Assessing complex PTSD and PTSD: validation of the German version of the International Trauma Interview (ITI).

Background: With the introduction of the ICD-11 into clinical practice, the reliable distinction between Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) becomes paramount. The semi-structured clinician-administered International Trauma Interview (ITI) aims to close this gap in clinical and research settings.Objective: This study investigated the psychometric properties of the German version of the ITI among trauma-exposed clinical samples from Switzerland and Germany.Method: Participants were 143 civilian and 100 military participants, aged M = 40.3 years, of whom 53.5% were male. Indicators of reliability and validity (latent structure, internal reliability, inter-rater agreement, convergent and discriminant validity) were evaluated. Confirmatory factor analysis (CFA) and partial correlation analysis were conducted separately for civilian and military participants.Results: Prevalence of PTSD was 30% (civilian) and 33% (military) and prevalence of CPTSD was 53% (civilians) and 21% (military). Satisfactory internal consistency and inter-rater agreement were found. In the military sample, a parsimonious first-order six-factor model was preferred over a second-order two-factor CFA model of ITI PTSD and Disturbances in Self-Organization (DSO). Model fit was excellent among military participants but no solution was supported among civilian participants. Overall, convergent validity was supported by positive correlations of ITI PTSD and DSO with DSM-5 PTSD. Discriminant validity for PTSD symptoms was confirmed among civilians but low in the military sample.Conclusions: The German ITI has shown potential as a clinician-administered diagnostic tool for assessing ICD-11 PTSD and CPTSD in primary care. However, further exploration of its latent structure and discriminant validity are indicated.

This study validated the German International Trauma Interview (ITI), a semi-structured clinician-administered diagnostic interview for ICD-11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder.Internal reliability, inter-rater agreement, latent structure, and convergent validity were explored in trauma-exposed clinical and military samples from five different in- and outpatient centres in Germany and German-speaking Switzerland.The findings supported the German ITI's reliability, inter-rater agreement, convergent validity and usefulness from a patient perspective. Future research should explore its factor structure and discriminant validity, for which differences between the samples were found.

Entrevistas en profundidad: técnica complementaria a las entrevistas clínicas en las intervenciones basadas en necesidades del paciente / In-depth interviews: complementary technique to the clinical interviews in the interventions based on the patient’s needs

Se brindó Comprehensive Medication Management a una mujer de 78 años, con antecedentes de trombosis venosa profunda y fractura de cadera. Diagnosticada de hidrocefalia, artrosis, hipertensión arterial y dislipemia, que tomaba 12 medicamentos. Se evaluaron las necesidades farmacoterapéuticas integrando aspectos biomédicos y psicosociales, a través de un análisis clínico, que permitió detectar 7 necesidades y un análisis complementario de narrativas extraídas de entrevistas en profundidad, que permitió la detección de 5 necesidades adicionales. Utilizar entrevistas en profundidad para interrelacionar aspectos cualitativos de la experiencia personal al evaluar la farmacoterapia, permitió plantear intervenciones biopsicosociales adaptadas a la resolución integral de necesidades farmacoterapéuticas, que fueron recogidas en un plan de cuidados, donde se incluyó un informe al médico de atención primaria con 4 recomendaciones de las cuales 2 fueron aceptadas y otras 4 fueron propuestas y aceptadas por la paciente y su cuidador, consiguiéndose la resolución de 8 necesidades farmacoterapéuticas.(AU)

Comprehensive Medication Management was provided to a 78-year-old woman. Medical history: deep vein thrombosis, hip fracture, hydrocephalus, arthrosis, arterial hypertension and dyslipidemia. She was taking 12 medications. Patient’s medication-related needs were evaluated integrating biomedical and psychosocial aspects, through a clinical analysis, which allowed the de-tection of 7 medication-related needs. Complemen-tary analysis of narratives extracted from in-depth interviews allowed detection of 5 additional medi-cation-related needs. Using in-depth interviews to interrelate qualitative aspects of personal experience when evaluating pharmacotherapy, allowed to propose biopsycho-social interventions adapted to the comprehensive resolution of medication-related needs, collected in a care plan. Included a medical report with 4 recommendations whereby 2 were accepted by the primary care physician. Another 4 medication-re-lated needs were proposed and accepted by the patient and her caregiver, achieving the resolution of 8 medication-related needs.(AU)

Comunicación en el consultorio de medicina familiar: trabajo multicéntrico, cualitativo cuantitativo, en los meses de abril a julio de 2014, en Buenos Aires, Rosario y Tucumán / Communication in Family Medicine practice: multicenter research trial, qualitative and quantitative, from April to June 2014. in the City of Buenos Aires, Rosario and Tucumán

Introducción: la comunicación es trascendental para la vida en sociedad. El éxito de cualquier entrevista clínica depende de la calidad de la comunicación entre el médico y el paciente. Distintos factores pueden interferir en esta, como el ambiente, el tiempo y las interrupciones. Objetivo: Evaluar el grado de comprensión del mensaje transmitido por el médico hacia el paciente. Material y método: Trabajo multicéntrico, cualitativo cuantitativo. Componente cuantitativo: descriptivo de corte transversal de abril a julio de 2014. Se incluyeron 1200 adultos de ambos sexos, que asistieron a los Ce.M.A.P y 40 médicos de familia. Componente cualitativo: Muestreo no probabilístico, intencional, hasta saturación de datos. Triangulación y convergencia de datos. Resultados y discusión: Respecto al componente cuantitativo, se encontró que nuestras hipótesis acerca de la falta de comprensión del mensaje (indicaciones y problema de salud) no pudieron comprobarse. Ya que las indicaciones realizadas por el médico tuvieron una adecuación total del 60% y comprendieron el problema de salud un 77% de los pacientes entrevistados. Para el componente cualitativo luego del análisis temático se obtuvieron barreras (tiempo, paciente polidemandante, ideas previas, omisión de indicaciones no farmacológicas) y facilitadores (conocimiento previo del problema de salud, longitudinalidad, paciente acompañado) para la comprensión del mensaje. Conclusiones: Los pacientes entienden el mensaje de sus médicos de familia, ya que contamos con herramientas concretas como la escucha empática, el proceso clínico centrado en la persona y la longitudinalidad en la atención (AU)

Introduction: communication is important for life in a society. Success in any clinical interview depends on the quality of patient-doctor communication. Different factors may interfere, like the environment, time and interruptions. Objective: Asses the level of understanding of the message given to the patient by the doctor. Material and method: Multicenter research trial, qualitative and quantitative. Quantitative component: cross sectional descriptive from April to June 2014. 1200 adults of both sexes who assisted to the primary health care center: "Ce.M.A.P." in the City of Buenos Aires, Rosario and Tucumán and 40 family practitioners. Qualitative component: nonprobability, intentional sampling upon data saturation. Data triangulation and convergence. Results and discussion: as regards the quantitative component, we found out that our hypothesis in relation to the lack of understanding in the message (indications and health problem) could not be proven. Since 60% of the practitioner's indications were followed and 77% of the interviewed patients understood the health problem. Considering the qualitative component after the thematic analysis, barriers (time, highly demanding patient, previous knowledge, omission of non-pharmacological indications) and facilitators were obtained (previous knowledge of health problem, longitudinality, accompanied patient) to understand the message. Conclusion: patients understand their family practitioner's message since we have specific tools like empathic listening, patient centered healthcare and longitudinality in attention (AU)

A clinician rating to diagnose CPTSD according to ICD-11 and to evaluate CPTSD symptom severity: Complex PTSD Item Set additional to the CAPS (COPISAC).

Background: Researchers who wish to study stress-related disorders need to use valid, reliable, and sensitive instruments and the Clinician-administered PTSD Scale (CAPS) constitutes the gold standard in the assessment of posttraumatic stress disorder (PTSD). While the CAPS corresponds with PTSD criteria according to the DSM-5, researchers face a challenge with the forthcoming ICD-11: ICD-11 introduces the new diagnosis Complex PTSD (CPTSD) that does not exist in DSM-5.Objective: Researchers as well as clinicians will need to assess the incidence and prevalence of CPTSD and will want to evaluate treatment effects according to both criteria sets. However, using two clinician-rated interviews is often not feasible and a burden to patients, particularly in psychotherapy research.Method & Results: We have therefore developed the Complex PTSD Item Set additional to the CAPS (COPISAC). This clinician rating is an easy-to-use and economic addition to the CAPS that permits assessing diagnosis and evaluating symptom severity of CPTSD. COPISAC consists of three items that assess disturbances in self-regulation including prompts for symptom description and frequency, and two additional items assessing impairment. Diagnostic status and severity ratings for CPTSD are possible. Items that account for the specific forms of trauma which the ICD-11 describes as precursors of CPTSD (e.g. torture, being enslaved) are further suggested as additions to the Life Events Checklist.Conclusion: With an introduction of COPISAC at this point, we aim at suggesting an easy transition into diagnosing CPTSD and evaluating its course over treatment.

The clinician rating COPISAC is an easy-to-use and economic addition to the Clinician-administered PTSD Scale.It permits to make a diagnosis of Complex PTSD and evaluate symptom severity.

[Sensitivity and specificity between the Composite International Diagnostic Interview Version 3.0 (World Mental Health, CIDI) and the Standardised Clinical Evaluation version I (SCID-I) in a mental health survey of the city of Medellin, 2012]. / Sensibilidad y especificidad entre la Entrevista Diagnóstica Internacional Compuesta versión 3.0 (World Mental Health, CIDI) con la Evaluación Clínica Estandarizada versión I (SCID-I) en la Encuesta de Salud Mental de la ciudad de Medellín, 2012.

INTRODUCTION: In order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. OBJECTIVE: To compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. METHODOLOGY: Cross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. RESULTS: The median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis - with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. CONCLUSIONS: SCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.

Sensibilidad y especificidad entre la Entrevista Diagnóstica Internacional Compuesta versión 3. 0 (World Mental Health, CIDI) con la Evaluación Clínica Estandarizada versión I (SCID-I) en la Encuesta de Salud Mental de la ciudad de Medellín, 2012 / Sensitivity and specificity between the Composite International Diagnostic Interview Version 3. 0 (World Mental Health, CIDI) and the Standardised Clinical Evaluation version I (SCID-I) in a mental health survey of the city of Medellin, 2012

Introducción: El abordaje de los problemas de salud mental de la población colombiana hace necesario disponer de instrumentos diagnósticos válidos, fáciles de aplicar y comparables (local e internacionalmente). Objetivo: Comparar la sensibilidad y la especificidad diagnóstica entre el CIDI 3.0 y el SCID-! para el trastorno depresivo mayor, el trastorno afectivo bipolar I y II y el trastorno por dependencia de sustancias. Metodología: Estudio transversal que comparó en 100 sujetos las prevalencias de vida de tres trastornos mentales por medio del CIDI 3.0 y el SCID-I. La investigación fue aprobada por el Comité de Ética Institucional. Se midieron la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo (con sus respectivos intervalos de confianza del 95%) de las dos entrevistas diagnósticas. Para el análisis de la información se utilizó el software SPSS® versión 21.0. Resultados: La mediana de edad fue 43,5 [intervalo intercuartílico, 30] anos. La sensibilidad (Se) y la especificidad (Es) más altas se observaron en el diagnóstico de trastorno por dependencia de drogas -Se, 80% (IC95%, 34,94%-100%); Es, 98,46% (IC95%, 94,7%-100%)-. Conclusiones: El SCID-I y el CIDI 3.0 mostraron diferentes niveles de sensibilidad y especificidad para los tres trastornos estudiados así: altas para el trastorno por dependencia de sustancias, moderadas para el trastorno afectivo bipolar I y II y bajas para el trastorno depresivo mayor.

Introduction: In order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. Objective: To compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. Methodology: Cross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. Results: The median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis - with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. Conclusions: SCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.

Estudio de traducción y validez del Sistema de Codificación Etológica para Entrevistas ECSI (Ethological Coding System for Interviews) / Study of the application and validation of the Ethological Coding System for Interviews (ECSI)

Antecedentes El diagnóstico psicoterapéutico se fundamenta en exploraciones verbales y/o pruebas psicológicas. En contraste, a menudo se descuida la relevancia de la comunicación no-verbal. El objetivo del presente artículo es aportar una herramienta para medir y evaluar conductas no-verbales en entrevistas clínicas, basado en el Ethological Coding System for Interviews (ECSI), desarrollado por Troisi (1999), el cual se tradujo y validó en español. Un etograma es un catálogo de conductas o patrones conductuales, operacionalizados y agrupados en categorías, como afiliación, evasión, asertividad, relajación, entre otras. Método Estudio 1. El etograma ECSI fue traducido al español. Tres observadores "ciegos" registraron las frecuencias de los patrones conductuales del paciente. Los registros se realizaron en intervalos de 15 segundos durante los primeros y últimos 10 minutos de la entrevista clínica. Se obtuvo una validez interobservador de r=0.989, p<0.001. Estudio 2. Con base en el primer estudio se consideró pertinente agregar patrones conductuales, así como reacomodar y redefinir las categorías propuestas. Los tres observadores realizaron el mismo procedimiento que en el estudio 1 con una segunda videograbación. Además de las frecuencias de las conductas observadas, se midió la duración de la conducta. Se obtuvo una validez interobservadores de r=0.993, p<0.001. Resultados y discusión Se probó que el ECSI es una herramienta confiable y válida para examinar la conducta no-verbal de pacientes durante entrevistas. Se espera que el ECSI se pueda incluir al proceso diagnóstico durante las sesiones psicoterapéuticas.

Background Psychotherapeutic diagnosis is largely based on verbal explorations and/or psychological tests. In contrast, the relevance of non-verbal communication is often disregarded. Here, we aim to provide a tool to measure and assess non-verbal behavior in clinical interviews, based on the Ethological Coding System for Interviews (ECSI), developed by Troisi (1999), which was translated and validated in Spanish. An ethogram is a catalogue of behaviours or patterns of behaviour, which are operationalized and grouped in categories such as affiliation, flight, assertiveness, relaxation and so forth. Method Study 1. The ECSI was translated into Spanish. Three "blind" observers registered the frequencies of the behavioral patterns of the patient. The recordings were made in 15 seconds intervals during the first and the last 10 minutes of a clinical interview. An inter-observer reliability of r=0.989, p<0.001 was obtained. Study 2. Based on the first study, it was considered pertinent to add behavioral patterns, as well as rearranging and redefining the proposed categories. The three "blind" observers performed the same task as in study 1 with a second video-recording. Aside from the frequency of the observed behaviours, the duration of the behavior was measured. An inter-observer reliability of r=0.993, p<0.001 was obtained. Results and discussion The ECSI has proven a reliable and valid tool for the examination of patients' nonverbal behaviour during interviews. It is hoped that the ECSI can be added to the diagnostic process during psychotherapeutic sessions.

Trastornos neuropsiquiátricos en estudiantes universitarios con bajo rendimiento académico de una universidad privada de Medellín / Neuropsychiatric disorders in a sample of university students with academic lower performance of a private Medellin University

El propósito de ésta investigación fue establecer la frecuencia de trastornos neuropsiquiátricos en estudiantes universitarios con bajo rendimiento académico de la Universidad San Buenaventura de la ciudad de Medellín (Colombia). De una población de 300 estudiantes se calculó una muestra aleatoria de 39 sujetos con problemas académicos de diferentes carreras, lo cual correspondió al 13 % de la población, para detectar trastornos cuya frecuencia fuera superior al 2%, con un nivel de confianza del 95% y un poder del 80%. Se utilizó una entrevista estructurada neuropsiquiátrica para adultos (MINI-Plus). Los trastornos que se presentaron con más frecuencia fueron depresión mayor (10.3%) y riesgo de suicidio (10.3%). El 61.5% de los estudiantes de la muestra no reunió criterios para ningún tipo de diagnóstico psiquiátrico.

The purpose of this research was to establish the frequency of neuropsychiatric disorders in college students with poor academic achievement of San Buenaventura University in Medellin- Colombia. From a population of 300 students, a random sample of 39 subjects with academic difficulties from different undergraduate programs which corresponds to 13% of the population was taken, in order to detect disorders with a frequency upper than 2%, a confidence level of 95 % and a power of 80 %. A neuropsychiatric structured interview for adults (Mini-PLUS) was used. 61.5% did not show any neuropsychiatric diagnosis; however, 10.3% presented major depression criteria, and 10.3% suicide risk.

Evento traumático, fibromialgia e complicações na saúde: um estudo de caso / Traumatic event, fibromyalgia and health complicationsa: a case study

Introdução: O presente artigo discorre sobre um caso clínico de uma paciente com os diagnósticos de fibromialgia e dor crônica, que procurou, voluntariamente, atendimento psicológico em um hospital de referência na cidade de São Paulo, para tratar de seu quadro doloroso e das consequências da história de abuso sexual ocorrido na infância. Objetivo: Assim, buscou-se investigar como um evento de vida traumático e mal elaborado pode implicar numa repetição de situações dolorosas, podendo estar associado à formação de sintomas corporais. Método: Foram realizadas dez entrevistas clínicas de orientação Psicanalítica, que duravam cerca de 50 minutos, durante um período de quatro meses. Resultados: As entrevistas foram um importante veículo para a exposição da angústia e conflitos da paciente, que associou os eventos de abuso sexual durante a infância ao surgimento e manutenção do quadro doloroso (fibromialgia e dor crônica). Além disso, observou-se a maneira como a paciente chegou até a analista, voluntariamente, o que apontou para um transbordamento de conteúdos que a estavam mobilizando naquele momento. Conclusões: Concluiu-se que o histórico de abuso sexual da paciente pôde gerar implicações na saúde e que ela ocupou durante a vida não somente o lugar de "abusada", mas também de "abusadora" de si mesma, nos momentos quando maltratou seu corpo, por meio da repetição de situações onde ela produziu, numa tentativa inconsciente de elaboração, satisfação pulsional. Foi também possível concluir que as entrevistas psicanalíticas, como método de investigação e tratamento psicanalítico, foram capazes de promover uma ressignificação do mundo interno da paciente e consequente mudança na posição subjetiva e na condição de saúde da mesma(AU)

Introduction: This article discusses a case of a patient with a diagnosis of fibromyalgia and chronic pain, which sought voluntarily psychological care in a referral hospital in the city of São Paulo, to treat their painful symptoms and consequences of history of sexual abuse in childhood. Objective: Thus, we sought to investigate as a traumatic life event and ill prepared can imply a repetition of painful situations, and may be associated with the formation of bodily symptoms. Method: Ten interviews were conducted clinics Psychoanalytic orientation, which lasted about 50 minutes over a period of four months. Results: The interviews were an important vehicle for the exposure of the patient's distress and conflict, which associated the events of sexual abuse during childhood to the emergence and maintenance of the pain (fibromyalgia and chronic pain). Furthermore, it was observed how the patient came to the analyst, voluntarily, which pointed to an overflow of content that were mobilizing at the time. Conclusions: We conclude that a history of sexual abuse of patients could generate implications for health and she held for life not only the place of "abused", but also "abuser" of herself at times when your body manhandled through the repetition of situations where she produced, in an unconscious attempt of elaboration, drive satisfaction. It was also possible to conclude that the psychoanalytic interviews as research method and psychoanalytic treatment were able to promote a redefinition of the internal world of the patient and the consequent change in subject position and the same health condition(AU)

Considerações preliminares à condução de uma avaliação psicológica / Preliminary considerations for conducting a psychological assessment / Consideraciones preliminares para la realización de una evaluación psicológica

Este texto examina algumas facetas da avaliação psicológica que requerem atenção antes do momento próprio da testagem com as técnicas específicas de exame psicológico no contexto clínico. Como um fenômeno complexo, a avaliação psicológica é o produto de vários fatores convergentes. Enquanto tal, o resultado da avaliação será influenciado pela demanda (explícita ou implícita), pela maneira em que é formulada, pela compreensão que o avaliador adquire dela e pelos objetivos que ele estabelece para a avaliação. Aspectos institucionais podem interferir e afetar o processo. O resultado será influenciado de maneira importante pelo significado que o sujeito atribui à avaliação, pelo seu contexto de vida e pela qualidade da relação entre avaliador e sujeito avaliado. Finalmente, o texto examina a influência de características pessoais do avaliador. Espera-se que o reconhecimento desses fatores possa levar a resultados mais satisfatórios, especialmente se forem tratados em supervisão durante a formação em avaliação psicológica.

This paper examines aspects of psychological assessment that require attention before the testing with specific psychological examination techniques in clinical settings. As a complex phenomenon, it is a product of several converging factors. As such, the assessment will be influenced by the demand (explicit or implicit), by its formulation, by the understanding the evaluator makes of it and by the objectives he sets for the evaluation. Institutional aspects can interfere and affect the process. The result will be significantly influenced by the meaning the subject gives to the assessment, by the context of one´s life and by the quality of one´s relationship with the evaluator. Finally, the influence of the evaluator’s personal characteristics is examined. It is expected that the recognition of these factors can lead to more satisfactory results, especially if highlighted in supervision during training in psychological assessment.

Este artículo examina aspectos de la evaluación psicológica que requieren atención antes del momento propio de las pruebas con técnicas específicas de evaluación psicológica en el ámbito clínico. Como un fenómeno complejo, ella es producto de varios factores convergentes y será influida por la demanda (explícita o implícita), por su formulación, por la comprensión que el evaluador hace de ella y por los objetivos que establece para la evaluación. Aspectos institucionales pueden interferir y afectar el proceso. El resultado se verá muy influenciado por el significado que el sujeto da a la evaluación, por el contexto de su vida y por la calidad de su relación con el evaluador. Por último, se examina la influencia de las características personales del evaluador. Se espera que el reconocimiento de estos factores pueda conducir a resultados más satisfactorios, sobre todo si son tratados en la supervisión durante el entrenamiento en evaluación psicológica.

Considerações preliminares à condução de uma avaliação psicológica / Preliminary considerations for conducting a psychological assessment / Consideraciones preliminares para la realización de una evaluación psicológica

Este texto examina algumas facetas da avaliação psicológica que requerem atenção antes do momento próprio da testagem com as técnicas específicas de exame psicológico no contexto clínico. Como um fenômeno complexo, a avaliação psicológica é o produto de vários fatores convergentes. Enquanto tal, o resultado da avaliação será influenciado pela demanda (explícita ou implícita), pela maneira em que é formulada, pela compreensão que o avaliador adquire dela e pelos objetivos que ele estabelece para a avaliação. Aspectos institucionais podem interferir e afetar o processo. O resultado será influenciado de maneira importante pelo significado que o sujeito atribui à avaliação, pelo seu contexto de vida e pela qualidade da relação entre avaliador e sujeito avaliado. Finalmente, o texto examina a influência de características pessoais do avaliador. Espera-se que o reconhecimento desses fatores possa levar a resultados mais satisfatórios, especialmente se forem tratados em supervisão durante a formação em avaliação psicológica.(AU)

This paper examines aspects of psychological assessment that require attention before the testing with specific psychological examination techniques in clinical settings. As a complex phenomenon, it is a product of several converging factors. As such, the assessment will be influenced by the demand (explicit or implicit), by its formulation, by the understanding the evaluator makes of it and by the objectives he sets for the evaluation. Institutional aspects can interfere and affect the process. The result will be significantly influenced by the meaning the subject gives to the assessment, by the context of one´s life and by the quality of one´s relationship with the evaluator. Finally, the influence of the evaluator’s personal characteristics is examined. It is expected that the recognition of these factors can lead to more satisfactory results, especially if highlighted in supervision during training in psychological assessment.(AU)

Este artículo examina aspectos de la evaluación psicológica que requieren atención antes del momento propio de las pruebas con técnicas específicas de evaluación psicológica en el ámbito clínico. Como un fenómeno complejo, ella es producto de varios factores convergentes y será influida por la demanda (explícita o implícita), por su formulación, por la comprensión que el evaluador hace de ella y por los objetivos que establece para la evaluación. Aspectos institucionales pueden interferir y afectar el proceso. El resultado se verá muy influenciado por el significado que el sujeto da a la evaluación, por el contexto de su vida y por la calidad de su relación con el evaluador. Por último, se examina la influencia de las características personales del evaluador. Se espera que el reconocimiento de estos factores pueda conducir a resultados más satisfactorios, sobre todo si son tratados en la supervisión durante el entrenamiento en evaluación psicológica.(AU)

Caracterização dos sintomas do transtorno de estresse pós-traumático (TEPT) em meninas vítimas de abuso sexual / Characterization of symptoms of posttraumatic stress disorder (PTSD) in girls victims of sexual abuse

O presente artigo descreve a presença de sintomas ou do diagnóstico do Transtorno do Estresse Pós-Traumático (TEPT) em meninas vítimas de abuso sexual. Além disso, buscou-se comparar o uso de dois instrumentos de avaliação diagnóstica do TEPT infantil em duas amostras clínicas. No Estudo I (n=40 meninas), os sintomas foram avaliados através de uma entrevista clínica, baseada no DSM-IV/SCID/TEPT. E no Estudo II (n=15 meninas), através da versão brasileira da K-SADS-PL/TEPT. Os resultados apontaram semelhanças na presença do diagnóstico de TEPT nas duas amostras, próxima a 70 por cento, apesar de os instrumentos indicarem diferenças específicas quanto à manifestação dos critérios C (evitação e entorpecimento) e critério D (excitabilidade aumentada). Pequenas diferenças na estrutura e na forma de aplicação dos instrumentos foram observadas. Conclui-se que ambos se aplicam à pesquisa e à avaliação clínica do TEPT infantil.

The present paper describes the presence of symptoms or diagnosis of Posttraumatic Stress Disorder (PTSD) in girls victims of sexual abuse, through two clinical interviews. Moreover, the use of two instruments of assessment of child PTSD diagnosis in two clinical samples has been compared. In Study I (n=40 girls) symptoms were assessed through clinical interview, based on DSM-IV/SCID/TEPT, and in Study II (n=15 girls) through the Brazilian version of K-SADS-PL/TEPT. The results pointed out similarities concerning the presence of PTSD diagnosis in both samples, around 70 percent, although instruments showed specific differences concerning the manifestation of criteria C (avoidance and numbing) and criteria D (excessive arousal). Small differences in the instruments' structure and application were observed. It has been concluded that both instruments can be applicable to research and to clinical assessment of child PTSD.

Caracterização dos sintomas do Transtorno de Estresse Pós-Traumático (TEPT) em meninas vítimas de abuso sexual / Characterization of symptoms of Posttraumatic Stress Disorder (PTSD) in girls victims of sexual abuse

O presente artigo descreve a presença de sintomas ou do diagnóstico do Transtorno do Estresse Pós-Traumático (TEPT) em meninas vítimas de abuso sexual. Além disso, buscou-se comparar o uso de dois instrumentos de avaliação diagnóstica do TEPT infantil em duas amostras clínicas. No Estudo I (n=40 meninas), os sintomas foram avaliados através de uma entrevista clínica, baseada no DSM-IV/SCID/TEPT. E no Estudo II (n=15 meninas), através da versão brasileira da K-SADS-PL/TEPT. Os resultados apontaram semelhanças na presença do diagnóstico de TEPT nas duas amostras, próxima a 70 por cento, apesar de os instrumentos indicarem diferenças específicas quanto à manifestação dos critérios C (evitação e entorpecimento) e critério D (excitabilidade aumentada). Pequenas diferenças na estrutura e na forma de aplicação dos instrumentos foram observadas. Conclui-se que ambos se aplicam à pesquisa e à avaliação clínica do TEPT infantil.(AU)

The present paper describes the presence of symptoms or diagnosis of Posttraumatic Stress Disorder (PTSD) in girls victims of sexual abuse, through two clinical interviews. Moreover, the use of two instruments of assessment of child PTSD diagnosis in two clinical samples has been compared. In Study I (n=40 girls) symptoms were assessed through clinical interview, based on DSM-IV/SCID/TEPT, and in Study II (n=15 girls) through the Brazilian version of K-SADS-PL/TEPT. The results pointed out similarities concerning the presence of PTSD diagnosis in both samples, around 70 percent, although instruments showed specific differences concerning the manifestation of criteria C (avoidance and numbing) and criteria D (excessive arousal). Small differences in the instruments' structure and application were observed. It has been concluded that both instruments can be applicable to research and to clinical assessment of child PTSD.(AU)

Reflexionando sobre la consulta médica: etnomecánica en medicina / Thinking about clinical interview: etnomechanics and medicine

Este artículo ofrece ejemplos de construcciones etnomecánicas para la explicación de la fisiopatogenia y la sintomatología de varias enfermedades comunes recogidas durante las consultas de un médico de familia. Discute la importancia del abordaje del conflicto transcultural, de la negociación de las diferencias y de la redefinición consensuada del problema con el objetivo de optimizar el funcionamiento de la relación médico-paciente.(AU)

Reflexionando sobre la consulta médica: etnomecánica en medicina / Thinking about clinical interview: etnomechanics and medicine

Este artículo ofrece ejemplos de construcciones etnomecánicas para la explicación de la fisiopatogenia y la sintomatología de varias enfermedades comunes recogidas durante las consultas de un médico de familia. Discute la importancia del abordaje del conflicto transcultural, de la negociación de las diferencias y de la redefinición consensuada del problema con el objetivo de optimizar el funcionamiento de la relación médico-paciente.

A Brazilian version of the Children's Interview for Psychiatric Syndromes (ChIPS) / A versão brasileira do Children's Interview for Psychiatric Syndromes (ChIPS)

OBJETIVE: The advance of research in child and adolescent psychiatry in Brazil heavily depends on the existence of instruments for the investigation of psychiatric syndromes adapted to Brazilian Portuguese. METHODS: This article describes a careful process of translation of the Children's Interview for Psychiatric Syndromes for the purpose of use in research in Brazil. The Children's Interview for Psychiatric Syndromes has a version for parents (P-ChIPs) and a version for children (ChIPS). In this article, the sections of P-ChIPS referring to attention-deficit hyperactivity disorder, oppositional-defiant disorder, conduct disorder, mania/hypomania, anorexia nervosa, bulimia nervosa and psychotic disorders were translated to Brazilian Portuguese. The sections of the ChIPS referring to substance use disorders, social anxiety disorder, specific phobias, obsessive-compulsive disorder, generalized anxiety disoder, separation anxiety disorder, post-traumatic disorders and depression/dysthimia were also adapted. Each section was translated by two independent translators and later discussed in a committee composed of experts in the field of Psychiatry and a professional of the field of linguistics. RESULT: A final version containing an interview for the main psychiatric syndromes was defined. CONCLUSION: The translated P-ChIPS is a helpful instrument in children and adolescent clinical evaluation.

OBJETIVO: O avanço em pesquisa em psiquiatria da infância e adolescência no Brasil depende da existência de instrumentos para a investigação de síndromes psiquiátricas adaptadas à Língua Portuguesa. Este artigo descreve um cuidadoso processo de tradução do Childrenïs Interview for Psychiatric Syndromes para o uso em pesquisa no Brasil. MÉTODOS: O Childrenïs Interview for Psychiatric Syndromes tem uma versão para pais (P-ChIPs) e uma versão para as crianças (ChIPs). Nesse artigo, as seções do P-ChIPs referentes ao transtorno do déficit de atenção, transtorno opositivo-desafiador, transtorno de conduta, mania/hipomania, anorexia nervosa, bulimia nervosa e transtorno psicótico foram traduzidas para a língua portuguesa. As seções do ChIPs referentes ao transtorno do uso de substâncias, ansiedade social, fobias específicas, transtorno obsessivo-compulsivo, transtorno de ansiedade generalizada, ansiedade de separação, estresse pós-traumático e depressão/distimia também foram adaptadas. Cada seção foi traduzida por dois tradutores independentes e depois discutida em um comitê composto por especialistas na área de psiquiatria e linguística. RESULTADO: A versão final, abrangendo as síndromes psiquiátricas, foi definida. CONCLUSÃO: O P-ChIPS traduzido é um instrumento que pode ser utilizado na avaliação de crianças e adolescentes.

Entrevista clínica com crianças e adolescentes vítimas de abuso sexual / Clinic interview with children and adolescents sexually abused

O abuso sexual contra crianças e adolescentes é atualmente um problema de saúde pública. A complexidade do fenômeno requer a capacitação dos profissionais que atuam na avaliação e intervenção clínica das vítimas. O presente artigo tem como objetivo fornecer subsídios teóricos e práticos sobre a entrevista clínica com crianças e adolescentes vítimas de abuso sexual, visando à obtenção do relato sobre a experiência abusiva. Aspectos como as possíveis conseqüências do abuso sexual, o setting da entrevista, a postura dos entrevistadores e as características da revelação pela criança estão apresentadas, bem como um roteiro de entrevista.

The sexual abuse against children and adolescents is an actual public health concern. The complexity of phenomenon requires special training of professionals who work in the clinic evaluation of victims and intervention. This study aims to provide theoretical and practical information about the clinic interview with victims of child sexual abuse, aiming at the attainment of the abusive experience report. An interview protocol is presented and the aspects discussed include: sexual abuse potential outcomes, the interview setting, the professional attitude, and children's disclosure.