Confiabilidade diagnóstica e linguagem / Diagnostic reliability and language / Fiabilité diagnostique et langage / Fiabilidad diagnóstica y lenguaje

Neste artigo defendemos que a busca operacional-pragmática de uma maior confiabilidade diagnóstica deve levar em conta o papel que a linguagem desempenha na conceituação psicopatológica. Concluímos que, na conceituação dos sintomas psicopatológicos, a ênfase deve se deslocar das vivências para o relato sobre elas. Isso exige considerar de maneira explícita uma semântica, ou seja, uma teoria da significação, apenas pressuposta. Além disso, mostramos que essa mudança de ênfase tem implicações na concepção que se tem da natureza do sintoma psicopatológico. Concluímos também que a estipulação de critérios de suficiência para o diagnóstico psicopatológico favorece um aumento da confiabilidade à custa da consideração clínica dos casos limítrofes, estreitando formalmente a visada clínica da psicopatologia a partir do operacionalismo pragmático.

This article argues that the operational-pragmatic search for greater diagnostic reliability must consider the role played by language in psychopathological conceptualization. When conceptualizing psychopathological symptoms, the emphasis must shift from experience to reporting, which requires explicitly considering a semantics - that is, a theory of meaning - only presupposed. This shift in emphasis influences our understanding of the nature of the psychopathological symptom. In conclusion, stipulating sufficiency criteria for psychopathological diagnosis favors an increase in reliability in detriment of the clinical consideration of borderline cases, formally narrowing the clinical approach to psychopathology based on pragmatic operationalism.

Cet article soutien que la recherche pragmatique-opérationnelle d'une plus grande fiabilité diagnostique doit tenir compte du rôle joué par le langage dans la conceptualisation psychopathologique. Lors de la conceptualisation des symptômes psychopathologiques, l'accent doit être déplacé de l'expérience vers le rapport, ce qui nécessite de considérer explicitement une sémantique, c'est-à-dire une théorie du sens, juste présupposée. Ce changement d'accent influence notre compréhension de la nature du symptôme psychopathologique. En conclusion, la stipulation de critères de suffisance pour le diagnostic psychopathologique favorise une augmentation de la fiabilité au détriment de la considération clinique des cas limites, rétrécissant formellement l'approche clinique de la psychopathologie basée sur l'opérationnalisme pragmatique.

En este artículo argumentamos que la búsqueda pragmática operativa de una mayor fiabilidad diagnóstica debe tener en cuenta el papel que desempeña el lenguaje en la conceptualización psicopatológica. En la conceptualización de los síntomas psicopatológicos, se debe pasar el enfoque de las experiencias al de informar sobre ellas. Esto requiere considerar explícitamente una semántica, es decir, una teoría del significado, solo presupuesta. Además, mostramos que este cambio de enfoque tiene implicaciones en la comprensión de la naturaleza del síntoma psicopatológico. También concluimos que el establecimiento de criterios de suficiencia en el diagnóstico psicopatológico favorece un aumento de la fiabilidad en la observación clínica de los casos límite, que estrecha formalmente el abordaje clínico de la psicopatología desde el operacionalismo pragmático.

Quando a Shoah é um trauma: e o pai desaparece da teoria analítica / When Shoah is a trauma: and the father disappears from the psychoanalytical theory

Interrogando as teorias psicanalíticas que se desenvolveram no pós-guerra em torno do traumatismo “extremo” sofrido pelos deportados para os campos de concentração nazistas, a autora estuda e critica o primado atribuído ao aniquilamento de toda vida psíquica no sobrevivente – com desqualificação dos mecanismos que permitem a representação psíquica, recusa de qualquer funcionamento do recalque, perda das referências simbólicas articuladas com a função paterna e prevalência dos processos empáticos – ao mesmo tempo em que, além disso, a pulsão de morte não é tida em conta. De que maneira a psicanálise respondeu com sua própria teoria do assassinato e da destrutividade, quando se constata que a barbárie teve como consequência uma modificação do marco teórico da metapsicologia? Até que ponto esse efeito não faria parte da tentativa totalitária de matar a própria psicanálise?

Questioning the psychoanalytical theories that developed in post-war around the “extreme” trauma suffered by people deported to the Nazis concentration camps, the author studies and criticizes the pre-eminence given to the annihilation of all psychic life in the survivor – with disqualifications of the mechanisms that allow the psychic representation, refusal of any functioning of repression, loss of the symbolic references articulated with the father function and prevalence of the empathic processes – at the same time that, besides that, the death drive is not taken into account. How did psychoanalysis with its own theory of murder and of destructiveness responded, when its found that the barbarie had as consequence a modification of the theoretical mark of metapsychology? Up to what point that effect would not make part on the sole attempt to destroy psychoanalysis?

Interrogando las teorías psicoanalíticas que se desarrollaron en el post guerra acerca del traumatismo “extremado” sufrido por los deportados hacia los campos de concentración nazistas, la autora estudia y critica el primado atribuido a la aniquilación de toda vida psíquica en el sobreviviente – con descalificación de los mecanismos que permiten la representación psíquica, rechazo de cualquier funcionamiento del recalque, pérdida de las referencias simbólicas articuladas con la función paterna y prevalencia de los procesos empáticos – al mismo tiempo que no se tiene en cuenta, además, la pulsión de muerte. ¿De qué manera el psicoanálisis ha respondido con su propia teoría del asesinato y de la destructividad, cuando se constata que la barbarie tuvo como consecuencia una modificación del marco teórico de la metapsicología? ¿Hasta qué punto ese efecto no formaría parte del intento totalitario de matar al mismo psicoanálisis?

A Case of Primary Cuteaneous CD30-Positive Lymphoproliferative Disorder of the Eyelid

PURPOSE: To report one case of lymphoproliferative disorder on the upper eyelid. METHODS: Primary CD30+ lymphoproliferative disorder on the skin is very rare. A 31-year-old female patient visited our clinic complaining of red, erosive papules on the right upper eyelid and on the left flank for two weeks. A 2.0 cm erythematous papule showed central ulceration. A 1.5 cm lymph node enlargement was palpated on the left groin. There was no abnormal finding on the slit-lamp test. Computed tomography showed a subcutaneous nodule on the anterolateral aspect of the flank and a lymph node enlargement on the left inguinal area. There was no evidence of other visceral involvement. Histopathologic finding showed diffuse infiltration of atypical cells with lobated nuclei showing multifocal positivity to CD30; a finding consistent with primary cutaneous CD30+ T-cell lymphoproliferative disorder and borderline lesion. RESULTS: This case seems to be a borderline case between CD30+ T-cell large cell lymphoma and lymphoid papulodesis. We are conducting conservative care and observing the progress on the skin lesion for further evaluation.

A Case of Lymphomatoid Papulosis / 대한피부과학회지

Primary cutaneous CD30+ lymphoproliferative disorders include primary cutaneous CD30+ (anaplastic) large T cell lymphoma, lymphomatoid papulosis, and borderline cases. These represent a clinical and histologic continuum rather than a separate entity. We report a 39-year-old woman with the clinical features of lymphomatoid papulosis. Histology favored primary CD30+ anaplastic large cell lymphoma. Although she was treated with aggressive combination chemotherapy, the lesions recurred shortly after discontinuation of chemotherapy. She is now regularly followed up without any treatment.

Upper and lower second premolar extraction treatment case: Treatment strategy for Class III borderline cases / 대한치과교정학회지

When treating borderline cases which have mild crowding, non-extraction treatment may be considered firstly. But crowding may be reappeared by relapse and it may have problems in esthetics and stability. Secondarily four first premolar extraction treatment may be considered. But this may cause dish-in face by overretracting anterior teeth. In this cases, extraction of four second premolar is preferred because this resolves crowding without aggravating profile and has good stability after treatment. So we review cases treated by four second premolar extraction which show good treatment results and stability. The patients had good profile, Class I molar relationship, mild crowding and skeletal discrepancy and their growth had almost completed.