An experiment was conducted to investigate three different treatment strategies in the rehabilitation of coronary artery bypass graft (CABG) patients. Fifteen CABG patients were randomly assigned to one of three training groups: an outpatient cardiac rehabilitation exercise group (which met three times per week for three months); a second group which participated in weekly stress management training for seven weeks in addition to the cardiac rehabilitation exercise sessions; and a third group which participated in a weekly discussion on social support in addition to the exercise sessions. The groups were compared (pre- and post training) on the following physiological dependent measures: systolic and diastolic blood pressure, mean heart rate, cholesterol, triglycerides, high density lipoproteins, and the cholesterol/high density lipoprotein ratio. Psychological self-report measures included: the Beck Depression Inventory, the Spielberger State/Trait Anxiety Index, the Jenkins Activity Survey, and the Hassles and Uplifts Questionnaire. The Structured Interview was given to each patient prior to training only. It was predicted that the group trained in stress management and exercise would show the most positive changes on physiological and psychological dependent measures compared to the other two groups. The results indicated no significant pre/post differences on any of the variables for any of the groups. Thus, the additional components of stress management training and the social support discussion group did not appear to effect more positive change in those patients compared to those who participated in exercise only. Findings may have been influenced by several factors including a small N in each group and large within group variability. Suggestions for future research are discussed.

A multiple baseline study was conducted across five hysterectomy patients between the ages of 30-36. Three patients received a treatment intervention consisting of general and sensory information, muscle relaxation, a cognitive coping technique, and a pre-anesthetic interview. Two yoked, placebo control patients watched a 20-min video· tape about surgery, practiced recovery exercises, and made up stories from TAT cards. Self-report measures taken were the Hospital Stress Rating Scale, a recovery inventory, and postsurgical pain ratings. Physiological measures consisted of pulse, respiration, blood pressure, skin temperature, and blood lactates. Recovery variables were taken on amount of pain medication taken, number ·of days in the hospital, · vomiting, and psychiatric or physical complications. The results indicated that patients in the treatment condition reported less pain and took fewer pain medications after surgery. All other variables indicated little or no change. All patients experienced a decrease in blood lactate levels after the training session. Training time was approximately 1 hour, and thus hospital staff could conduct the training in a reasonable amount of time.

A survey of stress and crisis literature indicated traumatic events tend to initially overwhelm individual coping resources. The adjustment process following such events appears to be characterized by phases in which gradual perceptual and cognitive reorganization occurs. Emotional shock, denial processes, and intrusive ideation accompany initial phases. A survey of stress and crisis literature indicated traumatic events tend to initially overwhelm individual coping resources. The adjustment process following such events appears to be characterized by phases in which gradual perceptual and cognitive reorganization occurs. Emotional shock, denial processes, and intrusive ideation accompany initial phases.

Thesis (MTh)--Stellenbosch University, 1993 / ENGLISH ABSTRACT: Seeing that breast cancer is the most common cancer in women and that it has such a high incidence that every woman should be aware of it, time has come for the theology, and especially for pastoral care, to provide some answers on the possible problems that accompany the illness. Treatment of breast cancer almost always include a degree of surgical intervention through which part of or a whole breast, and in extreme cases even the underlying tissue, is being removed. This procedure, to some extent, influences a woman's experience of her physique which in turn has an effect on the intimate space of her marriage. The mastectomy patient may experience that the operation, with all the psychological affects it has, disturbs her inner life rythm and that results in her relationships also being pressurised. The crisis of a mastectomy should be handled as a relationship crisis within a marriage, in which the husband can play an important therapeutic role. The husbands contribution will be greatly effected by: a) His commitment to the relationship and b) The correlation between his male identity, his sexuality and his perceptions of the female physique. Within the crisis of mastectomy, the woman's body-image should not be separated from her faith identity and the quality of her marriage - there exists a dynamic interaction between these three, which means that the handling of the crisis of a mastectomy is directly dependent on the quality if her loving relationship and on the way in which she experiences her faith. The faith factor plays an important role in the handling of the crisis, by creating a distance between the trauma of the loss and the way in which she experiences her identity. Pastoral care can play a vital role in the handling of the crisis of a mastectomy by means of guidance and support, as it proclaims the active presence of God through the marrid body of Jesus Christ. The husband of the mastectomy patient can, in his therapeutic role, be guided to be much more sensitive for the emotional needs of his wife, in regard to aspect of sexuality. This would give her the support she needs and work constructively towards the goal of healing. / AFRIKAANSE OPSOMMING: Aangesien borskanker die algemeenste kanker onder vroue is en dit sulke geweldige afmetings aangeneem het dat elke vrou daarmee moet rekening hou, het dit tyd geword dat die teologie, en met name die pastoraat, ditself ook ten opsigte van die moontlike problematiek wat daarmee saamgaan, moet verantwoord. Die behandeling van borskanker behels in die meerderheid van gevalle 'n mate van chirurgiese ingrepe waardeur 'n deel van of die hele bors, en in ekstreme gevalle ook die onderliggende weefsel, verwyder word. Hierdie prosedure oefen, in 'n mindere of meerdere mate, 'n invloed op die vrou se belewing van haar liggaamlikheid uit wat weer na die intieme band van die huwelik kan deurwerk. Die mastektomiepasiënt kan ervaar dat die operasie, met al die sielkundige effekte wat dit inhou, haar innerlike lewensritme versteur sodat die verhoudinge waarin sy leef ook onder druk geplaas word. Binne die huwelik sou 'n mens dan die krisis van 'n mastektomie as 'n verhoudingskrisis moet hanteer, waarin die eggenoot 'n belangrike terapeutiese funksie kan vervul. Die man se bydrae word egter deurslaggewend bepaal deur: a) Sy verbintenis aan die verhouding en b) Die korrelasie tussen sy manlike identiteit, seksualiteit en die persepsies met betrekking tot die liggaamlikheid van die vrou. Binne die krisis van 'n mastektomie kan die vrou se liggaamsbeeld nie van haar geloofsidentiteit en die kwaliteit van haar huwelik losgemaak word nie - hierdie drie staan in 'n interdinamiese verband en beteken dat die verwerking van die krisis van 'n mastektomie direk van die kwaliteit van die liefdesverhouding en die ervaring van geloof, afhang. In die verwerking van die krisis vervul die geloofsfaktor 'n deurslaggewende rol om afstand tussen die emosionele trauma van die verlies en die ervaring van identiteit te skep. Die pastoraat kan 'n belangrike funksie vervul ten opsigte van begeleiding en ondersteuning in die verwerking van die krisis van 'n mastektomie deurdat dit God se aktiewe betrokkenheid by die situasie, aan die hand van die liggaamlikheid van Jesus Christus, verkondig. As terapeut kan die eggenoot begelei word om, op die gebied van die seksuele, baie sterker op die emosionele behoeftes van die mastektomiepasiënt ingestel te wees, om haar sodoende te ondersteun en in die proses van heling mee te werk.

A obesidade apresenta-se como uma patologia que acomete um número crescente de pessoas, recebendo a denominação de doença do milênio. Mobiliza a atenção de programas de saúde pública, que investem continuamente em pesquisas procurando debelá-la. A cirurgia bariátrica apresenta-se como um eficiente método de controle da obesidade, implicando a atuação de uma equipe multiprofissional, composta por cirurgião, psicólogo, nutricionista e enfermeiro, que acompanha o paciente na fase pré-operatória e, igualmente, após a cirurgia. O objetivo da nossa pesquisa consistiu em investigar o movimento da pulsão oral em mulheres que se submeteram à cirurgia bariátrica. Buscamos contemplar os aspectos subjetivos implicados no processo de emagrecimento quando se faz necessária modificação na forma de satisfação oral, pesquisando assim o efeito de uma intervenção física no corpo pulsional. Para tanto, delimitamos nosso estudo nas mulheres uma vez que, no Hospital da Polícia Militar de Pernambuco, local onde realizamos a pesquisa, foram elas que demandaram em maior número à cirurgia e, da mesma forma, apresentaram mais dificuldades durante o período pós-cirúrgico. Trata-se de uma pesquisa que articula a teoria com a clínica, cujo referencial é o psicanalítico, na qual apresentaremos os relatos de três pacientes acompanhadas pela pesquisadora antes e após a cirurgia, para em seguida expormos a análise do material colhido. Nos casos acompanhados tornou-se evidente que a intervenção física, embora necessária ao controle de peso das pacientes, não foi suficiente para promover modificações no corpo pulsional. Foi possível constatarmos a importância do processo psicoterápico para que tais alterações possam ocorrer no corpo pulsional de cada paciente. / Obesity is considered nowadays a pathology that affects a growing number of people, reason for which its called the millennium disease. It mobilizes the attention of public healthy services, which invest continuously in research to control it. The bariatric surgery presents as an efficient method to control obesity through the intervention of a multi-professional team, composed by a surgeon, a psychologist, a nutritionist and a nurse, that take care of the patient during the pre-chirurgical phase and, afterwards, during the post-chirurgical one. The aim of our research was to investigate the movement of the oral compulsion in women that were submitted to the bariatric surgery. We searched the subjective aspects that always appear in the losing weight process in which its necessary a change in the ways of the oral satisfaction. We observed, therefore, the effects of the physical intervention in a compulsional body. In so doing, we restricted our analysis among the women for the reason that, in the Hospital da Polícia Militar de Pernambuco, place where the study was conducted, it was them that claimed more for the surgery and also because the women presented more difficulties after the surgery than the men. Its a research that focuses on the interaction between the theory and the clinics, which referential is the psychoanalytic one. Henceforth, we described the cases of three patients accompanied by the researcher before and after the surgery. Afterwards, we analyzed all the material collected. In all the cases it was verified that the physical intervention, although necessary to the patients weight control, was not sufficient to promote changes in the compulsional body. We concluded proving the importance of the psychotherapeutic process, which enabled the changes in the compulsional body of each patient.

This study aimed at exploring the impact of early traumatic experiences on bariatric patients with the intent to give "voice" to their experiences. The impact of morbid obesity and the lack of quality of life among those suffering from this form of chronic illness can be devastating. Meaningful support systems and bariatric surgery are therefore considered as forced behavioural interventions to remediate the impact of childhood trauma and subsequent development of morbid obesity among this group of bariatric patients. Through a process of social constructivism and dialogue between the researcher and the five participants, the co-construction according to themes was supported by a qualitative research approach and the case study method. For the analysis of the themes according to the participants' "voices", the thematic content analysis method was used to analyse the data and was finally linked to supportive literature. It is hoped that the results from this study will contribute to the development of a unique assessment and support programme to those who have to endure the burden of morbid obesity associated with early childhood trauma; and that the process prior to and post bariatric surgery will be an important contribution to finding quality of life and giving new meaning to patients after suffering through their bodies and traumatised minds. / Psychology / D.Litt. et. Phil (Psychology)

This study aimed at exploring the impact of early traumatic experiences on bariatric patients with the intent to give "voice" to their experiences. The impact of morbid obesity and the lack of quality of life among those suffering from this form of chronic illness can be devastating. Meaningful support systems and bariatric surgery are therefore considered as forced behavioural interventions to remediate the impact of childhood trauma and subsequent development of morbid obesity among this group of bariatric patients. Through a process of social constructivism and dialogue between the researcher and the five participants, the co-construction according to themes was supported by a qualitative research approach and the case study method. For the analysis of the themes according to the participants' "voices", the thematic content analysis method was used to analyse the data and was finally linked to supportive literature. It is hoped that the results from this study will contribute to the development of a unique assessment and support programme to those who have to endure the burden of morbid obesity associated with early childhood trauma; and that the process prior to and post bariatric surgery will be an important contribution to finding quality of life and giving new meaning to patients after suffering through their bodies and traumatised minds. / Psychology / D.Litt. et. Phil (Psychology)

Esta dissertação objetivou, de forma geral, analisar a ação do psicólogo clínico no processo de preparação e acompanhamento psicológico das pessoas que se submetem à cirurgia bariátrica. De forma específica pretendeu-se identificar os elementos que podem interferir positivamente e/ou negativamente, na relação terapeuta - paciente; analisar as ressonâncias que o acompanhamento terapêutico exerce sobre os pacientes que se submetem à cirurgia bariátrica. Para tanto buscou as contribuições teóricas a respeito do corpo na filosofia de Merleau Ponty e na psicanálise de Winnicott. Sobretudo, abordou o relacionamento terapeuta paciente pela abordagem winnicottiana e dentro do contexto dos psicólogos que trabalham com o tema da obesidade. Trata-se de uma pesquisa qualitativa, que tem como participantes sete psicólogas clínicas que desenvolvem atividades na área de cirurgia bariátrica, tanto no setor privado como público e duas pacientes compreendidas na faixa etária de 33 e 56 anos, que se submeteram à cirurgia e continuam em acompanhamento psicológico. Utilizamos a entrevista semidirigida tanto para as psicólogas como para as pacientes, através de uma questão disparadora diferenciada. A análise das narrativas foi feita a partir da análise temática, que permitiu identificar eixos temáticos ligados à questão da prática profissional e às concepções teóricas utilizadas pelas psicólogas, destacando-se eixos como a natureza do vinculo estabelecido na relação terapeuta e paciente, a importância da família na participação do processo e, sobretudo, a imagem corporal vivida pelo paciente antes, durante e depois do procedimento cirúrgico. O cuidado que o psicólogo deve ter para levar em consideração no seu relacionamento terapêutico, a promoção do autoconhecimento e a compreensão a respeito de um corpo vivido pelo paciente e, portanto, um corpo sujeito, não coisificado; constituíram-se como elementos de fundamental importância, lembrando-nos que, atitudes explicativas diretivas são necessárias, mas não suficientes para o sucesso do tratamento. Por essas razões, apontamos que questões intrapsíquicas e os recursos internos do paciente sejam suficientemente trabalhados, evitando, assim, que o mesmo substitua o sintoma da obesidade por outro sintoma de compulsão.

Moyamoya disease is a rare entity characterized by progressive narrowing of intracranial blood vessels. In most cases, Moyamoya does not respond well to medical therapy and often leads to surgical revascularization. The physiological benefits of the revascularization surgery for Moyamoya patients have been well documented, yet the effects of surgery on cognitive skills and abilities are far less studied. Participants in the current study were 33 patients, 24 to 85 years of age, who underwent revascularization surgery at the Mayo Clinic in Jacksonville, Florida. All patients underwent a physical and cognitive preoperative evaluation, where speech, memory, and intellectual processes were measured. After surgery, patients returned for three follow-up assessments over a period of six months. All patients experienced stabilization or improvement of physiological symptoms. Regarding cognitive functions, speech, memory, and intellectual processes improved significantly after surgery. Results showed not only a reduction of physiological symptoms, but also a significant cognitive improvement postsurgery. This study adds to the research of this disease and to the benefits of treatment. More research can only strengthen these findings and educate healthcare professionals; helping them reaffirm Moyamoya patients have a better quality of life, by reinforcing the benefits of revascularization surgery.

Made available in DSpace on 2017-06-01T18:09:02Z (GMT). No. of bitstreams: 1 Bibiana Poggi_confrontado.pdf: 581539 bytes, checksum: 0cc3101a9830767f7a227685df53c266 (MD5) Previous issue date: 2007-04-09 / Obesity is considered nowadays a pathology that affects a growing number of people, reason for which it s called the millennium disease. It mobilizes the attention of public healthy services, which invest continuously in research to control it. The bariatric surgery presents as an efficient method to control obesity through the intervention of a multi-professional team, composed by a surgeon, a psychologist, a nutritionist and a nurse, that take care of the patient during the pre-chirurgical phase and, afterwards, during the post-chirurgical one. The aim of our research was to investigate the movement of the oral compulsion in women that were submitted to the bariatric surgery. We searched the subjective aspects that always appear in the losing weight process in which it s necessary a change in the ways of the oral satisfaction. We observed, therefore, the effects of the physical intervention in a compulsional body. In so doing, we restricted our analysis among the women for the reason that, in the Hospital da Polícia Militar de Pernambuco, place where the study was conducted, it was them that claimed more for the surgery and also because the women presented more difficulties after the surgery than the men. It s a research that focuses on the interaction between the theory and the clinics, which referential is the psychoanalytic one. Henceforth, we described the cases of three patients accompanied by the researcher before and after the surgery. Afterwards, we analyzed all the material collected. In all the cases it was verified that the physical intervention, although necessary to the patients weight control, was not sufficient to promote changes in the compulsional body. We concluded proving the importance of the psychotherapeutic process, which enabled the changes in the compulsional body of each patient. / A obesidade apresenta-se como uma patologia que acomete um número crescente de pessoas, recebendo a denominação de doença do milênio. Mobiliza a atenção de programas de saúde pública, que investem continuamente em pesquisas procurando debelá-la. A cirurgia bariátrica apresenta-se como um eficiente método de controle da obesidade, implicando a atuação de uma equipe multiprofissional, composta por cirurgião, psicólogo, nutricionista e enfermeiro, que acompanha o paciente na fase pré-operatória e, igualmente, após a cirurgia. O objetivo da nossa pesquisa consistiu em investigar o movimento da pulsão oral em mulheres que se submeteram à cirurgia bariátrica. Buscamos contemplar os aspectos subjetivos implicados no processo de emagrecimento quando se faz necessária modificação na forma de satisfação oral, pesquisando assim o efeito de uma intervenção física no corpo pulsional. Para tanto, delimitamos nosso estudo nas mulheres uma vez que, no Hospital da Polícia Militar de Pernambuco, local onde realizamos a pesquisa, foram elas que demandaram em maior número à cirurgia e, da mesma forma, apresentaram mais dificuldades durante o período pós-cirúrgico. Trata-se de uma pesquisa que articula a teoria com a clínica, cujo referencial é o psicanalítico, na qual apresentaremos os relatos de três pacientes acompanhadas pela pesquisadora antes e após a cirurgia, para em seguida expormos a análise do material colhido. Nos casos acompanhados tornou-se evidente que a intervenção física, embora necessária ao controle de peso das pacientes, não foi suficiente para promover modificações no corpo pulsional. Foi possível constatarmos a importância do processo psicoterápico para que tais alterações possam ocorrer no corpo pulsional de cada paciente.