Pierre Janet: La Perdida De La Función De Lo Real En El Trastorno Obsesivo-Compulsivo, Psicosis Y Trauma / Pierre Janet And The Loss Of Reality Function In Obsessive Compulsive Disorder, Psychosis And Trauma

Resumen En el presente reporte se destaca la importancia de explicar y conocer los orígenes del concepto de "Función de lo real" en la perspectiva de Janet. Esto, dadas sus aplicaciones actuales en el estudio del trastorno obsesivo compulsivo, las psicosis, el trastorno por estrés postraumático y los síntomas disociativos. Se define la "Función de lo real" como la aprehensión de la realidad en todas sus formas, por percepción y acción, que modifica todas las demás operaciones psicológicas. Es entonces el resultados de tres operaciones psicológicas principales, que se encuentran dentro de una jerarquía de funciones organizadas y unidas por la tensión psicológica. Como eje teórico central, es la debilidad de dicha tensión lo que provoca un deterioro de estas operaciones y una pérdida de la función de lo real, originando variados síntomas. El deterioro de dichas operaciones y los síntomas derivados son: La acción voluntaria que lleva a conductas compulsivas. La percepción con creencia reflexiva conduce a síntomas obsesivos y la creencia aseverativa a síntomas psicóticos. Personificación y presentificación, relacionada con lo que actualmente denominamos trauma y síntomas disociativos.

In the following report the author remarks the importance of explaining and knowing the origins of the concept of "Function of the real" in Janet's perspective. The importance of shed some light on this concept derives from its current applications in the study of obsessive compulsive disorder, psychosis and post-traumatic stress disorder and dissociative symptoms. The "Function of the real" or "Reality function" is defined as the apprehension of reality in all its forms. It is the result of three main psychological operations, which are within a hierarchy of functions organized and united by a property called "psychological tension". The weakness of this tension causes a deterioration of these operations and a loss of the reality function causing, as a consequence, various symptoms. The affected operations and the derived symptoms are: The voluntary action that leads to compulsive behaviors. Perception with reflective belief, which conduces to obsessive symptoms, assertive belief and psychotic symptoms. Personification and presentification, related to what we now call trauma and dissociative symptoms.

Aspectos clínicos del trastorno obsesivocompulsivo y trastornos relacionados / Clinical aspects of obsessive-compulsive disorder and related disorders

El trastorno obsesivo-compulsivo (TOC) es una condición clínica heterogénea que presenta una prevalencia del 2% y causa una gran disfuncionalidad. Se han descrito cuatro dimensiones clínicas en esta entidad: simetría/orden, contaminación/lavado, acumulación y sexual/religiosa/agresión. Presenta una amplia comorbilidad y existe evidencia de diferencias neurobiológicas entre el TOC y los trastornos de ansiedad. El DSM-5 y la CIE-11 reconocen que la psicopatología nuclear en el TOC y trastornos relacionados es la compulsión y no la ansiedad. Se discute la posibilidad de añadir otros especificadores clínicos y se formula la esperanza de que sistemas como el Research Domain Criteria (RDoC), estudios dimensionales y la integración de diversas áreas de investigación marquen un futuro promisorio para estos y otros trastornos psiquiátricos.

Obsessive-compulsive disorder (OCD) is a heterogeneous clinical condition that presents a prevalence of 2% and causes great dysfunctionality. Four dimensions have been described for this condition: symmetry/order, contamination/washing, hoarding and sexual/religious/aggression. There is broad comorbidity and evidence of neurobiological differences between anxiety disorders and OCD. DSM-5 and ICD-11 recognize that the core psychopathology of OCD and related disorders is compulsion rather than anxiety. The possibility of adding other clinical specifiers is discussed, and perspectives such as the Research Domain Criteria Project (RDoC), dimensional studies and the integration of diverse research areas open a promising future for these and other psychiatric disorders.

Psychometric Properties of a Short Korean Version of the Revised Obsessive Intrusion Inventory

OBJECTIVE: The Revised Obsessive Intrusion Inventory (ROII) is a 52-item scale that evaluates obsessional intrusive thoughts. The aim of the present study was to validate a short, 20-item Korean version of the ROII (ROII-20). METHODS: Of the 1125 participants who completed the ROII-20, 895 participants completed the scale to examine the factor structure of the scale. A subgroup of these participants (n=53) completed the scale twice to determine test-retest reliability. To establish external validity, 230 participants completed the scale and other questionnaires. RESULTS: Exploratory factor analyses suggested a hierarchical model comprising two higher order factors of autogenous obsessions (resulting from aggressive thoughts and sexual thoughts) and reactive obsessions (resulting from thoughts about contamination, thoughts about accidents, and thoughts about dirt). Confirmatory factor analyses supported this model. The results indicated good internal consistency and test-retest reliability. External validity was supported by relationships with obsessive-compulsive symptoms and general distress. CONCLUSION: The ROII-20 presents good psychometric properties and may be considered as a promising instrument for measuring obsessional intrusions.

Las obsesiones antes de Freud: historia y clínica / Obsessions before Freud: history and clinical practice

Se analiza el significado del concepto de “obsesión” en el alienismo del siglo XIX. Desde el punto de vista clínico, la descripción de Esquirol fue completada por otros autores (Jules Falret, Legrand du Saulle). En el ámbito de la reflexión psicopatológica, el alienismo francés, con el delirio emotivo de Morel o la psicastenia de Janet, defendió la teoría emocional, frente al trastorno intelectual propuesto por los médicos alemanes. Finalmente, se insiste en la importancia del marco cultural en la aparición de los síntomas obsesivos y de su interpretación. En este sentido, se estudian las relaciones de los escrúpulos religiosos con la melancolía o la aparición de categorías diagnósticas sometidas a los códigos y mentalidades fin-de-siècle.

The article analyses the significance of the concept of “obsession” in nineteenth-century alienism. From a clinical point of view, Esquirol’s description was completed by other authors (Jules Falret, Legrand du Saulle). In the area of psychopathological studies, French alienism, with Morel’s emotional delirium or Janet’s psychasthenia, defended the emotional theory, as opposed to the intellectual disorder proposed by German doctors. Lastly, the importance of the cultural framework is stressed in the appearance of obsessive symptoms and their interpretation. Along these lines, the article discusses the relationship of religious scruples to melancholy or the appearance of diagnostic categories subject to fin de siècle codes and mentalities.

Comorbilidad entre esquizofrenia y trastorno obsesivo compulsivo: ¿Dos entidades diferentes o un mismo espectro entre los dos trastornos?

Through the study of human psychopathology found in complex cases, where in many cases, psychiatric symptoms of various mental disorders closely coexist in the same patient. In the case of schizophrenia and obsessive compulsive disorder has been found a clear association between OCD symptoms and psychotic symptoms which in many cases difficult distinction between obsessions and delusions. For this situation currently observed in recognition than-expected rates of comorbidity and observation of development or exacerbation of obsessive compulsive symptoms during periods of exacerbation of schizophrenia. Patients with schizophrenia and OCD comorbidity may represent a special category among patients with schizophrenia, it is proposed to call it schizophrenia, schizoaffective disorder or obsessive, which established more than a clinical challenge, a challenge semiological, trying to identify and accept a new concept of obsessive idea that could involve lack of awareness of disease where the idea is not considered obsessive and excessive. We describe the case of an adult 28 years old who presents initially negative symptoms alternating with positive symptoms characteristic of schizophrenia, obsessive ideas subsequently presenting with compulsive behaviors characteristic of OCD.

Por medio del estudio de la psicopatología humana se han encontrado casos complejos en los que, en muchas ocasiones, los síntomas psiquiátricos de los diferentes trastornos mentales coexisten de manera estrecha en un mismo paciente. En el caso de la esquizofrenia y el trastorno obsesivo-compulsivo se ha encontrado una clara asociación entre los síntomas obsesivo-compulsivos y síntomas psicóticos, lo que en muchas ocasiones dificulta la delimitación entre ideas obsesivas e ideas delirantes. Por dicha situación actualmente se observa el reconocimiento de tasas mayores a las esperadas de comorbilidad y la aparición o exacerbación de los síntomas obsesivo-compulsivos durante periodos de exacerbación de la esquizofrenia. Los pacientes con comorbilidad entre esquizofrenia y TOC pueden representar una categoría especial entre los pacientes con esquizofrenia, por ello se ha propuesto denominarla trastorno esquizo-obsesivo, lo que establecería, más que un reto clínico, un reto semiológico, tratando de determinar y aceptar un nuevo concepto de idea obsesiva que pueda implicar poca conciencia de enfermedad donde no se considere la idea obsesiva como excesiva. Se describe el caso de un adulto de 28 años de edad quien presentó inicialmente síntomas negativos alternados con síntomas positivos, característicos de la esquizofrenia, a lo que se agregaron posteriormente ideas obsesivas con comportamientos compulsivos característicos del trastorno obsesivo-compulsivo.

Predictors of Clinical Response to Escitalopram in Obsessive-Compulsive Disorder / 대한정신약물학회지

OBJECTIVE: In this study, we aimed to investigate the predictors of clinical response to escitalopram (ESC) in obsessive-compulsive disorder (OCD) from the baseline clinical characteristics. In addition, we aimed to search the differences of prescription pattern between responders and non-responders to ESC. METHODS: Two hundred and twenty-three patients who met the DSM-IV criteria for OCD and visited at least once after the initiation of ESC prescription were included in this study. A primary outcome measure was the Clinical Global Impression-Improvement scale (CGI-I), which was scored at the time of retrospective chart review. Responders were defined as those with a CGI-I score of 1 or 2 at the final point of evaluation. Baseline clinical characteristics, prescription patterns, and adverse events were compared between responders and non-responders. We also examined the validity of the prediction model regarding treatment response to ESC. RESULTS: The OCD patients having aggressive obsessions and related compulsions showed significantly decreased response rate to ESC (odd ratio=0.285) in comparison with the OCD patients not having aggressive symptom dimension (p=0.002). The maximum dose of ESC prescription and rate of antipsychotics combination were higher in responders in comparison to the nonresponders. Among the adverse effects, sedation and constipation showed significantly different occurrence rate between responders versus non-responders. CONCLUSION: Aggressive obsessions and related compulsions seem to be associated with poor clinical response to ESC in OCD. Obsessive-compulsive symptom dimension should be considered when choosing a serotonin reuptake inhibitor for OCD.

Sintomas obsessivo-compulsivos na depressão pós-parto: relatos de casos / Obsessive-compulsive symptoms in postpartum depression: case reports

A depressão pós-parto é o transtorno afetivo mais prevalente no puerpério. O seu quadro clínico apresenta algumas peculiaridades sintomatológicas, podendo uma delas ser a presença mais freqüente de obsessões e compulsões. Relatamos seis casos identificados pela análise de prontuários de puérperas atendidas no Programa de Saúde Mental da Mulher do Hospital das Clínicas da Universidade Federal de Pernambuco. Todas elas tinham diagnóstico de depressão através do Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) e apresentavam concomitantemente sintomas obsessivo-compulsivos. Nos relatos, abordamos o período de aparecimento desses sintomas nas mulheres deprimidas, assim como o seu conteúdo, duração e resposta ao tratamento. Em duas mulheres, os sintomas obsessivo-compulsivos precederam os depressivos, e em outras duas, deu-se o inverso. Houve exacerbação de obsessões e compulsões preexistentes em duas puérperas. O conteúdo mais freqüente foi de pensamentos agressivos contra o bebê. Os sintomas tenderam a diminuir juntamente com a melhora da depressão.

Postpartum depression is the most common affective disorder in the puerperium. There are some particular symptoms in its clinical presentation, and one might be the higher frequency of obsessions and compulsions. We report six cases identified from the analysis of medical charts of puerperal women receiving care at the Women's Mental Health Program, Hospital das Clínicas, Universidade Federal de Pernambuco, Brazil. All the women were diagnosed with postpartum depression using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and had associated obsessive-compulsive symptoms. We report time of onset, topics, course and treatment response of these symptoms. Obsessive-compulsive symptoms preceded depressive symptoms in two women, and were succeeded in two other women. There was exacerbation of preexisting obsessions and compulsions in two puerperal women. The most frequent topic was aggressive thoughts toward the baby. Improvement in depressive symptoms tended to reduce obsessive-compulsive symptoms.

Self-inconsistency, Alexithymia and Obsessions-Compulsions / 中国心理卫生杂志

Objective: To examine the relationship between self-inconsistency, alexithymia and Obsessions-Compulsions in neurotic patients and normal control.Methods: 59 patients and 54 control completed The Vancouver Obsessional Compulsive Inventory (VOCI), Self Consistency and Congruence Scale (SCCS), Toronto alexithymia scale (TAS-26), Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Results: 1) The difference of VOCI total score among patients with obsessive-compulsive disorder (OCD), anxiety/depression (A/D), and control was significant(111.2?36.0、57.0?33.0、39.4?22.5,F=35.46,P