O završnoj fazi terapijskog procesa u grupama pacijenata sa psihozom te o načinima izlaska individualnog pacijenta
iz grupe relativno malo je pisano u literaturi. Zbog prirode psihotičnog procesa ...koji remeti funkcioniranje ličnosti
u svim aspektima (emocionalnom, kognitivnom, voljno-nagonskom) te osobito na planu interpersonalnog i
socijalnog funkcioniranja, ciljevi dugotrajne analitičke grupne psihoterapije mogu se podijeliti na ciljeve rane i
kasne faze liječenja. U ranoj fazi liječenja cilj je stabilizacija bolesti, nestanak simptoma, kritičnost prema bolesti i
potrebi liječenja, prihvaćanje psihofarmakoterapije, prorada traumatskih iskustava hospitalizacije te stigmatizacije
u trajanju od godinu do dvije. U kasnijoj fazi liječenja težimo konsolidaciji selfa, postizanju konstantnosti i viših
razina objektnog odnosa, rekonstrukciji mehanizama obrane te uvidu u unutarnje konflikte. Završetak grupne
psihoterapije sa psihotičnim pacijentima je visokoindividualan proces u kojem sudjeluju sam pacijent, ostali članovi
grupe i terapeut/i. Za većinu psihotičnih pacijenata postignuće ciljeva prve faze liječenja znači i kraj terapije, a
za pacijente s većim kapacitetima za psihoterapijski rad i interesom za psihološko moguće je postići i više razine
objektnih odnosa i funkcioniranja.
U ovom radu prikazujemo iskustva iz dugotrajne grupne analitičke terapije pacijenata sa psihotičnim poremećajima
iz ambulantnog programa Klinike za psihijatriju Sveti Ivan. Opisuju se različiti načini izlaska pacijenata-članova
grupe iz grupne psihoterapije, a zajedničko obilježje je odsutnost procesa prorade separacije bez obzira na dužinu
participacije u grupi, postignute pomake te terapijski dogovor.
Od ranog dvadesetog stoljeća, filozofija se općenito smatra beskorisnim akademskim zanimanjem. No najviše je takozvanih terapija razgovorom u području mentalnog zdravlja zapravo slabo maskirana ...primijenjena filozofija. Ovaj rad argumentira da poučavanje filozofijskog sadržaja i filozofijske diskurzivne vještine mogu biti od velike dobrobiti za stručnost kliničara i drugih profesionalaca u području mentalnog zdravlja.
Adjuvantna radioterapija kod bolesnica s rakom dojke provodi se s ciljem smanjenja rizika povrata bolesti: lokalnog i sustavnog te je njome moguće postići i bolje ukupno preživljenje. Međutim, taj ...učinak radioterapije nije jednak u svim skupinama bolesnica. Kako zračenje ima i određene nuspojave, potrebno je definirati bolesnice kod kojih je učinak radioterapije na sveukupno kontrolu bolesti toliko malen da se ovaj oblik liječenja može i izostaviti. To su, načelno, bolesnice starije od 70 godina kod kojih je učinjen poštedni kirurški zahvat a tumori imaju pozitivne hormonske receptore, manji su od 2 cm (T1) i aksilarni limfni čvorovi nisu zahvaćeni (N0). Upitno je može li se indikacija za radioterapiju u toj skupini bolesnica otkloniti i u slučaju Her2 pozitivnih tumora, tumora veličine do 3 ili 4 cm te kod bolesnica starijih od 65 ili čak 60 godina. U slučaju provedenog radikalnog kirurškog zahvata radioterapija se izostavlja kod tumora manjih od 5 cm i nezahvaćenih limfnih čvorova aksile (pT1-2, N0). Ukoliko je provedeno neoadjuvantno sustavno liječenje, radioterapija se provodi uvijek nakon poštednog kirurškog zahvata, a nakon radikalnog kirurškog zahvata uvijek kod klinički ili patohistološki pozitivnih limfnih čvorova aksile (cN+ ili ypN+). Kriterij otklanjanja indikacija za radioterapiju nikako ne bi smjela biti isključivo stopa patološkog odgovora na provedenu neoadjuvantnu sustavnu terapiju.
The article deals with clinical diagnosis and treatment of pityriasis rubra pilaris (PRP). The authors analyze the diagnostic errors, present literature review, and their own observations. The ...clinical study included 23 patients with pityriasis rubra pilaris: 18 women and 5 men, average age of 54 ± 7.2. The clinical diagnosis of all examined patients was subsequently confirmed by histological analysis of the skin. The primary clinical diagnosis was psoriasis in 15 (65.2%) patients, 6 (26%) patients received treatment for toxic exanthema, and only 2 (8.8%) patients were presumptively diagnosed with pityriasis rubra pilaris. In conclusion, pityriasis rubra pilaris was initially misdiagnosed in 91.2% of patients. Considering the great number of diagnostic errors, we analyzed the main diagnostic and differential diagnostic features of PRP. The most effective of all synthetic retinoids in PRP treatment is acitretin. Although symptomatic improvement in PRP occurs within a month, substantial improvement, even clearing is possible within 4 - 6 months.
Collodion Baby - a Case Report Stojanović, Vesna; Doronjski, Aleksandra; Spasojević, Slobodan ...
Serbian Journal of Dermatology and Venerology,
12/2014, Letnik:
6, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Colloidon baby describes a highly characteristic clinical entity in newborns encased in a yellowish translucent membrane resembling collodion. In most cases the condition either precedes the ...development of one of a variety of ichthyoses, the commonest of which are lamellar ichthyosis and non-bullous ichthyosiform erythroderma, or occasionally represents an initial phase of other ichthyoses such as ichthyosis vulgaris. In at least 10% of all cases of collodion baby, the condition is followed by a mild ichthyosis of lamellar type, so mild as to be considered more or less normal, so-called self-healing collodion baby or ‘lamellar ichthyosis of the newborn’. In this report we present a rare case of collodion baby in whom, after collodion membrane peeled-off, the skin retained normal appearance.
Although toxoplasmosis is one of the most widely spread infections in the world, types that involve the skin are extremely rare. However, skin lesions are not specific; moreover, they are quite ...diverse, which makes the diagnosis of cutaneous toxoplasmosis rather difficult. Thus, differential diagnosis should include a number of other diseases. We present a case of a 43-year-old immunocompetent man with multiple livid erythematous papules and nodules with yellowish discharge that involved the skin of the body and the extremities. By using electro-chemiluminescence immunoassay, immunoglobulin G antibodies to Toxoplasma gondii were detected in the serum, confirming the diagnosis of toxoplasmosis. The treatment with pyrimethamine and trimethoprim-sulfamethoxazole led to complete resolution of skin lesions. In conclusion, although rare in the dermatological practice, cutaneous toxoplasmosis should be considered in all patients presenting with lymphadenopathy, non-specific skin eruptions, especially nodular and colliquative, blood eosinophilia and histological findigs revealing abundant eosinophilic inflitrations.
Keratosis lichenoides chronica represents a distinct entity, a rare disease of unknown etiology and pathogenesis, with clinical manifestations which, although typical, require extensive differential ...diagnosis. The course of the disease is chronic, progressive, and it is resistant to various treatment options, so despite variations in the clinical picture it is really easier to diagnose than to treat. This is a case report of a male patient in whom the diagnosis of keratosis lichenoides chronica was based on typical clinical picture, repeated biopsies and histopathological findings, course of the disease and poor response to any therapy.
Kroz promišljanja o bolesti i zdravlju; o tijelu i duhovnosti; o egzistencijalnim pitanjima s kojima se suočavaju i pacijenti i stručnjaci iz medicinskih i drugih disciplina koji se bave različitim ...područjima liječenja; rehabilitacije i palijativne skrbi; prikazani su suvremeni pristupi u području psihosocijalne onkologije i sofrologije. U okviru dubinsko-ekološkog i holističkog pristupa u zdravstvenoj skrbi; na načelima interdisciplinarnosti i komplementarnosti; prikazan je i pregled nekih suvremenih komplementarnih metoda koje mogu biti primijenjene u edukaciji; liječenju i rehabilitaciji oboljelih od raka.
Development of multiple basal cell carcinomas is commonly associated with immunosuppression or genetic disorders. The latter include congenital diseases such as Gorlin-Goltz syndrome, also known as ...nevoid basal cell carcinoma syndrome, or basal cell nevus syndrome. It is an autosomal dominant inherited disorder characterized by the development of multiple basal cell carcinomas at an early age and a variable combination of other phenotypic abnormalities that result in multiple organ involvement. The susceptibility gene was mapped to chromosome 9q22.3-3.1. Like other tumor suppressor genes, PTCH1 gene shows frequent deletion and a whole variety of other mutations. A high rate of new mutations and the variable expressivity of the condition make full diagnostic assessment difficult, especially in mildly affected individuals with no family history of the condition. It has been postulated that the presence of two major features or one major feature with two minor features classify a condition as Gorlin-Goltz syndrome.
We present a 42-year-old male patient with a 6-year-long history of multiple smooth and/or rough skin patches and plaques on the back and shoulders. Some of the lesions gradually progressed and increased in number without any sensation. Dotlike, flesh-colored and brownish pits were found on the patient’s palms. Further investigations revealed many musculoskeletal and craniofacial congenital abnormalities such as pectus excavatum, frontal and parietal bossing, exotropia, ectopic teeth (impacted tooth), mandibular hyperplasia, broad nose. Histopathological examination by light microscopy of biopsies taken from the nodular and patchy skin lesions showed findings typical for basal cell carcinoma. Family history revealed no members with similar health disorders.
The patient was treated for Hodgkin’s lymphoma with chemotherapy and radiation therapy 20 years before, with good therapeutic results, and no additional treatment was administered in the last ten years.
The treatment for multiple basal cell carcinomas included: 5% imiquimod cream, 5 days a week, for 12 weeks. After 12 weeks of treatment, the nodular lesion and all the superficial lesions cleared. One month later the lesions disappeared completely without any residual signs.
The patient was advised to use adequate photoprotection and to avoid future uncontrolled sun exposure. On follow-up visits during a three year period, no recurrent or new lesions indicative for BCC were seen. This is a case with late-onset multiple BCC in a patient with Gorlin-Goltz syndrome and a history of prior Hodgkin’s lymphoma. To the best of our knowledge hitherto only two cases of Hodgkin’s lymphoma in patients with Gorlin-Goltz syndrome have been reported in the literature. We also present therapeutic results of topical imiquimod for multiple basal cell carcinomas with no recurrent lesions over a three-year follow-up.
Cilj je ovog preglednog rada približiti logopedima ulogu metoda podrške. One se primjenjuju u logopedskoj terapiji radi provođenja i ispunjavanja zadanih aktivnosti i postavljenih terapijskih ...ciljeva. Metode podrške predstavljaju važan i nezaobilazan element u planiranju i provedbi terapije. Stoga je važno da logoped poznaje njihove prednosti i nedostatke, kao i mogućnosti i ograničenja u njihovoj primjeni s obzirom na vrstu poremećaja koji je u središtu terapije, te postavljenih ciljeva kako bi se promijenila ili ublažila klinička slika poremećaja. U radu je opisano i ukratko predstavljeno deset najčešćih metoda u logopedskoj terapiji jezičnih, govornih i komunikacijskih poremećaja, stoga navedene i opisane metode ne predstavljaju iscrpnu i sveobuhvatnu listu svih dostupnih metoda. Posebna je pažnja na kraju rada usmjerena postavljanju metoda na bihevioralno-kognitivnom teorijskom kontinuumu, odnosno u okvire onih dviju teorija koje su najviše utjecale na njihov nastanak i primjenu u kliničkom radu, te njihovo smještanje s obzirom na jezične, govorne i komunikacijske poremećaje.
The aim of this review is to help speech-language pathologists in understanding the role of ingredients used in speech-language therapy in order to perform specified activities and thus achieve set therapeutic goals. Ingredients represent an important and unavoidable element in planning and implementation of therapy. Therefore, it is important for speech-language pathologists to know their advantages and disadvantages, as well as possibilities and limitations of their use in relation to the type of disorder that is the focus of therapy and the goals set to modify or alleviate the clinical picture of the disorder. This paper describes and briefly introduces ten ingredients most commonly encountered in speech, language, and communication therapy, although the ingredients listed and described are by no means an exhaustive and comprehensive list of all available ingredients. At the end of the paper, special attention was given to the placement of ingredients on the behavioural-cognitive continuum, i.e., within the framework of the two theories that have most influenced their origin and application in clinical work, and to their placement with regard to speech, language, and communication disorders.
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