Mental strategies as mediators of the link between attachment and PTSD.

The authors analyzed the relationship between attachment dimensions (avoidance and anxiety) and posttraumatic stress disorder (PTSD) symptoms through the mediation of the mental strategies organization, that is, behavioral and intrapsychic strategies used to cope with traumatic events and symptoms, among a sample of war veterans. Sample was composed of Portuguese war veterans (N = 60): 30 veterans suffered from chronic PTSD (nonrecovered) and 30 veterans had remission from PTSD (recovered). Assessment of mental strategies was retrieved from 1 interview assessed by 3 judges, and attachment patterns and PTSD symptoms were assessed through self-report measures. Path coefficients of direct and total effects were estimated. Results showed lower mental strategies organization and higher attachment anxiety among nonrecovered participants. Indirect effect of attachment anxiety on PTSD symptoms through mental strategies was significant when no variable was entered as covariate. Indirect effect of attachment avoidance on PTSD symptoms through mental strategies organization was not significant. The authors discussed that the development of more mature mental strategies play a central role in working with veterans to cope with posttraumatic symptoms. (PsycINFO Database Record

The effects of combat exposure, abusive violence, and sense of coherence on PTSD and depression in Portuguese colonial war veterans.

We analyzed the effects of 3 war components-combat exposure (CES), observation of abusive violence (OBS), and participation in abusive violence (PARTC)-and sense of coherence (SOC) on the development of both posttraumatic stress disorder (PTSD) and depression among a sample of war veterans. We also analyzed the role of SOC as a mediator of the effects of CES, OBS, and PARTC on both depression and PTSD symptoms. Sample was composed of 120 Portuguese Colonial War veterans. A binomial logistic regression analysis was performed to determine the effects of these variables on depression and PTSD diagnosis. Mediation test was performed by conducting several hierarchical regression analyses. Results showed that OBS and PARTC, and lower levels of SOC were associated with increased odds for exceeding the clinical cutoff scores for diagnosis of depression. All variables were associated with increased odds for exceeding the clinical cutoff scores for diagnosis of PTSD. In mediation analysis, at first step, PARTC was not a significant predictor of both PTSD and depression symptoms, and PARTC did not enter in subsequent analysis. SOC was a full mediator of the effects of OBS and CES on both depression and PTSD symptoms. We propose that treatment of war veterans should aim the reconciliation of traumatic incongruent experiences in veterans' personal schemas to strengthen veterans' sense of coherence, especially for those exposed to acts of abusive violence.

Mental health literacy about schizophrenia: a survey of Portuguese youth.

AIM: Mental health literacy about psychotic disorders, specifically schizophrenia, may assist in appropriate help seeking and early intervention, preventing the exacerbation of symptoms and improving health outcomes in the medium and long term. The aim of this study was to characterize the level of mental health literacy of Portuguese youth concerning schizophrenia. METHODS: A mental health literacy questionnaire was administered to a random sample of Portuguese youth aged 14-24 years. This questionnaire evaluated the following components: recognition of disorders, knowledge about professionals and treatments available, knowledge about the effectiveness of self-help strategies, knowledge and skills to support and provide first aid to others, and knowledge of how to prevent mental disorders. RESULTS: There were 4938 adolescents and young adults who participated in the study. Schizophrenia or psychosis was recognized by 42.17% and 22.21%, respectively. Most young people recognized the potential helpfulness of family doctors, psychologists, psychiatrists and mental health services. There was also widespread belief in the potential helpfulness of family and friends, and lifestyle changes. However, teachers were not generally seen as a source of help. Appropriate mental health first-aid strategies were commonly endorsed, but there was a reluctance to ask about suicidal feelings and many endorsed speaking to the person firmly. Lifestyle factors were also commonly believed to be preventative. CONCLUSIONS: Although many Portuguese youth have beliefs that may assist early intervention, there was a substantial minority who did not. Given the central role of teachers in the lives of young people, it is notable that they were not seen as a potential source of help. Mental health first-aid skills of young people also need improvement.

O estudo de caso como metodologia de investigação psicanalítica / Case study as a methodology for psychoanalytic research

Registram-se divergências epistemológicas relativas ao estudo de caso como método adequado à validação da teoria psicanalítica entre uma posição que compreende a investigação psicanalítica como o estudo dos significados e método apropriado à investigação das teorias psicanalíticas e uma abordagem que privilegia a adoção de um caráter científico, baseando-se na integração de metodologias de investigação apoiada em lógicas de relações probabilísticas de causalidade. A investigação psicanalítica, de acordo com modelos de causalidade, parece não considerar a especificidade do seu campo de estudo, o inconsciente, requerendo uma abordagem específica de investigação. Neste trabalho os autores propõem a utilização do estudo de caso como metodologia de investigação psicanalítica científica, através da realização de supervisão clínica e da análise da contratransferência como metodologias geradoras de evidência científica para a teoria psicanalítica(AU)

Epistemological differences regarding case study as an appropriate validation method of psychoanalytic theory have been observed, from a position that understands psychoanalytic research as the study of meanings, and the appropriate method to research psychoanalytic theories; and an approach that favors the adoption of a scientific character, based on the integration of research methodologies supported on logics of probabilistic causal relations. The psychoanalytic investigation, according to causal models, does not seem to consider the specificity of its study field, the unconscious, requiring a specific approach to research. In this work the authors propose the use of case study as a methodology for psychoanalytic scientific research, by means of clinical supervision and the analyses of countertransference as methodologies that generate scientific evidence for the psychoanalytic theory(AU)

Existen diferencias epistemológicas en relación con el estudio de caso como método apropiado para validar la teoría psicoanalítica, entre una posición que comprende la investigación psicoanalítica como el estudio de los significados y el método adecuado para la investigación de las teorías psicoanalíticas y un enfoque a favor de la adopción de un carácter científico, basado en la integración de metodologías de investigación basándose en relaciones de causalidad lógica probabilística. La investigación psicoanalítica de acuerdo con modelos de causalidad no parece tener en cuenta la especificidad de su campo de estudio, el inconsciente, que requiere un método específico para su investigación. En este trabajo los autores proponen el uso del estudio de caso como metodología de la investigación psicoanalítica científica, mediante la realización de la supervisión clínica y el análisis de la contratransferencia como metodologías que generan evidencia científica para la teoría psicoanalítica(AU)

A relação terapêutica na psicoterapia psicanalítica. Experiências vividas por ex-pacientes / The therapeutic relationship in psychoanalytic psychotherapy. The experience lived by former patients

O presente estudo explora as experiências vividas de um processo psicoterapêutico por uma amostra clínica que realizou psicanálise ou psicoterapia psicanalítica. O principal objetivo é analisar e compreender como é que a relação entre psicoterapeuta e sujeito num processo psicanalítico ou psicoterapêutico psicanalítico é percebida em diferentes momentos, momentos inicial e final. O design de investigação remete para um estudo exploratório, recorrendo-se a um modelo de análise qualitativa de dados obtidos a partir de questionários e/ou entrevistas utilizando-se das recomendações metodológicas do Método de Investigação Qualitativa Consensual. Foram contactados cinco psicoterapeutas, e 13 sujeitos foram registrados como tendo aceitado realizar entrevista. Os dados foram recolhidos de 13 sujeitos que terminaram psicoterapia psicanalítica de longo tempo e psicanálise. Os dados revelaram diferentes argumentos acerca da relação terapêutica. Quanto ao momento inicial, os sujeitos evocaram mais conteúdos relacionados com questões/sentimentos acerca do próprio, enquanto que, relativamente ao momento final, os sujeitos evocaram mais conteúdos relacionados com a relação terapêutica e com o psicoterapeuta.(AU)

The present study explores lived experiences of the psychotherapeutic process in a clinical sample of those who finished a psychoanalytical psychotherapy or psychoanalysis. The main aim is to analyse and understand how the relationship between patient and therapist in the process of psychoanalytical psychotherapy or psychoanalysis is realized by the patients in different moments, initial and final moments. The research design was an exploratory study using qualitative analysis methodology by resorting to questionnaires and/or interviews, using methodological recommendations from the Consensual Qualitative Research (CQR) method. 5 psychotherapists were contacted, and 13 patients were registered as having agreed to make the interview. Data was collected from the 13 patients who finished a long-term psychodynamic psychotherapy or psychoanalysis. The data has shown different arguments about the therapeutic relationship. Patients evoke more contents related to questions/ feelings about themselves on an initial moment. On the contrary, on a final moment, patients evoke more contents related with the therapeutic relationship and toward psychotherapist.(AU)

Literacia em saude mental de adolescentes e jovens portugueses sobre abuso de alcool / Instruccion en salud mental de adolescentes y jovenes portugueses sobre el abuso del alcohol / Mental health literacy of portuguese adolescents and youth about alcohol abuse

OBJETIVO: Caracterizar a literacia em saúde mental de adolescentes e jovens relativamente ao consumo abusivo de álcool, nas diversas componentes do conceito de literacia. MÉTODOS: Estudo descritivo-exploratório, em que foi aplicado o QuALiSMental a uma amostra representativa de 4.938 adolescentes e jovens, com idades compreendidas entre os 14 e os 24 anos, que frequentam escolas do 3º ciclo do ensino básico e do ensino secundário da região centro de Portugal. RESULTADOS: O reconhecimento da vinheta do consumo abusivo de álcool pelos participantes é elevado (72,4%), ainda que seja também identificado como alcoolismo (70,3%), o que no entanto indica a percepção do problema como grave. Os participantes apresentam níveis modestos de literacia nas restantes componentes, preferindo as fontes informais de ajuda. CONCLUSÃO: Conclui-se que há necessidade de implementação de programas nas escolas que promovam a literacia em saúde mental, para adoção de comportamentos saudáveis nos jovens, que os transferem para a idade adulta. .

OBJETIVO: Caracterizar la instrucción en salud mental de adolescente y jóvenes con respecto al abuso del alcohol, en los diversos componentes del concepto de instrucción. MÉTODOS: Estudio exploratorio-descriptivo, con aplicación del instrumento QuALiSMental a partir de la muestra representativa de 4938 adolescentes y jóvenes adultos, con edades entre 14 y 24 años, que frecuentan escuelas del tercer ciclo de enseñanza básica y de educación secundaria en la región central de Portugal. RESULTADOS: El reconocimiento de la viñeta del abuso de alcohol por los participantes es alto (72,4%), aunque se identifica también como alcoholismo (70,3%), que sin embargo, indica la percepción del problema como siendo grave. Los participantes tienen modestos niveles de instrucción en los componentes restantes, prefiriendo las fuentes informales de ayuda. CONCLUSIÓN: Se concluye, así, que la necesidad de implementar en las escuelas programas que promueven la instrucción en salud mental para la adopción de conductas saludables en los jóvenes, que los transfieren hacia la edad adulta. .

Characterize the mental health literacy of adolescents and young people about alcohol abuse, in the various components of the concept. Exploratory descriptive study, through the application of the instrument QuALiSMental to a representative sample of 4938 adolescents and young adults aged between 14 and 24 years, attending schools in the 3rd cycle of basic and secondary education of the central region of Portugal. The recognition of the vignette of alcohol abuse by the participants is high (72.4%), although it is also identified as alcoholism (70.3%), which indicates the perception of the problem as serious. Participants have modest levels of literacy in the remaining components, preferring informal sources of help. Therefore, we conclude that there is a need to implement school programs that promote mental health literacy, to promote the adoption of healthy behaviors in young people, which transfer them into adulthood.

Cross-cultural adaptation of the Operationalized Psychodynamic Diagnosis (OPD-2) in Portugal / Adaptação transcultural do Diagnóstico Psicodinâmico Operacionalizado (OPD-2) em Portugal

Background: The Operationalized Psychodynamic Diagnosis (OPD-2) is internationally established as one of the major instruments available for clinical diagnosis and scientific research, being frequently used as an auxiliary tool in the selection of therapeutic interventions. Aims: 1) To describe the methodological aspects of the adaptation of the OPD-2 into Portuguese (Portugal and Brazil). 2) To assess inter-rater agreement for the different axes of the instrument when scoring clinical interviews. Method: The cross-cultural adaptation involved translation of the instrument by different independent translators, whose versions were compared in discussion groups in order to develop a final Portuguese version. In the presence of discrepancies regarding the translation of original concepts, the authors of the original instrument were contacted for clarification. Five interviews were used to assess inter-rater agreement. Each subject participated in two interviews, conducted by an experienced clinical psychologist. The interviews were recorded, transcribed and then analyzed by the principal investigator and by three independent examiners. Results: Axis IV (Structure) presented the highest inter-rater agreement (78%). Axes I (Experience of illness and prerequisites for treatment) and III (Conflict) showed the lowest inter-rater agreement results (66 and 57.7%, respectively). Conclusions: Our results point in the same direction as previous studies conducted in other countries. In our sample, the OPD-2 presented an acceptable inter-rater agreement; however, further studies are needed to assess the instrument's reliability (AU)

Introdução: O Diagnóstico Psicodinâmico Operacionalizado (OPD-2) constitui-se internacionalmente como um dos principais instrumentos de diagnóstico clínico e de investigação científica, sendo frequentemente utilizado como uma ferramenta auxiliar na seleção de intervenções terapêuticas. Objetivos: 1) Descrever os aspetos metodológicos do processo de adaptação transcultural do OPD-2 para a língua portuguesa (Portugal e Brasil). 2) Avaliar a concordância inter-avaliadores para os diferentes eixos do instrumento na cotação de entrevistas clínicas. Método: A adaptação transcultural envolveu a tradução do instrumento por vários tradutores independentes. As versões resultantes foram confrontadas em grupos de discussão para a redação da versão final do instrumento em português. Na presença de divergências relacionadas à tradução de alguns conceitos originais, os autores do instrumento original foram contactados para esclarecimento. Para a avaliação da concordância inter-avaliadores, foram utilizadas entrevistas de cinco sujeitos. Cada um dos sujeitos participou de duas entrevistas, conduzidas por uma psicóloga com experiência clínica. As entrevistas foram gravadas, transcritas e posteriormente analisadas pela investigadora principal e por três examinadores independentes. Resultados: O eixo IV (Estrutura) apresentou a maior concordância inter-avaliadores (78%). Os eixos I (Vivência da doença e pré-requisitos para o tratamento) e III (Conflitos) obtiveram a menor concordância inter-avaliadores (66 e 57,7%, respectivamente). Conclusão: Nossos resultados apontam na mesma direção de estudos anteriores realizados em outros países. Na nossa amostra, o instrumento obteve razoável concordância inter-avaliadores, porém novos estudos são necessários para investigar a confiabilidade do instrumento (AU)

Beyond the body image: a qualitative study on how adults experience lower limb amputation.

OBJECTIVE: To explore adults' experiences of lower limb amputation, focusing on the changes in self-identity related to the impairment. DESIGN: A cross-sectional and qualitative study, using semi-structured interviews. Interviews were transcribed, coded and analysed by two independent researchers. SETTING: A rehabilitation medicine service from a general public hospital. PARTICIPANTS: A convenience sample of 42 patients with lower limb amputation performed after the age of 18 and followed up in the physical medicine and rehabilitation department of a general hospital. MAIN OUTCOME MEASURES: A semi-structured interview, addressing three core areas: the emotional impact of amputation; the adjustment process; and the relation with the external resources. RESULTS: Eight themes emerged from interviews: reactions and feelings about becoming amputee; changes in own life; problems in well-being; relation with the prosthesis; self-perceptions; aims related to the rehabilitation and future plans; relation with the rehabilitation; and perceived social support. These results supported a theoretical model for the self-identity changes related to limb loss. CONCLUSIONS: The self-identity changes after a lower limb amputation appear beyond the patient's body image and functioning, affecting the patient's awareness of the impairment, biographical self and any future projections.

Cross-cultural adaptation of the Operationalized Psychodynamic Diagnosis (OPD-2) in Portugal.

BACKGROUND: The Operationalized Psychodynamic Diagnosis (OPD-2) is internationally established as one of the major instruments available for clinical diagnosis and scientific research, being frequently used as an auxiliary tool in the selection of therapeutic interventions. AIMS: 1) To describe the methodological aspects of the adaptation of the OPD-2 into Portuguese (Portugal and Brazil). 2) To assess inter-rater agreement for the different axes of the instrument when scoring clinical interviews. METHOD: The cross-cultural adaptation involved translation of the instrument by different independent translators, whose versions were compared in discussion groups in order to develop a final Portuguese version. In the presence of discrepancies regarding the translation of original concepts, the authors of the original instrument were contacted for clarification. Five interviews were used to assess inter-rater agreement. Each subject participated in two interviews, conducted by an experienced clinical psychologist. The interviews were recorded, transcribed and then analyzed by the principal investigator and by three independent examiners. RESULTS: Axis IV (Structure) presented the highest inter-rater agreement (78%). Axes I (Experience of illness and prerequisites for treatment) and III (Conflict) showed the lowest inter-rater agreement results (66 and 57.7%, respectively). CONCLUSIONS: Our results point in the same direction as previous studies conducted in other countries. In our sample, the OPD-2 presented an acceptable inter-rater agreement; however, further studies are needed to assess the instrument's reliability.

From self-awareness to self-identification with visual impairment: a qualitative study with working age adults at a rehabilitation setting.

OBJECTIVE: To explore the experience of vision loss, focusing on working age patients' self-awareness of impairment and self-identification with the impairment. DESIGN: A cross-sectional and qualitative study, using semi-structured interviews. SETTING: A specialized rehabilitation centre and a low vision unit at a public hospital. PARTICIPANTS: A convenience sample of 38 patients between the ages of 20 and 65, with sight loss caused by a serious ophthalmological condition acquired after the age of 18, and doing their rehabilitation. MAIN OUTCOME MEASURES: A semi-structured interview, addressing three core areas: the emotional impact of vision loss; adjustment; and social support. Interviews were transcribed, coded and analysed by two independent researchers. RESULTS: Seven themes emerged from interviews. Changes in patients' identity, achievement and future life projection arose as being the main transformations caused by vision loss. Self-awareness of impairment appeared associated with the patients' first contact with their loss, while self-identification with the impairment arose connected with the later embodiment process of the vision loss. CONCLUSIONS: Patients' self-awareness and self-perceptions of impairment appear to be two important milestones in the adjustment process to vision loss. Their assessment and monitoring over the rehabilitation period might help to promote impairment acceptance and rehabilitation outcomes.

O funcionamento perverso da mente / El funcionamiento perverso de la mente / Peverse operation of mental life

O autor aborda diferentes conceptualizações sobre o funcionamento mental associado à perversão, integrando contributos fundamentais de autores ingleses, franceses e sul-americanos. A ilustração de um caso clínico realça aspectos da relação psicanalítica, nas suas particularidades transferenciais e contratransferenciais, diferenciando aspectos técnicos do trabalho analítico.

El autor presenta distintas concepciones relativas al funcionamiento mental asociado a la perversión, integrando históricamente contribuciones fundamentales de autores ingleses, franceses y suramericanos. La ilustración de un caso clínico pone destaca aspectos de la relación psicoanalítica, en sus particularidades transferenciales y contra-transferenciales, distinguiendo aspectos técnicos del trabajo analítico.

The author mentions different conceptions about perversion and mental life. English, French and American psychoanalytical ideas about perversion and false self are discussed. A clinical case is present and takes in count transference and contra-transference aspects, as well as technical dimensions of the analytical work.

O funcionamento perverso da mente / El funcionamiento perverso de la mente / Peverse operation of mental life

O autor aborda diferentes conceptualizações sobre o funcionamento mental associado à perversão, integrando contributos fundamentais de autores ingleses, franceses e sul-americanos. A ilustração de um caso clínico realça aspectos da relação psicanalítica, nas suas particularidades transferenciais e contratransferenciais, diferenciando aspectos técnicos do trabalho analítico.(AU)

El autor presenta distintas concepciones relativas al funcionamiento mental asociado a la perversión, integrando históricamente contribuciones fundamentales de autores ingleses, franceses y suramericanos. La ilustración de un caso clínico pone destaca aspectos de la relación psicoanalítica, en sus particularidades transferenciales y contra-transferenciales, distinguiendo aspectos técnicos del trabajo analítico.(AU)

The author mentions different conceptions about perversion and mental life. English, French and American psychoanalytical ideas about perversion and false self are discussed. A clinical case is present and takes in count transference and contra-transference aspects, as well as technical dimensions of the analytical work.(AU)

Psychotherapy with physically disabled patients.

With the last decades, health care interventions have been more productively attuned to actualizing the potential for optimal recuperation of every patient. Unique and important contributions of psychotherapy to this effort include: 1) A formulation which synthesizes an understanding of clinical behaviors, reality-based physical limitations and risks with an appreciation of the patient's mechanisms of defense, ego strengths and weaknesses, and transference expectations which impact the treatment process; 2) The utilization of individual psychotherapy (focused on "insight") in combination with supportive individual and group experiences. For children and adolescents struggling with age-appropriate physical-developmental and social issues or learning disabilities, psychoeducational approach for disabled youngsters has proven very beneficial. 3) Occasional crises occur which involve the spouse or relatives more than the index patient. Working to provide supportive Couple or Family System intervention is sometimes as essential as caring for the disabled individual. 4) Numerous Group Therapy approaches have proven efficacious. Treatment in a group setting is attractive to those who are concerned about cost-containment. Unfortunately, groups for disabled are often "didactic" and utilize a format that provides factual information about disabilities, medical procedures, and sometimes an intellectual discussion of "emotional answers" for certain types of problems or conditions. Groups that facilitate self-disclosure and emotional interactions among the members accomplish more meaningful results. In conclusion, we wish to emphasize the importance of developing rigorous scientific research in the area of disabilities which will match the excellence of clinical work already being done in the field. Gaining an accurate and more thorough understanding of the psychological reality of a disabled person's internal world may be a key to facilitating his or her self-esteem and optimal adaptive functioning.