Circumcision and its potential effects on children's mental health state / Circuncisión y sus efectos potenciales sobre el estado de salud mental infantil

Objectives. Circumcision is one of the oldest elective surgical interventions in the history of mankind. Though many studies have been conducted on the surgical complications of circumcision, the potential effects on the mental state of the children has not been satisfactorily reviewed. In this prospective study, we analyzed potential effects of circumcision on their mental state, anxiety levels and moods using updated scales. Material and methods. One hundred and two male children aged between 6 and 8 and their families were included in the study. Children with their families completed sociodemographic data form Anxiety Sensitivity Index For Children, the Strengths and Difficulties Questionnaire (SDQ), Depression Scale for Children during the preoperative period. All children received oral 0.5mg/kg midazolam as a premedication before circumcision procedure. Circumcisions were performed under general anesthesia in the operating room. During the 6th week of the postoperative period, the children and their families were returned to the facility and parents were asked to complete the questionnaire again. Results. Mean score of the preoperative depression scale was statistically and significantly higher than the mean postoperative depression scale score (P=0.001; P<0.01). Pre-, and post-operative depression scale scores of the children with divorced parents showed a higher statistical significance higher than those of the children whose family togetherness was not broken (P=0.001; P<0.01). Conclusion. Before circumcision, in all children to be circumcised a tendency to depression and an increase in anxiety were observed regardless of the presence of subgroups. At the end of the study, it was found that low socioeconomic level, disrupted family dynamic, and/or the presence of mental disease in a parent could increase the predisposition to pre and post-operative depression. At this stage the main factor determining the level of anxiety is the procedure of circumcision itself (AU)

Objetivos. La circuncisión es una de las intervenciones quirúrgicas electivas más antiguas de la historia de la humanidad. Aunque muchos estudios se han realizado sobre las complicaciones quirúrgicas de la circuncisión, su efecto potencial sobre el estado mental de los niños no se ha aclarado mucho. En este estudio prospectivo se analizaron los efectos potenciales de la circuncisión en su estado mental, los niveles de ansiedad y estados de ánimo que por medio de escalas actualizadas. Material y métodos. Ciento dos niños varones de edades comprendidas entre los 6 y los 8 años y sus familias fueron incluidos en el estudio. Los niños con sus familias completaron el formulario de datos sociodemográficos Ansiedad Índice de Sensibilidad Para los niños, Capacidades y Dificultades (SDQ), escala de depresión para los niños durante el período preoperatorio. Todos los niños recibieron por vía oral 0,5mg/kg de midazolam como premedicación antes de procedimiento de circuncisión. Las circuncisiones se realizaron bajo anestesia general en la sala de operaciones. Durante la sexta semana del postoperatorio, los niños y sus familias regresaron y completaron las mismas encuestas una vez más. Resultados. La media de puntuación de la escala de depresión preoperatoria fue estadística y significativamente más alta que la puntuación media postoperatoria escala de depresión (p=0,001; p<0,01). Las puntuaciones pre y post operatorias en la escala de depresión de los niños con padres divorciados mostraron una mayor significación estadística que las de los niños cuyo núcleo familiar no estaba roto (p=0,001; p<0,01). Conclusión. Antes de la circuncisión, en todos los niños que iban a ser circuncidados se aprecia una tendencia a la depresión y el aumento de la ansiedad, independientemente de la presencia de subgrupos. Una vez concluida la investigación, se observó que un bajo nivel de ingresos, una dinámica familiar desequilibrada y/o la presencia de un trastorno mental en un progenitor podrían predisponer a la depresión pre y postoperatoria. En esta etapa el factor principal que determina el nivel de ansiedad es el procedimiento de la circuncisión sí mismo (AU)

Koro and schizophrenia in Singapore.

A case of Koro is described in an elderly person with associated inguinal hernia and schizophrenia. Its aetiology and origin are traced in Chinese culture, to the Chin Dynasty. A nosology for the classification of Koro Syndrome is proposed.

Depressive affect, anxiety, and psychic conflict in the phallic-oedipal phase.

The author's recent contributions to affect theory and its relation to psychic conflict are applied to the understanding of the nature, genesis, and consequences of psychic conflict in the phallic-oedipal phase. These contributions lead to a better understanding of 1) the importance of depressive affect in phallic-oedipal conflicts, 2) similarities and differences between such conflicts in boys and girls, 3) depression as a symptom in adult life, and 4) some aspects of narcissism.

"Johnny, I Hardly Knew Ye:" toward revision of the theory of male psychosexual development.

"The psychology of women," as it now exists, is a shadowy negative of the psychology of men, and can be successfully formulated only if male psychology is reassessed and considerably revised. Male theorists and practitioners have made virtues of the harsh facts of male socialization. These conditions, which have unhappy repercussions in the male ego and in the culture as a whole, are modifiable only if they are identified and understood.

Oedipal distortions in severe character pathologies. Developmental and theoretical considerations.

The oedipus complex is presented as a universal, developmentally determined mental organization that incorporates pregenital factors in a new hierarchic structure. Psychoanalysis with adults who have a variety of disorders, including severe character pathology, demonstrates the role of the oedipus complex and its variants as a dominant theme in these disorders. Recent trends in psychoanalytic theory are reviewed to facilitate our understanding of the newer metapsychological formulations that tend to de-emphasize oedipal constellations. Specific issues of changing emphasis in drive theory, ego organization, developmental levels of anxiety, and the separation-individuation process are considered.

Sadism revisited.

Sadism has been for a long time, among psychoanalytic and other writers, the subject of extensive theorizing and controversy. This paper takes a fresh look at the many dimensions (sexual, characterological, neurotic, psychotic, neurological) of this old aberrations.

Case reports the treatment of a child foot fetishist.

The history of a childhood foot fetishist is discussed from a developmental, psychodynamic, and therapeutic point of view. Therapy revealed that the symptom, while initially created in response to parental pathology, later led to specific defense mechanisms which were utilized to avoid developmental tasks, resolve ambivalence, and maintain body integrity.

A cross-cultural test of the Freudian theory of circumcision.

Freud's thesis that circumcision is a symbolic substitute for castration as a result of the Oedipus conflict was tested by examining 111 societies (see the note to Table 1). The results show that circumcision is likely to be found in societies in which (1) the son sleeps in the mother's bed during the nursing period in bodily contact with her, and/or (2) the father sleeps in a different hut, reducing his influence on the son as a superior and competing male. Since these two factors seems to intensify the son's oedipal attachment to the mother, the data are compatible with Freud's theory. Bettelheim's theory of circumcision is less fully formulated, and only when we assume that males significantly reduce their vagina envy after puberty rites is his theory compatible with the data.