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      Hospital de Día de Alcalá de Henares. Un hospital de día orientado a fomentar la mentalización Translated title: The Alcalá de Henares Day Hospital. A day hospital aimed at enhancing mentalization

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          Abstract

          Resumen: En este artículo se ofrece una descripción del modelo de hospital de día que hemos desarrollado en Alcalá de Henares, destinado fundamentalmente a personas diagnosticadas de trastornos de la personalidad y (actualmente) de trauma complejo. Se describen brevemente las teorías en las que se apoya: la Terapia Basada en la Mentalización y la Terapia de Grupo Interpersonal. El hospital de día está focalizado en activar la capacidad de mentalización de los pacientes y en mantener la de los profesionales mientras se interactúa en la compleja red de relaciones interpersonales que se constituye en él. Se explica el contexto en que se ha desarrollado, incluyendo cuestiones como la perspectiva de género, la importancia cada vez mayor que se está reconociendo al trauma en la aparición de la psicopatología, la necesidad de cuidar a los cuidadores o, más concretamente en Alcalá de Henares, el desarrollo de un “Proceso de atención a personas diagnosticadas de trastornos de la personalidad”, del que forma parte el hospital de día. Por último, se describe su funcionamiento a lo largo de las diferentes fases de tratamiento y se ofrecen algunos datos de un estudio pre-post tratamiento con datos del periodo comprendido entre 2007 y 2015.

          Translated abstract

          Abstract: This article provides a description of the day hospital model developed in Alcalá de Henares, aimed primarily at people diagnosed with personality disorders and (currently) complex trauma. The theories on which it relies are briefly described: Mentalization-Based Therapy and Interpersonal Group Therapy. The day hospital is focused on activating the mentalization capacity of patients and maintaining that of professionals, while interacting in the complex network of interpersonal relationships developed in it. It explains the context in which it has been developed, including issues such as the gender perspective, the increasingly recognized importance of trauma in the emergence of psychopathology, the need to care for caregivers or, more specifically in Alcalá de Henares, the development of a “Care process for people diagnosed with personality disorders”, of which the Day Hospital is part. Finally, its operation throughout the different phases of treatment is described and some data from a pre-post treatment study from the period between 2007 and 2015 are provided.

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          What we have changed our minds about: Part 1. Borderline personality disorder as a limitation of resilience

          This paper sets out a recent transition in our thinking in relation to psychopathology associated with personality disorder, in an approach that integrates our thinking about attachment, mentalizing (understanding ourselves and others in terms of intentional mental states) and epistemic trust (openness to the reception of social communication that is personally relevant and of generalizable significance) with recent findings on the structure of both adult and child psychopathology and resilience. In this paper – the first of two parts – we review evidence suggesting that a general psychopathology or p factor underlies vulnerability for psychopathology. We link this p factor to a lack of resilience using Kalisch and colleagues’ positive appraisal style theory of resilience (PASTOR). We argue that vulnerability for (severe) psychopathology results from impairments in three central mechanisms underlying resilience – positive situation classification, retrospective reappraisal of threat, and inhibition of retraumatizing triggers – which in turn result from a lack of flexibility in terms of social communicative processes. We suggest that, from this perspective, personality disorders, and borderline personality disorder (BPD) in particular, can be considered to be the prototype of disorders characterized by a lack of resilience. Part 2 proposes an evolutionary developmental psychopathology account linking this inflexibility in social communication to problems with the development of epistemic trust – that is, an evolutionary pre-wired social communication system that normally facilitates resilience through salutogenesis, that is, the capacity to learn and derive benefit from the (social) environment.
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            Mentalizing, motivation, and social mentalities: theoretical considerations and implications for psychotherapy.

            Mentalization has recently been identified as a major process in the origins, maintenance, and recovery from various mental disorders.
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              Mentalization-based treatment for psychotic disorder: protocol of a randomized controlled trial

              Background Many patients with a non-affective psychotic disorder suffer from impairments in social functioning and social cognition. To target these impairments, mentalization-based treatment for psychotic disorder, a psychodynamic treatment rooted in attachment theory, has been developed. It is expected to improve social cognition, and thereby to improve social functioning. The treatment is further expected to increase quality of life and the awareness of having a mental disorder, and to reduce substance abuse, social stress reactivity, positive symptoms, negative, anxious and depressive symptoms. Methods/design The study is a rater-blinded randomized controlled trial. Patients are offered 18 months of therapy and are randomly allocated to mentalization-based treatment for psychotic disorders or treatment as usual. Patients are recruited from outpatient departments of the Rivierduinen mental health institute, the Netherlands, and are aged 18 to 55 years and have been diagnosed with a non-affective psychotic disorder. Social functioning, the primary outcome variable, is measured with the social functioning scale. The administration of all tests and questionnaires takes approximately 22 hours. Mentalization-based treatment for psychotic disorders adds a total of 60 hours of group therapy and 15 hours of individual therapy to treatment as usual. No known health risks are involved in the study, though it is known that group dynamics can have adverse effects on a psychiatric disorder. Discussion If Mentalization-based treatment for psychotic disorders proves to be effective, it could be a useful addition to treatment. Trial registration Dutch Trial Register. NTR4747. Trial registration date 08-19-2014.
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                Author and article information

                Journal
                neuropsiq
                Revista de la Asociación Española de Neuropsiquiatría
                Rev. Asoc. Esp. Neuropsiq.
                Asociación Española de Neuropsiquiatría (Madrid, Madrid, Spain )
                0211-5735
                2340-2733
                December 2019
                : 39
                : 136
                : 259-280
                Affiliations
                [1] Alcalá de Henares Madrid orgnameHospital de Día de Alcalá de Henares España
                Article
                S0211-57352019000200014 S0211-5735(19)03913600014
                10.4321/s0211-57352019000200014
                32eeaccc-9c82-405b-9b55-2f14387d5ffd

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 31 October 2019
                : 09 July 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 22
                Product

                SciELO Spain

                Categories
                Dossier: Psicoterapias en el Sector Público

                mentalization,hospital de día,interpersonal therapy,trauma complejo,personality disorders,day hospital,complex trauma,trastornos de la personalidad,terapia interpersonal,mentalización

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