Maciej Pilecki, Patrycja Cygankiewicz

Specyfika, zasady i dylematy terapii pacjentek z rozpoznaniem jadłowstrętu psychicznego na młodzieżowym oddziale psychiatrycznym 17-27

Specificity, rules and dilemmas of therapy in patients diagnosed with anorexia nervosa within the frames of the Adolescent Psychiatric Ward 17-27

Streszczenie

Autorzy prezentują swoje dotychczasowe doświadczenia w terapii pacjentek z rozpoznaniem jadłowstrętu psychicznego hospitalizowanych w młodzieżowym wielodiagnostycznym oddziale psychiatrycznym. Opisując model opieki nad pacjentkami z zaburzeniami odżywiania się zwracają uwagę na trudności w pracy terapeutycznej, wynikające m.in. z gwałtowności narastania objawów i ich chroniczności, niskiej motywacji pacjentek do leczenia, wątpliwości zespołu leczącego co do zasadności łączenia metod behawioralno-poznawczych z podejściem psychodynamicznym, mnogości ról podejmowanych przez terapeutów.

Summary

The present article attempts to summarize the authors' experiences in the therapy of patients diagnosed with anorexia nervosa treated within the frames of the adolescent

multi-diagnostic in-patient ward. One of the most important elements that determines our therapy offer is the specificity of the group of patients diagnosed with anorexia nervosa and hospitalized in the ward. Patients can be described as difficult-to-treat for many reasons, among others, because of sudden symptoms' increase, their chronicity, or ineffectiveness of outpatients clinic treatment. Our comments and observations are made from the perspective of psychodynamic psychiatry and psychotherapy. In psychodynamic and psychoanalytical literature, anorexia nervosa is sometimes treated as a syndrome of a prepsychotic, personality or neurotic character. At least a dozen different understandings of dynamic causative mechanisms are mentioned in this context. An important supplement of dynamic theories that we have taken up is an attempt to understand the relations between individual psychopathology of a patient and functioning of the family system. Families of girls with the anorexia nervosa problem can be perceived as not helping their children in creating their own personality, one that is well-separated from the outside world. Therapy in the ward is based on therapeutic community, nutrition contract, family therapy, individual therapy, group therapy, artetherapy, and physiotherapy. None of the therapy forms can be deemed as dominating. They should rather be perceived as complementary. The model for treatment of patients with eating disorders that we have developed within the frames of the ward is accompanied with our numerous doubts, concerns and discussions, and it is not yet final.