Evaluando habilidades en psiquiatría. Implementación y experiencia del ECOE para pregrado de Medicina / Assessing Skills in Psychiatry. Experience and Implementation of OSCE for Medical Students

resumen Introducción: La formación médica ha venido transformándose, así como las estrategias de evaluación, lo que permite abordar, además de los conocimientos, las habilidades clínicas. En salud mental estas habilidades desempeñan un rol central. El Examen Clínico Objetivo Estructurado (ECOE) es una de las evaluaciones que tiene este potencial. El objetivo del presente artículo es describir la implementación y el desempeño que han tenido los estudiantes de pregrado desde la introducción de este en el año 2015. Métodos: Se recuenta la implementación y se describen los ECOE realizados a estudiantes de pregrado de Medicina que cursan el segundo semestre de Salud Mental tomando las bases de datos de los exámenes prácticos finales. Además se describe la percepción de los docentes del área. Resultados: El ECOE de salud mental se implementó en 2015-2, se desarrolla en el Hospital Simulado de la Universidad y cuenta con 5 estaciones (entrevista, examen mental, diagnóstico, tratamiento e información a la familia y ética). Entre 2016-2 y 2019-2, 486 estudiantes pasaron el ECOE con una nota promedio de 3,85 (baremo de 0 a 5). Se observó que la nota obtenida al evaluarse trastornos de ansiedad estuvo por debajo del promedio; la de trastornos afectivos, por encima del promedio y la de trastornos psicóticos, dentro del promedio. Los docentes resaltan la versatilidad, la mirada objetiva integral de los aspectos prácticos y teóricos y la posibilidad de comparación entre los diferentes grupos. Conclusiones: El ECOE brinda la posibilidad de evaluar las competencias en acción de los estudiantes de Medicina y permite la identificación de qué aspectos mejorar en el proceso de enseñanza-aprendizaje.

abstract Introduction: Medical education has been changing, and the evaluation strategies that make it possible to address not only theoretical knowledge but also clinical skills. In Mental Health, these skills play a central role. The Objective Structured Clinical Examination (OSCE) is one of the evaluations that could assess clinical skills. This article describes the implementation and performance for the evaluation of undergraduate students since the OSCE's introduction in 2015. Methods: An explanation of the implementation is made, and a description of the OSCEs carried out to undergraduate medical students in the second semester of mental health, using the databases of the final practical examinations during those years. The perception of mental health teachers is also described. Results: The mental health OSCE implemented in 2015-2, is developed in the Simulated Hospital of the University and has five stations (interview, mental examination, diagnosis, treatment and information to the family and ethics). Between 2016-2 and 2019-2, 486 students performed OSCE with an average score of 3.85 (scale 0-5). It was observed that the grade obtained when evaluating anxiety disorders was below average, that of affective disorders above average, while that of psychotic disorders was within the average. The professors highlight the versatility, the comprehensive objective evaluation of the practical and theoretical aspects, and the possibility of comparison between the different groups. Conclusions: The OSCE is an examination that provides the possibility to evaluate the competences in psychiatry of medical students and allows the identification of the aspects to be improved in the teaching learning process.

Integrating neuroscience and humanities in healthcare evolution: a multidisciplinary perspective / Integração das neurociências e das ciências humanas na evolução dos cuidados de saúde: uma perspetiva multidisciplinar

The trajectory of healthcare has evolved from ancient holistic practices to the present biomedical model, reflecting the dynamic interplay between scientific progress, technological advancements, and the integration of humanistic values. While biomedical advancements have revolutionized medical treatments, there is an emerging recognition of the importance of integrating neuroscience and humanities to foster holistic patient care and understanding. This paper aims to explore the historical development of medicine, emphasizing the convergence of neuroscience, psychiatry, and neurology within the biomedical framework. Additionally, it investigates the resurgence of humanities in healthcare and its role in promoting patientcentered care. Through a comprehensive review of literature, this study traces the historical roots of medicine and examines the interdisciplinary intersections of neuroscience, psychiatry, neurology, and medical humanities. The exploration reveals the significant contributions of interdisciplinary approaches in enhancing patient-centered care, fostering a comprehensive understanding of health and well-being, and shaping modern healthcare practices. The integration of neuroscience and humanities offers valuable insights into the complexities of human health, bridging legacy practices with innovative approaches. Embracing this interdisciplinary perspective is crucial for promoting holistic healthcare, emphasizing patient-centered care, and enriching the understanding of health and well-being in contemporary healthcare settings.

A trajetória dos cuidados de saúde evoluiu das antigas práticas holísticas para o atual modelo biomédico, reflectindo a interação dinâmica entre o progresso científico, os avanços tecnológicos e a integração de valores humanísticos. Embora os avanços biomédicos tenham revolucionado os tratamentos médicos, há um reconhecimento emergente da importância de integrar as neurociências e as humanidades para promover a compreensão e os cuidados holísticos dos doentes. Este artigo tem como objetivo explorar o desenvolvimento histórico da medicina, salientando a convergência da neurociência, da psiquiatria e da neurologia no quadro biomédico. Além disso, investiga o ressurgimento das humanidades nos cuidados de saúde e o seu papel na promoção de cuidados centrados no doente. Através de uma revisão exaustiva da literatura, este estudo traça as raízes históricas da medicina e examina as intersecções interdisciplinares da neurociência, psiquiatria, neurologia e humanidades médicas. A exploração revela os contributos significativos das abordagens interdisciplinares para melhorar os cuidados centrados no doente, promover uma compreensão abrangente da saúde e do bem-estar e moldar as práticas modernas de cuidados de saúde. A integração das neurociências e das humanidades oferece conhecimentos valiosos sobre as complexidades da saúde humana, fazendo a ponte entre práticas antigas e abordagens inovadoras. A adoção desta perspetiva interdisciplinar é crucial para promover cuidados de saúde holísticos, enfatizando os cuidados centrados no doente e enriquecendo a compreensão da saúde e do bem-estar nos contextos de cuidados de saúde contemporâneos.

Análisis sociodemográfico, metodológico y diagnóstico de los informes periciales en psiquiatría y psicología para la toma de decisiones legales en el Centro de Estudios en Derecho y Salud (Medellín, Colombia) / Socio-demographic, methodological and diagnostic analysis of expert reports in psychiatry and psychology for legal decision-making Centro de Estudios en Derecho y Salud (Medellín, Colombia) / Análise sociodemográfica, metodológica e diagnóstica de relatórios de especialistas em psiquiatria e psicologia para tomada de decisões legais no Centro de Estudios en Derecho y Salud (Medellín, Colombia)

El objetivo del presente estudio fue analizar las características sociodemográficas, metodológicas y diagnósticas de los informes periciales en psiquiatría y psicología realizados en el Centro de Estudios en Derecho y Salud entre 2011 y 2020. Se optó por un enfoque cuantitativo, descriptivo con intención analítica, transversal, con diseño retrospectivo. Se analizó la información obtenida en 145 peritajes. Se adelantó un análisis univariado para todas las variables sociodemográficas, metodológicas y diagnósticas de los informes periciales, según su naturaleza cualitativa o cuantitativa, y un análisis bivariado a través de tablas de contingencia para las variables mencionadas, con intervalos de confianza del 95 % para cada una de las medidas de prevalencia. Se encontró que la mayoría de peritajes fueron solicitados por el área del derecho contencioso-administrativo. Los diagnósticos más prevalentes fueron el trastorno adaptativo, el trastorno por estrés postraumático y el trastorno depresivo. Si bien los informes revisados cumplen con los lineamientos mínimos de ley, se encontraron algunas falencias relacionadas con la ausencia de información. Se espera que estos hallazgos permitan la reflexión por parte de los auxiliares de la justicia sobre los requerimientos de los informes periciales con miras a la humanización de la justicia y el apoyo a la toma de decisiones legales.

The aim of this study was to analyse the socio-demographic, methodological and diagnostic characteristics of the expert reports in psychiatry and psychology carried out at the Centre for Law and Health Studies between 2011 and 2020. We opted for a quantitative, descriptive approach with analytical, cross-sectional, retrospective design. The information obtained from 145 expert opinions was analysed. A univariate analysis was carried out for all sociodemographic, methodological and diagnostic variables in the expert reports, according to their qualitative or quantitative nature, and a bivariate analysis through contingency tables for the aforementioned variables, with confidence intervals of 95 % for each of the prevalence measures. It was found that the majority of expert opinions were requested by the area of contentious-administrative law. The most prevalent diagnoses were adjustment disorder, post-traumatic stress disorder and depressive disorder. Although the reports reviewed comply with the minimum legal guidelines, there were some shortcomings related to the absence of information. It is hoped that these findings will allow for reflection on the part of justice officials on the requirements of expert reports with a view to the humanisation of justice and support for legal decision-making.

O objetivo deste estudo foi analisar as características sociodemográficas, metodológicas e diagnósticas dos laudos periciais em psiquiatria e psicologia realizados no Centro de Estudos em Direito e Saúde entre 2011 e 2020. Optou-se por uma abordagem quantitativa e descritiva com desenho analítico, transversal e retrospectivo. Foram analisadas as informações obtidas de 145 pareceres de especialistas. Foi realizada uma análise univariada para todas as variáveis sociodemográficas, metodológicas e diagnósticas dos laudos periciais, de acordo com sua natureza qualitativa ou quantitativa, e uma análise bivariada por meio de tabelas de contingência para as variáveis mencionadas, com intervalos de confiança de 95 % para cada uma das medidas de prevalência. Verificou-se que a maioria dos pareceres foi solicitada pela área de direito contencioso-administrativo. Os diagnósticos mais prevalentes foram transtorno de ajustamento, transtorno de estresse pós-traumático e transtorno depressivo. Embora os relatórios analisados estejam em conformidade com as diretrizes legais mínimas, houve algumas deficiências relacionadas à ausência de informações. Espera-se que esses resultados permitam uma reflexão por parte dos envolvidos no sistema judiciário sobre os requisitos dos laudos periciais, com vistas à humanização da justiça e ao apoio à tomada de decisões legais.

Alteraciones psiquiátricas en pacientes con antecedentes de infección por SARS-CoV-2 / Psychiatric alterations in patients with a history of SARS-CoV-2 infection

Objetivo: Caracterizar los trastornos mentales de los pacientes consultantes del Servicio de Psiquiatría del Hospital Universitario de Caracas enero 2020 ­enero 2021, que acudieron por primera vez y habían presentado infección por COVID-19 3 a 6 meses antes de consultar. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo, de corte transversal en pacientes que acudieron al Servicio de Psiquiatría del Hospital Universitario de Caracas para emergencia (por primera vez y sucesivas) por presentar patologías mentales durante y posterior a infección por COVID-19 durante el periodo enero 2020-enero 2021. Resultados: De 718 pacientes, 53 que acudieron con patologías mentales habían presentado infección previa por COVID-19 representando el 7,38%. Edad promedio 27-29 años (66,03 %). La mayoría del sexo femenino (71,69 %). El 77,35 % provenían del Distrito Capital; el 18,86 % del estado Miranda, siendo el estado civil predominante la soltería con 73,58 %; el 56,60 % estaban desempleados y el 79,24 % no poseían nivel de instrucción. En relación a los diagnósticos: trastorno depresivo mayor con síntomas ansiosos (30,18 %), trastorno depresivo (18,86 %), episodio maniforme (1,88 %) episodio psicótico agudo (18,86 %), trastorno de ansiedad generalizada (7,54 %), entre otros. Conclusión: Los síntomas psiquiátricos originados por infección por COVID-19 aparecen de forma más tardía y persisten después de la infección. Las mujeres manifestaron mayor riesgo de presentar síntomas relacionados con la salud mental; se asocia a alto nivel de vulnerabilidad a causa de la influencia de los roles sociales, ciclo reproductivo y mayor morbilidad psiquiátrica(AU)

Objective: To characterize the mental disorders of the consulting patients of the Psychiatry Service of the University Hospital of Caracas January 2020 -January 2021, who came for the first time and hapresented COVID-19 infection 3 to 6 monthsbefore consulting. Methods: An observational, descriptive, retrospective, cross-sectional study was carried out in patients who attended the Psychiatry Service of the University Hospital of Caracas for emergencies (for the first time and successive ones) due to presenting mental pathologies during and after COVID-19 during the period January 2020-January 2021. Results: Of 718 patients, 53 who came with mental pathologies had previous COVID-19 infection, representing 7.38%. Average age 27-29 years(66.03%). The majority were female (71.69%). 77.35% came from the Capital District; 18.86% from the state of Miranda, with the predominant marital status being single with 73.58%; 56.60% were unemployed and 79.24% had no educational level. In relation to the diagnoses: major depressive disorder with anxious symptoms (30.18%), depressive disorder (18.86%), maniform episode (1.88%), acute psychotic episode (18.86%), generalized anxiety disorder (7.54%), among others. Conclusion: Psychiatric symptoms caused by COVID-19 infection appear later and persist after infection. Women expressed a greater risk of presenting symptoms related to mental health; It is associated with a high level of vulnerability due to the influence of social roles, reproductive cycle and greater psychiatric morbidit(AU)

Síndrome de Rapunzel: atadura sicológica y simulación orgánica / Rapunzel syndrome: psychological bondage and organic simulation

Introducción. El síndrome de Rapunzel es una entidad infrecuente, que se presenta como un tricobezoar a causa de una aglomeración de cabello acumulado dentro del tracto gastrointestinal, por lo que simula otras patologías quirúrgicas. Caso clínico. Paciente femenina de 10 años de edad, con tricotilomanía y tricofagia, dolor abdominal y síntomas inespecíficos de obstrucción intestinal de ocho meses de evolución. Al examen físico se encontró abdomen con distensión y masa palpable en epigastrio y mesogastrio. La ecografía permitió hacer el diagnóstico de tricobezoar gástrico extendido hasta el intestino delgado, por lo que se llevó a cirugía para gastrotomía y se extrajo el tricobezoar, con evolución satisfactoria de la paciente. El abordaje integral permitió conocer la atadura sicológica por posible maltrato infantil. Resultado. La paciente tuvo una evolución satisfactoria y se dio egreso al quinto día de hospitalización. Actualmente se encuentra en seguimiento por sicología, siquiatría infantil y pediatría. Discusión. El caso clínico denota la importancia en reconocer situaciones de presentación infrecuente en pediatría, que puedan estar asociadas a alteraciones sicológicas o presunción de maltrato infantil y que se presenten como una condición orgánica recurrente que simule otras patologías abdominales frecuentes en la infancia. El retraso diagnóstico puede conducir a un desenlace no deseado con complicaciones. Conclusión. Se hace mandatorio el manejo integral del paciente pediátrico y aumentar la sensibilidad para reconocer situaciones de presunción de maltrato infantil, sobre todo en pacientes con una condición orgánica quirúrgica recurrente.

Introduction. Rapunzel syndrome is an uncommon condition that manifests as trichobezoars, which are hair bundles in the stomach or small intestine that can mimics other surgical illnesses. Multiple complications can arise from delayed diagnosis and treatment. Clinical case. A 10-year-old female patient with trichotillomania and trichophagia, with abdominal pain and nonspecific symptoms of intestinal obstruction of eight months of evolution. Physical examination revealed epigastric tenderness and a solid mass was palpable in the mesogastric and epigastric region. An abdominal ultrasound showed gastric trichobezoar that extended into the small intestine. A gastrotomy was performed and the trichobezoar was extracted with satisfactory evolution of the patient. The comprehensive approach allowed knowing the psychological bond due to possible child abuse. Results. The patient had a satisfactory evolution and was discharged on the fifth day of hospitalization. He is currently being monitored by psychology, child psychiatry and pediatrics. Discussion. This clinical case highlights the importance of recognizing situations that seldom present in pediatrics, which may have a psychological aspect due to the presumption of child abuse, and which present as a recurrent organic condition simulating other frequent abdominal pathologies in childhood; all of which may lead to an unwanted outcome due to diagnostic delay. Conclusion. The comprehensive management of the pediatric patient is mandatory to recognize situations of presumed child abuse, in the face of a recurrent surgical conditions.

Trastornos Psiquiátricos en Gestantes Hospitalizadas en el Servicio de Alto Riesgo Obstétrico de la Clínica Universitaria Bolivariana de Medellín (Colombia) Durante los Años 2013 a 2017 / Psychiatric Disorders in Pregnant Women Admitted to the High-Risk Obstetric Service in a Colombian University Clinic Between 2013 and 2017

RESUMEN Objetivos: Determinar los diagnósticos psiquiátricos y describir características clínicas, el riesgo biopsicosocial y los tratamientos de las pacientes hospitalizadas en el servicio de alto riesgo obstétrico para las que se realizó una interconsulta con psiquiatría. Métodos: Estudio observacional descriptivo en el que se incluyó a las pacientes del servicio de alto riesgo obstétrico de una institución de alta complejidad de Medellín para las que se interconsultó por psiquiatría de enlace entre 2013 y 2017. Las principales variables de interés fueron los diagnósticos y tratamientos tanto psiquiátricos como gineco obstétricos, además de los factores de riesgo obstétricos y psicosociales. Resultados: Se cribaron en total 361 historias clínicas, y 248 pacientes cumplían los criterios de inclusión. El diagnóstico psiquiátrico principal más prevalente fue trastorno depresivo mayor (29%), seguido por el trastorno de adaptación (21,8%) y los trastornos de ansiedad (12,5%); los fármacos más prescritos por psiquiatría fueron antidepresivos ISRS (24,2%), trazodona (6,8%) y benzodiacepinas (5,2%). El diagnóstico obstétrico principal más común fue el parto espontáneo (46,4%) y los diagnósticos obstétricos secundarios que predominaron fueron trastorno hipertensivo asociado con el embarazo (10,4%), diabetes gestacional (9,2%) y abortos recurrentes (6,4%). El 71,8% de las pacientes tenían un riesgo biopsicosocial alto. Conclusiones: Los principales diagnósticos psiquiátricos fueron trastorno depresivo mayor, trastorno de adaptación y trastornos de ansiedad, lo que implica la importancia del oportuno reconocimiento en la evaluación prenatal de los síntomas de estas entidades, conjuntamente con los factores de riesgo obstétrico y social. La intervención psiquiátrica es necesaria considerando las implicaciones negativas que tiene el alto riesgo tanto para la madre como paraelniño.

ABSTRACT Objective To determine the psychiatric diagnoses and treatments of patients admitted to the high-risk obstetric service who underwent a consultation with a liaison psychiatrist. Methods: A descriptive observational study that included pregnant women from the high-risk obstetric service of a highly specialised clinic in Medellín, who had a liaison psychiatry consultation between 2013 and 2017. The main variables of interest were psychiatric and obstetric diagnoses and treatments, in addition to biopsychosocial risk factors. Results: A total of 361 medical records were screened, with 248 patients meeting the inclusion criteria. The main prevailing psychiatric diagnosis was major depressive disorder (29%), followed by adaptive disorder (21.8%) and anxiety disorders (12.5%). The pharmacologic treatments most used by the psychiatry service were SSRI antidepressants (24.2%), trazodone (6.8%) and benzodiazepines (5.2%). The most common primary obstetric diagnosis was spontaneous delivery (46.4%), and the predominant secondary obstetric diagnoses were hypertensive disorder associated with pregnancy (10.4%), gestational diabetes (9.2%) and recurrent abortions (6.4%). Overall, 71.8% of the patients had a high biopsychosocial risk. Conclusions: The studied population's primary psychiatric disorders were major depressive disorder, adjustment disorder and anxiety disorders, which implies the importance of timely recognition of the symptoms of these perinatal mental pathologies, together with obstetric and social risks, in the prenatal consultation. Psychiatric intervention should be encouraged considering the negative implications of high biopsychosocial risk in both mothers and children.

Negación psicótica del embarazo. Reporte de caso / Psychotic denial of pregnancy. Case report

La negación psicótica del embarazo es un trastorno poco frecuente y potencialmente peligroso que puede dividirse en dos variantes: psicótica y no psicótica. La negación psicótica del embarazo suele ir acompañada de antecedentes de enfermedad mental. Entre sus efectos negativos se encuentran la angustia psicológica, los partos no asistidos fuera de los hospitales y un aumento potencial de la morbilidad y mortalidad materna y neonatal. Es crucial incluir antecedentes personales y/o familiares de psicopatologías como parte de la anamnesis, ya que esta condición debe ser tratada por un psiquiatra. En cuanto al manejo de este trastorno durante el embarazo o puerperio, no existen recomendaciones específicas. Para proporcionar una atención integral, suele ser necesario un enfoque multidisciplinario. Se presenta un caso de negación psicótica del embarazo(AU)

Denial of pregnancy is a rare, potentially dangerous disorder that can be divided into two variants: psychotic and nonpsychotic. Psychotic denial of pregnancy is typically accompanied by a history of mental illness. Negative effects include psychological distress, unsupported births outside of hospital, and a potential rise in mother and newborn morbi-mortality. It is crucial to include a personal and/or family history of psychopathology as part of the anamnesis because this condition should be treated by a psychiatrist. Regarding the management of this disorder during pregnancy or puerperium, there are no specific recommendations. To provide comprehensive care, a multidisciplinary approach is typically required. A case of psychotic denial of pregnancy is presented(AU)

Telesalud mental en una unidad pública de psiquiatría infanto-juvenil en pandemia: estudio cualitativo de implementación / Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study

ANTECEDENTES: La pandemia por COVID-19 generó una implementación súbita de las atenciones a distancia, especialmente en atenciones de salud mental. La evidencia que sustenta esta modalidad de atención es aún emergente, con escasos estudios cualitativos que representen su implementación en países latinoamericanos. El objetivo de este trabajo es conocer la perspectiva de terapeutas y de usuarios, respecto del uso de la telesalud en una unidad de salud mental infantil y de la adolescencia de un servicio público chileno. MÉTODOS: Estudio cualitativo. Se establecieron dos grupos focales con 14 profesionales en total, y 16 entrevistas en profundidad con usuarios de una unidad ambulatoria de psiquiatría infanto juvenil.. Los datos se analizaron utilizando el modelo de teoría fundamentada. RESULTADOS: En el grupo de terapeutas surgen cuatro categorías fundamentales; antecedentes de la telesalud mental, implementación, telesalud mental desde la posición del terapeuta y proyecciones. En el grupo de usuarios surgieron tres categorías principales: implementación, evaluación de los usuarios de la telesalud mental y proyecciones. CONCLUSIONES: Existen elementos en común entre la opinión de los usuarios y terapeutas. Un elemento importante dentro del grupo de los usuarios es que, a pesar de aceptar la atención remota y reconocer aspectos positivos en esta, fuera del contexto de pandemia prefieren atenciones presenciales o mixtas.

BACKGROUND: The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. METHODS: This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. RESULTS: In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. CONCLUSIONS: There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.

Problematização sobre o Transtorno Disruptivo da Desregulação do Humor / Problematization about Disruptive Mood Dysregulation Disorder / Problématisation du Trouble Disruptif avec Dysrégulation émotionnelle / Problematización del Trastorno de Desregulación Disruptiva del Estado de Ánimo

Este artigo se propõe a delinear, historicamente, o diagnóstico clínico do Transtorno Disruptivo da Desregulação do Humor (TDDH). Com base no método genealógico, essa categoria diagnóstica é desnaturalizada e recontextualizada em sua origem. Analisa-se o conceito de desregulação do humor a partir da escala CBCL (Childhood Behaviour Checklist), sua identificação como um transtorno bipolar da infância, posterior transformação no diagnóstico de TDDH e subsequente crítica deste, com a proposta de englobar os sintomas de desregulação do humor na infância, no diagnóstico de transtorno opositor-desafiante. Como alternativa, o artigo sugere que o humor irritadiço na infância é um estado afetivo primário, constituindo-se, assim, em uma predisposição orgânica primária. Já a regulação emocional é uma construção adaptativa, que se modela ao longo da vida, gerando apresentações subjetivas diversas.

Resumos This article historically outlines the clinical diagnosis of disruptive mood dysregulation disorder (DMDD). Based on the genealogical method, this diagnostic category is denaturalized and recontextualized in its origin. The concept of mood dysregulation is analyzed from the Childhood Behavior Checklist scale (CBCL), its identification as a childhood bipolar disorder, subsequent transformation in the diagnosis of DMDD and subsequent criticism of it, with the proposal of encompassing the symptoms of mood dysregulation humor in childhood into the diagnosis of oppositional defiant disorder. As an alternative, the article suggests that irritable mood in childhood is a primary affective state, thus, constituting a primary organic predisposition. Emotional regulation, on the other hand, is an adaptive construction, which is modeled throughout life, generating diverse subjective presentations.

Cet article retrace l'historique du diagnostic clinique du trouble disruptif avec dysrégulation émotionnelle (TDDE). Basée sur la méthode généalogique, cette catégorie diagnostique est dénaturalisée et recontextualisée dans ses origines. Le concept de dysrégulation émotionnelle est analysé à partir de l'échelle CBCL (Childhood Behavior Checklist), de son identification en tant que trouble bipolaire de l'enfance, de sa transformation ultérieure en diagnostic de TDDE et de sa critique ultérieure, avec la proposition d'inclure les symptômes de dysrégulation émotionnelle dans l'enfance dans le diagnostic du trouble oppositionnel avec provocation. Comme alternative, l'article suggère que l'humeur irritable dans l'enfance est un état affectif primaire, constituant ainsi une prédisposition organique primaire. La régulation émotionnelle, quant à elle, est une construction adaptative qui est modelée tout au long de la vie, générant diverses présentations subjectives.

Este artículo describe historicamente el diagnóstico clínico del trastorno de desregulación disruptiva del estado de ánimo (TDDEA). Con base en el método genealógico, esta categoria diagnostica se desnaturaliza y recontextualiza en su origen. Se analiza el concepto de desregulación del estado de ánimo a partir de la escala CBCL (Childhood Behavior Checklist), su identificación como trastorno bipolar pediátrico, posterior transformación en el diagnóstico de TDDEA y posterior crítica al mismo, con la propuesta de englobar los síntomas de desregulación del estado de ánimo en el diagnóstico de trastorno negativista desafiante. Como alternativa, se sugiere que el estado de ánimo de irritabilidad en la infancia es un estado afectivo primario, constituyendo una predisposición orgánica primaria. La regulación emocional, por su parte, es una construcción adaptativa, que se modela a lo largo de la vida, generando diversas presentaciones subjetivas.

Impacto de las clases virtuales en la salud mental de la población pediátrica durante la pandemia de COVID-19 en septiembre-diciembre 2021 / Impact of Virtual Classes on the Mental Health of the Pediatric Population during the COVID-19 Pandemic

Introducción: El COVID-19 ha afectado la salud mental de la población pediátrica. Con la transición a la virtualidad, se han identificado posturas positivas y negativas. Debido a la diferencia de características sociodemográficas que posee la República Dominicana, es necesario describir el efecto de dichos cambios en la salud mental dentro de este contexto. Objetivo: Evaluar el efecto de las clases virtuales en la salud mental de los pacientes pediátricos. Metodología: Se utilizó el cuestionario de capacidades y dificultades en los pacientes que asistieron a consulta general. Se asignó una puntuación con la escala de puntuación estandarizada y se analizaron los resultados en gráficos de frecuencia y pruebas de correlación de spearman. Resultados: Existe una frecuencia del 10,4% (n=34) de alto riesgo de desarrollar algún trastorno psiquiátrico. Se observaron correlaciones débiles entre menor edad y trastorno de conducta, r(365) = -0,111, p = 0,034, y sexo masculino y cualquier trastorno pediátrico, r(365) = -0,131, p = 0,012. Hay una incidencia de 51,5% de síntomas físicos. Un 45.5% y un 30.2% identificó mejores e iguales calificaciones. Conclusión: Es necesario investigar los efectos identificados agregando la evaluación de especialistas para mayor precisión de los hallazgos observados.

Introduction: COVID-19 has affected the mental health of the pediatric population. With the transition to virtuality, positive and negative positions have been identified. Due to the difference in sociodemographic characteristics that the Dominican Republic has, it is necessary to describe the effect of these changes on mental health within this context. Objective: To assess the effect of virtual classes on the mental health of pediatric patients. Methodology: Strengths and Difficulties Questionnaire was used in the patients who attended the general consultation. A score was assigned using the standardized scoring scale and the results were analyzed in frequency plots and spearman correlation tests. Results: There is a frequency of 10.4% (n=34) of high risk of developing some psychiatric disorder. Weak correlations were observed between younger age and conduct disorder, r(365) = -0.111, p = 0.034, and male gender and any pediatric disorder, r(365) = -0.131, p = 0.012. There is a 51.5% incidence of physical symptoms. 45.5% and 30.2% identified better and equal qualifications. Conclusion: It is necessary to investigate the effects identified adding the evaluation of specialists for greater precision of the observed findings.

Violence tendency and internet addiction in adolescents

SUMMARY OBJECTIVE: The aim of this study was to determine the relationship between internet addiction and violence tendency in adolescent students and the factors affecting violence tendency. METHODS: The research was conducted on 2,648 middle school students in Turkey. A socio-demographic form, the Young Internet Addiction Scale, and the Violence Tendency Scale were used to collect data. The data were analyzed using descriptive statistics and multiple regression analysis. RESULTS: It was determined that there was a significant positive relationship between the Young Internet Addiction Scale and the Violence Tendency Scale. Age has a positive effect on violence tendency levels. CONCLUSION: These findings suggest that the variables of age and internet addiction contribute to the occurrence of violence tendency. Psychiatric nurses should plan trainings and evaluate its effectiveness to raise awareness.

Telepsiquiatria no Brasil: construção, validação e aplicação de questionário de Conhecimento, Atitude e Prática / Telepsychiatry in Brazil: development, validation and application of a Knowledge, Attitude and Practice questionnaire

RESUMO Introdução: A telepsiquiatria, utilizada para oferecer a distância cuidados psiquiátricos, ganhou destaque durante a pandemia de Covid-19 e as regulamentações da telemedicina no Brasil. Este estudo visa avaliar o uso da telepsiquiatria entre psiquiatras brasileiros, utilizando questionários de Conhecimento, Atitude e Prática (CAP) para compreender os conhecimentos, as atitudes e as práticas relacionados. Objetivo: Este estudo teve como objetivos construir, validar e aplicar um questionário para determinar o nível de conhecimento, atitude e prática dos psiquiatras brasileiros em relação à telepsiquiatria no último ano. Além de identificar fatores associados a conhecimento, atitude e prática adequados. Método: Realizou-se um estudo metodológico para a construção e validação do instrumento, seguido por um estudo transversal com um questionário de CAP analítico. Após a elaboração do questionário, especialistas em psiquiatria validaram o instrumento por meio do método Delphi. Posteriormente, o questionário foi distribuído a psiquiatras em todo o Brasil por meio de redes sociais e da Associação Brasileira de Psiquiatria. A análise dos dados foi realizada no software Stata 12.1, com a utilização de análises estatísticas multivariadas de Poisson. Resultado: O questionário de CAP foi validado com alto grau de concordância entre especialistas. Dos participantes, 68,3% apresentaram conhecimento adequado, 80,1% atitude adequada e 81,2% prática adequada em relação à telepsiquiatria. A análise multivariada revelou associações significativas, como atitudes adequadas relacionadas à não prática em consultórios e atendimento a crianças, e práticas adequadas associadas ao atendimento de idosos e adolescentes. Conclusão: O estudo conclui que o questionário de CAP é válido e pode ser aplicado em estudos futuros. Destaca-se a importância da telepsiquiatria na prática dos psiquiatras brasileiros, com diferenças notáveis nas atitudes e práticas adequadas conforme a faixa etária dos pacientes atendidos. Esses resultados indicam a necessidade de considerar essas variáveis ao implementar a telepsiquiatria, contribuindo para orientar políticas de saúde mental e práticas clínicas específicas para diferentes grupos etários.

ABSTRACT Introduction: Telepsychiatry, defined as the use of electronic communication to provide or support remote psychiatric care, has gained prominence during the COVID-19 pandemic and the emergence of telemedicine regulations in Brazil. This study aims to assess the adoption of telepsychiatry among Brazilian psychiatrists, employing KAP (Knowledge, Attitude, and Practice) questionnaires to understand their knowledge, attitudes, and practices related to this field. Objective: Constructing, validating, and applying a questionnaire to determine the level of knowledge, attitude, and practice of Brazilian psychiatrists regarding telepsychiatry in the past year and identifying factors associated with adequate knowledge, attitude, and practice. Method: A methodological study was conducted to construct and validate the instrument, followed by a cross-sectional study with an analytical KAP questionnaire. After the questionnaire development, psychiatry experts validated the instrument using the Delphi method. Subsequently, the questionnaire was distributed to psychiatrists across Brazil through social networks and the Brazilian Psychiatric Association. Data analysis was performed using the Stata 12.1 software, employing multivariate Poisson analyses. Results: The KAP questionnaire was validated with a high degree of agreement among the experts. Among the participants, 68.3% demonstrated adequate knowledge, 80.1% had an adequate attitude, and 81.2% exhibited adequate practices concerning telepsychiatry. The multivariate analysis revealed significant associations, such as adequate attitudes being linked to not practicing in medical offices and providing care to children, while adequate practices were associated with providing care to both the elderly and adolescent patients. Conclusion: The study concludes that the KAP questionnaire is valid and can be applied in future research. It underscores the significance of telepsychiatry in the practices of Brazilian psychiatrists, with notable differences in adequate attitudes and practices based on the age groups of treated patients. These findings indicate the need to consider these variables when implementing telepsychiatry, contributing to guiding mental health policies and specific clinical practices for different age groups.

Considerações nosológicas sobre a demência precoce de Pinel a Kraepelin / Considérations nosologiques sur la Démence Précoce de Pinel à Kraepelin / Consideraciones nosológicas sobre la Demencia Precoz desde Pinel hasta Kraepelin / Nosological considerations on dementia praecox from Pinel to Kraepelin

O artigo pretende abordar, por meio de uma revisão narrativa de literatura, a evolução conceitual do diagnóstico da demência precoce enquanto um constructo nosológico na tradição psiquiátrica do século XIX e na obra de Emil Kraepelin. Desviando dos anacronismos, percorremos os principais autores que trataram do tema, ao salientar as diferenças nas concepções das escolas francesa e alemã, com especial atenção a Kraepelin. O presente estudo fornece o terreno para o próximo, em que são exploradas as contribuições de Eugen Bleuler e Kurt Schneider, chegando às classificações propostas pelos sistemas CID e DSM de nossa época. Concluiu-se, ao abordar as diferentes definições desse transtorno, bem como suas mudanças fundamentais no período em questão, que a apreensão do conceito atual de esquizofrenia não pode se dar sem ser referenciada ao contexto nosográfico da demência precoce e de suas posteriores classificações.

Resumos This article intends to approach, through a narrative literature review, the conceptual evolution of the diagnosis of dementia praecox as a nosological construct in the psychiatric tradition of the 19th century and in the work of Emil Kraepelin. Dodging anachronisms, we go through the main authors who dealt with the subject, highlighting the differences in the conceptions of the French and German schools, with special attention to Kraepelin. The present study provides the ground for the next one, in which the contributions of Eugen Bleuler and Kurt Schneider are explored, arriving at the classifications proposed by the CID and DSM systems. It was concluded, when addressing the different definitions of this disorder, as well as its fundamental changes in the period in question, that the apprehension of the current concept of schizophrenia cannot occur without reference to the nosographic contexto of dementia praecox and its subsequente classifications.

L'article se propose d'aborder, à travers une revue de littérature narrative, l'évolution conceptuelle du diagnostic de démence précoce comme construct nosologique dans la tradition psychiatrique du XIXe siècle et dans l'æuvre d'Emil Kraepelin. S'écartant des anachronismes, nous passons en revue les principaux auteurs qui ont traité le sujet, soulignant les différences dans les conceptions des écoles française et allemande, avec une attention particulière pour Kraepelin. La présente étude jette les bases de la suivante, dans laquelle les contributions d'Eugen Bleuler et de Kurt Schneider sont explorées, aboutissant aux classifications proposées par les systèmes CID et DSM de notre époque. Il a été conclu, en abordant les différentes définitions de ce trouble, ainsi que ses changements fondamentaux dans la période considérée, que l'appréhension du concept actuel de schizophrénie ne peut se faire sans référence au contexte nosographique de la démence précoce et de ses classifications ultérieures.

El artículo pretende abordar, a través de una revisión narrativa de la literatura, la evolución conceptual del diagnóstico de demencia precoz como constructo nosológico en la tradición psiquiátrica del siglo XIX y en la obra de Emil Kraepelin. Saliendo de anacronismos, hacemos un recorrido por los principales autores que trataron el tema, destacando las diferencias en las concepciones de las escuelas francesa y alemana, con especial atención a Kraepelin. El presente estudio sienta las bases para el siguiente, en el que se exploran los aportes de Eugen Bleuler y Kurt Schneider, llegando a las clasificaciones propuestas por los sistemas CID y DSM de nuestro tiempo. Se concluyó, al abordar las diferentes definiciones de este trastorno, así como sus cambios fundamentales en el período en cuestión, que la aprehensión del concepto actual de esquizofrenia no puede ocurrir sin ser referenciada al contexto nosográfico de la demencia precoz y de sus posteriores clasificaciones.

Drug repurposing and personalized treatment strategies for bipolar disorder using transcriptomics: an exploratory study

Objective: The present study combined transcriptomic data and computational techniques based on gene expression signatures to identify new bioactive compounds or Food and Drug Administration-approved drugs for the treatment of bipolar disorder (BD). Methods: Five transcriptomic datasets containing 165 blood samples from individuals with BD were selected from the Gene Expression Omnibus (GEO). The number of participants varied from six to 60, with a mean age between 35 and 48 years and a gender difference between them. Most of these patients were receiving pharmacological treatment. Master regulator analysis (MRA) and gene set enrichment analysis (GSEA) were performed to identify genes that were significantly different between patients with BD and healthy controls and their associations with mood states in patients with BD. In addition, molecules that could reverse the transcriptomic profiles of BD-altered regulons were identified from the Library of Network-Based Cellular Signatures Consortium (LINCS) and the Broad Institute Connectivity Map Drug Repurposing Database (cMap) databases. Results: MRA identified 59 candidate master regulators (MRs) that modulate regulatory units enriched with BD-altered genes. In contrast, GSEA identified 134 enriched genes and 982 regulons whose activation state was determined. Both analyses revealed genes exclusively associated with mania, depression, or euthymia, and some genes were shared among these three mood states. We identified bioactive compounds and licensed drug candidates, including antihypertensives and antineoplastic agents, as promising candidates for the treatment of BD. However, experimental validation is essential to confirm these findings in further studies. Conclusion: Although our data are still preliminary, they provide some insights into the biological patterns of different mood states in patients with BD and their potential therapeutic targets. The strategy of transcriptomics plus bioinformatics offers a way to advance drug discovery and personalized medicine by using gene expression information.

Minimum required information for Psychiatric History Taking: a scoping textbook review / Informações básicas para anamnese Psiquiátrica: Uma revisão sistematizada de livros texto

ABSTRACT Objective In psychiatry, History Taking(HT) and Mental Status Examination are the only information source for diagnosis, resulting in reliability and validity issues. Standard Diagnostic Interviews(SDI) were prescribed as a solution for diagnostic unreliability but not used in clinical practice. Our objective is to describe and consolidate the "must be collected data" in psychiatric HT, and reasons why some information must be collected for an adequate diagnostic hypothesis generation. Methods Researchers and lecturers from different countries were consulted about Textbooks of Clinical Psychiatry, as a privileged source of consolidated HT information in psychiatric training, using a snowball methodology, complemented by references review and most sold textbooks. Data were systematically extracted by two authors, and then comprehensively synthesized. Results Twenty-five textbooks, from sixteen different countries, were accessed. We did not find a standard model, nor clear reasons for why HT components were chosen, but the manual's information grossly overlaps, suggesting a "validated by tradition" model in psychiatry. Conclusion The "must be collected data" are both risk factors and prototype building blocks for mental disorders, with different anti-bias strategies. HT content suggested by textbooks is different from what is addressed by SDI, and a consensual "minimum information" for diagnostic reasoning was described.

RESUMO Objetivo Em psiquiatria, a anamnese e o Exame Psíquico são as únicas fontes de informação para o diagnóstico, resultando em problemas de confiabilidade e validade. As entrevistas diagnósticas padronizadas (SDI) foram prescritas como uma solução para a falta de confiabilidade diagnóstica, mas não são utilizadas na clínica. Nosso objetivo é descrever e consolidar os "dados mínimos que devem ser coletados" na anamnese psiquiátrica, e as razões pelas quais estes dados devem ser coletados para a geração de hipóteses diagnósticas. Métodos Pesquisadores e professores de psiquiatria de diferentes países foram consultados sobre os livros didáticos de Psiquiatria Clínica usados em seus países. Usando uma metodologia de bola de neve, complementada por revisões de referências e os livros didáticos mais vendidos, selecionamos os livros texto como fontes de informação consolidada para o treinamento de anamnese em psiquiatria. Os dados foram sistematicamente extraídos por dois autores, e depois sistematizados e comentados. Resultados Vinte e cinco livros didáticos, de dezesseis países diferentes, foram acessados. Não encontramos um modelo padrão, nem razões claras para a escolha dos componentes da anamnese, mas as informações clínicas dos livros se sobrepõem consistentemente, sugerindo um modelo "validado pela tradição" em psiquiatria. Conclusões Os "dados mínimos que devem ser coletados" são tanto fatores de risco como blocos de construção de protótipos para distúrbios mentais, com diferentes estratégias anti-viés. O conteúdo da anamnese sugerido pelos manuais é diferente do abordado pelas SDIs, e a "informação mínima" para o raciocínio diagnóstico foi descrita.

O diagnóstico psiquiátrico como racionalização da classificação ontológica negativa dos sujeitos sem-abrigo / Psychiatric diagnosis as rationalization of the homeless' negative ontological classification / Psychiatric diagnosis as rationalization of the homeless' negative ontological classification

Resumo Desde o final do século XX, a intervenção sobre a vida na rua é crescentemente medicalizada. Com base num trabalho de mais de 500 horas de observação direta, realizado numa cidade portuguesa de média dimensão entre 2010 e 2014, discuto como assistentes sociais, psicólogos, psiquiatras, entre outros atores da intervenção, compreendem a vida na rua como um problema de insuficiência ontológico-psiquiátrica de cada sujeito sem-abrigo. Nesse contexto medicalizado, o diagnóstico psiquiátrico é uma técnica de intervenção importante pois é através dela que o julgamento coletivo sobre a anormalidade de cada sujeito sem-abrigo é validado. Não sendo um momento de descoberta médico-científica dessa anormalidade, o diagnóstico oficial pronunciado por um psiquiatra é um instante em que a classificação ontológica negativa apriorística é racionalizada em termos médico-científicos. Através de procedimentos como o diagnóstico psiquiátrico, a medicalização invisibiliza as características estruturais da vida na rua, legitimando um modelo societal desigual e injusto que torna alguns sujeitos sem-abrigo.

Abstract Since the late 20th century, intervention on homelessness became increasingly medicalized. Using fieldwork that consisted of more than 500 hours of direct observation in a medium-sized Portuguese city from 2010 to 2014, I discuss how social workers, psychologists, psychiatrists, among other actors, understand homelessness as the result of a ontological-psychiatric limitation of each homeless individual. In this medicalized context, psychiatric diagnosis is an important intervention technique since it validates the collective judgment on each homeless individual's abnormality. The official psychiatric diagnosis pronounced by a psychiatrist, rather than a moment of medical-scientific discovery of this abnormality, constitutes an instant in which a previous negative ontological classification is rationalized in medical-scientific terms. By procedures such as the psychiatric diagnosis, medicalization renders the structural features of homelessness invisible, thus operating to legitimize an unjust and unequal societal model that makes certain individuals homeless.

Revisiting the history of autism before Kanner and Asperger: a tribute to Grunya Sukhareva / Revisitando a história do autismo antes de Kanner e Asperger: um tributo a Grunya Sukhareva

Abstract Almost two decades before Kanner's and Asperger's works, the original paper by child psychiatrist Grunya Efimovna Sukhareva had already been written. It was published in 1926 by Sukhareva in a German scientific journal of psychiatry and neurology, with a detailed description of children who presented clinical conditions whose characteristics and evolution closely resemble autism, according to current criteria. In the present historical note, we intend to present Sukhareva's pioneering work and retrieve the meaning of her original contribution.

Resumo Quase duas décadas antes dos trabalhos de Kanner e Asperger, o artigo original da psiquiatra infantil Grunya Efimovna Sukhareva já havia sido escrito. Foi publicado por Sukhareva em 1926, em uma revista científica alemã de psiquiatria e neurologia, com uma descrição detalhada de crianças que apresentavam quadro clínico cujas características e evolução em muito se assemelham ao autismo, segundo os critérios atuais. Nesta nota histórica, pretende-se apresentar o trabalho pioneiro de Sukhareva e resgatar o significado da sua contribuição original.

Trastorno cognitivo comunicativo ligado a Esquizofrenia. Reporte de caso

La Esquizofrenia comprende un conjunto heterogéneo de trastornos, los cuales conforman un espectro con signos y síntomas variables que son diferentes en cada paciente e involucran alteraciones de la percepción, las emociones, la cognición, el pensamiento y el comportamiento. Por su parte, el Trastorno Cognitivo Comunicativo se entiende como un conglomerado de dificultades de la comunicación relacionadas con déficits lingüísticos, sobre todo en sintaxis, semántica y/o habilidades metalingüísticas, así como funciones cognitivas no lingüísticas. El caso clínico expuesto se enfoca en la presentación concomitante de Trastorno Cognitivo Comunicativo y Esquizofrenia. Los tratamientos médicos aplicados a menudo para la esquizofrenia tienden a reducir la desintegración que acompaña a los síntomas positivos, los cuales involucran alteraciones de la percepción, del pensamiento y de la conducta. Sin embargo, los síntomas negativos son atendidos con menor frecuencia, lo que puede impedir la reconexión del paciente con su entorno social. En el caso reportado, el abordaje integral de la sintomatología positiva junto con la negativa reflejan la potencialidad para la reinserción a la rutina social cotidiana.

Schizophrenia comprises a heterogeneous set of disorders, setting up a spectrum with variable signs and symptoms, different in each patient, involving alterations in perception, emotions, cognition, thinking and behavior. The Communicative Cognitive Disorder is understood as a conglomerate of communication impairments related to linguistic deficits, especially in syntax, semantics and/or metalinguistic skills, as well as non-linguistic cognitive functions. We present here a case with Communicative Cognitive Disorder concomitant with Schizophrenia. Medical treatments often applied for schizophrenia tend to reduce the disintegration associated with positive symptoms, thus improving perception, thinking, and behavior. However, negative symptoms are treated less frequently, which may prevent the patient from reconnecting with their social environment. In the case reported, the comprehensive approach to positive symptoms together with the negative ones reflect the potential for reinsertion into the daily social routine.

Daseinsanalyse psiquiátrica, fenomenologia das psicoses e ética da alteridade / Daseinsanalyse psychiatrique, phénoménologie des psychoses et éthique de l'altérité / Psychiatric Daseinsanalyse, phenomenology of psychoses and ethics of alterity / Daseinsanalyse psiquiátrica, fenomenología de las psicosis y ética de la alteridad

Este artigo tem por objetivo analisar o aspecto ético da fenomenologia das psicoses estabelecida pela Daseinsanalyse psiquiátrica de Ludwig Binswanger, a partir do modo como Merleau-Ponty concebe a experiência de outrem enquanto intercorporeidade. Inicialmente se apresenta a relação entre psiquiatria e fenomenologia, considerando a perspectiva de Binswanger sobre o problema da objetividade científica no campo da clínica e sua busca por desenvolver uma abordagem fundada na intersubjetividade. Ao final, procurou-se realizar alguns apontamentos sobre o sentido possível da aproximação entre fenomenologia e psiquiatria, de modo a tornar possível uma fenomenologia das psicoses que se constitua pelo reconhecimento da alteridade.

Resumos This article aims to analyze the ethical aspect of the phenomenology of psychoses established by Ludwig Binswanger's psychiatric Daseinsanalyse, based on the way Merleau-Ponty conceives the experience of others as intercorporeity. Initially, the relationship between psychiatry and phenomenology is presented, considering Binswanger's perspective on the problem of scientific objectivity in the clinical field and his quest to develop an approach based on intersubjectivity. Finally, we tried to make some notes about the possible meaning of the approximation between phenomenology and psychiatry, in order to make possible a phenomenology of psychoses that is constituted by the recognition of alterity.

Cet article analyse la dimension éthique de la phénoménologie des psychoses établie par la Daseinsanalyse psychiatrique de Ludwig Binswanger, basée sur la manière dont Merleau-Ponty conçoit l'expérience d'autrui comme intercorporéité. Dans un premier temps, nous présentons la relation entre la psychiatrie et la phénoménologie, en considérant la perspective de Binswanger sur le problème de l'objectivité scientifique dans le domaine clinique et sa quête pour développer une approche basée sur l'intersubjectivité. Enfin, nous essayons quelques remarques sur le sens possible du rapprochement entre phénoménologie et psychiatrie, afin de rendre possible une phénoménologie des psychoses qui soit constituée par la reconnaissance de l'altérité.

Este artículo tiene como objetivo realizar un análisis del aspecto ético de la fenomenología de las psicosis establecida por el Daseinsanalyse psiquiátrico de Ludwig Binswanger, a partir de cómo Merleau-Ponty concibe la experiencia del otro como intercorporeidad. Inicialmente, se presenta la relación entre psiquiatría y fenomenología teniendo en cuenta la perspectiva de Binswanger sobre el problema de la objetividad científica en el campo clínico y su búsqueda por desarrollar un enfoque basado en la intersubjetividad. Por último, se intenta hacer algunos apuntes sobre el posible significado de la aproximación entre fenomenología y psiquiatría para posibilitar una fenomenología de las psicosis que se constituya en el reconocimiento de la alteridad.

Human social isolation and stress: a systematic review of different contexts and recommendations for future studies

Abstract Objectives The emergence of the coronavirus disease 2019 (COVID-19) pandemic and subsequent lockdowns and social distancing measures adopted worldwide raised questions about the possible health effects of human social isolation. Methods We conducted a systematic review on PubMed, Scopus, and Embase electronic databases using terms related to human social isolation - defined as the isolation of an individual from regular routines and usual social contact - and psychological stress, searching for simulated or naturalistic isolation environments. We present the main results, as well as the validity and limitations of each model. PROSPERO registry number: CRD42021241880. Results Despite the diversity of contexts reviewed, some outcomes almost ubiquitously relate to psychological stress, i.e., longer periods, expectation of a longer period, confinement, lack of social interaction, and support. Based on the results, and considering that most studies were not designed for the purpose of understanding isolation itself, we propose a group of recommendations for future experimental or naturalistic research on the topic. Conclusion Evidence on the impact of different situations in which individuals are subjected to social isolation can assist in development of directed preventive strategies to support people under similar circumstances. Such strategies might increase the general public's compliance with social distancing as a non-pharmacological intervention for emerging infectious diseases.