ABSTRACT
Com base em experiências clínicas, foi observado que a ecolalia, em alguns casos, pode funcionar metaforicamente como uma janela que abre oportunidade para estabelecer uma relação dialógica entre o analista e crianças com sintomas autísticos (Kanner) e facilitar o desenvolvimento do paciente. No autismo encontramos uma organização de defesa altamente complexa e sofisticada, que tem o objetivo de garantir a invulnerabilidade do paciente, para evitar a recorrência das condições de ansiedade impensável (Winnicott). Neste estudo, o analista é considerado como uma "companhia viva" (Alvarez), que possibilita o processo de comunicação entre ele e o paciente, e diminui a sensação de isolamento entre eles. Este trabalho apresenta o estudo de um único caso, em que se desenvolveu e ampliou uma via de comunicação viva entre analista e paciente. O objetivo do trabalho psicanalítico não é necessariamente extinguir a ecolalia de forma indiscriminada, mas especialmente o de transformar esse modo estereotipado e repetitivo de comunicação num processo dialógico.
Based on clinical trials, it was observed that echolalia, in some cases, may metaphorically works as a window of opportunity that is open to establish a dialogic relationship between psychoanalyst and children with autistic symptoms (Kanner). It may, therefore, facilitate the patient's development. In autism, we find a highly complex and sophisticated organization of defense. Its purpose is to guarantee the patient's invulnerability in order to prevent repeated conditions of unthinkable anxiety (Winnicott). In this paper, the psychoanalyst is considered a "live company" (Alvarez), who allows the communication process between analyst and patient to occur. It also minimizes the feelings of isolation between them. This work presents a single case study in which a way of live communication between analyst and patient has been both developed and increased. Psychoanalytic work does not necessarily have the purpose of indiscriminately extinguishing echolalia, but it has the special purpose of transforming this stereotyped and repetitive way of communication into a dialogic process.
A partir de experiencias clínicas, se observó que la ecolalia, en algunos casos, puede funcionar metafóricamente como una ventana que abre la oportunidad de establecer una relación dialógica entre el analista y el niño con síntomas autístas (Kanner) facilitando el desarrollo del paciente. En el autismo encontramos una organización de defensas altamente compleja y sofisticada, que tiene el objetivo de garantizar la invulnerabilidad del paciente, para evitar la repetición de condiciones de ansiedad impensable (Winnicott). En este estudio, el analista es considerado como una "compañía viva" (Alvarez) que posibilita el proceso de comunicación entre paciente y analista y reduce la sensación de aislamiento entre ellos. Este trabajo presenta el estudio de un solo caso, en el que se desarrolló y se amplió una vía de comunicación viva entre analista y paciente. El objetivo del trabajo analítico no es necesariamente extinguir la ecolalia de forma indiscriminada, sino transformar, especialmente, ese modo estereotipado y repetitivo de comunicación en un proceso dialógico.
A partir d'expériences cliniques, on a observé que l'écholalie peut, dans certains cas, fonctionner métaphoriquement comme une fenêtre qui ouvre la possibilité d'établir une relation dialogique entre l'analyste et les enfants présentant des symptômes autistiques (Kanner) et ainsi rendre plus facile le développement du patient. Chez les autistes, nous trouvons une organisation de défense très complexe et sophistiquée qui vise à assurer leur invulnérabilité, afin d'éviter la récurrence des conditions d'anxiété impensable (Winnicott). Dans cette étude, l'analyste est considéré comme une "compagnie vivante" (Alvarez), ce qui rend possible le processus de communication entre le professionnel et son patient, permettant de réduire le sentiment d'isolement entre eux. Ce travail présente l'étude d'un seul cas, où une voie de communication vivante s'est développée entre l'analyste et son patient. L'objectif du travail psychothérapeutique n'est pas nécessairement faire disparaitre l'écholalie, mais c'est celui de transformer cette façon stéréotypée et répétitive de communication en un processus dialogique.
Subject(s)
PsychoanalysisABSTRACT
A hipocondria é associada a diversos transtornos de ansiedade, sobretudo ao transtorno de pânico (TP). Estima-se que 50 porcento a 70 porcento dos pacientes com TP tenham sintomas hipocondríacos e que 13 porcento a 17 porcento dos hipocondríacos tenham TP associado. Considera-se que há co-morbidade com hipocondria no TP quando as preocupações com saúde não se restringem aos sintomas das crises de pânico. Relatamos um caso de uma paciente que, durante seu acompanhamento, evoluiu com hipocondria e transtorno de pânico associado. Discutimos as manifestações psiquiátricas manifestadas pela paciente, assim como analisamos aspectos conceituais, diagnósticos e prognósticos.
Hypocondriasis is associated with several anxiety disorders, including panic disorder. The available estimates of panic disorder patients with identified hypochondriacal symptoms are 50% to 70%. Complimentary, 13% to 17% of hypochondriac patients were associated with panic disorder. Comorbidity and hypocondriasis occur when health care issues are not delimited by panic disorder symptoms. We reported a patient that, during the follow-up-period, has evolved to an associated hypocondriasis and panic disorder scenario. The psychiatric symptoms were properly addressed and discussed, as well the associated conceptual aspects, diagnoses and prognosis.
Subject(s)
Humans , Female , Adult , Comorbidity , Diagnosis, Differential , Hypochondriasis/diagnosis , Hypochondriasis/therapy , Panic Disorder/diagnosis , Panic Disorder/therapyABSTRACT
BACKGROUND: Schizobipolar disorder is considered related to both schizophrenia and bipolar disorder. We aimed to describe with retrospective methodology the demographic, clinical, and treatment features in a group of schizobipolar disorder patients who have been treated for at least a 5-year period and compare them with bipolar I and schizophrenic patients who were treated during the same period. METHOD: We compared the demographic and clinical data of 61 schizobipolar, 57 bipolar I, and 55 schizophrenic outpatients who were diagnosed and treated for at least 5 years in the outpatient clinic in the Federal University of Rio de Janeiro. RESULTS: The schizobipolar disorder patients had a profile similar to the bipolar I patients but are significantly different from schizophrenic patients in educational level, marital status, occupation, drug and alcohol abuse episodes, presence of depressive, mixed and maniac episodes, family history of bipolar I and mood disorders, and use of medications. Only the age of onset, suicide attempts, and family history of suicide are not significantly different among the groups. The schizophrenic patients used antipsychotics for more days and the schizobipolar and bipolar I used more antidepressants and mood stabilizers. 37 (60.6%) schizobipolar patients had their diagnosis changed to bipolar disorder by their physician in different periods during the period studied. LIMITATIONS: It is a retrospective data description based on a naturalistic treatment. The family history was collected from the patient and whenever possible from one first-degree relative. CONCLUSION: Schizobipolar disorder patients have demographic, clinical and therapeutic features similar to bipolar I patients and data support its definite inclusion in the bipolar spectrum group.
