Moving beyond psychiatric diagnosis and the medical framework towards social recovery: an interview with Jim van Os / Para além do diagnóstico psiquiátrico e do modelo médico, na busca pelo "recovery" social: uma entrevista com Jim van Os / Au-delà du diagnostic psychiatrique et du modèle médical vers le social recovery: un entretien avec Jim van Os / Más allá del diagnóstico psiquiátrico y del modelo médico hacia en la búsqueda del social recovery: una entrevista con Jim van Os

There is a growing realization in the field of psychiatry that we are unable to free ourselves of the constraints imposed by our concepts, as well as to move beyond them. Thus, the field demands not only more robust empirical evidence but also a more sophisticated conceptual framework, which would allow for critical and innovative thinking to conceive and to build better models of mental health care. In this spirit, we present a very thought-provoking interview with Dutch psychiatrist Jim van Os, encompassing biographical issues from his academic background as well as his ideas on recovery and the Dutch experience of the recovery colleges as a "shadow mental health system" in the Netherlands. Adopting a critical stance on psychiatric diagnosis and the validity of group-level comparisons in evidence-based psychiatry, and in line with the ideals of the recovery movement, van Os points out that the process of healing should surpass symptom reduction. For him, it should take into account the long-term process of developing resilience, learning to deal with suffering through interactions with other people, building up new perspectives, goals, and existential purposes. In other words, he emphasizes the idea of social recovery and favors the thought that mental health professionals should try to "help people to relate better to their mental variation and offer them ways of doing that differently."

Há uma crescente percepção no campo da psiquiatria de que somos incapazes de nos liberar das restrições impostas pelos conceitos do campo, bem como ir além deles. Assim, o campo demanda não somente evidências empíricas mais robustas, mas também um quadro de referências conceituais que permita um pensamento crítico e inovador que conceba e construa modelos mais apropriados de cuidado à saúde mental. Nesse espírito, apresentamos uma entrevista provocativa com o psiquiatria holandês Jim van Os, abrangendo desde questões sobre sua formação acadêmica até suas ideias sobre recovery e sobre a experiência dos recovery colleges na Holanda como "um sistema de saúde mental invisível". Adotando uma posição crítica sobre o diagnóstico psiquiátrico e a validade das comparações grupais preconizadas pela medicina baseada em evidências, e em sintonia com o movimento conhecido como recovery, van Os destaca que o processo de cura deve ir além da redução de sintomas. Para ele, é preciso levar em conta o longo processo de desenvolvimento de resiliência, aprendendo com os outros a lidar com o sofrimento, e construindo novas perspectivas, objetivos e propósitos existenciais. Em outras palavras, a ênfase recai sobre a ideia de social recovery e favorece a ideia de que profissionais de saúde mental devem "ajudar as pessoas a se relacionarem melhor com suas variações psicológicas e oferecer a elas formas diferentes de chegar até isso."

Il y a une perception croissante dans le champ de la psychiatrie selon laquelle nous ne sommes pas en mesure de nous libérer des contraintes imposées par les concepts de ce domaine, encore moins de les dépasser. Ainsi, le champ de la psychiatrie exigerait non seulement des évidences empiriques plus solides, mais aussi un cadre de références conceptuelles procurant une pensée critique et novatrice capable de concevoir et de construire des modèles plus appropriés aux soins de santé mentale. Dans cette démarche, nous présentons un entretien provocateur avec le psychiatre néerlandais Jim van Os, couvrant des questions sur son parcours universitaire, ainsi que ses idées sur le recovery, et sur l'expérience des recovery colleges aux Pays-Bas en tant que « système de santé mentale invisible ¼. C'est en adoptant une démarche critique à l'égard du diagnostic psychiatrique et de la validité des comparaisons de groupes préconisées par la médecine fondée sur les preuves et en accord avec le mouvement connu sous le nom de recovery que van Os souligne que le processus de guérison doit aller au-delà de la réduction des symptômes. Pour lui, il faut prendre en compte le long mouvement de développement de la résilience, de sorte à apprendre d'autrui comment faire face à la souffrance, pour construire de nouvelles perspectives, de nouveaux objectifs et de nouvelles finalités existentielles. Ses contributions soulignent le concept de social recovery et favorisent l'idée selon laquelle les professionnels de la santé mentale devraient «aider les gens à mieux gérer leurs variations psychologiques et leur proposer différentes façons d'y parvenir¼.

Hay una percepción creciente, en el campo de la psiquiatría, de que somos incapaces de librarnos de las restricciones impuestas por los conceptos del campo, así como también de ir más allá de ellas. Por lo tanto, el campo demanda no solamente evidencias empíricas más robustas, sino un marco de referencias conceptuales que permita un pensamiento crítico e innovador que conciba y construya modelos más apropiados de cuidado de la salud mental. En ese sentido, presentamos una provocadora entrevista con el psiquiatra holandés Jim van Os, abarcando, desde cuestiones sobre su formación académica hasta sus ideas sobre recovery y la experiencia de los recovery colleges en Holanda como "un sistema de salud mental invisible". Adoptando una postura crítica sobre el diagnóstico psiquiátrico y la validez de las comparaciones grupales defendidas por la medicina basada en evidencias, y alineado con el movimiento conocido como recovery, van Os destaca que el proceso de curar debe ir más allá de la reducción de los síntomas. Para él, es necesario considerar el largo proceso de desarrollo de la resiliencia, aprendiendo a lidiar con el sufrimiento a través de la interacción con los otros y construyendo nuevas perspectivas, objetivos y propósitos existenciales. En otras palabras, el énfasis recae sobre la idea del social recovery, favoreciendo la noción de que los profesionales de la salud mental deben "ayudar a las personas a relacionarse mejor con sus variaciones psicológicas y ofrecerles diferentes formas para llegar a ello".

Diagnostic Issues of Depressive Disorders from Kraepelinian Dualism to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Because the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) was mainly influenced by the neo-Kraepelinian approach, its categorical approach to defining mental disorders has been criticized from the viewpoint of etiological neutrality. In the context of bridging the gap between “presumed etiologies-based symptomatology” and “identifiable pathophysiological etiologies,” the content in 5th edition, the DSM-5, has been revised to incorporate a combination of categorical and dimensional approaches. The most remarkable change of note regarding the diagnostic classification of depressive disorders in the DSM-5 is the splitting of mood disorders into bipolar disorders and depressive disorders, which is in accordance with the deconstruction of the Kraepelinian dualism for psychoses. The transdiagnostic specifiers “with mixed features,” “with psychotic features,” and “with anxious distress” are introduced to describe the relationships of depressive disorders with bipolar disorders, schizophrenia, and generalized anxiety disorder, respectively, in a dimensional manner. The lowering of the diagnostic threshold for major depressive disorder (MDD) may be caused by the addition of “hopelessness” to the subjective descriptors of depressive mood and the elimination of “bereavement exclusion” from the definition of MDD. Since the heterogeneity of MDD is equivalent to the Wittgensteinian “games” analogy, the different types of MDD are related not by a single essential feature but rather by “family resemblance.” Network analyses of MDD symptoms may therefore need further review to elucidate the connections among interrelated symptoms and other clinical elements.

A dimensional approach to personality disorders in a sample of juvenile offenders / Uma abordagem dimensional a distúrbios de personalidade em uma amostra de menores infratores / Une approche dimensionnelle aux troubles de la personnalité dans un échantillon de mineurs délinquants / Un abordaje dimensional de los trastornos de personalidad en una muestra de delincuentes juveniles

In a sample of 60 male Italian subjects imprisoned at a juvenile detention institute (JDI), psychopathological aspects of the AXIS II were described and the validity of a psychopathological dimensional approach for describing criminological issues was examined. The data show that the sample has psychopathological characteristics which revolve around ego weakness and poor management of relations and aggression. Statistically these psychopathological characteristics explain 85% of criminal behavior.

Em uma amostra de 60 sujeitos italianos do sexo masculino presos em un instituto de detenção para menores (JDI), descreveram-se os aspectos psicopatológicos do Axis II e examinou-se a validade de uma abordagem de dimensão psicopatológica para a descrição das questões criminológicas. No conjunto, os dados apontam que a amostragem apresenta características psicopatolócas que dizem respeito à debilidade do Ego e a uma má gestão das relações e da agressão. Estatísticamente, essas características psicopatológicas explicam 85% do comportamento criminal.

Un échantillon de 60 sujets italiens de sexe masculin détenus dans un établissement pénitentiaire pour mineurs (JDI) nous a servi de base pour décrire les aspects psychopathologiques de l'Axe II et pour examiner la validité d'une approche à dimensions psychopathologique pour décrire les questions criminologiques. Dans l'ensemble, les données indiquent que l'échantillon présente des caractéristiques psychopathologiques qui relèvent de la faiblesse de l'ego et de la mauvaise gestion des relations et de l'agression. Statistiquement, ces caractéristiques psychopathologiques expliquent à 85% le comportement criminel.

En una muestra compuesta por 60 sujetos italianos de sexo masculino encarcelados en un instituto correccional para jóvenes (ICJ), se hizo la descripción de los aspectos psicopatológicos de los trastornos de personalidad (AXIS II) y se examinó la validez del abordaje dimensional psicopatológico para describir las cuestiones criminológicas. Los datos demuestran que la muestra tiene características psicopatológicas que giran alrededor de la debilidad del ego y de gestión deficiente de las relaciones y de la agresión. Estadísticamente, esas caracteristicas psicopatológicas explican el 85% del comportamiento criminal.

Augmentation mammaplasty Using saline filled implant: Clinical experience in 368 cases

The perfect breasts are supposed to be symmetrically balanced and proportionate to the rest of the body with softness, good-position, and mobility to respond to gravity and postural change. But saline filled implants have some disadvantages compared to silicone gel implant. Their low viscosity creates an unnatural feeling and suboptimal aesthetic result, their deflation offers the most important complication such as rippling or size reduction of breast. Therefore precise preoperative design, exact procedure and appropriate postoperative care are essential to optimal result. In past 5 years, we have performed the transaxillary subpectoral augmentation mammaplasty using saline filled implants on 183 female patients whose breasts were hypoplastic and followed up 58 months maximally. All patients were assisted with endoscopy. We employed round, textured type implant with the size ranging from 120cc to 270 cc and overinflated them 10 to 20% beyond its original volume. The overall result was satisfactory but some cases of capsular contracture, deflation, implant displacement and infection were found. On the basis of our experience, we suggest some critical points so as to obtain the best result: what conforms to the patients anatomy and satisfies her goal at the same time. First of all, preoperative design in accordance with the dimension is very important. The best dimension for each patient depends on the definition of the ideal base width of the breast. Secondly, exact subpectoral dissection using endoscopy, no-touch technique for the implant is essential to achieve excellent results. Finally, postoperative self management must not be ignored.