Anorexia Psihotica

CENTRUL DE FORMARE FORM ARE „FRACARITATIS” „FRACARITATIS”

LUCRARE DE DIPLOMA

ATITUDINEA ASISTENTEI DE PSIHIATRIE FATA DE ADOLESCENTA CU ANOREXIE NERVOASA

PLANUL LUCRARII

„ATITUDINEA ASISTENTEI DE PSHIHIATRIE FATA DE ADOLESCENTA CU ANOREXIE NERVOASA”

CAPITOLUL I - PARTE TEORETICA

Introducere Defnte Eto!"to#ene S$!to$"to%o#e C"r"cter&tc C"r"cter&tc C"r"cter&tc co$!ort"$ent"%e co$!ort"$ent"%e C"r"cter&tc C"r"cter&tc "'ect(e C"r"cter&tc C"r"cter&tc co#nt(e C"r"cter&tc &oco cu%tur"%e D"te !"r"c%nce & de %")or"tor D"#no&tc !o*t( D"#no&tc d'erent"% E(o%ute+ !rono&tc Metode de e("%u"re  Tr"t"$ent  Tr"t"$ent Conc%u*

,)%o#r"fe &e%ect("

CAP II II STUDIU DE CA

Introducere Pre*ent"re" c"*u%u An"%*" & nter!ret"re" d"te%or P%"nfc"re" n#r.r%or Inter(ent" "&&tente E("%u"re Conc%u* Ane/e

01Introducere

Anore/" ner(o"&" e&te tu%)ur"re !&22"trc" dn c"te#or" tu%)ur"r%or de "%$ent"te+ c"r"cter*"t" !rntr-o reducere "nor$"%" " #reut"t cor!or"%e & o de'or$"re " !erce!te $"#n !ro!ru%u cor! cu te"$" !re("%ent"+ !er&&tent" de n#r"&"re1

Per&o"ne%e &u'ernd de "nore/e ner(o"&" & %$te"*" #reut"te" cor!or"%" !rn ")tnere" (o%unt"r" un t! nde%u$#"t de %" 2r"nre1

Pr$e%e o)&er("t c%nce "%e !"cent%or "nore/c "u 'o&t '"cute de Rc2"rd Morton %" &'"r&tu% &eco%u%u "n XVII 3045671 A)" n 089: $edcu% %ondone* ;%%"$
neuro!&2"tru% Erne&t L"&&e=ue nde!endent unu% de ce%"%"%t !u)%c" de&crer "%e )o% con&der"nd-o c" fnd o tu%)ur"re dn &!ectru% &tere > „"nore/" &terc"”

In 088: H1 Huc2"rd o denu$e&te "nore/" ner(o"&"

In 05?@ H%de ,ruc2 " o)&er("t c" "ce&t co$!ort"$ent "nor$"% "(e" c" &co! &c"dere" &c"dere" n #reut"te „unc &ucce& n %u$e" ne'erct" n c"re tr""u "ce&te 'ete”1

1 Defnte

Anore/" ner(o"&" &e c"r"cter*e"*" !rn n'o$et"re" "uto$!u&" & re'u*u% de " $entne #reut"te" %" o ("%o"re $n$" " nor$"%u%u core&!un*"tor core&!un*"tor ("r&te & n"%t$ "&oc"t" cu o te"$" nten&" de " nu %u" n #reut"te1 Ace&te tu%)ur"r de "%$ent"te c"r"cter&tce "do%e¢e%or &unt c"r"cter*"te !rnB

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!erce!t" $or)d" !r(nd #reut"te" & 'or$" cor!u%u

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!ertur)"re" !ertur)"re" &e(er" " co$!ort"$entu%u co$!ort"$entu%u "%$ent"r

A&!ecte e!de$o%o#ce e!de$o%o#ce

In "nore/" ner(o"&" ("r&t" $ede e&te de 0? > 09 "n1

Co$!ort"$entu% "nore/c "nore/c !&2o#en &e !o"te nt"%n dn !r$" &"!t"$"n" de ("t"+ %" &u#"r d"r & n $c" co!%"re+ !re("%ent" n &!t"%e%e !&2"trce fnd de 0 > ? 

In #ener"% !re("%ent" "nore/e ner(o"&e n #ener"% n !o!u%"t" 'e$nn" de-" %un#u% (et e&te e&t$"t" %" @10 > @19 

Stud%e e'ectu"te "u con&t"t"t o r"t" " !re("%ente !r(nd "nore/" ner(o"&" de @1? -0  %" 'e$e%e dn u%t$" !"rte " "do%e¢e & nce!utu% !ero"de "du%te1

E/&t" !utne d"te re'erto"re %" &e/u% $"&cu%n1

De& $".ort"e" "do%e¢e%or '"c e'ortur !entru " f &%")e+ "nore/" &e de*(o%t" do"r %" ce%e c"re !re*nt" "nu$te tr"&"tur de !er&on"%t"te1 Frec(ent "u $" 'o&t ct"te tr"&"tur%e tr"&"tur%e o)&e&(-co$!u%&(e+ o)&e&(-co$!u%&(e+ !er'ecton&$u%+ r#dt"te"+ tr"&"tur%e n"rc&ce n"rc&ce & &terce+ $"turt"te" & 'rc" de "-& "&u$" re&!on&")%t"t%e1 re&!on&")%t"t%e1

R"t" de $ort"%t"te n tu%)ur"r%e de "%$ent"te e&te de 0@ 1

Ce% $" 'rec(ent dece&u% &e !roduce !rn n"nte+ tu%)ur"r c"rd"ce c"rd"ce 3d"tor"te de*ec2%)re%or e%ectro%tce7 &"u &ucd1

:1 Eto!"to#ene Eto!"to#ene

Tu%)ur"r%e de co$!ort"$ent co$!ort"$ ent "%$ent"r "u o eto%o#e $u%t'"ctor"%"1 $u%t'"ct or"%"1 F"ctor $!%c"t n eto!"to#en" "ce&tor" !ot f #ru!"t nB #enetc+ &oco-cu%tur"% & !&2o%o#c1

"7 F"ctor F"ctor #enetc &nt $!%c"t n tu%)ur"r%e de co$!ort"$ent "%$ent"r+ '"!t de$on&tr"t !rn &tud '"$%"%e contro%"te+ recente c"re "u "r"t"t o !re("%ent" cre&cut" de-" %un#u% (et %" rude%e de #r"du% I "%e !"cent%or cu "nore/e ner(o"&"B : -0 + co$!"r"t( cu %otur%e $"rtor > @-:191

In "nore/e ner(o"&" %" rude%e de #r"du% I "%e nd(*%or cu "nore/e ner(o"&"1 A&t'e% 'ete%e !"cente%or cu "nore/e ner(o"&" "u r&c de 4+4  de " de*(o%t" "nore/e ner(o"&"1

De "&e$ene" &-" con&t"t"t c" nd(* cu tu%)ur"r de co$!ort"$ent "%$ent"r "u un n(e% rdc"t de ("&o!re&n" & cort*o%1

A$) 2or$on &unt $!%c"t n r"&!un&u% or#"n&$u%u %" &tre&u% f*c & e$oton"%1

A%te &tud "u #"&t n(e%e cre&cute de neuro!e!td > & !e!td  %" !"cent cu "nore/e "nore/e ner(o"&"+ &u#er"nd c" "ce&t" "r "(e" un ro% n tu%)ur"r%e de co$!ort"$ent "%$ent"r1

)7 F"ctor !&2o%o#c Teor%e !&2o"n"%tce !&2o"n"%tc e e/!%c" tu%)ur"r%e de co$!ort"$ent "%$ent"r !rn e/&tent" une re%"t &educt(e+ de!endente " "do%e¢e '"t" de f#ur" !"tern" !"&("+ c"%d"+ d"r %!&t" de "utort"te & " unu &ent$ent de (no("te ntretnut de o "nore/e ner(o"&" "c"!"r"to"re+ "nore/e ner(o"&" )("%ent"+ cu c"re "do%e¢" re'u*" &" &e dentfce1

Une%e &tud "u de$on&tr"t c" !er'ecton&$u% !er'ecton&$u% e&te "&oc"t %" "ce&t !"cent cu rtu"%ur %e#"te de "%$ent"te & cu o re*&tent" $" $"re %" &c2$)"re !r(nd co$!ort"$entu% "%$ent"r1

In c"*u% co$!ort"$entu%u co$!ort"$entu%u "nore/e "nore/e ner(o"&e %" &u#"r & %" co!%u% $c &e !"re c" &-"r d"tor" unor "ttudn ne"dec("te "%e $"$e cu !ertur)"re" re%"te $"$"-co!% cee" ce dec%"&e"*" "nore/" "nore/" de o!o*te+ co!%u% n'runt"nd "&t'e% $"$"+ c"re de(ne fe 2!er"n/o"&"+ 2!er"n/o"&"+ re.ect"nt" & r#d"1 A%t '"ctor $!%c"t !ot f ")u*u% & ne#%."re" co!%u%u1 Contro%u% "!"rent "&u!r" co$!ort"$entu%u "%$ent"r+ dete%e re&trct(e !"r " o'er un '"%& "utocontro% n ("t" de * cu * %" !"cent cu "nore/e ner(o"&"1

c7 F"ctor &oco > cu%tur"% - Inc"!"ct"te" de " recuno"&te & de " re"cton" corect %" ne(o%e tru!u%u > cu$ "r f &en*"t" de 'o"$e "&oc"t" cu ne(o" de "tn#e &t"nd"rde%e &t"nd"rde%e de 'ru$u&ete $!u&e de &oc"et"tre" &oc"et"tre" conte$!or"n" & !ro$o("t" !er$"nent de c"n"%e%e $ed" &unt do"r c"te(" dn !ote*e%e eto!"to#ence !r(nd tu%)ur"r%e tu%)ur"r%e de "%$ent"te1

61 S$!to$"to%o#"

Anore/" ner(o"&" "re de)ut n &!ec"% n cur&u% !u)ert"t &" "do%e¢e+ "do%e¢ e+ %" tnere%e 'ete cu educ"te &o%d"+ ce tr"e&c ntr-un $edu de e/tre$" de!endent"+ "&cu%t"to"re & &tudo"&e cu re*u%t"te &co%"re 'o"rte )une+ !er'ecton&te cu e!&o"de de "nore/e ner(o"&" !recoce+ c"!rc "%$ent"re & )o% n "ntecedente1

For$e%e "nore/e ner(o"&eB

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"nore/e "nore/e de o!o*te > "#t"te+ re.ect"re" re.ect"re" "%$ente%or+ (o$&$ente1

%" !re&co%"rB c" re"cte de o!o*te '"t" de r#dt"te" !"rnt%or c"re $!un e/ce&e "%$ent"re "%$ent"re c"ntt"t( & c"%t"t(+ or"r &e(er de $e&e+ c"!rc n "%e#ere" "%$ente%or1

n "do%e¢"B "do%e¢" B re&trct%e "%$ent"re !ot "!"re" c" ur$"re " unu &oc e$oton"% &"u " unor concte !&2o%o#ce+ "%teor &e n&t"%e"*" !ro#re&( !ro#re&( '"r" o c"u*" "!"rent"+ c" ur$"re " unu re#$ de &%")re &"u " unor &tu"t conctu"%e !e c"re "do%e¢u% nu %e !o"te re*o%("1

Se d&tn# dou" t!ur de "nore/e ner(o"&"B

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t!u% re&trct(

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t!u% de $"nc"t e/ce&(!ur#"re

 T!u% de $"nc"t e/ce&(!ur#"r e/ce&(!ur#"reB eB "ce&t t! e&te e&te ut%*"t c"nd c"nd "do%e¢" &-" &-" "n#"."t n $od re#u%"t n $"nc"t e/ce&( &"u n !ur#"re or n "$)e%e n cur&u% e!&odu%u curent1 Ado%e¢" cu "nore/e ner(o"&" c"re $"n"nc" e/ce&( &e !ur#2e"*" !rn ("r&"tur "uto!ro(oc"te or !rn ")u* de duretce+ %"/"t(e &"u c%&$e1 A%teor nu $"n"c" e/ce&(+ d"r '"ce n $od re#u%"t !ur#"re du!" con&u%$u% unor c"ntt"t $c de "%$ente1

 T!u% re&trct( re&trct( de&cre t")%our%e t")%our%e c%nce c%nce n c"re c"re !erdere" !erdere" n #reut"te #reut"te e&te re"%*"t" re"%*"t" n !r$u% r"nd !rn det"+ !o&t &"u e/erct f*ce e/ce&(e1 In t$! "!"r tu%)ur"r &ecund"re d$nu"r "!ortu%u "%$ent"rB o"&e%e &e ("d &u) !e%e" u&c"t"+ !"ru% r"r & 'r")%+ e/tre$t"t rec & c"notce+ %$)" &")ur"%"+ con&t!"te1

A&!ectu% c%nc n "nore/" "nore/" ner(o"&" e&te 'o"rte !"rtcu%"r+ &$!to$"to%o#" !o"te "!"re du!" un e(en$ent !erce!ut c" !&2otr"u$"t*"nt &"u de ce%e $" $u%te or du!" re$"rc $"%to"&e %" "dre&" #reut"t !"cente%or1

Ado%e¢e%e Ado%e¢e%e n ntent" de " &%") &e "n#".e"*" n dete dr"&tce1

E(t" &" $"n"nce 2droc"r)on"t & #r"&$+ $ot( !entru c"re %e e/c%ud dn "%$ent"te1 Se &u!un unu re#$ de "uton'o$ent"re1 U%teror "ce&te" nu $" recuno"&c &en*"t" de 'o"$e1 I& contro%e"*" 'rec(ent #reut"te"+ & "%c"tue&c r#uro& det"+ c" nu$"ru% de c"%or n#ur#t"te &" fe redu&+ de ce%e $" $u%te or &u) ?@@ c"%* 3".un# &" $"n"nce un &n#ur $"r !e * &"u &" tn" !o&t ne#ru71 Une%e !"cente recur# %" "de("r"te rtu"%ur n !r(nt" co$!ort"$entu%u "%$ent"r+ de e/e$!%u c"ntt"t%e c"ntt"t%e redu&e de "%$ente &unt t""te n )uc"t 'o"rte $c !entru " f $"nc"te &"u & "&e"*" $"&" ntr-un "nu$t 'e%1

?1 C"r"cter&tc

"7

C"r"cter&tc C"r"cter&tc co$!ort"$ent"%e

( De ce%e $" $u%te or "nore/" "nore/" ner(o"&" e&te dec%"n&"t" de un e(en$ent !&2otr"u$"t*"nt !"rtcu%"rB &e &$t re.ect"t+ &unt (u%ner")%+ uneor nce! un

re#$ de &%")re1 Pot nter(en e(en$ente c" de&!"rtre" de !"rnt+ dfcu%t"t%e &co%"re+ ron%e "ntur".u%u1

)7

C"r"cter&tc C"r"cter&tc "'ect(e

( Perdere" n #reut"te e&te !entru e un &e$n de !utere c"re %e !er$te &" do$ne "ntur".u%1 Anore/c &unt "de&e" !er&o"ne &t"!"nte de 'rc"B 'rc" de " de(en "du%t & de "-& e/!r$" re&!on&")%t"t+ 'rc" c" o &" !"rd" contro%u% "&u!r" "%$ente%or1

c7

C"r"cter&tc C"r"cter&tc co#nt(e

( Anore/c "u dornt" de " &%") & de "-& !"&tr" contro%u% "&u!r" "%$ent"te "%$ent"t e core&!unde unu co$!ort"$ent e#o&ntotc > "dc" un co$!ort"$ent c"re concord" cu !ro!r%e de+ dornte & ("%or 3ne"#" 'o"$e"+ e!u*"re" f*c" & !&2c"71 Pentru e o)&e&" !r(nd $"nc"re" con&ttue un co$!ort"$ent nor$"%1

d7

C"r"cter&tc C"r"cter&tc &oco - cu%tur"%e

Intr-un &tudu '"cut n 058 &-" con&der"t c" 9@-8@ dntre &tudente nu &e con&der" &educ"to"re &educ"to"re !entru c" nu &unt &%")e d"tort" e/&tente $ode de " f &%")G$"nec2n1

In &ocet"te" "$erc"n" &%uet" e&te n #ener"% &non$" cu &educt"1

S-" con&t"t"t c" de*ordn%e "%$ent"re &unt 'rec(ente n &ocet"t%e de $.%oc &!re ce%e &u!ero"re 3Ru&&e% 058?+ ,ut%er 05887 ncdent" $"re n r"ndu% tnere%or !ro(ente dn '"$% n&t"rte1

41 D"te !"r"c%nce & de %")or"tor

Ind(* cu "nore/e ner(o"&" nu !re*nt" "no$"% de %")or"tor "ce"&t" tu%)ur"re !o"te "'ect" ce%e $" $u%te &&te$e & or#"ne $".ore & !roduce o d(er&t"te de !ertur)"t1

Ano$"%%e &unt tr"n*tor+ tr"n*tor + ncon&t"nte & re(er&)%e %" c"&t#u% n #reut"te1

Rt$u% c"rd"c e&te $" %ent+ "!"r $odfc"r E<1

Modfc"r 2e$"to%o#ceB "ne$e $"rc"t"+ uree &"n#(n" cre&cut"+ cre&cut"+ "no$"% re(er&)%e '"r" o %e#"tur" cu &c"dere" n #reut"te "r &&te$u% $unt"r r"$"ne n $od &ur!rn*"tor efc"ce1

Modfc"r endocrno%o#ceB endocrno%o#ceB %e#"te de !ertur)"re" !ertur)"re" "/e 2!ot"%"$o-2!of*"reB 2!ot"%"$o-2!of*"reB

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de!re&" de!re&" #%o)"%" " "ct(t"t 2!of*"-o("re

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&ecrete LH 32or$on %uten*"nt7 %uten*"nt 7 "&e$"n"to"re "&e$"n"to "re 'ete%er !re!u)ere

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!ertur)"re" $et")o%&$u%u $et")o% &$u%u e&tro#en%or

EE< !re*nt" "no$"% d'u*e+ reect" ence'"%o!"te $et")o%c"+ !ot re*u%t" dn $odfc"r &e$nfc"t(e "%e ude%or & e%ectro%t%or1

C2e%tu"%" de ener#e !entru re%"/"re e&te re%"t( redu&"1

91 D"#no&tc !o*t(

Crter de d"#no&tc DSM !entru "nore/" ner(o"&"1

A7 Re'u*u% $entner #reut"t cor!or"%e nor$"%e &"u de"&u!r" une

#reut"t $n$e nor$"%e !entru ("r&t" & n"%t$e" &"1

,7 Frc" nten&" de " nu %u" n #reut"te &"u de " nu de(en #r"&"  #r"&

C7 Pertur)"re" $odu%u n c"re e&te e/!r$"t" #reut"te" &"u oon'or$"t" cor!u%u ned"tor"t" nuente #reut"t &"u con'or$"te cor!or"%e1

D7 L" 'e$e%e !o&t$en"r2ce+ "!"re "$enoree" - ")&ent" " ce% !utn : cc%ur $en&tru"%e con&ecut(e1

S!ecfc"$ t!u%B

t! de $"nc"t e/ce&(+ !er&o"n" &e "n#".e"*" n $od re#u%"t ntr-un co$!ort"$ent de $"nc"t e/ce&(

t! re&trct(+ !er&o"n" nu &e "n#".e"*" n $od re#u%"t ntr-un co$!ort"$ent co$!ort"$ ent de !ur#"re1

81 D"#no&tc d'erent"%

D"#no&tcu% d'erent"% e&te "ce%"& cu &ndro$u% "rtere $e*enterce &u!ero"re c"r"cter*"t1 !rn ("r&"tur !o&t!r"nd"%e con&ecut(e o)&tructe !%oru%u1

D"#no&tcu% d'erent"% (" (*" tu%)ur"r%e !&2ce n c"re !ot "!"re" &$!to$e "&e$"n"to"re "nore/e !recu$B

J Tu%)ur"re" de!re&(" $".or"1 n c"re !"centu% !o"te &c"de" n #reut"te+ c" ur$"re " &c"der "!ettu%u d"r &!re deo&e)re de "nore/" ner(o"&"+ "ce&t" nu e&te !reocu!"t de det" &"u 'or$" cor!u%u+ nu "re o te"$" e/ce&(" de " nu %u" n #reut"te1 Cu to"te "ce&te" n "nore/" ner(o"&" &e !o"te "&oc" un &ndro$ de!re&( c"r"cter*"t !rn d&!o*te de!re&("+ "uto&t$" &c"*ut"1 %")%t"te "'ect("1

J Sc2*o'ren"+ n c"re !"centu% !o"te !re*ent" un co$!ort"$ent co$!ort"$e nt )*"r %e#"t de "%$ent"te+ e(entu"% cu &c"dere" n #reut"te d"r '"r" " f !reocu!"t !reocu!"t de $"#ne" &"1

J Tu%)ur"re" o)&e&(-co$(u%&("+ o)&e&(-co$( u%&("+ !"cente%e cu "nore/e ner(o"&" !ot "(e" o)&e& & con(u%& d"r nu$" n %e#"tur" cu co$!ort"$entu% "%$ent"r1

J Fo)" &oc"%" B !"cente%e !ot "(e" un co$!ort"$ent de e(t"re d"r "ce&t" e&te %e#"t nu$" de co$!ort"$entu% "%$ent"r1

J Tu%)ur"re" d&$orfc" cor!or"%" B !"centu% e&te !reocu!"t nu nu$" de #reut"te" cor!or"%" cor!or"%" c & de "%te de'ecte $"#n"re "%e "ce&tu"1

J

Ne#"t(&$u% "%$ent"r+ &c2*o'ren" &c2*o'ren"

J

P&22o*" c"t"tonc" ne#"t("

J

Anore/%e &terce

J

Anore/%e o)&e&on"%e n&otte de rtu"%ur "%$ent"re

J

Fo)" "%$ent"r" e&te de&eor n&ott" de "%te 'o) &&"u o)&e&

51 E(o%ute+ !ro#no&tc

Sunt ("r")%e n "nore/" ner(o"&"+ !o"te e/&t" o recu!er"re co$!%et" du!" un &n#ur e!&od+ n&" ce% $" 'rec(ent e(o%ut" e&te uctu"nt" cu e/"cer)"r & re$&un !"rt"%e1

E(o%ut" %" &u#"r & co! e&te n #ener"% '"(or")%" cu "$e%or"re" "$e%or"re" "ce&tu co$!ort"$ent n t$!1

In "nore/" ner(o"&" '"ctor de !ro#no&tc '"(or")% &unt B ("r&t" &u) 08 "n+ %!&" &!t"%*"r%or n "ntecedente+ ")&ent" co$!ort"$entu%u de !ur#"te1

Ce ne'"(or")% &untB concte%e ntr"'"$%"%e+ ntr"'"$%"%e+ tu%)ur"r%e de !er&on"%t"te !er&on"%t"te "&oc"te1

0@1 Metode de e("%u"re

P"cent cu "nore/e ner(o"&" &e $!otr(e&c con&u%tu%u+ de "cee e&te $!ot"nt " &e &t")%e"&c" o re%"te )un"1

Se " n con&der"te &torcu% "$"nuntt "% de*(o%"t"r tu%)ur"r+d"te tu%)ur"r+d"te de&!re $odu% "ctu"% de "%$ent"te+ contro%u% !onder"% & de&!re de%e !"centu%u "&u!r" #reut"t cor!or"te1

Sunt e%")or"te tre tre t!ur de n&tru$ente de e("%u"re e("%u"re " tu%)ur"r%or de "%$ent"te B

A1 con(er&"t" de o)&er("te

,1 &c"%e%e de o)&er("te

C1

"utoc2e&ton"re%e

Con(er&"t" de o)&er("te

#2du% de o)&er("te &t"nd"rd*"t &t"nd"rd*"t du!" ASM III+ DSM III R & ICD 0@ c"re contn %&te de ntre)"r !rec&e !entru "nore/" ner(o"&"

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DIS 3D"#no&tc Inter(eK Inter(e K Sc2edu%e+ Ro)ru&1 058?7

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SCAN 3Sc2edu%e 'or C%nc"% A&&e&&$ent n Neuro!&c2"tr+ Neuro!&c2"tr + ;n#+ 305887

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CIDI 3Co$!o&te Intern"ton"% Intern"ton"% D"#no&tc Inter(eK+ OMS 05807

-

SCID 3Structured 3Structured C%nc"% Inter(eK 'or DSM IIIR+ S!t*er Co+ 05887

Sc"%e%e de o)&er("teB !entru e("%u"re" &e(ert"t co$!ort"$ente%or "nore/ce "nore/ce !e !"rcur&u% &u!r"(e#2er & &u!r"(e#2ere" e(o%ute %or1

- Sc"%" %u S%"de 3Anore/c ,e2"(our Sc"%e+ 059:7

- E,RS 3E"tn# ,e2"(our R"tn# Sc"%e1 ;%&on  Co7

C7 Autoc2e&ton"reB Autoc2e&ton"reB !entru e("%u"re" co$un" " c%ent%or cu tu%)ur"r de "%$ent"teB

- EA EAT T 3E"tn# Atttude& Atttude& Te&t+ Te&t+ <"rfedu%  <"rner+ 05957 ce% $" de& ut%*"t+ o'er" o confr$"re " d"#no&tcu$1

- EDI 3E"tn# 3E"tn# D&order D&order In(ent"tr+ In(ent"tr+ <"$er  Co+ 058:7 cu!rnde 46 !o*t !entru e("%u"re" tr"&"tur%or tr"&"tur%or f*ce & co$!ort"$ent"%e "%e &u)ectu%u

001 Tr"t"$ent

In "nore/" ner(o"&" %" "do%e¢e tr"t"$entu% e&te dfc% d"tort" '"!tu%u c" !"cente%e cu "nore/e ner(o"&" &unt "$)("%ente '"t" de tr"t"$ent1

 Tr"t"$entu%  Tr"t"$entu% con&t" con&t" n !r$u% r"nd r"nd n o)tnere" o)tnere" une une #reut"t "dec("te1 "dec("te1

In "ce&t &co! &e (" e%")or" un !%"n "%$ent"r r#uro& $oreun" cu !"cent"1 A&t'e% &e (" ne#oc" cu "ce&t" #reut"te" tnt" & r"t" de cre&tere n #reut"te !e &"!t"$"n"+ &e c"%cu%e"*" c"%or%e nece&"re !entru " "tn#e "ce"&t" tnt"+ re#$u% "%$ent"r (" f &t")%t n 'uncte de "%$ente%e !e c"re !"cent" %e "cce!t" & re!"rt*"t n ? $e&e !e *+ : !rnc!"%e &  #u&t"r c"re &" contn" to"te !rnc!%e nutrt(eB !rotene+ #%ucde+ %!de+ (t"$ne+ $ner"%e1

 Tr"t"$entu%  Tr"t"$entu% !"cente !"cente &e !o"te '"ce '"ce n "$)u%"toru "$)u%"toru &"u n &!t"%1 &!t"%1

 Tr"t"$entu%  Tr"t"$entu% !&22oter"!eutc !&22oter"!eutc $!%c" ter"!e ter"!e &u!ort("+ co#nt(-co co#nt(-co$!ort"$ent"%"+ $!ort"$ent"%"+ '"$%"%" cu &t")%re" &t")%re" une re%"t ter"!eutce &o%de !"cent-!&2"tru1 !"cent-!&2"tru1

 Tr"t"$entu%  Tr"t"$entu% !&22o'"r$"co% !&22o'"r$"co%o#c o#c con&t" n "d$n&tr"re" "d$n&tr"re" de "ntde!re&( "ntde!re&(e e trcc%ce+ n2)tor &e%ect( " rec"t"r rec"t"r &erotonne c"re &-"u do(edt efcent" n &!t"% c"nd e/&t" &$!to$"to%o#e de!re&(" &"u co$!ort"$ente o)&e&(o-'o)ce "&oc"te1

PSIHOTERAPIA INDIVIDUALAB

 Ter"!eutu%  Ter"!eutu% & & ndre"!t" ndre"!t" "tent" &!re &!re &e$nfc"t" dn"$c" dn"$c" " "'ectun "'ectun !reocu!"re" !reocu!"re" !entru 2r"n" & #reut"te $"&c2e"*" !ro)%e$e%e 'und"$ent"% & nu$ero"&e%e ndoe%1

In #ener"% !"centu% "nore/c re'u*" &" (or)e"&c" &  &"u &"-& recuno"&c" )o"%" & e(t" co%")or"re" cu ter"!eutu%1 Ter"!eutu% tre)ue &"- c"&t#e ncredere" & &"-% $ot(e*e &"-& &c2$)e co$!ort"$entu%1 I% ".ut" &" ")" ncredere n 'ortee !ro!r+ &" " dec* c2"r d"c" uneor "ce&te" &unt !r!te & &" "cce!te no 'or$e de "d"!t"re %" &tu"t &tre&"nte1

E'ectee )enefce "%e tr"t"$entu%u tre)ue &u)%n"te cu "&#ur"re" c" nu (" "'ect" &co!u% !ro!u& de !"cent" 3$entnere" &%uete7

 Ter"!"  Ter"!" co#nt(-co$!ort"$en co#nt(-co$!ort"$ent"%" t"%" (*e"*" dentfc"re" dentfc"re" & & $odfc"re" $odfc"re" !erce!t%or !erce!t%or eron"te n !r(nt" "%$ent"te+ #reut"t & 'or$e cor!u%u "&u!r" &t$e de &ne1

PSIHOTERAPIA DE
PSIHOTERAPIA FAMILIAL FAMILIALA A du!" un c%ncen &e!"r"re" de '"$%e e&te tr"&"tur" (t"%" " tr"t"$entu%u "r du!" "%t dn contr" "re un ro% c2ee n re")%t"re" "nore/cu%u1

 Ter"!"  Ter"!" e&te centr"t" centr"t" "t"t !e !ro)%e$e%e !ro)%e$e%e de "%$ent"te "%$ent"te c"t & "&u!r" "&u!r" ce%or e$oton"%e "%e "do%e¢u%u1 "do%e¢u%u1

 TERAPIA  TERAPIA MEDICAMENTOASA MEDICAMENTOASA In ter"!" $edc"$ento"&" &-"u r"!ort"t &uce&e cu tr"nc2%*"nte+ tr"nc2%*"nte+ neuro%e!tce neuro%e!tce &ed"t(e & nc&(e c"re '"c !"centu% $" !utn te$"tor te$"tor de c"&t#u% !onder"%1

S-"u '"cut cercet"r !r(nd e'ectu% F%uo/etne co$!"r"t( cu ce% "% #ru!u%u !%"ce)o n ur$" c"ror" &-" con&t"t" c" o!ortunt"te" "d$n&tr"r F%uo/etne e&te %$t"t"1

01 Conc%u*

Anore/" e/!r$" o cr*" de de*(o%"t"re !e 'ondu% une !er&on"%t"t (u%ner")%e "!"rute %" !u)ert"te &"u n "do%e¢"+ c"r"cter*"t" c"r"cter*"t" !rn !erdere" de%)er"t" n #reut"te+ !erdere ndu&" & &u&tnut" de c"tre !"cent1

Perdere" n #reut"te &e re"%*e"*" !rn e%$n"re" c"ntt"t de "%$ente n#er"te1

Anore/" ner(o"&" !"re &" re*u%te dn co$)nre" une !red&!o*t nd(du"%e & " '"ctor%or de orce n"tur" c"re ncur".e"." det"1 O d"t" n&t"%"t" tu%)ur"re" r"&!un&u% '"$%e !o"te '"(or*" !er!etu"re" e1

Anore/" ner(o"&" e&te con&der"t" o urent" !&22o%o#c" $!un"ndu-&e nter(ent" $ed"t" !entru re&t")%re" #reut"t cor!or"%e+ n%"tur"re" "n/et"t & re&t")%re" re%"t%or re%"t%or nter!er&on"%e1 nter!er&on"%e1

St$" de &ne " nd(*%or cu "nore/e ner(o"&" e&te e/tre$ de de!endent" de #reut"te" & con'or$"t" cor!u%u %or1

0:1 ,)%o#r"fe

 Mc "t%"& encc%o!edc

An" ,o#d"n+ Se!t$u C2e%ce" - Dcton"r de !&2o%o#e &oc"%"

ICD 0@

DSM IV

Pro'1 Dr1 Petru Me%"+ Pro'1 Dr1 Ste'"n M%e" > Tr"t"t de !ed"tre

Dr1 M"r" <2d !r"ctc

Pro'1 Dr1 Con&t"ntn En"c2e&cu > Tr"t"t de #en" $nt"%"

Dr1 I%e"n" R"ut - Cur& de !&2"tre

A&1 Pr1 M"r"n" Feder#" > Mode%e de nur&n#

,"r)"r" F%nn Sde%e"nu > Nur&n# !&2"trc

Mur"ru Lett"+ I("n M"ruc"+ Puu Vctor"+ S!"t"ru Ru/"ndr"+ To'"n Ru/"ndr"+ C2ru F%or"n+ Sto"no(c Ser)"n > ,"*e%e teoretce & !r"ctce "%e n#r.r o$u%u &"n"to& & )o%n"(

CAPITOLUL II

Introducere

STUDIU DE CA

Atent" "cord"t" !"centu%u !"centu%u e&te 'o"rte $!ort"nt" tn"nd cont de '"!tu% c" )o%n"(u% c"re &o%ct" n#r.r $edc"%e & !une ("t" & &"n"t"te" n $"n%e !er&on"%u%u de n#r.r

Ace"&t" ncredere !re&u!une re&!on&")%t"t d"r & $u%te c"%t"tB )un"t"te+ !o%tete+ #enero*t"te+ t"ct & !ro'e&on"%&$1

Nur&" contr)ue %" "ct(t"t $!%c"te %" n#r.re" )o%n"(u%u !&2c c"re !"r uneor &$!%e+ d"r e%e tre)ue tre)ue nd(du"%*"te+ "d"!t"te %" ne(o%e & !o&)%t"t%e fec"ru !"cent1

Ro%u% nur&e+ &!une" Vr#n" Hender&on > !ro$oto"re" conce!tu%u de nur&n#+ e&te &" ".ut nd(du%+ fe )o%n"( &"u &"n"to& &"-& "e c"%e" &!re &"n"t"te &"u re")%"t"re+ &"-& 'o%o&e"&c" fec"re "ctune !entru " !ro$o(" &"n"t"te"1

Nur&" n c"dru% n#r.r )o%n"(u%u !"rtc!" %" "ct(t"t de cu%e#ere " d"te%or+ dentfc"re" !ro)%e$e%or de n#r.re+ &t")%re" o)ect(e%or !e ter$en %un# & &curt+ $!%e$ent"re" !%"nu%u de n#r.re & e("%u"re1

01 Cu%e#ere" d"te%orB nter(u% cu !"centu%+ '"$%"+ d"te o)tnute de %" "%t !ro'e&on&t1

1 Identfc"re" !ro)%e$e%or de n#r.re con&t" n c%"&fc"re" de%or & &t")%re" !o&)%t"t%or1

:1 St")%re" o)ect(e%or !e ter$en %un# & &curtB &co!u% & !%"nfc"re" n#r.r%or de !re'er"t $!reun" cu !"cent" & cu '"$%" "ce&te"1

61 I$!%e$ent"re" !%"nu%u de n#r.reB or#"n*"re" "ct(t"t%or de n#r.re !ro!ru*&e+ !ro!ru*&e+ !%"nfc"re" nter(ent%or n r"!ort cu ne(o%e nd(du%u1

?1 E("%u"re"B "n"%*" re*u%t"te%or o)tnute dn !"rte" !"centu%u1

,7Pre*ent"re" c"*u%u

CENTRUL DE FORMARE FORM ARE „FRACARITATIS” „FRACARITATIS”

FOAIE DE O,SERVATIE PENTRU NURSIN< PSIHIATRIC

I1

D"te "n"$ne&tce

Nu$e+ Prenu$e > M1S1

St"re" c(%" > nec"&"tort"

D"t" n"&ter > 0@1@510556

Ocu!"t" !re*ent" > e%e("

Adre&"+ Te%e'on > ud1 Me2ednt+ Me2ednt + Loc"%t"te" Loc"%t"te " ,ode&

Stud > c%"&" " VIII-"+ Sco"%"
A%er# > "%$ent"re

II1 Auton#r.re

Inde!endent

Ne(oe de ".utor

De!endent

01 Mo)%t"te

D"

-

-

1 Hr"nre

-

D"

-

:1 I#en"

D"

-

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61 I$)r"c"t

D"

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?1 Contnent"

D"

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-

III1

De&crere" De&crere" !"centu%u

"7

Cu%o"re" oc2%orB "%)"&tr

)7

Cu%o"re" !"ru%uB &"tn

c7

In"%t$eB 01?6 $

d7


e7

Pe%eB "%)"

'7

#7

DntB dentte co$!%et"+ !re*nt" !re*nt" dou" c"r

VedereB )un"

27

M"ner&$eB nu !re*nt"

7

Vor)reB coerent"

 .7

D'or$t"t D'or$t"t f*ce!o&tur"B f*ce!o&tur"B nu !re*nt" !re*nt"

1 Nu$e%e !e c"re !"centu% % !re'er"B D"n"

:1Tr"&"tur d&tnct(e

61 Ocu!"t" "ntero"r"B e%e("

?1 Ho))-ur & ntere&eB &" cte"&c"+ &" "&cu%te $u*c"+ &" &te" cu !reten

41 Per&o"ne dn '"$%e &"u &e$nfc"t(e dn ("t" !"centu%uB )unc $"tern"%+ $"tu&" $"tern" & $"$"1

91 Per&o"ne c"re "r !ute" &"-% (*te*e  Su!ort &oc"%B )unc+ $"tu&" 3!"cent" e&te ntern"t" cu $"$"1

81 Condt de %ocutB %ocue&te ntr-un "!"rt"$ent cu dou" c"$ere $!reun" cu )unc $"tern"%+ $"tu&" $"tern" & $"$" 364 "n+ nu $" %ucre"*" dn $ot(e $edc"%e+ !"rnt &unt d(ort"t+ !"cent" nu !"&tre"*" %e#"tur" cu t"t"% !e c"re % &te nu$" dn (edere17

IV1 IV1

Condt" !&2c"

0

,o% !&2ce "ntero"reB P"cent" " $" 'o&t ntern"t" n &!t"%u% de !ed"tre dn Dro)et" Turnu Se(ern cu d"#no&tcu% de "nore/e ner(o"&"+ !"cent" " &%")t 0# n  %un1

1

St"re !&2c" !re*ent"B

"7

A!"rent" #ener"%"B tnut" n#r.t"+ '"ce& de!re&(+ !%"n& '"c%+ necoo!er"nt"+ necoo!er"nt"+ rt")%t"te

)7

Co$!ort"$entB ne"#" e/&tent" !ro)%e$e%or+ to%er"nt" &c"*ut" %" 'ru&tr"re

c7

Co$unc"re Co$unc"re 3(or)recontnut7B cont"ctu% (er)"% &e &t")%e&te cu dfcu%t"te+ d"r !"cent" "fr$" c" &e $!"c" )ne cu ce%"%t co%e#1

Non(er)"%B cont"ctu% (*u"% &e re"%*e"*" u&or d"r nu &e $entne+ !r(re" e&te ndre!t"t" n .o&

d7

D&!o*teB *o%"t"+ retr"&"+ d&!o*te tr&t"

e7

Orent"reB Orent"reB te$!oro-&!"t"%"

'7

So$nB f*o%o#c

#7

Cu$ nte%e#e !"centu% )o"%" &"B ne"#" e/&tent" unor !ro)%e$e

27

Attudne" Attudne" '"$%e '"t" de )o"%" !"centu%uB !"cent" e*te n#r.t" de )unc" c"re o & n&ote&te+ $"$" e&te 'o"rte n#r.or"t" de &t"re" 'ete+ " &!u& c" „nu &te ce &" $" '"c" c" &"  fe )ne fce e”

:1 Su)ecte de n#r.o"re !entru !"centB

-

re'u*u% "%$ent"r

-

!reocu!"re o)&e&(" %e#"t" de #reut"te

-

defct !onder"% &e(er

V1

In'or$"t &u!%$ent"reB

P"cent" n ("r&t" de 0? "n & 9 %un+ e%e(" n c%"&" " VIII-"+ &e nterne"*" n &ect" " V-" " S!t"%u%u Pr1 Dr1 A%e/"ndru O)re#" !entruB

-

re'u* "%$ent"r

-

!reocu!"re o)&e&(" %e#"t" de #reut"te" cor!or"%"

-

$"#ne cor!or"%" d&tor&on"t" d&tor&on"t"

P"cent" " 'o&t ntern"t" n u%t$e%e dou" %un n S!t"%u% de Ped"tre dn Dro)et"  Turnu  Turnu Se(ern Se(ern cu d"#no&tcu% d"#no&tcu% de "nore/e "nore/e ner(o"&"+ ner(o"&"+ $"%nutrte $"%nutrte &e(er" n ur$" re'u*u%u "%$ent"r+ de unde &-" tr"n&'er"t n c%nc" no"&tr" !entru &t")%re" condute ter"!eutce1

P"cent" (ne n&ott" de )unc" n &ect" no"&tr" !entru re"!"rt" !reocu!"r%or e/"#er"te %e#"te de #reut"te1

P"cent" "&oc"*" de)utu% &$!to$"to%o#c cu "fr$"t" crtc" dn !"rte" une co%e#e „$-" &!u& c" &unt #r"&" & ur"t" & tre)ue &" &%")e&c”

P"rnt !"cente &unt d(ort"t+ !"cent" nu !"&tre"*" %e#"tur" cu t"t"% e !e c"re % cuno"&te do"r dn (edere1

A%te d"te

D"te de %")or"tor

98 $#d%

TP > 410 #d%

CA > 81@ $#d%

AST > @ UL

ALT > 05 UL

C"Q - 018@ ME#L

 T$o% > 0UML 0UML

H<, > 0:15 #dL

L > 0@15 0@4L

H > 61? 0@4L

H* > :918

 T > 410 0@:L

EE
Tr"&eu% EE< cu $odfc"r )oe%ectrce )oe%ectrc e d'u*e & (o%t". cu tendnte %" "!%"t*"re" tr"&eu%u de 'ond1

H!er(ent%"t" nu $odfc" &e$nfc"t( tr"&eu% de 'ond '"r" de&c"rc"r de&c"rc"r !"ro/&tce1

E/"$enu% !&2o%o#cB !&2o%o#cB

Tr"r "n/o"&e %e#"te de !o&)%t"te" !o&)%t"te " n#r"&"r+ $"#ne d&tor&on"t" " &%uete+ !reocu!"r nten&e de " &%")+ n"dec("re re%"ton"%"+ ne(o" "ccentu"t" de " !r$ "'ectune+ &u!r""!recere+ "utode"%*"re+ "ctone"*" ntr-o $"ner" ordon"t"+ ordon"t"+ $etodc"1

Pre*nt" Pre*nt" "#t"te+ n&t")%t"te+ n&t")%t"te+ rt")%t"te1 rt")%t"te1

Su) tr"t"$ent cu O%"n*e!n" 0?$#* Tord"*n Tord"*n 0?@ $#* o%o't 0@@ $#* !o%(t"$ne  t) * 4 <%u)'er : t)* e(o%ut" c%nc" e&te &"t&'"c"to"re1 &"t&'"c"to"re1

Se e/terne"*" %" cerere" '"$%e cu reco$"nd"re" de " contnu" tr"t"$entu%1 tr"t"$ent u%1

C1 An"%*" & nter!ret"re" d"te%or

Anore/" Anore/" e&te o tu%)ur"re tu%)ur"re de co$!ort"$ent "%$ent"r+ 'o"rte &ero"&"+ '"r" tr"t"$ent duce %" "!"rt" co$!%c"t%or de%oc u&o"re & c2"r %" e/tu&1

Nur&" tre)ue &" fe r")d"to"re cu !"centu%+ nte%e#"to"re+ nte%e#"to" re+ c"%$" & 'er$" cu !"centu%1 E" tre)ue &" de" !"centu%u !"centu%u & '"$%e c"t $" $u%te det"% de&!re )o"%" & de&!re tr"t"$entu% e1

In 'ond "nore/c re'u*" &" "d$t" c" "u o tu%)ur"re & &e o!un orc"re nter(ent c"re (*e"*" co$!ort"$entu% %or "%$ent"r d"r toto"d"t" e !ot "cce!t" $" u&or ".utoru% !entru re*o%("re" "%tor !ro)%e$e1

Nur&" $!reun" cu !"centu% & cu '"$%" "ce&tu" (" ntoc$ !%"nu% de n#r.re+ (" &t")% or"ru% & contnutu% $e&e%or tn"nd cont de !re'ernte%e "%$ent"re "%e !"centu%u & (" 'o%o& & d'erte te2nc de ter"!e1

In ter"!" '"$%"%" nur&" "re ro%u% de "B

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Defct nutrton"%+ %e#"t de "uto!r("re" de "%$ente & 2!er"ct(t"te

P"cent" & (" re&t")% #reut"te" cor!or"%" nor$"%"

- "$ &t")%t $!reun" $!reun" cu !"cent" & )unc" "ce&te" or"ru% & or#"n*"re" or#"n*"re" $e&e%or+ 6 !ort $c !e *1

- "$ $er& $!reun" cu !"cent" %" &"%" de $e&e+ unde " $"nc"t cu tot ce%"%t !"cent n !re*ent" $e"1

- "$ &u!r"(e#2e"t !"cent" n t$!u% & du!" $"&" !entru e(t"re" !ro(oc"r de ("r&"tur & &" nu "runce $"nc"re"1

- "$ 'e%ct"t !"cent" "tunc c"nd " reu&t &" $"n"nce tot ce ne-"$ !ro!u&

- "$ d&cut"t cu )unc" &!un"ndu c" &-" o)tnut un !ro#re& (*)% n cee" ce !r(e&te "%$ent"t" & #reut"te" cor!or"%"

- "$ c"nt"rt *%nc !"cent"+ !"cent"+ d$ne"t" n "ce"& tnut"1

- "$ ncerc"t !rn d&tr"#ere" "tente du!" fecr"e $"&" &" '"c !"cent" &" nu $" !%"n#" "ntren"nd-o "ntren"nd-o n &"%" de .o"c" n d'erte .ocur 3.oc de c"rt+ .oc cu )et&o"re7 )et&o"re7

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Pertur)"re" &t$e de &ne" "&oc"t" cu o to%er"nt" &c"*ut" %" 'ru&tr"re+ %e#"t" de ne(o" de " !%"ce ce%or%"t+ de " f "!ro)"t"+ "cce!t"t"

P"cent" (" d" do("d" de o cre&tere " &t$e de &ne+ (" c"!"t" $" $u%t" ncredere n 'orte%e !ro!r

- "$ ncur"."t-o ncur"."t-o &"-& defne"&c" !ro!r%e ntere&e ntere&e 3"ct(t"t !re'er"te7 !entru " o '"ce &" &e &$t" $" !utn %!&t" de ntere& o)tn"nd contro%u% "&u!r" !ro!re !er&o"ne

- "$ d&cut"t cu !"cent" de&!re de&!re ce  !%"ce &" '"c"+ cu$ "r dor &" fe n re%"t%e cu !"rnt & cu ce%"%t & $odu% !rn c"re &e (" '"ce "cce!t"re"1

- -"$ nt"rt !"cente !uncte%e 'orte+ "$ ("%or*"t-o '"c"nd-o &" fe $" ncre*"to"re n 'orte%e !ro!r

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I*o%"re" &oc"%"+ !ertur)"re" re%"t%or nter!er&on"%e d"tor"t" 'rc de " f re.ect"t"1

P"cent" P"cent" &e (" re%"ton" $" u&or cu ce%"%t & (" !"rtc!" %" "ct(t"t de #ru! &"u "%te "ct(t"t &oc"%e

- "$ ".ut"t !"cent" &" (or)e"&c" de&!re &ent$ente%e &"%e de &n#ur"t"te !rn nter"ctun nter"ctun !er$"nente cu "ce"&t" de $" $u%te or !e *1

- -"$ "r"t"t !"cente un ntere& &ncer ncerc"nd &" o con(n# c" $ !"&" de e"

-ncur".e* !"cent" n c"ut"re" unor $odur de " !etrece t$!u% %)er+ &" fe c"!")%" &" &e de&tnd"+ &"-& %"r#e"&c" cont"cte%e cont"cte%e &oc"%e1

--"$ reco$"nd"t !"cente &" e(te concte%e de orce n"tur" "t"t cu )unc" c"t & cu co%e# !rn to%er"nt" & ncredere n &ne1

6

An/et"te" de " %u" n #reut"te & de "!erde contro%u% "&u!r" "%$ente%or

P"cent" (" (or) cu $" $u%t" u&urnt" de&!re te$er%e &"%e

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- !rn d&cut &&te$"tce * de * -"$ e/!%c"t !"cente c" e&te un !ro#re& n re*o%("re" !ro)%e$e%or e $".ore !rn %u"re" n #reut"te '"r" &"- de'or$e*e $"#ne" de&!re f*cu% e

--"$ !re*ent"t un t")e% c"re !re*nt" #reut"te" #reut"te" de"%" %" ("r&t" & n"%t$e" e

-"$ d&cut"t cu !"cent" de&!re "%$ente%e c"re nu !re*nt" !erco% n " te n#r"&" c dn contr" !ot f 'o"rte )enefce n (edere" o)tner une )une 'uncton"%t"t 'uncton"%t"t " or#"n&$u%u or#"n&$u%u 3e/1 'ructe%e+ %e#u$e%e+ %"ct"te%e7

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Pertur)"re" dn"$c '"$%"%e d"tor"t" r#dt"t n e/erct"re" ro%ur%or

F"$%" (" de(en $" nte%e#"to"re+ (" f $" de&c2&" '"t" de !ro)%e$e%e !"cente & o (" ncur"." &" "ctone*e "utono$

- "$ e("%u"t re%"t%e '"$%"%e

- !rn d&cut cu $"$"  &-" &u#er"t d'erte $od"%t"t de ")ord"re ")ord"re " re%"t%or "ce&te" cu fc"

- dn d"%o#u% !urt"t cu $"$" !"cente "ce"&t" ".un#e %" conc%u*" c" tre)ue &"-& reor#"n*e*e de%e & $od"%t"te" de ")ord"re " &tu"t%or1 P"cent" (" f contro%"t" de $"$" „dn u$)r"” '"r" &"  &e "ccentue*e dee" de " $"nc" dn o)%#"te "&t'e% deten&on"nd conctu% dntre e%e

- n fn"% '"$%" e&te d&!u&" &" "do!te un d"%o# de&c2& ntre e )"*"t !e &ncert"te+ cee" ce (" ".ut" &" ")" o re%"te "r$ono"&" "r$ono"&" cu '"$%"1

E1 EVALUARE SI RASPUNSUL PACIENTULUI LA IN
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P"cent" &-" e/!r$"t &ent$ente%e re'ert"o"re %" !ro!r"- !er&o"n" & " nte%e& c"re &unt 'unct%e & ne(o%e or#"n&$u%u

P"cent" "re $" $u%t" ncredere n &ne & " #"&t $odur !rn c"re &e " '"ce "cce!t"t" de ce%"%t + d"nd do("d" de to%er"nt" & ncredere n &ne

P"cent" dore&te &" & $odfce co$!ort"$entu%+ $"n'e&t" ntere& !entru "ct(t"t%e !ro!u&e & & (er)"%*e"*" cu u&urnt" &ent$ente%e1

 Te"$"  Te"$" de " nu %u" n #reut"te #reut"te &" d$nu"t d$nu"t c" nten&t"te+ nten&t"te+ d"r &e $" !"&tre"*" !"&tre"*" nc"1 nc"1

F"$%" " "r"t"t nte%e#ere !entru !ro)%e$e%e !"cente nc"t &" deten&one*e !e c"t !o&)% &tu"t" dn '"$%e+ (" f n !er$"nent" $ereu "%"tur de e"+ '"r" &" &e &$t" con&tr"n&"1

S!ecfc c" du!" !%ec"re" )unc dn &!t"%+ !"cent" " $" r"$"& cu no o &"!t"$"n"+ t$! n c"re &-" "co$od"t $" )ne+ er" re%"/"t"+ $" d&!on)%" d&!on)%" n con(er&"t+ re%"ton"nd )ne cu co%e#e%e de &"%on cu c"re $"nc" $!reun" & de&'"&ur" %" &"%" de .o"c" d(er&e "ct(t"t1

Su) tr"t"$ent cu O%"n*e!n" 0?$#* Tord"*n Tord"*n 0?@ $#* o%o't 0@@ $#* !o%(t"$ne  t) * 4 <%u)'er : t)* e(o%ut" c%nc" e&te &"t&'"c"to"re1 &"t&'"c"to"re1

Se e/terne"*" %" cerere" '"$%e cu reco$"nd"re" de " contnu" tr"t"$entu%1

F7 Conc%u*

 Tu%)ur"r%  Tu%)ur"r%e e de "%$ent"te 3"nore/" 3"nore/" & )u%$" $nt"%"7 $nt"%"7 "!"r n #ener"% n !ero"d" !ero"d" de !u)ert"te & "do%e¢" !e un 'ond de (u%ner")%t"te !&2c" !&2c" cre&cut"+ "("nd n (edere condt%e &oco cu%tur"%e dn ce n ce $" !retento"&e+ "tent" ndre!t"ndu&e c"tre $"&e%e de tner !entru " !rent"$!n" n&t"%"re" "ce&tor tu%)ur"r1

Pentru "ce"&t" (" tre)u de*(o%t"t" rete"u" n#r.r n co$unt"te+ ntoc$re" de !ro#r"$e educ"t(e !entru "do%e¢+ de*(o%t"re" re%"t%or cu n&ttut%e &co%"re n c"re 'unctone"*" tner1

Se $!une e%")or"re" de !ro#r"$e educ"t(e !r(nd tu%)ur"r%e de "%$ent"te n r"ndu% tner%or+ ntruc"t "ce&te" "u or#ne !&2"trc" & nu or#"nc"1 E&te de dort c" "do%e¢u% &"-& cuno"&c" & &"-& nte%e"#" ro%u% n &ocet"te1

Pentru " e(t" r&cu% de dece& !rn co$!%c"t e&te nece&"r" de!&t"re" !recoce & "d$n&tr"re" corect" " tr"t"$entu%u+ c" & co%")or"re" '"$%e %" !%"nu% de n#r.r "% )o%n"(u%u1