Dra. Nellynette Torres Ramírez            787-298-0050   torres.nellynette@gmail.comNo hay salud sin salud mental Estudian...
Salud y psicología• Psicóloga clínica y consultora• Evaluación, diagnóstico y tratamiento• Emociones, conducta y pensamiento
Enfoque: Salud ecológico             Biológico    Social          Psicológico
No hay salud sin salud mental• Concepto salud• Enfermedad física• Datos comunes• Salud integrada• Barreras
Salud Mental                                          manejar                                                    productiv...
Discapacidad y salud mental
Depresión y salud      Estresores diarios             Resultado• Carga trabajo            • Falta concencentración• Privac...
Ansiedad y salud
Servicio primario salud                                Ejemplos   Edad             Queja principal                    Tras...
Tipos servicios salud        Especializado               Primario• Corto plazo            • Largo plazo• Reduccionista    ...
Datos salud primaria120.0%100.0% 80.0% 60.0%                                              Psicóloga                       ...
Servicios salud integrados
Barreras   Estigma     Desigualdad    Ineficiencia• Discrimen   • Status       • Recursos• Creencias   • Abusos       • Tr...
No hay salud sin salud mental• Significado salud mental• Relación discapacidad y salud mental• Efecto de la depresión y an...
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  • Opening Gambit:Pregunta: ¿Quéessalud mental? Y sies tan importantecomoafirmo; ¿ porqué no se le brinda la importancianecesaria?
  • USP = Unique Selling PropositionExplicar mi trabajo
  • Proof of Concept:Miconcepto de la saludesunoholístico, interrelacionado, sistémico. La salud mental debetomarse en cuent, incluso, desde la etapa prenatal. Una de misáreas de especialidades la niñeztemprana (0 – 6 años) Hice mi especialidad con NYU, en Ginebra, Suiza. Explicarcómo se da la integraciónallá.Point BCon estacharlapretendoenfatizar en la importancia de la salud mental paralograrunavida plena personal y profesional. No hay queconformarse con menos, existenlasherramientasparalograrla.Link:Para demostrarlovoy a estarhablando …
  • LeerlaRoadmap – Time:Este esnuestromapapara los próximos 20 minutos de presentación. Al final puedenhacersuspreguntas.
  • Definición:Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." WHO. (10/31/2011). Mental Health a State of Well Being. Retrieved from: http://www.who.int/features/factfiles/mental_health/en/index.html
  • The key messages from our Series are clear. First, mental health is a neglected aspect of human well- being, which is intimately connected with many other conditions of global health importance. Horton, R. (2007). Launching a New Movement for Mental Health. Lancet,370. DOI:10.1016/S0140- 6736(07)61243-4 WHO’s 2005 report attributed 31∙7% of all years lived-with-disability to neuropsychiatric conditions: the five major contributors to this total were unipolar depression (11∙8%), alcohol-use disorder (3∙3%), schizophrenia (2∙8%), bipolar depression (2∙4%), and dementia (1∙6%).4 However, the interaction between mental disorder and disability is more complex and extensive than the WHO report suggests. Depression predicts the onset and progression of both physical and social disability.5,6 Conversely, disability is an important prospective risk factor for depression in older adults,7–12 and mediates most of the effects of specific physical health conditions in this group.10,13–15 Social support is an effect modifier.10, Prince, M., Patel,V., Saxena,S., Maj,M., Maselko,J., Phillips,M.R.,& Rahman,A. (2007). No health Without Mental Health. Lancet, 370, p. 859-877. DOI:DOI:10.1016/S0140- 6736(07)61238-0
  • Depression remains a significant issue for medical trainees. This study highlights the importance of ongoing mental health assessment, treatment, and education for medical trainees. The number of women training to become physicians has more than doubled since 1980, and women currently make up 49% of medical school classes in the United States.33 We found that rates of depression among women were more than two times higher than for men. In a recent study, Tjia and colleagues14 found slightly higher rates among female medical students. Hsu and Marshall10 noted significantly more depressive symptoms in female residents, with 40% of female interns having at least mild depression. Goebert, D., Thompson, D., Takeshita, J., Beach, c.,, Bryson, P., Ephgrave, K.,Kent, A., Kunkel, M., Schechter, J.,& Tate, J. (2009). Depressive Symptoms in Medical Students and Residents: A MultischoolStudy. Academic Medicine, 84(2), p. 236-241.Twenty-four percent (n = 46) of the medical students were depressed by BDI criteria. Of the depressed students, only 22% (n = 10) were using mental health counseling services. Givens, J.L., Jennifer,J.(2002). Depressed Medical Students' Use of Mental Health Services and Barriers to Use. Academic Medicine, 77(9), p. 918-921
  • Ataques de pánicoEstrésagudoEstrés post-traumáticoFobiasOne in three patients who present in an emergency department for chest pain has depression or panic disorder (American Psychiatric Association, 1998).
  • he first patient is a 56-year-old woman with diabetes who is anxious about the course of her disease. She has heard about people going blind and losing limbs. She knows that her obesity is a contributory factor, yet she has had a hard time losing weight. She is worried about her weight and about what she eats most of the time. It is consuming her life. On the other hand, she sees her worry as a natural response to her medical situation and would never accept a referral for help to be less anxious. The next patient is a 33-year-old woman who is an immigrant from South America. Although a screening test would identify her as meeting criteria for a diagnosis of major depression, the concept of an emotional disorder would make no sense to her. In her culture, people are either considered sick or crazy. She is not crazy, like some of the homeless people she has seen talking to themselves, so to her, she is sick. It would make more sense to her for someone to tell her that a former girlfriend of her husband had put a curse on her than to tell her that she has an emotional disorder related to chemical processes in her brain. She is not going to follow through on a referral or treatment, though out of respect for the doctor, she will certainly agree to go for counseling or to take medication when she is in the consulting room. The 7-year-old boy has an earache. At the end of the visit, his mother says that she is concerned that he has started wetting the bed. She does not offer the information that she and the child’s father have recently separated because she feels bad enough about it without entertaining the idea that their stress is contributing to the child’s problems. She expects a medical definition of the problem and sees the physician as the person who should address it. A behavioral health referral would not be acceptable. he 52-year-old man has hypertension and high cholesterol. He is a type A personality who is driven in his work and stressed a lot of the time. He could benefit from stress management and relaxation work in addition to help with motivational interviewing about his diet. However, his health insurance company does not pay for behavioral health care where there is not psychiatric diagnosis. He will not accept a referral. The 38-year-old woman with frequent asthma exacerbations is struggling with family issues. Her physician has told her she must be in a smoke-free environment. Her husband thinks she uses her asthma as a weapon to try to make him quit smoking. He is not about to go for counseling about their relationship or about his smoking. She will not take a referral.
  • ExplicardiferenciasExplicarque el enfoquepsicológicodebesertambiénadaptado
  • Although only 20% of people who commit suicide had contact with a psychologist in their last month, 45% have had contact with a primary care medical professional (Luoma, Martin, & Pearson, 2002). *  Sixty-eight percent of patients with a diagnosable mental health condition will seek care from a primary care medical professional, whereas only 28% of such patients will see a psychologist (Miranda et al., 1994). *  Thirty-two percent of undiagnosed, asymptomatic adults say they would first turn to their primary care medical professional for assistance with a mental health issue, while only 4% stated they would approach a psychologist (National Mental Health Association, 2000).Even when patients do ultimately connect with a psychologist, the frequent lack of collaboration between the psychologist and the patients’ medical professionals reduces the effectiveness of both the medical and the psychotherapeutic treatments.
  • No es solo poner a un psicológo en la clínica.Todostrabajarhaciauna meta comúnMétodosinnovadoresEvcortasBasadas en la evidenciaTelefono, email, videoServicioespecializadoparalosmás gravesGunn, W.B., & Blaunt, A. (2009). PrimaryCareMentalHealth:ANewFrontierforPsychology. JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 65(3), 235-252. DOI: 10.1002/jclp.20499
  • The most frequently cited barriers to using these services were lack of time (48%), lack of confidentiality (37%), stigma associated with using mental health services (30%), cost (28%), ear of documentation on academic record (24%), and fear of unwanted intervention (26%). Though under-provision of resources remains the most important barrier to effective mental health care, even in the highest-income countries, most people with mental disorders receive no effective care; for example, in the USA, two-thirds of people with mental disorders received no treatment Stigma of mental illness can be defined as the negative attitude (based on prejudice and misinformation) that is triggered by a marker of illness—eg, odd behaviour or mention of psychiatric treatment in a person’s curriculum vitae. PosiblesimplicacionesfuturasPoverty is linked to poor health status. Poverty is more than low-income or low consumption;50 it encompasses non-monetary aspects such as social exclusion, social vulnerability, and denial of opportunities and choice. Inequity of access to scarce resources is especially pronounced for children and adolescents with mental Many people with mental disorders experience outright abuses of their human rights, and sometimes even within treatment facilities. Restricciones, falta de decisión en sutxdespite evidence that mental disorders cause a high and growing disability burden and long-term effects on quality of life, and that treatments for mental disorders are relatively cost effective, compared with those for other conditions.132 Governments still need to be persuaded to allocate much larger proportions of public resources to mental health, Ejemplo PR-noticiaTratamientospocoprobados, falta de evidenciacientífica, a pesar de haberseerradicadolasinfeccioneslascondicionesmáscrónicas, casiestánigualdesdeque hay historia.Saxena,S., Thornicroft,G., Knapp,M., & Whiteford,H. (2007). Resources for mental health: scarcity, inequity, and ineðciency. Lancet, 370, p. 878-879. DOI:10.1016/S0140- 6736(07)61239-2
  • ResumirQuépodemoshacerLa salud mental es parte de la salud. SomosseresintegradosNo estamosexentos de problemasdiarios y de salud mentalHay alternativasBuscaayuda y estimula a otros a hacer lo mismo.
  • Gracias!A los que les interese: me puedellamar y le ofrezcounaconsulta de 30 minutos gratis, si me indicaqueparticipó de la conferencia. Explicar en queconsiste.
  • 2012-01-08-psm_no_salud

    1. 1. Dra. Nellynette Torres Ramírez 787-298-0050 torres.nellynette@gmail.comNo hay salud sin salud mental Estudiantes y público Ponce School of Medicine 3/ noviembre/ 2011
    2. 2. Salud y psicología• Psicóloga clínica y consultora• Evaluación, diagnóstico y tratamiento• Emociones, conducta y pensamiento
    3. 3. Enfoque: Salud ecológico Biológico Social Psicológico
    4. 4. No hay salud sin salud mental• Concepto salud• Enfermedad física• Datos comunes• Salud integrada• Barreras
    5. 5. Salud Mental manejar productividad potencial bienestar Salud contribución mentalDefiniciónOrganización Mundialde la Salud (OMS)2011
    6. 6. Discapacidad y salud mental
    7. 7. Depresión y salud Estresores diarios Resultado• Carga trabajo • Falta concencentración• Privación sueño • Malestar general• Ambiente aprendizaje • Reducción energía• Preocupación económica • Animo variable• Sobrecarga información • Enfermedad física• Relaciones difíciles • Otros
    8. 8. Ansiedad y salud
    9. 9. Servicio primario salud Ejemplos Edad Queja principal Trasfondo56 años Diabético, pobre control Ansiedad33 años Múltiples quejas somáticas Depresión7 años Otitis media Euneresis52 años Hipertensión Factores riesgo cardiaco38 años Asma aguda No-adherencia medicamentos
    10. 10. Tipos servicios salud Especializado Primario• Corto plazo • Largo plazo• Reduccionista • Holístico• Poco común • Común• Individuo • Individuo, familia, población
    11. 11. Datos salud primaria120.0%100.0% 80.0% 60.0% Psicóloga Médico 40.0% 20.0% 0.0% Suicidio Diagnóstico Sin diagnóstico
    12. 12. Servicios salud integrados
    13. 13. Barreras Estigma Desigualdad Ineficiencia• Discrimen • Status • Recursos• Creencias • Abusos • Tratamiento
    14. 14. No hay salud sin salud mental• Significado salud mental• Relación discapacidad y salud mental• Efecto de la depresión y ansiedad• Cuidado integrado de salud como alternativa• Barreras