Prevalencia del Estrés Postraumático en médicos residentes, expuestos al SARS-COV-2 / Prevalence of posttraumatic stress in resident doctors, exposed to SARS-COV-2

Objetivo: Determinar la prevalencia del trastorno de estrés postraumático (TEPT) en una muestra de médicos residentes del Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina, un año después del cierre total durante la cuarentena por COVID-19. Materiales y métodos: Se administraron los siguientes cuestionarios autoadministrados: una encuesta demográfica, el cuestionario de la Escala de Trauma de Davidson y la Escala de Experiencias Disociativas (EED). Se excluyeron a los residentes de primer año de especialidades básicas, a aquellos que por su especialidad no tienen contacto con pacientes y a los médicos con licencia fueron excluidos. Resultados: La prevalencia de TEPT fue de 24.3% (n=25). Las medianas de las puntuaciones de DES fueron mayores en los participantes con puntaje positivo para TEPT en comparación con los que no lo presentaban (Mann-Whitney U:13.30, p = 0.001). Se encontraron asociaciones entre el género (X2:6.074, p = 0.013), el TEPT y el tipo de especialidad (prueba exacta de Fisher, p = 0.017). No se encontraron otras asociaciones entre las demás variables analizadas y el TEPT. Conclusion: La prevalencia del TEPT fue similar a los informes previos. Se hallaron asociaciones entre este desorden, el género y el tipo de especialidad. Estos resultados deberían llamar la atención de los sistemas de salud para establecer medidas preventivas y terapéuticas para manejar esta situación.

Objective: Determine the prevalence of posttraumatic stress disorder (PTSD) in a sample of resident doctors of the Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina, one year after the total closure during the quarantine by COVID-19. Materials and Methods: The following self-administered questionnaires were dispensed: a demographic survey, the Davidson Trauma Scale questionnaire, and the Scale of Dissociative Experiences (EED). First year residents of basic specialties were excluded, those who for their specialty do not have contact with patients and licensed doctors were excluded. Results: PTSD prevalence was 24.3% (n = 25). The medium-sized ones were greater in the participants with positive score for PTSD compared to those who did not present it (Mann-Whitney U: 13.30, p = 0.001). Associations between the genre were found (X2: 6,074, p = 0.013), the PTSD and the type of specialty (Fisher's exact test, p = 0.017). No other associations were found between the other variables analyzed and the PTSD. Conclusion: The prevalence of the PTSD was similar to the previous reports. Associations between this disorder, gender and type of specialty were found. These results should draw the attention of health systems to establish preventive and therapeutic measures to handle this situation

Situação-limite: por outro olhar sobre a violência em um Caps AD / Limit-situation: for another look on the violence in a CAPS AD / Situación límite: otra mirada sobre la violencia en un Caps AD

Este relato de experiência, situado no campo do cuidado a pessoas usuárias de álcool e outras drogas em contextos marcados por violência, tem como objetivo explorar os limites, desafios e caminhos possíveis, em um Centro de Atenção Psicossocial Álcool e Drogas (Caps AD III), para a sustentação de um cuidado orientado pela compreensão das pessoas usuárias do Caps a partir da sua existência, sofrimento e relação com o corpo social, mesmo diante de comportamentos tidos como violentos. De caráter qualitativo, o percurso de pesquisa foi conduzido por meio de dois recursos metodológicos: o relato de experiência, referente à trajetória de uma das autoras no Programa de Residência Multiprofissional em Saúde Mental do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ), e a metodologia caso traçador ou usuário-guia. O trabalho de cuidar de pessoas expostas à necropolítica exige um posicionamento ético dos trabalhadores de saúde mental de engendrar processos de resistências e produção de vida. Pela radicalidade que é vivenciá-la, a violência comparece como um elemento dificultador desse trabalho para os profissionais, fazendo com que, diante do desamparo, por vezes utilizem lógicas disciplinares para conseguir lidar com esse fenômeno. Propõe-se abordar as cenas nomeadas como violentas nos Caps com base na noção de situação-limite, retirando a situação da malha de sentidos que acompanha a palavra e remete a práticas disciplinares e ao contexto da violência urbana. Essa mudança de paradigma abre a possibilidade de que os trabalhadores se incluam nas situações, as entendam como relacionadas à complexidade e à singularidade da existência das pessoas envolvidas e, assim, proponham soluções produtoras de vida.(AU)

This experience report, situated in the field of care for people who use alcohol and other drugs in contexts marked by violence, aims to explore the limits, challenges, and possible paths, at a Psychosocial Care Center for Alcohol and Drugs (CAPS AD III), to support care guided by the knowledge of CAPS users based on their existence, suffering, and relationship with the social body, even in the face of behaviors considered to be violent. The path of this qualitative research was conducted with two methodological resources: the experience report, referring to the trajectory of one of the authors at the Multiprofessional Residency Program in Mental Health at the Institute of Psychiatry at the Federal University of Rio de Janeiro (IPUB/UFRJ), and the methodology of case tracer or user-guide. The work of caring for people exposed to necropolitics requires an ethical positioning of mental health workers to build resistance processes and life production. Due to it is radical to experience, violence appears as a complicating element of this work for the professionals, forcing them to, due to the lack of support, occasionally use disciplinary reasoning to deal with this phenomenon. This study proposes to approach violent scenarios in the CAPS under the guise of limit-situation, withdrawing the situation from the web of meanings that accompany the word and refer to disciplinary actions and the context of urban violence. This paradigmatic change opens the path for workers to include themselves in these situations, to understand their relationship with the complexity and singularity of the existence of the implicated people, and thus offer solutions that produce life.(AU)

Este reporte de experiencia se sitúa en el área de la atención a las personas que consumen alcohol y otras drogas en contexto de violencia y tiene por objetivo explorar los límites, desafíos y caminos posibles en un Centro de Atención Psicosocial Alcohol y Drogas (Caps AD III), para ofrecer un cuidado a los usuarios basado en la comprensión de las personas usuarias del Caps considerando su existencia, sufrimiento y relación con el cuerpo social, incluso ante situaciones violentas. Esta es una investigación cualitativa que se basó en dos recursos metodológicos: el reporte de experiencia sobre la trayectoria de una de las autoras en el Programa de Residencia Multiprofesional en Salud Mental de la Universidad Federal de Río de Janeiro (IPUB/UFRJ) y de la metodología del caso trazador o usuario guía. La labor de asistir a las personas expuestas a la necropolítica requiere un posicionamiento ético de los profesionales de la salud mental de producir vida y procesos de resistencia. Por la radicalidad de la experiencia, la violencia es un obstáculo para el trabajo de los profesionales, lo que los llevan a actuar de forma disciplinaria para hacer frente a este fenómeno. Se propone aquí abordar las escenas violentas bajo la noción de situación límite en el Caps, sacando del contexto la red semántica que acompaña la palabra y alude a las prácticas disciplinarias y la violencia urbana. Este cambio de paradigma permite que los trabajadores se incluyan en las situaciones, las comprendan en relación con la complejidad y la singularidad de la existencia de las personas y propongan soluciones que produzcan vida.(AU)

Poder, norma e ideário na lei da alienação parental / Power, norm and ideology in the law of parental alienation / Poder, norma e ideología en la ley de alienación parental

A recomendação ética do psicólogo para intervir criticamente sobre a demanda vai de encontro com a tarefa de diagnosticar atos de Alienação Parental e, num sentido amplo, com a judicialização das relações privadas. A genealogia de Foucault consiste num método capaz de lançar luz sobre as práticas de poder na base dos discursos relacionados ao tema da alienação parental. O eufemismo pedagógico empregado para designar as sanções da lei tem como finalidade estratégica o convencimento a respeito de supostos benefícios da tutela sobre as famílias, ao mesmo tempo em que lhes são atribuídas alguma patologia disfuncional. Numa perspectiva crítica, a assimetria de gêneros corresponde às relações de poder presentes no problema da alienação parental. Por fim, a inversão dos critérios de identificação da alienação parental revela o distanciamento entre o ideal normativo e a realidade da ruptura conjugal e familiar, apontando para a importância de práticas de cuidado e assistência em vez de judicativas e punitivas.(AU)

The psychologist's ethical recommendation to critically intervene on the demand goes against the task of diagnosing acts of Parental Alienation (AP) and, in a broad sense, with the judicialization of private relations. Foucault's genealogy consists of a method able to shed on the power practices on the basis of discourses related to the theme of Parental Alienation. The pedagogical euphemism used to designate the sanctions of the law has the strategic purpose of convincing about the supposed benefits of guardianship over families, while attributing some dysfunctional pathology to them. From a critical perspective, gender asymmetry corresponds to the power relations present in the Parental Alienation problem. Finally, the inversion of the Parental Alienation's identification criteria reveals the gap between the normative ideal and the reality of marital and family disruption, pointing to the importance of care and assistance practices instead of judicative and punitive ones.(AU)

La recomendación ética del psicólogo de intervenir críticamente sobre la demanda va en contra de la tarea de diagnosticar actos de Alienación Parental (AP) y, en un sentido amplio, con la judicialización de las relaciones privadas. La genealogía de Foucault consiste en un método capaz de arrojar luz sobre las prácticas del poder a partir de discursos relacionados con el tema de la Alienación Parental. El eufemismo pedagógico que se utiliza para designar las sanciones de la ley tiene el propósito estratégico de convencer sobre los supuestos beneficios de la tutela sobre las familias, atribuyéndoles alguna patología disfuncional. Desde una perspectiva crítica, la asimetría de género corresponde a las relaciones de poder presentes en el problema de la Alienación Parental. Finalmente, la inversión de los criterios de identificación de la Alienación Parental revela la brecha entre el ideal normativo y la realidad de la ruptura conyugal y familiar, señalando la importancia de las prácticas de cuidado y asistencia en lugar de las judicativas y punitivas.(AU)

Muito além do trauma: uma investigação sobre o papel das reações peritraumáticas sobre o transtorno de estresse pós-traumático / Beyond the trauma: an investigation of the role of peritraumatic reactions on posttraumatic stress disorder

O Transtorno de Estresse Pós-Traumático (TEPT) é uma condição debilitante que impacta significativamente a qualidade de vida dos seus portadores. Dentre vários fatores de risco para o TEPT, as reações peritraumáticas (RP), como a imobilidade tônica peritraumática (ITP), dissociação (DP) e reações físicas de pânico (RFP), estão entre as mais investigadas. No entanto, a maioria dos estudos avaliou essas RP separadamente, e o elo entre elas e o TEPT ainda não foi bem compreendido. Portanto, essa tese teve como objetivos: (i) estimar simultaneamente o efeito das três RP sobre o TEPT utilizando um instrumento validado; e (ii) avaliar se há efeito indireto da ITP sobre o TEPT mediado pelo sentimento de culpa/vergonha. Utilizamos modelagem de equações estruturais para analisar dados de 3211 participantes do Rio de Janeiro e de São Paulo. Tratamos as RP como variáveis latentes, selecionando desconfundidores específicos para cada reação. Nossas exposições foram as RP, sendo TEPT o desfecho. Calculamos odds ratios e intervalos de confiança de 95%. Utilizamos o Bayesian Information Criterion para comparar o ajuste de modelos não aninhados. Quando analisadas separadamente, todas as RP alcançaram significância estatística. No entanto, apenas DP (ORDP=1,8; IC95%:1,3-2,4) e RFP (ORRFP=2,5; IC95%:1,8-3,4) permaneceram estatisticamente significativas quando incluímos as três reações em um modelo com seus respectivos desconfundidores e correlações entre elas. Os resultados sugeriram um possível efeito da ITP sobre o TEPT (ORITP=1,4; IC95%:1,0-1,9). As interações entre as RP não foram estatisticamente significativas. Ao investigarmos o sentimento de culpa/vergonha como mediador entre ITP e TEPT, o efeito indireto alcançou apenas significância estatística limítrofe (ORITP(TNIE)=1,1; IC95%:1,0-1,2). Os efeitos direto (ORITP(PNDE)=1,3; IC95%: 0,8-1,8) e total (ORITP(TE)=1,4; IC95%:0,9-1,9) para ITP perderam significância quando todas as RP, seus desconfundidores e correlações entre elas fizeram parte do mesmo modelo. As demais RP, no entanto, permaneceram estatisticamente significativas (ORDP=1,7; IC95%:1,3-2,3 e ORRFP=2,5; IC95%:1,8-3,4). Nossos resultados mostraram que a DP e as RFP aumentaram o risco de TEPT mesmo quando consideradas em conjunto. A ITP pode ter efeito sobre o risco de TEPT, mas esse achado deve ser interpretado com cautela devido a significância limítrofe dessa RP em nosso modelo final. Também não identificamos uma mediação significativa entre ITP e TEPT pelos sentimentos de culpa/vergonha. Contudo, a significância limítrofe encontrada para o efeito indireto demanda investigações adicionais. Nossos achados reforçam a ideia de que as reações peritraumáticas devem ser analisadas e compreendidas como ocorrências simultâneas. Também seria oportuno que estudos envolvendo culpa/vergonha, ITP e TEPT focalizassem traumas caracterizados por aprisionamento e impossibilidade de escapar, dado que estas experiências são apontadas como mais susceptíveis para desencadear a ITP. (AU)

Posttraumatic stress disorder (PTSD) is a debilitating condition that greatly impacts quality of life. Among several PTSD risk factors, peritraumatic reactions (PR) such as peritraumatic tonic immobility (PTI), dissociation (PD) and physical panic reactions (PPR) are some of the most investigated. However, several studies have assessed these PR separately, and the pathway connecting them to PTSD is not well understood. Therefore, this thesis aimed to: (i) simultaneously estimate the effect of the three PR on PTSD using a validated instrument; and (ii) assess if there is an indirect effect of PTI on PTSD mediated by feelings of guilt/shame. We used structural equation modelling to analyse data from 3211 participants from Rio de Janeiro and São Paulo. We treated the PR as latent variables and selected specific confounders for each reaction. Our exposures were the PR, and PTSD was the outcome. We calculated odds ratios and 95% confidence intervals for each analysis. We also employed the Bayesian Information Criterion to compare the goodness of fit between non-nested models. Separately, all PR achieved statistically significant results. However, only PD (ORPD=1.8; 95%CI:1.3-2.4) and PPR (ORPPR=2.5; 95%CI:1.8-3.4) remained statistically significant when all three were included in a model with their respective confounders and correlations among all PR. Our findings suggested a possible effect of PTI on PTSD (ORPTI=1.4; 95%CI:1.0-1.9). Interactions between the PR were not statistically significant. When we investigated feelings of guilt/shame as the mediator between PTI and PTSD, the indirect effect achieved a borderline statistical significance (ORPTI(TNIE)=1.1; 95%CI:1.0-1.2). Direct (ORPTI(PNDE)=1.3; 95%CI:0.8-1.8) and total (ORPTI(TE)=1.4; 95%CI:0.9-1.9) effects lost their significance when all PR, their confounders and correlations were included in the same model. The other PR remained statistically significant (ORPD=1.7; 95%CI:1.3-2.3 and ORPPR=2.5; 95%CI:1.8-3.4). Our findings showed PD and PPR to increase the risk of PTSD even when considered in tandem. PTI could have an effect on PTSD, but this must be considered cautiously, as this PR only reached borderline significance in our final model. Feelings of guilt/shame did not significantly mediate PTI's effect on PTSD. However, a borderline statistical significance in the indirect effects warrants further investigation. Our findings reinforce the hypothesis that peritraumatic reactions should be analysed and understood as simultaneous occurrences, not as separate entities. It would also be appropriate for studies concerning guilt/shame, PTI and PTSD to focus on traumas characterized by imprisonment and feelings of inescapability, given that these experiences are allegedly more likely to trigger PTI. (AU)

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

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

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

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

[Functional coma: case report and systematic review]. / Functioneel coma: casusbeschrijving en systematisch literatuuroverzicht.

We describe a case of a patient with a functional coma ,and give a systemic review of literature. Functional coma is an extremely rare disorder with only 21 described cases in the literature. The disease is linked to a conversion disorder or a dissociative disorder and is predominantly found in females. Predisposing factors are a history of sexual or physical abuse, psychiatric disorders, previous episodes of functional coma, and recent surgery with general anesthesia. Several clinical signs are suggestive for the diagnosis, however none of them is sufficiently sensitive or specific. Therefore, functional coma remains an exclusion diagnosis. Vital signs must be normal, just as a routine blood examination, an electroencephalogram and imaging of the central nervous system. The most important differential diagnosis are catatonia, factitious disorder, and malingering. Spontaneous recovery can be expected after a duration of about 45 minutes to 4 days.

Pharmacological modelling of dissociation and psychosis: an evaluation of the Clinician Administered Dissociative States Scale and Psychotomimetic States Inventory during nitrous oxide ('laughing gas')-induced anomalous states.

RATIONALE: A significant obstacle to an improved understanding of pathological dissociative and psychosis-like states is the lack of readily implemented pharmacological models of these experiences. Ketamine has dissociative and psychotomimetic effects but can be difficult to use outside of medical and clinical-research facilities. Alternatively, nitrous oxide (N2O) - like ketamine, a dissociative anaesthetic and NMDAR antagonist - has numerous properties that make it an attractive alternative for modelling dissociation and psychosis. However, development and testing of such pharmacological models relies on well-characterized measurement instruments. OBJECTIVES: To examine the factor structures of the Clinician Administered Dissociative States Scale (CADSS) and Psychotomimetic States Inventory (PSI) administered during N2O inhalation in healthy volunteers. METHODS: Secondary analyses of data pooled from three previous N2O studies with healthy volunteers. RESULTS: Effect sizes for N2O-induced dissociation and psychotomimesis were comparable to effects reported in experimental studies with sub-anaesthetic ketamine in healthy volunteers. Although, like ketamine, a three-factor representation of N2O-induced dissociation was confirmed, and a more parsimonious two-factor model might be more appropriate. Bayesian exploratory factor analysis suggested that N2O-induced psychosis-like symptoms were adequately represented by two negative and two positive symptom factors. Hierarchical cluster analysis indicated minimal item overlap between the CADSS and PSI. CONCLUSION: N2O and ketamine produce psychometrically similar dissociative states, although parallels in their psychosis-like effects remain to be determined. The CADSS and PSI tap largely non-overlapping experiences under N2O and we propose the use of both measures (or similar instruments) to comprehensively assess anomalous subjective states produced by dissociative NMDAR antagonists.

Trauma y amnesia disociativa: la visión de Pierre Janet / Trauma and dissociative amnesia: Pierre Janet's vision

RESUMEN Se señala la importancia de reconsiderar el trabajo de Pierre Janet en trauma y amnesia disociativa, como elementos importantes en el estudio actual del trastorno de estrés postraumático (TEPT). Los objetivos de esta revisión histórica no sistemática y comparativa son: a) explicar, desde la perspectiva de Janet: el concepto de Idea Fija, que hoy denominamos trauma b) describir los diferentes tipos de amnesia en las cuales se basa el DSM para su clasificación actual y c) a través de un caso clínico descrito por Janet, mostrar su concordancia con lo que actualmente diagnosticamos como TEPT complejo, que denominó en su época: "una de las formas que puede tomar la histeria después de un accidente emocional". Esta revisión se basa principalmente en algunos capítulos originales de Janet publicados en Francés.

The present article gives emphasis in reconsidering the work of Pierre Janet in trauma and dissociative amnesia, as important aspects for the contemporary study of posttraumatic stress disorder (PTSD). The purpose of this non systematic historical review is to explain the following ideas under Janet´s perspective: a) the concept of fixed idea, denominated in our contemporary nomenclature as trauma, b) to describe the different types of amnesia described by Janet and its relation with DSM clasiffication for this penomenon, and c) to show through the analysis of a clinical case described by Janet, how a concordance exists between the current denomination of complex PTSD and what Janet nominated "one of the forms in which hysteria can presents after an emotional accident". This article is mainly based in some original chapters from Janet´s work published in French.

Traumatic experiences and somatoform dissociation in women with fibromyalgia.

Objective: Psychological factors like traumatic life events seem to affect the etiopathogenesis and the exacerbation of fibromyalgia (FM), a chronic widespread musculoskeletal pain syndrome. This Study investigated the prevalence of traumatic events, with a particular attention to the whole life span, and both psychoform and somatoform dissociation in patients with FM, compared with healthy controls (HC). In addition, the possible effects of traumatic events and dissociative experiences on FM symptoms have been analyzed. Method: Traumatic experiences, dissociative symptoms, and psychological distress were assessed in 99 consecutive patients with FM and 107 healthy women. Student t-tests for two independent samples were used to determine differences between the FM and HC groups. A hierarchical multiple regression analysis was used to explore the possible contribution of trauma and dissociation to FM symptoms. Results: Results revealed that the levels of both somatoform and psychoform dissociation were higher among patients with FM than HC (p < .001). Moreover, patients with FM experienced significantly more negative life events than HC (p < .001). Finally, the data suggested that the severity of FM disabilities was significantly predicted by the presence of depressive symptoms, somatoform dissociation, cumulative trauma, and educational level. The final Model explained 40% of the variance. Conclusions: Results suggest that the construct of somatoform dissociation could serve as a useful framework to improve our understanding of FM symptoms, and stressed the importance of evaluating the effects of multiple traumas in cumulative form because this has substantial implications for the evaluation and treatment of patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Experiências mediúnicas e dissociativas em Fernando Pessoa e C. G. Jung à luz da psicologia analítica e da psicologia anomalística / Mediumistic and dissociative experiences in Fernando Pessoa and C. G. Jung in light of analytical psychology and anomalistic psychology / Expériences médiumniques et dissociatives chez Fernando Pessoa et C. G. Jung à la lumière de la psychologie analytique et de la psychologie anomalistique / Experiencias mediúmnicas y disociativas en Fernando Pessoa y C. G. Jung a la luz de la psicología analítica y de la psicología anómala

Resumo O poeta Fernando Pessoa e o psiquiatra C. G. Jung desenvolveram suas obras em consonância com suas biografias. Ambos descreveram episódios que podem ser interpretados como mediúnicos, buscando, também, compreendê-los psicologicamente. Na literatura psicológica atual, a mediunidade pode ser entendida por meio do conceito de dissociação da personalidade. Dessa maneira, este artigo buscou examinar as relações entre dissociação e mediunidade a partir de episódios biográficos de Pessoa e de Jung, à luz da psicologia analítica e da psicologia anomalística. Hipotetiza-se que eles vivenciaram experiências dissociativas criativas e não patológicas, embora algum nível de sofrimento estivesse envolvido. Em Pessoa, as experiências dissociativas são relacionadas com sua produção hetoronímica, enquanto em Jung e suas investigações, com o desenvolvimento de seu modelo psicológico, que oferece elementos para um estudo psicobiográfico e artístico do poeta.

Abstract Poet Fernando Pessoa and psychiatrist C. G. Jung developed their works consonant with their biographies. Both described episodes that can be interpreted as mediumistic, seeking to understand them psychologically. In current psychological literature, mediumship is associated to the concept of personality dissociation. In this regard, this article examines the relationship between dissociation and mediumship based on Pessoa's and Jung's biographical episodes, in light of analytical psychology and anomalistic psychology. It is hypothesized that they experienced creative, non-pathological dissociations, although some level of suffering was involved. Pessoa's experiences are related to his hetoronymic production, whereas Jung's are tied with the development of his psychological model, which offers elements for a psychobiographical and artistic study of the poet.

Resumé Le poète Fernando Pessoa et le psychiatre C. G. Jung ont développé leurs œuvres en accord avec leurs biographies. Tous deux ont décrit des épisodes qui peuvent être interprétés comme médiumniques, en cherchant à les comprendre psychologiquement. Dans la littérature psychologique actuelle, la médiumnité est associée au concept de dissociation de la personnalité. À cet égard, cet article examine la relation entre dissociation et médiumnité à partir des épisodes biographiques de Pessoa et de Jung, à la lumière de la psychologie analytique et de la psychologie anomalistique. L'hypothèse est qu'ils ont fait l'expérience de dissociations créatives et non pathologiques, bien qu'un certain niveau de souffrance y ait été impliqué. Chez Pessoa, ces expériences sont liées à sa production hétéronymique, tandis que chez Jung, elles sont liées au développement de son modèle psychologique, ce qui offre des éléments pour une étude psychobiographique et artistic du poète.

Resumen El poeta Fernando Pessoa y el psiquiatra C. G. Jung desarrollaron sus obras en consonancia con sus biografías. Ambos describieron episodios que pueden interpretarse como mediúmnicos, también buscando comprenderlos psicológicamente. En la literatura de la psicología actual, la mediumnidad puede entenderse bajo el concepto de disociación de la personalidad. Así, este artículo buscó examinar la relación entre disociación y mediumnidad a partir de los episodios biográficos de Pessoa y Jung, a la luz de la psicología analítica y la psicología anomalística. La hipótesis supone que estos autores tuvieron experiencias disociativas creativas y no patológicas, aunque estas involucraron cierto nivel de sufrimiento. En Pessoa, las experiencias se relacionan con su producción de la heteronimia; y en Jung, con el desarrollo de su modelo psicológico, que ofrece elementos para un estudio psicobiográfico y artístico del poeta.

O consumo de substâncias psicoativas entre pessoas idosas: um olhar complexo / The consumption of psychoactive substances among older adults: a complex perspective / El consumo de sustancias psicoactivas en personas mayores: una mirada compleja

OBJETIVO: descrever o padrão de consumo de substâncias psicoativas entre pessoas idosas sob a ótica da complexidade. Método: qualitativo do tipo estudo de caso múltiplo, realizado com onze pessoas idosas no domicílio/serviço de saúde; os dados foram coletados através de documentos, observação assistemática e entrevista semiestruturada; foram analisados de forma geral, analítica e teórica por meio da comparação dos casos; teve como eixo teórico a complexidade, sendo aprovado pelo comitê de ética em pesquisa. RESULTADOS: quanto ao padrão de consumo de substâncias psicoativas foram achados dois temas: encontro com a substância, que identificou pessoas idosas utilizando substâncias lícitas e ilícitas, e formas de consumo; consequências e motivações do consumo e/ou abandono das drogas. São consequências as perdas materiais/econômicas e criminalidade e motivações a socialização e fuga do estresse/ansiedade. Os idosos que pararam ou diminuíram o consumo aderiram à estratégia de redução de danos. CONCLUSÃO: evidenciou-se o consumo de substâncias psicoativas por pessoas idosas, verificando-se espaço para o sucesso de intervenções de saúde/enfermagem com a criação de ações/programas de abordagem específica para redução de danos.

OBJECTIVE: to describe the pattern of consumption of psychoactive substances among older adults from the perspective of complexity. METHOD: a qualitative survey of the multiple-case study type, carried out with eleven older adults at their homes and/or at a health service; data was collected through documents, unsystematic observation and semi-structured interview; they were analyzed in a general, analytical and theoretical way by comparing the cases; its theoretical axis was complexity, being approved by the research ethics committee. RESULTS: regarding the pattern of consumption of psychoactive substances, two themes were found: encounter with the substance, which identified older adults using legal and illegal substances, and forms of consumption; consequences and motivations of drug use and/or abandonment. Consequences are material/economic losses and crime, and motivations for socialization and escape from stress/anxiety. The older adults who stopped or reduced their consumption adhered to the harm reduction strategy. CONCLUSION: the consumption of psychoactive substances by older adults was evidenced, with space for the success of health/nursing interventions, with the creation of actions/programs with a specific approach to harm reduction.

OBJETIVO: describir el patrón de consumo de sustancias psicoactivas en personas mayores desde la perspectiva de la complejidad. MÉTODO: estudio cualitativo, de tipo caso múltiple, realizado con once ancianos en el domicilio/servicio de salud; los datos se recopilaron a través de documentos, observación no sistemática y entrevista semiestructurada; se analizaron de forma general, analítica y teórica comparando los casos; su eje teórico fue la complejidad, siendo aprobado por el comité de ética en investigación. RESULTADOS: en cuanto al patrón de consumo de sustancias psicoactivas, se encontraron dos temas: contacto con la sustancia, que identificó a personas mayores que consumen sustancias legales e ilegales, y formas de consumo; consecuencias y motivaciones del consumo y/o abandono de las drogas. Las consecuencias son pérdidas materiales/económicas y delitos, y motivaciones para socializar y escapar del estrés/ansiedad. Las personas mayores que suspendieron o disminuyeron su consumo se adhirieron a la estrategia de reducción de daños. CONCLUSIÓN: se evidenció el consumo de sustancias psicoactivas por los adultos mayores, con espacio para el éxito de las intervenciones de salud/enfermería, con la creación de acciones/programas con un enfoque específico de reducción de daños.

Clarifying the Relationship of Dissociative Experiences to Suicide Ideation and Attempts: A Multimethod Examination in Two Samples.

Fears of pain, injury, and death may represent key barriers to acting on suicidal thoughts. Dissociation, which involves a disconnection from one's body, may reduce fears and sensations of pain associated with harming the body, in turn facilitating suicide attempts. This study examined whether dissociation differentiated individuals with a history of suicide attempts from those with a history of suicide ideation, and investigated whether other relevant constructs explain this relationship. Sample 1 included 754 undergraduates (Mage = 21, 79% female) who completed a battery of self-report measures. Sample 2 included 247 undergraduates (Mage = 19, 74% female) who completed a self-report measure of dissociation, a clinical interview regarding suicide history, and four counterbalanced behavioral pain tolerance tasks. In both samples, dissociation was elevated in lifetime attempters compared to ideators (d = 0.28; d = 0.46; ps = 0.01) and slightly elevated in lifetime ideators compared to nonsuicidal individuals (d = 0.19, p = .02; d = 0.24, p = .47), though this effect was non-significant in the latter sample. In Sample 1, dissociation no longer differentiated attempters from ideators after controlling for clinical covariates. In Sample 2, dissociation was unrelated to behavioral pain tolerance tasks, and these tasks did not account for the association between dissociation and attempts. Overall, dissociation differentiated individuals with a history of suicide attempts from those with ideation alone in both samples. Pain tolerance did not explain this association; instead, it is possible that the relationship of dissociation to suicide attempts is due to "third variables" associated with both phenomena, such as symptoms of borderline personality disorder or posttraumatic stress disorder.

Effect of psychosocial trauma and stress on sexual dysfunction in women with endometriosis.

BACKGROUND: Endometrial tissue plays an important role in the regulation of female fertility and there is evidence that endometrial pathology (including endometriosis) is closely related to endocrine disorders. On the other hand, various neuroendocrine changes can be significantly affected by psychosocial stress. In connection with these findings, we tested the relationship between neuroendocrine changes, sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms in women with endometriosis. METHODS: A total of 65 patients with endometriosis were included in the study. Clinical examinations were focused on the biochemical analysis of neuroendocrine markers of endometriosis (cancer antigen 125 [CA 125] and cancer antigen 19-9 [CA 19-9]), estradiol, psychometric evaluation of sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms. RESULTS: The results showed significant Spearman correlations between the values of the revised range of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale), psychosocial/traumatic stress (Trauma Symptoms Checklist) (R = 0.31), and dissociative symptoms (Somatoform Dissociation Questionnaire) (R = 0.33). Positive correlations were also found between CA 125 and CA 19-9 (R = 0.63), and between CA 125 and the results of the values of the revised scale of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale) (R = 0.29). Also psychosocial/traumatic stress (Trauma Symptoms Checklist) significantly correlated with CA 125 (R = 0.38) and with CA 19-9 (R = 0.33). CONCLUSION: These results represent the first findings regarding the relationship of the neuroendocrine markers CA 125 and CA 19-9 and sexual dysfunction with trauma/stress-related symptoms and dissociative symptoms in women with endometriosis.

Hystero-epilepsy in the Tuesday Lessons and NMDA receptor function: A hypothesis for dissociative disorder.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients demonstrate characteristic multistage progression and movement disorders, which are analogous to hystero-epilepsy in Jean-Martin Charcot's Tuesday Lessons. First, based on a review of the Tuesday Lessons recorded by Charcot's pupils, we hypothesized that there were patients with anti-NMDAR encephalitis among those diagnosed with hystero-epilepsy in the nineteenth century. We found acute-onset multiple neuropsychiatric manifestations resembling anti-NMDAR encephalitis among patients with hystero-epilepsy. Patients with drug withdrawal syndrome, dissociative and conversion disorders and patients under hypnosis from the modern point of view were also identified. These results suggested that hystero-epilepsy in the Tuesday Lessons could encompass dissociative and conversion disorders, hypnosis, drug withdrawal syndrome, and anti-NMDAR encephalitis-like manifestations. Based on Charcot's observations and current progress in molecular biology, such as the identification of glutamate/NMDAR system dysfunction in drug withdrawal syndrome, we then hypothesized that patients with dissociative and conversion disorders and those under hypnosis could also have hypofunction of the glutamatergic system. The NMDAR hypofunction hypothesis is emerging as a pathogenesis of schizophrenia. NMDAR antagonists are known to evoke symptoms similar to schizophrenia, anti-NMDAR encephalitis and near-death experiences. In current clinical reports, spectrum disorders such as dissociative disorder and conversion disorder have been observed in patients with anti-NMDAR encephalitis. Our hypothesis will offer an expansion of the NMDAR hypofunction hypothesis from psychosis to functional neurological disorders and normal specific situations, such as hypnosis, thanatosis, and near-death experiences.

Association of SARC-F and dissociation of SARC-F + calf circumference with comorbidities in older hospitalized cancer patients.

The Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F) score is a tool recommended for screening the risk of sarcopenia in older patients. However, the association between SARC-F or SARC-F + calf circumference (SARC-F + CC) and the Charlson Comorbidity Index (CCI) in hospitalized older cancer patients is not fully understood. Thus, our aim is to evaluate the association between the SARC-F or SARC-F + CC and the presence of comorbidities and risk of death in older hospitalized cancer patients. A cross-sectional study involving 90 (42 M/48F) hospitalized cancer patients over 60 years old with ongoing chemotherapy or surgical treatment is carried out. The SARC-F is performed to assess the muscle function loss (MFL if SARC-F ≥ 4), sarcopenia (SARC-F ≥ 6) and sarcopenia using the calf circumference (SARC-F + CC ≥11). CC is assessed using an inelastic tape. The CCI is used to assess the presence of comorbidities. Logistic regression is used to evaluate the association between the SARC-F and Charlson Comorbidity Index. Mean of age is 67.8 years and half (49%) of the patients present MFL (SARC-F ≥ 4), 31% present sarcopenia using the SARC-F ≥ 6 and 60% using the SARC-F + calf circumference ≥ 11. Although no association in the crude model, there is association after adjusting by age, sex, alcohol use, smoking habit, physical activity, use of oral nutritional supplementation, body mass index, performance status, tumor, and treatment type between SARC-F ≥ 4 or ≥ 6 and CCI (SARC-F ≥ 4 × CCI: OR: 2.31 [95%CI: 1.02-5.23], p = 0.04) and (SARC-F ≥ 6 × CCI: OR: 3.24 [95%CI: 1.21-8.65], p = 0.01), respectively. However, this association is lost when using the SARC-F + calf circumference (SARC-F + CC ≥11 × CCI: OR: 1.12 [95%CI: 0.63-1.90], p = 0.68). In conclusion, screening for the risk of sarcopenia in older cancer patients is highly recommended as sarcopenia is tightly associated with the clinical outcome. The use of the SARC-F score using a cut-off ≥4 or ≥ 6 is more relevant for clinical practice to detect comorbidities and risk of death than the use of SARC-F with the calf circumference.

Treatment of highly concentrated formaldehyde effluent using adsorption and ultrasonic dissociation on mesoporous copper iodide (CuI) nano-powder.

Herein we report a successful degradation of highly concentrated formaldehyde (HCHO, 900 ppm <) effluent from a petrochemical industry using sono-catalytic reaction on highly porous (BET surface of 128 m2 g-1) copper iodide (CuI) nanocrystals as the adsorbent. In this regard, the designed experiments for optimization indicated that the ultrasonic wave (40 kHz) and mass of adsorbent (30 g/L) were significant in HCHO removal so that the combination of the adsorption under ultrasonic degradation resulted in approaching the eliminating efficiency of more than 99%. In this way, GC-MS analysis confirmed the CO2 production during HCHO degradation. Although the physisorption mechanism (-15.56 kJ/mol) limited the HCHO concentration (~100 ppm) for removal, addition of ultrasonic irradiation significantly improved the process to eliminate 986 ppm of HCHO from the real petrochemical effluent. Moreover, the mechanisms of HCHO decomposition were scrutinized through theoretical studies (density functional theory (DFT)), as well as thermodynamic and kinetics theories. Correspondingly, as calculated from the DFT, the highest adsorption on cleavage plane (111) of the adsorbent was shown to be in complete agreement with its XRD analysis in which the main peak corresponds to the lattice plane (111).

Identification of isocyclosporins by collision-induced dissociation of doubly protonated species.

Nonribosomal cyclopeptide cyclosporin A (CsA), produced by fungus Tolypocladium inflatum, is an extremely important immunosuppressive drug used in organ transplantations and for therapy of autoimmune diseases. Here we report for the first time production of CsA, along with related cyclosporins B and C, by Tolypocladium inflatum strains of marine origin (White Sea). Cyclosporins A-C contain an unusual amino acid, (4R)-4-((E)-2-butenyl)-4,N-dimethyl-l-threonine (MeBmt), and are prone to isomerization to non-active isocyclosporin by N→O acyl shift of valine connected to MeBmt in acidic conditions. CsA and isoCsA are not distinguishable in MS analysis of [M+H]+ ions due to rapid [CsA + H]+→[isoCsA + H]+ conversion. We found that the N→O acyl shift is completely suppressed in cyclosporine [M+2H]2+ ions, and their collision-induced dissociation (CID) can be used for rapid and unambiguous analysis of cyclosporins and isocylosporins. Fragmentation patterns of [CsA+2H]2+ and [isoCsA+2H]2+ ions were analyzed and explained. The developed approach could be useful for MS analysis of other peptides containing ß-hydroxy-α-amino acids.

Rituximab Was Effective for Treatment of Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Early Adolescence in Initially Suspected Dissociative Disorder.

OBJECTIVES: Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an increasingly recognized etiology of psychiatric symptoms. Because patients with anti-NMDAR encephalitis frequently show aggression, mania, hallucination, depression, or delusion, they are initially diagnosed with schizophrenia or mood disorders. There is only 1 case report of an initially diagnosed dissociative disorder. METHODS: We obtained consent for the presentation and have not identified individuals for ethical reasons. RESULTS: We first report an adolescent female patient with anti-NMDAR encephalitis who was initially suspected of having dissociative disorder but was responsive to immunotherapies including rituximab. In this case, her symptoms and electroencephalogram findings were proportional to the antibody titer in the cerebrospinal fluid. CONCLUSIONS: It is important to consider the possibility of autoimmune encephalitis and immunotherapy including rituximab in cases of not only acute psychosis but also dissociation.

ACTION trial: a prospective study on diagnostic Accuracy of 4D CT for diagnosing Instable ScaphOlunate DissociatioN.

BACKGROUND: Early detection of scapholunate ligament (SLL) tears is essential after minor and major trauma to the wrist. The differentiation between stable and instable injuries determines therapeutic measures which aim to prevent osteoarthritis. Arthroscopy has since been the diagnostic gold standard in suspected SLL tears because non-invasive methods have failed to exclude instable injuries reliably. This prospective study aims to determine the diagnostic accuracy of dynamic, 4D computed tomography (CT) of the wrist for diagnosing instable SLL tears. METHODS: Single center, prospective trial including 40 patients with suspected SLL tears scheduled for arthroscopy. Diagnostic accuracy of 4D CT will be tested against the reference standard arthroscopy. Radiologists will be blinded to the results of arthroscopy and hand surgeons to radiological reports. A historical cohort of 80 patients which was diagnosed using cineradiography before implementation of 4D CT at the study site will serve as a comparative group. DISCUSSION: Static imaging lacks the ability to detect instable SLL tears after wrist trauma. Dynamic methods such as cineradiography and dynamic magnetic resonance imaging (MRI) are complex and require specific technical infrastructure in specialized centers. Modern super-fast dual source CT scanners are gaining popularity and are being installed gradually in hospitals and ambulances. These scanners enable dynamic imaging in a quick and simple manner. Establishment of dynamic 4D CT of the wrist in patients with suspected SLL tears in in- and outpatient settings could improve early detection rates. Reliable identification of instable injuries through 4D CT scans might reduce the number of unnecessary diagnostic arthroscopies in the future. TRIAL REGISTRATION: This study was registered prospectively at the German Clinical Trials Register (DRKS) DRKS00021110 . Universal Trial Number (WHO-UTN): U1111-1249-7884.

A simplified 6-Item clinician administered dissociative symptom scale (CADSS-6) for monitoring dissociative effects of sub-anesthetic ketamine infusions.

BACKGROUND: Dissociation is a treatment-emergent adverse event commonly associated with IV ketamine, often measured using the 23-item Clinician-Administered Dissociative States Scale (CADSS). The objective of this study was to develop a short form version of the CADSS for easier clinical use. METHODS: Retrospective data of 260 patients with treatment-resistant depression (TRD) receiving IV ketamine were randomly divided into two datasets. The first dataset (n = 130) was leveraged to develop a brief 6-item version of the CADSS (CADSS-6) based on items most sensitive to ketamine-induced dissociation. The CADSS-6 questions were then applied to the second dataset (n = 130) and the Spearman's correlation between the full-length CADSS and the CADSS-6 were assessed. RESULTS: The CADSS-6 was developed from questions 1, 2, 6, 7, 15, and 22 from the full length CADSS. There was a strong significant correlation between the CADSS-6 total score and the CADSS total score at infusions 1 (rs(106) = 0.92, p < 0.001), 2 (rs(100) = 0.91, p < 0.001), 3(rs(99) = 0.95, p < 0.001) and 4 (rs(102) = 0.94, p < 0.001). LIMITATIONS: The CADSS-6 was developed using a retrospective data; therefore, the scale remains unvalidated in this population. CONCLUSIONS: The CADSS-6 presented herein was sensitive to dissociation experienced by patients receiving IV ketamine. Overall, the CADSS-6 was strongly correlated at each infusion with the full-length CADSS. While future studies should look to validate the CADSS-6 in a TRD sample, this scale offers clinicians a brief assessment that can be used to characterize symptoms of dissociation.