Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units-A Pilot Study.

Introduction: Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The " N uremberg I ntegrated P sychosomatic A cute Unit" (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting. Method: NIPA has been established in inpatient internal medical wards for respiratory medicine, oncology and gastroenterology. One to two patients per ward are regularly enrolled in the NIPA treatment while remaining in the same inpatient bed after completion of the somatic care. In a naturalistic study design, we evaluated treatment effects by assessment of symptom load at admission and at discharge using the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Furthermore, we assessed the severity of morbidity using diagnosis data during treatment. At discharge, we measured satisfaction with treatment through the Patient Satisfaction Questionnaire (ZUF-8). Results: Data from 41 NIPA patients were analyzed (18-87 years, 76% female). Seventy-eight percent suffered from at least moderate depression and 49% from anxiety disorders. Other diagnoses were somatoform pain disorder, somatoform autonomic dysfunction, eating disorder and posttraumatic stress disorder. Hypertension, chronic lung diseases and musculoskeletal disorders as well as chronic oncological and cardiac diseases were the most common somatic comorbidities. Treatment resulted in a significant reduction of depressive mood (admission: M = 10.9, SD = 6.1, discharge: M = 7.6, SD = 5.3, d = 0.58, p = 0.001), anxiety (admission: M = 10.6, SD = 4.9, discharge: M = 7.3, SD = 4.1, d = 0.65, p< 0.001) and stress (admission: M = 6.0, SD = 3.6, discharge: M = 4.1, SD = 2.5, d = 0.70, p< 0.001). Somatic symptom burden was reduced by NIPA treatment (admission: M = 10.9, SD = 5.8, discharge: M = 9.6, SD = 5.5, d = 0.30), albeit not statistically significant (p = 0.073) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment. Discussion: NIPA acute care is bridging the gap for patients in need of psychosocial treatment with complex somatic comorbidity. Further long-term evaluation will show whether psychosocial NIPA care is able to reduce the course of physical illness and hospital costs by preventing hospitalization and short-term inpatient re-admissions.

ANTROPOGÊNESE DAS DOENÇAS ORGÂNICAS: UMA NOVA VISÃO EM PSICOSSOMÁTICA / ANTHROPOGENESIS OF ORGANIC DISEASES: A NEW VISION IN PSYCHOSOMATICS / ANTROPOGÉNESIS DE LAS ENFERMEDADES ORGÁNICAS: UNA NUEVA VISIÓN EN PSICOSOMÁTICA

O debate sobre a relação mente-corpo, um dos maiores problemas filosóficos existentes, perpassa outras áreas do conhecimento. Do ponto de vista da prática psicoterápica, o atendimento a pacientes com doenças orgânicas contribuiu para o surgimento do campo da psicossomática. Inicialmente, esse artigo visa apresentar os principais conceitos das Escolas de Psicossomática de Chicago e Paris, as mais relevantes no Ocidente. Como resposta a essas visões, consideradas reducionistas e exageradamente intrapsíquicas, serão apresentados estudos sobre o vínculo humano. A partir de tal descrição emergirá uma proposta de compreensão teórica do fenômeno psicossomático tomando como matriz as considerações conceituais de Danilo Perestrello e Abram Eksterman, psicanalistas brasileiros, cujo ponto nodal é o entendimento da doença somática em sua dimensão antropogênica. As ideias contidas nesse pensamento serão a base para a noção de adoecimento somático enquanto resposta às dificuldades presentes no campo relacional.

The debate about the mind-body relationship, one of the greatest philosophical problems, permeates other areas of knowledge. From the point of view of psychotherapeutic practice, care for patients with organic diseases contributed to the emergence of the psychosomatic field. Initially, this article aims to present the main concepts of Chicago and Paris Psychosomatic Schools, the most relevant in the West. In response to these views, considered reductionist and exaggeratedly intrapsychic, studies on the human bond will be presented. From this description, a theoretical proposal to understand the psychosomatic phenomenon will emerge, taking as matrix the conceptual considerations of Danilo Perestrello and Abram Eksterman, Brazilian psychoanalysts, whose nodal point is the understanding of somatic disease in its anthropogenic dimension. The ideas contained in this thought will be the basis for the notion of somatic illness as an answer to the relational field difficulties.

La relación mente-cuerpo, uno de los mayores problemas filosóficos existentes, impregna otras áreas del conocimiento. Desde la práctica psicoterapéutica, el cuidado de los pacientes con enfermedades orgánicas ha contribuido a la aparición del campo psicosomático. Inicialmente, este artículo tiene como objetivo presentar los principales conceptos de las Escuelas de Psicosomática de Chicago y París, las más relevantes en Occidente. En respuesta a estos puntos de vista, reduccionistas y exageradamente intrapsíquicos, se presentarán estudios sobre el vínculo humano. De esta descripción surgirá una propuesta teórica para comprender el fenómeno psicosomático tomando como matriz las consideraciones conceptuales de Danilo Perestrello y Abram Eksterman, psicoanalistas brasileños, cuyo punto nodal es la comprensión de la enfermedad somática en su dimensión antropogénica. Las ideas contenidas en este pensamiento serán la base de la noción de enfermedad somática como respuesta a las dificultades del campo relacional.

Ilusão simbiótica e construção da identidade feminina nos transtornos alimentares: perspectiva da psicossomática psicanalítica / Symbiotic illusion and female identity construction in eating disorders: a psychoanalytical psychosomatics' perspective

Abstract: This study aims primarily to reflect on the role of symbiotic illusion in the construction of female identity in women with eating disorders (ED), using premises from psychoanalytic psychosomatics. Considering ED as psychopathologies related to the affective economy, Oedipal relations play crucial role in the process of identity constitution. Mother-daughter relationships in ED are shaped in the molds of symbiotic illusion, with weak father figures. We presented a case study to briefly illustrate the theoretical framework. The omissive posture of a father to interdict the symbiotic relation leads daughters to find themselves unable to libidinally invest in other objects.

Resumo: Este estudo teve como objetivo refletir sobre o papel da ilusão simbiótica na construção da identidade feminina em mulheres com transtornos alimentares (TAs), utilizando as premissas da psicossomática psicanalítica. Considerando-se os TAs como psicopatologias relacionadas à economia afetiva, as relações edípicas desempenham papel crucial no processo de construção de identidade. As relações mãe-filha nos TAs são moldadas pela ilusão simbiótica, com figuras paternas enfraquecidas. Nós apresentamos brevemente um estudo de caso para ilustrar os conceitos do referencial teórico. A postura omissa do pai para interditar a relação simbiótica com a mãe leva a filha à impossibilidade de investir libidinalmente em outros objetos.

Impact of an educational workshop on psychiatrists' attitude towards psychosomatic medicine.

BACKGROUND: Although psychosomatic medicine is not recognised as a medical specialisation globally, it has proven useful for treating many disorders in Germany. This paper reports on the impact of an educational workshop as a tool for raising awareness about psychosomatic medicine among international psychiatrists. METHODS: Psychiatrists from eight different countries were educated on psychosomatic medicine and psychotherapy during a 90-min workshop using a video, a slide presentation and an innovative teaching format called 'speed coaching'. Learning outcomes were assessed by analysing questionnaires completed by the participants before and after the workshop. RESULTS: Half of the participants who initially rejected the notion that psychosomatic medicine should be a specialisation on its own changed their minds in favour for it to be a separate discipline (p = 0.125). Awareness about which diseases and patients psychosomatic doctors deal with was increased. The intent for treatment of patients with eating disorders by a psychosomatic physician quadrupled among the participants (p = 0.004). CONCLUSIONS: A brief educational intervention can influence psychiatrists' decisions to opt for approaches by doctors specialized in psychosomatics for certain disorders. Further studies may explore why psychiatrists agree or disagree that psychosomatic medicine should be a separate specialisation on its own.

Depression in the medically ill.

BACKGROUND: Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. METHODS: Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. RESULTS: Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug-drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. LIMITATIONS: Non-systematic review of the literature. CONCLUSION: Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.

Unexplained ocular and visual symptoms: The need for a psychosomatic approach in Ophthalmology. / Síntomas visuales y oculares sin causa: La necesidad de un enfoque psicosomático en oftalmología.

INTRODUCTION: Psychogenic causes for some somatic symptoms have been widely recognised. In Ophthalmology however, there are few studies that address this issue, and current Ophthalmology Training Programs do not include formal teaching in Psychosomatics. Psychosomatic phenomena in ophthalmology are probably under-diagnosed, which may reduce therapeutic effectiveness, decrease patient and physician satisfaction, and increase health costs due to multiple consultations and prescriptions. The aims of this study were to describe patients with unexplained visual/ocular symptoms (UVOS), and to estimate the prevalence of psychological distress (PD) among them. MATERIALS AND METHODS: Consecutive adults with UVOS were recruited over a 12 month period. Complete medical history and ocular examination were performed to rule out organic disease. Psychological Distress was defined by the presence of one or more of the following criteria: psychiatric diagnosis, use of psychotropic medication, psychosomatic disease in other organs, and biographical crisis in the last 6 months. Results were compared with a control group. RESULTS: A total of 39 cases of UVOS were recruited, corresponding approximately to 3% prevalence. The large majority (74%) were female. The mean age was 41.8 years. The most common complaints were ocular surface irritation symptoms (51%) and unspecific visual disturbances (17%). At least 1 of the PD criteria was found in 100%, including 46.2% with psychiatric comorbidity, 48.7% with psychotropic medications, 64% with psychosomatic disease in other organs, and 48.7% with recent life-stressful events. PD indicators were statistically higher compared with control group (P<.05). CONCLUSIONES: There was a high frequency of PD indicators in patients with UVOS. Although the causative role of PD remains unclear, the presence of UVOS should warn the ophthalmologist of an underlying psychic conflict and to make an appropriate psychological intervention.

Tumour growth activation by the central nervous system-An integrative theory of cancer.

The currently recognized mechanisms of the biology of cancer are not yet enough to explain the high incidence of the disease in industrialized countries. Survival and proliferation of cancer cells demand a well-orchestrated combination of functional capabilities, or hallmarks, which requires complex signalling networks that often exceed the tumour boundaries. Based on latest research on environmental health and aiming to provide cancer with a coherent set of organizing principles, we propose an integrative model of carcinogenesis founded on tumour growth activation by the central nervous system as an adaptive, allostatic response to both environmental and emotional challenges. In this way, chronicity of physical as well as psychological stressors may be directly involved in cancer genesis and progression, after an early inflammatory stage. The model also contemplates accidental activation of the tumour growth programme following direct DNA damage, but as a rare event that does not account for most cancers in humans. Bodily and cellular mechanisms designed to facilitate tumorigenesis may include exacerbation of the sympathetic activity, overexpression of membrane ion channels, promotion of selected mutations and methylations, degradation of the mitochondria and reprogramming of adult stem cells.

Medication prescriptions in 322 motor functional neurological disorder patients in a large UK mental health service: A case control study.

OBJECTIVE: This study describes medication prescribing patterns in patients with motor functional neurological disorder (mFND) treated in South London and Maudsley NHS Foundation Trust (SLaM), comparing outcomes to a control group of psychiatric patients from the same hospital trust. METHOD: This is a retrospective case-control study using a psychiatric case register. Cross-sectional data were obtained from 322 mFND patients and 644 psychiatry controls who had had contact with SLaM between 1st January 2006 and 31st December 2016. RESULTS: A slightly lower proportion of mFND patients received medication compared to controls (76.6% v. 83.4%, OR: 0.59, CI: 0.39-0.89, p < 0.05). Of medication recipients, mFND patients were prescribed a higher number of agents (mean: 4.7 v 2.9, p = 0.001) and had higher prescription rates of antidepressants, anti-epileptics, analgesics, and certain non-psychotropic medications. Higher numbers of prescriptions were associated with co-morbid physical conditions, and previous psychiatric admissions. CONCLUSIONS: This is the first study to describe medication prescriptions in a large cohort of mFND patients. Patients were prescribed a wide range of psychiatric and physical health medications, with higher rates of polypharmacy than controls. Psychotropic medication prescription is not necessarily the first line treatment for mFND, where physiotherapy and psychotherapy may be offered initially. There is limited, early-phase evidence for pharmacological therapies for mFND, and as such, the benefit-to-risk ratio of prescribing in this complex and poorly understood disorder should be carefully assessed.

Psicossomática: um fenômeno entre o saber e o gozo / Psychosomatics: a phenomenon between knowledge and jouissance / Psicosomática: un fenómeno entre el saber y el goce

O presente artigo se propõe a investigar o fenômeno psicossomático na clínica psicanalítica a partir das proposições freudo-lacanianas. Primeiramente, diferenciaremos o sintoma conversivo na histeria do acometimento corporal na psicossomática, apresentando a distância entre um sintoma e um fenômeno clínico. Entendemos que a psicossomática diferentemente do sintoma não porta uma mensagem passível de interpretação, é, antes, efeito de uma escrita que não pode ser lida. Uma escrita que sem a devida ascensão ao simbólico, mantém-se cristalizada no campo do gozo, portanto, sem representação psíquica. Para empreendermos essa discussão traremos a noção de letra em Lacan e, por fim, problematizaremos as possibilidades de atuação da psicanálise nos casos de psicossomática

The present article proposes to investigate the psychosomatic phenomenon in the psychoanalytic clinic from the Freudo-Lacanian propositions. First, we will differentiate the converting symptom in the hysteria of the bodily affection in psychosomatic, presenting the distance between a symptom and a clinical phenomenon. We understand that psychosomatics differently from the symptom does not carry a message that can be interpreted, it is rather an effect of a writing that cannot be read. A writing that, without the proper ascent to the symbolic, remains crystallized in the field of jouissance, therefore, without psychic representation. In order to undertake this discussion, we will bring the notion of letter in Lacan and, finally, we will problematize the possibilities of psychoanalysis in the cases of psychosomatics

El presente artículo se propone investigar el fenómeno psicosomático en la clínica psicoanalítica a partir de las proposiciones freudo-lacanianas. Primero diferenciaremos el síntoma conversivo en la histeria del acometimiento corporal en la psicosomática, presentando la distancia entre un síntoma y un fenómeno clínico. Entendemos que la psicosomática diferentemente del síntoma no porta un mensaje pasible de interpretación, es, antes, efecto de una escritura que no puede ser leída. Una escritura que sin la debida ascensión a lo simbólico, se mantiene cristalizada en el campo del goce, por lo tanto, sin representación psíquica. Para emprender esa discusión traemos la noción de letra en Lacan y, por fin, problematizaremos las posibilidades de actuación del psicoanálisis en los casos de psicosomática

A noção de "pensamento operatório", de Pierre Marty: Marcas distintivas e referências freudianas / Pierre Marty's notion of "operational thinking": distinctive features and Freudian references

Pierre Marty se destacou como o principal expoente da chamada Escola Psicossomática de Paris, a qual desenvolveu, com base em pressupostos psicanalíticos, um modelo teórico original sobre a interface mente-corpo. O autor afirmou que apoiou sua obra sobretudo nas concepções de Freud acerca do pré-consciente. Porém, talvez não tenha detalhado suficientemente as referências freudianas da noção de "pensamento operatório", uma de suas mais importantes inovações. Assim, o presente artigo tem como objetivo delinear as marcas distintivas do pensamento operatório descrito por Marty e estabelecer algumas relações com hipóteses de Freud. Relacionamos o mecanismo somático que estaria no cerne do pensamento operatório com aquele que, de acordo com Freud, operaria nas neuroses atuais. Além disso, argumentamos que o pensamento operatório consistiria em um meio-termo entre o pensamento prático e o pensamento teórico como definidos na obra inicial de Freud, já que em tal condição a possibilidade de uma atividade representacional e abstrata estaria prejudicada e a linguagem seria subsumida à atividade concreta.

Pierre Marty stood out as the main exponent of the so-called Paris Psychosomatic School, which developed an original theoretical model of the mind-body interface, based on psychoanalytic assumptions. Marty claimed to have based most of his work on Freud's concept of preconscious, although he may not have sufficiently detailed the Freudian inspiration of his notion of "operational thinking", one of his most important innovations. This article aims to outline the main features of the operational thinking such as described by Marty and establish some of its connections with Freud's hypotheses. In particular, the somatic mechanism at the heart of the operational thinking is related to the one that, according to Freud, is at work in the actual neuroses. It is argued that operational thinking is halfway between practical thinking and theoretical thinking, as defined in Freud's early work. In the operational thinking, the capacity for representational and abstract mental activity is impaired and language is subordinated to concrete activity.

A interface mente-corpo em Sándor Ferenczi: perspectiva histórica dos primórdios da Psicossomática Psicanalítica / The mind-body interface in Sándor Ferenczi: a historical perspective of the Psychoanalytic Psychosomatics beginnings

Este estudo teve como objetivo principal apresentar as concepções de Sándor Ferenczi (1873-1933) sobre a interface mente-corpo, destacando, sobretudo, dois conceitos fundamentais propostos pelo autor, a saber: patoneurose e neurose de órgão. Salientamos que o autor, fundamentando-se em Freud, recorre ao modelo teórico da histeria ao aludir às patoneuroses, mas alinha seu posicionamento às formulações acerca das neuroses atuais, ao descrever as neuroses de órgão. Dessa forma, sustentamos que as contribuições de Ferenczi forneceram subsídios de grande relevância para os progressos posteriores no campo da Psicossomática Psicanalítica, ainda que tal fato muitas vezes não seja devidamente reconhecido.

This study's primary objective was to present Sándor Ferenczi's (1873-1933) understanding regarding the mind-body interface, emphasizing two fundamental concepts proposed by the author: pathoneurosis and organ neurosis. Note that, based on his understanding of Freud, the author resorts to the theoretical model of hysteria to introduce pathoneuroses but aligns his position with the formulations of actual neuroses to describe organ neuroses. Therefore, we argue that Ferenczi provided very important support for further advancements in the field of Psychoanalytic Psychosomatics, even though this fact is often not properly acknowledged.

The management of fibromyalgia from a psychosomatic perspective: an overview.

Fibromyalgia (FM) is a central sensitization syndrome characterized by chronic widespread pain. FM is often comorbid with psychiatric disorders, as well as psychological distress that worsens the quality-of-life of people affected. The aim was to collect current evidence about the management of FM from a psychosomatic perspective. The literature was synthesized and summarized in a narrative format. The literature search was carried out in PubMed; review articles, meta-analysis, overview, and guidelines published in the last 10 years written in English were included. Five main topics (Diagnostic criteria of FM; Pathogenesis of chronic widespread pain in FM; Early stress and trauma as predisposing factors for central sensitization; FM and Psychiatric comorbidity; Implications for treatment) were pointed out and discussed. Much evidence underlies the importance of considering and treating the comorbidity of FM with psychiatric disorders and psychological factors that affect pain management. Validation of FM as a central sensitization syndrome by a clinician facilitates therapeutic strategies that involve patients as active participants in the pain management process, likely leading to improved outcomes.

Corpo, luto e representação no campo analítico: algumas reflexões sobre a psicossomática hoje / Body, grief and representation in the analytic field: some reflections upon psychosomatics today

O autor, contrário a existência de estruturas psicopatológicas fixas, posiciona-se em defesa da expressão psicossomática como uma via possível para a manifestação de inscrições ainda não representadas e contidas em zonas psíquicas específicas. A partir do conceito de regrediência dentro do campo analítico, mostra que o analista poderá auxiliar no caminho representacional das referidas inscrições arcaicas, balizado pela autoanálise constante e pela supervisão. A seguir, mostra que a evolução patológica de um processo de luto, estruturado pela desmentida da perda e cindindo o Ego, poderia produzir uma melancolia corporal: presença e retorno do objeto desmentido através do corpo. Por fim, o autor alerta que dentro da elaboração analítica do luto de um objeto arcaico perdido, o analista deverá contrabalançar o estímulo à neurose transferencial com momentos de posposição ou mesmo de anulação do investimento pulsional, ausentando-se suficientemente como objeto transferencial da pulsão, de forma a não contribuir para uma possível saída somática deste luto em decorrência do processo analítico(AU)

The author, who does not agree with the existence of fixed psychopathological structures, defends the psychosomatic expression as a possible way of manifesting inscriptions that are not yet represented and contained in specific psychic areas. Starting from the concept of regredience within the analytic field, he shows that the analyst may be of assistance as far as the representational path of archaic inscriptions is concerned, based on continuing self-analysis and supervision. Subsequently, the author points out that the pathological evolution of the grief process, based on the disavowal of the loss and the splitting of the Ego, could give rise to bodily melancholia: the presence and return of the disavowed object through the body. Finally, the author warns that within the analytic elaboration of grief regarding a lost archaic object, the analyst should counterbalance the stimulus to the transference neurosis with moments of postponement or even annihilation of the drive investment, withdrawing himself sufficiently as transference object of the drive, so as not to contribute to a possible somatic outlet of this grief arising from the analytic process(AU)

El autor, contrario a la hipótesis de la existencia de estructuras psicopatológicas fijas, se posiciona en defensa de la expresión psicosomática como una vía posible para la manifestación de inscripciones aún no representadas y contenidas en zonas psíquicas específicas. Partiendo del concepto de regrediencia dentro del campo analítico, muestra que el analista podrá ayudar en el camino representacional de dichas inscripciones arcaicas apoyándose en el autoanálisis constante y en la supervisión. A continuación, muestra que la evolución patológica de un proceso de duelo, estructurado por el desmentido de la pérdida y escindiendo el Ego, podría producir una melancolía corporal: presencia y retorno del objeto desmentido por medio del cuerpo. Por último, el autor advierte que dentro de la elaboración analítica del duelo de un objeto arcaico perdido, el analista deberá contrarrestar el estímulo a la neurosis transferencial con momentos de posposición o aun de anulación de la investidura pulsional, ausentándose suficientemente como objeto transferencial de la pulsión, evitando, así, contribuir a una posible salida somática de ese duelo en el transcurso del proceso analítico(AU)

Da tradição em Psicossomática às Considerações da Daseinsanálise / From Psychosomatic tradition to considerations on Daseinsanalysis / De la tradición en Psicosomática a las consideraciones del Daseinanalyse

Resumo Este artigo busca refletir sobre a dualidade entre soma e psique, que tende a obscurecer a unidade originária a partir da qual esses dois entes podem aparecer e serem compreendidos. Em seguida, conduz o leitor para uma compreensão crítica, lidando com aspectos da tradição em psicossomática e com base na fenomenologia-hermenêutica de Martin Heidegger e na Daseinsanalyse de Medard Boss. Tanto o filósofo alemão quanto o psiquiatra suíço operam não somente a desconstrução da ótica tradicional, mas também do próprio conceito de psicossomática. Mostram que o modo de acesso ao fenômeno produz a dicotomia, sendo, portanto, necessário modificá-lo a fim de apreender o que está em jogo no problema do corpo e do adoecer, isto é, a própria existência do homem que se revela todo o tempo através do corporar (Leiben), que é sempre gesto. Este último significa, em Heidegger, toda expressão do homem, indissociável de seu existir no mundo como Dasein. Este estudo tem a expectativa de contribuir na busca de outros fundamentos para a prática do cuidado psicológico em saúde....(AU)

Abstract The article presents aspects of the psychosomatic tradition and attempts to reflect on the duality generated between soma and psyche, which tends to overshadow the original unity from which these two entities can appear and be understood. Subsequently, it leads the reader to a critical comprehension based on Martin Heidegger’s hermeneutic phenomenology and Medard Boss’ dasensanalysis. Both the German philosopher and the Swiss psychiatrist dismantle not only the traditional view but also the concept of psychosomatics. They argue that the route of access to the phenomenon produces a dichotomy, which therefore proves itself necessary to be modified so that one can perceive what is at stake in terms of the body and of getting ill, i.e., the human existence which at all times reveals itself through bodying (Leiben), which is always gesture. The former means, in Heidegger, each human expression which is indistinguishable from their existence in the world as Dasein. Thus, this article contributes to the search of other fundamentals for the psychological practice in healthcare....(AU)

Resumen El artículo presenta los aspectos de la tradición en psicosomática y reflexiona sobre la dualidad engendrada entre soma y psique, que tiende a ocultar la unidad originaria desde la que estos dos entes pueden aparecer y ser comprendidas. Luego, conduce al lector a una comprensión crítica basada en la fenomenología- hermenéutica de Martin Heidegger y el Daseinanalyse de Medard Boss. Tanto el filósofo alemán como el psiquiatra suizo hacen no solo la deconstrucción de la óptica tradicional, sino también del propio concepto de psicosomática. Ellos enseñan que el modo de acceso al fenómeno produce dicotomía y por lo tanto, es necesario modificarlo para captar lo que está en juego en el problema del cuerpo y del enfermar, es decir, la existencia misma del hombre se revela todo el tiempo por medio de la corporalidad (Leiben), que siempre es gesto. Gesto para Heidegger significa toda expresión del hombre, inseparable de su existencia en el mundo como Dasein. Se cree que con esto se está contribuyendo a la búsqueda de otros fundamentos para la práctica del cuidado psicológico en las instituciones que cuidan de la salud....(AU)

As noções de trauma e regressão nos escritos de Sándor Ferenczi e suas possíveis articulações com as propostas teóricas da Escola Psicossomática de Paris / The concepts of trauma and regression in Sándor Ferenczi's work, and their possible articulations with the theoretical proposals of the Paris Psychosomatic School / Las nociones de trauma y de regresión en los escritos de Sándor Ferenczi y sus posibles vínculos con las propuestas teóricas de la Escuela Psicosomática de París

Neste estudo, temos como objetivo discutir as noções de trauma e regressão nos escritos de Sándor Ferenczi e suas possíveis articulações com as propostas da Escola Psicossomática de Paris, em particular aquelas estabelecidas por Pierre Marty. Ao tratar da imbricação entre corpo e psique para compreender a traumatogênese, a angústia e a formação de sintomas desprovidos de conteúdo representacional, associados a movimentos regressivos, Ferenczi esboça uma teorização que virá a convergir com desenvolvimentos posteriores no campo da psicossomática psicanalítica. Em nosso entendimento, há um diálogo fecundo a ser construído entre as últimas teses de Ferenczi e as formulações teóricas e clínicas de Marty, malgrado o fato de este não ser apontado como um leitor daquele. Consideramos possível reconhecer certas raízes ferenczianas, sobretudo acerca das noções de trauma e regressão, nas proposições teóricas de Marty, nomeadamente aquelas relativas às noções de pensamento operatorio, desorganização progressiva e regressão somática.

This paper aims to discuss both concepts of trauma and regression in Sándor Ferenczi's work, and its possible connections with the proposals of the Paris Psychosomatic School, particularly those established by Pierre Marty. By bringing up the imbrication between soma and psyche in order to understand the genesis of trauma, angst, and the development of symptoms (symptoms without any representational content and associated to regressive movements), Ferenczi outlines a theory which is going to converge towards later progress in the field of psychoanalytic psychosomatics. Although Marty has never been known to read Ferenczi's work, we believe that there is a fruitful dialogue to be built between Ferenczi's latest theories and Marty's theoretical and clinical formulations. Therefore, we think it may be found certain Ferenczian roots, especially concerning both concepts of trauma and regression, in Marty's theoretical proposals, specifically those related to his ideas of operative thinking, progressive disorganization, and somatic regression.

Este estudio analizará las nociones de trauma y de regresión en los escritos de Sándor Ferenczi y sus posibles vínculos con las propuestas de la Escuela Psicosomática de París, en particular las establecidas por Pierre Marty. Al tratar de la unidad establecida entre cuerpo y psique para entender la génesis del trauma, la angustia y la formación de síntomas que carecen de contenido representacional, asociados con movimientos regresivos, Ferenczi esboza una teoría que convergerá con los desarrollos posteriores en el campo de la psicosomática psicoanalítica. Hay un diálogo rentable hecho entre las últimas teorías de Ferenczi y las formulaciones teóricas y clínicas de Marty, a pesar de que este último no sea reconocido como un lector de Ferenczi. En última instancia, consideramos posible notar ciertas raíces ferenczianas, especialmente en relación a las nociones de trauma y de regresión, en las proposiciones teóricas hechas por Marty, en particular en las nociones de pensamiento operatorio, desorganización progresiva y regresión somática.

Anxiety Sensitivity in Dermatological Patients.

BACKGROUND: Anxiety symptoms commonly occur in dermatological patients and can affect the severity of dermatological symptoms. Anxiety sensitivity (AS), defined as the fear of anxiety symptoms, is a well-supported cognitive vulnerability factor that may be particularly significant in these patients. OBJECTIVE: This study compared the severity of AS between patients with psychodermatological (e.g., psoriasis) and nonpsychodermatological disorders (e.g., skin cancer). It was predicted that individuals with psychodermatological disorders would evidence significantly greater AS compared to individuals with nonpsychodermatological disorders. METHOD: Adults presenting to outpatient dermatology clinics with psychodermatological (n = 63) and nonpsychodermatological (n = 52) conditions completed self-report questionnaires assessing sociodemographic characteristics, general anxiety, and AS. RESULTS: Individuals with psychodermatological conditions reported significantly greater AS compared to individuals with nonpsychodermatological conditions (p < 0.05). Social concerns of AS emerged as the only significant factor that differentiated these categories of dermatological diseases, odds ratio = 1.13, 95% CI: 1.02-1.24, after adjusting for general anxiety. CONCLUSIONS: These findings contribute to an advancing area of research linking AS and physical health problems. The results suggest that adjunctive cognitive-behavioral treatments targeting AS reductions could help patients with psychodermatological conditions.

Por uma proposta baudrillardiana em psicossomática e psicanálise contemporâneas: algumas ponderações concernentes aos fenômenos corpo e alma na obra Da sedução / For a baudrillardian proposition in contemporary psychosomatics and psychoanalysis: some weightings concerning body and soul phenomena in Seduction piece of work

Resumo Jean Baudrillard, pensador francês contemporâneo, apresenta críticas instigantes à Psicanálise e à sociedade atuais, sua original teoria pode vir a contribuir significativamente em releituras de práticas e conceitos do modo como se desenvolve o cuidado em Saúde (Psicanálise e Psicossomática, mais estritamente abordadas aqui). Seu conceito de sedução conjuga-se com a crítica laplanchiana ao abandono da teoria da sedução frente à teoria da sexualidade, nos primórdios dos desenvolvimentos teóricos freudianos; ambas noções entrecruzadas podem possibilitar substantiva transvaloração de conceitos, quando articuladas com linhas psicanalíticas e psicossomáticas ortodoxas, podendo vir a impactar virtuosamente em práticas clínicas e sociais das mesmas.(AU)

Abstract Jean Baudrillard, French contemporary thinker, presents instigating critiques towards current Psychoanalysis and society, his original theory may contribute significantly in re-readings of practices and concepts in the way how it is developed care in Health (Psychoanalysis and Psychosomatics, more strictly here). His seduction concept goes hand in hand with laplanchian critique about the abandonment of seduction theory due to the outcoming of the theory of sexuality, in early times of freudian theoretical developments; both notions intercrossed may provide substantive transvaluation of concepts, while articulated with orthodox Psychoanalytical and Psychosomatical streams, which may virtuously impact in their clinical and social practices.(AU)

Psychosomatic breast and alexithymic breast: A Bionian psychosomatic perspective.

The author develops the concept of 'psychosomatic breast' in both clinical and theoretical terms, a concept developed by Bion (1962b) to account for a breast in charge of primary symbolization and of the psychosomatic integration of the infant's raw physiological, emotional and sensory experiences. As such, the psychosomatic breast is a prototype, a core in the mother endowed with the capacity for reverie insofar as the transformative function of the latter not only pertains to the primary symbolization of emotional life, but also to its secondary symbolization. The author contends that a primal failure in the transformation of such raw emotional and sensory experiences through the reverie of primary objects results in the incorporation of an 'alexithymic breast' - a kind of obstructive object that has become impervious to communication via projective identification and has been internalized as a source of psychic and physical breakdown. This early deficiency in parental reverie is experienced by the infant as a primitive disaster that establishes a point of fixation, a fault line in psychosomatic organization which the individual is likely to regress to, at a later stage, by developing physical illness. The author illustrates the dynamics and the economy of the conflict between psychosomatic and alexithymic breasts thanks to fragments from the analysis of a woman who developed cancer in the course of her psychoanalysis and was eventually cured.

A desconstrução da psicossomática na análise existencial de Heidegger e Boss / The deconstruction of psychosomatics in Heidegger’s and Boss’ Daseinsanalysis / La déconstruction de la psychosomatique dans la Daseinsanalyse de Heidegger et de Boss / La deconstrucción de la psicosomática en el análisis existencial de Heidegger y de Boss / Die Dekonstruktion des Psychosomatischen in der Daseinsanalyse von Heidegger und Boss / 在海德格尔和博斯的存在注意分析的心身解构

O presente artigo coloca em questão a compreensão tradicional da psicossomática por meio da dicotomia soma e psique e a relação de causalidade presente nessa tradição para, então, mediante uma perspectiva crítica, propor outra compreensão, com base na fenomenologia-hermenêutica de Heidegger e a Daseinsanálise de Boss. Este coloca, ainda, em questão a denominação psicossomática que mantém a dualidade da qual se pretende libertar.

This article brings into question the traditional understanding of psychosomatics by taking into account the dichotomy between soma and psyche and the causal relation present in this tradition. It suggests, from a critical point-of-view, a different understanding based on Heidegger’s phenomenology-hermeneutics and Boss’ Daseinsanalysis. This article also calls into question the term ‘psychosomatics’, which preserves the duality that has to be eliminated.

Cet article remet en question le concept traditionnel de la psychosomatique au moyen de la dichotomie entre soma et psyché et du rapport de causalité qui caractérise cette tradition. Par la suite, il propose, à partir d’un point-de-vue critique, une autre compréhension basée sur la phénoménologie herméneutique de Heidegger et sur la Daseinsanalyse de Boss, et met également en question le terme « psychosomatique ¼ qui préserve la dualité qu’on cherche à supprimer.

El presente artículo cuestiona la comprensión tradicional de la psicosomática mediante la dicotomía soma y psique, además de la relación de causalidad presente en esa tradición para proponer, a través de una perspectiva crítica, otro entendimiento basado en la fenomenología-hermenéutica de Heidegger y en el análisis del Dasein de Boss, que además pone en entredicho la palabra “psicosomática”, que mantiene la dualidad de la cual pretende liberarse.

Dieser Artikel stellt das traditionelle Konzept des Psychosomatischen in Frage und stützt sich dabei auf die Dichotomie zwischen Soma und Psyche, sowie auf die Kausalitätsbeziehung, die dieser Tradition zu eigen ist. Mittels einer kritischen Perspektive schlägt dieser Artikel ein neues Konzept vor, das auf Heideggers Phänomenologie-Hermeneutik und der Daseinsanalyse von Boss basiert. Boss stellt dabei den Begriff „Psychosomatik“ in Frage, da er die Dualität beinhaltet, von der man sich zu befreien versucht.

本文提出分析对心身的传统，其对索玛和精神的二分法及因果关系。在此基础上再通过所以通过海德格尔的现象-诠释学和博斯的存在分析从一个批判的角度建立另一个认识。他虽然希望脱离但还保持身心定义中的双重性。.

Aspects of the non-pharmacological treatment of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is one of the most commonly diagnosed gastrointestinal conditions. It represents a significant healthcare burden and remains a clinical challenge. Over the years IBS has been described from a variety of different perspectives; from a strict illness of the gastrointestinal tract (medical model) to a more complex multi-symptomatic disorder of the brain-gut axis (biopsychosocial/psychosomatic model). In this article we present aspects of the pathophysiology and the non-pharmacological treatment of IBS based on current knowledge. Effects of conditioned stress and/or traumatic influences on the emotional system (top-down) as well as effects on the intestine through stressors, infection, inflammation, food and dysbiosis (bottom-up) can affect brain-gut communication and result in dysregulation of the autonomic nervous system (ANS), playing an important role in the pathophysiology of IBS. Conditioned stress together with dysregulation of the autonomic nervous system and the emotional system may involve reactions in which the distress inside the body is not recognized due to low body awareness. This may explain why patients have difficulty identifying their symptoms despite dysfunction in muscle tension, movement patterns, and posture and biochemical functions in addition to gastrointestinal symptoms. IBS shares many features with other idiopathic conditions, such as fibromyalgia, chronic fatigue syndrome and somatoform disorders. The key to effective treatment is a thorough examination, including a gastroenterological examination to exclude other diseases along with an assessment of body awareness by a body-mind therapist. The literature suggests that early interdisciplinary diagnostic co-operation between gastroenterologists and body-mind therapists is necessary. Re-establishing balance in the ANS is an important component of IBS treatment. This article discusses the current knowledge of body-mind treatment, addressing the topic from a practical point of view.