Postpartum depression screening by telephone: a good alternative for public health and research.

This study verified the reliability and validity of the Edinburg Postpartum Depression Scale (EPDS) administered by telephone interviews. In a cross-sectional study of a cohort from Brazil (BRISA), the EPDS was administered by telephone to 1,083 women within 12 months postpartum, and 257 (23.7 %) participants had an EPDS score ≥10. At 67 ± 48 days after their telephone interview, 199 (EPDS ≥10 = 96; EPDS <10 = 103) participants were interviewed face-to-face using the Structured Clinical Interview for DSM-IV (SCID) and completed the EPDS again by self-report. In 90 participants, the diagnosis of major depressive episode was confirmed by the SCID (EPDS ≥10 = 65; EPDS <10 = 25). The Cronbach's alpha coefficient was 0.861. The Spearman's correlation between the EPDS administered by telephone and the self-reported EPDS was 0.69 (p < 0.001). The receiver-operating characteristic (ROC) curve for the EPDS administered by telephone was 0.78 (95 % confidence interval (CI) = 0.72 to 0.84). Scores ≥10 showed a sensitivity of 72.2 %, a specificity of 71.6 %, and a positive predictive value of 67.7 %. The application of the EPDS by telephone is a suitable alternative for clinical practice and research and represents a method to optimize the diagnosis of postpartum depression.

The Influence of genetic factors on peripartum depression: A systematic review.

BACKGROUND: This systematic review aimed to explore the potential influence of genetic factors on the symptoms of peripartum depression and to critically analyze the methodologies employed by the examined studies. METHODS: A systematic review of the literature indexed prior to July 2014 identified 200 articles. After applying the inclusion and exclusion criteria, 39 papers were included. RESULTS: The papers predominantly featured a molecular genetic approach (n=35), and the majority examined polymorphisms (n=27). Most studies used samples of Caucasians living in high income countries. The results suggest that the influence of genetic factors become more consistent when methodological variations among the studies are considered. Environmental stressors are also important variables that influence the relationship between genetic factors and peripartum depressive states. In addition, differences in the influence of genetic factors were observed depending upon the precise time point during pregnancy or the postpartum period that was examined in the studies. The late stages of pregnancy and the early postpartum period were times of greater genetic vulnerability. LIMITATIONS: This study was limited by the small number of papers reviewed and by the lack of information regarding whether the effects of genetics on peripartum depression are specific to certain ethnicities and/or stressors. CONCLUSIONS: Genetic studies of perinatal depression reinforce a pathophysiological role of the hormonal changes inherent in the childbirth period. However, the distinction between depressive episodes that begin during pregnancy from those that begin during the postpartum period can still be useful to improve our understanding of the physiopathology of depressive disorders.

Reflexões sobre o uso clínico do TAT na contemporaneidade / Reflection about the clinical use of TAT in contemporaneity

A elaboração de testes psicológicos ocorre em contextos socioculturais específicos e, portanto, não estão isentos de sua influência. Considerando as mudanças sociais que ocorreram desde a data de publicação do Teste de Apercepção Temática - TAT, é plausível indagar sobre as condições desse instrumento de apreender a subjetividade do indivíduo nos tempos atuais. Diante destas reflexões, este estudo buscou evidenciar a influência do contexto sócio-histórico-cultural e artístico na definição dos cartões do TAT, e refletir sobre sua utilização na realidade contemporânea. Nossas ponderações, sustentadas pela experiência clínica, sugerem que essas influências aparecem nas histórias contadas pelos sujeitos que referem-se aos cartões como imagens que dizem respeito ao passado, com conotações particulares. Diante disso, recomenda-se um uso crítico e cauteloso do TAT, no que diz respeito à análise das histórias produzidas, especialmente nas interpretações referentes ao uso dos mecanismos defensivos de isolamento e apego à realidade.(AU)

The elaboration of psychological tests occurs in specific social cultural contexts and, therefore, these are not free from their influence. Considering the social changes that have occurred since the date of publication of the Thematic Apperception Test - TAT, it is plausible to question the conditions of this instrument used for learning the individual's subjectivity nowadays. In face of such considerations, this study aimed at offering evidence of the influence of the social-historical-cultural and artistic context over the definition of the TAT cards, and pondering about its use in contemporary reality. Our considerations, supported by clinical experience, suggest that these influences appear in the stories told by the subjects, which refer to the cards as images related to the past, with particular connotations. Considering that, a critical and cautious use of TAT is recommended for the analyses of the stories produced, especially in the interpretations related to the use of defense mechanisms of isolation and attachment to reality.(AU)

Reflexões sobre o uso clínico do TAT na contemporaneidade / Reflection about the clinical use of TAT in contemporaneity

A elaboração de testes psicológicos ocorre em contextos socioculturais específicos e, portanto, não estão isentos de sua influência. Considerando as mudanças sociais que ocorreram desde a data de publicação do Teste de Apercepção Temática - TAT, é plausível indagar sobre as condições desse instrumento de apreender a subjetividade do indivíduo nos tempos atuais. Diante destas reflexões, este estudo buscou evidenciar a influência do contexto sócio-histórico-cultural e artístico na definição dos cartões do TAT, e refletir sobre sua utilização na realidade contemporânea. Nossas ponderações, sustentadas pela experiência clínica, sugerem que essas influências aparecem nas histórias contadas pelos sujeitos que referem-se aos cartões como imagens que dizem respeito ao passado, com conotações particulares. Diante disso, recomenda-se um uso crítico e cauteloso do TAT, no que diz respeito à análise das histórias produzidas, especialmente nas interpretações referentes ao uso dos mecanismos defensivos de isolamento e apego à realidade.

The elaboration of psychological tests occurs in specific social cultural contexts and, therefore, these are not free from their influence. Considering the social changes that have occurred since the date of publication of the Thematic Apperception Test - TAT, it is plausible to question the conditions of this instrument used for learning the individual's subjectivity nowadays. In face of such considerations, this study aimed at offering evidence of the influence of the social-historical-cultural and artistic context over the definition of the TAT cards, and pondering about its use in contemporary reality. Our considerations, supported by clinical experience, suggest that these influences appear in the stories told by the subjects, which refer to the cards as images related to the past, with particular connotations. Considering that, a critical and cautious use of TAT is recommended for the analyses of the stories produced, especially in the interpretations related to the use of defense mechanisms of isolation and attachment to reality.

Psicodinamismos de casais com Infertilidade decorrente de Endometriose / Psychodynamics of infertile couples due to endometriosis

A Endometriose representa uma das doenças ginecológicas mais estudadas nos últimos anos devido à dificuldade de estabelecer sua etiopatogenia, diagnóstico e tratamento. Sua incidência é de 10 a 15

na população geral, e de 20 a 40

Endometriosis represents one of the most studied gynecological diseases in the past years due to the difficulties in establishing its etiopathogeny, diagnostic and treatment. Its incidence ranges from 10

to 15

in general population, and from 20

to 40

em mulheres inférteis. Considerando o sofrimento físico e psíquico dos casais inférteis, este trabalho tem como objetivo geral investigar suas características psicodinâmicas. Desse modo, buscou-se conhecer a história de vida, o desenvolvimento psicossexual, os conflitos e mecanismos de defesa prevalentes desses indivíduos, bem como a qualidade do relacionamento conjugal e forma de enfrentamento da Infertilidade. Para sua operacionalização, optou-se pela metodologia do estudo de caso coletivo instrumental, com a utilização da entrevista semi-estruturada e do T.A.T. Esses instrumentos foram administrados a cinco casais sem filhos, que receberam o diagnóstico de Infertilidade devido à Endometriose na mulher. Os dados obtidos foram submetidos a uma análise dinâmica descritiva, com base nas orientações propostas no manual do T.A.T. e na livre inspeção clínica da entrevista, sob o referencial psicanalítico. Os resultados foram apresentados por meio de estudos de caso, análise dos resultados dos grupos de homens e mulheres, bem como de cada casal, buscando averiguar possíveis semelhanças e diferenças intra e intergrupos. Dentre os resultados está a concepção de uma relação conjugal positiva, em que se ressaltam o apoio e companheirismo. No grupo de mulheres encontrou-se um ambiente familiar conflituoso, ambivalência afetiva em relação à mãe e conotação negativa ao pai, sentimento de privação da infância, possibilidades restritas do brincar e livre fantasiar, assim como dificuldade de simbolização. Assim, a presença da rivalidade feminina, conflitos edípicos e sexualidade infantil mostram-se resultantes de vivências anteriores, relativas à qualidade das experiências transicionais...(AU)

in infertile women. Considering physical and psychic suffering of infertile couples, the objective of this work is to investigate their psychodynamic characteristics: their life story, psychosexual development, conflicts and prevailing defense mechanisms of these individuals, marital relationship quality and how they deal with infertility. The instrumental collective case study methodology was chosen for its utility, using semi-structured interview and TAT. These instruments were managed to five couples, having no children, who received the diagnosis of infertility due to endometriosis in the woman. The data obtained were submitted to a descriptive dynamic analysis, based on proposed directions in TAT manual and free clinical inspection of the interview under psychoanalytic referential. The results were introduced through case studies, women's and men's group results analysis as well as analysis of every couple, looking for possible similarities and dissimilarities in and between groups. There is the conception of a positive marital relationship among the results, emphasizing support and companionship. In the women's group, it was found a dysfunctional family environment, affective ambivalence related to the mother and negative connotation to the father, feeling of childhood deprivation, all restricted possibilities of playing and fantasizing freely as well as difficulty of symbolization. Therefore, the presence of female rivalry, oedipal conflicts and child sexuality indicate to be results from previous experiences, related to the quality of the transitional experiences which may be related to the development of psychosomatic diseases, in this case, the...(AU)