ABSTRACT
OBJECTIVE: To report a case and to discuss the use of psychodynamic psychotherapy (PD-P) to treat individuals at ultra-high risk (UHR) of psychosis. METHODS: An individual at UHR was followed up for 24 months. The baseline evaluation included a psychiatric interview, the Structured Interview for Prodromal Symptoms (SIPS), the Scale of Prodromal Symptoms (SOPS), and neuropsychological assessment. He underwent weekly sessions of PD-P for 12 months and was followed up for 12 months after the end of PD-P. The evaluations were at baseline, after 6-, 12-, and 24-month follow-up. No medication was prescribed during the 24-month follow-up. RESULTS: The prodromal symptoms remitted. The initial total score on the SIPS/SOPS was 37 points. After the first 12 months of PD-P, there was a reduction to 12 points on the SIPS/SOPS score, which stabilized in the 24-month follow-up. There was also a slight improvement in his performance on the neuropsychological evaluations. CONCLUSION: This case report suggests that PD-P can reduce prodromal symptoms; nevertheless, a better understanding of the specificity and efficacy of PD-P as an option of treatment for UHR individuals is needed.
OBJETIVO: Relatar um caso e discutir o uso da psicoterapia psicodinâmica (PD-P) no tratamento de indivíduos com risco ultra-alto (UHR) para psicose. MÉTODOS: Um indivíduo UHR foi acompanhado por 24 meses. A avaliação inicial incluiu entrevista psiquiátrica, aplicação de instrumentos padronizados, Entrevista Estruturada Para Sintomas Prodrômicos (SIPS), a Escala de Sintomas Prodrômicos (SOPS) e avaliação neuropsicológica. O indivíduo teve sessões semanais de PD-P durante os primeiros 12 meses e continuou acompanhamento durante os 12 meses seguintes após o término da PD-P. Avaliações foram feitas no início do estudo e após 6, 12 e 24 meses de seguimento. Nenhuma medicação foi prescrita durante todo o seguimento. RESULTADOS: Os sintomas prodrômicos remitiram. Apresentou, ainda, discreta melhora no desempenho nas avaliações neuropsicológicas. CONCLUSÃO: Este relato sugere que a PD-P pode reduzir os sintomas prodrômicos, no entanto uma melhor compreensão da especificidade e eficácia da PD-P como uma opção de tratamento para os indivíduos UHR é necessária.
ABSTRACT
El Factor Neurotrófico Derivado del Cerebro (BDNF) se ha relacionado con los síntomas cognitivos de la esquizofrenia, lo que se ha documentado en revisiones previas. Sin embargo, recientemente el foco de la investigación neurobiológica ha pasado de estudiar la esquizofrenia como enfermedad a estudiar las psicosis como grupo. El objetivo de esta investigación fue realizar una revisión actualizada de las publicaciones de los últimos cinco años (2013 a 2018) respecto a BDNF y síntomas cognitivos, tanto en esquizofrenia como en psicosis en general. Para esto se revisaron en PubMed los artículos con las palabras clave BDNF, cognitive y schizophrenia, y luego se repitió este proceso con la palabra psychosis. Como resultado, en el desarrollo del artículo se describe la manera en que distintos estudios, tanto en seres humanos como en modelos animales, dan cuenta de la relación entre BDNF y cognición, y de cómo influyen en ella elementos importantes como por ejemplo el género o el ejercicio. Sin embargo, se constata que aún la mayor parte de la investigación respecto a BDNF y síntomas cognitivos en psicosis se realiza en torno a la esquizofrenia como enfermedad. Por lo tanto, es necesario ampliar el estudio de la relación entre BDNF y síntomas cognitivos a cuadros psicóticos de distintos estadios y orígenes
Brain Derived Neurotrophic Factor (BDNF) has been linked to cognitive symptoms of schizophrenia, which has been documented in previous reviews. However, recently the focus of neurobiological research has moved from studying schizophrenia as a disease to studying psychosis as a group. The main aim of this research was to carry out an updated review of all relevant publications in the last 5 years (2013 to 2018) regarding BDNF and cognitive symptoms, both in schizophrenia and in psychosis. In order to achieve this, the keywords BDNF, cognitive and schizophrenia were reviewed in PubMed, and then this process was repeated with the word psychosis. As a result, in this article we describe the way in which different studies, both in human beings and in animal models, account for the relation between BDNF and cognition, and for the way in which important elements such as gender or exercise influence it. However, we found that still most of the research regarding BDNF and cognitive symptoms in psychosis is done around schizophrenia as a disease. Therefore, it is necessary to expand the study of the relationship between BDNF and cognitive symptoms to psychotic illnesses of different stages and origins