"CRISIS Y CONTENCIÓN: DEL ESTRÉS AL EQULIBRIO PSÍQUICO"

Avances en Salud Mental Relacional / Advances in relational mental health
Vol. 6, núm. 3 ­ Noviembre 2007
Órgano Oficial de expresión de la Fundación OMIE
Revista Internacional On-Line / An International On-Line Journal

RESUMEN Y CRÍTICA DE LIBROS

"CRISIS Y CONTENCIÓN: DEL ESTRÉS AL EQULIBRIO PSÍQUICO"
J.Guimón, R.Dávila, A.Andreoli (Eds). Ed. Eneida, Madrid, 2008

This book compiles the papers presented at a Symposium on "Crisis and
Contention" meeting organised by the Emergency Psychiatry section of the Association
of European Psychiatrists in Bilbao on 18th June 2007.
Epidemiological, clinical and therapeutic aspects of psychiatric crisis were
discussed at four Roundtables and with the participation of 25 speakers from five
European countries and 200 professionals from Spain.
The roundtable on aetiology showed that emotional crisis following private
events (frustrations, failures, emotional loss) or public events (natural disasters, wars,
attacks) assume significant importance in our times. Between birth and reaching 60
years old 57% of males and 72% of females in the West will show signs of a marked
mental imbalance and 6% and 15% respectively will show signs of a serious mental
disorder.
It became clear that the patients go to psychiatric emergency units as a result of
the breakdown in the psychological homeostasis, following an attempt to adapt to the
stressful circumstances. The community support mechanisms help to control the effects
of stress and avoid imbalances.
The clinical roundtable showed that at times the crisis occurs in patients with
prior serious psychiatric pathologies. However, in a great many number of cases the
crisis affect persons without any prior pathology who become imbalanced due to grave
ASMR Revista Internacional On-Line ­ Dep. Leg. BI-2824-01 ­ ISSN 1579-3516
CORE Academic, Instituto de Psicoterapia, Manuel Allende 19, 48010 Bilbao (España)
Copyright © 2007

Avances en Salud Mental Relacional / Advances in relational mental health
Vol. 6, núm. 3 ­ Noviembre 2007
Órgano Oficial de expresión de la Fundación OMIE
Revista Internacional On-Line / An International On-Line Journal

life situations which they can not overcome due to a lack of support from the vicinity or
due to fragility in their personality which prevents them from putting mechanisms into
action in order to adapt.
These imbalances are seen in Spain both at the primary healthcare centres and at
the specialised centres and from where they are sent to other services. Too commonly
they end up being concentrated at the emergency services of the general hospitals where
they receive momentary help, frequently only medication, and then return home. The
result is often that the patient and their families do not go back to the help system and
thus lose a unique opportunity to comprehend the predisposing factors and the events
leading to the crisis, and as such it repeats with the same or with difference
characteristics.
On other occasions the crisis are dealt with at the hospital although a not
insignificant percentage of cases do not remain long enough in order to obtain the
desirable benefit.
The experiences provided by the Bilbao, Barcelona, Paris and Geneva teams
show that other types of approach are preferable. More time (and space) is needed than
that which is available at the normal emergency services so that the manifestations
subside (e.g. one or two days) and to give some respite to the patient's environment. It
is necessary to create mobile emergency centres, extra-hospital crisis units or units next
to the general hospital's emergency services (such as the unit in Geneva) with specific,
well-trained personnel and with the participation of the patient's environment. Various
programmes were discussed which includes observation beds in the emergency
departments, day centres (such as those in Bilbao), telephone service (such as those in
the U.K.), home visits, etc. These are creative mechanisms which can not be copied
from those already existing and must be adapted in each of our health systems with
differential guidelines in the various countries.
It was discussed how the psychological imbalances can evolve towards
chronicity or, on the other hand, can present an exceptional opportunity to review a life
with fragilities which can be improved with the right treatment. Experiences were
presented with patients with serious somatic disorders, suicide-risk patients and violent
patients.
ASMR Revista Internacional On-Line ­ Dep. Leg. BI-2824-01 ­ ISSN 1579-3516
CORE Academic, Instituto de Psicoterapia, Manuel Allende 19, 48010 Bilbao (España)
Copyright © 2007

Avances en Salud Mental Relacional / Advances in relational mental health
Vol. 6, núm. 3 ­ Noviembre 2007
Órgano Oficial de expresión de la Fundación OMIE
Revista Internacional On-Line / An International On-Line Journal

It concluded that progress towards recovery or not depends to a large extent on
the attention that they are offered. But in order for this it is essential to improve the
training currently being offered at the Universities for health professionals working in
primary care in order to deal with these situations, which includes in some cases
properly referring them to the specialists. In any event, the awareness experiences with
interventions performed according to the model of the Balint groups (such as those in
Bilbao´s University) were extremely valuable.

ASMR Revista Internacional On-Line ­ Dep. Leg. BI-2824-01 ­ ISSN 1579-3516
CORE Academic, Instituto de Psicoterapia, Manuel Allende 19, 48010 Bilbao (España)
Copyright © 2007



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