Systematic Review and Meta-Synthesis: How Is Depression Experienced by Adolescents? A Synthesis of the Qualitative Literature.

OBJECTIVE: To systematically investigate how youth with lived experience report their experience of depression in terms of features of depression and in relation to themselves and their environment. METHOD: We conducted a systematic review of qualitative research around the world that explored the subjective experience of depression among youth (age range, 10-24 years) who had self-reported, screened positive for, or received a formal diagnosis of the disorder. We used multiple databases to search for relevant studies published in any language up until March 2023. Studies were coded regarding features of depression reported by adolescents. We also used thematic synthesis to extract and synthesize descriptions of the lived experience of depression, and to develop analytic themes. The study was registered with PROSPERO, CRD42021218300. RESULTS: We identified a total of 23,424 unique records, and included 39 studies in the final review, representing the views of 884 adolescents with lived experience of depression. Most of the studies were conducted in high-income countries (72.8%), and the majority of participants were female (65%). The most frequently reported features of depression were sadness (present in 92.3% of the studies), social withdrawal (76.9%), and loneliness (69.2%). In addition, we constructed 3 themes that aimed to synthesize youths' accounts of their perceptions and experiences of depression: (1) making sense; (2) factoring in culture and contextual influences; and (3) accessing support and care. CONCLUSION: Some of the more commonly reported features of depression among youth are not explicitly included in the DSM/ICD diagnostic criteria but are highly relevant and closely connected to the experiences of adolescents. Moreover, contextual interpretations of depression may be more sensitive to capture representations and narratives of depression among youth. Thus, incorporating features of depression reported by adolescents could potentially increase accuracy of detection, promote collaborative work, and enhance therapeutic and care outcomes. STUDY PREREGISTRATION INFORMATION: The lived experience of depression in adolescence: a systematic review of the qualitative literature; https://www.crd.york.ac.uk/prospero/; CRD42021218300.

Relationship between psychodynamic functioning, defensive mechanisms and trauma in patients with PTSD?

OBJECTIVE: Patients with Post-Traumatic Stress Disorder (PTSD) present a variety of symptoms, with different intensities, causing impairments in the individual, social and occupational functioning areas. The aim of this study was to understand the psychodynamic functioning of patients with PTSD, exploring the relationship between symptom severity, quality of life, subjective suffering, conflicts and psychic structure regarding sociodemographic characteristics, styles and defensive mechanisms. METHODS: This is a cross-sectional quantitative study with 60 participants. The following were used: sociodemographic questionnaire, the Operationalized Psychodynamic Diagnosis-2 (OPD-2) and the Defensive Style Questionnaire (DSQ-40). RESULTS: Participants had moderate to high symptom severity, with significant subjective suffering and isolation. The main conflict was Need for care x Self-sufficiency and the level of Total Structure was moderate/low. The use of immature, neurotic, and mature defensive styles was observed. More primitive personality structures, more rigid defenses and greater dependence were found in patients with history of past trauma. Other mental disorders were also associated. CONCLUSION: OPD-2 was effective to assess the psychodynamic functioning characteristics of patients with PTSD. Therapeutic treatment should focus on the psychic structure and not only on symptom control. Prevention strategies should target vulnerability factors and strengthening of protective factors.

Estruturas de interação no tratamento psicodinâmico de uma paciente com Transtorno de Personalidade Borderline / Estructuras de interacción en el tratamiento psicodinámico de un paciente con Trastorno Límite de la Personalidad / Interaction Structures in the Psychodynamic Therapy of a Patient with Borderline Personality Disorder

Estruturas de interação são padrões repetitivos que ocorrem entre terapeuta e paciente, mesmo que am-bos não sejam conscientes disso. Na pesquisa empíri-ca, elas ajudam a compreender como se estabelece o processo de mudança em psicoterapia. Nesse sentido, esta investigação utilizou 68 sessões de psicoterapia psicanalítica de um caso de uma jovem paciente com Transtorno de Personalidade Borderline (tpb) com o objetivo de identificar as estruturas de interação e sua correlação com o tempo de tratamento. Os dados fo-ram gravados em vídeo e posteriormente codificados através do Psychotherapy Process Q-Set (pqs), por duplas de juízes treinados na metodologia Q-Sort. A partir desses dados, foi realizada a análise fatorial do tipo Q de componentes principais que indicou quatro estruturas de interação, sendo fator 1: Colaborativo; fa-tor 2: Resistência; fator 3: Aliança/Ruptura e fator 4: Apoio/Encorajamento. As estruturas indicaram que a interação se voltou para o trabalho de manutenção da interação colaborativa, através de uma posição empá-tica do terapeuta, direcionado para o reconhecimento dos estados internos do paciente. Apesar do trabalho colaborativo, a resistência também surgiu como um padrão repetitivo. O terapeuta se tornou diretivo com intervenções estruturadas e questionando o paciente, desta forma contribuindo para o desenvolvimento da capacidade de mentalização. Implicações sobre o pro-cesso psicoterápico e indicações para estudos futuros são apresentados com o intuito de contribuir na com-preensão sobre o tratamento de pacientes com tpb em psicoterapia psicodinâmica.

Las estructuras de interacción son patrones repetitivos que ocurren entre el terapeuta y el paciente, incluso si ambos no son conscientes de esto. En la investigación empírica ayudan a comprender cómo se establece el proceso de cambio en psicoterapia. En tal sentido, esta investigación utilizó 68 sesiones de psicoterapia psicoanalítica del caso de un paciente joven con Tras-torno Límite de la Personalidad (tlp) para identificar las estructuras de interacción y su correlación con el momento del tratamiento. Los datos fueron grabados en video y posteriormente codificados utilizando el Q-Set Proceso de Psicoterapia (pqs), por pares de jueces en-trenados en la metodología Q-Sort. Con base en estos datos, se realizó un análisis factorial del tipo Q de componentes principales, el cual indicó cuatro estructuras de interacción, siendo factor 1: Colaborativo; factor 2: Resistencia; factor 3: Alianza/Disrupción y factor 4: Apoyo/Estímulo. Las estructuras indicaron que la interacción se tornó al trabajo de mantener la interacción colaborativa, a través de una posición empática del terapeuta, dirigida al reconocimiento de los estados internos del paciente. A pesar del trabajo colaborativo, la resistencia también surgió como un patrón repetitivo. El terapeuta se volvió directivo con intervenciones estructuradas cuestionando al paciente, contribuyendo así al desarrollo de la capacidad mentalizadora. Se presentan implicaciones en el proceso psicoterapéutico e indicaciones para futuros estudios con el objetivo de contribuir a la comprensión del tratamiento de pacientes con tlp en psicoterapia psicodinámica.

Interaction structures are repetitive patterns of interaction between therapist and patient, even if they are not conscious of it. In empirical research, they help to un-derstand how the process of change in psychotherapy is established. In this sense, the current research used 68 sessions of psychoanalytic psychotherapy in a young patient with Borderline Personality Disorder (bpd) to identify the interaction structures and their correlation with different moments of treatment. The sessions were recorded on video and later encoded through the Psy-chotherapy Process Q-Set (PQS) by pairs of judges trained in Q-Sort methodology. A factor analysis of the Q-type of main components was performed based on these data, which indicated four interaction structures. Factor 1: Collaborative; factor 2: Resistance; factor 3: Alliance/Rupture; and factor 4: Support/Encornment. The structures indicated the interaction became a work of maintenance of the collaborative interaction through an empathic position of the therapist, focused on recognizing the patient's internal states. Despite the collaborative work, resistance also appeared as a repetitive pattern. The therapist became more directive with more structured interventions questioning the patient, thus, contributing to the development of the capacity of mentalization. Implications for the psychotherapeutic process and in-dications for future studies are presented to contribute to the comprehension of the treatment of patients with bpd in psychodynamic psychotherapy.

Understanding the psychodynamic functioning of patients with PTSD and CPTSD: qualitative analysis from the OPD 2 interview.

The traumatic event produces intolerable excitations to the psychic apparatus that searches to relief them through the production of symptoms. When established, patients with post-traumatic stress disorders (PTSD) and complex post-traumatic stress disorder (CPTSD) may experience flashbacks, somatizations, negative emotions about themselves, and difficulty in social contact. This work seeks to understand how the psychodynamic functioning of women victims of interpersonal and urban violence, diagnosed with these disorders, is organized, identifying traumatic experiences, ways of interpersonal relationships, conflicts and psychic structures and use of defense mechanisms, and for peculiarities that may differentiate these disorders. The qualitative transversal method was used through the content analysis of clinical interviews based on the Operationalized Psychodynamic Diagnosis (OPD-2). The sample of this study consisted of five women with PTSD and five with CPTSD. The following categories were created: reasons for seeking care, symptoms and desire for treatment, traumatic developmental events, and characteristics of the psychic functioning. Early trauma generates psychic organizations with greater disintegration. A new traumatic event destabilizes the psychic organization and intensifies symptoms. Relationships were marked by dependence and isolation. Participants with CPTSD presented tendency to disintegration related to the object relation regulation and the psychic conflict was of Individuation versus Dependence, with more primitive flaws in object representations, existential need for the other and direct discharge of impulses. Participants with PTSD had moderate to low level of object relation integration and the conflict was need to be care of versus self-sufficiency, with self-representations being fragile and with reduced capacity to manage impulses. Thus, it could be observed that OPD-2 is capable of assessing in a broad and deep way patients with traumatic disorders, in addition to identifying essential peculiarities to guide health professionals towards treatment in the search for better quality of life for patients.

The experience of receiving a diagnosis of depression in adolescence: A pilot qualitative study in Brazil.

Receiving a diagnosis of depression can have an important impact on the lives of adolescents. However, there is limited information about how youth tackle, attribute meaning to and understand mental health diagnoses. The aim of this study was to explore adolescents' initial reactions after receiving a clinical diagnosis of Major Depressive Disorder in the context of a neurobiological study of depression in Brazil. Using a qualitative design, eight Brazilian adolescents were interviewed twice: immediately after a psychiatric assessment and neuroimaging study, in which they were given a diagnosis of depression, and in a follow-up visit 2 weeks later. Interviews were designed to explore the subjective experience of receiving the diagnosis and the impacts of depression on adolescents' lives. Framework Analysis was used to analyze the accounts. Diagnosis was perceived as a reification of an abnormal status, highlighting the role of stigma and the process of disclosing the diagnosis to others. Adolescents reported the multiple sensemaking processes that occurred when they received a diagnosis of depression, and most struggled with the idea that negative emotions would equate their experience with a disorder. The results show that future efforts could enhance clinical assessment processes with adolescents by exploring adolescents' reactions to diagnosis, as well as the support networks available to them, resulting in increased help-seeking behaviors, and diminished social and personal stigma.

Understanding the psychodynamic functioning of patients with PTSD and CPTSD: qualitative analysis from the OPD 2 interview

Abstract The traumatic event produces intolerable excitations to the psychic apparatus that searches to relief them through the production of symptoms. When established, patients with post-traumatic stress disorders (PTSD) and complex post-traumatic stress disorder (CPTSD) may experience flashbacks, somatizations, negative emotions about themselves, and difficulty in social contact. This work seeks to understand how the psychodynamic functioning of women victims of interpersonal and urban violence, diagnosed with these disorders, is organized, identifying traumatic experiences, ways of interpersonal relationships, conflicts and psychic structures and use of defense mechanisms, and for peculiarities that may differentiate these disorders. The qualitative transversal method was used through the content analysis of clinical interviews based on the Operationalized Psychodynamic Diagnosis (OPD-2). The sample of this study consisted of five women with PTSD and five with CPTSD. The following categories were created: reasons for seeking care, symptoms and desire for treatment, traumatic developmental events, and characteristics of the psychic functioning. Early trauma generates psychic organizations with greater disintegration. A new traumatic event destabilizes the psychic organization and intensifies symptoms. Relationships were marked by dependence and isolation. Participants with CPTSD presented tendency to disintegration related to the object relation regulation and the psychic conflict was of Individuation versus Dependence, with more primitive flaws in object representations, existential need for the other and direct discharge of impulses. Participants with PTSD had moderate to low level of object relation integration and the conflict was need to be care of versus self-sufficiency, with self-representations being fragile and with reduced capacity to manage impulses. Thus, it could be observed that OPD-2 is capable of assessing in a broad and deep way patients with traumatic disorders, in addition to identifying essential peculiarities to guide health professionals towards treatment in the search for better quality of life for patients.

Social isolation as a core feature of adolescent depression: a qualitative study in Porto Alegre, Brazil.

PURPOSE: The goal of this study was to explore the perspectives of different stakeholders regarding the experiences of adolescent depression in Porto Alegre, Brazil. METHODS: We conducted 54 key-informant interviews with adolescents, parents, social workers, health workers, educators, and policy makers and two focus group discussions with 5 adolescents and 6 parents. Data were analysed using a framework approach and guided by the adolescents' personal narratives, with adult stakeholders' views supplementing these perspectives. RESULTS: Four main themes emerged, creating a relational model of adolescent depression that highlights isolation as a central component of the experience. In relation to the self, the experience of depression led to a feeling of detachment from others resulting from the sensation that usual interactions did not have the same meaning as before. This disruption of interactions is perceived as self-isolation and is described in relation to coping mechanisms. CONCLUSION: These findings shed light on important aspects of the identification and management of adolescent depression in Brazil. Since social interaction was a core component of the descriptions and experiences of depression, we speculate that promising interventions are those that could enhance the promotion of a supportive environment and interpersonal relationships.

The Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo): Rationale, Methods, and Baseline Characteristics.

Background: The characterization of adolescents at high risk for developing depression has traditionally relied on the presence or absence of single risk factors. More recently, the use of composite risk scores combining information from multiple variables has gained attention in prognostic research in the field of mental health. We previously developed a sociodemographic composite score to estimate the individual level probability of depression occurrence in adolescence, the Identifying Depression Early in Adolescence Risk Score (IDEA-RS). Objectives: In this report, we present the rationale, methods, and baseline characteristics of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo), a study designed for in-depth examination of multiple neurobiological, psychological, and environmental measures associated with the risk of developing and with the presence of depression in adolescence, with a focus on immune/inflammatory and neuroimaging markers. Methods: Using the IDEA-RS as a tool for risk stratification, we recruited a new sample of adolescents enriched for low (LR) and high (HR) depression risk, as well as a group of adolescents with a currently untreated major depressive episode (MDD). Methods for phenotypic, peripheral biological samples, and neuroimaging assessments are described, as well as baseline clinical characteristics of the IDEA-RiSCo sample. Results: A total of 7,720 adolescents aged 14-16 years were screened in public state schools in Porto Alegre, Brazil. We were able to identify individuals at low and high risk for developing depression in adolescence: in each group, 50 participants (25 boys, 25 girls) were included and successfully completed the detailed phenotypic assessment with ascertainment of risk/MDD status, blood and saliva collections, and magnetic resonance imaging (MRI) scans. Across a variety of measures of psychopathology and exposure to negative events, there was a clear pattern in which either the MDD group or both the HR and the MDD groups exhibited worse indicators in comparison to the LR group. Conclusion: The use of an empirically-derived composite score to stratify risk for developing depression represents a promising strategy to establish a risk-enriched cohort that will contribute to the understanding of the neurobiological correlates of risk and onset of depression in adolescence.

Intervenção psicológica grupal com pais de crianças com transtorno de déficit de atenção e hiperatividade em unidade assistencial pública: relato de experiência / Group psychological intervention with parents of children with attention deficit disorder and hyperactivity in public care unit: An experience report / Intervención psicológica grupal con padres de niños con trastorno de déficit de atención y hiperactividad en una unidad asistencial pública: relato de experiencia

O artigo relata uma prática psicológica com um grupo de pais de crianças diagnosticadas com Transtorno de Déficit de Atenção/Hiperatividade (TDAH), no Centro de Referência Especializado de Assistência Social (CRAS) em um município situado ao noroeste do estado do Rio Grande do Sul (RS). Foram realizados seis encontros semanais, com duas horas e meia de duração e participação de treze pais que integraram o grupo. A estrutura dos encontros consistiu no oferecimento do espaço de escuta para as principais queixas dos pais em relação aos aspectos do TDAH apresentados pelos filhos e psicoeducar sobre os sintomas, curso do transtorno e intervenções para execução no manejo de problemas com os filhos. Como resultado da intervenção, os pais relataram ter melhorado a capacidade de compreender as situações relacionadas ao transtorno dos seus filhos e encontrar soluções assertivas. A intervenção grupal com pais de crianças com TDAH contribuiu como dispositivo para melhorar a qualidade de vida das famílias que vivenciam dificuldades relacionadas aos aspectos do transtorno dos seus filhos.

The article reports a psychological practice with a group of parents of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), at the Centro de Referência Especializado de Assistência Social (CRAS) in a city located in the northwest of the state of Rio Grande do Sul. Six weekly meetings were held, lasting two and a half hours, and with the participation of thirteen parents who were part of the group. The structure of the meetings consisted of offering the space for listening to the main complaints of parents regarding aspects of ADHD presented by their children and psychoeducation about the symptoms, course of the disorder, and interventions for execution in the management of problems with their children. As a result of the intervention, parents reported having improved their ability to understand the situations related to their children's disorder and to find assertive solutions. The group intervention with parents of children with ADHD contributed as a device to improve the quality of life of families that experience difficulties related to the aspects of their children's disorder.

El artículo relata una práctica psicológica con un grupo de padres de niños diagnosticados con el Trastorno por Déficit de Atención e Hiperactividad (TDAH), en el Centro de Referencia Especializado de Asistencia Social (CRAS) de una ciudad situada en el noroeste del estado de Rio Grande do Sul. Se realizaron seis reuniones semanales, de dos horas y media de duración, en las que participaron trece padres que formaban parte del grupo. La estructura de las reuniones consistió en ofrecer un espacio para escuchar las principales quejas sobre los aspectos del TDAH que presentan sus hijos y psicoeducar sobre los síntomas, el curso del trastorno y las intervenciones de ejecución en el manejo de los problemas con sus hijos. Como resultado de la intervención, los padres informaron que habían mejorado su capacidad para comprender las situaciones relacionadas con el trastorno de sus hijos y para encontrar soluciones asertivas. La intervención grupal con padres de niños con TDAH contribuyó como un dispositivo para mejorar la calidad de vida de las familias que experimentan dificultades relacionadas con los aspectos del trastorno de sus hijos.

Translation and cultural adaptation of the DSM-5 Personality Inventory - Brief Form (PID-5-BF)

Abstract Introduction The Personality Inventory for the DSM-5 - Brief Form (PID-5-BF) - is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. Objectives To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. Methods The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. Results The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. Conclusion The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians.

Intimate partner violence against women: Operationalized Psychodynamic Diagnosis (OPD-2).

INTRODUCTION: Intimate partner violence against women is one of the most common forms of violence. Different research fields are trying to understand the cycle of violence, such as the psychological field, to understand how these women's relational patterns and intrapsychic conflict function in the cycle of violence. OBJECTIVE: To investigate the operationalized psychodynamic diagnosis of women victims of domestic violence, exploring the severity and experience of violence, structural functions, dysfunctional interpersonal patterns, and intrapsychic conflicts. METHOD: We conducted a cross-sectional quantitative study using the OPD-2 Clinical Interviews, which were recorded and transcribed. The sample was composed by 56 women victims of domestic violence, mean age 30.07 (SD = ±9.65). Reliability was satisfactory for judges interviews(k>0,6). RESULTS: According to the OPD-2 evaluation, we found that the severity of the violence was associated with the intensity of women's subjective suffering. In the relational pattern, they stay in the relationship, leaving themselves vulnerable; perceive the partner as controlling, aggressive, offensive, and fear abandonment. As a defensive mechanism to relational discomfort and suffering victims anticipate the aggressor's desire, resulting in submissive behavior. The main psychic conflict was the "need for care versus self-sufficiency" (78.6%). And medium was the predominant structure level, in which they presented insecure internal objects, presenting difficulties in emotional regulation and perceiving reality in a distorted way. Hence, they do not recognize their limitations and needs. We found that 78.6% of the cases had some psychiatric disorder: MDD, PTSD. CONCLUSION: This study provides empirical evidence on clinical observations on the psychological functioning of this population and the issues that make up the maintenance of domestic violence against women. The understanding of internalized patterns, structural functions, and motivational tensions are fundamental for the prevention of re-victimization and improving coping mechanisms, as well as promoting greater adherence to treatment.

The Brazilian-adapted Working Alliance Inventory: preliminary report on the psychometric properties of the original and short revised versions.

INTRODUCTION: Alliance is an essential component of all psychotherapies and a consistent predictor of its outcomes. The Working Alliance Inventory (WAI) is a widely used and psychometrically sound measure of alliance. It assesses three key aspects of the construct: a) agreement on the tasks of therapy; b) agreement on the therapeutic goals; and c) development of an affective bond. OBJECTIVE: To preliminarily analyze the psychometric properties of the Brazilian version of both the original, 36-item WAI, and of the short form revised, 16-item version (WAI-SR). METHODS: The sample comprised 201 psychodynamic psychotherapy patients. Alliance assessments were made after the 4th treatment session. RESULTS: The inventory adapted to Brazilian Portuguese, in both the original and short forms, appears to be reliable and valid to measure alliance and its dimensions by clients in psychotherapy. Further studies are needed to replicate and expand the findings.

The Brazilian-adapted Working Alliance Inventory: preliminary report on the psychometric properties of the original and short revised versions

Abstract Introduction Alliance is an essential component of all psychotherapies and a consistent predictor of its outcomes. The Working Alliance Inventory (WAI) is a widely used and psychometrically sound measure of alliance. It assesses three key aspects of the construct: a) agreement on the tasks of therapy; b) agreement on the therapeutic goals; and c) development of an affective bond. Objective To preliminarily analyze the psychometric properties of the Brazilian version of both the original, 36-item WAI, and of the short form revised, 16-item version (WAI-SR). Methods The sample comprised 201 psychodynamic psychotherapy patients. Alliance assessments were made after the 4th treatment session. Results The inventory adapted to Brazilian Portuguese, in both the original and short forms, appears to be reliable and valid to measure alliance and its dimensions by clients in psychotherapy. Further studies are needed to replicate and expand the findings.

Preditores do abandono inicial em psicoterapia psicodinâmica / Predictors of initial abandonment in psychodynamic psychotherapy / Predictores del abandono inicial en psicoterapia psicodinámica

O abandono em psicoterapia é um fator amplamente estudado, tendo em vista sua relevância para a prática clínica. Algumas variáveis têm sido preditoras da interrupção da psicoterapia; no entanto, há poucos estudos que diferenciam os períodos do abandono. Este estudo objetiva identificar os preditores do abandono inicial no processo psicoterapêutico de 1.272 prontuários de pacientes adultos jovens. Os instrumentos utilizados foram: a ficha de contato inicial, a avaliação e a alta institucional e o SCL-90-R. Os resultados foram obtidos por meio da análise de Regressão Logística Binária Multivariada, que indicaram como preditoras do abandono inicial, as variáveis sociodemográfica: baixa renda; clínica: ansiedade fóbica; e as de tratamento: não ter realizado psicoterapia anteriormente; e razões do término de tratamento: tipo de abandono (não compareceu à sessão e não justificou); paciente (outros motivos: mudança de cidade, falta de recursos e motivos de saúde); fatores organizacionais; insatisfação. Os resultados sugerem uma atenção às consultas iniciais para auxiliar na adesão ao tratamento.

Abandonment in psychotherapy is a widely studied factor, considering its relevance to clinical practice. Some variables have been predictive of the interruption of psychotherapy; however, there are few studies that differentiate periods of abandonment. This study aims to identify the predictors of initial abandonment in the psychotherapeutic process of 1,272 medical records of young adult patients. The instruments used were the initial contact sheet, the evaluation, the institutional discharge and the SCL-90-R. The results were obtained through the analysis of Multivariate Binary Logistic Regression, which indicated as predictors of initial abandonment, the following variables: sociodemographic: low income; clinical: phobic anxiety; and treatment: not having previously performed psychotherapy; and reasons for termination of treatment: type of abandonment (did not attend the session and did not justify); patient (other reasons: change of city, lack of resources and reasons for health); organizational factors; dissatisfaction. The results suggest an attention to the initial appointments to help in treatment accession.

El abandono en psicoterapia es un factor ampliamente estudiado, teniendo en vista su relevancia para la práctica clínica. Algunas variables han sido predictores de la interrupción de la psicoterapia; sin embargo, hay pocos estudios que diferencian los períodos del abandono. Este estudio tiene como objetivo identificar los predictores del abandono inicial en el proceso psicoterapéutico de 1.272 prontuarios de pacientes adultos jóvenes. Los instrumentos utilizados fueron la ficha de contacto inicial, la evaluación y alta institucional y el SCL-90-R. Los resultados fueron obtenidos por medio del análisis de Regresión Logística Binaria Multivariada, que indicaron como predictores del abandono inicial, las variables: sociodemográfica: baja renta; clínica: ansiedad fóbica; y las de tratamiento: no haber realizado psicoterapia anteriormente; y razones del término de tratamiento: tipo de abandono (no compareció a la sesión y no justificó); paciente (otros motivos: cambio de ciudad, falta de recursos y motivos de salud); factores organizacionales; insatisfacción. Los resultados sugieren una atención a las consultas iniciales para ayudar en la adhesión al tratamiento.

Translation and cultural adaptation of the DSM-5 Personality Inventory - Brief Form (PID-5-BF).

INTRODUCTION: The Personality Inventory for the DSM-5 - Brief Form (PID-5-BF) - is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. OBJECTIVES: To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. METHODS: The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. RESULTS: The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. CONCLUSION: The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians.

Conjugando métodos clínico e empírico no estudo de caso de interrupção precoce em psicoterapia psicanalítica / Combining clinical and empirical methods for understanding a case of premature interruption in psychoanalytic psychotherapy

O objetivo deste estudo é conjugar métodos clínico e empírico de avaliação do processo psicoterapêutico para a compreensão dos fatores associados à interrupção precoce em um caso de psicoterapia psicanalítica. Os participantes foram uma díade terapêutica. A paciente é jovem adulta, atendida em uma clínica-escola, por um período de três meses. A psicoterapeuta registrou sua impressão das sessões e sua compreensão dinâmica do caso. O método de estudo do caso foi análise sistemática por meio do Psychotherapy Process Q-Set (PQS) e do Shedler-Westen Assessment Procedure (SWAP). As sessões foram gravadas em vídeo e posteriormente codificadas com os instrumentos por avaliadores externos treinados. As características do processo indicam foco nos relacionamentos amorosos e nas situações de vida atual; a paciente trazia material significativo; tendia a concordar com as intervenções da psicoterapeuta e demonstrava se sentir entendida. A psicoterapeuta, por sua vez, mostrou empatia e adotou atitude de apoio, realizando intervenções exploratórias. A sessão 6 constituiu um momento de mudança na direção do processo. Os resultados fornecem elementos para a compreensão dos fatores relacionados com a interrupção, tais como o incremento da resistência e ambivalência por parte da paciente não devidamente abordados pela terapeuta.(AU)

This study aims to combine clinical and empirical methods of therapeutic process evaluation for understanding factors associated with premature interruption in psychoanalytic psychotherapy. The participants were a therapeutic dyad. The patient is a female young adult treated in an outpatient clinic of a psychoanalytic psychotherapy training institution. The treatment lasted three months, and the patient attended 8 sessions. The psychotherapist made records about her impressions of the sessions and about her understanding of the case dynamics. The case was analyzed systematically through the Psychotherapy Process Q-Set (PQS) and the Shedler-Westen Assessment Procedure (SWAP). Therapy sessions were videotaped and later coded by external trained raters. The general features of this process indicated that psychotherapy focused on romantic relationships and actual life situations; patient usually had brought significant materials; patient tended to agree with therapist´s interventions, and appear to feel understood by the therapist. The therapist showed empathy and adopted a supportive attitude while conducting exploratory interventions. Session 6 was a turning point in the process direction. Results provide some elements for understanding process factors related to treatment interruption such as the increase of resistance and ambivalence on the part of the patient, which were not adequately addressed by the therapist.(AU)

Reflective function and identity in adolescents with clinical and nonclinical symptoms.

INTRODUCTION: Reflective function is developed in the context of secure attachment and corresponds to the ability to understand one's mental states and those of others. Thus, identity develops, which relates to the experience of self as unique, continuous and coherent. OBJECTIVE: To identify reflective function and identity features in adolescents with clinical and nonclinical symptoms of mental health problems. METHOD: Participants were 188 Brazilian high school students aged 14-17 years: 30.3% with clinical symptoms and 69.9% with nonclinical symptoms. RESULTS: Adolescents with clinical symptoms showed lower levels of reflective function and greater disintegration of identity. CONCLUSION: Adolescence is a vulnerable time for mental health problems associated with reflective function and identity. Early identification of symptoms is a matter that needs attention to prevent future consequences.

Reflective function and identity in adolescents with clinical and nonclinical symptoms / Função reflexiva e identidade em adolescentes com sintomas clínicos e não clínicos

Abstract Introduction Reflective function is developed in the context of secure attachment and corresponds to the ability to understand one's mental states and those of others. Thus, identity develops, which relates to the experience of self as unique, continuous and coherent. Objective To identify reflective function and identity features in adolescents with clinical and nonclinical symptoms of mental health problems. Method Participants were 188 Brazilian high school students aged 14-17 years: 30.3% with clinical symptoms and 69.9% with nonclinical symptoms. Results Adolescents with clinical symptoms showed lower levels of reflective function and greater disintegration of identity. Conclusion Adolescence is a vulnerable time for mental health problems associated with reflective function and identity. Early identification of symptoms is a matter that needs attention to prevent future consequences.

Resumo Introdução A função reflexiva é desenvolvida no contexto do apego seguro e corresponde à capacidade de compreender os seus próprios estados mentais e os dos outros. Assim, desenvolve-se a identidade, que se relaciona com a experiência do eu como única, contínua e coerente. Objetivo Identificar função reflexiva e características identitárias em adolescentes com sintomas clínicos e não clínicos de problemas de saúde mental. Médoto Os participantes foram 188 estudantes do ensino médio com idade de 14 a 17 anos: 30,3% com sintomas clínicos e 69,9% com sintomas não clínicos. Resultados Adolescentes com sintomas clínicos apresentaram menores níveis de função reflexiva e maior desintegração da identidade. Conclusão A adolescência é um momento vulnerável para problemas de saúde mental associados à função reflexiva e identidade. A identificação precoce dos sintomas é uma questão que precisa de atenção para evitar consequências futuras.

NMR model structure of the antimicrobial peptide maximin 3.

Maximin 3 is a 27-residue-long cationic antimicrobial peptide found in the skin secretion and brain of the Chinese red-belly toad Bombina maxima. The peptide is of biological interest as it possesses anti-HIV activity, not found in the other maximin peptides, in addition to antimicrobial, antitumor and spermicidal activities. The three-dimensional structure of maximin 3 was obtained in a 50/50% water/2,2,2-trifluoroethanol-d3 mixture using two-dimensional NMR spectroscopy. Maximin 3 was found to adopt an α-helical structure from residue G1 to A22, and a coil structure with a helical propensity in the C-terminal tail. The peptide is amphipathic, showing a clear separation between polar and hydrophobic residues. Interactions with sodium dodecyl sulfate micelles, a widely used bacterial membrane-mimicking environment, were modeled using molecular dynamics simulations. The peptide maintained an α-helical conformation, occasionally displaying a flexibility around residues G9 and G16, which is likely responsible for the peptide's low haemolytic activity. It is found to preferentially adopt a position parallel to the micellar surface, establishing a number of hydrophobic and electrostatic interactions with it.

A função reflexiva em adolescentes em conflito com a lei e em adolescentes escolares / The reflexive function in adolescents in conflict with the law and school adolescents / La función reflexiva en adolescentes en conflicto con la ley y en adolescentes escolares

A função reflexiva (FR) é identificada como um constructo importante à compreensão psicopatológica e para a prática clínica. Sendo assim, neste artigo, busca-se ampliar o conhecimento sobre a função reflexiva em dois grupos de adolescentes com diferentes trajetórias, um em conflito com a lei (G1=91, M idade 16,57 anos, DP=0,77) e outro de escolares (G2=64, M de idade 15,89 anos, DP=0,75). Os instrumentos utilizados foram dados sociodemográficos, Questionário sobre Função Reflexiva para Jovens e Questionário de Capacidade e Dificuldades. Da amostra, identificou-se que 119 adolescentes eram não clínicos e 95 clínicos. A análise univariada demonstrou diferenças significativas na função reflexiva considerando a interação entre a variável G1 e G2 e as categorias clínico e não clínico. Assim, o G2 não clínico apresentou maior função reflexiva (M=8,60; DP=0,68; F=4,66; p<0,05), seguido pelo G1 clínico (M=8,29; DP=0,68). Tal característica no grupo clínico de adolescentes em conflito com a lei assinala hipermentalização. Aponta-se, portanto, a necessidade de avaliação e desenvolvimento da função reflexiva como prevenção em saúde mental.

Reflexive Function is identified as an important construct for psychopathological understanding and for clinical practice. The aim of this study was to increase the knowledge about Reflexive Function in adolescents with different trajectories: a group of adolescents in conflict with the law (G1=91, M age=16.57 years, SD=0.77) and a group of teenager students (G2=64, M age=15,89 anos, SD=0,75). Instruments were a Sociodemographic Data Questionnaire, the Questionnaire on Reflexive Function for Young People and the Strenghts and Difficulties Questionnaire. Ninety-one non-clinical adolescents and 95 clinical teenagers took part in the study. Univariate analysis showed significant differences in the Reflexive Function considering the interaction between the G1 and G2 variables and the clinical and nonclinical categories. Thus, non-clinical G2 presented a greater reflex function (M=8.60, SD=0.68, F=4.66, p<0.05), followed by clinical G1 (M=8.29, SD=0.68). This characteristic in the clinical group of adolescents in conflict with the law points to hyper-inhalation. It is pointed out the need for evaluation and development of the Reflexive Function as prevention in mental health.

A funçión reflexiva ha sido identificado como un constructo importante para la comprensión psicopatológica y para una práctica clínica. Se busca ampliar el conocimiento de la función reflexiva en los adolescentes con diferentes trayectorias de desarrollo, grupo de adolescentes en conflicto con la ley (G1=91, M edad 16,57 anos, DP=0,77), y grupo de adolescentes escolares (G2=64, M de edad 15,89 anos, DP=0,75). Instrumentos: Ficha de datos sociodemográficos, Cuestionario sobre Función Reflexiva pata Jovens y Cuestionario de Capacidad e Dificuldades. Identificou-se 119 adolescentes no clínicos y 95 adolescentes clínicos. A análise univariada apontou que a función reflexiva demonstrou diferencias significativas considerando una interacción entre una variable G1 y G2 en las categorías clínicas y no clínicas. (M=8,60; DP=0,68; F=4,66; p <0,05), seguido por G1 clínico (M=8,29, DP=0,68). A presencia de elevada función reflexiva no grupo clínico de adolescentes en conflicto con una ley corrobora una característica de hipermentalización. Aponta-se la necessidade de evaluación y desarrollo de la función reflexiva como prevenición en salud mental.