ABSTRACT
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.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Aggression/physiology , Mental Disorders/physiopathology , Personality Disorders/physiopathology , Personality Disorders/therapy , Suicide, Attempted/statistics & numerical data , Mood Disorders/physiopathology , Mood Disorders/therapy , Emergency Services, Psychiatric/statistics & numerical data , Hospitalization/statistics & numerical data , Mental Disorders/therapy , Middle AgedABSTRACT
En este artículo describiremos brevemente ciertos pacientes que consultan por cuadros psiquiátricos agudos y que además sufren de difusión de identidad. Estos pacientes ofrecen dificultades importantes a su propio tratamiento porque tienden a no persistir en una tarea, no cuidar de sí mismos, no confiar en las personas y a no recuperarse de las fallas de mentalización que puedan tener en sus relaciones interpersonales, produciendo graves complicaciones en el proceso terapéutico. Describiremos el Programa de Intervención Psicoeducativa y Control Farmacológico en Grupo que hemos implementado en el Instituto Psiquiátrico José Horwitz Barak para manejar de mejor forma las dificultades terapéuticas que estos pacientes ofrecen.
In this article we will briefly describe certain patients who consult for acute psychiatric symptoms and who also suffer from identity diffusion. These patients offer significant difficulties to their own treatment because they tend not to persist in a task, do not take care of themselves, do not trust people and do not recover from the mentalization failures they may have in their interpersonal relationships, producing serious complications in the therapeutic process. We will describe the Program of Psychoeducative Intervention and Pharmacological Control in Group that we have implemented in the José Horwitz Barak Psychiatric Institute to better manage the therapeutic difficulties that these patients offer.
Subject(s)
Humans , Personality Disorders/psychology , Personality Disorders/therapy , Personality Disorders/drug therapy , Psychotherapy, Group , Patient Education as Topic , Treatment Refusal , Patient ComplianceABSTRACT
Paciente ELENA, 21 años. embarazo 27 semanas, separada, 4 intentos suicidas previos. Fue usuaria del programa de salud mental infantil y adulto Hospital el Pino (HEP). Hospitalizada en H. de día el año 2017. Año 2013, Alucinaciones auditivas y visuales y desajustes conductuales: Grita, rompe cosas, se pega en la cabeza. Comienza a aislarse y a faltar al colegio y atribuye sus síntomas a consumo de marihuana. Principales focos de terapia son: Disminuir situaciones de crisis y adherencia al tratamiento. Presenta mala adherencia a controles y fármacos de salud mental. Se deriva a Hospital de día. Rorschach muestra desarrollo anormal de la personalidad con rasgos histriónicos, juicio de realidad conservado y dificultad en capacidad de empatizar. Salud mental adulto: (Julio, 2015): Heridas autolíticas (cortes y rasguños), Ideas pasivas de muerte. Intervenciones desde hospital de día: Manejo de crisis, trabajar en vínculo simbiótico con madre; recibe atención por psiquiatra, terapeuta ocupacional, psicólogo y nutricionista, incluyendo intervenciones en equipo. Controles en ambulatorio (Nov 2015): Impresiona mayor conciencia de enfermedad. Abandona fármacos al sentirse mejor. Foco orientado a: Autorregulación emocional y entrenamiento cognitivo para manejo de síntomas ansiosos.
ELENA, 21 years old. Pregnancy 27 weeks, separate, 4 previous suicide attempts. She was a member of the children and mental health program Hospital el Pino (HEP). Hospitalized in Day Hospital in year 2017. 2013: Auditory and visual hallucinations and behavioral maladjustments: Screams, breaks things, hits herself in the head. She begins to isolate and to miss to the school and attributes her symptoms to consumption of marijuana. Main focuses of therapy are: To reduce crisis situations and adherence to treatment. She has poor adherence to mental health drugs and controls. She is derived to day hospital. Rorschach shows abnormal personality development with histrionic traits, a reality-preserved judgment, and difficulty in empathizing. Adult mental health: (July, 2015): Self-injuries (cuts and scratches), Passive death ideas. Interventions in day hospital: Crisis management, working in symbiotic relationship with mother; receives attention by psychiatrist, occupational therapist, psychologist and nutritionist, Including team interventions. Outpatient Control (Nov 2015): Increased awareness of illness. Abandon drugs because of feeling better. Focus oriented to: Emotional self-regulation and cognitive training for the management of anxious symptoms.
Subject(s)
Humans , Female , Young Adult , Personality Development , Personality Disorders/diagnosis , Personality Disorders/therapy , Patient Compliance , Self-Injurious Behavior , Suicidal Ideation , Treatment Adherence and ComplianceABSTRACT
Hay muchas razones por las que los hombres maltratadores contra la pareja deben recibir tratamiento psicológico. En este artículo se analizan los transtornos más relevantes, tales como el abuso de alcohol/drogas, los celos patológicos y los transtornos de personalidad (antisocial, límite, narcisista y paranoide), así como los déficits psicológicos de estas personas, tales como el descontrol de la ira, las dificultades emocionales, las distorsiones cognitivas, la baja autoestima y los déficits de comunicación y de solución de problemas. Se describen las tipologías de hombres maltratadores más relevantes y se señala su importancia para la planificación del tratamiento individualizado. La inclusión de medidas penales y de tratamiento psicológico es posible. Se analiza la motivación para el tratamiento y se señalan las principales vías de intervención terapéutica, así como los resultados obtenidos. Por último, se comentan las líneas de investigación más urgentes para el futuro.
There are many reasons why men who batter should be psychologically treated. In this paper the most relevant mental disorders, such as substance use disorder, pathological jealousy, and antisocial, borderline, narcissistic and paranoid personality disorders, and psychological deficits of batterer men, such as anger, emotional difficulties, cognitive distortions, low self-esteem and deficits in social skills and problem solving, are analyzed. Male domestic violence offender typologies according to the most relevant classifications are commented. The role of these typologies for treatment is pointed out. An analysis of how to combine court intervention and psychological treatment to rehabilitate abusive men is also carried out. Motivational enhancement strategies and effective therapy for men who batter are discussed. Finally, the future perspectives and the most relevant goals of research are commented on.
Subject(s)
Humans , Male , Intimate Partner Violence/psychology , Mental Disorders/therapy , Personality Disorders/therapy , Spouse Abuse/psychology , Alcoholism/psychologyABSTRACT
La personalidad puede ser entendida como una organización dinámica de los sistemas biológicos, psicológicos y sociales que determinan los modos de relación del individuo con su ambiente y las experiencias subjetivas concomitantes, que cumple una función adaptativa al intentar armonizar las necesidades internas con las exigencias externas. Su desarrollo anormal y perturbado, delimita los Trastornos del Desarrollo de la Personalidad (TDP). El abordaje terapéutico de los TDP, incluye intervenciones de diversa índole: Psicoeducación, Psicoterapia Individual, Terapia de Grupo, Terapia Familiar, Hospitalización, Hospitalización diurna y Psicofarmacológica. Estas intervenciones deben integrarse en un dispositivo terapéutico altamente estructurado e integrado, incorporando las consideraciones del desarrollo. El presente artículo pretende presentar evidencia disponible respecto de las intervenciones terapéuticas en población Infanto Juvenil con diagnóstico de TDP.
Personality can be understood as a dynamic organization of biological, social and psychological systems, which determine the ways an individual interacts with his environment and his subsequent subjective experiences, and it serves an adaptative function in that it attempts to harmonize internal needs with external demands. Personality development disorders (PDD) are defined by the personality's development in an abnormal and disturbed path. The treatment of PDD includes different types of interventions, such as: psychoeducation, individual psychotherapy, group therapy, family therapy, hospitalization, day time hospitalization and psychopharmacotherapy. These interventions must be integrated to a highly structured therapeutic device that considers developmental issues. This article attempts to review the available evidence of therapeutic interventions in children and adolescents with a PDD diagnosis.
Subject(s)
Humans , Child , Adolescent , Personality Disorders/therapy , Psychotherapy/methods , Personality Disorders/psychology , Personality Disorders/drug therapy , Antipsychotic Agents/therapeutic use , Borderline Personality Disorder/therapy , Cognitive Behavioral Therapy , Selective Serotonin Reuptake Inhibitors/therapeutic use , Dialectical Behavior Therapy , Emotional Regulation , Mentalization-Based TherapyABSTRACT
OBJECTIVE: To assess the clinical outcome of patients with personality disorder, receiving treatment with psychohistoriographic brief psychotherapy (PBP). METHOD: Patients seen in the author's private practice from 1974 - 2010 with a Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) personality disorder diagnosis were treated with PBP. Demographic, clinical responses and one-year clinical outcome measures were disaggregated and analysed, using SPSS, version 17. RESULTS: One hundred patients completed treatment with PBP, male:female 34:64; mean age of 35.86 ± 10.28 (range 16 - 66) years. Forty-five per cent were married, 73% were of predominantly African racial origin, with 59% from socio-economic class (SEC) I and 39% from SEC II and III. The presenting complaints were interpersonal conflict (35%), anxiety (21%) and depressed mood (20%). Major depression (30%), substance abuse disorder (18%) and generalized anxiety disorder (13%) were the most common Axis I diagnoses. Histrionic personality disorder (39%) and avoidant personality disorder (35%) were the main Axis II diagnoses. Psychohistoriography was completed with all patients, and charted by 96%. Transference variants were experienced by all patients and worked through with 87%. The quadranting process was completed by 42% with goal setting instituted by 96% and actualization scoring fully completed by 34%. A continuous exercise programme was instituted by all patients, and was maintained by 56% at one-year follow-up. Ninety-four per cent reported fair (10%), good (68%) to very good/excellent (16%) improvement on completion of PBP, with 72% assessed as maintaining fair to good clinical improvement by the therapist at one-year follow-up. CONCLUSION: Patients with personality disorders showed clinical improvement one year after being treated with psychohistoriographic brief psychotherapy.
OBJETIVO: Evaluar el resultado clínico de pacientes con trastorno de la personalidad, que reciben tratamiento con Psicoterapia Breve Psicohistoriográfica (PBP). MÉTODO: Pacientes vistos en la práctica privada del autor desde 1974-2010 con diagnóstico de trastorno de la personalidad sobre la base del Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta edición revisada (DSM-IV-TR), fueron tratados con PBP. Las respuestas demográficas, clínicas y las medidas de resultado clínicas de un año, fueron desglosadas y analizadas utilizando SPSS, versión 17. RESULTADOS: Cien pacientes completaron el tratamiento con PBP, 34:64 hombres: mujeres; edad promedio 35.86 ± 10.28 años (rango 16-66). El cuarenta y cinco por ciento eran casados, 73% eran de origen racial predominantemente africano, con el 59% de clase socio-económica (SEC) I, y 39% de SEC II y III. Los problemas presentados fueron: conflictos interpersonales (35%), ansiedad (21%), y estados de ánimo depresivo (20%). La depresión grave (30%), los trastornos por abuso de sustancias (18%), y los trastornos de ansiedad generalizada (13%) fueron los diagnósticos más comunes del Eje I.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Personality Disorders/therapy , Psychotherapy/methods , Personality Disorders/diagnosis , Treatment Outcome , Diagnostic and Statistical Manual of Mental Disorders , JamaicaABSTRACT
The intellectual exploration of phenomenological and psychiatric discovery that has flowered in the Caribbean in the period of political independence from British colonization is a reflection of the scholarship that has emerged from the academic nurturance by The University of the West Indies. Burgeoning migration of Caribbean people to England in the twentieth century has resulted in high reported rates of psychosis for this migrant population. Caribbean research into this condition has revealed that there exist hostile racial and environmental challenges in Britain that have had a profound pathological effect on the mental health of African Caribbean migrants. These findings have significantly shifted the pendulum of understanding of the aetiology of this condition from a genetic to a biopsychosocial position. Research has also revealed longstanding psychopathological effects of slavery and colonialism in the Caribbean that have had significantly negative long term effects on the mental health of many within the Caribbean population. Current research suggests that there is a need to nurture protective strategies to enhance resilience and social capital, which would ensure the wellness and continued survival of Caribbean people in spite of the many challenges they face.
La exploración intelectual del descubrimiento fenomenológico y psiquiátrico que ha florecido en el Caribe en el periodo de independencia política de la colonización británica, es un reflejo de la erudición surgida del cultivo académico de la Universidad de West Indies. La pujante migración de personas del Caribe a Inglaterra en el siglo 20, ha traído como consecuencia reportes de altas tasas de psicosis en relación con esta población de emigrantes. La investigación caribeña de esta condición ha revelado la existencia de retos producidos por la hostilidad racial y ambiental en Gran Bretaña, que han tenido un profundo efecto en la salud mental de los emigrantes afrocaribeños. Estos resultados han desplazado significativamente el péndulo de la comprensión de la etiología de esta condición, desde una posición genética a una posición biopsicosocial. La investigación también ha revelado la presencia de efectos psicopatológicos pertinaces provenientes de la esclavitud y el colonialismo en el Caribe. Se trata de efectos significativamente negativos y a largo plazo, sobre la salud mental de muchos dentro de la población caribeña. La investigación actual sugiere que hay una necesidad de fomentar estrategias de protección a fin de mejorar la resiliencia y el capital social, que asegurarían el bienestar y la continuación de la supervivencia de las personas del Caribe, a pesar de los muchos desafíos a que se enfrentan.
Subject(s)
History, 20th Century , Humans , Mental Disorders/therapy , Colonialism , Emigration and Immigration , Mental Disorders/history , Mental Health , Personality Disorders/therapy , Resilience, Psychological , West IndiesABSTRACT
Introduction: OPD (Operationalized Psychodynamic Diagnosis) is a recently introduced semi-structured and operationalized method of personality evaluation and diagnosis in developing countries. This preliminary report assess the impact of intensive training on OPD's criterion validity and inter rater reliability. Method: 15 psychotherapists recently introduced to OPD's theory and scoring procedures, rated a clinical interview during an 120 hours intensive training. Three months after training, they were asked to rate the same interview. Results: Concerning criterion validity, training does it impact on agreement with expert judgment, but it does on psychotherapeutic relevant items. Concerning inter-rater reliability our data matched already published studies, e.gr. inter-rater reliability of Axis I and IV improves significatively after training.
Introducción: El OPD (Diagnóstico Psicodinámico Operacionalizado) es un método semi-estructurado de evaluación y diagnóstico de personalidad, recientemente introducido en países desarrollados. Este reporte preliminar evalúa la validez de criterio y la confiabilidad inter -evaluador, a partir del impacto generado por un un entrenamiento intensivo en el uso del instrumento. Método: 15 psicoterapeutas recientemente introducidos a la teoría y al uso del OPD, evaluaron una entrevista clínica, mientras formaban parte de un entrenamiento de 120 horas. Tres meses después de finalizado el entrenamiento, se les pidió que volvieran a evaluar la misma entrevista. Resultados: De acuerdo a la validez de criterio externo el entrenamiento no impacta en el acuerdo con el evaluador experto, pero sí lo hace en los ítems psicoterapéuticamente relevantes. En relación a la confiabilidad inter-evaluador, los resultados se condicen con los estudios revisados en la literatura. Los resultados de la confiabilidad inter-evaluador del eje I y el eje IV se incrementan significativamente después del entrenamiento.
Subject(s)
Humans , Interview, Psychological , Psychiatric Status Rating Scales , Psychotherapy , Personality Disorders/diagnosis , Chile , Observer Variation , Personality , Personality Assessment , Psychometrics , Reproducibility of Results , Personality Disorders/therapyABSTRACT
Objective: To review the psichological effects of DM1 on children and adolescents, and review a clinical case. Method: SIBUC (Electronic System of PUC Lybrary) Bibliographic search. Clinical Case: 13 year old adolescent diagnosed with DM1 since the age of 3, with poor treatment adherence, and poor social relationships. History of Anxiety Disorders diagnosed at age 10, partially treated with medications and psychotherapy. Currently anxious, hopeless regarding illness outcome. Treated with Sertraline and psychotherapy, presented behavioral and autonomy issues. Review: The relationship between DM1 and psychiatric topics is reviewed, including some hypotheses, issues such as attachment, body-self relationship, separation-individuation. Suggestions are made for parents and treatment teams for systematic follow up of these patients and in preventing and treating psychological complications of DM1. Conclusions: DM1 is associated to significant psychopathology in children and adolescents. Due to its complications, it needs to be prevented and treated promptly to improve the outcome of these patients.
Objetivo: Revisar los efectos psicológicos de la DM1 sobre los niños y adolescentes; comentar un caso clínico. Métodos: Búsqueda en la base de datos de SIBUC (Sistema Electrónico de Bibliotecas de la Pontificia Universidad Católica de Chile) de artículos que incluyeran "Diabetes Mellitus Insulino Dependiente" y "Patología Psiquiátrica en la Infancia y Adolescencia". Caso clínico: Adolescente de 13 años con diagnóstico de DM1 desde los 3 años, con mala adherencia al tratamiento y problemas relaciónales. Antecedentes de trastorno ansioso, diagnosticado a los 10 años, cuya terapia, farmacológica y terapéutica, fue parcialmente cumplida. Al consultar, angustiado y desesperanzado respecto al pronóstico de su enfermedad. Se inició Sertralina y psicoterapia, con regular evolución, presentando problemas conductuales y de autonomía. Revisión: Se revisa la asociación entre DM1 y patología psiquiátrica, la hipótesis de la génesis de estas asociaciones y temas como el apego, la relación cuerpo-self y la individuación. Se realizan sugerencias para los padres y para el equipo médico, respecto del seguimiento sistemático de estos pacientes, y así contribuir a una mejor prevención y tratamiento de la psicopatología asociada a la DM1. Conclusión: La DM1 se asocia a importante psicopatología en la infancia y adolescencia. Por sus importantes implicancias esta debe ser estudiada en mayor profundidad y la enfermedad prevenida y tratada oportunamente para mejorar el abordaje de estos pacientes.
Subject(s)
Humans , Child , Adolescent , Diabetes Mellitus, Type 1/psychology , Mental Disorders/psychology , Mental Disorders/therapy , Diabetes Mellitus, Type 1/complications , Interviews as Topic , Object Attachment , Parent-Child Relations , Depressive Disorder/psychology , Depressive Disorder/therapy , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Personality Disorders/psychology , Personality Disorders/therapyABSTRACT
OBJECTIVE: This paper reports the first population estimates of prevalence and correlates of personality disorders in the Mexican population. METHOD: Personality disorders screening questions from the International Personality Disorder Examination were administered to a representative sample of the Mexican urban adult population (n = 2,362) as part of the Mexican National Comorbidity Survey, validated with clinical evaluations conducted in the United States. A multiple imputation method was then implemented to estimate prevalence and correlates of personality disorder in the Mexican sample. RESULTS: Multiple imputation method prevalence estimates were 4.6 percent Cluster A, 1.6 percent Cluster B, 2.4 percent Cluster C, and 6.1 percent any personality disorder. All personality disorders clusters were significantly comorbid with DSM-IV Axis I disorders. One in every five persons with an Axis I disorder in Mexico is likely to have a comorbid personality disorder, and almost half of those with a personality disorder are likely to have an Axis I disorder. CONCLUSIONS: Modest associations of personality disorders with impairment and strong associations with treatment utilization were largely accounted for by Axis I comorbidity suggesting that the public health significance of personality disorders lies in their comorbidity with, and perhaps effects upon, Axis I disorders rather than their direct effects on functioning and help seeking.
OBJETIVO: Este trabajo presenta las primeras estimaciones poblacionales de la prevalencia de los trastornos de personalidad y sus correlatos en la población mexicana. MÉTODO: Se aplicó un tamizaje con base en el International Personality Disorder Examination a una muestra representativa de la población adulta mexicana en áreas urbanas (n = 2362) como parte de la Encuesta Mexicana Nacional de Epidemiología Psiquiátrica, validada con evaluaciones clínicas realizadas en los Estados Unidos. RESULTADOS: Se implementó un método de imputación múltiple para estimar la prevalencia y los correlatos de los trastornos de personalidad en la muestra mexicana proporcionando una prevalencia de 4.6 por ciento Grupo A, 1.6 por ciento Grupo B, 2.4 por ciento Grupo C, y 6.1 por ciento cualquier trastorno de personalidad. Todos los grupos de trastornos de personalidad fueron significativamente comórbidos con los trastornos del Eje I del DSM-IV. Una de cada cinco personas con un trastorno de Eje-I en México presenta un trastorno de personalidad comórbido y casi la mitad de aquellos con un trastorno de personalidad presenta un trastorno del Eje I. CONCLUSIONES: Asociaciones modestas de trastornos de personalidad con discapacidad y asociaciones mayores con la utilización de servicios se debe a la comorbidad con el Eje-I. El impacto de los trastornos de personalidad en la salud pública reside en su comorbilidad con los trastornos del Eje-I y no en su impacto directo sobre el funcionamiento o la búsqueda de ayuda.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Diagnostic and Statistical Manual of Mental Disorders , Mental Health/statistics & numerical data , Personality Disorders/epidemiology , Population Surveillance , Comorbidity , Epidemiologic Methods , Mass Screening , Mental Health Services , Mexico/epidemiology , Personality Disorders/diagnosis , Personality Disorders/therapy , Social Work , Socioeconomic Factors , Urban Population , World Health Organization , Young AdultABSTRACT
OBJECTIVE: Comorbidity with personality disorders in obsessive-compulsive patients has been widely reported. About 40 percent of obsessive-compulsive patients do not respond to first line treatments. Nevertheless, there are no direct comparisons of personality traits between treatment-responsive and non-responsive patients. This study investigates differences in personality traits based on Cloninger's Temperament and Character Inventory scores between two groups of obsessive-compulsive patients classified according to treatment outcome: responders and non-responders. METHOD: Forty-four responsive and forty-five non-responsive obsessive-compulsive patients were selected. Subjects were considered treatment-responsive (responder group) if, after having received treatment with any conventional therapy, they had presented at least a 40 percent decrease in the initial Yale-Brown Obsessive Compulsive Scale score, had rated "better" or "much better" on the Clinical Global Impressions scale; and had maintained improvement for at least one year. Non-responders were patients who did not achieve at least a 25 percent reduction in Yale-Brown Obsessive Compulsive Scale scores and had less than minimal improvement on the Clinical Global Impressions scale after having received treatment with at least three selective serotonin reuptake inhibitors (including clomipramine), and at least 20 hours of cognitive behavioral therapy. Personality traits were assessed using Temperament and Character Inventory. RESULTS: Non-responders scored lower in self-directedness and showed a trend to score higher in persistence than responders did. CONCLUSION: This study suggests that personality traits, especially self-directedness, are associated with poor treatment response in obsessive-compulsive patients.
OBJETIVO: Comorbidade com transtornos de personalidade tem sido extensamente descrita no transtorno obsessivo-compulsivo. Aproximadamente 40 por cento dos pacientes com transtorno obsessivo-compulsivo não respondem a tratamentos de primeira linha. Não obstante, não existem estudos comparando diretamente traços de personalidade entre pacientes responsivos e refratários ao tratamento do transtorno obsessivo-compulsivo. Este estudo investiga diferenças nos traços da personalidade baseados no Inventário de Temperamento e Caráter de Cloninger (TCI) entre dois grupos de pacientes com transtorno obsessivo-compulsivo classificados segundo desfecho terapêutico: responsivos e refratários. MÉTODO: Quarenta e cinco pacientes refratários e 44 responsivos foram selecionados. Os indivíduos foram considerados responsivos se, após tratamento com terapêutica convencional, apresentaram diminuição de ao menos 40 por cento no escore inicial da Yale-Brown Obsessive Compulsive Scale, foram classificados como "melhor" ou "muito melhor" na Clinical Global Impressions; e mantiveram melhora por pelo menos um ano. Os refratários eram os pacientes que não atingiram redução de ao menos 25 por cento na Yale-Brown Obsessive Compulsive Scale e tiveram a melhoria menor que "mínima" na Clinical Global Impressions após o tratamento com ao menos três inibidores seletivos da recaptura de serotonina, incluindo clomipramina, e ao menos 20 horas da terapia cognitiva-comportamental. Os traços da personalidade foram avaliados através do Temperament and Character Inventory. RESULTADOS: Refratários pontuaram menos em autodirecionamento e tenderam a pontuar mais em persistência. CONCLUSÃO: Este estudo sugere que os traços de personalidade, especialmente autodirecionamento, estão associados com a resposta pobre do tratamento em pacientes com transtorno obsessivo-compulsivo.
Subject(s)
Adult , Female , Humans , Male , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/therapy , Personality Disorders/therapy , Temperament/physiology , Cross-Sectional Studies , Personality Disorders/psychology , Personality Inventory , Psychiatric Status Rating Scales , Psychotherapy , Self Efficacy , Statistics, Nonparametric , Treatment OutcomeABSTRACT
A etiologia do sintoma psicossomático continua indefinida, apesar de inúmeros estudos de ciências afins. Apresento a hipótese de que este só se desenvolve em paciente portador de personalidade autista como predisposição, isto é, que tenha barreiras autistas - apego às "formas autistas" e aos "objetos autistas" - em resposta a um trauma no período fetal ou do nascimento, que promova sensação de descontinuidade física. Essas formas e objetos são elementos do próprio corpo, como a saliva, a língua, os dedos e as mãos em contato com suas próprias superfícies sensórias, mais a pele. A soma do registro dessas sensações pela memória implícita incipiente ou em desenvolvimento funciona como um ego biológico sem sujeito cognitivamente interpretante. O paciente portador de personalidade autista, diante de um novo trauma com a mesma sensação de morte, retira-se para o estado de homeostase autista, como se já soubesse o caminho, e aí fica hospedado. Dessa forma, seu corpo se converte em uma "mãe suficientemente boa", conforme conceituada por Winnicott. O sintoma psicossomático é uma representação das defesas biológicas e não um representante de conflitos que têm como base elementos sexuais ou destrutivos reprimidos. Inclui a angústia de morte, de deixar de existir. Os fenômenos psicossomáticos escondem, paradoxalmente, uma luta pela vida e, especialmente, pela sobrevivência psíquica do paciente, segundo MacDougall.
Etiology of psychosomatic symptoms remains unclear, in spite of many studies by similar sciences. I present the hypothesis that the patient needs to have an autistic personality as predisposition, i.e., he needs to have autistic barriers - attachment to "autistic forms" and to "autistic objects" - in response to a fetal or postpartum trauma that produces a feeling of physical discontinuity. These forms and objects are elements of the body itself, such as saliva, fingers, tongue, and hands in contact with its own sensory surfaces, especially the skin. The sum of these registers by incipient or developing implicit memory works as a biological ego without a cognitively interpreting subject. The patient with an autistic personality withdraws to the autistic homeostatic state when there is a trauma with an instinctive notion of death, as if he already knew the way and remains in suspension there. Thus, the body becomes a "good enough mother," as quoted by Winnicott. Psychosomatic symptoms are a representation of biological defenses, and not a representative of conflicts based on repressed sexual or destructive elements. It includes death anxiety, of no longer existing. Psychosomatic symptoms paradoxically hide a fight to live and especially to the patient's psychic survival, according to MacDougall.