Psychosomatic symptoms and the 'group mind'.

OBJECTIVES: In this work, we propose a model, designed to understand mental symptoms and adapted for the analysis of psychosomatic symptoms, to be used as a tool to represent group phenomena, named the 'group mind'. DESIGN: A revision of the relevant literature on the concept of 'group mind' and psychosomatics, and the presentation of the Cambridge model. METHODS: We describe how unformatted experiences can appear as somatization, and how this process can be corrected via mental representations. Group dynamics can function creating these representations and thus contribute to solving psychosomatic symptoms. We refer to W. R. Bion's concepts, mainly the ones on proto-thoughts and the proto-mental system, comparing them to the proposed model and giving a foundation to this conceptual representation. We illustrate with four cases of clinical interaction. CONCLUSIONS: Psychotherapeutic groups are privileged places to comprehend and transform psychosomatic symptoms. The Cambridge model allows a representation of these processes. Further studies are necessary to assess its validity, test its adequacy, and expand its possibilities.

Mecanismos fisiopatológicos do delirium / Pathophysiological mechanisms of delirium

O delirium é uma das síndromes mais fascinantes na medicina, apesar de pobremente compreendida. Apesar de sua ocorrência freqüente e de haver crescente informação sobre o diagnóstico, fenomenologia, epidemiologia e etiologias, estudos sobre os mecanismos que mediam a fisiopatologia são, freqüentemente, ausentes. O desenvolvimento de sofisticadas metodologias de imagem cerebral tem permitido ir além das considerações diagnósticas e investigar a neurobiologia dos sintomas específicos observados no delirium. Esses avanços na neuropsiquiatria e na neuroimagem têm revelado diferenças entre as regiões cerebrais, incluindo os hemisférios. O delirium é uma síndrome que pode ocorrer como o resultado de múltipla e complexa interação entre sistemas de neurotransmissores e processos patológicos. Os neurotransmissores, acetilcolina e serotonina, podem ter participação importante no delirium devido a condições clínicas comuns, bem como no delirium pós-cirúrgico. Outros neurotransmissores (dopamina e GABA) e fatores neurobiológicos tais como citocinas, hormônios e radicais livres precisarão de mais estudos para definir as suas participações na gênese do delirium. Futuros estudos, centralizados na fisiopatologia do delirium, poderão levar a melhores estratégias de prevenção e tratamento.

Dysfonctionnements tissulaires / Tissular dysfunctions

Les paresthesies/dysesthesies font partie d'une semantique infraverbale irremplacable. Plus que jamais l'exterieur se revele etre a l'image de l'interieur. Leur comprehension passe par l'observation et par... (AU)

Manifestaçöes neuropsiquiátricas do hiperparatireoidismo primário no idoso: relato de casos e revisao da literatura / Neuropsychiatric manifestations of primary hyperparathyroidism in aged person: case report and review of literature

A osteoporose e os distúrbios neuropsiquiátricos surgem com maior frequência entre os pacientes idosos, quando comparados com as demais faixas etárias. Manifestações concomitantes destas síndromes podem apresentar causas comuns. Neste artigo, nós descrevemos os casos de duas mulheres com osteoporose estabelecida e idades de 75 e 80 anos, que desenvolveram sinais e sintomas neuropsiquiátricos (apatia, fraqueza, depressão e perda de memória) associados a hipercalcemia (cálcio iônico de 1,43mmol/L e ,65mmol/L (1,14 -1,30mmol/L), respectiva- mente). Na investigação laboratorial foi observado que os níveis da fração intacta do paratormõnio (PTHi) estavam dentro dos limites da normalidade (64 e 63pg/ml, respectivamente) ou não suprimidos. Após exploração cirúrgica cervical foram removidas, de cada paciente, massas tumorais únicas, cujo anátomo-patológico revelou adenoma de paratireóide. As duas pacientes apresentaram melhora dos sintomas e sinais neuropsiquiátricos após a cirurgia e a segunda paciente obteve ganho de massa óssea significativo, sem uso de qualquer droga antireabsortiva. A outra paciente não pode ser avaliada através da densitometria óssea, devido às deformidades na coluna torácica. A possibilidade de HPTP deve ser sempre considerada, principalmente em pacientes com níveis de paratormônio dentro da faixa de normalidade, ou não suprimidos apesar de cálcio ionizado elevado. Isso ocorre devi- do a alguns tumores de paratireóide apresentarem set poínt alterado em relação aos níveis de cálcio mas sem aumento significativo da pro- dução de paratormõnio. Outra correlação observada é que quanto menor forem os adenomas, maior a chance de serem hipersecretores e autõnomos. Em conclusão, a aferição do cálcio iõnico em pacientes idosos com osteoporose e ou sintomas e sinais neuropsiquiátricos deve ser feita de rotina com o objetivo de se excluir doenças que possam ser tratadas prontamente e com bons resultados.

Infertilidade e Emoçäo / Infertility and Emotion

Os aspectos psicológicos vivenciados pelos casais inférteis apresentam certas particularidades, podendo interferir na relaçäo do casal, nas relaçöes familiares e sociais e, em alguns casos, também no desempenho profissional. O conhecimento destas particularidades é de fundamental importância para que possamos ajudar esses casais durante o tratamento de infertilidade

Actitud del niño con asma frente al síntoma en institucione públicas y privadas / The attitude of a child with asthma towards sympton in public and private institutions

La actitud del niño ante la enfermedad se puede dividir en: sobreadaptados (con características de orden y prolijidad, buen rendimiento intelectual y sin dificultades aparentes de perentectomía, con reacción asmática tardía y respecto del conflicto, de alto riesgo en adolescencia), y actuadores (dramatiza su enfermedad, dependencia manifiesta con sus padres generando alto monto de ansiedad familiar, reacción asmática inmediata al conflicto, con pronóstico más favorable). Se comprobará si existe una diferencia significativa según esta clasificación en pacientes del ámbito privado y público. Se estudiaron 60 niños provenientes de un centro de atención privado, y 60 niños de una institución pública, con diagnóstico de asma y edades entre 4-12 años. Se aplicó: Entrevista operativa semi-abierta y entrevista pautada con ambos padres; Tests: Santuchi-Bender, Casa pintada, Figura humana, Familia, Desiderativo, Cat, Nemi y Raven. De acuerdo a la clasificación utilizada se encontraron: ámbito privado: 32 sobreadaptados (53 por ciento) y 28 actuadores (47 por ciento); ámbito público: 38 sobreadaptados (63 por ciento, p=NS) y 22 actuadores (37 por ciento, p=NS). Esto nos plantea la necesidad de un abordaje interdisciplinario para la detección temprana de los rasgos de sobreadaptación, dado que en este tipo de pacientes encontramos la paradoja de que lo ideal esconde lo mortífero: cuando aparece el pasaje al acto puede ser tarde

Actitud del niño con asma frente al síntoma en institucione públicas y privadas / The attitude of a child with asthma towards sympton in public and private institutions

La actitud del niño ante la enfermedad se puede dividir en: sobreadaptados (con características de orden y prolijidad, buen rendimiento intelectual y sin dificultades aparentes de perentectomía, con reacción asmática tardía y respecto del conflicto, de alto riesgo en adolescencia), y actuadores (dramatiza su enfermedad, dependencia manifiesta con sus padres generando alto monto de ansiedad familiar, reacción asmática inmediata al conflicto, con pronóstico más favorable). Se comprobará si existe una diferencia significativa según esta clasificación en pacientes del ámbito privado y público. Se estudiaron 60 niños provenientes de un centro de atención privado, y 60 niños de una institución pública, con diagnóstico de asma y edades entre 4-12 años. Se aplicó: Entrevista operativa semi-abierta y entrevista pautada con ambos padres; Tests: Santuchi-Bender, Casa pintada, Figura humana, Familia, Desiderativo, Cat, Nemi y Raven. De acuerdo a la clasificación utilizada se encontraron: ámbito privado: 32 sobreadaptados (53 por ciento) y 28 actuadores (47 por ciento); ámbito público: 38 sobreadaptados (63 por ciento, p=NS) y 22 actuadores (37 por ciento, p=NS). Esto nos plantea la necesidad de un abordaje interdisciplinario para la detección temprana de los rasgos de sobreadaptación, dado que en este tipo de pacientes encontramos la paradoja de que lo ideal esconde lo mortífero: cuando aparece el pasaje al acto puede ser tarde (AU)

Clinical and EEG analysis of mesial and lateral temporal lobe seizures.

The analysis of the temporal lobe seizures through video-EEG systems shows that they often consist of a sequence of clinical and EEG features which may suggest the localization and the lateralization of the epileptogenic lobe. We analyzed clinical and EEG features of 50 temporal lobe seizures which were separated in group 1 with 25 patients (related to mesial temporal sclerosis) and group 2 with 25 patients (other neocortical temporal lesions). Among the auras, the epigastric type was the most frequent and predominated in group 1. There were differences between the two groups, considering dystonic and tonic posturing and versive head and eye movements. Dystonic posturing was always contralateral to the ictal onset and was considered the most useful lateralizing clinical feature. Ictal speech, spitting and blinking automatisms, prolonged disorientation for place and a greatest percentage of postictal language preservation occurred in right temporal seizures. Postictal aphasia and global disorientation predominated in left temporal seizures. EEG was important for lateralizing the epileptogenic lobe, specially considering rhythmic ictal activity and postictal findings.

Clinical and EEG analysis of mesial and lateral temporal lobe seizures

The analysis of the temporal lobe seizures through video-EEG systems shows that they often consist of a sequence of clinical and EEG features which may suggest the localization and the lateralization of the epileptogenic lobe. We analyzed clinical and EEG features of 50 temporal lobe seizures which were separated in group 1 with 25 patients (related to mesial temporal sclerosis) and group 2 with 25 patients (other neocortical temporal lesions). Among the auras, the epigastric type was the most frequent and predominated in group 1. There were differences between the two groups, considering dystonic and tonic posturing and versive head and eye movements. Dystonic posturing was always contralateral to the ictal onset and was considered the most useful lateralizing clinical feature. Ictal speech, spitting and blinking automatisms, prolonged disorientation for place and a greatest percentage of postictal language preservation occurred in right temporal seizures. Postictal aphasia and global disorientation predominated in left temporal seizures. EEG was important for lateralizing the epileptogenic lobe, specially considering rhythmic ictal activity and postictal findings.

Implicações psiconeuroimunológicas do estresse no desencadeamento de doenças / Psychoneuroimmunology of stress implications in unchain diseases

Os autores apresentam as correlações do estresse com a patogênese de várias doenças. Antes, expõem os aspectos fundamentais da Psiconeuroimunologia, para uma compreensão das interconexões no complexo microambiente onde ocorrem as influências do estresse. Concluem que, apesar de todas as implicações do estresse na desestruturação da homeostasia imunológica ainda não estarem completamente definidas, e das limitações metodológicas, há consenso de que fatores estressantes propiciam a vulnerabilidade do organismo a determinadas doenças.

The authors introduce the correlations between stress and the pathogenesis of various diseases. Previously, they expose the fundamental factors of Psychoneuroimmunology for the comprehension of the inter-connections in the complex microenvoironment where the influence of stress occurs. They conclude that despite all the implications of stress on the desestruturation of immunologic homeostasy are not already completely defined and despite metodologic limitations, there are a consensus that stressor factors provide vulnerability to the organism concerned to certain disorders.

Plasma neurotransmitters and functional illness.

Although the concept of functional illness has blurred boundaries, some consensus exists on its understanding among clinicians. In short, it is easier to conceive than to define functional illness. Semantic and conceptual discussion concerning this issue have been endless. Many links exist that connect brain and body (mind and organs, psyche and soma). Amongst them, neurotransmitters, released by peripheral neurons and some glandular cells (adrenal, enterochromaffin cells, mast cells), are diverted into the bloodstream. Although neurotransmitters cannot cross the blood-brain barrier, basic and clinical research has progressively established the relationship between central and peripheral neurochemical activities. Hence, it is possible to obtain some approach to the central profile through the measurement of circulating neurotransmitters. However, this approach is more reliable if we can measure all circulating factors and, in addition, test the responses to different kinds of challenges (stressors, drugs, etc.). All diseases (somatic, psychiatric and psychosomatic) present some kind of plasma neurotransmitter disturbance; however, only in some has the whole abnormal profile been established. Technical difficulties as well as expensive procedures have interfered with the generalization of this research area. In the present review article, we summarize data quoted from current scientific literature reporting exhaustive research in this area.

Espectro neurológico del lupus eritematoso y su asociación con anticuerpos antifosfolípido / Neurologic symptoms of lupus and antiphospholipid antibodies

En el presente estudio se analizan las manifestaciones neuropsiquiátricas en 36 niños con lupus eritematoso sistémico (LES): 12 presentaban convulsiones, 10 cefalea frecuente y 10 hemiparesia. A 18 se les hizo electroencefalograma (EEG) que mostró encefalopatía difusa en 12. La tomografía cerebral (TAC) se hizo en nueve, encontrando vasculitis en cinco. En siete de estos niños se determinó los anticuerpos antifosfolípidos. No hubo diferencia alguna en las manifestaciones clínicas y los resultados del EEG y TAC entre los niños con AcAFL positivos y negativos

Enfoque homeopático de los trastornos psicopatológicos / Focus homeopathic of the phychopathologic disturbance

Esta colaboración tiene por objeto ampliar el concepto psicosomático jerarquizando la holística homeopática como realidad terapéutica

Enfoque homeopático de los trastornos psicopatológicos / Focus homeopathic of the phychopathologic disturbance

Esta colaboración tiene por objeto ampliar el concepto psicosomático jerarquizando la holística homeopática como realidad terapéutica (AU)

Phantom sensation, phantom pain, and stump pain.

Phantom sensation, phantom pain, and stump pain have been known since antiquity. For millenia, sensations in the missing body part were thought to be of psychic origin. During this century the psychic explanations have gradually given way to physiological explanations. However, these have been tenuous hypotheses that have poorly explained the reported symptoms. This history is reviewed here. It is now believed that phantom pain probably originated in the pain transmitting neurons of the dorsal horn. This has led to significant advances in the treatment of this disorder. It is now thought that phantom sensation is best explained as a sensory emgram or a part of the neuomatrix as purposed in 1989 by Melzack. This hypothesis is in agreement with newer theories of brain function. The differential diagnosis and treatment of stump pain are also reviewed. There is no current treatment for phantom sensation. The treatment of phantom pain and stump pain must be part of a more comprehensive rehabilitation program aimed at restoration of function in all spheres of the individual's life. Discussion of the role of "phantom" sensation and pain in the spinal cord injured is also presented.

Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women.

A long-standing hypothesis is that feelings of anger and anxiety increase the risk for essential hypertension. Most studies examining this hypothesis have been cross-sectional in design or undertaken with men only. We tested this hypothesis along with determination of the other behavioral and biological predictors of increases in systolic (SBP) and diastolic (DBP) blood pressure from baseline to a follow-up examination 3 years later in a prospective study of 468 middle-aged women whose blood pressure at the baseline examination was less than 140/90 mmHg. Analyses showed that increases in the Spielberger Trait Anger Scale between the baseline and 3-year follow-up examination, as well as Framingham Tension scores (a measure of anxiety) at baseline, independently predicted an increase in SBP (P less than 0.01). Other factors that independently predicted an increase in SBP were baseline fasting insulin, parental history of hypertension and increases in body mass index and in alcohol intake across the 3 years of follow-up. Increases in the Spielberger Trait Anger Scores independently predicted increases in DBP (P less than 0.02), as did black race, increases in body mass index and hematocrit and decreases in potassium intake. Although menopausal status and hormone replacement therapy were unrelated to changes in blood pressure, postmenopausal women on hormone replacement therapy did show significant increases in DBP in the univariate analysis. Anxiety at baseline, along with parental history of hypertension, baseline fasting insulin and baseline body mass index, predicted a later onset of hypertension, i.e. on pharmacologic treatment for hypertension, in the univariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Psychosomatic medicine and psychoanalytic observation: considerations on the mechanism of symptom formation]. / Medicina psicossomática e observação Psicanalítica: considerações sobre mecanismo de formação de sintoma.

The clinical symptom, perceived at body level, such as pain, dyskinesia, circulatory changes (tachycardia, blushing, pallor) is intrinsic and simultaneous with parallel changes at the mind level, such as anxiety, sorrow, instability, joy, depression and shame. Therefore, it has to be distinguished within the symptom, the overt component - somatic alterations - and the latent component - changes in mental processes. Hence, the global psychosomatic nature is intrinsic to the clinical symptoms.

Nerviosidad ingestión y dolor / Nervousness, indigestion and pain

Enfoca la medicina como un arte, un apostolado y un llamado al corazon y la cabeza. Se dedica a dar consejos sobre la atención y el trato a los pacientes a los efectos de detectar el origen de sintomas referidos por el enfermo. Destaca la necesidad de realizar una buena y detallada historia clínica y de comprender al paciente, dejandolo explayarse acerca de sus problemas