Estudio de la medicación prescrita a las personas afectadas de conductas hostiles sistemáticas en su ámbito laboral

Media type: E-Book

Title: Estudio de la medicación prescrita a las personas afectadas de conductas hostiles sistemáticas en su ámbito laboral

Contributor: Méndez Garcés, Juan Francisco [VerfasserIn]

imprint: [Erscheinungsort nicht ermittelbar]: Universitat de Barcelona, 2012

Language: Spanish

Identifier:

Origination:

University thesis: Dissertation, Universitat de Barcelona, 2012

Footnote:

Description: [spa] Fundamento y objetivo: El acoso laboral sistemático (ACS), a pesar de las diferentes tratamientos farmacológicos a largo plazo y tratamientos no farmacológicos, conduce a una alta tasa de incapacidades permanentes y graves trastornos mentales. El objetivo de esta comunicación es analizar la prescripción de medicamentos para el tratamiento de enfermedades, trastornos, síntomas y signos que experimentan los afectados de ACSa, teniendo en cuenta el diagnóstico establecido por los MAP o psiquiatras. Configuración y método: Estudio observacional, longitudinal, basado en la revisión de los registros médicos de las personas afectadas por HSW. Principales medidas de resultado: datos socio-demográficos, días de incapacidad temporal, el período de HSW psicológica, los principales diagnóstico de acuerdo a la Clasificación Internacional de Enfermedades (CIE-10), la prescripción patrón de acuerdo con la clasificación ATC. Resultados: 50 pacientes fueron incluidos en el estudio (edad media: 45,5 años; 62% mujeres). Los períodos medios de ACS y de ILT eran 4 años y 413 días respectivamente. Los principales diagnósticos fueron 76,5% F40-48 y el 23,1% F30-39 por médico de cabecera y el 49,4% F30-39 y del 42,1% F40-48 por el psiquiatra. El número total de prescripciones fue 909, incluyendo 67 diferentes principios activos, principalmente del grupo N de la clasificación ATC (88%), dirigidos a mitigar los síntomas mentales y lograr la remisión completa de los síntomas de la enfermedad mental. El restante (12%) se utiliza para tratar el estado psicosomático aparato locomotor, digestivo, cardiovascular, endocrino, dermatológicas infecciosas, respiratorias y los trastornos de dolor crónico. Los psiquiatras se centran su actividad en la depresión y, así, su prescripción es el 49% de los antidepresivos en comparación con el 29% de los ansiolíticos. Además, la prescripción de antidepresivos aproximadamente coincide con el porcentaje de pacientes con diagnóstico de depresión (43%), mientras que el porcentaje de casos diagnosticados de ansiedad (53%) es muy superior que receta ansiolíticos. Sin embargo, la Guía NICE para los estados depresivos que en el caso de los asociados síntomas de la depresión y la ansiedad, la depresión merece una atención prioritaria. Conclusiones: Los diagnósticos de los psiquiatras son consistentes con los criterios establecidos en la literatura internacional al describir los trastornos mentales graves y discapacitantes que afectan a HSW psicológico. La prescripción de antidepresivos está de acuerdo con el enfoque de diagnóstico informado por todos los especialistas, y también está de acuerdo con las recomendaciones de NICE Directrices para la depresión. ; [eng] Objectives: The first aim of this study was to examine the possible association of long standing Systematic psychological harassment at work (SPHW) with psychiatric disorders and its characteristics. The second aim was to analyze drug prescription used to treat diseases, disorders, symptoms, and signs of those affected with psychological SPHW, taking into account the established diagnosis by the General Physician (GP) or Psychiatrists. Method and study subjects: Design: Longitudinal observational study with follow up focused on persons undergoing a long duration SPHW; based on the review of medical records of people affected by SPHW Total length of the follow up period was 6 years, from 2006 to 2012. Mean duration of follow up was 3.1 years (range 1.1-6.3 years). Setting: Patients who voluntarily attend to a Catalonia Harassment Victims association (Associació de Víctimes d'Assejament laboral de Catalunya: AVALC) asking for psychological and laboral aid. Subjects: 132 persons were recruited along a seven years period, 84 women (63.6%) and 48 men (36.4%). Mean age was 45.5 years (SD ± 9.8), 43.8 years for women and 48.3 years for men (p= 0.114). SPHW was measured by self-reported data. All participants were assessed using several neuropsychological instruments such as the Beck Scale, the Hamilton Depression Scale, the Echeburua Scale, the PDS (Posttraumatic Diagnostic Scale) and the LIPT (Leymann Inventory of Psychological Terrorization). Medical records were examined to verify all the diagnosis affecting to the participants. After checking the medical records, only 50 cases (37.3%), 31 women and 19 men, had verified psychiatric diagnostics, according to ICD-10 criteria. Main outcome measures: - Socio-demographic data: age, gender - Work environment: types of harassers, mainly distributed by work sectors, public administration workers and private organizations workers, days of temporary disability, period of SPHW. - Main diagnosis according to International Classification of Diseases ICD-10 - Type of assistance: primary care, mental health unit, emergency department, neurologist or occupational health unit. - Previous pharmacotherapeutical history including all prescribed drugs (generic or brand) related with working problems and concomitant medication, number of prescriptions, active principles (DCI), reason for prescription, dose and dosing interval, duration of treatment, and number of drugs per patient. - Established treatment planning (pharmaceutical care) designed to detect, prevent and solve potential or acute problems related with the prescribed drugs, such as adherence, interactions, collateral effects, negative outcomes, effectiveness and safety. - Prescription pattern according to Anatomical, Therapeutic, Chemical Classification System (ATC classification). - Most prescribed active principles and percentages of utilization. Key terms: Systematic psychological harassment at work, mobbing, workplace bullying, stress, occupational health, work environment, psychosocial factors mental health disorders, gender, posttraumatic stress disorder, major depression disorder, depression, anxiety, comorbidity, insomnia, somatic disorder, prevalence, epidemiology, cost mental disorder, treatment / pharmacotherapy/ drug, compliance. Background/Introduction The phenomenon of systematic psychological harassment at work (SPHW) first described by Heinz Leymann, refers to systematic and prolonged exposure to frequent hostile behaviours at work. SPHW is commonly considered as an expression of violent behaviour. SPHW has been defined as ''harassing, offending, socially excluding someone or negatively affecting someone's work tasks. it has to occur repeatedly and regularly (e.g., weekly) and over a period of time (e.g., about six months). However, there is no accepted common definition as yet and different terminology is used as synonym of bullying (e.g., harassment, mobbing, emotional abuse, victimisation, psychological abuse at work). Research about this topic has dramatically increased in the last years. These behaviours may lead to the stigmatisation and victimization of the exposed individuals. A reciprocal relationship between SPHW and mental distress has been described. Several studies have shown that SPHW is associated with mental distress. Furthermore, mental distress was shown to be a predictor of bullying. It seems that experiencing workplace bullying can contribute to mental distress, but individual characteristics may also contribute to the perception of bullying. Thus, a significant relationship between general proneness to negative feelings and work victimization has been described. A theoretical framework, the cognitive theory of trauma, proposes the post-traumatic stress disorder (PTSD) as the result of systematic psychological harmful events. The traumatic potential of bullying is unquestionable. So, the path from job demands to PTSD through bullying seems plausible. PTSD is a severe anxiety disorder that can be developed after exposure to any event that results in psychological trauma. Diagnostic symptoms for PTSD include re-experiencing the original trauma(s) through flashbacks or nightmares, avoidance of stimuli associated with the trauma, and increased arousal, such as difficulty falling or staying asleep, anger, and hyper vigilance. Diagnostic criteria require that symptoms last more than one month and cause significant impairment in social, occupational, or other important areas of functioning. Exposure to intense bullying at work may change the individual's perceptions of their work-environment and life in general to one of threat, danger, insecurity and self-questioning, which may result in emotional, psychosomatic and psychiatric problems, even affecting the personal and familiar relationships of the victims. Most studies examining the relationship between psychosocial work characteristics and mental health outcomes, ranging from symptoms and psychological distress to diagnosed psychiatric disorders, have been cross-sectional and, therefore, the causal association between work stressors and mental health remains uncertain. The aim of this study is to describe and analyze the possible relationship between SPHW characteristics and the subsequent psychiatr...

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