,
dar adresats de asts dats "variabilelor \up0 \expndtw0\charscalex108
fiziologice" \up0 \expndtw0\charscalex127 (ibidem) se inscriu si o serie de
proceduri de biofeedback \up0 \expndtw0\charscalex119 adresate in special reducerii
tensiunii musculaturii faciale si efectuate din \up0 \expndtw0\charscalex114 1976
de Kotses si colab. si preluatS de alfi autori (Friedlund si colab.).
Referitor la bioteedback-ul de relaxare a musculaturii faciale, prin \up0
\expndtw0\charscalex118 aceastS metodS se inifiaza un reflex nervos cu aferenfe
trigeminale (cule\up0 \expndtw0\charscalex117 gand tensiunea fibrelor musculaturii
faciale) si eferenfele vagale (e nivelul \up0 \expndtw0\charscalex115 musculaturii
bronsice). conducand in ultimS instants la existenfa unui para\up0
\expndtw0\charscalex117 lelism intre starea de relaxare a musculaturii faciale
(apreciatS electromio\up0 \expndtw0\charscalex123 grafic s1 consideratS drept
obiectiv al tratamentului) si bronhodilatafie \up0 \expndtw0\charscalex114 (Glaus).
Un procedeu de biofeedback, accesibil bolnavului in conditiile unui \up0
\expndtw0\charscalex125 cost redus fate de celelalte metode implicand aparature
sofisticae, este \up0 \expndtw0\charscalex113 controlul zgomotului respirator (cu
ajutorul unui stetoscop) aplicat de bolnav \up0 \expndtw0\charscalex121 pe torace.
Bolnavului i se cere sa s> reduce zgomotul respirafiei, fapt ce \up0
\expndtw0\charscalex114 conduce la o usoare dimmuare a spasmului bronsic (Abdulan).
c) in afara acestor proceduri adresate bolnavului Tn exclusivitate si al
\par\pard\ql \li729\sb12\sl-195\slmult0 \up0 \expndtw0\charscalex122 cerui
beneliciu pr,� ""ai mult in plan psiholoaic decat in Dlan fiziologlc
\up0 \expndtw0\charscalex108 Elemente de psihosomatica generae si
aplicats\par\pard\qj \li1391\sb0\sl-240\slmult0 \par\pard\qj\li1391\sb0\sl-
\expndtw0\charscalex118 exists $i proceduri de terapie de grup. Creer si Kotses
inifiaza un program \up0 \expndtw0\charscalex117 complex ("comprehensive self
management") cu participarea familiei bol� \up0 \expndtw0\charscalex117 navului si
implicSnd in esenfa instruirea bolnavului si a celor apropiafi lui \up0
\expndtw0\charscalex116 (pSrinfi, bunici, etc.) reteritor la tehnici de asistare a
crizei astmatice (auto-\line \up0 \expndtw0\charscalex114 tratament, ajutor dat
bolnavului, etc.) \up0 \expndtw0\charscalex113 $i de evitare a factorilor
precipitanfi \par\pard\qj \li1387\ri231\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex112 d) Ca un alt corolar al implicafiilor psihice Tn
declansarea sau Tncetinirea \up0 \expndtw0\charscalex122 nespecificS a crizelor de
astm, apare scoaterea din mediul psihotrauma-\line \up0 \expndtw0\charscalex114
tizant. Aplicat special la copn - la care influenfa nefasts din partea
pSrinfilor \up0 \expndtw0\charscalex116 (vezi mamele astmogene. problemele
personalitSfii copilului astmatic etc.) \up0 \expndtw0\charscalex114 trebuie
suprimatS \u8226? procedeul acesta de recuperare, vizand intr-un nou camp \up0
\expndtw0\charscalex117 social instructional, cuplat cu schimbarea mediului
parental si alergic si cu \up0 \expndtw0\charscalex120 actiunea unor lactori
climatici etc.. s-a numit "parentectomie" \up0 \expndtw0\charscalex109 (Peshkin)
\par\pard\qj \li1387\ri230\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex119 Cadrul
de recuperare - centre de reabilitare denumite si campuri montane \up0
\expndtw0\charscalex116 (unui dintre cele mai moderne fiind amplasat la altitudine
de peste 2200 m. \up0 \expndtw0\charscalex114 la Font Romeu) - lace apel. pe langS
scoaterea din mediu (regulS de bazS in \up0 \expndtw0\charscalex129 tratamentul
astmului alergic), la o serie de proceduri psihoterapice: \up0
\expndtw0\charscalex119 psihagogia (Baumgarten - Tramer), ludoterapia si alte
terapii de grup, sau \up0 \expndtw0\charscalex124 de culture fizica medicala:
gimnastica respiratorie, inotul \up0 \expndtw0\charscalex111 (Quarles Van
\par\pard\ql \li1396\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex109 Ufford.
Baumgarten - Tramer). \par\pard\qj \li1387\ri205\sb0\sl-244\slmult0\fi297 \up0
\expndtw0\charscalex123 Faptul cS si adulfu pot fi tratafi prin aceastS metodS, ca
s1 actiunea \up0 \expndtw0\charscalex125 beneficS a unor cure hidrominerale sau
heliomarine asociate e/ectului \up0 \expndtw0\charscalex112 psihoterapie (I.Gr.
Popescu) pledeazS pentru inlocuirea termenului de paren� \up0
\expndtw0\charscalex118 tectomie cu eel de "ecoterapie" propus de Rappaport care
susfine, prin re\up0 \expndtw0\charscalex118 zultatele proprii foarte bune,
strategia recuperatorie complexS menfionatS \up0 \expndtw0\charscalex118 mai
sus. \par\pard\qj \li1387\ri231\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex126 e) Referitor la medicafia psihotropa utilizae in astmul
bronsic este \up0 \expndtw0\charscalex122 necesar sa sintetizSm cateva aspecte de
ordin concluziv, sedimentate in \up0 \expndtw0\charscalex125 decursul timpului,
inclusiv in cursul experienfei noastre Tn Tngrijirea \up0 \expndtw0\charscalex113
bolnavilor astmatici (lamandescu 1980. \up0 \expndtw-3\charscalex100 1993).
\par\pard\ql \li1665\sb8\sl-230\slmult0 \up0 \expndtw0\charscalex113 Au devenit
tradifionale urmStoarele atitudini terapeutice: \par\pard\qj \li1377\ri242\sb2\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex116 - administrarea unor psihotrope,
atSt intre accese, cat si in timpul crizei, \up0 \expndtw0\charscalex116 dominae de
regulS de anxietate.; \par\pard\qj \li1377\ri246\sb0\sl-240\slmult0\fi307 \up0
\expndtw0\charscalex121 - combaterea prin sedative a unor efecte secundare psihice
de tip ex-\line \up0 \expndtw0\charscalex114 citator induse de medicafia
bronhodilatatoare (Xantine si simpatomimetice); \par\pard\qj \li1387\ri236\sb0\sl-
\expndtw0\charscalex131 tratarea sindroamelor nevrotice asociate cu astmul bronsic,
in \up0 \expndtw0\charscalex117 majoritatea cazurilor fiind vorba de tulburari
induse \up0 \expndtw0\charscalex117 (secundare) in cursul \par\pard\ql
\li1387\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex107 evolufiei bolii;
administrarea de parasimpatolitice (in prezent preparate de aerosoli de \up0
\expndtw0\charscalex120 tip Ipratropium) ar avea un rol benefic, privind atenuarea
sau suprimarea \up0 \expndtw0\charscalex115 efectelor sugestiei asupra ceilor
respiratorii (Lane si Storr) deci de protejare \up0 \expndtw0\charscalex115 contra
declanserii reflex condi(ionate a crizelor, \par\pard\qj \li1406\ri230\sb0\sl-
\expndtw0\charscalex127 corectarea tulburarilor neuro-vegetative. frecvente in
astm, prin \up0 \expndtw0\charscalex119 preparate insumand acfiuni
parasimpatolitice si sedative (de tip bergonal, \up0 \expndtw0\charscalex109
etc) \up0 \expndtw0\charscalex120 (atenfie la marea "gae terapeutice" de a se
administra distonocalm -\line \up0 \expndtw0\charscalex113 care confine propanolol
- la astmatici); \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart Pg240}
\par\pard\qj\li888\ri733\sb145\sl-230\slmult0\fi283 \up0 \expndtw0\charscalex118 -
foiosirea frecvene a unei medicafii cu dubld acfiune: tranchilizanld �i \up0
\expndtw0\charscalex113 antihistaminicd (de exemplu hidroxizin Tn astmul alergic.
mai ales cand este \up0 \expndtw0\charscalex113 Tnsofit si de rinita si/sau
urticarie); \par\pard\qj \li883\ri747\sb2\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex123 - abfinerea de la administrarea de hipnotice si chiar
tranchilizante in \up0 \expndtw0\charscalex117 serile de rau astmatic. eel pufin in
cazurile lipsite de posibiliotatea asistam \up0 \expndtw0\charscalex117
respirafiei. in scopul evitarii efectelor bronhoplegic si dephmant respirator
\up0 \expndtw0\charscalex112 central. \par\pard\qj \li883\ri744\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex123 Arsenalul terapeutic psihotrop
folosit in astmul bronsic a fost si este \up0 \expndtw0\charscalex115 destul de
larg. \par\pard\qj \li883\ri750\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex115 In prezent. astmul bronsic beneficiaze major de medicafie
tranchilizante, \up0 \expndtw0\charscalex121 atat in faza de acalmie cSt si Tn
starea de rSu astmatic \up0 \expndtw0\charscalex118 (aici sub rezerva
\par\pard\ql \li883\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex113 administrSrii
intr-un serviciu de reanimare). \par\pard\qj \li883\ri750\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex117 Dintre tranchilizante considerSm ca
utile benzodiazepinele (diazepam, \up0 \expndtw0\charscalex117 oxazepam, medazepam)
iar dintre antidepresive: Mianserin si Maprotilma \up0 \expndtw0\charscalex114
(dotate si cu proprietafi antihistaminice) \par\pard\li888\sb3\sl-
230\slmult0\fi287\tx4617 \up0 \expndtw0\charscalex118 Recent, avem in studiu
tianeptina\tab \up0 \expndtw0\charscalex118 (Coaxil) adSugatS la tratamentul
de\par\pard\li888\sb5\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex118 sevraj al
astmaticilor corticodependenfi.\par\pard\ql \li1180\sb163\sl-230\slmult0 \up0
\expndtw0\charscalex117 4. Complianfa terapeutica \par\pard\ql \li1171\sb190\sl-
230\slmult0\tx2443\tx3801 \up0 \expndtw0\charscalex110 ConsiderSm \tab \up0
\expndtw0\charscalex115 (lamandescu \tab \up0 \expndtw0\charscalex123 1996a) cS
acest termen ar trebui folosit In \par\pard\qj \li878\ri749\sb2\sl-240\slmult0 \up0
\expndtw0\charscalex115 definirea gradului de adeziune (de conformare) a
pacientului fafa de indica\up0 \expndtw0\charscalex115 fnie terapeutice privind
medicafia cSt si tafa de alfi agenti terapeutici inclu\up0 \expndtw0\charscalex112
zand stilul de viafS. \par\pard\qj \li873\ri754\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex115 Majoritatea autorilor au raportat incS de la inceput si
pans Tn ultima de� \up0 \expndtw0\charscalex115 cade o compliante terapeutice de
50% (Tunster). \par\pard\qj \li873\ri745\sb5\sl-235\slmult0\fi288 \up0
\expndtw0\charscalex120 in ceea ce priveste complianta terapeuticS fafa de
tratamentul prescris \up0 \expndtw0\charscalex117 este necesar sS fie luafi in
considerate anumifi factori psihologici (psihici) \up0 \expndtw0\charscalex119 ce
fin atat de personalitatea pacientului astmatic si a medicului practician \up0
\expndtw0\charscalex125 cat s1 de influenfele psiho-sociale incepand cu cele
obisnuite, pSnS la \up0 \expndtw0\charscalex116 educafia medicals promovats de
mass-media. \par\pard\ql \li1161\sb10\sl-230\slmult0\tx3403 \up0
\expndtw0\charscalex116 intr-un studiu anterior \tab \up0 \expndtw0\charscalex115
(lamandescu 1996a) privind complianfa terapeu \par\pard\qj \li878\ri749\sb2\sl-
240\slmult0 \up0 \expndtw0\charscalex115 ticS, am arStat cS in cazul pacienfilor
astmatici, ca de altfel si in cazul altor \up0 \expndtw0\charscalex120 pacienfi cu
tulburSri psihosomatice, aceasta depinde de urmStorii factori \up0
\expndtw0\charscalex110 psihologici: \par\pard\li868\sb22\sl-
230\slmult0\fi297\tx1377\tx7219 \up0 \expndtw0\charscalex120 -\tab \up0
\expndtw0\charscalex124 comportamentul bolnavului fafa de prescripfia
clinics\tab \up0 \expndtw0\charscalex124 (hipo- si\par\pard\li868\sb5\sl-
230\slmult0\fi9 \up0 \expndtw0\charscalex125 hipercomplian(a. sau cresterea gradatS
a complianfei terapeutice pans la\par\pard\li868\sb20\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex124 corticodependenfS;\par\pard\qj \li868\ri759\sb0\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex116 \u8226? prestigiul medicului
practician (efect sugestiv crescut) cat si capacita� \up0 \expndtw0\charscalex116
tea sa persuasive, asociate cu calitefi relafionale (ceidura sufleteasca) si in\up0
\expndtw0\charscalex113 crederea (optimismul) in propriul tratament (in tratamentul
prescris); \par\pard\ql \li1161\sb1\sl-220\slmult0 \up0 \expndtw0\charscalex114 -
idei preconcepute (pozitive sau negative); \par\pard\qj \li868\ri760\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex121 - severitatea bolii si gradul in
care restricfiile terapeutice mfluenfeaza \up0 \expndtw0\charscalex114 calitatea
viefii pacientului \up0 \expndtw0\charscalex115 (incluzSnd resursele sale anti-
stres cat si nivelul \par\pard\ql \li878\sb1\sl-220\slmult0 \up0
\expndtw0\charscalex111 motivafiei sale); \par\pard\qj \li873\ri768\sb4\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex117 - succesul sau esecul anterior al
unor prescnpfn terapeutice similare cSt \up0 \expndtw0\charscalex117 Si efectele
secundare nedorite. \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart
psihosomaticS generae si aplicata\par\pard\ql \li1896\sb0\sl-230\slmult0
230\slmult0\tx7593 \up0 \expndtw0\charscalex115 Un studiu recent (lamandescu. Popa-
Velea $i Aura GSinS \tab \up0 \expndtw0\charscalex113 1996) asupra \par\pard\ql
\li1593\sb1\sl-217\slmult0\tx4204 \up0 \expndtw0\charscalex115 complianfei
terapeutice la \tab \up0 \expndtw0\charscalex114 100 pacienfi astmatici, in marea
majoritate aler� \par\pard\ql \li1598\sb13\sl-230\slmult0 \up0
\expndtw0\charscalex114 giei la arcadieni, a dovedit predominanfa urmStoarelor
aspecte: \par\pard\qj \li1603\ri91\sb2\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex115 - pacienfii nu au beneficial practic de un program
educational referitor la \up0 \expndtw0\charscalex116 problemele legate de boae
(51% manifestand interes pentru autodocumen\up0 \expndtw0\charscalex117 tare,
gasind informafii in mass-media sau de la alfi pacienfi, dar fere o sis\up0
\expndtw0\charscalex117 tematizarea nofiunilor); \par\pard\qj \li1593\ri96\sb9\sl-
230\slmult0\fi297 \up0 \expndtw0\charscalex115 - complianfa terapeutice foarte
bune. declaratS de 80% din subiecfi (pa� \up0 \expndtw0\charscalex116 cienfi). dar
in realitate mult mai scazue (50% nu au putut evita efortul, pra\up0
\expndtw0\charscalex116 ful, poluarea. etc): \par\pard\qj \li1593\ri96\sb2\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex114 - in absenfa unui program
educational, factorii socio-culturali si psiholo� \up0 \expndtw0\charscalex114 gici
sunt implicafi intr-o foarte mare tTesure; \par\pard\ql \li1900\sb1\sl-
215\slmult0\tx3983 \up0 \expndtw0\charscalex110 - prestigiul medicului \tab \up0
\expndtw0\charscalex112 (ca vindecetor); \par\pard\qj \li1598\ri89\sb5\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex117 - disponibilitatea afective (52% au
apreciat mai mult calitefile empatice \up0 \expndtw0\charscalex117 decat nivelul
intelectual - 30%); \par\pard\ql \li1896\sb9\sl-230\slmult0\tx3820 \up0
\expndtw0\charscalex119 - influenfa mamei \tab \up0 \expndtw0\charscalex122
(supraveghere, control) in a respecta prescripfiile \par\pard\qj
\li1598\ri89\sb2\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex119 medicale (la 50%
din cei 26 de adolescent! inclusi in studiu, la care scade \up0
\expndtw0\charscalex119 capacitatea de control si stima de sine); \par\pard\qj
\li1603\ri89\sb6\sl-233\slmult0\fi297 \up0 \expndtw0\charscalex120 Rezultatele
noastre sugereazS indirect necesitatea unei noi abordSri a \up0
\expndtw0\charscalex114 pacientului astmatic, bazatS pe parteneriatul cu medicul Tn
cadrul unui pro� \up0 \expndtw0\charscalex117 gram educational de monitorizare a
parametrilor diagnostici. a mijloacelor \up0 \expndtw0\charscalex117 terapeutice si
tratamentului. \par\pard\qj \li1598\ri89\sb10\sl-230\slmult0\fi297 \up0
\expndtw0\charscalex119 PSnS la introducerea pe scars largS a programului GINA,
complianfa \up0 \expndtw0\charscalex132 terapeuticS pare, in opinia noastra, sS
rSmanS sub influenfa pufin \up0 \expndtw0\charscalex113 controlabilS a numeroaselor
variabile psihologice. \par\pard\ql \li1900\sb90\sl-230\slmult0 \up0
\expndtw0\charscalex120 Bibliografie \par\pard\ql \li1900\ri82\sb87\sl-
210\slmult0\tx2102 \up0 \expndtw0\charscalex103 1. Anderson W Chap. Biochemical
mediators, pp. 95/111 in E.B Weiss ana M. \up0 \expndtw0\charscalex107 Stein
(eds). Bronchial Asthma. Mechanisms and Therapeutics. Little Brown \line\tab
\up0 \expndtw-9\charscalex91 1993. \par\pard\li1867\sb1\sl-223\slmult0\fi0 \up0
\expndtw0\charscalex104 2 Barnes PJ \u9632? Neural mechanisms in asthma in Advances
in allergy and clinical\par\pard\li1867\sb1\sl-197\slmult0\fi211\tx7252 \up0
\expndtw0\charscalex103 immunology (Ed.Godard Ph., Bousquet J $i Michel FB) pp.\tab
\up0 \expndtw-2\charscalex100 161-174. Parthenon\par\pard\li1867\sb1\sl-
207\slmult0\fi211\tx5553 \up0 \expndtw0\charscalex103 Publish. Group. Lanes UK New
Jersey,\tab \up0 \expndtw0\charscalex103 1992.\par\pard\qj \li1862\ri97\sb0\sl-
200\slmult0\tx2063 \up0 \expndtw0\charscalex103 3. Bender BG \u9632? Measurement of
quality of life in pediatric asthma clinical trials. \line\tab \up0 \expndtw-
3\charscalex100 Annals of Allergy, Asthma and Immunol. \up0 \expndtw-
4\charscalex100 1996, 77 (6), 638-447. \par\pard\qj \li1876\ri82\sb0\sl-220\slmult0
\up0 \expndtw0\charscalex107 4. Black S - Inhibition of immediate type
hypersensitivity by direct suggestion \up0 \expndtw-2\charscalex100 under hypnosis
- Brit.Med.J. 1963. 1, 925-929. \par\pard\qj \li1871\ri97\sb0\sl-200\slmult0
\up0 \expndtw0\charscalex107 5. Bousquet J - How do we optimise asthma
assessments ? tn Eds. Clark T H., \up0 \expndtw0\charscalex108 Fabri L.M. How to
optimise asthmalherapy" - pp. \up0 \expndtw0\charscalex103 27-30. Excerpta
Medica, \par\pard\ql \li2063\sb0\sl-180\slmult0 \up0 \expndtw-2\charscalex100
Amsterdam, 1992. \par\pard\ql \li1871\ri76\sb0\sl-210\slmult0\tx2078 \up0
\expndtw0\charscalex102 6 Bousquet J, Bullinger M. Fayol C. Marquis P. Valentin B,
Burtin B. Assessment \up0 \expndtw0\charscalex100 of quality of life in patients
with perennial rhinitis with the French version of the \line\tab \up0
\expndtw0\charscalex100 SF-36 health status questionnaire. J Allergy Clin Immunol
1994. 94; 1828 \par\pard\qj \li1896\ri84\sb0\sl-200\slmult0 \up0
\expndtw0\charscalex100 7. Brush J, Mathe A. Cap. Psychiatric aspects p. 1121-1131.
in Bronchial Asthma-\line \up0 \expndtw0\charscalex100 Mechanisms and Therapeutics,
eds. Weiss E. and Stein M., third ed. Little-\par\pard\li1886\sb1\sl-
202\slmult0\fi196\tx4972 \up0 \expndtw-2\charscalex100 Brown. Boston (Toronto)
London,\tab \up0 \expndtw-2\charscalex100 1993.\par\pard\li1886\sb1\sl-
206\slmult0\fi0\tx7127\tx7795 \up0 \expndtw-2\charscalex100 8. Creer TL -
Biofeedback and asthma. Adv. Allergy Asthma,\tab \up0 \expndtw-9\charscalex96 1974,
I,\tab \up0 \expndtw-2\charscalex100 6-14.\par\pard\ql \li1886\ri76\sb0\sl-
210\slmult0\tx2097 \up0 \expndtw0\charscalex104 9. Creer TL - Kotses H.. chap.47:
Asthma: psychologic aspects and management \up0 \expndtw0\charscalex100 pp 1015-
1036, in (Eds) Middleton F Jr.. Reed CE. Ellis E.F. - Allergy Principles
\line\tab \up0 \expndtw-2\charscalex100 and practice, \u9632? MosbyCo.. St. Louis.
Toronto, London. \up0 \expndtw-9\charscalex95 1983
\expndtw0\charscalex116 Cnep H.L. - cap.Emotional problems in the allergic child,
p. 383-441, in (Red)\par\pard\li1008\sb0\sl-207\slmult0\fi345 \up0
\expndtw0\charscalex116 CnepH.L. Allergy and clinical immunology Grune and Strtlon.
New York-London\par\pard\li1008\sb1\sl-194\slmult0\fi369 \up0
\expndtw0\charscalex115 1976.\par\pard\li1008\sb2\sl-207\slmult0\fi43\tx1382
\up0 \expndtw-8\charscalex80 11.\tab \up0 \expndtw0\charscalex115 French TM, and
Alexander F. Psychogentc factors in bronchial asthma.\par\pard\li1008\sb1\sl-
194\slmult0\fi340 \up0 \expndtw0\charscalex115 Psychosom Med. Monogr. 1941,
4:2.\par\pard\li1008\sb7\sl-207\slmult0\fi52\tx1353\tx7372\tx7655 \up0 \expndtw-
1\charscalex100 12\tab \up0 \expndtw0\charscalex112 Freour P.. Asthme - une maladie
complexe, \u9632? Bordeayx Med., 1969, 1.\tab \up0 \expndtw-8\charscalex73
11.\tab \up0 \expndtw0\charscalex115 1012.\par\pard\li1008\sb1\sl-
\expndtw0\charscalex116 Fuchs E., Schulz K-H. (eds.) - Manuale allergotogicum.
Kapitel
VIII (I-12). Dustri\par\pard\li1008\sb1\sl-201\slmult0\fi360\tx3225 \up0
\expndtw0\charscalex110 Verlag. Diesenhofen,\tab \up0 \expndtw0\charscalex115
14.\tab \up0 \expndtw0\charscalex115 Gheorghiu VI Hipnoza. Ed.St.Enctclop.,
Bucuresti 1977.\par\pard\li1008\sb1\sl-205\slmult0\fi47\tx1353 \up0 \expndtw-
8\charscalex82 15.\tab \up0 \expndtw0\charscalex116 Glaus. K.D.. and Kotses, H.
Generalization of conditioned muscle tension. A\par\pard\li1008\sb1\sl-
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16:563.\tab \up0 \expndtw0\charscalex115 1979.\par\pard\li1008\sb1\sl-
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\expndtw0\charscalex111 Hanson K. Atlergie. Thieme Verlag, Stuttgart,\tab \up0
\expndtw0\charscalex115 1961.\par\pard\li1008\sb1\sl-202\slmult0\fi43\tx1372
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\expndtw0\charscalex115 IMF Bucuresti 1980.\par\pard\li1008\sb1\sl-
199\slmult0\fi4\tx1363 \up0 \expndtw0\charscalex104 21.\tab \up0
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\expndtw0\charscalex115 Medicate (Paris) 1995. 3 sous
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Abstracts, 537 \par\pard\ql \li1008\sb15\sl-207\slmult0\tx1353 \up0
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200\slmult0\tx1756 \up0 \expndtw0\charscalex104 38. Mathov E New classification of
bronchial asthma, Alergol. et Immunopathol.. \line\tab \up0 \expndtw0\charscalex104
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Immunopathol..\tab \up0 \expndtw-9\charscalex69 10.\tab \up0
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\expndtw0\charscalex103 med.int.,\tab \up0 \expndtw-9\charscalex88 1968.\tab
\up0 \expndtw0\charscalex103 5. 321 328\par\pard\li1430\sb1\sl-199\slmult0\fi9 \up0
\expndtw0\charscalex104 43. Predescu V, Nica Udangiu St. Epidemiologia nevrozelor
in populafia urband,\par\pard\li1430\sb1\sl-213\slmult0\fi326\tx2841\tx3868
\up0 \expndtw-2\charscalex100 Neurologia.\tab \up0 \expndtw0\charscalex103
1976.21,3.\tab \up0 \expndtw0\charscalex103 169-178.\par\pard\qj
\li1435\ri352\sb0\sl-200\slmult0\tx1756 \up0 \expndtw0\charscalex109 44. Schmidt-
Traub S. The psychoimmunological network ot panic disorders, \line\tab \up0
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123-128. \par\pard\ql \li1435\sb7\sl-201\slmult0\tx7780 \up0
\expndtw0\charscalex103 45. Seropian E Terapia anlialergicd nespecificd. Ed.
Medicald Bucuresti, \tab \up0 \expndtw-9\charscalex89 1972. \par\pard\ql
\li1435\ri262\sb0\sl-200\slmult0\tx1761\tx1747 \up0 \expndtw0\charscalex108 46
Spedor SL and Nicklas RA (eds): Practice Parameters for the diagnostic and
\line\tab \up0 \expndtw0\charscalex104 treatment of asthma. Amer Acad. of Allergy
and Immunol. Amer. Colledge of \line\tab \up0 \expndtw-3\charscalex100 Allergy and
Immunol., \up0 \expndtw-9\charscalex91 1993. \par\pard\ql \li1430\ri322\sb24\sl-
220\slmult0\tx1742\tx1761 \up0 \expndtw0\charscalex103 47. Theodorakis R.
Adolescent asthma - in Conversations - 6 pp. 26-28 (American \line\tab \up0
\expndtw0\charscalex101 Academy of Allergy. Asthma and Immunology 54th Meeting)
\u9632? UCB Pharma -\line \tab \up0 \expndtw0\charscalex102 Brussels - Belgium 1998
\par\pard\ql\li1583\sb247\sl-253\slmult0 \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf8\f9\fs22 B. DERMATITA ATOPICA \par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 Dermatita atopies reprezintS o boalS cutanatS
inflamatorie cu un tablou \up0 \expndtw0\charscalex114 clinic s* lezional complex
si polimorf, dominae de prurit si avand o evolufie \up0 \expndtw0\charscalex114
cronicS sau in pusee recidivante. Ea survine pe un teren atopic fiind frecvent \up0
\expndtw0\charscalex116 asociatS cu manifestSri alergice respiratoru \up0
\expndtw0\charscalex120 (rinits si/sau astm), dar poate \par\pard\qj
\li1281\ri327\sb0\sl-240\slmult0\fi4\tx1579 \up0 \expndtw0\charscalex114 exista si
in afara aeestei asocieri (dermatita atopies "intrinsecS" - Wuthrich) \line\tab
\up0 \expndtw0\charscalex117 Ca orice boalS psihosomaticS cu patogenezS
multifactohalS, dermatita \up0 \expndtw0\charscalex120 atopicS este influentatS
Tntr-un mod "consistent" de factorul psihic. care \up0 \expndtw0\charscalex117
poate fi responsabil. atat de inducerea unor pusee de activare a bolii, cat si \up0
\expndtw0\charscalex117 de exacerbarea de moment a unor manifestSri clinice deja
existente (de ex. \up0 \expndtw0\charscalex118 pruritul) sau de favorizarea
actiunii unor factori ce complies evolufia bolii \up0 \expndtw0\charscalex118
(suprainfecfia cutanatS stafilococicS, de ex.) (Figura 1). \par\pard\ql
\li1593\sb1\sl-215\slmult0 \up0 \expndtw0\charscalex119 1. Rolul factorului psihic
Tn evolufia dermatitei atopice \par\pard\qj \li1291\ri327\sb5\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex113 in dermatita atopicS (DA.)
considerSm cS, pe ISngS stresui psihic - cu rol \up0 \expndtw0\charscalex118
declansant sau de Tntrefinere sau de agravare a puseelor evolutive - exists \up0
\expndtw0\charscalex116 o participare extrem de importantS a condifionSrii reflexe
intre unii stimuli \up0 \expndtw0\charscalex115 indiferenfi de mediu si pruritul
sau gratajul care reprezintS simptomele cele \up0 \expndtw0\charscalex115 mai
evidente in planul observafiei din exterior a bolnavului. \par\pard\qj
\li1310\ri297\sb5\sl-235\slmult0\fi288 \up0 \expndtw0\charscalex112 DacS stresui
psihic (SP) de orice fel poate sS declanseze ori sS accentueze \up0
\expndtw0\charscalex111 modificSrile lezionale, inclusiv cele ale microcirculafiel
cutanate, exists totusi \up0 \expndtw0\charscalex114 in DA o relativS preponderentS
a anumitor tipuri de SP care se remarcS prin \up0 \expndtw0\charscalex125
persistenta lor aproape obsedants pentru bolnav. Datele din literaturS \up0
\expndtw0\charscalex113 (Niebel, Gieler, Colfoiu. Bousquet, Wutrich) care
evidenfiazS circumstanfele
\expndtw0\charscalex124 \ul0\nosupersub\cf3\f4\fs18 Psihosomatica aplicata\tab \dn2
237\slmult0\fi14 \up0 \expndtw0\charscalex108 \ul0\nosupersub\cf8\f9\fs22 stresante
cu rol de constanta "presiune psihologicd" asupra bolnavului cu \up0
\expndtw0\charscalex106 DA. urmStoarele: conllicte familiale (fraterne sau cu
pSrinfii), scolare sau \up0 \expndtw0\charscalex104 profesionale. agenfn stresori
care produc o asteptare anxioasS sau provoaca \up0 \expndtw0\charscalex107
rSspunsun agresive (on exacerbeazS agresivitatea bolnavului), tulburarile \up0
\expndtw0\charscalex109 de dinamicS sexuae, activitatea mentals obositoare, serile
de disconfort -\line \up0 \expndtw0\charscalex106 incordarea - si de epuizare). Un
rol favorizant pentru perceperea mai acute \up0 \expndtw0\charscalex109 a pruntului
il au situaflile in care atenfia bolnavului nu este atrasd de alte \up0
\expndtw0\charscalex104 activitafi interesante (inactivitatea) sau cand bolnavul
este singur- ca de ex. \up0 \expndtw0\charscalex103 in situafiile de izolare
socials, favorizate prin instalarea unui cere vicios - de \up0
\expndtw0\charscalex103 jena lui fafa de cei din jur sau in cadrul depresiei
cauzate de boae. \par\pard\ql \li1118\sb0\sl-253\slmult0
\par\pard\ql\li1118\sb57\sl-253\slmult0 \up0 \expndtw0\charscalex110 Figura 5. In
serf!a stresului psihic in mecanismele patotlzlologlce \par\pard\ql \li1804\sb0\sl-
ruaina\par\pard\sect\sectd\sbknone\cols2\colno1\colw4443\colsr20\colno2\colw4397\co
\ul0\nosupersub\cf32\f33\fs40 �\par\pard\qj \li1612\sb0\sl-184\slmult0 \par\pard\qj
\ul0\nosupersub\cf19\f20\fs12 Stres paMc \line \tab \up0 \expndtw0\charscalex134
secundar \line \up0 \expndtw0\charscalex128 (ctscarrfort)\par\pard\qj
\li2976\ri0\sb108\sl-163\slmult0\tx3734 \up0 \expndtw0\charscalex130 Sistom narvoa
central \line \tab \up0 \expndtw0\charscalex127 nauroni\par\pard\ql
\li3527\sb45\sl-138\slmult0 \up0 \expndtw0\charscalex122 fastens
nergicf\par\pard\qj \li3086\sb0\sl-283\slmult0 \par\pard\qj \li2851\ri0\sb108\sl-
283\slmult0\fi235\tx3723 \up0 \expndtw0\charscalex130 Mecanisme locale \line
\up0 \expndtw0\charscalex123 micro-\tab \up0 \expndtw0\charscalex143 "bra
ale\par\pard\column \qj \li4463\sb0\sl-192\slmult0 \par\pard\qj
\li20\ri3584\sb92\sl-192\slmult0\tx203 \up0 \expndtw0\charscalex132 Stres psihic
\line \tab \up0 \expndtw0\charscalex123 prlmar \par\pard\sect\sectd\sbknone
\li2764\sb1\sl-135\slmult0\fi0 \up0 \expndtw0\charscalex135 dicuiatio "stemului
narvoa\par\pard\sect\sectd\sbknone \li2764\sb1\sl-127\slmult0\fi960 \up0
\expndtw0\charscalex135 autonom\par\pard\sect\sectd\sbknone \li2764\sb0\sl-
138\slmult0\fi4118 \up0 \expndtw0\charscalex135
IgE\par\pard\sect\sectd\sbknone\cols2\colno1\colw4299\colsr160\colno2\colw4401\cols
r160\ql \li3124\sb0\sl-111\slmult0 \up0 \expndtw0\charscalex119 ,
Umfocrte,\par\pard\qj \li2183\sb0\sl-177\slmult0 \par\pard\qj \li2183\sb0\sl-
177\slmult0 \par\pard\qj \li2183\ri284\sb148\sl-177\slmult0\tx2280 \up0
\expndtw0\charscalex138 Subetanfe veaoconattctlve \line \tab \up0
\expndtw0\charscalex136 Ihl.l.mioo, nauroklnlne,\par\pard\ql \li2649\sb48\sl-
138\slmult0 \up0 \expndtw0\charscalex135 eubatanfa P)\par\pard\ql \li2222\sb0\sl-
"'la^'t. lj\par\pard\column \ql \li154\sb1\sl-111\slmult0 \up0
\expndtw0\charscalex127 etc\par\pard\ql \li1316\sb0\sl-108\slmult0\tx2314 \up0
\expndtw0\charscalex118 imun\tab \up0 \expndtw0\charscalex141
cieaculI\par\pard\ql \li4459\sb0\sl-138\slmult0 \par\pard\ql \li4459\sb0\sl-
138\slmult0\tx2425 \up0 \expndtw0\charscalex111 cMokioo\tab \up0
\expndtw0\charscalex132 tpoarta)\par\pard\qj \li212\ri1420\sb142\sl-
235\slmult0\fi2179 \up0 \expndtw0\charscalex137 alaroar* \line \up0
pormaaWIHatna\par\pard\sect\sectd\sbknone\cols2\colno1\colw3623\colsr20\colno2\colw
.itunj.-.i\par\pard\ql \li3287\sb0\sl-138\slmult0 \par\pard\ql \li3287\sb0\sl-
138\slmult0 \up0 \expndtw0\charscalex124 0..1.J\par\pard\column \ql \li20\sb0\sl-
108\slmult0\tx1705 \up0 \expndtw0\charscalex121 Inflamata\tab \up0
\expndtw0\charscalex128 suprainfacpi\par\pard\ql \li485\sb230\sl-414\slmult0
\up0 \expndtw0\charscalex111 \ul0\nosupersub\cf5\f6\fs36 tt
242\tab \up0 \expndtw0\charscalex105 \u8226?>\tab \up0 \expndtw0\charscalex105
Elemente de psihosomatica generae si aplicata\par\pard\qj \li1444\sb0\sl-
De altfel. depresia a fost evidenfiata, in cadrul unui studiu relativ recent,
\up0 \expndtw0\charscalex115 realizat de Gupta si colab., ca avand un rol de
modulare - reducere a pragu� \up0 \expndtw-8\charscalex100 lui \up0
\expndtw0\charscalex114 (Crishold) de aparifie - a pruritului Tn D.A., psoriazis si
urticaria cronica \up0 \expndtw0\charscalex114 idiopaticS. \par\pard\qj
\li1440\ri165\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex118 0 evaluare cu
caracter epidemiologic a intervenfiei factorului psihic Tn \up0
\expndtw0\charscalex115 aparitia recidivelor (puseelor = faza de activitate) a DA
efectuae de Rowold \up0 \expndtw-9\charscalex76 Tn \up0 \expndtw0\charscalex130
1990 a evidential implicarea situafiilor conflictuale fl a celor de \up0
\expndtw0\charscalex113 comportament social defectuos in 66% din cazurile cu DA
studiate. \par\pard\qj \li1440\ri197\sb0\sl-260\slmult0\fi288 \up0
\expndtw0\charscalex124 2. Mecanisme psihoneurofiziologlce cu poslbilS acflonare de
cStre \up0 \expndtw0\charscalex125 factorii psihici \par\pard\qj
\li1440\ri192\sb0\sl-246\slmult0\fi288 \up0 \expndtw0\charscalex121 in evaluarea
"substratului" neuro-vegetativ s\\ endocrin asupra cSrora \up0
\expndtw0\charscalex122 acfioneaza factorul psihic in DA. trebuiesc avute in vedere
urmStoarele \up0 \expndtw0\charscalex117 "premize" ale moduerii - prin mecanisme
psihologice - a diversilor factori \up0 \expndtw0\charscalex117 etiopatogenici ai
aeestei boll: \par\pard\qj \li1444\ri163\sb0\sl-246\slmult0\fi307\tx2011 \up0
\expndtw-9\charscalex90 1. \tab \up0 \expndtw0\charscalex120 - unele caractere
generale ale patogeniei si patofiziologiei din DA, \up0 \expndtw0\charscalex116
dintre care considerSm ca esentiae pentru inserfia - la nivelul lor - a facto� \up0
\expndtw0\charscalex116 rului psihic: degranuiabilitatea mastocitard (mast cell
releasibility) crescutd \up0 \expndtw0\charscalex114 in puseele de activitate ale
bolii, tulburarile de imunoreglare si blocada beta\up0 \expndtw0\charscalex114
adrenergicd, acesta din urmS cu rol in favorizarea unui tonus colinergic res\up0
\expndtw0\charscalex115 ponsabil - pe langa o serie de tulburSri vasomotorii sau de
termoreglare - de \up0 \expndtw0\charscalex115 rSspunsul excesiv sudoral
(transpirafie facie) la bolnavii cu DA. \par\pard\qj \li1440\ri167\sb0\sl-
250\slmult0\fi292 \up0 \expndtw0\charscalex115 2 - interacfiunea bidirecfionald
intre sistemul nervos central (si periferic) \up0 \expndtw0\charscalex116 si
sistemul imun, ca si comunicarea de asemenea "reciprocd" intre mastocit \up0
\expndtw0\charscalex114 si neuroni. Tot la acest nivel al discufiei se inscrie si
rolul interleukinelor Tn \up0 \expndtw0\charscalex113 modularea activitSfii
cerebrae si a sistemului imun (inclusiv secrefia de glu� \up0
\expndtw0\charscalex113 cocorticoizi) (Niebel). \par\pard\ql \li1732\sb1\sl-
189\slmult0\tx1996 \up0 \expndtw-3\charscalex100 3. \tab \up0
\expndtw0\charscalex115 - importanfa mecanismelor locale neuro-vegetalive, axate pe
elibera� \par\pard\qj \li1435\ri187\sb5\sl-245\slmult0\fi14 \up0
\expndtw0\charscalex116 rea, prin reflex de axon, a neuropeptldelor. in special
substanfa P, consecu\up0 \expndtw0\charscalex113 tivS excitSrii receptorilor
polimodali cutanafi care au rol degranulant masto\up0 \expndtw0\charscalex117
citar. Nu este deloc imposibil ca un stres psihic sS moduleze, in ultimS in\up0
\expndtw0\charscalex119 stanfa, si activitatea aeestei instanfe supehoare a
sistemului nervos, la ni� \up0 \expndtw0\charscalex119 vel cutanat. \par\pard\qj
\li1449\ri156\sb0\sl-250\slmult0\fi292 \up0 \expndtw0\charscalex114 Desigur, SP
intervine prin numeroase mecanisme in etiopatogeneza unor \up0
\expndtw0\charscalex115 procese imunologice sau non-imunologice din cadrul D.A. ca
de ex. degra� \up0 \expndtw0\charscalex121 nularea mastocitare, scdderea
rezistenfei la stafilococ si la unele virusuri \up0 \expndtw0\charscalex118 sau
bacterii (generatoare de infecfii) care complice D.A. in acest din urme \up0
\expndtw0\charscalex118 caz este semnificative demonstrafia realizata de o serie de
autori \up0 \expndtw0\charscalex107 (Bartrop \par\pard\qj \li1449\ri189\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex120 sau Khansari) care evidenfiaze scederea
unor parametrii imuni Tn cursul \up0 \expndtw0\charscalex120 sehlor depresive
incercand o sistematizare a punctelor de impact posibil al SP Tn etiopa� \up0
\expndtw0\charscalex116 togenia D.A , vom avea in vedere urmetoarele:
\par\pard\qj \li1478\ri156\sb10\sl-240\slmult0\fi292\tx2025 \up0 \expndtw-
2\charscalex100 1 \tab \up0 \expndtw0\charscalex121 Punerea in miscare a unor
mecanisme colinergice, pe un fond deja \up0 \expndtw0\charscalex114 crescut at
tonusului colinergic din DA. in plus, ar exista si o crestere a nive-\line \up0
\expndtw0\charscalex112 lului monocitar al fosfodiesterazei \up0
\expndtw0\charscalex117 (Hanifin si colab), implicae in scSderea \par\pard\ql
\li1473\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex116 AMP ciclic s* evohzSnd,
deci, degranularea mai facile a mastocitelor. Prin
\up0 \expndtw0\charscalex118 \ul0\nosupersub\cf9\f10\fs20 aceste mecanisme
colinergice activate in cursul emotiilor se poate explica \up0
\expndtw0\charscalex114 agravarea pruritului ca urmare a transpiratiei excesive la
bolnavii cu DA. \par\pard\qj \li830\ri797\sb0\sl-240\slmult0\fi278 \up0
\expndtw0\charscalex122 2. Cresterea activitatii neuronilor histaminergici din
sistemul nervos \up0 \expndtw0\charscalex117 central, in cursul stresului psihic,
este probata. indirect, de cresterile hista\up0 \expndtw0\charscalex113 minemiei,
evidenfiate Tn situafiile experimentaie sau naturale de stres psihic \up0
\expndtw0\charscalex114 (exemplul lurnizat de cetre Ring al stresului pacientului
aliat pe scaunul sto\up0 \expndtw0\charscalex108 matologic). \par\pard\qj
\li825\ri793\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex130 3. Ipotetica
comandd corticald asupra unor mecanisme nervoase \up0 \expndtw0\charscalex115
autonomede la nivelul pielii implicate in eliberarea "preferenfiae" de
neuro-\line \up0 \expndtw0\charscalex115 peplide. intre care substanfa P este un
reputat degranulant al mastocitelor. \par\pard\qj \li815\ri813\sb6\sl-
233\slmult0\fi292 \up0 \expndtw0\charscalex122 4. Reacfia somatopsihica intrefinuta
de prurit cu efect de stres psihic \up0 \expndtw0\charscalex118 secundar si creare
a unui cere vicios intre stimulil lezionali primah (prurit \up0
\expndtw0\charscalex121 Si durerea dupe grataj) si eliberarea secundare de
histamine ca urmare a \up0 \expndtw0\charscalex114 disconfortului psihic creat.
Asocieri reflex condifionate, in secvenfa de grade multiple, intre di� \up0
\expndtw0\charscalex115 verse configurafii situafionale stresante constante (de ex.
vederea unor per� \up0 \expndtw0\charscalex114 soane cu care bolnavul se afIS in
conflict si fata de care el a dezvoltat o ade\up0 \expndtw0\charscalex116 varats
"alergie psihicS"), si manifestSrile percepute ale bolii in cursul stre� \up0
\expndtw0\charscalex115 sului determinat initial de conflicted declansate in
condifiile (de persoanele) \up0 \expndtw0\charscalex115 respective \par\pard\qj
\li811\ri797\sb7\sl-234\slmult0\fi287 \up0 \expndtw0\charscalex118 Trebuie
menfionat cS efectele stresului psihic asupra DA sunt inregis\up0
\expndtw0\charscalex125 trate de catre pacient numai sub forma unor simptome
perceptibile de \up0 \expndtw0\charscalex126 catre acesta cum ar fi pruritul si
usturimile Desigur, un stres prelungit \up0 \expndtw0\charscalex119 poate sa indues
o acutizare a bolii in cadrul cSreia pruritul poate prezenta \up0
\expndtw0\charscalex114 variafii legate de o multitudine de factori. Unui dintre
factorii de amplificare \up0 \expndtw0\charscalex116 a pruritului este
autoobservarea exagerats din partea pacientului dar - la co\up0 \expndtw-
4\charscalex100 pil \up0 \expndtw0\charscalex116 - mai importantS este atenfia
exagerats si plinS de interdicfii a parinfilor \up0 \expndtw0\charscalex113 fafS de
gratajul efectuat aproape involuntar de cStre bolnav. \par\pard\ql \li1094\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex120 3. Modificarile din sfera personalitafii
bolnavului cu DA \par\pard\qj \li806\ri792\sb0\sl-236\slmult0\fi288 \up0
\expndtw0\charscalex131 Aparifia bolii in prima copierie s> persistenta ei la
varsta adulte \up0 \expndtw0\charscalex119 realizeaze premizele unei "psihizSri" a
DA.si, mai ales, a stabilizSrii unor \up0 \expndtw0\charscalex115 modificSri
apSrute la suprafafa personalitafii asa meat ele sS devinS stabile \up0
\expndtw0\charscalex119 $i sS fie induse in structura personalitafii devenind
"personality troubles" \up0 \expndtw0\charscalex118 (ceea ce in taxonomia mai veche
se apropia - fSrS sS coincidS perfect - de \up0 \expndtw0\charscalex121 a$a
numitele stari psihopatoide, cum era de ex. cazul bolnavilor cu crize \up0
\expndtw0\charscalex115 comitiale, care dezvoltau o personalitate epileptics).
Exists cu certitudine
douS categorii de opinii antagonice, referitoare la \up0 \expndtw0\charscalex112
personalitatea bolnavului cu DA \par\pard\ql \li1099\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex116 \u8226? teoria ctasicd, de esenfd psihanaliticd, ce
atribule bolnavului cu DA un \par\pard\qj \li801\ri803\sb15\sl-231\slmult0\fi9 \up0
\expndtw0\charscalex113 profil de personalitate specific (fie coincident fie
predispozant pentru boalS), \up0 \expndtw0\charscalex114 ca de ex. tipurile
descrise de Stokvis. Beerman, Ingram cSt si de Colfoiu, ca-\line \up0
\expndtw0\charscalex123 racterizate prin: sentimente de nesiguranfS, inferioritate,
agresivitate si \up0 \expndtw0\charscalex118 egocentrism, cu o reactivitate de
tipul "totul sau nimlc" si cu o inteligenfS \up0 \expndtw0\charscalex117 peste
medie. AceastS din urmS constatare este valabie, intr-adevSr, pentru \up0
\expndtw0\charscalex113 majoritatea bolnavilor alergiei dar. in opinia noastrS,
prezenfa unei inteligen-\line \up0 \expndtw0\charscalex116 te crescute a acestor
bolnavi poate fi doar o simpIS asociere a unor gene cu \up0 \expndtw0\charscalex112
exprimare la nivelul gandirii si. respectiv, imunitafii, fSrS o
intercondifionare \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart
psihosomaticS generae si aplicata\par\pard\qj \li1300\sb0\sl-240\slmult0
240\slmult0\fi19 \up0 \expndtw0\charscalex121 importantS, cum ar fi aceea intre
vulnerabilitatea afectivS a unui bolnav \up0 \expndtw0\charscalex116 atopic fafa de
stres si ritmarea evolufiei bolii atopice respective - astm, DA \up0
\expndtw0\charscalex112 etc. \up0 \expndtw0\charscalex113 - sub acfiunea trigerr-
ului psihic. \par\pard\qj \li1300\ri317\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex118 O alts tipologie "predispozants" pentru DA a mai lost
descrisS de catre \up0 \expndtw0\charscalex115 Witkower si Russel: bolnavii cu
aceastS afecfiune sunt egoisti, rSzbunStoh, \up0 \expndtw0\charscalex118 ostili si
eel mai adesea introvertifi. Chiar Tnainte de ultimele 3 decenii ale \up0
\expndtw0\charscalex115 acestui secol au apSrut critici referitoare 1a aceste
teorii vizand preexistenta \up0 \expndtw0\charscalex116 unei personalitSfi primare
in DA. Astlel, Sulzberger a evidential - pe langS \up0 \expndtw0\charscalex114
lipsa unui profil de personalitate specific in DA - "normalitatea" trSsSturilor
\up0 \expndtw0\charscalex123 de personalitate la bolnavii allafi Tn cursul unor
perioade prelungite de \up0 \expndtw0\charscalex113 remisiune a bolii. \par\pard\ql
\li1603\sb1\sl-191\slmult0 \up0 \expndtw0\charscalex119 \u8226? modificari de
personalitate induse secundar de cdtre reacfia psihicd a \par\pard\qj
\li1300\ri323\sb1\sl-250\slmult0\fi14 \up0 \expndtw0\charscalex125 bolnavului la
evolufia bolii Este o opinie probats de observatia clinics \up0
\expndtw0\charscalex114 precum si de logica rafionamentului diagnostic. Astfel,
Sonneck si colab. au \up0 \expndtw0\charscalex117 remarcat influenfa negativS a
perioadei de scolarizare asupra a 90 de elevi \up0 \expndtw0\charscalex123 cu DA.,
manifestata prin tulburSri de atenfie, agresivitate, indisciplinS, \up0
\expndtw0\charscalex122 toate acestea disperand in timpul vacanfei scolare \up0
\expndtw0\charscalex121 (dar trebuie avute in \par\pard\qj \li1300\ri318\sb19\sl-
240\slmult0 \up0 \expndtw0\charscalex116 vedere si modificarea climatului, devenit
uscat si cald). O remarce sintetice \up0 \expndtw0\charscalex114 a lui Kulawik
releritoare la bolnavii cu D.A. este centrate pe reacfia acestora \up0
\expndtw0\charscalex114 fate de disconfortui bolii \up0 \expndtw0\charscalex116
(pruritul in special), cat si implicafiile ei estetice. \par\pard\qj
\li1296\ri306\sb12\sl-250\slmult0 \up0 \expndtw0\charscalex119 Aceaste reactie fafa
de boae se transmite in doue direcfii. desi divergenfa \up0 \expndtw0\charscalex115
cetre care tinde bolnavul intr-un mod oscilant: apropierea fafe de cei din jur \up0
\expndtw0\charscalex115 (incurajae sau nu din exterior sau permise ocazional de
remisiunea bolii) s* \up0 \expndtw0\charscalex116 indepartarea fafe de ace$tia (in
funcfie de respunsul negativ al celor din jur \up0 \expndtw0\charscalex116 1a
"avansurile" sale sau de agravarea bolii). \par\pard\qj \li1296\ri307\sb0\sl-
246\slmult0\fi287 \up0 \expndtw0\charscalex122 Aceaste ambivalenfe a contactelor
sociale ale bolnavului cu DA este \up0 \expndtw0\charscalex120 intrefinuta si de
marea susceptibilitate a bolnavilor respectivi, preocupafi \up0
\expndtw0\charscalex121 incontinuu de boala lor, fapt ce le genereaza (sau le
amplitica) o stare de \up0 \expndtw0\charscalex121 anxietate (persistene)
(Col(oiu). \par\pard\ql \li1583\sb22\sl-230\slmult0 \up0 \expndtw0\charscalex123 4.
Date psihometrice si psihiatrice \par\pard\qj \li1300\ri308\sb0\sl-
250\slmult0\fi292 \up0 \expndtw0\charscalex110 Importantul discomfort prezent Tn
DA, polimorfismul contextului biografic \up0 \expndtw0\charscalex124 al pacienfilor
ca si al tabloului clinic si evolutiv al bolii, condifioneaze \up0
\expndtw0\charscalex126 aparifia unor tulburari de personalitate secundare. Tn
cazul evolufiei \up0 \expndtw0\charscalex116 Tndelungate si severe a DA. Din acest
punct de vedere nu este surprinzetor \up0 \expndtw0\charscalex117 ce datele mai
vechi sau mai noi, cu privire la trasatunle de personalitate ale \up0
\expndtw0\charscalex122 acestor bolnavi, sunt inregistrate destul de diferit de
cetre diversi autori \up0 \expndtw0\charscalex112 Astfel Borelli si Schnyder, ince
din \up0 \expndtw0\charscalex112 1962, descriu 3 tipuri de bolnavi cu DA:
egocentrici, hipersensibili, anxiosi Si iritabili, schizotimi. Hoek eviden� \up0
\expndtw0\charscalex113 fiaze, cu ajutorul MMPI, la 254 pacienti cu DA, prezenta
unor valori crescute \up0 \expndtw0\charscalex111 la scalele Hs (hypochondria), Hy
(hysteria) \up0 \expndtw0\charscalex111 $i D (depresia). De altfel, Niebel,
sistematizand datele din literature \tab \up0 \expndtw0\charscalex128 (inclusiv
cele personae), descrie o \par\pard\qj \li1320\ri292\sb0\sl-253\slmult0 \up0
\expndtw0\charscalex114 reactie relativ uniforme a bolnavilor cu DA fate de
suferinta lor, manifestata \up0 \expndtw0\charscalex130 prin atitudine negative si
preocupari fafa de propria piele si printr-o \up0 \expndtw0\charscalex126
dificultate de a colabora cu ceilalfi Izvorata din senzafia cS - datoritS \up0
\expndtw0\charscalex126 leziunilor cutanate - este lipsit(a) de atractivitate
\par\pard\qj\li825\ri828\sb85\sl-250\slmult0\fi292 \up0 \expndtw0\charscalex116 in
planul manileserilor clinice cu caracter psihiatric se remarcS la copiii \up0
\expndtw0\charscalex111 cu DA asa-numitul ADDH (Attention Deficit Disorder
Hyperreactivity) mani-\line \up0 \expndtw0\charscalex118 festat printr-o stare de
agitafie cvasipermanentS si scSderea atenfiei \up0 \expndtw0\charscalex104 (mai
ales in cadrul orelor de scoae). iar la adult o tendinfa spre hiperactivitate.
\line\tab \up0 \expndtw0\charscalex111 Totusi. date mai recente (Mc Gee si colab..
1993) pun sub semnul indoielii \up0 \expndtw0\charscalex105 relafia dintre ADDH si
DA. \par\pard\qj \li815\ri812\sb0\sl-244\slmult0\fi302 \up0 \expndtw0\charscalex122
De altfel, chiar si opinia referitoare la gradul ridicat de inteligenfS al \up0
\expndtw0\charscalex121 atopicilor a fost puss la indoialS de cStre Colfoiu care a
intalnit, in lotul \up0 \expndtw0\charscalex115 studiat de peste 250 atopici, 6
familii de copli atopici cu un grad moderat de \up0 \expndtw0\charscalex117
oligolrenie (cSfiva copii prezentau chiar un teren comifial dar acest fapt ar
\up0 \expndtw0\charscalex118 putea justiiica. din contrS. o posibie intarziere
mintalS dobanditS, ceea ce \up0 \expndtw0\charscalex121 ar anula contestarea
trSsSturilor mentale pozitive \up0 \expndtw-2\charscalex100 -\up0
\expndtw0\charscalex108 inteligenfa \up0 \expndtw0\charscalex113 induse
\par\pard\ql \li815\sb13\sl-230\slmult0 \up0 \expndtw0\charscalex113 genetic, o
data cu terenul atopic, la bolnavii cu DA). \par\pard\qj \li820\ri792\sb0\sl-
253\slmult0\fi283 \up0 \expndtw0\charscalex120 Sistematizand datele prezentate
referitoare e personalitatea bolnavilor \up0 \expndtw0\charscalex124 cu DA, se
poate alirma cS ea suferS in mod extrem de variat impactul \up0
\expndtw0\charscalex119 variatelor aspecte climcoevolutive ale bolii. ca si al
condifiilor diverse de \up0 \expndtw0\charscalex111 re/afionare a bolnavilor cu
mediul lor socio-fami/ial. \par\pard\qj \li811\ri791\sb0\sl-245\slmult0\fi297
\up0 \expndtw0\charscalex113 Se pot distinge ca elemente comune majoritSfii
bolnavilor cu DA. urme� \up0 \expndtw0\charscalex114 toarele: tendinfa la
introversie. agresivitate. iritabilitate (consecutiv manifes-\line \up0
\expndtw0\charscalex111 tSrilor de grataj generate de prurit si care nu pot li
exteriorizate in public), an� \up0 \expndtw0\charscalex113 xietate (generae de
expectafii negative referitoare la cursul bolii) si depresie, \up0
\expndtw0\charscalex127 ca stare afectiva "finald", cu
cdracter de descurajare fafd de esecurile \up0 \expndtw0\charscalex114 terapeutice
si afectarea inserfiei sociale a bolnavului cu DA; uneori depresia \up0
\expndtw0\charscalex115 apare pur si simplu ca depresie de epuizare. prin recul
somato-psihic fafa de \up0 \expndtw0\charscalex115 disconfortui prelungit si
agasant din cursul puseelor de activitate a bolii. \par\pard\ql \li1099\sb13\sl-
230\slmult0 \up0 \expndtw0\charscalex119 5. Psihoterapia bolnavilor cu DA
imbracS forme variate (ca forme generale sau speciale) de aplicare dar \up0
\expndtw0\charscalex114 se pot considera douS direcfii. obiective majore, ale
utilizShi mSsuhlor psi� \up0 \expndtw0\charscalex114 hoterapeutice: \par\pard\qj
\li815\ri813\sb0\sl-250\slmult0\fi307 \up0 \expndtw0\charscalex132 J suportul
psihologie acordat problemelor generale ale bolii, cu \up0 \expndtw0\charscalex127
accent pe contactele sociale ale pacientului; tot in aceastS direcfie se \up0
\expndtw0\charscalex116 inscriu si diferitele metode cu caracter antistres,
\u9633? mijloace psihologice axate pe modificarile comportamentale lega� \up0
\expndtw0\charscalex130 te de tolerarea pruritului si prevenirea \up0
\expndtw0\charscalex127 (sau atenuarea) gratajului. in \par\pard\qj
\li811\ri812\sb0\sl-260\slmult0 \up0 \expndtw0\charscalex122 cadrul unor ingrijiri
ale pielii prescrise de dermatolog cuplate cu terapia \up0 \expndtw0\charscalex125
comportamentale exercitate de cetre psihologul din echipa \up0
\expndtw0\charscalex124 (team) de \par\pard\ql \li815\sb1\sl-195\slmult0 \up0
\expndtw0\charscalex109 ingrijire a bolnavului cu DA. \par\pard\ql \li1104\sb17\sl-
230\slmult0 \up0 \expndtw0\charscalex115 Se pot distinge mai multe tipuri de
proceduri psihoterapeutice: \par\pard\qj \li815\ri808\sb0\sl-250\slmult0\fi283 \up0
\expndtw0\charscalex119 a) Schimbarea condifiilor favorabile declansarii pruritului
$i gratajului \up0 \expndtw0\charscalex115 prin instrucfiuni cu caracter antistres
specifice situafiilor psihotraumatizan-\line \up0 \expndtw0\charscalex114 te pentru
bolnavul in cauze. Aceste indicafii cu caracter profilactic rezulta in \up0
\expndtw0\charscalex117 urma convorbirii anenuntite cu bolnavul asupra problemelor
sale psiholo� \up0 \expndtw0\charscalex109 gice. \par\pard\qj \li815\ri835\sb0\sl-
260\slmult0\fi288 \up0 \expndtw0\charscalex120 b) Strategii cognitive induse
bolnavului cu DA Tn scopul indepertam \up0 \expndtw0\charscalex115 gendurilor sale
obsesive de la pielea bolnave.
240\slmult0\fi292 \up0 \expndtw0\charscalex114 c) Exercifii inductoare de relaxare,
Tn conditiile Tmbinerii unei activitafi \up0 \expndtw0\charscalex116 motorii
moderate cu tehnici de inducere a unui autocontrol (adresat in spe� \up0
\expndtw0\charscalex114 cial comportamentului de grataj) conducand la realizarea
unui echilibru intre \up0 \expndtw0\charscalex114 excitafia date de prurit si
componenta motorie a gratajului. \par\pard\ql \li1521\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex113 d) Aplicarea unor stimuli cutanafi care seed pruritul.
\par\pard\qj \li1224\ri398\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex117 e)
Inducerea unor strategii generale de autocontrol general, extinse $i la \up0
\expndtw0\charscalex117 comportamentul de grataj. \par\pard\qj
\li1224\ri373\sb0\sl-232\slmult0\fi297 \up0 \expndtw0\charscalex121 f) Aplicarea in
colaborare cu dermatologul a unui program centrat pe \up0 \expndtw0\charscalex114
imbinarea tratamentului medical cu un program de terapie comportamentald \up0
\expndtw0\charscalex118 adresat Tn special pacientului cu DA ce prezinta tulburari
psihice sau cu o \up0 \expndtw0\charscalex119 personalitate afectae intens de boae
(Gabnele Niebel). De altfel o compa\up0 \expndtw0\charscalex118 rafie intre
randamentul terapeutic al programulul de ingrijire a pielii reco\up0
\expndtw0\charscalex114 mandat de dermatolog si eel al terapiei comportamentale,
conduce la o apre\up0 \expndtw0\charscalex115 ciere favorabie a acesteia din urmS.
Dar, a$a cum remarcS Gabrielle Niebel \up0 \expndtw0\charscalex120 (1995), eel mai
bun randament este dat de Imbinarea celor douS metode \up0 \expndtw0\charscalex114
(medicals si psihologica) \par\pard\qj \li1233\ri399\sb7\sl-220\slmult0\fi283
\up0 \expndtw0\charscalex121 6. Particularitafi ale complianfei terapeutice si ale
indicilor de calita� \up0 \expndtw0\charscalex121 te a viefii la bolnavii cu DA.
\par\pard\qj \li1238\ri389\sb4\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex122 Au
fost studiate mai putin, dar considerable generale de la capitolele \up0
\expndtw0\charscalex117 respective cu caracter general sau cele legate astmului
bron$ic - reman va\up0 \expndtw0\charscalex107 labile. \par\pard\ql \li1516\sb1\sl-
215\slmult0 \up0 \expndtw0\charscalex115 Cateva considerafii merits (Scute,
raportate e specificul DA. \par\pard\ql \li1516\sb13\sl-230\slmult0 \up0
\expndtw0\charscalex121 a) Complianfa terapeutica \par\pard\qj
\li1224\ri379\sb8\sl-233\slmult0\fi307 \up0 \expndtw0\charscalex119 La copilul cu
DA este extrem de importanta atragerea pannfilor sSi in \up0
\expndtw0\charscalex115 echipa terapeuticS (un model general, ca eel al grupului
Monte Verita, creat \up0 \expndtw0\charscalex116 de Luban Plozza apare ca extrem de
benefic), dar si participarea acestora la \up0 \expndtw0\charscalex122 practicarea
unui Training Comportamental, la fel ca si copiii afectafi de \up0
\expndtw0\charscalex120 boae. Cu aceastS ocazie se pot reglementa procesele de
interacfiune intre \up0 \expndtw0\charscalex112 pSrinfi si copii, cu implicafii in
patogenezS, inclusiv fixafia excesivS, in scop \up0 \expndtw0\charscalex112 de
reprimare, asupra comportamentului de grataj. \par\pard\qj \li1224\ri393\sb6\sl-
235\slmult0\fi283 \up0 \expndtw0\charscalex112 AceastS includere in cadrul
compliantei terapeutice a modificSrii compor� \up0 \expndtw0\charscalex116
tamentului parenteral fafa de copii se justifies prin beneficiul terapeutic
ur\up0 \expndtw0\charscalex116 mSrit si care nu este legat si de acest pattern
attitudinal (behaviour pattern) \up0 \expndtw0\charscalex114 tinzand spre
eliminarea tensiunilor intrafamiliale, inclusiv a anxietSfii de a$\up0
\expndtw0\charscalex114 teptare din partea amandurora. \par\pard\ql
\li1224\ri379\sb0\sl-237\slmult0\fi297\tx1516 \up0 \expndtw0\charscalex112 De
asemenea, mesurile de ingrijire a pielii, concepute - nu in stil primitiv -\line
\up0 \expndtw0\charscalex114 ci de "cultivare" a unei pieli senetoase, pot fi mai
usor urmate de cetre copii. \line\tab \up0 \expndtw0\charscalex113 Adultul cu DA
este mai putin receptiv fate de indicafiile medicului in mo-\line \up0
\expndtw0\charscalex119 mentele de acalmie ale bolii (observafii personae),
revenind la consultatii \up0 \expndtw0\charscalex115 numai in perioadele de
recidive. mai ales cand implicat hie estetice ale bolii \up0
\expndtw0\charscalex128 sau complicafiile ei sunt relativ scezute. Cufundarea intr-
o activitate \up0 \expndtw0\charscalex122 pecute, pasionante, poate abate atenfia
de la prurit dar - peste o anumite \up0 \expndtw0\charscalex118 limite a
suprasolicierii \up0 \expndtw0\charscalex120 - acest simptom reapare si. o date cu
el, bolnavul \par\pard\ql \li1252\sb1\sl-197\slmult0 \up0 \expndtw0\charscalex114
revine la o complianfa terapeutice mai bune. \par\pard\ql \li1540\sb16\sl-
230\slmult0 \up0 \expndtw0\charscalex118 b) Indicii de calitate a viefii in DA
\par\pard\ql \li1550\sb10\sl-230\slmult0\tx6120 \up0 \expndtw0\charscalex120 Pot fi
cei generali, valabili pentru orice boae \tab \up0 \expndtw0\charscalex116 (cum
sunt cei inclusi Tn \par\pard\ql \li1257\sb1\sl-217\slmult0 \up0
\expndtw0\charscalex117 testul SF-36) dar $i cei legafi de prurit. tentafia
gratajului si usturimile sau
Psihosomatica aplicats\tab \up0 \expndtw0\charscalex126 \u9830? 247\par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 durerile aperute secundar acestuia. in plus, jena fafd
de anturajul care \up0 \expndtw0\charscalex132 observa gratajul sau consecintele
acestuia si ale bolii, Tn general, \up0 \expndtw0\charscalex126 (tegumentele cu
escohafii, lichenificate). precum si tendinta la eritem \up0
\expndtw0\charscalex118 emofional cantonat la fafe si gat, pot fi incluse aeturi de
"indicii somatici" \up0 \expndtw0\charscalex118 descrisi mai sus. \par\pard\qj
\li815\ri817\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex125 in afarS de
prurit. inclusiv accentuarea lui Tn serile depresive deja \up0
\expndtw0\charscalex115 menfionate, literatura consultatS de noi si consacrate DA
nu este bazatS Tn \up0 \expndtw0\charscalex110 date referitoare 1a indicii Quality
of Life Tn aceastS boalS. \par\pard\ql \li1118\sb69\sl-230\slmult0 \up0
\expndtw0\charscalex119 Blbllografle \par\pard\li1113\sb121\sl-
1.\tab \up0 \expndtw0\charscalex116 Bartrop R. W., Lazarus L.. Luckhurst E. si
colab. Depressed lymphocyte\par\pard\li1113\sb1\sl-205\slmult0\fi230\tx4967\tx5155
\up0 \expndtw0\charscalex111 function after bereavement \u9632? Lancet
1977,\tab \up0 \expndtw-4\charscalex100 1,\tab \up0 \expndtw0\charscalex116
Bienenstock J. Psychoneuroallergology - a reality - Conversations in
allergy\par\pard\li1113\sb0\sl-207\slmult0\fi230\tx2116\tx5937 \up0
\expndtw0\charscalex104 (IV). pp\tab \up0 \expndtw0\charscalex105 15-18, UCB
\u9632? Institute Allergy. Brain I'Alleud.\tab \up0 \expndtw0\charscalex116
\expndtw0\charscalex114 3. Bousquet J How do we optimise asthma assessments ? in
Eds. Clark TH, Fabri \line\tab \up0 \expndtw0\charscalex135 L.M "How to optimise
asthma therapy" pp \up0 \expndtw0\charscalex125 27-30 Excerpta Medica, \par\pard\ql
\li1329\sb2\sl-198\slmult0 \up0 \expndtw0\charscalex107 Amsterdam, 1992
4. Bousquet J., Godard Ph. Michel FB (eds) Allergologie, pp. 227-242. Ellipses.
\line\tab \up0 \expndtw0\charscalex103 Paris, 1993. \par\pard\ql \li1123\sb2\sl-
198\slmult0\tx7727 \up0 \expndtw0\charscalex119 5. Bousquet J.. Michel FB. Socio
economic aspects ot allergic diseases p. \tab \up0 \expndtw-8\charscalex100
178-\par\pard\qj \li1343\ri794\sb21\sl-200\slmult0\fi28 \up0
\expndtw0\charscalex111 184. m Wuthrich 8. - Highlights in allergy and clinical
Immunology Hogrete and \up0 \expndtw0\charscalex105 Huber. Bern 1991
ColfoiuA., Dermatoze dispozifionale Editura Medicald, Bucuresti.\tab \up0
\expndtw0\charscalex113 7. Dock P. Le prurit Essentialia (UCB - Bruxelles) 1985. 2
si 3, p. 29. 57.\par\pard\li1128\sb0\sl-207\slmult0\fi0\tx2539 \up0
\expndtw0\charscalex112 8. Hanifin J. M.\tab \up0 \expndtw0\charscalex112 19g6j
Pharmacophysiology of Atopic Dermatitis Clin. rev. Allergy\par\pard\li1128\sb5\sl-
207\slmult0\fi215 \up0 \expndtw0\charscalex112 4:43-65.\par\pard\qj
\li1123\ri844\sb0\sl-220\slmult0\tx1339 \up0 \expndtw0\charscalex114 9. Khansari
D.N.. Murgo A E.. Eath RE. Effects of stress on the immune system. \line\tab
\up0 \expndtw0\charscalex102 Immunology Today, 1990, vol. II, 5,170-175.
10. Kulawik H. Psychoterapie bei somatischen Erkrangungen und Funk/tons-\line
\tab \up0 \expndtw0\charscalex111 storungon, G. Fisher, Jena, 1984. \par\pard\qj
\li1151\ri809\sb0\sl-200\slmult0\tx1411 \up0 \expndtw0\charscalex120 11. Luban
Plozza 8.. Poldinger W., Kroger F.. Boli psihosomatice in practica \line\tab
\up0 \expndtw0\charscalex111 medicald (trad. E. Toma). Ed. Medicald, Bucuresti,
1996. \par\pard\ql \li1156\ri798\sb13\sl-200\slmult0\tx1444\tx1478 \up0
\expndtw0\charscalex117 12. Luban Plozza 8. - Empowerment techniques' from doctor -
centered (Balint \line\tab \up0 \expndtw0\charscalex119 approach) to patient -
centered discussion groups. Patient Educ. Consoling \line\tab \up0
\expndtw0\charscalex107 1995. 26. 257-264 \par\pard\ql \li1161\ri799\sb20\sl-
200\slmult0\tx1440\tx1435 \up0 \expndtw0\charscalex117 13. Niebel Gabrielle -
Verhaltensmedizin der chronischen Hautkrankheiten und \line\tab \up0
\expndtw0\charscalex119 ihrer Bohandlung Interdisztplinare Perspektive der
Atopischen Dermatitis. \line\tab \up0 \expndtw0\charscalex106 Huber. Bern. \up0
200\slmult0\tx1440 \up0 \expndtw0\charscalex114 14 Ring J. Pales E, Zimmermann F,
Psychosomatische Aspekie der Eitern-Kind-\line \tab \up0 \expndtw0\charscalex111
Beziehung bei atopischem Ekzem im Kindesalter. I Hautarzt 1986, 37. 560-567
Ring J. \tab \up0 \expndtw0\charscalex121 - Adverse food reactions between
psychology and allergy Fisons \par\pard\ql \li1435\sb1\sl-198\slmult0 \up0
\expndtw0\charscalex109 Summary Service at EAACI, p. 4. Zurich. May 1991
(Wednesday). \par\pard\qj \li1166\ri798\sb21\sl-200\slmult0\tx1435 \up0
\expndtw0\charscalex112 16. Scheich G., Florin I.. Rudolph R . Wilhelm S. \u9632?
Personality characteristics and \line\tab \up0 \expndtw0\charscalex112 serum IgE
level in patients with atopic dermatitis - J Pschychosom. Res 1993,
37\t \up0 \expndtw-5\charscalex100 (6).\tab \up0 \expndtw0\charscalex108 637-
42\par\pard\ql \li1166\sb1\sl-177\slmult0 \up0 \expndtw0\charscalex102 17. Solomon
M. L., Seerman H. \u9632? Atopic Dermatitis. Amer. J. med. Sci.. 1966. 252. 478.
Sulzberger M. B. \tab \up0 \expndtw0\charscalex122 \u9632? Atopic Dermatitis In:
Dermatology-Diagnostic and \par\pard\ql \li1463\sb1\sl-198\slmult0 \up0
\expndtw0\charscalex107 treatment, Year Book for 1961. \par\pard\qj
Szentivany A.. The belaandrenergic theory of the atopic abnormality in \line\tab
\up0 \expndtw0\charscalex110 bronchial asthma, J Allergy, 1968, 42, 4. 203-216.
Wuthrich 8.\tab \up0 \expndtw0\charscalex110 - Atopic dermatitis, pp. 112-129 in
UCB - Allergy Manual. Braine\par\pard\li1166\sb1\sl-205\slmult0\fi268 \up0
\expndtw0\charscalex110 L Alleud
psihosomaticS generae si aplicata\par\pard\ql \li1492\sb0\sl-253\slmult0
\up0 \expndtw-7\charscalex100 \ul0\nosupersub\cf8\f9\fs22 C. ALERGIA MEDICAMENTOASA
\expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 Reacfiile de tip alergic la
medicamente reprezintS un cSmp de acfiune ce \up0 \expndtw0\charscalex114
ilustreaza exemplar cercul vicios psihosomatic - somato-psihic prin impactul
\up0 \expndtw0\charscalex122 psihic brutal si persistent al unor accidente
medicamentoase anafilactice \up0 \expndtw0\charscalex117 asupra unor bolnavi care
dezvolts ulterior o asteptare anxioasS sau verita� \up0 \expndtw0\charscalex118
bite fobii lafa de medicamentele necesare, manifestSnd tulburSri psihoso \up0
\expndtw0\charscalex115 matice ample la liecare nouS administrare de medicament.
Aceste tulburSri \up0 \expndtw0\charscalex120 confundabile adesea cu simptomele de
alergie medicamentoasS propriu-\line \up0 \expndtw0\charscalex108 zisS.
\ul0\nosupersub\cf18\f19\fs20\ul ConceptuI de RtAM \par\pard\ql \li1502\sb70\sl-
Sub acest termen am considerat anterior (lamandescu 1987 \tab \up0 \expndtw-
9\charscalex100 $i \tab \up0 \expndtw0\charscalex105 1993) cS \par\pard\ql
\li1209\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 pot fi grupate urmStoarele
tipuri de manifestSri clinico-patogenice: \par\pard\qj \li1209\ri413\sb5\sl-
237\slmult0\fi292 \up0 \expndtw0\charscalex115 \u9633? manifestdri clinice
obiective \u9632? sindroame cutanate. respiratorii. diges� \up0
\expndtw0\charscalex119 tive sau sistemice care sunt generate efectiv, per se, de
medicamente prin \up0 \expndtw0\charscalex116 mecanisme alergice propriuzise
("alergia vera") sau pseudoalergice (tablou \up0 \expndtw0\charscalex116 clinic
identic - astm, sindrom urticahan, soc - declansat de mediatorii vaso\up0
\expndtw0\charscalex116 activi si musculo-consthctoh eliberafl de cStre efectori
precum mastocitele, \up0 \expndtw0\charscalex112 bazofiiele plus celulele
infiltratului inplacentar, fSrS aparifia reacfiei alergen\up0
\expndtw0\charscalex117 anticorp. asa cum este cazul medicamentelor AINS ori al
celor care degra\up0 \expndtw0\charscalex114 nuleazS nespecific s> direct
mastocitul, ca de exemplu: cofeina. pollmixina. \up0 \expndtw0\charscalex114
Dextranul, etc ). \par\pard\ql \li1521\sb1\sl-240\slmult0\tx8380 \up0
\expndtw0\charscalex126 _l simptome subiective, prezentate sau interpretate ca
"alergice" \tab \up0 \expndtw-2\charscalex100 -\par\pard\qj \li1204\ri410\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex118 Acestea sunt de lapt reactii nevrotice
(adesea conditionate reflex) care mi-\line \up0 \expndtw0\charscalex112 meazS un
episod alergic real anterior, adesea chiar cu scSderi tensionale mo� \up0
\expndtw0\charscalex112 derate \u8226? (vezi Seropian si lamandescu - 1980) dar, de
regulS, se manifests prin \up0 \expndtw0\charscalex112 simptome subiective cefalee,
amefeli, anxietate extremS, stSri lipotimice. \par\pard\qj \li1209\ri394\sb0\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex116 Cei mai frecvent sunt luate in
considerate de cStre clinicieni simptomele \up0 \expndtw0\charscalex113 obiective
din primul grup, al doilea avand o componenfa psihice doar secun� \up0
\expndtw0\charscalex116 dare dar. ulterior, simptomele subiective din grup devin
parazitare si creaza \up0 \expndtw0\charscalex117 man probleme in special unui
terapeut mai pufin sigur de cunostinfele sale \up0 \expndtw0\charscalex117
alergologice si cu o personalitate cu un grad crescut de anxietate bazae.
\par\pard\ql \li1511\sb49\sl-230\slmult0 \up0 \expndtw0\charscalex111 2. Parametri!
psihologici ai bolnavilor RtAM \par\pard\qj \li1219\ri399\sb79\sl-220\slmult0\fi302
\up0 \expndtw0\charscalex121 Factorii de care trebuie se
se fine cont Tn abordarea psihosomatice a \up0 \expndtw0\charscalex115 acestor
bolnavi sunt: \par\pard\ql \li1526\sb12\sl-230\slmult0 \up0 \expndtw0\charscalex120
\u9633? Trasaturi psihice acute si "de fond" ale bolnavilor cu RtAM \par\pard\qj
\li1238\ri369\sb2\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex115 Problema
centrald a bolnavului alergic la medicamente. ca si a medicului \up0
\expndtw0\charscalex116 sau curant, este aceea a repetabilitdfii accidentului
alergic, fapt ce generea\up0 \expndtw0\charscalex118 zd amandorura o anxietate in
legeture cu nevoia de a se administra acelasi \up0 \expndtw0\charscalex115
medicament sau noi medicamente pentru tralarea unor boli asociate care nu \up0
\expndtw0\charscalex115 pot evita tratamentul medicamentos. \par\pard\ql
\li1550\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex114 Existe cateva nuanfe
referitor la aceastS problems: \par\pard\qj \li1262\ri383\sb0\sl-
250\slmult0\fi287 \up0 \expndtw0\charscalex125 \u8226? Situafia bolnavilor cu
"accidente" medicamentoase de tip alergic \up0 \expndtw0\charscalex125 ce nu au de
tratat Tn mod expres o boala asociata. Acestia dezvolta o \up0
\expndtw0\charscalex118 simpla anxietate pentru un viitor TndepSrtat in care vor
trebui sS recurgS \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart
\par\pard\qj\li897\ri735\sb102\sl-240\slmult0 \up0 \expndtw0\charscalex118 totusi
la medicamente. Cea mai Irecventa situatie o reprezintS problemele \up0
\expndtw0\charscalex118 stomatologice, legate de administrarea anestezicelor si/sau
antibioticelor. \par\pard\ql \li1310\sb0\sl-230\slmult0
\par\pard\ql\li1310\sb99\sl-230\slmult0 \up0 \expndtw0\charscalex121 Figura 1.
Reacfii consecutive unui accident
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5tff)S\par\pard\sect\sectd\sbknone\cols3\colno1\colw3386\colsr110\colno2\colw549\co
lsr40\colno3\colw4785\colsr160\ql \li1627\sb0\sl-144\slmult0 \up0 \expndtw-
1\charscalex100 \ul0\nosupersub\cf13\f14\fs16 STRES M\par\pard\ql \li2572\sb0\sl-
180\slmult0\tx3081 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 )\tab
\up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf13\f14\fs16 son\par\pard\ql
\li1699\sb59\sl-184\slmult0 \up0 \expndtw0\charscalex103 REFLEXE\par\pard\ql
CONDITtOMATE\par\pard\ql \li2640\sb0\sl-160\slmult0 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 )\par\pard\column \ql \li20\sb84\sl-
L(\par\pard\column \ql \li485\sb128\sl-195\slmult0\tx3039 \up0
\expndtw0\charscalex115 \ul0\nosupersub\cf13\f14\fs16 Ach.\tab \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 TNV\par\pard\ql \li20\sb36\sl-
CATECOLAMINE\par\pard\ql \li1301\sb0\sl-160\slmult0 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf9\f10\fs20 ) \par\pard\sect\sectd\sbknone \qj
\u8226? Situafia bolnavilor care au suferit episoade alergice sau \up0
\expndtw0\charscalex124 pseudoalergice severe (in special soc anafilactic si edem
glotic) si care \up0 \expndtw0\charscalex121 necesita tratament medicamentos pentru
o boalS cronica Acesti bolnavi \up0 \expndtw0\charscalex112 vor reprezenta douS
tipuri de tablouri clinico-psihologice: \par\pard\qj \li921\ri711\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex121 \u8226? ca stare "de fond", in
asteptarea aparifiei unei indicafii de tratament \up0 \expndtw0\charscalex114
medicamentos, la acesti bolnavi se Tntalnesc (v.lamandescu 1993 si laman� \up0
\expndtw0\charscalex115 descu $i colab. \up0 \expndtw-3\charscalex100 1996):
\par\pard\ql \li1224\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex116 \u9830? un
grad crescut al anxielafii bazale, nespecifice; \par\pard\qj \li926\ri702\sb39\sl-
220\slmult0\fi297 \up0 \expndtw0\charscalex118 \u9830? veritabie fobii(a\\a de boae
in general (nosofobie) si In special fafa de \up0 \expndtw0\charscalex112
medicament; \par\pard\ql \li1224\sb32\sl-230\slmult0\tx3767 \up0
\expndtw0\charscalex133 \u9830? preocupdri crescute \tab \up0
\expndtw0\charscalex133 (uneori de intensitate nevroticS) fafa de \par\pard\qj
\li931\ri711\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex132 probabilitatea
aparifiei unei faze a bolilor cronice care sS necesite \up0 \expndtw0\charscalex111
medicafie; \par\pard\qj \li926\ri691\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex124 \u8226? ca manifestari psihice si psihosomatice acute Tn
cursul tentative! \up0 \expndtw0\charscalex123 de introducere a unui nou
medicament: cefalee, amefeli si cenestopatii \up0 \expndtw0\charscalex117 diverse,
tahicardie si dispnee. \par\pard\qj \li931\ri700\sb0\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex142 Aceste simptome apar chiar si la preparatele placebo sau la
\up0 \expndtw0\charscalex116 medicamente "/nocenfe" (selecfionate cu grijS de medic
si care nu declan� \up0 \expndtw0\charscalex116 seaza simptome obiective).
236\slmult0\fi302 \up0 \expndtw0\charscalex119 De regulS simptomele neuro-
vegetatlve (veritabite tulburSri psihoso� \up0 \expndtw0\charscalex121 matice),
mimeaza tabloul clinic al manifestSrilor subiective generate de \up0
\expndtw0\charscalex123 accidentele medicamentoase anterioare dar ele pot constitui
$i expresia \up0 \expndtw0\charscalex115 clinics a unei anxieefi extreme, mergand
pSnS la tabloul atacului de panics, \up0 \expndtw0\charscalex121 asa cum am
observat in cazul a douS paciente cu alergie la PenicilinS si \up0
\expndtw0\charscalex111 respectiv la Norfloxacin. \par\pard\qj
\li1185\ri433\sb38\sl-220\slmult0\fi283 \up0 \expndtw0\charscalex135 Q Tipul de
personalitate al bolnavilor cu RtAM si simptomele \up0 \expndtw0\charscalex125
nevrotice asociate \par\pard\qj \li1180\ri448\sb0\sl-250\slmult0\fi288 \up0
\expndtw0\charscalex113 intre bolnavii cu RtAM considerSm cS se pot deosebi din
punct de vedere \up0 \expndtw0\charscalex119 al trSsSturilor de personalitate, douS
subpopulafii conforme cu cele douS \up0 \expndtw0\charscalex119 grupe clinlco-
patogenice desemnate de noi mai sus: \par\pard\qj \li1180\ri453\sb11\sl-
220\slmult0\fi297 \up0 \expndtw0\charscalex137 e Bolnavii cu alergie pura sau
pseudoalergie la medicamente \up0 \expndtw0\charscalex117 (sublotul A) \par\pard\ql
\li1463\sb32\sl-230\slmult0\tx5913 \up0 \expndtw0\charscalex121 Acestia evidenfiazS
la chestionarul MMPI \tab \up0 \expndtw0\charscalex118 (Inventarul Multifazic de
Personalitate Minnesota) trasaturi accentuate la majoritatea scalelor \up0
\expndtw0\charscalex119 clinice, atingSnd o amplitudine la fel ca si ceilalfi
bolnavi psihosomatici: \par\pard\li1185\sb1\sl-230\slmult0\fi0\tx2011\tx5385
\up0 \expndtw0\charscalex116 alergiei\tab \up0 \expndtw0\charscalex116 (astm si
urticarie) sau nealergici\tab \up0 \expndtw0\charscalex116 (ulcer, hipertensiune
arteriale),\par\pard\li1185\sb0\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex116
(lamandescu s' Popa-Velea, 1996).\par\pard\li1185\sb5\sl-
230\slmult0\fi292\tx2256\tx4804 \up0 \expndtw0\charscalex111 Din cei\tab \up0
\expndtw0\charscalex116 79 bolnavi studiafi de noi\tab \up0 \expndtw0\charscalex116
(lamandescu, Popa-Velea si Mazuru -\par\pard\li1185\sb10\sl-
230\slmult0\fi19\tx5342\tx5961 \up0 \expndtw0\charscalex116 1996, lamandescu,
Mazuru si Horopciuc -\tab \up0 \expndtw-5\charscalex100 1997),\tab \up0
\expndtw0\charscalex116 55,7% prezentau valori T\par\pard\qj \li1180\ri442\sb0\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex113 peste 70 centile la scalele Hs
(Hypochondria). D (Depresia) si Hy (Hysteria), \up0 \expndtw0\charscalex112 ce
alcetuiesc impreune asa numita "triada nevrotica". De asemenea totalizSnd \up0
\expndtw0\charscalex116 evenimentele de pe Scala Holmes s* Rahe. \up0
\expndtw0\charscalex116 82,3% dintre acesti bolnavi au \par\pard\ql
\li1185\ri418\sb0\sl-240\slmult0\tx1473 \up0 \expndtw0\charscalex112 prezentat un
scor total de peste 300 puncte, referitor la Tnsumarea evenimen� \up0
\expndtw0\charscalex111 telor psihotraumatizante din ultimele 6 luni care au
precedat primele RtAM \line\tab \up0 \expndtw0\charscalex118 Tofi acesti bolnavi
acuzau simptome nevrotice (chestionar Predescu si \up0 \expndtw0\charscalex115
Nica-Udangiu). mai putin numeroase (sub 5 simptome) decat celdlaft sublot \up0
\expndtw0\charscalex113 cu tulburdri osihosomatice allergic-like (95%), existand
chiar 6 pacienfi fSrS \up0 \expndtw0\charscalex113 nici un simptom nevrollc.
\par\pard\qj \li1190\ri438\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex122 Se
poate opinia ca sublotul bolnavilor cu reacfii alergice si pseudo� \up0
\expndtw0\charscalex122 alergice la medicamente confine o populafic mlxtS din punct
de vedere \up0 \expndtw0\charscalex123 al acuzelor clinice s< Tncadrarii lor
nosologice: \par\pard\ql \li1483\sb1\sl-200\slmult0 \up0 \expndtw0\charscalex114 -
bolnavi psihosomatici puri, fdrd sau cu pufine simptome nevrotice, \par\pard\qj
\li1195\ri427\sb7\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex112 \u9632? bolnavi
cu RtAM avand tulburdri nevrotice asociate (peste 5 simptome), \up0
\expndtw0\charscalex114 Tn special secundare RtAM. Exists o corelafie crescuts e
acesti bolnavi intre \up0 \expndtw0\charscalex114 valorile crescute (>70 centile)
1a scalele tnadei nevrotice $i numarui crescu' \up0 \expndtw0\charscalex114 de
simptome nevrotice. \par\pard\ql \li1497\sb9\sl-230\slmult0\tx7228\tx7699\tx7944
\up0 \expndtw0\charscalex112 Spre deosebire de bolnavii astmatici studiafi de noi
in 1980, \tab \up0 \expndtw-4\charscalex100 1984 \tab \up0 \expndtw-9\charscalex100
$i \tab \up0 \expndtw-2\charscalex100 1985, \par\pard\qj \li1209\ri414\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex109 tot cu ajutorul MMPI. bolnavii cu RtAM au
intrunit o medie a valorilor tiecSrei \up0 \expndtw0\charscalex121 scale clinice
realizand un profil general cu o amplitudine medie similara \up0
\expndtw0\charscalex121 celei obfinute de bolnavii nevrotici, fiind difenfi
statistic de alfi bolnavi \up0 \expndtw0\charscalex116 psihosomatici (astmatici si
ulcerosO al cSror "nevrozism" se situeazS la un \up0 \expndtw0\charscalex116 nivel
intermediar intre bolnavii nevrotici s* subiecfii sSnStosi-\par\pard\qj
\li1248\ri404\sb0\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex127 \u8226? Bolnavi
cu tulburari psihosomatice "mimand alergia", apSrute e \up0 \expndtw0\charscalex116
repetarea administrarii unor medicamente (altele decat cele inifiale, cauza\up0
\expndtw0\charscalex107 loare de RtAM), (sublotul B).
Psihosomatica aplicata\tab \dn3 \expndtw0\charscalex114 \u9830? 251\par\pard\ql
\par\pard\ql\li1055\sb134\sl-230\slmult0\tx2471 \up0 \expndtw0\charscalex121 Acest
sublot \tab \up0 \expndtw0\charscalex130 (40 bolnavi) intruneste caracterlstici
patente pentru \par\pard\qj \li772\ri845\sb2\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex119 coexistenfa unei adevarate nevroze, atat prin numdrul mare
de simptome \up0 \expndtw0\charscalex122 nevrotice (>5) prezentate de fiecare
bolnav (95% din cazuri) cSt si prin \up0 \expndtw0\charscalex112 valorile crescute
ale cotelor T la scalele trladei nevrotice ale MMPI (90% din \up0
\expndtw0\charscalex112 cazuri). \par\pard\ql \li1065\sb9\sl-230\slmult0\tx7646
\up0 \expndtw0\charscalex134 Tofi bolnavii au prezentat stresuri psihice totalizand
peste \tab \up0 \expndtw0\charscalex106 300 \par\pard\qj \li777\ri855\sb2\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex118 puncte pe Scala Holmes $i Rahe in
ultimae 6 luni care au precedat primul \up0 \expndtw0\charscalex112 episod de RtAM,
sugerand importanta stresului Tn aparifia intoleranfei de tip \up0
\expndtw0\charscalex112 alergic la unele medicamene. ' \par\pard\qj
\li777\ri850\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex120 Diferenfierea
sublotului cu tulburSri psihosomatice care nu mimeazS \up0 \expndtw0\charscalex114
alergia sau pseudoalergia de eel format din bolnavi cu alergie si pseudoaler\up0
\expndtw0\charscalex119 gie reals, medicamentoasa, s-a putut face pe baza reacfiei
bolnavilor res� \up0 \expndtw0\charscalex123 pectivi la testae de provocare cu
medicamente bine tolerate ulterior din \up0 \expndtw0\charscalex115 punct de vedere
clinic. TulburSrile psihosomatice acuzate de acesti bolnavi \up0
\expndtw0\charscalex126 au apSrut in special in primul moment al testShi, eel al
administrSrii \up0 \expndtw0\charscalex124 prealabile a unui preparat placebo
despre care bolnavul credea cS este \up0 \expndtw0\charscalex124 vorba de un
preparat clinic activ la care testele de laborator IndicaserS \up0
\expndtw0\charscalex114 probabilitatea unei toleranfe complete.
230\slmult0\fi0\tx4022 \up0 \expndtw0\charscalex117 Parametri i psihologici\tab
\up0 \expndtw0\charscalex117 Subpopulafil de pacienfi cu reacfii
de\par\pard\li883\sb10\sl-230\slmult0\fi3614 \up0 \expndtw0\charscalex117
\ul0\nosupersub\cf18\f19\fs20\ul tip aler\ul0\nosupersub\cf9\f10\fs20
gl\ul0\nosupersub\cf18\f19\fs20\ul c la medi\ul0\nosupersub\cf9\f10\fs20
camente\par\pard\li883\sb6\sl-230\slmult0\fi2956\tx5966 \up0
\expndtw0\charscalex117 Simptome mimand\tab \up0 \expndtw0\charscalex117 Simptome
alergice\par\pard\li883\sb19\sl-230\slmult0\fi3436\tx5836 \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf18\f19\fs20\ul alergia\ul0\tab \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf18\f19\fs20\ul sau
pseudoalergice\par\pard\ql \li897\sb0\sl-227\slmult0 \up0
\expndtw0\charscalex112 \ul0\nosupersub\cf9\f10\fs20 1. Evenimente biograflce
\par\pard\li868\sb20\sl-253\slmult0\fi268\tx4238\tx6614 \dn2
\expndtw0\charscalex122 stresante\tab \dn2 \expndtw-10\charscalex91
\ul0\nosupersub\cf8\f9\fs22 TTTT\tab \up0 \expndtw-11\charscalex86
\ul0\nosupersub\cf14\f15\fs24 TTT\par\pard\li868\sb1\sl-213\slmult0\fi244 \up0
\expndtw0\charscalex116 \ul0\nosupersub\cf9\f10\fs20 Vulnerabilitate crescuts
la\par\pard\li868\sb14\sl-253\slmult0\fi273\tx4238\tx6676 \up0
\expndtw0\charscalex108 stres (MMPI)\tab \up0 \expndtw-10\charscalex92
\ul0\nosupersub\cf8\f9\fs22 TTTT\tab \up0 \expndtw-11\charscalex83
\ul0\nosupersub\cf14\f15\fs24 TT\par\pard\li868\sb1\sl-213\slmult0\fi0 \up0
\expndtw0\charscalex115 \ul0\nosupersub\cf9\f10\fs20 3. Simptome
nevrotice\par\pard\li868\sb23\sl-230\slmult0\fi9\tx4425\tx6614 \up0
\expndtw0\charscalex120 - absente\tab \up0 \expndtw-2\charscalex100 0\tab \up0
\expndtw-10\charscalex94 \ul0\nosupersub\cf8\f9\fs22 TTT\par\pard\li868\sb11\sl-
\ul0\nosupersub\cf9\f10\fs20 - pufine (<3)\tab \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf8\f9\fs22 T\tab \up0 \expndtw-10\charscalex94
TT\par\pard\li868\sb1\sl-231\slmult0\fi24\tx4243\tx6758 \up0
\expndtw0\charscalex112 \ul0\nosupersub\cf9\f10\fs20 - frecvente (>3)\tab \up0
\expndtw-10\charscalex91 \ul0\nosupersub\cf8\f9\fs22 TTTT\tab \up0 \expndtw-
3\charscalex100 T\par\pard\qj \li801\sb0\sl-240\slmult0
\ul0\nosupersub\cf9\f10\fs20 3. Relatia dintre
trdsdturii\ul0\nosupersub\cf18\f19\fs20\ul e de person\ul0\nosupersub\cf9\f10\fs20
alitate. antecedente stresanto s! \up0 \expndtw0\charscalex113 simptomele nevrotice
ConcluzionSnd asupra aeestei relafii
pe baza lucrSrilor noastre mai sus \up0 \expndtw0\charscalex113 mentionate. se pot
emite urrriatoarele concluzii: \par\pard\qj \li791\ri851\sb0\sl-
243\slmult0\fi302 \up0 \expndtw0\charscalex115 _l Factorul permeabihzant pentru
Instalarea RtAM ca si a unor tulburSri \up0 \expndtw0\charscalex121 nevrotice
secundare RtAM a fost vulnerabilitatea generae fafa de stres a \up0
\expndtw0\charscalex110 majorltafll bolnavilor, probate de rezultatele testSrii
psihologice (MMPI) unde \up0 \expndtw0\charscalex112 s-au obtinut valori
caractehstice bolnavilor cu nevroze (triada nevrotlcS: Hs + \up0
\expndtw0\charscalex108 D + Hy) la 55.7% cazuri din primul sublot (cu tulburSri
nevrotice mai reduse) si \up0 \expndtw0\charscalex107 la 90% dintre bolnavii celui
de-al doiiea sublot (cu tulburSri nevrotice cronice si \up0 \expndtw0\charscalex107
reacfii zgomotoase psihosomatice la testarea Placebo). \par\pard\qj
\li801\ri865\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex109 LI La marea
majoritate a bolnavilor cu RtAM - 82,3% din cei 79 bolnavi cu \up0
\expndtw0\charscalex109 reacfii exclusiv alergice sau pseudoalergice la medicamente
si 100% din cei \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart Pg255}
psihosomatica generala s< aplicae\par\pard\qj \li1286\sb0\sl-240\slmult0
240\slmult0 \up0 \expndtw0\charscalex118 40 bolnavi cu RtAM mifiale urmate de
tulburSri psihosomatice la admi� \up0 \expndtw0\charscalex119 nistrarea de Placebo
- s-a constatat. Tnaintea declansSrii phmelor RtAM. \up0 \expndtw0\charscalex119
prezenfa unor stresuri majore in biografia lor, amplificate ulterior de ex� \up0
\expndtw0\charscalex127 perienfa psihotraumatizanta a accidentelor medicamentoase
inclusiv \up0 \expndtw0\charscalex114 teama tatS de eventualitatea repetSni lor.
\par\pard\qj \li1291\ri350\sb0\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex114 J
Simptomele nevrotice evtdenfiate de noi e bolnavii cu RtAM (aprecia-\line \up0
\expndtw0\charscalex118 te in prezent ca "tulburSri nevrotice ale personalitafii")
au fost prezente la \up0 \expndtw0\charscalex117 acesti bolnavi, fie sub forma
izolata: \up0 \expndtw0\charscalex111 1-2 tulburSri \up0 \expndtw0\charscalex112
(ex.: anxietate si depre� \par\pard\qj \li1296\ri359\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex119 sie) cu evolufie pasagerS, fie grupate in adevarate
"sindroame nevrotice" \up0 \expndtw0\charscalex112 Si avand un caracter evolutiv
cronic. \par\pard\qj \li1296\ri346\sb0\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex128 Se poate afirma, pe baza rezultatelor obfinute sus
menfionate, cS \up0 \expndtw0\charscalex126 bolnavii cu RtAM sunt in marea lor
majoritate veritabili nevrotici s1 \up0 \expndtw0\charscalex111 anume: \par\pard\qj
\li1296\ri331\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex117 - bolnavi
prezentand exclusiv tulburdri psihice $i psihosomatice ample, \up0
\expndtw0\charscalex115 ce apar la fiecare noud administrae de medicament (sau
Placebo), ca urma� \up0 \expndtw0\charscalex122 re a unor reactii alergice sau
pseudoalergice medicamentoase anterioare \up0 \expndtw0\charscalex115 reale,
initiate (sublotul B). Acesti bolnavi constituie in totalitate o populafie \up0
\expndtw0\charscalex117 nevroticS (95% dintre ei au evidential peste 5 simptome
nevrotice la ches\up0 \expndtw0\charscalex114 tionarul Predescu - Nica-Udangiu)
Vulnerabilitatea lor 1a stres este extremS \up0 \expndtw0\charscalex113 iar pehbada
de dinaintea aparifiei primelor RtAM reale a fost marcats. la tofi \up0
\expndtw0\charscalex113 acesti bolnavi, de stresuri psihice majore sau
numeroase; \par\pard\qj \li1300\ri312\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex112 - bolnavi cu RtAM bine exprimate sub raport diagnostic si
avand un tablou \up0 \expndtw0\charscalex115 de tulburdri psihosomatice redus, ei
nereacfionand prin astfel de simptome. \up0 \expndtw0\charscalex105 nici \up0
\expndtw0\charscalex129 1a preparate Placebo si nici la alte medicamente care le-au
fost \up0 \expndtw0\charscalex111 administrate ulterior (sublotul A).
Chiar si la acesti bolnavi s-au Tnregistrat numeroase stresuri psihice \up0
\expndtw0\charscalex125 majore in perioada anterioarS debutului RtAM si, de
asemenea, Ii s-a \up0 \expndtw0\charscalex117 evidenfiat o vulnerabilitate fafS de
stres crescuts - dar nu de o amplitudine \up0 \expndtw0\charscalex119 similars
celei a bolnavilor nevrotici sau a celor dm sublotul B Referitor la \up0
\expndtw0\charscalex124 prezenfa simptomelor nevrotice, acesti bolnavi "autentici"
alergiei sau \up0 \expndtw0\charscalex124 pseudoalergici la medicamente, se impart
in doua subpopulafii: \par\pard\qj \li1310\ri317\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex115 a) nevrotici - dar cu un numSr de simptome mult mai redus
decat cei din \up0 \expndtw0\charscalex115 sublotul B si fara tabloul de tulburSri
psihosomatice zgomotoase al acestora \up0 \expndtw0\charscalex115 in situafia
administrSrii unor noi medicamente sau 1a preparatele Placebo. \par\pard\ql
\li1603\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex121 b) bolnavi fara nevroze sau
cu acuze nevrotice reduse; \par\pard\qj \li1320\ri293\sb0\sl-237\slmult0\fi283 \up0
\expndtw0\charscalex122 Ceea ce ni se pare interesant este cS diferenfa. din punct
de vedere a \up0 \expndtw0\charscalex113 simptomatologiei nevrotice (dar pe un
numSr redus de cazuri), intre bolnavii \up0 \expndtw0\charscalex116 alergiei e
medicamente (de ex.; Penicilina) si cei cu pseudoalergli medica� \up0
\expndtw0\charscalex114 mentoase (de regulS, la aspirins si alte AINS) pe care i-am
studiat, a constat \up0 \expndtw0\charscalex120 in aceea cS simptomele nevrotice du
fost reduse sau absente numai la cei \up0 \expndtw0\charscalex116 cu alergie "purd"
medicamentoasd. Nu putem se generalizem aceste obser-\line \up0
\expndtw0\charscalex112 vafii deoarece am Tntalnil, in alte ocazii, bolnavi -mari
nevrotici - cu antece� \up0 \expndtw0\charscalex112 dente de reactii alergice 1a
Peniciline s' alte medicamente diferite de AINS. \par\pard\ql \li1631\sb1\sl-
222\slmult0 \up0 \expndtw0\charscalex114 in concluzie se Doate alirma ce (vezi
Tabelul 1): \par\pard\qj \li1358\ri313\sb4\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex114 3 Bolnavii cu RtAM prezinta extrem de frecvent tulburdri
psihice. avand \up0 \expndtw0\charscalex114 Si o posibie relafie cu o "cantitate"
mai mare de stres perceputa;
PsihosomaticS aplicata\tab \up0 \expndtw0\charscalex124 \u9830? 253\par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 G O mare parte dintre ei este reprezentatd de bolnavi
nevrotici, iar dintre \up0 \expndtw0\charscalex117 acestia, un nunrer important
reacfioneazS disproporfionat \up0 \expndtw0\charscalex118 - prin tulburari
psihosomatice ample ce mimeazd simptomatotogia psihicd a unor reacfii \up0
\expndtw0\charscalex118 anafilactice sauanatilactoideanterioare\u9632? atunci cend
Ii seadmlnistreaze un \up0 \expndtw0\charscalex116 nou medicament sau chiar
preparate Placebo; \par\pard\qj \li873\ri748\sb6\sl-233\slmult0\fi292 \up0
\expndtw0\charscalex114 G Simptomatologia nevrotice, extrem de frecvent tntalnita
1a bolnavii cu \up0 \expndtw0\charscalex124 RtAM (inclusiv fata de astmatici) pare
sa fie indusd secundar de cdtre \up0 \expndtw0\charscalex122 trdiroa anxioasd a
accidentului medicamentos. aceaste veritabie react ie \up0 \expndtw0\charscalex122
somato-psihica fafe de RtAM se poate condifiona la unii bolnavi \up0
\expndtw0\charscalex104 (vezi \par\pard\qj \li873\ri769\sb38\sl-220\slmult0\fi4
\up0 \expndtw0\charscalex118 sublotul B) dar ea realizeaze aceaste "nevrotizare'
secundare a pacientului \up0 \expndtw0\charscalex117 numai in cazul preexistenfei
unor trasatun \up0 \expndtw0\charscalex116 (mergand pane la tulburSri) de
personalitate ale bolnavilor respectivi ce le confere acestora o importanta \up0
\expndtw0\charscalex115 vulnerabilitate fafe de stres. \par\pard\qj
Ab\ul0\nosupersub\cf18\f19\fs20\ul ordarea psihosomaticd a bolnavilor cu RtAM
\up0 \expndtw0\charscalex112 \ul0\nosupersub\cf9\f10\fs20 Trebuie se se face pe
parcursul mai multor etape: \par\pard\ql \li1171\sb2\sl-230\slmult0 \up0
\expndtw0\charscalex119 G Pentru bolnavul cu RtAM obiectivabile, fard dubii
diagnostice \par\pard\ql \li1175\sb10\sl-230\slmult0\tx1430\tx5880 \up0 \expndtw-
9\charscalex90 1. \tab \up0 \expndtw0\charscalex126 Ana'iza riguroasa a relafiei de
cauzalitate \tab \up0 \expndtw0\charscalex118 (inclusiv pe baza unor
\par\pard\qj \li873\ri775\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex124 tesen
alergologice, dintre medicamentele incriminate s1 tabloul clinic \up0
\expndtw0\charscalex115 relatat de bolnav sau inregistrat de cetre medic.
Evaluarea starii de sanatate a bolnavului cu RtAM si includerea pe \up0
\expndtw0\charscalex120 lista medicamentelor necesare a celor ce nu se inrudesc cu
medicamen� \up0 \expndtw0\charscalex126
tele cauzale ale RtA Bolnavul trebuie convins de sansa lui de a toera \up0
\expndtw0\charscalex124 aceste medicamente, ca si de faptul cS. in condifllle unei
supravegheri \up0 \expndtw0\charscalex115 stricte \up0 \expndtw0\charscalex124 (cu
"periuzie de asteptare ", etc.) \up0 \expndtw0\charscalex126 - riscul este minim
sau chiar \par\pard\qj \li873\ri759\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex115
absent in plus, nu trebuie ISsat bolnavul sS-si administreze medicamente in \up0
\expndtw0\charscalex119 lipsa unei supravegheri medicale. aceastS asigurare - o
data luatS - avand \up0 \expndtw0\charscalex117 Si un rol pozitiv in plan
emofional. Se va insista si asupra unor posibilitafi \up0 \expndtw0\charscalex126
terapeutice din domeniul medicinii alternative, dar si a altor forme de \up0
\expndtw0\charscalex115 terapie nemedicamentoasS (agenfl fizici, balneo- si
kinototerapie, de ex.) \par\pard\ql \li1171\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex125 3. Includerea obligatorie a unui test la Placebo, inaintea
testului de \par\pard\qj \li883\ri775\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex114 provocare cu medicamentul proprluzis (absenfa simptomelor
dupS Placebo, \up0 \expndtw0\charscalex125 rupe cercul vicios anterior Tntre
administrarea noulul medicament s1 \up0 \expndtw0\charscalex113 simptomele alergice
cu aparifie prompta la medicamentele "vechi"); \par\pard\qj \li888\ri744\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex116 4. incheierea fiecerui "episod"
reusit oe aomimstrare a unui medicament \up0 \expndtw0\charscalex128 (tolerat de
bolnav) cu dezvoltarea. la acesta. a unei viziuni optimiste \up0
\expndtw0\charscalex118 asupra perspectivei sale terapeutice incluzSnd holile
actuae cat $i ocaziile \up0 \expndtw0\charscalex112 frecvent intSlnite \up0
\expndtw0\charscalex117 (viroze, probleme stomatologies, traun.atisme, etc.)
care \par\pard\ql \li883\sb0\sl-217\slmult0 \up0 \expndtw0\charscalex115 vor
necesita fortuit terapie medicamentoasS \par\pard\ql \li1180\sb33\sl-230\slmult0
\up0 \expndtw0\charscalex120 G Bolnavul nevrotic ce mimeaza alergia
medicamentoasS \par\pard\qj \li897\ri730\sb0\sl-246\slmult0\fi287 \up0
\expndtw0\charscalex119 Exise bolnavi neurotic!. fdrd experienfa trditd a unui
"accident alergic \up0 \expndtw0\charscalex122 medicamentos", care -impresionafi de
ceea ce au vazul ori auzit despre \up0 \expndtw0\charscalex116 RtAM la alte
persoane (mai ales rude) - pot avea simptome ce mimeazS, in \up0
\expndtw0\charscalex116 planul acuzelor subiective, alergia. \par\pard\qj
\li888\ri744\sb0\sl-250\slmult0\fi302 \up0 \expndtw0\charscalex115 Mai frecvent
sunt intainifi pacienfii descrisi deja, care au trdit "pe pielea \up0
\expndtw0\charscalex115 lor" reacfiile alergice si devin timorafi, mimand apoi
reacfule respective cu \up0 \expndtw0\charscalex115 ocazia administraru altor
medicamente. \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart Pg257}
240\slmult0\fi302 \up0 \expndtw0\charscalex139 Maril nevrotici trebuie obligatoriu
indrumafi spre consultul psihia \up0 \expndtw0\charscalex140 trie dar obligafla
medicului alergolog este de a le solufiona problema \up0 \expndtw0\charscalex138
relafiei dintre simptomele lor, Tn special subiective, si medicamentele \up0
\expndtw0\charscalex145 presupuse a fi alergene cauzale ale simptomelor respective.
Pentru \up0 \expndtw0\charscalex130 bolnavii nevrotici din prima categorie
(nevroticil puri, fSrS antecedente de \up0 \expndtw0\charscalex127 RtAM) este
suficient adesea un test de provocare la o fiolS de ser fiziologic, \up0
\expndtw0\charscalex127 prezentatS drept "medicament" \par\pard\qj
\li1233\ri410\sb3\sl-237\slmult0\fi297 \up0 \expndtw0\charscalex125 Pentru bolnavii
nevrotici cu antecedente de RtAM dar cu reactii ulterioare \up0
\expndtw0\charscalex127 neuro-vegetative psihosomatice - mimSnd tabloul simptomelor
(subiectiv in \up0 \expndtw0\charscalex126 special) ale accidentului medicamentos
real, trSit Tn trecut - conduita medi� \up0 \expndtw0\charscalex125 cului alergolog
trebuie sS fie aceeasi ca si Tn cazul bolnavilor cu reactii aler� \up0
\expndtw0\charscalex130 gice si pseudoalergice veritabite la medicamente (survenlnd
in continuarea \up0 \expndtw0\charscalex129 episoduiul initial), deci cele 4 etape
descrise mai sus, dar acesti bolnavi pot \up0 \expndtw0\charscalex127 fi trimisi la
psihiatru numai dupS ce au fost instruifi asupra modului Tn care \up0
\expndtw0\charscalex126 vor trebui sa coopereze cu medicul in cazul administrSrii
medicamentului si. \up0 \expndtw0\charscalex130 mat ales, dace asiguranle date de
cStre medicul alergolog curent nu au reu \up0 \expndtw0\charscalex103 Sit \up0
\expndtw0\charscalex128 sS-i detensioneze din punct de vedere psihic.
\ul0\nosupersub\cf9\f10\fs20 Blbliografie \par\pard\ql \li1564\sb89\sl-
207\slmult0 \up0 \expndtw0\charscalex113 \ul0\nosupersub\cf3\f4\fs18 1. Bousquet J,
Godard Ph. Michel FB (eds): Altergologie, Ellipses. Paris 1993 \par\pard\ql
\li1531\sb1\sl-198\slmult0\tx3249\tx3436 \up0 \expndtw0\charscalex121 2. lamandescu
IB \tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw0\charscalex123
Considerations on some psychological and psychiatric \par\pard\ql \li1756\sb15\sl-
207\slmult0 \up0 \expndtw0\charscalex119 aspects ot allergy, based on personal
studies, Rev. Roum. Psychol. Sciences \par\pard\li1756\sb20\sl-
207\slmult0\fi0\tx3484\tx3945\tx4286\tx4468 \up0 \expndtw0\charscalex106
Sociales \u9632? Psychol\tab \up0 \expndtw-8\charscalex95 1987.\tab \up0 \expndtw-
4\charscalex100 31.\tab \up0 \expndtw-4\charscalex100 1.\tab \up0
\expndtw0\charscalex106 81-84.\par\pard\qj \li1531\ri421\sb0\sl-
240\slmult0\tx1756 \up0 \expndtw0\charscalex120 3. lamandescu IB - Principles ot
psychosomatic approach to allergic patients. \line\tab \up0 \expndtw0\charscalex113
RevRoum-Psycho! 1993, 37, 1. 79-89 \par\pard\ql \li1536\sb0\sl-162\slmult0 \up0
\expndtw0\charscalex115 4 lamandescu IB-Manual de Psihologie Medicald. Infomedica,
Bucuresti, 1995 \par\pard\qj \li1536\ri395\sb0\sl-220\slmult0\tx1751 \up0
\expndtw0\charscalex113 5. lamandescu IB. Popa-Velea O. Neurotic symptomatology in
allergic and in non \line\tab \up0 \expndtw0\charscalex113 allergic asthma
patients. Allergy 1995. 50. 26, 310. \par\pard\li1536\sb14\sl-207\slmult0\fi0
\up0 \expndtw0\charscalex117 6. lamandescu IB. Popa-Velea O, Mazuru Georgiana
\u9632? Psychological parameters\par\pard\li1536\sb5\sl-207\slmult0\fi220\tx8059
\up0 \expndtw0\charscalex117 in patients with allergic and pseudoatlergic reactions
to drugs Allergy,\tab \up0 \expndtw0\charscalex116 1997,\par\pard\li1536\sb8\sl-
207\slmult0\fi220\tx3004 \up0 \expndtw0\charscalex113 52, suppl, 37,\tab \up0
\expndtw0\charscalex116 7. Predescu V, Nica-Udangiu St The etiologie fadyors in
neurasthenica.\par\pard\li1536\sb8\sl-207\slmult0\fi220\tx5025\tx5515\tx5817\tx6000
\up0 \expndtw0\charscalex113 Rev.Roum.Psychiat. Neurol. Psychol.\tab \up0 \expndtw-
8\charscalex97 1977,\tab \up0 \expndtw-8\charscalex85 15,\tab \up0 \expndtw-
4\charscalex100 1.\tab \up0 \expndtw0\charscalex116 25-33.\par\pard\li1536\sb5\sl-
207\slmult0\fi4\tx7785 \up0 \expndtw0\charscalex116 8. Seropian E. Alergia
respiratorie si digestivd. Ed.Medical*. Bucuresti.\tab \up0 \expndtw0\charscalex116
Seropian E., lamandescu IB.-Falso reacfii alergice la medicamente induse
de\par\pard\li1536\sb9\sl-207\slmult0\fi225 \up0 \expndtw0\charscalex117 experienfa
psihotraumatizantd a unor socuri anafilactice la penicilme.
Viafa\par\pard\li1536\sb9\sl-207\slmult0\fi235\tx2692 \up0 \expndtw0\charscalex107
Medicald.\tab \up0 \expndtw0\charscalex116 1980. 37, 401-
10. Van Arsdel PP Jr. Adverse drug reactions.\tab \up0 \expndtw0\charscalex116
1389-1414 In: E.J.Middleton,\par\pard\li1536\sb9\sl-207\slmult0\fi321 \up0
\expndtw0\charscalex117 C.E.Reed. EF. Ellis (eds). Allergy. Principles and
Practice. Mosby St. Louts,\par\pard\li1536\sb14\sl-207\slmult0\fi335\tx2635 \up0
\expndtw-1\charscalex100 Toronto.\tab \up0 \expndtw0\charscalex116
1983\par\pard\li1536\sb4\sl-207\slmult0\fi52\tx4780 \up0 \expndtw0\charscalex116 n
Vervolet D. Drug allergy pp.\tab \up0 \expndtw0\charscalex116 185-192. In.
UCB-Allergy Manual. UCB\par\pard\li1536\sb18\sl-207\slmult0\fi307\tx4459 \up0
\expndtw0\charscalex112 Pharm.Sect.Braine - L'Alleud,\tab \up0
276\slmult0 \up0 \expndtw0\charscalex118 \ul0\nosupersub\cf14\f15\fs24 Capitolul
4 \par\pard\ql \li1137\sb0\sl-276\slmult0 \par\pard\ql\li1137\sb188\sl-
276\slmult0 \up0 \expndtw-1\charscalex100 PSIHOSOMATICA ENDOCRINOLOGICA
\ul0\nosupersub\cf9\f10\fs20 Fraga Paveliu, Sorin Paveliu \par\pard\qj
\par\pard\qj\li1137\ri1622\sb240\sl-340\slmult0\tx1368
\up0 \expndtw0\charscalex133 I. Sindroame psihoneuroendo<rine (deregldri endocrine
\line\tab \up0 \expndtw0\charscalex134 aparent exclusiv psihogene) \par\pard\qj
\li844\ri798\sb167\sl-260\slmult0\fi287 \up0 \expndtw0\charscalex110 Sindroamele
psihoneuroendocrine reprezinta o expresie a respunsului orga� \up0
\expndtw0\charscalex112 nismului uman la acfiunea stresului cronic (amenoreea si
impotenfa psihoge� \up0 \expndtw0\charscalex111 ne, nanismul psihosocial, sindromul
\u8222?bolii eutiroidiene", hipocorticismul cen� \up0 \expndtw0\charscalex110 tral)
sau reprezinte tulburari psihice ale comportamentului alimentar: \up0
\expndtw0\charscalex107 anorexia \par\pard\ql \li849\sb25\sl-230\slmult0\tx1080
\up0 \expndtw-9\charscalex84 Si \tab \up0 \expndtw0\charscalex111 bulimia nervoase.
obezitatea. \par\pard\ql \li2438\sb0\sl-240\slmult0
\par\pard\ql\li2438\ri2332\sb22\sl-240\slmult0\tx3475 \up0 \expndtw0\charscalex116
Tabelul 1. Patologia psihoneuroendoerind \line\tab \up0 \expndtw0\charscalex114
(dupa Coculescu M.) \par\pard\qj \li1636\ri4193\sb198\sl-340\slmult0\tx2294 \up0
\expndtw0\charscalex118 1. Patologia endocrina de stres \line\tab \up0
\expndtw0\charscalex111 Amenoreea de stres \par\pard\qj \li2303\ri3147\sb17\sl-
320\slmult0\fi4 \up0 \expndtw0\charscalex109 Deficitul sexual de stres al
barbatuiui \up0 \expndtw0\charscalex110 Pseudociesis (Sarcina lantome) \par\pard\qj
\li2303\ri2426\sb0\sl-340\slmult0 \up0 \expndtw0\charscalex106 Sindromul "bolii
eutiroidiene" (Euthyroid sick \up0 \expndtw0\charscalex104 syndrome)
Nanismul psihosocial \up0 \expndtw0\charscalex106 Hipocorticismul central
2 Patologia comportamentului alimentar \line\tab \up0 \expndtw0\charscalex108
Anorexia nervoase \par\pard\ql \li2308\sb95\sl-230\slmult0 \up0
\expndtw0\charscalex108 Bulimia nervoase \par\pard\ql \li2308\sb90\sl-
230\slmult0 \up0 \expndtw0\charscalex109 Neuroendocrinologia obeziefii \par\pard\ql
\li1161\sb0\sl-230\slmult0 \par\pard\ql\li1161\sb60\sl-230\slmult0\tx7123 \up0
\expndtw0\charscalex110 Bolile cunoscute ca avand etiologie psihice aparent
exclusive si \tab \up0 \expndtw0\charscalex111 mecanism \par\pard\ql
\li868\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex118 patogenic neuroendocrin
demonstrat sunt relativ pufme, insS numSrul lor
\expndtw0\charscalex114 �>\tab \up0 \expndtw0\charscalex114 Elemento de
240\slmult0 \up0 \expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 creste rapid,
odats cu progresul endocrinologiei, proces ce are drept consecin\up0
\expndtw0\charscalex114 fS utilizarea neurohormonilor in tratamentul acestor
boli. \par\pard\qj \li1104\ri519\sb4\sl-260\slmult0\fi283 \up0
\expndtw0\charscalex114 Stresui cronic acfioneazS asupra sistemului endocrin pnn
douS mecanisme \up0 \expndtw0\charscalex114 Itziopatologice: amplificarea si
disprotecfia (dupa Coculescu M.) (Tabelul 2). \par\pard\qj \li1896\sb0\sl-
240\slmult0 \par\pard\qj\li1896\ri947\sb57\sl-240\slmult0\tx2817 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf14\f15\fs24 Tabelul 2. Mecanisme flzlopatologlce
prin cere stresui cronic \line\tab \up0 \expndtw-2\charscalex100 acfloneaza asupra
sistemului
endocrin\par\pard\sect\sectd\sbknone\cols2\colno1\colw4229\colsr110\colno2\colw4521
\colsr160\ql \li1564\sb0\sl-230\slmult0 \par\pard\ql \li1564\sb67\sl-230\slmult0
\up0 \expndtw0\charscalex113 \ul0\nosupersub\cf9\f10\fs20
Amplificare\par\pard\ql \li1574\sb0\sl-230\slmult0 \par\pard\ql \li1574\sb0\sl-
230\slmult0 \par\pard\ql \li1574\sb69\sl-230\slmult0 \up0 \expndtw0\charscalex112 -
amenoree si infertilitate\par\pard\ql \li1579\sb149\sl-230\slmult0 \up0
\expndtw0\charscalex110 - disfuncfii sexuale la bSrbat\par\pard\ql
\li1574\sb144\sl-230\slmult0 \up0 \expndtw0\charscalex113 -
imunosupresie\par\pard\ql \li1588\sb145\sl-230\slmult0 \up0 \expndtw0\charscalex111
- hipercorticism reactiv\par\pard\ql \li1440\sb0\sl-230\slmult0 \par\pard\ql
\expndtw0\charscalex117 1. Amenoreea de stres\par\pard\column \ql \li4339\sb0\sl-
Disprotecfie (exagerarea , stingerii'\par\pard\ql \li269\sb154\sl-230\slmult0
\up0 \expndtw0\charscalex121 \ul0\nosupersub\cf18\f19\fs20\ul reacfiei endocrine la
stres acut)\par\pard\ql \li29\sb145\sl-230\slmult0 \up0 \expndtw0\charscalex109
\ul0\nosupersub\cf9\f10\fs20 - hipocorticism central\par\pard\ql \li29\sb149\sl-
230\slmult0 \up0 \expndtw0\charscalex112 - nanism psihosocial
\expndtw0\charscalex124 Amenoreea hipogonadotropicS sau amenoreea secundarS apare
prin \up0 \expndtw0\charscalex116 alterarea bioritmului circadian al secrefiei de
GnRH s* secundar al LH, fSrS \up0 \expndtw0\charscalex116 leziuni organice.
Amenoreea hipogonadotropicS este datoratS unor cauze diverse. Cea mai \up0
\expndtw0\charscalex118 frecvents formS dobanditS de amenoree hipogonadotropicS
este de naturS \up0 \expndtw0\charscalex113 psihogene. survenind in asociere lie cu
stresui emofional acut. fie cu eel cronic \up0 \expndtw0\charscalex105 (Williams W.
Beck Jr.). \par\pard\qj \li1113\ri520\sb2\sl-260\slmult0\fi283 \up0
\expndtw0\charscalex118 Amenoreea de stres se produce brusc - uneori fiind precedae
de deregeri \up0 \expndtw0\charscalex115 ale ciclului menstrual - in urma unei
emofil puternice, a unei traume afective, \up0 \expndtw0\charscalex115 a unor stari
de tensiune psihicS, etc. (Dumitrache C s' colab.). \par\pard\qj
\li1113\ri510\sb0\sl-255\slmult0\fi292 \up0 \expndtw0\charscalex116 Amenoreea din
anorexia nervoasS este expresia unui dezechilibru secre\up0 \expndtw0\charscalex117
tor de prolactinS cu o hipersecretie exagerats in condifii de stimulare si care
\up0 \expndtw0\charscalex113 contribuie la reducerea secrefiei de LH Amenoreea din
anorexia nervoasS este \up0 \expndtw0\charscalex122 consecinfa unor lactori
endochno-metabolici. Poate fi si consecinfa unor \up0 \expndtw0\charscalex110
disfuncfii hipotalamice. \par\pard\qj \li1132\ri501\sb0\sl-254\slmult0\fi278
\up0 \expndtw0\charscalex110 Clinic, manifestSrile sunt urmStoarele: amenoree
(minim 4 luni), anovulafie, \up0 \expndtw0\charscalex128 reducerea caracterelor
sexuale secundare, frigiditate. semnele cauzei \up0 \expndtw0\charscalex112
(stres/efort lizic intens/anorexie nervoasS/pseudociesis - sarcina fantomS). Din
\up0 \expndtw0\charscalex125 punct de vedere al testelor de laborator este o
amenoree prin disfuncfie \up0 \expndtw0\charscalex112 hipotalamo-hipofizarS (tip II
OMS): estradiolul plasmatic este suficient pentru \up0 \expndtw0\charscalex119 ca
administrarea de progesteron sS declanseze menstra, exists pulsafii mai \up0
\expndtw0\charscalex113 rare ale LH $i FSH. Tratamentul contine: Clomifen 50 mg x 5
zile/lunS per os \up0 \expndtw0\charscalex113 sau LHRH i.v.. s.c. pulsalil la 90 de
minute. \par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart Pg260}{\bkmkend
\expndtw0\charscalex108 \ul0\nosupersub\cf8\f9\fs22 Figura 1. AlgorJtm diagnostic
pentru femet cu amenoree secundara\par\pard\li1224\sb1\sl-237\slmult0\fi1358
\up0 \expndtw0\charscalex108 sau infertltltate (dupa M.
Coculescu)\par\pard\sect\sectd\sbknone\cols3\colno1\colw1692\colsr160\colno2\colw22
76\colsr110\colno3\colw4632\colsr160\ql \li998\sb0\sl-138\slmult0 \par\pard\ql
\ul0\nosupersub\cf19\f20\fs12 NCWdfl\par\pard\column \ql \li998\sb0\sl-
184\slmult0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf13\f14\fs16 I
Ta�\ul0\nosupersub\cf19\f20\fs12 ; a pogeslorwi\par\pard\ql \li20\sb29\sl-
ef\par\pard\ql \li443\sb1\sl-154\slmult0 \up0 \expndtw-6\charscalex96
\ul0\nosupersub\cf23\f24\fs14 Hperproaclinemie\par\pard\column \ql \li998\sb0\sl-
161\slmult0 \par\pard\ql \li92\sb116\sl-161\slmult0\tx1456 \up0 \expndtw-
5\charscalex91 Nu apare menslra\tab \up0 \expndtw0\charscalex110
\ul0\nosupersub\cf19\f20\fs12 -\u8226?\u8226? Taai\par\pard\ql \li998\sb0\sl-
207\slmult0 \par\pard\ql \li20\sb97\sl-207\slmult0\tx1374\tx2665 \up0
\expndtw0\charscalex104 \ul0\nosupersub\cf3\f4\fs18 tHMh\tab \up0 \expndtw-
1\charscalex100 \ul0\nosupersub\cf19\f20\fs12 Merislll\tab \up0 \expndtw-
4\charscalex100 \ul0\nosupersub\cf9\f10\fs20 o
qmwmen\par\pard\sect\sectd\sbknone\cols2\colno1\colw3708\colsr160\colno2\colw4992\c
olsr160\ql
\expndtw-1\charscalex100 \ul0\nosupersub\cf13\f14\fs16 Ijnoral\tab \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf23\f24\fs14 Funcjoruil\par\pard\qj
\li2164\ri246\sb116\sl-321\slmult0 \up0 \expndtw-6\charscalex94 lumon ou MM
lacltKrnlt \line \up0 \expndtw-6\charscalex97 Union ou iintfom oa li|
l\par\pard\ql \li998\sb0\sl-184\slmult0 \par\pard\ql \li998\sb0\sl-184\slmult0
\par\pard\ql \li998\sb80\sl-184\slmult0\tx3378 \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf13\f14\fs16 GrupaOMS\tab \up0 \expndtw0\charscalex43
\ul0\nosupersub\cf3\f4\fs18 If\par\pard\column \ql \li332\sb0\sl-774\slmult0\tx1652
\up0 \expndtw0\charscalex112 \ul0\nosupersub\cf1\f2\fs86 A\tab \up0
\expndtw0\charscalex120 A\par\pard\ql \li20\sb0\sl-126\slmult0\tx832 \up0
\expndtw0\charscalex112 \ul0\nosupersub\cf23\f24\fs14 pjuHntnt\tab \up0
\expndtw0\charscalex108 ITSH>3 Cmat\par\pard\ql \li20\sb0\sl-144\slmult0 \up0
\expndtw-2\charscalex100 \ul0\nosupersub\cf13\f14\fs16 \u9632?
blMjinM\par\pard\ql \li25\sb0\sl-108\slmult0\tx832\tx1437\tx2214\tx3193 \up0
\expndtw0\charscalex111 \ul0\nosupersub\cf19\f20\fs12 Oitlurcta\tab \up0
\expndtw0\charscalex100 Orar\tab \up0 \expndtw0\charscalex108 leiiician<a\tab
\up0 \expndtw0\charscalex128 lnsuaan|l\tab \up0 \expndtw0\charscalex120 Laiuu da
trad\par\pard\ql \li25\sb1\sl-127\slmult0\tx841\tx2209\tx3193 \up0 \expndtw-
2\charscalex100 hipoUUmo-\tab \up0 \expndtw0\charscalex105 polichisiic ovananl\tab
\up0 \expndtw-3\charscalex100 liipoUrara\tab \up0 \expndtw-1\charscalex100
genital\par\pard\ql \li25\sb27\sl-138\slmult0\tx1437 \up0 \expndtw0\charscalex109
hipafuari\tab \up0 \expndtw0\charscalex113 primtit\par\pard\ql \li5520\sb0\sl-
138\slmult0 \par\pard\ql \li1839\sb104\sl-138\slmult0\tx2589 \up0
\expndtw0\charscalex106 turrcraii\tab \up0 \expndtw0\charscalex105
nHumorill\par\pard\ql \li5520\sb0\sl-184\slmult0 \par\pard\ql \li1672\sb43\sl-
184\slmult0\tx2037\tx2857\tx3563 \up0 \expndtw0\charscalex60
\ul0\nosupersub\cf13\f14\fs16 III\tab \up0 \expndtw-7\charscalex74 VII\tab \up0
\expndtw-2\charscalex100 I\tab \up0 \expndtw-7\charscalex72 IV
\par\pard\sect\sectd\sbknone \ql \li1094\sb0\sl-230\slmult0
\ul0\nosupersub\cf9\f10\fs20 2. Deflcltul sexual de stres al barbatului
Stresui poate provoca o insuficienfa orhitica de tip hipotalamic hipogo\up0
\expndtw0\charscalex115 nadotrop, similars cu amenoreea de stres a femeii, cu
deficit in producfia de \up0 \expndtw0\charscalex115 testosteron, sau poate
declansa tulburSri de dinamicS sexualS. fSrS substrat \up0 \expndtw0\charscalex114
hormonal aparent. Numai tulburarile sexuale functionale cu deficit endocrin \up0
\expndtw0\charscalex109 beneficiazS de terapie hormonalS. \par\pard\qj
\li801\ri826\sb20\sl-260\slmult0\fi283 \up0 \expndtw0\charscalex119 in
etiopatogenie intervin amplificarea reacfiei endocrine fiziologice de \up0
\expndtw0\charscalex126 stres si factorii psihologici din copilSrie si adolescents;
orice condifie \up0 \expndtw0\charscalex114 psihologica sau psihiatricS asociae cu
teama (anxietatea) sau depresia. poate \up0 \expndtw0\charscalex116 conduce la
ImpotenfS sau ejaculare precoce Factorul decisiv este reprezen\up0
\expndtw0\charscalex108 tat de nivelul stresului (Coculescu M.). \par\pard\qj
\li806\ri826\sb0\sl-260\slmult0\fi288 \up0 \expndtw0\charscalex111 Criteriile de
diagnostic sunt reprezentate de nivelul scSzut de testosteron in \up0
\expndtw0\charscalex114 asociere cu un nivel normal sau redus de hormoni
gonadotropi; trebuie fScut \up0 \expndtw0\charscalex123 diagnostic de excludere a
unei eventuae cauze organice, a insuficienfei \up0 \expndtw0\charscalex106
hipotalamo-hipofizare. \par\pard\qj \li801\ri835\sb0\sl-263\slmult0\fi297 \up0
\expndtw0\charscalex118 Dintre metodele de tratament se pot menfiona preparatele
hormonale -\line \up0 \expndtw0\charscalex113 hormonii androgent, gonadolibennele -
eficiente cand nivelul testosteronului \up0 \expndtw0\charscalex122 plasmatic este
diminuat. Hormonii androgenl sunt eficienfi Tn corecfia \up0
\expndtw0\charscalex109 comportamentului; gonadolibennele (GnRH) restabilesc
secrefia pulsatilS a LH \up0 \expndtw0\charscalex110 S' FSH, corectand atat
deficitul hormonal cat si spermatogeneza. Psihoterapia, \up0
\expndtw0\charscalex117 Tn aceste cazuri, este obligatorie. De asemenea, trebuie
evitat efortul fizic \up0 \expndtw0\charscalex100 major.
8\charscalex70 <>\tab \dn2 \expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs20
Elemente de psihosomatica generala si aplicata\par\pard\ql \li1459\sb0\sl-
230\slmult0 \up0 \expndtw0\charscalex122 3. Pseudociesis (sarcina fantoma)
Pseudociesis este un sindrom nepsihotic Tn cadrul cSruia, la o femeie \up0
\expndtw0\charscalex123 convinsS cS este gravidS (desi nu este). apare amenoree
insofie de unele \up0 \expndtw0\charscalex117 semne clinice de sarcinS Este o forms
de amenoree neurogenS ce apare mai \up0 \expndtw0\charscalex117 frecvent
postpubertar sau in premenopauzS. \par\pard\ql \li1459\sb189\sl-230\slmult0 \up0
\expndtw0\charscalex118 4. Sindromul ..bolii eutiroidiene" \par\pard\qj
\li1161\ri440\sb182\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex122 Prin
sindromul bolii eutiroidiene se infelege scaderea nivelului de T3 \up0
\expndtw0\charscalex118 Si/sau T4 farS o crestere a TSH serie, ca urmare a
stresului cronic determi\up0 \expndtw0\charscalex118 nat de bolile acute sau
cronice ale organismului. \par\pard\ql \li1156\ri438\sb0\sl-
240\slmult0\fi297\tx1449\tx1449\tx1454 \up0 \expndtw0\charscalex116 Bolile non-
tiroidiene pot afecta funcfia tiroidianS la orice nivel, inclusiv \up0
\expndtw0\charscalex110 secrefia hormonae, transportul si metabolismul hormonilor
tiroidieni. \line \tab \up0 \expndtw0\charscalex111 Cele mat importante alterSn
comune majoritafii proceselor patologice, sunt \up0 \expndtw0\charscalex110 cele
care implies transportul hormonilor tiroidieni $i cSile metabolice. \line \tab \up0
\expndtw0\charscalex113 in stresui cronic provocat de afecfiunile sistemice acute
sau cronice sau de \up0 \expndtw0\charscalex126 traumatisme accidentale sau
chirurgicale apare de obicei o diminuare \up0 \expndtw0\charscalex116 accentuate a
concentrafiei serice de T2care. ocazional. poate sS scadS pans \up0
\expndtw0\charscalex121 la nivele nedetectabile prin evaluSrile clinice de rutinS.
DatoritS acestor \up0 \expndtw0\charscalex113 rezultate si aparentei lipse de
simptome si semne compatibiie cu diagnosticul \up0 \expndtw0\charscalex116 de
hipotiroidism. a fost introdus termenul de sindrom al "bolii eutiroidiene" \up0
\expndtw0\charscalex111 (sindrom cu nivel scSzut de T.,) Aceste expresii nu sunt
cele mai potrivite. \line\tab \up0 \expndtw0\charscalex123 in alara scSderii
concentrafiei serice a T3, trebuie avutS in vedere si \up0 \expndtw0\charscalex111
posibilitatea ca nivelele hormonale tisulare sS nu fie profund diminuate, sau ca
\up0 \expndtw0\charscalex126 valonle concentrafiei tisulare de T3 sS fie adecvate
pentru modilicSri \up0 \expndtw0\charscalex108 concomitente ale densitSfii
receptorilor sSi tisulari. Sindromul \u8222?bolii eutiroidie� \up0
\expndtw0\charscalex108 ne" prezintS trei forme: \par\pard\ql \li1468\sb29\sl-
230\slmult0 \up0 \expndtw0\charscalex114 - forma comunS cu eutiroidie; \par\pard\ql
\li1569\sb1\sl-193\slmult0 \up0 \expndtw0\charscalex112 forma cu T4 crescut
reprezentae prin semne $i simptome de hipertiroidie: \par\pard\ql \li1468\sb17\sl-
230\slmult0 \up0 \expndtw0\charscalex118 - forma severa cu semne si simptome de
insuficiefa tiroidianS. \par\pard\qj \li1171\ri422\sb2\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex112 insS multi pacienfi au manifestSri sugestive de hiper- sau
hipometabolism. \up0 \expndtw0\charscalex125 Este discutabil dacS aceste modilicSri
metabolice sunt dependente de \up0 \expndtw0\charscalex108 acfiunea hormonilor
tiroidieni. \par\pard\qj \li1171\ri430\sb0\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex110 Sindromul ..bolii eutiroidiene" trebuie diferentiat de
hipotiroidismul primar, \up0 \expndtw0\charscalex113 secundar si terfiar; in acest
sindrom, rT3 este crescut, iar in hipotiroidism rT3 \up0 \expndtw0\charscalex113
este scazut. \par\pard\ql \li1660\ri960\sb180\sl-240\slmult0\tx3235 \up0
\expndtw0\charscalex120 Tabelul 3. Diferenflerea intre sindromul \u8222?bolii
eutiroidiene" si \line\tab \up0 \expndtw0\charscalex116 hipotiroidism (dupd Ml leu
St.) \par\pard\li1324\sb197\sl-230\slmult0\fi3009\tx7113 \up0
\expndtw0\charscalex112 rl\\\tab \up0 \expndtw0\charscalex112
TSH\par\pard\li1324\sb135\sl-230\slmult0\fi0\tx4967\tx6580 \up0
\expndtw0\charscalex112 Sindromul\tab \up0 \expndtw0\charscalex112 eel mai
frecvent\tab \up0 \expndtw0\charscalex112 eel mai Irecvent\par\pard\li1324\sb10\sl-
230\slmult0\fi0\tx4967\tx6585 \up0 \expndtw0\charscalex112 ..bolii
eutiroidiene'\tab \up0 \expndtw0\charscalex112 este normal\tab \up0
\expndtw0\charscalex112 este normal\par\pard\li1324\sb101\sl-
230\slmult0\fi0\tx3360\tx6590 \up0 \expndtw0\charscalex112 Hipotiroidism\tab
\up0 \expndtw0\charscalex112 normal\tab \up0 \expndtw0\charscalex112 T (in
hipotiroi�\par\pard\li1324\sb10\sl-230\slmult0\fi2040\tx6585
\up0 \expndtw0\charscalex112 sau i\tab \up0 \expndtw0\charscalex112 dismul
primar)\par\pard\sect\sectd\fs24\paperw9000\paperh13160{\bkmkstart Pg262}{\bkmkend
Concentrafia series a T3 este de obicei redusS in mod disproporfional \up0
\expndtw0\charscalex110 comparativ cu reducerile corespunzStoare ale nivelelor
proteinelor de transport \up0 \expndtw0\charscalex101 sau ale TA. \par\pard\ql
\li1108\sb25\sl-230\slmult0\tx6849 \up0 \expndtw0\charscalex114 in astfel de
situafii, nivelul absolut de triiodotironinS libers \tab \up0
\expndtw0\charscalex114 (T3) este, de \par\pard\qj \li820\ri798\sb26\sl-
260\slmult0\fi9 \up0 \expndtw0\charscalex125 asemenea diminuat. Mecanismul
responsabil pentru aceastS reducere \up0 \expndtw0\charscalex111 selectivS a T3
serie implies degradarea hormonae prin monodeiodare tisularS. \up0
\expndtw0\charscalex108 cu o scSdere a conversiei T4 la T3. \par\pard\qj
\li825\ri803\sb0\sl-260\slmult0\fi292 \up0 \expndtw0\charscalex125 Cresterea
concentratiei serice de revers-T3, care insofese de obicei \up0
\expndtw0\charscalex118 nivelele reduse de T3 se datoreazS probabil alterSrii
clearance-ului. Acest \up0 \expndtw0\charscalex116 aspect este in concordanfS cu
activitatea diminuatS a 5"-deiodazei, enzimS \up0 \expndtw0\charscalex112
responsabie nu numai de produeerea de T3 dar si de degradarea rT3 \par\pard\qj
\li825\ri798\sb0\sl-268\slmult0\fi302 \up0 \expndtw0\charscalex125 Nivelul
enzimelor hepatice induse de hormonii tiroidieni diminuS. \up0
\expndtw0\charscalex106 Activitatea \up0 \expndtw0\charscalex118 5*-deiodazei se
reduce, diminuand astfel conversia T4 Tn T3. \up0 \expndtw0\charscalex113
Glutationul este cofactor in reacfia de deiodare. Ca urmare a aportului scSzut \up0
\expndtw0\charscalex110 de glucide, disponibilitatca glutationului se reduce.
Aportul de numai 50 g glu\up0 \expndtw0\charscalex112 cide la subiecfii in stare de
inamfie, amelioreazS mecanismul de transformare \up0 \expndtw0\charscalex106 a T4
in T3 la nivel pehfenc. \par\pard\qj \li1574\sb0\sl-240\slmult0
Tabelul 4. Diagnostics de in bora tor al sindromului bolii \up0
\expndtw0\charscalex115 eutiroidiene" (dupa) I. G. Toto/enu, G, Vasiiescu. 1993)
\up0 \expndtw0\charscalex119 Sindromul .bolii eutiroidiene'" \par\pard\ql
\ul0\nosupersub\cf18\f19\fs20\ul (Euthyroid sick syndrome) \par\pard\li940\sb17\sl-
\ul0\nosupersub\cf9\f10\fs20 Hormonii\tab \up0 \expndtw0\charscalex114 Forma comuna
cu\tab \up0 \expndtw0\charscalex114 Forma gravS cu\tab \up0 \expndtw0\charscalex114
Forma\par\pard\li940\sb15\sl-230\slmult0\fi1382\tx4627\tx6815 \up0
\expndtw0\charscalex114 eutiroidie\tab \up0 \expndtw0\charscalex114
hipotiroidie\tab \up0 \expndtw0\charscalex114 tireotoxicS\par\pard\li940\sb14\sl-
\ul0\nosupersub\cf18\f19\fs20\ul (Low T3 syndrome)\ul0\tab \up0
\expndtw0\charscalex114 \ul0\nosupersub\cf18\f19\fs20\ul (Low T4
syndrome)\par\pard\li940\sb68\sl-230\slmult0\fi14\tx2323\tx4632\tx6825 \up0
\expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 LT,\tab \up0
\expndtw0\charscalex114 scSzut\tab \up0 \expndtw0\charscalex114 normal\tab \up0
\expndtw0\charscalex114 scSzut\par\pard\li940\sb68\sl-
230\slmult0\fi0\tx2323\tx4632\tx6830 \up0 \expndtw0\charscalex114 TT,\tab \up0
\expndtw0\charscalex114 scSzut\tab \dn2 \expndtw0\charscalex114 normal\tab \dn2
\expndtw0\charscalex114 normal\par\pard\li940\sb58\sl-
230\slmult0\fi0\tx2323\tx4627\tx6815 \up0 \expndtw0\charscalex114 TT,\tab \up0
\expndtw0\charscalex114 normal\tab \up0 \expndtw0\charscalex114 scSzut\tab \up0
\expndtw0\charscalex114 crescut\par\pard\li940\sb67\sl-
230\slmult0\fi14\tx2328\tx4632\tx6820 \up0 \expndtw0\charscalex114 LT,\tab \dn2
\expndtw0\charscalex114 usor crescut\tab \dn2 \expndtw0\charscalex114 scSzut\tab
\up0 \expndtw0\charscalex114 crescut\par\pard\li940\sb77\sl-
230\slmult0\fi14\tx2323\tx4627\tx6830 \up0 \expndtw0\charscalex114 rT,\tab \up0
\expndtw0\charscalex114 crescut\tab \up0 \expndtw0\charscalex114 crescut sau\tab
\up0 \expndtw0\charscalex114 normal sau\par\pard\li940\sb6\sl-
230\slmult0\fi3691\tx6820 \dn2 \expndtw0\charscalex114 normal\tab \up0
\expndtw0\charscalex114 crescut\par\pard\li940\sb58\sl-
230\slmult0\fi9\tx2328\tx4636\tx6835 \up0 \expndtw0\charscalex114 TSH\tab \up0
\expndtw0\charscalex114 normal\tab \up0 \expndtw0\charscalex114 normal sau\tab \up0
\expndtw0\charscalex114 normal sau\par\pard\li940\sb14\sl-230\slmult0\fi3686\tx6830
\up0 \expndtw0\charscalex114 diminuat\tab \up0 \expndtw0\charscalex114
scSzut\par\pard\qj \li950\ri917\sb47\sl-220\slmult0\fi9 \up0
\expndtw0\charscalex103 LT3� triiodotironina sericd liberd: TT3= triiodotironina
tntald (liberd si legate de \up0 \expndtw-2\charscalex100 proteine vectoare): TT4 =
tiroxina totald (liberd si legatd de proteine vectoarej: L T4= \up0 \expndtw-
3\charscalex100 tiroxina sericd libera: rT3= revers triiodotironina.
\par\pard\ql \li1137\sb0\sl-230\slmult0 \par\pard\ql\li1137\sb2\sl-230\slmult0 \up0
\expndtw0\charscalex119 5. Nanismul psihosocial \par\pard\qj \li849\ri817\sb57\sl-
270\slmult0\fi288 \up0 \expndtw0\charscalex111 Nanismul psihosocial este un sindrom
psihoendocrin reprezenend expresia \up0 \expndtw0\charscalex121 mecanismului de
disprotecfie prin care stresui cronic acfioneazS asupra \up0
\expndtw0\charscalex109 sistemului endocrin.
\expndtw0\charscalex109 Contextul clinic si social de aparifie a nanismului poate
fi foarte diferit. Sunt \up0 \expndtw0\charscalex111 cunoscute deficitul statural
si intarzierea vSrstei osoase, uneori si a maturizShi \up0 \expndtw0\charscalex111
pubertare, survenite la copii institufionalizafi avand inteligenfa normale, pe
de \up0 \expndtw0\charscalex114 o parte, precum $' la copii provenind din familii
cu probleme, generatoare de \up0 \expndtw0\charscalex122 carenfa psihoafective
continue si intense, pe de alte parte \up0 \expndtw0\charscalex116 (Popa M.). in
etiologia aeestei boli, alaturi de deprivarea psiho-afective si mediul familial
\up0 \expndtw0\charscalex112 dezorganizat. intervin si tulburarile de somn, precum
si carenfele nutrifionale. \up0 \expndtw0\charscalex112 Copiii respectivi pot
prezenta un comportament bizar, retras. \par\pard\qj \li1521\ri125\sb34\sl-
220\slmult0\fi292 \up0 \expndtw0\charscalex115 Majoritatea pacienfilor prezinta
valori normale ale rezervei hipofizare de \up0 \expndtw0\charscalex108 STH dupe
testare prin diferifi stimuli. \par\pard\qj \li1511\ri130\sb24\sl-240\slmult0\fi302
\up0 \expndtw0\charscalex120 Existe o mare asenenare intre nanismul prin deprivare
psihosociale si \up0 \expndtw0\charscalex115 nanismul hipofizar; chiar si unele
teste de functionalitate somatotrope pot fi \up0 \expndtw0\charscalex113 parfial
modificate. Astfel, testul la insulma dS rezultate sub limitele normale, \up0
\expndtw0\charscalex120 dar se normalizeazS dupS remedierea situatiei psihosociale
nefavorabile. \up0 \expndtw0\charscalex109 Somatomedinele sunt in limite
normale. \par\pard\qj \li1526\ri123\sb20\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex115 Caracteristica esenfialS a aeestei tulburSri de cresere
este reversibilitatea \up0 \expndtw0\charscalex116 sa dupa remedierea factorului
psihoafectiv, uneori fiind prezent chiar feno\up0 \expndtw0\charscalex116 menul
cresterii compensator^ \par\pard\ql \li1819\sb189\sl-230\slmult0 \up0
\expndtw0\charscalex118 6. Hipocorticismul central \par\pard\qj
\li1521\ri123\sb157\sl-246\slmult0\fi297 \up0 \expndtw0\charscalex111 Dintre
factorii etiopatogenici ai hipocorticismului se menfioneazS actiunea \up0
\expndtw0\charscalex119 unui factor stresant ce survine pe fondul unei insuficienfe
corticosuprare\up0 \expndtw0\charscalex116 nale cronice, agentul stresant putand fi
reprezentat de orice boae acue, stare \up0 \expndtw0\charscalex116 lebrie, elort
fizic, stres emotional etc. \par\pard\qj \li1516\ri122\sb0\sl-246\slmult0\fi297
\up0 \expndtw0\charscalex119 Patogenia hipocorticismului central este
caracteristica disprotecfiei: se \up0 \expndtw0\charscalex112 supreseaza producfia
de cortizoi pentru a evita rSspunsul prelungit la actiunea \up0
\expndtw0\charscalex113 factorului stresant aplicat cronic. Supresia excesivS scade
producfia bazae de \up0 \expndtw0\charscalex113 hormoni corticosteroizi (Coculescu,
\expndtw0\charscalex129 Manifestarea clinics este aceea de surmenaj: astenie,
inapetenfS. \up0 \expndtw0\charscalex109 hipotensiune arterialS ortostaticS.
Tratamentul conse in TndepSrtarea agentului stresant, vitamina B6, lecitlnS,
\up0 \expndtw0\charscalex101 ACTH (uneori). \par\pard\ql \li1838\sb182\sl-
230\slmult0
\up0 \expndtw0\charscalex115 7. Anorexia nervoasa \par\pard\qj
\li1531\ri128\sb182\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex112 Refuzul
alimentar si vSrsaturile provocate determinS Tn timp condifionSrl \up0
\expndtw0\charscalex112 care, in urma denutrifiei si a anemiei severe, produc
dereglSrl hipotalamice si \up0 \expndtw0\charscalex105 insuficienfS hipofizarS
pluritropS. \par\pard\qj \li1545\ri118\sb0\sl-250\slmult0\fi278 \up0
\expndtw0\charscalex108 in contextul celorlalte tulburSri hipofizare (corticotropS
si tireotropS) apar si \up0 \expndtw0\charscalex112 tulburari gonadale, manifestate
prin dereglSri aleciclului menstrual, finalizate \up0 \expndtw0\charscalex112 cu
amenoree (Dumitrache C. si colab.). \par\pard\ql \li1555\ri118\sb0\sl-
240\slmult0\fi283\tx1848 \up0 \expndtw0\charscalex118 in mecanismul de realizare a
amenoreei din anorexia nervoasS inervin \up0 \expndtw0\charscalex109 factori
metabolici si neuroendocrini, ca expresie a unei disfuncfii hipotalamice. \line\tab
\up0 \expndtw0\charscalex112 Sindromul apare la adolescente sub varsta de 22 de ani
si se caracterizeazS \up0 \expndtw0\charscalex121 prin trlada clasica: amenoree,
scSdere Tn greutate \up0 \expndtw0\charscalex114 $1 modificSri ale
PsihosomaticS aplicats\tab \up0 \expndtw0\charscalex111 \u9830? 261\par\pard\qj
comportamentului alimentar. mai ales anorexie, fara se se exclude si \up0
\expndtw0\charscalex110 perioade de bulimie. \par\pard\qj \li940\ri711\sb0\sl-
260\slmult0\fi292 \up0 \expndtw0\charscalex121 Pe langS semnele sj simptomele de
malnutrifie protein-calorice sunt \up0 \expndtw0\charscalex110 prezente si
tulburari psihice comportamentale. \par\pard\qj \li940\ri698\sb0\sl-
260\slmult0\fi292 \up0 \expndtw0\charscalex115 Boala apare mai ales la fete Tn
perioada postpuberae si se caracterizeaze \up0 \expndtw0\charscalex110 printr-o
sebire accentuate autoimpusS, ce are o frecvenfe de 4:100.000 (Kalney
\par\pard\ql \li945\sb5\sl-230\slmult0 \up0 \expndtw0\charscalex110 R. C. si
colab.) la populafia generae, dar de 1:100 de fete adolescente (Kendell
\par\pard\ql \li945\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex108 R. E si
colab.). \par\pard\ql \li940\ri702\sb14\sl-250\slmult0\fi278\tx1219 \up0
\expndtw0\charscalex120 Anorexia nervoase a castigat importanta in ultima perioade,
odatS cu \up0 \expndtw0\charscalex113 perfecttonarea metodelor biochimice si fizice
de apreciere a masei osoase. \line\tab \up0 \expndtw0\charscalex114 Astfel. studii
recente \up0 \expndtw0\charscalex115 (Golden N. H. si colab. \up0 \expndtw-
2\charscalex100 -\up0 \expndtw0\charscalex114 1992) au demonstrat cS
amenoreea prelungite predispune la osteopenie, apoi osteoporoze care poate \up0
\expndtw-9\charscalex82 fi \up0 \expndtw0\charscalex120 ireversibilS. afectand grav
si starea de sSnState a pacientelor la vSrstS \up0 \expndtw0\charscalex112 adults.
Ea se datoreazS deficitului cronic de estrogenl, cauzS de amenoree. \par\pard\qj
\li945\ri703\sb2\sl-260\slmult0\fi292 \up0 \expndtw0\charscalex109 S-au mai descris
si alte modificSri ale sistemului neuroendocrin, reflectSnd, \up0
\expndtw0\charscalex109 in buns parte. o adaptare a sistemului endocrin la
stres. \par\pard\qj \li935\ri683\sb5\sl-254\slmult0\fi302 \up0
\expndtw0\charscalex116 Modificarile funcfiei tiroidiene observate la paclentele cu
anorexie ner� \up0 \expndtw0\charscalex111 voasS sunt asemSnStoare celor constatate
Tn cursul deprivSrll calorice. Sem� \up0 \expndtw0\charscalex125 nele si simptomele
care apar pot sugera existenfa unui hipotiroidism. \up0 \expndtw0\charscalex122
Persoanele cu anorexie prezintS tegumente uscate s' reci, o temperaturS \up0
\expndtw0\charscalex110 scSzutS a organismului, constipafie, amenoree. Nivelul
scSzut al concentrafiei \up0 \expndtw0\charscalex113 T3, concentratia mare a revers
T3 si diminuarea r6spunsului TSH la TRH, au \up0 \expndtw0\charscalex114 tendinfa
de a ameliora, dace nu chiar de a normaliza, cresterea ponderae (De \up0
\expndtw0\charscalex106 Groot L. 1996). \par\pard\qj \li945\ri695\sb2\sl-
260\slmult0\fi288 \up0 \expndtw0\charscalex112 in amenoreea din anorexia nervoase
se constae nivele scSzute de FSH, LH \up0 \expndtw0\charscalex112 precum si de
estrogenl. Nivelurlle de prolactine sunt Tn llmite normale. \par\pard\ql
\li1243\sb185\sl-230\slmult0 \up0 \expndtw0\charscalex116 8. Bulimia nervoasd
Profllul neuroendocrin din bulimia nervoase prezinta o oarecare suprapune\up0
\expndtw0\charscalex113 re. atat cu anorexia nervoase, cat si cu depresia.
AsemSnerile dintre anorexia \up0 \expndtw0\charscalex117 nervoasS, depresie si
bulimie includ lipsa supresiei la testul de supresle cu \up0
\expndtw0\charscalex120 dexametazonS si un rSspuns anormal al hormonului de
crestere la TRH \up0 \expndtw0\charscalex114 Pacienfii ce suferS de bulimie, ca si
cei cu anorexie, tind sS aibS un rSspuns \up0 \expndtw0\charscalex113 TntSrziat al
TSH la TRH. niveluri bazale de prolactinS reduse, s' pot avea un \up0
\expndtw0\charscalex114 rSspuns exagerat al prolactine! la TRH. Exists date care
sugereazS faptul cS \up0 \expndtw0\charscalex111 bulimicii pot prezenta un profit
gonadotropinic diferit de subiecfii cu anorexie \up0 \expndtw0\charscalex111
nervoasS sau cu depresie, ca si cu alte endocrinopatii. Desi multe dintre aceste
\up0 \expndtw0\charscalex110 anomalii pot reflecta existenta malnutrifiei in ciuda
greuefii corporale in limite \up0 \expndtw0\charscalex123 normale, alfi factori,
TncS neidentificafi sunt considerafi a contribui la \up0 \expndtw0\charscalex111
deregerile endocrine observate in cadrul bulimiei. \par\pard\ql \li1238\sb26\sl-
230\slmult0 \up0 \expndtw0\charscalex112 S-au mai descris si alte modificSri ale
sistemului neuroendocrin la stres. \par\pard\qj \li950\ri707\sb6\sl-
260\slmult0\fi283 \up0 \expndtw0\charscalex119 Astfel se activeazS axul hipotalamo-
hipofizo-corticosuprarenalian, cu \up0 \expndtw0\charscalex111 cresterea
nivelurilor de cortizoi si inhibarea axului gonadic sau tiroidian.
generae $i\ul0\nosupersub\cf9\f10\fs20 aplicats\par\pard\qj \li1473\sb0\sl-
II. Boli endocrine plurietiologice cu components psihogena \line\tab \up0
\expndtw0\charscalex134 importanta \par\pard\ql \li1468\sb198\sl-230\slmult0
\up0 \expndtw0\charscalex119 A. Aspecte psihosomatice ale principalelor
endocrinopatii \par\pard\qj \li1180\ri442\sb121\sl-266\slmult0\fi292 \up0
\expndtw0\charscalex118 in etiopatogenia plurifactorialS a majoritSfii afecfiunilor
endocrine sunt \up0 \expndtw0\charscalex115 invocafi factorii ereditari,
nutrifionali, tizico-chimici sau biologici etc., dar si \up0
\expndtw0\charscalex112 factorii psihici. Analiza acestora din urmS este limitatS,
Tn cadrul paragrafului \up0 \expndtw0\charscalex112 de fafa, la bolile tiroidei.
\par\pard\ql \li1473\sb124\sl-230\slmult0 \up0 \expndtw0\charscalex122 B. Rolul
stresului in patologia tiroidiana \par\pard\qj \li1195\ri452\sb126\sl-
260\slmult0\fi283 \up0 \expndtw0\charscalex118 Bolile psihosomatice - definite,
chiar si in prezent. extrem de eterogen -\line \up0 \expndtw0\charscalex109 includ
la loc de Irunte hipertiroidismul. \par\pard\qj \li1180\ri438\sb20\sl-
260\slmult0\fi302 \up0 \expndtw0\charscalex123 Indilerent de posibilul substrat
imunologic al uneia dintre formele de \up0 \expndtw0\charscalex109
hipertiroidism \up0 \expndtw0\charscalex117 (boala Basedow), manifestSrile
patologice Tntalnite in acest \par\pard\qj \li1180\ri433\sb0\sl-266\slmult0\fi4
\up0 \expndtw0\charscalex119 sindrom au la baza aparifiei lor intervenfia
sistemului nervos, perturbat Tn \up0 \expndtw0\charscalex114 cursul unei reacfii
acute (brutaie) sau cronice (prelungite) de stres psihic. Asa \up0
\expndtw0\charscalex113 cum s-au conturat mecanismele patogenice ale stresului in
ultimele decenii (v. \up0 \expndtw0\charscalex112 Poenaru -\up0
\expndtw0\charscalex110 1986 s> lamandescu -\up0 \expndtw0\charscalex116 1993)
exists posibilitatea ca aceasta reactie \par\pard\qj \li1185\ri433\sb0\sl-
260\slmult0 \up0 \expndtw0\charscalex123 generae de suprasolicitare a organismului
sS afecteze una dintre verigile \up0 \expndtw0\charscalex115 reglatorii, cea
endocrinS - de exemplu (studiatS initial de Selye), implicate in \up0
\expndtw0\charscalex117 medierea transmiterii impulsurilor cortico-neurovegetative
la organele fintS \up0 \expndtw0\charscalex117 perilence. \par\pard\ql
\li1521\sb140\sl-230\slmult0 \up0 \expndtw0\charscalex119 /. Argumente
epidemiologice si experimente/e \par\pard\qj \li1185\ri436\sb126\sl-
260\slmult0\fi288 \up0 \expndtw0\charscalex114 Este deci explicabilS valabilitatea
unor observafii epidemiologice care pun \up0 \expndtw0\charscalex121 in relafie
cronologicS \up0 \expndtw0\charscalex127 (dar cu mari posibilitSfi cauzale)
prezenfa unor \par\pard\qj \li1190\ri428\sb20\sl-260\slmult0 \up0
\expndtw0\charscalex117 evenimente stresante majore
anterior debutului bolii Basedow, dar si a altor \up0 \expndtw0\charscalex112
lorme de hipertiroidism. Astfel de evenimente, precum decesele celor apropiafi \up0
\expndtw0\charscalex112 (accidentele) \up0 \expndtw0\charscalex116 (expenentele
Luban-Plozza si colab.), deporterile, persecufnle \up0 \expndtw0\charscalex114
politice, bombardamentele, grijile matenaie, profesionale sau conjugae au fost \up0
\expndtw0\charscalex114 observate frecvent inainte de aparitia
hipertiroidismulul. \par\pard\ql \li1488\sb25\sl-230\slmult0\tx8356 \up0
\expndtw0\charscalex120 Manifestariie psihice din hipertiroidism sunt justificate
prin influenfa \tab \up0 \expndtw-2\charscalex100 -\par\pard\qj
\li1190\ri428\sb2\sl-265\slmult0 \up0 \expndtw0\charscalex117 bine demonstrate - a
sistemului nervos central asupra tiroidei (cu includerea \up0
\expndtw0\charscalex114 produsilor de secrefie ai aeestei glande in randul
hormonilor de stres). Nu este \up0 \expndtw0\charscalex118 inse excluse nici
acfiunea realizata de stres, cu implicafii asupra sistemului \up0
\expndtw0\charscalex127 imun si cu modiliceri imunologice consecutive ce pot fi
implicate Tn \up0 \expndtw0\charscalex111 patogeneza uneia dintre formele de
hipertiroidism, de exemplu boala Basedow. \par\pard\ql \li1516\sb144\sl-230\slmult0
\up0 \expndtw0\charscalex121 1.1 Intervenfia stresului psihic la animae
\par\pard\ql \li1516\sb150\sl-230\slmult0 \up0 \expndtw0\charscalex103 Multe dintre
modificSrile funcfiei tiroidiene pot fi datorate Tn parte stresului.
Poate cS eel mai dramatic studiu al stresului emotional a lost raportat de
Krocht, \up0 \expndtw0\charscalex105 care a descopent cS stresui a provocat
tireotoxicoza la iepurii sSlbatlci. Desi
\ul0\nosupersub\cf9\f10\fs20 acelasi tip de stres poate determina secrefia de
hormoni tiroidieni la animalele \up0 \expndtw0\charscalex113 sSlbatice, acest efect
este pufin probabil sS aparS la om. Cresterea activitSfii \up0
\expndtw0\charscalex113 corticosuprarenalei indusS de stres tinde nu numai sS
supreseze eliberarea de \up0 \expndtw0\charscalex107 TSH. dar si sS inhibe
conversia lui T4 in T3. \par\pard\ql \li1070\sb125\sl-230\slmult0\tx1224 \up0
\expndtw-2\charscalex100 1 \tab \up0 \expndtw0\charscalex118 2 Intervenfia
stresurilor chirurgicale \par\pard\qj \li758\ri865\sb126\sl-260\slmult0\fi297
\up0 \expndtw0\charscalex116 La animate intervenfiile chirurgicale experimentale au
fost utilizate ca o \up0 \expndtw0\charscalex112 metodS de a studia efectul
stresului asupra fiziologiei glandei tiroide. Studiile \up0 \expndtw0\charscalex116
la oameni au pornit de la suspiciunea cS hormonii tiroidieni ar putea media \up0
\expndtw0\charscalex120 modificSrile metabolice postoperatorii care conduc e consum
crescut de \up0 \expndtw0\charscalex104 oxigen \up0 \expndtw0\charscalex123 $i
catabolism proteic Unele discrepanfe in datele disponibile se \up0
\expndtw0\charscalex117 datoreazS lipsei uniformiefii in lotunle de pacienfi
studiafi in privinfa seni \up0 \expndtw0\charscalex115 clinice a bolnavului inainte
de intervenfia chirurgicale, in privinfa tipului de \up0 \expndtw0\charscalex121
intervenfie chirurgicale, a anestezicelor si a altor medicamente utilizate. \up0
\expndtw0\charscalex111 precum $' in privinta evolufiei postoperatorii incluzand
alimentafia si perioada \up0 \expndtw0\charscalex111 de convalescenfa. \par\pard\qj
\li768\ri854\sb0\sl-262\slmult0\fi287 \up0 \expndtw0\charscalex111 Cea mai
importante modificare a funcfiei tiroidiene conste in scederea con-\line \up0
\expndtw0\charscalex125 centratiilor serice de T3 total s' T3 liber la scurt timp
dupa intervenfia \up0 \expndtw0\charscalex123 chirurgicale; concentrafiiie de
revers T3 sunt crescute in perioada post \up0 \expndtw0\charscalex114 operatorie.
Toate acestea sugereaze o deviere de la ceile normale de deiodu-\line \up0
\expndtw0\charscalex110 rare a T\u8222?. Nivelele de T4 liber pot fi de asemenea
scSzute in perioada postope-\line \up0 \expndtw0\charscalex114 ratone. dar intr-o
mai mica mSsurS. AceastS reducere clara a concentrafiilor \up0
\expndtw0\charscalex110 tormelor active ale tromonilor tiroidieni este precedatS de
0 crestere usoarS, de \up0 \expndtw0\charscalex119 scurts duratS. a concentratnlor
T4 liber si T3 liber in cursul intervenfiilor \up0 \expndtw0\charscalex123
chirurgicale. Dimensiunea reduceni ulterioare a nivelului T3 pare sS se \up0
\expndtw0\charscalex125 coreieze cu sevoritatea traumelor si morbiditatea din
timpul evolufiei \up0 \expndtw0\charscalex112 postoperatorii Concentratiile serice
ale TSH tind de asemenea se diminueze). \par\pard\qj \li772\ri864\sb0\sl-
260\slmult0\fi297 \up0 \expndtw0\charscalex118 Deoarece trauma chirurgicale
determine o cre$tere prompe a nivelelor \up0 \expndtw0\charscalex111 cortizolului
plasmatic, iar aportul de hrane este opnt Tn perioada pre-, intra- si \up0
\expndtw0\charscalex109 postoperatorie. nu a lost luate Tn considerare
posibilitatea ca glucocorticoizii si \up0 \expndtw0\charscalex111 lipsa aportului
alimentar sa fie principalii factori determinanfi ai modificarilor \up0
\expndtw0\charscalex109 observate in funcfta tiroidianS. \par\pard\qj
\li777\ri850\sb0\sl-260\slmult0\fi287 \up0 \expndtw0\charscalex130 Totusi. Brandt
si colab. au descoperit diminueri e fel de man ale \up0 \expndtw0\charscalex114
concentrafiilor serice ale T3 atunci cand intervenfia chirurgicale s-a etectuat
\up0 \expndtw0\charscalex116 sub anestezie epidurae. care are proprietatea de a
aboli cresterea nivelurilor \up0 \expndtw0\charscalex113 cortizolului plasmatic. in
mod asemenetor. perfuzarea de glucoze ar trebui se \up0 \expndtw0\charscalex122
previna modilicenle nivelelor T3 s* revers T3 serie dace lipsa aportului \up0
\expndtw0\charscalex112 alimentar a |ucat un rol major in produceroa modilicerilor
observate cu ocazia \up0 \expndtw0\charscalex107 intervenfiilor chirurgicale
\par\pard\ql \li1089\sb144\sl-230\slmult0 \up0 \expndtw0\charscalex118 1.3 Stresui
psihic acut la bolnavii psihici \par\pard\qj \li787\ri865\sb66\sl-260\slmult0\fi292
\up0 \expndtw0\charscalex113 Datele despre efectele stresului emotional asupra
funcfiei tiroidiene la om \up0 \expndtw0\charscalex110 sunt in principal derivate
din studiile electuate la pacienfii cu tulburari psihice.
generae $i aplicata\par\pard\qj \li840\sb0\sl-264\slmult0
264\slmult0 \up0 \expndtw0\charscalex132 \ul0\nosupersub\cf9\f10\fs20 Astfel. chiar
si in cazul in care sunt luafi in studiu doar pacienfii cu \up0
\expndtw0\charscalex117 decompensare psihice acute, rezultatele obfinute depind de
natura afecfiunii \up0 \expndtw0\charscalex116 psihice. de istoricul lor si de
administrarea de medicamente. O prime ipoteze \up0 \expndtw0\charscalex113 a unei
secrefn hormonale intensificate a aparut dupe observarea unui nivel se� \up0
\expndtw0\charscalex114 rie crescut al proteinei fixatoare de iod (PBI) la
pacienfii cu boli psihice aflafi \up0 \expndtw0\charscalex112 sub influenfa unui
stres emofional, precum si la studenfii la medicine in timpul \up0
\expndtw0\charscalex132 desfesurem examenelor semestriale in studii mai recente,
cresterile \up0 \expndtw0\charscalex128 nivelurilor de T4 liber au fost
inregistrate in mod constant Tn timpul \up0 \expndtw0\charscalex123 mternarii
pacienfilor cu afectiuni psihice care prezinta manifesteh acute \up0
\expndtw0\charscalex112 Inctdenta a avut valori intre 7 si 18%. intr-un studiu, un
nunrer egal de pacienfi \up0 \expndtw0\charscalex107 (9%) au prezentat un nivel
scezut al T4 liber, in majoritatea cazurilor, valorile s-au \up0
\expndtw0\charscalex116 normalizat in timp $i dupe tratarea afecfiunii psihice.
Respunsul TSH-ului la \up0 \expndtw0\charscalex113 TRH este diminuat sau chiar
absent la majoritatea pacienfilor psihiatrici cu T4 \up0 \expndtw0\charscalex113
liber crescut Anomaliile semnificative ale concentrafiei T3 serie sunt rare.
\par\pard\ql \li1156\sb145\sl-230\slmult0 \up0 \expndtw0\charscalex119 1.4 Stresui
psihic cronic \par\pard\qj \li840\ri949\sb122\sl-265\slmult0\fi297 \up0
\expndtw0\charscalex113 intrucat nu existe dovezi ce traumele psihice pot determina
in mod constant \up0 \expndtw0\charscalex113 aparifia bolii Graves, medicii
clinicieni urmaresc existenfa unui istoric de stres \up0 \expndtw0\charscalex110
emofional cu pufin timp Tnainte de aparitia pnmelor simptome ale bolii Graves. \up0
\expndtw0\charscalex114 De exemplu, incidenfa crescute a tireotoxicozei in
Danemarca in timpul celui \up0 \expndtw0\charscalex114 de-al ll-lea Razboi Mondial
a fost atribuie stresului psihic cronic. \par\pard\qj \li840\ri948\sb0\sl-
264\slmult0\fi302 \up0 \expndtw0\charscalex122 Majoritatea studiilor privind
mcidenfa episoadelor stresante din viafa \up0 \expndtw0\charscalex128 pacienfilor
cu boala Graves nu indice o frecvenfe mai mare a acestor \up0
\expndtw0\charscalex119 evenimente comparativ cu grupul de control, desi unele date
susfin
aceaste \up0 \expndtw0\charscalex120 asociere. Desigur, se poate sustine in mod
legitim ideea ce in aceaste boae \up0 \expndtw0\charscalex114 terenul endocrin s<
eel imunologic constituie factori permisivi pentru efectele \up0
\expndtw0\charscalex114 patogene ale stresului psihic. \par\pard\qj
\li854\ri939\sb11\sl-266\slmult0\fi292 \up0 \expndtw0\charscalex117 Pacienfii cu
boae Graves nu par a avea personalitate anormae inainte sau \up0
\expndtw0\charscalex120 dupe boae, dar este foarte posibil ca manifeserile
neuropsihice ale bolii se \up0 \expndtw0\charscalex122 modilice secundar
comportamentul acestor bolnavi. Un indice crescut al \up0 \expndtw0\charscalex113
tiroxinei libere (FT..I) apare la aproximativ 20% din pacienfii cu psihoze acute
\up0 \expndtw0\charscalex118 Si in decursul catorva sepemani revme la normal.
Aceaste crestere nu are o \up0 \expndtw0\charscalex116 legeture Clare cu
administrarea antenoare a medicamentelor psihotrope, desi \up0
\expndtw0\charscalex116 aceasta ar putea constitui 0 explicate posibie.
Mecanismul implicerii stresului psihic este urmatorui \tab \up0
\expndtw0\charscalex110 hormonii \par\pard\qj \li873\ri939\sb2\sl-265\slmult0
\up0 \expndtw0\charscalex115 glucocorticoizi deprime. probabil, producfia de TRH.
si deprinre in mod cert \up0 \expndtw0\charscalex114 secretia de TSH si
responsivitatea hipolizare la TRH. O acfiune direce asupra \up0
\expndtw0\charscalex138 tiroidei este mai pufin dare. De asemenea, glucocorticoizi)
scad \up0 \expndtw0\charscalex119 deiodurarea T4 in T3. Dace cortexul suprarenalet
respunde normal la stres \up0 \expndtw0\charscalex110 pnntr-o productie crescute de
glucocorticoizi, producfia de hormoni tiroidieni si \par\pard\qj
\li907\ri934\sb0\sl-260\slmult0\fi9 \up0 \expndtw0\charscalex117 imunitatea ar
trebui se lie scazute, nu crescute. Secrefia glandei suprarenale \up0
\expndtw0\charscalex117 este in mod categoric crescuta in boala Graves, dar acest
lucru s-ar putea \par\pard\sect\sectd\fs24\paperw9180\paperh13300{\bkmkstart Pg268}
264\slmult0 \up0 \expndtw0\charscalex117 sa nu fie valabil la debutul bolii. La un
individ cu susceptibilitate genetics, \up0 \expndtw0\charscalex111 respunsul
suprarenahan la stres ar putea, eel pufin teoretic, se modifice funcfia \up0
\expndtw0\charscalex112 limfocitelor supresoare sau T helper, se augmenteze un
raspuns imun anterior \up0 \expndtw0\charscalex115 Si se mifieze boala Graves
clinice. Glucocorticoizil au, totusi, in principal o \up0 \expndtw0\charscalex115
acfiune imunosupresoare, desi mecanismul este neclar. Ei par a depresa atat \up0
\expndtw0\charscalex115 limfocitele T helper, cat si pe cele supresoare, ere ca -
in majoritatea studiilor \par\pard\ql \li1324\sb25\sl-230\slmult0 \up0
\expndtw0\charscalex106 - sa le modifice Tn mod clar raportul. \par\pard\ql
\li1631\sb150\sl-230\slmult0\tx1795 \up0 \expndtw-2\charscalex100 1 \tab \up0
\expndtw0\charscalex117 5 Activarea sistemului nervos simpatic \par\pard\qj
\li1324\ri473\sb124\sl-262\slmult0\fi288 \up0 \expndtw0\charscalex115 Stimularea
sistemului nervos simpatic ar putea Ii implicae intr-o activare \up0
\expndtw0\charscalex112 induse de stres a tiroidei. La animae, agonistii alfa-
adrenergicl inhiba secrefia \up0 \expndtw0\charscalex112 de TSH. Acest efect este
variabil si nu este prezent la oameni. La oameni nici \up0 \expndtw0\charscalex113
agonistii alfa. nici cei beta nu modifice respunsul hipofizar la TRH Agonistii \up0
\expndtw0\charscalex118 alfa-adrenergici produc de obicei stimularea directe a
sintezei si eliberarii \up0 \expndtw0\charscalex118 hormonilor tiroidieni la
animate in vivo si in vitro, iar stimularea nervului \up0 \expndtw0\charscalex123
simpatic cervical creste secrefia hormonale. Agonistii beta-adrenergici \up0
\expndtw0\charscalex123 determine de asemenea secretarea de hormoni tiroidieni e
animae Nici \up0 \expndtw0\charscalex113 Dlocada alfa-adrenergica, nici blocada
beta-adrenergica nu s-a demonstrat ce \up0 \expndtw0\charscalex111 modifice
eliberarea de hormoni tiroidieni la oameni. Blocada beta-adrenergice \up0
\expndtw0\charscalex113 inhiba conversia tisulare perilerlce a T4 in T3, scade
nivelul T3 serie si poate \up0 \expndtw0\charscalex114 creste ocazional nivelul T4,
dar nu s-a demonstrat ce ar afecta direct secrefia \up0 \expndtw0\charscalex125 de
hormoni tiroidieni Numeroase studii din literature IndicS faptul cS \up0
\expndtw0\charscalex131 sistemul nervos autonom reprezinta o cale improbabila de
activare \up0 \expndtw0\charscalex117 tiroidianS in boala Graves \par\pard\ql
\li1627\sb185\sl-230\slmult0 \up0 \expndtw0\charscalex118 2. Trasaturi de
personalitate ale bolnavilor hipertiroidieni \par\pard\qj \li1329\ri477\sb182\sl-
264\slmult0\fi292 \up0 \expndtw0\charscalex120 Referitor la analiza unor trasaturi
psihologice in sfera personalitafii la \up0 \expndtw0\charscalex121 bolnavii
hipertiroidieni. este important de stabilit dace anumite trSsStuh \up0
\expndtw0\charscalex126 psihologice evidenfiate la nivelul observafiilor clinice si
al metodelor \up0 \expndtw0\charscalex110 psihometrice realizeazS sau nu un profit
de personalitate specific hipertiroidis\up0 \expndtw0\charscalex115 mului. in
virtutea influenfel, sj ea demonstrae, a hormonilor tiroidieni, con\up0
\expndtw0\charscalex111 cretizatS prin modificSri ale echilibruiui ionic, cu
consecinfe asupra cronaxiei \up0 \expndtw0\charscalex113 Si metabolismului celulei
nervoase (Athanasiu), datele din literaturS converg \up0 \expndtw0\charscalex113
asupra unor trSsStun afectiv-comportamentale, precum "nellnistea motorie si \up0
\expndtw0\charscalex115 interioara. agitafia si iritabilitatea permanenta" (Luban-
Plozza si colab.) sau \up0 \expndtw0\charscalex109 labilitatea emofionalS.
interpretatS de Danielopolu, specifice hipertiroidienilor. \up0
\expndtw0\charscalex119 Aceste trSsSturi psihologice accesibile observafiilor
clinice sunt adeseori \up0 \expndtw0\charscalex121 sesizate cu mulfi ani inainte de
aparifia bolii, motiv pentru care se poate \up0 \expndtw0\charscalex112 lormula
ipoteza unei "fragilitSti de organ" (conform teoriei lui Adler), care la \up0
\expndtw0\charscalex117 viitorul pacient hipertiroidian, ar putea reprezenta o
tendinta spre cresterea \up0 \expndtw0\charscalex125 rapida a secrefiei hormonilor
tiroidieni sub actiunea diversilor stimuli \up0 \expndtw0\charscalex118 electivi,
in special a celor nervosi
260\slmult0\fi297 \up0 \expndtw0\charscalex114 Important apare faptul cS, din punct
de vedere fiziologic reacfia la stres a \up0 \expndtw0\charscalex111 acestor
bolnavi \up0 \expndtw0\charscalex113 (experimentul lui Flagg cu prezentarea unor
tilme stresante) \par\pard\ql \li758\sb25\sl-230\slmult0 \up0
\expndtw0\charscalex112 conduce la un rSspuns al secrefiei tiroidiene mai prompt si
mai intens. \par\pard\ql \li1060\sb30\sl-230\slmult0\tx3590 \up0
\expndtw0\charscalex118 Din aceste motive, chiar \tab \up0 \expndtw0\charscalex118
$i rezultatele teserii psihologice a bolnavilor \par\pard\qj \li768\ri1045\sb6\sl-
260\slmult0 \up0 \expndtw0\charscalex111 hipertiroidieni au tost interpretate ca
aparfinand slructurii personalitStu (avand \up0 \expndtw0\charscalex107 atributul
stahilitSfii) acestor bolnavi. \par\pard\li768\sb52\sl-230\slmult0\fi283 \up0
\expndtw0\charscalex121 Astfel, s-au citat: rSspunsul masiv, de tip arhaic si
agresiv la frustrare,\par\pard\li768\sb30\sl-230\slmult0\fi0\tx6043 \up0
\expndtw0\charscalex120 corespunzand unei dorinfe inconstiente de moarte\tab
\up0 \expndtw0\charscalex120 (Ham, Alexander si\par\pard\li768\sb29\sl-
230\slmult0\fi0\tx6000\tx6624 \up0 \expndtw0\charscalex120 Caramidul) sau tendinfa
impulsive e sarcini repetate\tab \up0 \expndtw-3\charscalex100 (Lidz)\tab \up0
\expndtw0\charscalex120 (autor citat de\par\pard\li768\sb44\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex120 Athanasiu).\par\pard\qj \li763\ri1026\sb0\sl-
260\slmult0\fi297 \up0 \expndtw0\charscalex127 in planul observafiei clinice,
atrage atenfia extrema sensibilitate a \up0 \expndtw0\charscalex112 bolnavilor
hipertiroidieni (85% femei), cu o alternanfa crescuta intre manie si \up0
\expndtw0\charscalex119 iritabilitate Indiferent de laptul ce aceste treseturi deja
propuse ar putea fi \up0 \expndtw0\charscalex120 completate cu altele. in funcfie
si de natura testelor utilizate, este posibie \up0 \expndtw0\charscalex122
existenfa unui evantai de trasaturi psihice ce pot fi observate la bolnavii \up0
\expndtw0\charscalex106 hipertiroidieni. \par\pard\qj \li768\ri1020\sb0\sl-
261\slmult0\fi287 \up0 \expndtw0\charscalex125 Toate considerable teorettce de mai
sus ne oblige la rezerve asupra \up0 \expndtw0\charscalex124 aprecierii
trasaturilor psihice ale bolnavilor hipertiroidieni ca fiind in� \up0
\expndtw0\charscalex117 duse in sfera personalitafii (ele puend fi prezente doar
temporar, paralel cu \up0 \expndtw0\charscalex119 evolufia bolii) dar. tot
considerable respective, ne sugereazS posibilitatea \up0 \expndtw0\charscalex111
unei
obiectlvSn a unor modificSri psiho-comportamentale ce par a avea o mai \up0
\expndtw0\charscalex116 mare stabiiitate. Stabilitatea aceasta poate avea la bazS o
existenfa de lungs \up0 \expndtw0\charscalex126 durata la acesti bolnavi a unui
tonus tiroidian crescut. care, in virtutea \up0 \expndtw0\charscalex120 unei
interrelafii dintre glanda tiroida si sistemul nervos (azi concepute ca \up0
\expndtw0\charscalex115 un "tot luncfional". anticipat de pionierii neurocriniei,
de la GH.T.Popa spre \up0 \expndtw0\charscalex121 zilele noastre), poate sS
contureze specific (in afectivitate, mai ales, s' m \up0 \expndtw0\charscalex119
comportament) un tip de personalitate, care - spre deosebire de profiluhle \up0
\expndtw0\charscalex120 specifice unor boli psihosomatice. elaborate de Dunbar \up0
\expndtw0\charscalex127 - este secundar \par\pard\ql \li777\sb11\sl-230\slmult0
\up0 \expndtw0\charscalex109 modiiicSrilor endocrin-psihice induse de boalS.
\expndtw0\charscalex119 3. Analiza unor trasaturi de personalitate la bolnavii
hipertiroidieni -\line \tab \up0 \expndtw0\charscalex119 studiu personal
Dintre trSsStunle considerate ca fiind in concordanfS cu observafiile noastre
\up0 \expndtw0\charscalex114 clinice. am constatat ca fiind relevante: anxietatea,
impulsivitatea si tendinfa \up0 \expndtw0\charscalex118 spre activitate, motiv
pentru care am fost inclinafi sS apeISm la un test de \up0 \expndtw0\charscalex109
personalitate (Chestionarul ..Vitrail". al lui G. Monn) care include parametrii
de \up0 \expndtw0\charscalex109 bazS ai personalitafii si primele douS din
trSsSturile de mai sus. \par\pard\ql \li1089\sb25\sl-230\slmult0 \up0
\expndtw0\charscalex111 Testarea psihologice deceleaza urmetoarele caracteristici
psihologice: \par\pard\qj \li825\ri1016\sb6\sl-260\slmult0\fi278 \up0
\expndtw0\charscalex111 \u8226? Prezenfa S" evaluarea anxieefii (printr-o lise pe
care pacienfii trebuiau se \up0 \expndtw0\charscalex122 bifeze raspunsurile
potrivite. confinute de scala de anxietate Taylor din \up0 \expndtw0\charscalex108
componenfa inventarului multifazic de personalitate de la Minnesota) (MMPI).
\par\pard\ql \li1123\sb45\sl-230\slmult0 \up0 \expndtw0\charscalex109 \u8226? Tipul
de personalitate (prin chestionarul Vitrail).
\dn2 \expndtw0\charscalex113 \u9830? 267\par\pard\qj \li1180\sb0\sl-260\slmult0
260\slmult0\fi302 \up0 \expndtw0\charscalex116 Referitor la acest test, vom incerca
o prezentare a sa in detaliu, deoarece \up0 \expndtw0\charscalex122 este pentru
prima dae cand a lost utilizat in fara noastre \up0 \expndtw0\charscalex110
(concomitent cu \par\pard\qj \li1195\ri627\sb0\sl-260\slmult0 \up0
\expndtw0\charscalex114 utilizarea sa de cetre o parte din autorii prezentei
lucreri intr-o ale cercetare) \up0 \expndtw0\charscalex114 (lamandescu I. B).
Diferitele sectoare ale testului \tab \up0 \expndtw0\charscalex110 (Tn varianta
Caille) sunt apreciate cu valori \par\pard\ql \li1195\sb30\sl-230\slmult0 \up0
\expndtw0\charscalex109 numerice in jurul mediei de 4,5 - 5 si crescute peste 5
(scala fiind cuprinsS intre \par\pard\li1185\sb31\sl-230\slmult0\fi0\tx1612 \up0
\expndtw0\charscalex110 0 si\tab \up0 \expndtw0\charscalex110 16). Au fost
investigate:\par\pard\li1185\sb226\sl-230\slmult0\fi686\tx2155 \up0 \expndtw-
9\charscalex96 A.\tab \up0 \expndtw0\charscalex110 Impulsivitatea\par\pard\ql
\li2462\sb73\sl-230\slmult0 \up0 \expndtw0\charscalex103 - optimismul; \par\pard\ql
\li2452\sb70\sl-230\slmult0 \up0 \expndtw0\charscalex111 - nevoia fizice de acfiune
si acfiuni spectaculoase: \par\pard\ql \li2452\sb50\sl-230\slmult0 \up0
\expndtw0\charscalex111 - pregetirea insuficiene a acfiunilor; \par\pard\ql
\li2457\sb50\sl-230\slmult0 \up0 \expndtw0\charscalex109 \u9632? iner(ia paradoxae
la debutul acfiunilor pe termen lung; \par\pard\ql \li2452\sb50\sl-230\slmult0 \up0
\expndtw0\charscalex109 - nerSbdare, toleranfS redusS la frustrare.
\par\pard\li1886\sb127\sl-230\slmult0\fi0\tx2145 \up0 \expndtw-9\charscalex96
B.\tab \up0 \expndtw0\charscalex105 Voinfa\par\pard\ql \li2462\sb73\sl-
230\slmult0 \up0 \expndtw0\charscalex109 - organizarea activS a prolesiei $i viefii
profesionale; \par\pard\ql \li2452\sb50\sl-230\slmult0 \up0 \expndtw0\charscalex109
- tendinte spre rol notabil in viata socialS; \par\pard\ql \li2457\sb50\sl-
230\slmult0 \up0 \expndtw0\charscalex111 - spirit de decizie, bun gestionar;
\par\pard\ql \li2457\sb70\sl-230\slmult0 \up0 \expndtw0\charscalex109 - metode de
convingere directe; \par\pard\ql \li2467\sb50\sl-230\slmult0 \up0
\expndtw0\charscalex110 - buns pSrere de sine; \par\pard\ql \li2462\sb50\sl-
230\slmult0 \up0 \expndtw0\charscalex110 - "se poate conta pe el".
\par\pard\li1876\sb125\sl-230\slmult0\fi0\tx2160 \up0 \expndtw0\charscalex114 C\tab
\up0 \expndtw0\charscalex114 Inventlvitatea\par\pard\ql \li2462\sb75\sl-230\slmult0
\up0 \expndtw0\charscalex111 - cerebralitatea depSsind slera intelectualS;
deschiderea spre lumea cunostmfelor; \par\pard\ql \li2462\sb70\sl-230\slmult0
\up0 \expndtw0\charscalex108 - interes pentru micile probleme. \par\pard\ql
\li1886\sb110\sl-230\slmult0\tx2155 \up0 \expndtw-9\charscalex96 D. \tab \up0
\expndtw0\charscalex120 Sensibilitatea \par\pard\ql \li2462\sb70\sl-230\slmult0
\up0 \expndtw0\charscalex115 - senzorialitatea deoseble; \par\pard\ql
\li2592\sb70\sl-230\slmult0 \up0 \expndtw0\charscalex108 receptivitate crescuts la
stimuli ex term, \par\pard\ql \li2467\sb50\sl-230\slmult0 \up0
\expndtw0\charscalex108 - gandirea poate rStSci liber; \par\pard\ql
\li2467\sb50\sl-230\slmult0 \up0 \expndtw0\charscalex108 - gandirea funcfioneazS
prioritar prin imagini; \par\pard\ql \li2467\sb50\sl-230\slmult0 \up0
\expndtw0\charscalex107 - timp $i loc pentru visare; \par\pard\ql \li2467\sb70\sl-
230\slmult0 \up0 \expndtw0\charscalex108 - tendinte depresive (melancolice) period
ice \par\pard\li1891\sb103\sl-230\slmult0\fi0\tx2155 \up0 \expndtw-7\charscalex100
E.\tab \up0 \expndtw0\charscalex108 Memoria\par\pard\ql \li2471\sb77\sl-230\slmult0
\up0 \expndtw0\charscalex109 - tendinfa de a se sprijini pe trecut si
conservatorism crescut; \par\pard\ql \li2471\sb50\sl-230\slmult0 \up0
\expndtw0\charscalex109 - utilizeazS frecvent "clasamente" (fapte, obiecte,
etc.); \par\pard\ql \li2471\sb70\sl-230\slmult0 \up0 \expndtw0\charscalex110 -
nevoia de revedere si reordonare a cunostinfelor; \par\pard\ql \li2471\sb50\sl-
230\slmult0 \up0 \expndtw0\charscalex105 - iubeste cSIStoriile; \par\pard\ql
\li2471\sb50\sl-230\slmult0 \up0 \expndtw0\charscalex110 - isi urmSreste atent
propriile interese. \par\pard\sect\sectd\fs24\paperw9180\paperh13300{\bkmkstart
psihosomatica generae si aplicats\par\pard\ql \li1684\sb0\sl-230\slmult0
\par\pard\ql\li1684\sb86\sl-230\slmult0 \up0 \expndtw0\charscalex115 F.
Expresivitatea \par\pard\qj \li2251\ri1198\sb57\sl-270\slmult0 \up0
\expndtw0\charscalex110 - Tn domeniul expresivitafii si sensibiliefii subiectul se
arate \up0 \expndtw0\charscalex120 sub aspectul sau eel mai accesibil: in acest
domeniu se \up0 \expndtw0\charscalex111 manilesta s< expresia sexualiefii sale;
\par\pard\ql \li2251\sb44\sl-230\slmult0 \up0 \expndtw0\charscalex113 - este mai
atasat de literature decat de stiinfe; \par\pard\qj \li2251\ri1193\sb46\sl-
260\slmult0 \up0 \expndtw0\charscalex116 - nevoia de a Ii Tnfeles, aprobal,
asigurat=persoane foarte \up0 \expndtw0\charscalex117 atasabie; \par\pard\ql
\li2246\sb45\sl-230\slmult0 \up0 \expndtw0\charscalex109 - elanuri foarte
altruiste; \par\pard\ql \li2246\sb50\sl-230\slmult0 \up0 \expndtw0\charscalex111 -
gust pentru romanesc; \par\pard\ql \li2251\sb70\sl-230\slmult0 \up0
\expndtw0\charscalex111 - crize sentimentale vii si pasionale. \par\pard\qj
\up0 \expndtw0\charscalex126 Uttlizarea unui astfel de test psihologie, structural
pe dimensiunile \up0 \expndtw0\charscalex111 fundamentale ale personalitafii
(testul Vitrail), ca si a unei scale (AMT) pentru \up0 \expndtw0\charscalex118
anxietate ne-a permis o analiza 'pe secfiuni" capabile se reliefeze trasaturi
\up0 \expndtw0\charscalex109 psihologice distincte corelabile cu boala
(hipertiroidismul). \par\pard\qj \li984\ri790\sb0\sl-264\slmult0\fi292 \up0
\expndtw0\charscalex115 Treseturile evidentiate de aplicarea testelor menfionate au
apSrut cu mult \up0 \expndtw0\charscalex117 hipertrofiate fafa de normal, in
special impulsivitatea, voinfa si anxietatea. \up0 \expndtw0\charscalex113
Rezultatele obfinute de noi par sS fie confirmate s* de observafia clinicS. Ele
\up0 \expndtw0\charscalex114 conduc la o inevitabila corelare dintre psihic s*
sistemul neuroendocrin (sau, \up0 \expndtw0\charscalex115 mai bine zis. la
confirmarea unitSfii acestui sistem psiho-neuroendocrin) cu \up0
\expndtw0\charscalex109 exprimare Tn siera psihocomportamentalS a bolnavilor.
Aplicarea clinicS a rezultatelor furnizate de testarea practicats de noi poate
\up0 \expndtw0\charscalex113 constitui o bazS pentru o psihoterapie diferenfiae a
bolnavilor hipertiroidieni, \up0 \expndtw0\charscalex113 cu sau ere (in cazurile
mai usoare) participarea psihologului in cadrul echipei \up0
\expndtw0\charscalex113 terapeutice. \par\pard\ql \li1291\sb35\sl-
230\slmult0\tx8078 \up0 \expndtw0\charscalex117 in condifiile in care scorurile
obfinute sunt in mod evident deviate de \tab \up0 \expndtw-9\charscalex87 1a
normal, poate fi utila colaborarea cu psihologul in incercarea de a rupe un cere
\up0 \expndtw0\charscalex112 vicios al cSrui punct de plecare nu este ince elucidat
(mai TntSi boala sau mai \up0 \expndtw0\charscalex110 intai terenul predispozant
manifestat prin tulburSri psihice). \par\pard\qj \li1008\ri785\sb0\sl-
265\slmult0\fi283 \up0 \expndtw0\charscalex119 Apare ca fiind de mare interes
utilizarea acestui gen de chestionare. ce \up0 \expndtw0\charscalex114
investigheazS personalitatea, si la alte categorii de pacienfi, Tn special la
cei \up0 \expndtw0\charscalex106 spitalizafi \up0 \expndtw0\charscalex109 (care au
mai mult timp la dispozifie si posibilitSfi de monitorizare Tn \up0
\expndtw0\charscalex114 timp). extmzand aria de studiere a bolnavilor dintr-o
perspective psihologice \up0 \expndtw0\charscalex110 dar cu largi implicafii
psihoterapeutice. \par\pard\ql \li1324\sb140\sl-230\slmult0 \up0
\expndtw0\charscalex114 Bibliografie \par\pard\ql \li1363\sb70\sl-
230\slmult0\tx7632 \up0 \expndtw0\charscalex100 i. AthanasiuA. Elemente de
psihologie medicala. Ed. Medicald, Bucuresti. \tab \up0 \expndtw-9\charscalex87
1983. \par\pard\qj \li1324\ri787\sb0\sl-220\slmult0\tx1540 \up0 \expndtw-
2\charscalex100 2 Beck William W .Jr. Obstetrtcd si Ginecologie. Ed. a 4-a.
Edtfia in limba romand. \line\tab \up0 \expndtw-3\charscalex100 sub redactia R
Vlddareanu, Ed. Medicald Amaltea. Bucuresti. 1997 \par\pard\ql \li1339\sb2\sl-
217\slmult0\tx2827 \up0 \expndtw-2\charscalex100 3. Coculescu M. \tab \up0
\expndtw0\charscalex100 \u9632? Neuroendocrinologie clinicd. Ed. Stiin(ificd si
Enciclopedicd, \par\pard\li1555\sb10\sl-230\slmult0\fi0\tx2467 \up0 \expndtw-
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Greenspan Francis S. \u9632? Basic and Clinical Endocrinology Third Edition,
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Resumption of \line\tab \up0 \expndtw0\charscalex108 menses in anorexia nervosa.
Arch. Adolesc. Pediatr. Med., 1997, 151:16-21. \par\pard\qj \li1823\ri287\sb4\sl-
220\slmult0\tx2092 \up0 \expndtw0\charscalex118 10 Golden N H.. Schenker I. E.
Amenorrhea in anorexia nervosa: etiology and \line\tab \up0 \expndtw0\charscalex111
implications Adolesc. Med. State Rev. \up0 \expndtw0\charscalex103 1992: 3: 503-507
Harris T, Creed F and Brugha T.S\tab \up0 \expndtw0\charscalex112 - Stress Life
Events and Graves Disease.\par\pard\li1823\sb5\sl-
207\slmult0\fi249\tx3686\tx4032 \up0 \expndtw0\charscalex105 Br.J.Psych.
(1992).\tab \up0 \expndtw-8\charscalex85 161.\tab \up0 \expndtw0\charscalex112 535-
541.\par\pard\li1823\sb18\sl-207\slmult0\fi0\tx6139 \up0 \expndtw0\charscalex112 12
Harrison's Principles ot Internal Medicine.\tab \up0 \expndtw0\charscalex112 141"
edition. A S. Fanci, E\par\pard\li1823\sb5\sl-207\slmult0\fi273 \up0
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L. Kasper, S.L. Hauser,\par\pard\li1823\sb4\sl-207\slmult0\fi273\tx4272 \up0
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210\slmult0\tx2083\tx2088 \up0 \expndtw0\charscalex111 14. lamandescu 1.8. - The
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\par\pard\li1823\sb25\sl-207\slmult0\fi0 \up0 \expndtw0\charscalex116 15 Kalney R.
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\expndtw0\charscalex109 nervosa. Aust. N. Z. J. Psychiatry, 1977.\tab \up0
\expndtw0\charscalex61 11\tab \up0 \expndtw0\charscalex115 251:257\par\pard\qj
\li1823\ri329\sb15\sl-200\slmult0\tx2088 \up0 \expndtw0\charscalex110 16. Kendell
R.E.. Hall D. J.. Babigan H. M. The epidemiology of anorexia nervosa. \line\tab
\up0 \expndtw0\charscalex110 Psychol. Med. 1973:2:200-203. \par\pard\qj
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(sub redacfia)- Tratat de Endocrinologie Clinicd. vol.1. Ed. Academiei \line\tab
\up0 \expndtw0\charscalex107 Romane, Bucuresti. 1992 \par\pard\ql \li1823\sb11\sl-
207\slmult0\tx6009 \up0 \expndtw0\charscalex113 18. Nomerotf B Charles, Krishnan K.
Ranga R. \tab \up0 \expndtw0\charscalex114 - Neuroendocrine Alterations in
\par\pard\ql \li2111\sb13\sl-207\slmult0 \up0 \expndtw0\charscalex106 Psychiatric
Disorders. In: Neuroendocrinoiogy, p.413-432. \par\pard\li1823\sb18\sl-
207\slmult0\fi0 \up0 \expndtw0\charscalex118 19. Paveliu F.. lamandescu I.B,
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la bolnavii hipetiroidieni. Rev. Infomedica\par\pard\li1823\sb9\sl-
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Popa M. Endocrinopediatrie si anxologie \u9632? adualitdfi Ed.Cerma. Bucuresti.
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Smith LH. Jr.. Wyngaarden J.B (Ed). W.B. Saunders Co, 1985 \par\pard\ql
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Thier S.O. \tab \up0 \expndtw0\charscalex116 - Pathophysiology. The Biological
Principles of \par\pard\ql \li2111\sb13\sl-207\slmult0 \up0 \expndtw0\charscalex114
Diseases. 2* Edition \par\pard\li1795\sb19\sl-207\slmult0\fi0\tx7761 \up0
\expndtw0\charscalex114 25. Totoianu I.G., Vasilescu Gh. Bolile timidei la adult si
copii. Vol.\tab \up0 \expndtw0\charscalex113 2. Casa de\par\pard\li1795\sb14\sl-
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Transilvaniei". Targu Mures.\tab \up0 \expndtw0\charscalex113
Totoianu I.G. Introducere in fiziologia clinicd a sistemului endocrin. od. S.
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\up0 \expndtw0\charscalex113 21 Wilson J.D.. Foster D.W.\tab \up0
\expndtw0\charscalex113 - Williams Textbook of Endocrinology 8* Ed.
W.B\par\pard\li1795\sb52\sl-207\slmult0\fi316 \up0 \expndtw0\charscalex113 Saunders
Co.\par\pard\sect\sectd\fs24\paperw9180\paperh13300{\bkmkstart Pg273}{\bkmkend
\up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf14\f15\fs24 ELEMENTE DE PSIHOSOMATICA CHIRURGICALA
\expndtw0\charscalex134 \ul0\nosupersub\cf9\f10\fs20 Corneliu Dragomirescu. loan
Bradu lamandescu, \up0 \expndtw0\charscalex130 Ovidiu Popa Velea \par\pard\qj
240\slmult0\fi288 \up0 \expndtw0\charscalex123 Chirurgia este cea mai dramatice si.
deci, spectaculoasS specialltate a \up0 \expndtw0\charscalex125 medicinei. Este un
domeniu fascinant, atat pentru viitorii medici cal \up0 \expndtw-5\charscalex100 $i
pentru marele public, cu tofil sesizand maxima incSrcSturS emofionala ce in\up0
\expndtw0\charscalex116 sofeste fiecare acfiune a chirurgului, dar $1 a celui ce
asteaptS, acesea 1a II\up0 \expndtw0\charscalex117 mita supraviefuirii, rezullatul
luptei deschise, transante cu boala - mai hote\up0 \expndtw0\charscalex114 rate S'
rnai grabita ca niciodate se-i curme firul viefii. Viziunea galenice asu� \up0
\expndtw0\charscalex119 pra bohi, ca fund rezultatul unei disfuncfii localizate la
nivelul unei parfi a \up0 \expndtw0\charscalex110 corpului \up0
\expndtw0\charscalex121 (vmdecarea fiind considerate ca rezultand din extirparea
acestui \up0 \expndtw0\charscalex114 reu localizat) \up0 \expndtw0\charscalex117 -
a avut mentul de a incuraia progresele chirurgiei, ca si dez� \up0
\expndtw0\charscalex118 voltarea unei aborden anahtice a procesului patologie.
in zilele noastre, conceptia psihosomatice, promovate ince de la marele \up0
\expndtw0\charscalex120 Hipocrat. restabileste locul psihicului, aeturi de soma,
atat in procesul im-\line \up0 \expndtw0\charscalex115 bolnevirii, cSt $i in eel al
vindecSrli. Viziunea holisticS moderns, statuatS in \up0 \expndtw0\charscalex114
SUA de cStre Engel (modelul bio-psiho-social. completat de cStre Ikemi prin \up0
\expndtw0\charscalex118 latura existenfiae), dezvoltatS si in alte fSri \up0
\expndtw0\charscalex112 (Elvefia: Heim si Wild, Germa-\par\pard\qj
\li1300\ri494\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex120 nia: Stocksmeyer
etc.) propune ca si in chirurgie sa se reconsidere impor� \up0
\expndtw0\charscalex121 tanta factorului psihic, apreciat drept un cofactor
important, indispensabil \up0 \expndtw0\charscalex120 unei reusite complete a
actului operator. De altfel, o ramurS desprinsS din \up0 \expndtw0\charscalex117
chirurgie - oncologia - a devenit o importantS subdiviziune a psihosomaticii
\up0 \expndtw0\charscalex117 contemporane (anume "psihooncologia" - Buddeberg)
Din aceastS perspectlvS apare ca o necesitate reconsiderarea actului \up0
\expndtw0\charscalex117 chirurgical ca fiind dependent nu numai de gandirea lucidS
s* miscarea fara \up0 \expndtw0\charscalex118 de gre$ a mainii chirurgului "cu
nervi de ofel", ci si de modul cum va reac\up0 \expndtw0\charscalex115 fiona
bolnavul la impactul cu actul operator, sau mai tarziu de modul cum va \up0
\expndtw0\charscalex121 recupera el brutalele transformSn (fie ele si salvatoare)
produse de mane\up0 \expndtw0\charscalex121 vrele chirurgicale. \par\pard\qj
\li1300\ri498\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex135 In cele ce
urmeaza existe Tn mod evident intenfia de a racorda \up0 \expndtw0\charscalex121
principaleie demersuri ale actului chirurgical la conceptia psihosomatica, \up0
\expndtw0\charscalex118 fere a nega prioritatea meiestriei demiurgului-chirurg in
reusie obiectivului \up0 \expndtw0\charscalex119 operator, dar incercSnd sS
argumentSm ideea cS o bunS cunoastere a ele� \up0 \expndtw0\charscalex117 mentelor
psihologice - implicate in mod merent. insd coversitor in dinamica \up0
\expndtw0\charscalex117 actului operator - poate servi la optimizarea evidene a
acestuia. \par\pard\sect\sectd\fs24\paperw8940\paperh13300{\bkmkstart Pg274}
psihosomaticd generala si aplicats\par\pard\qj \li787\sb0\sl-240\slmult0
240\slmult0\fi287 \up0 \expndtw0\charscalex117 Vom Tncerca o caracterizare succinta
a aspectelor de ordin psihosomatic \up0 \expndtw0\charscalex117 legate de
activitatea chirurgului, inclusiv - si mai ales - a relafiei acestuia cu \up0
\expndtw0\charscalex113 bolnavul chirurgical. \par\pard\qj \li1080\ri870\sb171\sl-
300\slmult0 \up0 \expndtw0\charscalex135 Chirurgia - domeniu de interferenfo <u
psihoiogia medicala fl \up0 \expndtw0\charscalex133 psihosomatica \par\pard\qj
\li787\ri780\sb162\sl-250\slmult0\fi297 \up0 \expndtw0\charscalex118 Exists unele
opinii in favoarea ideii cS rezolvarea operatorie a bolii este \up0
\expndtw0\charscalex115 un act tehnic, a cSrui Tndeplinire depinde numai de
indemSnarea chirurgului \up0 \expndtw0\charscalex115 Si rezistenfa biologies a
pacientului. \par\pard\qj \li787\ri771\sb0\sl-244\slmult0\fi283 \up0
\expndtw0\charscalex118 Aceste idei sunt legate de faptul cS, atunci cSnd opereazS,
chirurgul ac-\line \up0 \expndtw0\charscalex118 fioneazS asupra unei structun
anatomice care - chiar si Tn cazul sistemului \up0 \expndtw0\charscalex117 nervos -
reprezinta un substrat al funcfiilor organismului. Ecoul actelor sale \up0
\expndtw0\charscalex118 (pur materiale, ca "operator", sau psihologice - ca element
mitic, forfS ma-\line \up0 \expndtw0\charscalex118 gice) este receptat. insa. la
nivelul psihicului bolnavului operat, declansand \up0 \expndtw0\charscalex117 un
Tntreg cortegiu de influente cortico-viscerale ce nu trebuie subestimate.
Din acest punct de vedere, chirurgia moderne, caracterizate tot mai mult \up0
\expndtw0\charscalex117 prin rapiditatea execufiei ca si prin cresterea cahtafii
viefii celui operat, este \up0 \expndtw0\charscalex121 ameninfate de ignorarea
factorului psihic, inclus Tn mod inerent Tn orice \up0 \expndtw0\charscalex125
relatie interpersonal, dar mai ales in relafia terapeutice dintre chirurg si
\up0 \expndtw0\charscalex112 bolnavul operabil. \par\pard\qj \li787\ri776\sb0\sl-
245\slmult0\fi287 \up0 \expndtw0\charscalex117 Aceaste mentalitate tehnlcise -
somatizanta este necesar sS fie TnlocuitS \up0 \expndtw0\charscalex119 cu o alta,
psihosomaticS, avand la baze recunoasterea faptului cS in marea \up0
\expndtw0\charscalex116 majoritate a intervenfiilor chirurgicale sunt prezente douS
mari caracteristici \up0 \expndtw0\charscalex120 de ordin psihologie: ineditul
situatiei create prin existenfa leziunii sau dis-\line \up0 \expndtw0\charscalex120
funcfiei ce trebuie corectatS prin actul operator \up0 \expndtw0\charscalex116 (cu
rSsfrSngere in primul \par\pard\qj \li791\ri782\sb0\sl-250\slmult0\fi4 \up0
\expndtw0\charscalex115 rSnd asupra chirurgului) si anxietatea (extreme - pentru
bolnav, uneori destul \up0 \expndtw0\charscalex121 de crescute si pentru chirurg)
generate de existenfa unor riscuri operatorli \up0 \expndtw0\charscalex118 ce
vizeaza adesea chiar supravietuirea bolnavului. \par\pard\qj \li791\ri766\sb0\sl-
246\slmult0\fi288 \up0 \expndtw0\charscalex118 Considerarea factorului psihologie
de cetre chirurg Tl va ajuta pe acesta \up0 \expndtw0\charscalex115 se sesizeze o
serie de particularltSfi Tn cadrul carora se TnfSptuieste actul o-\line \up0
\expndtw0\charscalex116 perator \up0 \expndtw0\charscalex125 - cu repercusiuni
asupra psihicului bolnavului, dar si o serie de \up0 \expndtw0\charscalex122
implicafii pozitive ale unor tentative psihoterapeutice simple \up0
\expndtw0\charscalex122 (de suport \par\pard\qj \li801\ri761\sb0\sl-246\slmult0
\up0 \expndtw0\charscalex116 moral) in dinamica recuperSrii post-operatorii. in
plus, un chirurg care se va \up0 \expndtw0\charscalex120 putea cunoaste mai bine
sub raport psihologie, va avea sansa unei evolutii \up0 \expndtw0\charscalex119
profesionale rodnice, TnlSturand sau diminuand - in acelasi timp - efectele \up0
\expndtw0\charscalex119 celui mai mare du$man personal, stresui psihic.
\par\pard\ql \li1094\sb1\sl-207\slmult0 \up0 \expndtw0\charscalex115 in ordinea
argumentatiei noastre vom avea Tn vedere: \par\pard\ql \li1104\sb215\sl-253\slmult0
\up0 \expndtw0\charscalex121 \ul0\nosupersub\cf8\f9\fs22 Caracterele de ordin
psihologie ale actului chirurgical \par\pard\ql \li1104\sb186\sl-230\slmult0\tx4185
\up0 \expndtw0\charscalex121 \ul0\nosupersub\cf9\f10\fs20 Vom enumera acele
trSsSturi \tab \up0 \expndtw0\charscalex125 - cu implicafii psihologice ale actului
chirurgical diferite (calitativ sau cantitativ) de cele care caracterizeazS
actul \up0 \expndtw0\charscalex113 medical nechirurgical: \par\pard\ql
\li1132\sb0\sl-180\slmult0 \up0 \expndtw0\charscalex116 \u9632? Este o relafie
transants. lipsits eel mai adesea de echivocuri, bolnavul \par\pard\ql
\li835\sb12\sl-230\slmult0 \up0 \expndtw0\charscalex113 avSnd perspectiva unei
vindecSri rapide si. de regulS, definitive;
\u9632? Este dominat totusi de nscun, uneori majore - amenlnfSnd integritatea \up0
\expndtw0\charscalex115 Si, uneori, viafa bolnavului; \par\pard\qj
incSrcStura emofionalS este maximS Tn raport cu relafia existentS in \up0
\expndtw0\charscalex114 cadrul altor specialitati nechirurgicale si se refers nu
numai la bolnavul chi� \up0 \expndtw0\charscalex120 rurgical ci si 'a chirurgul
care opereazS, acestuia nefiindu-i indiferent un \up0 \expndtw0\charscalex117
eventual esec al intervenfiei (inclusiv efectele secundare sau complicafiile
\up0 \expndtw0\charscalex117 postoperatorii); \par\pard\qj \li1022\ri565\sb26\sl-
233\slmult0\fi297 \up0 \expndtw0\charscalex132 \u9632? intreaga desfSsurare a
actului chirurgical poarts pecetea unui \up0 \expndtw0\charscalex115 dramatism
generat, in primul rand, de riscul chirurgical perceput de bolnav, \up0
\expndtw0\charscalex115 Si, in al 2-lea rand de numeroasele surprize ce pot apare
in dinamica actului \up0 \expndtw0\charscalex115 operator; \par\pard\qj
Bolnavul poate avea senzafii si sentimente generate de ideea de \up0
\expndtw0\charscalex116 "prejudiciu corporal" in cadrul unor exereze interesand
segmente sau orga\up0 \expndtw0\charscalex116 ne ale propriulul sSu corp;
\u9632? Anxietatea. care este o dominants Tn plan psihologie a bolnavului, este
\up0 \expndtw0\charscalex115 extremS si ea dominS bolnavul aproape pe tot parcursul
actului chirurgical, \up0 \expndtw0\charscalex118 TncepSnd cu momentul internarii,
continuand cu pregStirea preoperatorie \up0 \expndtw0\charscalex115 (ganduri despre
riscul operator) sau cu momentul anesteziei (griji referitoa� \up0
\expndtw0\charscalex114 re ia posibilitatea de "a nu se mai trezi"). amphficandu-se
- paradoxal - dupe \up0 \expndtw0\charscalex117 reusita intervenfiei chirurgicale
("ganduri negre" despre poslbilele sechele \up0 \expndtw0\charscalex121 sau
complicatii, ca si despre viitoarea sa reinsertie socio-profesionae). O \up0
\expndtw0\charscalex115 detaliere a surselor principale de anxietate la bolnavul
chirurgical figureazS \up0 \expndtw0\charscalex112 in tabelul \up0 \expndtw-
2\charscalex100 1 \up0 \expndtw0\charscalex115 (dupS Spingte si Droh). Fiind cea
mai vizibie expresie Tn plan \up0 \expndtw0\charscalex116 afectiv a stresului
psihic perioperator (pre-, intra- si pos\up0 \expndtw0\charscalex107 t-operator),
anxieta� \par\pard\qj \li1031\ri536\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex118
tea a fost cercetats de cStre psihologi (chestionare de anxietate de tip Ha�
\up0 \expndtw0\charscalex113 milton, Hospital Anxiety and Depression, scala
anxietSfii manifesto - "decu\up0 \expndtw0\charscalex113 pata" de Taylor din
Inventarul Multifazic de Personalitate Minnesota), dar si \up0
\expndtw0\charscalex114 de cStre medici, in special de cei activand in domeniul
psiho-neuro-endocri-\line \up0 \expndtw0\charscalex116 nologiei, ce au studiat
modificSrile hormonilor de stres in diferite etape ale \up0 \expndtw0\charscalex116
actului operator; \par\pard\qj \li1036\ri546\sb0\sl-240\slmult0\fi287 \up0
\expndtw0\charscalex115 \u9632? Atat asupra bolnavului, cat si a medicului,
Impactul psihologie al bolii \up0 \expndtw0\charscalex116 chirurgicale este
crescut: dacS am evidenfiat anterior problemele bolnavu� \up0
\expndtw0\charscalex116 lui. este necesar sS menfionSm $i reversul medaliei:
sentimentul responsa\up0 \expndtw0\charscalex116 bilitstii la chirurg, care nu
dispare odatS cu sfarsltul operafiei. Acest senti� \up0 \expndtw0\charscalex120
ment este accentuat. sau apare ca rSspuns si la suprainvestirea medicului \up0
\expndtw0\charscalex113 de cStre pacient, s> uneori ca urmare a supralicitSrii
radicalitSfii intervenfiei \up0 \expndtw0\charscalex113 terapeutice;
\u9632? Reducerea timpului de contact cu pacientul creazS in chirurgie posibi� \up0
\expndtw0\charscalex113 litatea preluSrii unei pSrfi din responsabilitatea aferentS
relafiei cu pacientul \up0 \expndtw0\charscalex117 de cStre echipa de asistenfa
medicals (asistente medicale, studenfi), crean\up0 \expndtw0\charscalex118 du-se,
din nefericire, posibilitatea unor influente cu sens contrar sau near\up0
\expndtw0\charscalex118 monizate, in raport cu cele pe care le exercitS
chirurgul; \par\pard\ql \li1339\sb9\sl-230\slmult0\tx7435 \up0
\expndtw0\charscalex124 \u9632? "Pierderea contactului" de cStre pacient cu medicul
sSu \tab \up0 \expndtw0\charscalex117 (eel mai \par\pard\qj \li1041\ri545\sb2\sl-
240\slmult0 \up0 \expndtw0\charscalex118 adesea pe parcursul anesteziei generale)
este perceputS diferit, Tn funcfie \up0 \expndtw0\charscalex115 de tipul de
"coping" al pacientului \up0 \expndtw0\charscalex118 (modalitatea dominants a
acestuia de a \par\pard\ql \li1046\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex125
face fata stresului): se citeazS "copingul" centrat pe problems, in care
230\slmult0\fi19 \up0 \expndtw0\charscalex117 \ul0\nosupersub\cf8\f9\fs22 individul
este permeabil la argumente de ordin rational, in perioada \up0
\expndtw0\charscalex104 preoperatone (isi dominS anxietatea prin intelectualizare),
dar si "copingul" \up0 \expndtw0\charscalex104 centrat pe emofie. in care se pune
accentul pe mesajul de Tncurajare; \par\pard\qj \li868\ri664\sb5\sl-
237\slmult0\fi297 \up0 \expndtw0\charscalex103 \u9632? Confinutul nou al nofiunii
de "compliants terapeuticS": definie ca "gra\up0 \expndtw0\charscalex104 dul in
care indicafiile medicului sunt respectate de pacient"; CT dobandeste \up0
\expndtw0\charscalex105 o dimensiune nouS. generate de punctul de plecare: cu
excepfii foarte rare. \up0 \expndtw0\charscalex107 relafia medic-bolnav este. de la
bun inceput, asimetricS. in sensul pozifiei \up0 \expndtw0\charscalex105 dominante
a medicului-chirurg fafa de pacientul sSu. AmSnuntele concrete \up0
\expndtw0\charscalex104 ale intervenfiei chirurgicale, procedeul folosit. tipul de
anestezie, etc. nu fac \up0 \expndtw0\charscalex109 de regue obiectul conteserii de
cetre pacient. remanand o zone "obscure" \up0 \expndtw0\charscalex105 pentru
acesta, astfel, se accentueaze dimensiunea "mitice" a chirurgului (ca \up0
\expndtw0\charscalex105 percepfie individuae, de cetre pacient, sau chiar sociale).
\up0 \expndtw0\charscalex115 \ul0\nosupersub\cf3\f4\fs18 Tabelul 1. Cauzele
anxietafii perioperatorii (dupa Spingte si Droh,
1992)\par\pard\sect\sectd\sbknone\cols2\colno1\colw4390\colsr160\colno2\colw4250\co
\up0 \expndtw0\charscalex115 u Internarea in climca\par\pard\ql \li1233\sb1\sl-
188\slmult0 \up0 \expndtw0\charscalex109 i. Separarea de lamilie si de
prioteni\par\pard\qj \li1099\ri60\sb0\sl-190\slmult0\fi100 \up0
\expndtw0\charscalex113 2. Mediu strain, zgomote Si mirosuri \up0
\expndtw0\charscalex107 (mai intense decdt in alte servicii)\par\pard\ql
\li1209\sb0\sl-192\slmult0 \up0 \expndtw0\charscalex100 3. ingrijtri de
rutina\par\pard\qj \li1094\ri66\sb0\sl-189\slmult0\fi115 \up0
\expndtw0\charscalex101 4. Gri/i cu pnvire la recuperates sanaia(ii \line \up0
\expndtw0\charscalex101 $i a capacita\\u de elort in familie.
profesie\par\pard\qj \li1099\ri71\sb1\sl-192\slmult0\fi110 \up0
\expndtw0\charscalex106 5 Teama de nocunoscut, iminenfa con-\line \up0
\expndtw0\charscalex106 tactulut cu acesta\par\pard\ql \li1099\sb0\sl-
Q Interventia chirurgicale:\par\pard\qj \li1099\ri51\sb5\sl-206\slmult0\fi144
\up0 \expndtw0\charscalex108 1. Operafia ca o leziune si agresionare \up0
\expndtw0\charscalex105 a corpului $i sulletului\par\pard\qj \li1099\ri61\sb0\sl-
204\slmult0\fi110 \up0 \expndtw0\charscalex101 2. Aprecieri prin pnsma experienfei
per� \up0 \expndtw0\charscalex103 sonate (alte operafii sau
recidiva)\par\pard\ql \li1214\sb1\sl-201\slmult0 \up0 \expndtw0\charscalex105 3.
Temerl cu pnvite la:\par\pard\qj \li1099\ri51\sb0\sl-201\slmult0\fi230 \up0
\expndtw0\charscalex109 a) rezultawi intervenfiei chirurgicale \line \up0
\expndtw0\charscalex105 (dacd i$t va mai reveni la vechile capaci\par\pard\ql
tl\par\pard\ql \li1104\sb0\sl-207\slmult0 \par\pard\ql \li1214\sb1\sl-
207\slmult0 \up0 \expndtw0\charscalex113 \ul0\nosupersub\cf3\f4\fs18 \u9633?
Anestezia\par\pard\ql \li1248\sb0\sl-158\slmult0 \up0 \expndtw0\charscalex108 7.
Teama de moate\par\pard\qj \li1104\ri40\sb7\sl-206\slmult0\fi115 \up0
\expndtw0\charscalex111 2 Senzafie stranie de "pseudomoate". \up0
\expndtw0\charscalex115 datorita pierderii cunostintet in cursul \up0
\expndtw0\charscalex110 anesteziei\par\pard\ql \li1224\sb0\sl-196\slmult0 \up0
\expndtw0\charscalex106 3. Sentimentul unui abandon total\par\pard\qj
\li1113\ri42\sb7\sl-201\slmult0\fi110 \up0 \expndtw0\charscalex112 A. Teama
excesiva de complicatiilo \up0 \expndtw0\charscalex107 anesteziei (ex.
alergice)\par\pard\column \qj \li4550\sb0\sl-188\slmult0 \par\pard\qj
\li20\ri1005\sb80\sl-188\slmult0\fi120 \up0 \expndtw0\charscalex105 6 Pterderea
stapamrn
de sine in relatule \up0 \expndtw-1\charscalex100 cu cei dm /ur, consttin(a
nea/utorani, comu \up0 \expndtw0\charscalex100 nicarea dificila cu lumea
exterioard, desfa \up0 \expndtw0\charscalex102 surarea neobi$nuita a zileor de
spital\par\pard\ql \li159\sb1\sl-192\slmult0 \up0 \expndtw-4\charscalex100 7.
Pierdetea condifiei fizice\par\pard\qj \li30\ri1009\sb1\sl-191\slmult0\fi105
\up0 \expndtw0\charscalex103 8. Reialarile unor pacienfi despre nereu-\line \up0
\expndtw0\charscalex108 sitete sau sechelele operatiitor ori acci� \up0
\expndtw0\charscalex113 dental anesteziei\par\pard\qj \li30\ri1000\sb0\sl-
190\slmult0\fi110 \up0 \expndtw0\charscalex108 9 Relatdrile din presa despre
e$ecurile \up0 \expndtw0\charscalex105 sau gre$elile intra- $i
postoperatorii\par\pard\qj \li4560\sb0\sl-206\slmult0 \par\pard\qj
\li34\ri995\sb18\sl-206\slmult0\fi220 \up0 \expndtw0\charscalex102 b) eventualele
"surprize"negative intra-\line \up0 \expndtw0\charscalex101 operatorii
(ex.cancer)\par\pard\qj \li30\ri1000\sb0\sl-206\slmult0\fi235 \up0
\expndtw0\charscalex113 c) urmarile operafiei (aceleasi ca la \up0
\expndtw0\charscalex106 punctele 4 si 7anterioare)\par\pard\qj \li39\ri1026\sb0\sl-
201\slmult0\fi220 \up0 \expndtw0\charscalex104 d) ingrijlile adiacente (sonde.
peduzii. \up0 \expndtw0\charscalex104 cateterizare. etc.)\par\pard\ql
\li150\sb1\sl-206\slmult0 \up0 \expndtw0\charscalex102 4. Vest! proaste inaintea
operafiei\par\pard\ql \li4569\sb0\sl-207\slmult0 \par\pard\ql \li4569\sb0\sl-
207\slmult0 \up0 \expndtw0\charscalex104 5. Grija fa\\d de momentul
trezirii\par\pard\qj \li39\ri1005\sb0\sl-204\slmult0\fi110 \up0
\expndtw0\charscalex108 6. Nepldceri cauzate de peduzii. injec-\line \up0
\expndtw0\charscalex107 fii, masca\par\pard\qj \li44\ri985\sb6\sl-201\slmult0\fi120
\up0 \expndtw0\charscalex117 7. Teama de a nu comile indiscrefii \up0
\expndtw0\charscalex105 asupra intimitdfilor sale\par\pard\ql \li159\sb6\sl-
207\slmult0 \up0 \expndtw0\charscalex107 8. Experienje anterioare nepldcute
\par\pard\qj\li1128\ri1645\sb59\sl-200\slmult0\fi110 \up0 \expndtw0\charscalex112 U
Momentul trezirii din anestezie si al evaluarii Imediate a rezultatelor \up0
\expndtw0\charscalex106 operafiei \par\pard\ql \li1276\sb2\sl-198\slmult0 \up0
\expndtw0\charscalex103 1. Griji cu privlre la recuperarea sAnStSfii si a
capacttdfii de efot \par\pard\ql \li1248\sb2\sl-198\slmult0 \up0
\expndtw0\charscalex102 2. Pierderea condifiei fizice.
\ul0\nosupersub\cf8\f9\fs22 Probleme si incidente cu consecinte psihologice in
decursul \up0 \expndtw0\charscalex115 actului chirurgical \par\pard\qj
\li1060\ri558\sb210\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex105 O clasificare
simple, dar utila. a intervenfiilor chirurgicale pune in evi� \up0
\expndtw0\charscalex105 denfe cateva probleme de bazS: \par\pard\qj
\li1065\ri530\sb8\sl-255\slmult0\fi302 \up0 \expndtw0\charscalex103 _l in
intervenfia "de urgenfe", stresui psihic al bolnavului este produs Tn \up0
\expndtw0\charscalex103 principal de boae (v. impactul psihologie al durerii) si
mai pufin de percepe-\line \up0 \expndtw0\charscalex103 rea si anticiparea
necesiefii intervenfiei chirurgicale. Nu e mai pufin adevS-\line \up0
\expndtw0\charscalex110 rat. existe o doze redutabiie de anxietate, ce poate fi
pusa in legeturS cu \up0 \expndtw0\charscalex108 adeverata plonjare a bolnavului in
necunoscut \up0 \expndtw0\charscalex107 (prin bruschetea aparifiei \par\pard\qj
\li1065\ri531\sb0\sl-250\slmult0\fi4 \up0 \expndtw0\charscalex102 unui simptom
important: ex. hemoragie, asociate imposibilitefii de control al \up0
\expndtw0\charscalex107 acesteia), dar. nu Tn pufme cazuri si prin incapacitatea
pacientului de a-si \up0 \expndtw0\charscalex107 alege medicul curant (boala
preseaza. are o evolufie supraacute); \par\pard\ql \li1368\sb1\sl-
225\slmult0\tx5222 \up0 \expndtw0\charscalex105 \u9633? in intervenfiile
chirurgicale "la rece" \tab \up0 \expndtw0\charscalex102 (de tipul urgenfelor
"amanate"). \par\pard\qj \li1070\ri516\sb0\sl-250\slmult0 \up0
\expndtw0\charscalex107 stresui psihic este produs Tntr-o mesure mai mice (sau
deloc) de simptom \up0 \expndtw0\charscalex107 (parametri ca durerea, temperatura,
TA, statusul hemodinamic sunt stabi-\line \up0 \expndtw0\charscalex108 lizati), si
intr-o pondere sporie de anticiparea momentului operator \up0 \expndtw-
7\charscalex100 (fiind \par\pard\qj \li1070\ri495\sb14\sl-240\slmult0 \up0
\expndtw0\charscalex113 accentuat de vidui de inlormafii cu privire la boae. la cei
ce-si donuna \up0 \expndtw0\charscalex107 anxietatea prin intelectualizare, sau de
lipsa de suport social, de securitate \up0 \expndtw0\charscalex107 emofionale 1a
cei ce au o strategie adaptive de tip "coping" emotional). \par\pard\qj
\li1075\ri496\sb20\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex104 Petrunderea in
lumea spitalului, nefamlliare i rece, confruntarea cu sufe-\line \up0
\expndtw0\charscalex113 rinfele, eventual decesul altor bolnavi, ruperea punfilor
de legatura cu \up0 \expndtw-3\charscalex100 mediul TnconjurStor \up0
\expndtw0\charscalex104 (diminuarea suportului social, \up0 \expndtw0\charscalex106
(ie prin impcsibilitatea \par\pard\qj \li1065\ri506\sb0\sl-250\slmult0\fi14 \up0
\expndtw0\charscalex112 includeni familiei in planul de asistenfa terapeuticS, fie
prin retragerea \up0 \expndtw0\charscalex107 deliberae a acesteia intr-un moment
"cheie" pentru bolnav (pacienti aban-\line \up0 \expndtw0\charscalex102
donafi/neglijafi. Tn special eel cu prognostic prost \up0 \expndtw0\charscalex100 -
ex. unii bStram cu can� \par\pard\ql \li1065\sb1\sl-228\slmult0\tx1588 \up0
\expndtw-2\charscalex100 cer)) \tab \up0 \expndtw0\charscalex105 - sunt de asemenea
factori ce ndicS serioase probleme psihologice. \par\pard\qj \li1070\ri495\sb23\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex122 O importantS deosebits o are, si
aste normal s-o aibS, tipul de \up0 \expndtw0\charscalex108 personalitate a
bolnavului, in relafie cu tipul de personalitate a medicului \up0
\expndtw0\charscalex108 care trateazS (v. tabelul 2). \par\pard\qj
\li1070\ri490\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex103 Balanfa
beneficiu-risc a oricarei intervenfu chirurgicale ridicS si proble� \up0
\expndtw0\charscalex104 ma deciziei asupra tipului de operafie. este mai utila o
intervenfie paliativa, \up0 \expndtw0\charscalex104 care exclude insasi ideea de
vindecare, sau trebuie se minimalizem riscurile \up0 \expndtw0\charscalex104
interventiei radicae, propunandu-ne obiective maxime? Respunsurlle varia-\line \up0
\expndtw0\charscalex111 ze de la o scoae chirurgicale la alta, dar exista si
variafii transculturale, \up0 \expndtw0\charscalex106 strSns legate de atitudinea
fafe de problema adeverului in boae (cu refehre \up0 \expndtw0\charscalex105
directe la boala incurabie). Remarcem la acest punct diferenfele dintre
sco-\line \up0 \expndtw0\charscalex108 hle amencana s' europeana. expresie a unei
atitudini diferite asupra drep-\line \up0 \expndtw0\charscalex108 turilor omului
bolnav. dar si asupra valorii sociale a acestuia, Tn cadrul dat. \par\pard\qj
\li1089\ri516\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex100 Excluzand
pentru moment cazul bolnavului incurabil, alegerea momentu� \up0
\expndtw0\charscalex103 lui intervenfiei chirurgicale "elective" este
mdiscutabil \up0 \expndtw0\charscalex103 $i la latitudinea pa� \par\pard\qj
\li1075\ri510\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex106 cientului, prevaland
motive dintre cele mai diverse (tratament medical erS \up0 \expndtw0\charscalex106
rezultat, la un bolnav cu aspirafii profesionale ridicate; complicative bolii. \up0
\expndtw0\charscalex104 care scad calitatea viefii pacientului; un statut socio-
profesional - ex. om de \up0 \expndtw0\charscalex104 afaceh - care nu permite
boala, etc.). \par\pard\sect\sectd\fs24\paperw8940\paperh13300{\bkmkstart Pg278}
\expndtw0\charscalex120 \u9830?\tab \dn2 \expndtw0\charscalex118
\ul0\nosupersub\cf3\f4\fs18 Elemente de psihosomatica generala S'
aplicats\par\pard\li1175\sb0\sl-230\slmult0\par\pard\li1175\sb0\sl-
230\slmult0\fi335 \up0 \expndtw0\charscalex119 \ul0\nosupersub\cf9\f10\fs20 Tabelul
2. Tipuri de medici, Tn funcfie de comportamentul fafa\par\pard\li1175\sb5\sl-
230\slmult0\fi1660 \up0 \expndtw0\charscalex118 de bolnav (dupa Boettcher,
1988)\par\pard\li1175\sb149\sl-207\slmult0\fi2812 \up0 \expndtw0\charscalex113
\ul0\nosupersub\cf37\f38\fs18\ul 1) Tipul Isterie\par\pard\li1175\sb1\sl-
\ul0\nosupersub\cf18\f19\fs20\ul Celltitl\ul0\tab \up0 \expndtw0\charscalex104
\ul0\nosupersub\cf9\f10\fs20 Defecte\par\pard\li1175\sb1\sl-201\slmult0\fi72\tx4756
\up0 \expndtw0\charscalex105 \ul0\nosupersub\cf3\f4\fs18 activ. pltn de elan,
simpatic.\tab \up0 \expndtw0\charscalex105 \u9632? sensibil la
admira(ia/laudele\par\pard\li1175\sb1\sl-167\slmult0\fi72\tx4732 \up0
\expndtw0\charscalex107 radiazd optimism\tab \dn2 \expndtw0\charscalex105
pacientului\par\pard\li1175\sb1\sl-191\slmult0\fi76\tx4756 \up0
\expndtw0\charscalex106 boala este
pentru el "un meci al viefii"\tab \up0 \expndtw0\charscalex105 \u9632? se
demobilizeazd usor si ii scade\par\pard\li1175\sb1\sl-175\slmult0\fi62\tx4742
\up0 \expndtw0\charscalex107 pentru toate, el gases te o solufie\tab \up0
\expndtw0\charscalex109 repede interesul pentru pacient. In\par\pard\li1175\sb1\sl-
183\slmult0\fi62\tx4737 \up0 \expndtw0\charscalex101 poate obfine mai mult (cu o
batista umedd)\tab \up0 \expndtw0\charscalex110 caz de insucces
terapeutic\par\pard\li1175\sb1\sl-181\slmult0\fi62\tx4756 \up0
\expndtw0\charscalex106 decdt atfii cuojumatate de larmacie\tab \up0
\expndtw0\charscalex106 - fi lipsesto rdbdarea si
dispozifia\par\pard\li1175\sb1\sl-177\slmult0\fi81\tx4737 \up0
\expndtw0\charscalex107 fiecare pacient este pentru el o provocare\tab \up0
\expndtw0\charscalex107 pentru o munca
migaloasd\par\pard\sect\sectd\sbknone\cols2\colno1\colw3396\colsr160\colno2\colw524
4\colsr160\ql \li1175\sb1\sl-177\slmult0 \up0 \expndtw0\charscalex105 \u9632?
deschis. spontan, direct\par\pard\ql \li2385\sb0\sl-207\slmult0 \par\pard\ql
Calitdfi\par\pard\column \qj \li1211\ri1471\sb3\sl-180\slmult0\fi9 \up0
\expndtw0\charscalex106 \u9632? lubesie efectele spectaculoase \up0
\expndtw0\charscalex103 \u9632? practicd polipragmazia $i este \up0
\expndtw0\charscalex105 adeptul noilor medicamente\par\pard\qj
\li1211\ri1332\sb0\sl-184\slmult0\fi9 \up0 \expndtw0\charscalex103 \u9632? ordinea,
linistea $i obiectivilatea \up0 \expndtw0\charscalex106 nu Ii sunt
specifice\par\pard\ql \li20\ri2224\sb0\sl-321\slmult0\tx2325 \up0
\expndtw0\charscalex110 2) Tipul autoritar (tlranic) \line\tab \up0
Defecte\par\pard\sect\sectd\sbknone\cols2\colno1\colw4582\colsr160\colno2\colw4058\
colsr160\qj \li1142\ri975\sb0\sl-207\slmult0\fi14 \up0 \expndtw0\charscalex104 -
constant grijuliu. responsabil, \up0 \expndtw0\charscalex110 consecvent fi
perseverent\par\pard\ql \li1156\sb1\sl-175\slmult0 \up0 \expndtw0\charscalex102 -
competenta protesionatd,\par\pard\ql \li1147\sb1\sl-177\slmult0 \up0
\expndtw0\charscalex105 nu! scapd nimic dm ceea ce are pacientul\par\pard\qj
\li1156\ri0\sb0\sl-181\slmult0\tx1252 \up0 \expndtw0\charscalex102 - examinare
minufioasd (palpate, auscultate) \line\tab \up0 \expndtw0\charscalex105 ordine
des&vdrsitd in sectorul sdu\par\pard\column \qj \li44\ri1004\sb0\sl-
207\slmult0\tx92 \up0 \expndtw0\charscalex110 \u9632? conservatorism. axare
excesivd pe \line\tab \up0 \expndtw0\charscalex109 reguli\par\pard\qj
\li20\ri933\sb3\sl-172\slmult0\fi19 \up0 \expndtw0\charscalex104 - teama de a omite
ceva ce II macind, si \line \up0 \expndtw0\charscalex100 poate dezvolta la
pacientii sai reacfii de\par\pard\ql \li78\sb3\sl-187\slmult0 \up0 \expndtw-
3\charscalex100 tip ipohondric\par\pard\qj \li39\ri1365\sb0\sl-177\slmult0\tx87
\up0 \expndtw0\charscalex103 \u9632? idealizeazd Increderea In lorfele \line\tab
\up0 \expndtw0\charscalex108 naturale sanogenetico ale\par\pard\ql \li30\sb0\sl-
182\slmult0 \up0 \expndtw0\charscalex104 organismului\par\pard\qj
\li30\ri1337\sb0\sl-180\slmult0\fi4 \up0 \expndtw0\charscalex100 \u9632? susfine
intr-un mod agresiv leges, \line \up0 \expndtw0\charscalex106 ordinea si datoria.
ca $i ierarhia\par\pard\ql \li39\sb2\sl-182\slmult0 \up0 \expndtw0\charscalex106 -
tinde sd se tereasca permanent de\par\pard\qj \li73\ri1193\sb5\sl-177\slmult0
\up0 \expndtw0\charscalex102 gre$eli, dispdrdndu-i spontaneitatea. \up0
\expndtw0\charscalex103 "aerul glumet" sau pasional \par\pard\sect\sectd\sbknone
\ql \li3873\sb88\sl-207\slmult0 \up0 \expndtw0\charscalex113 3) Tipul dopresiv
\par\pard\li1262\sb123\sl-230\slmult0\fi1123\tx5447 \dn2 \expndtw0\charscalex118
\ul0\nosupersub\cf18\f19\fs20\ul Calftitl\ul0\tab \up0 \expndtw0\charscalex116
\ul0\nosupersub\cf3\f4\fs18 Defecte\par\pard\li1262\sb0\sl-
184\slmult0\fi0\tx4766 \up0 \expndtw0\charscalex106 cdldura, apropiere fafd de
bolnav\tab \up0 \expndtw0\charscalex105 - nu pot sd spund
"nu"\par\pard\li1262\sb1\sl-176\slmult0\fi0\tx4920 \up0 \expndtw0\charscalex109
harnic\tab \dn2 \expndtw0\charscalex105 vulnerabil la bolile
psihosomatice\par\pard\ql \li4756\sb6\sl-175\slmult0 \up0 \expndtw0\charscalex104
(devotat pdnd la sacrificiul de sine) \par\pard\qj \li4756\ri990\sb1\sl-
180\slmult0\fi91 \up0 \expndtw0\charscalex100 autoculpablllzare ("alfi medici
vindecd \up0 \expndtw0\charscalex100 mai bine si mai repede") \par\pard\ql
\li4867\sb5\sl-175\slmult0 \up0 \expndtw-1\charscalex100 rtemcrez&tori in propriile
forte \par\pard\qj \li4752\ri969\sb1\sl-180\slmult0\fi14 \up0
\expndtw0\charscalex104 - incapabili de agresivitate (desi ii pot \up0
\expndtw0\charscalex104 face pe alfii sd se ru$ineze de defectele \up0 \expndtw-
1\charscalex100 proprii) \par\pard\ql \li4771\sb5\sl-175\slmult0 \up0
\expndtw0\charscalex101 \u9632? creaza pacientului imprests de \par\pard\qj
\li4756\ri980\sb1\sl-180\slmult0 \up0 \expndtw0\charscalex111 neajutorare:
identilicare cu pacientul \up0 \expndtw0\charscalex105 sulerind \par\pard\ql
\li3892\sb98\sl-207\slmult0 \up0 \expndtw0\charscalex115 4) Tipul schizoid
\ul0\nosupersub\cf37\f38\fs18\ul Cetltdtl\ul0\tab \up0 \expndtw0\charscalex102
\ul0\nosupersub\cf37\f38\fs18\ul Defecte\par\pard\li1180\sb1\sl-
\u9632? subtilitate superinteligenta\tab \up0 \expndtw0\charscalex102 - rdceald,
distanfa\par\pard\li1180\sb1\sl-179\slmult0\fi0\tx4776 \up0 \expndtw0\charscalex102
(de?i inctina spre izolare)\tab \up0 \expndtw0\charscalex102 \u9632? fnchis in
sine\par\pard\li1180\sb1\sl-183\slmult0\fi14\tx4776 \up0 \expndtw0\charscalex102 -
obieciivitate maxima in\tab \up0 \expndtw0\charscalex102 - poate favoriza un climat
impersonal in\par\pard\li1180\sb1\sl-175\slmult0\fi9\tx4766 \up0
\expndtw0\charscalex102 evaluarea suferinfei pacientului\tab \up0
\expndtw0\charscalex102 clinicd\par\pard\qj \li1195\ri4483\sb0\sl-200\slmult0
\up0 \expndtw0\charscalex100 (de care nu se lasd influen\{at in stabilirea \up0
\expndtw-1\charscalex100 diagnosticutui si tratamentului)
\ul0\nosupersub\cf9\f10\fs20 Dinamica problemelor psihologice ale pacientului in
raport cu \up0 \expndtw0\charscalex132 momentul actului operator \par\pard\qj
\li1108\ri483\sb190\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex119 DacS anterior
ne-am referit la problemele din perioada preoperatorie, \up0
\expndtw0\charscalex115 dacS in momentul intraoperator problemele sunt generate in
special de dis� \up0 \expndtw0\charscalex112 confortui fizic i psihic pe care-l
presupune intervenfia (incluzand aici in spe� \up0 \expndtw0\charscalex113 cial
incidentele si complicafiile intraoperatorii la care pacientul are acces di�
\up0 \expndtw0\charscalex117 rect: durere. hemostaze dificilS, sau, indirect, de
ex. auzindu-i pe membrii \up0 \expndtw0\charscalex115 echipei de interventie),
momentul postoperator este eel care, prin durata lui \up0 \expndtw0\charscalex117
relativ sporite. si Prin anumifi factori obiectivi sau subiectivi, are o
impor\up0 \expndtw0\charscalex117 tanfa deosebite in plan psihologie:
\par\pard\qj \li1108\ri469\sb37\sl-220\slmult0\fi297 \up0 \expndtw0\charscalex120 e
in perioada postoperatorie precoce disconfortui este mixt: fizic, prin \up0
\expndtw0\charscalex118 dureri, verseturi, meteorism, impotenfe funcfionale, dar
\up0 \expndtw0\charscalex119 $i posibil psihic \par\pard\ql \li1113\ri469\sb1\sl-
243\slmult0\fi4\tx1396 \up0 \expndtw0\charscalex117 (numai ideea - cazul psihozelor
post-partum - sau chiar prezenta mutilSrli, \up0 \expndtw0\charscalex114
sechelelor, infirmitstii - ca de ex. in amputafnle de necesitate); \line \tab
\up0 \expndtw0\charscalex114 in aceastS perioada, de multe ori, ritmul progresului
stSrii de sSnState. al \up0 \expndtw0\charscalex115 recuperSrii este neconcordant
cu al a$teptSnlor bolnavului. Acest lucru este \up0 \expndtw0\charscalex116
perceput dureros de persoanele vulnerable la frustrare (ex. tipul psihocom� \up0
\expndtw0\charscalex120 portamental A. care are o motivafie de tip social, de
autoafirmare, foarte \up0 \expndtw0\charscalex110 pregnantS). \par\pard\qj
\li1108\ri459\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex116 in perioada
postoperatorie precoce, pacientul este confruntat eventual si \up0
\expndtw0\charscalex118 cu esecul intervenfiei terapeutice. cu rezultate
disproporfionat de mici sau \up0 \expndtw0\charscalex116 chiar dramatice, raportate
la expectafiile medicului sau ale pacientului (ex. \up0 \expndtw0\charscalex117
descopenrea intraoperatorie a unui cancer Inoperabil). Tot acum, bolnavul \up0
\expndtw0\charscalex118 este mai susceptibil la stresui psihic iatrogen
(disconfortui "minim" in alte \up0 \expndtw0\charscalex114 situafii este
amplificat, pregStirea psihologica a pacientului se centreazS eel \up0
\expndtw0\charscalex115 mai adesea pe acceptarea si desfSsurarea momentului
operator, si mai pufin \up0 \expndtw0\charscalex115 sau deloc pe perioada
postoperatorie). \par\pard\qj \li1113\ri464\sb23\sl-237\slmult0\fi292 \up0
\expndtw0\charscalex119 e in perioada postoperatorie tardiva se pot manifesta douS
tendinte cu \up0 \expndtw0\charscalex118 sens contrar; pe de-o parte, recidiva/
recSderea (corelatS cu supralicitarea
\up0 \expndtw0\charscalex120 antenoarS de cStre pacient a intervenfiei
chirurgicale) erodeazS puternic \up0 \expndtw0\charscalex113 fundamentul increderii
in medic "DacS nu chirurgia. atunci ce ?"; pe de alta, \up0 \expndtw0\charscalex118
in aceastS perioada se rup adesea legaturile cu terapeutul (de regue. ele se
\up0 \expndtw0\charscalex120 menfin doar scurt timp dupe operafie. Iar problemele
aperute tardiv sunt \up0 \expndtw0\charscalex125 gestionate adesea de medicii de
medicine generae sau internistt. pane \up0 \expndtw0\charscalex112 devin
critice). \par\pard\qj \li1118\ri469\sb1\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex113 Desigur. in cadrul factorilor de prognostic prost in plan
psihologie, se pot \up0 \expndtw0\charscalex117 include in aceaste perioade S"
complicafiile generate de insSsi intervenfia \up0 \expndtw0\charscalex117
chirurgicale (granulom de, fir, eventrafii, eviscerafii, etc.). \par\pard\ql
\li1411\sb229\sl-230\slmult0 \up0 \expndtw0\charscalex133 Chirurgul in relafie cu
pacientul sau \u8226? probleme \par\pard\qj \li1128\ri488\sb202\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex122 FerS a le epuiza. citSm cSteva din
problemele de relationare in plan \up0 \expndtw0\charscalex115 psihologie pe care
si le creazS sau pe care doar le simte chirurgul: \par\pard\qj
predominanfa anamnezei de tip tehmcist. centratS pe simptom, si nu \up0
\expndtw0\charscalex116 pe percepfia lui \up0 \expndtw0\charscalex116 (inclusiv
psihologicS). Din donnfa cresterii eflcienfei s' a
\up0 \expndtw0\charscalex131 actiunii prompte, unii medici se cantoneazS Tn acest
tip de relafie \up0 \expndtw0\charscalex115 (medicul=activ pacientul=pasiv, obiect,
caz), nepermifand expresia liberS a \up0 \expndtw0\charscalex116 acestuia (garanfia
catharsisului, a descSrcSrii emofionale) sau rSspunsul la \up0
\expndtw0\charscalex105 multiplele lui TntrebSri; \par\pard\ql
\li820\ri771\sb22\sl-240\slmult0\fi297\tx1123 \up0 \expndtw0\charscalex127 e strans
legats de cele de mai sus este dezumanizarea pacientului, \up0
\expndtw0\charscalex112 transformarea lui intr-un caz, intr-un "ulcer", "adenom",
etc; \line \tab \up0 \expndtw0\charscalex127 e atitudinea interventionists
exagerats, frecvents, nu Tntotdeauna \up0 \expndtw0\charscalex116 justificatS;
alegerea unui tip de operafie comod, convenabil pentru chirurg, \up0
\expndtw0\charscalex120 nu pentru pacient \up0 \expndtw0\charscalex121 (ambele
justificate prin nevoia de succes \up0 \expndtw0\charscalex116 $i prestigiu
\par\pard\ql \li820\sb1\sl-215\slmult0 \up0 \expndtw0\charscalex114 social a
terapeutului); \par\pard\ql \li820\ri767\sb25\sl-240\slmult0\fi302\tx1118 \up0
\expndtw0\charscalex117 \u8226? scSderea e minim a duratei contactului cu
pacientul, si chiar a duratei \up0 \expndtw0\charscalex109 spitalizSrii \up0
\expndtw0\charscalex114 (motivats prin necesitatea cresterii eficienfei actului
medical); \line\tab \up0 \expndtw0\charscalex122 e impactul frecvent, violent,
frustrant cu moartea sau incurabilitatea \up0 \expndtw0\charscalex112 ameninfS
echilibrul psihic al chirurgului. \par\pard\qj \li820\ri777\sb0\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex111 Un model al posibilitSfilor de
proastS funcfionare a relafiei medic-pacient, \up0 \expndtw0\charscalex111 cu
particularizare imediatS la chirurg, este prezentat in tabelul 3. \par\pard\ql
\expndtw0\charscalex109 Tabelul 3. Forme de refuz al pmluarll problemelor
\par\pard\ql \li2836\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 psihologice
ale pacientului grav \par\pard\ql \li2428\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex106 (dupe Rosier, Szewczyk. Wl/dgrube, 1996)
\ul0\nosupersub\cf42\f43\fs4 : '.\tab \up0 \expndtw0\charscalex100
'\par\pard\qj \li1080\sb0\sl-260\slmult0 \par\pard\qj\li1080\ri1173\sb161\sl-
Evitare directd prin indicarea altor factori competent!: sistemul de \up0
\expndtw0\charscalex109 consiliere, inclusiv consult psihologie \par\pard\ql
\li1363\sb85\sl-230\slmult0 \up0 \expndtw0\charscalex108 2. Evitare indirectd,
prin: \par\pard\qj \li1080\ri1168\sb46\sl-260\slmult0\fi283 \up0
\expndtw0\charscalex109 a) Reducerea individualitdfli bolnavului la nivelul unui
simplu "caz" \up0 \expndtw0\charscalex110 medical si tdentificarea acestuia
dupd: \par\pard\ql \li1377\sb85\sl-230\slmult0 \up0 \expndtw0\charscalex109 -
natura si forma clinicd a bolii \par\pard\ql \li1382\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex106 - istoricul bolii \par\pard\qj \li1382\ri1178\sb6\sl-
260\slmult0 \up0 \expndtw0\charscalex109 \u9632? localizare ("bolnavul de la
fereastrd", "patu/2dln salonul 4", etc.) \up0 \expndtw0\charscalex115 \u9632?
natura investigafiilor necesare \up0 \expndtw0\charscalex120 ("bolnava care trebuie
sd facd \par\pard\ql \li1089\sb25\sl-230\slmult0 \up0 \expndtw0\charscalex108
ecografie") \par\pard\ql \li1377\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex110
b) Retragere in birou sau in laborator \par\pard\qj \li1089\ri1173\sb66\sl-
260\slmult0\fi287 \up0 \expndtw0\charscalex111 c) T&gdduirea (negarea) propriei
implicdri emotionale (mai ales in \up0 \expndtw0\charscalex109 cazurile unor boli
cu prognostic letat) \par\pard\ql \li1377\sb65\sl-230\slmult0 \up0
\expndtw0\charscalex111 3. Ldsarea in suspensie a unor adevdruri, in cazul unor
boli severe: \par\pard\ql \li1377\sb90\sl-230\slmult0 \up0 \expndtw0\charscalex110
a) evitarea expiica\up0 \expndtw0\charscalex109 t'tilor asupra prognosticului vital
\par\pard\ql \li1391\sb70\sl-230\slmult0 \up0 \expndtw0\charscalex110 b) invocarea
faptulul cd pacientul nu poate sd totereze adevdru! \par\pard\qj
Etichetarea bolnavului ca pacient cu o boald imposibil de discutat \up0
\expndtw0\charscalex110 (despre care nu are ce discuta)
300\slmult0 \up0 \expndtw0\charscalex134 Rolul psihoterapiei suportive in evolufia
favorabila \up0 \expndtw0\charscalex135 perioperatorie a bolnavului \par\pard\qj
\li1147\ri445\sb190\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex115 Este de
domeniul evidenfei cS un bun chirurg este de multe ori si un bun \up0
\expndtw0\charscalex108 psiholog. \par\pard\qj \li1137\ri440\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex130 Totusi, pe ISngS faptul cS unii
chirurgi nu au vocafia unei bune \up0 \expndtw0\charscalex116 comunicSri cu
bolnavul, exists riscul - chiar $1 la chirurgii experimental si \up0
\expndtw0\charscalex112 buni psihologi. de a comite greseli Tn planul relafiei
psihologice cu bolnavul. \up0 \expndtw0\charscalex120 cauzSnd efecte iatrogene ce
pot avea uneort repercusiunl violente asupra \up0 \expndtw0\charscalex110 sSnStSfii
bolnavului \up0 \expndtw0\charscalex124 (de ex. comunicarea. fSrS o acoperire
diagnostics \par\pard\qj \li1137\ri441\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex114 fermS, a unei suspiciunl de cancer poate produce o gravS
depresie bolnavu� \up0 \expndtw0\charscalex118 lui, cu atat mai severs cu cat
dovezile necesare diagnosticului pot, in mod \up0 \expndtw0\charscalex116 obiectiv,
sS intarzie, iar atunci cand sosesc. sS fie prea tarzlu; eel mai ade� \up0
\expndtw0\charscalex117 sea. bolnavul persists in reacfia sa. nelinistit de ideea
ce asigurenle date de \up0 \expndtw0\charscalex117 medic ascund, de fapt.
diagnostics pozitiv al cumplitei boli) \par\pard\qj \li1147\ri439\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex118 Elementul care, totusi. marcheaza Tn
modul eel mai favorabil evolutia \up0 \expndtw0\charscalex116 bolnavului este
constituit de cSteva trasaturi de baza ale personalitafii chi� \up0
\expndtw0\charscalex106 rurgului: \par\pard\qj \li1147\ri430\sb0\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex119 e ceidura umane. optimismul.
darzenia s* disponibilitatea sa (in limite \up0 \expndtw0\charscalex118
"rezonabile"') pentru bolnav, inciusiv pentru unele probleme sufletestl ale \up0
\expndtw0\charscalex118 acestuia; \par\pard\qj \li1142\ri440\sb0\sl-
246\slmult0\fi292 \up0 \expndtw0\charscalex117 e caracterul activ al demersunlor
sale psihologice. mergand de la expli\up0 \expndtw0\charscalex112 cafiile. cu
caracter intuitiv. metaforic - date bolnavului despre boala si obiec� \up0
\expndtw0\charscalex117 tivele actului operator, si pane la susfmerea morals a
acestuia pe parcursul \up0 \expndtw0\charscalex117 tuturor etapelor actului
chirurgical. \par\pard\qj \li1142\ri430\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex116 Nu trebuie neglijat faptul ce un chirurg trebuie se se
protejeze impotriva \up0 \expndtw0\charscalex118 stresului psihic. Iar acest
capitol necesar in viafa fieceruia dintre noi are o \up0 \expndtw0\charscalex117
extensie si particularitafi deosebite in profesiunea chirurgicale.
Un chirurg \up0 \expndtw0\charscalex121 mai pufin stresat va avea capaciefi mai
man pentru actul psihoterapeutic \up0 \expndtw0\charscalex114 de susfinere a
bolnavului. \par\pard\qj \li1142\ri441\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex121 Existe numeroase cerceeri care atestS rolul favorabil al
psihoterapiei \up0 \expndtw0\charscalex113 suportive aplicats la bolnavul
chirurgical. Ele se refers la bunul mers al ope� \up0 \expndtw0\charscalex112
rafiei, diminuarea intensitSfii durerilor, dar si a complicafiilor
postoperatorii. \up0 \expndtw0\charscalex112 ca $i 'a scurtarea perioadei de
recuperare a bolnavului. \par\pard\ql \li1435\sb0\sl-253\slmult0
\ul0\nosupersub\cf8\f9\fs22 Situafii speciale \u8226? comentarii \par\pard\ql
\ul0\nosupersub\cf9\f10\fs20 \u9633? Bolnavul neoplazic \par\pard\qj
bolnavilor cu cancer se ridice unele probleme importanta de \up0
\expndtw0\charscalex111 ordin psihologie: \par\pard\qj \li1147\ri435\sb6\sl-
233\slmult0\fi297 \up0 \expndtw0\charscalex119 \u8226? problema adeverului despre
boae (secvenfa parcursS eel mai adesea \up0 \expndtw0\charscalex117 de bolnav la
aflarea diagnosticului este, in lipsa intervenfiei psihoterapeu� \up0
\expndtw0\charscalex120 tice. urmStoarea: negare - revolts - resemnare - disperare
cu posibie con\up0 \expndtw0\charscalex120 dulte de tip suiddar),
236\slmult0\fi292 \up0 \expndtw0\charscalex117 - deciderea modalitSfii de
intervenfie radicae sau pallativS (riscurile Tn \up0 \expndtw0\charscalex115 sine
ale intervenfiei radicale. mutilarea definitivS, fSrS certitudinea salvSrii \up0
\expndtw0\charscalex115 viefii sau vindecSrii, scSderea dramatics a calitSfii
viefii omului bolnav, Tn \up0 \expndtw0\charscalex120 balanfS cu certitudinea
lipsei vindecSrii si prin aceasta, acceptarea prog\up0 \expndtw0\charscalex113
nosticului infaust (echivalentS cu o condamnare), chiar dacS pentru moment \up0
\expndtw0\charscalex113 calitatea viefii se pSstreazS); \par\pard\ql
\li1132\sb9\sl-230\slmult0\tx7257 \up0 \expndtw0\charscalex121 e cointeresarea
membrilor familiei Tn asistenta psihologice \tab \up0 \expndtw0\charscalex105 (Tn
fapt, \par\pard\qj \li840\ri748\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex122
premisa este asistenfa psihologice inclusiv pentru membrii familiei, eel \up0
\expndtw0\charscalex111 pufin la debut); \par\pard\qj \li835\ri732\sb0\sl-
233\slmult0\fi302 \up0 \expndtw0\charscalex118 e punerea Tn discufie a imaginii de
sine a terapeutului (confruntat cu o \up0 \expndtw0\charscalex117 stare de
neputinfe/frustrare, consecutive lipsei posibilitafilor de vindecare) \up0
\expndtw0\charscalex121 reclame, eel pufin Tn serviciile de oncologie. colaborarea
cu psihologul \up0 \expndtw0\charscalex113 clinician, inserat Tn echipa
terapeuticS; \par\pard\qj \li840\ri727\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex114 e existenfa unei relafii de conlucrare optime cu ceilalfi
membri ai echipei \up0 \expndtw0\charscalex113 chirurgicale, personalul auxiliar.
dar si cu alfi specialist! care trateaze bolna� \up0 \expndtw0\charscalex113 vul
(evitarea asa-numitului "circuit al speciallstllor", in care bolnavul schim\up0
\expndtw0\charscalex115 bS, Tn scurt timp, spitale, secfii, fara posibilitatea
constituiril unei relafii de \up0 \expndtw0\charscalex117 suflet cu vreunul din
medicii care-l trateaze, si cu consecinfe nefavorabile, \up0
\expndtw0\charscalex117 prin tracasari inutile, asupra insasi star ii lui precare
de sSnState). \par\pard\qj \li840\ri727\sb210\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex121 \u9633? Bolnavul murlbund (v. s1 tabelul 4 asupra
percepfiei psihologice a \up0 \expndtw0\charscalex111 apropiatei morfi).
240\slmult0\tx2582 \up0 \expndtw0\charscalex116 Tabelul 4. Cele 5 faze ale
evolufiei' spre moarte la bolnavul \line\tab \up0 \expndtw0\charscalex113 incurabil
(dupd Kiibter si Rose, 1988) \par\pard\ql \li1142\sb229\sl-230\slmult0 \up0
\expndtw0\charscalex109 1. Socul la af/area destinului necrufdtor \par\pard\ql
\li1094\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 2. Negare sau amagire
\par\pard\ql \li1104\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex107 3. Revoltd.
furie \par\pard\qj \li1108\ri1126\sb0\sl-240\slmult0\tx1339 \up0
\expndtw0\charscalex117 4. Depresie (tristefe), pe fondul cdreia se contureazd doud
tipuri de \line\tab \up0 \expndtw0\charscalex109 comportament: \par\pard\ql
\li2577\sb1\sl-218\slmult0 \up0 \expndtw0\charscalex109 - tentative de "negociere",
docilitate \par\pard\ql \li2572\sb3\sl-217\slmult0 \up0 \expndtw0\charscalex110 -
inchidere in sine, confuzie \par\pard\qj \li1104\ri1120\sb4\sl-
240\slmult0\tx1353 \up0 \expndtw0\charscalex117 5. Pierderea vitalitdfii, ca $i a
posibilitdfil de comunicdre (mai intai \line\tab \up0 \expndtw0\charscalex108
verbald, mai apoi non-verbald) \par\pard\qj \li1113\ri1158\sb177\sl-
220\slmult0\fi28 \up0 \expndtw0\charscalex114 ' In toatd perioada aeestei evolufii,
bolnavul oscileazd intre speranfd. \up0 \expndtw0\charscalex110 lipsd totald de
speranfd si indoiatd. \par\pard\qj \li868\sb0\sl-240\slmult0
Aflat Tn imposibilitatea de a vindeca sau de a TntSrzia evolufia bolii, me� \up0
\expndtw0\charscalex121 dicului Ti ramane doar posibilitatea usurarii sufehnfelor
bolnavului prin \up0 \expndtw0\charscalex116 apelul la mijloace terapeutice si
psihologice. Dace ne referim la acest ultim \up0 \expndtw0\charscalex117 aspect, se
doreste reumanlzarea bolnavului, prin respectarea tuturor nevoi\up0
\expndtw0\charscalex109 lor sale: \par\pard\qj \li1190\ri3729\sb20\sl-
240\slmult0 \up0 \expndtw0\charscalex113 e bazale (confort alimentar, termic,
etc.); \up0 \expndtw0\charscalex114 e de contact ("NU" eviehi bolnavului);
\par\pard\ql\li1329\sb141\sl-230\slmult0 \up0 \expndtw0\charscalex116 e de
comunicare si siguran,S; \par\pard\ql \li1329\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex116 \u8226? de adevar (dace bolnavul o cere). \par\pard\qj
\li1046\ri570\sb19\sl-220\slmult0\fi273 \up0 \expndtw0\charscalex115 in practice,
de prea multe ori, asa cum arate un studiu publlcat de British \up0
\expndtw0\charscalex111 Med. Journal, (oct. \up0 \expndtw0\charscalex114 1994),
aceste nevoi nu sunt satisfecute, faptul putSnd fi \par\pard\ql
\li1027\ri564\sb8\sl-235\slmult0\fi4\tx1315 \up0 \expndtw0\charscalex114 explicat
si prin nevoia de "supraviefuire afective" a medicului (a cSrui ima� \up0
\expndtw0\charscalex115 gine de sine este serios pusS Tn discufie de un astfel de
caz). \line \tab \up0 \expndtw0\charscalex115 Cointeresarea membrilor familiei Tn
asistenfa psihologicS a bolnavului, \up0 \expndtw0\charscalex116 ca si a tuturor
membrilor echipei terapeutice este adeseori o alternative cS-\up0
\expndtw0\charscalex116 reia i se acordS prea pufinS atenfie. \par\pard\qj
\li1036\ri545\sb10\sl-230\slmult0\fi292 \up0 \expndtw0\charscalex120 Este
discutabiie foiosirea Tn cazul bolnavului muribund a eutanaslei, \up0
\expndtw0\charscalex119 chiar a celei paslve, intrucat ea creazS mai multe probleme
decat rezolva \up0 \expndtw0\charscalex116 (acceptand ce viafa unui om, chiar
muribund, poate fi considerate o simple \up0 \expndtw0\charscalex116 "probleme"!).
Dilemele etice, morale, asupra statutului social s' imaginii de \up0
\expndtw0\charscalex116 sine ale medicului sunt extrem de serioase si profunde.
\up0 \expndtw0\charscalex119 \u9633? Bolnavul-medic \par\pard\qj
\li1031\ri551\sb139\sl-220\slmult0\fi288 \up0 \expndtw0\charscalex116 in relafia cu
un coleg de brease, apar probleme psihologice specifice, ca \up0
\expndtw0\charscalex116 de ex.: \par\pard\ql \li1329\sb12\sl-230\slmult0\tx6067
\up0 \expndtw0\charscalex117 e satisfacerea nevoii de Informare a pacientului
\tab \up0 \expndtw0\charscalex111 (in general, Tsi domine \par\pard\qj
\li1036\ri550\sb10\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex117 anxietatea prin
intelectualizare, dupe o evaluare atenta a tuturor posibilitS\up0
\expndtw0\charscalex119 filor si riscurilor), dar rSmanand constienfi cS, prin
specificul muncii lui, \up0 \expndtw0\charscalex119 medicul-pacient este totusi mai
anxios decat media pacienfilor; \par\pard\qj \li1036\ri550\sb2\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex116 e mai ales in etapa preoperatorie este necesare
discutarea TmpreunS cu \up0 \expndtw0\charscalex118 pacientul a alternativelor
terapeutice, si alegerea, de comun acord, a celor \up0 \expndtw0\charscalex115
optime. in acest fel, respecem nevoia de initiative a unui pacient Tn general
\up0 \expndtw0\charscalex115 compliant; \par\pard\qj \li1036\ri536\sb0\sl-
235\slmult0\fi302 \up0 \expndtw0\charscalex136 e respectarea algohtmului terapeutic
si diagnostic este adesea
\up0 \expndtw0\charscalex113 subminate (consultatii fugitive, telefonice. bazate
pe o radiografie. etc.) Me� \up0 \expndtw0\charscalex118 dicul terapeut poate avea,
eel pufin in etapa mifiae, o tendinta la scSderea \up0 \expndtw0\charscalex116
responsabilltSfii, in ideea cS pacientul dispune de mijloacele necesare de a
\up0 \expndtw0\charscalex116 corecta eventualele erori; \par\pard\qj
respectarea statutului social al pacientului este beneficS: evitarea \up0
\expndtw0\charscalex115 pozifiei de superioritate a mediculul-terapeut porneste de
la premisa inexis\up0 \expndtw0\charscalex115 tenfei unei relafii asimetrice medic-
pacient, ca in majoritatea cazurilor \par\pard\qj \li1041\ri561\sb217\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex121 \u9633? Chirurgia la varste extreme,
copilul si batranul Tn fafa Intervenfiei \up0 \expndtw0\charscalex121
chirurgicale \par\pard\qj \li1051\ri536\sb6\sl-233\slmult0\fi278 \up0
\expndtw0\charscalex115 in cazul varstelor fragede nu a fost niciodatS subliniatS
Tndeajuns nece\up0 \expndtw0\charscalex119 sitatea adoptSrii unei atitudini de
tact, blSndefe, rSbdare, calm din partea \up0 \expndtw0\charscalex115 medicului (un
traumatism psihic la aceastS varste poate avea impact major, \up0
\expndtw0\charscalex115 chiar decisiv, asupra evolufiei ulterioare a copilului).
Planul terapeutic trebuie se fie coerent, unitar (a se avea Tn vedere aso� \up0
\expndtw0\charscalex116 cierea membrilor familiei, dace este posibil), cu
ineturarea mScar parfiae a \up0 \expndtw0\charscalex124 imaginii negative
preformate pe care o are copilul despre doctor, si cu \up0 \expndtw0\charscalex119
reducerea la minim a impactului negativ cu lumea spitalului (satisfacerea \up0
\expndtw0\charscalex119 nevoii de comunicare, de joacS. etc.).
psihosomaticS generala si aplicata\par\pard\qj \li998\sb0\sl-240\slmult0
240\slmult0\fi288 \up0 \expndtw0\charscalex131 In ceea ce priveste indicafia
chirurgicale, este necesare evitarea \up0 \expndtw0\charscalex116 atitudinilor
exagerat-intervenfioniste (mai ales la cererea familiei: amigda\up0
\expndtw0\charscalex116 lectomie, apendicectomie, etc.) \par\pard\qj
\li998\ri590\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex121 La varse a 3-a
se impune evaluarea exacts a beneficiului intervenfiei \up0 \expndtw0\charscalex115
terapeutice, in raport cu riscul: \par\pard\qj \li1008\ri583\sb20\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex115 e fie in contextul stSrii generale a
pacientului (tare organice care contra\up0 \expndtw0\charscalex115 indicS
intervenfia chirurgicalS (sau numai pe cea radicae); \par\pard\qj
\li1003\ri579\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex114 \u8226? fie in
contextul evolufiei prognosticat lente a bolii, Tn raport cu nevoile \up0
\expndtw0\charscalex118 pacientului si riscurile aferente interventiei chirurgicale
propriu-zise \up0 \expndtw0\charscalex106 (mai \par\pard\ql \li1003\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex110 ales Tn cancer), \par\pard\qj
\li998\ri569\sb8\sl-233\slmult0\fi288 \up0 \expndtw0\charscalex119 in orice
situafie este utilS (dacS este posibil) informarea pacientului in \up0
\expndtw0\charscalex124 vederea anticipSrii desfSsurSril actului operator si a
posibilelor riscuri \up0 \expndtw0\charscalex118 (cicatrizare TntarziatS, riscul de
infecfie mai mare, persistenta unor acuze \up0 \expndtw0\charscalex118 reziduale
timp mai indelungat, etc.). \par\pard\qj \li998\ri572\sb2\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex119 Din motivele arState mai devreme, este utilS cointeresarea
membrilor \up0 \expndtw0\charscalex120 familiei, pentru prevenirea abandonului sau
retragerii suportului social \par\pard\ql \li1300\sb230\sl-253\slmult0 \up0
\expndtw0\charscalex114 \ul0\nosupersub\cf8\f9\fs22 Chirurgul si lucrul in
echipei \par\pard\qj \li1003\ri563\sb176\sl-243\slmult0\fi292 \up0
\expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 Munca in echipa chirurgicalS
implies o mare rSspundere, oricum, dar ea, \up0 \expndtw0\charscalex117
rSspunderea, este maxims la conducStorul aeestei echipe. Cazul ideal ar fi \up0
\expndtw0\charscalex115 valorificarea optimS a poslbilitSfilor fiecSrui membru al
echipei, lucru incS \up0 \expndtw0\charscalex118 greu de realizat intr-o
specialitate dominate de ambifii si orgolii personae. \up0 \expndtw0\charscalex118
Ceea ce poate realiza practic seful echipei chirurgicale este Tncercarea de \up0
\expndtw0\charscalex124 a "tesi" aspehefile, fere a recurge inse la egalitarism,
care ar fi. pane la \up0 \expndtw0\charscalex117 urne, in defavoarea pacientului
insusi. \par\pard\qj \li998\ri565\sb0\sl-246\slmult0\fi292 \up0
\expndtw0\charscalex117 in al doilea rand, este imperative o bune eolaborare cu
anestezistul/spe-\line \up0 \expndtw0\charscalex119 cialistul Tn terapie intensive,
a cerui imagine (percepfie) socials este mai \up0 \expndtw0\charscalex116
intotdeauna inferioarS celei a chirurgului (se considers cS "este normal" ca
\up0 \expndtw0\charscalex116 anestezia sS meargS bine, se minimalizeazS riscurile
si Incidentele, etc ). \par\pard\qj \li1008\ri564\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex115 in al treilea, dar nu in ultimul rand, se cere instituirea
si menfinerea unor \up0 \expndtw0\charscalex121 raporturi de eolaborare cu
psihologul clinician, si in acest sens se contu\up0 \expndtw0\charscalex115 reazS
necesitatea unui astfel de specialist, eel pufin Tn spitalele mari, cu un \up0
\expndtw0\charscalex115 rulaj mare de bolnavi (universitare), combaterea
reticenfelor nefondate fafa \up0 \expndtw0\charscalex115 de acesta (existente Tn
tipul de educafie materialist, tradifia scolii, sau con\up0 \expndtw0\charscalex115
servatorismul chirurgului). \par\pard\ql \li1315\sb103\sl-230\slmult0 \up0
\expndtw0\charscalex119 Bibliografie \par\pard\li1012\sb103\sl-
\expndtw0\charscalex105 Buddeberg C, Kaufmann P., Radwilla A Medicine
psychosomatique et\par\pard\li1012\sb1\sl-219\slmult0\fi0 \up0
\expndtw0\charscalex105 psychosociaie en Suisse, Babler, Berne,
2. Boettcher J. Normabweichend akzentuierle Artze. tn: Szewzcyk H.\tab \up0
\expndtw0\charscalex105 (Hrsg.)\par\pard\li1012\sb1\sl-216\slmult0\fi43 \up0
\expndtw0\charscalex106 "Medizinische Psychologie in der drztlichen Praxis",
Berlin: Volk und Gesundheit,\par\pard\li1012\sb1\sl-222\slmult0\fi57 \up0
\expndtw0\charscalex105 110-113.\par\pard\li1012\sb1\sl-208\slmult0\fi311\tx7257
\up0 \expndtw0\charscalex103 3. lamandescu I. B. Psihologie Medicald, Ed.
Infomedica, Bucuresti,\tab \up0 \expndtw0\charscalex105
Kubler-Ross E. Interviews mil Sterbenden (14. Aufl.), Kreuz Verlag,
Stuttgart,\par\pard\li1012\sb1\sl-221\slmult0\fi67 \up0 \expndtw0\charscalex105
5 Mills Mina, Davies Huw T 0.. Macrae William A. Ingrijirea in spital a
bolnavilor\par\pard\li1046\sb1\sl-213\slmult0\fi9\tx7516 \up0
\expndtw0\charscalex100 muribunzi In: British Medical Journal (ed. in lb. romdnd).
nr. 2, vol. 1, dec.\tab \up0 \expndtw0\charscalex100 1994,
Rosier H. D.. Szewczyk H., Wildgrube K. Medizinische Psychologie,
Spektrum\par\pard\li1046\sb1\sl-209\slmult0\fi0\tx3643 \up0 \expndtw0\charscalex100
Akademischer Verlag, Berlin,\tab \up0 \expndtw0\charscalex100
7 Springte Droh. \u9632? Musikmedizin, Fischer Verlag, Stuttgart,\tab \up0
INTERFERENTELE DINTRE FACTORII PSIHOSOCIALI \up0 \expndtw-2\charscalex100
COMPORTAMENTALI $1 CANCER \par\pard\ql \li1204\sb189\sl-253\slmult0 \up0
\expndtw0\charscalex105 \ul0\nosupersub\cf8\f9\fs22 Coralia Mirsu Pdun \par\pard\qj
248\slmult0\fi302 \up0 \expndtw0\charscalex113 Legatura dintre serile emotionale si
cancer a fost sesizatS de secole. \up0 \expndtw0\charscalex105 Valul cercetSrilor
de psihosomaticS a declansat
o serie de alte studii, privind \up0 \expndtw0\charscalex108 personalitatea
premorbidS a bolnavilor de cancer, consecintele stresului la \up0
\expndtw0\charscalex110 animal si om, variabilele psihosociale si
comportartamentale Implicate in \up0 \expndtw0\charscalex108 aparifia cancerului s*
adaptarea la boalS. OdatS cu aparifia unei noi disci� \up0 \expndtw0\charscalex105
pline, PSIHOONCOLOGIA. s-a intensificat cercetarea aspectelor psihoso� \up0
\expndtw0\charscalex106 ciale legate de cancer iar rezultatele acestor studii s-au
transferat Tn clinice, \up0 \expndtw0\charscalex106 in multe din feme avansate.
prezent. se inregistreaze progrese mari Tn Tnfelegerea impactului \up0
\expndtw0\charscalex105 factorilor psihologici, fiziologici, sociologici si
antropologici asupra pacien� \up0 \expndtw0\charscalex105 filor, familiilor
acestora precum si asupra celor care participa la ingrijirea lor. \par\pard\qj
\li907\ri659\sb0\sl-260\slmult0\fi287 \up0 \expndtw0\charscalex107 Direcfiile de
cercetare a interferenfelor dintre factorii psihosociall. com\up0
\expndtw0\charscalex107 portamentali sj cancer sunt: \par\pard\ql \li1209\sb89\sl-
253\slmult0 \up0 \expndtw0\charscalex113 \u8226? Factori pslhosociali de rise in
aparifia cancerului; \par\pard\qj \li1209\ri670\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex112 e Efectele diagnosticului, bolii si tratamentului asupra
funcfionSrii \up0 \expndtw0\charscalex113 psihologice si neuropsihologice,
\par\pard\ql \li1204\sb8\sl-253\slmult0 \up0 \expndtw0\charscalex112 e Reactie si
adaptare psihologica la cancer; \par\pard\li1204\sb1\sl-248\slmult0\fi0 \up0
\expndtw0\charscalex111 e Impactul factorilor psihosociali asupra cursulul bolii.
tratamentu�\par\pard\li1204\sb1\sl-238\slmult0\fi230\tx1761 \up0 \expndtw-
5\charscalex100 lui\tab \up0 \expndtw0\charscalex111 $1 supraviefuirii.\par\pard\qj
\li911\ri641\sb112\sl-240\slmult0\fi288 \up0 \expndtw0\charscalex105 Sunt
investigate Tn egae masure cele doue cei prin care se presupune ce \up0
\expndtw0\charscalex107 factorii psihosociali s1 comportamentali. pot influenfa
riscul de aparifie si \up0 \expndtw0\charscalex107 evolufia cancerului.
1. Calea indirecta \tab \up0 \expndtw-1\charscalex100 (externS) \tab \up0
\expndtw0\charscalex105 - prin. care unele comportamente ar afecta \par\pard\ql
\li1459\sb10\sl-253\slmult0\tx6624 \up0 \expndtw0\charscalex108 indirect riscului
de apnfie si progresie a cancerului \tab \up0 \expndtw0\charscalex100
(comportamente \par\pard\qj \li1440\ri634\sb0\sl-250\slmult0 \up0
\expndtw0\charscalex100 care determinS expunerea la carcinogeni, de exemplu
fumatul) sau afec\up0 \expndtw0\charscalex104 teazS supraviefuirea (comportamentul
de amanare sau de neacceptare \up0 \expndtw0\charscalex105 a tratamentului).
Calea directs (interns) \tab \up0 \expndtw0\charscalex104 - pnn care factorii
psihosociali s1 comporta� \par\pard\qj \li1454\ri645\sb3\sl-240\slmult0 \up0
\expndtw0\charscalex103 mentali ar afecta mediul intern, liziologic al persoanei
Influenfind pro\up0 \expndtw0\charscalex103 mofia si progresia tumoralS.
2\charscalex100 \ul0\nosupersub\cf8\f9\fs22 286\tab \up0 \expndtw-
2\charscalex100 \u9830?\tab \up0 \expndtw-2\charscalex100 Elemente de psihosomatica
generae si aplicats\par\pard\qj \li868\sb0\sl-236\slmult0
236\slmult0\fi297 \up0 \expndtw0\charscalex104 in ultimii ani, toate aceste
probleme au fost studiate cu ajutorul celor mai \up0 \expndtw0\charscalex102
complexe tehnici ale psihoneuroimunologiei. disciplinS devenitS un domeniu \up0
\expndtw0\charscalex107 ce integreazS variabilele bio-psiho-sociale implicate in
starea de sanatate. \up0 \expndtw0\charscalex109 riscul de aparitie si de evolufie
a cancerului. Acum se cunoaste mult mai \up0 \expndtw0\charscalex113 mult despre
transformarea maligns si despre factorii de promofie care \up0
\expndtw0\charscalex104 favorizeazS progresia tumorae (Welnstein, \up0 \expndtw-
\expndtw0\charscalex109 CercetStorii din domeniul psihologiei si cei care lucreazS
in biologia \up0 \expndtw0\charscalex102 tumorii oferS un domeniu de explorare a
rolului posibil al factorilor psihoso� \up0 \expndtw0\charscalex102 ciali sj
comportamentali Tn cancerul uman. \par\pard\ql \li1166\sb190\sl-253\slmult0 \up0
\expndtw0\charscalex122 Discutarea problemei in sens larg \par\pard\qj
\li878\ri668\sb178\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex105 Cancerul
reprezintS, in practicS. o multitudine de variante de dezvoltare \up0
\expndtw0\charscalex105 tumorae care au si elemente comune. \par\pard\qj
\li878\ri658\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex105 Toate cancerele
apar ca rezultat al unor modificSri Tn sectoare cheie din \up0
\expndtw0\charscalex104 matehalul genetic al unor celule. Consecinfa esenfialS este
cS aceste celule, \up0 \expndtw0\charscalex105 prin mecanisme diferite, Tn funcfe
de tipul alterSrii genetice in cauzS, au o \up0 \expndtw0\charscalex105 crestere
autonomd fafa de restul organismului din care s-au format. \par\pard\ql
\li1166\sb1\sl-215\slmult0\tx6494 \up0 \expndtw0\charscalex108 Cauzele
modificSrilor genetice menfionate, precum \tab \up0 \expndtw0\charscalex118 $i
cauzele care \par\pard\qj \li873\ri678\sb11\sl-233\slmult0\fi4\tx1171 \up0
\expndtw0\charscalex102 contribuie ulterior la progresia bolii sunt diverse,
insuficient Tnfelese TncS. \line\tab \up0 \expndtw0\charscalex112 Exists unele
aspecte ale miflerii si cresterii tumorae, bine precizate: \up0
\expndtw0\charscalex106 virusi, substante chimice, radiafii, hormoni, traumS
cronicS, paraziti, pre� \up0 \expndtw0\charscalex106 cum si caracteristicile
genetice $' fizice ale persoanei. \par\pard\qj \li873\ri673\sb7\sl-
233\slmult0\fi292 \up0 \expndtw0\charscalex105 in afara comportamentelor care
determinS expunerea la factorii de me� \up0 \expndtw0\charscalex109 diu, crescand
riscul aparafiei cancerului, este posibil ca o serie de factori \up0
\expndtw0\charscalex102 psihologici (pe calea mediului intern fiziologic) sS
contribuie intr-un procent \up0 \expndtw0\charscalex106 mic la riscul total, in
paralel cu carcinogenil socotlfi puternici \up0 \expndtw-9\charscalex100 (Fox, \up0
\expndtw-9\charscalex100 1981). \par\pard\ql \li878\ri663\sb2\sl-
240\slmult0\fi9\tx1175 \up0 \expndtw0\charscalex105 Factorii psihosociali si
comportamentali pot actiona, de$i in micS mSsurS, \up0 \expndtw0\charscalex102 atat
Tn direcfia reducerii, cat si Tn cea a cresterii riscului. \line \tab \up0
\expndtw0\charscalex107 Dar trebuie sS mai avem Tn vedere si faptul cS existe o
game large de \up0 \expndtw0\charscalex105 reacfii psihologice, iar cancerul
reprezinte o game de neoplasme care pot fi \up0 \expndtw0\charscalex105 sensibile
la diferite influenfe. \par\pard\qj \li883\ri669\sb7\sl-232\slmult0\fi283 \up0
\expndtw0\charscalex106 in orice caz, dezvoltarea unei tumori, indiferent de
localizare, trece prin \up0 \expndtw0\charscalex107 mai multe etape, de la
inlfierea transformers maligne la promofie si apoi e \up0 \expndtw0\charscalex111
progresia tumorae. in tot cursul acestui proces este posibil ca mai mulfi \up0
\expndtw0\charscalex108 factori se acfioneze sinergic Progresia este influenfatS si
de varsta, sexul, \up0 \expndtw0\charscalex104 nutrifia persoanei. Factorii
psihologici si/sau sociali, pot constitui co-factori \up0 \expndtw0\charscalex104
in dezvoltarea unor celule care au sulerit deja transformarea maligne. \par\pard\qj
\li897\ri667\sb2\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex112 Cei mai mare
interes pentru urnrenrea rolului potential al factorilor \up0
\expndtw0\charscalex106 psihosociali i au prezentat, in general, tumohle hormono-
sensibile, in spe� \up0 \expndtw0\charscalex106 cial cele ale sa.iului.
\par\pard\qj \li1185\ri1239\sb94\sl-320\slmult0 \up0 \expndtw0\charscalex122 Factoi
psihosociali si comportamentali de rise in aparitia \up0 \expndtw0\charscalex112
cancerului \par\pard\qj \li926\ri668\sb187\sl-240\slmult0\fi273 \up0
\expndtw0\charscalex109 Avand Tn vedere multiplicitatea factorilor care concure la
aparifia si \up0 \expndtw0\charscalex110 progresiunea cancerului. orice evaluare a
importan^ eventuae a factorilor
psihologici de rise presupune analiza stilului de viafe s' comportamentele \up0
\expndtw0\charscalex119 care pot influenfa vulnerabilitatea la cancer. \par\pard\qj
\li1036\ri541\sb20\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex114 Cerceterile
stilului de viafe urneresc obisnuintele sociale (fumatul, alcoo-\line \up0
\expndtw0\charscalex117 lul). alimentafia. comportamentele sexuale, expunere la
soare. expunere la \up0 \expndtw0\charscalex117 agenfi chimici \up0
\expndtw0\charscalex121 (profesiune), mediul social s* legaturile sociale, statutul
\par\pard\qj \li1031\ri536\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex115 socieo-
economic s1 suportul social, influenfele cuiturale.
sociale, religioase \up0 \expndtw0\charscalex115 Si psihologice care contribuie la
modul de viafe obisnuit. zilnic. \par\pard\ql \li1329\sb189\sl-230\slmult0 \up0
\expndtw0\charscalex119 Factorii psihologici \par\pard\qj \li1031\ri531\sb182\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex115 Personalitatea, ingloband
trasaturiie stabile, stilurile de reacfie in situafii \up0 \expndtw0\charscalex122
de stres, mecanismele psihologice de aparare a fost semnalate de multe \up0
\expndtw0\charscalex116 vreme ca un factor de rise al apahtiei cancerului si
duratei de supraviefuire. \par\pard\ql \li1031\ri522\sb17\sl-
244\slmult0\fi283\tx1329 \up0 \expndtw0\charscalex118 Viziunea simpllse a legaturii
\u8222?stare mentalS-cancer" a fost inlocuitS cu \up0 \expndtw0\charscalex114
ipoteze si modele testabile pnn intermediul psihoneuroimunologiei \line \tab
\up0 \expndtw0\charscalex117 Primele studii care urnereau conturarea personaliefii
predispuse la can� \up0 \expndtw0\charscalex120 cer au fost retrospective.
Pacienfii erau Tntrebafi despre personalitatea si \up0 \expndtw0\charscalex115
reacfiile lor psihologice dm perioada dinaintea aparifiei cancerului. Rezerva
\up0 \expndtw0\charscalex112 cu care sunt privite rezultatele studiilor
retrospective provine din faptul catre-\line \up0 \expndtw0\charscalex118 seturile
presupuse a fi ale persoanei predispuse la cancer pot fi consecinfe \up0
\expndtw0\charscalex116 ale bolii s* nu neaperat manifeseh ale personalitafii
premorbide Ele descriu \up0 \expndtw0\charscalex113 persoana predispuse la cancer
ca pe o ..persoane calme, cu mers lin, care ls>i \up0 \expndtw0\charscalex118
reprime si neage emofiile", in special pe cele negative (LeSchan. Morris) \up0
\expndtw0\charscalex114 Este imaginea persoanei refinute, care nu se plSnge, este
cooperante si nu-si \up0 \expndtw0\charscalex128 exprime cu usuhnfe suferinfa,
tnstefea. tuna, anxietatea: este calme, \up0 \expndtw0\charscalex118 pecute,
compliante, pasiva (Renneker, Bahnson) Bahnson subliniaza s< o \up0
\expndtw0\charscalex119 alte treseture, \up0 \expndtw0\charscalex116 $i anume
exprimarea anormae a emotiilor, reactia la eveni� \par\pard\ql \li1036\sb8\sl-
230\slmult0 \up0 \expndtw0\charscalex118 mentele stresante prin negare s'
represie \par\pard\qj \li1041\ri511\sb0\sl-250\slmult0\fi283 \up0
\expndtw0\charscalex132 Constaterile privind reprimarea emofiilor ca insu$ire de
bazS a \up0 \expndtw0\charscalex120 persoanelor predispuse la cancer, au contribuit
la conturarea tipului C de \up0 \expndtw0\charscalex112 personalitate
(Temoshock, \up0 \expndtw-3\charscalex100 1984) \par\pard\qj \li1036\ri517\sb0\sl-
245\slmult0\fi297 \up0 \expndtw0\charscalex113 Pe baza unui studiu retrospectiv,
comparSnd reacfia emofionalS la o serie \up0 \expndtw0\charscalex117 de stimulSn
electrice cutanate a unor pacienfi cu melanom malign, compa\up0
\expndtw0\charscalex115 rativ cu un lot de bolnavi cu afecfiuni cardiovasculare.
autoarea citats a for\up0 \expndtw0\charscalex123 mulat trasaturiie acestui tip C
de personalitate. loiosind conceptele de e \up0 \expndtw0\charscalex114 tipurile A
si B de personalitate din bolile cardiovasculare. \par\pard\qj
\li1041\ri527\sb0\sl-244\slmult0\fi288 \up0 \expndtw0\charscalex113 Tipul C de
personalitate descris de Temoshock cuprinde urmStoarele tra� \up0
\expndtw0\charscalex112 saturi de bazS: persoana menfine controlul emofional si
Intrefine relatli inter\up0 \expndtw0\charscalex121 personale pecute, in pofida
disperSrii interioare pe care nu s10 exprime; \up0 \expndtw0\charscalex121 are
simfemantul lipsei de speranfe, uneori cronicS dar mascae; exprime \up0
\expndtw0\charscalex115 pufin din tensiunea, suferinfa cronice pe care o resimte in
urma unor eveni� \up0 \expndtw0\charscalex115 mente stresante ale viefn
general insa se considere ce este necesar un studiu prospectiv bine \up0
\expndtw0\charscalex117 controlat care sa confirme un tip de personalitate asociat
cu riscul aparifiei \up0 \expndtw0\charscalex125 cancerului. Un astfel de studiu
prospectiv a fost reallzat de Grossarth-\line \up0 \expndtw0\charscalex106 Maticek
(1983, \up0 \expndtw-3\charscalex100 1985, \up0 \expndtw0\charscalex110 1989) pe
douS populafil diferite cultural - Tn lugoslavia
248\slmult0\fi4 \up0 \expndtw0\charscalex120 Si in Germania. Ei au identificat
patru tipuri de personalitate, cu anumite \up0 \expndtw0\charscalex123 modele
comportamentale, legate de tipuri specifice de stres si reacfii la \up0
\expndtw0\charscalex117 stres. DupS zece ani. timp Tn care au urmSnt subiecfii. au
gSsit cS au dez\up0 \expndtw0\charscalex119 voltat cancer dintre cei care
relevasers lipsS de speranfS cronicS, rezultae \up0 \expndtw0\charscalex114 din
evenimentele dureroase ale viefii sau cei care si-au exprimat foarte pufin \up0
\expndtw0\charscalex112 emofionalitatea. \par\pard\qj \li801\ri737\sb0\sl-
246\slmult0\fi292 \up0 \expndtw0\charscalex115 Au fScut parte din tipul de
personalitate desris ca fiind predispus la can� \up0 \expndtw0\charscalex117 cer
cei care au exprimat o nevoie acutS de a fi alSturi de o persoanS foarte \up0
\expndtw0\charscalex115 importantS din punct de vedere emofional, pentru ei sau de
a atinge un scop \up0 \expndtw0\charscalex115 important . Acestea Ti pSreau de
neatins. Totusi. persoana continuS sS per\up0 \expndtw0\charscalex118 ceapS
obiectul investifei ca pe cea mai importantS condifie ca sS trSiascS \up0
\expndtw0\charscalex118 bine incercarile de a gSsi un nou obiect de investifie care
sa-l Tnlocuiasce \up0 \expndtw0\charscalex118 pe eel vechi sau cei pufin sa-l ajute
se se detaseze de acesta, esueaza Dim \up0 \expndtw0\charscalex114 potrive.
obiectul investifiei este idealizat Tn timp ce el scade in proprii ochi, \up0
\expndtw0\charscalex127 aprecierea de sine se micsoreaze. reactioneaze prin
depresie, lipsa de \up0 \expndtw0\charscalex122 speranfe, pe care incearca se le
ascunde. Acest profit a fost semnificativ \up0 \expndtw0\charscalex116 corelat s'
cu moartea in cancer (46%). \par\pard\qj \li811\ri737\sb13\sl-240\slmult0\fi283
\up0 \expndtw0\charscalex120 Toate aceste studii nu pot fi ignorate; ele aduc date
suplimentare celor \up0 \expndtw0\charscalex117 care au propria lor expenanfa in
clinice si au constatat multe din trSsStunle \up0 \expndtw0\charscalex126 descrise.
De altfel, este recunoscut cS anumifi factori de personalitate \up0
\expndtw0\charscalex112 influenfeazS riscul la cancerul sinului. Impactul s*-'
exercilS fie indirect, prin \up0 \expndtw0\charscalex117 influenfarea
comportamentelor de expunere la carcinogeni \up0 \expndtw0\charscalex123 (la soare)
sau \par\pard\qj \li806\ri732\sb12\sl-250\slmult0 \up0 \expndtw0\charscalex115
dimpotnvS, de a practica o ingrijire optimS a sanatafii (palparea saniior), fie
\up0 \expndtw0\charscalex126 pe cale directs, prin anumite stSri emofionale care au
influents asupra \up0 \expndtw0\charscalex124 mecanismelor hormonale sau celulare
care pot afecta riscul \up0 \expndtw0\charscalex112 1a cancer. \par\pard\qj
\li815\ri723\sb0\sl-246\slmult0 \up0 \expndtw0\charscalex121 Starea psihologice sau
un eveniment stresant este posibil se actioneze ca \up0 \expndtw0\charscalex121 un
promotor in prezenfa unui factor initiator, in special dace apare ca un \up0
\expndtw0\charscalex131 stres in timpul cand fesutul sanului este eel mai
vuinerabil la unele \up0 \expndtw0\charscalex112 modificeri anormale (Holland J.C.,
Rowland J.H., \up0 \expndtw-3\charscalex100 1989). \par\pard\qj
\li811\ri723\sb0\sl-250\slmult0\fi302 \up0 \expndtw0\charscalex129 Relafia
stresului cu aparifia cancerului este controversatS. Exists \up0
\expndtw0\charscalex116 observafii numeroase care sugereazS cS stresui provocat de
traumele viefii, \up0 \expndtw0\charscalex122 (Tn special suferinfa produse de o
pierdere importane) este precursor al \up0 \expndtw0\charscalex124 aparifiei
cancerului. Demonstrarea stiinfifice Tnempine inse o serie de \up0
\expndtw0\charscalex114 dificultafi metodologice. Greene, \up0
\expndtw0\charscalex120 1956 a semnalat asaltul unei maligniefi \par\pard\ql
\li830\ri718\sb0\sl-245\slmult0\tx1123 \up0 \expndtw0\charscalex115 hematologice
dupe pierderi majore, la copii si adulfi tineri. lacobs, Charles, \up0
\expndtw0\charscalex116 1989 au relevat ce pierderile din copierie preced aparifia
cancerului. \line \tab \up0 \expndtw0\charscalex123 Probabil, nu evenimentul a
inifiat neoplasmul care este posibil sS fi \up0 \expndtw0\charscalex113 apSrut cu
luni sau ani Tn urmS, TnsS starea de suferinfa emofionala produsS \up0
\expndtw0\charscalex117 de o pierdere importantS ar putea fi un promotor al
cresterii tumorae. dupS \up0 \expndtw0\charscalex128 inifiere. CercetStorii au
evidential o cale posibie prin care o stare de \up0 \expndtw0\charscalex115
supSrare profundS in perioada de doliu sau dupS o alts pierdere importantS \up0
\expndtw0\charscalex118 is* poate exercita actiunea. Ei au Tnregistrat activitatea
celulelor \up0 \expndtw0\charscalex113 - NK si \par\pard\qj \li859\ri713\sb0\sl-
250\slmult0\fi4 \up0 \expndtw0\charscalex130 subpopulafiile celulelor T, la
persoane aflate in astfel de situafii. in \up0 \expndtw0\charscalex118 comparafie
cu un lot martor. Persoanele cu cele mai accentuate simptome \up0
\expndtw0\charscalex125 de depresie au prezentat cea mai redusS activitate a
celulelor \up0 \expndtw0\charscalex120
- NK si \par\pard\sect\sectd\fs24\paperw8940\paperh13300{\bkmkstart Pg290}
\ul0\nosupersub\cf9\f10\fs20 schimbSri in rafia de celule\tab \up0
\expndtw0\charscalex118 - helper T, pane\tab \up0 \expndtw0\charscalex118 1a
suprlmarea celulelor T\par\pard\li1060\sb19\sl-230\slmult0\fi9\tx3643 \up0
\expndtw0\charscalex112 (Holland J.. Rowland J.H.,\tab \up0 \expndtw0\charscalex118
1989).\par\pard\qj \li1065\ri512\sb0\sl-260\slmult0\fi292 \up0
\expndtw0\charscalex112 Hu $i Silberfab, 1988, facand o trecere in reviste a
studiilor privind relafia \up0 \expndtw0\charscalex123 intre stresui provocat de
evenimentele viefii \up0 \expndtw0\charscalex124 (pierderea unei persoane
apropiate) si aparifia cancerului au relevat ce 7 dintre acestea au stabilit o \up0
\expndtw0\charscalex118 corelatie pozitive, iar \up0 \expndtw0\charscalex117 9 una
negative. Cooper, \up0 \expndtw0\charscalex118 1989 subliniaze un aspect
\par\pard\qj \li1065\ri493\sb0\sl-247\slmult0 \up0 \expndtw0\charscalex116 foarte
important si anume, ce este posibil ca evenimentul viefii, Tn sine, se \up0
\expndtw0\charscalex125 nu fie atat de nociv, cat semnificafia pe care el o are
pentru individ. in \up0 \expndtw0\charscalex132 aceeasi direcfie sunt orientate si
studiile care subliniaze o serie de \up0 \expndtw0\charscalex123 caracteristici de
personalitate ce pot acfiona ca un tampon Tn raport cu \up0 \expndtw0\charscalex125
stresui si P�' prevent simptomele si bolile asociate stresului. Maddi s1 \up0
\expndtw0\charscalex110 Kobasa, \up0 \expndtw0\charscalex117 1984 au relevat faptul
ce personalitatea \u8222?rezistente", caracterizae \up0 \expndtw0\charscalex115
prin faptul ce priveste stresui ca pe o schimbare si incearce se ia sub control
\up0 \expndtw0\charscalex120 situafia, prin angajare. au avut mai pufine sufehnfe
psihice decat cei fara \up0 \expndtw0\charscalex120 aceste insuslrl.
\up0 \expndtw0\charscalex117 Concluzii \par\pard\qj \li1070\sb0\sl-248\slmult0
Existe destule argumente ce tactorii psihosociali si comportamentali \up0
\expndtw0\charscalex116 joace un rol in riscul si progresia cancerului, in primul
rand, prin influenfa\up0 \expndtw0\charscalex123 rea comportamentelor care due la
expunerea la carcinogenii din mediu \up0 \expndtw0\charscalex118 (expunerea la
soare, fumat. obiceiuri personae, expunere la mediul ocupa\up0
\expndtw0\charscalex118 fional). Predispozifia la cancer a unui anumit stll de
personalitate - stabilit \up0 \expndtw0\charscalex118 pe baza relaerilor
retrospective - rerTene o probleme discutabie. inse tipul \up0
\expndtw0\charscalex118 C de personalitate descris este explorat in continuare ca o
posibie variabie \up0 \expndtw0\charscalex119 de influente asupra riscului de
aparifie a cancerului s' progresiei acestuia. \up0 \expndtw0\charscalex132 Dar si
in acest caz existe date contradlctorii asupra posibilitefii de \up0
\expndtw0\charscalex118 influenfare a progresiei tumorae de cetre acesti factori de
personalitate, in \up0 \expndtw0\charscalex118 absenfa legeturii lor cu
comportamentul. \par\pard\qj \li1080\ri493\sb0\sl-250\slmult0\fi283 \up0
\expndtw0\charscalex121 in prezent existe un mare interes pentru studiul
potenfialei contribufii \up0 \expndtw0\charscalex114 personate la boala s1
controlul ei, mai ales in lumina rezultatelor obfinute in \up0
\expndtw0\charscalex118 legatura cu influenfele stranlor psihologice adupra
sistemului imunologic, \up0 \expndtw0\charscalex132 precum si cu reglarea funcfiei
imunitare pe cale hormonale si prin \up0 \expndtw0\charscalex114 neuropeptidele
mediate prin sistemul nervos central. \par\pard\qj \li1377\sb0\sl-320\slmult0
\par\pard\qj\li1377\ri769\sb64\sl-320\slmult0 \up0 \expndtw-7\charscalex100
\ul0\nosupersub\cf8\f9\fs22 IMPACTUL DIAGNOSTICULUI, BOLII SI TRATAMENTULUI
ASUPRA \up0 \expndtw-7\charscalex100 FUNCTIONARII PSIHOLOGICE SI
NEUROPSIHOLOGICE \par\pard\qj \li1084\ri478\sb170\sl-260\slmult0\fi287 \up0
\expndtw0\charscalex121 \ul0\nosupersub\cf9\f10\fs20 Cancerul continue se tie
considerat o boae mai serioase decat oricare \up0 \expndtw0\charscalex110 alta.
Aparifia bolii determine noi solicieri, opereaze Importante s* inerente \up0
\expndtw0\charscalex115 modificeri in starea sufleteasca a bolnavului; descoperirea
il sperie. se feme \up0 \expndtw0\charscalex123 ce va fi stigmatizat, ce va muri in
chinuri, peresit; sau, se simte vinovat \up0 \expndtw0\charscalex115 pentru
greutafile si suferinfele pe care e va provoca celor apropiati.
245\slmult0\fi287 \up0 \expndtw0\charscalex120 Odate cu utilizarea unor tehnici
agresive de tratament a crescut durata \up0 \expndtw0\charscalex130 de
supraviefuire in cancer. Au aperut in schimb noi solicieh la care \up0
\expndtw0\charscalex123 bolnavul trebuie se se adapteze psihologie Se apreciaze ce
40-60% din \up0 \expndtw0\charscalex131 suferinfele emofionale traite de pacientii
cu cancer, pot fi atribuite \up0 \expndtw0\charscalex117 aspectelor medicale si
legate de tratament mai mult decat bolii insasi.. \par\pard\qj \li830\ri727\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex122 Bolnavii oncologici, asadar, au de
IScut fafa acestor douS probleme \up0 \expndtw0\charscalex116 dificile
diagnosticului de cancer - ideii ce sufera de o boae care le ameninfe \up0
\expndtw0\charscalex124 viafa. pe de o parte sj tratamentelor, uneori greu de
suportat, pe de alte \up0 \expndtw0\charscalex118 parte. Ei dovedesc adesea ce pot
indura mult, in special cSnd cred in cura\up0 \expndtw0\charscalex119 biiitate. De
fapt. un studiu recent, arae ce pacienfii cu cancer sunt dispusi \up0
\expndtw0\charscalex119 se accepte un tratament radical cu sanse minime de ajutor,
mult mai mult \up0 \expndtw0\charscalex119 decat pacienfii cu alte boli.
\par\pard\qj \li835\ri713\sb20\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex117 Nu
putem afirma, totusi- ce suferinfele emofionale sunt la fel de intense \up0
\expndtw0\charscalex118 sau ce tulburarile psihice sunt inevitable. Respunsurile
bolnavilor e aceste \up0 \expndtw0\charscalex116 probleme potential traumatizante
variaze semmficativ, influenfand adapta� \up0 \expndtw0\charscalex116 rea.
intr-un studiu care unrerea prevalenfa tulburarilor psihice, in timpul \up0
\expndtw0\charscalex116 tratamentului. pe un lot de 215 pacienti din trei centre,
Derogatis a gasit. \par\pard\ql \li1569\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex116 - 53% \u8226? pacienfi cu adaptare adecvate
\par\pard\li1574\sb30\sl-230\slmult0\fi0\tx1708 \up0 \expndtw-5\charscalex100 -\tab
\up0 \expndtw0\charscalex116 47% - pacienfi cu depresie s* anxietate reactive, din
care:\par\pard\li1574\sb15\sl-230\slmult0\fi724\tx2452 \up0 \expndtw-
2\charscalex100 -\tab \up0 \expndtw0\charscalex116 13% - depresie
severe\par\pard\qj \li840\ri717\sb237\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex123 In ultimul timp, s-au facut eforturi considerabil pentru
determinarea \up0 \expndtw0\charscalex130 prevalenfei unor tulburari psihice si
unor posibile efecte secundare \up0 \expndtw0\charscalex114 neuropsihologice ale
radioterapiei si chimioterapiei. \par\pard\qj \li840\ri713\sb0\sl-244\slmult0\fi288
\up0 \expndtw0\charscalex117 in general, interesul asupra impactului pe care
diagnosticul de cancer si \up0 \expndtw0\charscalex125 tratamentul il au asupra
adaperii psihologice si funcfionarii neuropsi� \up0 \expndtw0\charscalex116
hologice, a atins un nivel inalt. Pe nesure este si efortul pentru gesirea celor
\up0 \expndtw0\charscalex116 mai adecvate mijloace de intervenfie psihosociale si
de evaluare a efectelor \up0 \expndtw0\charscalex132 pe care acestea le au asupra
sern psihice a pacientului. adapterii la \up0 \expndtw0\charscalex114 tratament,
cursului bolii, duratei de supraviefuire. \par\pard\qj \li844\ri709\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex126 Deoarece in prezent existe in ceea
ce priveste boala canceroase un \up0 \expndtw0\charscalex116 potential terapeutic
si implicit de supraviefuire mai ridicat, se acorde din ce \up0
\expndtw0\charscalex131 Tn ce mai multe atenfie cresterii caiitafii viefii
bolnavilor odate cu \up0 \expndtw0\charscalex113 ameliorarea starii lor emofionale.
\up0 \expndtw0\charscalex134 Privire de ansamblu \par\pard\ql
Tabloul sterilor psihice care acompaniaze boala canceroase este dominat \up0
\expndtw0\charscalex116 de incertitudine, teama, trica: de boae, de recidive, de
suferinfe, de moarte. \line\tab \up0 \expndtw0\charscalex119 Frecvent, bolnavul
este invadat de nesigurante,
confuzie in legeture cu \up0 \expndtw0\charscalex117 ce va face ce-i rezene
viitorul; se simte devastat, pustiit. \line \tab \up0 \expndtw0\charscalex117 Cele
mai trecvente tulburari psihice in cazul bolnavului de cancer, sunt \up0
\expndtw0\charscalex117 anxietatea si depresia. \par\pard\qj \li897\ri709\sb0\sl-
240\slmult0\fi273 \up0 \expndtw0\charscalex114 Anxietatea este mai accentuate in
timpul perioadelor de mare importanfe \up0 \expndtw0\charscalex114 pentru bolnav:
cSnd se stabileste diagnosticul, Tnceputul tratamentului. cSnd
\par\pard\qj\li988\ri600\sb112\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex119 se
asleapte rezultatele diverselor investigafu dar si in cazul in care planul \up0
\expndtw0\charscalex119 de tratament este schimbat sau intrerupt. \par\pard\qj
bolnavilor de cancer, existe o relafie complexe a anxieefii (traita \up0
\expndtw0\charscalex116 Irecvent ca o tensiune in crestere. asociate cu slmtemSntuI
apesetor al unei \up0 \expndtw0\charscalex129 nenorociri iminente) atat cu boala
cat si cu tratamentul Simptomele \up0 \expndtw0\charscalex117 anxietefii se pot
asocia cu anorexia, greafa. voma, diareea, oboseala si in� \up0
\expndtw0\charscalex120 somnia, toate fiind greu de deosebit de efectele secundare
pe care terapia \up0 \expndtw0\charscalex121 cu citostate le poate produce Pe de
ale parte. diverse disfuncfii biologice \up0 \expndtw0\charscalex122 prezente la
acesti bolnavi. sau medicafia care II se administreaze pot de \up0
\expndtw0\charscalex122 asemenea produce anxietate. \par\pard\qj
\li988\ri576\sb0\sl-250\slmult0\fi297 \up0 \expndtw0\charscalex121 Depresia. al
cerui diagnostic so stabileste finand seama si de semnee \up0
\expndtw0\charscalex120 somatice - oboseala. anorexia, scederea in greutate - care
in cancer pot fi \up0 \expndtw0\charscalex121 deopotrive consecintele
tratamentului. trebuie evaluate mai ales pe baza \up0 \expndtw0\charscalex118
prezenfei stSrilor disforice, senzafiei lipsei de ajutor/sperantS, simfSmSn\up0
\expndtw0\charscalex118 tulut de vmovSfie si apreciere de sine redusS. \par\pard\qj
\li993\ri574\sb5\sl-246\slmult0\fi288 \up0 \expndtw0\charscalex122 Pacienfii cu
riscul eel mai mare pentru depresie sunt si cei Tn stadiu \up0
\expndtw0\charscalex123 avansat. cei cu o capacitate slabs de a deslasura o
activitate, eel cu boli \up0 \expndtw0\charscalex128 psihiatrice antenoare
Tmbolnevirii si cei cerora nu Ii se pot controla \up0 \expndtw0\charscalex114
satisfecetor simptomele majore. \par\pard\qj \li984\ri575\sb19\sl-240\slmult0\fi297
\up0 \expndtw0\charscalex127 Des* anxietatea s1 depresia sunt. in general, sterile
dominante, in \up0 \expndtw0\charscalex119 diferitele momente. reacfiile pot
fluctua intre euiorie si disperare, suprem \up0 \expndtw0\charscalex119 optimism in
legeture cu tratamentul si pesimism privind rezultatul lui. \par\pard\qj
\li988\ri580\sb12\sl-250\slmult0\fi292 \up0 \expndtw0\charscalex115 Imediat ce-$i
recapata un oarecare echilibru dupe efortunle de a face fate \up0
\expndtw0\charscalex115 solicitahlor strict medicale de operafie. radioterapie,
chimioterapie. pacien� \up0 \expndtw0\charscalex115 fii pot avea de depesit o
multitudine de probleme psihosociale. \par\pard\qj \li988\ri569\sb0\sl-
252\slmult0\fi292 \up0 \expndtw0\charscalex116 Depresia si anxietatea par a avea o
incidenfe crescute si in perioada post \up0 \expndtw0\charscalex126 terapeutice.
Cauza poate fi frica de a avea o boae pe care o considere \up0
\expndtw0\charscalex115 ingrozitoare, dar alte lucruri pot contribui la persistenta
starilor de depresie/ \up0 \expndtw0\charscalex120 anxietate sau pot rezulta din
aceste stari. Sunt induse in aceaste categorie \up0 \expndtw0\charscalex125
problemele legate de imaginea corporae, disfuncfiile sexuale, frica de \up0
\expndtw0\charscalex117 recidiva sau metastaza, durerea. \par\pard\qj
\li984\ri584\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex114 Durerea este o
probleme cu care se confrune mulfi bolnavi de cancer mai \up0
\expndtw0\charscalex118 ales cei cu metastaze (20-30%) S' cei aflafi in stadiul
terminal al bolii \up0 \expndtw-1\charscalex100 (66-\par\pard\ql \li984\sb16\sl-
230\slmult0 \up0 \expndtw0\charscalex105 80%). \par\pard\ql \li1267\sb230\sl-
230\slmult0 \up0 \expndtw0\charscalex134 Aspecte legate de diagnostic
Din cauza Iricii de cancer, subestimehi ratelor de supravietuire sj \up0
\expndtw0\charscalex119 supradimensioneru caracterului mortal atribuit bolii Tn
randul populafiei, \up0 \expndtw0\charscalex120 prima benuiala, descopenrea unei
excrescente sau altor simptome creaze \up0 \expndtw0\charscalex121 anxietate si
pesimism. \par\pard\ql \li1281\sb6\sl-230\slmult0 \up0 \expndtw0\charscalex118
Frica de cancer poate duce la amanarea prezeneru la medic. \par\pard\qj
\li988\ri584\sb0\sl-250\slmult0\fi292 \up0 \expndtw0\charscalex125 Negarea ca
reactie posibie. in acest moment, poate fi un mecanism \up0 \expndtw0\charscalex121
protector dm punct de vedere psihic. dar deunetor prin consecinfele sale \up0
\expndtw0\charscalex115 biologice. atunci cand are drept urmare amenarea
tratamentului. \par\pard\sect\sectd\fs24\paperw8940\paperh13300{\bkmkstart Pg293}
246\slmult0\fi297 \up0 \expndtw0\charscalex122 Intervalul de timp de e deplstarea
unor "semne TngrijorStoare" cand \up0 \expndtw0\charscalex119 apare susptciunea de
cancer si pane la confirmarea sa, prin diverse inves-\line \up0
\expndtw0\charscalex117 tigafii este \up0 \expndtw0\charscalex121 (posibil) cea mai
stresante parte din toae experienfa traita de \up0 \expndtw0\charscalex125 pacient
in raport cu boala sa. in aceasta perioade, de asteptare a rezul-\line \up0
\expndtw0\charscalex116 tatelor, cei mai mulfi pacienti sunt speriafi. nelinistiti;
pot se apare deterio-\line \up0 \expndtw0\charscalex114 rari ale capacitafii de
concentrare si de cognifie precum si cote inalte de an� \up0
\expndtw0\charscalex110 xietate. \par\pard\qj \li830\ri742\sb0\sl-246\slmult0\fi287
\up0 \expndtw0\charscalex117 Reactiile pacientilor la aflarea diagnosticului sunt
foarte variate. Pentru \up0 \expndtw0\charscalex117 unn. diagnosticul de cancer
reprezinta o catastrofe emofionale; produce un \up0 \expndtw0\charscalex117 soc.
Pentru alfii este o greutate in plus, un obstacol pe care trebuie sa-l de-\line
\up0 \expndtw0\charscalex114 peseasce ca si pe celelalte multe dificultafi si
nedreptefi aperute in viafa lor. \par\pard\qj \li830\ri742\sb0\sl-244\slmult0\fi292
\up0 \expndtw0\charscalex115 Diversitatea atitudinilor poate fi explicate pnn
intervenfia unor variabile: \up0 \expndtw0\charscalex118 strategiile individuae de
reactie la situafiile noi, dificile (stil de coping) s* \up0
\expndtw0\charscalex134 traseturile personalitetii premorbide a pacientului dar sj
iscusinfa \up0 \expndtw0\charscalex114 personalului medical, in special a
medicului, de a comunica cu bolnavul. Un \up0 \expndtw0\charscalex119 rol aparte Tl
pot avea factorii legafi de disponibilitatea unui suport social \up0
\expndtw0\charscalex110 Si/sau familial. \par\pard\ql \li1123\sb218\sl-
230\slmult0 \up0 \expndtw0\charscalex134 Impactul tratamentului asupra
psihicului \par\pard\qj \li830\ri733\sb202\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex116 Tratamentul cancerului este complex, el include tratamentul
chirurgical, \up0 \expndtw0\charscalex118 radioterapta, chimioterapia. De cele mai
multe ori pacientul le urmeaza pe \up0 \expndtw0\charscalex118 toate trei. Uneori
urmeaze si alte tratamente specializate. \par\pard\ql \li1118\sb229\sl-
230\slmult0 \up0 \expndtw0\charscalex134 Operatic \par\pard\ql
\li830\ri738\sb198\sl-245\slmult0\fi287\tx1128 \up0 \expndtw0\charscalex121 Aproape
tofi pacienfii care urmeaze se fie operafi sunt anxiosi Unele \up0
\expndtw0\charscalex120 persoane au fobii de anestezie sau de operate si frica de
sale de operafie. \line\tab \up0 \expndtw0\charscalex115 Pregetirea psihologica
pentru operafie, foloslnd unele tehnici comporta� \up0 \expndtw0\charscalex121
mentale (indeosebi relaxarea musculare progresivS) si. dupS caz terapia \up0
\expndtw0\charscalex114 cognitivS. de cele mai multe ori dimmueazS starea de
anxietate. S-a consta� \up0 \expndtw0\charscalex123 tat cSacest lucru. deosebit de
important pentru bolnavul care trebuie sa \up0 \expndtw0\charscalex114 treacS
printr-o astlel de experientS, are s> unele rezultate benefice postope� \up0
\expndtw0\charscalex117 ratorii: reducerea durerii. mai pufine complicatii,
spitalizare mai scurta (L. \up0 \expndtw0\charscalex106 Fallowtield, \up0 \expndtw-
\expndtw0\charscalex118 Imediat dupa operate, preocupafi de reechihbrarea din punct
de vedere \up0 \expndtw0\charscalex123 fizic. bolnavii nu mai au nici timp nici
energie psihica pentru a reflecta \up0 \expndtw0\charscalex119 asupra implicafiilor
pe termen lung a ceea ce s-a intamplat (in special din \up0 \expndtw0\charscalex118
cei cu actul chirurgical ca prim tratament). Ca
urmare, se intampe sS aibS \up0 \expndtw0\charscalex116 o senzafie de eliberare.
uneori chiar o stare euloricS. Bolnavul odatS intors \up0 \expndtw0\charscalex115
acasS insS. cu toate ce se poate simfi mat bine fizic, se poate simfi mai rau. \up0
\expndtw0\charscalex117 psihic. Temerile privind tratamentele care vor urma.
rezultatul lor, frica de \up0 \expndtw0\charscalex117 recidive il pot asalta
caz special il prezine femeile cu cancer al sanului diagnosticat pnn \up0
\expndtw0\charscalex125 examen histopatologic intraoperator. penlru care mamectomia
nu era \up0 \expndtw0\charscalex126 prevezute cu certiludine Cele mai multe cand
i$i revin dupe anestezie.
\expndtw0\charscalex121 \u8226?> 293\par\pard\qj \li988\sb0\sl-240\slmult0
reacfioneaze ca in stare de soc, cu hohote de plans, agilafie; pot dezvolta \up0
\expndtw0\charscalex120 depresie cu numeroase semne somatice asociate. \par\pard\qj
\li993\ri579\sb16\sl-245\slmult0\fi278 \up0 \expndtw0\charscalex122 Asistenfa
psihologice este impenos necesara in asemenea momente. \up0 \expndtw0\charscalex123
Pacienta trebuie ajutata sa yaseasca cea mai eficiente cale pentru a face \up0
\expndtw0\charscalex114 fafa situatiei, pentru a se echilibra emofional; acest
lucru. important in recu\up0 \expndtw0\charscalex126 perarea postoperatorie, este
esenfial pentru adaptarea psihicS e trata� \up0 \expndtw0\charscalex113 mentul pe
care il va urma. \par\pard\qj \li988\ri585\sb0\sl-248\slmult0\fi288 \up0
\expndtw0\charscalex121 in cazul bolnavelor cu cancer al senului operat, pentru
care planul de \up0 \expndtw0\charscalex116 tratament postoperator se stabileste Tn
funcfie de rezultatul analizei care se \up0 \expndtw0\charscalex121 face piesei
operatorn e parafine, perioada de asteptare este stresanta mai \up0
\expndtw0\charscalex118 ales din cauza multiplelor necunoscute introduse de ele
insele Tn ecuafie. \up0 \expndtw0\charscalex118 Presupuneri in legeture cu numarul
ganglionilor axilari invadafi si variate \up0 \expndtw0\charscalex118 scheme de
tratament, pronosticun privind evolutia, cele mai nefericite ex-\line \up0
\expndtw0\charscalex113 pectafii, temeri, tot lelul de informafii eronate circue
printre bolnave $i fami-\line \up0 \expndtw0\charscalex100 Inle lor.
\expndtw0\charscalex115 Anxietatea aperute in asemenea situafii duce deseori la
insomnii. anore� \up0 \expndtw0\charscalex118 xie, stari de sebiciune care pot
ingreuna recuperarea postoperatorie \line \tab \up0 \expndtw0\charscalex117
Consilierea suportiv-informative, in grup sau individuae, ajue infelege-\up0
\expndtw0\charscalex117 rea corecte a unor date privind tratamentul: astfel se
reduce starea de stres, \up0 \expndtw0\charscalex119 bolnavele putand se se
adapteze mai bine soliciterilor in aceaste perioade \up0 \expndtw0\charscalex119 de
asteptare. \par\pard\qj \li979\ri573\sb11\sl-250\slmult0\fi297 \up0
\expndtw0\charscalex125 Mamectomia, ca forme de tratament in cancerul sanului
determina \up0 \expndtw0\charscalex115 modificeri in imaginea corporals. Toate
femeile isi simt amenintate femini\up0 \expndtw0\charscalex122 tatea S' aprecierea
de sine. Desigur, poate fi mult mai dificil pentru cele \up0
\expndtw0\charscalex115 tinere pentru care alractivitatea s1 fertilitatea sunt
esenfiale, mai ales pentru \up0 \expndtw0\charscalex115 cele singure, lare partener
\expndtw0\charscalex115 Este evident inse ce cele mai multe lemei sunt mult mai
mult preocupate \up0 \expndtw0\charscalex117 de faptul ce au cancer decet de faptul
ce s'-au pierdut un san. \line \tab \up0 \expndtw0\charscalex114 Ideea de a pune
trauma psihologica in principal pe seama pierderii sanu� \up0
\expndtw0\charscalex117 lui nu mai poate fi sustmue mull timp. Femeile care i$i
salveaza sanul prin \up0 \expndtw0\charscalex113 operafie conservatoare constand Tn
excizia tumorn maligne urmatS de radio-\up0 \expndtw0\charscalex116 terapie- des'
rezoIvS problema imaginii corporale, manifests totus* deseori \up0
\expndtw0\charscalex118 tulburSri psihice determinate de teama de recidive si
uneori sentimente de \up0 \expndtw0\charscalex121 vmovafie pentru alegerea IScutS.
Independent de tipul de operafie apare \up0 \expndtw0\charscalex122 sutennfa
provocata de diagnostic, socotit de cele mai multe bolnave a fi \up0
\expndtw0\charscalex114 fatal, impreunS cu teama cS vor fi sligmatizate, evitate $'
ca vor muri in du� \up0 \expndtw0\charscalex114 reri si parasite \par\pard\ql
\li1276\sb197\sl-230\slmult0 \up0 \expndtw0\charscalex135 Radioterapia \par\pard\qj
\li979\ri594\sb217\sl-246\slmult0\fi297 \up0 \expndtw0\charscalex132 Radioterapia
este asociats uneori de catre pacienti. cu teama ce \up0 \expndtw0\charscalex121
iradierea ar putea fi nociva. Aceaste teama se poate accentua la sfarsitui \up0
\expndtw0\charscalex125 tratamentului cand, prin cumulare. posibilele efecte
secundare fizice-\line \up0 \expndtw0\charscalex122 anorexia, senzafia de
siebictune, iritarea pielii si oboseala \up0 \expndtw0\charscalex124 - fac ca
unii \par\pard\ql \li979\sb28\sl-230\slmult0 \up0 \expndtw0\charscalex117 pacienu
se se stmta mult mai rau decat atunci cand au inceput tratamentul.
240\slmult0\fi288 \up0 \expndtw0\charscalex118 in timpul sedmfei de iradiere, mai
ales la persoanele anxioase dinalntea \up0 \expndtw0\charscalex114 imbolnavini, pot
apSrea pronunfate stSri de anxietate. \par\pard\ql \li1041\sb229\sl-230\slmult0
\up0 \expndtw0\charscalex131 Chimioterapia \par\pard\qj \li744\ri829\sb197\sl-
246\slmult0\fi292 \up0 \expndtw0\charscalex119 Chimioterapia are cea mai proastS
reputafie dintre toate tratamentele, \up0 \expndtw0\charscalex118 din cauza
numeroaselor electe secundare (cele mai frecvente fiind: greafa, \up0
\expndtw0\charscalex121 voma, alopecia), desi ele pot varia in sevehtate de la
individ la individ si \up0 \expndtw0\charscalex116 intr-un oarecare grad si in
funcfie de medicamente si calea de administrare. \par\pard\ql \li744\ri809\sb0\sl-
244\slmult0\fi302\tx1051 \up0 \expndtw0\charscalex135 Necesitatea de a urma
tratament citostatic adSugatS la trauma \up0 \expndtw0\charscalex115 diagnosticului
de cancer creazS alte suferinfe psihologice. \line \tab \up0
\expndtw0\charscalex114 Exists dovezi cS anumite medicamente din cele utilizate in
ohimioterapie \up0 \expndtw0\charscalex118 afecteazS starea sufleteascS, dispozifia
si funcfiile cognitive; totusi aceste \up0 \expndtw0\charscalex117 efecte pot fi
datorate la fel de mult extenuSrii psihice cat si efectului direct \up0
\expndtw0\charscalex112 biochimic asupra creierului (Silberfab 1980).
\par\pard\qj \li748\ri815\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex119 De
asemenea unh pacien(i se pot confrunta cu situafia in care constae \up0
\expndtw0\charscalex125 ca lea scSzut semnificativ numSrul de celule albe \up0
\expndtw0\charscalex124 (ceea ce determine \par\pard\qj \li748\ri820\sb0\sl-
260\slmult0\fi4 \up0 \expndtw0\charscalex125 reducerea rezistentei organismului la
infecfii). Acease scedere este un \up0 \expndtw0\charscalex115 efect secundar al
citostaticelor. \par\pard\qj \li748\ri815\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex123 In afara efectelor secundare fizice, chimioterapia produce
o serie de \up0 \expndtw0\charscalex117 efecte secundare psihologice care sunt, din
pacate. neglijate. \par\pard\ql \li1046\sb46\sl-230\slmult0 \up0
\expndtw0\charscalex122 Problemele psihologice in legatura cu chimioterapia
Maguire atregea atenfia asupra faptului cS "personalul care acorda \up0
\expndtw0\charscalex122 ingrijire bolnavilor, adesea trece cu vederea problemele
psihologice ale \up0 \expndtw0\charscalex121 acestora; suferinfa psihice este
acceptate in loc se fie sistematic evaluae; \up0 \expndtw0\charscalex117 personalul
medical asleapte ca pacientul se solicite ajutor psihologie". \par\pard\ql
\li748\ri810\sb0\sl-247\slmult0\fi297\tx1046 \up0 \expndtw0\charscalex117 Pacientul
inse. deseori nu indrezneste se iase din rolul de "pacient bun" \up0
\expndtw0\charscalex114 Si ca urmare, nu vorbeste despre dificultatea cu care face
fafa tratamentului \line\tab \up0 \expndtw0\charscalex119 Este necesare o mai
atente urmenre a acestor greutefi suplimentare pe \up0 \expndtw0\charscalex123 care
chimioterapia le aduce unui bolnav care deja isi simfise ameninfat \up0
\expndtw0\charscalex113 contortul, echilibrul emofional, rolul social, planurile de
viitor, viafa insasi, e \up0 \expndtw0\charscalex123 aflarea diagnosticului. Este
importanta cunoasterea tulburarilor pe care \up0 \expndtw0\charscalex122 electele
secundare le pot produce in activitatea cognitive, emofionale si \up0
\expndtw0\charscalex122 fizice a pacientului. afectandu-i capacitatea de a lucra in
meserie sau Tn \up0 \expndtw0\charscalex116
case, de a se angaja Tn activitafi sociale. \par\pard\qj \li758\ri814\sb0\sl-
246\slmult0\fi292 \up0 \expndtw0\charscalex120 Identificarea acestor factori de
stres major ar trebui se fie prioritare in \up0 \expndtw0\charscalex123 acfiunile
de asistenfa si de aiutorare a bolnavilor. Intervenfiile practice \up0
\expndtw0\charscalex114 adecvate, de conciliere si psihoterapie. pot sS reducS
disfuncfiile emofiona� \up0 \expndtw0\charscalex114 le. psihologice care apar Tn
general sub urmSloarele forme-\par\pard\ql \li1094\sb96\sl-230\slmult0 \up0
\expndtw0\charscalex115 1) - Fried si suspiciune inainte de inceperea primei
cure \par\pard\qj \li787\ri804\sb122\sl-240\slmult0\fi283 \up0
\expndtw0\charscalex113 Sunt determinate de istohoarele TnspSimantStoare despre
chimioterapie, \up0 \expndtw0\charscalex118 rSmase din anii dm urmS, cand efectele
secundare nu puteau fi finute sub \up0 \expndtw0\charscalex113 control (gama
anttemeticelor era restrSnsa) \par\pard\ql \li1080\sb69\sl-230\slmult0 \up0
\expndtw0\charscalex115 2) - Incertitudine si anxietate, depresie
\par\pard\qj\li1022\ri560\sb94\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex123 La
nesiguranfS. preocuparea in legatura cu neprevSzutuI bolii, unii \up0
\expndtw0\charscalex116 pacienfi adaugS o ghjS, fries suplimentarS si anume, cS
tratamentul prin el \up0 \expndtw0\charscalex116 insusi are efecte toxice care
trebuie monitorizate cu gnjs. Aceste temeri pot \up0 \expndtw0\charscalex116 crea o
stare depresivS si o permanents fhcS de tratament. \par\pard\qj
\li1027\ri558\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex115 Depresia poate
Influenfa somnul s< determina starea fizicS de obosealS. \up0
\expndtw0\charscalex116 Oboseala poate fi resimfitS ca si cum ar domina starea
generae a persoanei \up0 \expndtw0\charscalex129 facand dificie stimularea
emofiilor pozitive sau intreprinderea unor \up0 \expndtw0\charscalex109 activitafi.
\par\pard\ql \li1310\sb49\sl-230\slmult0 \up0 \expndtw0\charscalex115 3) -
Dtspozifii. stari sutletesti oscilante \par\pard\qj \li1012\ri546\sb65\sl-
237\slmult0\fi297 \up0 \expndtw0\charscalex114 De cele mai multe ori, trecand prin
stresui tratamentului, este suficient ca \up0 \expndtw0\charscalex120 se apare o
stare de suferinfa. tristefe. Se intampe inse ca pacienfii se de� \up0
\expndtw0\charscalex121 clare ce " nu mai au control asupra propriilor emofii", ce
Ii se inempe se \up0 \expndtw0\charscalex122 planga din lucruri marunte, dupe care
tree la cealale extreme, cu o stare \up0 \expndtw0\charscalex116 sulleteasce mai
bune, cSnd se simt chiar euforici fere un motiv evident. De \up0
\expndtw0\charscalex120 exemplu prednisonul s1 dexametasonul, antiemetice folosite
adesea. pot \up0 \expndtw0\charscalex118 determina aceste neobisnulte "stari de
bine" urmate de inexplicabile "stari \up0 \expndtw0\charscalex116 de bine" urmate
de inexplicabile "stari de cedere" care pot deveni depresie. \up0
\expndtw0\charscalex120 cu simptomele ei: stare "proase", tristefe, incapacitate de
a se mai bucura \up0 \expndtw0\charscalex120 de lucruhle care inainte ii feceau
pecere, tulburdri de alimentatie si somn. \par\pard\ql \li1305\sb49\sl-
230\slmult0 \up0 \expndtw0\charscalex113 4) - Irttabtlitate \par\pard\qj
\li1022\ri551\sb70\sl-230\slmult0\fi292 \up0 \expndtw0\charscalex119 Pacientii
apreciaze ei Insist ce se pot simfi frustrafi si descuraiafi mult \up0
\expndtw0\charscalex125 mai usor decat de obicei si ce tolereaza mult mai greu
decat de obicei \up0 \expndtw0\charscalex114 frustrafiile. Este o forme de reacfle
la stresui fizic si emofional. \par\pard\ql \li1305\sb70\sl-230\slmult0 \up0
\expndtw0\charscalex113 5) - Dificultdfi de concentrare si cognitive, in timpul
tratamentului \par\pard\qj \li1017\ri536\sb62\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex119 Unele persoane spun ce au greutafi in a-si aminti ceva sau
ce nu se pot \up0 \expndtw0\charscalex136 concentra se citeasce un ziar/carte sau
se lucreze. intrucat aceste \up0 \expndtw0\charscalex126 simptome pot fi subtile,
fie nu sunt observate, fie sunt puse pe seama \up0 \expndtw0\charscalex115
modificehlor psihologice-depresiei, anxieefii. \par\pard\qj \li1017\ri536\sb5\sl-
235\slmult0\fi292 \up0 \expndtw0\charscalex118 Se pare inse, ce unii agenfi
chimioterapeutici Tn special Tn doze mari, \up0 \expndtw0\charscalex120 afecteaze
temporar capacitatea de gandire. Acest lucru TncS nu este bine \up0
\expndtw0\charscalex114 emurit; sunt necesare noi studii. Exists un domeniu separat
de cercetare care \up0 \expndtw0\charscalex111 se adreseazS impactului pe care Tl
are cancerul si tratamentul acestuia, asupra \up0 \expndtw0\charscalex107
functionSrii cognitive 1a adulfi si copii (Massie M.J., Holland J.C., \up0
\expndtw-3\charscalex100 1983). \par\pard\ql \li1315\sb70\sl-230\slmult0 \up0
\expndtw0\charscalex116 6) - Efectele secundare psihologice asociate chimioterapiei
Efectele secundare fizice \tab \up0 \expndtw0\charscalex123 (Tn special greafa si
voma) pot determina \par\pard\qj \li1027\ri552\sb2\sl-240\slmult0 \up0
\expndtw0\charscalex123 perturbSh serioase in functionarea zilnicS si pot conthbui
la prezenta si \up0 \expndtw0\charscalex115 severitatea depresiei si anxietSfii.
prezent exists o vanetate de medicamente care permit un mai bun \up0
\expndtw0\charscalex112 control antiemetic. \par\pard\qj \li1017\ri536\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex120 Este bine ca acest control sS
TnceapS odats cu prima administrare de \up0 \expndtw0\charscalex116 citostatice
decat sS fie ISsat pacientul sS aibS o experienfa negative care se \up0
\expndtw0\charscalex116 favohzeze dezvoltarea senzafillor de greafe/vome.
anticipatorii. \par\pard\qj \li1017\ri551\sb0\sl-230\slmult0\fi292 \up0
\expndtw0\charscalex118 De asemenea este important felul Tn care Ti sunt explicate
pacientului \up0 \expndtw0\charscalex116 aceste efecte secundare. Unii nu sunt de
acord se se dea exphcafii, socotind \up0 \expndtw0\charscalex116 ce tocmai eie
"pregetesc" pacienfii pentru toxicitatea gastrointestinae.
\expndtw0\charscalex105 \u9830?\tab \up0 \expndtw0\charscalex105 Elemento de
\up0 \expndtw0\charscalex116 Numeroase studii au aratat inse cS pacienfii care se
a$teapta sS aibS greafa \up0 \expndtw0\charscalex122 Si vomS au mai mari sanse se
treiasca aceaste experientS decat cei care \up0 \expndtw0\charscalex125 cunoscand
riscul, cred ca ei nu vor avea aceste dificulefi \up0 \expndtw0\charscalex110 (Redd
W.H., \par\pard\ql \li859\sb10\sl-230\slmult0 \up0 \expndtw-2\charscalex100
\expndtw0\charscalex117 O informare corece (care se anihileze zvonuhle care circue
printre bol� \up0 \expndtw0\charscalex116 navi si creaze cele mai sumbre asteperi).
dublate de o pregetire psihologice \up0 \expndtw0\charscalex116 adecvate pot avea
consecinfe benefice pentru pacient. \par\pard\ql \li1128\sb1\sl-
193\slmult0\tx3273\tx3422 \up0 \expndtw0\charscalex114 Cu toate intervenfiile
\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw0\charscalex115 farmacologice
si psihologice - aproximativ 45% \par\pard\qj \li844\ri754\sb0\sl-240\slmult0
\up0 \expndtw0\charscalex115 din pacientii cu cancer (adulfi) vor dezvolta senzafia
de greafe si'sau voma. \up0 \expndtw0\charscalex112 cu 24 ore inainte de
chimioterapie (Burish T.G.. Carey M.P., \up0 \expndtw-3\charscalex100 1986).
Respunsul anticipat este un sindrom conditional, \tab \up0 \expndtw0\charscalex118
(lormat prin reflex \par\pard\ql \li840\sb0\sl-219\slmult0\tx7175 \up0
\expndtw0\charscalex121 condifionat clasic). la o serie de stimuli asociafi
tratamentului \tab \up0 \expndtw0\charscalex106 (ollactivi, \par\pard\qj
\li835\ri732\sb12\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex120 vizuali, sa.).
Aceasta condifionare poate fi atat de puternica incat, simplu \up0
\expndtw0\charscalex126 gand al pacientului ce va merge la spital sau vederea unei
seringi sau \up0 \expndtw0\charscalex117 mirosul de spirt/parfum \up0
\expndtw0\charscalex125 (al asistentei) sunt suliciente pentru a produce
greafa/voma. Aceste efecte secundare psihologice ale chimioterapiei pot \up0
\expndtw0\charscalex123 persista si dupa terminarea tratamentului, mulfi ani.
Efectele secundare \up0 \expndtw0\charscalex129 psihice anticipatorii sunt puternic
asociate cu intensitatea \up0 \expndtw0\charscalex126 $i durata \par\pard\qj
\li840\ri722\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex119 grefurilor si
vomei aperute imediat dupe administrarea citostaticelor $i se \up0
\expndtw0\charscalex119 coreleaze pozitiv cu nivelul de anxietate. \par\pard\ql
\li849\ri743\sb0\sl-230\slmult0\fi288\tx1137 \up0 \expndtw0\charscalex123 Cei mai
eficient control al respunsului conditional anticipat poate fi \up0
\expndtw0\charscalex114 realizat prin tehnicile de psihoterapie comportamentale.
\line \tab \up0 \expndtw0\charscalex115 Acest tip de interventie este de ajutor
multor pacienfi si trebuie conside� \up0 \expndtw0\charscalex113 rate partea
integrante a unei abordan complete a controlului grefurilor si vo� \up0
\expndtw0\charscalex113 mei, ca electe secundare ale chimioterapiei.
\par\pard\ql \li1166\sb21\sl-230\slmult0 \up0 \expndtw0\charscalex109 7) \u9632?
Complexul "Nu mai sunt eu insumi" \par\pard\qj \li849\ri713\sb46\sl-
236\slmult0\fi297 \up0 \expndtw0\charscalex116 Unele schimberi in aspectul
persoanei, determinate de caderea pSrului, \up0 \expndtw0\charscalex126 paloare.
cresterea sau scSderea in greutate. senzafia lipsei de energie. \up0
\expndtw0\charscalex115 contribuie la aparifia acestui complex care poate fi
devastator prin faptul ca \up0 \expndtw0\charscalex117 dezvSluie lumii cS urmeaze
tratament pentru cancer El poate determina de \up0 \expndtw0\charscalex116 asemenea
semnificative schimberi in propria imagine despre sine, stima de \up0
\expndtw0\charscalex116 sine. \par\pard\qj \li849\ri719\sb0\sl-230\slmult0\fi297
\up0 \expndtw0\charscalex120 Terapiile cognitiv comportamentale care au ca scop
promovarea unei \up0 \expndtw0\charscalex128 gandiri pozitive. in particular
incurajarea aprecierii de sine, pot ajuta \up0 \expndtw0\charscalex116 bolnavul
care se confrune cu astfel de probleme. \par\pard\ql \li1156\sb59\sl-230\slmult0
\up0 \expndtw0\charscalex112 8) - Impactul psihologie al schimbarilor in funcfiile
sexuale \par\pard\qj \li868\ri708\sb50\sl-230\slmult0\fi288 \up0
\expndtw0\charscalex116 Electele chimioterapiei asupra sexualitafii pacientului
includ modificeri \up0 \expndtw0\charscalex114 privind fertilitatea. libidoul s<
funcfionarea sexuale. Ele pot crea importante \up0 \expndtw0\charscalex114
sulerinfe psihice. \par\pard\qj \li878\ri713\sb2\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex119 Informarea privind aceste potentiae probleme si discutarea
lor trebuie \up0 \expndtw0\charscalex119 ecuta intr-un fel in care pacientul se se
simte confortabil. Poate fi nevoie, \up0 \expndtw0\charscalex119 dupe caz, de
psihoterapie \par\pard\ql \li1243\sb150\sl-253\slmult0 \up0 \expndtw-
7\charscalex100 \ul0\nosupersub\cf8\f9\fs22 REACTIE SI ADAPTARE PSIHOLOGICA LA
CANCER SI TRATAMENT \par\pard\qj \li902\ri709\sb198\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 Impactul pe care diagnosticul
de cancer, boala si tratamentul il au asupra \up0 \expndtw0\charscalex114 serii
emofionale a pacienfilor variazS loarte mult in intensitate si
comple-\par\pard\sect\sectd\fs24\paperw8940\paperh13300{\bkmkstart Pg298}{\bkmkend
<\u9632?\tab \up0 \expndtw0\charscalex105 297\par\pard\qj \li1017\sb0\sl-
\par\pard\qj\li1017\ri555\sb99\sl-240\slmult0 \up0 \expndtw0\charscalex118 xitate
de la bolnav la bolnav. Este o experienfa subiectivS dar cu multiple \up0
\expndtw0\charscalex122 modificSri dinamice in insasi starea psihice a fiecarut
pacient in dilerite \up0 \expndtw0\charscalex111 momente ale bolii \par\pard\qj
\li1017\ri549\sb0\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex119 in prezent
inse, aspectele psihopatologice sj legetura lor cu personali� \up0
\expndtw0\charscalex115 tatea premorbide nu mai sunt subiecte prioritare de
cercetare. Atentia se in\up0 \expndtw0\charscalex118 dreapte indeosebi asupra
analizei $' Tnfelegerii valorii "adaptative" a unor \up0 \expndtw0\charscalex116
reacfii ale bolnavului in raport cu boala si asupra gasini celor mai eficier.te
\up0 \expndtw0\charscalex118 metode de intervenfia psiho-sociale pentru ameliorarea
adapterii psiholo� \up0 \expndtw0\charscalex118 gice si cresterea caliefn viefii
\expndtw0\charscalex118 Cancerul este o sursa de stres major pentru tofi bolnavii,
de$i este trait \up0 \expndtw0\charscalex124 emotional diferit. Este foarte
important se se infeleaga natura stresului \up0 \expndtw0\charscalex117
diagnosticului de cancer inainte de a urmerl reacfia la acest stres.
Stresui, in contextul bolii canceroase, este multideterminat. Pe de o \up0
\expndtw0\charscalex115 parte, este boala percepute deseori ca o ameninfare pentru
Integhtatea, via� \up0 \expndtw0\charscalex110 fa individului \up0
\expndtw0\charscalex118 (cu unele diferenfe in funcfie de diagnostic), tratamentul
de \up0 \expndtw0\charscalex127 lunga durata si greu de suportat \up0 \expndtw-
8\charscalex100 $i. \up0 \expndtw0\charscalex126 pe de alte parte, sunt
problemele \par\pard\qj \li1031\ri536\sb2\sl-240\slmult0 \up0
\expndtw0\charscalex121 preexistente si cele aperute odate cu boala. cerora
individul trebuie se le \up0 \expndtw0\charscalex118 face fata, in aceastS
situafie, dapa resursele psiholog'ce proprii si/sau cele \up0
\expndtw0\charscalex130 de suport psihosocial sunt reduse, stresui se amplifies iar
adaptarea \up0 \expndtw0\charscalex116 psihologice a bolnavului la situafia dae
este greu de realizat. \par\pard\qj \li1022\ri535\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex125 Starea psihologice a unui bolnav. la un moment dat. este
rezultatul \up0 \expndtw0\charscalex114 interacfiunii $i echilibrSni delicate a
unor conditii. solicitSri particulare care \up0 \expndtw0\charscalex114 ii vor
influenfa reacfia si. 'n final, adaptarea. \par\pard\ql \li1320\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex114 J.C. Holland(1987) a grupat aceste
condifii variabile Tn trei categorii: \par\pard\ql \li1636\sb130\sl-230\slmult0
\up0 \expndtw0\charscalex125 Probleme fundamental fn adaptarea psihologica la
cancer\par\pard\sect\sectd\sbknone\cols2\colno1\colw3448\colsr60\colno2\colw5292\co
Contextul\par\pard\ql \li1406\sb6\sl-230\slmult0 \up0 \expndtw0\charscalex124
socio-cultutal\par\pard\ql \li1142\sb0\sl-230\slmult0 \par\pard\ql \li1142\sb0\sl-
230\slmult0 \par\pard\ql \li1142\sb5\sl-230\slmult0 \up0 \expndtw0\charscalex120 2.
Contextul medical\par\pard\ql \li1147\sb0\sl-230\slmult0 \par\pard\ql
\expndtw0\charscalex120 3 Contextul psihologie\par\pard\column \qj
\li20\ri892\sb205\sl-232\slmult0\fi4\tx160 \up0 \expndtw0\charscalex114 -
atitudinile sociale, idoile, conceptiilo nulturii \line\tab \up0
\expndtw0\charscalex118 respective despre cancer, pot afecta modul \line \up0
\expndtw0\charscalex114 e cum sunt tratafi pacienfii si familiile
lor\par\pard\qj \li25\ri670\sb1\sl-235\slmult0 \up0 \expndtw0\charscalex112
\ul0\nosupersub\cf18\f19\fs20\ul e cum se vSd pacienfii pe ei insi$i, boala.
vi\ul0\nosupersub\cf9\f10\fs20 i\ul0\nosupersub\cf18\f19\fs20\ul tprul \up0
\expndtw0\charscalex115 \ul0\nosupersub\cf9\f10\fs20 \u8226? date clinice stadiul
$i evolufia clinicS,\par\pard\qj \li155\ri855\sb0\sl-233\slmult0 \up0
\expndtw0\charscalex118 localizare. natura dislundiilor si simptomele \up0
\expndtw0\charscalex112 produse;\par\pard\ql \li25\sb0\sl-230\slmult0 \up0
\expndtw0\charscalex113 - tratamente;\par\pard\ql \li25\sb1\sl-225\slmult0 \up0
\expndtw0\charscalex114 - oofiuni de recuperare;\par\pard\qj \li25\ri1344\sb6\sl-
230\slmult0\tx160 \up0 \expndtw0\charscalex115 - suport psihologie dm parte
personalului \line\tab \up0 \expndtw0\charscalex110
in\ul0\nosupersub\cf18\f19\fs20\ul grijire.\par\pard\qj \li155\ri896\sb15\sl-
225\slmult0 \up0 \expndtw0\charscalex115 \ul0\nosupersub\cf9\f10\fs20 momentul din
viatS (biologic si sub aspectul \up0 \expndtw0\charscalex118 responsabilitSfilor
personae si sociale):\par\pard\ql \li30\sb11\sl-230\slmult0 \up0
\expndtw0\charscalex120 - resurse intrapersonale: stilul de reactie
e\par\pard\ql \li159\ri857\sb0\sl-232\slmult0 \up0 \expndtw0\charscalex118 stres
(coping), defensele, personalitatea \up0 \expndtw0\charscalex117 premorbidS,
concepfille, Ideile despre boae. \up0 \expndtw0\charscalex117 legatuhle anterioare
cu cancerul\par\pard\ql \li35\ri1174\sb1\sl-228\slmult0\tx165\tx174 \up0
\expndtw0\charscalex116 - resurse Interpersonale: natura $i \line\tab \up0
\expndtw0\charscalex115 dispombilitatea suportului social: familie, \line \tab \up0
\expndtw0\charscalex114 prieteni, colegi, grupuri aflllate.
\up0 \expndtw0\charscalex117 Contextul socio-culturel \par\pard\qj
\li772\ri785\sb178\sl-245\slmult0\fi297 \up0 \expndtw0\charscalex121 Conextul
socio-cultural are influents asupra felului in care i$i privesc \up0
\expndtw0\charscalex120 bolnavii diagnosticul si boala. La noi, informarea
publicului este redusS\up0 \expndtw0\charscalex116 inclusiv a populafiei cu rise
crescut in legSturS cu cancerul (factori de rise, \up0 \expndtw0\charscalex127 csi
de prevenire, importanta depistShi precoce. posibilitSfi actuae de \up0
\expndtw0\charscalex117 tratament, etc.). Ca urmare, foarte mulfi oameni TncS
considers cancerul o \up0 \expndtw0\charscalex126 boalS incurabie. iar unii se ten
cS este contagioasS. Reacfia la aflarea \up0 \expndtw0\charscalex116
diagnosticului. atitudinea de neincredere fafa de curabihtatea tratamentului
\up0 \expndtw0\charscalex126 poartS amprenta acestor conceptii in plus, ea poate
crea dificultSfi de \up0 \expndtw0\charscalex115 reintegrare in societate. Unii
bolnavi sunt dezorientafi, nu stiu cum ar fi mai \up0 \expndtw0\charscalex116 bino
sS se comporte, cum sS spunS sau sS ascundS o realitate care le poate \up0
\expndtw0\charscalex108 modifica \up0 \expndtw0\charscalex118 (dupS pSrerea lor)
Imaglnea in fafa oamenilor, relafiile sociale, \up0 \expndtw0\charscalex114
situafia la,locul de munca. \par\pard\qj \li772\ri781\sb0\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex124 Este problema la care pot reacfiona foarte diferit, uneori
straniu, cu \up0 \expndtw0\charscalex115 consecinfe in planul trairilor emofionale
si nu numai. \up0 \expndtw0\charscalex117 0 bolnave i$i amanS \par\pard\qj
\li768\ri776\sb17\sl-244\slmult0\fi4 \up0 \expndtw0\charscalex121 operafia cand
intalneste in sectia de chirurgie o conseteance, de teaire ce \up0
\expndtw0\charscalex128 aceasta va rSspandi vestea cS are cancer in tot targul si
'S* va pierde \up0 \expndtw0\charscalex125 serviciul. O alta se simte agresatS si
imobilizats de ochiul scrutStor si \up0 \expndtw0\charscalex117 compasiunea
exprimatS de o colegS care bSnuieste cS i s-a fScut mamec\up0
\expndtw0\charscalex112 tomie. O persoana cu o funcfie de conducere la o lirmS
importantS, dupS ma\up0 \expndtw0\charscalex116 mectomie. decide cS trebuie sS se
retragS din functie motivand ca stie cum \up0 \expndtw0\charscalex118 gandesc
oamenii, iar discrepanta dintre statutul si starea ei va submina pu \up0
\expndtw0\charscalex125 terea deciziilor pe care trebuie se e ia la locul de munca
Neexcluzand \up0 \expndtw0\charscalex126 posibilitatea schimberii imaginii de sine
in acest caz, fere o cauze din \up0 \expndtw0\charscalex116 exterior, problema
informerii corecte a populafiei remSne aceeasi. pSstran\up0 \expndtw0\charscalex118
du-si caracterul de necesitate stringente. Efectele benefice pe care le poate
\up0 \expndtw0\charscalex118 avea informarea prin mijloace mass-media atat in
prevenfia cancerului cat \up0 \expndtw0\charscalex119 Si in adaptarea psihologice
la diagnosticul de cancer sunt argumentele de \up0 \expndtw0\charscalex116 baza
penfru demararea unor programe in aceaste direcfie. \par\pard\ql \li1080\sb188\sl-
230\slmult0 \up0 \expndtw0\charscalex116 Contextul medical \par\pard\qj
\li777\ri766\sb178\sl-245\slmult0\fi292 \up0 \expndtw0\charscalex117 Diagnosticul
de cancer cuprinde numeroase localizari. mai multe stadii \up0
\expndtw0\charscalex114 ale bolii. diverse tratamente cu evolufii S' prognosticuri
diferite. Este o mare \up0 \expndtw0\charscalex117 diferenfa Tntre problemele cu
care se confruntS si trebuie sS le facS fafa o \up0 \expndtw0\charscalex116 bolnavS
cu leziune in situ la colul uterin fafd de alta. cu o tumors invazivS, \up0
\expndtw0\charscalex129 cu posibie metastaze la col. in acest ultim caz este vorba
de un stres \up0 \expndtw0\charscalex116 particular, asociat diagnosticului care
poate Influenfa reacfia la problemele \up0 \expndtw0\charscalex116 cu care se
confruntS, implicit starea psihicS. Cu toate acestea. se Tntalnesc \up0
\expndtw0\charscalex114 in clinicS bolnavi cu tumori in stadiu incipient $i
localizare cunoscuts a avea \up0 \expndtw0\charscalex118 sanse mari de vindecare,
care reacfioneazS cu neincredere fafa de eficaci\up0 \expndtw0\charscalex115 tatea
tratamentului, prin stare depresivS si senzafie de neputinfS s1 lipsa de \up0
\expndtw0\charscalex117 speranfS, Tn timp ce bolnavi cu prognostic mai pufin bun se
angajeaza Tn \up0 \expndtw0\charscalex116 lupte cu boala, iar Tntre curele
terapeutice se streduiesc se duca o viafe cSt \up0 \expndtw0\charscalex113 mai
apropiats de cea dinaintea imbolnSvirii.
\up0 \expndtw0\charscalex116 Contextul psihologie \par\pard\qj
\li1008\ri575\sb62\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex114 Ideile.
concepfiile despre cancer, resursele psihologice s* cele suportive, \up0
\expndtw0\charscalex117 momentul in care apare boala. situafia familiala. stilul de
reactie in situafii \up0 \expndtw0\charscalex116 dificile. personalitatea sunt
elemente care pot explica diferenfele de reactie \up0 \expndtw0\charscalex116 in
Impactul cu boala. \par\pard\qj \li1003\ri564\sb17\sl-244\slmult0\fi297 \up0
\expndtw0\charscalex112 La orice varse. in orice moment al viefii. aparifia
cancerului are un impact \up0 \expndtw0\charscalex115 asupra percepfiei propriei
persoane si a mediului inconjurStor si produce un \up0 \expndtw0\charscalex125
dezechilibru in activitate. Tn relafiile interpersonale, creazS probleme \up0
\expndtw0\charscalex127 existenfiale. afecteazS integritatea, imaginea corporae si
sexuale. La \up0 \expndtw0\charscalex120 acestea, de cele mai multe ori, se adauge
un stres special, produs de per� \up0 \expndtw0\charscalex114 turbarea, ameninfarea
sau intreruperea unor responsabiliefi, planuri. resurse \par\pard\qj
\li1003\ri559\sb16\sl-245\slmult0\fi287 \up0 \expndtw0\charscalex114 O tanSrS de 33
de ani (fara parinfi. frafi) se confruntS dupS mamectomie \up0
\expndtw0\charscalex117 cu certitudinea cS proiectata cSsStorie nu va mai avea loc
iar dorinta ei de \up0 \expndtw0\charscalex113 a avea copii nu va mai fi implinitS
vreodatS.O mamS care T$i creste singurS \up0 \expndtw0\charscalex128 copiii minori
trebuie sS-i lase sS se descurce singuri in absenfa ei..O \up0
\expndtw0\charscalex114 persoanS (47 de ani) care primise o ofertS de promovare
profesionalS, dupS \up0 \expndtw0\charscalex121 mamectomie este convinsS cS trebuie
sS se pensioneze.. O persoanS in \up0 \expndtw0\charscalex130 varste trebuie sS se
descurce singurS, inclusiv cu greutSfile finan� \up0 \expndtw0\charscalex117
cial...Reacfiile, mai ales la ailarea diagnosticului, sunt influenfate Tn mare \up0
\expndtw0\charscalex117 parte de starea psihica create de acest tip de probleme.
Aprecierile, evaluerile. ideile bolnavului privind cancerul apar deseori in \up0
\expndtw0\charscalex118 urma unei expehenfe antehoare nefericite cu cancerul
\up0 \expndtw0\charscalex116 $i au repercursiuni \par\pard\qj
\li1003\ri564\sb16\sl-245\slmult0 \up0 \expndtw0\charscalex114 asupra
comportamentului, atitudinii fafe de propria boalS. Cand i$i exprimS \up0
\expndtw0\charscalex113 nemcrederea ca se pot lace bine, bolnavii se refers deseori
la cazuri de cancer \up0 \expndtw0\charscalex120 (rude, prieteni) care au sfarsit
intr-un mod nefericit. Suportul psihologie, \up0 \expndtw0\charscalex114 demontaroa
prin stabilirea diferentelor intre cazuri a ansamblului de ganduri \up0
\expndtw0\charscalex114 negative, pot ajuta bolnavul sS priveascS din alt unghi
propria-i boalS. \par\pard\qj \li993\ri556\sb0\sl-250\slmult0\fi297 \up0
\expndtw0\charscalex122 infelegerea ideilor, sensurllor acordate bolii. constituie
o dimensiune \up0 \expndtw0\charscalex114 importantS pentru infelegerea
comportamentului in boae. Lipowski enumere \up0 \expndtw0\charscalex116 cele mai
tipice sensuri acordate bolii: boala ca provocare cereia trebuie so-i \up0
\expndtw0\charscalex121 face fafe, inamic sau pedeapse, sebiciune, usurare,
pierdere irecuperabie \up0 \expndtw0\charscalex115 sau pericol. \par\pard\qj
\li998\ri554\sb0\sl-246\slmult0\fi292 \up0 \expndtw0\charscalex113 Se TntampIS ca
bolnavul sS capete Tncredere in tratament cand cunoaste \up0
\expndtw0\charscalex119 pe cineva care se simte bine, dupS mulfi ani de 1a
operafie, isi duce viafa \up0 \expndtw0\charscalex127 normal, este vindecat.
Prezentarea pe care o poate face acesta despre \up0 \expndtw0\charscalex116 propria
experienfa, dezvSluirea propriilor temeri, a luptelor \up0 \expndtw0\charscalex115
$i a victoriilor \par\pard\qj \li993\ri556\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex119 sale, pot avea un efect benefic asupra bolnavilor.
Discufiile pe care acesti \up0 \expndtw0\charscalex115 "veterani" le pot avea cu
bolnavii vizitandu-i Tn spital pot constitui o forms \up0 \expndtw0\charscalex115
de suport social important. \par\pard\ql \li1281\sb1\sl-220\slmult0\tx3844 \up0
\expndtw0\charscalex115 Absenfa suportului social \tab \up0 \expndtw0\charscalex116
(familie. rude, grupurl suportive) constituie o \par\pard\qj \li993\ri556\sb24\sl-
240\slmult0\fi4 \up0 \expndtw0\charscalex121 sursa importantS de stres pentru
bolnavul de cancer. Bolnavii nostri fara \up0 \expndtw0\charscalex121 familie care
sa-l susfine sunt intr-o situafie pe care o traiesc ca fiind fere \up0
\expndtw0\charscalex116 ie$ire (la not neexlstand ince o retea organizae pentru
suportul psiho-social \up0 \expndtw0\charscalex112 ai bolnavilor de cancer). Mulfi
bolnavi au mari greuefi si nici un fel de ajutor. \up0 \expndtw0\charscalex112
DimpothvS. au mari responsabilitSti fie fafS de parinfi in varstS bolnavi, fie
240\slmult0\fi4 \up0 \expndtw0\charscalex116 fafS de copii. Apreciindu-se
cS suportul social poate reduce sau poate avea \up0 \expndtw0\charscalex122 rol de
tampon fafa de impactul negativ al bolii, el trebuie recunoscut ca \up0
\expndtw0\charscalex111 forms de ajutor al pacientului in fafa bolii (S.Cohen, T.A
Wills, \up0 \expndtw0\charscalex105 1985: Thoits, \par\pard\ql \li849\sb9\sl-
230\slmult0 \up0 \expndtw-3\charscalex100 1986). \par\pard\qj \li825\ri733\sb2\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex117 Credintele, atitudiniie.
activitSfile religioase pot avea un Impact pozitiv \up0 \expndtw0\charscalex123
asupra rSspunsului la o boala serioasa cum este cancerul, la solicitarile \up0
\expndtw0\charscalex129 multiple aperute. in general, ele alcetuiesc o strategie
importante de \up0 \expndtw0\charscalex117 mentinere a echilibrului psihologie in
raport cu stresui provocat de boae si \up0 \expndtw0\charscalex114 de diminuare a
anxieefii Pentru bolnavii nostri. credinfa in Dumnezeu a fost \up0
\expndtw0\charscalex114 Si rSmane o forms importanta de suport si surse de
speranfe. \par\pard\ql \li825\ri743\sb0\sl-240\slmult0\fi297\tx1123 \up0
\expndtw0\charscalex119 Speranfa, in esenfa un mod de a trai, o pozifie personae Tn
fafa viefii, \up0 \expndtw0\charscalex115 Tncredere Tn viafe, are ea insasi
importante implicafii in situafia de boae. \line\tab \up0 \expndtw0\charscalex124
Resursele personate, forfa interioare. stilul de reacfie \up0
\expndtw0\charscalex118 (coping) sunt \par\pard\qj \li825\ri747\sb0\sl-
240\slmult0\fi9 \up0 \expndtw0\charscalex116 importante pentru strategia adoptata
si comportamentele bolnavului in con\up0 \expndtw0\charscalex116 fruntarea cu
boala. \par\pard\qj \li825\ri728\sb20\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex118 Odats cu diagnosticul unei boli cum este cancerul. la care
se adaugS de \up0 \expndtw0\charscalex119 cele mai multe ori si surse de stres
suplimentar. pacientul se confruntS cu \up0 \expndtw0\charscalex127 soliciteri
dificile si neobisnuite, care uneori ii depasesc posibilitefile, \up0
\expndtw0\charscalex122 resursele. El se afla intr-o situafie care solicie noi
strategii de acfiune ca \up0 \expndtw0\charscalex123 raspuns la situafia date.
Copingul, reacfia individului, poate fi eficient\up0 \expndtw0\charscalex124 ducand
la adaptarea psihoiogica-sau ineficient-producand tulburSri in \up0
\expndtw0\charscalex124 starea lui psihica. Situafia poate fi uneori atat de greu
de suportat meat \up0 \expndtw0\charscalex117 pacientul respunde defensiv (mecanism
psihologie de aperare) prin evitare \up0 \expndtw0\charscalex120 sau negare.
Negarea poate fi protective in faza initiae de adaptare la boae \up0
\expndtw0\charscalex122 dar trebuie descurajatS cand interlereazS cu tratamentul
sau cu deciziile \up0 \expndtw0\charscalex113 familiei in alte etape ale bolii.
Weisman si Worden au afirmat cS cele mai eficiente strategii de coping \up0
\expndtw0\charscalex117 due la o acceptare deschisS a diagnosticului de cancer
(fSrS obsesia bolii), \up0 \expndtw0\charscalex133 urmate de strategiile care
constau intr-o acfiune fermS, bazatS pe \up0 \expndtw0\charscalex114 infelegerea
situafiei-problemS \up0 \expndtw0\charscalex119 (cautS mai multe informatii,
solicits sfatul \par\pard\qj \li825\ri728\sb0\sl-250\slmult0\fi9 \up0
\expndtw0\charscalex115 specialistului si consimte). Cei mai pufin eficiente
strategii au fost apreciate \up0 \expndtw0\charscalex116 a fi cele de retragere,
evitare, pasivitate, cedare, apatie (incearcS sS uite, se \up0
\expndtw0\charscalex116 supune si accepts inevitabtlul. se izoleaze social).
Respunsurile la diagnosticul de cancer pot Ii integrate intr o serie de \up0
\expndtw0\charscalex114 categorii dar conturate. Morris (1977) stabilea cinci
grupun de reacfii pentru \up0 \expndtw0\charscalex114 pacientele cu cancer al
sanului: \par\pard\qj \li830\ri723\sb0\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex118 - negare: respinge evidenfa, pare retinue Tn a se angaja
Tntr-o discufie \up0 \expndtw0\charscalex118 detaliate despre cancer;
spiritul luptetor: atitudine pozitive. luptetoare cu tendinfa de a solicita \up0
\expndtw0\charscalex117 cat mat multe informafii despre diagnostic si tratament.
\par\pard\ql \li1137\sb1\sl-210\slmult0\tx5687 \up0 \expndtw0\charscalex128 -
acceptarea stoica: pnme$te diagnosticul \tab \up0 \expndtw0\charscalex129 $i apoi
tratamentul cu \par\pard\ql \li854\sb14\sl-230\slmult0 \up0 \expndtw0\charscalex117
detasare, urmeaze curele prescrise oricare ar Ii acestea ("ce va fi, va ft"):
\par\pard\ql \li1147\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 - acceptare
anxios-depresive: tinde se priveasce totul cu pesimism; \par\pard\qj
\li864\ri733\sb22\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex119 - neajutorare,
fere speranfe: are senzafia ce nimic nu o mai poate ajuta \up0
\expndtw0\charscalex118 Si nu mai poate spera nimic, vede viitorul cu extrem
pesimism', disfuncfii \up0 \expndtw0\charscalex118 serioase in relafiile
sociale. \par\pard\sect\sectd\fs24\paperw8940\paperh13300{\bkmkstart Pg302}
\up0 \expndtw0\charscalex61 <\u8226?\tab \up0 \expndtw0\charscalex107
30i\par\pard\qj \li1108\sb0\sl-240\slmult0 \par\pard\qj\li1108\sb0\sl-
\expndtw0\charscalex129 Este posibil ca furmzarea unor informatii dare, exacte.
oferite cu \up0 \expndtw0\charscalex123 sensibiiitate, erS grabs, sS-l ajute pe
pacient sS pnmeascs vestea \up0 \expndtw0\charscalex115 $i sS \par\pard\qj
\li1094\ri489\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex119 gSseascS ceva
care sS-i dea speranfe Acest lucru trebuie facut cu grija in \up0
\expndtw0\charscalex119 cazul pacientului care reacfloneaza prin negare.
Este rSspanditS ideea cS informarea pacientului privind diagnosticul il \up0
\expndtw0\charscalex115 poate ajuta sa-si asume un rol activ Tn luarea deciziiior,
deci sa menfina un \up0 \expndtw0\charscalex128 anumit control asupra situatiei
stresante, realizand astfel o mai buna \up0 \expndtw0\charscalex116 adaptare
Opiniile privind cresterea autonomiei pacienfilor prin participarea \up0
\expndtw0\charscalex117 la luarea deciziiior a fost imbrafisats de multi,
socotindu-se cS este solufia \up0 \expndtw0\charscalex122 ideae S' dezirabie. in
raport cu acest mod de abordare, lucrurile nu sunt \up0 \expndtw0\charscalex113
atSt de simple. Au aparut o multitudine de probleme psihologice, mai ales in
\up0 \expndtw0\charscalex115 situafia in care nu exists un consens intre medicii
Tnsisî in legSturS cu cea \up0 \expndtw0\charscalex123 mai eiiciente cale de
tratament si pacientul este solicitat sS opteze iex.: \up0 \expndtw0\charscalex114
intre diferite strategii chirurgicale. etc.). \par\pard\qj \li1094\ri474\sb0\sl-
241\slmult0\fi297 \up0 \expndtw0\charscalex124 Uneori, pacientul se lupe cu frica
de diagnostic Supraincercarea cu \up0 \expndtw0\charscalex128 informafii care prin
ele insele fi produc anxietate poate compromite \up0 \expndtw0\charscalex119
capacitatea de a lua o decizie. Este bine de stlut cate informafii doreste si
\up0 \expndtw0\charscalex115 cate poate se pnmeasce. Nu tofi pacienfii doresc
informatii amenuntite, unii \up0 \expndtw0\charscalex113 au nevoie doar de
incurajSh. At fi Tnsa o eroare se se creade ce tofi pacientii \up0
\expndtw0\charscalex124 acorde medicului Tncredere, consimfind necondifionat si
neinformat \up0 \expndtw0\charscalex118 Eroarea generae conse in donnfa de a
sistematiza cu orice pref o atitudine \up0 \expndtw0\charscalex135 privind
comunicarea diagnosticului de cancer, amenunte privind \up0 \expndtw0\charscalex116
tratamentul. Atitudinea nu poate fl conturae decSt pe baza unei conversafii \up0
\expndtw0\charscalex120 bazate pe empatie cu fiecare bolnav. Obiectivul trebuie se
fie acela de al \up0 \expndtw0\charscalex134 ajuta se gaseasca respunsul eficient
pentru a se adapta la situafie \up0 \expndtw0\charscalex117 Adeverata autonomie S'
respectul pentru bolnav ar trebui se fine cont $i de \up0 \expndtw0\charscalex132
dorinfa unora de a decllna responsabilitatea medicului sau. Lesley \up0
\expndtw0\charscalex114 Fallowfield o nume�te "autonomie psihologice1', ceea ce
TnseamnS cS pa� \up0 \expndtw0\charscalex114 cientul informat opteazS de a nu lua
el Tnsusi o decizie ci modicul sSu. \par\pard\qj \li1104\ri478\sb0\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex116 La noi sunl necesare studii pentru
stabilirea tipului de informafii pe care \up0 \expndtw0\charscalex126 pacienfii
nosth le doresc \up0 \expndtw0\charscalex131 $i cat de dornici sunt sS participe la
luare \par\pard\qj \li1094\ri473\sb0\sl-242\slmult0 \up0 \expndtw0\charscalex115
deciziiior Numai pnn cunoasterea adeveratelor dorinfe ale bolnavilor putem \up0
\expndtw0\charscalex116 proiecta un program de suport informational al pacienfilor.
in aceaste etape \up0 \expndtw0\charscalex118 inse. este imperios necesare
ameliorarea educafiei pacienfilor in probleme \up0 \expndtw0\charscalex114 generale
Dhvind tratamentul. efectele secundare, pentru a inlStura confuzia, \up0
\expndtw0\charscalex114 inlormafiile eronate si refinerea pacienfilor de a pune
intrebari. Informatiile. \up0 \expndtw0\charscalex118 consilierea, sunt foarte
necesare, mai ales in timpul chimioterapiei. pentru \up0 \expndtw0\charscalex121 a
ajuta adaptarea la acest tratament dilicil. Tipehrea unor brosuri care se \up0
\expndtw0\charscalex124 confine emurirea unor termeni,
explicarea unor proceduri terapeutice, \up0 \expndtw0\charscalex115 posibilele
efecte secundare. indicafii privind modul de viafe, dieta, exercifii \up0
\expndtw0\charscalex114 fizice, posibilele coniraindicafii, etc. \up0
\expndtw0\charscalex116 - pot diminua mcertitudinea s' stresui \par\pard\ql
\li1099\sb1\sl-211\slmult0 \up0 \expndtw0\charscalex118 determinat de aceasta.
nelinistea, dezonentarea. \par\pard\ql \li1391\sb14\sl-230\slmult0\tx3667 \up0
\expndtw0\charscalex123 Strategiile de reacfie \tab \up0 \expndtw0\charscalex122
(coping) intluenteazS adaptarea psihologica a \par\pard\ql \li1104\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex115 pacientului in fiecare etapa a
tratamentului. \par\pard\qj \li1094\ri489\sb19\sl-220\slmult0\fi302 \up0
\expndtw0\charscalex126 Penman a identificat, imediat dupa mamectomie. un mSnunchi
de \up0 \expndtw0\charscalex120 comportamente, strategii de coping, considerate a
fi cele mai eficiente in
psihosomaticS generae si aplicata\par\pard\qj \li729\sb0\sl-240\slmult0
\up0 \expndtw0\charscalex118 adaptarea la cancerul sanului: "o atitudine
particulars" fafa de problemele \up0 \expndtw0\charscalex118 apSrute odate cu
diagnosticul s> operatia, o strategie de "confruntare", de \up0
\expndtw0\charscalex120 abordare directa a situatiei El a constatat ce persoanele
care au adoptat o \up0 \expndtw0\charscalex119 strategie de evitare sau capitulare
sunt mai thste, suferinta lor emotionale \up0 \expndtw0\charscalex116 este mai
accentuate dupe mamectomie. in plus, cele care simt ce au control \up0
\expndtw0\charscalex114 asupra evenimentelor, asumandu-$i un rol activ in
activitatea de recuperare. \up0 \expndtw0\charscalex123 se adapteaze mai bine decat
cele cu idei pesimiste-care declare ce s'-au \up0 \expndtw0\charscalex116 pierdut
speranfa \par\pard\qj \li729\ri869\sb0\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex119 Consecintele de ordin psihosocial ale bolii si
tratamentului in cancerul \up0 \expndtw0\charscalex119 sanului se apreciaze a
fi: \par\pard\ql \li1017\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex114 -
disconfortui psihic (anxietate. depresie, manie); \par\pard\ql \li1262\sb10\sl-
230\slmult0\tx4598 \up0 \expndtw0\charscalex114 schimberi in modul de viafe
\tab \up0 \expndtw0\charscalex115 (consecinfa disconfortului fizic.
\par\pard\ql \li724\sb1\sl-217\slmult0 \up0 \expndtw0\charscalex113 perturbehlor
mantale sau sexuale, diminuSrii activitSfii); \par\pard\ql \li1027\sb33\sl-
230\slmult0 \up0 \expndtw0\charscalex113 - frica, temerile si preocupSrile privind
mamectomla si recidiva. \par\pard\qj \li720\ri847\sb2\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex120 Aceste aspecte variazS TnsS foarte mult Tn funcfie de
personalitatea \up0 \expndtw0\charscalex123 premorbidS, de stilul de reactie. O
pacients. medic, la cateva zile dupS \up0 \expndtw0\charscalex117 mamectomie, se
duce sS-si vadS proprii bolnavi in spitalul unde lucreazS, \up0
\expndtw0\charscalex118 considerand cS ea nu are timp ss-$i intrerupS activitatea.
in timp ce o alte \up0 \expndtw0\charscalex123 bolnave crede ce este indicat se se
pensioneze medical dupe o astfel de \up0 \expndtw0\charscalex112 operafie.
Felul in care bolnava abordeaze problemele si reuseste se le face fafe au \up0
\expndtw0\charscalex124 efect asupra adapterii post mamectomie Desigur. reacfia
bolnavei este \up0 \expndtw0\charscalex123 influenfate s' de alfi factori vSrste,
stabllitatea emofionale. prezenfa s> \up0 \expndtw0\charscalex114 disponibilitatea
unui suport interpersonal. \par\pard\qj \li720\ri856\sb0\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex113 intr-o cercetare efectuate pe un lot de 174 de bolnave
cu cancer al sanului \up0 \expndtw0\charscalex110 Si 64 cu cancer al colului uterin
tratate Tn I.O.B. (1985-1987) s-a constatat (pe \up0 \expndtw0\charscalex115 baza
rezultatelor la festul de personalitate M.M.P.I.) ce bolnavele care si-au \up0
\expndtw0\charscalex115 reluat activitatea au note mult nrai scezute la indicatorii
de tulburare psihice \up0 \expndtw0\charscalex123 decat cele care s-au pensionat $i
chiar in raport cu cele din lotul martor \up0 \expndtw0\charscalex116 (selectionate
doar dupS critehul sanatafii din punct de vedere oncoloyic). \par\pard\ql
\li1012\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex117 Cercetarea ansamblului de
reacfii si adaptarea la cancer au relevat ca: \par\pard\qj \li724\ri863\sb0\sl-
250\slmult0\fi292 \up0 \expndtw0\charscalex120 \u8226? strategiile care stau 1a
baza unui raspuns activ (fafe de unui pasiv si \up0 \expndtw0\charscalex118 lipsit
de sperante) in comportamentul de rezolvare a problemelor, este eel \up0
\expndtw0\charscalex111 mai eficieni; \par\pard\qj \li720\ri857\sb1\sl-
230\slmult0\fi292 \up0 \expndtw0\charscalex131 e copingul este un proces dinamic,
schimbandu-se in funcfie de \up0 \expndtw0\charscalex118 circumstanfele si de
gandurile pacientului privind supraviefulrea. viltorul, \up0
\expndtw0\charscalex113 relafiile cu semenii. autoprefuirea, realizarea scopurilor:
\u8226? cine dovedeste flexibilitate, cine poate se respunde mai repede la \up0
\expndtw0\charscalex124 solicitSri sj schimberi prin dezvoltarea unor strategii. va
respunde mai \up0 \expndtw0\charscalex111 elicient; \par\pard\qj
\li748\ri853\sb2\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex130 e natura
suportului social mfluenfeaza capacitatea de a face fafe \up0
\expndtw0\charscalex120 solicitSrilor; suportul social este un determinant puternic
al unui respuns \up0 \expndtw0\charscalex108 eficient. \par\pard\ql \li1036\sb9\sl-
230\slmult0 \up0 \expndtw0\charscalex113 Copingul eficient este eel care:
\par\pard\ql \li1051\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex109 - menfine
stresui Tn limite rezonabile; \par\pard\ql \li1051\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex113 - menfine respectul de sine:
\expndtw0\charscalex124 \ul0\nosupersub\cf3\f4\fs18 Psihosomaticd aplicata\tab \up0
\up0 \expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 - menfine sau
restabileste relafiile cu semenii; \par\pard\ql \li1320\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex113 - creste posibilitatea de restabilire a funcfiilor
organismului, \par\pard\qj \li1027\ri570\sb22\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex125 Existe un rise crescut se apare probleme Tn adoptarea unui
coping \up0 \expndtw0\charscalex114 eiicient cu consecinfe in planul adapterii, in
urmetoarele situafii: \par\pard\ql \li1766\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex114 - izoiare sociale \par\pard\ql \li1761\sb30\sl-
230\slmult0 \up0 \expndtw0\charscalex115 - statut socio-economic scezut
\par\pard\ql \li1771\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex109 - alcool,
droguri \par\pard\ql \li1771\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 -
probleme psihiatrice antehoare \par\pard\ql \li1761\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex115 - pierderi recente \par\pard\ql \li1766\sb10\sl-230\slmult0
\up0 \expndtw0\charscalex108 - obligafii multiple \par\pard\ql \li1761\sb30\sl-
230\slmult0 \up0 \expndtw0\charscalex111 - Inflexibilitatea si rigiditatea
copingului \par\pard\ql \li1756\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 -
conceptii pesimiste despre viafe \par\pard\ql \li1315\sb10\sl-230\slmult0\tx3307
\up0 \expndtw0\charscalex112 Obligafiile multiple \tab \up0 \expndtw0\charscalex120
(Tn afara bolii), care solicits pacientul emotional \par\pard\qj
\li1027\ri560\sb0\sl-250\slmult0 \up0 \expndtw0\charscalex115 Si/sau fizic, ii scad
resursele energetice. Forfa redusS rSmasS, constituie un \up0
\expndtw0\charscalex126 obstacol pentru unele acfiuni solicitate de tratament,
starea psihicS se \up0 \expndtw0\charscalex116 inrautSfese, facand dificilS
adaptarea. \par\pard\ql \li1320\sb1\sl-182\slmult0\tx3177 \up0
\expndtw0\charscalex118 Pierderile recente \tab \up0 \expndtw0\charscalex121
(deces.etc.) produc tulburSri in starea sufleteascS, \par\pard\qj
\li1027\ri565\sb31\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex122 perturband
reacfia bolnavului fafa de boae. Mulfi vorbesc despre forfa, \up0
\expndtw0\charscalex114 optimismul cu care au infruntat greutSfi multe o viatS
TntreagS. Devastarea \up0 \expndtw0\charscalex125 sufleteascS dupS pierderea
sufehts au secat resursele necesare pentru \up0 \expndtw0\charscalex108 rezistenfa
Tn fafa bolii. \par\pard\ql \li1027\ri564\sb16\sl-245\slmult0\fi288\tx1305 \up0
\expndtw0\charscalex124 Suportul psihosocial este necesar in aceste cazuri, pentru
delegarea \up0 \expndtw0\charscalex116 responsabilitstilor, acordarea unor resurse.
reducerea stresului \line \tab \up0 \expndtw0\charscalex124 Anumite caracteristici,
seri sufletesti ale bolnavului, sau situafii pot \up0 \expndtw0\charscalex122
determina sporirea tulburdrilor emotionale, ingreunand adoptarea unui \up0
\expndtw0\charscalex111 coping eficient: \par\pard\ql \li1334\sb0\sl-230\slmult0
\par\pard\ql\li1334\sb38\sl-230\slmult0 \up0 \expndtw0\charscalex123 Caracteristici
asociate cu cresterea tulburarilor
emofionale \par\pard\ql \li1761\sb30\sl-230\slmult0 \up0
\expndtw0\charscalex122 \u8226? pesimism \par\pard\ql \li1766\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex119 \u8226? multe regrete \par\pard\ql
\li1766\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex117 \u8226? probleme
maritale \par\pard\qj \li1761\ri4861\sb0\sl-260\slmult0 \up0
\expndtw0\charscalex118 \u8226? probleme psihiatrice \up0 \expndtw0\charscalex119 e
anxietate crescuts \par\pard\ql \li1761\sb1\sl-218\slmult0 \up0
\expndtw0\charscalex118 \u8226? forta eului scSzute \par\pard\qj
\li1766\ri3353\sb24\sl-240\slmult0 \up0 \expndtw0\charscalex115 \u8226? multe
evenimente ale viefii (recente) \up0 \expndtw0\charscalex116 e eficacitate
redusS \par\pard\ql \li1761\ri4612\sb0\sl-260\slmult0\fi4 \up0
\expndtw0\charscalex115 e suportul familiei, redus \up0 \expndtw0\charscalex112 e
cancer Tn familie \line \up0 \expndtw0\charscalex113 e izolat \par\pard\ql
\li1766\sb1\sl-216\slmult0 \up0 \expndtw0\charscalex122 e se supune pasiv
biameazS pe alfii \par\pard\ql \li1766\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex117 \u8226? a|utor redus, din partea medicului \par\pard\qj
\li1031\ri586\sb226\sl-260\slmult0\fi292 \up0 \expndtw0\charscalex118 Depistarea
acestor probleme cat mai devreme si Intervenfia psihotera\up0
\expndtw0\charscalex119 peuticS si socials poate reduce riscul de decompensare
psihica \par\pard\sect\sectd\fs24\paperw8940\paperh13300{\bkmkstart Pg305}{\bkmkend
\ul0\nosupersub\cf18\f19\fs20\ul Elemente de
psihosomaticS\ul0\nosupersub\cf9\f10\fs20 generae $1 aplicata\par\pard\qj
latS o strategie de intervenfie pentru reducerea anxieefii propusS de \up0
\expndtw0\charscalex103 A.SHberfab: \par\pard\ql \li1094\sb169\sl-230\slmult0
\up0 \expndtw0\charscalex117 Reducerea anxietafii la bolnavii de cancer
\par\pard\ql \li1089\sb170\sl-230\slmult0 \up0 \expndtw0\charscalex115 \u8226? Vezi
pacientul la intervale regulate \par\pard\ql \li1084\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex115 \u8226? EvitS linistirea, incurajarea premature; in primul
rand asculte pacientul \par\pard\ql \li1084\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex119 \u8226? Corecteaze concepfiile gresite despre boae si
tratament \par\pard\qj \li791\ri801\sb2\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex120 \u8226? Fii realist si deschis cu pacientul si familia.
dar, intotdeauna. acorde \up0 \expndtw0\charscalex120 sau lase loc pentru
sperante \par\pard\ql \li1094\sb1\sl-215\slmult0 \up0 \expndtw0\charscalex114 e
Evalueaze nevoile familiei si ofere tratament preventiv \par\pard\ql
\li1094\sb13\sl-230\slmult0 \up0 \expndtw0\charscalex119 \u8226? Permite o negare
si o regresie rezonabie \par\pard\ql \li1084\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex114 \u8226? Fii vigilent in alinarea disconfortului fizic
Uneori anxietatea apare sau se accentueaze din cauza anticipant unui \up0
\expndtw0\charscalex112 rSu. unui pericol, fSrS o bazS reals. \par\pard\qj
\li787\ri795\sb6\sl-233\slmult0\fi297 \up0 \expndtw0\charscalex115 Fie din lipsS de
informafie, fie cS are date insuficiente sau gresite (sursS \up0
\expndtw0\charscalex121 de ambiguitate si incertitudine), fie cS este chinult de
propriile-i temeri, \up0 \expndtw0\charscalex114 bolnavul poate intra in starea de
deruts, agitafie, premergStoare momentulul \up0 \expndtw0\charscalex114
catastrotic, a$teptat \par\pard\qj \li787\ri790\sb38\sl-220\slmult0\fi287 \up0
\expndtw0\charscalex122 in asemenea situafii se intervme prin mijloace psihologice,
adecvate \up0 \expndtw0\charscalex113 momentelor de chzS. \par\pard\qj
\li791\ri790\sb4\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex128 Este necesarS
identificarea problemelor sufletesti ale bolnavului. \up0 \expndtw0\charscalex134
zbaterilor apSrute din multiple cauze si intervenfia prin mijloace \up0
\expndtw0\charscalex116 psihoterapeutice si de suport social adevSrat
\par\pard\ql \li1070\sb9\sl-230\slmult0\tx6835 \up0 \expndtw0\charscalex119 Aceste
intervenfii, oferind cadrul exprimSrii emofionale \tab \up0 \expndtw0\charscalex112
$i reducer ii \par\pard\ql \li782\ri794\sb8\sl-233\slmult0\fi4\tx1080 \up0
\expndtw0\charscalex122 stresului produs de multe greutSfi cSrora bolnavul nu le
poate face fafe \up0 \expndtw0\charscalex114 singur, Tl pot ajuta se reacfioneze
mai bine la solicitarile tratamentului. \line \tab \up0 \expndtw0\charscalex116
Bolnavul care nu reuseste se acfioneze eficient intr-un moment sau altul \up0
\expndtw0\charscalex119 pe parcursul bolii (nici Tn direcfia diminuarn sursei de
stres nici Tn cea a \up0 \expndtw0\charscalex130 regerii tulburarii psihice) are
mari dificultafi in adaptarea la boae si \up0 \expndtw0\charscalex128 tratament. in
asemenea situafie se accentueaze serile de anxietate si \up0
\expndtw0\charscalex116 depresie care pot determina: \par\pard\ql \li1084\sb10\sl-
230\slmult0 \up0 \expndtw0\charscalex115 - accentuarea durerii
\expndtw0\charscalex115 - dezvoltarea simptomelor anticipatoril\tab \up0
\expndtw0\charscalex115 (psihice) din chimioterapie\tab \up0
\expndtw0\charscalex115 (s-a\par\pard\li787\sb15\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex116 constatat o corelafie pozitive intre nivelul de anxietate
si dezvoltarea acostor\par\pard\li787\sb5\sl-230\slmult0\fi4 \up0
\expndtw0\charscalex115 simptome)\par\pard\ql \li1084\sb1\sl-215\slmult0 \up0
\expndtw0\charscalex116 - accentuarea efectelor secundare fizice - greata si
voma \par\pard\qj \li796\ri796\sb5\sl-240\slmult0\fi278 \up0
\expndtw0\charscalex121 - accentuarea binecunoscutelor sechele sexuale ale
tratamentului din \up0 \expndtw0\charscalex110 cancer. \par\pard\qj
\li806\ri796\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex121 Bolnavul de
cancer trebuie ajutat se nu cade in deznedejde (conform \up0
\expndtw0\charscalex115 modelului C, senzafia lipsei de speranfe/ajutor. sunt
treseturi dominante) si \up0 \expndtw0\charscalex115 incurajat sa-si exprime
treirile. mai ales pe cele negative. \par\pard\qj \li820\ri790\sb0\sl-
233\slmult0\fi278 \up0 \expndtw0\charscalex123 Acest lucru este posibil numai prin
crearea unei retele adeverate de \up0 \expndtw0\charscalex122 suport psihosocial.
Dezideratul ca la sfarsitul tratamentului se fie intr-o \up0
\expndtw0\charscalex127 stare de integritate funcfionale si psihice, trebuie se ne
fie ceeuza Tn \up0 \expndtw0\charscalex114 acfiunlle pe care le vom intreprinde
pentru aceasta \par\pard\sect\sectd\fs24\paperw8940\paperh13300{\bkmkstart Pg306}
\up0 \expndtw0\charscalex115 +305\par\pard\qj \li955\sb0\sl-233\slmult0
233\slmult0\fi302 \up0 \expndtw0\charscalex133 Recuperarea psiho-lunctionae a
bolnavilor de cancer in vederea \up0 \expndtw0\charscalex124 reintegrSrii lor
profesionale, sociale este un lucru foarte important, prin \up0
\expndtw0\charscalex126 consecintele benefice pe care le poate avea asupra
pacientului. aceastS \up0 \expndtw0\charscalex114 reintegrare. \par\pard\qj
\li1248\ri947\sb169\sl-280\slmult0\fi4 \up0 \expndtw-6\charscalex100
\ul0\nosupersub\cf8\f9\fs22 IMPACTUL FACTORILOR PSIHOLOGICI ASUPRA CURSULUI
BOLII, \up0 \expndtw-9\charscalex100 TRATAMENTULUI, SUPRAVIETUIRII \par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 Ideea ca psihicul. atitudinea mentae pot afecta cursul
bolii, ce dorinfa \up0 \expndtw0\charscalex118 persoanei insasi de a trei sau mun,
Tn fafa unei asemenea lovituri. influen\up0 \expndtw0\charscalex114 teaze evolufia,
este TntalnitS tot mai des Tn randul populafiei sj ca temS lite\up0
\expndtw0\charscalex108 rarS. \par\pard\qj \li960\ri631\sb9\sl-230\slmult0\fi292
\up0 \expndtw0\charscalex125 Posibie contribute a factorilor psihologici in
Influenfarea duratei de \up0 \expndtw0\charscalex119 supraviefuire in cancer este o
temS de cercetare de mare interes Tn ultimii \up0 \expndtw0\charscalex110 ani, \up0
\expndtw0\charscalex113 (des* aceastS contribufie este micS. probabil dacS ea
exists - Fox, \up0 \expndtw-3\charscalex100 1978). \par\pard\qj
\li955\ri626\sb2\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex125 Rolul factorilor
psihologi in influenfarea cresterii tumorae a fost de \up0 \expndtw0\charscalex119
asemenea reexaminat. pe baza legSturilor dintre creer si sistemele imun si \up0
\expndtw0\charscalex112 endocrin, Tn cercetSri din domeniul
psihoneuroimunologiel \par\pard\qj \li960\ri626\sb0\sl-233\slmult0\fi292 \up0
\expndtw0\charscalex124 Date privind legStura dintre stres si boalS au rezultat
dintr-o serie de \up0 \expndtw0\charscalex117 studii pe animate si oameni. Oricum,
stresui produce perturbarea sistemelor \up0 \expndtw0\charscalex116 endocrin si
imun Acest lucru poate fi mai important Tntr-o localizare tumo� \up0
\expndtw0\charscalex116 rae cum este slnul. \par\pard\qj \li960\ri631\sb0\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex124 Aceste studii, ca si declarable unor
pacienfi care explicS importanta \up0 \expndtw0\charscalex127 propriei lor "dorinte
de a trSI" in supraviefuirea Tn cancer au slimulat \up0 \expndtw0\charscalex119
interesul pentru
posibilele cSi de crestere a eficacitafii sistemului imunitar \up0
\expndtw0\charscalex119 Si implicit a capacitSfii organismului de a controla
cresterea tumorae \par\pard\qj \li955\ri626\sb0\sl-236\slmult0\fi297 \up0
\expndtw0\charscalex118 De aceea, factorii psihici care pot contribui pe o ruts
directs influenfand \up0 \expndtw0\charscalex122 mediul intern fiziologic la
supraviefuirea in cancer, au captat o mai mare \up0 \expndtw0\charscalex118
relevanfS clinicS decat factorii psihologici care pot afecta riscul de aparifie
\up0 \expndtw0\charscalex125 al cancerului. Pare in general mai logic se se
presupune ce un lactor de \up0 \expndtw0\charscalex121 ordin psihic ar putea
acfiona ca un promotor al diviziunii celulei maligne \up0 \expndtw0\charscalex118
dintr-o celue tumorae care deja a fost afectate de un initiator al unui proces \up0
\expndtw0\charscalex118 de malignizare celulara. \par\pard\qj \li955\ri632\sb0\sl-
237\slmult0\fi292 \up0 \expndtw0\charscalex116 Privind in acest fel lucrurile,
impactul factorilor psihici asupra progresiei \up0 \expndtw0\charscalex116 tumorae
devine un subiect mai rezonabil de studiu. Oricum, timpul scurs de \up0
\expndtw0\charscalex120 la inifierea procesului neoplazic si cresterea tumorae la
un nivel la care se \up0 \expndtw0\charscalex119 poate fi observate clinic, este
cunoscut a ft lung, prin urmare descurajeaze \up0 \expndtw0\charscalex117
explicatia simplistS a unui eveniment stresant urmat de aparifia cancerului.
\up0 \expndtw0\charscalex132 Totusi, rae progresiei tumorae este afectae de
numeroase Influenfe \up0 \expndtw0\charscalex122 hormonale care ar putea fi
perturbate prin slSri emofionale puternice, pe \up0 \expndtw0\charscalex119 axele
psihoneuroendocnne. Invers, este la lei de posibil, intrucat hormonii \up0
\expndtw0\charscalex119 ectopici produsi de tumora afecteazS starea psihica
Lippman (1985), a propus un model al complicatelor legSturi dintre creer \up0
\expndtw0\charscalex130 Si sistemele imun s' endocrin prin care emofiile pot afecta
cresterea \up0 \expndtw0\charscalex121 tumorae. \par\pard\ql \li1257\sb1\sl-
187\slmult0 \up0 \expndtw0\charscalex118 Exists numeroase studii care au stabilit
unn factori de personalitate care \par\pard\ql \li960\sb18\sl-230\slmult0 \up0
\expndtw0\charscalex116 ar putea influenfa durata de supraviefuire in cancer.
\expndtw0\charscalex108 \ul0\nosupersub\cf18\f19\fs20\ul 306 \u9830?\ul0\tab
\up0 \expndtw0\charscalex108 \ul0\nosupersub\cf18\f19\fs20\ul Elemente de
240\slmult0\fi288 \up0 \expndtw0\charscalex113 \ul0\nosupersub\cf9\f10\fs20 Weisman
(1975). a studiat timpul de supravietuire la bolnavi cu localizSri \up0
\expndtw0\charscalex124 dilerite. aplicSnd TnsS un coeficient de supraviefuire care
a comparat \up0 \expndtw0\charscalex117 supraviefuirea observate fafe de cea
asteptate Tn cazul fiecSrei localizSri. \up0 \expndtw0\charscalex117 Supraviefuirea
mai mare au avut-o cei cu relafii interumane bune. cei care \up0
\expndtw0\charscalex121 solicits S' phmesc suport medical si psihologie, cei care
recunosc natura \up0 \expndtw0\charscalex122 bolii lor serioase dar nu sunt
depresivi sau furiosi. Cei care au trSit mai \up0 \expndtw0\charscalex129 putin,
aveau relafii sociale proaste de multS vreme, multe tulburSri \up0
\expndtw0\charscalex114 psihiatrice, depresie. pesimism. unii dorind sS moarS.
grup de cercetStori britanici au sugerat Tn urma unor studii cS \up0
\expndtw0\charscalex113 supraviefuirea fSrS recidive este mai mare la femeile cu
"spirit luptStor" sau \up0 \expndtw0\charscalex123 cu rSspuns psihologie de aparare
prin negare fafa de cele cu acceptare \up0 \expndtw0\charscalex122 stoics sau cele
care se slmt lipsite de ajutor $i sperantS (Greer S., \up0 \expndtw-6\charscalex100
1975-\par\pard\ql \li1151\sb10\sl-230\slmult0\tx2990 \up0 \expndtw0\charscalex110
1985, Pettingalaet, \tab \up0 \expndtw-3\charscalex100 1985). \par\pard\qj
\li1132\ri449\sb2\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex112 Corelafii
pozitive au fost gSsite intre supravietuire si exprimarea emofiilor \up0
\expndtw0\charscalex113 negative, intr-un grup de femei, studiate din momentul
incepehi chimiotera� \up0 \expndtw0\charscalex118 piei pentru cancer al sanului Tn
stadiu avansat. Cele cu supraviefuire mai \up0 \expndtw0\charscalex114 TndelungatS
(mai mult de 1 an) aveau dar isi si exprimau mai mult emofiile \up0
\expndtw0\charscalex119 negative, in special nenia, ostilitatea, decat cele care nu
se plangeau, erau \up0 \expndtw0\charscalex119 cooperante (mai pufin de 1an):
Temoshok (1984), a inifiat o serie de studii urmerind vahablle psiho� \up0
\expndtw0\charscalex141 sociale si prognostics la pacienfi cu melanom malign
cutanat. \up0 \expndtw0\charscalex123 Caracteristicile de prognostic cunoscute
pentru aceaste localizare sunt: \up0 \expndtw0\charscalex117 merimea leziunii si
profunzlmea invaziei la momentul exciziei. Rezultatul \up0 \expndtw0\charscalex121
prin urmare. depinde de diagnosticul precoce. Cursul melanomulul este \up0
\expndtw0\charscalex118 extrem de variabil Dar este cunoscut a fi sensibil la
influenfele hormonale \up0 \expndtw0\charscalex113 Si imunologice care pot fi
afectate, la rSndul lor, de starea emofionale. Deci, \up0 \expndtw0\charscalex126
melanomul se preteaza bine prin el insusi. la explorarea unor posibie \up0
\expndtw0\charscalex112 influenfe psiho-sociale. \par\pard\qj \li1128\ri453\sb5\sl-
235\slmult0\fi283 \up0 \expndtw0\charscalex119 Temoshok a identificat doue
variabile legate de prognostic, si anume: \up0 \expndtw0\charscalex121
comportamentul de amanare, intarziere a consultatiei s' ipoteticul model \up0
\expndtw0\charscalex115 comportamental tip C. Personalitatea de tip C indice
persoana rebdetoare si \up0 \expndtw0\charscalex117 pecute cu alfii, rareon
exphmandu-si furia, mSnia. insusirea cheie a tipului \up0 \expndtw0\charscalex126 C
de personalitate descris. \up0 \expndtw0\charscalex119 - neexprimarea emofiilor
disfonce \up0 \expndtw-2\charscalex100 -\up0 \expndtw0\charscalex127 a fost
apreciate, dupe \tab \up0 \expndtw0\charscalex123 18 luni de urmehre, ce poate
prezice cine a muht sau a \par\pard\qj \li1132\ri445\sb2\sl-240\slmult0 \up0
\expndtw0\charscalex117 ecut recidive. Mare parte din bolnavii examinati erau
depresivi, sj cu toate \up0 \expndtw0\charscalex118 acestea, nici unui nu a
declarat o stare afective disforicS (care in cele mai \up0 \expndtw0\charscalex128
multe cazuri rezulta din stesurile viefii si era cronice). isi blocheazS \up0
\expndtw0\charscalex122 exprimarea emofiilor si simfSmantului de pierdere a
speranfei care este \up0 \expndtw0\charscalex121 cronic dar mascat. in aceastS
serie de studii a fost urmShtS si reacfia de \up0 \expndtw0\charscalex114 represie.
Pacienfii cu melanom s'-au reprimat rSspunsul la stimulli cutanafi. \up0
\expndtw0\charscalex115 Gradul reprimSrii acestor raspunsuri i-a dilerenfiat pe
acesti pacienfi de cei \up0 \expndtw0\charscalex120 cu boli cardiovasculare \up0
\expndtw0\charscalex114 (Cassileth Br., \up0 \expndtw0\charscalex125 1985) Gradul
de reprimare s-a \par\pard\qj \li1166\ri453\sb17\sl-220\slmult0 \up0
\expndtw0\charscalex116 dovedit a contribui la variafia semnlficativS a progresiei
cancerului mamar \up0 \expndtw0\charscalex110 (Jensen M.R., \up0 \expndtw-
3\charscalex100 1987). \par\pard\li1175\sb22\sl-230\slmult0\fi287\tx2044 \up0
\expndtw0\charscalex100 Levy\tab \up0 \expndtw0\charscalex124 (1965) a oterit un
model util de examinare concomitants a\par\pard\li1175\sb5\sl-
230\slmult0\fi0\tx4948 \up0 \expndtw0\charscalex118 variabilelor psihologice si
biologice\tab \up0 \expndtw0\charscalex124 (in special statusul imun).
Acele\par\pard\sect\sectd\fs24\paperw8940\paperh13520{\bkmkstart Pg308}{\bkmkend
\par\pard\qj\li744\ri823\sb111\sl-240\slmult0 \up0 \expndtw0\charscalex121 paciente
la care s-a gSsit in timpul mastectomiei un numSr mai mare de \up0
\expndtw0\charscalex118 noduli axilari pozitivi, au dovedit \up0
\expndtw0\charscalex121 $i o "mai bunS" adaptare psihologicS \par\pard\qj
\li744\ri828\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex115 (mSsuratS prin redusa
exprimare a suferlnfei psihice) si un nivel mai scezut \up0 \expndtw0\charscalex113
al activitatii ceiuiei natural killer (NK), in comparand cu pacientele cu noduli
\up0 \expndtw0\charscalex113 pufim sau fere noduli invadafi Variafia activitSfii
celulei NK a fost explicats \up0 \expndtw0\charscalex129 in coreiafie cu trei
indicator! de suferinfa psihica profundS: ajustare \up0 \expndtw0\charscalex115
(aplanare), lipsa suportulul social, simptome de oboseala s1 depresie. \par\pard\qj
\li739\ri823\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex123 Aceste studii au
un interes special intrucat alfi autori au constatat ce \up0
\expndtw0\charscalex116 activitatea celulei NK este perturbate in sens negativ la
persoane sSnStoase \up0 \expndtw0\charscalex119 fizic dar
aflate in stresui examenelor si cu o stare de tristefe provocatS de \up0
\expndtw0\charscalex113 singurState (studenfi medicimsti); \par\pard\qj
\li758\ri824\sb0\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex124 De asemenea,
prezintS interes pentru cS activitatea celulei NK este \up0 \expndtw0\charscalex112
importantS in rSspunsul tumohlor de origine viralS. \par\pard\qj
\li748\ri815\sb0\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex125 De curand, a
crescut interesul pentru cercetarea efectului posibil al \up0
\expndtw0\charscalex123 dispozifiei sufletesti pozitive asupra sistemelor
reglatorii cum sunt cele \up0 \expndtw0\charscalex119 imun si''sau endocrin.
Asemenea Tnsusiri pozitive: speranfa, optimismul. \up0 \expndtw0\charscalex127
bucuha, vigoarea, rezlstenfa, tSria au fost asociate Tn mod curent cu \up0
\expndtw0\charscalex121 rSspunsul la boae. S-a demonstrat cS in boala
cardlovascularS gradul de \up0 \expndtw0\charscalex121 optimism prezice
complicafiile Intraoperatorii si timpul de recuperare la \up0
\expndtw0\charscalex125 pacienfii cu operafie bypass. Cei optimisti au semnificativ
mai pufine \up0 \expndtw0\charscalex115 complicafii si o perioada de refacere mai
scurtS. \par\pard\qj \li753\ri809\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex131 Intr-o populafie cu cancer mamar avansat, un studiu a
arStat cS \up0 \expndtw0\charscalex117 "bucuria", capacitatea de a se bucura.
Independent, este factor de predicfie \up0 \expndtw0\charscalex120 pentru timpul de
supraviefuire. Pacienfii cu un scor mai ridicat al aeestei \up0
\expndtw0\charscalex113 caiitSfi. au tins sS trSiascS semnificativ mai mult.
Probabil cS un mecanism prin care fenomenul suportului psiho-social \up0
\expndtw0\charscalex118 afecteazS rSspunsul la boae conste tocmai in imbunetSflrea
unei astfel de \up0 \expndtw0\charscalex115 dispozifn pozitive sau Tntr-o serie de
modele de rSspuns, Tncadrate in ceea \up0 \expndtw0\charscalex115 ce se numeste -
stare de bine . \par\pard\qj \li753\ri795\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex116 Cercetetorn din fSnie in care sistemul de mtervenfie psiho-
sociae pentru \up0 \expndtw0\charscalex127 bolnavii de cancer este bine pus la
punct, continuS sS fie fascinafi de \up0 \expndtw0\charscalex122 efectele posibie
ale acestor intervenfii asupra cursului bolii. Numeroase \up0
\expndtw0\charscalex122 studii au scos Tn evidenfe cS Intervenfia psiho-socialS
creste nu numai \up0 \expndtw0\charscalex112 confortul pacientului, ci Tnsa$i
calitatea viefii lui si cS il pot ajuta sS trSiasca \up0 \expndtw0\charscalex113
mai mult. "Rezultatele acestor studii indicS dar faptul cS intervenfiile psiho�
\up0 \expndtw0\charscalex118 sociale au efecte pozitive asupra adaperii emofionale,
adaperii funcfionale \up0 \expndtw0\charscalex112 Si asupra simptomelor legate de
boalS si tratament Tn cazul aduifiior bolnavi \up0 \expndtw0\charscalex112 de
cancer" \par\pard\sect\sectd\fs24\paperw8940\paperh13220{\bkmkstart Pg309}{\bkmkend
\ul0\nosupersub\cf18\f19\fs20\ul Elemente de\ul0\nosupersub\cf9\f10\fs20
psihosomatica yenerae si aplicata\par\pard\qj \li1008\sb0\sl-280\slmult0
280\slmult0\fi4 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf8\f9\fs22
INTERVENTII PSIHO-SOCIALE PENTRU BOLNAVII DE CANCER. \up0 \expndtw-6\charscalex100
PRINCIPII DE ABORDARE \par\pard\qj \li724\ri823\sb160\sl-232\slmult0\fi292 \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 Numai "tratamentul
cancerului". singur nu mai poate fi acceptat ca unic \up0 \expndtw0\charscalex116
obiectiv a! unei institufii de cercetare a cancerului. Prelungirea timpului de \up0
\expndtw0\charscalex120 supraviefuire de calitate este un obiectiv pentru jumdtate
din pacientii cu \up0 \expndtw0\charscalex118 cancer care nu au sanse sd fie
vindecafi astazi Pentru a realiza acest lucru, \up0 \expndtw0\charscalex114 va fi
nevoie sa se acorde o mai mare atenfie aspectului "uman" si psihologie \up0
\expndtw0\charscalex114 ai cancerului. atat in cercetare cat si in ingrijire
(Jlmmie C. Holland, MD.) \par\pard\qj \li720\ri837\sb197\sl-246\slmult0\fi292
\up0 \expndtw0\charscalex118 La noi, intervenfiile psihosociale privind cancerul au
nevote de suport \up0 \expndtw0\charscalex127 Ele trebuie sS lie parte integrants a
acfiunilor de prevenfie. control si \up0 \expndtw0\charscalex119 recuperare in
cancer. O retorma a inghjihi pentru sSnState pentru a atinge \up0
\expndtw0\charscalex119 anumite standarde trebuie se dezvolte toate aspectele
ei. \par\pard\qj \li724\ri843\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex126
Intervenfiile psihosociale pentru bolnavii de cancer au ca obiectiv \up0
\expndtw0\charscalex119 principal Tmbuneefirea stSrii psihice si funcfionale,
\up0 \expndtw0\charscalex118 (reducand suferinfa \par\pard\ql \li724\sb8\sl-
230\slmult0 \up0 \expndtw0\charscalex117 emofionale si facilitand adaptarea la boae
si tratament). \par\pard\qj \li724\ri847\sb2\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex117 Unele intervenfii se adreseazS s' membrilor familiei
bolnavilor. intrucat \up0 \expndtw0\charscalex129 reusie lor in a face fafa
situatiei este esentiae pentru starea de bine a \up0 \expndtw0\charscalex112
\expndtw0\charscalex113 Calitatea viefii pacientului s> adaptarea lui in fiecare
moment al bolii este \up0 \expndtw0\charscalex115 in funcfie de ba;ansul delicat
intre aspectele medicale. diminuarea efectelor \up0 \expndtw0\charscalex119 unei
stSri psihice proaste s1 suportul social In cazul in care starea psihica \up0
\expndtw0\charscalex118 este echilibratS. boala este incipientS si bolnavul
beneficiaze de un suport \up0 \expndtw0\charscalex116 psiho-social eficient, atunci
pacientul are mai putine difi^tilteti psihologice \up0 \expndtw0\charscalex134
importante. Dace starea psihice este proaste s' resursele, atat cele \up0
\expndtw0\charscalex122 personae, cSt s' cele sociale au unele dilicuitSfi.
pacientul are nevoie de \up0 \expndtw0\charscalex126 ajutor. suport psihosocial,
chiar dacS severitatea bolii nu este mare si \up0 \expndtw0\charscalex128
incapacitatea este minims, in prezenfa unei boli severe, uneori s1 \up0 \expndtw-
2\charscalex100 � \par\pard\qj \li729\ri838\sb12\sl-220\slmult0 \up0
\expndtw0\charscalex121 persoana cu resurse psihice - forfa. echilibru emotional,
stil eficient de a \up0 \expndtw0\charscalex116 lace fafa dificultsfilor \up0
\expndtw0\charscalex125 - poate simfl la un moment dat cS ii este greu sa
\par\pard\ql \li734\sb12\sl-230\slmult0 \up0 \expndtw0\charscalex116 reziste si din
acel moment are nevoie de ajutor. \par\pard\qj \li739\ri843\sb19\sl-
244\slmult0\fi278 \up0 \expndtw0\charscalex120 Cand resursele personae �i.'sau
sociale prezintS deficienfe, probabili\up0 \expndtw0\charscalex117 tatea unor
tulburSri psihice semnificative este foarte mare. Este necesar ca \up0
\expndtw0\charscalex121 aceste probleme sS fie identificate cat mai devreme, sS se
acorde suport \up0 \expndtw0\charscalex118 psiho social astfel incat sS poatS fi
redus riscul de decompensare psihicS \up0 \expndtw0\charscalex121 Vorbind de
suportul psiho-social al bolnavilor de cancer avem in vedere \up0
\expndtw0\charscalex106 intervenfiile: \par\pard\li1036\sb11\sl-
230\slmult0\fi4\tx1939 \up0 \expndtw0\charscalex105 - familiei\tab \up0
\expndtw0\charscalex113 (sot. sofie. partener, alte rude):\par\pard\li1036\sb10\sl-
230\slmult0\fi0\tx2107 \up0 \expndtw0\charscalex111 - societefti\tab \up0
\expndtw0\charscalex113 (pneteni, vecini, colegl);\par\pard\li1036\sb10\sl-
230\slmult0\fi9\tx2913 \up0 \expndtw0\charscalex113 - comunitefii\tab \up0
\expndtw0\charscalex113 - asociafii. fundafil, servicii de
ingrijire,\par\pard\ql \li2918\sb7\sl-230\slmult0 \up0 \expndtw0\charscalex114 -
grupuri de auto-a|utorare: \par\pard\ql \li2918\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex114 - biserica; \par\pard\ql \li1060\sb10\sl-230\slmult0
\up0 \expndtw0\charscalex112 - personalului din domeniul sanatafii, specialistllor.
Ariile cele mai importante pe care le pot aborda sunt: informational, \up0
\expndtw0\charscalex111 emofional-afectiv, praclic (financiar, instrumental).
in orice situafie, supravegherea, atenfia acordae stSrii ps'hice a \up0
\expndtw0\charscalex121 pacientului. dm partea intregului personal care se ocupa de
inghjirea lui \up0 \expndtw0\charscalex119 este esenfiae pentru adaptarea la
solicitSri. pentru cresterea calitafii viefii \up0 \expndtw0\charscalex114
pacientului in toate etapele bolii. \par\pard\qj \li244\ri1323\sb0\sl-
244\slmult0\fi302 \up0 \expndtw0\charscalex116 Un sistem de ingrijire optim,
cornplet, are in vedere faptul ca tulburarea \up0 \expndtw0\charscalex119
emotionalS face parte din boae. in cazul fiecSrui pacient. Suportul psmo-\line \up0
\expndtw0\charscalex115 social la nivelul de bazS trebuie se fie asigurat de toft
membrii personaluiui \up0 \expndtw0\charscalex112 de ingrijire, mat ales prin
ofenrea unor informafii si direcfionare a
bolnavilor, \up0 \expndtw0\charscalex117 in general. Acesl nivel de intervenfie se
adreseaza perturnenlor emotionale \up0 \expndtw0\charscalex113 fuesti. \par\pard\qj
\li254\ri1328\sb0\sl-260\slmult0\fi278 \up0 \expndtw0\charscalex118 Al doilea nivel
al ingnjirii sub aspect psihosocial este eel de rutina care \up0
\expndtw0\charscalex121 trebuie sa fie asigurat de asistenfii sociali \up0
\expndtw0\charscalex120 (caie se ocupa de problemele \par\pard\qj
\li259\ri1328\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex115 practice ale
bolnavilor legate de bola lor), preofi (suport spiritual), consilie-\line \up0
\expndtw0\charscalex112 ri. pacienfi ..veterani" \up0 \expndtw0\charscalex116 (care
pot vorbi despre propria lor expehenfe in lupta \par\pard\ql \li254\sb1\sl-
210\slmult0 \up0 \expndtw0\charscalex116 cu boae), grupurile de autoajutor.
Urmetorul nivel este eel Tn care sunt abordate problemele speciaie. unele \up0
\expndtw0\charscalex124 tulburari psihice care necesite un diagnostic diferenfiat,
probleme care \up0 \expndtw0\charscalex118 soiidte psihoterapie, intervenfu
comportamentale pentru controlul durerii, \up0 \expndtw0\charscalex115 anxietefii,
dar si suport psihosocial. \par\pard\ql \li552\sb0\sl-230\slmult0
\par\pard\ql\li552\sb19\sl-230\slmult0 \up0 \expndtw0\charscalex135 Interventii
psihoterapeutice \par\pard\qj \li259\ri1303\sb177\sl-246\slmult0\fi292 \up0
\expndtw0\charscalex119 Pentru bolnavii de cancer, psihoterapia este in esenfe
suportiva s> este \up0 \expndtw0\charscalex122 practicate in situafii de stres
major. Jinta este boae s1 consecinfele ei in \up0 \expndtw0\charscalex120 acest caz
nu se incearca demontarea defenselor psihologice; intenfia este \up0
\expndtw0\charscalex118 de a ajuta pacientul de a gasi "mecanismele de coping" cele
mai eficiente, \up0 \expndtw0\charscalex120 in cazul lui Are lorma unei Intervenfli
in criza, mai dograba decat a unei \up0 \expndtw0\charscalex118 psihotorapii
intensive incearce se se centreze pe problemele specifice mai \up0
\expndtw0\charscalex120 degraba decSt sa incerce o analizS mai generala, o exammare
pe termen \up0 \expndtw0\charscalex123 lung, a psihicului bolnavului. Terapia
individuae dupS diagnosticul de \up0 \expndtw0\charscalex132 cancer se centreaza in
special pe urmStcarele probleme: depresie, \up0 \expndtw0\charscalex115 anxietate,
unele disfuncfii (incapacitate de concontrare). probleme speril.cn \par\pard\ql
\li273\ri1294\sb0\sl-245\slmult0\tx561 \up0 \expndtw0\charscalex116 - consecinfe
ale bolii S' stSpanirea lor, unele schimbari apSrute Tn familie. \up0
\expndtw0\charscalex117 probleme care au existat anterior si au fost accentuate de
cancer \line \tab \up0 \expndtw0\charscalex117 Problemele specifice - consecinfele
aparifiei bolii, cei mai des abordate \up0 \expndtw0\charscalex120 sunt: frica de
recidivS. de durere de moarte; frica de operafiile adifionale \up0
\expndtw0\charscalex114 care pot crea alte probleme; dificultafi practice
Prin diferite procedee. psihoterapia elimina o serie de reacfii emotionale \up0
\expndtw0\charscalex120 cu caracter dezaptativ $i comportamente neadecvate Bolnavul
este ajutat \up0 \expndtw0\charscalex115 sS elaboreze modele de comportament mai
eficiente \par\pard\ql \li556\sb209\sl-230\slmult0 \up0 \expndtw0\charscalex103
Coeslaiaree \par\pard\qj \li273\ri1299\sb154\sl-250\slmult0\fi283 \up0
\expndtw0\charscalex125 Consilierea. o intervenfie mai restransS decat
psihoterapia, este de \up0 \expndtw0\charscalex117 obicei do nature suportiva,
mformativa, cathartics, cataiiticS. confruntafio \up0 \expndtw0\charscalex117 nae
Este utila in fiecare moment important, in penoadele intens stresante.
240\slmult0\fi4 \up0 \expndtw0\charscalex123 pe parcursul tratamentului. Obiectivul
este adaptarea si Tmbunetefirea \up0 \expndtw0\charscalex126 capacitefii
funcfionale. Se ofera posibilitatea ameliorern tehnicilor de \up0
\expndtw0\charscalex110 rezolvare a problemelor. \par\pard\qj \li1166\ri401\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex132 Psihoterapia de acest gen se poate
desesura si in grup, conteaze \up0 \expndtw0\charscalex114 prelerinfa pacientului.
Unii se simt mai bine Tn grup intrucet ?si diminueaze \up0 \expndtw0\charscalex114
simtemantul de izolare. \par\pard\ql \li1454\sb189\sl-230\slmult0 \up0
\expndtw0\charscalex110 InUrvontii <ognitiv-comportamonaU \par\pard\qj
\li1161\ri423\sb182\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex117 Sunt centrate
pe terapia durerii cronice (de intensitate medie), controlul \up0
\expndtw0\charscalex127 apetitului. electele secundare asociate chimioterapiei si
radioterapiei, \up0 \expndtw0\charscalex116 simptomelor de anxietate si depresie
Tehnicile comportamentale includ. relaxarea musculare progresiva, \up0
\expndtw0\charscalex121 hipnoza. imagieria mentae, tehnicile cognitive feedback,
desensibilizare \up0 \expndtw0\charscalex121 sistematicS \par\pard\qj
\li1166\ri401\sb0\sl-244\slmult0\fi297 \up0 \expndtw0\charscalex116 Scopul acestor
terapii este de a usura problemele cu care se confrunte in \up0
\expndtw0\charscalex119 prezent pacientul, este eticiente cand simptomul este bine
precizat Aceste \up0 \expndtw0\charscalex122 metode de control al simptomelor este
eficient in ineturarea tulburarilor \up0 \expndtw0\charscalex115 legate de
tratament in timpul terapiei, a procedurilor. Pot ii utile Tn electele \up0
\expndtw0\charscalex116 secundare anticipatorn prin chimioterapie, Tn special
greafa si voma Acest \up0 \expndtw0\charscalex116 gen de terapie se poate desesura
si in grup. \par\pard\qj \li1161\ri397\sb53\sl-245\slmult0\fi292 \up0
\expndtw0\charscalex116 Grupuri suportiva cognitiv-conportamontalo, ajuta pacienfii
se face fafe \up0 \expndtw0\charscalex130 tricn. prin izoiarea gandurilor negative
si apoi sugerarea diferitelor \up0 \expndtw0\charscalex122 comportamente care pot
aiuta pe cineva se depeseasca frica. Sunt foarte \up0 \expndtw0\charscalex117
eficiente pentru pregeiirea pacientilor in vederea Tnceperii chimioterapiei.
\up0 \expndtw0\charscalex117 Se practice relaxarea musculare, imagehe ghidatS.
Grupuri suporfivo \u8226?dvtationol*, oferS pacienfilor informafii care sS-i
ajute \up0 \expndtw0\charscalex125 sS obfina simfSmSntuI capaciefii de control in
legSturS cu boala lor. \up0 \expndtw0\charscalex123 Informafii privind boala.
impactul tratamentului, dieta, exercifii pentru \up0 \expndtw0\charscalex129
recuperare. relaxare si diminuare a stresului. Se reduce Tn acest fel \up0
\expndtw0\charscalex114 tulburarea psihologica \par\pard\ql \li1468\sb169\sl-
230\slmult0 \up0 \expndtw0\charscalex111 Grupurile dt autoajutor (self-h�lp group)
unolo <onduso do profosionisti \par\pard\qj \li1180\ri392\sb162\sl-
240\slmult0\fi278 \up0 \expndtw0\charscalex116 Sunt foarte rSspandite in unele (Sri
si recunoscute pentru succesul lor in \up0 \expndtw0\charscalex127 ajutarea*
bolnavilor sS se simtS mai pufin singuri Tn a-$i comunica \up0
\expndtw0\charscalex116 simfamintele altora care infeleg ceea ce simt ei. Studiile
conlirmS ce existe \up0 \expndtw0\charscalex115 avantaje dare se vezi boala din
perspectiva altora si sS observi cum fac fafa \up0 \expndtw0\charscalex115 alfli
problemelor similare \par\pard\qj \li1200\sb0\sl-245\slmult0
Psihoterapia de grup expresiv suportiva. un model de intervenfie \up0
\expndtw0\charscalex115 pentru imbunatSfirea calitSfii viefii pacienfilor cu
cancer, expehmentatS in \up0 \expndtw0\charscalex126 SUA s'-a dovedit elicienfa; ea
este bazatS pe conceptia existentialists \up0 \expndtw0\charscalex115 orientate pe'
aici si acum, urmand ceutarea unor sensuri, Tnfetesuri in viafS \up0
\expndtw0\charscalex115 Si Importanta inlruntarii morfii s' altor probleme
dificlle. \par\pard\sect\sectd\fs24\paperw8940\paperh13220{\bkmkstart Pg312}
\ul0\nosupersub\cf3\f4\fs18 Psihosomatica aplicata\tab \up0
311\par\pard\ql \li974\sb0\sl-207\slmult0 \par\pard\ql\li974\sb0\sl-207\slmult0
\expndtw0\charscalex133 Bibliografte \par\pard\qj \li993\sb0\sl-220\slmult0
\par\pard\qj\li993\ri906\sb3\sl-220\slmult0\tx1180\tx1180 \up0
\expndtw0\charscalex139 I Burish T G. Carey M.P Conditioner aversive responses in
cancet \line\tab \up0 \expndtw0\charscalex122 chemotherapy patients: Theoretical
and developmental analysis. J Consult \line\tab \up0 \expndtw0\charscalex111 Clin.
Psich. 54. 593-600. \up0 \expndtw-7\charscalex100 1936. \par\pard\li955\sb31\sl-
207\slmult0\fi0 \up0 \expndtw0\charscalex115 2. Cella D. F Psychological adjustment
and cancer outcome: Levy versus Taylor\par\pard\li955\sb18\sl-
207\slmult0\fi216\tx3787 \up0 \expndtw0\charscalex110 Am. Psychologist 40:1275-
76.\tab \up0 \expndtw0\charscalex114 1985\par\pard\qj \li960\ri902\sb0\sl-
220\slmult0\tx1185 \up0 \expndtw0\charscalex114
3. Cox T. C Mackay. psychological factors and psychophsysiologtcn! mechanism
\line\tab \up0 \expndtw0\charscalex112 m tne aetiology and development of cancers.
Soc. Set. Med. 16:381-96. \up0 \expndtw-4\charscalex100 1982. \par\pard\qj
\li964\ri933\sb0\sl-220\slmult0\tx1175 \up0 \expndtw0\charscalex119 4 Cullen J W
Behavioral, psychological and social influences on risk factors. \line\tab \up0
\expndtw0\charscalex113 prevention and early detection Cancer 50 (Suppl. November
I). 1946-53. \up0 \expndtw-7\charscalex100 1982. \par\pard\ql \li960\sb9\sl-
207\slmult0\tx5841 \up0 \expndtw0\charscalex119 5. Datinoiu I Sugetie si hipnoza Ed
$tunid si fhenicd, \tab \up0 \expndtw-7\charscalex100 1996. \par\pard\qj
\li960\ri907\sb3\sl-220\slmult0\tx1180 \up0 \expndtw0\charscalex118 6 Derogatis L
M Abellof and N Melisaratos Psychological coping mechanism \line\tab \up0
\expndtw0\charscalex119 and survival t.me in metastatic breast cancer JAMA \up0
\expndtw0\charscalex106 242:1504-8.1979 \par\pard\qj \li984\ri912\sb0\sl-
240\slmult0\tx1214 \up0 \expndtw0\charscalex111 7. FatlofietdL J. Counselling tor
patients with cancer. Br. Med 297(6650) 727-728. \line\tab \up0 \expndtw-
\expndtw0\charscalex112 8 Fallowfteld L, Clark A Breast cancer, Rout/edge. London
and New York, \tab \up0 \expndtw-3\charscalex100 1992 \par\pard\qj
\li960\ri912\sb9\sl-220\slmult0\tx1185 \up0 \expndtw0\charscalex116 9. Fox B H and
8 H Newberry (eds.) Impact of Psychoneuroendocnne system in \line\tab \up0
\expndtw0\charscalex113 cancer and immunity Lewiston. N.Y.. C.J. Hogrete. \up0
\expndtw-6\charscalex100 1984. \par\pard\li998\sb26\sl-207\slmult0\fi4 \up0
\expndtw0\charscalex115 10. Fox 8 H. Psychosociai factors and the immune system in
human Cdncet tn R\par\pard\li998\sb14\sl-207\slmult0\fi264\tx7320 \up0
\expndtw0\charscalex114 Ader ted), Psychoneuroimmunology, New York: Academic Press,
p.\tab \up0 \expndtw0\charscalex114 103 57.\par\pard\li998\sb24\sl-
207\slmult0\fi302 \up0 \expndtw0\charscalex114 1981\par\pard\li998\sb13\sl-
207\slmult0\fi0\tx6307 \up0 \expndtw0\charscalex113 11. Ghilezan N. Oncoiogie
generald. Ed. Medicald, Bucuresti.\tab \up0 \expndtw0\charscalex114
12. Golu M. Dinamica personalitd(ii, Bucuresti, Ed Geneze,\tab \up0
\expndtw0\charscalex115 13. Golu P. Psihologie sociaid. Bucuresti. Ed. Didacticd si
Pedagogica.\tab \up0 \expndtw0\charscalex114 1974.\par\pard\li998\sb9\sl-
207\slmult0\fi9 \up0 \expndtw0\charscalex115 14 Greer S, Morns T. Pettinga/e KW
Psychological response to brest concer:\par\pard\li998\sb14\sl-
207\slmult0\fi278\tx3672 \up0 \expndtw0\charscalex114 Effect on outcome Lancet.\tab
\up0 \expndtw0\charscalex114 1979. 2 785 787\par\pard\qj \li998\ri923\sb0\sl-
240\slmult0\tx1276 \up0 \expndtw0\charscalex125 15. Greer S and M Watson. Tov/ards
a psychobtologicat model ot cancer. \line\tab \up0 \expndtw0\charscalex117
Psychologycal considerations Soc Sci Med. 20 773-77, \up0 \expndtw-6\charscalex100
\expndtw0\charscalex115 16. Greer S. and T Morris. Psychological attributes ot
women who develop brest \line\tab \up0 \expndtw0\charscalex113 cancer. A controlled
study. J. Psychosom. Res. 19:147 53, i?75 \par\pard\ql \li1003\sb0\sl-
174\slmult0 \up0 \expndtw0\charscalex115 17 Grossarth -Mancek R..D. T Kanazir. H
Vetler and P. Schmidt Psychosomatic \par\pard\qj \li1267\ri917\sb0\sl-
240\slmult0\fi9 \up0 \expndtw0\charscalex119 (actors involved in the process of
cancerogenesis. Psychother. Psychosom. \up0 \expndtw0\charscalex100 40:191-210.
Holdevici I. Vasilescu P. Psihoterapia. tratament fdrd medicament, Bucuresti.
\line\tab \up0 \expndtw0\charscalex114 Ed Ceres. 1993 \par\pard\li964\sb1\sl-
162\slmult0\fi38\tx5347 \up0 \expndtw0\charscalex114 19. Hoidevici I. Psihoterapie
ed. Ceres. Bucuresti.\tab \up0 \expndtw0\charscalex116
1993.\par\pard\li964\sb12\sl-207\slmult0\fi0 \up0 \expndtw0\charscalex117 20
Holland J C. Rowland J. H Handoook of Psychooncology. New York,
Oxford\par\pard\li964\sb23\sl-207\slmult0\fi335\tx2860 \up0 \expndtw0\charscalex116
University Press,\tab \up0 \expndtw0\charscalex116 1989.\par\pard\li964\sb4\sl-
207\slmult0\fi0 \up0 \expndtw0\charscalex117 21. Holland JC. Management depression
with cancer. Cancer 37(6) 366-371,\par\pard\li964\sb14\sl-207\slmult0\fi359 \up0
\expndtw0\charscalex116 22. lamandescu I 8 Manual de psihologie medicald, Ed
Infomedica,\tab \up0 \expndtw0\charscalex116 1995.\par\pard\li964\sb14\sl-
207\slmult0\fi0\tx5731 \up0 \expndtw0\charscalex116 23. lonescu G. Psihoterapia.
Bucuresti. Ed Stiin(ificd.\tab \up0 \expndtw0\charscalex116 1990.\par\pard\ql
\li969\sb14\sl-207\slmult0 \up0 \expndtw0\charscalex114 24. lonescu G Tratat de
psihologie medicald si psihoterapie. Ed. Asklepios, 1995. \par\pard\ql
\li969\sb13\sl-207\slmult0 \up0 \expndtw0\charscalex114 25. Ldzdrescu M
Psihopatologio Clinicd Ed Helicon. Timisoara, 1994. \par\pard\qj
\li969\ri883\sb3\sl-220\slmult0\tx1291 \up0 \expndtw0\charscalex121 26. LeShan t.
psychological states as factors in the development of malignant \line\tab \up0
\expndtw0\charscalex114 disease: A critical review J.NC.122: > \up0 \expndtw-
8\charscalex89 18. \up0 \expndtw-7\charscalex100 1959. \par\pard\ql
\li974\ri893\sb0\sl-220\slmult0\tx1305\tx1291 \up0 \expndtw0\charscalex116 27 LevyS
. Herhan R.. M Lippman and T. d'Angelo Correlation of stress factors \line\tab \up0
\expndtw0\charscalex116 with sustained depresion of natural killer activity and
predicted prognosis in \line\tab \up0 \expndtw0\charscalex116 patients with breast
cancer. J. Clin Oncol 5- 348-53
psihosomatica generae s> aplicata\par\pard\li1560\sb0\sl-
32. Shelley E. Taylor. Health Psychology. Random House, New York,
Spiegel D, Boolm J., Yalom S.: Group support for patients with
metastatic\par\pard\li1560\sb14\sl-207\slmult0\fi321\tx5558 \up0
\expndtw0\charscalex113 cancer. Arch. Gen Psychiatry 38: 527-533,\tab \up0
\expndtw0\charscalex116 x Journal of the American Cancer Society by J.\tab
\up0 \expndtw0\charscalex116 8. Lippincolt Company,\par\pard\li1560\sb14\sl-
207\slmult0\fi153\tx2932 \up0 \expndtw0\charscalex113 Philadelphia.\tab \up0
\ul0\nosupersub\cf14\f15\fs24 PROBLEMELE MEDICINII FAMILIEI DIN PERSPECTIVA \up0
\expndtw-1\charscalex100 PSIHOSOMATICA \par\pard\ql \li1118\sb208\sl-230\slmult0
\up0 \expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 Grigore Busoi
240\slmult0\fi287 \up0 \expndtw0\charscalex118 Subiectul pus in discufie este
complex dificil de structural pentru medi� \up0 \expndtw0\charscalex118 cul de
familie la inceput de drum dar generos prin deschideri \par\pard\ql \li1108\sb0\sl-
230\slmult0 \par\pard\ql\li1108\sb39\sl-230\slmult0 \up0 \expndtw0\charscalex115 Ne
propunem sS dezvoltSm patru setun de probleme: \par\pard\qj \li811\ri763\sb142\sl-
240\slmult0\fi307 \up0 \expndtw0\charscalex116 1) Promovarea. menfmerea si
recastigarea sanatafii familiei pnn modelul \up0 \expndtw0\charscalex116 bio-psiho-
socio-cultural si ecologia \par\pard\qj \li811\ri762\sb0\sl-250\slmult0\fi287
\up0 \expndtw0\charscalex117 2) Abordarea familiei din perspectiva psihosomatice,
demers fecund prin \up0 \expndtw0\charscalex121 apel la principii metodologice
provenite din teoria generae a sistemelor si \up0 \expndtw0\charscalex114
psihosociologia grupurilor mici. \par\pard\qj \li801\ri757\sb11\sl-
240\slmult0\fi297 \up0 \expndtw0\charscalex116 3) Decriptarea tulburarilor si
patologiei psihosomatice a familiei, plecend \up0 \expndtw0\charscalex114 de la
disiuncfionalitefile viefii familiale. \par\pard\qj \li815\ri774\sb0\sl-
260\slmult0\fi278 \up0 \expndtw0\charscalex126 4) Se evidenfiem reperele esenfiale
ale teoriei si practicii medicinii \up0 \expndtw0\charscalex115 psihosomatice
familiale. \par\pard\ql \li1104\sb1\sl-216\slmult0 \up0 \expndtw0\charscalex115
Pentru Tnceput inse simtim nevoia unei puneri succinte in temS. \par\pard\ql
\par\pard\ql\li1104\sb33\sl-230\slmult0 \up0 \expndtw0\charscalex132 I. Corpus:
medicina familiei-medicina psihosomatica \par\pard\qj \li815\ri757\sb186\sl-
Vom prezenta o serie de teme Tn consonants care permit TnstSpanirea \up0
\expndtw0\charscalex121 medicului asupra teoriei si practicii medicinii
psihosomatice \par\pard\qj \li1147\ri923\sb140\sl-260\slmult0 \up0
\expndtw0\charscalex120 /. Sustinerea sanatafii familiei prin modelul bio-psiho-
socio-cultural \up0 \expndtw0\charscalex119 Si ecologic \par\pard\ql
\li811\ri762\sb170\sl-248\slmult0\fi297\tx1104 \up0 \expndtw0\charscalex114 Pentru
medicul de MG/MF elementul de relerintS al intregii sale activitafi \up0
\expndtw0\charscalex120 este sSnStatea, in acest context boala este o pierdere a
sanatafii. \line \tab \up0 \expndtw0\charscalex121 SSnetatea in derularea ei, de la
senetatea dephna la senetatea pierdute, \up0 \expndtw0\charscalex125 este, in
substanfe si forma, o rezultanta multifactoriae bio-psiho-socio-\line \up0
\expndtw0\charscalex122 culturae sj ecologies de tip vectorial, expnmata ca
libertate funcfionale s' \up0 \expndtw0\charscalex122 relafionae. \par\pard\qj
\li820\ri767\sb0\sl-260\slmult0\fi287 \up0 \expndtw0\charscalex117 Lucrunle ar fi
relativ simple dace am aborda senetatea individului izolat, \up0
\expndtw0\charscalex117 scos din cempul seu de viafe, cu secfionarea conexiunilor.
Numai ce \par\pard\sect\sectd\fs24\paperw8940\paperh13220{\bkmkstart Pg315}
psihosomatica gciaiala si aplicata\par\pard\qj \li1151\sb0\sl-250\slmult0
250\slmult0\fi9 \up0 \expndtw0\charscalex116 individul apartine unei grupari umane
de tip special care este familia sa. cS \up0 \expndtw0\charscalex115 el acfioneazS
Tntr-un camp existential multiplu articulat, intr-o refea, plasS \up0
\expndtw0\charscalex115 care-l sustine, il Tnvaluie si ii leagSnS. \par\pard\qj
\li1147\ri420\sb0\sl-250\slmult0\fi297 \up0 \expndtw0\charscalex117 Revelator Tn
aceastS conexiune este relafia dialectics prims mintecorp, \up0
\expndtw0\charscalex123 relafia dialectics secundS ins-familie. relatia dialectics
terfiarS familie\up0 \expndtw0\charscalex117 comunitate (societate) si relafia
dialectice cuaternare societate-mediu \par\pard\qj \li1147\ri416\sb0\sl-
250\slmult0\fi292 \up0 \expndtw0\charscalex113 Acum putem spune ca infelegem
senetatea familiei ca o capacitate func� \up0 \expndtw0\charscalex113 fionale a
sistemului familial, mereu pus in condifii de solicitare, care dispune \up0
\expndtw0\charscalex120 de raspunsuri adecvae, de riposte s< de repliere s' care
conduce In final e \up0 \expndtw0\charscalex115 menfinerea homeostaziei familiale
sau la aiustarea ei in limitele unei redun\up0 \expndtw0\charscalex115 dante
reacfionale, acceptate ca satisecatoare. \par\pard\qj \li1147\ri422\sb0\sl-
246\slmult0\fi297 \up0 \expndtw0\charscalex126 in acelasi timp trebuie spus ce
familia este o case cu use batamo a \up0 \expndtw0\charscalex119 existenfei umane
care face trecerea intre Individ si societate. Este evident \up0
\expndtw0\charscalex115 cS individul si familia se alls Tntr-o unitate dialectics,
tar familia este ger.ul \up0 \expndtw0\charscalex115 proxim al relafiilor sociale
ale omului. \par\pard\ql \li1151\ri411\sb0\sl-247\slmult0\fi292\tx1440\tx1449
\up0 \expndtw0\charscalex120 Umanizarea si socializarea indivizilor se realizeazS
in familie, s* tara \up0 \expndtw0\charscalex116 acest adevSr once discutie despre
om rSmane sSracS si porifencS. \line \tab \up0 \expndtw0\charscalex119 in
ciclicitatea evolufiei sale, de e copii e adult s< varstnic, individul se \up0
\expndtw0\charscalex117 afIS aletun de ceilalfi membri ai familiei in dube posture,
de receptor si de \up0 \expndtw0\charscalex118 emifetor al unor semnale si situafii
care indue procese transformatoare sa-\line \up0 \expndtw0\charscalex116 nogene sau
patogene cetre sine si spre membrii familiei sale. \line \tab \up0
\expndtw0\charscalex118 Experienfele interpersonale ale copilului, deprinse in
familie, se inschu \up0 \expndtw0\charscalex116 adanc in forul seu interior,
condiflonand hoterator abordarile si expectafiile \up0 \expndtw0\charscalex113
relafiilor interpersonale \up0 \expndtw0\charscalex115 $i reusitele omului de
maine, in exercitarea rolului \par\pard\ql \li1156\sb0\sl-224\slmult0 \up0
\expndtw0\charscalex120 seu de partener con|ugal, de parinte s' de ceefean.
Modelul bio-psiho-socio-cultural al sanatafii si al bolii a IScut carierS si
\up0 \expndtw0\charscalex126 el este operational pentru specialists de MG/MF prin
aceea ca ind'ice \up0 \expndtw0\charscalex113 abordarea comprehensiv-holislicS a
omului. \par\pard\qj \li1156\ri416\sb0\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex122 DacS acest model este privit dinspre polul pozitiv avem de
a face cu \up0 \expndtw0\charscalex116 sSnStatea si el traduce: \par\pard\qj
\li1156\ri407\sb19\sl-240\slmult0\fi297 \up0 \expndtw0\charscalex118 >\u9632?
mostenire genetics fSrS defecte importante si liberete funcfionala a \up0
\expndtw0\charscalex118 sistemelor organismului, \par\pard\ql \li1161\ri411\sb0\sl-
250\slmult0\fi307\tx1463 \up0 \expndtw0\charscalex113 >\u9632? trSire ceneslezicS.
echilibru dispozifionai, contacte interumane lejere; \line\tab \up0
\expndtw0\charscalex124 > indeplinirea indatohrilor cotidierie S' participare
opfionae la viafa \up0 \expndtw0\charscalex113 sociala. \par\pard\ql
\li1459\sb1\sl-228\slmult0 \up0 \expndtw0\charscalex116 > stil de viafS sanogen, cu
evitarea factorilor de rise. \par\pard\ql \li1171\ri406\sb18\sl-
245\slmult0\fi283\tx1459 \up0 \expndtw0\charscalex115 Invers, acelasi model pnvit
prin polul negativ conduce e detnurea bolu \line\tab \up0 \expndtw0\charscalex122
Psihosomatica este importanta pentru medicul de MG/MF pentru cS \up0
\expndtw0\charscalex116 permite studierea interrelafiei mintecorp ("mind-body"),
inclusiv cunoa?te-\up0 \expndtw0\charscalex114 rea condifionSrii si amorsSrii
psihofiziologico - cStre sSnatate sau psihopa� \up0 \expndtw0\charscalex114
tologice - catre boae. \par\pard\ql \li1200\ri405\sb16\sl-
220\slmult0\fi273\tx1488 \up0 \expndtw0\charscalex112 Este de suhlmiat ce
psihosomatica cultive actiunl pertinente in scop diag� \up0 \expndtw0\charscalex114
nostic (clinica psihosomatica) si terapeutic (diferite forme de psihoterapie)
\line\tab \up0 \expndtw0\charscalex114 Este adevarat ce psihosomatica s-a
ocupat de analiza factorilor \par\pard\ql \li1200\sb32\sl-230\slmult0 \up0
\expndtw0\charscalex117 psihocomportamentali implicafi In aparitia si
dezvoltarea diferitelor
imbolnevtri exprimate somatic, dar noi am don se recuperem psihosomatica \up0
\expndtw0\charscalex115 pentru medicina sanetafii \par\pard\qj \li772\ri796\sb0\sl-
250\slmult0\fi292 \up0 \expndtw0\charscalex123 De aceea vechiul adagiu "minte
sSnStoasS in corp sanStos" poate li \up0 \expndtw0\charscalex116 actualizat in
formula: sSnStatea mmfil pentru sSnStatea individului, pentru \up0
\expndtw0\charscalex116 sanatatea familiei. pentru sSnStatea societSfii si pentru
sSnStatea mediului. \par\pard\qj \li787\ri1019\sb171\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex118 ?. f-amlila ca sistem si ca microgrup. percepfit
deschizdtoare pentru \up0 \expndtw0\charscalex119 medicina psihosomatica
Abordarea sistemicS a familiei permite studiul ei in interrelafii ierarhic in-\line
\up0 \expndtw0\charscalex121 ferioare Individul si ierarhic superioare \up0
\expndtw0\charscalex117 - comunitatea, socletatea ?i me� \par\pard\ql
\li777\sb9\sl-230\slmult0\tx7939 \up0 \expndtw0\charscalex122 diul. cu
posibilitatea interpretSru si e<plicent manifesenlor functional \tab \up0 \expndtw-
2\charscalex100 -\par\pard\ql \li777\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex114 compoitamentale ale familiei in viafa de toate zilele.
\expndtw0\charscalex133 Fenomenele familiale gandite sistemic, prin modelul
structure\up0 \expndtw0\charscalex116 interacfiune. au valoare eunstlca in
psihoiogia si psihopatologia familiei. \line\tab \up0 \expndtw0\charscalex123
Stadiilo succesive ale tamiliei, atat in procesele de dllatare cat \up0
\expndtw0\charscalex123 $i de \par\pard\qj \li777\ri781\sb0\sl-244\slmult0 \up0
\expndtw0\charscalex119 contracfie. cuprind momente de stabilltate $i de tranzifie
cu relevanfS Tn \up0 \expndtw0\charscalex115 patologia psihosomatice. Copilul, ca
initiator al proceselor familiale de res� \up0 \expndtw0\charscalex115 tructurare,
la care se pot adSuga si factorii externi. in diferitele lor ipostaze, \up0
\expndtw0\charscalex122 probeazS capacitatea de autoreglare a sistemului familial,
pnn relevarea \up0 \expndtw0\charscalex114 unor reguli ie comportare si modalltSfi
de comunicare, pnn evidentierea to� \up0 \expndtw0\charscalex114 nusului afectiv s<
a capaciefii reacfionale. \par\pard\qj \li777\ri786\sb0\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex113 Dintre mdicatorn global! ai organizani sistemice a
familiei trebuie luaft in \up0 \expndtw0\charscalex113 considorafie:
\expndtw0\charscalex113 \u9650? nomeostazia familiei (echiiibru. stabihtate)
\up0 \expndtw0\charscalex114 A coeticientul de coeziune \par\pard\qj
conligurafia reteiei comunicafionale \up0 \expndtw0\charscalex113 \u9650? tendinfa
de evolufie \par\pard\ql \li1075\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex118 A
capacitate reacfionaia \par\pard\qj \li772\ri786\sb2\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex121 Abordarea complexS, multitactonae a interdependenfelor Tn
campul \up0 \expndtw0\charscalex119 sistemic se lace prin aplicarea legilor
stocastice, prin elaborarea unor mo\up0 \expndtw0\charscalex119 dele matematice
Parafrazand pe V. SShleanu putem spune cS, pentru medic, dacS e greu \up0
\expndtw0\charscalex124 sS aplice matematica, stiinfa rece. e mai usor s1 mai
potrivit sS aplice, \up0 \expndtw0\charscalex115 creativ, arta terapeutice
fierbinte. \par\pard\qj \li777\ri782\sb0\sl-240\slmult0\fi307 \up0
\expndtw0\charscalex119 Inir-o viziune antropoiogtce si dmainica, familia
corespunde definifiei \up0 \expndtw0\charscalex122 mlcrogrupului prin ceea ce arc
el esenfial. adice prin coeziune \up0 \expndtw0\charscalex104 (indlvizii
\par\pard\ql \li782\sb0\sl-230\slmult0 \up0 \expndtw0\charscalex116 coexiste.
renunfand e individualism, in iavoarea grupului luat ca intreg). \par\pard\qj
\li791\ri834\sb0\sl-260\slmult0\fi278 \up0 \expndtw0\charscalex116 Coeziunea
tamiliei din perspectiva conflictogene, via medicina psihoso \up0
\expndtw0\charscalex114 matice, are patru momente de dificultate: \par\pard\qj
\li787\ri786\sb0\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex121 a apropierea
dintre cei doi parteneh conjugali este marcata de aparte\up0
\expndtw0\charscalex112 nenfa lor ia famiiule din care provin, \par\pard\qj
\li787\ri771\sb0\sl-260\slmult0\fi287 \up0 \expndtw0\charscalex121 b. salisfacerea
nevoilor membrilor familiei, luafi individual, in relatia \up0
\expndtw0\charscalex110 cerere-ofertS: \par\pard\ql \li1075\sb0\sl-180\slmult0 \up0
\expndtw0\charscalex117 c despnnderea copiilor (separare precoce. fuga
adolescenfilor etc.); \par\pard\ql \li1075\sb33\sl-230\slmult0 \up0
\expndtw0\charscalex117 d. desperfinie (divort, deces. instreinarea).
psihosomatica generae si aplicata\par\pard\ql \li1252\sb0\sl-240\slmult0
240\slmult0\fi297\tx1545 \up0 \expndtw0\charscalex114 Pentru pSstrarea coeziunii.
familia emite norme, in registru propriu axio\up0 \expndtw0\charscalex112 logic,
care reglementeazS comportamentele membrilor. \line \tab \up0
\expndtw0\charscalex120 Coeziunea familiei relevS caracterul propriu al relafiilor
afective si ea \up0 \expndtw0\charscalex117 este pusS in valoare in momentele
diticile ale existenfei familiei penoadele \up0 \expndtw0\charscalex117 de
tranzifie si in rezolvarea crizelor. \par\pard\qj \li1252\ri295\sb0\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex121 Eterogenitatea microgrupurilor
produsS prin caracteristici diferite ale \up0 \expndtw0\charscalex115 componentilor
(functie de: varste si sex, statusuri si roluri si capacttefi ope-\line \up0
\expndtw0\charscalex117 rafionale) se evidenfiaze mai ales in registrul psihologie:
aspecte cognitive \up0 \expndtw0\charscalex115 (fiecare are un anumit Ql si nivel
cultural; comunicarea este diferite datorite \up0 \expndtw0\charscalex122
diferenfelor de limbaj proprii diferitelor varste), dezvoltare afective \up0
\expndtw0\charscalex109 (de \par\pard\qj \li1252\ri312\sb0\sl-230\slmult0 \up0
\expndtw0\charscalex119 exemplu reactivitate emofionale diferite in fafa unui
eveniment la nivelul \up0 \expndtw0\charscalex113 familiei) si evolufie
psihosociale (de exemplu adulfii isi conserve autonomia. \up0
\expndtw0\charscalex113 copni lupte pentru castigarea identitafu). \par\pard\qj
\li1257\ri306\sb11\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex116 in tuiburehle
afective la nivelul familiei. asistam la perturbari ale rolului \up0
\expndtw0\charscalex112 jucat in familie de membrii sei. Prin rol intelegem un
ansamblu de comporta� \up0 \expndtw0\charscalex112 mente asteptate in functie de
locul sau functia pe care un individ il are intr-un \up0 \expndtw0\charscalex112
grup social. \par\pard\ql \li1252\ri291\sb0\sl-
238\slmult0\fi307\tx1550\tx1555\tx1564 \up0 \expndtw0\charscalex114 Perturbehle de
rol pot imbreca dilerite forme de exprimare, ele putand fi: \up0
\expndtw0\charscalex116 insuficiente, excesive, fluctuante sau de necunoastere.
\line \tab \up0 \expndtw0\charscalex114 Astfel, in mod normal, tatal este liderul
instrumental al familiei. el emane \up0 \expndtw0\charscalex120 autoritate, este
responsabii cu securitatea familiei si realitafile extratami-\up0
\expndtw0\charscalex120 liale. Iar mama este acreditate ca lider emofional al
familiei, ea identitica \up0 \expndtw0\charscalex116 nevoile afective ale familiei
si aste responsabie cu relafiile intrafamiliale. \line\tab \up0
\expndtw0\charscalex119 Ne vine Tn minte o exprimare sugestivS, de sorginte
popuere. privind \up0 \expndtw0\charscalex124 rolurile barbatului si femeii in
familie: "Casa lara bSrbat este pustie pe \up0 \expndtw0\charscalex117 dinafare,
Iar cea fere de femeie este pustie pe dinauntru". \line \tab \up0
\expndtw0\charscalex121 Inversarea rolunlor parentale sau lipsa uniefii coahfiei
parentale aduc \up0 \expndtw0\charscalex112 prejudicii dezvoltSrii psiho-socio-
somatice a copiilor. \par\pard\ql \li1560\sb51\sl-230\slmult0 \up0
\expndtw0\charscalex118 3. Dlstuncflonalitatile viefii familiale si patologia
psihosomatica \par\pard\qj \li1262\ri296\sb68\sl-233\slmult0\fi297 \up0
\expndtw0\charscalex121 Pentru a aplica la familie conceptul psihosomatic si pentru
a tnfelege \up0 \expndtw0\charscalex111 mecanismele de artlculare morbigene Tn
aceastS asoctere, trebuie sS expunem \up0 \expndtw0\charscalex108 funcfiile
familiei si sS trecem in revists principiile fundamentale ale functionSrii \up0
\expndtw0\charscalex108 familiei \par\pard\qj \li1267\ri289\sb2\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex121 DacS avem Tn vedere funcfiile
esenfiale ale familiei si potentiae! lor \up0 \expndtw0\charscalex113 conllictogen
inductor de patologie psihosomaticS, pentru o mat bunS cunoas \up0
\expndtw0\charscalex124 tere s' acfiune noi le ordonSm Tntr-o dispunere propne.
Astlel. familia \up0 \expndtw0\charscalex113 asigura urmetoarele funcfii:
\par\pard\ql \li1579\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex113 1. cadrul
material al existenfei comune (hrana. adSpost, TmbrScSminte); \par\pard\ql
\li1564\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 2 reglementarea viefii
sexuale s* reproducerea umanS; \par\pard\qj \li1560\ri3154\sb0\sl-240\slmult0
\up0 \expndtw0\charscalex112 3. pregStirea copiilor pentru rolul de adulft. \up0
\expndtw-2\charscalex100 4. \up0 \expndtw0\charscalex112 (uncfia de stabilizator
emofional. \par\pard\ql \li1574\sb1\sl-218\slmult0 \up0 \expndtw0\charscalex112 5.
rolul de purtStoare a valorilor morale si a tradifiilor; \par\pard\qj
\li1574\ri286\sb4\sl-240\slmult0\tx1823 \up0 \expndtw0\charscalex116 6. cooperarea
economics, cu repartifie de bunun ce vizeazS dezvoltarea \line\tab \up0
\expndtw0\charscalex110 Si menfinerea unitafii microgrupului; \par\pard\qj
\li1583\ri281\sb0\sl-240\slmult0\tx1833 \up0 \expndtw0\charscalex112 7. cadrul de
protecfie a membrilor allafi in impas, dezideratul maxim fiind \line\tab \up0
\expndtw0\charscalex112 reinserfia socialS.
\expndtw0\charscalex124 \ul0\nosupersub\cf3\f4\fs18 Psihosomatica apiicata\tab \up0
\expndtw0\charscalex124 O 317\par\pard\li744\sb0\sl-
late acum\tab \up0 \expndtw0\charscalex119 $i phncipille fundamentalo ale
funciionerii familiei. Aceste\par\pard\li744\sb0\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex119 principii sunt:\par\pard\qj \li734\ri803\sb0\sl-
240\slmult0\fi316\tx1310 \up0 \expndtw-9\charscalex90 1. \tab \up0
\expndtw0\charscalex125 Familia este mai mult decat o colecfie de individualiefi,
ea este o \up0 \expndtw0\charscalex118 unitate sistei.nca interactive ce are ca
parfi comune. un anumit rise genetic, \up0 \expndtw0\charscalex118 diferite
ntuaiuri existenfiale si o anumite experienfa de viafe. \par\pard\qj
\li744\ri844\sb6\sl-220\slmult0\fi278 \up0 \expndtw0\charscalex115 2. Familia
propune modole ciedibile care reglementeaze comportamentul \up0
\expndtw0\charscalex111 membrilor ei. \par\pard\qj \li734\ri829\sb24\sl-
240\slmult0\fi287 \up0 \expndtw0\charscalex116 3. Simptomele unui membru sau unor
membri ai familiei pol da refennfe \up0 \expndtw0\charscalex117 despre
funcfionalitatea intregulul. \par\pard\qj \li744\ri840\sb0\sl-240\slmult0\fi283
\up0 \expndtw0\charscalex122 4. Abilitatea de a se adapta la o realitate
schimbetoare este un semn al \up0 \expndtw0\charscalex116 funcfionsni sanogene a
familiei. \par\pard\qj \li739\ri839\sb17\sl-220\slmult0\fi292 \up0
\expndtw0\charscalex123 5. in lamille tuuefioneaza reiatia diagnostica si
erapeutica in triunghi: \up0 \expndtw0\charscalex115 caz (persoana Tn cauze). medic
(agentul sanatafii) si restul familiei (cadru s� \up0 \expndtw0\charscalex115
suport; \par\pard\qj \li739\ri843\sb24\sl-240\slmult0\fi288 \up0
\expndtw0\charscalex113 6. In familie funcfioneaza modelul umanist "tofi pentru
unu" care facilitea\up0 \expndtw0\charscalex113 ze atat diagnosticul cat $i terapia
instituite \par\pard\ql \li739\ri829\sb0\sl-240\slmult0\fi288\tx1031\tx1036 \up0
\expndtw0\charscalex112 7. Nu exists o familie standard, ci familu, cu structuri si
expnmen functio� \up0 \expndtw0\charscalex112 nale specifice. si acest lucru
trebuie avut in vedere de medic Tn actiunile sale \line\tab \up0
\expndtw0\charscalex117 Fiecare din cele 7 funcfii aparfinatoare unei familli poate
fi analizate ca \up0 \expndtw0\charscalex114 disfuncfie. Condensandu-le ajunqem la
3 funcfii importante si anume: \line \tab \up0 \expndtw0\charscalex111 \u9660?
funcfia referitoare la cuplu; \par\pard\qj \li1031\ri2971\sb0\sl-240\slmult0
\up0 \expndtw0\charscalex113 \u9660? funcfia care are ca obiect dezvoltarea
copilului; \up0 \expndtw0\charscalex114 T lunete ce se raporteazA la societate.
Conflictele e nivelul cuplului apar, spre exemplu, cand parteneriatul nu \up0
\expndtw0\charscalex116 funcfioneazS cand exists tulburSri sau neimpliniri Tn sfera
sexualS $i cand \up0 \expndtw0\charscalex116 exists mostenin sau percepfii diferite
asupra viefii. \par\pard\qj \li734\ri824\sb9\sl-230\slmult0\fi292 \up0
\expndtw0\charscalex117 O problems centrae a familiei este reprezentatS de funcfia
de Ingrijire a \up0 \expndtw0\charscalex121 copilului. unde nevoia de afecfiune si
de asigurare a securitSfii lui devin \up0 \expndtw0\charscalex117 elemente
obligatoni a!e acestui derners actional \par\pard\qj \li739\ri820\sb2\sl-
240\slmult0\fi283 \up0 \expndtw0\charscalex115 AceastS functie este la rindul el
dependents de o serie de alfi factori cum \up0 \expndtw0\charscalex115 ar fl:
relafiile dintre parinfi, varsta pannfilor \up0 \expndtw0\charscalex116 (pannii
tinen \up0 \expndtw0\charscalex112 - personalitSfi in \par\pard\ql \li748\sb9\sl-
230\slmult0\tx6014 \up0 \expndtw0\charscalex126 plina structurare), aportul de
incercare cu sarcini \tab \up0 \expndtw0\charscalex122 (de exemplu mama
profeseaze, are raspunderi mari in gospoderie si are grija de mai mulfi \up0
\expndtw0\charscalex111 copii), veniturile familiei \up0 \expndtw0\charscalex118
(surse fmanciare modeste) asigurarea educafiei. \par\pard\qj \li734\ri824\sb6\sl-
233\slmult0\fi287 \up0 \expndtw0\charscalex115 in ceea ce priveste funcfia ce se
raporteaza la societate, apare un conflict \up0 \expndtw0\charscalex119 intre ceea
ce ofere societatea (de exemplu pierderea locului do munce) s1 \up0
\expndtw0\charscalex113 cehnfeie tamiliei (soful este singurul susfinStor al
familiei) Pot apSrea si alto \up0 \expndtw0\charscalex113 situafii: soful militar
sau soful care profeseazS departe de casS. \par\pard\qj \li1027\ri2410\sb116\sl-
320\slmult0\tx1334 \up0 \expndtw0\charscalex118 \ul0\nosupersub\cf8\f9\fs22 II.
Repere esenfiale in teoria si practice medicinii \line\tab \up0
\expndtw0\charscalex119 psihosomatice familiale \par\pard\qj \li739\ri808\sb87\sl-
1. \tab \up0 \expndtw0\charscalex127 Medicina generalS/medicina de familie in acord
cu doctrina sa \up0 \expndtw0\charscalex121 antropo-socio-ecologico-sophicS, ca
disciphnS medicae integratoare s< \up0 \expndtw0\charscalex120 mtegralists. ca
specialitate a cursului viefii care are ca punct de referinfa \up0
\expndtw0\charscalex130 sSnStatea, infelege relafia psyche-soma mai ales prin
manifestanie \up0 \expndtw0\charscalex114 rezultate. normale si patologice,
constatate la nivelul individului $i tamiliei.
psihosomatica yer.eraio $i aplicata\par\pard\qj \li1166\sb0\sl-236\slmult0
236\slmult0\fi288 \up0 \expndtw0\charscalex126 2. Familia in evolutia ei exprime
douS etuh o laturS conservatoare \up0 \expndtw0\charscalex113 (relevS o relative
stabtlitate cu pSstrarea coeziumi s> identieth familiei), ca� \up0
\expndtw0\charscalex113 re se face prin efortul coectiv al componenfilor, ?i o
laturS evolutivS (pertoa \up0 \expndtw0\charscalex115 de de tranzitie, cu tensiuni
S' anxietSfi) produse prin intermediul membrilor \up0 \expndtw0\charscalex118 ei,
luafi individual. Din punct de vedere psihosomatic prima latura induce \up0
\expndtw0\charscalex118 senetatea familiei, iar cea de-a doua produce, de regue,
suferinfa si. posi� \up0 \expndtw0\charscalex118 bil. boae \par\pard\qj
\li1161\ri398\sb1\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex117 3. Plecand de e
unitatea psihosomatice a organismului uman si a fami� \up0 \expndtw0\charscalex117
liei, medicina psihosomatice releve atat sSnetatea cat s* patologe corporae \up0
\expndtw0\charscalex112 a individului sau a unor component! ai familiei, in relafie
directe cu viata psi� \up0 \expndtw0\charscalex114 hice. Astfel. expresii
psihologice, simfemlnte pozitive $1 emofii negative Isi \up0
\expndtw0\charscalex115 gSsesc corespondent in exphmeh somatice: senetate �izicS,
respectiv simp� \up0 \expndtw0\charscalex117 tome (prepozifii psihosomatice),
tulburari \up0 \expndtw0\charscalex117 (propozifii psihosomatice) sau
boll \tab \up0 \expndtw0\charscalex115 (fraze psihosomatice). \par\pard\qj
\li1161\ri397\sb0\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex127 4 in cercetarea
starii de senetate a famil'ei trebuie sS plecem de la \up0 \expndtw0\charscalex120
cunoasterea stAni de funcfionare a coalifiei parentale, intrucat ea asigura \up0
\expndtw0\charscalex120 unitatea conducern \par\pard\qj \li1161\ri396\sb2\sl-
240\slmult0\fi297\tx1795 \up0 \expndtw-6\charscalex100 5. \tab \up0
\expndtw0\charscalex128 Acflunile s> comportamentele fiecSrui membru al familiei au
\up0 \expndtw0\charscalex126 consecinte directe si indirecle, manifeste sau
latente. asupra colorlalfi \up0 \expndtw0\charscalex112 membri ai tamiliei.
intre membrii familiei exists in anumite perioade tensiuni, ce pot \up0
\expndtw0\charscalex119 ajunge e conflicte. Problemele psihologice create Tn
dublete (de exemplu \up0 \expndtw0\charscalex126 tats-fiu) sau triplete \up0
\expndtw0\charscalex122 (de exemplu tatS-mamS-copll) indue o atmosfers \par\pard\ql
\li1171\sb0\sl-204\slmult0 \up0 \expndtw0\charscalex114 psihosomatizante
familiala \par\pard\ql \li1161\ri387\sb7\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex117 7 Medicul de familie trebuie se depisteze stSnle
disarmonice familiale \up0 \expndtw0\charscalex121 care se manifests ca: familie
supraprotectivS, familie rigidS, fan. \up0 \expndtw0\charscalex121
superpermislvS, familia disipatS ca si aliantele intrafamiliale Tmpotriva \up0
\expndtw0\charscalex111 membrului "pus la colt". \par\pard\qj \li1161\ri392\sb0\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex125 8. in patologia psihosomatica
familiala apar tenomene specifics: in \up0 \expndtw0\charscalex114 conflictul
dintre sofi rezonatcrul este copilul, contagiunea emofionale (boala \up0
\expndtw0\charscalex118 Tn doi sau Tn cascade), copilul Tn rol de rival cu
perintele de acelasi sex, \up0 \expndtw0\charscalex118 alegerea fapului ispasitor,
inceicarea limitelor intre generafii \par\pard\qj \li1175\ri388\sb0\sl-
240\slmult0\fi273 \up0 \expndtw0\charscalex125 9. Pentru un medic aflat in ceutarea
adevSrului stiinfific existe si o \up0 \expndtw0\charscalex120 patologie
psinosomatica familiala ms^catS \up0 \expndtw0\charscalex125 (nu este relevat unui
diniro \par\pard\ql \li1171\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex115
termenii procesulu' psinosomatic). \par\pard\qj \li1171\ri387\sb2\sl-
240\slmult0\fi302 \up0 \expndtw0\charscalex117 10. Pentru un medic experimental
apare ca indubitabil faptul ce in crice \up0 \expndtw0\charscalex125 tulburare sau
boae psihosomatica exise s1 o redScinS familiala: teran \up0
\expndtw0\charscalex115 reactiv mostenit. stil de viafa deficient, relafii
tamiliale perturbate. \par\pard\qj \li1185\ri301\sb0\sl-240\slmult0\fi302\tx1809
\up0 \expndtw0\charscalex56 11 \tab \up0 \expndtw0\charscalex117 Bolile
psihosomatice pot Ii mostenite, ele intalrnndu-se in generafii \up0
\expndtw0\charscalex123 succesive Este posibi! se apare si fenomenul de secular
trend. O istorte \up0 \expndtw0\charscalex115 familiale pozitive In acest sens am
intalnit la aslmul bronsic. hipertensiunea \up0 \expndtw0\charscalex120 arteriale,
ulcerul duodenal, cancer de san, migrenS. sindromul dispeptic, \up0
\expndtw0\charscalex112 colonul iritabil, tulburSri funcfionale cardiace, vitiligo,
eczema \par\pard\qj \li1204\ri382\sb0\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex122 12. in supravegherea stSrii de sSnState psihosomatice si
relational a \up0 \expndtw0\charscalex128 copilului trebuie sS ne concentrSm
atenfia asupra catorva puncte de \up0 \expndtw0\charscalex113 importanta
strategica: \par\pard\sect\sectd\fs24\paperw8940\paperh13220{\bkmkstart Pg320}
\expndtw-8\charscalex73 <\u8226?\tab \up0 \expndtw0\charscalex118
\expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 de/voltaroa copilului se
realizeazS pnn internalizarea figurit parenlalo \up0 \expndtw0\charscalex115 de
acelasi sex si "competnie "afectivS cu pSrintele de sex opus; \par\pard\ql
\li902\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex116 - panntii sunt pnmii
educator! at copilului. dar stiu ei ce sS I invefe? \par\pard\qj
\li609\ri958\sb0\sl-260\slmult0\fi292 \up0 \expndtw0\charscalex126 - trSirea unei
relafii afective continue a copiiului cu mama sa, sub \up0 \expndtw0\charscalex113
prezenfa autohtSfii planante a tatSlui. \par\pard\qj \li604\ri963\sb0\sl-
240\slmult0\fi312 \up0 \expndtw0\charscalex126 13. in prezent, factorii
psihosociali in relate cu somatizarea par sS \up0 \expndtw0\charscalex113 Tmbrace
aspecte particuiare: \par\pard\qj \li604\ri958\sb0\sl-246\slmult0\fi302 \up0
\expndtw0\charscalex117 - starea de sarScie induce pentru indivizi suferinfe care
se exprimS mai \up0 \expndtw0\charscalex124 mult in plan somatic decat Tn plan
psihic, in timp ce familiile cautS sa \up0 \expndtw0\charscalex121 demonstreze
contrariul, respingSnd somatizarea. penlru ca ea inseamnS \up0
\expndtw0\charscalex118 costun sociale ndicate; \par\pard\qj \li609\ri968\sb0\sl-
246\slmult0\fi451 \up0 \expndtw0\charscalex119 societatea contemporanS. aflata sub
formula senzoriala prea repede, \up0 \expndtw0\charscalex116 proa mult, prea tare,
prea lucitoare, induce sindroame psihosomatice com� \up0 \expndtw0\charscalex115
plexe, intricate, in acest sens sedescrlu- sindromul oboselii cronice $i
fibro\up0 \expndtw0\charscalex108 mialgia; \par\pard\qj \li604\ri962\sb0\sl-
245\slmult0\fi297 \up0 \expndtw0\charscalex116 - dezordiniie dm viafa familiale,
conflictele aperute pe un fond deficient \up0 \expndtw0\charscalex118 educational
si/sau nutritional in multe cazuri scurtcircuiteaze somatizarea, \up0
\expndtw0\charscalex121 transformandu-se in actiuni motoni, cu suspendarea
controlului mental. \up0 \expndtw0\charscalex117 Astfel apar violonfe de mare
gravitate, distrugeri de bunurl. violurl si chiar \up0 \expndtw0\charscalex117
omuciden in unole din aceste famihi, iadul pare a fi adus pe pamant.
in cadrul pslhosociofizicochimioterapiei, Tn care-si geseste locul si \up0
\expndtw0\charscalex121 psihoterapia, educafia \up0 \expndtw0\charscalex130 $i
autoajutorul sunt puncte forte care ineresc \par\pard\ql \li614\sb1\sl-
225\slmult0 \up0 \expndtw0\charscalex113 parteneriatui medic- pacient- familie.
Daca marile valenfe ale medicului de MG/MF Tn asistenfa preventive, \up0
\expndtw0\charscalex118 curativ-recuperativS si de predicfie sunt cunoscute, este
de recunoscut sub \up0 \expndtw0\charscalex117 acelea$i instanfe si rolul familiei.
in aceste rolun familia poate potenfa sau \up0 \expndtw0\charscalex112 ingradi
acfiunile medicului \par\pard\ql \li892\sb170\sl-253\slmult0 \up0
\expndtw0\charscalex103 \ul0\nosupersub\cf8\f9\fs22 Concluzii \par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 1. \tab \up0 \expndtw0\charscalex117 Medicina
psihosomatica esto importanta pentru practica medicale in \up0
\expndtw0\charscalex126 general si pentru medicul de familie Tn special pentru ce
evidenfiaze \up0 \expndtw0\charscalex121 unitatea organismului, revalonzeazS
personalitatea subiecfilor si terenul \up0 \expndtw0\charscalex115 reactiv. invie
la depistarea ccmponentei psihice Tn etiopatogenia bolilor \par\pard\qj
\li614\ri958\sb0\sl-240\slmult0\fi273 \up0 \expndtw0\charscalex124 2. in realitatea
practice cuplajul psihosomatic ca fenomon raspuntic \up0 \expndtw0\charscalex123
(punte cu raspantu la cele doua capete confluenfe, respectiv altenative)
releve intranle\tab \up0 \expndtw0\charscalex121 (agresiunea psihice, terenul
reactiv\tab \up0 \expndtw0\charscalex121 $i mediul familial\par\pard\li604\sb20\sl-
230\slmult0\fi9\tx1593\tx2601 \up0 \expndtw0\charscalex110 permisiv)\tab \up0
\expndtw-3\charscalex100 $' n=*sirile\tab \up0 \expndtw0\charscalex121 (entitafi
morbide aperute) s> pune in ecuafie cei trei\par\pard\li604\sb10\sl-
230\slmult0\fi96\tx2630\tx5784 \up0 \expndtw0\charscalex121 C" acice
creierul\tab \up0 \expndtw0\charscalex121 (receptor s* rezonator). corpul\tab
\up0 \expndtw0\charscalex121 (reactor, expozant sj\par\pard\li604\sb10\sl-
230\slmult0\fi4\tx3268 \up0 \expndtw0\charscalex121 solicitant) s'
comunitatea\tab \up0 \expndtw0\charscalex121 (care ingauuie. suporta, moduleaza S'
codifica\par\pard\li604\sb14\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex121
stresui- suferinfa).\par\pard\ql \li888\sb0\sl-228\slmult0\tx2798 \up0
\expndtw0\charscalex126 3. in cunoasterea \tab \up0 \expndtw0\charscalex126 $'
sepantrea prccesului psihosomatic medicul de \par\pard\ql \li614\sb11\sl-
230\slmult0\tx7195 \up0 \expndtw0\charscalex114 MG/MF, prin pozifla si ofertele
sale in sistemul medical al sanatafii \tab \up0 \expndtw0\charscalex108 (medi'j
\par\pard\qj \li600\ri969\sb22\sl-240\slmult0 \up0 \expndtw0\charscalex123 de pnm
contact, medic al continuitafii si integrarii, medicul personal al \up0
\expndtw0\charscalex126 pacientului. gate-keeper-ul sistemului), devine personajul
principal al \up0 \expndtw0\charscalex113 actiunii medicale.
psihosomatica generala $i apit�:.it.i\par\pard\qj \li1171\sb0\sl-240\slmult0
240\slmult0\fi292 \up0 \expndtw0\charscalex120 4. Abordarea psihosomatice
reprezinte pentru specialitatea MG/MF o \up0 \expndtw0\charscalex114 prime forme si
treapte de acfiune holistica. Modelul de refennfa al viitorului \up0
\expndtw0\charscalex114 va fi inse eel bio-psiho-socio-ecologic; acolo si atunci
empatia. eticul si eco\up0 \expndtw0\charscalex114 nomicul vor intra in hora
unirii. \par\pard\qj \li1175\ri383\sb20\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex117 5. Sunt necesare studii si conlrunteri care se clarifice
dezvoltarea rapor\up0 \expndtw0\charscalex117 tului psiche-soma ca nucleu al unei
medicinl antropologice, se se realizeze \up0 \expndtw0\charscalex115 o clasificare
taxonomice a patologiei psihosomatice si se se descifreze etio� \up0
\expndtw0\charscalex117 patogenia unor sindroame psihosomatice Insuficient
cunoscute (de exem� \up0 \expndtw0\charscalex118 plu: sindromul oboselii
cronice). \par\pard\ql \li1483\sb0\sl-230\slmult0 \par\pard\ql\li1483\sb19\sl-
230\slmult0 \up0 \expndtw0\charscalex119 Bibiiografie \par\pard\ql
\li1511\sb230\sl-230\slmult0\tx8011 \up0 \expndtw0\charscalex102 I. Athanasiu A.
Elemente de psihologie medicald. Ed. Medicald. Bucuresti. \tab \up0 \expndtw-
9\charscalex87 1973. \par\pard\qj \li1468\ri373\sb15\sl-200\slmult0\tx1684 \up0
\expndtw0\charscalex110 2 Busoi Gr. Bazele teoretice si practice ale medicinii
generale. in Medicina \line\tab \up0 \expndtw0\charscalex102 generald (sub red
Mann Voiculescu). Ed. Medicald, Bucuresti. \up0 \expndtw-9\charscalex90 1990.
3. Busoi Gr. Sdndtatea si patologia familiei. in: sdptdmdnalul Viata Medicala.
\line\tab \up0 \expndtw-4\charscalex100 1991. nr.38, 39 si 40.
Busoi Gr. Bolile psihosomatice\tab \up0 \expndtw0\charscalex108 $i medicina
generald, Revisla Medicald\par\pard\li1473\sb1\sl-216\slmult0\fi216 \up0
\expndtw0\charscalex108 Romdnd, 1997. nr. 1, 2-6.\par\pard\ql \li1473\sb2\sl-
205\slmult0\tx7588 \up0 \expndtw0\charscalex103 5. lamandescu IB. Stresui psihic si
bolile interne I. Ed. All. Bucuresti, \tab \up0 \expndtw-9\charscalex92 1993.
lamandescu IB. Psihologie medicala. Ed Infomedica, Bucuresti, \tab \up0 \expndtw-
9\charscalex91 1995. \par\pard\ql \li1492\ri368\sb10\sl-210\slmult0\tx1694 \up0
\expndtw0\charscalex105 7. lamandescu IB. Probleme de ordin psihosomatic in
cardiologte s< modalitdti \up0 \expndtw0\charscalex107 principiale de abordare
psihosomatica a bolnavilor cardio vasculari, Revista \line\tab \up0 \expndtw-
2\charscalex100 Medicald Romdnd. 1996. nr. 2-3, 55-60. \par\pard\ql
lonescu Aurelia Psihoiogia tamiliei. Normalitate si psihopatologie familiala. in
\line\tab \up0 \expndtw0\charscalex104 Psihologie ciinica (colectiv de redacfie. G
lonescu, M. Be/at. V. Pavelcu). Ed \line\tab \up0 \expndtw0\charscalex100 Academiei
R.S.R.. Bucuresti, \up0 \expndtw-9\charscalex90 1985. \par\pard\li1473\sb1\sl-
227\slmult0\fi0\tx6129 \up0 \expndtw0\charscalex106 9. lonescu G. Psihoterapia. Ed
Stiinfiticd, Bucuresti.\tab \up0 \expndtw0\charscalex106
Luban-Plozza B.. Pbldinger W. Krbger F. Boli psihosomatice in
practice\par\pard\li1473\sb1\sl-222\slmult0\fi302\tx4881 \up0
\expndtw0\charscalex105 medicald. Ed Medicald. Bucuresti.\tab \up0
\expndtw0\charscalex106 1996\par\pard\qj \li1516\ri273\sb0\sl-220\slmult0\tx1776
\up0 \expndtw0\charscalex102 II. Peseschkian N. Positive Family Therapy (The Family
as Therapist). Springer-\line\tab \up0 \expndtw-3\charscalex100 Verlag Berlin
Heidelberg New-York Tokyo, \up0 \expndtw-9\charscalex90 1986.
12. Sdhleanu V. Conceptii despre om in medicina contemporana. Ed. Dacia,
Cluj-\line\tab \up0 \expndtw0\charscalex100 Napoca. 1976. \par\pard\ql
\li1507\sb0\sl-180\slmult0 \up0 \expndtw0\charscalex100 13. Tudose F. Corpul in
psihiatrie (tezd de doctoral). Umversitatea de Medicind $i \par\pard\li1516\sb9\sl-
230\slmult0\fi264\tx4924 \up0 \expndtw0\charscalex102 Farmacie "Carol Davila",
Bucuresti.\tab \up0 \expndtw0\charscalex102 1996.\par\pard\li1516\sb0\sl-
207\slmult0\fi0\tx7886 \up0 \expndtw0\charscalex100 14 XXX \u9632? Dtctionar de
psihologie sociald. Ed. Stimfiftca si Enciclopedicd,\tab \up0
\expndtw0\charscalex103 15. XXX Health promotion research - Towards a new social
epidemiology (edited\par\pard\li1516\sb1\sl-209\slmult0\fi264 \up0
\expndtw0\charscalex102 by B.Badura and llona Kickbusch). WHO Regional Publications
European\par\pard\li1516\sb1\sl-223\slmult0\fi268\tx3038 \up0
\expndtw0\charscalex102 Series No 37\tab \up0 \expndtw0\charscalex102
\expndtw0\charscalex119 \ul0\nosupersub\cf8\f9\fs22 Capitolul 8 \par\pard\qj
\ul0\nosupersub\cf14\f15\fs24 ALGORITM DE INVESTIGATE PSIHOSOMATICA IN \up0
\expndtw-3\charscalex100 PEDIATRIE \par\pard\ql \li1166\sb0\sl-253\slmult0
\ul0\nosupersub\cf8\f9\fs22 Carmen Ciotu. LI liana Diaconescu \par\pard\ql
240\slmult0\tx6883 \up0 \expndtw0\charscalex104 "Nu existd nimic mai psihosomatic
decat copilul" \line\tab \up0 \expndtw0\charscalex105 Ajuriaguerra \par\pard\ql
\expndtw0\charscalex124 Premize teoretice \par\pard\qj \li849\ri688\sb182\sl-
236\slmult0\fi292 \up0 \expndtw0\charscalex112 Tratatele de psihosomatice, fie ele
clasice sau actuae, mentioneaze o \up0 \expndtw0\charscalex104 serie de reguli
privind abordarea psihosomalice a bolnavilor, valabile in spe� \up0
\expndtw0\charscalex110 cial pentru adulfi. referirile asupra evaluani in plan
psihologie a copilului \up0 \expndtw0\charscalex106 bolnav fiind concentrate (dace
sunt luate in considerate !) Tn capitole sepa� \up0 \expndtw0\charscalex114 rate. O
astfel de "tratare" a aeestei probleme deosebit de complexe are, \up0
\expndtw0\charscalex109 inse. justificarile sale pe care vom incerca se le
Tmperesim Tn cele ce ur� \up0 \expndtw0\charscalex109 meaze. \par\pard\qj
\li844\ri698\sb0\sl-260\slmult0\fi287 \up0 \expndtw0\charscalex106 Complexitatea s'
parttcuiaritafile abordehi psihosomatice a copilului sunt \up0
\expndtw0\charscalex106 determinate de o varietate de factori: \par\pard\ql
\li1142\sb0\sl-198\slmult0 \up0 \expndtw0\charscalex107 - copilul este un organism
in crestere ce prezinte modificeri dinamice; \par\pard\qj \li844\ri694\sb33\sl-
\expndtw0\charscalex116 prezenfa patologiei pe un astfel de teren aflat Tn rapid
proces de \up0 \expndtw0\charscalex113 crestere si dezvoltare se repercuteaze.
uneori ireversibil, asupra intregii \up0 \expndtw0\charscalex104 dezvoltari psihice
a copilului: \par\pard\qj \li849\ri693\sb28\sl-233\slmult0\fi292\tx1329 \up0
\expndtw-3\charscalex100 -\tab \up0 \expndtw0\charscalex115 legetura dintre
dezvoltarea somatice sj psihice esle foarte stransS \up0 \expndtw0\charscalex113
(afecfiunile somatice se Tnsotesc de Tncetinin sau opriri ale dezvoltarii \up0
\expndtw0\charscalex122 psihice. tulburarile psihice sunt, mult mai pregnant decat
la adult, \up0 \expndtw0\charscalex103 TntovSrSsite sau reflectate de tulburSri
somatice); \par\pard\ql \li849\ri693\sb2\sl-240\slmult0\fi292\tx1281 \up0
\expndtw0\charscalex105 - boala psihosomaticS a copilului este definita dupS
Pinkerton prin triada: \up0 \expndtw0\charscalex106 profil personal; contribufie
parentalS; stresuri emofionale, deseori banale. \line\tab \up0
\expndtw0\charscalex107 stadiul dezvoltarii psihoafective si mintale a copilului
este important in \up0 \expndtw0\charscalex107 momentul impactului cu factorul care
decianseazS boala psihosomaticS; \par\pard\qj \li854\ri693\sb9\sl-230\slmult0\fi283
\up0 \expndtw0\charscalex111 - cu cat copilul este mai mic, cu atat sunt mai
exprimate modificSrile \up0 \expndtw0\charscalex110 psihosomatice (vezi sugarul
care reactioneazS "primar" la stimuli simpli: \up0 \expndtw-1\charscalex100 luminS,
zgomot); \par\pard\qj \li844\ri680\sb2\sl-240\slmult0\fi297 \up0
\expndtw0\charscalex112 - prezenfa particulahtSfilor psihice, neurologice si
somatice specifice \up0 \expndtw0\charscalex104 diferitelor etape de vSrsta
conditioneazS modul si cSile de abordare terapeu� \up0 \expndtw-6\charscalex100
ticS; \par\pard\sect\sectd\fs24\paperw8940\paperh13220{\bkmkstart Pg323}{\bkmkend
\expndtw0\charscalex105 \u9830?\tab \up0 \expndtw0\charscalex105 Eiomente de
psihosomaticd gonerala si aplicata\par\pard\qj \li1031\sb0\sl-250\slmult0
\expndtw0\charscalex130 statutul socio-familial plaseazS copiiul intr-o posturS de
totals \up0 \expndtw0\charscalex115 dependenfa afective si materiae, iar familia
apare Tn pcstura de intermediar \up0 \expndtw0\charscalex115 intre medic si bolnav;
medicul pediatru trebuie sa obfine o relafie psihologica cu copilul s' \up0
\expndtw0\charscalex121 increderea acestuia, iar pentru verstele mici, mai
Important este o relafie \up0 \expndtw0\charscalex117 pozitiva cu familia
copilului, respectiv mama sau persoana care Tngrijeste \up0 \expndtw0\charscalex118
copilul, care devine o sursS de informafii esentiae pentru diagnostic: (date
\up0 \expndtw0\charscalex112 complete de anamnezS. tulburSri de comportament,
etc.). Modul Tn care sunt \up0 \expndtw0\charscalex123 relatate suferinfele
copilului \up0 \expndtw0\charscalex128 (empatic, indiferent, cu note personals)
constituie elemente suplimentare pentru diagnostic. Convorbirea cu pahnfii \up0
\expndtw0\charscalex124 evidenfiazS familnle hiperprotectoare, familiile cu nivel
socio cultural \up0 \expndtw0\charscalex115 scSzut. elemente care si-au pus
amprenta asupra dezvoltSrii socio-cogmtiva \up0 \expndtw0\charscalex116 sau
comportamentalS a copilului \up0 \expndtw0\charscalex114 ("sindromul Munchausen pnn
inlocuitor" \par\pard\qj \li1031\ri527\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex119 caractehzat prin aceea cS mama - prezentand o atitudine
hiperprotectoare \up0 \expndtw0\charscalex114 Si o autoritate patologicS - solicits
un numSr enorm de consultatii medicale, \up0 \expndtw0\charscalex114 desi copilul
este normal dezvoltat fizic, intelectual si sexual). \par\pard\qj
\li1041\ri522\sb4\sl-230\slmult0\fi288 \up0 \expndtw0\charscalex112 Once examen
psihologie va f i precedat de examen pediatnc complex care \up0
\expndtw0\charscalex119 sS evalueze sufehntele organice ale copilului. eventuae
incadrare Tntr-un \up0 \expndtw0\charscalex119 sindrom genetic, etc.
Anamneza, pe langS elementele medicale propriu-zise treouie sa aibS \up0
\expndtw0\charscalex110 in vedere: \par\pard\ql \li1036\sb0\sl-245\slmult0
\par\pard\ql\li1036\ri551\sb148\sl-245\slmult0\fi297 \up0 \expndtw0\charscalex124
I. Antecedente personate fiziologice - cu implicafii psihologice si \up0
\expndtw0\charscalex113 psihosomatice in cadrul cSrora o importanfS maximS o are
dezvoltarea \line \up0 \expndtw0\charscalex116 neuropsihicS si comportamentalS a
copilului, definie de H Ey ca proces de \up0 \expndtw0\charscalex114 metamorfozS a
nou-nascutului subordonat principiuiui placehi in adultul \up0
\expndtw0\charscalex114 care asculta de imperativelo realului si rafiunii
\par\pard\ql \li1334\sb168\sl-230\slmult0 \up0 \expndtw0\charscalex119 Dezvoltarea
neuropsihicS si comportamentalS cuprinde: \par\pard\qj \li1041\sb0\sl-
\expndtw0\charscalex118 1. Dezvoltarea motorio. Trebuie subliniat cS dezvoltarea
copilului este \up0 \expndtw0\charscalex116 progresiva, avand caracterele unei
splrale. Noile achizifii s^ dSdesc pe ceie \up0 \expndtw0\charscalex128
preexistente in perioadele de boae sau stress se remarcS regresiunea \up0
\expndtw0\charscalex114 temporare a performanfelor motoni $i sociale.
2. Dezvoltarea cognitiva. Aceasta include procesele meniale sau \up0
\expndtw0\charscalex118 operattonale prin care sugarul devine constient de
existenta obientelor din \up0 \expndtw0\charscalex125 mediu. Procesele cognitive
includ percepfia. rationameniul, judecata, \up0 \expndtw0\charscalex114 memoria.
Conform lui Jean Piaget. dezvoltarea cognitive cuprindo: perioada \up0
\expndtw0\charscalex125 senzoh-motorie. stadiul de dezvoitare preoperafional,
etapa de gandle \up0 \expndtw0\charscalex119 concret operafionae. Majoritatea
comportamentelor copiilor dupe nastere \up0 \expndtw0\charscalex113 sunt innescute,
dar ele pot fi modificate prin stimuli din mediul inconjurStor. \up0
\expndtw0\charscalex123 Dezvoltarea cognitiva este influenlata de factori
biologici, psihologici, \up0 \expndtw0\charscalex125 sociali. medicali, de mediu,
aflafi Tntr-o stransa interdepondentS. S-a \up0 \expndtw0\charscalex114 observat c6
tactorii nebiologici au un rol preponderent daca sistemul nervos
Psihosomatica aplicats\tab \up0 \expndtw0\charscalex116 \u9830? 323\par\pard\ql
\par\pard\ql\li724\sb151\sl-230\slmult0\tx7233 \up0 \expndtw0\charscalex126 nu este
grav afectat. Dintre tofi, decisiv este factorul familial \tab \up0
\expndtw0\charscalex103 (nivelul \par\pard\qj \li720\ri852\sb19\sl-244\slmult0 \up0
\expndtw0\charscalex116 educativ al mamei starea ei maritae. nivelul economic $i
cultural, stresurile \up0 \expndtw0\charscalex111 familiale). Astfel. in cazul unui
deficit al funcjiei cognitive a copilului, trebuie \up0 \expndtw0\charscalex129
luae in considerare existenfa unor factori de rise in familie, frecvent \up0
\expndtw0\charscalex117 incriminandu-se o comunicare defectuoase parinfi-copii, o
substimulare in \up0 \expndtw0\charscalex120 cadrul interaefmnii parinfi-copn.
separarea temporare sau indelungata de \up0 \expndtw0\charscalex107 parinfi.
3. Inteligenfa. in determinismul inteligenfei copilului trebuie inclusi \up0
\expndtw0\charscalex114 factorii genebci \up0 \expndtw0\charscalex116
(determinanfi) si factorii de mediu. Unele studii au stabilit \par\pard\qj
\li720\ri852\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex115 existenfa unei
corelafii intre comportamentul mamei si inteligenfa copilului \up0
\expndtw0\charscalex124 (oslilitatea mamei In prima copierie se coreleaze cu un
nivel scSzut de \up0 \expndtw0\charscalex114 inteligenfa a copilului ajuns la
varsta adulta) \par\pard\qj \li715\ri848\sb120\sl-240\slmult0\fi292 \up0
\expndtw0\charscalex124 4. Comportamentul prosocial si sociallzarea. Primele
relafii sociale \up0 \expndtw0\charscalex118 apar la varsta de trei tun. OdatS cu
aparifia vorbirii Tncepe si socializarea \up0 \expndtw0\charscalex116 copilului
Socializarea este un proces pnn care un individ devine membru al \up0
\expndtw0\charscalex122 unui grup social: familie, comunitate. Pentru a fi acceptat
ca membru al \up0 \expndtw0\charscalex115 grupului, el trebuie se cunoasce
obiceiurile, atttudinile, donnfele, valorile si \up0 \expndtw0\charscalex118
expectanfeie grupului. Copilul incepe sa infeieage ce asteapte familia (sau \up0
\expndtw0\charscalex115 comunitatea) de la el, cum se-$i controleze reacfiile
agresive concordant cu \up0 \expndtw0\charscalex118 normele de convtefuire sociale.
in timpul procesului de sociahzare copilul \up0 \expndtw0\charscalex127 invafa
normele de comportare in societate, rolurile sociale, sensuhle \up0
\expndtw0\charscalex119 ritualurilor, autocontrolul sj autostima. in socializare un
rol important au: \up0 \expndtw0\charscalex106 parinfii \up0
\expndtw0\charscalex119 (ca modelul social eel mai apropiat de urmat), relafiile cu
ceilalfi \up0 \expndtw0\charscalex113 copii. jocul. televiziunea. \par\pard\qj
\li720\ri843\sb120\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex122 5. Dezvoltarea
afectivitSfii. Procesele afective se refers la: anxietate, \up0
\expndtw0\charscalex119 depresie, frica. gelozie. bucurie, amplitudinea emofiilor
La nastere. exists \up0 \expndtw0\charscalex121 circuito neuronale performate care
controleazS emofiile. Esential pentru \up0 \expndtw0\charscalex122 atectivitate
este primirea unui rSspuns \up0 \expndtw0\charscalex118 (feed-back) din partea
Interlocu-\par\pard\qj \li715\ri833\sb0\sl-240\slmult0\fi4 \up0
\expndtw0\charscalex116 torulul. existenfa unei stSri emofionale reciproce si rolul
modelului matern \up0 \expndtw0\charscalex125 Dezvoltarea afectivitSfii depinde de:
atitudinea empaticS a pSrinfilor. \up0 \expndtw0\charscalex117 calmul/descSrcanle
emofionale necontrolate ale pennfilor, stresui familial. \up0
\expndtw0\charscalex116 Nevoia de alecfiune este una dintre trebuinfele umane ce
trebuie satisfecute \up0 \expndtw0\charscalex116 (asa cum reznle din piramida
trebuinfeior prezentate de A.Maslow) \par\pard\qj \li720\ri833\sb125\sl-
235\slmult0\fi288 \up0 \expndtw0\charscalex116 6. Achizifia lingvlstlca.
Dezvoltarea vorbirii este o dovade de dezvoltare \up0 \expndtw0\charscalex123
cognitive, iar prin comunicare infiuenfeaze inserfia sociae. Capacitatea \up0
\expndtw0\charscalex118 copilului de a vorbl apare in jurul varstei de un an.
Dezvoltarea vorbirii se \up0 \expndtw0\charscalex114 face in legetura cu factorii
de mediu (de exemplu, copiil ce provin din medii \up0 \expndtw0\charscalex114
sociale precare vor utiliza un limbaj sArac, neexpresiv) \par\pard\li720\sb137\sl-
\expndtw0\charscalex127 Jocul Exprime stadiul de dezvoltare fizice, cognitive s'
psiho-\par\pard\li720\sb14\sl-230\slmult0\fi0 \up0 \expndtw0\charscalex127
emofionaie.\par\pard\qj \li729\ri849\sb111\sl-240\slmult0\fi278 \up0
\expndtw0\charscalex121 De subhniat este faptul ce atat factorii biologici cat si
cei psihosociali \up0 \expndtw0\charscalex126 reprezinta in egae masure factori de
rise pentru dezvoltarea copilului \up0 \expndtw0\charscalex102 (Tabelul nr. I)
Tabelul nr. 1. Fectorll de rise pentru dezvoltarea copilului \up0
\expndtw0\charscalex120 (reprodus partial dupa Buddeberg-Flscher und Buddeberg)
230\slmult0\fi4\tx5654 \up0 \expndtw0\charscalex104 FACTORI DE RISC\tab \up0
\expndtw0\charscalex104 EXEMPLE\par\pard\li1574\sb72\sl-230\slmult0\fi4 \up0
Biologici:\par\pard\sect\sectd\sbknone\cols2\colno1\colw5095\colsr160\colno2\colw35
45\colsr160\ql \li1574\sb63\sl-230\slmult0 \up0 \expndtw0\charscalex116 Dispozitia
genetica\par\pard\qj \li1574\ri1826\sb256\sl-292\slmult0 \up0
\expndtw0\charscalex115 Leziuni prenalale \up0 \expndtw0\charscalex120
Pennatale\par\pard\qj \li1579\ri2327\sb242\sl-302\slmult0 \up0
\expndtw0\charscalex117 Postnatale \line \up0 \expndtw0\charscalex114
Psihosociali\par\pard\ql \li1574\sb0\sl-230\slmult0 \par\pard\ql \li1574\sb118\sl-
230\slmult0 \up0 \expndtw0\charscalex115 Boala psihice in familu\par\pard\qj
\expndtw0\charscalex116 Condifii educafionale inadecvate \up0
\expndtw0\charscalex117 lipsa de experienfa a mamei\par\pard\qj
\li1574\ri506\sb46\sl-249\slmult0\fi4 \up0 \expndtw0\charscalex120 Factor stress
prin indepertarea \up0 \expndtw0\charscalex113 din familie\par\pard\ql
\li1583\sb60\sl-230\slmult0 \up0 \expndtw0\charscalex117 Factori stresanfi
sociali\par\pard\column \qj \li25\ri497\sb50\sl-240\slmult0 \up0
\expndtw0\charscalex116 Diabet zaharat, boli autoimune, \up0
\expndtw0\charscalex118 schizolrenie, depresie\par\pard\ql \li30\sb66\sl-
230\slmult0 \up0 \expndtw0\charscalex113 Infecfii materne\par\pard\qj
\li20\ri996\sb69\sl-235\slmult0 \up0 \expndtw0\charscalex116 Complicafii
obstetncale la \up0 \expndtw0\charscalex119 nastere\par\pard\ql \li35\sb68\sl-
230\slmult0 \up0 \expndtw0\charscalex119 Hemoragn cerebrae\par\pard\ql
\li5260\sb0\sl-268\slmult0 \par\pard\ql \li25\ri572\sb61\sl-268\slmult0 \up0
\expndtw0\charscalex116 Conflicte, abuzun corporale \up0 \expndtw0\charscalex114
Tulbureri comportamentale ale \up0 \expndtw0\charscalex108 parinfilor.
frafilor\par\pard\ql \li30\sb71\sl-230\slmult0 \up0 \expndtw0\charscalex114
Hiperprotecfie, respingere.\par\pard\qj \li5270\sb0\sl-240\slmult0 \par\pard\qj
\li40\ri785\sb55\sl-240\slmult0\tx112 \up0 \expndtw0\charscalex114 Internal sau
orlelinat, familii \line\tab \up0 \expndtw0\charscalex112 adoptive\par\pard\ql
\li35\sb71\sl-230\slmult0 \up0 \expndtw0\charscalex115 Discnminare, migrafie
\par\pard\qj\li1608\ri3486\sb243\sl-440\slmult0 \up0 \expndtw0\charscalex133 II.
Antecedente heredo-colaterale \up0 \expndtw0\charscalex123 Se refers e:
220\slmult0\fi297 \up0 \expndtw0\charscalex119 e starea sanatafii mamei inainte sau
in timpul sarcinii. varsta mamei la \up0 \expndtw0\charscalex119 nasterea
copilului. boli ale mamei debutate postnatal \par\pard\ql \li1622\sb152\sl-
230\slmult0 \up0 \expndtw0\charscalex121 \u8226? starea sanatafii tatelui
\expndtw0\charscalex119 \u8226? existenta unor boli in familie (tuberculoza.
luessul, starea de purtetor \up0 \expndtw0\charscalex111 de AgHBs a mamei)
existenfa unor boli psihice Tn lamilie (schizofreniaj \par\pard\ql
\li1636\sb130\sl-230\slmult0 \up0 \expndtw0\charscalex115 \u8226?
existenfa unor boli cu transmitere genetice in randul Irafilor, rudelor
Toate acestea sunt de importanfe extreme pentru diagnosticul si \up0
\expndtw0\charscalex118 incadrarea bolnavului. in special bolile psihice si cele
genetice, chiar dace \up0 \expndtw0\charscalex125 nu sunt manifeslate la copii,
inlluenteazS psihicul acesluia \up0 \expndtw0\charscalex126 (ce poate
\par\pard\qj \li1368\ri244\sb0\sl-260\slmult0 \up0 \expndtw0\charscalex134 prezenta
o fragilitate emofionalS) sau pot determina ulterior boli \up0
\expndtw0\charscalex112 psihosomatice.
\expndtw-8\charscalex82 \u8226?>\tab \up0 \expndtw0\charscalex112
\expndtw0\charscalex130 \ul0\nosupersub\cf9\f10\fs20 III. Cadrul
familial\par\pard\li955\sb0\sl-230\slmult0\par\pard\li955\sb126\sl-
230\slmult0\fi307 \up0 \expndtw0\charscalex117 De mare insemnstate sunt s>
aspectele legate de familie:\par\pard\li955\sb0\sl-
230\slmult0\par\pard\li955\sb25\sl-230\slmult0\fi321\tx1593 \up0 \expndtw-
9\charscalex87 1.\tab \up0 \expndtw0\charscalex141 Calitatea viefii de familie este
influenfats de factori ce au\par\pard\li955\sb10\sl-230\slmult0\fi9 \up0
\expndtw0\charscalex115 repercusiunt asupra dezvoltarii copilului:\par\pard\ql
\li1257\sb3\sl-230\slmult0 \up0 \expndtw0\charscalex113 a) Nivel maerial
(economic). \par\pard\ql \li1703\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 -
stresui unor fmanfe insuficiente=sursS de instabilitate a familiei; \par\pard\qj
\li1699\ri608\sb0\sl-260\slmult0 \up0 \expndtw0\charscalex120 - aparifia unui copii
scade standardul economic al unei familii cu \up0 \expndtw0\charscalex121 resurse
financiare limitate \par\pard\ql \li1257\sb1\sl-218\slmult0 \up0
\expndtw0\charscalex110 b) Nivel intelectual \par\pard\ql \li1252\sb13\sl-
230\slmult0 \up0 \expndtw0\charscalex109 c) Nivel cultural \par\pard\ql
\li1257\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex115 d) Nivel de educafie
sanitara \par\pard\qj \li974\ri598\sb0\sl-260\slmult0\fi273 \up0
\expndtw0\charscalex123 Ambu parinfi exercite influenfe asupra copilului. dar mama
rSmane \up0 \expndtw0\charscalex116 penntele crucial \par\pard\ql \li1252\sb0\sl-
230\slmult0 \par\pard\ql\li1252\sb1\sl-230\slmult0 \up0 \expndtw0\charscalex120 2.
Echilibrul. stabilitatea familiei se refers la urmetoarele aspecte: \par\pard\ql
\li1252\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 a) situafii
conflictuale \par\pard\ql \li1252\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114
b) familii dezorganizate \par\pard\ql \li1252\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex110 c) divorful pehnfilor \par\pard\ql \li1243\sb30\sl-
230\slmult0 \up0 \expndtw0\charscalex116 d> boala cronice a unui pennte sau
frate \par\pard\ql \li1252\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 e) boh
psihice in familie \par\pard\ql \li1252\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex115 f) decesul unuia din pennfi sau a unui copii
Toate aceste situafii afecteaze echilibrul familiei. ceea ce va determina \up0
\expndtw0\charscalex116 afectarea emotionale a copilului \up0
\expndtw0\charscalex118 (in functie de vulnerabilitatea acestuia la \par\pard\ql
\li969\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex117 stress). \par\pard\ql
\expndtw0\charscalex120 3 interacfiunile din cadrul familiei: \par\pard\ql
\expndtw0\charscalex118 a) Relafia copil-familie. \par\pard\qj \li964\ri609\sb2\sl-
240\slmult0\fi292 \up0 \expndtw0\charscalex134 Este o relafie in dublu sens familia
inlluenfeaze dezvoltarea si \up0 \expndtw0\charscalex117 comportamentul copilului,
iar copilul influenteaze familia \up0 \expndtw0\charscalex120 (nasterea unui
\par\pard\qj \li960\ri598\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex122 copii.
schimbarile intervenite in viafa acestuia. conouc la restructurarea \up0
\expndtw0\charscalex113 activitafii familiei). Din acest motiv examinarea copilului
trebuie efectuate in \up0 \expndtw0\charscalex113 corelafie cu datele familiei si
nu ca un caz izolat. \par\pard\ql \li1252\sb0\sl-230\slmult0
\par\pard\ql\li1252\sb39\sl-230\slmult0 \up0 \expndtw0\charscalex118 b) Relafia
copii bolnav-familie: \par\pard\qj \li955\ri598\sb2\sl-240\slmult0\fi302 \up0
\expndtw0\charscalex119 Boae cronicS a copilului produce stress emofional. social
si economic \up0 \expndtw0\charscalex117 asupra familiei (in special asupra mamei).
Boala cronicS afecteazS copilul \up0 \expndtw0\charscalex117 pentru perioade
indelungate de timp (uneori pentru toae viafa). ceea ce are \up0
\expndtw0\charscalex120 consecinfe asupra interacfiunn cu mediul fizic si social,
mama si familia, \up0 \expndtw0\charscalex130 coieg.i de scoais. Boala copilului
are implicafii Tn liecare etapS de \up0 \expndtw0\charscalex135 dezvoltare
cognitivS si psihosociala. Efectele sunt diferite, dupS \up0
\expndtw0\charscalex118 temperamenlul copilului, suportul psihologie oferit de
familie, intervenfia \up0 \expndtw0\charscalex118 medicae s' asistenfa sociaia.
vSrsta de debut a afecfiunii. Boala cronicS
psihosomaticS generae si aplicats\par\pard\ql \li1219\sb0\sl-230\slmult0
230\slmult0\tx7003 \up0 \expndtw0\charscalex117 afecteazS legStura cu mediul si
interacfiunea pSnnfi copii \tab \up0 \expndtw0\charscalex122 (aceasta poate
\par\pard\qj \li1214\ri349\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex122 evolua
pe o scae large, pornind de 1a hiperprotecfie pane la rejecfie sau \up0
\expndtw0\charscalex122 abandonare psihice). \par\pard\ql \li1502\sb229\sl-
230\slmult0 \up0 \expndtw0\charscalex119 4. Tipul de dominare parentalS:
\par\pard\qj \li1224\ri343\sb2\sl-240\slmult0\fi287 \up0 \expndtw0\charscalex133 a)
parinfn autoritari combine autoritatea s' fermitatea Tn luarea \up0
\expndtw0\charscalex137 hotaranlor cu o modalitate de relafie cu copilul cSruia ii
cultivS \up0 \expndtw0\charscalex115 independenfa si recunoasterea drepturilor
\par\pard\qj \li1214\ri349\sb0\sl-240\slmult0\fi302 \up0 \expndtw0\charscalex113 hi
parinfii hiperprotectori. Supraprotecfia parentalS apare in cazurile unui \up0
\expndtw0\charscalex121 contact excesiv intre mamS si copii, la vSrsta la care ar
fi trebuit sa se fl \up0 \expndtw0\charscalex126 instalat relativa lui
independents. Hiperprotecfia parentalS din timpul \up0 \expndtw0\charscalex119
copieriei genereazS lipsa de eficienfS si competitivitate socials, tulburSri
\up0 \expndtw0\charscalex119 emofionale si sexuale la varsta adults.
\par\pard\qj \li1219\ri344\sb0\sl-240\slmult0\fi283 \up0 \expndtw0\charscalex128 c)
parinfn induigenfi nu reusesc sS controleze adecvat activitatea \up0
\expndtw0\charscalex115 copilului, accepte si se supun fere discernemSnt cererilor
lui. Reprezinte un \up0 \expndtw0\charscalex127 aspect disruptiv al relafiei
parinfi-copii si survine in situafii familiale \up0 \expndtw0\charscalex114
disarmonice. \par\pard\qj \li1214\ri344\sb5\sl-235\slmult0\fi292 \up0
\expndtw0\charscalex117 d) pehnfii severi nu lase initiative copilului S'-l oblige
se se supune fere \up0 \expndtw0\charscalex131 comentarii unor mastin educative
aspre. Agresiunea parentale este \up0 \expndtw0\charscalex120 consecinta
frustrarilor repetate Tn viafa conjugae sau la locul de muncS. \up0
\expndtw0\charscalex114 MSsurile de severitate excesivS conduc la creserea
agresivitSfii si ostilitSfii \up0 \expndtw0\charscalex114 copilului, producand
tensiuni si conflicte parinfi-copii. \par\pard\qj \li1219\ri343\sb1\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex136 e) pSrmfii agresivi provin din
randul indivizilor cu expenenfe \up0 \expndtw0\charscalex126 dezastruoase in timpul
copieriei. care au situafii tensionate in familie. \up0 \expndtw0\charscalex129
neincadraft social. Un copii agresat sexual sau victims a unui incest \up0
\expndtw0\charscalex115 prezintS acuze psihosomatice sau tulbureri de comportament.
\par\pard\qj \li1219\ri353\sb240\sl-240\slmult0\fi297\tx1833 \up0 \expndtw-
8\charscalex100 5. \tab \up0 \expndtw0\charscalex132 Problemele psihologice cu rol
determinant asupra psihicului \up0 \expndtw0\charscalex118 copilului. avand si
implicafii Tn patogenezS. \par\pard\qj \li1214\ri345\sb0\sl-240\slmult0\fi302
\up0 \expndtw0\charscalex109 Redem Clasilicarea DSM IV, axul IV privind problemele
copilului in cadrul \up0 \expndtw0\charscalex109 disfuncfiilor familiale:
\par\pard\ql \li1511\sb9\sl-230\slmult0\tx4948 \up0 \expndtw0\charscalex117 -
decesul unui membru al familiei \tab \up0 \expndtw0\charscalex118 (tata, mama),
probleme de sSnState \par\pard\ql \li1219\sb10\sl-230\slmult0\tx6710 \up0
\expndtw0\charscalex117 fizicS sau mentals in cadrul familiei, disrupfii
familiale \tab \up0 \expndtw0\charscalex114 (separare, divorf). \par\pard\qj
\li1224\ri333\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex122 pierderea
mediului de familie, recasStonrea unui pSrinte rSmas smgur. \up0
\expndtw0\charscalex120 supraprotecfie familiala, abuz sexual, neglijarea
copilului, dezacord intre \up0 \expndtw0\charscalex103 frafi.
\par\pard\li1243\sb1\sl-230\slmult0\fi283\tx1689 \up0 \expndtw0\charscalex118 -\tab
\up0 \expndtw0\charscalex118 Probleme educafionale: dificultSfi scoiare, conflicte
la scoalS, mediu\par\pard\li1243\sb15\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex118 inadecvat pentru educafie corectS\par\pard\qj
\li1238\ri344\sb0\sl-240\slmult0\fi278 \up0 \expndtw0\charscalex119 - Probleme
economice: sSrScie extrems, resurse financlare putine sau \up0
\expndtw0\charscalex120 rSu distribute, cheltuieli inadecvate resurselor
llmitate. \par\pard\ql \li1526\sb156\sl-230\slmult0 \up0 \expndtw0\charscalex128
IV. Anomalia relafiei parinti-copii \par\pard\ql \li1536\sb170\sl-230\slmult0
\up0 \expndtw0\charscalex118 Este determinae de trei mari categorii de cauze:
\par\pard\li1262\sb0\sl-230\slmult0\par\pard\li1262\sb8\sl-230\slmult0\fi283\tx5558
\up0 \expndtw0\charscalex132 a) Patologia relafionala familiala\tab \up0
\expndtw0\charscalex132 (familia dezorganizatS sau\par\pard\li1262\sb1\sl-
dlzarmonicS);\par\pard\sect\sectd\fs24\paperw8940\paperh13220{\bkmkstart Pg328}
\up0 \expndtw0\charscalex115 \ul0\nosupersub\cf9\f10\fs20 Situafiile nevrotigene
(cauzatoare de stress); \par\pard\qj \li1128\ri2188\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex114 Familii cu parinfi hiperprotectori sau parinfi foarte
seven, \up0 \expndtw0\charscalex115 Esecun scolare repetate. \par\pard\qj
\li835\ri762\sb0\sl-220\slmult0\fi292 \up0 \expndtw0\charscalex129 b)
Particularitafile psihice s1 somatice nefavorabile ale copilului \up0
\expndtw0\charscalex114 (handicap fizic sau mental); \par\pard\qj
\li1118\ri796\sb16\sl-200\slmult0\fi4 \up0 \expndtw0\charscalex114 Sindromul
psihoorganic cronic (instabilitate, agresivitate, impulsivitate); \up0
\expndtw0\charscalex114 Copii dilictli, greu de educat. \par\pard\qj
\li830\ri747\sb24\sl-220\slmult0\fi287 \up0 \expndtw0\charscalex123 c) Disfuncfia
parentalS, determinate de: complexe de interiohtate la \up0 \expndtw0\charscalex122
locul de munca sau Tn familie. frustrare, ostilitate, situafii conflictuale,
\up0 \expndtw0\charscalex113 anxieiate. \par\pard\qj \li825\ri737\sb0\sl-
220\slmult0\fi288 \up0 \expndtw0\charscalex120 Anomalia relafiei pShnfi-copii se
traduce clinic printr-un complex de \up0 \expndtw0\charscalex135 simptome ce apar
in cadrul bolilor somatice sau a tulburarilor de \up0 \expndtw0\charscalex113
comportament \par\pard\ql \li1132\sb2\sl-218\slmult0\tx7276 \up0
\expndtw0\charscalex126 1) Malnutrlfia s\\ intarzierea cresterii de cauza
neorganlcS \tab \up0 \expndtw0\charscalex112 (nanism \par\pard\qj
\li825\ri743\sb21\sl-220\slmult0\fi9 \up0 \expndtw0\charscalex122 psihosocial) sunt
determinate de neglijarea psihologicS a copilului si de \up0
\expndtw0\charscalex113 deprivarea emotionalS. \par\pard\qj \li825\ri753\sb20\sl-
220\slmult0\fi292 \up0 \expndtw0\charscalex118 2) Disfuncfii psihice: dificultafi
de TnvSfare, tulburSri de comunicare, \up0 \expndtw0\charscalex114 tulburSri de
comportament (sindronmul tulburSrii de atenfie, hiperactivitate, \up0
\expndtw0\charscalex114 comportament agresiv) \par\pard\li830\sb9\sl-
230\slmult0\fi278\tx4094 \up0 \expndtw0\charscalex123 3) Tulburari
psihosomatice\tab \up0 \expndtw0\charscalex123 ("somatizarea" unor suferinfe din
sfera\par\pard\li830\sb0\sl-230\slmult0\fi4 \up0 \expndtw0\charscalex123
psihica)\par\pard\li830\sb1\sl-225\slmult0\fi287 \up0 \expndtw0\charscalex124 a)
prophu-zise: discordanta dintre "severitatea" simptomatologiei, pe
de\par\pard\li830\sb1\sl-214\slmult0\fi0 \up0 \expndtw0\charscalex123 o parte, si
saracia modificarilor obiective clinice si normalitatea\par\pard\li830\sb1\sl-
222\slmult0\fi14 \up0 \expndtw0\charscalex123 investigafiilor de laborator. pe de
alta parte.\par\pard\li830\sb1\sl-225\slmult0\fi287 \up0 \expndtw0\charscalex123 b)
nediferenfiate- oboseae, lipsS de apetit, suferinfe
digestive\par\pard\li830\sb1\sl-220\slmult0\fi412\tx1449\tx7752 \up0
\expndtw0\charscalex120 i\tab \up0 \expndtw0\charscalex123 tulburari de conversie:
simptomatologie "pseudoneurologice"\tab \up0 \expndtw0\charscalex123
(ca\par\pard\li830\sb1\sl-227\slmult0\fi0 \up0 \expndtw0\charscalex123 rezolvare
simbolice a unui conflict psihologie inconstient)\par\pard\li830\sb1\sl-
230\slmult0\fi283 \up0 \expndtw0\charscalex123 d) durerile
neorganice.\par\pard\li830\sb1\sl-225\slmult0\fi287\tx1463 \up0
\expndtw0\charscalex123 4.\tab \up0 \expndtw0\charscalex123 Tulburarile ingestiei
de alimente ruminafie, pica, anorexia\par\pard\li830\sb6\sl-230\slmult0\fi4 \up0
\expndtw0\charscalex123 nervoasa. bulimia nervoase\par\pard\ql \li1108\sb1\sl-
202\slmult0 \up0 \expndtw0\charscalex120 5. Tulburari de eliminare si continenfa
sfincterianS: \par\pard\qj \li830\ri732\sb0\sl-224\slmult0\fi283 \up0
\expndtw0\charscalex118 a) enurezisui functional este favorizat de existenfa
pSrinfilor hiperpro� \up0 \expndtw0\charscalex127 tectori sau foarte seven,
situafiile familiale conflictuale, separarea pe \up0 \expndtw0\charscalex122 termen
lung. Este un mod de reactie considerat ca inacceptabil social si \up0
\expndtw0\charscalex124 creeazS marl complexe de inleriontate copilului Importanta
lactorului \up0 \expndtw0\charscalex118 psihogen este demonstrae de procentul
ridicat de copii enuretici intalnit in \up0 \expndtw0\charscalex111 randul copiilor
institutionalizafi \par\pard\qj \li830\ri738\sb0\sl-230\slmult0\fi292 \up0
\expndtw0\charscalex113 tO encoprezisul nu este exclusiv o tulburare de
comportament la copiii cu \up0 \expndtw0\charscalex125 opozifionism ce isi
"pedepsesc'" astfel pSrinfii, ci trebuie corelat si cu \up0 \expndtw0\charscalex114
existenfa consttpatiei cronice functionale \par\pard\qj \li835\ri716\sb0\sl-
230\slmult0\fi283\tx1478 \up0 \expndtw-9\charscalex90 r. \tab \up0
\expndtw0\charscalex134 Tulburarile somnului trezirea Tn cursul nopfilor, insomnia,
\up0 \expndtw0\charscalex124 parasomnnle sunt determinate de factori temperamentali
precum si de \up0 \expndtw0\charscalex114 greseli educafiunale si relafii madecvate
parinfi-copii. \par\pard\qj \li849\ri749\sb0\sl-240\slmult0\fi278 \up0
\expndtw0\charscalex120 7 Retariul mintal este determinat de o mullitudme de lacton
biologici \up0 \expndtw0\charscalex119 (determmanfi) si psiho-emotionali. de mediu
familial si social \up0 \expndtw0\charscalex107 (contextul \par\pard\ql
\li849\sb1\sl-196\slmult0 \up0 \expndtw0\charscalex114 relational familial,
atlludinea parinftlor in timpul ingrijini copilului. sistemul \par\pard\ql
\li840\sb16\sl-230\slmult0 \up0 \expndtw0\charscalex112 educational)
Depresia se datoreaza unor factori biologici (depresia endogena) cat \up0
\expndtw0\charscalex109 St unor factori psiho-familiali \up0
\expndtw0\charscalex116 (depresia exogena) Este insofita de simptome
\ul0\nosupersub\cf3\f4\fs18 328\tab \up0 \expndtw0\charscalex115 <'\tab \up0
\expndtw0\charscalex115 Elemente de psihosomatica yenorala �1
\expndtw0\charscalex120 \ul0\nosupersub\cf9\f10\fs20 somatice (instabilitate
motone. agitafie, anorexie sau bulimie. tulburari de \up0 \expndtw0\charscalex122
somn, tulburSri digestive) s' comportamentale (dezinteres pentru propria \up0
\expndtw0\charscalex135 persoanS sj pentru ceilalfi. ruperea contactelor sociale,
neglijarea \up0 \expndtw0\charscalex130 pehormanfelor academice s1 a igienei
personae) Este determinae In \up0 \expndtw0\charscalex119 principal de pierderea
unei persoane dragi (decesul unui pSrinte, pierderea \up0 \expndtw0\charscalex113
unui pSrinte prin divorf) \par\pard\qj \li1214\ri343\sb0\sl-240\slmult0\fi292
\up0 \expndtw0\charscalex123 9. Anxietatea are drept cauze principale existenfa
relafiilor anormale \up0 \expndtw0\charscalex119 parinfi-copit. lipsa afectiunii
materne, separarea. Manifestarile clinice sunt \up0 \expndtw0\charscalex119
diferite in funcfie de varste. \par\pard\qj \li1219\ri364\sb17\sl-220\slmult0\fi374
\up0 \expndtw0\charscalex120 sugarul prezinte fipete excesive, somn agitat,
dezinteres pentru masa, \up0 \expndtw0\charscalex111 ruminafie. \par\pard\qj
\li1224\ri364\sb4\sl-240\slmult0\fi292 \up0 \expndtw0\charscalex124 - copilul
prescolar se manileste prin hiperactivitate, suptul degetelor, \up0
\expndtw0\charscalex113 rosul unghlilor, micfiuni frecvente, enurezis; \par\pard\qj
\li1214\ri338\sb0\sl-240\slmult0\fi446 \up0 \expndtw0\charscalex124 copilul scoer
refuze se mearge la scoae, invocand diverse suferinfe \up0 \expndtw0\charscalex121
somatice. imaginare sau prin conversie (de exemplu, durerile abdominale \up0
\expndtw0\charscalex121 care apar la ora plecahi la scoae). \par\pard\qj
\up0 \expndtw0\charscalex128 V. Vulnerabilitatea copilului la stress depinde de
facton genetici \up0 \expndtw0\charscalex118 Si psihosociali (in primul rend
relafia cu familia. ulterior cu scoae si alte \up0 \expndtw0\charscalex118 medu
sociale). Nu existe copii care se nu aibe stress in familie \par\pard\ql
\up0 \expndtw0\charscalex117 Se descrlu: \par\pard\ql \li1531\sb1\sl-
217\slmult0 \up0 \expndtw0\charscalex124 - factori ce pot favorlza relatia
copilului cu stresui: \par\pard\ql \li1536\sb0\sl-230\slmult0
\par\pard\ql\li1536\sb23\sl-230\slmult0 \up0 \expndtw0\charscalex111 \u9632?
factorul stress familial \par\pard\ql \li1968\sb10\sl-230\slmult0\tx2140 \up0
\expndtw-2\charscalex100 i \tab \up0 \expndtw0\charscalex115 situafiile ce
afecteaza stabilitatea familiei \par\pard\ql \li1958\ri2355\sb2\sl-240\slmult0 \up0
\expndtw0\charscalex112 ii. relafii defectuoase pannfi-copii (tabelul nr.2) \up0
\expndtw0\charscalex114 iii. tlpurile inadecvate de dominare parentalS \up0
\expndtw0\charscalex115 iv. separarea temporare sau de lunge durata \par\pard\ql
\expndtw0\charscalex114 - factori ce (in de copii \par\pard\li1224\sb14\sl-
230\slmult0\fi744\tx2227\tx3792 \up0 \expndtw0\charscalex121 1\tab \up0
\expndtw0\charscalex113 temperamentul\tab \up0 \expndtw0\charscalex121 (copii
"usor", copii "dificil", copii "flegmatic".\par\pard\li1224\sb10\sl-230\slmult0\fi4
\up0 \expndtw0\charscalex122 ultimele doua categorii prezentand mai Irecvent
disfuncfionalitSfi psiholo�\par\pard\li1224\sb5\sl-230\slmult0\fi0 \up0
\expndtw0\charscalex121 gice)\par\pard\li1224\sb10\sl-230\slmult0\fi744\tx2241 \up0
\expndtw-9\charscalex97 ii.\tab \up0 \expndtw0\charscalex121 Inteligenfa (copiii cu
Ql ridicat respund adaptativ Tn condifii do\par\pard\li1224\sb10\sl-
230\slmult0\fi14 \up0 \expndtw0\charscalex121 stress)\par\pard\li1224\sb10\sl-
230\slmult0\fi748\tx2328\tx2942 \up0 \expndtw0\charscalex121 if\tab \up0
\expndtw0\charscalex108 sexul\tab \up0 \expndtw0\charscalex121 (baiefn sutere mai
mult decat ietele dace sunt supusi\par\pard\li1224\sb10\sl-230\slmult0\fi14 \up0
\expndtw0\charscalex121 acelorasi situafii de stress)\par\pard\li1224\sb0\sl-
230\slmult0\fi321\tx5721 \up0 \expndtw0\charscalex121 factori protector! impotriva
stressului\tab \up0 \expndtw0\charscalex121 (ce pot acftona aditiv
sau\par\pard\li1224\sb5\sl-230\slmult0\fi33 \up0 \expndtw0\charscalex121
Independent)\par\pard\ql \li1536\sb6\sl-230\slmult0 \up0 \expndtw0\charscalex112 a)
relafia bune mame-copil \par\pard\ql \li1540\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex116 b) relafia bune tae-copil \par\pard\qj
\li1271\ri329\sb2\sl-240\slmult0\fi268 \up0 \expndtw0\charscalex129 c) interesul
particular al unui coptl pentru un anumit domeniu de \up0 \expndtw0\charscalex112
activitate \par\pard\qj \li1276\ri345\sb0\sl-240\slmult0\fi273 \up0
\expndtw0\charscalex134 d) copilul recompensat pentru mente scoiare sau alte
activitafi \up0 \expndtw0\charscalex111 extratamillale
Psihosomatica aplicats\tab \up0 \expndtw0\charscalex110
\ul0\nosupersub\cf9\f10\fs20 \u9830? 329\par\pard\ql \li1075\sb0\sl-230\slmult0
\up0 \expndtw0\charscalex112 e) relafii bune cu unui din frafi \par\pard\ql
\li1080\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex114 0 relafii bune cu un adult
din atara familiei \par\pard\ql \li1075\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex120 g) reefii de prieteme stransa cu un coieg de scoae
260\slmult0\fi52 \up0 \expndtw0\charscalex120 Tabelul nr.2: Relafii defectuoase
pdrinficopii \up0 \expndtw0\charscalex121 (reprodus dupa R.C Carson and J.N.
Butcher) \par\pard\li1046\sb0\sl-230\slmult0\par\pard\li1046\sb7\sl-
230\slmult0\fi0\tx4536 \up0 \expndtw0\charscalex121 Condifii nedorite\tab \up0
\expndtw0\charscalex121 Efectele asupra dezvoltarii\par\pard\ql \li4536\sb0\sl-
228\slmult0 \up0 \expndtw0\charscalex122 \ul0\nosupersub\cf18\f19\fs20\ul
personalitafii
copiilor\par\pard\sect\sectd\sbknone\cols2\colno1\colw4411\colsr110\colno2\colw4279
\colsr160\ql \li1051\sb51\sl-230\slmult0 \up0 \expndtw0\charscalex117
\ul0\nosupersub\cf9\f10\fs20 Respingere\par\pard\ql \li1046\sb0\sl-230\slmult0
Hiperprotecfie si restricfii excesive\par\pard\ql \li1046\sb0\sl-230\slmult0
\up0 \expndtw0\charscalex113 Hiperpermislvitate $i indulgenfS\par\pard\ql
\li1041\sb22\sl-230\slmult0 \up0 \expndtw0\charscalex117 Cerinfe
nerealiste\par\pard\qj \li1051\sb0\sl-230\slmult0 \par\pard\qj \li1051\sb0\sl-
\li1051\ri1087\sb35\sl-230\slmult0 \up0 \expndtw0\charscalex115 Discipline
defectuoasS \up0 \expndtw0\charscalex114 \ul0\nosupersub\cf18\f19\fs20\ul LipsS de
discipli\ul0\nosupersub\cf9\f10\fs20 ne\par\pard\ql \li1055\sb48\sl-230\slmult0
\up0 \expndtw0\charscalex116 Discipline severe\par\pard\ql \li1051\sb0\sl-
Discipline inconstante\par\pard\ql \li1046\sb0\sl-230\slmult0 \par\pard\ql
\expndtw0\charscalex117 Comunicare inadecvate\par\pard\column \qj
\li20\ri1026\sb60\sl-225\slmult0 \up0 \expndtw0\charscalex110 Anxietate.
insecuritate, negativism, \up0 \expndtw0\charscalex116 ostilitate, singurState,
gelozie,\par\pard\ql \li25\sb1\sl-220\slmult0 \up0 \expndtw0\charscalex106
TntSrziere Tn dezvoltarea\par\pard\ql \li25\sb1\sl-225\slmult0 \up0
\expndtw0\charscalex112 \ul0\nosupersub\cf18\f19\fs20\ul constiinfei\par\pard\ql
Supunere, lipsa de\par\pard\ql \li30\sb0\sl-230\slmult0 \up0
\expndtw0\charscalex118 autoincredere. dependents in\par\pard\ql \li25\sb1\sl-
225\slmult0 \up0 \expndtw0\charscalex116 \ul0\nosupersub\cf18\f19\fs20\ul relafiile
cu ceilalfi, subevaluarea\par\pard\qj \li25\ri1154\sb56\sl-228\slmult0\fi4 \up0
\expndtw0\charscalex114 \ul0\nosupersub\cf9\f10\fs20 Egoism, atitudine
revendicativS, \line \up0 \expndtw0\charscalex112 inabilitate Tn tolerarea
frustrarii. \line \up0 \expndtw0\charscalex116 nesupunere in fata
autohtSfii,\par\pard\qj \li25\ri1050\sb0\sl-222\slmult0 \up0
\expndtw0\charscalex118 nevoie excesivS de a i se acorda \up0
\expndtw0\charscalex118 atenfie, lipsa de responsabilitate, \up0
\expndtw0\charscalex113 exploatare in relafiile\par\pard\ql \li39\sb1\sl-
225\slmult0 \up0 \expndtw0\charscalex115 \ul0\nosupersub\cf18\f19\fs20\ul
interpersonale\par\pard\qj \li25\ri1049\sb53\sl-225\slmult0\fi4 \up0
\expndtw0\charscalex116 \ul0\nosupersub\cf9\f10\fs20 LipsS de spontaneitate,
conflicte, \up0 \expndtw0\charscalex113 tendinte 1a autoinvinovSfire daca \up0
\expndtw0\charscalex119 nu reusesc sS indephneascS\par\pard\ql \li20\sb1\sl-
220\slmult0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf18\f19\fs20\ul cerinfele
pSrinfilor\par\pard\qj \li20\ri1081\sb237\sl-283\slmult0 \up0
A\ul0\nosupersub\cf18\f19\fs20\ul gresivitate, tendinfe antisociale \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf9\f10\fs20 Teama sau ura fafe de
parinfi.\par\pard\qj \li35\ri1034\sb8\sl-211\slmult0 \up0 \expndtw0\charscalex118
initiative si spontaneitate reduse. \up0 \expndtw0\charscalex117 lipsa
sentimentelor pnetene$ti\par\pard\ql \li30\sb9\sl-230\slmult0 \up0
\expndtw0\charscalex113 \ul0\nosupersub\cf18\f19\fs20\ul fafe de
ceilalfi\par\pard\qj \li30\ri1214\sb49\sl-225\slmult0\fi4 \up0
\expndtw0\charscalex113 \ul0\nosupersub\cf9\f10\fs20 Dificultate in stabihrea
valorilor \up0 \expndtw0\charscalex116 ce ghideaze comportamentul,\par\pard\ql
\ul0\nosupersub\cf18\f19\fs20\ul tendinfe la comportament agreslv\par\pard\qj
\ul0\nosupersub\cf9\f10\fs20 Tendinfa la contuzie. lipsa \up0
\expndtw0\charscalex114 inifiativei. autoidentificare \up0 \expndtw0\charscalex117
neclare, devalorizare \par\pard\sect\sectd\sbknone \ql \li1084\sb119\sl-230\slmult0
\up0 \expndtw0\charscalex113 Efectele relafiilor defectuoase parinfi-copii depind
de mai mulfi factori: \par\pard\ql \li1526\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex109 - vSrsta copilului \par\pard\ql \li1526\sb10\sl-230\slmult0
\up0 \expndtw0\charscalex113 - personalitatea copilului \par\pard\ql
\li1531\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 - durata $i gradul
relafiilor defectuoase \par\pard\ql \li1526\sb10\sl-230\slmult0 \up0
\expndtw0\charscalex112 - percepfia copilului asupra relafiilor \par\pard\ql
\li1526\sb10\sl-230\slmult0 \up0 \expndtw0\charscalex113 - contextul de viafe si
situafia familiala \par\pard\sect\sectd\fs24\paperw8940\paperh13220{\bkmkstart
240\slmult0\fi288 \up0 \expndtw0\charscalex118 Toate cele prezentate subliniaze
importanta si necesitatea insusirn unor \up0 \expndtw0\charscalex123
cunostlnte de psihologie \up0 \expndtw0\charscalex129 $i in special de psihologie
pedtatrice. fiind \par\pard\qj \li1339\ri237\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex131 evldente importanfa factorilor stresanfi familiali asupra
dezvoltam \up0 \expndtw0\charscalex112 neuropsihice s> comportamentale a
copilului \par\pard\ql \li1636\sb0\sl-230\slmult0 \par\pard\ql\li1636\sb219\sl-
230\slmult0 \up0 \expndtw0\charscalex135 Principii de apreciere a complianfei
terapeutice la copii \par\pard\qj \li1334\ri218\sb198\sl-245\slmult0\fi297 \up0
\expndtw0\charscalex116 Complianfa terapeutice se defineste ca un complex de
reacfii psihice ale \up0 \expndtw0\charscalex130 pacientului la recomanderile
medicale Ea reprezinta o components \up0 \expndtw0\charscalex131 majorltar
psihologice a actului medical care valideaza demersunie \up0
\expndtw0\charscalex121 diagnostice s' terapeutice intrepnnse de catre medic si
echipa de ingrijire \up0 \expndtw0\charscalex114 (lamandescu, \up0
\expndtw0\charscalex118 1996). Depinde de o serie de factori \up0
\expndtw0\charscalex114 (lamandescu. \up0 \expndtw-1\charscalex100 1998) s>
\par\pard\ql \li1334\sb8\sl-230\slmult0 \up0 \expndtw0\charscalex112 anume.
Medicul, care prescne tratamentul. poate inliuenfa complianta \up0
\expndtw0\charscalex121 terapeutica pnn prestigml seu, pnn calitSfile sale de
instructor \up0 \expndtw0\charscalex113 (rebdare, \par\pard\qj
\li1343\ri224\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex134 tact, mod explicit de
prezentare a tratamentului si a efectelor sale \up0 \expndtw0\charscalex120
secundare). prin caliefile reiafionale fafe de bolnav \up0 \expndtw0\charscalex115
(autohtate/apropiere/ \par\pard\ql \li1343\sb29\sl-230\slmult0 \up0
\expndtw0\charscalex111 distanfS fafe de bolnav); \par\pard\qj
\li1334\ri229\sb2\sl-240\slmult0\fi465 \up0 \expndtw0\charscalex117 Bolnavul, ca
receptor s> executant al Indicafiilor medicale, prezinte o \up0
\expndtw0\charscalex116 complianfe terapeutica ce vanaze in lunctie de nivelul seu
de infelegere, de \up0 \expndtw0\charscalex120 tipul seu de personalitate, de
existenfa pereriior preconeepute \up0 \expndtw0\charscalex110 (negai
\par\pard\ql \li1339\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex117 despre
tratament, putand aiunge pana e noncomplianfa. \par\pard\qj \li1343\ri229\sb2\sl-
240\slmult0\fi288 \up0 \expndtw0\charscalex125 - Boala, pnn caractehsticile sale'
seventate. evolufie acuta/cronicS. \up0 \expndtw0\charscalex115 tmplicafiile asupra
activitatii bolnavului, \up0 \expndtw0\charscalex125 1a care se adauga si
restncfiiie \par\pard\ql \li1348\sb29\sl-230\slmult0 \up0 \expndtw0\charscalex115
impuse bolnavului precum s' electele secundare ale tratamentului \par\pard\ql
\li1636\sb10\sl-230\slmult0\tx8318 \up0 \expndtw0\charscalex118 Inliuenfa socials
se relere in primul rand la rolul esenfial al taminei \tab \up0
\expndtw0\charscalex100 (in \par\pard\qj \li1329\ri224\sb2\sl-240\slmult0 \up0
\expndtw0\charscalex125 general pozitiv, de optimizare a cumplianfoi terapeutice,.
precum si e \up0 \expndtw0\charscalex114 intervenfia colegiloi sau a ceiorlalfi
bolnavi \up0 \expndtw0\charscalex114 (ce pot inliuenfa fie pozitiv. fie
\par\pard\ql \li1339\sb9\sl-230\slmult0 \up0 \expndtw0\charscalex112 negativ
comportamenlul pacientului). \par\pard\ql \li1636\sb0\sl-230\slmult0
\par\pard\ql\li1636\sb20\sl-230\slmult0 \up0 \expndtw0\charscalex115 La copii,
complianfa terapeuticS este influenfate in mod particular de: \par\pard\ql
\li2083\sb30\sl-230\slmult0 \up0 \expndtw0\charscalex111 - varsta copilului
nivelul de Tnfeiegere al copilului (in funcfie de varsta si dezvoltarea \up0
\expndtw0\charscalex112 neuropsihicS) \par\pard\ql \li2078\sb12\sl-230\slmult0 \up0
\expndtw0\charscalex111 - temperamentul copilului \par\pard\li2073\sb30\sl-
230\slmult0\fi0\tx2332\tx5121\tx7713 \up0 \expndtw0\charscalex120 -\tab \up0
\expndtw0\charscalex127 comportamentul parental\tab \up0 \expndtw0\charscalex127 $i
relafia pannfi-copii\tab \up0 \expndtw0\charscalex127 (mamole\par\pard\qj
\li1343\ri229\sb2\sl-240\slmult0 \up0 \expndtw0\charscalex126 hiperprotectoare sau
cu comportament de rejecfie sau de abandonare \up0 \expndtw0\charscalex117 psihica
a copilului due la scaderea complianfei erapeutice) \par\pard\qj
\li1363\ri666\sb0\sl-260\slmult0\fi720 \up0 \expndtw0\charscalex116 - nivelul
intelectual, material S' de educate sonitara al pSrinfllt \up0
\expndtw0\charscalex117 special al mamei \par\pard\ql \li2078\sb1\sl-192\slmult0
\up0 \expndtw0\charscalex114 - mstabilitatea sau dezechilibtul familial
implicarea lamiliei privind: respectatea tratamentuiiii, asigurarea \up0
\expndtw0\charscalex126 condifiilor necesare vindecahi, educarea connini In vedorea
insusirn \up0 \expndtw0\charscalex113 comportamentelor sanogenetice si de
prevei.ire a imboinavihior
Psihosomatica aplicata\tab \up0 \expndtw0\charscalex111 � 331\par\pard\qj
Pentru a optimiza compiianta terapeutice, medicul pediatru trebuie se ia \up0
\expndtw0\charscalex121 Tn considerare tofi acesti factori si mai ales faptul ce un
copii nu poate fi \up0 \expndtw0\charscalex133 abordat clinic si terapeutic decat
in corelafie cu cadrul seu \up0 \expndtw0\charscalex108 (amilial \par\pard\qj
\li763\ri833\sb0\sl-240\slmult0\fi4 \up0 \expndtw0\charscalex116 (stabilitate,
interacfium pannfi-copii. tipuri de dominare parentale, existenfa \up0
\expndtw0\charscalex113 factorilor favorizanti/protectori impotriva stresului).
\up0 \expndtw0\charscalex124 Bibliogratie selectiva \par\pard\li1051\sb0\sl-
230\slmult0\par\pard\li1051\sb12\sl-230\slmult0\fi38\tx1276 \up0 \expndtw-
5\charscalex100 1.\tab \up0 \expndtw0\charscalex105 Buddeberg C, With J-
Psychosoziale Medizin, Springer Berlin-Heidelberg,\par\pard\li1051\sb1\sl-
223\slmult0\fi259 \up0 \expndtw0\charscalex104 1998\par\pard\li1051\sb1\sl-
202\slmult0\fi0\tx7435 \up0 \expndtw0\charscalex104 2. Ciutu C. - Inleracfiunea
pannti-copii. Ed Medicald Amaltea, Bucuresti,\tab \up0 \expndtw0\charscalex104
1998\par\pard\li1051\sb1\sl-220\slmult0\fi4 \up0 \expndtw0\charscalex105 3. Ciofu
C, Ciofu E. - Examen clinic in pediatne. Ed.$tiintiticd si
Enciclopedicd.\par\pard\li1051\sb2\sl-230\slmult0\fi225\tx2236 \up0 \expndtw-
1\charscalex100 Bucuresti.\tab \up0 \expndtw0\charscalex104
Carson R.C. Butcher J.N\tab \up0 \expndtw0\charscalex104 - Abnormal psychology and
modern life, Ninth\par\pard\li1051\sb0\sl-219\slmult0\fi220 \up0
\expndtw0\charscalex104 Edition. Harper Collins Publishers Inc..
Gorgos C\tab \up0 \expndtw0\charscalex104 Dicfionar enciclopedic de psihiatne.
vol III. Ed.Medicald,\par\pard\li1051\sb9\sl-230\slmult0\fi220\tx2236 \up0
\expndtw-1\charscalex100 Bucuresti.\tab \up0 \expndtw0\charscalex104
lamandescu I B. Psihologie medicald, Edilnfomedica. Bucuresti.\tab \up0
\expndtw0\charscalex103 7. lamandescu IB. Psychoneuroallergology,
Ed.Romcartexim,\tab \up0 \expndtw0\charscalex104 1998\par\pard\li1051\sb1\sl-
222\slmult0\fi4\tx7449 \up0 \expndtw0\charscalex104 8 MeildP.. MileaSt. - Tratat de
pediatne. vol. VI, Ed.Medicald, Bucuresti.\tab \up0 \expndtw0\charscalex104
\expndtw0\charscalex104 9 Piaget J.\tab \up0 \expndtw0\charscalex104 -\tab \up0
\expndtw0\charscalex104 Nasterea inteligenfet la copii. Ed. Dtdacticd si
Pedagogicd.\par\pard\li1051\sb1\sl-222\slmult0\fi225\tx2236 \up0
1973\par\pard\li1051\sb1\sl-202\slmult0\fi43 \up0 \expndtw0\charscalex105 10 Piaget
J. Inhelder 8 Psihoiogia copilului, Ed Dtdacticd si
Pedagogicd.\par\pard\li1051\sb1\sl-230\slmult0\fi312\tx2328 \up0
\expndtw0\charscalex100 Bucuresti,\tab \up0 \expndtw0\charscalex104
1970\par\pard\li1051\sb1\sl-200\slmult0\fi43\tx7574 \up0 \expndtw0\charscalex102
11. Schtopu V. (coordonator) Dicfionar de psihologie. Ed. Babel. Bucuresti,\tab
\up0 \expndtw0\charscalex104 1997.\par\pard\sect\sectd\fs24}

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