Transtorno Obsessivo-Compulsivo: Relato de um Caso Atípico / Obsessive Compulsive Disorder: Report of an Atypical Case

A Terapia Cognitivo-Comportamental (TCC) é uma ferramenta indispensável durante o processo terapêutico de pacientes que se enquadram no Transtorno Obsessivo-Compulsivo (TOC). O presente artigo teve como objetivo principal relatar que, mesmo em um caso grave deste transtorno, através da TCC associada à psicofarmacologia, foi possível diminuir os sintomas obsessivo-compulsivos. Este caso retrata um processo diagnóstico de TOC de um paciente de 59 anos, cujos sintomas se iniciaram na infância e foram tratados somente com ênfase em um tipo medicamentoso (Clomipramina, 300 mg/dia), causando persistência dos sintomas. Os comportamentos-alvo selecionados (todos sendo parte do espectro obsessivo-compulsivo), analisados funcionalmente e com intervenções bem descritas propunham diminuir a apresentação dos sintomas, entretanto, sem a pretensão de suprimi-los completamente. Este estudo de caso permitiu verificar uma melhora significativa nos comportamentos-problema apresentados inicialmente pelo paciente e, assim, constatar a efetividade da terapia cognitivo-comportamental associada à psicofarmacologia e da escolha das intervenções, com base na aplicação da escala Yale-Brown Obsessive-Compulsive (Y-BOCS) durante o período de 20 semanas, com a diminuição de quase 50% dos sintomas na percepção dos pacientes.

Cognitive Behavioral Therapy (CBT) is an indispensable tool during the therapeutic process of patients who fall into Obsessive Compulsive Disorder (OCD). The main objective was to report that, even in a severe case of this disorder, through CBT associated with psychopharmacology, it was possible to decrease the obsessive-compulsive symptoms. This case portrays a diagnostic process of OCD of a 59-year-old patient whose symptoms started in childhood and were treated only with an emphasis on one type of medication (Clomipramine, 300 mg/day), causing the persistence of symptoms. The selected target behaviors (all being part of the obsessive-compulsive spectrum) were functionally analyzed and with well-described interventions proposed to decrease the presentation of symptoms, however, without the pretension of completely suppressing them. This case study allowed us to verify a significant improvement in the problem behaviors initially presented by the client and, thus, to verify the effectiveness of the cognitive behavioral therapy associated with psychopharmacology and the choice of interventions, based on the application of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) during 20 weeks, with a decrease of almost 50% of the symptoms in the patient's perception.

Mental health of Brazilian university students during the Covid-19 / Saúde mental dos estudantes universitários brasileiros durante a pandemia de Covid-19 / Salud mental de estudiantes universitarios brasileños durante la pandemia Covid-19

This study aimed to investigate the effects of positive and negative affects, anxiety, and obsessive and compulsive thoughts and behaviors on Brazilian university students during the Covid-19 pandemic. Participated in this study 492 students, aged 18 years or over, from all regions of the country. The survey was conducted between April and May 2020, using self-report instruments applied in the online format. The results indicated that 37% (N=182) of the students had a high level of anxiety and 46.1% (N=227) moderate levels for obsessive and compulsive thoughts and behaviors. In addition, it was found that positive affects were negatively correlated with anxiety, as well as with obsessive and compulsive thoughts and behaviors, while negative affects were positively correlated with independent variables. It is concluded that the mental health of university students must be monitored during pandemics.

Este estudo teve como objetivo investigar os efeitos dos afetos positivos e negativos, da ansiedade e dos pensamentos e comportamentos obsessivos e compulsivos nos estudantes universitários brasileiros durante a pandemia da Covid-19. Participaram deste estudo 492 estudantes de todas as regiões do país e com idades a partir de 18 anos. A pesquisa foi realizada entre os meses de abril e maio de 2020, por meio de instrumentos de autorrelatos aplicados no formato on-line. Os resultados indicaram que 37% (N = 182) dos estudantes apresentaram alto nível de ansiedade e 46,1% (N = 227) níveis moderados para os pensamentos e comportamentos obsessivos e compulsivos. Além disso, verificou-se que os afetos positivos se relacionaram negativamente à ansiedade, assim como se relacionaram negativamente aos pensamentos e comportamentos obsessivos e compulsivos, enquanto os afetos negativos se relacionaram positivamente às variáveis independentes. Conclui-se que a saúde mental dos estudantes universitários deve ser monitorada durante pandemias.

Este estudio tuvo como objetivo investigar los efectos de los afectos positivos y negativos, la ansiedad y los pensamientos y comportamientos obsesivos y compulsivos en estudiantes universitarios brasileños durante la pandemia de Covid-19. En este estudio participaron 492 estudiantes de todas las regiones del país y mayores de 18 años. La encuesta se realizó entre los meses de abril y mayo de 2020, utilizando instrumentos se autoinforme aplicados en formato online. Los resultados indicaron que el 37% (N = 182) de los estudiantes tenían niveles altos de ansiedad y el 46,1% (N = 227) niveles moderados de pensamientos y comportamientos obsesivos y compulsivos. Además, se encontró que los afectos positivos se correlacionaron negativamente con la ansiedad, así como el pensamiento y el comportamiento obsesivo y compulsivo se correlacionaron negativamente, mientras que los afectos negativos se correlacionaron positivamente con variables independientes. Se concluye que la salud mental de los estudiantes universitarios debe ser monitoreada durante las pandemias.

Análogos de somatostatina radiomarcados en el acercamiento diagnóstico del síndrome de Sjögren: Imágenes moleculares aportando a los criterios clínicos y paraclínicos hoy conocidos / Radiolabelled somatostatin analogues in the diagnostic approach to Sjögren's syndrome: molecular imaging contributing to the current clinical and para-clinical criteria

RESUMEN El diagnóstico del síndrome de Sjögren se basa en los criterios del consenso americano y europeo (AECG), sin embargo, en muchas oportunidades no se alcanza a detectar el compromiso glandular o extraglandular. Presentamos la evidencia de la utilidad de la gammagrafía con los análogos de somatostatina radiomarcados como prueba novedosa en el acercamiento diagnóstico al compromiso glandular y extraglandular del síndrome de Sjögren.

ABSTRACT Sjögren syndrome is diagnosed using American European Consensus Group (AECG) criteria, although frequently these criteria are not enough to detect the glandular and extra-glandular compromise. Evidence is presented on the use of whole body somatostatin scintigraphy as a novel probe in the diagnostic approach to the glandular and extra-glandular compromise in Sjögren s syndrome.

Freud, a construção da neurose obsessiva nos primeiros escritos e as diferenças em relação ao TOC / Freud, the construction of obsessional neurosis in the first writings and the differences in OCD

A neurose obsessiva é uma das estruturas clínicas evidenciadas por Freud em 1894, nas suas primeiras publicações, cujo foco predominante era a histeria. Com a proposta de rastrear as movimentações da construção do conceito de neurose obsessiva do período pré-psicanalítico até 1900, buscamos levantar as características dessa organização psíquica para diferenciá-la do Transtorno Obsessivo Compulsivo (TOC), que se encontra no Manual Diagnóstico e Estatístico de Transtornos Mentais, 5ª edição (DSM-V). Dessa maneira, nos arriscamos a ampliar e a refletir sobre novas possibilidades de intervenção para além da medicalização.(AU)

Obsessive neurosis is one of the clinical structures evidenced by Freud in 1894, in his first publications, whose predominant focus was hysteria. With the proposal to trace the movements of the construction of the concept of obsessive neurosis of the pre-psychoanalytic period until 1900, we sought to bring up the characteristics of this psychic organization in order to differentiate it from the Obsessive Compulsive Disorder (OCD), which is found in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V). In this way, we risk widening and reflecting on new intervention possibilities beyond medicalization.(AU)

La neurosis obsesiva es una de las estructuras clínicas evidenciadas por Freud en 1894, en sus primeras publicaciones, cuyo enfoque predominante era la histeria. Con la propuesta de rastrear los movimientos de la construcción del concepto de neurosis obsesiva del período pre-psicoanalítico hasta 1900, buscamos levantar las características de esa organización psíquica para diferenciarla del Trastorno Obsesivo Compulsivo (TOC), que se encuentra en el Manual Diagnóstico y Estadístico de los Trastornos Mentales, 5ª edición (DSM-V). De esa manera, nos arriesgamos a ampliar y a reflexionar sobre nuevas posibilidades de intervención más allá de la medicalización.(AU)

Application of a direct current circuit to pick up and to store bioelectricity produced by microbial fuel cells / Aplicación de un circuito de corriente continua para la colección y almacenamiento de bioelectricidad producida por celdas de combustible microbianas / Aplicação de um circuito de corrente contínua para coleta e armazenamento de bioeletricidade produzida por células a combustível microbianas

Abstract Every year the demand for energy worldwide is increasing. There are some alternatives to reduce these problems, such as clean energy or renewable energy. A particular alternative is the microbial fuel cells. These cells are biochemical reactors that convert chemical energy into electricity. The present research evaluated the dairy serum to produce bioelectricity from micro fuel cells (MFC) that were constructed with low-cost materials and with isolated bacteria in anaerobic sediments, located in Ecuadorian national territory, producing maximum voltages of 0.830 V in the circuit and a maximum power density of 30 mW / m2. This low voltage was worked with 50 mL MFCs and with an output voltage of 300 mV. Under these conditions, a FLYBACK lift circuit isolated by the transformer was designed. This new circuit could increase the voltage from 30 mV to enough voltage to light a 2.5 V LED. Therefore, the energy produced by the MFC can be directly used to light a LED and to charge capacitors. This study shows that these MFCs, together with the designed circuit, could be used potentially to generate clean energy.

Resumen Cada año la demanda de energía, en todo el mundo, va en aumento. Existen algunas alternativas para reducir estos problemas, tales como las energías limpias y renovables. Una alternativa muy específica es el uso de celdas de combustible microbianas. Dichas celdas son reactores bioquímicos que convierten la energía química en electricidad. La presente investigación evaluó el suero lácteo para la producción de bioelectricidad en celdas de combustible microbianas (MFC). Estas fueron construidas con materiales de bajo costo y con bacterias aisladas en sedimentos anaeróbicos, ubicados en territorio nacional ecuatoriano, produciendo voltajes máximos de 0,830 V en el circuito y una densidad de potencia máxima de 30 mW / m2. Este bajo voltaje se trabajó con MFC de 50 mL y con un voltaje de salida de 300 mV. Bajo estas condiciones, se diseñó un circuito de elevación FLYBACK aislado por transformador. Este nuevo circuito aumentará el voltaje de 30 mV a un voltaje suficiente para encender un LED de 2.5 V. Por lo tanto, la energía producida por las MFC puede ser directamente utilizable para encender un LED y cargar los condensadores. Este estudio muestra que dichas celdas MFC, junto con el circuito diseñado, podrían utilizarse, potencialmente, para generar energía limpia.

Resumo Todos os anos a demanda por energia, em todo o mundo, está aumentando. Existem algumas alternativas para reduzir esses problemas, como energias limpas e renováveis. Uma alternativa muito específica é o uso de células combustíveis microbianas. Essas células são reatores bioquímicos que convertem energia química em eletricidade. O presente trabalho avaliou o soro lácteo para a produção de bioeletricidade em células a combustível microbianas (CCM), Estes foram construídos com materiais de baixo custo e bactérias isoladas em sedimentos anaeróbios, localizados no território nacional equatoriano, produzindo tensões máximas de 0,830 V no circuito e uma densidade de potência máxima de 30 mW / m2. Esta baixa voltagem trabalhamos com CCM de 50 mL e com uma voltagem de saída de 300 mV. Sob essas condições, um circuito de elevação FLYBACK isolado por transformador foi projetado. Este novo circuito aumentará a tensão de 30 mV para uma tensão suficiente para ligar um LED de 2,5 V. Portanto, a energia produzida pelo MFC pode ser diretamente utilizável para ligar um LED e carregar os capacitores. Este estudo mostra que essas células CCM, juntamente com o circuito projetado, poderiam ser usadas para gerar energia limpa.

Methodological strategies for functional analysis and evaluation of obsessive-compulsive behavior / Estratégias metodológicas para avaliação e análise funcional do comportamento obsessivo-compulsivo / Estrategias metodológicas para evaluación y análisis funcional de la conducta obsesiva-compulsiva

The study aimed to identify the controlling variables of obsessive-compulsive behaviors of an adult participant, based on three evaluation strategies. For the first one, Indirect Functional Assessment, the researchers recovered records of therapy sessions attended by the participant, in which conditions favorable to obsessive-compulsive behaviors were described. For the second one, Descriptive Functional Assessment, the researchers observed the participant's behavior during sessions in which they presented tasks previously mentioned as triggering of the problem behavior. For the third one, Brief Functional Analysis - Single Function Test, the researchers manipulated a demand condition and a control condition, aiming to examine the functional hypothesis that the problem behavior would be maintained by escape/avoidance of tasks. Although dissonant, the results allowed the researchers to discard the negative reinforcement hypothesis. The pertinence of the adoption of different evaluation strategies for clinical practice and the frailties of interventions guided only by verbal reports are discussed.

O estudo teve por objetivo identificar variáveis controladoras de comportamentos obsessivo-compulsivos de um participante adulto, com base em três estratégias de avaliação. Na primeira, Avaliação Funcional Indireta, recuperaram-se registros de sessões de terapia frequentadas pelo participante, em que foram descritas condições favorecedoras dos comportamentos obsessivo-compulsivos. Na segunda, Avaliação Funcional Descritiva, observou-se o comportamento do participante em sessões nas quais se dispunham tarefas antes indicadas como desencadeantes do comportamento-problema. Na terceira, Análise Funcional Breve - Teste de Função Única, foram manipuladas condições de demanda e controle, a fim de examinar a hipótese funcional de que o comportamento-problema seria mantido por fuga/ esquiva de tarefas. Embora divergentes, os resultados das avalições permitiram descartar a hipótese de que o comportamento-alvo seria mantido pela retirada da tarefa. Discutem-se a pertinência da adoção de diferentes estratégias de avaliação no trabalho clínico e a fragilidade de intervenções unicamente orientadas por relatos verbais.

El estudio objetivó identificar variables controladoras de la conducta obsesiva-compulsiva de un participante adulto, basando-se en tres estrategias de evaluación. Por la primera, Evaluación Funcional Indirecta, fueran recuperados registros de sesiones de terapia frecuentadas por el participante, en que se describieron condiciones favorecedoras de los comportamientos obsesivo-compulsivos. Por la segunda, Evaluación Funcional Descriptiva, fue observada la conducta del participante en sesiones en las cuales se disponían tareas indicadas como desencadenantes de la conducta-problema. Por la tercera, Análisis Funcional - Prueba de Función Única, fueran manipuladas condiciones de demanda e control, objetivando examinar la hipótesis funcional de que la conducta problema sería mantenida por fuga/evasión de tareas. Aunque divergentes, los resultados permitirán descartar a la hipótesis de que la conducta objetivo sería mantenida por reforzamiento negativo. Se discute la pertinencia de la adopción de diferentes estrategias de evaluación del trabajo clínico, y debilidades de intervenciones únicamente orientadas por relatos verbales.

A perspectiva simbólica do espectro obsessivo-compulsivo: O "projeto" de Freud revisitado pelo arquétipo de Jung / The symbolic perspective of the obsessive-compulsive spectrum Freud: "Project" revisited by Jung's archetype / La perspectiva simbólica del espectro obsesivo-compulsivo: El "proyecto" de Freud revisitado por el arquetipo de Jung

O autor aborda o espectro obsessivo-compulsivo através da dimensão simbólica e arquetípica enraizada em três vertentes: neurológica, psicofarmacológica, e psicodinâmica. Associa os dinamismos arquétipos matriarcal, patriarcal, de alteridade e de totalidade com estruturas e funções do sistema nervoso. A seguir, o autor retoma a hipótese de Katz (1991), segundo a qual o TOC apresenta um distúrbio do processo de repressão (Freud) possivelmente por uma disfunção neuroquímica, envolvendo neurotransmissores, principalmente a serotonina. A interpretação arquetípica desta disfunção é a debilitação da função de delimitação, de organização e de contenção do Arquétipo Patriarcal, que compromete a eficácia de todo o quadro defensivo e configura sua exuberância sintomática projetiva e ritualizadora num esforço para suprir a deficiência. O autor tece considerações sobre a ineficiência da psicoterapia dinâmica exclusivamente verbal no TOC e a relativa eficiência da Terapia Comportamental Cognitiva e argumenta que a associação destas duas teorias através do conceito de técnicas expressivas poderá contribuir com maior eficiência no tratamento não só do TOC, como das fobias e da síndrome do pânico, desde que seja exercido dentro de um enfoque simbólico e arquétipo que inclua a relação terapêutica no nível transferencial criativo e defensivo. ■

The author approaches the obsessive-compulsive spectrum through the symbolic archetypal dimension rooted in three perspectives: neurological, psycho-pharmacological and psychodynamic. He associates matriarchal, patriarchal, alterity and totality archetypes with structures and functions of the nervous system. The author considers the hypothesis developed by Katz (1991) according to which OCD presents a disturbance of repression due to a neurotransmitter disfunction, mainly of serotonin. From an archetypal perspective, this neuro-chemical disfunction develops a deficiency of the delimiting, organizing and contention functions of the Patriarchal Archetype. The intensification of repression, projection and ritualization in OCD is a neurological and psychological reaction to deal with this deficiency. The author mentions his experience according to which exclusively verbal psychodynamic psychotherapy is largely inefficient in OCD, phobias and panic syndrome. He argues that the relative efficiency of Cognitive Behavior Therapy can be improved if exposure and avoidance techniques are employed as expressive techniques considering the transference relationship and the defenses present within an overall symbolic and archetypal theory of personality development. ■

El autor aborda el espectro obsesivo-compulsivo a través de la dimensión simbólica y arquetípica enraizada en tres vertientes: neurológica, psicofarmacológica, y psicodinámica. Asocia los dinamismos arquetipos matriarcal, patriarcal, de alteridad y de totalidad con estructuras y funciones del sistema nervioso. A continuación el autor retoma la hipótesis de Katz (1991), según la cual el TOC presenta un disturbio del proceso de represión (Freud) posiblemente por una disfunción neuroquímica, involucrando neurotransmisores, principalmente la serotonina. La interpretación arquetípica de esta disfunción es la debilitación de la función de delimitación, de organización y de contención del Arquetipo Patriarcal, que compromete la eficacia de todo el cuadro defensivo y configura su exuberancia sintomática proyectiva y ritualizadora en un esfuerzo por suplir la discapacidad. El autor hace consideraciones sobre la ineficiencia de la psicoterapia dinámica exclusivamente verbal en el TOC y la relativa eficiencia de la Terapia Comportamental Cognitiva y argumenta que la asociación de estas dos teorías a través del concepto de técnicas expresivas podrá contribuir con mayor eficiencia en el tratamiento no sólo del TOC, fobias y del síndrome del pánico, siempre que sea ejercido dentro de un enfoque simbólico y arquetipo que incluya la relación terapéutica en el nivel transferencial creativo y defensivo. ■

Trastornos Neuropsiquiátricos Autoinmunes Pediátricos Asociados a Estreptococo: Presentación de un caso / Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Presentation of a case

Los trastornos neuropsiquiátricos autoinmunes pediátricos asociados a estreptococo (PANDAS) fueron creados para describir un subgrupo teórico de casos de trastornos obsesivo compulsivos (TOC) y / o tics en los que el inicio o la exacerbación de los síntomas es desencadenado por infección del estreptococo hemolítico del grupo A (SBHGA) ; Si bien aún no hay datos de incidencia se estima que el trastorno afecta aproximadamente al 1% de niños menores de 12 años, porque es menos probable que tengan anticuerpos contra el estreptococo y probablemente esté infradiagnosticado. La existencia de este trastorno ha generado considerables avances clínicos y científicos, así como controversia. Fisiopatológicamente, PANDAS se propone ser un trastorno autoinmune postestreptocócico similar a corea de Sydenham, hipotetizandose mas específicamente que los tics y la sintomatología obsesivo compulsiva son el resultado de la activación del sistema inmune adaptativo por el estreptococo del grupo A. Se presenta el caso de un paciente masculino de 6 años, con cuadro de tres semanas de evolución de movimientos involuntarios en cabeza y miembros superiores, así como cambios de conducta, cuyo antecedente de importancia fue una infección respiratoria y en piel varias semanas previo al inicio de los síntomas..(AU)

Comparación de la respuesta inhibitoria en niños y adolescentes diagnosticados con trastorno obsesivo compulsivo (TOC) y trastorno por déficit de atención e hiperactividad (TDAH) / Comparing Inhibitory response in Children and Teenagers Diagnosed with Obsessive and Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD)

Los trastornos de comportamiento tienen asociados una serie de factores que van más allá de los síntomas, entre los cuales está el funcionamiento cognoscitivo y la relación con los mismos sistemas neurofuncionales. En TOC y TDAH se han descrito dificultades en el funcionamiento ejecutivo, siendo la inhibición de respuestas una de las fallas comunes más consistentes en diferentes estudios, a pesar de que los dos cuadros clínicos difieren en las características de comportamiento relacionadas con esta habilidad. Este estudio comparó la respuesta inhibitoria de niños y adolescentes colombianos sanos y diagnosticados con TDAH o TOC. Se hizo un análisis descriptivo, comparativo, correlacional de casos y controles, donde se seleccionaron por muestreo intencionado a 31 pacientes con TDAH, 31 con TOC y 66 controles, de origen colombiano, de entre 10-19 años, a quienes se les aplicó el Test Stroop de Colores y Palabras segunda edición, haciendo análisis de las puntuaciones T de la interferencia calculada. Se encontró a través de test no paramétricos de Kruskal-Wallis diferencias generales entre los grupos clínicos con los controles (K-W:10.979, d/ = 2, p = 4.13x10-3); y diferencias específicas con el Test de Wilcoxon; entre Controles vs TOC (W-T p = 0.03), vs TDAH (W-T p = 2.00 x 10-3), pero no entre los grupos clínicos TOC vs TDAH (p = 0.27). Al comparar a través de test de U Mann-Whitney por rango de edad se encuentran diferencias entre los mismos grupos para los participantes entre 13-16 años en TDAH vs controles (p = 5.00 x 10-3), identificándose correlación entre edad e interferencia solo para el grupo TOC (R2:= 0.98). Conclusiones: Como se ha descrito en literatura científica, no se consigue identificar diferencias en el rendimiento entre casos y controles en cuanto a las habilidades de control inhibitorio de interferencia entre personas con TOC y TDAH, pero sí entre éstos y los controles, confirmando el aspecto común de fallas inhibitorias, aun cuando difieren en las manifestaciones conductuales. La edad representa un elemento importante indicando que hay un componente de cambio relacionado con maduración del sistema nervioso, llevando a mejor rendimiento en inhibición a medida que aumenta la edad, para el grupo de TOC.

Behavior disorders are associated with a number of factors that go beyond symptoms, including cognitive functioning and the relationship with the neurofunctional systems. In OCD and ADHD difficulties in executive functioning have been described, being the response inhibition one of the most consistent common failures in different studies despite that the two clinical pictures differ in behavioral characteristics related to this skill. The aim was to compare the inhibitory response of healthy Colombian children and adolescents and diagnosed with ADHD or OCD. A descriptive, comparative, correlational analysis of cases and controls, where the sample of 31 patients with ADHD, 31 with OCD and 66 controls were selected by intention, being of Colombian origin, between 10-19 years old to whom the Test Stroop of Colors and Words second edition was applied doing analysis of the scores T of the calculated interference. Through non-parametric Kruskal-Wallis tests, we identify general differences between the clinical groups with the controls (K-W:10.979, d/ = 2, p = 4.13x10-3). And specific differences with the Wilcoxon Test; Between Controls vs TOC (W-T p = 0.03), vs ADHD (W-T p = 2.00x10-3), but not between clinical groups TOC vs ADHD (p = 0.27). When comparing through U-Mann- Whitney test by age range differences are found between the same groups for participants between 13-16 years in ADHD vs controls (p = 5.00x10-3), identifying correlation between age and interference only for the TOC group (R2 = 0.98). As described in the scientific literature, it is not possible to identify differences in case-control performance in inhibitory control of interference between people with OCD and ADHD, but between these and controls, confirming the common aspect of inhibitory failures, even when differ in behavioral manifestations. Age represents an important element indicating that there is a change component related to maturation of the nervous system, leading to better inhibition performance as the age for the OCD group increases.

Características del self en pacientes con trastorno obsesivo compulsivo: una aproximación desde el enfoque integrativo supraparadigmatico / Self features in patients with obsessive compulsive disorder: an approach from supraparadigmatic integrative model

En la presente investigación, se intenta comprender el trastorno Obsesivo Compulsivo (TOC) más allá de los síntomas, como una forma de planear estrategias de intervención diferentes y que ayuden a aliviar el sufrimiento de los pacientes. Este trastorno presentaría una prevalencia aproximada entre un 1.5 por ciento y un 3 por ciento con variaciones en diferentes ciudades, por lo que es alta la presencia de él, sin embargo, la consulta por éste es baja, ya que el trastorno en sí conlleva vergüenza y miedo, afectando así a la persona en su identidad, en como el sujeto se aproxima al mundo, como desea que la vida sea para él. Se toma el marco referencial del Enfoque Integrativo Suprapradigmático, especialmente las funciones del Self propuestas por éste enfoque. La investigación es descriptiva y pretende caracterizar las funciones del Self de pacientes con TOC, la muestra es de 18 pacientes de un centro de atención psicológica de la ciudad de Santiago de Chile y que responden la Ficha de Evaluación Clínica Integral (FECI)...

In this research, we try to understand Obsessive Compulsive Disorder (OCD) beyond its symptoms, as a way of planning different intervention strategies to help alleviate the suffering of patients. This disorder has a prevalence between 1.5 percent and 3 percent with variations in different cities. Despite its high prevalence, consultation levels are low since the disorder itself is associated with shame and fear, affecting a person’s identity, the way the subject approaches the world and the life wished for. The reference frame adopted is the Suprapradigmatic Integrative Model, especially the functions of the Self proposed by this approach. The research is descriptive and aims to characterize the functions of the Self of patients with OCD. The sample is of 18 patients attended at a Psychological Services Center in Santiago, Chile, evaluated with the Integral Clinical Evaluation (FECI)...

04-11 Quality assessment of Japanese Biofango through tensiometric approach by TVS mud index / 日本温泉気候物理医学会雑誌

Introduction: Sanraku-en spa started to purpose the “Shogawa biofangotherapy” using hot spring water and different kind of clays of natural origin (called Biofango) matured for three weeks during which bacterial flora develop with production of constitutive elements having therapeutic properties [4]. In collaboration with Ascendant Co. Ltd was ideated and developed the production of the first japanese Biofango supported by Toho University, University of Science and Technology of Hokuriku, and University of Hishigawa opening at new perspective in mudtherapy for therapeutic use in Japan (Biofango project). Objectives: The goal was the assessing the surface energy of Biofango by TVS modelling and TVS mud index 1, 2). Tensiometric analyses of Biofango mixtures were performed at Sanraku-en spas centre (Tonami-Japan) and its quality control has been carried out in the Permanent Thermal Observatory (OTP) of University of Padova. Organic compounds analysis (TOC) were performed in the Department of Pharmaceutical and Pharmacological Sciences of University of Padova (Italy). Materials and Methods: Biofango was prepared using KomatsuClay, MotoyamaClay, WakuraDiatomite and KasaokaBentonite. Pre-test mixtures were K01 (Bentonite 1.75, KomatsuClay 0.5, Diatomite 0.25) and M01 (Bentonite 1.75 MotoyamaClay 0.5 Diatomite 0.25). After were prepared K02 (Bentonite 1.25, Kaolinite 1.5, Diatomite 0.25) and A01 (KasaokaBentonite 1.25, Kaolinite 0.5, Diatomite 0.25) mixtures. Final Biofangos were BFM+0%Dolomite, MAT1+10%Dolomite, MAT2+18%Dolomite, and MAT3+35%Dolomite were analysed by XRF/XRD. TOC analyses were performed on a Perkin-Elmer-2400 analyser with Perkin-Elmer-AD-4 autobalance and tensiometric investigations were performed by DSA 10 (Krüss) tensiometer employing (a) PFPE, Fomblin HC/OH-1000, diiodomethane, glycerine as liquid tests and (b) Owens-Wendt3) mathematical model to convert contact angles in surface enery parameters. Results: XRD analyses of Biofango demonstrating presence of Kaolinite-Quartz-Feldspar in Komatsu Clay, Kaolinite-Quartz-Feldspar-Carbon in MotoyamaClay, Quartz-Montmorillonite-Feldspar-Grauconite in WakuraDiatomite, and Montmorillonite-Quartz-Feldspar-Christoballite in KasaokaBentonite while XRF showed presence of SiO2 (KomatsuClay 53.38%, MotoyamaClay 48.86%, WakuraDiatomite 78.20%, KasaokaBentonite 66.01%) and Al2O3 (KomatsuClay 53.38%, MotoyamaClay 48.86%, WakuraDiatomite 78.20%, KasaokaBentonite 66.01%) as principal elements. TOC analyses demonstrated an increase of C% with production of CO2 in relation to the amount of Dolomite in Biofango mixtures (MAT1=1.26%, MAT2=2.36%, MAT3=3.29%). Tensiometric investigations showed a correlation between C% and dispersed components (DC) measured on Biofango mixtures (MAT1=3.0 mN/m, MAT2=2.1 mN/m, MAT3=2.0 mN/m) and between C% and TVS mud index levels (MAT1=68.7 mN/m eq., MAT2=74.06 mN/m eq., MAT3=75.9 mN/m eq.). Conclusions: Tensiometric investigations of Biofango consented to determine the correlations between chemico-mineralogical data and surface energy parameters. Thanking to the high sensitivity of TVS mud index used as integrated tensiometric marker was possible to determine directly and in a non invasive way the quality of Biofango mixtures opening at new perspective in their monitoring and control before their employment in mudtherapy in Japanese spas after their maturation process.

04-10 Quality assessment of maturation process of Japanese Biofango by TVS mud index / 日本温泉気候物理医学会雑誌

Introduction: TVS mud index1) is a tensiometric marker for quality and maturation process control of Italian Euganean Thermal Muds (ETM) which sensitivity defined on objective basis their quality and maturation degree. Objectives: The goal was to assess the maturation process of Biofango by TVS mud index (Sanraku-en spas centre, Japan and Osservatorio Termale Permanente-OTP, Italy), and its organic compounds by TOC analyses (University of Padova, Italy). Materials and Methods: Biofango was prepared using KomatsuClay, MotoyamaClay, WakuraDiatomite and KasaokaBentonite giving K02 (Bentonite 1.25, Kaolinite 1.5, Diatomite 0.25) and A01 (KasaokaBentonite 1.25, Kaolinite 0.5, Diatomite 0.25). Final Biofango BFM+0%Dolomite, MAT1+10%Dolomite, MAT2+18%Dolomite, and MAT3+35%Dolomite were analyzed by TOC (Perkin-Elmer-2400) and DSA10-Krüss employing (a) PFPE, Fomblin HC/OH-1000, diiodomethane, glycerine as liquid tests and (b) Owens-Wendt mathematical model for conversion of contact angles in surface energy parameters2). Results: The behaviour of C(%) in MAT1, MAT2, and MAT3 during maturation process (20°C) showed respectively (a) MAT1t0h=1.26%, MAT1t216h=0.91%, MAT1t360=1.08%, MAT1t576h=1.23%, MAT1t720h=0.98%, (b) MAT2t0h=2.36%, MAT2t216h=1.80%, MAT2t360=1.49%, MAT2t576h=1.86%, MAT2t720h=1.68%, (c) MAT3t0h=3.29%, MAT3t216h=2.71%, MAT3t360=2.57%, MAT3t576h=2.6%, MAT3t720h=2.7%. C% decrease demonstrating the influence of Dolomite in Biofango mixtures. Dispersed energy components (DC) of MAT1, MAT2, and MAT3 showed respectively (a) MAT1t0h=3.0mN/m, MAT1t216h=3.1mN/m, MAT1t360=2.9mN/m, MAT1t576h=3.8mN/m, MAT1t720h=2.5mN/m, (b) MAT2t0h=2.1mN/m, MAT2t216h=2.2mN/m, MAT2t360=3.1mN/m, MAT2t576h=3.7mN/m, MAT2t720h=2.6mN/m, (c)MAT3t0h=2.0mN/m, MAT3t216h=2.6mN/m, MAT3t360=2.6mN/m, MAT3t576h=2.9mN/m, MAT2t720h=3.0mN/m. On the other side TVS mud index showed respectively (a) MAT1t0h=68.7mN/m, MAT1t216h=70.26mN/m, MAT1t360=71.78mN/m, MAT1t576h=64.69mN/m, MAT1t720h=71.84mN/m, (b) MAT2t0h=74.06mN/m, MAT2t216h=71.69mN/m, MAT2t360= 70.36mN/m, MAT2t576h=65.83mN/m, MAT2t720h=71.23mN/m, (c) MAT3t0h=75.9mN/m, MAT3t216h=73.05mN/m, MAT3t360=73.34mN/m, MAT3t576h=68.52mN/m, MAT3t720h=68.66mN/m proportionally inverse with DC behaviour. MAT3 with highest content in Dolomite demonstrated great capability to uptake DC during maturation process with consequently decrease of TVS mud index levels accordingly with TOC result. Conclusions: Tensiometric investigations of Biofango underlined the links between chemical and surface energy data. The high sensitivity of TVS mud index consented to follow directly in a non invasive way the structural-surface changes in Biofango mixtures occurred during maturation process opening at new perspective for their control.

04-8 Typical application of TVS modelling to two natural materials from Brenta’s alluvional plan (Italy) for mudtherapy and cosmetic characterization / 日本温泉気候物理医学会雑誌

Introduction: Mineralogical, granulometrical and chemical investigations of Brenta’s silt-clay confirmed its common origin with natural Euganean Thermal Muds (ETM)1) opening perspectives in the treatment of inflammatory pathologies as rheumatic diseases. Basing on these evidences, surface energy investigations of Brenta’s silt-clay and ETM by TVS modelling were considered within correlation studies between physic-chemical and tensiometric data. Objectives: Basing on Brenta’s silt-clay and ETM common origin, the aim of this work was to confirm the suitability of Brenta’s silt-clay in thermal field by comparative analyses of their matrices and on these basis hypothesize the potentialities of Brenta’s silt-clay in mudtherapy and cosmetic field. Materials and Methods: Brenta’s silt-clay (BrentaKerÒ) samples and ETM were collected respectively from EGAP’s gravel pit and Euganean thermal spa’s maturation plant, undergone at maturation process employing thermal water at different temperature, investigated using (a) DSA10-Kruss tensiometer (diiodomethane, PFPE, glycerine as liquid tests) for surface energy characterization, and (b) Perkin Elmer TOC Analyser for C (%) and H (%) detection. Tensiometric characterizations were performed by measurement of contact angles (deg) of different liquid tests converted successively in surface energy (mN/m) by Owens mathematical model 2). Contact angles of PFPE were performed by Perfluoropolyether Contact Angle Measurement Method (PCAM). Results: Correlation degree between dispersed surface energy component (DC) of Brenta’s silt-clay and contact angles of PFPE (deg) measured during 6 weeks of maturation resulted satisfactory (R2=0.90). Considering the typical maturation’s temperature measured from third week to sixth (40°Ct3, 41°Ct4, 42°Ct5, 43°Ct6), the correlation degree between them and values of DC (mN/m) of Brenta’s silt-clay (DCt3=18.9 mN/m, DCt4=20.3 mN/m, DCt5=19.9 mN/m, DCt6=20.6 mN/m) resulted maximal (R2=1). Brenta silt-clay and ETM DC levels (DCt3=21.2 mN/m, DCt4=20.4 mN/m, DCt5=20.9 mN/m, DCt6=20.7 mN/m) demonstrated optimally correlated (R2=0.97). TOC analyses performed on Brenta’s silt-clay and ETM after maturation showed an increase of C% respectively +1.4% and +4.3% and percentage loss of H of -37.8% and -10.7% with an increase of DC and PC of +17.8 mN/m and +21.0 mN/m confirming the great affinity between the two geomaterials. Regarding ETM it demonstrated also the capability to deliver DC (-44.8%) uptaking PC (+50%) during mudtherapy as result of the modification of selective permeability of skin. Conclusions: Chemical-mineralogical analyses, tensiometric investigations, and studies of correlations between Brenta’s silt-clay and ETM demonstrated a great affinity between them. Surface energy evaluations of ETM, its capability to deliver DC to skin uptaking PC during mudtherapy modifying skin’s selective permeability and favouring the permeation of therapeutic substances product during maturation process, suggest new perspectives for the employment of Brenta’s silt-clay in thermal field as anti-inflammatory agent for rheumatic diseases and in cosmetic sector.

04-8Typical application of TVS modelling to two natural materials from Brenta’s alluvional plan (Italy) for mudtherapy and cosmetic characterization / 日本温泉気候物理医学会雑誌

<b>Introduction:</b> Mineralogical, granulometrical and chemical investigations of Brenta’s silt-clay confirmed its common origin with natural Euganean Thermal Muds (ETM)¹⁾ opening perspectives in the treatment of inflammatory pathologies as rheumatic diseases. Basing on these evidences, surface energy investigations of Brenta’s silt-clay and ETM by TVS modelling were considered within correlation studies between physic-chemical and tensiometric data.<BR><b>Objectives: </b>Basing on Brenta’s silt-clay and ETM common origin, the aim of this work was to confirm the suitability of Brenta’s silt-clay in thermal field by comparative analyses of their matrices and on these basis hypothesize the potentialities of Brenta’s silt-clay in mudtherapy and cosmetic field.<BR><b>Materials and Methods: </b>Brenta’s silt-clay (BrentaKerÒ) samples and ETM were collected respectively from EGAP’s gravel pit and Euganean thermal spa’s maturation plant, undergone at maturation process employing thermal water at different temperature, investigated using (a) DSA10-Kruss tensiometer (diiodomethane, PFPE, glycerine as liquid tests) for surface energy characterization, and (b) Perkin Elmer TOC Analyser for C (%) and H (%) detection. Tensiometric characterizations were performed by measurement of contact angles (deg) of different liquid tests converted successively in surface energy (mN/m) by Owens mathematical model ²⁾. Contact angles of PFPE were performed by Perfluoropolyether Contact Angle Measurement Method (PCAM). <BR><b>Results: </b>Correlation degree between dispersed surface energy component (DC) of Brenta’s silt-clay and contact angles of PFPE (deg) measured during 6 weeks of maturation resulted satisfactory (R2=0.90). Considering the typical maturation’s temperature measured from third week to sixth (40°Ct3, 41°Ct4, 42°Ct5, 43°Ct6), the correlation degree between them and values of DC (mN/m) of Brenta’s silt-clay (DCt3=18.9 mN/m, DCt4=20.3 mN/m, DCt5=19.9 mN/m, DCt6=20.6 mN/m) resulted maximal (R2=1). Brenta silt-clay and ETM DC levels (DCt3=21.2 mN/m, DCt4=20.4 mN/m, DCt5=20.9 mN/m, DCt6=20.7 mN/m) demonstrated optimally correlated (R2=0.97). TOC analyses performed on Brenta’s silt-clay and ETM after maturation showed an increase of C% respectively +1.4% and +4.3% and percentage loss of H of -37.8% and -10.7% with an increase of DC and PC of +17.8 mN/m and +21.0 mN/m confirming the great affinity between the two geomaterials. Regarding ETM it demonstrated also the capability to deliver DC (-44.8%) uptaking PC (+50%) during mudtherapy as result of the modification of selective permeability of skin. <BR><b>Conclusions:</b> Chemical-mineralogical analyses, tensiometric investigations, and studies of correlations between Brenta’s silt-clay and ETM demonstrated a great affinity between them. Surface energy evaluations of ETM, its capability to deliver DC to skin uptaking PC during mudtherapy modifying skin’s selective permeability and favouring the permeation of therapeutic substances product during maturation process, suggest new perspectives for the employment of Brenta’s silt-clay in thermal field as anti-inflammatory agent for rheumatic diseases and in cosmetic sector.

04-11Quality assessment of Japanese Biofango through tensiometric approach by TVS mud index / 日本温泉気候物理医学会雑誌

<b>Introduction: </b>Sanraku-en spa started to purpose the “Shogawa biofangotherapy” using hot spring water and different kind of clays of natural origin (called Biofango) matured for three weeks during which bacterial flora develop with production of constitutive elements having therapeutic properties [4]. In collaboration with Ascendant Co. Ltd was ideated and developed the production of the first japanese Biofango supported by Toho University, University of Science and Technology of Hokuriku, and University of Hishigawa opening at new perspective in mudtherapy for therapeutic use in Japan (Biofango project).<BR><b>Objectives: </b>The goal was the assessing the surface energy of Biofango by TVS modelling and TVS mud index ^{1, 2)}. Tensiometric analyses of Biofango mixtures were performed at Sanraku-en spas centre (Tonami-Japan) and its quality control has been carried out in the Permanent Thermal Observatory (OTP) of University of Padova. Organic compounds analysis (TOC) were performed in the Department of Pharmaceutical and Pharmacological Sciences of University of Padova (Italy).<BR><b>Materials and Methods: </b>Biofango was prepared using KomatsuClay, MotoyamaClay, WakuraDiatomite and KasaokaBentonite. Pre-test mixtures were K01 (Bentonite 1.75, KomatsuClay 0.5, Diatomite 0.25) and M01 (Bentonite 1.75 MotoyamaClay 0.5 Diatomite 0.25). After were prepared K02 (Bentonite 1.25, Kaolinite 1.5, Diatomite 0.25) and A01 (KasaokaBentonite 1.25, Kaolinite 0.5, Diatomite 0.25) mixtures. Final Biofangos were BFM+0%Dolomite, MAT1+10%Dolomite, MAT2+18%Dolomite, and MAT3+35%Dolomite were analysed by XRF/XRD. TOC analyses were performed on a Perkin-Elmer-2400 analyser with Perkin-Elmer-AD-4 autobalance and tensiometric investigations were performed by DSA 10 (Krüss) tensiometer employing (a) PFPE, Fomblin HC/OH-1000, diiodomethane, glycerine as liquid tests and (b) Owens-Wendt³⁾ mathematical model to convert contact angles in surface enery parameters. <BR><b>Results: </b>XRD analyses of Biofango demonstrating presence of Kaolinite-Quartz-Feldspar in Komatsu Clay, Kaolinite-Quartz-Feldspar-Carbon in MotoyamaClay, Quartz-Montmorillonite-Feldspar-Grauconite in WakuraDiatomite, and Montmorillonite-Quartz-Feldspar-Christoballite in KasaokaBentonite while XRF showed presence of SiO₂ (KomatsuClay 53.38%, MotoyamaClay 48.86%, WakuraDiatomite 78.20%, KasaokaBentonite 66.01%) and Al₂O₃ (KomatsuClay 53.38%, MotoyamaClay 48.86%, WakuraDiatomite 78.20%, KasaokaBentonite 66.01%) as principal elements. TOC analyses demonstrated an increase of C% with production of CO₂ in relation to the amount of Dolomite in Biofango mixtures (MAT1=1.26%, MAT2=2.36%, MAT3=3.29%). Tensiometric investigations showed a correlation between C% and dispersed components (DC) measured on Biofango mixtures (MAT1=3.0 mN/m, MAT2=2.1 mN/m, MAT3=2.0 mN/m) and between C% and TVS mud index levels (MAT1=68.7 mN/m eq., MAT2=74.06 mN/m eq., MAT3=75.9 mN/m eq.).<BR><b>Conclusions:</b> Tensiometric investigations of Biofango consented to determine the correlations between chemico-mineralogical data and surface energy parameters. Thanking to the high sensitivity of TVS mud index used as integrated tensiometric marker was possible to determine directly and in a non invasive way the quality of Biofango mixtures opening at new perspective in their monitoring and control before their employment in mudtherapy in Japanese spas after their maturation process.

04-10Quality assessment of maturation process of Japanese Biofango by TVS mud index / 日本温泉気候物理医学会雑誌

<b>Introduction: </b>TVS mud index¹⁾ is a tensiometric marker for quality and maturation process control of Italian Euganean Thermal Muds (ETM) which sensitivity defined on objective basis their quality and maturation degree. <BR><b>Objectives: </b>The goal was to assess the maturation process of Biofango by TVS mud index (Sanraku-en spas centre, Japan and Osservatorio Termale Permanente-OTP, Italy), and its organic compounds by TOC analyses (University of Padova, Italy).<BR><b>Materials and Methods:</b> Biofango was prepared using KomatsuClay, MotoyamaClay, WakuraDiatomite and KasaokaBentonite giving K02 (Bentonite 1.25, Kaolinite 1.5, Diatomite 0.25) and A01 (KasaokaBentonite 1.25, Kaolinite 0.5, Diatomite 0.25). Final Biofango BFM+0%Dolomite, MAT1+10%Dolomite, MAT2+18%Dolomite, and MAT3+35%Dolomite were analyzed by TOC (Perkin-Elmer-2400) and DSA10-Krüss employing (a) PFPE, Fomblin HC/OH-1000, diiodomethane, glycerine as liquid tests and (b) Owens-Wendt mathematical model for conversion of contact angles in surface energy parameters²⁾.<BR><b>Results:</b> The behaviour of C(%) in MAT1, MAT2, and MAT3 during maturation process (20°C) showed respectively (a) MAT1t0h=1.26%, MAT1t216h=0.91%, MAT1t360=1.08%, MAT1t576h=1.23%, MAT1t720h=0.98%, (b) MAT2t0h=2.36%, MAT2t216h=1.80%, MAT2t360=1.49%, MAT2t576h=1.86%, MAT2t720h=1.68%, (c) MAT3t0h=3.29%, MAT3t216h=2.71%, MAT3t360=2.57%, MAT3t576h=2.6%, MAT3t720h=2.7%. C% decrease demonstrating the influence of Dolomite in Biofango mixtures. Dispersed energy components (DC) of MAT1, MAT2, and MAT3 showed respectively (a) MAT1t0h=3.0mN/m, MAT1t216h=3.1mN/m, MAT1t360=2.9mN/m, MAT1t576h=3.8mN/m, MAT1t720h=2.5mN/m, (b) MAT2t0h=2.1mN/m, MAT2t216h=2.2mN/m, MAT2t360=3.1mN/m, MAT2t576h=3.7mN/m, MAT2t720h=2.6mN/m, (c)MAT3t0h=2.0mN/m, MAT3t216h=2.6mN/m, MAT3t360=2.6mN/m, MAT3t576h=2.9mN/m, MAT2t720h=3.0mN/m. On the other side TVS mud index showed respectively (a) MAT1t0h=68.7mN/m, MAT1t216h=70.26mN/m, MAT1t360=71.78mN/m, MAT1t576h=64.69mN/m, MAT1t720h=71.84mN/m, (b) MAT2t0h=74.06mN/m, MAT2t216h=71.69mN/m, MAT2t360= 70.36mN/m, MAT2t576h=65.83mN/m, MAT2t720h=71.23mN/m, (c) MAT3t0h=75.9mN/m, MAT3t216h=73.05mN/m, MAT3t360=73.34mN/m, MAT3t576h=68.52mN/m, MAT3t720h=68.66mN/m proportionally inverse with DC behaviour. MAT3 with highest content in Dolomite demonstrated great capability to uptake DC during maturation process with consequently decrease of TVS mud index levels accordingly with TOC result.<BR><b>Conclusions: </b>Tensiometric investigations of Biofango underlined the links between chemical and surface energy data. The high sensitivity of TVS mud index consented to follow directly in a non invasive way the structural-surface changes in Biofango mixtures occurred during maturation process opening at new perspective for their control.

Psicoterapia cognitiva individual del TOC / Individual cognitive psychotherapy of OCD

A case study is presented in which cognitive therapy is applied to a case of obsessive-compulsive disorder, with contamination and verification rituals. The treatment emphasizes the importance of intervening on the specific metacognitive biases that patients have on their intrusive thoughts. The center of the intervention is not in the obsessions, but in the biased assessments. The post treatment evaluation showed a moderate improvement, a reduction of the biases, and a notable improvement of the functionality of the patient.

Se presenta un estudio de caso en el que se aplica psicoterapia cognitiva en un paciente con trastorno obsesivo compulsivo con intrusiones de contaminación y duda con rituales de lavado y verificación. El tratamiento se basa en el modelo cognitivo del TOC, que propone que los sesgos a través de los cuales se valoran las ideas intrusivas son el principal factor de mantenimiento del trastorno. Las intervenciones que de él se derivan incluyeron psicoeducación y técnicas cognitivas para flexibilizar esos sesgos. La evaluación de resultados post tratamiento mostró una mejoría moderada de los síntomas, una marcada flexibilización de los sesgos y una notable mejoría en la funcionalidad del paciente.

PET-CT: tumores de cabeza y cuello. Ensayo pictórico y revisión de la literatura / PET-CT: Head and Neck Tumors. Picture essay and literature review

La PET-CT como modalidad diagnóstica es muy útil en la evaluación anatomofisiológica de la cabeza y el cuello. Proporciona una alta sensibilidad y especificidad en la estadificación de neoplasias primarias, la respuesta al tratamiento médico o quirúrgico y la detección de recurrencias. Dichas enfermedades representan un alto impacto sobre la mortalidad y morbilidad de los pacientes. El principal objetivo de esta publicación es hacer una revisión de los hallazgos en la PET-CT de los tumores más frecuentes de cabeza y cuello, con énfasis en los procesos malignos, estudiados en nuestra institución.

PET-CT as a diagnostic modality which is very useful in the anatomical-physiological assessment of the head and neck. It provides high sensitivity and specificity in the staging of primary tumors, the response to medical or surgical treatment and the detection of recurrences. These diseases represent a high impact on the mortality and morbidity in our patients. Our main objective is to review the findings on PET-CT of the most common head and neck tumors with an emphasis on malignancy which are studied in our institution.

Tique e TOC / Tic and OCD

Tique psíquico e TOC (transtorno obsessivo-compulsivo) compõe a "síndrome auto-obsessiva" com duas modalidades: psicomotora e psicoatuante, respectivamente, que aparentam uma auto-hipnose inconsciente. Esquisitices e algumas neuroses nem sempre são bem distintas, e casos de pessoas célebres são apresentados. Confirma-se a falta de lesões anatômicas evidentes nesta síndrome, se bem que a bioquímica e o mapeamento eletrônico das zonas cerebrais possam denotar hiperatividade. "Egrégora" é a condensação de pensamentos, por afinidade, de várias pessoas, ou de fluido-magnetismo de muitos animais afins, e que pode justificar, além da visão, a "contaminação" da "SAO", principalmente dos tiques.

Psychic tic and obsessive compulsive disturbance (OCD) compound the "auto-obsessive syndrome" that has two forms: psychomotor and psychoactive, respectively, and both seem an unconscious auto-hipnosis. Queerness and some neurosis are not always well distinguishable, and a few cases of celebrated persons are presented. The lack of anatomic lesions is confirmed in this syndrome, although the biochemistry and the map of the cerebral zones can denote hyperactivity. "Égregora" is a condensation of thinking, byaffinity, from various persons, or of fluid-magnetism from many related animals, and that can justify, in addition to the vision, the "contamination" of the "AOS", mainly in the tics.

Funcionamiento familiar, creencias e inteligencia emocional en pacientes con trastorno obsesivo-compulsivo y sus familiares / Family functioning, beliefs regarding illness and emotional intelligence in patients with Obsessive Compulsive Disorder and in their relatives

Mental health problems, specifically mental disorders, develop from a complex system and not from a single cause. Obsessive-compulsive disorder (OCD) affects more than 2% of the population and generally the course of the illness is insidious and chronic. When functioning adequately, family constitutes a very important resource to face health problems and to help to improve the patient's life quality. This is the reason why it is important to underline the relevance of a stable, good functioning of the family system aimed at attaining an optimal development of all its members. Such development may be hindered by the family's incapability to modify functioning patterns at crucial moments when they are trapped in a series of inadaptable interactions which prevent to give specific solutions to the problems that are appearing, and when reporting, within a context of expressed emotion, an emotional over-involvement and high levels of hostility and criticism towards the member with OCD. Family accommodation is a phenomenon typical of families where the identified patient exerts a control based on aggressiveness when his/her wishes are not rewarded within the group. There are very few researches on the functioning of families of patients diagnosed with obsessive-compulsive disorder. Generally, these researches are related with the partially negative effects that the interactions have on the behavior of patients and their relatives by preventing or hindering the development of the subject's system. The accordance between the patient's emotional regulation or emotional intelligence and their relatives has not been studied. On the other hand, the knowledge of the beliefs that relatives hold regarding the illness may be related with the functioning of the group as a family, whereas beliefs will provide consistency to family life because they provide continuity between past, present and future. They are also a way to address new and ambiguous situations such as mental illness. This is the reason why getting to know these family systems may allow elaborating more specific and effective intervention programs for groups and families. Objective To determine the family types through a member identified with obsessive-compulsive disorder; to compare the emotional intelligence profile between patients and relatives according to the perceived type of family; to compare the relatives' beliefs toward the illness according to the perceived type of family. Material and methods A sample of patients and their families with obsessive-compulsive disorder was obtained from those who were sent by the doctor in charge of their treatment to participate in a model of group therapy for OCD, consisting of cognitive behavioral theory, practices and psychoeducation. During the first session patients and their relatives answered the following instruments: Family Adjustment and Cohesion scales (FACES-II) by Olson, Profile of Emotional Intelligence (PIEMO) by Cortés et al., Beck Inventory of Anxiety. Relatives answered too the Beliefs and Attributions Questionnaire by Salorio et al. In addition, data on family structure was complied. The sample was constituted by 48 patients and 61 relatives. All instruments were self-applied. Once that the type was obtained according to the Olson's circumflex model, the emotional profile, the anxious and the depressive symptoms were compared through factorial 2x3 ANOVA. Beliefs and attributions were compared through simple ANOVA. Results Three types of families were determined as follows: high cohesion with chaotic standards for expressing emotions and ideas; high cohesion with a rigid expression of ideas and emotions; low cohesion with a little expression of ideas and emotions. Different profiles of emotional intelligence were found not only for patients but also for relatives, in each family type. Families with high cohesion and high adjustment appear as most emotionally intelligent, less anxious and depressed, and with beliefs more attuned to reality. This type of family function was the less frequent. For beliefs and illness attributions, it was observed that comprehension of the disorder increases in proportion to a higher family adaptation, while the tendency of family members to experience feelings of guilt either towards themselves or towards the patient is decreased. As a result, the perception of experiencing the patient's illness as a nuisance disappears. With regard to the results of the Beck scales, family members perceived a high cohesion and low adaptation had higher scores for depression and anxiety. In patients who show high levels of depression and anxiety perceive family functioning as a rigid structure, with little prospect of change and interaction that prevents growth (high cohesion, low adaptation), and in those perceived isolation, without significant emotional ties with other family members and with the rigidity that prevents problem situations. Conclusions The results obtained are congruent with Olson's statements in regard to family functioning in the specific case of obsessive- compulsive disorder; these findings permit to understand the family dynamics which may typify the symptoms in the identified patients, and also to explain the adjustment situation described in literature. Family intervention is justified, stressing the handling of emotions as an important element to be considered in order to obtain higher therapeutic benefits for the patient. This study found differences in adjustment between patients and their families, do not perceive the need for flexibility in the operation of the system to find solutions that do not perpetuate and sustain interactions that reinforce symptoms. As for depression and anxiety, similar levels in either condition may be observed, thus confirming the close relationship between both. It was found that in patients and relatives, higher levels of family adaptation correspond to lower levels of depressive and anxious symptoms. One of the first approaches to the dynamics of these systems must be headed towards the family systems of beliefs, as the ideas that family members hold regarding the importance of their participation in the whole process of the illness has an impact in its course. Many families have rigid systems that make them more vulnerable to the fluctuations that this illness presents since for their members it is important and decisive to have control over the ailment. Families with flexible systems of beliefs are more prone to experience losses with a feeling of acceptance and therefore it is easier for them to let their members to implement changes in their functioning, thus compensating and overcoming their limitations. In this sense it is important to attain a therapeutic collaboration relationship that may create within the family a sense of realistic control and may help also to put into action the system's capabilities to promote improvement. This idea allows for openness in the system that may lead it to consider that there are more efficient operational measures that those applied to date.

Los problemas de salud mental y específicamente los trastornos mentales se desarrollan a partir de un complejo sistema biopsicosocial y difícilmente se puede identificar una causa única. El trastorno obsesivo compulsivo (TOC) afecta a más de 2% de la población y en general el curso de la enfermedad es insidioso y crónico. La familia es un importante recurso para enfrentar los problemas de salud y facilitar el mejoramiento de la calidad de vida del paciente, cuando su funcionamiento es adecuado. Existen pocas investigaciones realizadas sobre el funcionamiento de las familias de pacientes diagnosticados con trastorno obsesivo-compulsivo. Generalmente estas investigaciones están relacionadas con los efectos potencialmente negativos que dichas interacciones tienen en las conductas de pacientes y familiares que impiden u obstaculizan el desarrollo del sistema y de los individuos. La concordancia de la regulación emocional o inteligencia emocional de los pacientes y sus familiares no ha sido estudiada. Por otra parte el conocimiento de las creencias sobre la enfermedad por parte de los familiares puede estar relacionado con el funcionamiento del grupo como familia. Es por ello que el conocimiento de estos sistemas familiares podrá permitir estructurar programas de intervención grupal o familiar más específicos y eficaces. Objetivo Determinar la tipología de las familias con un miembro identificado con trastorno obsesivo compulsivo, comparando tres aspectos: 1) El perfil de inteligencia emocional entre pacientes y familiares según el tipo de familia percibido. 2) La ansiedad y depresión entre pacientes y familiares según el tipo de familia percibido y 3) Las creencias de los familiares hacia la enfermedad según el tipo de familia percibido. Material y métodos Se obtuvo una muestra de pacientes y sus familiares con trastorno obsesivo compulsivo (TOC) los que fueron enviados por su médico tratante a participar en el modelo terapéutico grupal para TOC, que consiste en Teoría y Técnicas cognitivo conductuales y psicoeducativas. Durante la primera sesión los pacientes y sus familiares acompañantes contestaron los siguientes instrumentos: Escala de cohesión y adaptación familiar (FACES-II) de Olson et al., Perfil de Inteligencia Emocional (PIEMO 2000) de Cortés et al., Inventario de Ansiedad de Beck, Inventario de depresión de Beck. Los familiares contestaron además el Cuestionario de Creencias y Atribuciones sobre la enfermedad de Salorio et al. Además se recabaron datos sobre la estructura familiar. La muestra se conformó por 48 pacientes y 61 familiares. Todos los instrumentos fueron autoaplicados. Una vez obtenida la tipología según el modelo circumplejo de Olson se compararon el perfil emocional y los síntomas ansiosos y depresivos por medio de ANOVA factorial 2x3. Las creencias y atribuciones se compararon por medio de ANOVA simple. Resultados Se determinaron tres tipos de familia: 1. Las de alta cohesión con lineamientos caóticos para la expresión de emociones e ideas. 2. Las de alta cohesión con rigidez en la expresión de ideas y emociones y 3. Las de baja cohesión con escasa expresión de ideas y emociones. Se encontraron perfiles de inteligencia emocional diferentes tanto para pacientes como para familiares en cada uno de los tipos de familia. Las familias con alta cohesión y adaptación se manifiestan como las más inteligentes emocionalmente, menos ansiosas y deprimidas y con creencias más apegadas a la realidad. Sin embargo, este grupo fue el menos frecuente. Conclusiones Los resultados obtenidos son coherentes con los planteamientos de Olson en relación al funcionamiento de las familias. En el caso específico del trastorno obsesivo-compulsivo estos hallazgos permiten entender la dinámica familiar que pudiera caracterizar el mantenimiento de la sintomatología en los pacientes identificados. La intervención familiar es un elemento importante a considerar para obtener mayores beneficios terapéuticos para el paciente.