{"id":695,"date":"2020-02-21T11:33:52","date_gmt":"2020-02-21T10:33:52","guid":{"rendered":"https:\/\/fjarno.org\/revista-renal\/?p=695"},"modified":"2020-06-09T15:04:08","modified_gmt":"2020-06-09T13:04:08","slug":"psiconutricio-en-la-malaltia-renal-cronica","status":"publish","type":"post","link":"https:\/\/fjarno.org\/revista-renal\/psiconutricio-en-la-malaltia-renal-cronica\/","title":{"rendered":"PSICONUTRICI\u00d3 en la malaltia renal cr\u00f2nica"},"content":{"rendered":"

Com la nutrici\u00f3 influencia en aspectes psicol\u00f2gics <\/i><\/b><\/span><\/p>\n

Com aspectes psicol\u00f2gics influencien en la nutrici\u00f3<\/i><\/b><\/span><\/p>\n

\u201c<\/i><\/span>La alimentaci\u00f3n constituye una v\u00eda privilegiada para reflejar las manifestaciones del pensamiento simb\u00f3lico y la alimentaci\u00f3n misma establece una forma de simbolizar la realidad.\u201d <\/i><\/p>\n

SIGMUND FREUD<\/i><\/p>\n

Esther Jim\u00e9nez Garriga<\/span>
\nPsic\u00f2loga Sanit\u00e0ria i Psicoanalista<\/span>
\n<\/span><\/span><\/b><\/p>\n

Annabel Mart\u00ednez Mu\u00f1oz<\/span>
\nNutricionista-Dietista<\/span><\/span><\/span><\/p>\n

El terme psiconutrici\u00f3 engloba una visi\u00f3 transdisciplin\u00e0ria tant de la nutrici\u00f3 en si mateixa, com de la conducta aliment\u00e0ria. Dos o m\u00e9s professionals sanitaris com s\u00f3n el psic\u00f2leg i el nutricionista-dietista cooperen per abordar, d\u2019una forma m\u00e9s espec\u00edfica, el tractament a realitzar a la persona que acudeix a la consulta.<\/p>\n

En la societat occidental, l\u2019alimentaci\u00f3 transcendeix la necessitat corporal. La dieta en si mateixa compleix una funci\u00f3 reguladora a trav\u00e9s del control i mesura del consum d\u2019aliments. Aquest control \u00e9s, a la vegada, sobre les passions i sobre el cos (Figari, 2015).<\/i><\/span> En el cas de la dieta per la Malaltia Renal Cr\u00f2nica (MRC)<\/b><\/span>, la funci\u00f3 reguladora \u00e9s eclipsada per una funci\u00f3 privadora, ja que suposa canvis alimentaris molt bruscos que necessiten ser adaptats a la vida quotidiana. L\u2019adher\u00e8ncia al tractament diet\u00e8tic i el suport nutricional s\u00f3n vitals per a un bon control de la malaltia, ja que la baixa adhesi\u00f3 a la dieta compromet l\u2019estat nutricional i afavoreix l\u2019aparici\u00f3 d\u2019altres complicacions m\u00e8diques. <\/b><\/span><\/p>\n

Tamb\u00e9 hi ha una gran dist\u00e0ncia entre les pr\u00e0ctiques d\u2019alimentaci\u00f3 quotidianes i la informaci\u00f3 sobre nutrici\u00f3 (Mart\u00edn, 2007)<\/i><\/span> essent que, no per estar m\u00e9s informada, la persona adquireix uns h\u00e0bits m\u00e9s saludables. Aquest punt ens orienta de cara a la intervenci\u00f3 que s\u2019ha de fer, ja que el que s\u2019intenta abordar \u00e9s la causa de la situaci\u00f3 actual a fi de tractar l\u2019arrel de la problem\u00e0tica i no els s\u00edmptomes de superf\u00edcie. Per tant, tenint en compte l\u2019objecte d\u2019estudi i de treball de cada especialista en la MRC, poden donar-se dues situacions:<\/p>\n

a) S\u2019acudeix a la consulta de nutrici\u00f3 per una necessitat d\u2019informaci\u00f3 dels nous h\u00e0bits alimentaris a assolir, amb la demanda d\u2019una dieta individualitzada, una avaluaci\u00f3 i un seguiment constant. <\/b><\/span>El professional busca una adher\u00e8ncia al tractament mitjan\u00e7ant una estrat\u00e8gia i una motivaci\u00f3 nutricional que ha d\u2019acompanyar tota la vida a la persona amb MRC. Malgrat la voluntat del pacient, acostumen a sorgir dificultats en el manteniment del tractament. En aquest context, \u00e9s necessari derivar el malalt a la consulta de psicologia, ja que hi ha una interfer\u00e8ncia de resist\u00e8ncies a nivell inconscient.<\/p>\n

b) S\u2019acudeix a consulta de psicologia per iniciar, en el millor dels casos, un proc\u00e9s terap\u00e8utic a causa d\u2019un malestar que incideix en la vida quotidiana del pacient. <\/b><\/span>En el transcurs del proc\u00e9s, ja sigui com a motivador de la consulta o no, apareixen elements com la impot\u00e8ncia vinculada al maneig de la dieta o la dificultat relacionada amb la restricci\u00f3 de l\u00edquids, entre d\u2019altres… \u00c9s en aquest moment en el qual, normalment, el malalt veu com un pas l\u00f2gic demanar suport nutricional especialitzat.<\/p>\n

Qualsevol de les dues situacions desemboquen en una necessitat de l\u2019altre professional. \u00c9s a dir, es produeix una retroalimentaci\u00f3. Aquesta ha de ser constant per consolidar el canvi en la persona que ha sol\u00b7licitat l\u2019ajut. Si s\u2019actua nom\u00e9s des del vessant nutricional, o nom\u00e9s del vessant psicol\u00f2gic, no podem assegurar una modificaci\u00f3 de la conducta sostinguda en el temps, sin\u00f3 que s\u2019estableix un circuit com el que s\u2019il\u00b7lustra a continuaci\u00f3:<\/p>\n

\"\"<\/p>\n

Quan es detecta una baixa adher\u00e8ncia al tractament psicol\u00f2gic o nutricional apareixen efectes com l\u2019angoixa (una de les seves expressions seria l\u2019estr\u00e8s) o estats depressius (on es poden incloure afectacions com la impot\u00e8ncia, tristesa, avorriment…), entre d\u2019altres. Aquests, es poden expressar amb una falta d\u2019autocontrol i autoconsci\u00e8ncia, de manera que sostenir una dieta adequada a la MRC resulta gaireb\u00e9 impossible. \u00c9s aleshores quan apareixen complicacions m\u00e8diques (taquic\u00e0rdies, edemes, rampes\u2026). Aquestes afectacions corporals incrementen m\u00e9s l\u2019angoixa i\/o l\u2019estat depressiu, podent provocar un rebuig a l\u2019aplicaci\u00f3 de tot el tractament.<\/p>\n

S\u2019ha de tenir en compte que parlem de refer\u00e8ncies gen\u00e8riques. En l\u2019aplicaci\u00f3 del cas per cas cal, conjuntament amb el pacient, detectar el simbolisme i funci\u00f3 que envolta l\u2019alimentaci\u00f3 i les coordenades que impliquen l\u2019aparici\u00f3 o desaparici\u00f3 de l\u2019angoixa i\/o de les conductes compulsives, entre d\u2019altres.<\/p>\n

La import\u00e0ncia de la psiconutrici\u00f3 en la MRC recau en aconseguir tallar el circuit anterior. D\u2019aquesta manera, s\u2019implementa un canvi de paradigma, establint un nou model de relaci\u00f3 vers l\u2019alimentaci\u00f3.<\/p>\n

\"\"<\/p>\n

Aix\u00ed doncs, gr\u00e0cies al treball realitzat, la persona afectada aconsegueix trencar amb aquella resposta autom\u00e0tica que, a la vegada, implicava conseq\u00fc\u00e8ncies negatives per a la seva salut. \u00c9s a dir, realitza un canvi de posici\u00f3 inconscient vers l\u2019est\u00edmul x, aix\u00ed disposa de m\u00e9s llibertat en la resposta d\u2019afrontament i aconsegueix fer m\u00e9s propi el tractament. Aquest canvi nom\u00e9s \u00e9s possible fruit d\u2019un treball interdepartamental: formaci\u00f3 nutricional + formaci\u00f3 psicol\u00f2gica (i viceversa).<\/p>\n

En conclusi\u00f3, les persones amb MRC han d\u2019adaptar-se a canvis d\u2019h\u00e0bits molt espec\u00edfics i \u00e9s necessari plantejar el treball pacient-professional a llarg termini. \u00c9s a dir, prendre consci\u00e8ncia que el seguiment de les indicacions nutricionals no \u00e9s una cura, sin\u00f3 que ha d\u2019acompanyar el pacient renal per sempre a fi que aquesta adaptaci\u00f3 esdevingui una millora en la qualitat de vida (7). <\/b><\/p>\nBIBLIOGRAFIA<\/strong>
\n1. Freud, S. (1900). Obras completas. Volumen V: La interpretaci\u00f3n de los sue\u00f1os.<\/i> Amorrortu editores.
\n2. Herrero, G.; Andrades, C. (2019). Psiconutrici\u00f3n. Aprende a tener una relaci\u00f3n saludable con la comida.<\/i> Espa\u00f1a: Editorial Arcopress.
\n3. Figari, A. E. (2015). Cuerpo, imagen y goce: Aproximaciones a la obesidad desde el psicoan\u00e1lisis.<\/i> TFG. Universidad de la Rep\u00fablica, Montevideo (Uruguay).
\n4. Mart\u00f3n, E. (2007). El conocimiento nutricional apenas altera las pr\u00e1cticas de alimentaci\u00f3n: El caso de las madres de clases populares en Andaluc\u00eda.<\/i> Rev Esp Salud P\u00fablica, 2007; 81: 519-528.
\n5. Castrillo, D. (2011). El estatuto del cuerpo en psicoan\u00e1lisis: del organismo viviente al cuerpo gozante. <\/i>Freudiana 2011; 63: 33-55.
\n6. Moya Ru\u00edz, M. A. (2017). Estudio del estado emocional de los pacientes en hemodi\u00e1lisis. <\/i>Hospital Universitario Reina Sof\u00eda. C\u00f3rdoba, Espa\u00f1a. Enferm Nefrol 2017: enero-marzo; 20 (1): 48\/56.
\n7. Garcia Jorge Anes. E. M.; Vicente Castro, F. (2011). Adhesi\u00f3n de los pacientes en insuficiencia renal cr\u00f2nica a la dieta.<\/i> International Journal of Developmental and Educational Psychology. INFAD Revista de Psicolog\u00eda, N\u00ba2-Vol.1,2011. ISSN:0214-9877. pp: 9-20.
\n8. Soler, C. (2016). Los afectos lacanianos.<\/i> Buenos Aires, Argentina. Letra Viva.
\n<\/span>\n","protected":false},"excerpt":{"rendered":"

Com la nutrici\u00f3 influencia en aspectes psicol\u00f2gics Com aspectes psicol\u00f2gics influencien en la nutrici\u00f3 \u201cLa alimentaci\u00f3n constituye una v\u00eda privilegiada para reflejar las manifestaciones del pensamiento simb\u00f3lico y la alimentaci\u00f3n misma establece una forma de simbolizar la realidad.\u201d SIGMUND FREUD Esther Jim\u00e9nez Garriga Psic\u00f2loga Sanit\u00e0ria i Psicoanalista Annabel Mart\u00ednez Mu\u00f1oz Nutricionista-Dietista El terme psiconutrici\u00f3 engloba […]<\/p>\n","protected":false},"author":2,"featured_media":696,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30],"tags":[27],"class_list":{"0":"post-695","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-psiconutricio","8":"tag-numero-2"},"yoast_head":"\nPSICONUTRICI\u00d3 en la malaltia renal cr\u00f2nica | Revista Renal<\/title>\n<meta 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