Um estudo sobre as incidências da pulsão oral nas psicoses maníaco-depressivas / Une étude à propos des incidences de la pulsion orale dans les psychoses maniaco-dépressives / A study about the occurrences of oral drive in manic-depressive psychosis

Este artigo apresenta uma discussão sobre as repercussões do modo de funcionamento marcado pela pulsão oral como um elemento decisivo para que alcancemos as bases mais primordiais da psicose maníaco- depressiva. Entendemos que este estudo também pode auxiliar na elucidação da presença de estados melancoliformes e maniformes em configurações neuróticas de maior gravidade, ou ainda, em psicoses não desencadeadas. Nosso recorte temático será desenvolvido a partir do referencial freudiano, conferindo um espaço significativo às contribuições de Karl Abraham. Também contará com a exposição de novas colaborações da psicanálise pós-freudiana, com enfoque nos impactos da voracidade pulsional na vida humana e as consequências psicopatológicas desse tipo de fixação libidinal. Por fim, buscaremos alinhavar pontos levantados com o diferencial das teorizações de Jacques Lacan, resgatando sucintamente princípios de sua teoria da clínica como a relação ao grande Outro, a lógica fantasmática, o objeto a e o significante paterno.

Cet article présente une discussion sur les répercussions du mode de fonctionnement subjectif marqué par la pulsion orale comme un élément fondamental pour comprendre les bases les plus primordiales de la psychose maniaco-dépressive. Nous comprenons que cette étude peut également aider à élucider la présence d'états en format mélancolique et maniaque dans des configurations névrotiques de gravité plus élevée, ou encore, dans des psychoses non déclenchées. Notre découpage thématique sera développé à partir de la théorie freudienne, accordant un espace significatif aux contributions de Karl Abraham. Il inclura également l'exposition de nouvelles collaborations de la psychanalyse post-freudienne, en mettant l'accent sur les conséquences de la voracité pulsionnelle dans la vie humaine et les conséquences psychopathologiques de ce genre de fixation libidinale. Enfin, nous chercherons à relier les points relevés avec la spécificité des théorisations de Jacques Lacan, reprenant brièvement les principes de sa théorie clinique tels que la relation au grand Autre, la logique du fantasme, l'objet a et le signifiant paternel.

This article presents a discussion about the repercussions of the predominance of the oral drive in subjective functioning as a decisive element to reach the primordial bases of manic-depressive psychosis. We understand that this study can also help enlighten the presence of melancholic and manic states in more severe neurotic configurations, or even in untriggered psychoses. Our thematic framework will be based on Freudian theory, giving significant space to the contributions of Karl Abraham. It will also include the exposition of new contributions from post-Freudian psychoanalysis, focusing on the impacts of drive eagerness in human life and the psychopathological consequences of this type of fixation of libido. Finally, we will seek to connect the issues raised with the uniqueness of Jacques Lacan's theorizations, briefly revisiting the principles of his clinical theory such as the relation to the Other, the phantasmatic logic, the object a, and the fatherly signifier.

Clinical characteristics and related factors of patients with schizophrenia in different ages of onset / 中国心理卫生杂志

Objective:To explore the clinical characteristics and related socio-demographic factors of schizo-phrenia patients with different ages of onset.Methods:Totally 2 016 patients with schizophrenia aged 15 to 70 were selected according to the diagnostic criteria for schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition.All of the patients were interviewed by psychiatrists using the Mini International Neuropsy-chiatric Interview to diagnose schizophrenia,Clinical-Rated Dimensions of Psychosis Symptom Severity(CRDPSS)and the Positive and Negative Syndrome Scale(PANSS)to assess symptoms.The cut-off points were 18 and 25 years old for three age groups,i.e.early onset(EOS),youth onset(YOS)and adult onset(AOS).Statistical analy-ses were performed by analysis of variance Pearson correlation analysis,and multivariate linear regression.Results:The early-onset patients had the highest total PANSS score(73.8±28.0)and CRDPSS score(11.7±5.4).Fe-male gender,high education level,Han ethnicity,early onset age,and slower onset of illness were negatively corre-lated with the total and dimension score of PANSS scale and CRDPSS scale(standardized regression coefficient:0.04-0.47),and income level and smoking were negatively correlated with those score(standardized regression coefficient:-0.04--0.14).Conclusion:Early-onset schizophrenia patients have more severe symptoms,and fe-male,high education level,early-onset disease,and chronic onset are the risk factors of symptom severity in patients with schizophrenia.

Stigma of ultra-high risk for psychosis: an updated systematic review

Objective: To determine whether the stigma associated with schizophrenia has also been directed towards people at ultra-high risk of psychosis (UHR), the present review aimed to synthetize the literature to update and extend our understanding of this topic. Methods: A systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in the PubMed, EMBASE, Cochrane, and Web of Science databases for articles published until April 30, 2023, using a combination of search terms describing at-risk mental states for psychosis, stigma, and related terms. Results: Thirty-eight studies were included. Twenty-nine addressed individuals with UHR directly, and nine conducted interviews with non-patients regarding UHR. A total of 2,560 individuals with UHR were assessed, with a mean sample size of 88.3 participants. Most were quantitative non-randomized/observational studies with young adults, 71.4% used the Structured Interview for Psychosis-Risk Syndromes, and 25% used the Comprehensive Assessment of At-Risk Mental States. Overall, the studies mainly involved patients of UHR clinics from high-income Western countries. The described stigma can be grouped into five forms, the most frequently explored of which was perceived public stigma, followed by public stigma, self-stigma/internalized stigma, stigma stress, and associative stigma. Quantitative nonrandomized studies predominated: only one was an interventional study. Most of the results confirmed the presence of stigma toward individuals with UHR. Conclusion: Despite the knowledge gaps and scarcity of research on UHR-related stigma, the results suggest that stigma toward people with UHR exists and that it is already present at early stages of psychosis. Registration number: PROSPERO CRD42022332037.

Síndrome serotoninérgico inducido por ayahuasca: a propósito de un caso

El síndrome serotoninérgico es un conjunto de signos y síntomas generados por hiperactividad serotoninérgica, caracterizado principalmente por alteración del sistema nervioso central. La medicina tradicional, históricamente utiliza herbales con fines curativos y religiosos que podrían tener efectos sobre el sistema serotoninérgico, receptores de dopamina, glutamato y noradrenalina, en este contexto se menciona la ayahuasca o "yagé" como un brebaje con potencial psicoactivo que por lo general se relaciona con síntomas psicóticos. En esta ocasión presentamos un caso clínico de una paciente con síndrome serotoninérgico posterior al consumo por primera vez de ayahuasca en un ritual indígena. Se trata de una paciente femenina de 31 años quien por primera vez ingirió yagé y en cantidad desconocida durante dos días consecutivos en el municipio de Cachipay, Cundinamarca, por sus síntomas clínicos se consideró que cursaba con un síndrome serotoninérgico, recibió tratamiento con adecuado control de su cuadro. Existen múltiples reportes bibliográficos sobre trastornos psicóticos derivados especialmente del uso de DMT en preparación de ayahuasca, sin embargo, la ocurrencia de síntomas psicóticos prolongados, más allá de 48 horas, se considera excepcional; se han descrito en pacientes con antecedentes personales y familiares de psicosis, manía, hipomanía o abuso de sustancias psicoactivas.

Serotonin syndrome is a set of signs and symptoms caused by serotonergic hyperactivity, primarily characterized by alterations in the central nervous system. Historically, traditional medicine has used herbal remedies for healing and religious purposes, which could affect the serotonergic system, dopamine, glutamate, and noradrenaline receptors. In this context, ayahuasca or «yagé» is mentioned as a brew with psychoactive potential that is generally associated with psychotic symptoms. Here, we present a clinical case of a patient with serotonin syndrome following her first-time consumption of ayahuasca in an indigenous ritual. The patient is a 31-year-old female who ingested an unknown quantity of yagé over two consecutive days in Cachipay, Cundinamarca. Given her clinical symptoms, she was considered to have serotonin syndrome and received treatment with adequate control of her condition. Multiple reports in the literature discuss psychotic disorders especially from DMT use in ayahuasca preparation; however, the occurrence of prolonged psychotic symptoms beyond 48 hours is considered exceptional and has been described in patients with personal and family histories of psychosis, mania, hypomania, or abuse of psychoactive substances.

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.

Transferência e a clínica psicanalítica das psicoses / Transference and the psychoanalytic clinic of the psychosis / La transferencia y la clínica psicoanalítica de las psicosis / Transfert et la clinique psychanalytique des psychotiques

Resumo: Desde o início do desenvolvimento de sua teoria, Freud observara que os psicóticos não respondiam ao tratamento psicanalítico, levando à ideia de que à psicose corresponderia um mecanismo de constituição diferente. Aos poucos, a transferência passou a ser alvo da investigação que conduzisse à descoberta de um modo a lidar com a psicose. Mas as descobertas freudianas foram insuficientes para se estabelecer um laço transferencial satisfatório para os psicóticos. Com Jacques Lacan, alguns conceitos freudianos sofreram modificação, com a criação de operadores próprios, surgindo a erotomania, consequência estrutural e lógica do vínculo entre analista e psicótico. Sendo assim, este artigo busca demonstrar uma clínica possível, sob a perspectiva psicanalítica, para o tratamento da psicose, a partir do estabelecimento do laço transferencial, por meio do manejo apropriado do gozo, que promova estabilização e consiga mitigar o sofrimento, como saída possível para o problema da indicação do tratamento psicanalítico aos psicóticos.

Résumé : Au début de ses développements théoriques, Freud a observé que les psychotiques ne répondaient pas au traitement psychanalytique, indiquant qu'un mécanisme de formation différent correspondrait à la psychose. Progressivement, le transfert est devenu la cible de la découverte d'une manière pour faire face à la psychose. Jacques Lacan a modifié certains concepts freudiens pour crée des opérateurs propres et a inventé l'érotomanie, la conséquence structurelle et logique de la relation entre analyste et psychotique. Cet article propose une clinique possible, dans la perspective psychanalytique, comme solution possible au traitement de la psychose à partir de l'établissement du transfert par le biais du maniement approprié de la jouissance qui conduise à la stabilisation.

Abstract: Early in his theoretical developments, Freud noticed that psychotics did not respond to the psychoanalytic treatment, suggesting that psychosis would correspond to a different constitution mechanism. Gradually, transference became the target of investigation for discovering a way to tackle psychosis. However, Freud's findings were insufficient to solve the issue of establishing a satisfactory transference bond with psychotics. Jacques Lacan modified some Freudian concepts to create his own operators and coined erotomania, the structural and logical consequence of the bond between analyst and psychotic. This article proposes a possible clinic, from a psychoanalytic perspective, as a possible treatment route for psychosis by establishing a transference bond via the appropriate management of jouissance, which promotes stabilization.

Resumen: Desde el comienzo del desarrollo de su teoría, Freud observó que los psicóticos no respondían al tratamiento psicoanalítico, lo que dio lugar a la idea de que la psicosis correspondía a un mecanismo de formación diferente. Gradualmente, la transferencia se convirtió en el objetivo de la investigación que podría conducir al descubrimiento de una manera peculiar para hacer frente a la psicosis. En el estudio de Jacques Lacan, algunos conceptos freudianos se han modificado con la creación de operadores propios, y emergió la erotomanía como consecuencia estructural y lógica de la relación entre el analista y el psicótico. Así, este artículo busca demostrar una posible clínica desde una perspectiva psicoanalítica para el tratamiento de la psicosis, basada en el establecimiento del vínculo transferencial, a través del adecuado manejo del goce que promueva la estabilización y logre mitigar el sufrimiento, como una posible salida al problema de indicar tratamiento psicoanalítico a los psicóticos.

Interpretación psiquiátrica forense de la fórmula de inimputabilidad del nuevo Código Penal cubano de 2022 / Psychiatric forensic interpretation of non-imputability formula in the new 2022 Cuban Penal Code

Resumen: En 2022 el Código Penal cubano incorporó una nueva fórmula de inimputabilidad. Este artículo aborda el problema de cómo interpretarla y aplicarla durante las pericias psiquiátricas a imputados. Es su objetivo analizar desde la Psiquiatría dicha fórmula penal para su interpretación forense. Se muestran las críticas que, en publicaciones y ámbitos académicos, fueron hechas a la anterior fórmula; así como la norma complementaria del organismo rector para su interpretación pericial. Se expone y analiza la actual fórmula, elaborada con asesoría de psiquiatras al proceso legislativo, para superar aquellas críticas, pero que, precisamente por diferente, demanda actualizar su interpretación y los métodos periciales para calificar casos acertadamente, detectar simulación y ser controlable como prueba por los jueces. Un criterio de interpretación fue elaborado por el autor y se le sometió a grupos de expertos para consensuar una propuesta final normativa, consistente en considerar pericialmente pretenso inimputable a quién actuó ilícitamente por un trastorno psicótico diagnosticado que se manifestó directamente en el delito, lo que debe quedar demostrado en el informe. En su generalidad, estos criterios pueden aplicarse a valoración de inimputabilidad según otros códigos penales.

Introduction: In 2022 a new Cuban Penal Code incorporated a new requirement of non-imputability. This article approaches to the problem of how to interpret and apply this new non-imputability formula to the psychiatric examination of defendants and has the objective of analyzing it in forensic interpretation. It shows the academic and publisher's criticism made of the previous Cuban non-imputability formula and the complementary precept of the health ministry for forensic interpretation. The new non-imputability formula, elaborated with psychiatrists' assistance during a legislative process to surpass those previous criticisms, is exposed and analyzed. This new different penal requirement put under obligation to change in forensic interpretations and methods to identify criminal non-imputability, pretenders and to be a clue controlled by judges. A new forensic interpretation criterion was elaborated and submitted to groups of psychiatrist experts, to obtain a normative proposition that considered in possible non-imputability of the person who committed the crime during a diagnosed psychotic disorder that was the certain direct determinant of the fact. The psychiatric report may show all mentioned below and, in general view, according to other penal codes, these criteria can be applied in the forensic expertise relative to non-imputability.

Coexistencia de distintos síndromes de falsos reconocimientos delirantes en la práctica clínica: serie de casos

Objetivo: El objetivo de este estudio es analizar la coexistencia de varios síndromes de falsos reconocimientos delirantes en una muestra clínica. Métodos: A lo largo de 1 ano, se seleccionó una muestra de 6 pacientes con 2 o más tipos de falsos reconocimientos delirantes durante el mismo episodio. Todos ellos se encontraban hospitalizados en la unidad de hospitalización psiquiátrica en un hospital de España. Resultados: A pesar de los distintos diagnósticos, los pacientes incluidos presentaban diferentes tipos de falsos reconocimientos delirantes, tanto de hiperidentificación como de hipoidentificación. El tratamiento antipsicótico fue escasamente eficaz contra estos síndromes de falsos reconocimientos delirantes. Conclusiones: La coexistencia de varios síndromes de falsos reconocimientos delirantes indica que la etiopatogenia de los distintos tipos es similar. Se trata de un campo con importantes implicaciones tanto clínicas, por la baja respuesta al tratamiento, como las posibles médico-legales.

Objective: The objective of this study is to analyze the coexistence of several delusional misidentification syndromes in a clinical sample. Methods: Over one year, a sample of six patients presenting two or more types of delusional misidentification syndromes was selected. All these patients were admitted to the psychiatric inpatient unit of a Spanish hospital. Results: Despite the different diagnoses, the patients included presented different types of delusional misidentification syndromes, both hyperidentification and hypoidentification. Antipsychotic treatment was not very effective against these delusional misidentification syndromes Conclusions: The coexistence of several delusional misidentification syndromes indicates that the aetiopathogenesis of the different types is similar. It is a field with important clinical implications, due to the poor response to treatment, as well as the possible medico-legal implications.

Relative impact of diagnosis and clinical stage on response to electroconvulsive therapy: a retrospective cohort

Objectives: Electroconvulsive therapy (ECT) is commonly indicated for refractory psychiatric disorders. However, little research has compared response across diagnoses. Here, we aimed to evaluate the relative impact of diagnosis and clinical staging as response predictors in a cross-diagnostic sample. Methods: In a retrospective cohort of adult inpatients (n=287) who underwent at least six sessions of ECT, we investigated predictors of complete response (a clinical global impression of 1) to ECT. We use adjusted regression models to estimate the impact of clinical diagnosis and staging on complete response and dominance analysis to assess the relative importance of these predictors. Results: Those for whom a depressive episode was a primary indication for treatment were the most likely to have complete improvement, while those with psychosis were the least likely; clinical stage had a significant influence on outcome in all diagnoses. A diagnosis of psychosis was the strongest predictor of non-response. Conclusions: A diagnosis of psychosis (mainly schizophrenia) was the strongest predictor of non-response. We also found that clinical staging can aggregate information on ECT response that is independent of clinical diagnosis.

El problema etiológico de los delirios en la esquizofrenia para la neuropsiquiatría actual / The Etiological Problem of Psychotic Delusions in Current Neuropsychiatry / O problema etiológico dos delírios na esquizofrenia para a neuropsiquiatria atual

Introducción: el delirio constituye uno de los síntomas más complejos y severos de la psicosis. Uno de los problemas más fundamentales que enfrenta la investigación en el campo de la neuropsiquiatría tiene que ver con el desafío de producir teorías explicativas para la producción de este tipo de estado mental, a lo que se denomina problema etiológico de los delirios psicóticos. Desarrollo: se analizan críticamente las principales alternativas dentro de la neuropsiquiatría contemporánea al problema etiológico en el contexto de la esquizofrenia. Conclusión: el análisis indica que las tres teorías fundamentales que conviven en la actualidad poseen problemas para avanzar en el desafío de explicar la etiología de los delirios. Por lo anterior, se propone la idea de que, a la luz del estado del debate reciente, la hibridación teórica podría perfilarse como el mejor candidato metodológico para generar progreso real en la disciplina

Introduction: Delusions constitute one of the most complex and severe symptoms of psychosis. One of the most fundamental problems within current research in neuropsychiatry has to do with the challenge of producing explanatory theories of the aetiology of the phenomenon. I call this the etiological problem of psychotic delusions. Development: The main alternatives to the etiological problem in schizophrenia in current neuropsychiatry are critically assessed. Conclusion: The three current co-existing approaches possess a number of problems to make real progress in the etiological debate. For this reason, I suggest that, in light of the current state of the art, theoretical hybridization could become the best methodologi- cal candidate to make progress within the target debate

Introdução: o delírio é um dos sintomas mais complexos e graves da psicose. Um dos problemas mais fundamentais enfrentados atualmente pelas pesquisas no campo da neuropsiquiatria diz respeito ao desafio de produzir teorias explicativas para a produção desse tipo de estado mental, que chamo de o problema etiológico dos delírios psicóticos. Desenvolvimento: são analisadas criticamente as principais alternativas da neuropsiquiatria contemporânea ao problema etiológico no contexto da esquizofrenia. Conclusão: a análise indica que as três teorias fundamentais que coexistem atualmente têm problemas para avançar no desafio de explicar a etiologia dos delírios. Portanto, propõe-se a ideia de que, à luz do estado atual do debate, a hibridação teórica poderia surgir como o melhor candidato metodológico para gerar um progresso real na disciplina.

Acute-onset psychosis induced by a therapeutic dose of parenteral hyoscine butylbromide: A case report

Anticholinergic medications are frequently prescribed for gastrointestinal and genitourinary spasms. Psychosis, when present, results from anticholinergic overdose or toxicity. In the literature, anticholinergic-induced psychosis at therapeutic doses in patients with normal cognition is extremely uncommon. Here, we describe the case of a 28-year-old female who presented with auditory and visual hallucinations, stereotypy, and agitation after receiving a single intramuscular injection of 20 mg hyoscine butylbromide for dysmenorrhea. Even though it is rare for a therapeutic dose of hyoscine butylbromide to cause psychosis, clinicians should maintain a high index of suspicion and be cautious when administering or prescribing anticholinergics.

The impact of childhood trauma on cognitive function in individuals with clinical high risk of psychosis / 中华行为医学与脑科学杂志

Objective:To explore the impact of cognitive function and childhood trauma in individuals with clinical high risk of psychosis (CHR).Methods:From June 2017 to September 2022, a total of 62 individuals with CHR(CHR group) were screened by structured interviews with psychiatric risk syndrome (SIPS) at Beijing Anding Hospital, and 61 healthy controls(healthy control group) matched in gender, age, and educational years were recruited. All participants were evaluated by the childhood trauma questionnaire (CTQ) and the Chinese version of the MATRICS consensus cognitive test battery (MCCB). Differences in cognitive function and childhood trauma between the two groups were compared by R4.1.1 software, and the correlation between cognitive function and childhood trauma in the CHR group was analyzed.Results:The scores of MCCB composite score (41.46±6.97), information processing speed (40.20±8.40), attention vigilance (40.92±11.00), working memory (41.09±9.97), verbal learning, and visual learning of CHR group were significantly lower than those of healthy controls(MCCB composite score(46.26±7.64), information processing speed(45.83±8.36), attention vigilance(46.30±9.57), working memory(46.18±8.49)), and with statistically significant differences ( t=-3.73--2.03, P<0.05). The total CTQ score, emotional abuse, physical abuse, and physical neglect factor scores of the CHR group (40.0 (36.0, 50.8), 7.5 (6.0, 10.0), 5.0 (5.0, 7.0), 9.0 (7.0, 11.0)) were significantly higher than those of the healthy control group (34.0 (31.0, 40.0), 6.0 (5.0, 8.0), 5.0 (5.0, 6.0), 9.0 (6.0, 10.0) ) ( Z=-4.07--2.06, P<0.05). In the CHR group, the total score of childhood trauma and the score of physical abuse factors were negatively correlated with working memory ( r=-0.29, -0.28, P<0.05), and the total score of cognitive function, attention vigilance, and word learning were negatively correlated with physical neglect ( r=-0.28, -0.26, -0.31, P<0.05). After partial correlation analysis using gender, age, years of education, and total SIPS score as covariates, the aforementioned correlation remained significant. Conclusion:CHR individuals have multiple cognitive deficits, and childhood trauma is more serious. Childhood trauma, especially physical trauma, may affect the cognitive function of CHR individuals.

Translation and cross-cultural adaptation to Brazilian Portuguese of two brief screening tools for youth at risk of psychosis: the Prodromal Questionnaire (PQ-16) and the PRIME-Screen

Abstract Introduction Prodromal characteristics of psychosis have been described for more than a century. Over the last three decades, a variety of studies have proposed methods to prospectively identify individuals (and youth in particular) who are at high risk of developing a psychotic disorder. These studies have validated various screening instruments and made them available in several languages. Here, we describe the translation into Brazilian Portuguese and cross-cultural adaptation of two such screening tools - the Prodromal Questionnaire-16 (PQ-16) and the Prevention through Risk Identification, Management, and Education (PRIME)-Screen. Method Two bilingual native speakers of Brazilian Portuguese translated the questionnaires from English. A native English speaker then performed back-translations into English. These back-translated versions were submitted to the original authors. They provided feedback and later approved the final versions. Results After translation and cross-cultural adaptation, no items needed to be changed in the adapted PQ-16 and four items were revised in the PRIME-Screen. After the peer-review process, we included two suggestions in the PQ-16 to facilitate use of the tool in our cultural and social contexts. The PRIME-Screen did not need further changes. Conclusion These new instruments can help screen Brazilian Portuguese-speaking patients who are at risk of psychosis in primary care.

"Amanhã você estará aqui?" O trabalho com objetos em uma instituição para crianças com dificuldades no laço social / « Est-ce que demain tu seras là? ¼ Le travail à partir des objets dans une institution pour enfants en difficulté au niveau du ien social / "Will you be here tomorrow?" The work with objects in an institution for children with social bond difficulties / "¿Estarás aquí mañana?"El trabajo con los objetos en una institución para niños con dificultades en el lazo social

Este artigo trata de uma experiência institucional de estágio no Institut Médico Pédagogique Notre Dame de la Sagesse, também conhecido como Le Courtil. O Courtil é uma instituição belga que acolhe crianças e jovens com impasses no laço social. A partir do caso clínico de uma garota de oito anos, discute-se a importância dos objetos para a invenção e o tratamento que o sujeito dá ao real. Demonstra-se que o tratamento é um trabalho singular realizado pelo sujeito em parceria com os interventores. A prática entre vários e a transferência são colocadas em evidência como dispositivos que favorecem esse trabalho

Cet article est à propos d'une expérience institutionnel de stage à l'Institut Médico Pédagogique Notre Dame de la Sagesse, connu comme Le Courtil. Le Courtil est une institution belge qui accueille des enfants et des jeunes en difficultéau niveau du lien social. À partir d'un cas clinique d'une fille de huit ans, on discute l'importance des objets pour l'invention et pour le traitement du réel donné par le sujet. On démontre que le traitement est un travail singulier réalisé par le sujet en partenariat avec des intervenants. La pratique à plusieurs et le transfert sont mis en avant comme dispositifs qui favorisent ce travail

This article is about an internship experience that took place at the Institut Médico Pédagogique Notre Dame de la Sagesse, known as Le Courtil. Le Courtil is a Belgian institution dedicated to the reception and treatment ofchildren and young people with social bond difficulties. Based on a clinical case of an eight-year-old girl, the importance of objects for the invention and treatment of the real given by the subject is discussed. It is shown that the treatment is a singular work carried out by the subject in partnership with intervening parties. The multi-person practice and the transfer are put forward as devices that favour this work

Este artículo trata de una experiencia de pasantía institucional en el Institut Médico Pédagogique Notre Dame de la Sagesse, también conocido como Le Courtil. Le Courtil es una institución belga que acoge a niños y jóvenes con impasses en el lazo social. A partir del caso clínico de una niña de ocho años, se discute la importancia de los objetos para la invención y el tratamiento que el sujeto hace de lo real. Se demuestra que el tratamiento es un trabajo único realizado por el sujeto en compañía de los interventores. La práctica entre varios y la transferencia se destacan como dispositivos que favorecen este trabajo

A dopamine receptor D2 genetic polymorphism associated with transition to mental disorders in a cohort of individuals with at-risk mental state for psychosis

Objectives: To test the association of 45 single nucleotide polymorphisms (SNPs) with transition to psychiatric disorders in a cohort of individuals at ultrahigh risk (UHR) mental state for psychosis. Methods: Through general population screening, 88 non-help-seeking UHR subjects and 130 healthy control individuals were genotyped for 45 SNPs related to psychosis. They were followed for a mean of 2.5 years, and conversion to psychotic and to general psychiatric disorders was assessed. Genotype frequencies between controls, converters, and non-converters were analyzed. Results: There were no differences in sociodemographics between controls and UHR. Also, UHR converters and non-converters had no differences in their baseline symptoms scores. The dopamine receptor D2 gene (DRD2) SNP rs6277 was significantly more common among UHR who transitioned to psychosis (p < 0.001) and to UHR who transitioned to any psychiatric disorders (p = 0.001) when compared to UHR who did not transition. The rs6277 T allele was related to psychiatric morbidity in a dose-response fashion, being significantly more frequent in UHR converters than UHR non-converters and control subjects (p = 0.003). Conclusion: Our findings suggest that rs6277 could potentially constitute a genetic marker of transition to psychiatric disorders in subjects with at-risk mental states, warranting further investigation in larger samples.

Lifetime cannabis use and childhood trauma increase risk of psychosis in carriers of CNR1 genetic variants: findings from the STREAM study

Objectives: Gene-environment interactions increase the risk of psychosis. The objective of this study was to investigate gene-gene and gene-environment interactions in psychosis, including single nucleotide variants (SNVs) of dopamine-2 receptor (D2R), N-methyl-d-aspartate receptor (NMDAR), and cannabinoid receptor type 1 (CB1R), lifetime cannabis use, and childhood trauma. Methods: Twenty-three SNVs of genes encoding D2R (DRD2: rs1799978, rs7131056, rs6275), NMDAR (GRIN1: rs4880213, rs11146020; GRIN2A: rs1420040, rs11866328; GRIN2B: rs890, rs2098469, rs7298664), and CB1R (CNR1: rs806380, rs806379, rs1049353, rs6454674, rs1535255, rs2023239, rs12720071, rs6928499, rs806374, rs7766029, rs806378, rs10485170, rs9450898) were genotyped in 143 first-episode psychosis patients (FEPp) and 286 community-based controls by Illumina HumanCoreExome-24 BeadChip. Gene-gene and gene-environment associations were assessed using nonparametric Multifactor Dimensionality Reduction software. Results: Single-locus analyses among the 23 SNVs for psychosis and gene-gene interactions were not significant (p > 0.05 for all comparisons); however, both environmental risk factors showed an association with psychosis (p < 0.001). Moreover, gene-environment interactions were significant for an SNV in CNR1 and cannabis use. The best-performing model was the combination of CNR1 rs12720071 and lifetime cannabis use (p < 0.001), suggesting an increased risk of psychosis. Conclusion: Our study supports the hypothesis of gene-environment interactions for psychosis involving T-allele carriers of CNR1 SNVs, childhood trauma, and cannabis use.

The (un)veiling of the object a and the Superego in Melancholia / O (des)velamento do objeto a e o supereu na melancolia

RESUMO: Partindo do pressuposto freudiano no qual a melancolia se enquadra entre as neuroses narcísicas em oposição às neuroses de transferência, pretende-se apresentá-la no ensino de Lacan, entendendo-a como uma estrutura clínica psicótica. A melancolia é abordada como sendo um efeito de estrutura em função da não separação do objeto a, que fica (des)velado, a partir da foraclusão do Nome-do-Pai. Destaca-se o papel do supereu através do objeto voz.

ABSTRACT: Based on the Freudian assumption in which melancholy is included among the narcissistic neuroses in opposition to the transference neuroses, it is intended to present it in Lacan's teaching, understanding it as a psychotic clinical structure. Melancholy is approached as a structure effect due to the non-separation of the object a, which is (un)veiled from the foreclosure of the Name-of-the-Father. The role of the superego through the voice object is highlighted.

O psicótico e o outro: o fenômeno do duplo deus na psicose / The psychotic and the Other: the phenomenon of the double god in psychosis

RESUMO: Baseando-se na perspectiva psicanalítica, o objetivo deste artigo consiste em pesquisar o que ocorre na relação entre o sujeito psicótico e o Outro, que retorna no real sob o significante Deus, a partir do que intitulamos Fenômeno do duplo deus. Percebemos esse fenômeno em comum nos discursos de Estamira (documentário homônimo), Arthur Bispo do Rosário e Daniel Paul Schreber, o que nos permite a construção de hipóteses a respeito de uma possível inconsistência do Outro - estabelecido o duplo -, bem como apontar seus efeitos no laço social e na clínica com a psicose.

ABSTRACT: Based on the psychoanalytic perspective, this article aims to investigate what happens in the relationship between the psychotic subject and the Other, who returns in the real under the signifier God, from what we call the Phenomenon of the double god. We find this phenomenon in common in the speeches of Estamira - from the acclaimed documentary of the same name -, Arthur Bispo do Rosário and Daniel Paul Schreber, which allows us to build hypotheses about an inconsistency of the Other, establishing the double, as well as pointing out its effects on the social bound and the clinic with psychosis.

The first generation and second generation antipsychotic drugs and their pharmacology in treatment of schizophrenia

In this review report, an attempt made to present an overview of schizophrenia & those drugs which are used in treatment of psychiatric disorders as well as some treatments for psychosis. In 1908, the schizophrenia word was coined by Eugen Bleuler (Swiss psychiatrist). The use antipsychotics as medication began from 1933 in France. Laborit and Huguenard administrated the aliphatic Phenothiazine, Chlorpromazine during surgery due to its potential anesthetic effect, in 1951. Thereafter, Hamon and Delay extended the use of this treatment in psychiatric patients. Due to abnormal brain structure & functioning occurs schizophrenia as well as psychotic disorders. Schizophrenia a condition in people unable to differentiate between real & imaginary world. In this article we all know about Schizophrenia & Antipsychotics drugs. In that include symptoms & their types, cause, risk factor, antipsychotics classification & their pharmacology etc. In that there are three types of symptoms namely positive, Negative, Cognitive. Exact causes of schizophrenia are unknown. In the treatment of Schizophrenia or psychotics disorders the physicians commonly used antipsychotic medicines or drugs to treat their symptoms. Antipsychotic drugs further divided into two major classes namely Typical & Atypical antipsychotics. Chlorpromazine is the first medicine or drug which is used to treat symptoms of schizophrenia and schizoaffective disorders. Clozapine is most effective or potent antipsychotics drug. Which is belongs to the atypical antipsychotics which are reducing the risk of schizoaffective patients. Physicians recommend a combination of antipsychotics along with psychotherapy. In this article we have covered Brahmyadiyoga is an Ayurvedic remedies.

Construção simbólica frente à falha do recurso à droga na psicose / Construction symbolique face à l'échec de la consommation de drogue dans la psychose / Symbolic construction on the failure of drug use in psychosis

A inserção de psicanalistas em instituições da rede de saúde mental, em especial nos dispositivos de atenção a usuários de álcool e outras drogas, amplia a discussão sobre o diagnóstico estrutural frente ao uso de substâncias psicoativas. O recurso às drogas na psicose pode operar como uma tentativa de estabilização ao localizar no real da substância os efeitos da invasão do real dos sintomas psicóticos. O objetivo deste artigo é discutir, a partir de um caso clínico, a possibilidade de construção simbólica frente à falha deste recurso. O caso analisado pela teoria lacaniana demonstra que o uso de drogas pode ser capturado pelo processo de desorganização pulsional. Discute-se a função do sonho na psicose e sua relação com a construção delirante. O endereçamento transferencial ao analista, por outro lado, permite que o discurso sobre as drogas em sua dimensão significante opere como uma forma de construção simbólica para a amarração dos registros

L'insertion despsychanalystes dans les établissements du réseau d'assistance de la santé mentale, notamment dans les dispositifs de prise en charge des usagers d'alcool et d'autres drogues, élargit la réflexion sur le diagnostic structurel face à l'usage de substances psychoactives. L'usage de drogues dans la psychose peut opérer comme une tentative de stabilisation en situant dans le réel de la substance les effets de l'envahissement du réel des symptômes psychotiques. L'objectif de cet article est de discuter, a partir d'un cas clinique, de la possibilité d'une construction symbolique face à l'échec de cette ressource. Le cas, pour la théorie lacanienne, démontre que la consommation de drogues peut être capturée par le processus de désorganisation de la pulsion. Les rêves sont discutés a partir du délire et de sa fonction dans la psychose. L'adresse du transfert à l'analyste, au contraire, permet au discours sur la drogue dans sa dimension signifiante d'opérer comme une forme de construction symbolique pour nouer les registres.

The insertion of psychoanalysts in institutions of the mental health network, especially in spaces dedicated to the care of users of alcohol and other drugs, broadens the discussion on the structural diagnosis in the face of psychoactive substance use. The use of drugs in psychosis can operate as an attempt at stabbilization by locating in the real of the substance the effects of the invasion of the real of psychotic symptoms. The objective of this article is to discuss, based on a clinical case, the possibility of symbolic construction when facing the failure of this resource. The case demonstrates through lacan´s theory that drug use can be captured by the process of disorganization of the drive. The function of dream in psychosis is discussed through its relation to delusion. The transferential addre to the analyst, on the other hand, allows the discourse about drugs in its signifying dimension to operate as a form of symbolic construction for tying the registers