Considerações psicanalíticas da avaliação psicodinâmica, imagem corporal e de personalidade de pacientes no preparo à cirurgia bariátrica.
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2023-02-03
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Universidade Estadual Paulista (Unesp)
Resumo
A obesidade é considerada um problema de saúde pública na atualidade e acomete indivíduos de ambos os sexos e de todas as idades. O paradigma biomédico a estabelece como doença de incidência e prevalência crescente e determinante na associação a outras doenças metabólicas, aumentando a morbimortalidade e os gastos em saúde. Entre as estratégias de tratamento, a cirurgia bariátrica (CB) consiste no método para controle de peso, frente ao insucesso de medidas convencionais anteriores nos casos graves. A avaliação e acompanhamento psicológico é uma exigência antes e depois do procedimento cirúrgico, constituindo o tema central do presente estudo. A tese está estruturada em compilação de três artigos que versam sobre a prática da autora como psicóloga pertencente à equipe multiprofissional de um ambulatório de cirurgia bariátrica. Os trabalhos aqui descritos estão organizados em três vertentes de atuação: 1. a proposição de um protocolo psicodiagnóstico interventivo para investigação e compreensão de aspectos psicodinâmicos, de imagem corporal e personalidade de pessoas com obesidade grave, candidatas à cirurgia bariátrica; 2. um estudo prático formativo que abordou a intervenção grupal realizada como tratamento pré-operatório e 3. um ensaio teórico-clínico em psicanálise, sintetizando a distinção sobre a concepção de corpo para a medicina e para a psicanálise. A coleta de dados do primeiro e segundo estudo foi realizada no ambulatório de Gastrocirurgia Bariátrica e Metabólica do Hospital das Clínicas da Faculdade de Medicina de Botucatu – HCFMB. A tese contempla a avaliação e intervenção psicológica elaborada para candidatos à CB, visando contribuir com a literatura da área ao fornecer uma proposta de manejo clínico na abordagem individual e grupal, articulada ao instrumental teórico psicanalítico. Deste modo, consideramos que a proposta apresentada pode favorecer a abordagem psicológica da pessoa com obesidade, no que concerne à compreensão psicodinâmica, e auxiliar no aprimoramento da assistência prestada às pessoas que recorrem ao tratamento cirúrgico.
Obesity is considered a public health problem today and affects individuals of both sexes and all ages. The biomedical paradigm establishes obesity as a disease of increasing incidence and prevalence, and as a determinant in the association with other metabolic diseases, which increases morbidity, mortality and health care costs. Among the treatment strategies, bariatric surgery is the method for weight control when conventional measures have failed in severe cases. Psychological evaluation and follow-up are required before and after the surgical procedure, and constitute the central theme of the present study. The thesis is structured as a compilation of three articles that deal with the author's practice as a psychologist member of a multiprofessional team of a bariatric surgery ambulatory clinic. The works described here are organized in three strands of action: 1. the proposition of an interventional psychodiagnostic protocol for the investigation and understanding of psychodynamic, body image and personality aspects of people with severe obesity, candidates to bariatric surgery; 2. a practical formative study that approached the group intervention performed as a preoperative treatment and 3. a theoretical-clinical essay in psychoanalysis, synthesizing the distinction about the body conception for medicine and psychoanalysis. The data collection of the first and second study was carried out at the Bariatric and Metabolic Gastrosurgery Outpatient Clinic of Hospital das Clínicas da Faculdade de Medicina de Botucatu, Brazil. The thesis contemplates the psychological assessment and intervention designed for candidates for bariatric surgery, aiming to contribute to the scientific literature by providing a proposal for clinical management for both individual and group approaches, articulated to the psychoanalytic theoretical instrument. Therefore, we consider that the proposal presented can favor the psychological approach of the obese individuals, regarding the psychodynamic understanding, and can help to improve the assistance provided to people who resort to surgical treatment
Obesity is considered a public health problem today and affects individuals of both sexes and all ages. The biomedical paradigm establishes obesity as a disease of increasing incidence and prevalence, and as a determinant in the association with other metabolic diseases, which increases morbidity, mortality and health care costs. Among the treatment strategies, bariatric surgery is the method for weight control when conventional measures have failed in severe cases. Psychological evaluation and follow-up are required before and after the surgical procedure, and constitute the central theme of the present study. The thesis is structured as a compilation of three articles that deal with the author's practice as a psychologist member of a multiprofessional team of a bariatric surgery ambulatory clinic. The works described here are organized in three strands of action: 1. the proposition of an interventional psychodiagnostic protocol for the investigation and understanding of psychodynamic, body image and personality aspects of people with severe obesity, candidates to bariatric surgery; 2. a practical formative study that approached the group intervention performed as a preoperative treatment and 3. a theoretical-clinical essay in psychoanalysis, synthesizing the distinction about the body conception for medicine and psychoanalysis. The data collection of the first and second study was carried out at the Bariatric and Metabolic Gastrosurgery Outpatient Clinic of Hospital das Clínicas da Faculdade de Medicina de Botucatu, Brazil. The thesis contemplates the psychological assessment and intervention designed for candidates for bariatric surgery, aiming to contribute to the scientific literature by providing a proposal for clinical management for both individual and group approaches, articulated to the psychoanalytic theoretical instrument. Therefore, we consider that the proposal presented can favor the psychological approach of the obese individuals, regarding the psychodynamic understanding, and can help to improve the assistance provided to people who resort to surgical treatment
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Obesidade, Cirurgia bariátrica, Psicodiagnóstico interventivo, Psicanálise, Obesity, Bariatric surgery, Interventional psychodiagnosis, Psychoanalysis