Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

Psychometric properties of the BALCI Turkish version

The present study aimed to adapt and validate the Beliefs About Losing Control Inventory (BALCI) in the non-clinical Turkish emerging adults sample. The study group consisted of 549 participants from three study phases and aged between 18 and 28 years and mainly women. According to the results of the confirmatory factor analysis (CFA), the BALCI Turkish Version (BALCI-TV) confirmed 21 items in three factors. The network analysis findings showed that the items including the factors were together. The results indicated that configural, metric, scalar, and strict invariance across the gender. Cronbach's α and McDonald's ω of the total BALCI-TV were .90. Test-retest correlation result was .89. All results indicated that the BALCI-TV had good psychometric properties. The BALCI-TV can be provided to measure control and beliefs related to control within obsessive-compulsive disorder for Turkish academics and mental health practitioners.

Prevenção do suicídio: esquecimento do ser e era da técnica / Suicide prevention: forgetfulness of being and technical era / Prevención del suicidio: olvido del ser y la era de la técnica

Martin Heidegger, em sua ontologia, destaca uma característica específica da atualidade que atravessa o comportamento humano, na filosofia, na ciência ou no senso comum: o esquecimento do ser. O filósofo diferencia a época atual das demais épocas históricas. O horizonte histórico contemporâneo se desvela por meio do desafio e da exploração, da tentativa de controle e domínio dos acontecimentos, ao modo da disponibilidade e em função da produtividade. O filósofo esclarece que todo esse desenraizamento do homem atual está atrelado ao esquecimento daquilo que é o mais essencial, qual seja, a existência. A questão que norteia este estudo é apurar, por meio das referências de Heidegger e dos estudos sobre suicídio, o quanto a interpretação da morte voluntária nos dias atuais está atravessada por tal esquecimento. Pretendemos investigar o quanto as ações de prevenção desenvolvidas pela suicidologia se encontram atravessadas por tal esquecimento do ser do homem e, dessa forma, acabam por estabelecer relações entre ser e ente em uma consequente redução ao ente como invariante e atemporal. O caminho para investigar a questão iniciará por abordar, em maiores detalhes, a analítica existencial, a questão da técnica e o movimento de esquecimento do ser apontados por Heidegger a fim de problematizar as perspectivas científicas atuais sobre o suicídio em sua prevenção para, então, estabelecer uma compreensão fenomenológica e existencial sobre o referido fenômeno.(AU)

Martin Heidegger, in his ontology, highlights a specific characteristic of the present moment that crosses human behavior, in philosophy, science, or common sense: the forgetfulness of being. The philosopher differentiates the current age from other historical ages. The contemporary historical horizon is unveiled by the challenge and the exploration, from the attempt to control and dominate events, to the mode of standing reserve and in terms of productivity. The philosopher clarifies that all this uprooting of the current man is linked to the forgetfulness of what is the most essential, namely, the existence itself. The question that guides this study is to investigate, via Heidegger's references and studies on suicide, to what extent the interpretation of voluntary death today is crossed by such forgetfulness. We intend to investigate to what extent the prevention actions developed by suicidology are crossed by such forgetfulness of the human's being and, in this way, they end up establishing relationships between being and entity in a consequent reduction to entity as an invariant and timeless. The path to investigate the issue will start by addressing, in greater detail, the existential analytics, the question concerning technique and the movement of forgetting the being pointed out by Heidegger to problematize the current scientific perspectives on suicide and its prevention to, then, propose a phenomenological and existential understanding about the referred phenomenon.(AU)

Martin Heidegger en su ontología destaca una característica específica del presente que atraviesa el comportamiento humano, ya sea en la filosofía, la ciencia o el sentido común: el olvido del ser. El filósofo diferencia la época actual de otras épocas históricas. El horizonte histórico contemporáneo se devela el desafío y la exploración, el intento de controlar y dominar los eventos, en la modalidad de disponibilidad y en términos de productividad. Y así aclara que todo este desarraigo del hombre actual está involucrado en el olvido de lo más esencial, que es la existencia misma. A partir de las referencias a Heidegger y de los estudios sobre el suicidio, este estudio busca saber hasta qué punto la interpretación de la muerte voluntaria hoy está atravesada por este olvido. Pretendemos investigar en qué medida las acciones de prevención desarrolladas por la suicidología se encuentran atravesadas por el olvido del ser del hombre y, de esta manera, terminan por establecer relaciones entre el ser y el ente, en una consecuente reducción al ente como invariante y atemporal. Para investigar el tema se abordará inicialmente, con mayor detalle, la analítica existencial, la cuestión de la técnica y el movimiento del olvido del ser señalado por Heidegger para problematizar las perspectivas científicas actuales sobre el suicidio y su prevención y, luego, proponer una comprensión fenomenológica y existencial sobre el referido fenómeno.(AU)

Transtorno Obsessivo-Compulsivo: Relato de um Caso Atípico / Obsessive Compulsive Disorder: Report of an Atypical Case

A Terapia Cognitivo-Comportamental (TCC) é uma ferramenta indispensável durante o processo terapêutico de pacientes que se enquadram no Transtorno Obsessivo-Compulsivo (TOC). O presente artigo teve como objetivo principal relatar que, mesmo em um caso grave deste transtorno, através da TCC associada à psicofarmacologia, foi possível diminuir os sintomas obsessivo-compulsivos. Este caso retrata um processo diagnóstico de TOC de um paciente de 59 anos, cujos sintomas se iniciaram na infância e foram tratados somente com ênfase em um tipo medicamentoso (Clomipramina, 300 mg/dia), causando persistência dos sintomas. Os comportamentos-alvo selecionados (todos sendo parte do espectro obsessivo-compulsivo), analisados funcionalmente e com intervenções bem descritas propunham diminuir a apresentação dos sintomas, entretanto, sem a pretensão de suprimi-los completamente. Este estudo de caso permitiu verificar uma melhora significativa nos comportamentos-problema apresentados inicialmente pelo paciente e, assim, constatar a efetividade da terapia cognitivo-comportamental associada à psicofarmacologia e da escolha das intervenções, com base na aplicação da escala Yale-Brown Obsessive-Compulsive (Y-BOCS) durante o período de 20 semanas, com a diminuição de quase 50% dos sintomas na percepção dos pacientes.

Cognitive Behavioral Therapy (CBT) is an indispensable tool during the therapeutic process of patients who fall into Obsessive Compulsive Disorder (OCD). The main objective was to report that, even in a severe case of this disorder, through CBT associated with psychopharmacology, it was possible to decrease the obsessive-compulsive symptoms. This case portrays a diagnostic process of OCD of a 59-year-old patient whose symptoms started in childhood and were treated only with an emphasis on one type of medication (Clomipramine, 300 mg/day), causing the persistence of symptoms. The selected target behaviors (all being part of the obsessive-compulsive spectrum) were functionally analyzed and with well-described interventions proposed to decrease the presentation of symptoms, however, without the pretension of completely suppressing them. This case study allowed us to verify a significant improvement in the problem behaviors initially presented by the client and, thus, to verify the effectiveness of the cognitive behavioral therapy associated with psychopharmacology and the choice of interventions, based on the application of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) during 20 weeks, with a decrease of almost 50% of the symptoms in the patient's perception.

Análisis de la correlación del trastorno obsesivo-compulsivo con la ansiedad de estudiantes universitarios de medicina / Analysis of the correlation between obsessive-compulsive disorder and anxiety in university medical students

INTRODUCCION: en América Latina y el Caribe, tanto los trastornos de ansiedad como el Trastorno ObsesivoCompulsivo (TOC) se ocupan como algunos de los trastornos mentales más comunes. En Paraguay se ha estudiado a ambos trastornos de manera individual, más no así en correlación. OBJETIVO: determinar la correlación de las dimensiones del trastorno obsesivo-compulsivo con los factores de ansiedad de estudiantes universitarios de medicina de la Universidad Nacional de Asunción en el año 2019. MATERIAL Y MÉTODO: estudio cuantitativo, diseño correlacional - descriptivo, muestreo no probabilístico por conveniencia en cadena, desde abril hasta mayo del 2019, en la Facultad de Ciencias Médicas (sede Sajonia). Universo conformado por N=450 estudiantes y muestra necesaria de n=201. Se aplicó el Inventario Obsesivo Compulsivo -Revisado (OCI-R) y el Inventario De Ansiedad Estado -Rasgo (STAIC). RESULTADOS: se analizaron 208 encuestas,. donde se pudo determinar una Edad media de 20,875±1,76 años; la mayoría de los encuestados corresponden al sexo femenino. Se encontró una correlación (r=0,431) significativa (p<0,05) entre el TOC y ansiedad de estudiantes de medicina. CONCLUSIÓN: en la presente investigación se determinó una correlación positiva para las dimensiones del trastorno obsesivo-compulsivo y los factores de la ansiedad; se indica que el aumento cuantitativo en el puntaje de dichas dimensiones se acompaña con un aumento en los factores de la ansiedad.

BACKGROUND: in Latin America and the Caribbean, both anxiety disorders and Obsessive-Compulsive Disorder (OCD) are among the most common mental disorders. In Paraguay, both disorders have been studied, but not in correlation. OBJECTIVE: to determine the correlation of the dimensions of obsessive-compulsive disorder with anxiety factors in undergraduate medical students of the National University of Asuncion in 2019. METHODS: quantitative study, correlational-descriptive design, non-probabilistic chain convenience sampling, from April to May 2019, at the Faculty of Medical Sciences (Saxony campus). Universe made up of N=450 students and necessary sample of n=201. The Obsessive Compulsive Inventory-Revised (OCI-R) and the StateTrait Anxiety Inventory (STAIC) were applied. RESULTS: 208 surveys were analyzed. Mean age was 20.875±1.76 years. The majority of respondents were female. A significant correlation (r=0.431) (p<0.05) was found between OCD and Anxiety in medical students. CONCLUSION: in the present investigation a positive correlation was determined for the dimensions of obsessive-compulsive disorder and anxiety factors; it is indicated that the quantitative increase in the score of these dimensions is accompanied by an increase in anxiety factors.

Psychological well-being in patients undergoing stem cell transplantation

The aim of the study is to determine the psychological well-being of patients who underwent stem cell transplantation. This cross-sectional study was conducted with 100 patients. Data were collected face-to-face using an introductory information form and the Brief Symptom Inventory.When the results of the patients were examined, the interpersonal sensitivity of the sub-dimensions of the scale was found to be 5.0 ± 4.06, depression 7.60 ± 5.37, and anxiety disorder 7.90 ± 5.34. There was a significant difference between the diagnosistime of the patients and all sub-factors of the scale, except phobic anxiety. It was found that the psychological state of the patients was directly related to the time of first diagnosis. As a result, the importance of following the psychological processof the patients during the treatment process was revealed when planning nursing care.

Revisão de escopo das publicações sobre transtorno obsessivo-compulsivo (TOC) e a pandemia de Covid-19 entre 2020 e 2022 / Scope review of the publications on obsessive compulsive disorder (TOC) and pandemic between 2020 and 2022

A proposta desta dissertação foi realizar uma revisão de escopo de 96 artigos científicos que analisaram a relação do quadro psicopatológico do Transtorno Obsessivo-Compulsivo (TOC) no contexto da pandemia de Covid-19, disponíveis em revistas indexadas. Tais publicações utilizadas neste mapeamento foram retiradas das bases de dados PubMed, PsyInfo e da biblioteca virtual Scielo. Elas são referentes ao período entre 2020 até março de 2022. A busca e filtragem deste material foi orientada pela metodologia da revisão de escopo. A análise destes artigos indicou a presença de dois objetivos nas pesquisas indicadas: a discussão da trajetória de evolução dos quadros de TOC e a terapêutica do TOC na pandemia. No capítulo a respeito dos quadros clínicos, a análise dos dados foi organizada a partir dos grupos populacionais estudados pelos autores (adultos, profissionais de saúde, gestantes e puérperas e crianças e adolescentes). A partir da divisão em grupos populacionais, as publicações foram agrupadas tendo em vista suas metodologias para o exame de seu desenvolvimento e achados. No capítulo sobre a terapêutica do TOC na Covid-19, os achados foram organizados por metodologias para seu exame. Os dados destes estudos mostraram que a maior parte dos autores se dedicaram a analisar o público adulto ou não especificaram objetivamente a idade das pessoas que avaliaram. Os profissionais de saúde foram a população menos contemplada por esta temática dentro das populações sobre as quais os artigos versaram. Os artigos sobre grávidas e puérperas buscaram discutir a influência das condições de vida para a saúde mental e o TOC destas pessoas, o que destoa das outras pesquisas nesta revisão de escopo. O impacto da pandemia, a explicação deste impacto para indivíduos com TOC, a influência das informações midiáticas sobre a Covid-19 e do grupo familiar sobre pessoas com TOC foram questões contempladas pelos autores mencionados neste capítulo. Os artigos sobre a terapêutica do transtorno em questão na Covid-19 discutiram as limitações originárias da crise sanitária para o tratamento do TOC, e exemplificaram ferramentas tecnológicas que podem ser utilizadas no tratamento das pessoas em questão. Alguns também buscaram traçar perfil de vulnerabilidade para o TOC na pandemia com a majoritariedade dos resultados apontando para a vulnerabilidade feminina. O tratamento da população composta por crianças e adolescentes com o transtorno foi pouco foi contemplado pelos pesquisadores nesta seção. Os determinantes sociais de saúde relacionadas ao gênero feminino, indicado como mais vulnerável ao TOC nos dois capítulos acima mencionados foram discutidos em uma seção própria. Nesta seção, dados de estudos sobre as condições de vida na pandemia da população feminina no Brasil e na América Latina foram utilizados para ilustrar a vulnerabilidade desta população.

The proposition of this dissertation was to make a scope review of 96 scientific articles that analyzed the relation of the psychopathological board of obssessive compulsive disorder (OCD) in the context of covid-19 pandemics, available in indexed magazines. Such publications utilized in this mapping were taken from the databases PubMed, PsyInfo and from the Scielo virtual library. They refer to the year of 2020 up to March 2022. The research and filtering of this material were oriented by the scope review methodology. The analysis of these articles pointed to the presence of two objectives in the referred researches: the discussion about the evolutionary trajectory of OCD cases and the therapeutics of OCD in the pandemic. In the chapter about the clinical cases, the data analysis was organized by the populational groups studied by the authors (adults, health professionals, pregnant and puerperal women, children and adolescents). By dividing the populational groups, the publications were arranged considering their methodologies for examining the developments and findings. In the chapter about the therapeutics of OCD during Covid-19, the findings were organised by the methodologies for their examination. The data from these studies show that the majority of authors have either dedicated themselves to analyze the adult public or didn´t speciffy objectively the age of the population evaluated. Health professionals were the population less considered by this thematics. The articles about pregnant and puerperal women focused on discussing the influence of the living conditions to mental health and the OCD of these people, wich differs from the other researches in this scope review. The impact of the pandemic, the explanation of this impact to individuals with OCD, the influence of media informations about Covid-19 and the family group about people with OCD were points contemplated by the authors mentioned in this chapter. The articles about the therapeutics of the disorder in question, during Covid-19, argued about the limitations that came from the sanitary crisis for the treatment of OCD, and exemplified technological tools that can be used on the treatment of such people. Some also tried to trace the profile of vulnerability to OCD in the pandemic, with the majority of the results pointing to female vulnerability. The treatment of the population composed by children and adolescents with the disorder was mentioned little by the researches in this section. The social determiners of health related to the female gender, pointed as the most vulnerable to OCD in the two chapters mentioned before, were discussed in a chapter of their own. In this chapter, data from studies about the life conditions, in the pandemic, of the feminine population in Brazil and Latin America were used to illustrate the vulnerability of this population.

Thermocoagulation as a Surgical Approach for the Treatment of Obsessive-Compulsive Disorder in Refractory Patients: Systematic Review

Obsessive-compulsive disorder (OCD), a disabling chronic neuropsychiatric disease, entails high economic costs to society and has high morbidity and mortality rates. The first-line treatments for OCD are selective serotonin reuptake inhibitors and cognitivebehavioral therapy. However, this disorder has the highest refractory index to noninvasive treatment. Alternatively, ablative thermocoagulation neurosurgical techniques have shown efficacy and few adverse effects. The present systematic review aimed to identify validated protocols to observe the effectiveness of ablative procedures in the treatment of severe and refractory OCD, as well as their possible adverse effects and benefits. This review supports the effectiveness of ablative methods by presenting them as a safe non-experimental therapeutic option for cases of highlyrefractory OCD. Additional relevant findings were the improvement in cognitive function, functional capacity, affective orientation, and quality of life, which contribute to the destigmatization of this surgical technique. Further controlled studies may lead to the individualization of recommendations of targets for ablative thermocoagulation.

Efectividad de la terapia cognitivo conductual para trastorno obsesivo compulsivo en pacientes con trastorno del espectro autista: Artículo de revisión / Effectiveness of cognitive behavioral therapy for obsessive compulsive disorder in patients with autism spectrum disorde: Review article

La terapia cognitivo conductual (TCC), es el tratamiento de elección para el trastorno obsesivo compulsivo (TOC), principalmente la exposición con prevención de respuesta (EPR). En pacientes que presentan TOC co-ocurrente con trastorno del espectro autista (TEA) se cree que la TCC tendría un menor efecto debido al empobrecimiento de la comprensión de las propias emociones y de la rigidez cognitiva de estos pacientes. A través de la siguiente revisión se busca evaluar la efectividad de la TCC en pacientes que tengan TOC en asociación a TEA en niños, adolescentes y adultos. Métodos: Se realizó una búsqueda de artículos, de los últimos 10 años, que abordasen la efectividad de la TCC en niños, adolescentes o adultos con TOC y TEA en conjunto. Resultados: A pesar de que no todos los estudios concuerdan en sus resultados, la mayoría de éstos, indican que hay efectividad en la TCC en disminuir la sintomatología del TOC en pacientes con TEA co-ocurrente tanto en niños como en adolescentes y adultos. Existen terapias de TCC con ciertas adaptaciones que mejorarían los resultados de estos pacientes al personalizar su tratamiento, por lo que se incentiva al mayor desarrollo de este tipo de terapias. Conclusión: Los estudios revisados respaldan que a pesar de la rigidez que presentan los pacientes con TEA co-ocurrente, la TCC es efectiva para tratar TOC en niños, adolescentes y adultos, especialmente al realizar adaptaciones de esta.

The treatment of choice for obsessive compulsive disorder (OCD) is cognitive behavioral therapy (CBT), mainly exposure with response prevention (ERP). In patients with OCD co-occurring with autism spectrum disorder (ASD), it is believed that CBT should have a lesser effect due to the impoverishment of the understanding of their own emotions and the cognitive rigidity of these patients. The following review seeks to evaluate the effectiveness of CBT in patients who have OCD in association with ASD in children, adolescents and adults. Methods: A search was carried out for articles, from the last 10 years, that addressed the effectiveness of CBT in children, adolescents or adults with OCD and ASD together. Results: Although not all studies agree on their results, most of these indicate that CBT is effective in reducing OCD symptoms in patients with co-occurring ASD in children, adolescents and adults. There are CBT therapies with certain adaptations that would improve the results of these patients by personalizing their treatment, which is why the further development of this type of therapy is encouraged. Conclusion: The reviewed studies support that despite the rigidity that patients with co-occurring ASD present, CBT is effective to treat OCD in children, adolescents and adults, especially when making adaptations to it.

Obsessive-compulsive disorder reinforcement during the COVID-19 pandemic

Abstract The COVID-19 pandemic is unquestionably impacting on the mental health of the population worldwide. Fear of contamination can both increase levels of stress in healthy individuals and intensify psychiatric symptoms in patients with pre-existing conditions, especially obsessive-compulsive disorder (OCD). During the COVID-19 pandemic, the imminent risk of contamination creates a logical need for self-surveillance and hygiene habits. However, this kind of information can have drastic implications for subjects with OCD, since cognitive distortions and compensatory strategies (cleansing rituals) are no longer irrational or oversized - rather, these ideas become legitimate and socially accepted, generating plausible validation for the intensification of compulsive cleaning rituals. Patients who presented remission of OCD symptoms would be more likely to have a relapse, and subclinical patients may scale up and ultimately be diagnosed with OCD due to the reinforcement of their habits, emotions and thoughts.

Alterações cognitivas e transtorno obsessivo-compulsivo em mulheres jovens no sul do Brasil: um estudo de coorte / Cognitive disorders and obsessive-compulsive disorder in young women in southern Brazil: a cohort study

RESUMO Introdução: O Transtorno Obsessivo-Compulsivo (TOC) tem sido associado ao comprometimento da função cognitiva. No entanto, a relação entre o TOC e o desempenho cognitivo de mulheres jovens no ciclo gravídico-puerperal ainda não está bem esclarecida. Este estudo teve como objetivo investigar a associação entre desempenho cognitivo e a presença de TOC em mulheres jovens no período perinatal e 30 meses após o parto. Método: Foi realizado um estudo de coorte com 435 mulheres, recrutadas em 47 unidades de atenção básica e 3 clínicas obstétricas públicas de uma cidade do sul do Brasil. O TOC foi identificado por meio da Entrevista Neuropsiquiátrica Internacional (MINI PLUS) e o desempenho cognitivo foi examinado por meio da Avaliação Cognitiva de Montreal (MoCA). Um modelo de regressão linear múltipla foi utilizado para verificar a relação entre o TOC e o desempenho cognitivo. Resultados: Nossos resultados mostraram que as mulheres diagnosticadas com TOC apresentaram pior desempenho cognitivo no escore total do MoCA (ß = -0,25 p<0,05) e no domínio da memória de curto prazo (ß = -0,27 p=0,02). Conclusões: O TOC esteve associado aos escores do MoCA aos 30 meses após o parto. A manutenção do TOC por períodos mais longos foi associada a maiores alterações de memória nessas mulheres. Alterações globais aparecem quando o TOC ocorre no momento presente, o que poderá trazer prejuízos na relação díade mãe-bebê. PALAVRAS-CHAVE: Transtorno obsessivo-compulsivo, função cognitiva, perinatal, mulheres, memória

ABSTRACT Introduction: Obsessive-Compulsive Disorder (OCD) has been associated with impaired cognitive function. However, the relationship between OCD and cognitive performance of young women in the pregnancy-puerperal cycle is still not well understood. This study aimed to investigate the association between cognitive performance and the presence of OCD in young women in the perinatal period and 30 months after delivery. Method: A cohort study was carried out with 435 women, recruited from 47 primary care units and 3 public obstetric clinics in a city in southern Brazil. OCD was identified through the International Neuropsychiatric Interview (MINI PLUS) and cognitive performance was examined through the Montreal Cognitive Assessment (MoCA). A multiple linear regression model was used to determine the relationship between OCD and cognitive performance. Results: Our results showed that women diagnosed with OCD had worse cognitive performance in the total MoCA score (ß = -0.25 p<0.05) and in the short-term memory domain (ß = -0.27 p=0.02). Conclusions: OCD was associated with MoCA scores at 30 months after delivery. The maintenance of OCD for longer periods was associated with greater memory changes in these women. Global changes appear when OCD occurs in the present moment, which can harm the mother-infant dyad. Keywords: Obsessive-compulsive disorder, cognitive function, perinatal, women, memory

Association of insight, avoidance behavior, indecisiveness, and inflated responsibility with other clinical characteristics in children and adolescents with obsessive-compulsive disorder

Objectives: Although the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) includes ancillary symptom dimensions - insight, avoidance, degree of indecisiveness, inflated sense of responsibility, pervasive slowness/disturbance of inertia, and pathological doubting -, we know little about their clinical/scientific utility. We examined these ancillary dimensions in childhood obsessive-compulsive disorder (OCD), and tested their associations with clinical characteristics. Methods: Treatment-seeking children and adolescents (n=173) with a DSM-5 OCD diagnosis were recruited from six centers in India and evaluated with a semi-structured proforma for sociodemographic/clinical details, the Structured Clinical Interview for DSM-5, the CY-BOCS, the Children's Depression Rating Scale, and the Family Interview for Genetic Studies. Regression analysis was used to study the associations between ancillary dimensions (independent variables) and clinical variables (dependent variables). Results: 87.9% of the sample reported at least a mild-moderate severity of ancillary dimensions, which were highly intercorrelated. Multiple ancillary dimensions were correlated with illness severity on the CY-BOCS. On regression analysis, only insight and avoidance retained significance. There were few differential associations between OCD symptom and ancillary dimensions. Conclusion: Ancillary dimensions are more a feature of illness severity than differentially associated with individual symptom dimensions in childhood OCD. Insight and avoidance should be considered for inclusion in the assessment of illness severity in childhood OCD.

Nivel de ansiedad según el tipo de desayuno en escolares durante el estado de alarma por la COVID-19 en España / Anxiety level and breakfast type in schoolchildren during the COVID-19 state of alarm in Spain

Introducción: El desayuno suscita un considerable interés científico como posible parámetro relacionado con el estilo de vida. Objetivo: Analizar los niveles de ansiedad según el tipo de desayuno en escolares de Educación Primaria durante el estado de alarma decretado en España a causa de la COVID-19. Métodos: Estudio transversal compuesto por 116 escolares de la Isla de Fuerteventura. Se valoró la ansiedad a través del cuestionario Spence Children Anxiety Scale (SCAS). Los ítems referidos al desayuno fueron extraídos del test de Adhesión a la Dieta Mediterránea KIDMED. Las pruebas estadísticas utilizadas fueron el análisis de varianza simple (one way ANOVA) y la prueba de regresión logística multivariante. Resultados: La ingesta de un cereal se asocia con una menor probabilidad de desarrollar ataques de pánico y agorafobia (OR = 1,14, p < 0,01), fobia social (OR = 0,71, p < 0,05), trastorno obsesivo-compulsivo (OR = 1,22, p < 0,05) e índice ansiedad global (OR = 1,05, p < 0,05). Asimismo, no desayunar bollería habitualmente se asoció con una menor probabilidad de desarrollar un trastorno obsesivo-compulsivo (OR = 1,13; p < 0,05). Conclusiones: Una calidad del desayuno óptima, como consumir cereales saludables y no consumir bollería industrial, se asocia con menores niveles de ansiedad en escolares de Educación Primaria durante el estado de alarma decretado en España a causa de la COVID-19(AU)

Introduction: Breakfast arouses considerable scientific interest as a potential lifestyle parameter. Objective: Analyze the relationship between anxiety levels and breakfast type in schoolchildren. Methods: A cross-sectional study was conducted of 116 schoolchildren from the Isle of Fuerteventura. Anxiety was evaluated with the Spence Children Anxiety Scale (SCAS) questionnaire. Items about breakfast were taken from the KIDMED Test of Adherence to the Mediterranean Diet. Statistical processing was based on one way ANOVA and the multivariate logistic regression test. Results: Intake of a cereal is associated to a lesser probability of developing agoraphobia and panic attacks (OR = 1.14, p < 0.01), social phobia (OR = 0.71, p < 0.05), obsessive-compulsive disorder (OR = 1.22, p < 0.05) and overall anxiety index (OR = 1.05, p < 0.05). On the other hand, not having pastry for breakfast habitually was associated to a lesser probability of developing obsessive-compulsive disorder (OR = 1.13; p < 0.05). Conclusions: Optimum breakfast quality, such as eating healthy cereals and not eating industrial pastries, is associated to lower levels of anxiety in schoolchildren during the state of alarm decreed in Spain due to the COVID-19 pandemic(AU)

Ocorrência de sintomas de transtorno de ansiedade generalizada (TAG) e transtorno obsessivo-compulsivo (TOC) em estudantes de 11 a 18 anos de uma escola pública de Salvador / Occurrence of generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) in students aged 11 to 18 years from a public school in Salvador

Introdução: o objetivo deste estudo é descrever a ocorrência de sintomas de TAG e TOC em adolescentes, com idade entre 11 e 18 anos, procedentes de escola pública da cidade do Salvador. Metodologia: estudo observacional e transversal, com 674 adolescentes de uma escola pública, que responderam a uma escala para avaliação de sintomas de TAG e TOC, aplicada entre o período de março e dezembro de 2015. Resultados: os escores da RCADS para TAG e TOC foram, em média, superiores aos pontos de corte estabelecidos pela escala, sugerindo aumento da presença desses sintomas na população estudada, com prevalência maior entre as alunas nos ois grupos de sintomas estudados. Conclusão: os dados apontam para a presença de sintomas de ansiedade generalizada e de TOC entre escolares, sugerindo uma maior necessidade de estudos para a compreensão do papel desses sintomas na qualidade de vida dessa população, como também sua importância como fatores de risco para o adoecimento mental. Medidas de prevenção devem direcionar os esforços para estudos metodologicamente mais robustos na área.

Introduction: the aim of this study is to describe the occurrence of symptoms of GAD and OCD in adolescents, aged between 11 to 18 years old, from a public school in the city of Salvador. Methodology: observational and cross-sectional study with 674 adolescents from a public school, who responded to a scale for assessing symptoms of GAD and OCD applied from March to December 2015. Results: the RCADS scores for GAD and OCD were on average higher than the cutoff points established by the scale, suggesting an increased presence of these symptoms in the studied population, with a higher prevalence among girls in the two groups of symptoms studied. Conclusion: data point to the presence of symptoms of generalized anxiety and OCD among schoolchildren, suggesting a greater need for studies to understand the role of these symptoms in the quality of life of this population, as well as their importance as risk factors for mental illness. Prevention measures should direct efforts towards more methodologically robust studies in the area.

Cribado de trastornos psiquiátricos y patrones de consumo de sustancias en estudiantes de Medicina / Screening for psychiatric disorders and patterns of substance use in Medicine students

Existen varios trastornos mentales que se relacionan con el consumo del alcohol y otras drogas, cierto número de personas desarrollan un patrón evolutivo al abuso, sea este persistente o esporádico, produce perturbaciones o limitaciones clínicamente significativas con variadas manifestaciones en el hogar, la escuela y el trabajo. Se determinó la frecuencia y asociación entre trastornos psiquiátricos, patrones de consumo de sustancias y variables sociodemográficas en estudiantes de medicina de la Universidad Nacional de Asunción. El diseño de estudio fue observacional, analítico, corte transversal, La población estuvo constituida por 626 estudiantes de la carrera de medicina del primero al quinto curso, que fueron seleccionados por un muestreo no probabilístico por conveniencia. Se aplicaron 3 cuestionarios que abarcaban tres aspectos: datos sociodemográficos, abuso de drogas y diagnóstico psiquiátrico. Los datos fueron analizados mediante GNU Perfect Statistics Professionally Presented y Epi Info. Se concluyó que el trastorno más frecuente fue el Trastorno por Abuso de drogas, seguido del Trastorno Obsesivo-Compulsivo y el Trastorno Depresivo Mayor. La sustancia más consumida fue el alcohol, seguido del tabaco y la marihuana. Esta última fue la única que se asoció con todas las sustancias. El consumo de alcohol presentó asociación con TOC, Fobia Social y Ansiedad; los consumidores de benzodiacepinas presentaron mayor riesgo de Trastorno Depresivo, Trastorno por Estrés Postraumático, Bulimia, Pánico, Agorafobia, Ansiedad y Trastorno de Somatización. Se recomienda la implementación de políticas de educación preventiva, así como estudios prospectivos para evaluar relaciones de causalidad en las asociaciones encontradas.

There are several mental disorders that are related to the consumption of alcohol and other drugs, a number of people develop an evolutionary pattern of abuse, whether it is persistent or sporadic, it produces clinically significant disturbances or limitations with various manifestations at home, school and the job. The frequency and association between psychiatric disorders, patterns of substance use and socio-demographic variables in medical students of the National University of Asunción was determined. The study design was observational, analytical, cross-sectional. The population consisted of 626 medical students from the first to the fifth year, who were selected by a non-probabilistic convenience sampling. 3 questionnaires were applied that covered three aspects: sociodemographic data, drug abuse and psychiatric diagnosis. The data was analyzed using GNU Perfect Statistics Professionally Presented and Epi Info. It was concluded that the most frequent disorder was Drug Abuse Disorder, followed by Obsessive-Compulsive Disorder and Major Depressive Disorder. The most used substance was alcohol, followed by tobacco and marijuana. The latter was the only one that was associated with all substances. Alcohol consumption was associated with OCD, Social Phobia and Anxiety; Benzodiazepine users had a higher risk of Depressive Disorder, Post-Traumatic Stress Disorder, Bulimia, Panic, Agoraphobia, Anxiety and Somatization Disorder. The implementation of preventive education policies is recommended, as well as prospective studies to evaluate causal relationships in the associations found.

Pierre Janet: La Perdida De La Función De Lo Real En El Trastorno Obsesivo-Compulsivo, Psicosis Y Trauma / Pierre Janet And The Loss Of Reality Function In Obsessive Compulsive Disorder, Psychosis And Trauma

Resumen En el presente reporte se destaca la importancia de explicar y conocer los orígenes del concepto de "Función de lo real" en la perspectiva de Janet. Esto, dadas sus aplicaciones actuales en el estudio del trastorno obsesivo compulsivo, las psicosis, el trastorno por estrés postraumático y los síntomas disociativos. Se define la "Función de lo real" como la aprehensión de la realidad en todas sus formas, por percepción y acción, que modifica todas las demás operaciones psicológicas. Es entonces el resultados de tres operaciones psicológicas principales, que se encuentran dentro de una jerarquía de funciones organizadas y unidas por la tensión psicológica. Como eje teórico central, es la debilidad de dicha tensión lo que provoca un deterioro de estas operaciones y una pérdida de la función de lo real, originando variados síntomas. El deterioro de dichas operaciones y los síntomas derivados son: La acción voluntaria que lleva a conductas compulsivas. La percepción con creencia reflexiva conduce a síntomas obsesivos y la creencia aseverativa a síntomas psicóticos. Personificación y presentificación, relacionada con lo que actualmente denominamos trauma y síntomas disociativos.

In the following report the author remarks the importance of explaining and knowing the origins of the concept of "Function of the real" in Janet's perspective. The importance of shed some light on this concept derives from its current applications in the study of obsessive compulsive disorder, psychosis and post-traumatic stress disorder and dissociative symptoms. The "Function of the real" or "Reality function" is defined as the apprehension of reality in all its forms. It is the result of three main psychological operations, which are within a hierarchy of functions organized and united by a property called "psychological tension". The weakness of this tension causes a deterioration of these operations and a loss of the reality function causing, as a consequence, various symptoms. The affected operations and the derived symptoms are: The voluntary action that leads to compulsive behaviors. Perception with reflective belief, which conduces to obsessive symptoms, assertive belief and psychotic symptoms. Personification and presentification, related to what we now call trauma and dissociative symptoms.

Particularidades del trastorno obsesivo compulsivo en el niño y el adolescente / Particularities of obsessive - compulsive disorder in children and adolescents

RESUMEN El trastorno obsesivo en el niño y el adolescente, sus peculiaridades, formas de presentación y los rituales de la propia enfermedad interfieren en su diagnóstico temprano. Antes de la intervención médica es necesario explicar con claridad todo lo relacionado con el trastorno, su naturaleza y procederes. El distanciamiento psicológico se indica en los niños pequeños donde se les pide exteriorizar los síntomas nombrándolos como ellos lo deseen. En estudios recientes se ha descrito que la terapia cognitiva conductual resulta ser el tratamiento de elección en niños y adolescentes cuando su nivel cognitivo y emocional así lo permite. En esta investigación se explicaron los modelos implicados en la etiopatogenia que abordan la neurobiología para la comprensión del trastorno. Se brindaron las orientaciones para un mejor tratamiento psicológico y farmacológico de los pacientes, y se precisaron las dosis recomendadas para este grupo en particular.

ABSTRACT Obsessive disorder in children and adolescents, its peculiarities, forms of presentation and rituals of the disease itself interfere with its early diagnosis. Explaining clearly everything related to the disorder, its nature and procedures is necessary before medical intervention. Psychological distancing is indicated in young children where they are asked to externalize the symptoms by naming them as they wish. Recent studies have been described that cognitive- behavioral therapy turns out to be the treatment of choice in children and adolescents when their cognitive and emotional level allows it. In this research, the models involved in the etiopathogenesis that address neurobiology for the understanding of the disorder were explained. Orientations were provided for a better psychological and pharmacological treatment of the patients, and the recommended doses for this particular group were specified.