Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients.

OBJECTIVE: Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC). METHODS: BSC recruited from a surgical clinic (N = 213, 82.2% women, 43 [SD 12] years, mean BMI: 49 [SD 9] kg/m2 ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms. RESULTS: After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion. CONCLUSIONS: The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.

Lifetime patterns of comorbidity in eating disorders: An approach using sequence analysis.

OBJECTIVE: Eating disorders (EDs) have high rates of psychiatric comorbidity. This study aimed to characterize longitudinal patterns of comorbidities in adults with EDs. METHODS: Sequence analysis and hierarchical clustering were applied to ages of onset and recency for select eating, substance, mood, and anxiety disorders from the 479 participants in the Collaborative Psychiatric Epidemiology Surveys with lifetime DSM-IV bulimia nervosa, binge eating disorder, or anorexia nervosa. External validators were compared across clusters using chi-square tests. RESULTS: Five clusters were identified among individuals with any lifetime ED based on longitudinal sequence of psychiatric disorder onset and remission, characterized as: (1) multi-comorbid with early onset of comorbid disorder (46%); (2) moderate preeminent anxiety with moderate comorbidity and low ED persistence (20%); (3) late ED onset with low comorbidity (15%); (4) early onset, persistent ED with low comorbidity (14%); and (5) chronic, early onset depression (5%). Clusters were well differentiated by significant differences in age, body mass index, race, and psychiatric indicators. CONCLUSIONS: This study demonstrates a new method to assess clustering of comorbidity among individuals with lifetime EDs. Having a psychiatric diagnosis prior to an ED was associated with greater psychopathology and illness duration. Information on timing of diagnoses may allow for more refined comorbidity classification.

Personality psychopathology: Longitudinal prediction of change in body mass index and weight post-bariatric surgery.

OBJECTIVE: Bariatric surgery is an effective treatment for obesity, which has been increasing worldwide. However, bariatric surgery causes dramatic physical changes that can cause significant stress. Prior research has found that psychological variables such as personality traits and levels of psychopathology can influence success after bariatric surgery (in terms of body mass index [BMI] reduction and weight loss). However, most prior studies have been limited by small sample sizes, inconsistent follow up, and categorical assessment of psychopathology. METHOD: The present study examines the predictive utility of the Personality Assessment Inventory (PAI) scales for three bariatric surgery outcomes (BMI reduction, weight loss, and percent excess weight loss [%EWL]) across 10 follow-up points 5 years after surgery. It also examines the largest sample of bariatric surgery-completing patients (N = 2,267) on the PAI to date. Latent growth modeling was used to examine change in the outcome variables. RESULTS: Results indicate that personality and psychopathology variables predicted less BMI reduction, weight loss, and %EWL 5 years after surgery and also affected the trajectories of change in the outcome variables across time. The PAI scales predicted more variance in the 5-year BMI outcomes than did age and gender. The most robust effects were for scales assessing phobias, traumatic stress, identity problems, and negative relationships. CONCLUSION: The PAI may be useful to clinical health psychologists who conduct recommended psychological evaluations with potential bariatric surgery candidates. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Using network analysis to examine links between individual depressive symptoms, inflammatory markers, and covariates.

BACKGROUND: Studies investigating the link between depressive symptoms and inflammation have yielded inconsistent results, which may be due to two factors. First, studies differed regarding the specific inflammatory markers studied and covariates accounted for. Second, specific depressive symptoms may be differentially related to inflammation. We address both challenges using network psychometrics. METHODS: We estimated seven regularized Mixed Graphical Models in the Netherlands Study of Depression and Anxiety (NESDA) data (N = 2321) to explore shared variances among (1) depression severity, modeled via depression sum-score, nine DSM-5 symptoms, or 28 individual depressive symptoms; (2) inflammatory markers C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α); (3) before and after adjusting for sex, age, body mass index (BMI), exercise, smoking, alcohol, and chronic diseases. RESULTS: The depression sum-score was related to both IL-6 and CRP before, and only to IL-6 after covariate adjustment. When modeling the DSM-5 symptoms and CRP in a conceptual replication of Jokela et al., CRP was associated with 'sleep problems', 'energy level', and 'weight/appetite changes'; only the first two links survived covariate adjustment. In a conservative model with all 38 variables, symptoms and markers were unrelated. Following recent psychometric work, we re-estimated the full model without regularization: the depressive symptoms 'insomnia', 'hypersomnia', and 'aches and pain' showed unique positive relations to all inflammatory markers. CONCLUSIONS: We found evidence for differential relations between markers, depressive symptoms, and covariates. Associations between symptoms and markers were attenuated after covariate adjustment; BMI and sex consistently showed strong relations with inflammatory markers.

Personality Disorders as Emergent Interpersonal Syndromes: Psychopathic Personality as a Case Example.

Personality disorders have long been bedeviled by a host of conceptual and methodological quandaries. Starting from the assumption that personality disorders are inherently interpersonal conditions that reflect folk concepts of social impairment, the authors contend that a subset of personality disorders, rather than traditional syndromes, are emergent interpersonal syndromes (EISs): interpersonally malignant configurations (statistical interactions) of distinct personality dimensions that may be only modestly, weakly, or even negatively correlated. Preliminary support for this perspective derives from a surprising source, namely, largely forgotten research on the intercorrelations among the subscales of select MMPI/MMPI-2 clinical scales. Using psychopathic personality as a case example, the authors offer provisional evidence for the EIS hypothesis from four lines of research and delineate its implications for personality disorder theory, research, and classification. Conceptualizing some personality disorders as EISs elucidates long-standing quandaries and controversies in the psychopathology literature and affords fruitful avenues for future investigation.

Abbreviated assessment of psychopathology in patients with suspected seizure disorders.

PURPOSE: Psychopathology is common in patients undergoing investigation for seizure-related disorders. Psychometric examination using self-report instruments, such as the Symptom Checklist 90 - Revised (SCL-90-R), can assist diagnosis. The SCL-90-R, however, is a lengthy instrument and might not be tolerated by all patients. We assessed several abbreviated forms of the SCL-90-R in patients undergoing video encephalographic monitoring (VEM). METHOD: Six hundred eighty-seven patients completed the SCL-90-R, and scores were computed for the full SCL-90-R and five abbreviated forms. Correlations and mean differences were computed between different forms. Classification accuracy was assessed via receiver operating characteristic (ROC) curves, and measurements models were examined using confirmatory factor analysis (CFA). RESULTS: All abbreviated forms were strongly correlated with the SCL-90-R for general psychopathology (r = 0.93-0.99), depression (r = 0.89-0.95), anxiety (r = 0.97-0.98), psychosis (r = 0.95-0.99), and obsessive-compulsive symptoms (r = 0.97). Classification performance was similar across forms for depression and anxiety, with high negative predictive values (0.90-0.94) and lower positive predictive values (0.34-0.38). Classification performance for psychotic and obsessive-compulsive disorders was poor. Differences were observed between the full SCL-90-R and its abbreviated forms across most domains (d = 0.00-0.65). The published measurement model was most strongly validated for the SCL-27, SCL-14, and the SCL-K-9. CONCLUSIONS: These five SCL-90-R abbreviated forms show high convergent validity with the full version. In patients undergoing investigation for seizure-related disorders, the Brief Symptom Inventory full form (BSI) or short form (BSI-18) is most appropriate where screening for both depression and anxiety is required. The SCL-K-9 is appropriate when only a single measure of global psychological distress is required. None of the instruments were able to detect psychotic or obsessive-compulsive symptoms with great accuracy. Caution should be exercised when making direct comparisons across the different forms.

Racial Comparisons of Postoperative Weight Loss and Eating-Disorder Psychopathology Among Patients Following Sleeve Gastrectomy Surgery.

OBJECTIVE: This study aimed to examine racial differences in postoperative eating-disorder psychopathology, psychosocial functioning, and weight loss among adults with loss-of-control (LOC) eating following sleeve gastrectomy. METHODS: Participants were 123 patients (n = 74 non-Hispanic White and n = 49 non-Hispanic Black) who underwent sleeve gastrectomy surgery within the previous 4 to 9 months and reported regular LOC eating during the previous month. The Eating Disorder Examination Bariatric Surgery Version assessed LOC eating, eating-disorder psychopathology, and meal patterns. Participants completed self-report measures, including the Beck Depression Inventory-II and Medical Outcomes Study Short-Form Health Survey. RESULTS: Presurgical BMI did not differ by race, but Black patients had significantly less percent total weight loss and percent excess weight loss than White patients. Black and White patients did not differ significantly in LOC eating frequency, onset time of postoperative LOC eating, eating-disorder psychopathology, depressive symptoms, or physical or mental health-related quality of life. White patients were significantly more likely to meet criteria for lifetime binge-eating disorder than Black patients. Black patients were significantly more likely to skip breakfast and dinner and engage in night eating than White patients. CONCLUSIONS: Our findings suggest that among patients with LOC eating following sleeve gastrectomy surgery, there exist few racial differences in current eating-disorder psychopathology and psychosocial functioning, although Black patients achieved less weight loss than White patients.

Conceptualizing the role of disgust in avoidant/restrictive food intake disorder: Implications for the etiology and treatment of selective eating.

Selective eating is a common presenting problem in Avoidant/Restrictive Food Intake Disorder (ARFID). Understanding the etiology of selective eating will lead to the creation of more effective treatments for this problem. Recent reports have linked disgust sensitivity to picky eating, and the field has yet to conceptualize the role that disgust might play in ARFID. Disgust has long been tied to formation of taste aversions and is considered at its core to be a food-related emotion. A brief review of the literature on disgust reveals that disgust has a unique psychophysiological profile compared to other emotions, like anxiety, and that disgust is resistant to extinction procedures. If disgust is implicated in the etiology of selective eating, its presence would have a significant impact on treatment approaches. This article provides an overview of the research on disgust and eating, a clinical example of the treatment challenges that disgust may pose, and an overview of the unique clinical features of disgust as they apply to psychopathology. We pose several research questions related to disgust and selective eating and discuss initial hypotheses for pursing this line of inquiry. Finally, we discuss the possible implications of this line of research for treatment.

Problematic eating behaviors and psychopathology in patients undergoing bariatric surgery: The mediating role of loss of control eating.

OBJECTIVE: This study compares different problematic eating behaviors (PEBs; objective [OBE]/subjective [SBE] binge-eating and compulsive [CG]/noncompulsive [NCG] grazing) in relation to the severity of loss of control (LOC) and psychopathology. We also investigate LOC as a mediator between PEBs and psychopathology. METHOD: This cross-sectional study assessed a group of patients before bariatric surgery (n = 163), and a group of bariatric patients 12 months or more after surgery (n = 131). Face-to-face assessment: Eating Disorders Examination for binge-eating episodes; Rep(eat) for grazing. LOC was measured by five questions answered in a 5-point Likert scale. Self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. RESULTS: OBEs were reported by 26(8.8%), SBE by 29(9.8%), CG by 35(11.9%), and NCG by 36(12.2%) of patients. The different PEBs differed significantly in the severity of LOC (F(3,120)= 25.81, p < .001). Patients reporting OBEs scored higher and patients with NCG scored lower in most measures than patients with other PEBs. Patients with any PEBs scored higher in all self-report measures than those not reporting any PEBs, with statistical significance reached for uncontrolled eating (F(4,288)= 20.21, p < .001), emotional eating (F(4,288)= 23.10, p < .001), repetitive eating F(4,288)= 18.34, p < .001), and compulsive grazing (F(4,288)= 27.14, p < .001). LOC was found to be a full mediator between PEBs and psychopathology. DISCUSSION: There is no evidence that the different PEBs differ in the psychopathology severity, independently of the experience of LOC eating during the eating episodes. We show evidence for the conceptualization of different PEB, including grazing, on a continuous scale of LOC and psychopathology.

Mental disorder screening on cancer patients before and after radiotherapy and at the 1-month follow-up.

BACKGROUND: The aim was to study the accuracy of different screening tests to detect psychopathological disorders in cancer patients treated with radiotherapy before (T1) and after radiotherapy (T2), and at the 1-month follow-up (T3). METHODS: The Mini International Neuropsychiatric Interview (MINI), the Hospital Anxiety and Depression Scale (HADS), and the distress thermometer (DT) (0-10) were administered, together with a depression scale (DEPQ) (1-5), an anxiety scale (ANSQ) (1-5), and a physical symptoms questionnaire, to patients treated with radiotherapy at T1 (232 participants), T2 (130 participants), and T3 (130 participants). RESULTS: The accuracy of the screening tests was higher at T2, with the HADS-T test (cut-off ≥ 10) yielding the best results: sensitivity = 0.80, specificity = 0.92, with an excellent AUC (0.91). The DT test (cut-off ≥ 4) showed a sensitivity = 0.66, a specificity = 0.91, and an AUC = 0.825, and the DEPQ (cut-off > 1) yielded a sensitivity = 0.74, a specificity = 0.78, and an AUC = 0.776. The ANSQ (cut-off > 1) showed a sensitivity = 0.60, a specificity = 0.97, and an AUC = 0.831. At T1 and T3, the sensitivity tests were unsatisfactory. The increase in sensitivity at T2 may be due to an increase of physical symptoms at such time, which occurred more frequently in those patients who scored higher on screening tests and showed mental disorders. CONCLUSIONS: The diagnostic accuracy of the screening tests was higher at T2. At this time, HADS-T proved to be a good screening instrument; whereas at T1 and T3, screening instruments were only useful to detect cases without mental disorders, but not to identify those who suffer from them.

The relationship between eating psychopathology and obstructive sleep apnea in bariatric surgery candidates: A retrospective study.

OBJECTIVE: Obstructive sleep apnea (OSA), eating psychopathology, and major depressive disorder (MDD) are highly prevalent in patients with severe obesity. Our study aimed to identify differences in binge-eating disorder (BED) prevalence in bariatric surgery candidates with and without OSA. METHODS: In this retrospective study, demographic data, psychiatric diagnoses, OSA diagnosis, binge eating, depressive and quality of life (QOL) symptoms were collected from 1,099 bariatric surgery candidates from a Canadian setting. Analysis of variance was used to identify differences in psychopathology and QOL between groups with OSA and BED, BED alone, OSA alone or neither BED or OSA. RESULTS: Study participants' mean body mass index was 49.3 kg/m2 and 52.6% had a diagnosis of OSA. Patients with OSA were significantly more likely to have a diagnosis of past BED (χ2 = 6.848, p = .009) and current MDD (χ2 = 5.165, p = .023). Binge-eating (p < .001) and depressive symptoms (p < .001) were significantly higher in patients with co-morbid BED and OSA compared to patients with OSA alone or patients with no diagnosis of BED or OSA. Patients with co-morbid BED and OSA only had significantly lower physical (p < .001) and mental QOL (p = .007) compared to patients with no diagnosis of BED or OSA. DISCUSSION: Our findings suggest that patients with a history of BED should be reassessed for OSA. Research is needed to examine whether BED may predispose individuals to developing obesity and OSA.

Substance use or abuse, internet use, psychopathology and suicidal ideation in adolescents. / Uso y abuso de sustancias psicotrópicas e internet, psicopatología e ideación suicida en adolescentes.

Substance and Internet use or abuse, psychopathology and suicidal ideation appear to be related. The aim of this study is to investigate the association between use of psychotropic substances, inadequate Internet use, suicidal ideation and other psychopathological symptoms within the adolescent population. The present study was carried out as part of the Saving and Empowering Young Lives in Europe (SEYLE) project, funded by the European Union. The sample is composed of 1026 adolescents aged between 14 and 16 years from 12 state schools in Asturias (530 men and 496 women). This study adds to the possibility of knowing whether the SEYLE data is confirmed in a relatively isolated and recession hit province of Spain. In the present study the following consumption rates were obtained: a) alcohol 11.89% in males and 7.86% in females; b) tobacco: 4.15% and 5.44 % in males and females respectively; c) other drugs: 6.98% in males and 4.44% in females; d) maladaptive or pathological Internet use: 14.53% and 20.77% in males and females respectively. The variables that predict suicide ideation in the logistic regression model were: previous suicide attempts, depression, maladaptive or pathological Internet use, peer problems and alcohol consumption.

El uso o abuso de sustancias o internet, la psicopatología y la ideación suicida parecen estar relacionadas. El objetivo del presente estudio es investigar la asociación en población adolescente entre consumo de sustancias potencialmente adictivas, uso inadecuado de internet, psicopatología e ideación suicida. El estudio forma parte del proyecto europeo Saving and Empowering Young Lives in Europe (SEYLE). La muestra está compuesta por 1026 adolescentes con edades comprendidas entre 14 y 16 años procedentes de 12 centros escolares públicos del Principado de Asturias (530 varones y 496 mujeres). El presente trabajo aporta la posibilidad de conocer si los datos generales del proyecto SEYLE varían en una zona relativamente aislada y socioeconómicamente en recesión. Las tasas obtenidas de consumo de las distintas sustancias y de uso de internet fueron: a) alcohol: 11,89% en varones y 7,86% en mujeres; b) tabaco: 4,15% y 5,44% en varones y mujeres respectivamente; c) otras drogas: 6,98% en varones y un 4,44% en mujeres; d) uso de internet desadaptativo o patológico: 14,53% y 20,77% en varones y mujeres respectivamente. Se ha observado que las variables con capacidad predictiva sobre las conductas suicidas fueron: tentativas suicidas previas, síntomas depresivos, uso desadaptativo o patológico de internet, problemas con los compañeros y consumo de alcohol.

Screening for Persistent Psychopathology in 4-Year-Old Children.

OBJECTIVE: To inform primary care screening and preventive intervention efforts, the authors examined the screening efficiency of the parent version of the Strengths and Difficulties Questionnaire (SDQP4-16) for persistent disorders relative to transient disorders and its capacity to distinguish between the two. METHODS: Persistence and transience in preschool-onset psychiatric disorders were identified by using data from a large population-based cohort study in Norwegian children initially assessed at age 4 and followed up at age 6 (n = 1038). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnoses at both time points were assigned by using the Preschool Age Psychiatric Assessment Interview, against which the SDQP4-16 was compared through receiver operating characteristics analysis. RESULTS: The screening efficiency for persistent disorders exceeded that for transient disorders with a specificity of 86.1%, a sensitivity of 79.3%, and an area under the curve value of 0.85. The SDQP4-16 was able to discriminate persistent disorders from transient disorders at an area under the curve value of 0.71. At the selected cutoff of 10, the negative predictive value was 99.6%, whereas the positive predictive value was 9.5%, partly due to the low prevalence (1.8%) of persistent disorders. CONCLUSIONS: The SDQP4-16 is a sensitive tool for detecting persistent psychiatric disorders in young children. However, a large proportion of positive screens are nonpersistent cases, as indicated by the high false-positive rate. Thus, the clinical utility of the SDQP4-16 in primary care screening for persistent disorders is uncertain, particularly in samples in which the rate of psychiatric disorders is low.

Transtornos depressivos em pacientes que buscam cirurgia plástica estética: uma visão ampla e atualizada / Depressive disorders in patients who seek cosmetic surgery: a broad and updated view

INTRODUÇÃO: A cirurgia estética pode melhorar a qualidade de vida de pacientes, porém alguns que se apresentam para o procedimento são portadores de transtornos depressivos (TD) e podem evoluir, no pós-operatório, de forma desastrosa do ponto de vista psicológico e até mesmo evoluir para o suicídio. A prevalência de TD em pacientes de cirurgia plásticaestética é em média de 20%, podendo chegar até 70%. Este artigo tem por objetivo fazer uma revisão sobre depressão e cirurgia estética bem como alertar e conscientizar os cirurgiões plásticos sobre o crescente aumento destes pacientes nos consultórios. Objetiva, ainda, orientar os cirurgiões quanto a abordagem adequada e condutas específicas perante estes. MÉTODOS: Realizou-se busca nos bancos de dados MEDLINE/PubMed e Embase e cruzamento de palavras chaves, incluindo "cirurgia plástica estética", "depressão"; "transtornos de humor", "transtorno depressivo", "sintomas depressivos", "suicídio e cirurgia plástica". RESULTADOS: O sucesso de uma cirurgia plástica depende em muito da seleção dos pacientes para o procedimento. Pacientes suspeitos, pacientes com sintomas depressivos elevados nos questionários (como o BDI) e pacientes com "marcadores" de psicopatologia deverão ser encaminhados ao psiquiatra para avaliação adequada. CONCLUSÃO: Pela elevada prevalência de TD em cirurgia plástica estética, todo paciente de cirurgia plástica deverá ser avaliado adequadamente para identificação daqueles com possíveis TD no pré-operatório e encaminhado ao psiquiatra, para assim tentar se evitar evolução psicológica desfavorável pós-operatória.

INTRODUCTION: Aesthetic surgery can improve the quality of life of patients, but some candidates for the procedure have depressive disorders (DDs) that may develop, in the postoperative period, in a disastrous manner from a psychological point of view and even progress to suicide. The prevalence of DDs in cosmetic surgery patients is 20% on average and reaches 70%. This article aims to review depression and aesthetic surgery as well as to alert and educate plastic surgeons on the growing number of these patients in clinical settings. It also aims to guide surgeons to the appropriate approach and specific behaviors with these patients. METHODS: A search was performed in MEDLINE/PubMed and Embase, and key words were entered, including "cosmetic surgery," "depression," "mood disorders," "depressive disorder," "depressive symptoms," and "suicide and plastic surgery." RESULTS: The success of plastic surgery depends a great deal on the selection of patients for the procedure. Suspect patients, patients with elevated depressive symptoms in questionnaires (such as the BDI), and patients with psychopathology "markers" should be forwarded to a psychiatrist for proper evaluation. CONCLUSION: Due to the high prevalence of DDs in aesthetic plastic surgery patients, every plastic surgery patient should be evaluated properly to identify those with possible DDs in the preoperative period, and those should be forwarded to a psychiatrist, thus avoiding an unfavorable postoperative psychological evolution.

A noção de representação em psicanálise: da metapsicologia à psicossomática / The concept of representation in psychoanalysis: from metapsychology to psychosomatics / La noción de representación en psicoanálisis: de la metapsicología a la psicosomática

Este artigo se propõe, inicialmente, a apresentar sinteticamente os aspectos fundamentais da concepção freudiana original da representação e sua relação com as origens da reflexão metapsicológica. A seguir, são descritos conceitos centrais da psicossomática psicanalítica de Pierre Marty, com destaque para o conceito de mentalização e sua relação com a atividade representacional. Também é abordada a categorização do campo das neuroses fundamentada pela teoria de Marty. Procura-se, dessa maneira, evidenciar a continuidade entre os fundamentos teóricos da psicossomática psicanalítica e a reflexão metapsicológica freudiana. Busca-se também argumentar que as resistências ainda encontradas, dentro dos meios psicanalíticos mais tradicionais, às inovações teóricas e clínicas da psicossomática psicanalítica resultam de um mal-entendido quanto aos fundamentos teóricos e à filiação conceitual desta última, uma vez que essas críticas frequentemente se justificam por um suposto afastamento entre a psicossomática e o projeto metapsicológico.

First, this paper sets out to synthetically expose some fundamental aspects of Freud's original concept of representation and its relationship with the origins of metapsychological reflection. Next, some central concepts of Pierre Marty's psychoanalytic psychosomatics are described, emphasizing the notion of mentalization and its relations to representational activity. The categorization of the field of neuroses allowed by Marty's theory is also approached. This paper, thus, underline the continuity between the theoretical foundations of psychoanalytic psychosomatics and Freud's metapsychological reflection. It is thus argued that the resistances to psychosomatics' theoretical and clinical innovations that can still be found in the more traditional psychoanalytic milieus result from the misunderstanding of its theoretical foundations and conceptual affiliation, since this criticism is often justified by psychosomatics' supposed removal from the metapsychological project.

Este trabajo se propone inicialmente a presentar brevemente los aspectos fundamentales de la concepción original de Freud sobre la representación y su relación con los orígenes de la reflexión metapsicológica. A continuación, se describen algunos de los conceptos centrales de la psicosomática psicoanalítica de Pierre Marty, con énfasis en el concepto de mentalización y su relación con la actividad de representación. También se abarca la clasificación del campo de la neurosis permitido por la teoría de Marty. Se busca mostrar la continuidad entre los fundamentos teóricos de la psicosomática psicoanalítica y el pensamiento metapsicológico freudiano. Se busca también sostener que las resistencias que todavía se encuentran, en los medios psicoanalíticos más tradicionales, a las innovaciones teóricas y clínicas de la psicosomática psicoanalítica resultan de un malentendido en cuanto a la afiliación teórica y conceptual de esta última, ya que esta crítica es a menudo justificada por un supuesto alejamiento entre la psicosomática y el proyecto metapsicológico.

A direção de pesquisa fenomenológica na psicopatologia / The direction of phenomenological research in psychopathology

É usual, na investigação de doentes mentais, diferenciar entre sintomas objetivos e subjetivos. Sintomas objetivos são todos os processos que comparecem na manifestação de modo sensorialmente perceptível: reflexos, movimentos registráveis, o rosto fotografável, excitações motoras, expressões linguísticas, produtos escritos, ações, conduta de vida, etc.; além disso, pertencem aos sintomas objetivos todas as atividades mensuráveis, como capacidade de trabalho, capacidade de exercício, atividades mnemônicas etc. Finalmente, também se costuma contar entre os sintomas objetivos, as ideias da demência, os falseamentos da recordação e coisas do tipo, em uma palavra, os conteúdos racionais de produtos linguísticos, que nós, na verdade, não percebemos sensorialmente, mas só podemos compreender; que nós, entretanto, compreendemos simplesmente através do pensar, isto é, racionalmente, sem recorrer à ajuda de qualquer transferência interior para dentro do anímico2.

Screening for autism spectrum disorders with the brief infant-toddler social and emotional assessment.

OBJECTIVE: Using parent-completed questionnaires in (preventive) child health care can facilitate the early detection of psychosocial problems and psychopathology, including autism spectrum disorders (ASD). A promising questionnaire for this purpose is the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). The screening accuracy with regard to ASD of the BITSEA Problem and Competence scales and a newly calculated Autism score were evaluated. METHOD: Data, that was collected between April 2010 and April 2011, from a community sample of 2-year-olds (N = 3127), was combined with a sample of preschool children diagnosed with ASD (N = 159). For the total population and for subgroups by child's gender, area under the Receiver Operating Characteristic (ROC) curve was examined, and across a range of BITSEA Problem, Competence and Autism scores, sensitivity, specificity, positive and negative likelihood ratio's, diagnostic odds ratio and Youden's index were reported. RESULTS: The area under the ROC curve (95% confidence interval, [95%CI]) of the Problem scale was 0.90(0.87-0.92), of the Competence scale 0.93(0.91-0.95), and of the Autism score 0.95(0.93-0.97). For the total population, the screening accuracy of the Autism score was significantly better, compared to the Problem scale. The screening accuracy of the Competence scale was significantly better for girls (AUC = 0.97; 95%CI = 0.95-0.98) than for boys (AUC = 0.91; 95%CI = 0.88-0.94). CONCLUSION: The results indicate that the BITSEA scales and newly calculated Autism score have good discriminative power to differentiate children with and without ASD. Therefore, the BITSEA may be helpful in the early detection of ASD, which could have beneficial effects on the child's development.

Somatization and somatic symptom presentation in cancer: a neglected area.

Abstract The recognition of somatization process in cancer patients is a challenging and neglected area, for the extreme difficulty in differentiating and assessing the psycho(patho)logical components from those biologically determined and related to cancer and cancer treatment, as well as for the scarce usefulness of rigid categorical DSM criteria. However, several dimensions of somatization (and the interconnected concept of abnormal illness behaviour) have been shown to be diagnosable in cancer patients and to negatively influence coping and quality of life outcomes. An integration of the formal DSM-ICD nosology with a system specifically taking into account the patients' emotional responses to cancer and cancer treatment, such as the Diagnostic Criteria for Psychosomatic Research (DCPR), is suggested. More data on some specific symptom dimensions, including pain, fatigue and sexual disorders, are needed to examine their possible psychological components. More research is also needed regarding the association of somatization with personality traits (e.g. type D distressed personality, alexithymia), developmental dimensions (e.g. attachment), and cultural issues (e.g. culturally mediated attributional styles to somatic symptoms). Also, the impact and effectiveness of specific therapeutic intervention in 'somatizing' cancer patients is necessary.

Modelos animales en psicopatología: modelos históricos y la contribución pavloviana / Animal models of psychopathology: historical models and the pavlovian contribution

La investigación con animales no humanos como sujetos experimentales, para entender el comportamiento humano, se basa en la noción darwiniana de la continuidad de las especies. En este marco encontramos modelos análogos para entender la biología y el comportamiento humanos en especies no humanas. En psicología, los modelos animales han probado ser una herramienta efectiva para el entendimiento del comportamiento humano, tanto normal como anormal. En la presente revisión discutimos cómo los modelos animales han sido usados al investigar la psicopatología. Luego de revisar tres modelos animales históricos de psicopatologías específicas, discutimos cómo los fenómenos descubiertos al estudiar el condicionamiento pavloviano han contribuido a nuestra comprensión de la etiología y mantención de la psicopatología humana, cómo la tradición pavloviana ha contribuido al desarrollo de mejores formas de tratamiento para desórdenes del comportamiento, y de forma más general, cómo los fenómenos pavlovianos se encuentran implicados en casi todas las interacciones entre un organismo y su ambiente.

Research using non-human animals as experimental subjects to understand human behavior have been based on the Darwinian notion of continuity between species. In this framework, we find analogous models to understand human biology and behavior in nonhuman species. In the scientific study of psychology, animal models have proven to be an effective tool for understanding both normal and abnormal human behaviors. In the present review, we discuss how animal models have been used in investigating psychopathology. After reviewing three historical animal models of specific psychopathologies, we discuss how phenomena discovered while studying Pavlovian conditioning have contributed to our understanding of the etiology and maintenance of human psychopathology, how the Pavlovian tradition has contributed to the development of better ways to treat these behavioral disorders, and more generally, how Pavlovian phenomena are implicated in almost all interactions between an organism and its environment.

Quality of life after surgery for temporal lobe epilepsy: a 5-year follow-up.

The authors carried out a 5-year prospective study about the effects epilepsy surgery can have on a patient's quality of life (QOL). They looked for the relationship between improvement on QOL after surgery and reduction of seizure frequency, seizure focus, age at surgery and previous psychopathology. They concluded that improvement in overall, cognitive and social function scores were statistically significant throughout the study. Seizure worry score ceased to be significant at the fifth year. Previous psychopathology was a negative influence on social and seizure worry score. Compared to left lobectomies, right lobectomies showed significant better results in overall scores at six months and one year follow-up. At 1 month follow-up, cognitive function was also significantly better in right lobectomies. Engels class I patients demonstrated statistically better results in the fourth and fifth years of follow-up. Neither years of disease nor patient age at surgery seemed to influence QOL.