A Interconsulta Psiquiátrica é considerada por muitos pesquisadores como sendo a área prática e aplicada da Medicina Psicossomática, de conhecimento concernente à investigação da interação entre fatores biológicos e psicossociais no desenvolvi-mento, curso e resultado de todas as doenças. A prevalência de transtornos psiqui-átricos em hospitais gerais pode variar de 20 a 40% entre pacientes internados, po-rém uma reduzida parcela é assistida pela Interconsulta e consequentemente recebe tratamento psiquiátrico. Sendo assim, o presente estudo teve por objetivos: a) obter informações dos dados sociodemográficos dos pacientes e seus históricos em sa¬úde mental (tratamentos anteriores e tentativa de suicídio); b) analisar o uso do ser¬viço de Interconsulta Psiquiátrica, tais como as clínicas solicitantes, função dos pro¬fissionais solicitantes, motivos de solicitação, tempo de internação dos pacientes assistidos, tempo de solicitação do PI e de sua resposta, e o número de atendimen-tos realizados; c) descrever os diagnósticos clínicos e psiquiátricos dos pacientes avaliados através dos critérios estabelecidos pela CID-10; d) analisar intervenções farmacoterapêuticas e não medicamentosas, tais como as condutas sugeridas pelo interconsultor, profissionais solicitados durante a internação, as medicações psico-trópicas em uso e prescritas; e) caracterizar aspectos relacionados aos médicos clí-nicos, aos profissionais de saúde e aos interconsultores; e f) avaliar a qualidade es-trutural da solicitação psiquiátrica realizada pelo profissional clínico e a resposta dada pelo interconsultor. Para tanto, foi realizada uma análise retrospectiva de todas as solicitações consecutivas realizadas entre janeiro de 1981 a dezembro de 2010 para a Psiquiatria do Serviço de Interconsulta em Saúde Mental do Hospital das Clí-nicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo assim como a consulta dos prontuários de todos os pacientes assistidos pelo serviço para obter outras informações. Foram realizadas 4882 solicitações psiquiátricas e a taxa de encaminhamento variou de 0,7 a 1,1%. Dados sociodemográficos dos paci-entes que foram atendidos com mais fre¬quência relacionados ao sexo, cor e/ou et-nia, estado civil, com quem os pacientes residiam (somente para os homens), situa-ção laboral (somente para as mulheres), escolaridade e procedência tenderam a permanecer relativamente estáveis ao longo dos anos. As mulheres apresentaram idade média menor que os homens e foram atendidos com mais frequência: homens e mulheres casados (e mais homens soltei¬ros quando comparados com as mulhe¬res), homens que residiam com seus pais e mulheres que residiam com seus cônju¬ges e filhos, homens afastados de seus tra¬balhos e mulheres responsáveis pelos cuidados da casa, e também pacientes de ambos os sexos com idades entre 21 e 50 anos, pacientes caucasianos, pacientes procedentes do estado de São Paulo e pacientes com escolaridade até ensino fun¬damental completo. As mulheres foram mais frequentemente assistidas pelo serviço de Intercon¬sulta Psiquiátrica ao longo de todos os anos, assim como ficaram menos tempo in¬ternadas e também tiveram solicitações psiquiátricas realizadas em um menor inter¬valo de tempo após a admis¬são hospitalar. Em trinta anos, a Clínica Médica Geral foi a clínica que mais realizou solicitações psiquiátricas, o motivo de solicitação mais frequente foi a presença de sintomas psiquiátricos e o tempo de internação dos pacientes assistidos pela Inter¬consulta foi maior quando comparado aos pacientes internados no hospital de modo geral. Os transtornos neuróticos, somatoformes e relacionados ao estresse foram os diagnósticos psiquiátricos mais comuns entre as mulheres e homens atendidos pelo SISMen, seguido pelos transtornos de humor e transtornos mentais orgânicos nas mulheres e transtornos mentais orgânicos e transtornos devido ao uso de substân¬cias nos homens. Já em relação ao diagnóstico clínico, foram atendidos com mais frequência mulheres com doenças endócrinas, metabólicas e nutricionais e homens com doenças infecciosas e parasitárias; e casos de múltiplas comorbidades clínicas se tornaram mais frequentes com o passar dos anos. As principais condutas sugeri¬das pelos interconsultores foram: atendimento individual, orientação à equipe e prescrição de psicofármacos para ambos os pacientes, permanecendo frequentes ao longo dos anos, com destaque para um aumento progressivo de casos em que medicações psicotrópicas foram prescritas a partir de meados dos anos 90. E com o passar dos anos, os planos de tratamento se tornaram mais complexos e abran¬gentes e houve um aumento progressivo no número de encaminhamentos para atendimento psiquiátrico ambulatorial. Em relação à qualidade estrutural das solici¬tações psiquiátricas e das respostas dadas pelos interconsultores, ambas foram consideradas aceitáveis ou boas na maioria dos casos, sendo um indicativo positivo na qualidade de comunicação entre os profissionais. Pode-se dizer que este foi o primeiro estudo longitudinal a analisar consecutivamente trinta anos e também toda a população assistida por um serviço de Interconsulta Psiquiátrica / Consultation-liaison Psychiatry is considered by many researchers as the practical and applied area of psychosomatic medicine, which is an area of knowledge concerning the investigation of the interaction between biological and psychosocial factors in the development, course and outcome of all diseases. The prevalence of psychiatric disorders in general hospitals range from 20 to 40% of hospitalized patients, but a small portion is assisted by the consultation-liaison and consequently receives psychiatric treatment. Considering this background, this study aimed: a) to obtain information about sociodemographic characteristics of patients and their mental health history (previous treatment and attempted suicide); b) to analyze the referral patterns of consultation-liaison psychiatry, such as referral sources, reasons for referral, length of stay, lagtime and other; c) to describe clinical and psychiatric diagnoses according by ICD-10; d) to analyze pharmacotherapeutic and non-drug interventions; e) to describe aspects related to physicians, health professionals and psychiatrists; and f) to analyze the structural quality of the request made by the physicians and psychiatrists. For this purpose, it was performed a retrospective analysis of all consecutive referrals made between January 1981 and December 2010 to consultation-liaison psychiatry of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo as well as the review of medical charts of all patients assisted by the service. 4882 referrals were made and consultation rate ranged from 0.7 to 1.1%. Sociodemographic characteristics related to sex, color or ethnicity, marital status, patients who lived (for men), employment status (for women), education and origin tended to remain relatively stable over the years. Women had a lower average age than men and were seen more frequently: married men and women (and more single men compared with women), men who lived with their parents and women who lived with their spouses and children, and also patients of both sexes aged between 21 and 50 years, caucasian patients and patients from the state of Sao Paulo. Women were more often assisted by the consultation-liaison service over the years and the length of stay and lagtime were lower than men. In thirty years, internal medicine was the most frequent referral source, presence of psychiatric symptoms was the common reason for referral and the length of stay of patients assisted by consultation-liaison psychiatry was higher compared to those admitted to the hospital in general. The main clinical diagnoses for women and men were endocrine, nutritional and metabolic, cardiovascular diseases and infectious and parasitic diseases and cases with multiple morbidities have become more frequent over the years. One third of patients were diagnosed with neurotic disorders, stress related and somatoform disorders in women and men, followed by mood disorders and organic mental disorders in women, and organic mental disorders and due to substance use in men. The main interventions were individual therapy, guidelines for staff and prescription of psychotropic drugs for women and men. There was a increase in the number of referrals to outpatient psychiatric care. Psychiatric referrals and responses by psychiatrist were considered acceptable or good in most cases, a positive indicative on the quality of communication between professionals. This was the first longitudinal study to examine thirty years consecutively and also the entire population assisted by Consultation-liaison Psychiatry.

Este trabalho tem como objetivo fazer um estudo compreensivo clínico das vivências emocionais da gestante de alto risco com o diagnóstico de Diabetes Gestacional (DG). Realizamos a pesquisa no Centro de Parto Humanizado e Obstetrícia do Hospital do Servidor Público Estadual de São Paulo, Francisco Morato de Oliveira (IAMSPE). Fundamentamo-nos na leitura das Obras Completas de Sigmund Freud, Melanie Klein, Donald W. Winnicott, autores que trazem importantes contribuições teóricas para a psicanálise contemporânea. A avaliação foi feita, em entrevistas clínicas antes do nascimento do recém-nascido, com a aplicação do Teste das Relações Objetais de Phillipson, (TRO), técnica projetiva usada como instrumento facilitador do contato terapêutico e mediador do trabalho interventivo no contexto diagnóstico. As gestantes com Diabetes foram acompanhadas até a sala de parto e durante o puerpério, tiveram seguimento, em Consultas Terapêuticas no sentido de buscar suporte e propiciar alívio para o sofrimento de ver o seu bebê recém-nascido, internado em Unidade de Terapia Intensiva Neonatal (UTIN). O resultado revelou que este teste, utilizado como mediador do diagnóstico, facilitou a comunicação com o mundo interno da paciente e fez aumentar a compreensão dos problemas vividos pelas gestantes de alto risco com DG. Chegamos à conclusão de que a Compreensão Clínica e as Consultas Terapêuticas são formas de atendimento às gestantes diabéticas que contribuem para a evolução clínica das pacientes e são adequadas ao contexto hospitalar / This assignment has as a goal the comprehensive clinical study of the emotional experience of righ risk pregnant women with the diagnosis of gestational diabetes (GD). We performed this research consulting the Humanized Pregnant and Obstetric Center of Hospital of Publish State Servant of São Paulo, Francisco Morato de Oliveira- IAMSPE. We based our thesis on Sigmund Freud, Melanie Klein and Donald W, Winnicott, authors who have given an important contribution to contemporary psychoanalysis. The evaluation was performed in clinical interwies before the birth of the baby with the application of the Objective Relations Test, by Phillipson (ORT). This is a projective technique used as a facilitator instrument for therapeutic contact and as a mediator process of the interventive work, as well as the diagnostic source. The diabetic pregnant women were accompanied to the delivery room and during the puerperal they had follow up in Therapeutic Consultations with the aim to support and relieve the suffering of seeing their newly born babies in a New born Intensive Therapy Unite (UTIN). The results revealed that this test, used as a process mediator, facilitated communication with the internal world of the patient and the understanding of anxiety experienced by the high risk patients with gestational diabetes. We reached the conclusion that the Clinical Understanding and Therapeutic Consultant are forms of dealing with diabetic pregnant women, making the clinical evolution easier and the Test (ORT) are also appropriated to a hospital context

Made available in DSpace on 2016-08-19T18:15:56Z (GMT). No. of bitstreams: 1 Erika Krogh.pdf: 139556 bytes, checksum: 216878ad89ff19e3e8bc335f8838580a (MD5) Previous issue date: 2008-10-25 / Introduction: A gynecological appointment in adolescence is usually surrounded by anxiety and ignorance for an adolescent. The lack of information and fear of new discoveries make that the adolescent delayed this first consultation. Objective: To identify determinant motivations for a gynecological appointment in adolescence. Method: Questionnaires were applied in the form of interview, in 45 female adolescents from 10 to 19 years in order to evaluate aspects related to knowledge and information to adolescents about the gynecologist and a gynecological appointment in the period from January to May of 2008. The participants were chosen at random from among the participants of Adolescentro - Vila Embratel. Results: The average age of adolescents was 14.5 years. The average age that patients seek medical care was 12.9 years. The menarche occurred between 10 to 12 years for most teenagers. Approximately 78% of the interviewees did not start sex life and 55.6% knew the area in which the gynecologist served, whereas only 37.8% had attended a gynecological consultation. The initiative of seeking medical care comes from the mothers in 82.4% of cases. The most quoted reason for the search by the gynecologist was routine gynecological. As the DST's and contraceptive methods, the adolescents who had a consultation, said to meet them at 100% and 70.6% respectively. Conclusion: It was concluded in this work that the demand for consultation on the initiative of a teenager is still very low, being the mother the determining factor for this search. The higher the education level, the family income and the knowledge of STD's, the greater the demand for a gynecological appointment. / Introdução: A consulta ginecológica na adolescência é geralmente cercada de ansiedade e desconhecimento para a adolescente. A falta de informação e o medo das novas descobertas fazem com que a adolescente protele esta primeira consulta. Objetivo: Identificar motivações determinantes para a consulta ginecológica na adolescência. Método: Foram aplicados questionários, na forma de entrevista, em 45 adolescentes do sexo feminino, de 10 a 19 anos , para avaliar aspectos relacionados ao conhecimento e informação das adolescentes sobre o ginecologista e a consulta ginecológica no período de janeiro a maio de 2008. As participantes foram escolhidas aleatoriamente, dentre as freqüentadoras do Adolescentro Vila Embratel. Resultados: A média de idade das adolescentes foi de 14,5 anos. A idade média que as pacientes buscaram atendimento ginecológico foi 12,9 anos. A menarca ocorreu entre 10 a 12 anos para a maior parte das adolescentes. Aproximadamente 78% das entrevistadas não iniciaram vida sexual e 55,6% conheciam a área em que atuava o ginecologista, sendo que somente 37,8% já compareceram a uma consulta ginecológica. A iniciativa de procurar atendimento ginecológico partiu das mães em 82,4% dos casos. O motivo de busca pelo ginecologista mais citado foi rotina ginecológica. Quanto as DST s e os métodos anticoncepcionais, as adolescentes que já foram a consulta, referiram conhecê-los em 100% e 70,6% respectivamente. Conclusão: Concluiu-se neste trabalho que a procura pela consulta ginecológica por iniciativa da adolescente ainda é muito baixa, sendo a mãe o fator determinante para essa busca. Quanto maior o nível de escolaridade, a renda familiar e o conhecimento das DST s, maior é a procura pelo atendimento ginecológico.

Este trabalho tem como objetivo fazer um estudo compreensivo clínico das vivências emocionais da gestante de alto risco com o diagnóstico de Diabetes Gestacional (DG). Realizamos a pesquisa no Centro de Parto Humanizado e Obstetrícia do Hospital do Servidor Público Estadual de São Paulo, Francisco Morato de Oliveira (IAMSPE). Fundamentamo-nos na leitura das Obras Completas de Sigmund Freud, Melanie Klein, Donald W. Winnicott, autores que trazem importantes contribuições teóricas para a psicanálise contemporânea. A avaliação foi feita, em entrevistas clínicas antes do nascimento do recém-nascido, com a aplicação do Teste das Relações Objetais de Phillipson, (TRO), técnica projetiva usada como instrumento facilitador do contato terapêutico e mediador do trabalho interventivo no contexto diagnóstico. As gestantes com Diabetes foram acompanhadas até a sala de parto e durante o puerpério, tiveram seguimento, em Consultas Terapêuticas no sentido de buscar suporte e propiciar alívio para o sofrimento de ver o seu bebê recém-nascido, internado em Unidade de Terapia Intensiva Neonatal (UTIN). O resultado revelou que este teste, utilizado como mediador do diagnóstico, facilitou a comunicação com o mundo interno da paciente e fez aumentar a compreensão dos problemas vividos pelas gestantes de alto risco com DG. Chegamos à conclusão de que a Compreensão Clínica e as Consultas Terapêuticas são formas de atendimento às gestantes diabéticas que contribuem para a evolução clínica das pacientes e são adequadas ao contexto hospitalar / This assignment has as a goal the comprehensive clinical study of the emotional experience of righ risk pregnant women with the diagnosis of gestational diabetes (GD). We performed this research consulting the Humanized Pregnant and Obstetric Center of Hospital of Publish State Servant of São Paulo, Francisco Morato de Oliveira- IAMSPE. We based our thesis on Sigmund Freud, Melanie Klein and Donald W, Winnicott, authors who have given an important contribution to contemporary psychoanalysis. The evaluation was performed in clinical interwies before the birth of the baby with the application of the Objective Relations Test, by Phillipson (ORT). This is a projective technique used as a facilitator instrument for therapeutic contact and as a mediator process of the interventive work, as well as the diagnostic source. The diabetic pregnant women were accompanied to the delivery room and during the puerperal they had follow up in Therapeutic Consultations with the aim to support and relieve the suffering of seeing their newly born babies in a New born Intensive Therapy Unite (UTIN). The results revealed that this test, used as a process mediator, facilitated communication with the internal world of the patient and the understanding of anxiety experienced by the high risk patients with gestational diabetes. We reached the conclusion that the Clinical Understanding and Therapeutic Consultant are forms of dealing with diabetic pregnant women, making the clinical evolution easier and the Test (ORT) are also appropriated to a hospital context

Submitted by Maicon Juliano Schmidt (maicons) on 2015-04-28T18:18:05Z No. of bitstreams: 1 Luciana Catarina Pires da Rocha.pdf: 791814 bytes, checksum: 448871269f52c6cb8b863f33eaa068f9 (MD5) / Made available in DSpace on 2015-04-28T18:18:05Z (GMT). No. of bitstreams: 1 Luciana Catarina Pires da Rocha.pdf: 791814 bytes, checksum: 448871269f52c6cb8b863f33eaa068f9 (MD5) Previous issue date: 2014-03-31 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Neste trabalho, buscamos entender o que Benveniste chama de comunicação intersubjetiva para, a partir dessa noção, examinar a natureza da interlocução que se estabelece toda vez que, na situação específica de enunciação em consulta ambulatorial, os interlocutores (médico e paciente) assumem a língua. Nesse processo, derivamos dos estudos de Benveniste, os conceitos de alocução e troca. Entendemos que a alocução resulta da reversibilidade entre eu e tu, sendo necessária ao estabelecimento do efeito pragmático da comunicação intersubjetiva. No entanto, ela não é suficiente para garantir a comunicação intersubjetiva, que está relacionada ao estabelecimento de troca, definida como a assunção pelos parceiros de uma posição de protagonismo na enunciação. Com base nessa elaboração teórica, analisamos uma consulta ambulatorial para observar se a tomada da palavra pelos interlocutores viabiliza (ou não) a troca entre ambos, capaz de instaurar a comunicação intersubjetiva. Os resultados da análise mostram que o estabelecimento de troca entre médica e paciente, nessa situação, institui-se como um processo descontínuo e contingencial, pois coloca em jogo fatores diversos, nem todos passíveis de ser identificados. Desse modo, podemos dizer que a comunicação intersubjetiva, na consulta examinada, se dá como efeito momentâneo, sempre que, na enunciação, o par eu e tu realiza movimentos em direção ao estabelecimento de uma troca. Concluímos, então, que a assunção, pelos participantes do diálogo, de um engajamento subjetivo na enunciação está sempre sujeita a oscilar no decorrer do processo. / In this work, we seek to understand what Benveniste calls intersubjective communication, to examine, from this notion, the nature of the interlocution that establishes itself every time that, in the specific situation of enunciation in outpatient visit, the interlocutors (doctor and patient) take on the language. In the process, we derive from studies of Benveniste, the concepts of allocution and exchange. We understand that allocution results from the reversibility between I and you, being necessary to establish the pragmatic effect of intersubjective communication. However, this is not sufficient to ensure intersubjective communication, which is related to the establishment of exchange, defined as the taking of a position of prominence in the enunciation by the partners. Based on this theoretical work, we analyze an outpatient visit to see if the taking of the word by the interlocutors enables (or not) the exchange between the two, being able to establish intersubjective communication. The analysis results show that the establishment of an exchange between doctor and patient, in this situation, establish itself as a discontinuous and contingent process because it puts at stake a number of factors, not all likely to be identified. Thus, we can say that intersubjective communication, in an outpatient visit, occurs as a momentary effect always that, in the enunciation, the pair I and you makes movements towards establishing an exchange. We conclude that the taking of a subjective engagement in the enunciation by the participants of the dialogue is always subject to oscillating in the process.

Abstract not available

<p>Vårt syfte med den här uppsatsen är att besvara följande frågeställningar:</p><ul><li>Vilka fördelar och nackdelar ser remissinstanserna med utredningens förslag?</li><li>Är det några speciella områden där åsikterna går isär eller är liknande?</li><li>Vilket stöd finns för utredningens förslag? </li></ul><p>Bakgrunden till att vi valt just detta ämne är att sambandet mellan redovisning och beskattning är ett komplicerat område som är sammankopplat på olika sätt.</p> / <p>Our purpose with this paper is to find out:<strong><em></em></strong></p><ul><li>What advantages and disadvantages does the proposal have, according to the bodies to which the proposal has been referred for consultation?</li><li>Are there any special areas where the opinions are alike or part from each other?</li><li>What is the support for the proposal?</li></ul><p>The reason for choosing this specific subject is that the connection between accounting and taxation is a complicated area, with many interconnections in different ways.</p>

Vårt syfte med den här uppsatsen är att besvara följande frågeställningar: Vilka fördelar och nackdelar ser remissinstanserna med utredningens förslag? Är det några speciella områden där åsikterna går isär eller är liknande? Vilket stöd finns för utredningens förslag? Bakgrunden till att vi valt just detta ämne är att sambandet mellan redovisning och beskattning är ett komplicerat område som är sammankopplat på olika sätt. / Our purpose with this paper is to find out: What advantages and disadvantages does the proposal have, according to the bodies to which the proposal has been referred for consultation? Are there any special areas where the opinions are alike or part from each other? What is the support for the proposal? The reason for choosing this specific subject is that the connection between accounting and taxation is a complicated area, with many interconnections in different ways.

This research project studies the military exchanges between the United States and People's Republic of China. US-PRC relations have experienced uneven developments over the last decadeas the two major powers have grappled with the evolving post-Cold War international security Environment as well as shifting domestic agendas and foreign policy priorities. While the October 2002 Crawford summit between Presidents Bush and Jiang, and the resumption of the Defense Consultation Talks in December 2002 offer the prospect for restoring bilateral military exchanges. For a more stable bilateral military relationship to develop and be sustained, longer-term strategies must be formulated that emphasize engagement, exchanges, and better understanding of each other's common interests, priorities, and policy options. Among the key features of this relationship are high-level exchange visits of defense ministers and military leaders; confidence-building measures, including the Military Maritime Consultative Agreement, annual Defense Consultation Talks, and port visits; and regular contacts at the functional level between the two countries' national defense universities and military academies. The EP-3 incident raised the importance of China in the Bush Administration's immediate policy agenda. The resolution of the incident has pointed to the need for dialogue. The 11 September 2001 terrorist attacks provided additional impetuses for rebuilding the bilateral relationship, including efforts to restore military-to-military exchanges.

Depression is a common mental health problem in primary health care. One third of the Swedish population is expected to experience depression at some point in their lives. The understanding of depression has expanded, both from a lay and primary health care perspective. The number of persons considering themselves as depressed, receiving the diagnosis, and getting treatment for it has increased steadily over the last decades. Unchanged, however, is that depression is diagnosed twice as often in women as in men, while twice as many men as women commit suicide. These gender differences appear in adolescence. In earlier research biomedical, psychological, and social-cultural explanations of gender differences have been discussed. Patient’s own perspectives have more seldom stood in focus, and men’s narratives in particular are still scarce. In this thesis, gender, i.e. how to be a woman or a man, is considered as a construct, formed and negotiated in social interaction. The aim of the study is to explore the gendered face of depression from a patient perspective: How is depression expressed and explained by patients in primary health care, by women and men, adults and adolescents? How are depressed women and men portrayed in the media? How do patient and media accounts of depression compare with the perspective offered in medical research articles? Method and material The analyses are based on data from three different sources: patient narratives, newspaper portrayals and scientific medical articles. – 37 in-depth interviews were undertaken with primary health care patients diagnosed with depression. Informants were chosen to include both men and women, grown-ups (Studies I + II) and young adults (Study V) of varying occupational and social class backgrounds. Data were analyzed according to grounded theory. – 26 articles portraying lay informants with depression (Study III) were drawn from three major Swedish daily newspapers by a search of database Mediearkivet 2002. The articles were analyzed by qualitative content analysis. –82 scientific articles concerning depression in relation to gender were identified in a PubMed search 2002. The understanding of depression in these articles was explored and compared with findings in the grown-up patient narratives and in the media portrayals by means of discourse analysis (Study IV). Findings Study I captured women’s and men’s formulations of their experiences of depression. To be marked with demands constituted a central experience for both women and men, but the outward manifestations differed in relation to gender as well as to class. Home and work had different priority. Men talked more about physical distress (often chest pain) than about emotions. Women readily verbalized emotional distress – shame and guilt – while physical symptoms were vague and secondary (often about the stomach). Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement. Study II disclosed gendered trajectories into depression. Four symbolic illness narratives were identified: struck by lightning, nagging darkness, blackout and slowly suffocating. Most of the men considered their bodies suddenly “struck” by external circumstances beyond their control. The stories of women in the study were more diverse, reflecting all four illness narratives. However, the women had a tendency to blame their own personality and to describe depression as insidious and originating from the inside. The women expressed feelings of guilt and shame but also conveyed a personal responsibility and concern with relationships. Study III identified four themes in media portrayals of depression: displaying a successful facade, experiencing a cracking facade, losing and regaining control and explaining the illness. The mediated image of depression both upheld and challenged traditional gender stereotypes. The women’s stories were more detailed, relational, emotionally oriented and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression. Study IV revealed gaps in how depression in relation to gender is understood by the patients, the media, and the medical research establishment. There were differences in recognition, in understanding of the reasons, and in contextualization of depression. Although women and men described different symptoms and reasons for falling ill, in scientific articles these gendered differences were conceptualized mainly in terms of hormones and other biological markers. Study V elucidated the impact of gender on adolescent depression. The young women and men were all striving to be normal, influenced by demanding media images, confronted by identity trouble, and overwhelmed by feelings. They had dreams of an ordinary family and described normative expectations. Getting a safety net of friends and other adults was a way out. Both the young women and men were eager to communicate their distress when given the opportunity. This seemed especially important to some of the young men, who in talking about their emotional problems transgressed gender norms. Conclusions Patient perspectives enrich the understanding of gendered expressions of depression by making visible transgressions of and breaks with stereotype gender norms. Gender awareness is an important key in clinical consultation. To recognize gendered narratives of illness might have a salutary potential, making depression more visible among men, and relieving self-blame among women. By re-evaluating restrictive gender patterns, the clinician might encourage development of healthier practices of how to be a man or a woman, a development especially important for adolescents. An integrated model for understanding biological, gender and cultural aspects of depression has yet to be developed. As general practitioners we have a unique possibility to see and to study the whole individual in her social and cultural context.