Desmontagem do diagnóstico e orientação para o singular: apresentações de pacientes de Jacques Lacan / Disassembly of diagnosis and orientation towards the singular: Jacques Lacans patient presentations / Démontage du diagnostic et orientation au singulier: présentations des patients de Jacques Lacan / Desmontaje del diagnóstico y orientación para el singular: presentaciones de pacientes de Jacques Lacan

Resumo A empiria analisada neste artigo são as transcrições de três apresentações de pacientes conduzidas por Jacques Lacan no Hospital de Sainte-Anne, em 1976. A análise dessas entrevistas teve como objetivo apreender como Lacan procedia como analista no que diz respeito ao uso das categorias diagnósticas e ao manejo da tensão entre a universalidade do tipo clínico e a singularidade do caso único. A análise revelou que, embora Lacan não se recusasse a empregar termos oriundos da psiquiatria clássica nem a fazer o diagnóstico estrutural dos sujeitos entrevistados, esses aspectos não estavam no foco de seu interesse. Lacan prescindia da rigidez das categorias diagnósticas, realizando operações de desarme, inversão, anulação ou desmontagem do diagnóstico-padrão, inventando nomes - e não diagnósticos - que não fundavam novas classes para caracterizar os pacientes.

Abstract This article analyzed the transcriptions of three patient presentations conducted by Jacques Lacan at the Hospital of Sainte-Anne in 1976. The analysis of these interviews aimed to apprehend how Lacan proceeded as an analyst with respect to the use of diagnostic categories and the management of the tension between the universality of the clinical type and the singularity of the single case. The analysis revealed that although Lacan did not refuse to use terms derived from classical psychiatry or to make the structural diagnosis of the interviewed patients, these aspects were not the focus of his interest. Lacan dispensed the rigidity of diagnostic categories, performing disarmament, inversion, annulment or disassembling operations of the standard diagnosis, inventing names - and not diagnoses - that did not establish new classes to characterize patients.

Résumé Cet article analyse l'étude empirique composée par les transcriptions de trois entrevues de patients menées par Jacques Lacan à l'Hôpital de Sainte-Anne, en 1976. Cette analyse visait à comprendre comment Lacan procédait en tant qu'analyste à l'égard de l'utilisation des catégories diagnostiques et de la gestion des tensions entre l'universalité du type clinique et la singularité du cas unique. L'analyse a révélé que, bien que Lacan ne refusât pas d'utiliser des termes issu de la psychiatrie classique ou de faire le diagnostic structurel des sujets interrogés, ces aspects n'étaient pas au centre de son intérêt. Lacan s'est dispensé de la rigidité des catégories diagnostiques, effectuant le démontage, l'inversion, l'annulation ou le désassemblage du diagnostic standard, en inventant des noms - et non des diagnostics - qui n'ont pas trouvé de nouvelles classes pour caractériser les patients.

Resumen En este artículo se analizan las transcripciones de tres presentaciones de pacientes conducidas por Jacques Lacan en el Hospital de Sainte-Anne, en 1976. El análisis de esas entrevistas tuvo como objetivo aprehender cómo Lacan procedía como analista en lo que se refiere al uso de las categorías diagnósticas y al manejo de la tensión entre la universalidad del tipo clínico y la singularidad del caso único. El análisis reveló que, aunque Lacan no se negaba a emplear términos oriundos de la psiquiatría clásica ni a hacer el diagnóstico estructural de los sujetos entrevistados, esos aspectos no estaban en el foco de su interés. Lacan prescindía de la rigidez de las categorías diagnósticas, realizando operaciones de desarme, inversión, anulación o desmontaje del diagnóstico estándar, inventando nombres -y no diagnósticos- que no fundaban nuevas clases para caracterizar a los pacientes.

Transtorno mental no puerpério: riscos e mecanismos de enfrentamento para a promoção da saúde / Mental disorder in the puerpério: risks and mechanisms of counseling for the promotion of health / Transtorno mental en el puerto: riesgos y mecanismos de enfrentamiento para la promoción de la salud

Objetivo: Compreender os riscos e os mecanismos de enfrentamento apresentados pelas puérperas diante dos transtornos mentais no pós-parto. Métodos: Pesquisa qualitativa, de caráter descritivo, realizada com 12 puérperas, na faixa etária de 16 a 35 anos, que fizeram o acompanhamento do pré-natal na unidade de Atendimento Multiprofissional Especializado em Petrolina/PE, por meio de entrevista semiestruturada e observação dos conteúdos implícitos no comportamento das puérperas. A coleta dos dados ocorreu em novembro e dezembro de 2016. Resultados: Identificou-se que fatores como gravidez precoce ou não planejada, carência de apoio do companheiro, instabilidade familiar e baixas condições socioeconômicas podem contribuir como agentes facilitadores no surgimento de algum transtorno mental na puérpera. Conclusão: Considerando que os transtornos mentais são comuns no puerpério, quanto mais precocemente detectar os fatores de risco, melhor assistência poderá ser oferecida à puérpera

Objective: To understand the risks and coping mechanisms presented by puerperal women in the face of postpartum mental disorders. Methods: A descriptive qualitative study was carried out with twelve puerperae, in the age group of 16 to 35 years old who underwent prenatal follow-up at the Multiprofessional Specialized Care Unit in Petrolina-PE, through a semi-structured interview and observation of the contents implicit in the behavior of puerperal women. Data collection took place in November and December 2016. Results: It was identified that factors such as early or unplanned pregnancy, lack of support from the partner, family instability and low socioeconomic conditions can contribute as facilitating agents in the emergence of some mental disorder in the puerpera. Conclusion: Considering that chronic disorders are common in the puerperium, the earlier the risk factors are detected, the better care can be given to the woman

Objetivo: Comprender los riesgos y mecanismos de enfrentamiento presentados por las puérperas ante los trastornos mentales en el posparto. Métodos: Investigación cualitativa, de carácter descriptivo, realizada con doce puérperas, en el grupo de edad de 16 a 35 años que hicieron el seguimiento del prenatal en la unidad de Atención Multiprofesional Especializado en Petrolina-PE, por medio de entrevista semiestructurada y observación de los contenidos implícitos en el comportamiento de las puérperas. La recolección de los datos ocurrió en noviembre y diciembre de 2016. Resultados: Se identificó que factores como embarazo precoz o no planificado, carencia de apoyo del compañero, inestabilidad familiar y bajas condiciones socioeconómicas pueden aportar como agentes facilitadores en el surgimiento de algún trastorno mental en la puérpera. Conclusión: Considerando que los trastornos mentales son comunes en el puerperio, cuanto más precozmente detecte los factores de riesgo, mejor asistencia podrá ser ofrecida a la puérpera

From anatomy to function: the role of the somatosensory cortex in emotional regulation

Since the pioneering work of Penfield and his colleagues in the 1930s, the somatosensory cortex, which is located on the postcentral gyrus, has been known for its central role in processing sensory information from various parts of the body. More recently, a converging body of literature has shown that the somatosensory cortex also plays an important role in each stage of emotional processing, including identification of emotional significance in a stimulus, generation of emotional states, and regulation of emotion. Importantly, studies conducted in individuals suffering from mental disorders associated with abnormal emotional regulation, such as major depression, bipolar disorder, schizophrenia, post-traumatic stress disorder, anxiety and panic disorders, specific phobia, obesity, and obsessive-compulsive disorder, have found structural and functional changes in the somatosensory cortex. Common observations in the somatosensory cortices of individuals with mood disorders include alterations in gray matter volume, cortical thickness, abnormal functional connectivity with other brain regions, and changes in metabolic rates. These findings support the hypothesis that the somatosensory cortex may be a treatment target for certain mental disorders. In this review, we discuss the anatomy, connectivity, and functions of the somatosensory cortex, with a focus on its role in emotional regulation.

Child and Adolescent Psychosocial Care Center service use profile in Brazil: 2008 to 2012

Objective: To describe the service use profile of Child and Adolescent Psychosocial Care Centers (Centro de Atenção Psicossocial Infanto-Juvenil [CAPSi]) in Brazil regarding diagnostic categories, sociodemographic aspects, and care modalities between 2008 and 2012. Methods: A descriptive, ecological study was performed using data from the Unified Health System regarding high-complexity procedure authorizations (Autorização de Procedimentos de Alta Complexidade [APAC]) for the period from 2008-2012. The variables sex, age, diagnosis (F00-F99 of ICD-10), and type of care provided were examined. The data were processed using TabWin and STATA version 12. Results: A total of 837,068 records were examined, each representing one visit to CAPSi. Most visits were by male users (68.8%). The most common diagnoses were hyperkinetic disorders (13%), pervasive developmental disorders (12.4%), and conduct disorders (8.4%). Conclusions: Behavioral and emotional disorders that usually appear during childhood or adolescence and psychological development disorders were frequent, with more than 50% of the latter comprising autism spectrum disorders. Regional differences were observed, with a higher presence of this diagnosis in the Southeast, while the North and Northeast had a high percentage of visits due to mental retardation.

Revisión de trastornos psiquiátricos en enfermedad de Parkinson (EP): a propósito de un caso / Review of psychiatric disorders in Parkinson's disease (PD): about a case

La Enfermedad de Parkinson se inicia generalmente en las personas entre los 50 y 60 años, La mayoría de los pacientes de Parkinson se encuentran en situación de doble vulnerabilidad: vejez y discapacidad. El objetivo del tratamiento es reducir la velocidad de progresión de la enfermedad, controlar los síntomas y los efectos secundarios derivados de los fármacos que se usan para tratarla. La presentación de las alteraciones psiquiátricas se caracteriza por episodios de alucinaciones, trastornos confusionales, trastornos del control de los impulsos, hipersexualidad o Parasomnias, siendo de presentación habitualmente vespertina. Estos pueden evolucionar llegando a cuadros de psicosis, estados confusionales crónicos, ideas delirantes en forma permanente, con alto contenido paranoide, existiendo un gran riesgo de intentos suicidas.

Parkinson's disease usually begins in people between the ages of 50 and 60. Most Parkinson's patients are in a situation of double vulnerability: old age and disability. The goal of treatment is to reduce the rate of progression of the disease, control of the symptoms and side effects derived from the drugs used to treat it. The presentation of the psychiatric alterations is characterized by episodes of hallucinations, confusional disorders, disorders of the control of the impulses, hypersexuality or Parasomnias, being usually of evening presentation. These can evolve into psychosis, chronic confusional states, persistent delusional ideas, with high paranoid content, and there is a high risk of suicide attempts.

Bipolar disorders: is there an influence of seasonality or photoperiod?

Objective: To increase understanding of the influence of photoperiod variation in patients with bipolar disorders. Methods: We followed a sample of Italian bipolar patients over a period of 24 months, focusing on inpatients. All patients admitted to the Psychiatric Inpatient Unit of San Luigi Gonzaga Hospital in Orbassano (Turin, Italy) between September 1, 2013 and August 31, 2015 were recruited. Sociodemographic and clinical data were collected. Results: Seven hundred and thirty patients were included. The admission rate for bipolar patients was significantly higher during May, June and July, when there was maximum sunlight exposure, although no seasonal pattern was found. Patients with (hypo)manic episodes were admitted more frequently during the spring and during longer photoperiods than those with major depressive episodes. Conclusions: Photoperiod is a key element in bipolar disorder, not only as an environmental factor but also as an important clinical parameter that should be considered during treatment.

Maternal recognition of child mental health problems in two Brazilian cities

Objective: To identify child behaviors and types of impairment that increase the likelihood of maternal recognition of emotional/behavioral problems (EBP) in children and adolescents. Methods: Maternal-reported data were obtained from two subsamples of 11-to-16-year-olds derived from cross-sectional studies conducted in two Brazilian municipalities: Itaboraí, state of Rio de Janeiro (n=480), and Embu, state of São Paulo (n=217). The Itaboraí study involved a representative sample of 6-to-16-year-olds (n=1,248; response rate = 86.0%) selected from the Family Health Program registry, which covered 85.5% of the municipal population. The Embu study was based on a probabilistic sample of clusters of eligible households (women aged 15-49 years, child < 18 years), with one mother-child pair selected randomly per household (n=813; response rate = 82.4%). The outcome variable was mother's opinion of whether her child had EBP. Potential correlates included types of child behaviors (hyperactivity/conduct/emotional problems as isolated or combined conditions) and impairment, assessed using the Strengths and Difficulties Questionnaire (SDQ); child's age and gender; maternal education and anxiety/depression (assessed using the Self-Reporting Questionnaire [SRQ]). Results: Multivariate regression models identified the following correlates of maternal perception of child EBP: comorbidity (co-occurring hyperactivity/conduct/emotional problems), emotional problems alone, and interference of problems with classroom learning and friendships. Conclusion: Comorbidity of different problem types, emotional problems alone, and interference with classroom learning and friendships increase the likelihood of maternal recognition of EBP in children.

Mental status and suicide probability of young people: A cross-sectional study

Summary Objective: The most important determinant of suicide ideation, tendency and initiative is the presence of mental disorders. Since the number of those who lost their lives due to suicide in the world rose rapidly among the young population, the World Health Organization emphasizes the importance of assessing young people in the high-risk age group to prevent suicidal behavior. This study aimed to determine psychological symptom levels and suicide probability in young people. Method: The cross-sectional research consisted of 15-24 year-old individuals (N=348), who have sought a psychiatric clinic between February and June, 2015. The Research Data was collected by applying Data Collection Form, Suicide Probability Scale (SPS) and Brief Symptom Inventory (BSI). SPSS 22.0 statistical package program was used for data analysis. Results: There was a statistically significant difference (p<0.05) between the mean SPS scores according to education, psychiatric treatment, self-harm, smoking and drinking status of the participants in the study. Apart from this, there was also a statistically significant correlation between anxiety, depression, negative self and hostility according to the SPS and BSI subscales (p<0.001, r=0.739; p<0.001, r=0.729; p<0.001, r=0.747; p<0.001, r=0.715; respectively). Conclusion: The results of our study show that suicide risk is significantly higher in young people with depression, anxiety, negative self-perception and hostility symptoms. In this regard, we suggest the relevance of assessing the suicide risk of young people seeking a psychiatric clinic, with thorough attention to those who have high potential for suicide.

Tipos de transtornos mentais não psicóticos em mulheres adultas violentadas por parceiro íntimo: uma revisão integrativa / Tipos de trastornos mentales no psicóticos en mujeres adultas violadas por pareja íntima: una revisión integrativa / Types of non-psychotic mental disorders in adult women who suffered intimate partner violence: an integrative review

RESUMO Objetivo: Identificar na literatura os tipos de transtornos mentais não psicóticos em mulheres adultas vítimas de violência por parceiro íntimo. Método: Revisão integrativa realizada nas bases de dados MEDLINE, CINAHL, LILACS, Web of Science e SCOPUS. Resultados: Foram selecionados 19 artigos, publicados em revistas internacionais, na língua inglesa, com predomínio de estudos transversais (78,9%). Os tipos de transtornos mentais não psicóticos mais encontrados foram: depressão (73,7%) e transtorno de estresse pós-traumático (52,6%). Observou-se que 78,9% dos artigos apresentaram nível de evidência 2C. Conclusão: Os estudos evidenciaram que mulheres adultas vítimas de violência por parceiro íntimo sofrem, em sua maioria, de depressão e transtorno de estresse pós-traumático, além de outras morbidades, fato que mostra quão devastadora pode se tornar a violência por parceiro íntimo na saúde mental de quem a vivencia.

RESUMEN Objetivo: Identificar en la literatura las clases de trastornos mentales no psicóticos en mujeres adultas violadas por pareja íntima. Método: Revisión integrativa llevada a cabo en las bases de datos MEDLINE, CINAHL, LILACS, Web of Science y SCOPUS. Resultados: Fueron seleccionados 19 artículos, publicados en revistas internacionales, en lengua inglesa, con predominio de estudios transversales (78,9%). Las clases de trastornos mentales no psicóticos más encontradas fueron: depresión (73,7%) y trastorno de estrés postraumático (52,6%). Se observó que el 78,9% de los artículos presentaron nivel de evidencia 2C. Conclusión: Los estudios evidenciaron que mujeres adultas víctimas de violencia por pareja íntima sufren, en su mayoría, de depresión y trastorno de estrés postraumático, además de otras morbilidades, hecho que muestra cuán devastadora puede hacerse la violencia por pareja íntima en la salud mental de quien la vive.

ABSTRACT Objective: Identifying the types of non-psychotic mental disorders in adult women who suffered intimate partner violence in the literature. Method: An integrative review carried out in the MEDLINE, CINAHL, LILACS, Web of Science and SCOPUS databases. Results: We selected 19 articles published in international journals in English, with a predominance of cross-sectional study studies (78.9%). The most common types of non-psychotic mental disorders were: depression (73.7%) and post-traumatic stress disorder (52.6%). It was observed that 78.9% of the articles presented a 2C level of evidence. Conclusion: Studies have shown that adult women who are victims of intimate partner violence mostly suffer from depression and post-traumatic stress disorder, as well as other morbidities; a fact that highlights how devastating violence by an intimate partner can impact on the mental health of those who experience it.

Latent class profile of psychiatric symptoms and treatment utilization in a sample of patients with co-occurring disorders

Objective: To identify symptom-based subgroups within a sample of patients with co-occurring disorders (CODs) and to analyze intersubgroup differences in mental health services utilization. Methods: Two hundred and fifteen patients with COD from an addiction clinic completed the Symptom Checklist 90-Revised. Subgroups were determined using latent class profile analysis. Services utilization data were collected from electronic records during a 3-year span. Results: The five-class model obtained the best fit (Bayesian information criteria [BIC] = 3,546.95; adjusted BIC = 3,363.14; bootstrapped likelihood ratio test p < 0.0001). Differences between classes were quantitative, and groups were labeled according to severity: mild (26%), mild-moderate (28.8%), moderate (18.6%), moderate-severe (17.2%), and severe (9.3%). A significant time by class interaction was obtained (chi-square [χ2[15]] = 30.05, p = 0.012); mild (χ2[1] = 243.90, p < 0.05), mild-moderate (χ2[1] = 198.03, p < 0.05), and moderate (χ2[1] = 526.77, p < 0.05) classes displayed significantly higher treatment utilization. Conclusion: The classes with more symptom severity (moderate-severe and severe) displayed lower utilization of services across time when compared to participants belonging to less severe groups. However, as pairwise differences in treatment utilization between classes were not significant between every subgroup, future studies should determine whether subgroup membership predicts other treatment outcomes.

Psicose e esquizofrenia: efeitos das mudanças nas classificações psiquiátricas sobre a abordagem clínica e teórica das doenças mentais / Psychosis and schizophrenia: effects of changes in psychiatric classifications on clinical and theoretical approaches to mental illness

Resumo Abordam-se as mudanças nos sistemas de classificação diagnóstica das doenças mentais, em especial o enfraquecimento conceitual da categoria “psicose” e a dominância da esquizofrenia como psicose única. As classificações atuais priorizam uma abordagem fisicalista da patologia mental. Ocorrem, então, a medicalização das condições antes associadas à neurose e à subjetividade; a localização de quadros antes reconhecidos como psicóticos na rubrica dos transtornos de personalidade; e a redução da psicose à esquizofrenia, abordada como deficit das funções psíquicas. Aponta-se a validade clínica e operatória da noção de “psicose” como categoria nosográfica que permite abordagem mais complexa da “esquizofrenia”, última noção, na psiquiatria, com o peso simbólico da loucura.

Abstract This article discusses changes in the diagnostic classification systems for mental illness, especially the conceptual weakening of the “psychosis” category while schizophrenia became the only psychosis. Current pathological classifications prioritize a physicalist approach. Consequently, conditions that previously were associated with neurosis and subjectivity are being medicalized, conditions previously recognized as psychotic are relocated under the heading of personality disorders, and psychosis has been reduced to schizophrenia and considered a deficit of psychic functions. This article indicates the clinical and operational validity of the notion of “psychosis” as a nosographic category permitting a more complex approach to “schizophrenia”, which in psychiatry is the last concept that bears the symbolic weight of madness.

Global Mental Health and systems of diagnostic classification: clinical and cultural perspectives / Salud Mental Global y sistemas de clasificación diagnóstica: perspectivas clínicas y culturales / Saúde Mental Global e sistemas de classificação diagnóstica: perspectivas clínicas e culturais

Historical and conceptual aspects of Global Health and Global Mental Health are examined and topics such as resources, professional and social attitudes toward mental disorders, the multidimensional experience of getting ill and the presence of world systems of psychiatric diagnosis and classification, are reviewed. The application of these areas of knowledge in medical practice require the integrated use of clinical and socio-cultural perspectives whose precise alignment is an essential component of accurate diagnoses, successful treatments and a consistent improvement of mental health as a component of public health. The latter includes preventive measures applicable to general populations, communities and health care proper. Management of socio-cultural aspects of diagnosis and treatment is imperative as is that of the growing relationship between mental health and neurosciences. The operationalization of this series of interactive processes must be part of legislations which, in turn, can make training, research and dissemination of the resulting data, possible.

Se examinan aspectos históricos y conceptuales de Salud Global y Salud Mental Global, formulándose temas de revision sobre recursos, actitudes profesionales y sociales o colectivas en torno a la enfermedad mental, las varias dimensiones de la experiencia de enfermar y la vigencia de sistemas diagnósticos y de clasificación psiquiátrica a nivel mundial. Las aplicaciones de estas áreas de conocimiento en la práctica médica requieren el uso integrado de perspectivas clínicas y socio-culturales cuyo alineamiento preciso es componente esencial de un diagnóstico acertado, un tratamiento exitoso y una mejoría consistente de la salud mental como componente de la salud pública. Esta última incluye medidas preventivas aplicables en niveles de población general, comunitario y de atención en salud propiamente tal. El manejo de aspectos socio-culturales de diagnóstico y tratamiento es imperativo, al igual que el de la creciente relación entre salud mental y neurociencias. La operacionalización de estos procesos interactivos debe ser materia de legislaciones que posibiliten, a su vez, programas de adiestramiento profesional, investigación y difusión adecuada de la información resultante.

São examinados aspectos históricos e conceituais de Saúde Global e Saúde Mental Global, formulando-se temas de revisão sobre recursos, atitudes profissionais e sociais ou coletivas em torno da enfermidade mental, as várias dimensões da experiência de enfermar e a vigência de sistemas diagnósticos e de classificação psiquiátrica em nível mundial. As aplicações destas áreas de conhecimento na prática médica requerem o uso integrado de perspectivas clínicas e socioculturais cujo alinhamento preciso é componente essencial de um diagnóstico acertado, um tratamento exitoso e uma melhoria consistente da saúde mental como componente da saúde pública. Esta última inclui medidas preventivas aplicáveis em níveis de população geral, comunitário e de atenção em saúde propriamente dita. O manejo de aspectos socioculturais de diagnóstico e tratamento é imperativo, igual ao da crescente relação entre saúde mental e neurociências. A operacionalização destes processos interativos deve ser matéria de legislações que possibilitem, por sua vez, programas de adestramento profissional, pesquisa e difusão adequada da informação resultante.

Outcomes of inpatients with severe mental illness: a naturalistic descriptive study

Objective: To describe and evaluate the response and predictors of remission during inpatient treatment in a psychiatric unit in a general hospital based on symptomatology, functionality, and quality of life (QoL). Methods: Patients were admitted to a psychiatric unit in a tertiary general hospital in Brazil from June 2011 to December 2013 and included in the study if they met two of the severe mental illness (SMI) criteria: Global Assessment of Functioning (GAF) ≤ 50 and duration of service contact ≥ 2 years. Patients were assessed by the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) Severity Scale , GAF, the World Health Organization Quality of Life Instrument – Abbreviated version (WHOQOL-Bref), and specific diagnostic scales. Results: A total of 239 patients were included. BPRS mean scores were 25.54±11.37 at admission and 10.96±8.11 at discharge (p < 0.001). Patients with manic episodes (odds ratio: 4.03; 95% confidence interval: 1.14-14.30; p = 0.03) were more likely to achieve remission (CGI ≤ 2 at discharge) than those with depressive episodes. Mean length of stay was 28.95±19.86 days. All QoL domains improved significantly in the whole sample. Conclusion: SMI patients had marked improvements in symptomatic and functional measures during psychiatric hospitalization. Patients with manic episodes had higher chance of remission according to the CGI.

¿Los trastornos mentales son clases naturales? / Are Mental Disorders Natural Kinds?

Uno de los problemas que ocupa tanto a filósofos de la psiquiatría como a psiquiatras en el dominio de la nosología consiste en determinar cuál es el modelo que podría resultar más adecuado para la clasificación de las enfermedades mentales. Semejante tarea exige, además, que se indague por la naturaleza misma de los trastornos mentales. En un intento por enfrentar los retos filosóficos que impone dicha tarea, Peter Zachar se propone mostrar que la empresa nosológica en psiquiatría no debe suscribir el modelo de las clases naturales, e incluso considera que es equivocado tratar los trastornos mentales como clases naturales. Con todo, la posición de Zachar acerca de la existencia de clases naturales -incluso en dominios donde no parece ponerse en duda que las haya, como la química- es muy inestable. En 2001 mantenía que no hay clases naturales, pero en 2008, sostiene que sus reparos al modelo de las clases naturales son más la manifestación de su escepticismo contra una tradición. Aunque en este trabajo no me ocuparé del problema de la existencia de clases naturales, indicaré brevemente hasta qué punto Zachar deflacta su posición sobre este asunto en 2008, y dedicaré el grueso del ensayo a reconstruir y examinar los argumentos en los que basa su tesis de que los trastornos mentales no son clases naturales. En el acápite dedicado al análisis crítico de los argumentos mantendré que, aun cuando la tesis de Zachar quizá sea correcta, los argumentos que esgrime en su defensa tienen defectos considerables.

A problem for both philosophers of Psychiatry and Psychiatrists within the domain of nosology is to determine which could be the more appropriate model to classify mental illnesses. Such an endeavor also requires questioning the very nature of mental illness. While trying to cope with the philosophical challenges of such a task, Peter Zachar purports to show that the nosological work in Psychiatry should not adhere to the model of natural kinds. He even considers that it is mistaken to treat mental disorders as natural kinds. Nonetheless, Zachar's view on the existence of natural kinds-even in domains where there is little room for doubting about their existence, like Chemistry-is very unstable. In 2001 he holds that there are no natural kinds, but in 2008 he argues that his objections to the model of natural kinds are more the manifestation of his skepticism against a tradition. Although the problem of the existence of natural kinds shall not be dealt with in this article, a brief description on how deflated is Zachar's view on this matter in 2008 is presented, with the central part of the article devoted to reconstruct and examine his rationale for the thesis that mental disorders are not natural kinds. In the critical section of this paper, it is suggested that, although Zachar's thesis may be right, the arguments he gives to support it are quite flawed.

Alterations in psychosocial health of people affected by asbestos poisoning / Alteraciones de la salud psicosocial en afectados por intoxicación por amianto

OBJECTIVE To analyze the state of psychosocial and mental health of professionals affected by asbestos.METHODS A cross-sectional study was conducted with 110 professionals working in the Ferrolterra region of Spain, who were affected by asbestos poisoning. This group was compared with a group of 70 shipyard workers with no manifestation of work-related diseases. All the participants were male with a mean age of 67 years. This study was conducted in 2013, between January and June, and used the SCL-90 questionnaire by Derogatis as its primary measure for research. This questionnaire consists of 9 variables that measure psychosomatic symptoms. In addition, an overall index of psychosomatic gravity was calculated. The participants were also asked two questions concerning their overall perception of feeling good. Data were analyzed by ANOVA and logistic regression.RESULTS Participants affected by asbestos poisoning showed high occurrence rates of psychological health variables such as somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and global severity index.CONCLUSIONS Social interaction as a differentiating factor between workers affected by work-related chronic syndromes as compared to healthy participants will possibly aid in the development of intervention programs by improving the social network of affected individuals.

OBJETIVO Analizar el estado de salud psicosocial y mental de profesionales afectados por el amianto.MÉTODOS Estudio transversal con 110 profesionales en la comarca de Ferrolterra, España, afectadas por intoxicación por amianto; y un grupo de comparación de 70 trabajadores de astilleros, que no presentaban manifestación de enfermedades profesionales. Todos fueron del sexo masculino con edad promedio de 67 años. El estudio se llevó a cabo entre Enero y Junio de 2013. Para la realización de la investigación se empleó como instrumento el cuestionario SCL-90 de Derogatis. Este cuestionario está formado por nueve variables que miden la sintomatología psicosomática, y también, se calculó un índice global de gravedad psicosomática. Se les preguntó a los sujetos sobre su percepción global de sentirse bien. Se analizaron los datos mediante la técnica del Anova, y se realizó una regresión logística.RESULTADOS Los sujetos afectados por la intoxicación por amianto presentaron altos índices de alteración de su salud psicológica en variables como somatización, obsesión-compulsión, sensibilidad interpersonal, depresión, ansiedad, hostilidad, ansiedad fóbica, ideación paranoide, psicoticismo e indicador global de gravedad.CONCLUSIONES La interacción social como factor diferenciador entre trabajadores afectados por síndromes crónicos, debidos al trabajo, frente a los no afectados, permitirá desarrollar programas de intervención basados en el fomento de la red social de los afectados.

Aportaciones y limitaciones del DSM-5 desde la psicología clínica / Contributions and limitations of DSM-5 from clinical psychology

La reciente publicación del Manual Diagnóstico y Estadístico de los Trastornos Mentales (5ª edición) por la Asociación Americana de Psiquiatría ha suscitado un gran debate. Una clasificación efectiva requiere un sistema fiable y válido de los cuadros clínicos para facilitar la comunicación, elegir los tratamientos, señalar la etiología, predecir los resultados y proporcionar una base sólida para la investigación. El DSM-5 es una clasificación categorial de los trastornos mentales, pero estos no siempre encajan adecuadamente dentro de los límites de un trastorno único. Hay algunas aportaciones interesantes del DSM-5, como los capítulos de adicciones y de trastornos de la personalidad. Las adicciones ya no se limitan a las sustancias químicas, sino que se extienden a los excesos conductuales (por ejemplo, el trastorno del juego). Los trastornos de personalidad no se han modificado, pero se ha añadido un modelo alternativo en la Sección III basado en un enfoque dimensional que podría sustituir a las categorías actualmente existentes. El motivo más importante de controversia es el aumento de diagnósticos psiquiátricos, así como una exigencia menos estricta para los criterios diagnósticos en las categorías antiguamente existentes. Se comentan finalmente algunas cuestiones no resueltas con vista a investigaciones futuras.

The recent release of the Diagnostic and Statistical Manual of Mental Disorders (5th edition) by the American Psychiatric Association has led to much debate. An effective classification requires a reliable and valid system for categorization of clinical phenomena in order to aid communication, select interventions, indicate aetiology, predict outcomes, and provide a basis for research. DSM-5 remains a categorical classification of separate disorders, but mental disorders do not always fit completely within the boundaries of a single disorder. There are some interesting contributions of DSM-5, such as the chapters of addictions and of personality disorders. Addiction label has also been given to behavioral excesses that have no external substance as a goal (e.g. gambling disorder). Personality disorders remain unchanged, but there is an alternative model in Section III based on a dimensional approach which might replace the current categories. The basic reason for controversy is the expansiveness of DSM-5 psychiatric diagnosis, both in terms of newly introduced categories and loosening the criteria for diagnosis in existing categories. Unanswered questions for future research in this field are commented upon.

Clasificación mediante análisis de conglomerados: un método relevante para la psiquiatría / Classification by cluster analysis: a relevant method for psychiatry

El objetivo de este artículo es describir el método de análisis por conglomerados y sus aplicaciones especialmente en la investigación psiquiátrica. El análisis de conglomerados es un método que permite clasificar individuos u objetos en grupos homogéneos (conglomerados o clusters). Dentro de cada conglomerado los objetos tienen características similares entre ellos pero diferentes a las de los objetos de otros conglomerados. El análisis por conglomerados tiene aplicaciones en diversas áreas que van desde la biología hasta los negocios, particularmente es muy importante para la psiquiatría donde la clasificación de los trastornos mentales ha sido motivo de controversia.

The objective of this paper is to describe the cluster analysis method and its applications especially in psychiatric research. Cluster analysis is a method for classifying individuals or objects into homogeneous groups (clusters). Within each cluster, objects have similar features among them but different from those of objects of other clusters. Cluster analysis has applications in diverse fields ranging from biology to business, it is particularly important for psychiatry where the classification of mental disorders has been controversial.