Clinical differences between melancholic and nonmelancholic depression as defined by the CORE system.

BACKGROUND: The definition and delineation of melancholia have remained elusive for an extended period. A longstanding signal of psychomotor disturbance has been operationalized via the observer-rated CORE measure and with CORE-assigned melancholic and nonmelancholic compared in several Australian studies. Replication studies in other regions have not previously been reported. This study compares Brazilian patients with melancholic and nonmelancholic depression according to the CORE measure of psychomotor disturbance in terms of clinical characteristics, suicide ideation, stressful life events, quality of life, parental care, and personality styles. METHODS: A total of 181 patients with unipolar major depression attending a tertiary care outpatient service in Brazil were evaluated in relation to melancholic status and study variables. RESULTS: The CORE-assigned melancholic patients presented higher symptom severity, greater prevalence of suicide ideation, and Axis I comorbidities than nonmelancholics. Scores of dysfunctional personality styles and dysfunctional parental care measures were also higher among melancholics. Quality-of-life scores were low in both groups. LIMITATIONS: The absence of a criterion standard for the diagnosis of melancholia and the use of medication can be potential limitations of the study. CONCLUSION: Differences suggest that CORE-assigned melancholia defines a distinct group of patients and probably a disorder distinct from nonmelancholic depression not only in quantitative but also in qualitative aspects.

Prevalence of psychotic symptoms in those with melancholic and nonmelancholic depression.

The best classification of depressive disorders is still to be established. A melancholic subtype has a lengthy history, and recent research demonstrates its relevance. This study compares the prevalence of psychotic symptoms in nonmelancholic and melancholic depression and assesses whether there is a dimensional pattern in the severity of symptoms among the subtypes. Patients with unipolar depression were assessed for melancholic status, psychotic symptoms, and severity of depression. The diagnosis of melancholia was made by both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), criteria and CORE measure. The DSM criteria assigned a much higher percentage of patients as melancholics (67.4%) than did the CORE (24.9%). Prevalence of psychosis was distinctly higher in the melancholics. Symptoms severity was higher among the melancholics when compared with the nonmelancholics. The presence of psychotic symptoms was not associated with an increase in the intensity of depressive symptoms. Psychotic symptoms are more frequently associated with the melancholic subtype of depression. This suggests clinical contiguity between the melancholic and psychotic subtypes and the clinical relevance of identifying melancholia.

Mental health outcomes in Syrian refugees: A systematic review.

BACKGROUND: Syria is the main country of origin for refugees in the world. The prevalence of mental disorders in this population is high, but there is a lack of more comprehensive data on mental health issues in this population. AIM: This study aims to review the literature for mental health outcomes in Syrian refugees. METHODS: We performed a systematic quantitative literature review of original observational studies indexed on the MEDLINE via PubMed, Embase, Web of Science, PsycINFO, LILACS, and SciELO databases with quantitative data reporting mental health outcomes in Syrian refugees. A descriptive analysis was conducted, and the quality of the included studies was assessed using an adaptation from The National Institutes of Health (NIH) quality assessment tool for observational studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS: A total of 64 studies were included. The majority were published between 2019 and 2020, and focused on the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety, with a wide range of variations. Other outcomes were difficulties in the post-migration period and promotive factors for mental health, such as resilience, positive coping strategies, and psychosocial well-being. CONCLUSIONS: High prevalence rates of mental disorders were observed, as well as risk factors for their occurrence. Studies showed a very high variability of prevalence rates and heterogeneity in methodologies. There is a need for research focusing on other determinants and specific necessities for mental health, especially in the post-resettlement period.

Psychiatric symptoms, burnout and associated factors in psychiatry residents.

INTRODUCTION: Mental health in training physicians is a growing issue. The aim of this study was to investigate emotional distress in psychiatry residents. METHOD: This web-based survey evaluated 115 (62%) psychiatry residents in training in the Brazilian State of Rio Grande do Sul. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult, the Patient Health Questionnaire-2, the Alcohol Use Disorders Identification Test-concise, and the Maslach Burnout Inventory were all administered. Linear regression models were estimated with burnout dimensions as dependent variables. RESULT: Positive screening rates were 53% for anxiety, 35.7% for somatization, 16.5% for depression, and 7% for suicidal ideation. Half of the male residents were at risk of alcohol abuse and dependence. Regarding burnout, 60% met criteria for emotional exhaustion, 54.8% for depersonalization, and 33% for low personal accomplishment. The most consistent risk factors were the nature of the relationships with preceptors, relations to the institutions themselves, age, and the quality of relationships with family. CONCLUSION: Besides disconcerting rates of psychiatric symptoms, the study revealed that characteristics of the workplace (i.e., the nature of relationships with preceptors and relations to the institution) can be regarded as potential targets for development of interventions aimed at improving mental health during training periods.

Work Environment Evaluation Instrument (WEEI): development, validation, and association with burnout.

Introduction Physician burnout is considered an epidemic. In 2019, 44% of U.S. physicians reported feeling burned out. The work environment is a central risk factor for this. The aim of this study is to develop and test an instrument to evaluate work environment factors in medical training courses. Method After focus groups, an initial pool of 14 items was generated and tested in a pilot study (n = 66). Face validity was verified, and small adjustments were made. The resulting version was administered to a sample of 115 psychiatry residents. Eleven items were selected based on the correlations between them, principal component analysis, and theoretical reasons, and then tested for internal and construct validity. Results The final version had high reliability (Cronbach's alpha = 0.898) and comprised three dimensions: relations with the institution; with colleagues; and with preceptors. Both total scores and dimensions correlated significantly with burnout scores (p < 0.01). Cutoffs defining the environment as healthy (>32 points); risky (23-31 points); or toxic (<22 points) were suggested and related to the risk of burnout. Conclusion Several authors have emphasized the importance of approaching institutional factors as an effective strategy for coping with the increased prevalence of burnout. This instrument should contribute to these efforts.

Readmission in psychiatry inpatients within a year of discharge: The role of symptoms at discharge and post-discharge care in a Brazilian sample.

INTRODUCTION: Readmission into inpatient psychiatric beds is a useful outcome for patients, care providers, and policymakers. This study aims to investigate the role of level of symptoms at discharge and type of post-discharge care in determining readmissions after a year before a psychiatric admission. METHODS: We performed a prospective and observational study in a general hospital psychiatric facility. Patients were assessed at admission, discharge, and one year after discharge. We used a multivariable logistic regression to determine predictors of readmission. RESULTS: In total, 488 patients were included at admission, and 401 (82,17%) were accessed in the follow-up period. Psychiatric readmissions occurred in 29.17% of the followed patients. The number of previous admissions represents a 38% higher chance of being readmitted (OR 1.38; CI 1.16-1.60). For patients admitted in a depressive episode, not being in remission at discharge increases 140% the chance to be readmitted (OR 2.40; CI 1.14-5.07) as well as the follow-up at primary (OR 5.27; CI 1.06-26.15). For those with Schizophrenia and related disorders, higher scores in BPRS at discharge increases the chance to be readmitted (OR 1.28, CI 1.11-1.48). CONCLUSION: Level of symptoms at discharge was related to higher chance to be readmitted in patients admitted in a depressive episode and those with schizophrenia and related disorders. Findings of the type of care raise the need for further investigation. Also, this finding confirms the importance of the history of previous admissions in predicting future admissions.

Psychiatric symptoms, burnout and associated factors in psychiatry residents

Abstract Introduction Mental health in training physicians is a growing issue. The aim of this study was to investigate emotional distress in psychiatry residents. Method This web-based survey evaluated 115 (62%) psychiatry residents in training in the Brazilian State of Rio Grande do Sul. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult, the Patient Health Questionnaire-2, the Alcohol Use Disorders Identification Test-concise, and the Maslach Burnout Inventory were all administered. Linear regression models were estimated with burnout dimensions as dependent variables. Result Positive screening rates were 53% for anxiety, 35.7% for somatization, 16.5% for depression, and 7% for suicidal ideation. Half of the male residents were at risk of alcohol abuse and dependence. Regarding burnout, 60% met criteria for emotional exhaustion, 54.8% for depersonalization, and 33% for low personal accomplishment. The most consistent risk factors were the nature of the relationships with preceptors, relations to the institutions themselves, age, and the quality of relationships with family. Conclusion Besides disconcerting rates of psychiatric symptoms, the study revealed that characteristics of the workplace (i.e., the nature of relationships with preceptors and relations to the institution) can be regarded as potential targets for development of interventions aimed at improving mental health during training periods.

Work Environment Evaluation Instrument (WEEI): development, validation, and association with burnout

Abstract Introduction Physician burnout is considered an epidemic. In 2019, 44% of U.S. physicians reported feeling burned out. The work environment is a central risk factor for this. The aim of this study is to develop and test an instrument to evaluate work environment factors in medical training courses. Method After focus groups, an initial pool of 14 items was generated and tested in a pilot study (n = 66). Face validity was verified, and small adjustments were made. The resulting version was administered to a sample of 115 psychiatry residents. Eleven items were selected based on the correlations between them, principal component analysis, and theoretical reasons, and then tested for internal and construct validity. Results The final version had high reliability (Cronbach's alpha = 0.898) and comprised three dimensions: relations with the institution; with colleagues; and with preceptors. Both total scores and dimensions correlated significantly with burnout scores (p < 0.01). Cutoffs defining the environment as healthy (>32 points); risky (23-31 points); or toxic (<22 points) were suggested and related to the risk of burnout. Conclusion Several authors have emphasized the importance of approaching institutional factors as an effective strategy for coping with the increased prevalence of burnout. This instrument should contribute to these efforts.

O ressentimento na psicoterapia de orientação analítica / Resentment in psychonalytic psychotherapy

INTRODUÇÃO: Apesar de ser um aspecto frequente e marcante, o tema do ressentimento foi pouco abordado pela teoria psicanalítica. Este trabalho tem o objetivo de (1) buscar na teoria psicanalítica uma compreensão do ressentimento, tendo como foco as situações onde há uma separação conjugal envolvida, e (2) buscar caminhos possíveis para sua resolução. MÉTODOS: O ressentimento foi considerado a partir das questões que emergiram no atendimento de uma paciente com dificuldades de elaborar um divórcio. Para tanto, realizou-se uma revisão na literatura psicanalítica específica sobre o ressentimento, além de temas relacionados, como luto, inveja e masoquismo. RESULTADOS: O paciente ressentido é caracterizado como aquele que não pode deixar de recordar. Nessas situações, a libido está tenazmente ligada a um objeto devedor, prevalecendo uma inércia psíquica através da qual o paciente pode ficar retido na temática torturante. Na psicoterapia, o ressentimento se apresenta como uma face intransigente da resistência. CONSIDERAÇÕES FINAIS: A elaboração do ressentimento é um longo e complexo processo. Um foco possível no tratamento desses casos pode ser resumido em fazer do ressentimento interminável - baseado na memória do rancor - terminável, relacionado com a memória da dor. O ressentimento interminável pode passar a ser terminável quando o sujeito puder abrir mão do desejo de triunfar sobre o outro por meio da vingança. Essa renúncia se dá através de um trabalho de elaboração, no qual o cindido e projetado no ressentimento deve ser reintegrado e introjetado no próprio sujeito.(AU)

INTRODUCTION: Despite resentment is a frequent issue in psychoanalytic psychoterapy, this topic was not broadly discussed by the psychoanalytic theory. This work aims to (1) review psychoanalytic theory an understanding of resentment, focusing on situations where there is a marital separation involved, and (2) to seek possible ways of its resolution. METHODS: Resentment was considered from the issues that emerged in the care of a patient with difficulties to conduct a divorce. Therefore, there was a review of the specific psychoanalytic literature about resentment and related topics such as grief, envy and masochism. RESULTS: The resentful patient is characterized as one that can not stop to remember. In these situations, the libido is tenaciously linked to a debtor object, prevailing psychic inertia through which the patient can be held in torturous theme. In psychotherapy, resentment appears as an uncompromising face of resistance. FINAL CONSIDERATIONS: Treatment of resentment is a long and complex process. A focus in treatment of these cases can be summarized in making endless resentment - based on the rancor memory - in terminable resentment, related to the memory of pain. The resentment may become terminable when the subject can give up the desire to triumph by revenge. This waiver is through when that splited and designed in resentment should be reinstated and introjected in the subject itself.(AU)

Vivências psíquicas da infância no filme "Onde Vivem os Monstros / Psychic childhood experiences in the movie "Where the Wild Things Are"

INTRODUÇÃO: "Onde vivem os monstros" é um conto infantil adaptado para o cinema que aborda diversos aspectos das vivências psíquicas da infância. Os contos infantis têm importante papel na compreensão e elaboração dos conflitos psíquicos. Sendo assim, podem ser utilizados como ponto de partida para explorar diversos temas relacionados ao desenvolvimento psíquico infantil. OBJETIVOS: Este trabalho tem por objetivo partir da estória do filme "Onde vivem os monstros" e abordar alguns aspectos do desenvolvimento psíquico infantil. MÉTODOS: Foram revisados textos de Freud, Klein e outros autores que abordaram temas específicos da infância. Fragmentos do filme foram divididos em primeira, segunda e terceira partes, e, em cada uma dessas partes, foram abordados alguns tópicos, como: complexo de Édipo; agressividade; defesas maníacas; narcisismo infantil; posição esquizoparanoide versus depressiva; princípio do prazer versus princípio de realidade. CONSIDERAÇÕES FINAIS: A estória narrada no filme pode ser compreendida como uma alegoria do processo de elaboração dos conflitos psíquicos infantis. O contato atento com manifestações artísticas de todas as naturezas enriquece o trabalho de psiquiatras e psicoterapeutas, sendo uma infinita fonte de material a ser explorado sob a perspectiva psicanalítica.(AU)

INTRODUCTION: "Where the wild things are" is a children's story adapted to the movies that approaches some aspects of the psychic experiences during childhood. Children's stories have an important role in the comprehension and elaboration of psychic conflicts. Thus, they can be used as a starting point to explore different issues related to the child's psychic development. OBJECTIVE: This article's intention is to use the story of the movie "Where the wild things are" to approach some aspects of the child's psychic development. METHODS: Freud's and Klein's texts as well as material from authors who also approached specific child issues were reviewed. Movie fragments were divided into beginning, middle and end. In each of these parts, specific topics were discussed, such as Oedipus complex, aggressiveness, manic defenses, child narcissism, paranoid-schizoid versus depressive position and pleasure principle versus reality principle. FINAL CONSIDERATIONS: This story can be understood as an allegory of the process of elaboration of the child's psychic conflicts. Looking closely at all kinds of artistic expressions enriches psychiatrists and psychotherapists work, for they are an infinite source of material to be explored under the psychoanalytical perspective.(AU)