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      Enseñanza de psicoterapia en la profesión médica en el Perú Translated title: Teaching psychotherapy in the medical profession in Peru

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          Abstract

          RESUMEN La psicoterapia busca modificar la conducta anormal y promover conductas normales por medios psicológicos y actitudinales, así como de experiencias correctivas. Su utilidad está plasmada en guías de práctica clínica que la ubican dentro de las primeras líneas de tratamiento de los trastornos mentales. En Perú, los médicos son capacitados en psicoterapia en el pregrado de medicina y en el residentado de psiquiatría. Sin embargo, se reportan algunos problemas en su enseñanza. En el pregrado, solo algunas escuelas de medicina brindan clases de psicoterapia, y aquellas que lo hacen, invierten pocas horas de enseñanza. En el residentado de psiquiatría, algunos residentes reportan no llevar clases teóricas o prácticas que le permitan aplicar psicoterapia de soporte. Adicionalmente, los programas de postgrado en psicoterapia, aparte del residentado de psiquiatría, son escasos. El manuscrito analiza la capacitación en psicoterapia en la profesión médica, y propone una estructura de enseñanza según etapas de estudios.

          Translated abstract

          ABSTRACT Psychotherapy seeks to modify abnormal behavior and promote normal behaviors through psychological and attitudinal means, as well as corrective experiences. Its utility is reflected in clinical practice guidelines that place it within the first lines of treatment for mental disorders. In Peru, physicians are trained in psychotherapy in the medical school and the psychiatry residency program. However, some problems are reported in his teaching. Only some medical schools offer psychotherapy classes; and among whose do, they invest few hours of teaching. In the psychiatry residency program, some residents report not holding theoretical classes, or practices that allow them to apply support psychotherapy. Also, graduate psychotherapy programs, apart from the psychiatry residency program, are few. The manuscript analyzes psychotherapy training in the medical profession, and proposes a teaching structure according to the stages of study.

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          Evidence-Based Psychotherapy: Advantages and Challenges

          Evidence-based psychotherapies have been shown to be efficacious and cost-effective for a wide range of psychiatric conditions. Psychiatric disorders are prevalent worldwide and associated with high rates of disease burden, as well as elevated rates of co-occurrence with medical disorders, which has led to an increased focus on the need for evidence-based psychotherapies. This chapter focuses on the current state of evidence-based psychotherapy. The strengths and challenges of evidence-based psychotherapy are discussed, as well as misperceptions regarding the approach that may discourage and limit its use. In addition, we review various factors associated with the optimal implementation and application of evidence-based psychotherapies. Lastly, suggestions are provided on ways to advance the evidence-based psychotherapy movement to become truly integrated into practice. Electronic supplementary material The online version of this article (doi:10.1007/s13311-017-0549-4) contains supplementary material, which is available to authorized users.
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            National trends in psychotherapy by office-based psychiatrists.

            In addition to prescribing medications, providing psychotherapy has long been a defining characteristic of the practice of clinical psychiatry. However, there are indications that the role of psychiatrists in providing psychotherapy may have diminished in recent years. To examine recent national trends in the provision of psychotherapy by office-based psychiatrists. Data from the 1996 through 2005 cross-sectional National Ambulatory Medical Care Survey were analyzed to examine trends in psychotherapy provision within nationally representative samples of visits to office-based psychiatrists. Multivariate analyses examined the time trend, adjusting for patient, visit, and setting characteristics. Practice-level analyses examined time trends in the percentage of psychiatrists who provided psychotherapy to all, some, or none of their patients during a typical week. Office-based psychiatry practices in the United States. Patients with psychiatric diagnoses visiting outpatient psychiatrists. Provision of psychotherapy in visits longer than 30 minutes. Psychotherapy was provided in 5597 of 14,108 visits (34.0% [weighted]) sampled during a 10-year period. The percentage of visits involving psychotherapy declined from 44.4% in 1996-1997 to 28.9% in 2004-2005 (P < .001). This decline coincided with changes in reimbursement, increases in managed care, and growth in the prescription of medications. At the practice level, the decrease in providing psychotherapy corresponded with a decline in the number of psychiatrists who provided psychotherapy to all of their patients from 19.1% in 1996-1997 to 10.8% in 2004-2005 (P = .001). Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits, and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often. There has been a recent significant decline in the provision of psychotherapy by psychiatrists in the United States. This trend is attributable to a decrease in the number of psychiatrists specializing in psychotherapy and a corresponding increase in those specializing in pharmacotherapy--changes that were likely motivated by financial incentives and growth in psychopharmacological treatments in recent years.
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              Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments

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                Author and article information

                Journal
                afm
                Anales de la Facultad de Medicina
                An. Fac. med.
                Universidad Nacional Mayor de San Marcos. Facultad de Medicina (Lima, , Peru )
                1025-5583
                September 2020
                : 81
                : 3
                : 348-353
                Affiliations
                [3] Lima Lima orgnameUniversidad Nacional Mayor de San Marcos orgdiv1Facultad de Medicina Peru
                [1] Lima orgnameUniversidad de San Martín de Porres orgdiv1Facultad de Medicina Humana orgdiv2Centro de Investigación en Epidemiología Clínica y Medicina Basada en Evidencias Peru
                [2] Lima orgnameInstituto Nacional de Salud Mental Honorio Delgado - Hideyo Noguchi orgdiv2DEIDAE de Adultos y Adultos Mayores Perú
                Article
                S1025-55832020000300348 S1025-5583(20)08100300348
                10.15381/anales.v81i3.18039
                d1169c14-a173-46d1-8404-f2f51c25aa76

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 17 June 2020
                : 10 September 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 6
                Product

                SciELO Peru

                Categories
                Articulo especial

                Psiquiatría,Psicoterapia,Peru,Schools, Medical,Education, Medical,Psychiatry,Psychotherapy,Perú,Facultades de Medicina,Educación Médica

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