Un hombre mecánico. A Clockwork Orange, de Stanley Kubrick / A mechanical man. A Clockwork Orange, by Stanley Kubrick

En diciembre 2021 el periodista Oscar Ranzani publicó en el diario Página/12 dos importantes notas por el 50 aniversario del estreno de La naranja mecánica. En una de ella entrevistó a gente de cine, en la otra a psicoanalistas. El presente artículo, preparado especialmente por Eduardo Laso desarrolla esta segunda perspectiva a partir de tesis anteriores contenidas en su libro "Ética y malestar" y retomadas en el comentario de Juan Jorge Michel Fariña, que forma parte del mencionado reportaje: "Alex, el personaje de La naranja mecánica, funda su ética en la máxima de goce del marqués de Sade. Es decir, edifica sus acciones y las de sus drugos (los jóvenes que integran la banda criminal que comanda Alex) en una forma del mal que le genera, sin embargo, un inquietante bienestar (…) Cuando Alex es apresado y sometido al tratamiento Ludovico, nos encontramos con el reverso de esta máxima sadeana, ahora ejercida por la ciencia. Podemos decir que el programa de rehabilitación ejerce el bien en el mal, es decir, en nombre de un bien supremo (la curación, la rehabilitación) somete al sujeto a las peores vejaciones. Esta dialéctica kantiano-sadeana entre el mal en el bien y el bien en el mal, formalizada por Lacan en 1966, es un hallazgo de la novela de Burgess, publicada en 1962. Y por cierto una de las cuestiones analíticas más potentes de la película de Kubrick

In December 2021, the journalist and psychologist Oscar Ranzani published two important notes in the newspaper Página/12 for the 50th anniversary of the premiere of A Clockwork Orange. In one of them he interviewed film people, in the other psychoanalysts. This article, specially prepared by Eduardo Laso, develops this second perspective based on previous theses contained in his book "Ethics and Malaise" and taken up in the comment by Juan Jorge Michel Fariña, which is part of the aforementioned report: "Alex, the character of A Clockwork Orange, bases its ethics on the maxim of jouissance of the Marquis de Sade. That is to say, he builds his actions and those of his droogs (the young people who make up the criminal gang commanded by him) in a form of evil that generates, however, a disturbing well-being (...) When Alex is arrested and subjected to the Ludovico treatment, we find the reverse of this Sadean maxim, now exercised by science. We can say that the rehabilitation program exercises good in evil, that is, in the name of a supreme good (healing, rehabilitation) it subjects Alex to the worst abuse. This Kantian-Sadean dialectic between evil in good and good in evil, formalized by Lacan in 1966, is a finding of Burgess's novel, published in 1962. And certainly one of the most powerful analytical questions of the film of Kubrick

The putative catalytic role of higher serotonin bioavailability in the clinical response to exposure and response prevention in obsessive-compulsive disorder

Objective: Exposure and response prevention (ERP) is effective to treat obsessive-compulsive disorder (OCD), but the lack of tolerance to the aversion nature of exposure techniques results in a high drop-out rate. There have been reports of a generic stress endurance effect of serotonin (5-HT) in the central nervous system (CNS) which might be explained by suppression of defensive fixed action patterns. Previous studies have proposed that higher baseline 5-HT concentration and slow decrease in concentration during drug treatment of OCD were predictors of good clinical response to 5-HT reuptake inhibitors. The objective of this study was to investigate whether pre-treatment platelet rich plasma (PRP) 5-HT concentration is associated with latency of treatment response and final response to an ERP protocol for obsessive-compulsive disorder (OCD). Methods: Thirty adult and treatment-free OCD patients were included in an 8-week, 16-session ERP protocol. 5-HT concentration was determined at baseline and after treatment. Patients with a reduction ≥30% on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at the end of ERP were defined as responders. Results: A positive correlation between baseline 5-HT concentration and reduction of symptoms on the Y-BOCS was observed after 4 weeks. Baseline 5-HT concentration was not correlated with clinical response after 8 weeks of ERP, possibly due to the similar though delayed clinical response of patients with lower (compared to those with higher) baseline 5-HT concentration. Patients with higher 5-HT baseline concentration also showed more improvement in depressive symptoms with treatment. Conclusion: The present results partially support the hypothesis of a stress endurance effect of 5-HT in OCD patients. According to the literature, fast onset responders possibly have more or larger 5-HT containing neurons, higher endogenous 5-HT synthesis or lower monoamine oxidase activity; all these hypotheses remain to be investigated.

La importancia de la terapia ocupacional a través del cuidado en pacientes psiquiátricos / The importance of occupational therapy by taking care in psychiatric patients

Introducción: El enfermo neuropsiquiátrico requiere de una estancia hospitalaria prolongada por las condiciones de su patología, por lo que es importante considerar a la persona en su aspecto biológico, psicológico y social. La terapia ocupacional es una alternativa y, a su vez, una herramienta que se utiliza como apoyo para la rehabilitación de este tipo de enfermos; además contribuye a que la persona se mantenga activa. Objetivo: Fomentar la integración grupal y el desarrollo de sus capacidades para expresar su creatividad. Metodología: El profesional de enfermería interviene en este proceso de rehabilitación de la enfermedad a través de la incorporación de las actividades que se realizan en la terapia; reincorpora a la persona lo antes posible a su vida cotidiana, familiar y social. La terapia ocupacional es una herramienta terapéutica que le permite al enfermo desarrollar su habilidad mediante actividades encaminadas a responder a las necesidades de tratamiento de cada persona. En algunos casos se implementan estrategias que faciliten la actividad que se está llevando a cabo. Meyer concebía al hombre como un organismo que se mantiene y equilibra en el mundo real, actualizándose a través de una vida activa y participativa. Resultados: A lo largo de la historia de la profesión, la ocupación humana ha sido típicamente clasificada por los terapeutas ocupacionales en tres áreas: autocuidado, incorporación a la vida social y laboral, todas ellas actividades productivas; así también el juego y las actividades de esparcimiento. Conclusiones: La terapia ocupacional juega un rol importante en la recuperación del enfermo neuropsiquiátrico, busca que la persona sea productiva durante su estancia hospitalaria, contribuye a mejorar su condición de salud y lo reintegra a su ámbito social y familiar.

Introduction: The neuropsychiatric illness requires a prolonged hospital stay by the conditions of their disease so it is important to consider the person in their biological, psychological and social. Occupational therapy is an alternative and also a tool used as support for the rehabilitation of such patients, helps the person to stay active. Objective: Encourage group integration and the development of their ability to express their creativity. Methodology: The nurse involved in the rehabilitation process of the disease through the incorporation of the activities taking place in therapy, rejoins the person as soon as possible to your everyday life, family and social. Occupational therapy is a therapeutic tool that allows the patient to develop their skills with activities to meet the treatment needs of each person; in some cases implemented strategies to facilitate the activity being carried out. Meyer conceived to man as an organism that maintains and balances in the real world, updated through an active and participatory. Results: Over the history of the profession, human occupation has been typically classified by occupational therapists in three areas: self-care, incorporating the social and working life, all of these productive activities, also play and leisure activities. Conclusions: Occupational therapy plays an important role in the recovery of neuropsychiatric illness, looking for a person to be productive during their hospital stay, helping to improve their health, and their social reintegration and family.

Reacciones adversas al tratamiento antirretroviral de gran actividad en pacientes pediátricos del Instituto Nacional de Salud del Niño, 2004-2010 / Adverse reactions antiretroviral therapy highly active in pediatrics hte National Institute of child Health, 2004 - 2010

Dentro de las patologías preponderantes de las últimas décadas, la infección por Virus de Inmunodeficiencia Humana (VIH), y el Síndrome de Inmunodeficiencia Adquirida (SIDA), son sin dudas las que mayor morbimortalidad ocasionan a nivel latinoamericano y mundial, siendo en gran porcentaje los pacientes Pediátricos los que lo padecen. Dado el advenimiento del Tratamiento Antirretroviral de Gran Actividad (TARGA), y su uso ampliado en pacientes Pediátricos se reportan numerosas reacciones adversas (RAM), que requieren su estudio y análisis respectivo. Objetivos: Describir las reacciones adversas al Tratamiento Antirretroviral de Gran Actividad en pacientes Pediátricos del Instituto Nacional de Salud el Niño, durante el periodo de Enero 2004 a Diciembre 2010. Diseño: Descriptivo, Retrospectivo, Longitudinal. Materiales y métodos: La población en estudio lo conforman los pacientes menores de 18 años, del Instituto Nacional de Salud del Niño, con diagnóstico de Infección VIH/SIDA en TARGA, que son controlados u hospitalizados por el Servicio de Infectología. El periodo de estudio es de Enero 2004 a Diciembre 2010 (7 años). Se realizó la revisión individualiza de cada paciente y su seguimiento (no menor de 12 meses) desde iniciado el TARGA...

Involvement of GABAergic mechanisms of the dorsal periaqueductal gray and inferior colliculus on unconditioned fear

The fact that the dorsal periaqueductal gray (dPAG) and inferior colliculus (IC), together with superior colliculus, medial hypothalamus and amygdala, constitute the brain aversion system has been well-established. Stepwise increases in the intensity of electrical stimulation of dPAG or IC cause freezing and escape responses, which are followed by a freezing behavior that lasts after the interruption of the stimulation. Freezing and escape are unconditioned defensive behaviors derived from the stimulation of the output centers for the defense reaction, whereas the post-stimulation freezing is the behavioral counterpart of the processing of aversive information. Although GABA-A mechanisms of the midbrain tectum exert a tonic inhibitory influence on the neural substrates of unconditioned fear, their influence on the processing of aversive information is not completely understood. Thus, the present study examines the effects of injections of the GABA-A receptor agonist muscimol (1 and 2 nmol/0.2 µL) or the glutamic acid decarboxylase blocker semicarbazide (5 and 7.5 µg/0.2 µL) into dPAG or IC of Wistar rats on freezing and escape thresholds determined by electrical stimulation of these same structures and on post-stimulation freezing. Intra-dPAG injections of muscimol increased and semicarbazide decreased the freezing and escape thresholds of electrical stimulation of the dPAG. Only semicarbazide enhanced the dPAG post-stimulation freezing. Intra-IC injections of muscimol significantly increased aversive thresholds, while having no effect on IC post-stimulation freezing. Intra-IC injections of semicarbazide had no significant effects. These findings suggest that GABAergic mechanisms are important regulators of the expression of unconditioned fear in dPAG and IC, whereas only in dPAG GABA appears to play a role on the sensory gating towards aversive information during post-stimulation freezing.

Intermittent ethanol binge exposure impairs object recognition but spares contextual and tone fear memory in adolescent rats

Adolescent brain development seems to be important for the maturation of brain structures and behavior. Intermittent binge ethanol drinking is common among adolescents, and this type of drinking can induce brain damage and cognitive deficits. In addition, emotional changes are frequently seen in alcoholics and rodents treated with ethanol. Considering the close relation between emotional arousal and cognitive responses, the present work investigates if intermittent ethanol binge exposure could differentially alter the performance of adolescent rats in aversive and non-aversive motivated tests. Male adolescent rats were submitted to ethanol treatment (2.5 or 5.0 g/Kg, o.a.) at 48-h intervals over postnatal day (PND) 30 to 60. Control animals were exposed to a similar administration protocol with saline administration. At PND61-PND63 animals were submitted to one-trial object recognition or contextual and tone fear conditioning paradigms. Binge ethanol drinking (at both 2.5 and 5.0 g/Kg) did not change freezing response in the contextual and tone fear conditioning. However, all doses impaired recognition rates 24h after training in object recognition test. In addition, despite a diminution of horizontal locomotion in the open field (only for the 5.0 g/Kg dose), no difference was detected regarding time in immobility, time in grooming and number of rearing in this paradigm. The present results show that the cognitive impairment resulting from intermittent binge ethanol exposure has a negative correlation with learning-associated emotional arousal.

Cognitive behavior therapy for trichotillomania: report of a case resistant to pharmacological treatment

To report a case of trichotillomania that was resistant to pharmacological treatment but responded well to a behavioral therapy program based on habit reversal. The patient was a 47-year-old lady. Her problem had started at the age of seventeen. She had experienced several treatments including full doses of antidepressants, mood stabilizers, antipsychotic, and benzodiazepines as single treatments or in combination. The mentioned medication did not affect her condition. In addition, she was drowsy during the daytime and her function was seriously impaired. At the time CBT was started for the patient, she was receiving fluoxetine 40 mg daily, which she had received during the treatment period. Initial assessments included a detailed behavioral interview, daily chart of activities, record of hair pulling behavior with a description of patient's emotional and situational status during the action. The treatment procedures included self monitoring, pulled hair saving and competing response. The patient was followed for 18 months. Only 2 bouts of hair pulling were reported, both of which occurred in the first 6 months of the treatment. The patient's hair became thicker, and she was very satisfied with the therapy. Her social relations and function improved markedly, and her anxiety and sadness left her. This case showed that certain components of habit reversal such as awareness, self-monitoring, pulled hair saving, and competing response were effective in our patient

Uso de técnicas aversivas de controle de comportamento em Odontopediatria / Use of aversive techniques for behavior management in pediatric dentistry

O presente estudo trata das técnicas aversivas de contenção física para o controle de comportamento em odontopediatria. Essas técnicas têm sido utilizadas com o objetivo de restringir movimentos inapropriados da criança durante o tratamento, que poderiam causar danos ao próprio paciente ou ao equipamento. Procura-se demonstrar, através de pesquisa bibliográfica, que para uso de qualquer procedimento aversivo é necessário que o profissional tenha conhecimento não apenas das técnicas, mas principalmente dos fundamentos e dos aspectos éticos e legais de suas indicações. Não existem equações que o levem a prever qual criança apresentará melhora de seu comportamento ao ser submetida a um desses procedimentos. Técnicas de controle de comportamento não-aversivas devem sempre ser tentadas antes de se partir para uma técnica aversiva. O consentimento esclarecido dos pais deve sempre ser obtido, por escrito, antes do emprego de uma técnica aversiva.

Aversive stimulation during the stress-hyporesponsive period does not affect the number of corticotroph cells in neonatal male rats

Immunohistochemistry was used to evaluate the effects of neonatal handling and aversive stimulation during the first 10 days of life on the number of corticotrophs in the anterior lobe of the pituitary of 11-day-old male Wistar rats. Since adult rats handled during infancy respond with reduced corticosterone secretion in response to stressors and with less behavior inhibition in novel environments, we assumed that neonatal stimulation could affect pituitary morphology during this critical period of cell differentiation. Three groups of animals were studied: intact (no manipulation, N=5), handled (N=5) and stimulated (submitted to 3 different aversive stimuli, N=5). The percentage of ACTH-immunoreactive cells in the anterior lobe of the pituitary (number of ACTH-stained cells divided by total number of cells) was determined by examining three slices per pituitary in which a minimum of 200 cells were counted by two independent researchers. Although animals during the neonatal period are less reactive to stress-like stimulation in terms of ACTH and corticosterone secretion, results showed that the relative number of ACTH-stained cells of neonatal handled (0.25 + 0.01) and aversive stimulated (0.29 + 0.03) rats was not significantly different from intact (0.30 + 0.03) animals. Neonatal stimulation may have a differential effect on the various subpopulations of corticotroph cells in the anterior pituitary.

Response threshold to aversive stimulated early protein-malnourished rats

Two animal models of pain were used to study the effects of short-term protein malnutrition and environmental stimulation on the response threshold to aversive stimuli. Eighty male Wistar rats were used. Half of the pups were submitted to malnutrition by feeding their mothers a 6 per cent protein diet from 0 to 21 days of age while the mothers of the other half (controls) were well nourished, receiving 16 per cent protein. From 22 to 70 days all rats were fed commercial lab chow. Half of the animals in the malnourished and control groups were maintained under stimulating conditions, including a 3-min daily handling from 0 to 70 days and an enriched living cage after weaning. The other half was reared in a standard living cage. At 70 days, independent groups of rats were exposed to the shock threshold or to the tail-flick test. The results showed lower body and brain weights in malnourished rats when compared with controls at weaning and testing. In the shock threshold test the malnourished animals were more sensitive to electric shock and environmental stimulation increased the shock threshold. No differences due to diet or environmental stimulation were found in the tail-flick procedure. These results demonstrate that protein malnutrition imposed only during the lactation period is efficient in inducing hyperreactivity to electric, shock and that environmental stimulation attenuates the differences in shock threshold produced by protein malnutrition.

El tratamiento antialcoholico: Apreciaciones sobre sus recursos y comportamiento del paciente / Antialcoholic treatment: Appreciations on its resources and the patients behavior

Se estudiaron tres grupos de pacientes con dependencia alcoholica primaria que recibieron tratamiento antialcoholico institucional integral con la adicion de Ipecacuana en Grupo I y de Disulfiram en el Grupo II. Los pacientes (75 en cada grupo) tuvieron procedencia urbana y rural, y se exploro su apreciacion sobre los recursos terapeuticos utilizados asi como su asistenciaa seguimiento y evolucion a los seis meses del egreso. La psicoterapia didactica, el recurso aversivo utilizado, la imposibilidad de acceso al alcohol por el internamiento, los medicamentos y la ayuda de otros pacientes ingresados, resultaron en orden decreciente de frecuencia los recursos considerados como mas utiles.La asistencia al seguimiento programado fue muy pobre en todos los grupos y el porciento de abstinencia total a los 6 meses fue de 16, 37 y 8,6 en los grupos respectivos. No se evidenciaron diferencias relevantes en los aspectos explorados entre los pacientes urbanos y rurales

Técnica de tratamiento aversivo en drogadicción / Aversive technique in drugs addiction

1. Se describen las características de un caso de adicción a Fentanyl, derivado opiáceo sintético. 2. Se comenta el método clásico de tratamiento de las adicciones, sugiriendo que una de las causas de su alta tasa de fracasos es deshabituar paulatinamente al paciente y aliviar medicamente el síndrome de abstinencia. 3. Se propone una técnica de tratamiento basada en los principios del condicionamiento y que utiliza como estímulo aversivo el propio síndrome de abstinencia. 4. Se describe la aplicación de esta técnica, cuya etapa aversiva en este caso particular duró tan sólo 4 días. 5. El resto del tratamiento siguió en líneas generales las normas habituales en este tipo de casos con énfasis en psicoterapia de orientación conductual, lográndose una abstinencia hasta ahora de 9 años de duración

behavioral non aversive [gentle] teaching approach and its therapeutic applications in severe behavioral problems

The gentle non-aversive approach is a new and promising treatment modality in severe behavioral problems. It has been recently presented as an option to the classical control-oriented approaches of behavior therapy. This paper reviewed this approach by focusing on areas of application, general theorization, and basic techniques commonly used by adherers of this modality. Particularly emphasized, this approach's emphasis is one anti-authoritarian values, the role of bonding and reciprocity that need to exist between the person and his social environment, and the value of creating rewarding relationship with the behaviorally disturbed person. The major techniques were discussed including the ignoring-redirect-reward paradigm; environmental management, and teaching in silence. In this paper we will present a clinical application of this approach in a case of severe violence

La ipecacuana y el disulfiram: su valoración como recursos aversivos en el tratamiento del alcoholismo / Ipecacuana and disulfiram: their assessment as aversive resources in alcoholism treatment

Tres grupos de 35 pacientes con dependencia alcohólica primaria, ingresados en un servicio psiquiátrico organizado en comunidad terapéutica, fueron estudiados con el propósito de obtener criterios sobre la repercusión psíquica y somática, así como sobre la efectividad de la ipecacuana y el disulfiram como recursos aversivos. Todos los integrantes de la muestra, recibieron un tratamiento integral que incluyó psicoterapia individual y de grupo, así como recursos biológicos y sociales. En los grupos I y II se incluyeron además respectivamente la ipecacuana y el disulfiram como recursos aversivos y el III fungió como control. Se evidenció una mayor repercusión del disulfiram sobre los signos vitales y las manifestaciones objetivas y subjetivas expresaron los efectos parasimpáticos-miméticos a predominio digestivo en la ipecacuana, así como la potencialidad ansiogénica y repercusión cardiovascular del disulfiram. La instalación y desaparición de los efectos inmediatos de la ipecacuana fue más tardía, aunque en ambos recursos se hizo evidente la dispersión temporal de efectos. Los pacientes integrantes de los grupos aversivos respectivos evaluaron ambos recursos como los más útiles y los porcientos de abstinentes a los 6 meses del egreso fueron de 37,1; 17,1; y 8,6 para los grupos disulfiram, ipecacuana y control en igual orden

El acondicionamiento de escape ante estímulo eléctrico: su utilidad en el tratamiento del alcoholismo / Escape conditioning in the presence of electrical stimulation: its usefulness in the treatment of alcoholism

El estudio de dos grupos de pacientes con dependencia alcohólica primaria, tratados con recursos convencionales o con éstos, más la incorporación de una técnica de acondicionamiento de escape ante estímulo eléctrico, evidenció discretas modificaciones de los signos vitales ante el estímulo eléctrico; mayor proporción de respuestas de evitación ante el alcohol al concluir el tratamiento institucional en el grupo tratado con técnica aversiva; y una evolución similar con pobres resultados en el seguimiento de seis meses