Suicidal patients in a psychiatric emergency unit: clinical characteristics and aggression profile / Pacientes suicidas em uma unidade de emergência psiquiátrica: características clínicas e perfil de agressão

Abstract Objective To explore and describe a profile of patients admitted to a psychiatric emergency facility, comparing patients with and without a recent suicide attempt in terms of their clinical characteristics and aggression. Methods This was an exploratory comparative study where patients were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Overt Aggression Scale (OAS). Participants with a suicide attempt in the last 24 hours (SA) were compared to participants with a prior history of suicide attempt but no recent attempt (PHSA). Results 63 individuals (SA: 26; PHSA: 37) were selected. Both groups had similar demographic and clinical characteristics. The most prevalent diagnoses were mood (57.1%) and personality (50.8%) disorders. The majority of patients in both groups had a history of aggression episodes. Physical aggression in the week prior to admission was more prevalent in the PHSA group (51.4 vs. 19.2%, p = 0.017). The PHSA group also presented higher activation scores (p = 0.025), while the SA group presented higher affect scores on BPRS dimensions (p = 0.002). Conclusion The majority of individuals with a history of suicide attempt also presented a history of aggression. Inpatients with recent suicide attempt were hospitalized mainly due to the risk of suicide, while those with no recent suicide attempt were hospitalized mainly due to the risk of hetero-aggression. These findings support the hypothesis of an aggressive profile in suicidal patients and may open up a path for future research.

Resumo Objetivo Explorar e descrever o perfil de pacientes internados em uma unidade de emergência psiquiátrica, comparando os pacientes com e sem tentativa recente de suicídio em termos de suas características clínicas e agressividade. Métodos Trata-se de um estudo exploratório comparativo, onde os pacientes foram avaliados por meio da Escala Breve de Avaliação Psiquiátrica (BPRS) e da Escala de Agressividade Declarada (OAS). Os participantes com tentativa de suicídio (TS) nas últimas 24 horas foram comparados com participantes com história prévia de tentativa de suicídio, mas sem tentativa recente (HPTS). Resultados Foram selecionados 63 indivíduos (TS: 26; HPTS: 37). Ambos os grupos tinham características demográficas e clínicas semelhantes. Os diagnósticos mais prevalentes foram transtornos de humor (57,1%) e de personalidade (50,8%). A maioria dos pacientes em ambos os grupos apresentava história de agressão. A agressão física na semana anterior à internação foi mais prevalente no grupo HPTS (51,4 vs. 19,2%, p = 0,017). O grupo HPTS também apresentou maior ativação (p = 0,025), enquanto o grupo TS apresentou maior afetividade nas dimensões da BPRS (p = 0,002). Conclusão A maioria dos indivíduos com história de tentativa de suicídio também apresentou história de agressão. Os pacientes internados com tentativa recente de suicídio foram hospitalizados principalmente devido ao risco de suicídio, enquanto aqueles sem tentativa recente de suicídio foram hospitalizados principalmente devido ao risco de heteroagressão. Esses achados apoiam a hipótese de um perfil agressivo em pacientes suicidas e podem abrir caminho para pesquisas futuras.

Aportes sobre el correlato neuroanatómico de la personalidad / Contributions on neuroanatomical correlate of personality

Concept of personality is refers to stable and relevant attributes of a person, that explain consistent behavior patterns. Many researchers have different brain areas involved in controlling personality. Several highlighted the role of the orbitofrontal cortex in the ability to reverse the association between stimulus and reinforcement, others associated it later with the prediction ofsensory events subsequent results. The medial frontal cortex has been involved with functions as the control of actions, monitoring results as punishments and rewards, personal perception of stimuli and social cognition. Others include the lateral prefrontal cortex in complex issues of valuation. Finally, the anterior temporal region is considered to be related with facial recognition and social knowledge. In this paper we review evidence available in today’s literature about the neuroanatomical substrate ofpersonality, and its application to the study of two disorders: psychopathy and borderline personality disorder. Understanding this substrate could mean a contribution for treatment.

La personalidad corresponde a aquellos atributos estables y relevantes de una persona, que explican patrones consistentes de comportamiento. Muchos investigadores han implicado distintas áreas cerebrales en el control de la personalidad. Varios destacaron el papel de la corteza orbitofrontal en la capacidad de revertir la asociación estímulo refuerzo y posteriormente en la predicción de resultados posteriores a eventos sensoriales. Se ha involucrado a la corteza medial frontal en funciones como el control de las acciones, el monitoreo de resultados como castigos y recompensas, la percepción personal de estímulos y la cognición social. Otros incluyen a la corteza prefrontal lateral en aspectos complejos de la valoración. Por último, se considera a la región temporal anterior en el reconocimiento facial y también en el conocimiento social. En la presente revisión se expone parte de la evidencia disponible en la actualidad en la literatura, acerca del sustrato neuroanatómico de la personalidad y su aplicación al estudio de dos patologías: la psicopatía y el trastorno limítrofe. La comprensión de este sustrato puede significar un aporte para el tratamiento.

Personality prototype as a risk factor for eating disorders

Objective: To establish whether the risk of suffering from an eating disorder (ED) is associated with the high-functioning, undercontrolled, or overcontrolled personality prototype groups. Method: The Revised NEO Personality Inventory (NEO-PI-R) and the Eating Disorder Inventory 2 (EDI-2) were administered to 69 patients diagnosed as suffering from EDs (cases) and 89 people free of any ED symptoms (control group). A cluster analysis was carried out to divide the participants into three groups based on their scores in the Big Five personality dimensions. A logistic regression model was then created. Results: Participants in the undercontrolled group had a risk of suffering from an ED 6.517 times higher than those in the high-functioning group (p = 0.019; odds ratio [OR] = 6.517), while those in the overcontrolled subgroup had a risk of ED 15.972 times higher than those in the high-functioning group. Conclusions: Two personality subtypes were identified in which the risk of EDs was six times higher (the undercontrolled group) and almost 16 times higher (the overcontrolled group). Prevention and treatment programs for ED could benefit from focusing on the abovementioned personality profiles.

Trichotillomania and personality traits from the five-factor model

Objective: To examine whether personality traits have predictive validity for trichotillomania (TTM) diagnosis, pulling severity and control, and hair pulling style. Methods: In study 1, logistic regression was used with TTM cases (n=54) and controls (n=25) to determine if NEO Five-Factor Inventory (NEO-FFI) personality domains predicted TTM case vs. control classification. In study 2, hierarchical multiple regression was used with TTM cases (n=164) to determine whether NEO-FFI personality domains predicted hair pulling severity and control as well as focused and automatic pulling styles. Results: TTM case vs. control status was predicted by NEO-FFI neuroticism. Every 1-point increase in neuroticism scores resulted in a 10% greater chance of TTM diagnosis. Higher neuroticism, higher openness, and lower agreeableness were associated with greater pulling severity. Higher neuroticism was also associated with less control over hair pulling. Higher neuroticism and lower openness were associated with greater focused pulling. None of the personality domains predicted automatic hair pulling. Conclusions: Personality traits, especially neuroticism, can predict TTM diagnosis, hair pulling severity and control, and the focused style of pulling. None of the personality traits predicted automatic pulling. Longitudinal studies are needed to determine whether personality variables predispose to TTM onset, impact disorder course, and/or result from hair pulling behavior.

Role of personality traits in cocaine craving throughout an outpatient psychosocial treatment program

Objective: Cocaine dependence is a major international public health concern. Its chronically relapsing nature is possibly related to craving intensity, which can be influenced by diverse biological and psychological aspects. This study aimed to evaluate the role of different personality traits in craving measured throughout a psychosocial treatment program. Method: The sample comprised 66 cocaine-dependent outpatients who were enrolled in an individual and manualized cognitive-behavioral therapy program. The influence of personality traits on craving intensity, frequency, and duration was analyzed using a generalized estimating equations model with an autoregressive correlation structure. Results: Craving varied during treatment. The personality traits of novelty seeking, reward dependence, and harm avoidance interacted with craving intensity, and the personality trait of persistence interacted with craving duration throughout the treatment period. Furthermore, there were significant interactions between drug use and craving intensity, and between different routes of administration and craving intensity. Participants who used cocaine/crack while in treatment and concurrent users of crack (i.e., freebase) cocaine and powder cocaine also had a higher craving intensity. Conclusion: The extent of craving variation can depend on certain personality styles. This study shows that craving is influenced by personality traits, and this may presumably change clinical expression involved in disease. .

Evaluación de trastorno de personalidad a partir de estudios de Neuro-SPECT / Assessment of personality disorder by means of NeuroSPECT

We report on functional imaging results in 24 patients of Personality Disorder (P.D.) performed with NeuroSPECT by means of Tc99m HMPAO, in Basal state and during frontal cortical activation by means of the Wisconsin Card Sorting Test. Results demonstrate that we can make the diagnosis of P.D. when we detect significant hypoperfusion (- 2 Stand/ Deviations below the normal mean for the same age group) in the subgenual area (Area 25 of Brodmann) and in Area 24 of Brodmann, the anterior cingulated gyrus. Both areas are paradoxically more hypoperfused during the Wisconsin Test. Among patients diagnosed with P.D. NeuroSPECT can distinguish between patients of Cluster B from the ones from Cluster C in both Basal and Activation State, while Cluster A from B could be differentiated only in Basal State. On the other hand Motor Impulsivity patients could be differentiated from the Cognitive group due to paradoxical hypoperfusion in motor areas 1,2,3, and 4 of Brodmann. While the number of patients studied appears reduced these results demonstrate the capability of diagnosing Personality Disorder and also the capability to improved understanding of the subgroups of this Disorder.

Se comunican los resultados de 24pacientes con Trastornos de Personalidad estudiados mediante Neuro-SPECT HMPAO Tc99m, técnica de imagenología funcional cerebral en condicionas basales y durante activación de la corteza frontal ejecutiva mediante la prueba de Wisconsin. Los resultados demuestras fehacientemente que el diagnóstico de Trastorno de Personalidad se basa en la presencia de disminución de perfusión (- 2 Desviaciones Standard bajo el promedio normal para el mismo grupo etario) en el Cingulado Anterior y región subgenual, exageradas paradojalmente durante la prueba de Wisconsin. Dentro de los pacientes demostrados como Trastorno de Personalidad, Neuro-SPECT es capaz de distinguir los pacientes del Cluster B de los del Cluster C en ambos estados de medición,(Estado Basal vs Prueba de Wisconsin) mientras los Cluster A y B fueron diferenciables en estado Basal solamente. Por otra parte, la Impulsividad Motora pudo ser distinguida de la Cognitiva por la hipoperfusión paradojal de las áreas frontales de Brodmann motoras 1,2,3 y 4. Si bien el número total de pacientes reportados en este trabajo, es relativamente limitado, abre posibilidades interesantes a la imagenología funcional cerebral en estado basal y durante activación mediante la prueba de Wisconsin para el diagnóstico y exploración del Trastorno de Personalidad.

Síndrome de personalidade interictal na epilepsia do lobo temporal não-dominante: relato de caso / Interictal personality syndrome in non-dominant temporal lobe epilepsy: case report

A síndrome de personalidade interictal na epilepsia do lobo temporal não-dominante consiste de hipossexualidade, hiperreligiosidade, alteração do humor e hipergrafia. Sua descrição, em 1974, foi seguida de extensa busca por estes sinais em uma vasta população de pacientes epilépticos. No entanto, estes estudos científicos fracassaram em encontrar este síndrome na epilepsia do lobo temporal em geral. Sua existência foi, por conseguinte, posta em dúvida. Apresentamos o caso de um senhor de 35 anos cuja peculiaridade hipergráfica é o desenho de plantas de construção civil em grande quantidade, além de hiperreligiosidade, hipossexualidade e circunstancialidade. É o primeiro relato deste tipo de expressão gráfica associada à epilepsia parcial complexa e esclerose mesial temporal. Dentre os mecanismos fisiopatológicos propostos, o mais coerente é o da hiperconexão temporal. Embora as crises possam ser controladas em grande parte dos casos com tratamento clínico ou cirúrgico, a sintomatologia comportamental é refratária ao tratamento psicoterápico.

De cómo Edipo llegó a ser complejo / How Oedipus became a complex

En un artículo anterior publicado en esta revista, expuse la propuesta de Jean Starobinski respecto al uso de la psiquiatría y el psicoanálisis como recursos hemenéuticos en el campo de la crítica literaria. En este segundo artículo -continuación del anterior- intento mostrar la forma en que Starobinski analiza la relación entre el autoanálisis de Freud, la construcción de la teoría psicoanalítica y algunos personajes de la literatura universal, como edipo y Hamlet. El análisis que Starobinski hace de la obra de Freud, muestra que los paradigmas que sirvieron a éste para la construcción del psicoanálisis son esencialmente literarios y que por lo tanto las grandes obras literarias pueden funcionar como moldes o guías para el proceso de reconstrucción del psíquismo en la psicoterapia. Es decir la literatura puede ser un recurso terapéutico

Personalidad y enfermedades afectivas / Personality and affective diseases

El tema de la relación entre la personalidad y las enfermedades afectivas (depresión mayor, ciclotimia y las distintas formas de bipolaridad) ha sido revisado extensamente en los últimos años por los autores norteamericanos H.S. Akiskal (1983) y Katherine Phillips et al.(1990). Los resultados de ambas revisiones son al menos confusos, puesto que muestran una enorme gama de formas distintas de relacionarse la personalidad y el cuadro afectivo ( ninguna de ellas esencial). Esto contradice en cierto modo la experiencia clínica cotidiana de que los depresivos monopolares son personas con características más o menos comunes y propias y lo mismo valdría para los bipolares. El autor plantea que las razones de la confusión reinante, así como de los resultados contradictorios obtenidos a este respecto en investigaciones empíricas, se podría deber a la falta de definiciones adecuadas (y no sólo estrictas) tanto del síndrome depresivo como del trastorno de personalidad. Lo primero intenta demostrarlo a través de las ventajas que tendría una fenomenología del síndrome depresivo sobre las definiciones operacionales. Lo segundo, a través de la teoría de los tipos ideales de Max Weber, que parece mucho más adecuada para la conceptualización de los trastornos de personalidad que la mera enumeración de rasgos obtenidos estadísticamente. Ejemplos de tipos ideales demostrados luego por investigaciones empíricas (von Zerssen y col., 1969, 1982, 1988) serían el typus melancholicus de Tellenbach (1961) y el typus manicus de von Zerssen (1988). Por último, se dan a conocer los interesantes resultados de una investigación sobre el tema realizada en Chile por Anneliese Dörr (1991) y dirirgida por el autor y en la cual los planteamientos de los mencionados autores alemanes sobre las relaciones entre personalidad y enfermedad afectiva se vieron ampliamente confirmados