Sexual Abuse, Post-Traumatic Stress Disorder and Psychopathological Characteristics in Women with Functional/Dissociative Seizures.

BACKGROUND: Functional/dissociative seizures (FDS), also known as psychogenic non-epileptic seizures (PNES), are sudden, transient, and involuntary events that include motor, sensory, cognitive or autonomic function alterations. In this work we analyzed the psychopathological characteristics of a subgroup of women who suffer from FDS with the aim to analyze the role of psychological trauma, with special emphasis on trauma due to sexual abuse (SA). METHODS: Forty-five women diagnosed with FDS were included in the study (age range 18 to 64 years, mean = 34.7, standard deviation (SD) = 13.1). Clinical and psychopathological characteristics were reviewed. All patients have completed the clinical interviews, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID II) and the Global Assessment of Functioning (GAF) according to a special protocol for mental health assessment. Also, the history of sexual abuse trauma, the history of other non-sexual traumas and absence of history of trauma were reviewed. RESULTS: Eighty percent of the cases reported a history of trauma, and 40% reported a history of SA. Patients with a history of SA presented a significantly lower average age of seizure onset than patients with a history of other non-sexual traumas (p = 0.021). Significant associations were found between SA and post-traumatic stress disorder (PTSD) (p = 0.031), and SA and history of suicide attempts (p = 0.037). CONCLUSIONS: SA carries serious implications for the mental health of women suffering from FDS. Mental health professionals must consider the history of this type of trauma to provide the necessary care for this patient population.

Estrategias de afrontamiento en adultos con crisis funcionales disociativas: Una revisión sistemática / Coping strategies in adults with functional dissociative seizures: A systematic review

Resumen Introducción: las crisis funcionales disociativas (CFD) son episodios que se asemejan a las crisis epilépticas, pero son causadas por diversos factores biopsicosociales. La forma en la que estos pacientes enfrentan los desafíos de su padecimiento se ha considerado un importante factor mantenedor. El objetivo de esta revisión sistemática es identificar las estrategias de afrontamiento utilizadas por pacientes adultos con CFD, y los instrumentos usados para evaluarlas. Método: la revisión se realizó siguiendo la guía PRISMA. Se hizo una búsqueda en las bases de datos Pubmed, Cochrane Library, Scielo, Science Direct y Lilacs. Resultados: once artículos cumplieron con los criterios de inclusión y se integraron en una síntesis narrativa. Los pacientes con CFD utilizan más estrategias de evitación y centradas en la emoción que la población general. Su uso excesivo se ha relacionado a una mayor psicopatología, una peor calidad de vida y mayor malestar frente al estrés. Por otro lado, la diversidad de instrumentos de evaluación del afrontamiento refleja la heterogeneidad del campo. Conclusiones: más investigaciones son necesarias para comprender las estrategias de afrontamiento de los pacientes con CFD y ofrecer un tratamiento más personalizado y efectivo.

Abstract Introduction: Functional dissociative seizures (FDS) are episodes that resemble epileptic seizures, but are caused by different biopsychosocial factors. The way in which these patients cope with the challenges of their condition has been considered an important maintaining factor. The aim of this systematic review is to identify the coping strategies used by adult patients with FDS, and the measures used to assess them. Methods: The review was conducted following the PRISMA guidelines. A search was conducted in Pubmed, Cochrane Library, Scielo, Science Direct and Lilacs databases. Results: Eleven articles met the inclusion criteria and were integrated into a narrative synthesis. FDS patients use more avoidance and emotion-focused strategies than the general population. Their excessive use has been related to greater psychopathology, poorer quality of life and greater distress in the face of stress. On the other hand, the diversity of coping assessment instruments reflects the heterogeneity of the field. Conclusions: More research is needed to understand the coping strategies of FDS patients and to offer more personalized and effective treatment.

Cultural adaptation and psychometric properties of the Patient-weighted Quality of Life in Epilepsy 31 Inventory (QOLIE-31P) in Argentina.

OBJECTIVE: This study presents the cultural and linguistic adaptation and psychometric properties of the Argentine version of the Quality of Life in Epilepsy Inventory (QOLIE-31P) scale. METHODS: An instrumental study was carried out. A version of QOLIE-31P translated into Spanish was provided by the original authors. To assess the content validity, evaluation of expert judges was requested, and the degree of agreement was determined. The instrument was administered to 212 people with epilepsy (PWE) of Argentina, together with the BDI-II, B-IPQ and a sociodemographic questionnaire. A descriptive analysis of the sample was carried out. Discriminative capacity of the items was performed. Cronbach's alpha was calculated to assess reliability. To study the dimensional structure of the instrument, a confirmatory factorial analysis (CFA) was performed. Convergent and discriminant validity was tested through mean difference tests, linear correlation, and regression analysis. RESULTS: Aiken's V coefficients ranged between .90 and 1 (acceptable), which allows to state that a conceptually and linguistically equivalent version of the QOLIE-31P was reached. Cronbach's Alpha of 0.94 was obtained for the Total Scale (optimal). As a result of CFA, 7 factors were obtained, being the dimensional structure similar to the original version. Also, unemployed PWE reported significant lower scores than employed PWE. Finally, QOLIE-31P scores negatively correlated with depression symptom severity and negative illness perception. CONCLUSION: The Argentine version of the QOLIE-31P is a valid and reliable instrument, presenting good psychometric properties, such as high internal consistency and a dimensional structure similar to that of the original version.

Calidad de vida en pacientes con epilepsia y crisis no epilépticas psicógenas: una revisión sistemática / Quality of life in patients with epilepsy and psychogenic nonepileptic seizures: a systematic review

Resumen Se han revisado artículos que estudiaron la calidad de vida en las personas con crisis no epilépticas psicógenas (CNEP) y crisis epilépticas. Se siguió la guía PRISMA y, previo a la búsqueda, se realizó un protocolo publicado en PROSPERO. Se incluyeron estudios aleatorizados y no aleatorizados, de tipo cuantitativo o mixtos, de corte transversal o longitudinal, escritos en lengua inglesa o española publicados hasta el año 2020, y cuyos participantes fueran mayores de 16 años. Luego de filtrar los resultados según los criterios de selección, se incluyeron 11 artículos y una tesis doctoral cuyos años de publicación datan de 1998 a 2020. En su mayoría, se informaba que las personas con CNEP tenían menor calidad de vida, asociadas a presencia de psicopatología, así como también a la toma de medicación antiepiléptica, factores sociodemográficos y relacionados con las crisis (frecuencia, severidad y duración de enfermedad), funcionamiento familiar, trauma y somatización.

Abstract Psychogenic non epileptic seizures (PNES) are disruptive changes in behaviour, thought, or emotion that resemble an epileptic seizure, but without paroxysmal neuronal discharge detectable by electroencephalography (EEG), and are not caused by another medical condition. On the other hand, epileptic seizures (ES) are defined as clinical events that reflect the presence of hypersynchronous discharges of neurons located in the cerebral cortex, which have the particularity of starting and ending abruptly. The diagnosis of epilepsy is made when an epileptic seizure was experienced and there is a risk of having another. The objective of this paper is to present the results of a systematic review of articles that have studied quality of life in people with PNES and ES. This review has been performed following the PRISMA guide (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Prior to the beginning of the search, a protocol was carried out and it is published for consultation in the International prospective register of systematic reviews (PROSPERO). The review includes randomized and non-randomized, quantitative or mixed, cross-sectional or longitudinal studies, published in English or Spanish until 2020. In addition, participants had to be over 16 years old. PNES diagnosis must have been confirmed by video-electroencephalography (VEEG) or a similar procedure-which is considered the gold standard for the diagnosis of PNES.

Updated Review on the Diagnosis and Primary Management of Psychogenic Nonepileptic Seizure Disorders.

Psychogenic nonepileptic seizures (PNES) are paroxystic and episodic events associated with motor, sensory, mental or autonomic manifestations, which resemble epileptic seizures (ES), but are not caused by epileptogenic activity. PNES affect between 20% and 30% of patients attending at epilepsy centers and constitute a serious mental health problem. PNES are often underdiagnosed, undertreated and mistaken with epilepsy. PNES are diagnosed after medical causes (epilepsy, syncope, stroke, etc.) have been ruled out, and psychological mechanisms are involved in their genesis and perpetuation. For psychiatry, there is not a single definition for PNES; the DSM-IV and ICD-10/11 describe the conversion and dissociative disorders, and the DSM-5 describes the functional neurological disorders. However, patients with PNES also have a high frequency of other comorbidities like depression, particularly trauma and post-traumatic stress disorder. It has been postulated that PNES are essentially dissociations that operate as a defensive psychological mechanism that use the mind as a defense to deal with traumas. With the advent of VEEG in the 90s, the recognition of PNES has significantly increased, and several psychological treatments have been developed. In this manuscript, we carried out a state-of-the-art review, with the aim to provide a critical approach to the extensive literature about PNES, focusing on diagnostic aspects, the primary management, and the available treatments that have been shown to be effective for the improvement of PNES.

Reducing Allostatic Load in Depression and Anxiety Disorders: Physical Activity and Yoga Practice as Add-On Therapies.

The allostatic load (AL) index constitutes a useful tool to objectively assess the biological aspects of chronic stress in clinical practice. AL index has been positively correlated with cumulative chronic stress (physical and psychosocial stressors) and with a high risk to develop pathological conditions (e.g., metabolic syndrome, cardiovascular pathology, inflammatory disorders) and the so-called stress-related psychiatric disorders, including anxiety and depressive disorders. Chronic stress has negative effects on brain neuroplasticity, especially on hippocampal neurogenesis and these effects may be reversed by antidepressant treatments. Several evidences indicate that non-pharmacological interventions based on physical activity and yoga practice may add synergizing benefits to classical treatments (antidepressant and benzodiazepines) for depression and anxiety, reducing the negative effects of chronic stress. The aim of this review is to provide a general overview of current knowledge on AL and chronic stress in relation to depression and anxiety, physical activity and yoga practice.

¿Qué informa la prensa escrita argentina acerca del fenómeno de cyberbullying? / What does the argentine written press report about the phenomenon of cyberbullying?

Resumen En los últimos años, los términos bullying y cyberbullying se han ido instalando en los medios de comunicación argentinos, entre ellos en la prensa escrita. Se trata de términos técnicos, ya que hacen referencia a problemáticas específicas, que han sido adoptados por la prensa local a fin de dar cuenta, principalmente, de las características, consecuencias y posibles abordajes de estos fenómenos. Teniendo en cuenta que la lectura y análisis de aquello que publica la prensa respecto de un fenómeno permitiría observar aspectos interesantes del proceso de difusión de la información, del discurso empleado y del sentido colectivo que le otorga, el objetivo general de este trabajo se orientó a indagar el tipo de información y su contenido con respecto al fenómeno de cyberbullying en la prensa escrita argentina. Se discuten los hallazgos obtenidos mediante el empleo de un análisis temático y de contenido a fin de ampliar el conocimiento sobre este fenómeno en nuestro medio local.

Abstract In recent years, the terms "bullying" and "cyberbullying" have been adopted by the Argentinian media, including the written press. These are technical terms that refer to specific problems. The local press has adopted them in order to report about the characteristics, consequences, and possible approaches to these situations. The analysis of the press' publications on a certain phenomenon enables us to see interesting aspects of the process of dissemination of information, the discourse used and the collective consciousness it creates. Therefore, the general objective of this work is focused on investigating the type of information and contents regarding cyberbullying in the Argentinian press. A qualitative methodological approach was used, which included the use of a thematic and content analysis. It is noted that only a low proportion of journalism articles was found in which the three basic characteristics of the cyberbullying were pointed out (the intentionality, the repetition in time and the existence of an imbalance of power). In addition, it is observed that the written press provides more information related to the characteristics and possible approaches to cyberbullying, and, to a lesser extent, to its detection. The negative consequences of this problem regarding the psychological health of those involved are mentioned, highlighting indicators and individual consequences, but without referring to indicators or to collective, institutional or social consequences. The development of a hostile and unsupportive school environment, the normalization of aggressive behaviors, the positive assessment of violent behavior in order to obtain social success, and the possible consequences for teachers and families are not mentioned by the press. Also, it is observed that the press gives little room to the students' point of view, who, from their experiences, attitudes and perspectives on this phenomenon, could make important contributions for the development of both prevention strategies and effective boarding tools. The findings obtained are discussed through thematic and content analysis in order to broaden the knowledge about this phenomenon in our local environment. Within the limitations of this study, it is worth mentioning that the different publications began the digitization of their copies in different years, which could affect the total number of articles surveyed and the amount registered for each of the digital portals. Likewise, for this study, only two descriptors were used to carry out the search, so future studies could incorporate other terms in order to broaden and deepen the findings. This could also contribute to generate other analysis categories, in order to record other aspects related to the type and content of information not addressed in this study.

La experiencia de pacientes con crisis no epilépticas psicógenas: marcos interpretativos y de acción / A experiência de pacientes com crises não epiléticas psicogênicas: marcos interpretativos e de ação / The experience of patients with psychogenic non epileptic seizures: interpretative and action framework / L´expérience des patients atteints de crise psychogène non épileptique: cadres dinterprétation et daction

Resumen La perspectiva del paciente se presenta como algo importante a tener en cuenta para la comprensión del padecimiento y para lograr un tratamiento efectivo. El objetivo de la presente investigación es indagar las trayectorias terapéuticas y las experiencias durante el recorrido terapéutico de pacientes con Crisis No Epilépticas Psicógenas (CNEP) pertenecientes a un Hospital General de la Ciudad Autónoma de Buenos Aires. Se realizaron entrevistas semiestructuradas a diez pacientes diagnosticados con CNEP. Para el análisis de los datos se utilizó una metodología cualitativa basada en los principios del análisis temático. Se ha identificado una categoría central: Itinerarios terapéuticos dentro del sistema etnomédico y tres subcategorías: (1) Diagnósticos Recibidos; (2) Recursos del sistema etnomédico y (3) Evaluaciones de los recursos utilizados. La dificultad de arribar a un diagnóstico y un tratamiento que permitiera mejorar las CNEP, así como el uso de distintas medicinas, fue destacada por la totalidad de los pacientes.

Resumo A perspectiva do paciente se apresenta como algo importante a levar em conta para a compreensão do sofrimento e para se alcançar um tratamento eficaz. O objetivo desta pesquisa é investigar as trajetórias terapêuticas e as experiências durante a jornada terapêutica de pacientes com crise não epilética psicogênica (CNEP) de um Hospital Geral da Cidade Autônoma de Buenos Aires. Entrevistas semiestruturadas foram realizadas com dez pacientes com diagnóstico de CNEP. Para a análise dos dados, utilizou-se metodologia qualitativa baseada nos princípios da análise temática. Uma categoria central foi identificada: Itinerários terapêuticos dentro do sistema etnomédico; e três subcategorias: (1) Diagnósticos recebidos; (2) Recursos do sistema etnomédico; e (3) Avaliações dos recursos utilizados. A dificuldade de se chegar a um diagnóstico e a um tratamento que permitisse melhorar a CNEP, bem como o uso de diferentes medicamentos, foi destacada por todos os pacientes.

Abstract The patient's perspective is essential to understand their condition and to achieve an effective treatment. The objective of this paper is to investigate the therapeutic trajectories and experiences of patients with Psychogenic Non-Epileptic Crisis (PNES) under treatment in a General Hospital of the Autonomous City of Buenos Aires. Semi-structured interviews were conducted with ten patients diagnosed with PNES. For data analysis, a qualitative methodology based on thematic analysis was adopted. A central category has been identified: Therapeutic Itineraries within the Ethnomedical System, and three subcategories: (1) Diagnoses received; (2) Resources of the ethnomedical system; and (3) Evaluation of the resources used. The difficulty of finding a diagnosis, a treatment to improve PNES, and proper medicine were highlighted by all the patients.

Résumé Le point de vue du patient est présenté comme quelque chose d'important à prendre en compte afin de comprendre la maladie et d'obtenir un traitement efficace. L'objectif de cette recherche est d'analyser les trajectoires thérapeutiques et les expériences au cours du parcours thérapeutique des patients atteints de Crise Psychogénique Non Épileptique (CPNE) dans un hôpital général de la ville de Buenos Aires. Des entretiens semi-structurés ont été menés auprès de 10 patients diagnostiqués avec une CPNE. Pour l'analyse des données, une méthodologie qualitative basée sur les principes de l'analyse thématique a été utilisée. Une catégorie centrale a été identifiée : Les itinéraires thérapeutiques au sein du système ethno-médical et trois sous-catégories : (1) Diagnostics reçus ; (2) Ressources du système ethno-médical ; et (3) Évaluations des ressources utilisées. La difficulté d'arriver à un diagnostic et à un traitement permettant d'améliorer la CPNE, ainsi que l'utilisation de médicaments différents, a été soulignée par l'ensemble des patients.

Long-term outcome in a sample of underprivileged patients with psychogenic nonepileptic seizures (PNES) living in Argentina.

OBJECTIVE: The objective of the present study was to perform a long-term follow-up of economically disadvantaged Latin American patients diagnosed as having psychogenic nonepileptic seizures (PNES) and contribute to the field's understanding of outcome in this population. BACKGROUND: A handful of studies have examined outcome of patients once the diagnosis of PNES has been communicated. However, the vast majority of these have been conducted in the first world countries with samples that were predominantly Caucasian. There is limited knowledge about outcome in economically disadvantaged Latin American patients diagnosed as having PNES. METHODS: This is a study of 23 patients (20 women, 3 men) with PNES in which demographic data (age, education, nationality, presence of psychological trauma, age of onset) were retrospectively retrieved from medical files. Follow-up was done through a telephonic questionnaire in which investigators collected clinical information (seizure characteristics at follow-up, and treatments employed) and changes in demographic data. RESULTS: Patients from this Argentinian PNES sample demonstrated having many similar demographic and clinical characteristics to samples from US and European studies. Long-term follow-up revealed, however, decreased seizure frequency and intensity as well as a substantial improvement in occupational status. A majority had engaged in psychotherapy as well as alternative and complementary approaches. A majority had also developed what are suspected to be other functional symptoms. CONCLUSIONS: Argentinian patients from economically disadvantaged backgrounds, diagnosed as having PNES reported improvements in seizure frequency and occupational status during long-term follow-up. Future studies will need to focus on what (e.g., communication of diagnosis, psychotherapy, alternative treatments) may have contributed to these changes.

A life with seizures: Argentine patients' perspectives about the impact of drug-resistant epilepsy on their lives.

PURPOSE: To understand the experience of drug-resistant epilepsy in patients from Argentina, a developing nation. METHOD: A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of 20 patients with DRE. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS: Six main themes emerged: 1) Characteristics of the illness, including seizure features -unpredictability, presence of auras, physical and cognitive consequences- and how patients relate with the use of antiepileptic drugs; 2) interactions with health system, regarding the features of the Argentine's health system, and patient's health-seeking behaviours; 3) beliefs about the illness, including psychosocial, biological and folk explanatory models; 4) beliefs about how other people perceive them, which included prejudice, responsibility and overprotection; 5) self-perception, and 6) impact of the illness on their activities. CONCLUSIONS: This information might be useful to help in the development of a conceptual model of the impact epilepsy on patients' lives. Many of the topics mentioned as relevant in Argentina coincide with those highlighted in studies that were carried out in first-world countries. However, additional topics were also reported including the role of traditional healing in health-seeking behaviour and explanatory models of illness. It is important to understand these perspectives to develop appropriate psychosocial interventions for this specific population.

Cruzando el Rubicón: del psicoanálisis a la terapia cognitiva / Franchir le Rubicon: de la psychanalyse à la thérapie cognitive / Atravessando o Rubicão: da psicanálise à terapia cognitiva / Crossing the Rubicon: from psychoanalysis to cognitive therapy

En este trabajo nos proponemos describir algunas de las causas que llevan a Aaron T. Beck a abandonar el psicoanálisis y a participar de la creación de la terapia cognitiva. Para ello, describiremos los trabajos de investigación desarrollados por Beck entre los años 1959 y 1962. En ellos se empiezan a procesar los datos que darán lugar a la caída de la hipótesis explicativa psicoanalítica de la depresión. Dentro de este análisis incluiremos algunos elementos que consideramos esenciales para entender este proceso de cambio: la obtención de un subsidio para investigar la depresión y la aparición de colaboradores como Marvin Hurvich y Seygmour Feshbach, cuyas nuevas herramientas y metodologías ayudaron a Beck a poner a prueba la hipótesis psicoanalítica de la depresión. Por último, incluiremos cuestiones referidas a las políticas de investigación del Instituto Nacional de Salud Mental, así como motivos personales y de la política institucional.

Cet article a l'objectif de décrire quelques-unes des causes qui mènent Aaron T. Beck à abandonner le psychanalyse et de participer à la création de la thérapie cognitive. Avec cet intérêt, l'article explore ce travail de recherche développé par Beck entre les années 1959 et 1962. Dans cette période, se commencent à traiter les données qui mèneront à la chute de l'hypothèse explicative psychanalytique de la dépression. Dans cette analyse l'article inclut certains éléments que nous considérons essentiels afin de comprendre ce processus de changement : l'obtention d'une subvention pour étudier la dépression et l'entrée en scène de collaborateurs comme Marvin Hurvich et Seymour Feshbach, qui ont apporté de nouveaux outils et méthodologies pour tester l'hypothèse psychanalytique de la dépression. Enfin, nous allons inclure des questions liées à la recherche sur les politiques à l'Institut National de la Santé Mentale, ainsi que des raisons personnelles et de la politique institutionnelle.

Neste trabalho, descrevemos algumas das causas que levam Aaron T. Beck a abandonar a psicanálise e participar da criação da terapia cognitiva. Com este objetivo, vamos descrever os trabalhos de investigação desenvolvidos por Beck entre 1959 e 1962, quando começa a processar os dados que derrubarão a hipótese explicativa psicanalítica da depressão. Nesta análise, incluiremos alguns elementos que consideramos essenciais para entender esse processo de mudança: a obtenção de um subsídio para pesquisar a depressão e a presença de colaboradores como Marvin Hurvich e Seygmour Feshbach, cujas novas ferramentas e metodologias ajudaram Beck a testar a hipótese psicanalítica da depressão. Por último, incluiremos questões que se referem às políticas de investigação do Instituto Nacional de Saúde Mental, assim como motivos pessoais e de política institucional.

In this study we describe some of the reasons that lead Aaron T Beck to move away from psychoanalysis and participate in the creation of cognitive therapy. With this aim in view, we describe the research developed by Beck between 1959 and 1962. In these studies the data that promotes the fall of the psychoanalytic explanatory hypothesis for depression began to be processed. Within this analysis we include some elements that we consider essential to understand this process of change: From Beck´s obtaining a grant to investigate depression and his starting to work with collaborators like Marvin Hurvich and Sigmour Feshbach, whose new tools and methodologies helped Beck to test a psychoanalytic hypothesis of depression. Finally, we will include questions related to the research policies of the National Institute of Mental Health, and some commentaries about personal and institutional policy reasons that influenced Beck's work.

What patients think about psychogenic nonepileptic seizures in Buenos Aires, Argentina: A qualitative approach.

PURPOSE: To analyse the methods of reasoning with regard to patients' experiences of living with psychogenic nonepileptic seizures (PNES) in Buenos Aires, Argentina. METHOD: A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of five patients with PNES. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS: Explanatory models and prototypes were identified from the patients' narratives. Four patients related their suffering regarding psychosocial causes -family conflicts, sexual harassment, and life changes, among others-. Hereditary and organic hypotheses appeared to be unspecific. Folk explanations were common to all participants (magic, witchcraft, energetic causes). Four patients used the term epilepsy as an illness prototype, focusing on seizures and the use of antiepileptic drugs. Three of them also compared their illness to other people's "attacks" (heart attacks, panic attacks, nervous breakdown). Only one of them referred to someone who was suspected of having epilepsy. CONCLUSION: Patients' psychosocial explanatory models are different from the results of previous studies because these studies indicate that most patients support somatic explanations. Patients also use folk explanations related to traditional medicine, which highlights the interpersonal aspects of the disease. Doctor-patient communication is essential for a correct understanding of PNES, resulting in better outcomes. It could also help to reduce the cultural distance between professionals and patients, leading to narrowing inequalities present in multicultural healthcare services.

[MINDFULNESS-BASED COGNITIVE THERAPY (MBCT) AND THE "THIRD WAVE" OF COGNITIVE-BEHAVIORAL THERAPIES (CBT)]. / Terapia Cognitiva basada en Atención Plena (mindfulness) y la <> en Terapias Cognitivo-Conductuales.

The paper presents the reasons that led to the incorporation of mindfulness as part of a cognitive therapy approach to the prevention of relapse of recurrent depressive disorders. It describes the context in which models focused on the contents of cognition gave way to models focused on cognitive processes. We highlight the problems encountered by the standard cognitive model when trying to account for the cognitive vulnerability of individuals who, having experienced a depressive episode, are in remission. We briefly describe the theoretical foundations of Mindfulness-Based Cognitive Therapy and its therapeutic approach.

The origins and professionalization of cognitive psychotherapy in Argentina.

The growing popularity of cognitive-behavioral therapy (CBT) has helped reshape the mental health scene in the city of Buenos Aires, historically the stronghold of psychoanalysis. In the early 1980s, CBT was infrequently used and sometimes overtly resisted in the field of mental health. Almost 3 decades later, the impact of CBT has increased dramatically in Argentina, not only in independent practice but also in the health system and in everyday life. This article aims to describe the process by which Argentine psychotherapists first adopted this new theoretical framework.

El legado psicoanalítico en la terapia cognitiva de Aaron Beck / The legacy of psychoanalysis in Aaron Beck's cognitive therapy / O legado da psicanálise à terapia cognitiva de Aaron Beck

El psicoanálisis en el que Beck se formó tenía como objetivo incluir al psicoanálisis dentro del modelo científico. Esto era consistente con los intereses de un gran número de investigadores clínicos en los Estados Unidos durante las décadas de 1950 y 1960. Este trayecto intelectual lo llevará, años después, a desarrollar la terapia cognitiva. En este trabajo nos enfocaremos en el entrenamiento psicoanalítico de Beck así como en las primeras publicaciones de éste como especialista en psiquiatría durante su práctica hospitalaria en la Clínica de Austen Riggs y en el Hospital Valley Forge Army. Analizaremos sus primeras hipótesis, intentando rastrear los indicios de su modo de actuar como psicoanalista. Esta misma formación posteriormente lo llevará a un replanteo del modelo psicoanalítico, hecho que será clave para explicar las características que adoptará la terapia cognitiva...

The psychodynamic model in which Beck was formed tried to include psychoanalysis into the scientific model. This was consistent with the aims of many clinical researchers in the 1950-1960 decades in the United States. This will take him, years later, to develop the cognitive therapy. In this paper we will focus on Beck psychoanalytic training and his firsts publications as a specialist in psychiatry during his hospital practice (at the Austen Riggs Clinic and in the Valley Forge Army Hospital). We will analyze his first hypotheses, trying to trace the evidence of his mode of action as a psychoanalyst. This formation will subsequently lead him to rethink the psychoanalytic theory, a fact that will be the key to explain the features that will adopt cognitive therapy...

A psicanálise em que Beck se formou tinha como objetivo incluir esse campo dentro do modelo científico. Isso era coerente com os interesses de numerosos pesquisadores clínicos nos Estados Unidos durante as décadas de 1950 e 1960. Esse percurso intelectual o levará, anos depois, a desenvolver a terapia cognitiva. Neste artigo, enfocaremos a formação psicanalítica de Beck, assim como suas primeiras publicações como especialista em psiquiatria durante sua prática hospitalar na clínica Austen Riggs, no Hospital Valley ForgeArmy. Analisaremos suas primeiras hipóteses, com o objetivo de rastrear os indícios de seu modo de atuação como psicanalista. Essa mesma formação, posteriormente, o levará a repensar o modelo psicanalítico, fato que será capital para explicar as características que a terapia cognitiva adotará...

Salud mental y nuevas complementariedades terapéuticas. La experiencia en dos hospitales públicos de Buenos Aires, Argentina / Saúde mental e novas complementaridades terapêuticas. Experiência em dois hospitais públicos de Buenos Aires, Argentina / Mental health and new therapeutic complementarities. The experience in two public hospitals in Buenos Aires, Argentina

En las últimas décadas las terapias alternativas se han convertido en una opción cada vez más frecuente entre la población general de las ciudades industrializadas, aunque su aceptación como opciones válidas en el sistema de salud aún se encuentra en discusión. A pesar de ello, en la Ciudad de Buenos Aires (Argentina) han surgido talleres dentro de los hospitales generales que ofertan terapias alternativas/complementarias, asociadas a servicios o profesionales de la salud mental. A partir de un estudio cualitativo en dos hospitales públicos de la Ciudad Autónoma de Buenos Aires, indagaremos los motivos que dan origen a dicho fenómeno, destacando las formas de expresión que adquiere y la complejidad de un campo en construcción.

Nas últimas décadas, terapias alternativas têm se tornado cada vez mais comuns entre a população geral em cidades industrializadas, embora sua aceitação como opções válidas no sistema de saúde ainda esteja em discussão. No entanto, na Cidade de Buenos Aires (Argentina), oficinas emergiram dentro de hospitais gerais que oferecem terapias alternativas / complementares, serviços associados e profissionais de saúde mental. A partir de um estudo qualitativo em dois hospitais públicos da Cidade Autônoma de Buenos Aires, vamos investigar as razões que dão origem a este fenômeno, destacando as formas de expressão que adquirem e a complexidade de um campo em construção.

In recent decades, alternative therapies have become an increasingly common option among the general population in industrialized cities, although their acceptance as valid options in the health system is still under discussion. Nevertheless, in the City of Buenos Aires (Argentina) workshops have emerged within general hospitals that offer alternative / complementary therapies, associated to mental health professionals and departments. From a qualitative study in two public hospitals in the Autonomous City of Buenos Aires, we will investigate the reasons that lead to this phenomenon, emphasizing the forms of expression they acquire and complexity of a field under construction.

Combinación de tratamientos y complementariedad terapéutica en los trastornos de ansiedad / Combined treatment and therapeutic complementary for the anxiety disorders

El presente artículo revisa la literatura científica referida a la combinación entre tratamientos farmacológicos y psicosociales en los trastornos de ansiedad. Se reseñan aquellos estudios que han realizado la evaluación empírica de la combinación de tratamientos con el mayor rigor metodológico a través de las bases de datos de PubMed y PsycINFO. A partir de los ensayos realizados, se observa que la información disponible acerca de la ventaja del tratamiento combinado por encima de algún tipo de monoterapia, parece ser bastante controvertida y no concluyente en la mayoría de los trastornos de ansiedad. Esto puede observarse en los ensayos realizados sobre el trastorno por pánico con y sin agorafobia, el trastorno de ansiedad social y el trastorno de ansiedad generalizada. Se observa un déficit de investigación en general pero particularmente en la fobia específica, para la cual no encontramos estudios comparativos. En el tratamiento del trastorno por estrés postraumático, sólo se considera la combinación cuando la psicoterapia no haya alcanzado sus objetivos, y en el abordaje del trastorno obsesivo-compulsivo es donde contamos con evidencia aunque bastante limitada acerca de la superioridad del tratamiento combinado sobre la monoterapia. Se comentan las implicaciones clínicas de estos estudios.

Combinación de tratamientos y complementariedad terapéutica en el abordaje de los trastornos depresivos / Treatment combination and therapeutic complementary in the approach of depressive disorders

El presente artículo revisa la literatura científica referida a la combinación entre tratamientos farmacológicos y psicosociales en los trastornos depresivos. Se reseñan aquellos artículos que han realizado la evaluación empírica de la combinación de tratamientos con el mayor rigor metodológico a través de las bases de datos de PubMed y PsycINFO. Asimismo, se comentan y discuten las guías clínicas más difundidas en el campo de la salud mental. Como conclusión, puede decirse que los trastornos depresivos constituyen el grupo de trastornos donde se lograron los mayores avances: la combinación simultánea de medicación y psicoterapia es especialmente importante en los pacientes con depresión crónica mientras que la combinación alternada debe considerarse en los pacientes con depresión recurrente (especialmente en aquellos casos con 3 o más episodios depresivos).

This article reviews the scientific literature concerning to the combination of pharmacological and psychological treatments. We include studies that evaluate the combined treatment in PubMed and PsycINFO databases and show the best methodological rigor. Also, we comment the clinical guidelines with major diffusion in the mental health field. The most important developments was made in depressive disorders, where the simultaneous combination is specific for chronic depression and cross-over combination in recurrent depression (more specifically in those cases with 3 or more depressive episodes).

Cultura y depresión: aportes antropológicos para la conceptualización de los trastornos mentales

Contenido: Los sistemas diagnósticos operativos. Emoción, mente-cuerpo. Enfoque cualitativo desde la perspectiva de los usuarios. Modelos de enfermedad: el caso de la depresión...

Guías clínicas en salud mental: la situación en Argentina / Clinical guidelines in mental health: situation in Argentina

La actualización permanente de los profesionales de la salud mental se ha vuelto una necesidad. Existe actualmente una importante preocupación por colocar al alcance de los pacientes las terapéuticas que mejor respondan a sus necesidades concretas. Las denominadas Guías Clínicas son herramientas para lograr ese objetivo. En el Reino Unido, los EE.UU., Canadá, Alemania, los Países Bajos, Francia y algunos países latinoamericanos han surgido diferentes organismos avocados al desarrollo de las Guías Clínicas. En la Argentina, la situación es precaria. En la Ciudad de Buenos Aires, son escasos los esfuerzos dirigidos en tal dirección. Una serie heterogénea de factores (políticos, sociales, económicos, corporativos, teórico-académicos o curriculares e ideológicos) parecen dificultar la puesta en práctica de un proyecto de estas características adaptado a nuestra población.

The permanent update of the mental health professionals has become an actual requirement. Nowadays, there is an important concern to offer to the patient's problems the best therapeutics that respond to their specific needs. The well known Clinical Guides are tools to address that objective. In the United Kingdom, USA, Canada, Germany, the Netherlands, France and some Latin American countries different organisms have been created with the objective to develop clinical guidelines. In Argentina, the situation is precarious. In Buenos Aires City, there are few efforts in such direction. An heterogeneous group of factors (social, economic, corporative, theoretical-academic or curricular and ideological) seem to difficult the development of a project of these characteristics, adapted to this population.