Avaliação da qualidade de sono e ansiedade em profissionais e estudantes da saúde no contexto da pandemia pela covid-19 / Evaluación de la calidad del sueño y la ansiedad en profesionales y estudiantes de la salud en el contexto de la pandemia de COVID-19 / Assessment of sleep quality and anxiety in healthcare professionals and students in the context of the COVID-19 pandemic

Introdução: Na pandemia desencadeada pela COVID-19, o desenvolvimento progressivo de sintomas de ansiedade e a má qualidade do sono devem ser investigados em profissionais e estudantes da área da saúde para o adequado manejo. Objetivo: Identificar a prevalência de problemas de sono e sintomas ansiosos em profissionais e estudantes da saúde, e analisar o efeito de variáveis sociodemográficas-clínicas na ansiedade e sono dessa população.Metodologia: Neste estudo transversal de caráter quantitativo aplicou-se um formulário online a 3.337 profissionais e estudantes da saúde do Brasil participantes de um congresso virtual, contendo 51 perguntas subdivididas em três categorias: Perfil sociodemográfico-clínico, Escala de Sono de Jenkins e Inventário de Ansiedade de BECK.Resultados: Dentre os participantes, 81,4% eram estudantes da área da saúde e 12,8% profissionais de saúde. Os achados obtidos indicam que 41% dos participantes apresentaram problemas de sono muito frequentes e 46,6% sinais de ansiedade moderada a grave. Houve associação estatisticamente significativa entre as variáveis sociodemográficas-clínicas e os questionários validados de sono e ansiedade. Conclusão: Essa pesquisa identificou importante prevalência de problemasde sono e sintomas ansiosos em profissionais e estudantes da saúde, sendo primordial a identificação precoce dessas alterações para um manejo efetivo (AU).

Introduction: In the pandemic triggered by COVID-19, the progressive development of anxiety symptoms and poor sleep quality should be investigated in healthcare professionals and students for proper management.Objective: To identify the prevalence of sleep problems and anxious symptoms in healthcare professionals and students, and to analyze the effect of sociodemographic-clinical variables on anxiety and sleep in this population. Methodology: In this cross-sectional quantitative study, an online form was applied to 3,337 healthcare professionals and students from Brazil participating in a virtual congress, containing 51 questions subdivided into three categories: Sociodemographic-clinical profile, Jenkins Sleep Scale and BECK Anxiety Inventory.Results: Among the participants, 81.4% were healthcare students and 12.8% were healthcare professionals. The findings indicate that 41% of the participants had very frequent sleep problems and 46.6% showed signs of moderate to severe anxiety. There was a statistically significant association between the sociodemographic-clinical variables and the validated sleep and anxiety questionnaires. Conclusion:This study identified a high prevalence of sleep problems and anxiety symptoms among healthcare professionals and students, and early identification of these alterations is essential for effective management (AU).

Introducción: En la pandemia desencadenada por el COVID-19, el desarrollo progresivo de síntomas de ansiedad y la mala calidad del sueño deben ser investigados en profesionales y estudiantes de la salud para su adecuado manejo. Objetivo: Identificar la prevalencia de problemas de sueño y síntomas ansiosos en profesionales y estudiantes de la salud, y analizar el efecto de las variables sociodemográficas-clínicas sobre la ansiedad y el sueño en esta población. Metodología:En este estudio transversal y cuantitativo, se aplicó un formulario línea 3.337 profesionales y estudiantes de la salud de Brasil que participaron en un congreso virtual, conteniendo 51 preguntas subdivididas en tres categorías: perfil sociodemográfico-clínico, Escala de Sueño de Jenkins e Inventario de Ansiedad de BECK. Resultados: Entre los participantes, 81,4% eran estudiantes de salud y 12,8% profesionales de la salud. Los resultados indican que el 41% de los participantes tenía problemas de sueño muy frecuentes y el 46,6% mostraba signos de ansiedad de moderada a grave. Hubo una asociación estadísticamentesignificativa entre las variables sociodemográficas-clínicas y los cuestionarios validados de sueño y ansiedad. Conclusión:Este estudio identificó una alta prevalencia de problemas de sueño y síntomas de ansiedad en profesionales de la salud y estudiantes, y la identificación precoz de estas alteraciones es esencial para un manejo eficaz (AU).

Impacto da solidão na qualidade de vida de universitários de Minas Gerais / The impact of solitude in the quality of life of college students in Minas Gerais / Impacto de la soledad en la calidad de vida de estudiantes universitarios de Minas Gerais

O ingresso na universidade é marcado por intensas transformações pessoais e pela necessidade de adaptação para um modelo de ensino mais autônomo. Esse cenário pode contribuir para o surgimento de sentimentos de solidão e impactar a qualidade de vida dos universitários. O presente estudo visou investigar as relações entre a solidão e a qualidade de vida em universitários de uma universidade pública do interior de Minas Gerais. Participaram da pesquisa 268 estudantes de graduação selecionados aleatoriamente. Como instrumentos, foram utilizados um questionário sociodemográfico e de hábitos de vida, o Medical Outcomes Study 36 - item Short Form (SF-36), e a Escala Brasileira de Solidão (UCLA-BR). Foram conduzidas análises descritivas e inferenciais (correlação, Kruskal-Wallis e regressão logística). O domínio da qualidade de vida com maior escore foi Capacidade Funcional e Vitalidade foi o menor. Referente à solidão, 60,82% da amostra apresentou nível mínimo. Houve associação significativa entre a solidão e seis domínios da qualidade de vida. A solidão dobrou a chance de pior qualidade de vida nos domínios: aspectos sociais (β = 2,66), limitação emocional (β = 2,18) e saúde mental (β = 2,61). Conclui-se que a solidão impacta negativamente a qualidade de vida dos universitários e que, por isso, são necessárias intervenções para essa população.(AU)

Enrollment in the university is marked by intense personal transformations and the need to adapt to a more autonomous teaching model. This scenario can contribute to the emergence of feelings of loneliness and impact the quality of life of college students. This study aimed to investigate the relationship between loneliness and quality of life in college students at a public university in the interior of the state of Minas Gerais. A total of 268 undergraduate students randomly select took part in the study. The instruments used were a sociodemographic and lifestyle questionnaire, the Medical Outcomes Study 36 - item Short Form (SF-36), and the Brazilian Loneliness Scale (UCLA-BR). Descriptive and inferential analyzes were conducted (correlation, Kruskal-Wallis, and logistic regression). The highest score in the quality of life's domain was Functional Capacity and the lowest was Vitality. Regarding loneliness, 60.82% of the sample had a minimum level. There was a significant association between loneliness and six quality of life domains. Loneliness doubled the chance of worse quality of life for the domains: social aspects (β = 2.66), emotional limitation (β = 2.18), and mental health (β = 2.61). In conclusion, loneliness negatively impacts the quality of life of university students and, therefore, interventions are required for this population.(AU)

El ingreso a la universidad está marcado por intensas transformaciones personales y la necesidad de adaptarse a un modelo de enseñanza más autónomo. Este escenario puede contribuir a la aparición de sentimientos de soledad e impactar la calidad de vida de los estudiantes universitarios. Este estudio tuvo como objetivo investigar las relaciones entre la soledad y la calidad de vida en los estudiantes universitarios de una universidad pública del interior de Minas Gerais (Brasil). En la investigación participaron 268 estudiantes universitarios seleccionados al azar. Los instrumentos que se utilizaron fueron cuestionario de hábitos sociodemográficos y de estilo de vida, el Medical Outcomes Study 36 -item Short Form (SF-36) y la Escala de soledad brasileña (UCLA-BR). Se realizaron análisis descriptivos e inferenciales (correlación, Kruskal-Wallis y regresión logística). El dominio de la calidad de vida con la puntuación más alta fue la capacidad funcional, y el de la vitalidad fue la más baja. En cuanto a la soledad, el 60,82% de la muestra presentó nivel mínimo. Hubo una asociación significativa entre la soledad y seis dominios de calidad de vida. La soledad duplicó la posibilidad de una peor calidad de vida para los dominios: aspectos sociales (β = 2,66), limitación emocional (β = 2,18) y salud mental (β = 2,61). Se concluye que la soledad afecta negativamente la calidad de vida de los estudiantes universitarios y, por lo tanto, está prohibida para esta población.(AU)

Estrategias de evaluación en la narración como tarea metacognitiva en personas con esquizofrenia / Narrative evaluation strategies as metacognitive task in subjects with schizophrenia

RESUMEN Objetivo Este estudio procura explorar las diferencias en el componente evaluativo de la estructura narrativa en personas con diagnóstico de esquizofrenia, en comparación con personas con diagnóstico de psicosis afectiva. Método El presente estudio es descriptivo, no experimental, y comprende el análisis de los componentes evaluativos de la narrativa, en entrevistas realizadas a 25 individuos con diagnostico psiquiátrico de esquizofrenia crónica y a 25 individuos diagnosticados de psicosis afectiva crónica, pareados por edad, género y características sociodemográficas. Resultados La relación entre diagnóstico y tipo de evaluación arrojó resultados estadísticamente significativos con un valor de chi cuadrado de 39,880a (p< 0.00). Fue posible observar que en la esquizofrenia existe una mayor inhibición en la elaboración de expresiones que impliquen opiniones, que los relatos tendieron a identificar los hechos independientemente de cómo les afectaron, sugiriendo una limitación de la función intersubjetiva. Conclusión La variable diagnóstico confirma que en la esquizofrenia existe un deterioro funcional en la elaboración de estructuras narrativas y en la articulación del componente evaluativo. En el caso de la psicosis afectiva se manifiestan disfunciones superficiales, sin comprometer su desempeño en la evaluación de las narraciones.

ABSTRACT Purpose This study aims to explore the differences in the evaluative component of the narrative structure in subjects diagnosed with schizophrenia compared to subjects diagnosed with affective psychosis. Methods The present investigation was descriptive, not experimental and it included the analysis of the narration evaluative components of interviews of 25 individuals with psychiatric diagnosis of chronic schizophrenia and 25 of chronic affective psychosis, matched by age, gender and sociodemographic characteristics. Results The relationship between diagnosis and type of evaluation showed statistically significant results with a chi square value of 39.880a (p <0.00). It was possible to observe that in the schizophrenia there is a greater inhibition in the elaboration of expressions that imply opinions and that narratives tended to identify facts regardless of how they affected subjects, suggesting a limitation of intersubjective function. Conclusion The diagnostic variable confirms that in schizophrenia there is a functional deterioration in the process of elaborating narrative structures especially in the articulation of the evaluative component. In the case of the affective psychosis group, superficial dysfunctions were manifested, without compromising their performance in the evaluation of narratives.

Estigma internalizado em pacientes com transtorno de humor e fatores associados / Internalized stigma in patients with mood disorder and associated factors

Nos transtornos de humor, o estigma internalizado (internalização de estereótipos depreciativos associados a uma condição) é desafiador e prejudicial para a reabilitação e qualidade de vida do indivíduo. O presente estudo tem como objetivo investigar o estigma internalizado e as associações entre essa variável e as variáveis sociodemográficas e clínicas, além da esperança e adesão ao tratamento entre pessoas com transtornos de humor. Este estudo com abordagem quantitativa foi realizado com uma amostra de conveniência de 108 pacientes com transtornos de humor, em tratamento em um Centro de Atenção Psicossocial no interior de São Paulo - Brasil. Na coleta de dados foram aplicados os instrumentos: ISMIBR para investigar o estigma internalizado; MAT para investigar a adesão ao tratamento, EEH para analisar a esperança; aplicação da BPRS-a para observar a sintomatologia dos pacientes, e um questionário com questões sociodemográficas e clínicas. Na análise de dados foram empregados testes de comparação de média, teste de correlação e regressão linear múltiplo. Neste estudo predominam mulheres, sem ensino superior, sem companheiro, sem trabalho. A maioria tinha transtorno afetivo bipolar, era aderente ao tratamento medicamentoso, referiu internações psiquiátricas e tentativas prévias de suicídio e negou episódios de heteroagressão. Na amostra investigada, maiores níveis de estigma estiveram associados à maior sintomatologia, menor nível de esperança, tentativas prévias de suicídio, histórico de comportamento agressivo, internações psiquiátricas, não adesão ao tratamento e não ter trabalho. No modelo de regressão linear múltiplo estiveram associadas ao estigma as variáveis trabalho, tentativas de suicídio, sintomas e esperança. Nesse estudo foram identificados fatores que podem conferir ao indivíduo maior vulnerabilidade ao estigma internalizado e que precisam ser cuidadosamente investigados e abordados em intervenções voltadas para a redução do estigma e à reabilitação psicossocial

In mood disorders, the internalized stigma (internalization of derogatory stereotypes associated with a condition) is challenging and detrimental to the individual's rehabilitation and quality of life. The present study aimed to investigate the internalized stigma and the associations between these variables and sociodemographic, clinical variables, as well as hope and adherence to treatment among people with mood disorders. This quantitative approach was carried out with a convenience sample of 108 patients with mood disorders undergoing treatment at a Psychosocial Care Center in the interior of São Paulo - Brazil. In the data collection, the following instruments were applied: ISMI-BR to investigate internalized stigma; MAT to check adherence to treatment, EEH to examine the hope and application of BPRS-a to observe patient's symptomatology and a questionnaire with sociodemographic and clinical issues. In the data analysis, mean comparison, correlation test, and multiple linear regression tests were used. In this study, women predominated, without higher education, without a partner, without work. Most of them presented bipolar affective disorder, adhered to drug treatment, reported psychiatric hospitalizations and previous suicide attempts, and denied episodes of heteroaggression. In the sample investigated, higher levels of stigma were associated with greater symptomatology, lower level of hope, previous attempts of suicide, history of aggressive behavior, psychiatric hospitalizations, non-adherence to treatment and not having a job. In the multiple linear regression model, the variables labor, suicide attempts, symptoms, and hope were associated with the stigma. In this paper, were identified factors that may give the individual greater vulnerability to internalized stigma and which need to be carefully investigated and addressed in interventions or aiming at reducing stigma and psychosocial rehabilitation

Marcadores inmunológicos humorales y su asociación con el estado psicoafectivo de pacientes con lupus eritematoso sistémico / Humoral immune markers and their association with the psychoemotional state of patients with systemic lupus erythematosus

Se realizó una investigación descriptiva y transversal de 154 pacientes, de 20 a 59 años de edad, con lupus eritematoso sistémico, atendidos en la consulta Provincial de Enfermedades Autoinmunes del Hospital Clínico-Quirúrgico Arnaldo Milián Castro de Santa Clara (provincia de Villa Clara), desde junio de 2014 hasta mayo de 2015, con vistas a determinar la asociación de los marcadores inmunológicos humorales con el estado psicoafectivo, como factores pronóstico de descompensación en estos afectados. En la serie predominaron los adultos jóvenes, el sexo femenino, el color blanco de la piel, los trabajadores como ocupación, hipertensión arterial como antecedente patológico personal y la adicción al café. De igual modo, las alteraciones detectadas constituyeron marcadores inmunohumorales inflamatorios para el pronóstico de posible actividad de la enfermedad en la etapa subclínica y ello estuvo fuertemente asociado a la presencia de alteraciones psicoafectivas (ansiedad y depresión) en el paciente, lo que puede sugerir una crisis aguda futura e inminente de la enfermedad

A descriptive and cross-sectional investigation of 154 patients, aged 20 to 59, with systemic lupus erythematosus assisted in the Autoinmune Diseases Provincial Service of Arnaldo Milián Castro Clinical Surgical Hospital in Santa Clara (Villa Clara), was carried out from June, 2014, to May, 2015, aimed at determining the association of the humoral immune markers with the psychoemotional state, as predictive factors of decompensating events in these affected patients. In the series, there was a prevalence of the young adults, female sex, white color of the skin, workers as occupation, hypertension as personal pathological history and coffeeholism. At the same time, the detected disorders constituted humoral immune and inflammatory markers to predict possible activity of the disease in the subclinical stage and it was strongly associated with the presence of emotional disorders (anxiety and depression) in the patient, what can suggest an imminent future acute crisis of the disease

Vivencias afectivas y factores condicionantes en adultos mayores sin relación de pareja / Emotional experiencies and conditioning factors in elderly without couple relationship

Se describen las vivencias afectivas y los factores condicionantes de 2 adultos mayores sin relación de pareja, pertenecientes al Policlínico Docente José Martí Pérez de Santiago de Cuba. Ambos manifestaron vivencias afectivo- negativas, dado principalmente por la depresión, la soledad, la frustración y la infelicidad, asociado a sus características personológicas y agravado por pertenecer a una familia disfuncional. A tales efectos, se propuso una estrategia de intervención con enfoque individual, familiar y comunitario, a fin de contribuir al bienestar emocional de este grupo poblacional.

The emotional experiencies and conditioning factors of 2 elderly without couple relationship, belonging to José Martí Pérez Teaching Polyclinic in Santiago de Cuba are described. Both manifested negative emotional experiencies, given mainly by depression, loneliness, frustration and unhappiness, associated to their personal characteristics and worsened by belonging to a dysfunctional family. To such effects, an intervention strategy with individual, family and community approach was suggested, in order to contribute to the emotional well-being of this population group

Psychoses puerpérales : aspects épidémiologiques, cliniques et thérapeutiques. A propos de 37 cas colligés dans le service de psychiatrie du CHU-Yalgado Ouédraogo de Ouagadougou, Burkina Faso

Objectif : Etudier les aspects épidémiologiques, cliniques et thérapeutiques des psychoses puerpérales dans le service de psychiatrie du CHU-Yalgado Ouédraogo. Patientes et méthodes : Nous avons mené une étude rétrospective à visée descriptive qui a porté sur 10 ans d'activité hospitalière (de janvier 2005 à décembre 2014). Notre étude a concerné toutes les patientes admises et hospitalisées pour psychoses puerpérales durant la période d'étude. Résultats : La fréquence hospitalière de la psychose puerpérale est de 2,2%. L'âge moyen des patientes était de 26,5 ± 5,3 ans avec des extrêmes de 17 et 37 ans. La tranche d'âge de 25 à 34 ans a représenté 56,8%. Les patientes vivant maritalement ont représenté 70,3% des cas. Les ménagères ont constitué 67,6% des cas. Dans notre série, les patientes primipares ont constitué 56,8% des cas. Nous avons noté chez 23 patientes soit 62,2%, une situation conflictuelle dans la famille. L'agitation et/ou l'agressivité a été constamment évoquée comme motif de consultation suivie de la logorrhée. Le refus d'allaiter a motivé la consultation dans 45,9% des cas. Le délire et les hallucinations ont été retrouvés respectivement chez 54,1% et 37,8% des patientes. Les troubles psychotiques ont représenté 56,8% des cas. La prise en charge thérapeutique des patientes était basée sur le volet psychothérapeutique et le volet chimio-thérapeutique. Conclusion : Un diagnostic précoce des psychoses puerpérales dans les services de maternité améliorerait le pronostic de cette affection

Padrão dos atendimentos em uma emergência psiquiátrica de referência para a Região Central do Rio Grande do Sul / Patterns of consultations in a reference psychiatric emergency service in the central region of Rio Grande do Sul

Introdução: Os Serviços de Emergência Psiquiátrica (SEPs) constituem um elemento fundamental na rede de atendimento em saúde mental, intervindo principalmente em situações de crise. Procurando levantar dados sobre a demanda pelo serviço de emergência, este artigo objetiva descrever as características dos atendimentos realizados em um SEP de referência para a região central do Rio Grande do Sul. Métodos: Foi realizado um estudo transversal retrospectivo, com dados dos atendimentos do SEP do Hospital Universitário de Santa Maria (SEP/HUSM), de 2010 e 2011, utilizando o formulário de registro das consultas e dados do sistema de informática do hospital. Foram construídas tabelas de frequência e foi utilizado o Teste Qui-quadrado para comparações entre variáveis. Resultados: A amostra foi composta por 7853 atendimentos, sendo a maioria do sexo masculino (52%), na faixa etária de 25-44 anos (49,7%). Os diagnósticos mais comuns foram os transtornos de humor (39,6%), de uso de substâncias (28,8%) e de personalidade (26,1%). Homens consultam mais por transtornos de uso de substâncias (49,1%), transtornos de humor (27,4%) e de personalidade (14,2%), e mulheres, por transtornos de humor (52,8%), de personalidade (39,0%) ou transtornos neuróticos (14,4%). Os pacientes foram admitidos à sala de observação ou internados em 40,4% dos casos e encaminhados para CAPS ou UBS em 39,9% dos casos. Conclusão: Os pacientes que consultam no SEP/HUSM são adultos com diagnósticos de transtorno de humor, de uso de substâncias e de personalidade, na maioria dos atendimentos. Casos graves que necessitam de tratamento intensivo são atendidos em aproximadamente metade dos casos(AU)

Introduction: Psychiatric Emergency Services (PES) are a key element in the mental health care network, intervening mainly in crisis situations. Searching for data on the demand for emergency services, this article aims to describe the characteristics of mental care provided in a reference PES in the central region of Rio Grande do Sul. Methods: A retrospective cross-sectional study was conducted with PES consultations data at the School Hospital of Santa Maria (SEP/HUSM) from 2010 and 2011, using the consultation record forms and hospital information system data. Frequency tables were constructed and the chi-square test was used for comparisons between variables. Results: The sample consisted of 7,853 visits, mostly by male patients (52%) aged 25-44 years (49.7%). The most common diagnoses were mood disorders (39.6%), substance use disorder (28.8%) and personality disorder (26.1%). Men consulted more for substance use disorder (49.1%), mood disorders (27.4%) and personality disorders (14.2%), and women for mood disorders (52.8%), personality disorders (39.0%), or neurotic disorders (14.4%). Patients were admitted to the observation room or hospitalized in 40.4% of cases and forwarded to Psychosocial Attention Centers (CAPS) or Basic Health Units (UBS) in 39.9% of cases. Conclusion: The patients who consult the PES/HUSM are adults with diagnoses of mood, substance use, and personality disorders in most visits. Severe cases requiring intensive care are treated in about half the cases(AU)

A clínica de família no centro de atenção psicossocial III: psicose e configurações vinculares / The family clinic in center psychosocial care III: psychosis and link configurations / La cinica familiar en el centro de atencion psicossocial: psicosis y configuraciones vinculares

O presente artigo pretende lançar um olhar sobre a clínica de família nos Centros de Atenção Psicossocial- CAPS, discutindo as estratégias de atendimento à família nas modalidades do grupo de familiares e da terapia familiar. Primeiro abordamos o contexto das mudanças da atenção em saúde mental com o foco na atenção psicossocial e o dispositivo dos CAPSs. Discute-se a contribuição da Psicanálise para o contexto da Saúde Mental e especificamente a Psicanálise de Família ou das Configurações Vinculares. Apresentamos um fragmento de um atendimento de família. Ressaltamos a importância da escuta de toda a família para que o novo modelo de atenção psicossocial se constitua. Assim, a terapia familiar no CAPS se insere como um dos dispositivos de cuidado fundamental no encontro cotidiano com o sofrimento, tomando como ponto de partida não apenas o sujeito, mas seus vínculos, ampliando o cuidado a família de modo significativo.

This article aims to cast a glance over the family clinic at the Psychosocial Care Centers - PCCs, discussing the strategies of family care in the forms of family groups and family therapy. First we address the context of changes in mental health care with the focus on psychosocial care and the implement of the PCCs. We discuss the contribution of Psychoanalysis to the context of Mental Health and specifically the Psychoanalysis of Family or the Psychoanalysis of Link Configurations. We present a fragment of a family treatment. We emphasize the importance of listening to the whole family in order to enable the constitution of a new psychosocial care model. Thus, family therapy at the PCCs becomes one of the fundamental care devices in the daily encounter with suffering, taking as a point of departure not only the subject, but his links, thus expanding family care in a significant way.

Este artículo tiene como objetivo poner atención a la clínica en CAPS Centros de Cuidado Psicosocial-, discutiendo las estrategias de atendimiento a la familia en términos del grupo familiar y terapia familiar. En primer lugar se acercó el contexto de los cambios en la atención de saludmental con un enfoque en la atención psicosocial y el dispositivo del CAPS. Se discute la contribución del Psicoanálisis con el contexto de la Salud Mental y, específicamente, el Psicoanálisis de la Familia o de las Configuraciones de Vínculos. Presentamos un fragmento de un atendimiento de familia. Resaltamos la importancia de escuchar toda la familia para que el nuevo modelo de atención psicosocial se constituya. Así que la terapia familiar en el CAPS se incluye como uno de los dispositivos de cuidados fundamentales en el encuentro diario con el sufrimiento, tomando como punto de partida no sólo el sujeto, pero sus vínculos, ampliando significativamente el cuidado de la familia.

Pesquisa psicanalítica sobre os fenômenos psicossomáticos / Psychoanalytic research on psychosomatic phenomena

Lacan abordou os fenômenos psicossomáticos através do conceito de significante congelado. Os autores que se inspiraram nele fizeram uso desse conceito de diversas maneiras. Existem diferenças entre esses autores quanto à possibilidade de uma determinação concreta de tais significantes congelados (holófrases) que seriam suscetíveis de serem enfatizados pelo analista. Segundo alguns desses autores, o enfatizar tais significantes poderia colocar fim aos fenômenos psicossomáticos. Outros autores lacanianos contestam o valor clínico desse tipo de intervenção. O autor questiona também o parentesco entre os fenômenos psicossomáticos e outros fenômenos clínicos como a alucinação, a emoção, o humor e a passagem ao ato.

Psychoanalytic research on psychosomatic phenomena. Lacan approached the psychosomatic phenomena using the concept of the frozen signifier. Lacanian authors have used this concept in a variety of ways. Yet differences do exist among Lacanian writers themselves, mainly in what concerns the possibility of a concrete determination of such frozen signifiers (holophrasis), which could be spotted by the therapist. According to some of these authors, emphasizing such signifiers could lead the psychosomatic phenomena to an end. Other Lacanian writers question the clinical value of this type of intervention. The author also questions the kinship between the psychosomatic phenomena and other clinical phenomena such as hallucination, emotion, mood and passing in the action.

Therapeutic Misconception in Psychiatry Research: A Systematic Review

Therapeutic misconception (TM) denotes the phenomenon in which research subjects conflate research purpose, protocols and procedures with clinical treatment. We examined the prevalence, contributory factors, clinical associations, impact, and collated solutions on TM within psychiatric research, and made suggestions going ahead. Literature search for relevant empirical research papers was conducted until February 2015. Eighty-eight reports were extracted, of which 31 were selected, summarised into different headings for discussion of implications and collated solutions of TM. We found variable and high rates of TM (ranging from 12.5% to 86%) in some psychiatry research populations. Contributory factors to TM included perceived medical roles of researchers, media, research setting and subject factors. Greater TM in affective, neurodevelopmental and psychotic spectrum conditions were associated with demographic variables (such as lower education, increased age), clinical factors (such as poor insight, cognitive deficits, increased symptoms, poorer self-rated quality of health), and social functioning (such as decreased independence). Inattention to TM may lead to frustration, negative impression and abandonment of participation in psychiatry research. Strategies such as the employment of a neutral educator during the informed consent process and education modules may be effective in addressing TM. Further research is warranted to examine the different TM facets, specific clinical correlates and more effective management strategies.

Síndrome de Cotard asociado a trastorno depresivo mayor con síntomas catatonicos: informe de caso / Síndrome de Cotard associada ao transtorno depressivo maior com sintomas catatonicos: relato de caso / Cotard Syndrome Associated to major depressive disorder with catatonic symptoms: case report

Catatonia is a neuropsychiatric syndrome with abnormal postures, mutism and stupor. Colombia has a prevalence of 11.4% of psychiatric patients. Objective: To discuss the clinical curse of a 34-year-old woman with major depressive disorder that presents to emergency department with nihilistic delirium and catatonic symptoms. Case presentation: A young woman with history of unipolar major depression with psychotic features was hospitalized nine months ago. She was medicated with a pharmacological treatment she did not remember. At admission, the patient had three days of bizarre behavior, mutism and negativism. Paraclinics and brain computer tomography did not report any abnormality or changes. Treatment began with benzodiazepine, which achieved full remission of catatonic symptoms. After this, she developed anhedonia, sadness and nihilistic delusions and was considered as a relapse of a previous depressive episode from nine months ago, associated with CotardÆs syndrome. Sertraline was added with gradual increase to 100mg and 5mg of olanzapine, getting a complete remission of psychotic and mood symptoms. Discussion: Affective disorders are most common cause of catatonia. There has already been a history of similar reports, but in few times these three entities were associated; this is the first case reported in Hospital Universitario de Santander, with informed consent. Conclusions: It is unusual for a depressed patient to present denial delusions and catatonic symptoms simultaneously; therefore this case is unusual and may contribute to literature. The catatonic symptoms make it difficult to explore other mental spheres, though they may be secondary to a medical condition, therefore, it is essential to dismiss organic pathologies and give initial treatment, so we can discover the underlying etiopsychopathology.

A catatonia é uma síndrome neuropsiquiatrica com posturas anormais, silêncio e estupor. A Colômbia tem uma prevalência de 11,4% de pacientes psiquiatricos. Objetivo: Discutir o caso clínico de uma mulher de 34 anos com uma história de transtorno depressivo maior que chega ao departamento de emergência com delírios niilistas e os sintomas catatónicos. Relato de caso: Foi relatado o caso de uma jovem adulta com transtorno depressivo maior e sintomas psicóticos que tinha sido hospitalizada nove meses antes, a quem deram alta com tratamento medicamentoso que ela não se lembrava. A paciente chegou ao pronto socorro do Hospital Universitário de Santander, apresentando três dias de um comportamento incomum, mutismo e negativismo. Exames laboratoriais e tomografia do crânio normal. O tratamento foi iniciado com uma benzodiacepina que a remeteu aos sintomas catatónicos. Posteriormente demonstrou anedonia, tristeza e delírios niilistas; considerou-se que seu estado correspondia a uma recorrência de episódio depressivo, começado nove meses antes, relacionado com a síndrome de Cotard. Gradualmente a paciente foi medicada com sertralina de 150,0 mg a 5,0 mg e olanzapina de 5.0 mg, obtendo a remissção dos sintomas afetivos e psicoticos. Discussão: A desordem afetiva é a causa mais comum de catatonia. Hß relatos semelhantes, embora poucos onde coexistam os três sintomas; este é o primeiro caso relatado no Hospital Universitário de Santander, com prévio consentimento informado. Conclusões: É incomum para uma pessoa deprimida ter delírios de negação e sintomas catatónicos simultaneamente, de modo que este caso, por ser único, gera novidade para a literatura. No caso, os sintomas catatónicos dificultam a exploração de outras esferas mentais e podem ser considerados secundários a uma condição médica, motivo pelo qual é essencial excluir causas orgânicas, trata-los prontamente e assim esclarecer a psicopatologia subjacente.

Psychiatric disorders; pattern and trends of patients attending out patient department at govt. Sarhad Hospital for Psychiatric Illnesses, Peshawar

The study was conducted to examine the pattern/trend of psychiatric disorders in a hospital based setting. Conducted at Govt. Sarhad Hospital for Psychiatric Diseases, Peshawar in March-April, 2010. Simple Observational. A Retrospective record review was done to determine the disease pattern for patients examined in the OPD [out patient deptt.]. All the patients who attended OPD in year 2010 and 2004 were included.The diseases were coded and classified according to ICD- 9 and 10. Comparison and Statistical analysis of both years was done. The findings of the study suggested that disease pattern seen at hospital, represents mental diseases prevalent in Distt. Peshawar. It showed the predominance of schizophrenic group and neurotic [31 -35%], stress related disorders [30-31%] group over other diseases. Next were the mode effective disorders [12- 16%] and episodal and paroxysmal disorders group [16-17%]. Drug dependence and mental retardation showed low percentage of 2%. Rest of diseases also showed low percentage. Although similar patterns were observed for both years but there were statistically significant difference between the two years. Hospital utilization pattern is a useful guide to the prevalence of mental diseases in general community.The chronic illnesses consisted of major burden of disease. Major groups were Schizophrenic and Neurotic, and Stress related disorders group. Pattern of psychiatric illness have not changed much from 2004 to 2010. Although the hospital is catering a large number of patients, yet there is a dire need of organizing mental health services at community level to reach undiagnosed patients

Stress and cardiovascular disease

As we have summarized, a confluence of pathophysiological and epidemiological studies establish that both acute and chronic forms of psychosocial stress contribute to the pathogenesis of atherosclerosis. Clinical consequences of acute stress include the development of myocardial ischemia, cardiac arrhythmias, and fostering of more vulnerable coronary plaques and hemostatic changes. Chronic stress and affective disorders, such as depression, appear to promote atherosclerosis via hypothalamic-pituitary-adrenal (HPA) axis overstimulation. Chronic stress can contribute to the occurrence of cardiovascular disease (CVD) by direct and indirect pathways. These results establish that, in addition to traditional CVD risk factors, psychosocial factors contribute to CVD. Physicians should never neglect to assess psychosocial risk factors, for example depression, hostility, social isolation, and chronic life stress and job stress, by clinical interview or standardized questionnaires. Management approaches include directly treating patients with mild forms of psychological distress by applying multifactorial lifestyle interventions and treating patients with clinical depression and anxiety. However, patients with severe psychological distress should be referred to specialists. Additional attention and research related to stress and CVD will be needed in the future.

A Case of Delayed Encephalopathy of Carbon Monoxide Intoxication / 신경정신의학

Occurrence of carbon monoxide intoxication has decreased due to decline in use of coal briquettes (anthracite) in Korea. However, suicide attempt by use of a coal fire lighter (beon-gae-tan) has shown a rapid increase over the past five years with relevance to imitated suicide. Acute carbon monoxide intoxication is a dangerous problem affecting the brain, kidney, lung, and other major organs. Sometimes, delayed encephalopathy after carbon monoxide intoxication makes clinical psychiatric diagnosis and treatment puzzling because neuropsychiatric sequelae are ambiguous with premorbid psychiatric problems, such as mood disorder, psychotic disorder, or other substance dependence. We report on a case of delayed encephalopathy of carbon monoxide intoxication and discuss its diagnosis and management.

Manifestaciones psiquiátricas en epilepsia / Psychiatric manifestations in epilepsy

La Organización Mundial de la Salud (OMS) y la Liga Internacional contra la Epilepsia (ILAE), la definen como una afección neurológica crónica, recurrente y repetitiva de fenómenos paroxíticos, ocasionados por descargas neuronales desorganizadas y excesivas. La epilepsia es la condición neurológica más seria y más común. Se estima que la prevalencia actual del trastorno es de 5-10/1000 personas; excluyendo a las convulsiones febriles, los casos de una crisis única y los casos inactivos. Sus causas pueden ser muy diversas y sus manfiestaciones muy variadas, de esta manera su sintomatología se ubica dentro de un polimorfismo acentuado. Dentro de las posibles manfiestaciones clínicas que pueden presentarse, se encuentran aquellas en las que predominan las alteraciones conductuales. El objetivo de la presente revisión es el poder dar cuenta de la presentación de los síntomas psiquiátricos en epilepsia, el impacto de estos y la importancia del manejo interdisciplinario con neurólogos. El reconocimiento de estos cuadros resulta de suma importancia en la práctica de la interconsulta, dada la implicancia de los profesionales de salud mental en el manejo sintomático de dichas manifestaciones.

The World Health Organization (WHO) and the International League Against Epilepsy (ILAE) define epilepsy as a chronic neurological affection, characterized by recurrent and repetitive paroxysmal phenomena generated by disorganized and excessive neuronal discharges. Epilepsy is the most serious and frequent neurological condition. It is estimated that its current prevalence is 5-10/1,000 people; excluding febrile seizures, single seizures and inactive cases. Because its causes and manifestations can be very varied, its symptomatology is placed with in a marked polymorphism. Among the possible clinical manifestations that may appear are those in which behavioral alterations prevail. The aim of this review is to describe the onset of psychiatric symptoms in epilepsy, their impact and the importance of interdisciplinary management of this disease with Neurologists. Identifying these clincal symptoms is of the utmost importance, given the involvement of healthcare profesionals in the symptomatic treatment of those manifestations.

Polaridad predominante en pacientes bipolares tipo I. Estudio en una población aislada con alta prevalencia de trastornos de ánimo / Predominant polarity in type-I bipolar patients. Study in an isolated population with a high prevalence of mood disorders

Introducción: Estudios recientes han demostrado que la descripción de la polaridad predominante tiene efectos en la detección temprana y el inicio oportuno del tratamiento en los pacientes con trastorno afectivo bipolar (TAB). Metodología: Estudio descriptivo de corte transversal en 101 pacientes con TAB procedentes de una muestra poblacional genéticamente aislada de la región colombiana de Antioquia. Resultados: El estudio abarcó una población de 101 pacientes con diagnóstico de TAB tipo I, de los cuales 57,4% cumplieron criterios de polaridad maniaca (PM), 10,1% presentaron polaridad depresiva (PD) y 25,7% fueron clasificados con polaridad indefinida (PI). En comparación con los otros, los pacientes con PM tienen menor nivel educativo y menor edad de inicio y hay más solteros que en los otros grupos. La mayor prevalencia de suicidio se dio dentro del grupo de PM. El grupo de PM presentó un mayor consumo de cannabinoides y cocaína. Dentro del grupo de PD se registró una fuerte tendencia al consumo de cigarrillo y alcohol. Respecto a los fármacos consumidos a lo largo de la vida por los pacientes que conforman el estudio, los antipsicóti-cos fueron el grupo más usado, seguido por el litio y los anticonvulsivantes. Hay un elevado porcentaje de pacientes con PM que usaron antidepresivos a lo largo de su vida. Conclusiones: La polaridad del primer episodio de la enfermedad parece ser un parámetro de pronóstico válido en cuanto a la polaridad de los episodios subsiguientes; por lo tanto funciona de forma indirecta como predictor del curso de la enfermedad...

Introduction: Recent studies have shown that the predominant description of polarity has effects upon early detection and the timely beginning of treatment in patients with bipolar affective disorder (BAD). Methodology:Cross sectional cut and descriptive study in 101 BAD patients coming from a genetically isolated population from the Colombian Region of Antioquia. Results: The study covered a population of 101 patients with type-I BAD diagnosis, out of which 57,4% met the criteria for maniac polarity (MP), 10,1% exhibited depressive polarity (DP) and 25,7% were classified with Indefinite Polarity (IP). In comparison, MP patients have a lower education level and less starting age, including a greater number of single people. The MP group showed the greatest prevalence of suicide and greater use of cannabinoids and cocaine. Within the DP group there was a strong tendency to cigarette and alcohol consumption. With respect to pharmaceutical drugs consumed by the study patients during their lives, antipsychotics were the most widely used group, followed by lithium and anticonvulsivants. There is high percentage of MP patients who have used antidepressants during their lives. Conclusion: The polarity of the first episode of the disease seems to be a valid predictive parameter concerning the polarity of subsequent episodes; therefore, it works indirectly as a valid predictor of the disease’s course...