Trastornos mentales

Trastornos mentales
  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    目标:表征健康的社会决定因素,哥伦比亚因内部武装冲突而流离失所的成年人口的心理健康问题和潜在问题症状。
    方法:横断面描述性研究,随机抽取98名被强行转移到Soacha的成年人,哥伦比亚,由于国内武装冲突。自我报告问卷,以检测潜在的问题心理健康问题和症状,并应用了关于健康社会决定因素的结构化问卷。
    结果:中位年龄为38[四分位距,28-46年,女性占主导地位(69.39%)。流离失所以来的中位时间为36[16-48]个月,以及在索阿查定居以来的时间,48[5-48]个月。86.32%的人每月工资低于最低工资,93.87%的人没有劳动合同。42.86%和7.14%的人报告说在流离失所之前和之后是他们的房屋所有者,分别。一到达Soacha,79.60%用于主要支持网络,3%用于机构。在流离失所之前,16.33%的人缺乏健康保险,之后的27.55%。关于心理健康问题;57.29%的人可能有抑郁或焦虑障碍;36.73%的人可能有精神病;91.66%的人可能有问题症状,在女性中更为普遍和严重(p=0.0025)。
    结论:据报道,与该国其他地区相比,定居在Soacha的流离失所成年人群的生活条件恶化,潜在有问题的心理健康问题和症状的患病率更高。需要具有互补观点的分析来评估这些差异。
    OBJECTIVE: To characterise social determinants of health, mental health problems and potentially problematic symptoms in the adult population displaced by internal armed conflict in Colombia.
    METHODS: Cross-sectional descriptive study with a random sample of 98 adults forcefully displaced to Soacha, Colombia, due to internal armed conflict. The Self Report Questionnaire to detect potentially problematic mental health problems and symptoms, and a structured questionnaire on social determinants of health were applied.
    RESULTS: The median age was 38 [interquartile range, 28-46] years, and women predominated (69.39%). The median time since displacement was 36 [16-48] months, and time since settlement in Soacha, 48 [5-48] months. 86.32% survived on less than the minimum wage per month and 93.87% did not have an employment contract. 42.86% and 7.14% reported being owners of their homes before and after displacement, respectively. Upon arriving in Soacha, 79.60% went to primary support networks and 3% to institutions. Before displacement, 16.33% lacked health insurance and 27.55% afterwards. Regarding mental health problems; there were possible depressive or anxious disorders in 57.29%; possible psychosis in 36.73%; and potentially problematic symptoms in 91.66%, being more prevalent and serious in women (p = 0.0025).
    CONCLUSIONS: A deterioration in living conditions and a higher prevalence of potentially problematic mental health problems and symptoms was reported in displaced adult populations settled in Soacha compared to other regions of the country. Analyses with complementary perspectives are required to evaluate these differences.
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  • 文章类型: Journal Article
    背景:物质使用障碍与至少一种其他精神障碍的并存称为双重病理,其特征在于难以诊断且对治疗反应差的异质性症状。出于这个原因,生物标志物的鉴定和验证是必要的.在这个群体中,据报道,可能的脑电图生物标志物可用于诊断,治疗和随访,在神经精神疾病和物质使用障碍中。本文旨在对脑电图生物标志物在双重病理中的现有文献进行综述。
    方法:对文献进行叙述性回顾。在PubMed上进行了书目搜索,科学直接,OVID,BIREME和Scielo数据库,关键词:电生理生物标志物和物质使用障碍,电生理生物标志物和精神障碍,生物标志物和双重病理学,生物标志物和物质使用障碍,脑电图,和物质使用障碍或合并症精神障碍。
    结果:鉴于大量文献发现脑电图作为精神疾病和物质使用障碍的生物标志物,以及关于双重病理学的几篇文章,证据被组织为精神病学中的生物标志物,用于诊断和预测风险,并作为双重病理的生物标志物。
    结论:虽然证据不足,这表明存在一部分部位和机制,其中精神活性物质的作用和某些精神障碍的神经生物学可能重叠或相互作用。
    BACKGROUND: The co-occurrence of substance use disorder with at least one other mental disorder is called dual pathology, which in turn is characterised by heterogeneous symptoms that are difficult to diagnose and have a poor response to treatment. For this reason, the identification and validation of biomarkers is necessary. Within this group, possible electroencephalographic biomarkers have been reported to be useful in diagnosis, treatment and follow-up, both in neuropsychiatric conditions and in substance use disorders. This article aims to review the existing literature on electroencephalographic biomarkers in dual pathology.
    METHODS: A narrative review of the literature. A bibliographic search was performed on the PubMed, Science Direct, OVID, BIREME and Scielo databases, with the keywords: electrophysiological biomarker and substance use disorder, electrophysiological biomarker and mental disorders, biomarker and dual pathology, biomarker and substance use disorder, electroencephalography, and substance use disorder or comorbid mental disorder.
    RESULTS: Given the greater amount of literature found in relation to electroencephalography as a biomarker of mental illness and substance use disorders, and the few articles found on dual pathology, the evidence is organised as a biomarker in psychiatry for the diagnosis and prediction of risk and as a biomarker for dual pathology.
    CONCLUSIONS: Although the evidence is not conclusive, it suggests the existence of a subset of sites and mechanisms where the effects of psychoactive substances and the neurobiology of some mental disorders could overlap or interact.
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  • 文章类型: Journal Article
    目的:确定接受联络精神科医生咨询的高风险产科服务的患者的精神病诊断和治疗。
    方法:一项描述性观察性研究,包括来自麦德林一家高度专业化诊所的高风险产科服务的孕妇,他在2013年至2017年之间进行了联络精神病学咨询。感兴趣的主要变量是精神病和产科诊断和治疗,除了生物心理社会风险因素。
    结果:共筛选了361份医疗记录,248例患者符合纳入标准。主要的精神病诊断是重度抑郁症(29%),其次是适应性障碍(21.8%)和焦虑症(12.5%)。精神病学机构最常用的药物治疗是SSRI抗抑郁药(24.2%),曲唑酮(6.8%)和苯二氮卓类药物(5.2%)。最常见的主要产科诊断是自发分娩(46.4%),主要的继发产科诊断是与妊娠相关的高血压疾病(10.4%),妊娠期糖尿病(9.2%)和复发性流产(6.4%)。总的来说,71.8%的患者有较高的生物心理社会风险。
    结论:研究人群的原发性精神疾病是重度抑郁症,适应障碍和焦虑症,这意味着及时识别这些围产期精神疾病症状的重要性,连同产科和社会风险,在产前咨询中。考虑到母亲和儿童的高生物心理社会风险的负面影响,应鼓励进行精神病学干预。
    OBJECTIVE: To determine the psychiatric diagnoses and treatments of patients admitted to the high-risk obstetric service who underwent a consultation with a liaison psychiatrist.
    METHODS: A descriptive observational study that included pregnant women from the high-risk obstetric service of a highly specialised clinic in Medellín, who had a liaison psychiatry consultation between 2013 and 2017. The main variables of interest were psychiatric and obstetric diagnoses and treatments, in addition to biopsychosocial risk factors.
    RESULTS: A total of 361 medical records were screened, with 248 patients meeting the inclusion criteria. The main prevailing psychiatric diagnosis was major depressive disorder (29%), followed by adaptive disorder (21.8%) and anxiety disorders (12.5%). The pharmacologic treatments most used by the psychiatry service were SSRI antidepressants (24.2%), trazodone (6.8%) and benzodiazepines (5.2%). The most common primary obstetric diagnosis was spontaneous delivery (46.4%), and the predominant secondary obstetric diagnoses were hypertensive disorder associated with pregnancy (10.4%), gestational diabetes (9.2%) and recurrent abortions (6.4%). Overall, 71.8% of the patients had a high biopsychosocial risk.
    CONCLUSIONS: The studied population\'s primary psychiatric disorders were major depressive disorder, adjustment disorder and anxiety disorders, which implies the importance of timely recognition of the symptoms of these perinatal mental pathologies, together with obstetric and social risks, in the prenatal consultation. Psychiatric intervention should be encouraged considering the negative implications of high biopsychosocial risk in both mothers and children.
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  • 文章类型: Journal Article
    背景:创伤后应激障碍(PTSD)在获得性脑损伤(ABI)患者中普遍存在。尽管眼动脱敏和后处理(EMDR)对PTSD的疗效已确立,对ABI伴PTSD患者的EMDR评估研究有限.目的:探讨临床特点,治疗特点,EMDR在成人ABI伴PTSD患者中的可行性和疗效的初步指征。方法:本回顾性连续病例系列包括ABI患者,他们在2013年1月至2020年9月期间接受了至少一次针对PTSD的EMDR。治疗前后使用事件影响量表(IES)测量PTSD症状。使用第一目标的治疗前后的主观痛苦单位(SUD)测量情感痛苦。结果:16例ABI患者(中位年龄46岁,50%男性),主要包括中度或重度TBI(50%)或卒中(25%).治疗持续时间的中位数为七个疗程。治疗后IES评分显著低于治疗前评分(p<.001)。在81%的病例中,有单独的统计学和临床相关的IES评分变化。与治疗开始时的分数相比,第一个目标的平均SUD分数在治疗结束时显著较低(p<.001)。在88%的患者中,完成了对第一目标的0-1的SUD的完全脱敏。只需要对标准EMDR方案进行少量调整。结论:研究结果表明EMDR是可行的,ABI患者对PTSD的耐受性良好且可能有效的治疗。对于ABI患者的临床实践,建议考虑将EMDR作为治疗选择.
    这项回顾性连续病例系列(N=16)探讨了临床特征,治疗特点,在获得性脑损伤(ABI)和创伤后应激障碍(PTSD)的成年患者中,眼球运动脱敏和再处理(EMDR)的可行性和疗效的第一指征。结果表明,EMDR是ABI患者PTSD的可行且潜在有效的治疗方法,因为患者在EMDR治疗后,PTSD症状在统计学和临床上显着大幅减轻。对于ABI患者的临床实践,我们建议考虑将EMDR作为一种治疗选择.
    Background: Posttraumatic stress disorder (PTSD) is prevalent in people with acquired brain injury (ABI). Despite the established efficacy of eye movement desensitization and reprocessing (EMDR) for PTSD in general, evaluation studies on EMDR in ABI patients with PTSD are limited.Objective: The aim of this study is to explore clinical features, treatment characteristics, feasibility and first indications of efficacy of EMDR in adult ABI patients with PTSD.Method: This retrospective consecutive case series included ABI patients, who received at least one session of EMDR for PTSD between January 2013 and September 2020. PTSD symptoms were measured using the Impact of Event Scale (IES) pre- and post-treatment. Affective distress was measured using the Subjective Units of Distress (SUD) pre- and post-treatment of the first target.Results: Sixteen ABI patients (median age 46 years, 50% males), with predominantly moderate or severe TBI (50%) or stroke (25%) were included. Treatment duration was a median of seven sessions. Post-treatment IES scores were significantly lower than pre-treatment scores (p < .001). In 81% of the cases there was an individual statistically and clinically relevant change in IES score. Mean SUD scores of the first target were significantly lower at the end of treatment compared to scores at the start of treatment (p < .001). In 88% of the patients full desensitization to a SUD of 0-1 of the first target was accomplished. Only few adjustments to the standard EMDR protocol were necessary.Conclusions: Findings suggest that EMDR is a feasible, well tolerated and potentially effective treatment for PTSD in ABI patients. For clinical practice in working with ABI patients, it is advised to consider EMDR as a treatment option.
    This retrospective consecutive case series (N = 16) explores clinical features, treatment characteristics, feasibility and first indications of efficacy of eye movement desensitization and reprocessing (EMDR) in adult patients with acquired brain injury (ABI) and Posttraumatic stress disorder (PTSD).The results suggest that EMDR is a feasible and potentially efficacious treatment for PTSD in ABI patients, as patients demonstrated statistically and clinically significant large sized reductions in PTSD-symptoms after EMDR treatment.For clinical practice in working with ABI patients, we advise to consider EMDR as a treatment option.
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  • 文章类型: Journal Article
    BACKGROUND: One of the population groups at higher risk of suicide is that of people who attend mental health institutions.
    OBJECTIVE: To know the demographic and clinical characteristics of people admitted for suicidal ideation and suicide attempt to the observation area of a psychiatric hospital in a period of 10 non-consecutive months.
    METHODS: Retrospective, descriptive, correlational study. A total of 439 medical records were collected, out of which 62.9% (n = 276) corresponded to women, 36.7% (n = 161) to men and 0.5% (n = 2) to transgender people; age ranged from 17 to 74 years.
    RESULTS: The highest incidence of cases was observed between 18 and 25 years of age; the most frequent diagnosis was depressive disorder, and 45.5% (n = 200) of the cases had a suicide attempt. The main method for committing a suicidal act was poisoning by taking various medications, followed by self-inflicted injuries with sharp objects. A positive correlation was found between suicide attempt and self-harm (c² = 1.965, p < 0.05).
    CONCLUSIONS: The findings highlight the importance of early identification of risk factors that may contribute to an increase in suicidal behaviors.
    BACKGROUND: Uno de los grupos poblacionales en mayor riesgo de suicidio lo constituyen las personas que asisten a instituciones de salud mental.
    OBJECTIVE: Conocer las características demográficas y clínicas de las personas ingresadas por ideación e intento suicida al área de observación de un hospital psiquiátrico en un periodo de 10 meses no consecutivos.
    UNASSIGNED: Estudio retrospectivo, descriptivo y correlacional. Se recabaron 439 expedientes, de los cuales las mujeres representaron 62.9 % (n = 276), los hombres 36.7 % (n = 161) y las personas transgénero 0.5 % (n = 2); el rango de edad varió de 17 a 74 años.
    RESULTS: La mayor incidencia de casos se observó entre los 18 y 25 años, el diagnóstico más frecuente fue el trastorno depresivo y 45.5 % (n = 200) de los casos presentó una tentativa suicida. El principal método para cometer un acto suicida fue el envenenamiento por diversos medicamentos seguido por las lesiones autoinflingidas con objeto punzocortante. Se encontró correlación positiva entre intento suicida y autolesiones (c² = 1.965, p < 0.05).
    CONCLUSIONS: Los hallazgos resaltan la importancia de la identificación temprana de los factores de riesgo que pueden contribuir al incremento del comportamiento suicida.
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  • 文章类型: Journal Article
    背景:电惊厥疗法是一种有效且安全的方法,这主要适用于单相和双相抑郁发作的患者,躁狂症和精神分裂症,当他们对其他治疗没有反应时。
    目的:为了描述人口统计,一组患者的社会和临床特性,这些患者在UniversydaddeLaSabana诊所接受了麻醉和肌肉松弛剂的电惊厥疗法(ECT)治疗,为期8年。
    方法:从2009年1月1日至2017年12月31日对这些程序的数据库和记录进行了审查。用描述性统计进行分析。
    结果:在此期间,对143例患者(54.5%的女性)进行了1322次手术,其中57%的患者诊断为重度抑郁症。人均治疗次数为9.2次,并发症发生率为3.8%,没有任何需要侵入性管理的人。
    结论:电惊厥治疗是安全的,患者的年龄参数不同,性别和诊断,与拉丁美洲和世界其他国家相比。重要的是要共同努力研究,以便对其在该国的应用特征进行更完整的概述。
    BACKGROUND: Electroconvulsive therapy is an effective and safe procedure, which is indicated mainly in patients with both unipolar and bipolar depressive episodes, mania and schizophrenia, when they do not respond to other treatments.
    OBJECTIVE: To describe the demographic, social and clinical properties of a group of patients treated with electroconvulsive therapy (ECT) with anaesthetic and muscular relaxant at the Universidad de La Sabana Clinic for a period of 8 years.
    METHODS: The databases and records of the procedures were reviewed from 1 January 2009 to 31 December 2017. An analysis was performed with descriptive statistics.
    RESULTS: In this period, 1322 procedures were performed on 143 patients (54.5% women) with an associated diagnosis of major depression in 57%. The number of treatments per person was 9.2 and complications occurred in 3.8%, without any of them requiring invasive management.
    CONCLUSIONS: Electroconvulsive therapy is performed safely in patients and with different parameters in terms of age, gender and diagnosis, in comparison to other countries in Latin America and the world. It is important to join efforts in research that allow a more complete overview of the characteristics of its application in the country.
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  • 文章类型: English Abstract
    目的:描述不良经历的扩展,包括受害,居住在巴塞罗那的严重精神疾病患者的童年和成年时期,西班牙。
    方法:描述性,定量和横断面研究。使用儿童不良经历问卷(ACE-IQ)中的26个项目评估了不良和受害经历。包括的项目获取有关成年期间受害的信息。采访了74名患有严重精神疾病的人(平均年龄:42.03岁;标准偏差:9.60)。
    结果:所有参与者在其一生中至少报告了两次受害经历。最常见的经历是常规犯罪(87.8%)和护理人员的受害(86.5%)。在18岁之前,一半的参与者报告说他们的照顾者遭受过身体暴力(52.7%),几乎三分之一的人报告是性虐待的受害者(32.4%)。女性一生中遭受性伤害的可能性几乎是男性的13倍(赔率比:12.75;95%置信区间:4.19-38.71)。
    结论:严重精神疾病患者的受害是一个普遍的问题,很少受到关注。这项研究的结果与先前调查中获得的结果一致,并强调需要将这些知识转化为医疗实践,考虑它们,以便开发具有全面的心理健康方法的治疗方法。
    To describe the extension of the adverse experiences, including victimization, lived in childhood and adulthood in a sample of people with severe mental illness residing in Barcelona, Spain.
    Descriptive, quantitative and cross-sectional study. Adverse and victimization experiences were assessed using 26 items from the Adverse Childhood Experiences Questionnaire (ACE-IQ). Items were included obtain information regarding victimization during adulthood. Seventy-four people with severe mental illness were interviewed (median age: 42.03 years; standard deviation: 9.60).
    All participants reported at least two victimization experiences throughout their lifetime. The most frequent experiences were conventional crimes (87.8%) and victimization by caregivers (86.5%). Before age 18, half of the participants reported having experienced physical violence by their caregivers (52.7%) and almost one out of three reported to have been victim of sexual abuse (32.4%). Women were almost 13 times more likely to experience sexual victimization than men throughout their lifetime (odds ratio: 12.75; 95% confidence interval: 4.19-38.71).
    Victimization experienced by people with severe mental illness is a widespread problem that has received little attention. The results of this study are consistent with those obtained in previous investigations and underscore the need to translate this knowledge into medical practice into medical practice, considering them in order to develop treatments with a comprehensive approach to mental health.
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  • 文章类型: Journal Article
    背景:有儿童虐待(CM)经历的个体表现出情绪识别(ER)的改变。然而,以前的研究主要集中在患有特定精神障碍的人群上,这使得面部表情识别的改变是否与CM有关,精神障碍的存在或CM和精神障碍的组合,在情感上,而不是中性的面部表情。此外,通常,研究了静态刺激物质的识别。目标:我们评估了对动态(更接近现实生活)负面的认识,以CM为特征的个体的积极和中性面部表情,而不是特定的精神障碍.此外,我们评估了他们是否对中性面部表情表现出消极偏倚,以及一种或多种精神障碍的存在是否会影响识别.方法:98名具有CM经验的成年人(CM)和60名非虐待(CM-)成人对照观看了200名非操纵彩色视频序列,表现出20种中立和180种情感的面部表情,并指出他们是否将每个表达解释为中性或八种情绪之一。结果:CM+在识别阳性方面得分明显较低,阴性和中性面部表情比CM组(p<.050)。此外,CM+组对中性面部表情表现出负偏倚(p<.001)。当考虑精神障碍时,显著的效果保持一致,除了识别积极的面部表情外:有但没有精神障碍的CM组的个体得分低于没有精神障碍的对照组。结论:CM可能对受影响者的ER能力具有长期影响。未来的研究应该探索ER改变对日常生活的可能影响,包括中性面部表情的负面偏见对情绪健康和关系满意度的影响,为改善社会功能的干预措施提供基础。
    如果目前没有精神障碍,成人中的儿童虐待(CM)与情绪识别改变有关。积极的解释,负面和中性的面部表情受损。有CM病史的成年人倾向于将中性表达解释为阴性。
    Background: Individuals with child maltreatment (CM) experiences show alterations in emotion recognition (ER). However, previous research has mainly focused on populations with specific mental disorders, which makes it unclear whether alterations in the recognition of facial expressions are related to CM, to the presence of mental disorders or to the combination of CM and mental disorders, and on ER of emotional, rather than neutral facial expressions. Moreover, commonly, recognition of static stimulus material was researched.Objective: We assessed recognition of dynamic (closer to real life) negative, positive and neutral facial expressions in individuals characterised by CM, rather than a specific mental disorder. Moreover, we assessed whether they show a negativity bias for neutral facial expressions and whether the presence of one or more mental disorders affects recognition.Methods: Ninety-eight adults with CM experiences (CM+) and 60 non-maltreated (CM-) adult controls watched 200 non-manipulated coloured video sequences, showing 20 neutral and 180 emotional facial expressions, and indicated whether they interpreted each expression as neutral or as one of eight emotions.Results: The CM+ showed significantly lower scores in the recognition of positive, negative and neutral facial expressions than the CM- group (p < .050). Furthermore, the CM+ group showed a negativity bias for neutral facial expressions (p < .001). When accounting for mental disorders, significant effects stayed consistent, except for the recognition of positive facial expressions: individuals from the CM+ group with but not without mental disorder scored lower than controls without mental disorder.Conclusions: CM might have long-lasting influences on the ER abilities of those affected. Future research should explore possible effects of ER alterations on everyday life, including implications of the negativity bias for neutral facial expressions on emotional wellbeing and relationship satisfaction, providing a basis for interventions that improve social functioning.
    Child maltreatment (CM) in adults is linked to emotion recognition alterations if no current mental disorders are present.Interpretation of positive, negative and neutral facial expressions is impaired.Adults with a history of CM tend to interpret neutral expressions as negative.
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  • 文章类型: Journal Article
    The objective of this study was to describe the interventions for the labor reintegration of workers on medical leave due to musculoskeletal and mental health diseases, according to actions related to the worker, the employer, and the workplace. This study consists of a qualitative systematic review, without restriction of publication date, conducted in the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE/PubMed scientific bases. In addition, the Epistemonikos database was used. Nineteen articles were selected. It is observed that all interventions proposed actions with the workers, such as rehabilitation programs, therapies and return to work plans. Regarding the actions in the workplace, only three interventions articulated actions with workers and evaluation of the workplace. Finally, actions with employers were considered in 10 interventions with the objective of involving the employer in the improvement of the workplace and planning for the worker\'s return to work. It can be seen that interventions for patients with musculoskeletal and mental health disorders can be divided into the following categories: worker-oriented interventions, employer-oriented interventions, and workplace actions. In each of these categories, various interventions can be seen, ranging from multidisciplinary intervention to exercise-based rehabilitation, in the case of musculoskeletal disorders, and occupational therapy to the psychotherapeutic method based on music, for mental health disorders.
    El objetivo de este estudio fue describir las intervenciones para la reinserción laboral de trabajadores en licencia médica por enfermedades musculoesqueléticas y de salud mental, en términos de acciones relativas al trabajador, al empleador y al lugar de trabajo. Este estudio consiste en una revisión sistemática cualitativa, sin restricción de fecha de publicación, en las bases científicas de Registro Cochrane Central de Ensayos Controlados (CENTRAL) y MEDLINE/PubMed. Además, se utilizó la base de datos Epistemonikos. Fueron seleccionados 19 artículos. Se observó que todas las intervenciones propusieron acciones con los trabajadores, tales como programas de rehabilitación, terapias y planes de regreso al trabajo. En cuanto a las acciones en el lugar de trabajo, solo tres intervenciones articularon acciones con el trabajador y evaluación del lugar de trabajo. Por último, las acciones con los empleadores fueron consideradas en 10 intervenciones, con el objetivo de involucrar al empleador en las mejorías del lugar de trabajo y planificación para el regreso al trabajo del trabajador. Se puede advertir que las intervenciones para los pacientes con trastornos musculoesqueléticos y de salud mental se pueden dividir en las siguientes categorías: intervenciones orientadas al trabajador, orientadas al empleador, y acciones en el lugar de trabajo. En cada una de estas categorías se pueden apreciar intervenciones variadas, que van desde la intervención multidisciplinaria hasta la rehabilitación en base a ejercicios, en el caso de los trastornos musculoesqueléticos, y de la terapia ocupacional hasta el método psicoterápico basado en la música, para los trastornos de salud mental.
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