ABSTRACT
Studies suggest that the relationship between psychosocial well-being and type 1 diabetes (T1D) is bidirectional, with T1D typically having a negative influence on psychological functioning, which in turn negatively affects the course of T1D. Here, we investigate the potential role of the capacity for mentalizing, or reflective functioning, in children and their mothers in diabetes control. We tested differences in mentalizing as assessed by the Reflective Functioning Scale in two groups of mother-son dyads with good (GDC) versus poor (PDC) diabetes control. Fifty-five boys (8-12 years old) and their mothers were recruited from the Juvenile Diabetes Foundation in Santiago, Chile. The mothers were interviewed with the Parental Development Interview and the children with the Child Attachment Interview, and both were scored for reflective functioning by using the Reflective Functioning Scale. Self-report measures of stress and diabetes outcomes were completed by the mothers and children, and levels of glycated hemoglobin (HbA1c) were assessed as an index of diabetes control. The results showed that both maternal and child reflective functioning were higher in the GDC than the PDC group and were negatively correlated with HbA1c in the total sample. Our findings suggest an important role for mentalizing in diabetes outcomes, but further prospective research is needed.
Subject(s)
Diabetes Mellitus, Type 1 , Mentalization , Child , Chile , Female , Humans , Male , Mothers , ParentsABSTRACT
En este artículo se ofrece una perspectiva y un panorama general acerca de los efectos y consecuencias de un amplio grupo de experiencias traumáticas tempranas, organizadas bajo el concepto abarcador de experiencias adversas tempranas y trauma de apego: abuso sexual, maltrato físico y verbal, abandono parental temprano e interacción en un ambiente familiar caótico, entre otras. Se considera un mecanismo general por el cual, las experiencias adversas generan estrés agudo o crónico que se evidencia por alterciones en la regulación del eje hipotálamo-hipófisis-suprarrenal actuando el estrés así generado como una carga alostática que genera alteraciones mente/cuerpo. Las dificultades para regular la respuesta al estrés o factores que actúan en forma independiente pueden conducir a desorganización parcial de la estructura cortical cerebral especialmente en los sistemas neuronales que procesan las emociones (sistema límbico), la memoria (hipocampo) y la capacidad de reconocer estados mentales en el propio individuo y en las personas con las cuales interactúa (teoría de la mente). Se analizan los mecanismos moleculares de resiliencia que permiten recuperarse o resistir dichas experiencias. Se menciona la importancia de reconocer un período crítico basado en el desarrollo cerebral, que podría generar una latencia en los efectos de los acontecimientos trumáticos generando vulnerabilidad y daño tanto en la infancia como durante la adolescencia o adultez joven bajo la forma de depresión, ansiedad, trsatornos de la personalidad o abuso de sustancias. El reconocimiento e investigación del trauma temprano resulta fundmental para evitar la repetición intergeneracional de las adversidades y para el desarrollo de tratamientos efectivos...
This article offers an insight and an overview of the effects and consequences of a wide range of early traumatic experiences organized within the encompassing concept of early adverse experiences and attachment trauma: sexual abuse, physical and verbal harassment, early parental abandonment and interaction in a chaotic family environment. It is considered a general mechanism by which adverse experiences generate chronic or acute stress evidenced by alterations in the regulation of the hippocampal-hypophiseal-suprarenal axis; the generated stress thus acts as an allostatic load that generates mind/body alterations. Difficulties to regulate the response to stress or factors that act independently may lead to a partial disorganization of the cerebral, cortical structure, particularly in the neuronal systems that process emotions (limbic system), memory (hippocampus) and the ability to recognize mental states within the same individual and the interacting people (theory of the mind). The author analyzes the molecular mechanisms of resilience that enable to recover from or resist to such experiences, higlighting the importance of recognizing a critical period bases on brain development, which might generate a latency in the effects of traumatic events, generating vulnerability and abuse both in the childhood as well as in the adolescence or young adulthood in the shape of depression, anxiety, personality disorders or drug abuse. The recognition and research of early trauma is key to avoid the intergenerational repetition of advesities and for the develpment of effective treatments...
Subject(s)
Humans , Adult Survivors of Child Abuse , Child Abuse , Family Relations , Gene-Environment Interaction , Life Change Events , Pituitary-Adrenal System , Limbic System/pathology , Stress Disorders, Traumatic/prevention & control , Domestic Violence/psychologyABSTRACT
INTRODUCTION: The presence of negative symptoms (NS) in different clinical entities other than schizophrenia, with a dimensional approach of negative symptoms, was considered in this work. OBJECTIVES: Determine the presence and distribution of NS, in a population of patients with non schizophrenic psychiatric disorders attending ambulatory treatment at public hospitals. METHODS: Patients with define DSM IV diagnosis criteria for different disorders; affective, alimentary, substance abuse, anxiety, personality disorders and patients with ILAE diagnoses criteria for temporal lobe epilepsy were included. All patients underwent the subscale PANNS for negative symptoms of schizophrenia. Student T test was calculated to determine the differences of frequency for NS among psychiatric disorders. RESULTS: 106 patients were included; 60 women, 46 men, 38 years +/- 12.1. The 90% of patients have a low score of NS. Media 11.6, Max/min 9.38 -14.29. Emotional withdrawal and passive social withdrawal were more frequent in alimentary disorders than in affective disorder and than in epilepsy. Emotional withdrawal was more frequent in substance disorders than epilepsy. CONCLUSIONS: According this study, negative symptoms are present in a low to moderate intensity in non schizophrenic psychiatry entities and in the temporal lobe epilepsy.
Subject(s)
Mental Disorders/diagnosis , Adult , Female , Humans , Male , Mental Disorders/psychologyABSTRACT
En este trabajo se integra el modelo de apego (conductas maternantes) en su dimensión psicopatológica aplicado al trastorno límite de la personalidad y los descubrimientos neurocientíficos recientes de la base genética de los endofenotipos de hipersensibilidad de las relaciones interpersonales asociados con la inestabilidad afectiva y la impulsividad. Para este propósito, el autor con 20 años de experiencia en el tratamiento de estos pacientes, realiza una puesta al día de dos modelos neuroquímicos, el modelo opioide y una actualización del modelo serotonérgico que explicarían manifestaciones clínicas altamente frecuentes en el TLP: afectos disfóricos, afectos negativos, ansiedades de abandono e intolerancia a la soledad y conductas autoagresivas, entre otros. Se propone que la base genética para estas conductas y su posible grado de heredabilidad se encuentra relacionada con el polimorfismo de genes que controlan la síntesis del receptor para la recaptación de serotonina y la síntesis de receptores tipo Mu en áreas cruciales para el procesamiento emocional y la regulación de la conducta: el cerebro límbico y sus conexiones recíprocas con la corteza prefrontal. Se describen las evidencias experimentales que sustentan esta relación y la posible aplicación para la terapia farmacológica. Se concluye que el trastorno límite de la personalidad representa una vía final común de múltiples dominios alterados a partir de interacciones complejas entre factores ambientales y factores genéticos.
In this work, the author sets out the relationships that can be established between the psychopathology of attachment (maternal behavior) and its influence, together with the generation of endophenotypes of hypersensitivity to interpersonal relationships, associated with emotional instability and impulsiveness. For such purpose, the author, who has more than 20 years experience in the treatment of these patients, provides an update of two neurochemical models, the opioid odel and an update of the serotonergic model which might account for clinical manifestations which are highly frequent in BDP: dysphoric affections, negative affections, abandonment anxieties and intolerance to loneliness and self-aggresive behaviors, among others. The author proposes that the genetic basis for these behaviours and their possible degree of inheritance is related with the genetic polymorphism controlling the receptor synthesis for serotonin reuptake and the synthesis of Mu receptor types in key areas of emotinal processing, and the regulation of behavior: the limbic brain and its reciprocal connections with prefrontal cortex. There is a description of the experimental evidences supporting this relationship ant the possible application in pharmacological therapy. The author conculudes that borderline personality disorder represents a final common pathway of multiple disrupted domains, based upon complex interactions between environmental factors and genetic factors.
Subject(s)
Humans , Borderline Personality Disorder , Maternal Behavior , Mood Disorders , Neurobiology , Receptors, Opioid , Serotonin , Serotonin Plasma Membrane Transport ProteinsABSTRACT
The traumatic memory is conceptualized by means of an amplified Freudian neuropsychoanalytic model using a contemporary memory system based on its contents, conscious and unconscious recollection (explicit and implicit memories) highlighting the validity of the Freudian discoveries. This is then related to the psychoanalytical theories of consciousness, affects and thinking. Particular importance is given to Freud's seduction theory, its relation to memory and the clinical application of these concepts to the basic organization of the personality, together with the relation to Bowlby's concept of emotional deprivation. The development and working trough of trauma is postulated as a vector to make "real" or phantasized trauma unconscious through repression in neurosis, splitting in borderline personality organization, and primitive mechanisms of projection in psychosis.
Subject(s)
Memory , Mental Disorders , Humans , Mental Disorders/psychology , Psychoanalytic TheoryABSTRACT
Se conceptualiza la memoria traumática utilizando un modelo neuropsicoanalítico freudiano, ampliado con un modelo contemporáneo de los sistemas de memoria en base a sus contenidos y recolección consciente e inconsciente (memorias explícitas e implícitas respectivamente), destacando la vigencia de los descubrimientos freudianos. Se lo relaciona con las teorías psicoanalíticas de la conciencia, afectos y pensamiento. Se otorga importancia a la teoría de la seducción de Freud, la relación con la memoria y la aplicación clínica de estos conceptos a las organizaciones básicas de la personalidad y a la relación con el concepto de discarencia afectiva de Bowlby. Se postula que el trabajo psíquico del trauma facilita hacer inconsciente el trauma psíquico "real" o fantaseado; este trabajo estaría a cargo de la represión en las neurosis, de la escisión en la organización borderline de la personalidad, y de formas primitivas de proyección en las psicosis.(AU)
The traumatic memory is conceptualized by means of an amplified Freudian neuropsychoanalytic model using a contemporary memory system based on its contents, conscious and unconscious recollection (explicit and implicit memories) highlighting the validity of the Freudian discoveries. This is then related to the psychoanalytical theories of consciousness, affects and thinking. Particular importance is given to Freuds seduction theory, its relation to memory and the clinical application of these concepts to the basic organization of the personality, together with the relation to Bowlbys concept of emotional deprivation. The development and working trough of trauma is postulated as a vector to make "real" or phantasized trauma unconscious through repression in neurosis, splitting in borderline personality organization, and primitive mechanisms of projection in psychosis.(AU)
Subject(s)
Humans , Stress Disorders, Traumatic , Memory , Conscience , Unconscious, Psychology , Personality , Psychotic DisordersABSTRACT
Se describen los algoritmos (guías prácticas de la American Psychiatric Association) para el tratamiento psicofarmacológico del trastorno límite de la personalidad. La dimensión síntomas afectivos (depresión, inestabilidad afectiva, disforia, ansiedad, síntomas afectivos secundarios a ansiedades de abandono) puede responder favorablemente a antidepresivos inhibidores de la recaptación de serotonina e inhibidores de la monoamino oxidasa. Los dos grupos de drogas cuentan con la mayor evidencia basada en estudios doble ciego controlados con placebo. La dimensión impulsión/agresión (ira, irritabilidad, conductas impulsivas) tiene buena respuesta a las mismas drogas antidepresivas señaladas en la dimensión anterior, lo que permite inferir mecanismos de procesamiento afectivo en común. Como ocurre en la dimensión ya señalada, los antipsicóticos típicos y atípicos (haloperidol, risperidona, olanzapina, quetiapina, clozapina y aripiprazol), se muestran como una buena opción frente a la falta de respuesta a las drogas de primera elección.En la dimensión impulsión/agresión comienza a observarse buena respuesta a los estabilizantes del humor. La dimensión cognitiva/perceptual (micropsicosis, psicosis breve y probablemente trastorno esquizoafectivo) tienen buena respuesta a antipsicóticos típicos y atípicos. La clozapina obtuvo buena respuesta en estados psicóticos refractarios y psicosis prolongadas (una situación de excepción en el trastorno límite). Se concluye que el tratamiento psicofarmacológico debe orientarse a una polifarmacia racional y que las guías brindan un marco de referencia útil para lograrlo. Si bien todavía parece lejano un tratamiento óptimo para el trastorno límite, los abordajes con antidepresivos y antipsicóticos atípicos parecen ser los más promisorios.(AU)
There is a description of the algorithms (American Psychiatric Association Practice Guidelines) for the psychopharmacological treatment of borderline personality disorder. The dimensio, "affective symptons" (depression, affective instability, dysphoria, anxiety, affective symptoms secondary to abandonment fears) can demonstrte a favorable response to selective serotonin reuptake inhibitor antidepressants and monoamine oxidase inhibitors. Both groups of drugs constitute the most extensive evidence based on double-blind, placebo controlled studies. The impulsivity/aggression dimension (anger, irritability, impulsive behaviour) shows a good response to the antidepressants mentioned in conncection with the previous dimensio, which may point to mechanisms underlying affective processing in common with the two of them. As is the case with the already mentioned dimention, both typical and atypical antipsychotics (haloperidol, risperidone, olanzapine, quetiapine, clozapine and aripiprazole) appear to be a good option against the lack of response to first-choice drugs. As regards the impulsivity/aggression dimension, a good response to mood stabilizers has started to be noted. Cognitive/perceptual dimensio (micropsychosis, brief psychotic disorder, and probably, shizoaffective disorder), show a good response to typical and atypical antipsychotics. Clozapine demonstrated a good response in refractory psychotic states, as well as on prolonged psychosis (an exceptional situation in borderline personality disorder). The conclusion of the present article is that psychopharmacological treatment should be aimed towards a rational polypharmacy, and tht guidelines serve as a useful reference framework to achieve it. Although an optimum treatment for borderline disorders seems to be a long way off, the use of antidepressants and atypical antipsychotics appear to be the most promising option.(AU)
Subject(s)
Humans , Borderline Personality Disorder/therapy , Double-Blind Method , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Practice Guidelines as Topic , Borderline Personality Disorder/etiologyABSTRACT
Se describen los algoritmos (guías prácticas de la American Psychiatric Association) para el tratamiento psicofarmacológico del trastorno límite de la personalidad. La dimensión síntomas afectivos (depresión, inestabilidad afectiva, disforia, ansiedad, síntomas afectivos secundarios a ansiedades de abandono) puede responder favorablemente a antidepresivos inhibidores de la recaptación de serotonina e inhibidores de la monoamino oxidasa. Los dos grupos de drogas cuentan con la mayor evidencia basada en estudios doble ciego controlados con placebo. La dimensión impulsión/agresión (ira, irritabilidad, conductas impulsivas) tiene buena respuesta a las mismas drogas antidepresivas señaladas en la dimensión anterior, lo que permite inferir mecanismos de procesamiento afectivo en común. Como ocurre en la dimensión ya señalada, los antipsicóticos típicos y atípicos (haloperidol, risperidona, olanzapina, quetiapina, clozapina y aripiprazol), se muestran como una buena opción frente a la falta de respuesta a las drogas de primera elección.En la dimensión impulsión/agresión comienza a observarse buena respuesta a los estabilizantes del humor. La dimensión cognitiva/perceptual (micropsicosis, psicosis breve y probablemente trastorno esquizoafectivo) tienen buena respuesta a antipsicóticos típicos y atípicos. La clozapina obtuvo buena respuesta en estados psicóticos refractarios y psicosis prolongadas (una situación de excepción en el trastorno límite). Se concluye que el tratamiento psicofarmacológico debe orientarse a una polifarmacia racional y que las guías brindan un marco de referencia útil para lograrlo. Si bien todavía parece lejano un tratamiento óptimo para el trastorno límite, los abordajes con antidepresivos y antipsicóticos atípicos parecen ser los más promisorios.
There is a description of the algorithms (American Psychiatric Association Practice Guidelines) for the psychopharmacological treatment of borderline personality disorder. The dimensio, "affective symptons" (depression, affective instability, dysphoria, anxiety, affective symptoms secondary to abandonment fears) can demonstrte a favorable response to selective serotonin reuptake inhibitor antidepressants and monoamine oxidase inhibitors. Both groups of drugs constitute the most extensive evidence based on double-blind, placebo controlled studies. The impulsivity/aggression dimension (anger, irritability, impulsive behaviour) shows a good response to the antidepressants mentioned in conncection with the previous dimensio, which may point to mechanisms underlying affective processing in common with the two of them. As is the case with the already mentioned dimention, both typical and atypical antipsychotics (haloperidol, risperidone, olanzapine, quetiapine, clozapine and aripiprazole) appear to be a good option against the lack of response to first-choice drugs. As regards the impulsivity/aggression dimension, a good response to mood stabilizers has started to be noted. Cognitive/perceptual dimensio (micropsychosis, brief psychotic disorder, and probably, shizoaffective disorder), show a good response to typical and atypical antipsychotics. Clozapine demonstrated a good response in refractory psychotic states, as well as on prolonged psychosis (an exceptional situation in borderline personality disorder). The conclusion of the present article is that psychopharmacological treatment should be aimed towards a rational polypharmacy, and tht guidelines serve as a useful reference framework to achieve it. Although an optimum treatment for borderline disorders seems to be a long way off, the use of antidepressants and atypical antipsychotics appear to be the most promising option.
Subject(s)
Humans , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Double-Blind Method , Practice Guidelines as Topic , Borderline Personality Disorder/etiology , Borderline Personality Disorder/therapyABSTRACT
Se conceptualiza la memoria traumática utilizando un modelo neuropsicoanalítico freudiano, ampliado con un modelo contemporáneo de los sistemas de memoria en base a sus contenidos y recolección consciente e inconsciente (memorias explícitas e implícitas respectivamente), destacando la vigencia de los descubrimientos freudianos. Se lo relaciona con las teorías psicoanalíticas de la conciencia, afectos y pensamiento. Se otorga importancia a la teoría de la seducción de Freud, la relación con la memoria y la aplicación clínica de estos conceptos a las organizaciones básicas de la personalidad y a la relación con el concepto de discarencia afectiva de Bowlby. Se postula que el trabajo psíquico del trauma facilita hacer inconsciente el trauma psíquico "real" o fantaseado; este trabajo estaría a cargo de la represión en las neurosis, de la escisión en la organización borderline de la personalidad, y de formas primitivas de proyección en las psicosis.
The traumatic memory is conceptualized by means of an amplified Freudian neuropsychoanalytic model using a contemporary memory system based on its contents, conscious and unconscious recollection (explicit and implicit memories) highlighting the validity of the Freudian discoveries. This is then related to the psychoanalytical theories of consciousness, affects and thinking. Particular importance is given to Freud's seduction theory, its relation to memory and the clinical application of these concepts to the basic organization of the personality, together with the relation to Bowlby's concept of emotional deprivation. The development and working trough of trauma is postulated as a vector to make "real" or phantasized trauma unconscious through repression in neurosis, splitting in borderline personality organization, and primitive mechanisms of projection in psychosis.
Subject(s)
Humans , Conscience , Unconscious, Psychology , Memory , Stress Disorders, Traumatic , Personality , Psychotic DisordersABSTRACT
Se estudiaron los síntomas negativos y rasgos de personalidad esquizoide y esquizotípico en 19 pacientes varones esquizofrénicos crónicos. Los hallasgos demuestran una relación directa entre síntomas negativos y rasgos esquizotípicos de personalidad. Se plantea que los síntomas negativos no forman una dimensión unitária y que algunos de ellos forman parte de la personalidad previa del enfermo. (AU)
Subject(s)
Humans , Male , Adult , Schizophrenia/physiopathology , Schizotypal Personality Disorder/physiopathology , Schizotypal Personality Disorder/psychology , Chronic DiseaseABSTRACT
Se estudiaron los síntomas negativos y rasgos de personalidad esquizoide y esquizotípico en 19 pacientes varones esquizofrénicos crónicos. Los hallasgos demuestran una relación directa entre síntomas negativos y rasgos esquizotípicos de personalidad. Se plantea que los síntomas negativos no forman una dimensión unitária y que algunos de ellos forman parte de la personalidad previa del enfermo.