magistrsko delo
Nikol Krizmancic (Author), Irena Hočevar-Boltežar (Mentor)

Abstract

Psihogene disfonije so glasovne motnje, ki izvirajo iz psihološkega neravnovesja bolnika. Uvrščamo jih med funkcionalne glasovne motnje, saj nastopijo kljub normalnemu organskemu stanju vokalnega aparata tj. odsotnosti strukturnih poškodb in/ali nevroloških motenj. Podatkov o pogostosti psihogenih glasovnih motenj v Sloveniji nimamo. Zaradi njihovega zapletenega profila in nesistematskih terapevtskih postopkov so psihogene disfonije malo in slabo raziskovane. Magistrska naloga ugotavlja poznavanje te patologije med osebami, ki pridejo s temi pacienti najverjetneje in najpogosteje v stik, to so logopedi in drugi zdravstveni delavci. Posebej odkriva pojavnost in razširjenost motnje na podlagi izkušenj respondentov, ki so z bolniki že kdaj prišli v stik. V raziskavi je sodelovalo 43 slovenskih logopedov in 22 drugih zdravstvenih delavcev (različnih profilov,zaposlenih v različnih regijah in ustanovah na Slovenskem). Za namen raziskave smo zasnovali dvodelni anketni vprašalnik, ki so ga respondenti anonimno izpolnjevali jeseni 2016. Iz prvega dela raziskave je razvidno, da je pojem »psihogene disfonije« bolj poznan logopedom. To se da pripisati boljši seznanjenosti z motnjo, saj jo logopedi spoznajo v okviru študija, ostali zdravstveni profili pa razen zdravnikov ne. Logopedi se med študijem srečujejo s profilom foniatra, zato jim je ta izraz znan in vedo, s čim se foniater ukvarja. Tudi zaradi tega bi logopedi hripavega bolnika najprej napotili k foniatru, ostali zdravstveni delavci pa se odločajo za otorinolaringologa. Respondenti so večinoma seznanjeni, da sestavljajo tim, ki obravnava psihogene disfonije, foniater, logoped in psiholog, medtem ko so manj seznanjeni s kliničnimi izrazi motnje, saj so bili odgovori zelo variabilni in so se v glavnem nagibali le k hripavosti. Slovenski logopedi v skladu s podatki iz tujih raziskav menijo, da je tudi na slovenskem psihogena glasovna motnja pogostejša pri ženskah, medtem ko tako meni manj kot polovica vprašanih ostalih zdravstvenih delavcev. Manjšina respondentov ve za različne vrste disfonije – najmanj poznajo transseksualni glas. Približno v enaki meri bi napotili pacenta brez strukturnih okvar k psihologu. Izkazalo se je, da so respondenti imeli bolj malone posrednih izkušenjah z bolniki s psihogeno disfonijo. Drugi del vprašalnika je bil namenjen le tistim, ki so že kdaj prišli v stik s psihogeno disfonijo. Ta kriterij je izpolnjevalo le šest sodelujočih, kar nam potrjuje redkost motnje tudi pri nas ter majhno število strokovnjakov, ki se ukvarjajo z njo. Drugi možni vzrok je slabo poznavanje te problematike in zato manjše število odkritih in zdravljenih bolnikov. Vsak respondent je povprečno srečal le 20 tovrstnih bolnikov. Polovica respondentov se srečuje s takimi bolniki več kot trikrat letno, drugi redkeje. Bolniki s psihogeno disfonijo so prav tako pri polovici respondentov v obravnavi manj kot pol leta. To so večinoma ženske med 20. in 40. letom starosti. Večina bolnikov, s katerimi so se srečali respondenti, je bila afonična, dva respondenta sta imela opravka z neustreznim glasom po koncu pubertete, le eden je obravnaval transseksualno spremembo glasu. Po izkušnjah polovice respondentov so nekateri bolniki istočasno razvili še druge motnje. Najpogostejši povzročitelji psihogenih glasovnih težav so po mnenju respondentov stresni dejavniki na delu, konflikti v družini ter travmatski dogodki. Med dejavnike, ki pripomorejo k pozitivnemu izidu terapije, pa spadajo motivacija bolnika, sodelovanje med strokovnjaki, ki bolnika obravnavajo, sočasnost psihoterapevtske in logopedske obravnave, razširitev osnovnega problema, kombinacija različnih terapevtskih pristopov in terapevtska podpora. Nihče izmed respondentov ni obravnaval osebe sam. Vsak izmed njih je sodeloval še z drugimi profili, naj si bo z otorinolaringologom, foniatrom, psihologomali psihiatrom. Vsi, ki so imeli opravka z bolniki s psihogeno disfonijo, so poročali, da je bila obravnava uspešnane glede na vrsto motnje. Prva raziskava o psihogenih disfonijah v slovenskem prostoru doslej je dala začetni vpogled v značilnosti vzorca bolnikov s psihogeno disfonijo/afonijo na Slovenskem in odkrila potrebo po večji informiranosti med zdravstvenimi delavci, študenti in laiki, ki bi z pacienti s psihogeno disfonijo lahko prišli v stik. Le dobro znanje o tej funkcionalni glasovni motnji omogoča prepoznavanje teh bolnikov, ustrezne diagnostične postopke in ustrezno timsko obravnavo.

Keywords

psihogene disfonije;puberfonija;afonija;transseksualen glas;logopedi;zdravstveni delavci;glasovne motnje;

Data

Language: Slovenian
Year of publishing:
Typology: 2.09 - Master's Thesis
Organization: UL PEF - Faculty of Education
Publisher: [N. Krizmančič]
UDC: 616.22-008.5(043.2)
COBISS: 11889993 Link will open in a new window
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Downloads: 239
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Other data

Secondary language: English
Secondary title: Knowledge about psychogenic dysphonias among speech and language therapists and other health care workers
Secondary abstract: Psychogenic dysphonias are voice disorders stemming from psychological imbalances of the individual. They are classified as functional voice disorders because they occur despite normal organic state of the vocal apparatus i.e. absence of structural damage and/or neurological disorders. The data about the frequency of psychogenic voice disorders in Slovenia are not known. Due to their complex profile and not systematical therapeutic procedures, psychogenic dysphonias are little and poorly researched. This master's thesis explores how well this pathology is known among the occupations that meet these patients most likely and most often: these are health care professionals and speech language therapists. In addition it specifically detects the incidence and prevalence of the desease based on the experience of respondents who have ever come into contact with these patients. The research involved 43 Slovenian speech and language therapists and 22 other health professionals employed in different Slovenian regions and institutions. For the purpose, a two-part survey was carried out. The data were collected in autumn 2016. The results from the first part of the research show that the term "psychogenic dysphonia" is more familiar to speech language therapists than to other health care professionals. This can be attributed to a better knowledge of the disorder, resulting from the studies curriculum. Speech language therapists, in contrast to healthcare professionals, also know the profile of the phoniatrician better because they come in contact with this specialist during their studies. Due to this knowledge, speech language therapist would initially refer a hoarse pacient to a phoniatrician, while the other healthcare professionals would opt for the otorhinolaryngologist (ENT). As far as the inclusion of different profiles of experts in the treatment of people with psychogenic dysphonia is concerned, the respondents are fairly familiar with the three mainly involved specialists: the phoniatrician, a speech language therapist, and a psychologist. However they are less acquainted with clinical manifestations of the disorders, in fact the responses are highly variable with the tendency towards hoarseness. Slovenian speech language therapists think that even in our country psychogenic voice disorders are more common in women, as it is also reported in professional literature; this, on the other hand, is the belief of less than half of other healthcare workers. Only a minority of respondents know about different types of dysphonia - they are least aware of the transsexual voice problems. Both groups would have referred a hoarse patient without any structural lesion to the psychologist equally. As far as direct experience with psychogenic patients, it turned out that both groups have had few. The second part was designed only for those who have ever come into contact with psychogenic dysphonia. This criterion was met by only six participants, what confirms the rarity of the disorder even in our country and a small number of professionals who deal with it. Each respondent has met on average only 20 of these patients. Half of the respondents treated such patients more than three times a year, others less often. About half of the respondents reported to have patients with psychogenic dysphonia in therapy less than half a year, and they were mostly women between the age of 20 and 40. The patients were mostly aphonic, only two respondents had to treat patients with inadequate voice at the end of puberty, and only one respondent reported treating a patient with a transsexual change of the voice. Some patients simultaneously developed other pathologies, while half of the respondents did not notice additional disturbances. The most frequent causes of the psychogenic voice problems are stress at work, family conflicts and traumatic events. Factors that contribute to a positive outcome of the therapy are patient's motivation, cooperation between experts, simultaneity of psychotherapy and speech-language therapy, extension of the basic problems, as well as a combination of different approaches, such as breathing exercises, relaxation exercises, voice exercises and therapeutic support. None of the respondents treated the patient alone. Each has collaborated with other profiles, whether with an ENT, a phoniatrician, a psychologist or a psychiatrist. The therapy outcome of those who had dealt with patients with psychogenic dysphonia, independently of the type of the disease, has been successfull. This type of survey, which has not been carried out in the Slovenian area yet, has given an initial insight into the characteristics of the sample of patients with psychogenic dysphonia/aphonia in Slovenia. It has revealed the need for better awareness among professionals, students and laymen who might come into contact with patients who have developed any type of psychogenic dysphonia.
Secondary keywords: speech defect;govorna motnja;
File type: application/pdf
Type (COBISS): Master's thesis/paper
Thesis comment: Univ. v Ljubljani, Pedagoška fak., Logopedija in surdopedagogika
Pages: 90 str.
ID: 10896547