Ayurvedic Management of Acute Dissociative Reactions to Stressful Life Events - A Case Study

Mental diseases known as dissociative disorders are characterised by a sense of discontinuity and separation from one's thoughts, memories, environment, activities, and identity. People with dissociative disorders unintentionally and unhealthily flee reality, which makes it difficult for them to carry on with daily activities. Dissociative identity disorder (DID, sometimes known as multiple personality disorder), fugue, "psychogenic" or "functional" amnesia, and depersonalization disorder are examples of dissociative disorders. Other specified dissociative disorder is subcategory of dissociative disorders that describes presentations in which symptoms are typical of a dissociative disorder but do not fully match the diagnostic criteria for any of the illnesses in the diagnostic class of dissociative disorders. In Ayurveda this condition can be considered as Unmada. 34 year female patient hailing from Malappuram, Kerala, brought to Manasanthi OPD of VPSV Ayurveda College, Kottakka,l by husband and relatives complains of lack of desire to live, wants to end her life, loss of sleep, difficulty to walk and doing daily activities since 3 days. She was very much concerned about the behavioural issues and wellbeing of her elder son since 12 years. According to the informant, the patient was having increased tension, repeated talking about her elder son, making loud noises and suicidal thoughts. Also, she had an attempt to suicide. She was treated on an IP level with a combination of Ayurvedic internal medications and Panchakarma procedures. The treatment protocol includes Snehapana, Virecana, Nasya, Shirodhara, and Dhoopana. Satvavajaya methods including Yoga also administered. There were considerable relief from symptoms and HAM D score was reduced from 21 to 6.

La importancia del cribado orgánico. A propósito de un caso clínico

Introducción: Antes de catalogar un proceso morboso como trastorno mental, es imprescindible tener presente la importancia del diagnóstico precoz de causas de origen no psiquiátrico para una posible presentación clínica. Por ello, trataremos de reflejar este hecho, que se antoja necesario recordar aunque sea bien sabido, ya que puede pasarse por alto en situaciones de urgencia en el ámbito hospitalario, con las consecuencias derivadas de un cribado incompleto y con el potencial riesgo vital para el paciente. Presentación del caso: Adolescente mujer, de 13 años, que presentó un cuadro clínico agudosugestivo de carácter disociativo. Se precisó su ingreso hospitalario para la aclaración diagnóstico-terapéutica, y mediante neuroimagen se diagnosticó inicialmente como lesión neoplásica en el tronco del encéfalo y, finalmente, como lesión isquémica de origen vasculítico en dicha localización. Discusión: Se planteó un diagnóstico diferencial a través de las diferentes etiologías tanto psíquicas como no psíquicas del cuadro clínico, pero fue necesaria la intervención del servicio de pediatría hospitalario para la orientación y filiación definitiva, ante la sospecha de enfermedad no psiquiátrica tras una evolución tórpida a pesar de intervenciones psicoterapéuticas y psicofarmacológicas. Conclusiones: A través de la presentación y revisión de un caso clínico que sucedió en nuestro hospital de trabajo, se debe insistir en un adecuado abordaje integral del paciente, especialmente con población infanto-juvenil, ante una presentación clínica aguda y sin previas evaluaciones físicas de relevancia.

Introduction: Before cataloguing a morbid process as a "mental disorder", it is essential to bear in mind the importance of early diagnosis of causes of non-psychiatric origin for a possible clinical presentation. For this reason, we will try to reflect this fact, which it seems necessary to remember even though it is well known, since it can be overlooked in emergency situations in the hospital setting, with the consequences derived from an incomplete diagnosis and with the potential life-threatening risk for the patient. Case presentation: A 13-year-old female adolescent, who presented an acute clinical picture suggestive of dissociative disorder. She required hospital admission for diagnostic-therapeutic clarification, and neuroimaging findings led to an initial diagnosis of a neoplastic lesion in the brain stem and, finally, as ischaemic lesion of vasculitic origin in said location. Discussion: A differential diagnosis was proposed through the different psychic and nonpsychic aetiologies of the clinical picture, being the intervention of the hospital's paediatric service necessary for orientation and definitive affiliation, given the suspicion of non-psychiatric illness after a torpid evolution in spite of psychotherapeutic and psychopharmacological interventions. Conclusions: Through the presentation and review of a clinical case that happened in our hospital, we must insist on an adequate comprehensive approach to the patient, especially with the child-adolescent population, when faced with an acute clinical presentation and without previous studies at a relevant physical level.

Dissociative Experiences Scale: Psychometric Analysis in Puerto Rico and Contributions to the Discussion of the Factor Structure / Escala de Experiencias Disociativas: Análisis Psicométrico en Puerto Rico y Aportaciones a la Discusión sobre la Estructura Factorial

Introduction: The Dissociative Experiences Scale (DES-II) is a widely used psychometric tool to assess dissociative symptoms. Over the years, it has been the subject of numerous studies and research in various fields of psychology and psychiatry. Numerous studies have supported the validity and reliability of the DES-II as a reliable measure of dissociative experiences. The most problematic aspect of the DES-II is the inconsistency in its factor structure. Objective: This research aimed to examine the psychometric properties of the DES-II in a clinical and non-clinical sample from Puerto Rico. Method: This research had an instrumental design. An availability sampling of 341 adult participants was used. Several competing models of the DES-II were analyzed, including a bifactor model. Result: Psychometric analyses concluded that the scale has a unidimensional structure, strong reliability, and construct validity. All 28 items met adequate discrimination values. Participants with dissociative disorders obtained higher means on the DES-II than the other diagnostic groups. Furthermore, the more adverse experiences in childhood, the more dissociative experiences in adulthood. Conclusion: The DES-II should be treated and interpreted as a unidimensional dissociation index rather than a multidimensional instrument. This study will advance further research on dissociation and dissociative disorders in Puerto Rico and Latin America.

Introducción: La Escala de Experiencias Disociativas (DES-II) es una herramienta psicométrica ampliamente utilizada para evaluar síntomas disociativos. A lo largo de los años, ha sido objeto de numerosos estudios e investigaciones en diversos campos de la psicología y la psiquiatría. Numerosos estudios han respaldado la validez y la fiabilidad de la DES-II como una medida confiable de las experiencias disociativas. El aspecto más problemático del DES-II es la inconsistencia de su estructura factorial. Objetivo: Esta investigación tuvo como objetivo examinar las propiedades psicométricas de la DES-II en una muestra clínica y no clínica de Puerto Rico. Método: Esta investigación tuvo un diseño instrumental. Se utilizó un muestreo por disponibilidad compuesto por 341 participantes adultos. Se analizaron varios modelos competitivos de la DES-II, incluyendo un modelo bifactorial. Resultados: Los análisis psicométricos concluyeron que la escala posee una estructura unidimensional y una sólida confiabilidad y validez de constructo. Los 28 ítems cumplieron con valores adecuados de discriminación. Los participantes con trastornos disociativos obtuvieron medias más altas en la DES-II que los otros grupos diagnósticos. Además, a mayores experiencias adversas en la infancia, mayores experiencias disociativas en la adultez. Conclusión: La DES-II debería tratarse e interpretarse como un índice unidimensional de disociación y no como un instrumento multidimensional. Este estudio permitirá el avance de nuevas investigaciones sobre disociación y trastornos disociativos en Puerto Rico y América Latina.

Factors affecting dissociative tendency among middle school students / 预防医学

Abstract@#Objective To investigate the prevalence of dissociative tendency and its influencing factors among middle school students, so as to provide insights into prevention and early interventions of adolescent dissociative tendency.@* Methods@# Students at ages of 13 to 18 years that studied in 9 high schools were sampled using a multistage, stratified, cluster sampling method from 3 counties (districts) of Hangzhou City from January, 2021 and March, 2022. Participants' demographics and social, school, family environment and psychological factors were collected using self-designed questionnaires and standardized scales. The dissociative tendency was initially screened using the Adolescent Dissociative Experience Scale (A-DES), and the diagnosed by three psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders (5th Edition). Factors affecting ADT were identified using a multivariable logistic regression model. @*Results@# Totally 3 240 students were recruited, and 2 841 students were qualified, with a response rate of 87.69%. The respondents included 1 389 men (48.89%) and 1 452 women (51.11%), and had a mean age of (15.69±1.58) years. The prevalence of dissociative tendency was 24.04%, and the detection of dissociative tendency was higher among men than among women (29.23% vs. 19.08%; χ2=24.529, P<0.001). Multivariable logistic regression analysis identified negative teacher-student relationship (OR=1.055, 95%CI: 1.010-1.103), family emotional expressiveness (OR=0.872, 95%CI: 0.777-0.978), family conflict (OR=1.152, 95%CI: 1.045-1.271), family organization (OR=0.880, 95%CI: 0.780-0.992) and family cohesion (OR=0.871, 95%CI: 0.766-0.987) as factors affecting dissociative tendency among men, and somatization (OR=1.041, 95%CI: 1.002-1.082) and paranoid ideation (OR=1.094, 95%CI: 1.006-1.190) as factors affecting dissociative tendency among women. @*Conclusions@# The prevalence of dissociative tendency was 24.04% among middle school students. Negative teacher-student relationship, family emotional expressiveness, family conflict, family organization, and family cohesion may affect dissociative tendency among men, while somatization and paranoid ideation may affect dissociative tendency among women.

Association of S(+) ketamine, dexmedetomidine and butorphanol for chemical restraint in scarlet macaws (Ara macao) / Associação cetamina S(+), dexmedetomidina e butorfanol na contenção química de araracangas (Ara macao)

The present study aimed at assessing the effects of combining 20 mg/kg S(+) ketamine with 25 µg/kg dexmedetomidine and 0.4 mg/kg butorphanol on the physiological parameters and anesthetic recovery time and score of eight captive scarlet macaw (Ara macao) specimens. These specimens were captured at the Marabá Zoobotanic Foundation (Fundação Zoobotânica de Marabá), Pará, using butterfly and mist nets, and subsequently subjected to the proposed protocol. The following physiological parameters were evaluated: heart rate (HR), respiratory rate (RR), saturation of peripheral oxygen (SpO2), body temperature (BT), and non-invasive blood pressure 5 min after drug administration (M0) and every 10 min thereafter (M1‒M5), with a total of 55 min of analysis of anesthetic effects. Glycemia was measured 5 min after drug administration and every 30 min thereafter. Anesthetic induction and recovery times were also determined. Among the parameters evaluated in this study, both HR and BT significantly decreased throughout the anesthetic period, with the lowest levels at 55 min after drug administration (M5). In contrast, RR did not significantly differ, and all animals remained stable, maintaining an RR close to a mean of 20 ± 8 cpm. Throughout the anesthetic period, SpO2was 92 ± 5%, with no significant difference. The birds remained under spontaneous ventilation and without oxygen supplementation. Systolic, diastolic, and mean blood pressures remained stable, with no significant differences in any of these measurements. At M0 and M3, the glycemia decreased slightly, albeit with no significant difference justifying an adverse effect or even hypoglycemia. The anesthetic induction time, from M0 to decubitus, was 2.4 ± 0.7 min. The anesthetic recovery time, from M0 to effortless bipedal position and adequate phalangeal flexion, was 99.3 ± 32.4 min. The sedation was assessed as intense, and the anesthetic recovery was rated excellent in 62.5% and good in 37.5% of the animals.(AU)

O presente estudo objetivou avaliar os efeitos do uso da cetamina S(+) 20 mg/kg associada à dexmedetomidina 25 µg/kg e butorfanol 0,4 mg/kg sobre os parâmetros fisiológicos, tempo e qualidade da recuperação anestésica de araracangas (Ara macao). Foram utilizados oito espécimes de Ara macao cativas da Fundação Zoobotânica de Marabá, Pará. A captura foi realizada com o uso de puçá e rede de contenção e em seguida as aves foram submetidas ao protocolo proposto. Foram avaliados: frequência cardíaca, frequência respiratória, saturação parcial da oxihemoglobina (SpO2), temperatura corporal e pressão arterial não-invasiva a partir de 5 minutos após a aplicação dos fármacos (M0) e a cada 10 minutos seguintes (M1, M2, M3, M4 e M5), totalizando 55 minutos de contemplação dos efeitos anestésicos. A glicemia foi avaliada aos 5 minutos da aplicação dos fármacos e repetida após 30 minutos. Também foi determinado o tempo de indução e de recuperação. Dentre os parâmetros avaliados, a frequência cardíaca e a temperatura demonstraram queda estatisticamente significativa ao longo do período anestésico, ambas com os menores valores registrados aos 55 minutos após a aplicação dos fármacos (M5). A frequência respiratória não apresentou diferença estatística e todos os animais se mantiveram estáveis e com a frequência próxima a média de 20±8mpm. A saturação da oxihemoblobina (SpO2) ao longo do período anestésico foi de 92±5%, não houve diferença estatisticamente relevante, as aves permaneceram sob ventilação espontânea e sem suplementação de oxigênio. As pressões arteriais sistólica, diastólica e média, mantiveram-se estáveis e não houve diferença estatística para nenhuma dessas medidas. A glicemia, mensurada em M0 e M3 demonstrou queda discreta, sem diferença significativa capaz de justificar um efeito adverso ou mesmo hipoglicemia. O tempo de indução, desde aplicação dos anestésicos até o decúbito, foi de 2,4±0,7 minutos. O tempo de recuperação, compreendido desde a aplicação dos fármacos (M0) até a constatação da posição bipedal sem esforço e adequada flexão das falanges, foi de 99,3±32,4 minutos. A qualidade de sedação foi considerada intensa e a recuperação anestésica foi classificada como ótima para 62,5% e boa para 37,5% dos animais.(AU)

DISSOCIATIVE TRANCE AND POSSESSION DISORDER IN A MULTIPAROUS FEMALE WITH BAD OBSTETRIC HISTORY – A CASE REPORT

Dissociative trance and possession disorder is common in clinical settings and is dif?cult to differentiate from psychotic disorder by clinicians. It has also been associated with non-suicidal self-injurious behaviours. A case of 24-year-old married female who is 4 months ANC was diagnosed with a case of trance and possession disorder with a bad obstetric history. She received treatment on OPD basis.

The mind possessed: well-being, personality, and cognitive characteristics of individuals regularly experiencing religious possession

Objective: To further our understanding of religious possession experiences by focusing on personality, cognitive, and quality of life outcomes. Methods: Data collection was undertaken at Umbanda sessions in Brazilian cities. Participants were mediums who regularly experienced possession (n=334) or those who attended the same rituals but had never been possessed (n=54). Results: We found that mediums were not significantly different across variables from the control group, except for anxiety, which was lower among mediums. Correlational and regression analysis showed that the level of meaningfulness attributed to possession and fusion with the spiritual entity were strongly positively correlated with most quality-of-life dimensions, and negatively with anxiety; in addition, level of meaningfulness predicted lower anxiety, and psychological quality of life was predicted by level of fusion and meaningfulness. Contrary to expectations, there were no detrimental effects of a lower level of bodily control over the possession experience. Conclusion: Together, these results suggest that individuals regularly experiencing possession within a religious context are psychologically similar to those who attend the same rituals without experiencing possession, and that the way they appraise their experiences as meaningful, as well as the level of spiritual fusion, are predictors of well-being.

Calidad de vida en pacientes con epilepsia y crisis no epilépticas psicógenas: una revisión sistemática / Quality of life in patients with epilepsy and psychogenic nonepileptic seizures: a systematic review

Resumen Se han revisado artículos que estudiaron la calidad de vida en las personas con crisis no epilépticas psicógenas (CNEP) y crisis epilépticas. Se siguió la guía PRISMA y, previo a la búsqueda, se realizó un protocolo publicado en PROSPERO. Se incluyeron estudios aleatorizados y no aleatorizados, de tipo cuantitativo o mixtos, de corte transversal o longitudinal, escritos en lengua inglesa o española publicados hasta el año 2020, y cuyos participantes fueran mayores de 16 años. Luego de filtrar los resultados según los criterios de selección, se incluyeron 11 artículos y una tesis doctoral cuyos años de publicación datan de 1998 a 2020. En su mayoría, se informaba que las personas con CNEP tenían menor calidad de vida, asociadas a presencia de psicopatología, así como también a la toma de medicación antiepiléptica, factores sociodemográficos y relacionados con las crisis (frecuencia, severidad y duración de enfermedad), funcionamiento familiar, trauma y somatización.

Abstract Psychogenic non epileptic seizures (PNES) are disruptive changes in behaviour, thought, or emotion that resemble an epileptic seizure, but without paroxysmal neuronal discharge detectable by electroencephalography (EEG), and are not caused by another medical condition. On the other hand, epileptic seizures (ES) are defined as clinical events that reflect the presence of hypersynchronous discharges of neurons located in the cerebral cortex, which have the particularity of starting and ending abruptly. The diagnosis of epilepsy is made when an epileptic seizure was experienced and there is a risk of having another. The objective of this paper is to present the results of a systematic review of articles that have studied quality of life in people with PNES and ES. This review has been performed following the PRISMA guide (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Prior to the beginning of the search, a protocol was carried out and it is published for consultation in the International prospective register of systematic reviews (PROSPERO). The review includes randomized and non-randomized, quantitative or mixed, cross-sectional or longitudinal studies, published in English or Spanish until 2020. In addition, participants had to be over 16 years old. PNES diagnosis must have been confirmed by video-electroencephalography (VEEG) or a similar procedure-which is considered the gold standard for the diagnosis of PNES.

Exploiting Genetic Counseling as a Tool for the Analysis of Dissociative Behavior and Sub-normality from Conception to Birth among Maladjusted Blind, Deaf and Dumb Infants

This paper analyzes the dissociation behavior of children from pregnancy to birth and resultant sub-normality using genetic counseling in an attempt to mainstream children with birth disabilities and the challenges of the genetic counselor. Genetic counseling is a process of communication to provide information about a genetic condition, or inheritance, and support decision making and adjustment in families with the inheritance gene. It uses children that need special needs, the blind, deaf and dumb. Genetic counseling approach, re-affirmation, care and integration, and confidence-building institutionalized in school and family life remains some of the vital tools needed to support these children using genetic guidance and counseling as the best approach to adjusting the different maladaptive behavior of children. The genetic counseling approach includes information about the implications of testing positive for the genetic disorder, including the psychological impact and other consequences, whether to inform relatives of your intention to test, or not to test and the usual pattern of progression of the sub-normality identified tested for and its potential treatments. Thus, the paper seems to analyze sub-normality as classified within the adequacy of social adaptation. Analysis of dissociation behavior associated with sub mentality shows discouragement, contempt, and neglect from an early age, emotionally and maladjusted social growth. Therefore, the counselor must experience sub-normality by getting involved and clarifying their feeling toward the children with these disabilities.

Trastornos sensitivos genitales y maltrato psicológico en la relación de pareja: una revisión bibliográfica / Sensitive genital disorders and psychological abuse in the couple relationship: a bibliographic review

INTRODUCCIÓN: Los trastornos sensitivos genitales y su relación con el maltrato psicológico en la pareja es un tema poco tratado en la literatura y, sin embargo, presente en la entrevista médica y psicológica. Aplica para aquellos casos en que no se aprecia alteración en la exploración física suficiente como para atribuirlo a causas orgánicas. OBJETIVO: Recopilar e integrar diferentes visiones acerca del síntoma de insensibilidad genital durante las relaciones sexuales, definir si este síntoma corresponde a una disfunción sexual e indagar sobre su relación con la violencia psicológica en la relación de pareja. MÉTODO: Revisión bibliográfica. Resultados: Los trastornos sensitivos cuya base orgánica es descartada no corresponderían a una disfunción sexual, sino más bien a una alteración sensorial disociativa como respuesta a una situación de violencia psicológica acompañada de violencia sexual en todos los casos. CONCLUSIONES: La insensibilidad genital es un tema que debe ser considerado al hacer la anamnesis de una paciente, para así ser derivada a un especialista con la intención de abordarlo de forma interdisciplinaria y, por ende, evaluar y diferenciar los elementos orgánicos y funcionales del síntoma.

INTRODUCTION: Genital sensory disorders and how they relate to psychological abuse in the couple is a topic that is scarcely address in the literature, however present it might be in medical and psychological interviews. It is often found in cases where there is no perceived sufficient alteration in physical examinations in order to attribute it to organic causes. OBJECTIVE: To collect and integrate different views regarding the symptom of genital insensitivity during sexual intercourse, define whether this symptom relates to sexual dysfunction and inquire about its connection with psychological violence in the couple. METHOD: Bibliographic assessment. Results: Sensory disorders, whose organic basis is ruled out, do not relate to sexual dysfunction but rather to a dissociative sensory alteration in response to a situation of psychological violence accompanied, in all cases, by sexual violence. CONCLUSIONS: Genital insensitivity is an issue that must be taken into account at the time of taking the patients medical history. This way, it can be referred to a specialist with the intention of addressing it in an interdisciplinary way and, therefore, evaluate and differentiate the organic and functional elements of the symptom.

A study of expressed emotion, perceived stress and socio-demographic profile in patients of dissociative disorder

Background: Dissociation is understood as one of coping mechanism to deal with intense stressors. Individuals vary widely in their subjective response to a similar stressful event depending on number of factors including their family and social support system. So, authors tried to study the expressed emotion in patients of dissociative disorder along with other socio-demographic factors and its relation with perceived stress.Methods: This cross-sectional descriptive study was done on 100 patients with primary diagnosis of dissociative disorder. Hamilton depression rating scale (HAM-D) was used to assess comorbid Depressive symptoms and Hamilton anxiety rating scale (HAM-A) was used to asses comorbid anxiety symptoms. Perceived stress scale (PSS) was used to assess the perception of stress. Family emotional involvement and criticism scale (FEICS) was used to measure perceived criticism (PC) and intensity of emotional involvement (EI).Results: Mean perceived stress in this study was 25.8. Mean score for perceived criticism (PC) was 16.5 and emotional involvement (EI) was 15.7. Both measures of expressed emotions were significantly higher in females and subjects belonging to joint families and rural area. In this study perceived stress by subjects was significantly (p=0.001) correlated to perceived criticism (Pearson r = 0.78) and emotional involvement (Pearson r = 0.77).Conclusions: High perceived criticism and emotion over involvement of family member was associated with perceived stress in dissociation patients.

A 10 Year Study Of Dissociative Stupor And Possession In Psychiatry Opd

The aim of the present study is to identify the incidence of Dissociative Stupor and Possessions in psychiatry OPD population. 8.92% of patients in last 10 years were in the screening group. There were 10.03% of the subjects in 2007 sliding through to 7.76% in 2016, a visible decline. Males are affected earlier (mean age 18.59 years) than females (mean age 23.4 years). The study also proved that females far outnumber males in this category of illness but in the ages between 6 to 12 years, this relationship is reversed.

Anesthetic quality and cardiovascular and respiratory effects of continuous intravenous infusion of tiletamine-zolazepam in bitches / Qualidade anestésica e efeitos cardiovascular e respiratória da infusão intravenosa contínua de tiletamina-zolazepam em cadelas

The objective of this study was to evaluate the quality and recovery from anesthesia promoted by the tiletamine-zolazepam (TZ) combination administered intravenously (IV) continuously in bitches pre-medicated with acepromazine. Eight cross-bred, clinically healthy bitches weighing 13.7 ±1.9kg on average were used in this study. After a food fast of 12 h and a water fast of four hours, the animals were treated with acepromazine (0.1mg/kg, intramuscular) and, after 15 minutes, anesthesia was induced with a combination of tiletamine-zolazepam (2mg/kg, IV) immediately followed by continuous IV infusion thereof at a dose of 2mg/kg/h for 60 min. The following parameters were measured in all animals immediately before administration of acepromazine (M15), immediately before anesthetic induction (M0), and at 5, 10, 20, 30, 40, 50, and 60 min after initiation of continuous infusion (M5, M10, M20, M30, M40, M50, and M60): electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), body temperature (BT), and arterial hemogasometry, with the last performed only at experimental times M15, M0, M30, and M60. A subcutaneous electrical stimulator was used to evaluate the degree of analgesia. Myorelaxation and quality of anesthetic recovery were also assessed, classifying these parameters as excellent, good, and poor. Anesthetic recovery time was recorded in minutes. HR increased significantly at time M10 in relation to that at M-15, and at times M5, M10, M40, and M50 in relation to that at M0. MAP decreased significantly at M20 and M30 compared with the baseline. BT decreased significantly at M50 compared with that at M0, but no hypothermia was observed. RR showed significant reduction at M5, M10, and M20 in relation to that at M-15, and at M5 and M10 in relation to that at M0, and bradypnoea was observed during the first 20 min after anesthetic induction. Significant decreases in the PR interval at times M10, M40, and M50 were observed in relation to that at M15. Amplitude of the R wave showed significant decrease at M20 compared with that at M-15. In the other ECG parameters, no significant difference was observed between the times evaluated. Hemogasometric parameters and analgesia did not show significant alterations. Myorelaxation and quality of anesthetic recovery were considered excellent. Recovery time was 15.1±7.7 min for positioning of sternal decubitus and 45.5±23.1 minutes for return of ambulation. Continuous IV administration of TZ combination does not produce satisfactory analgesia and does not cause severe cardiorespiratory and hemogasometric effects in bitches pre-medicated with acepromazine.(AU)

Objetivou-se avaliar a qualidade e a recuperação da anestesia promovida pela associação tiletamina-zolazepam, administrada por via intravenosa (IV) contínua, em cadelas pré-medicadas com acepromazina. Foram utilizadas oito cadelas, sem raças definidas, clinicamente sadias, pesando em média 13,7±1,9kg. Após jejum alimentar de 12 horas e hídrico de quatro horas, os animais foram medicados com acepromazina (0,1mg/kg, via intramuscular) e, após 15 minutos, a anestesia foi induzida com a associação tiletamina-zolazepam (2mg/kg, IV) seguida imediatamente pela infusão IV contínua da mesma, na dose de 2mg/kg/h, durante 60 minutos. Os parâmetros que foram mensurados em todos os animais, imediatamente antes da administração da acepromazina (M-15), imediatamente antes da indução anestésica (M0) e, aos 5, 10, 20, 30, 40, 50 e 60 minutos após o início da infusão contínua (M5, M10, M20, M30, M40, M50 e M60) foram os seguintes: eletrocardiografia (ECG), frequência cardíaca (FC), pressão arterial média (PAM), frequência respiratória (f), temperatura corpórea (TC) e hemogasometria arterial, esta sendo realizada apenas nos momentos M-15, M0, M30 e M60. Para avaliação do grau de analgesia foi empregado um estimulador elétrico subcutâneo. Também se avaliou o miorrelaxamento e a qualidade da recuperação anestésica, classificando estes parâmetros em: excelente, bom e ruim. O tempo de recuperação anestésica foi registrado em minutos. A FC aumentou significativamente no momento M10 em relação ao M-15, e nos momentos M5, M10, M40 e M50 em relação ao M0. A PAM diminuiu significativamente em M20 e M30 em comparação ao valor basal. A TC diminuiu significativamente em M50 em comparação ao M0, mas não foi observada hipotermia. A f apresentou uma redução significativa nos momentos M5, M10 e M20 em relação ao M-15, e em M5 e M10 em relação ao M0, sendo observado bradipneia durante os primeiros 20 minutos após a indução anestésica. Foram observadas diminuições significativas do intervalo PR nos momentos M10, M40 e M50, em relação ao M-15. A amplitude da onda R apresentou diminuição significativa em M20 em comparação ao M-15. Nos demais parâmetros da ECG não houve diferença significativa entre os momentos avaliados. Os parâmetros hemogasométricos e a analgesia não apresentaram alterações significativas. O miorrelaxamento e a qualidade da recuperação anestésica foram considerados excelentes. O período de recuperação foi de 15,1±7,7 minutos para posicionamento do decúbito esternal e 45,5±23,1 minutos para retorno da deambulação. A administração intravenosa contínua de tiletamina-zolazepam não produz analgesia satisfatória e não causa efeitos cardiorrespiratórios e hemogasométricos severos, em cadelas pré-tratadas com acepromazina.(AU)

A utilização do Método de Rorschach no diagnóstico diferencial da Esquizofrenia e Transtorno Dissociativo de Identidade / Using the Rorschach Method in The Differential Diagnosis of Schizophrenia and Dissociative Identity Disorder

RESUMO O objetivo deste artigo foi investigar a prevalência do Transtorno Dissociativo de Identidade (TDI) em dez pacientes diagnosticados com esquizofrenia com característica paranóide, com base no Método de Rorschach. Foram registrados indicadores ou sintomas psicológicos que caracterizaram o diagnóstico diferencial desses pacientes, analisadas diferenças clínicas específicas e verificado o enquadramento dos dados obtidos, com a aplicação da Técnica de Rorschach. Para fins de diagnóstico diferencial, observou-se que dois pacientes apresentaram sintomas diferenciais aos da esquizofrenia, sendo que um deles apresentou sintomas dissociativos, não sendo confirmada a prevalência do TDI entre os esquizofrênicos. No caso da esquizofrenia e do TDI, devido às características similares que apresentam, avaliações multidisciplinares são indicadas para se fazer o diagnóstico diferencial entre eles.

ABSTRACT The aim of this article was to investigate the prevalence of the Dissociative Identity Disorder (DID) in ten patients diagnosed with schizophrenia with paranoid characteristic, based on the Rorschach approach. Psychological symptoms that characterize the differential diagnosis of these patients were registered, specific clinical differences were analyzed and the framework of the data obtained with the application of the Rorschach approach. For purposes of differential diagnosis, it was observed that two patients had differential symptoms to schizophrenia, one of which showed dissociative symptoms, not confirmed the prevalence of DID among schizophrenics. In the case of schizophrenia and DID due to exhibit similar characteristics, multidisciplinary evaluations are set to make a differential diagnosis between them.

AVALIAÇÃO DE SINTOMAS DISSOCIATIVOS E PÓS-TRAUMÁTICAS EM CRIANÇAS INTERNADAS EM UNIDADES PEDIÁTRICAS / EVALUATION OF DISSOCIATIVE AND POST-TRAUMATIC SYMPTOMS IN INJURED CHILDREN IN PEDIATRIC UNITS

O objetivo foi investigar a presença de sintomas dissociativas pós-traumáticas infantis decorrentes de hospitalizações superiores a cinco dias. Investigação avaliativa descritiva. Abrangeu crianças de cinco a doze anos. Critérios de inclusão: crianças entre cinco e doze anos, internadas por mais de cinco dias, autorizadas por seus cuidadores e/ou responsáveis à participar da pesquisa. Critérios de exclusão: crianças menores de cinco anos e maiores de doze anos, que apresentaram patologias neurofisiológicas, crianças indígenas, surdas e mudas. Foi utilizada a Child Dissociative Checkist (CDC) e Children's Dissociative Experience Scale (CDES) para a coleta de dados. De acordo com Children Dissociative Checklist, as crianças sem transtornos dissociativos foram de 58% e sem transtorno foram de 42%, em ambos os hospitais, de acordo com a Children's Dissociative Experience Scale, na Santa Casa as crianças sem transtorno foram de 27%, com síndrome pós trauma foram de 26%, com transtorno dissociativo foram de 27% e falsa escala foram de 26%, no hospital Barros Barreto foram de 21% sem transtornos dissociativos, com síndrome pós trauma foram de 27%, com transtorno dissociativo foram de 13% e falsa escala foram de 33%. Concluiu se que os transtornos dissociativos afetaram a população infantil que estava hospitalizada, e a ideia da infância como um período puramente alegre e livre de sofrimentos, foi desmitificada.

The objective was to investigate the presence of dissociative children's post-traumatic symptoms resulting from hospitalizations of more than five days. Descriptive evaluative research. It covered children from five to twelve years. Inclusion criteria: children between five and twelve years old, hospitalized for more than five days, authorized by their caregivers and / or caregivers to participate in the research. Exclusion criteria: children younger than five years and older than twelve years, who presented neurophysiological pathologies, indigenous children, deaf and dumb. The Child Dissociative Checker (CDC) and Children's Dissociative Experience Scale (CDES) were used for data collection. According to the Children Dissociative Checklist, children without dissociative disorders were 58% and no disorder were 42%, in both hospitals, according to the Children's Dissociative Experience Scale, at Santa Casa children without disorder were 27%, With post-trauma syndrome were 26%, dissociative disorders were 27% and false-scale were 26%, Barros Barreto hospital were 21% without dissociative disorders, with post-trauma syndrome were 27%, with dissociative disorder were 13% and false scale were 33%. It was concluded that dissociative disorders affected the hospitalized infant population, and the idea of childhood as a purely joyous and suffering-free period was demystified.

La histeria moderna: Parte III trastornos disociativos y conversión / The modern hysteria: Part III dissociative disorders and conversion

La conciencia: característica esencial de esta dimensión de autorepresentación es la interpretación de ciertos estados internos del propio cuerpo como identidad mental y somática. La neurociencia de la conciencia sugiere fuertemente que un nivel de sincronización y unión entre varias partes del cerebro hasta cierto punto refleja la accesibilidad de varios contenidos mentales. Janet (1889) propuso el término désagrégation para referirse a los fenómenos de «no integración¼ y lo situó en el terreno de la anormalidad. Trastornos disociativos: en estos trastornos hay pérdida parcial o completa de la integración normal entre ciertos recuerdos del pasado, la conciencia de la propia identidad, ciertas sensaciones inmediatas y el control de los movimientos corporales (conversión)

The conscience: essential feature of this dimension of self-representation is the interpretation of certain internal states of the body itself as mental and somatic identity. The neuroscience of consciousness strongly suggests that a level of synchronization and union between various parts of the brain to some extent reflects the accessibility of various mental contents. Janet (1889) proposed the term désagrégation to refer to the phenomena of "non integration" and placed it in the terrain of abnormality. Dissociative disorders: in these disorders there is partial or complete loss of normal integration between certain memories of the past, awareness of one's own identity, certain immediate sensations and control of bodily movements (conversion)

La histeria moderna: Parte IV: evolución de criterios diagnósticos del trastorno por somatización / The modern hysteria: Part III dissociative disorders and conversion

La conciencia: característica esencial de esta dimensión de autorepresentación es la interpretación de ciertos estados internos del propio cuerpo como identidad mental y somática. La neurociencia de la conciencia sugiere fuertemente que un nivel de sincronización y unión entre varias partes del cerebro hasta cierto punto refleja la accesibilidad de varios contenidos mentales. Janet (1889) propuso el término désagrégation para referirse a los fenómenos de «no integración¼ y lo situó en el terreno de la anormalidad. Trastornos disociativos: en estos trastornos hay pérdida parcial o completa de la integración normal entre ciertos recuerdos del pasado, la conciencia de la propia identidad, ciertas sensaciones inmediatas y el control de los movimientos corporales (conversión)

The conscience: essential feature of this dimension of self-representation is the interpretation of certain internal states of the body itself as mental and somatic identity. The neuroscience of consciousness strongly suggests that a level of synchronization and union between various parts of the brain to some extent reflects the accessibility of various mental contents. Janet (1889) proposed the term désagrégation to refer to the phenomena of "non integration" and placed it in the terrain of abnormality. Dissociative disorders: in these disorders there is partial or complete loss of normal integration between certain memories of the past, awareness of one's own identity, certain immediate sensations and control of bodily movements (conversion)

Dissociative Experience in Unipolar and Bipolar Depression: Exploring the Great Divide

OBJECTIVE: Unipolar and bipolar depression (UD and BD) differ strikingly in respect to neurobiology, course and management, but their apparent clinical similarity often leads to misdiagnosis resulting in chronicity of course and treatment failure. In this study we have tried to assess whether UD and BD can be differentiated on the basis of their dissociative symptoms. METHODS: Thrty-six UD patients and 35 BD patients in active episodes, without any psychiatric comorbidity were selected from outpatient department and compared for depressive and dissociative symptoms using Hamilton Depression Rating Scale and Dissociative Experience Scale-II (DES-II). RESULTS: We found that thought the two groups didn’t differ in terms of the socio-demographic or clinical variables, BD group had significantly higher dissociative experience (U=343, p=0.001) than UD and the difference remained significant even after adjusting for the confounding factors. CONCLUSION: Our study shows that dissociative symptoms are significantly more prevalent in the depressive episodes of bipolar affective disorder as compared to the UD and can be an important tool in differentiating between the two disorders with very similar clinical profile. The difference can be measured using a simple self-report questionnaire like DES-II.

Sub-dissociative dose ketamine administration for managing pain in the emergency department / 世界急诊医学杂志（英文）

BACKGROUND: We describe our experience of utilizing sub-dissociative dose ketamine (SDK) in managing a variety of acute and chronic painful conditions in the emergency department (ED). METHODS: A descriptive study was conducted in our ED over a period of seven years (2010–2016) by retrospectively reviewing charts of patients aged 18 and older presenting to the ED with painful complaints and receiving SDK analgesia. Primary data analyses included type of SDK administration (intravenous push [IVP], short-infusion [SI] or continuous infusion [CI]), dosing, rates of analgesic utilization before and after SDK administration, and adverse effects. RESULTS: Three hundred sixty-two patients were enrolled in the study. Mean ketamine doses given by IVP, SI and CI were 26.3 mg, 23.4 mg, and 11.3 mg. The mean duration of CI was 135.87 minutes. The percentage of patients not requiring post-SDK analgesia increased by 16％, 18％, and 37％ in IVP, SI and CI groups. Adverse effects were recorded for 13％ of patients. CONCLUSION: SDK administered by IVP, SI, and CI in the ED for a variety of painful conditions is a feasible analgesic modality in the ED that is associated with a decrease in overall requirements of post-ketamine analgesia and opioid sparing.

Selected ophthalmic and physiologic parameters in rabbits (Oryctolagus cuniculus) submitted to retrobulbar block with lidocaine, morphine or ketamine / Avaliação de parâmetros oftálmicos e fisiológicos em coelhos (Oryctolagus cuniculus) submetidos a bloqueio retrobulbar com lidocaína, morfina ou cetamina

The aim of the present study was to evaluate selected ophthalmic and physiologic parameters in rabbits submitted to retrobulbar blockade with lidocaine, morphine or ketamine. Eighteen adult rabbits, seven males and eleven females, New Zealand White breed, weighing 3.9 ± 0.7 kg were randomly assigned to perform the retrobulbar block according to the groups: LID (2% lidocaine without a vasoconstrictor - 7 mg kg-1); MOR (1% morphine - 1 mg kg-1) or KET (10% Ketamine - 5 mg kg-1). Ophthalmic and physiologic parameters were assessed, including lacrimal production using Schirmer tear test (STT), corneal touch threshold (CTT), pupillary diameter, intraocular pressure (IOP), pulse rate (PR), respiratory rate (RR), oxyhemoglobin saturation (SpO2), rectal temperature (RT) and systolic, mean and diastolic blood pressures (SAP, MAP and DAP) and were evaluated every 10 minutes for 70 minutes. All drugs used in the present study promoted central positioning of the eyeball for up to one minute later the retrobulbar administration in all cases. There was a significant increase of STT values in MOR and LID, when compared to baseline, while the CTT values had a significant decrease in all groups. KET kept the IOP values unaltered at the time points and there was a significant decrease of pupillary diameter in MOR. There was no significant change in PR, RR and SpO2; however, LID presented significantly lower values of SAP. MOR had increased values for RT when compared to the other two groups. The established parameters may help in ophthalmic procedures using retrobulbar nerve blocks.

Objetivou-se com o presente estudo estabelecer parâmetros oftálmicos e hemodinâmicos em coelhos submetidos ao bloqueio retrobulbar com lidocaína, morfina ou cetamina. Dezoito coelhos da raça Nova Zelândia, adultos, sete machos e onze fêmeas, com peso de 3,9 ± 0,7 kg foram aleatoriamente distribuídos para realização de bloqueio retrobulbar de acordo com os seguintes grupos: LID (lidocaína 2% sem vasoconstrictor ­ 7 mg/kg); MOR (morfina 1% - 1 mg/kg) ou KET (cetamina 10% ­ 5 mg/kg). Os seguintes parâmetros oftálmicos e hemodinâmicos foram avaliados: produção lacrimal através do teste lacrimal de Schirmer (TLS), limiar de sensibilidade corneana ao toque, diâmetro pupilar, pressão intraocular (PIO), frequência de pulso (FP) e respiratória (FR), saturação da oxihemoglobina (SpO2), temperatura retal (TR) e pressão arterial sistólica, diastólica e média (PAS, PAD e PAM). Todos os fármacos utilizados no presente estudo promoveram centralização do bulbo do olho em até um minuto após a sua administração retrobulbar em todos os casos. Houve um aumento significativo do TLS no grupo MOR e LID, quando comparados aos valores basais, enquanto o limiar de sensibilidade corneana reduziu significativamente em todos os grupos. O grupo KET manteve os valores da PIO inalterados em todos os tempos e houve uma redução significativa do diâmetro pupilar no grupo MOR. Não houve alteração significativa dos valores de FP, FR e SpO2. No entanto, o grupo LID apresentou valores significativamente menores de PAS. O grupo MOR apresentou maiores valores de TR quando comparado aos demais grupos. Os parâmetros estabelecidos no presente estudo podem servir como base para a realização de procedimentos oftálmicos que requerem o uso de bloqueio retrobulbar.