Resiliência: avaliação de pacientes queimados em um hospital de urgência e emergência / Resilience: evaluation of burned patients in an urgency and emergency hospital / Resiliencia: evaluación de pacientes quemados en un hospital de urgencias y emergencias

A recuperação de vítimas de queimaduras é longa e dolorosa e afeta diversas esferas da vida do paciente. A resiliência, que se refere à capacidade humana de enfrentar e se adaptar a eventos adversos, exerce grande importância no processo de recuperação da queimadura. Logo, este trabalho objetiva avaliar a capacidade de resiliência de pacientes queimados, no momento da admissão e da alta hospitalar, em um hospital de emergência e urgência de Goiânia. Trata-se de um estudo descritivo, quantitativo e transversal que utiliza a Escala de Resiliência de Connor-Davidson (CD-RISC) como instrumento de mensuração. Na admissão hospitalar, a média da resiliência foi de 71,35, tendo sido observada uma relação significativa entre o fator Amparo da escala CD-RISC e a presença do(a) companheiro(a). O escore de resiliência encontrado nesta pesquisa é consistente com outros achados da literatura científica internacional e nacional referente à expressão da resiliência em vítimas de queimaduras e outros adoecimentos. A relação entre o fator Amparo e a presença de um(a) companheiro(a) enfatiza a importância da rede de apoio familiar na reabilitação do paciente queimado.(AU)

The recovery of burned patients is long and painful and impacts on different areas of people's lives. Resilience, which refers to the human capacity to face and adapt to adverse events, plays a major role in the process of recovery from burns. Therefore, the present study aims to assess the resilience of burned patients, on admission and hospital discharge, in an emergency and urgency hospital in Goiânia. This is a descriptive, quantitative and cross-sectional study that uses the Connor-Davidson Resilience Scale (CD RISC) as a measuring instrument. At hospital admission, the mean resilience was 71.35, with a significant association between the Support factor on the CD RISC scale and the presence of a partner. The resilience score found in the present study is consistent with other findings in the international and national scientific literature regarding the expression of resilience in victims of burns and other illnesses. The relationship between the Support factor and the presence of a partner emphasizes the importance of the family support network in the rehabilitation of the burned patient.(AU)

La recuperación de los pacientes quemados es larga y dolorosa e impacta en diferentes esferas de la vida de las personas. La resiliencia, que se refiere a la capacidad humana para enfrentar y adaptarse a eventos adversos, juega un papel importante en el proceso de recuperación de las quemaduras. Por tanto, el presente estudio tiene como objetivo evaluar la resiliencia de los pacientes quemados, en el momento del ingreso y el alta, en un hospital de emergencia y urgencia en Goiânia. Se trata de un estudio descriptivo, cuantitativo y transversal que utiliza la Escala de Resiliencia Connor-Davidson (CD RISC) como instrumento de medida. Al ingreso hospitalario, la resiliencia media fue de 71,35, con associación significativa entre el factor Amparo de la escala CD RISC y la presencia de pareja. El puntaje de resiliencia encontrado en el presente estudio es consistente con otros hallazgos en la literatura científica nacional e internacional sobre la expresión de resiliencia en víctimas de quemaduras y otras enfermedades. La relación entre el factor Amparo y la presencia de pareja enfatiza la importancia de la red de apoyo familiar en la rehabilitación del paciente quemado.(AU)

Violência sexual e aborto legal: possibilidades e desafios da atuação psicológica / Sexual offence and legal abortion: opportunities and challenges from psychological working / Violencia sexual y aborto legal: posibilidades y desafíos de la atención psicológica

A violência sexual e o aborto legal são temas tabus em nossa sociedade. No campo da saúde, a(o) psicóloga(o) atua em fases distintas, seja na avaliação psicológica do pedido pelo aborto legal, que culminará ou não em sua aquiescência; seja no momento posterior à solicitação, no atendimento em enfermarias ou ambulatorial. Partindo de relato de experiência, este artigo tem como objetivo refletir sobre as possibilidades e desafios da atuação psicológica no atendimento em saúde para pessoas em situação de gestação decorrente de violência sexual e que buscam pelo aborto legal. Para tanto, dividimos o artigo em três momentos. No primeiro deles, será possível encontrar dados conceituais, estatísticos e históricos sobre ambos os temas, trazendo recortes nacionais e internacionais. No segundo, trazemos apontamentos sobre o que chamamos de "eixos norteadores", ou seja, dialogamos com aspectos fundamentais para o trabalho nesta seara, sendo eles gênero, família, sexualidade e trauma. Por fim, no terceiro, aprofundamos a reflexão sobre o atendimento psicológico atrelado aos conceitos já discutidos, analisando de forma crítica principalmente um dos pontos mais espinhosos da atuação: a avaliação para aprovação (ou recusa) do pedido pelo aborto. Apoiamo-nos no referencial psicanalítico e defendemos que esta atuação psicológica é primordialmente uma oferta de cuidado, comprometido com as demandas das pessoas atendidas e com a promoção de saúde mental, e consideramos que o papel da psicologia é essencial para o reconhecimento do sofrimento e dos efeitos do abandono socioinstitucional na vida do público atendido.(AU)

Sexual abuse and legal abortion are taboo subjects in our society. On the health area, the psychologist works on different fields, such as psychological evaluation from the request of legal abortion, that will end or not on its approval, and also in a further moment, either the care on wards or ambulatorial treatment. Relying on a case report, this article aims to contemplate the possibilities and challenges from psychological work on healthcare to pregnant women from sexual violence and seek legal abortion. For this purpose, we divide this article in three moments. On the first, it will find definitions, statistics, and historical data about both issues, including national and international information. On the second, we bring notes called 'guiding pillar,' that is, we interact with fundamental aspects from this area, such as gender, family, sexuality, and trauma. On the third one, in-depth discussions we dwell on psychological care tied to the concepts previously addressed, critically analyzing one of the hardest moments of working in this area: the evaluation to approve (or refuse) the request for abortion. We lean over psychoanalytic thoughts and argue that this psychological work is primarily an offer of care, committed to the needs from those who seek us and to promoting good mental health and, also, we consider that psychology is essential to acknowledge the suffering and the effects of social and institutional neglect on the lives of the people seen.(AU)

La violencia sexual y el aborto son temas tabús en nuestra sociedad. En el campo de la salud, el(la) psicólogo(a) actúa en diferentes fases: en la evaluación psicológica de la solicitud del aborto legal, que culminará o no en su obtención, y/o en el momento posterior a la solicitud en la atención en enfermería o ambulatorio. Desde un reporte de experiencia, este artículo pretende reflexionar sobre las posibilidades y los desafíos de la Psicología en la atención en salud para personas en estado de embarazo producto de violencia sexual y que buscan un aborto legal. Para ello, este artículo está dividido en tres momentos. En el primer, presenta datos conceptuales, estadísticos e históricos sobre los dos temas, trayendo recortes nacionales e internacionales. En el segundo, comenta los llamados "ejes temáticos", es decir, se establece un diálogo con aspectos fundamentales para el trabajo en este ámbito, como género, familia, sexualidad y trauma. Por último, en el tercer, profundiza en la reflexión sobre la atención psicológica asociada a los conceptos discutidos, analizando de forma crítica uno de los puntos más espinosos de la actuación: la evaluación para la aprobación (o negativa) de la solicitud de aborto. Se utilizó el referencial psicoanalítico y se argumenta que esta atención psicológica es sobre todo una forma de cuidado, comprometida con las demandas de las personas atendidas y la promoción de la salud mental, y el papel de la Psicología es esencial para reconocer el sufrimiento y los efectos del abandono socioinstitucional en la vida del público atendido.(AU)

Domestic violence against women in the brazilian media: study of social representations / Violencia doméstica contra las mujeres en los medios de comunicación brasileños: estudio de representaciones sociales / Violência doméstica contra as mulheres na mídia brasileira: estudo de representações sociais

This study examined the content published by the newspaper Folha de São Paulo regarding domestic violence before and after Law 11340/06, commonly known as Maria da Penha Law, came into force. A retrospective and comparative documentary research analyzed 3408 news reports published between 1994 and 2018. Divided into two corpora, '12 years before' and '12 years after' the Law, the material was analyzed using the IRaMuTeQ software and Descending Hierarchical Classification. The first corpus included news reports on cases involving celebrities and little about ordinary people. It also covered the feminist struggle to reduce domestic violence, focusing on specialized police stations and shelters. The second corpus included reports on the achievements generated by the Law and its challenges, pointing out the need to regard the law as more than a punitive instrument, addressing its preventive and care spheres. Problematizing how the media discloses such law is paramount, since the content divulged affects the construction of social representations.(AU)

Este artículo tuvo por objetivo identificar el contenido de la violencia doméstica transmitido en el periódico Folha de S. Paulo antes y después de la Ley 11.340/2006 (Ley Maria da Penha). La investigación fue de carácter documental retrospectivo y comparativa, realizada a partir de 3.408 noticias difundidas entre 1994 y 2018. El material se dividió en dos corpus: 12 años antes y 12 años después de la Ley, y se analizó con el software IRaMuTeQ. En el primer corpus, los medios informaron casos de celebridades y poco sobre la gente común. También abordaron la lucha feminista para reducir la violencia doméstica. Como no existe una legislación específica, la atención se centró en estaciones de policía especializadas y refugios. En el segundo corpus, se observaron los logros generados por la Ley y sus desafíos. Se identificó la necesidad de mirar la Ley desde un punto de vista no solo punitivo, sino también abordando las esferas preventivas y de asistencia. Se enfatiza la importancia de problematizar la difusión de la Ley en los medios, ya que los contenidos generalizados afectan la construcción de las representaciones sociales.(AU)

Este artigo pretende identificar o conteúdo sobre violência doméstica difundido no jornal Folha de S. Paulo antes e depois da Lei 11340/06 (Maria da Penha). A pesquisa foi documental, retrospectiva e comparativa; com 3408 reportagens entre 1994 e 2018. O material foi dividido em dois corpora: 12 anos antes e 12 anos depois da lei, e analisado com software IRaMuTeQ. No primeiro corpus, a mídia divulgava casos de celebridades e pouco acerca de pessoas do cotidiano. Também trouxe a luta feminista para diminuir a violência doméstica. Em virtude da então inexistência de uma legislação específica, os destaques eram as delegacias especializadas e as casas abrigo. No segundo corpus, observou-se as conquistas geradas pela lei e seus desafios. Identificou-se a necessidade de olhar para a lei por um viés não apenas punitivista, abordando as esferas preventivas e assistenciais. Destaca-se a importância de problematizar a difusão da lei na mídia, visto que os conteúdos perpassados afetam a construção de representações sociais.(AU)

O protocolo ASSYST-RG reduz estresse em profissionais da saúde na pandemia / The ASSYST protocol reduces stress in health care workers in the pandemic

Introdução: o aparecimento de casos de COVID-19 acarretou o surgimento de estresse agudo na população em geral, em especial nos profissionais da saúde e, dentre eles, nos de saúde mental, que passaram a ter alta demanda para atendimento a pessoas acometidas de transtornos relacionados a trauma e a estressores, em decorrência de isolamento social, internação hospitalar, óbitos, piora da situação financeira com a perda de emprego, dentre outros. Objetivo: este trabalho, realizado com o Protocolo para Estabilização da Síndrome do Estresse Agudo remoto, em formato grupal, tem por Objetivo fornecer os primeiros cuidados psicológicos, visando a reduzir as perturbações e melhorar o funcionamento adaptativo, evitando a evolução para quadros psicológicos mais disfuncionais, como o transtorno de estresse pós-traumático (TEPT). Metodologia: foram selecionados 23 participantes (psicólogos) e todos responderam às escalas de avaliação psicométrica (HADS e PCL-5) antes e depois de duas (2) sessões de terapia on-line (videoconferência), com aplicação do referido Protocolo. Resultados: o modelo de regressão mostra redução média no escore de ansiedade de -2,3 (ep 0,9), com p-valor = 0,0010 (significante); no escore de depressão, média de 1,13 (p=0,125); e no escore de TEPT, redução média de ­9,5 (3,3), com p-valor=0,006. Discussão: os Resultados estatísticos revelaram aproximação com os Resultados da pesquisa realizada por Becker et al. Assim como esses autores, nenhum efeito adverso foi relatado pelos participantes durante a intervenção, confirmando a eficácia, a viabilidade e a segurança do Assyst-RG. Conclusão: os Resultados evidenciam que o Assyst-RG foi eficaz na diminuição da ansiedade, da depressão e do TEPT.

Introduction: the emergence of cases of COVID-19 led to the emergence of acute stress in the general population, especially in health professionals and, among them, in mental health, who began to have a high demand for care for people suffering from disorders. related to trauma and stressors as a result of: social isolation, hospitalization, deaths, worsening of the financial situation with loss of job, among others. Objective: this work with the Protocol for the Stabilization of Acute Remote Stress Syndrome in Group Format aims to provide the first psychological care to reduce disturbances and improve adaptive functioning, avoiding the evolution to more dysfunctional psychological conditions such as Post Stress Disorder -Traumatic (PTSD). Methodology: twenty-three (23) participants (psychologists) were selected and all responded to psychometric assessment scales (HADS and PCL-5) before and after 2 (two) online therapy sessions (videoconference) with application of the protocol. Results: the regression model shows a mean reduction in the anxiety score of -2.3 (ep 0.9), with p-value = 0.0010; significant; in the depression score, mean of 1.13 (p=0.125); and in the PTSD score, a mean reduction of ­9.5 (3.3), with p-value=0.006. Discussion: the statistical Results revealed an approximation with the Results of the research carried out by Becker et al (2021). According to these authors, no adverse effects were reported by the participants during the intervention, confirming the efficacy, feasibility and safety of ASSYST-RG. Conclusion: the Results show that ASSYST-RG was effective in reducing anxiety, depression and PTSD.

Impact of COVID-19 ­ experiences of 5th year medical students at the university of KwaZulu-natal

Background: The global pandemic associated with coronavirus disease 2019 (COVID-19) had a considerable effect on higher education in South Africa, with online instruction replacing traditional lectures for many students. Medical students were required to vacate their residences in March 2020 but returned to campus in July 2020 to enable them to continue with clinical teaching and learning. The aim of this study was to understand the learning experiences of 5th year medical students at the University of KwaZulu-Natal (UKZN) during 2020. Methods: This was a qualitative study conducted via Zoom in December 2020 with 18 students in four focus group discussions and four semi-structured interviews. These were all facilitated by an independent researcher with experience in qualitative research. All the interviews were recorded, transcribed verbatim and analysed qualitatively through the identification of codes, categories and themes. Results: The following major themes emerged: A stressful and at times an overwhelming year, mental health issues, developing strategies to cope, and issues that related to teaching and learning. Conclusion: The disruptions caused by COVID-19, the lockdown, a condensed academic programme and uncertainty about their competency resulted in high levels of anxiety and stress among medical students. Participants highlighted strategies that had helped them to cope with the isolation and academic pressures. Given the large volume of work, careful thought needs to be given to what should be taught and how it should be taught to ensure that graduates have the competencies they need to practise.

War in the midst of a pandemic: the synergy accelerating mental health disorders

War and displacement can have long-term and disastrous repercussions on people's mental, emotional, and physical health. Bombardments, invasions, occupation desertion, and being forced to flee diminish people's sense of security. The risk of being hurt or maimed as a result of conflict causes acute dread, which sets in motion other cascades of mental illnesses such as depression, anxiety, and post-traumatic stress disorder. These mental and emotional impacts are exacerbated by a co-existing pandemic, as migration and populations forced into cramped, dangerous situations are likely to contribute significantly to disease spread, particularly given the current surge of the highly transmissible omicron variant of COVID-19. This threat to life and livelihood eventually leaves some survivors with mental health disorders.

Síntomas de ansiedad y depresión en personal de salud que trabaja con enfermos de COVID-19 / Anxiety and depression symptoms in health personnel who work with COVID-19 patients

El personal de salud pública que se enfrenta a la COVID-19, está expuesto a múltiples riesgos entre ellos los trastornos psicológicos. El objetivo de este estudio fue determinar la presencia de síntomas asociados a ansiedad y depresión en personal de salud que trabaja con enfermos de la COVID-19. Se realizó un estudio descriptivo de corte transversal en el que participaron 61 profesionales y técnicos de atención sanitaria, que trabajaban directamente con pacientes con COVID-19, a los cuales se les consultó acerca de la presencia de síntomas asociados a la depresión y ansiedad, sus principales preocupaciones y el tiempo de trabajo continuo para evitar la aparición de síntomas psicológicos. El 64,1% de los participantes relató nerviosismo y 59,2% cansancio, para el 90,16% la principal preocupación fue el fallecimiento del paciente y el 60,66% de los participantes indicó que el período ideal, de atención continua de pacientes COVID-19, para evitar la aparición de síntomas psicológicos era de 7 días. Nuestros resultados sugieren que es necesario elaborar estrategias de trabajo para disminuir la aparición de síntomas asociados al deterioro de la salud mental de los profesionales de la salud que atienden pacientes COVID-19

Public health personnel facing COVID-19 are exposed to multiple risks including psychological disorders. The goal of this study was to determine the presence of symptoms associated with anxiety and depression in health personnel working with COVID-19 patients. A descriptive cross-sectional study involving 61 health care professionals and technicians was conducted, working directly with COVID-19 patients, who were consulted about the presence of symptoms associated with depression and anxiety, their main concerns and ongoing working time to avoid the onset of psychological symptoms. 64.1% of participants reported nervousness and 59.2% tiredness, for 90.16% the main concern was the patient's death and 60.66% of participants indicated that the ideal period, of continuous care of COVID-19 patients, to prevent the onset of psychological symptoms was 7 days. Our results suggest that work strategies need to be developed to decrease the onset of symptoms associated with deteriorating mental health of health professionals caring for COVID-19 patients

The effect of clinical simulation assessment on stress and anxiety measures in emergency care students

Background: Clinical simulation has become widespread as a training and assessment tool across a range of health professions, including emergency care. As with any form of assessment, simulations may be associated with stress and anxiety ("distress") which may have a negative effect on student performance if demands required by the simulation outweigh the available resources. This study aimed to assess the effect of participation by students in an emergency care simulation on an objective measure of stress and a subjective measure of anxiety. Methods: Heart rate variability (HRV) and scores from a validated state anxiety instrument (the State-Trait Anxiety Inventory) were assessed in 36 emergency medical care students participating in scheduled simulation assessments. Data recorded during a resting control period were used for comparison. Results: HRV variables showed changes in the simulation assessment group suggesting decreased variability and parasympathetic withdrawal, however these were not significantly different to control. Heart rate in the simulation assessment group increased significantly (73.5/min vs. 107.3/min, p < 0.001). State anxiety scores increased significantly both before (33.5 vs. 49.1, p < 0.001) and after (33.5 vs. 60, p < 0.001) the simulation assessment, compared to control. No linear relationship was found between any HRV variables and anxiety scores. Conclusion: Participating in an emergency care simulation assessment significantly elevated levels of anxiety in a group of 36 students, however an objective measure of stress did not identify changes significantly different to those at rest, with the exception of heart rate. The high levels of anxiety documented before and after simulation assessments may have a negative effect on performance and require further investigation

Evaluation of BDNF levels in patients hospitalized for physical trauma at an emergency hospital in Porto Alegre, southern Brazil / Avaliação dos níveis de BDNF em pacientes hospitalizados por trauma físico em um hospital de emergência de Porto Alegre, sul do Brasil

Abstract Objective To assess the association between brain-derived neurotrophic factor (BDNF) levels and acute stress disorder (ASD) in patients who have suffered physical trauma. Methods Data were collected at an emergency hospital in Porto Alegre, state of Rio Grande do Sul, southern Brazil. Participants were over 18 years of age, victims of physical trauma, and had been hospitalized for a minimum of 48 hours. A total of 117 hospitalized patients who agreed to participate in the research were grouped according to the shift in which blood was collected (38 subjects from the morning shift and 79 from the afternoon shift), had their BDNF levels measured and responded to other questionnaires. Respondents were further grouped by age into three ranges: 18-30, 31-50 and 51-70 years. Results We found a significant difference in the distribution of BDNF between the two shifts in which blood samples were collected, with the afternoon group having higher BDNF levels (U = 1906.5, p = 0.018). A difference was observed only between the 18-30 group and the 51-70 group in the afternoon shift (Umorning = 1107, pmorning = 0.575; Uafternoon = 7175, pafternoon = 0.028). Conclusions The population whose blood samples were collected in the afternoon showed significantly higher values of BDNF compared to those of the morning shift. This same population presented lower BDNF levels when associated with ASD subtypes A1, A2, and A. We hypothesize that the lower values of BDNF measured in the morning shift were due to a response to the circadian cycle of cortisol, whose action inhibits the expression of serum neurotrophins.

Resumo Objetivo Verificar a associação entre os níveis de fator neurotrófico derivado do cérebro (brain-derived neurotrophic factor [BDNF]) e transtorno de estresse agudo (TEA) em pacientes que sofreram trauma físico. Métodos Os dados foram coletados em um hospital de emergência de Porto Alegre, Rio Grande do Sul, Brasil. Os participantes eram maiores de 18 anos, vítimas de trauma físico e estavam hospitalizados por um período mínimo de 48 horas. Um total de 117 pacientes hospitalizados que concordaram em participar da pesquisa foram agrupados de acordo com o turno de realização da coleta de sangue (38 sujeitos no turno da manhã e 79 sujeitos no turno da tarde), tiveram seus níveis de BDNF medidos e responderam a outros questionários. Os entrevistados também foram agrupados por idade em três faixas etárias: 18-30, 31-50 e 51-70 anos. Resultados Encontramos uma diferença significativa na distribuição de BDNF entre os turnos, sendo que o grupo da tarde apresentou níveis maiores de BDNF (U = 1906,5, p = 0,018). Houve diferença entre o grupo de 18-30 anos e o de 51-70 anos no turno da tarde (Umanhã = 1107, pmanhã = 0,575; Utarde = 7175, ptarde = 0,028). Conclusões A população cuja coleta ocorreu à tarde apresentou valores significativamente maiores de BDNF em relação à coleta do turno da manhã. Esta mesma população apresentou menores níveis dessa neurotrofina quando associada com os subtipos A1, A2 e A de TEA. É possível hipotetizar que os menores valores de BDNF aferidos na coleta do turno da manhã se devam a uma resposta ao ciclo circadiano do cortisol, cuja ação inibe a expressão de neurotrofinas séricas.

The Psychophysiological Responses of the Chronic Ischemic Stroke Patients to the Acute Stress were Changed

Abstract: Mood disorder is one of the complications of stroke. The inability to cope with stress is also a prognosis of depression and anxiety. The aim of this study is to assess the response of stress system in the post stroke patients. Twelve healthy controls (HC) and twelve post-stroke patients after filling in the State-Trait Anxiety Inventory completed the Trier Social Stress Test (TSST) which induces acute stress. Salivary samples were collected to determine salivary cortisol levels and ECG record were taken in four times (before, right after stress, after two recoveries: 20 and 40 minutes after stress). ECG was also recorded during TSST and then the linear and non-linear features of Heart Rate Variability (HRV) were analyzed. The results showed that trait anxiety score and baseline salivary cortisol level were higher in post stroke than HC group (P-value <0.05). The increase of cortisol level after stress was only observed in HC that returned to baseline after the second recovery time. The stress increased the relative low frequency of HRV in both groups, however it was significantly lower in the stroke than HC group (P-value < 0.005). There was also a significant difference between alpha 1 DFA measures in stroke group and HC group (P-value <0.05). It is concluded that the impairment of the hormonal axis of stress system in the post-stroke patients that until now was not reported.

Psychiatric Symptoms and Clinical Diagnosis in High School Students Exposed to the Sewol Ferry Disaster

BACKGROUND: Two hundred and fifty 11th grade students and teachers from Danwon High School drowned, during a school trip, in the Sewol Ferry Disaster. The goal of this study was to investigate the experiences of the psychiatrists who volunteered and provided psychiatric services to the students at Danwon High School. METHODS: From the second day to the 138th day after the disaster, pro bono psychiatrists provided post-disaster interventions to the 10th and 12th-grade Danwon High School students who did not attend the trip. Officially, 167 psychiatrists conducted outreach in approximately 550 encounters. The study questionnaires were distributed retrospectively to psychiatric volunteers who conducted outreach at Danwon High School. We surveyed the pro bono psychiatrists about their experiences, including the students' chief complaints, psychiatric problems, clinical diagnoses, and psychiatrists' treatment recommendations. RESULTS: We reached 72 (43.1%) of the 167 volunteers, and they reported on 212 (38.6%) of the 550 encounters. The common chief complaints were mental health problems, companion problems, and family problems. The most frequent psychiatric symptoms were anxiety (76.89%), depressive mood (51.42%), and concentration difficulty (50.94%). The most frequent clinical diagnoses of the students were normal reaction (41.04%), acute stress disorder (24.53%), adjustment disorder (17.92%), anxiety disorders (9.43%), and posttraumatic stress disorder (6.60%). More than half of the students needed “additional counseling/therapy” (41.04%) or “referral to psychiatric treatment” (14.15%). CONCLUSION: During the acute aftermath of the Sewol Ferry Disaster, volunteer psychiatrists were able to provide services. These services included psychiatric assessments, crisis counseling, psychological first aid, and referrals for ongoing care. More than half of the students were perceived to have a psychiatric diagnosis, and a substantial proportion of students needed further treatment. Future research should focus on the short- and long-term effects of psychiatric interventions and the characterization of post-disaster mental health needs and service provision patterns.

Increased Frontal Gamma and Posterior Delta Powers as Potential Neurophysiological Correlates Differentiating Posttraumatic Stress Disorder from Anxiety Disorders

OBJECTIVE: Posttraumatic stress disorder (PTSD) is distinct from anxiety disorders in its etiology and clinical symptomatology, and was reclassified into trauma- and stressor-related disorders in DSM-5. This study aimed to find neurophysiological correlates differentiating PTSD from anxiety disorders using resting-state quantitative electroencephalography (qEEG). METHODS: Thirty-six patients with either PTSD or acute stress disorder and 79 patients with anxiety disorder were included in the analysis. qEEG data of absolute and relative powers and patients’ medication status on the day of qEEG examination were obtained. Electrodes were grouped into frontal, central, and posterior regions to analyze for regional differences. General linear models were utilized to test for group differences in absolute and relative powers while controlling for medications. RESULTS: PTSD patients differed from those with anxiety disorders in overall absolute powers [F(5,327)=2.601, p=0.025]. Specifically, overall absolute delta powers [F(1,331)=4.363, p=0.037], and overall relative gamma powers [F(1,331)=3.965, p=0.047] were increased in PTSD group compared to anxiety disorder group. Post hoc analysis regarding brain regions showed that the increase in absolute delta powers were localized to the posterior region [F(1,107)=4.001, p=0.048]. Additionally, frontal absolute gamma powers [F(1,107)=4.138, p=0.044] were increased in PTSD group compared to anxiety disorder group. CONCLUSION: Our study suggests increased overall absolute delta powers and relative gamma powers as potential markers that could differentiate PTSD from anxiety disorders. Moreover, increased frontal absolute gamma and posterior delta powers might pose as novel markers of PTSD, which may reflect its distinct symptomatology.

Three years after Typhoon Ondoy until Habagat rains: Prevalence of acute stress disorder and post-traumatic stress disorder among residents of Barangay Tumana, Marikina: A cross-sectional analytical study

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to determine the prevalence of Acute Stress Disorder and Post Traumatic Stress Disorder among residents of Barangay Tumana, Marikina exposed to Typhoon Ondoy in September 2009 and Habagat rains in August 2012.</p><p style="text-align: justify;"><strong>METHODOLOGY:</strong> The Acute Stress Disorder Scale (ASDS) and Impact of Events Scale-Revised (IESR) were administered to 212 subjects. Trauma history was also obtained. When screened positive for Acute Stress Disorder (ASD) and/or Post Traumatic Stress Disorder (PTSD), a confirmatory diagnosis was done through psychiatric clinical interview.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The study showed a prevalence rate of 10% for ASD and 5% for PTSD. Co-morbid ASD and PTSD were seen in 4% of the subjects. Frequency and type of prior traumatic events were not significantly different among subjects who were positive or negative for ASD/PTSD diagnoses.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> There was a significant prevalence of ASD/PTSD diagnoses among residents exposed to Typhoon Ondoy and Habagat, thus the need for developing a means of early detection and immediate therapeutic intervention in Filipino communities exposed to natural disasters.</p>

Acute stress disorder and defense mechanisms: a study of physical trauma patients admitted to an emergency hospital / Transtorno de estresse agudo e mecanismos de defesa: pesquisa com pacientes que sofreram trauma físico atendidos em um hospital de emergência

Abstract Introduction: Acute stress disorder (ASD) encompasses a set of symptoms that can arise in individuals after exposure to a traumatic event. This study assessed the defense mechanisms used by victims of physical trauma who developed ASD. Method: This was a controlled cross-sectional study of 146 patients who suffered physical trauma and required hospitalization. A structured questionnaire was used to evaluate ASD symptoms based on DSM-5 diagnostic criteria, in addition to the Defense Style Questionnaire (DSQ). Results: Ten participants (6.85%) received a positive diagnosis of ASD, and 136, (93.15%) a negative diagnosis. The majority of the sample consisted of men with median age ranging from 33.50 to 35.50. The most prevalent defense mechanisms among the 10 patients with ASD were cancellation and devaluation, which belong to the neurotic and immature factors, respectively. Positive associations between the presence of symptoms from criterion B of the DSM-5 and defense mechanisms from the DSQ were found. These included the mechanisms of undoing, projection, passive aggression, acting out, autistic fantasy, displacement, and somatization. Conclusion: Patients with ASD employed different defense mechanisms such as undoing and devaluation when compared to patients not diagnosed with ASD. These results mark the importance of early detection of ASD symptoms at a preventative level, thereby creating new possibilities for avoiding exacerbations related to the trauma, which represents an important advance in terms of public health.

Resumo Introdução: O transtorno de estresse agudo (TEA) reúne um conjunto de sintomas que pode surgir nos indivíduos após exposição a um evento traumático. Este estudo verificou a relação entre o estilo defensivo e o desenvolvimento de TEA e seus sintomas em uma amostra de pacientes que sofreram trauma físico. Métodos: Este estudo transversal controlado envolveu 146 pacientes que sofreram trauma físico e necessitaram hospitalização. Um questionário estruturado foi utilizado para avaliar sintomas de TEA, baseado nos critérios diagnósticos do DSM-5, além do Questionário de Estilo Defensivo (Defense Style Questionnaire - DSQ). Resultados: Dez (6,85%) pacientes tiveram diagnóstico positivo para TEA, e 136 (93,15%), diagnóstico negativo. A maioria da amostra foi composta por homens com idade mediana variando de 33,50 a 35,50. Nos 10 pacientes positivos para TEA, destacou-se a maior utilização de mecanismos de defesa de anulação e desvalorização, pertencentes ao fator neurótico e ao fator imaturo, respectivamente. Foram observadas associações positivas entre presença de sintomas de TEA do critério B do DSM-5 e os mecanismos de defesa do DSQ, sobretudo nos mecanismos de anulação, projeção, agressão passiva, acting out, fantasia autística, deslocamento e somatização. Conclusão: Pacientes com TEA utilizaram mais mecanismos de defesa do tipo anulação e desvalorização quando comparados aos pacientes sem diagnóstico de TEA. Ressalta-se a importância da detecção precoce de sintomas de TEA a fim de evitar outros agravos relacionados ao trauma, o que representa uma importante evolução em termos de saúde pública.

Psychiatric Symptoms in Teachers from Danwon High School after Exposure to the Sinking of the Motor Vessel Sewol

OBJECTIVE: The goal of this study was to describe the psychiatric symptoms in the teachers from Danwon High School who were exposed to the sinking of the Motor Vessel Sewol. METHODS: Data were collected from 32 teachers who underwent psychiatric interventions by 16 volunteer psychiatrists for 3 months after the sinking of the Motor Vessel Sewol. RESULTS: The most commonly diagnosed clinical diagnosis in the teachers were normal reaction, acute stress disorder and adjustment disorder. Psychiatric symptoms including anxiety, depressed mood and sleep disturbances were also observed. CONCLUSION: In the acute aftermath of the Sewol Ferry sinking on April 16, 2014, psychiatrists volunteered to provide professional psychiatric interventions to Danwon High School teachers. These results suggest the importance of crisis intervention focused on the teachers who are exposed to disasters. The implications for future research and interventions are discussed.

Proteínas de fase aguda em cães e gatos / Acute-phase proteins in dogs and cats / Proteínas de fase aguda en perros y gatos

As proteínas de fase aguda (PFA) são um grupo de proteínas sanguíneas que apresentam alterações nas suas concentrações em animais acometidos por infecções, inflamações, trauma cirúrgico ou mesmo submetido ao estresse. São proteínas que alteram as suas concentrações em pelo menos 25% durante a inflamação. As PFA consistem em proteínas de fase aguda negativa e/ou positiva, diminuindo ou aumentando a sua concentração, respectivamente, em resposta a um estímulo inflamatório. Dentre as PFA negativas mais importantes estão a albumina e a transferina. As PFA positivas são a haptoglobina (Hp), proteína C-reativa (CRP), amiloide A-sérico (SAA), ceruloplasmina (Cp), fibrinogênio e a alfa 1 glicoproteina ácida(APG). As avaliações da concentração das PFA e proteínas totais propiciam subsídios para adequada interpretação do estado de hidratação, bem como de inflamação, infecção, doença imunomediada e alteração da síntese proteica. Sendo as PFA mediadores inflamatórios das respostas imunes agudas, e consideradas marcadoras das lesões teciduais na sua fase aguda nos animais, é importante realizar uma revisão sobre as PFA mais importantes e suas funções nos cães e gatos.

Acute-phase proteins (APP) are a group of blood proteins exhibiting changes in their concentrations in animals suffering from infections, inflammation, surgical trauma or even which have been subjected to stress. These proteins present at least 25% changes in their concentrations during inflammation. APPs consist of negative- and positive-phase proteins that can decrease or increase their concentration in response to an inflammatory stimulus. The most important negative APP are albumin and transferrin; and the most important positive APP are haptoglobin (Hp) , C-reactive protein (CRP), serum amyloid A (SAA), ceruloplasmin (Cp), fibrinogen and alpha 1 glycoprotein acid (AGP). APP concentration and total protein reviews provide information for proper interpretation of hydration status, as well as inflammation, infection, immune-mediated diseases and impaired protein synthesis. APPs are inflammatory mediators of acute immune responses and are considered markers for tissue damages in the acute phase in animals. Therefore, it is important to further review the most important APPs and their functions in dogs and cats.

Las proteínas de fase aguda (PFA) son un grupo de proteínas sanguíneas que presentan cambios en sus concentraciones en animales acometidos por infecciones, inflamaciones, trauma quirúrgico o mismo sometido a estrés. Son proteínas que alteran sus concentraciones de al menos 25 % durante la inflamación. Las PFA consisten en proteínas de fase aguda negativa y/o positiva, disminuyendo o aumentando su concentración, respectivamente, en respuesta a un estímulo inflamatorio. Entre las PFA negativas más importantes están la albúmina y la transferrina. Las PFA positivas son la haptoglobina (Hp), proteína C - reactiva (CRP), amiloideo A-sérico (SAA), ceruloplasmina (Cp), fibrinógeno y la alfa 1-glicoproteína ácida (APG). Las evaluaciones de la concentración de las PFA y proteínas totales proporcionan informaciones para la interpretación apropiada del estado de hidratación, así como de la inflamación, infección, enfermedad inmune-mediada y alteración de síntesis proteica. Siendo las PFA mediadores de respuestas inmunes inflamatorias agudas y consideradas marcadoras de lesiones tisulares en su fase aguda en los animales, es importante llevar a cabo una revisión sobre las PFA más importantes y sus funciones en los perros y gatos.

Acute stress-induced antinociception is cGMP-dependent but heme oxygenase-independent

Endogenous carbon monoxide (CO), which is produced by the enzyme heme oxygenase (HO), participates as a neuromodulator in physiological processes such as thermoregulation and nociception by stimulating the formation of 3′,5′-cyclic guanosine monophosphate (cGMP). In particular, the acute physical restraint-induced fever of rats can be blocked by inhibiting the enzyme HO. A previous study reported that the HO-CO-cGMP pathway plays a key phasic antinociceptive role in modulating noninflammatory acute pain. Thus, this study evaluated the involvement of the HO-CO-cGMP pathway in antinociception induced by acute stress in male Wistar rats (250-300 g; n=8/group) using the analgesia index (AI) in the tail flick test. The results showed that antinociception induced by acute stress was not dependent on the HO-CO-cGMP pathway, as neither treatment with the HO inhibitor ZnDBPG nor heme-lysinate altered the AI. However, antinociception was dependent on cGMP activity because pretreatment with the guanylate cyclase inhibitor 1H-[1,2,4] oxadiazolo [4,3-a] quinoxaline-1-one (ODQ) blocked the increase in the AI induced by acute stress.

Proteínas de fase aguda em cães e gatos / Acute-phase proteins in dogs and cats / Proteínas de fase aguda en perros y gatos

As proteínas de fase aguda (PFA) são um grupo de proteínas sanguíneas que apresentam alterações nas suas concentrações em animais acometidos por infecções, inflamações, trauma cirúrgico ou mesmo submetido ao estresse. São proteínas que alteram as suas concentrações em pelo menos 25% durante a inflamação. As PFA consistem em proteínas de fase aguda negativa e/ou positiva, diminuindo ou aumentando a sua concentração, respectivamente, em resposta a um estímulo inflamatório. Dentre as PFA negativas mais importantes estão a albumina e a transferina. As PFA positivas são a haptoglobina (Hp), proteína C-reativa (CRP), amiloide A-sérico (SAA), ceruloplasmina (Cp), fibrinogênio e a alfa 1 glicoproteina ácida (APG). As avaliações da concentração das PFA e proteínas totais propiciam subsídios para adequada interpretação do estado de hidratação, bem como de inflamação, infecção, doença imunomediada e alteração da síntese proteica. Sendo as PFA mediadores inflamatórios das respostas imunes agudas, e consideradas marcadoras das lesões teciduais na sua fase aguda nos animais, é importante realizar uma revisão sobre as PFA mais importantes e suas funções nos cães e gatos.

Acute-phase proteins (APP) are a group of blood proteins exhibiting changes in their concentrations in animals suffering from infections, inflammation, surgical trauma or even which have been subjected to stress. These proteins present at least 25% changes in their concentrations during inflammation. APPs consist of negative- and positive-phase proteins that can decrease or increase their concentration in response to an inflammatory stimulus. The most important negative APP are albumin and transferrin; and the most important positive APP are haptoglobin (Hp) , C-reactive protein (CRP), serum amyloid A (SAA), ceruloplasmin (Cp), fibrinogen and alpha 1 glycoprotein acid (AGP). APP concentration and total protein reviews provide information for proper interpretation of hydration status, as well as inflammation, infection, immune-mediated diseases and impaired protein synthesis. APPs are inflammatory mediators of acute immune responses and are considered markers for tissue damages in the acute phase in animals. Therefore, it is important to further review the most important APPs and their functions in dogs and cats.

Las proteínas de fase aguda (PFA) son un grupo de proteínas sanguíneas que presentan cambios en sus concentraciones en animales acometidos por infecciones, inflamaciones, trauma quirúrgico o mismo sometido a estrés. Son proteínas que alteran sus concentraciones de al menos 25 % durante la inflamación. Las PFA consisten en proteínas de fase aguda negativa y/o positiva, disminuyendo o aumentando su concentración, respectivamente, en respuesta a un estímulo inflamatorio. Entre las PFA negativas más importantes están la albúmina y la transferrina. Las PFA positivas son la haptoglobina (Hp), proteína C - reactiva (CRP), amiloideo A-sérico (SAA), ceruloplasmina (Cp), fibrinógeno y la alfa 1-glicoproteína ácida (APG). Las evaluaciones de la concentración de las PFA y proteínas totales proporcionan informaciones para la interpretación apropiada del estado de hidratación, así como de la inflamación, infección, enfermedad inmune-mediada y alteración de síntesis proteica. Siendo las PFA mediadores de respuestas inmunes inflamatorias agudas y consideradas marcadoras de lesiones tisulares en su fase aguda en los animales, es importante llevar a cabo una revisión sobre las PFA más importantes y sus funciones en los perros y gatos.

Las crisis de angustia en la urgencia y su relación con los factores desencadenantes desde una perspectiva de género / [Acute stress disorder in the emergency, its relationship with trigger factors from a gender perspective].

BACKGROUND: Anxiety disorders and, in particular, acute stress disorder are one of the principal reasons for medical assistance, being the women the ones who frequently consult. AIMS: To describe and analyze, from a perspective of gender, the factors that unleash the consultation of an episode of acute stress disorder in the emergency. MATERIALS AND METHOD: An exploratory descriptive study was performed. A semi-directed interview and a socio-demographic questionnaire were assessed and scales to evaluate anxiety and depression were administered to females that consulted for an acute stress disorder. RESULTS: Sixty nine percent of the patients described the physical discomfort as trigger factor, presenting in the 85

of the cases a degree of major anxiety; associating the family conflicts as the principal cause of distress, followed by violence against women. The situation of distress, in 75

of the cases, did not correspond with an isolated episode. CONCLUSION: The physical symptomatology was the principal cause for consultation of an episode of acute stress disorder in the emergency, being the family conflicts and the violence against women the principal reasons of distress. Therefore, interdisciplinary approach for the assistance of mental disorders in emergency should be taken in consideration.

Treatment Response of Affect Regulation Group Therapy for Recently Traumatized School Children / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the treatment effect and predictors of response of affect regulation group therapy (ARGT) delivered to a group of recently traumatized children. METHODS: A total of 464 school children, who had witnessed or confronted a tragic accident at school, were given a single-session of affect regulation group therapy, that which included psychoeducation and affect regulation elements from eye movement desensitization and reprocessing. Of 213 children whose with initial score of Subject Unit of Disturbance Scale (SUDS) score over 4, we compared pre- and post-treatment scores and performed conducted the responder vs. non-responder comparison. The pPost-traumatic disorder (PTSD) symptom scores measured by using Child Reaction to Traumatic Events Scale-Revised (CRTES-R), demographic variables, and clinical variables were considered. RESULTS: Affect regulation group therapy was effective for children who had experienced an acute traumatic event (t=16.3, p<0.001). Baseline SUDS score of for non-responder were was significantly higher (t=-2.89, p<0.001) and CRTES-R score approached a level of significance level (t=-1.72, p=0.09). However, results of logistic regression analysis identified showed that the pretreatment SUDS score was the only significant predictor of non-response. CONCLUSION: Affect regulation group therapy appeared to be effective for children who had undergone experienced an acute traumatic event. And in addition, the survivors' subjective distress was more important to treatment response than severity of PTSD symptoms severity.