ABSTRACT
Los sueños en niños y adultos son frecuentes, pero con contenido perturbador y un aumento en la frecuencia, deben ser una alarma para el médico y la familia. Las pesadillas son un tipo de parasomnia, principalmente asociada con el sueño REM. Las pesadillas son más frecuentes en el insomnio y también pueden causar insomnio debido al miedo al sueño. Están relacionados con altos niveles de ansiedad, miedo a conciliar el sueño o déficits cognitivos secundarios a la privación del sueño y, por lo tanto, pueden aumentar la vulnerabilidad al desarrollo de otros trastornos mentales. Las pesadillas tienen relevancia clínica porque deterioran la salud física y mental y están relacionadas con una mayor tasa de suicidio. La consulta debe guiarnos como una bandera roja para evaluar el estado de salud; la cantidad y calidad del sueño; y factores como comorbilidades asociadas, consumo de drogas o síntomas de abstinencia, o vulnerabilidades. Esta revisión se basó en dos casos clínicos, un niño que se presentó en la pandemia y un adolescente que presentó inicio abrupto de pesadillas.
Dreams in children and adults are frequent, but with disturbing content and an increase in frequency, they should be an alarm for the doctor and the family. Nightmares are a type of parasomnia, mostly associated with REM sleep. Nightmares are more frequent in insomnia and can also themselves cause insomnia due to fear of sleep. They are related to high levels of anxiety, fear of falling asleep or cognitive deficits secondary to sleep deprivation and, therefore, may increase vulnerability to the development of other mental disorders. Nightmares have clinical relevance because they deteriorate physical and mental health and are related to a higher suicide rate. The consultation should guide us as a red flag to evaluate the state of health; the quantity and quality of sleep; and factors such as associated comorbidities, drug use or withdrawal symptoms, or vulnerabilities. In this review based on two clinical cases, a child who presented in the pandemic and an adolescent who presented abrupt onset and nightmares.
Subject(s)
Humans , Male , Female , Child , Adolescent , Dreams/psychology , Parasomnias/psychologyABSTRACT
Se describe caso clínico de un escolar de 6 años y 3 meses de edad, quien a partir del aislamiento social por la COVID-19 presentó pesadillas asociadas a irritabilidad, desinterés por las clases y necesidad de la presencia de los padres a la hora de dormir. Se efectuó evaluación y se descartaron clínicamente enfermedades orgánicas, así como trastornos mentales. Se realizaron recomendaciones psicológicas y se indicó la terapia floral de Bach. El paciente tuvo una evolución favorable.
The case report of a 6 year and three months school boy is described; he had nightmares associated with irritability, lack of interest for the classes and necessity of his parents presence at bed time, due to social isolation for the COVID 19. An evaluation was carried out and organic diseases were clinically ruled out, as well as mental disorders. Psychological recommendations were carried out and Bach's floral therapy was indicated. The patient had a favorable clinical course.
Subject(s)
Sleep , Social Isolation/psychology , COVID-19/complications , Child , Night Terrors/therapy , DreamsABSTRACT
Nightmares are vivid, unpleasant dreams that result in awakening during sleep. According to previous studies, the prevalence of nightmare disorder is 2–5% of the general population and is associated with other medical conditions and mental illnesses. Imagery rehearsal therapy (IRT) is an evidence-based treatment for nightmare disorder. The current study is a case study with a 35-year-old female who was diagnosed with nightmare disorder and posttraumatic stress disorder, and participated in IRT for five sessions. Prior to treatment, the patient reported difficulties initiating and maintaining sleep, and reported suffering from nightmares more than 2–3 times per week. After treatment, the patient reported no longer experienced nightmares, accompanied by improvements in both sleep and clinical indicators.
Subject(s)
Adult , Female , Humans , Dreams , Prevalence , Sleep Initiation and Maintenance Disorders , Stress Disorders, Post-TraumaticABSTRACT
A autora parte de um pesadelo que, considera, nasceu dentro de um contexto de análise para observar, em vários níveis, aspectos possíveis do aparecimento de novas configurações na mente da analista e na relação analítica. Compreende o momento em que novas configurações podem surgir como de simultaneidade morte/vida e pretende enfatizar a importância desses momentos como ferramenta de observação psicanalítica.
Given that this nightmare has arisen with in a context of analysis, the author starts from an analyst's nightmare in order to observe, at various levels, possible aspects of the emergence of new configurations in both the analyst's mind and the psychoanalytic relationship. The author understands the moment when new configurations may appear as being simultaneously of life and death. Her purpose is to emphasize these moments as tools of psychoanalytic observation.
La autora parte de una pesadilla de la analista que, se considera, nació dentro de un contexto de análisis, para observar, en varios niveles, aspectos posibles del surgimiento de nuevas configuraciones en la mente de la analista y en la relación analítica. Comprende el momento en que pueden surgir nuevas configuraciones como simultaneidad de muerte/vida y pretende enfatizar estos momentos como herramientas de observación psicoanalítica.
L'auteur part d'un cauchemar de l'analyste qui, d'après ses considérations, est né dans un contexte d'analyse pour observer à plusieurs niveaux des aspects possibles de l'apparition de nouvelles configurations dans l'esprit de l'analyste et dans la relation analytique. L'auteur comprend le moment où de nouvelles configurations peuvent surgir comme relevant simultanément de la vie et de la mort. Met l'accent sur ces moments comme des outils d'observation psychanalytiques
ABSTRACT
Neste trabalho, a partir da leitura de várias vozes sobre o Homem dos Lobos, procurei localizar o que para mim soava como um sonho e o que me parecia da ordem do pesadelo, para Freud, para Sergei Pankejeff e, principalmente, para os psicanalistas no contato com a obra de Freud. Neste último caso, pensar o quanto a idealização de Freud tem nos dificultado, assim como possivelmente dificultou para o Homem dos Lobos, seguir sonhando o impacto que o contato com sua genialidade provoca. E questionar o quão flexível tem sido o continente oferecido pelo grupo psicanalítico (um determinado imaginário que varia de lugar para lugar e que se espera que varie com a passagem do tempo) para propiciar que cada analista se aproxime da escrita freudiana com liberdade criativa, possibilitando um conhecimento enativo, que se constrói a cada momento através da experiência. Quanto mais afastados deste ideal, mais próximos de pesadelos.
In this paper, from reading several views about the Wolf Man, I tried to detect what sounded like a dream for me and what seemed, for me, like a nightmare for Freud, Sergei Pankejeff, and notably for the psychoanalysts that are connected with Freud's work. As for the last ones, we wonder how much Freud's idealization has made it harder - as it possibly made it harder for the Wolf Man - to keep dreaming the impact caused by being in contact with his genius. And we question how flexible is the vessel that is offered by the psychoanalytic group (a certain imagery that is different in each place and - we hope - that varies with time) in order to enable each analyst to be closer to Freudian writing with creative freedom - in order to allow an enactive knowledge, which is constantly built through experience. The farther (we are) from this ideal, the closer (we are) to nightmares.
En este trabajo, a partir de la lectura de varias voces sobre el Hombre de los Lobos, traté de localizar lo que para mí sonaba como un sueño y lo que me parecía una pesadilla para Freud, para Sergei Pankejeff y, principalmente, para los psicoanalistas en contacto con la obra de Freud. En este último caso, pensar cuánto nos ha dificultado la idealización de Freud, así como posiblemente dificultó al Hombre de los Lobos, el hecho de seguir soñando el impacto que provoca el contacto con su genialidad. Y cuestionar cuán flexible ha sido el continente ofrecido por el grupo psicoanalítico (un determinado imaginario que varía de un lugar a otro y que se espera que varíe con el paso del tiempo) para permitir que cada analista se aproxime a la escritura freudiana con libertad creativa, haciendo posible un conocimiento enactivo, que se construye en todo momento a través de la experiencia. Cuanto más nos alejamos de este ideal, más próximo estamos de las pesadillas.
ABSTRACT
O autor faz um link entre literatura e psicanálise, inspirado em um ensaio de J.L. Borges sobre o pesadelo. Destaca nuances e as coloca lado a lado de questões contidas em obras de Sigmund Freud e de outros autores. Com isso, utiliza a observação dos escritores e poetas como subsídio à psicanálise no sentido da apreensão da realidade psíquica e da descrição fenomenológica do estado de pesadelo, o sonho de angústia. A intenção é também enriquecer o conhecimento dos estados da alma humana apresentado por escritores e poetas e, dessa maneira, atentar para a importância do vértice artístico como mais uma forma de observação no trabalho analítico.
Inspired by J.L. Borges' essay on nightmare, the author establishes a link between literature and psychoanalysis. He shows nuances that are put side by side with matters contained in the work of Sigmund Freud and other authors. Thus, he uses the observation of writers and poets as a contribution to psychoanalysis, in the sense of apprehending the psychic reality and the phenomenological description of the state of nightmare - the anguish dream. This paper aims to enrich the knowledge about the states of the human soul - a knowledge that was brought by writers and poets - and, therefore, it also aims to underline the importance of the artistic vertex as another way of observation in the analytic practice.
El autor hace un enlace de la literatura con el psicoanálisis, inspirado en un ensayo de J.L. Borges sobre la pesadilla. Señala matices y los pone lado a lado con asuntos presentes en las obras de Sigmund Freud y otros autores. De esa forma, utiliza la observación de escritores y poetas como un subsidio al psicoanálisis en sentido de la aprehensión de la realidad psíquica y la descripción fenomenológica del estado de pesadilla, el sueño de angustia. La intención es enriquecer el conocimiento de los estados del alma humana traído por escritores y poetas y así prestar atención a la importancia del vértice artístico como otra forma de observación en el trabajo analítico.
ABSTRACT
A partir de um fragmento de material clínico, a autora teoriza a respeito dos sonhos, dos pesadelos, do representável e do irrepresentável.
From a fragment of clinical material, the author proposes a theory about dreams and nightmares, about what can and what cannot be represented.
A partir de un fragmento de un material clínico, la autora teoriza a respecto de los sueños, las pesadillas, lo representable y lo irrepresentable.
ABSTRACT
Uma reflexão sobre a relevância do pesadelo em literatura deve levar em conta o ofício dos sonhadores, tão em vista na Antiguidade. Em nossos tempos, o domínio literário do pesadelo foi descoberta do Romantismo, o qual, reagindo contra a Revolução Industrial e seus valores, apela para o predomínio do irracional. O primado da razão, típico da época das Luzes, vai ser contestado pelos românticos, que põem em xeque o equilíbrio, as proporções e a simetria do Neoclassicismo. Em troca, vão privilegiar o impulso, o informe, o desequilibrado, o assimétrico. O sonho e o pesadelo como mananciais da arte serão postos acima de tudo. Daí derivam as simpatias pelo satanismo, pelo oculto e pelas perquirições do lado negro da alma. Grandes escritores figuram entre aqueles que assim procederam.
A reflection on the importance of the nightmare in literature should consider the profession of dreamer, which was very common in Ancient Times. In our time, the literary domain of nightmares was discovered from Romanticism, which turned to the irrational supremacy as a reaction against the Industrial Revolution. The primacy of reason, which was typical in the Age of Enlightenment, was contested by romantic writers, who questioned the neoclassic balance, proportions and symmetry. In return, they privileged the impulse, lack of shape, imbalance, asymmetry. Dream and nightmare were prioritized as the sources of art. A sympathy for Satanism, occultism, and searching for the dark side of the soul was originated therefrom. There are great writers among those who adopted the new aesthetics.
Para evaluar la relevancia de la pesadilla en la literatura es necesario tener en cuenta la importancia del oficio de soñador, muy en boga en la Antigüedad. En nuestra época, el dominio literario de la pesadilla fue un descubrimiento del Romanticismo, el cual, en reacción a la Revolución Industrial y sus valores, apela para el predominio de lo irracional. El primado de la razón, típico de la época del Iluminismo, será contestado por los románticos, que ponen en jaque al equilibrio, a las proporciones y a la simetría del Neoclasicismo. A cambio, van a privilegiar el impulso, el informe, lo desequilibrado, lo asimétrico. El sueño y la pesadilla como manantiales serán puestos por encima de todo. De donde derivan las simpatías por el satanismo, por lo oculto y por las peregrinaciones del lado negro del alma. Grandes escritores están entre los que se adhirieron a este nuevo movimiento.
ABSTRACT
Post-traumatic stress disorder (PTSD) is a pathological response to trauma characterized by frequent recollections, recurrent nightmares, and flashbacks of the traumatic event(s). To date, the precise mechanisms underlying the development of PTSD remain unknown. Several studies have suggested that antiepileptic drugs, such as gabapentin and lamotrigine, may be effective in the treatment of PTSD symptoms. We report on a 15-year-old Japanese female junior high school student who developed PTSD symptoms following repeated teasing from male classmates. Additionally, we underscore the beneficial effects of treatment with gabapentin and lamotrigine on flashbacks and nightmares. This patient developed PTSD symptoms after repeated teasing from male classmates at school. Her flashbacks and nightmares were treated with a combination of gabapentin and lamotrigine. After recovery, treatment with lamotrigine alone controlled her symptoms. Our observations suggest that a process of sensitization may be involved in the development of PTSD symptoms. Additionally, gabapentin and/or lamotrigine were effective in the treatment of flashbacks and nightmares in this patient. Thus, doctors should consider using these anti-epileptic drugs as an alternative approach to treating PTSD symptoms.
Subject(s)
Adolescent , Female , Humans , Male , Anticonvulsants , Asian People , Dreams , Stress Disorders, Post-TraumaticABSTRACT
Borderline personality disorder (BPD) is characterized by identity and interpersonal problem, affective dysregulation and pervasive severe impulsivity. Although sleep disturbances are not primary symptoms of BPD, they are important aspects of this disorder. However, clinicians and researchers did not give much attention to the sleep symptoms of BPD yet. Measured by nocturnal polysomnography, increased sleep latency as well as reduced total sleep time and sleep efficiency, and 'depression-like' REM abnormalities (i.e., reduced REM latency and increased REM density) are found in BPD patients. Co-morbid sleep disorders such as chronic insomnia, nightmare disorder or circadian rhythm sleep disorder associated with BPD have been reported. Clinicians should focus on the sleep complaints of BPD patients, and carefully manage such symptoms with sleep hygiene education, cognitive psychotherapy or light therapy.