A gravidez da analista: criação e destruição de um espaço para sonhar / The analyst’s pregnancy: Creation and destruction of a space to dream

Neste trabalho são mostradas três situações clínicas nas quais pacientes com um funcionamento predominantemente psicótico detectam, durante as primeiras semanas, a gravidez de sua analista e expressam-no através de um sonho ou de sonhos diurnos. Observa-se que em seus sonhos, as pacientes tentam simbolizar um ponto muito importante e doloroso de suas próprias histórias, o momento ambivalente de sua concepção (Feder, 1980). Conclui-se que a gravidez da analista revive emoções muito primitivas, principalmente de rejeição, vivenciadas por estas pacientes durante sua gestação e nascimento, e que as pacientes conseguem sonhá-las por estarem contidas na situação analítica, que fornece um espaço para sonhar. No entanto, estas experiências nem sempre podem ser elaboradas em profundidade na situação analítica, razão pela qual suas possíveis causas são discutidas.

In this article, three clinical situations are shown in which patients with a predominant psychotic functioning, detect, during the first weeks, their analyst’s pregnancy and they express it through a dream or through daydreaming. It is observed that in their dreams, patients try to represent a very important and painful point of their own stories, the ambivalent moment of their conception (Feder, 1980). It has been concluded that the analyst’s pregnancy, revive very primitive emotions, mainly of rejection, lived by these patients during their own gestation and birth, and that this patients are able to dream them by being contained in the analytical situation, which provides a space to dream. However, these experiences cannot always be profoundly performed in the analytical situation, reason why, its possible causes are being brought to discussion.

En este trabajo se muestran tres situaciones clínicas en las que pacientes con un funcionamiento predominantemente psicótico detectan durante las primeras semanas el embarazo de su analista y lo expresan a través de un sueño o de los sueños diurnos. Se observa que, en sus sueños, las pacientes intentan simbolizar un punto muy importante y doloroso de sus propias historias: el momento ambivalente de su concepción (Feder, 1980). Se concluye que el embarazo de la analista revive emociones muy primitivas, sobre todo de rechazo, que estos pacientes experimentaron durante su gestación y nacimiento y que se logran soñar gracias a que las pacientes están contenidas en la situación analítica que provee un espacio para soñar. Sin embargo, estas experiencias no siempre pueden ser elaboradas a profundidad en la situación analítica, por lo que se discuten las posibles causas de ello.

Cerebral blood flow changes associated with experimental pain stimulation in patients with major depression.

BACKGROUND: The clinical relationship between pain and depression has been extensively reported. The purpose of this study was to compare the cerebral blood flow (CBF) of patients with major depressive disorder (MDD) during stimulation with experimental pain tolerance or sham stimulation, before and after 2 weeks of at least partially effective antidepressant treatment (ADT), in order to determine the cerebral regions associated with pain processing in the two clinical states. METHODS: Twenty-four antidepressant-free outpatients diagnosed with MDD (DSM-IV), without any pain complaints and a basal score>or=20 points on the Hamilton Rating Scale for Depression were included. Cerebral SPECTs were performed before and after ADT. Patients were stimulated with pain pressure tolerance (PT) or sham stimulation during the radiotracer cerebral uptake time. RESULTS: The comparison between PT and sham stimulation before ADT showed an increase of CBF of PT stimulated patients in right temporal gyrus, left amygdale, right anterior cingulated cortex, bilateral medial frontal gyrus, bilateral insula, lingual gyrus, right precentral gyrus and left postcentral gyrus. Equal comparison after ADT showed an increase of CBF of PT stimulated patients only in left middle frontal gyrus. LIMITATIONS: The sample includes exclusively outpatients with mild-moderate depression. CONCLUSION: CBF before ADT increases in brain areas related with the affective and cognitive components of pain; in contrast, after ADT increases only in cognitive pain related areas. These results offer new avenues to investigate the cerebral substrate of the common relationship between pain and depression.

Correlation between cerebral blood flow and items of the Hamilton Rating Scale for Depression in antidepressant-naive patients.

BACKGROUND: The purpose of this study was to correlate the basal cerebral blood flow (CBF) in patients with major depressive disorder (MDD) with the score for each of the 21 questions in the Hamilton Rating Scale for Depression (HRSD), in order to determine the cerebral regions associated with each item. METHODS: Fourteen antidepressant-naive patients with unipolar depression (DSM-IV criteria for MDD) participated in this study with a HRSD score of >/=20 points. CBF images obtained by SPECT were analyzed by SPM99 software. The significant correlation threshold for a priori regions (frontocortical and limbic regions) was a Z value of at least 2.25 and clusters formed by more than 10 voxels. RESULTS: Items 1, 6, 11 and 20 were positively correlated with right medial frontal gyrus; item 7 was negatively correlated with bilateral medial frontal gyrus. Items 2 and 10 were positively correlated with right anterior and medial cingulate, respectively. Item 5 was negatively correlated with the left amygdala. Item 9 was negatively correlated with bilateral insula, and item 16 with right insula. Items 12 and 14 were positively correlated with right and left precentral frontal gyrus, respectively. LIMITATIONS: The small sample size and only out-patients included in the study. CONCLUSIONS: The frontal cortex plays an important role in the expression of MDD symptoms. Not all the symptoms evaluated correlated with one single structure, which may explain the diverse results reported in the literature. These preliminary results support the necessity of further analyses by symptoms that could provide more specific information on the pathophysiology of MDD.