Illness Denial in Medical Disorders: A Systematic Review.

INTRODUCTION: Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment. OBJECTIVE: This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders. METHODS: The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science. RESULTS: The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation. CONCLUSIONS: This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.

Intimate Partner Violence Perpetration Denial and Underreporting in Cisgender Male Couples / [Negar y no informar el haber ejercido violencia de pareja en parejas de hombres cisgénero]

Intimate partner violence (IPV) perpetrators often deny their actions, limiting opportunities for intervention. Cisgender male couples experience similar IPV rates to mixed-gender couples, yet less is known about how men in same-sex relationships deny or report their IPV behavior. This study aimed to describe perpetration denial across emotional, monitoring/controlling, and physical/sexual IPV, and to identify correlates of perpetration denial, in a convenience sample of male couples (N = 848; United States, 2016-2017). Past-year victimization and perpetration were measured with the IPV-Gay and Bisexual Men (GBM) scale; perpetration deniers were men whose self-reported perpetration contradicted their partner’s reported victimization. Individual-, partner-, and dyadic-correlates of perpetration denial, by IPV-type, were identified using actor-partner interdependence models. We identified 663 (78.2%) perpetrators: 527 emotional; 490 monitoring/controlling; 267 physical/sexual. Thirty-six percent of physical/sexual-, 27.7% of emotional-, and 21.43% of monitoring/controlling-perpetrators categorically denied their actions. Depression was negatively associated with denying monitoring/controlling-perpetration (odds ratio 95% confidence interval: 0.91 [0.84, 0.99]) and physical/sexual-perpetration (0.91 [0.83, 0.97]); dyadic differences in depression were associated with emotional-perpetration denial (0.95 [0.90, 0.99]). Recent substance users had 46% lower odds of monitoring/controlling-denial (0.54 [0.32, 0.92]), versus non-users. Partner-race and employment were also significantly associated with emotional perpetration denial. This study highlights IPV denial’s complexities, including differences across IPV types. Further investigations into how cisgender men in same-sex couples perceive and report various types of IPV perpetration will provide valuable insight into how an underserved and understudied population experiences IPV.(AU)

Los agresores de pareja a menudo niegan sus actos, lo que reduce la posibilidad de intervención. Las parejas de hombres cisgénero presentan índices de violencia de pareja (VP) semejantes a las parejas de distinto género, aunque se sabe menos de cómo niegan la VP los hombres que están en una relación del mismo sexo. El estudio pretende describir la negación de que se ejerce VP en sus variantes emocional, vigilancia/control y física/sexual, así como conocer los correlatos de dicha negación, en una muestra de conveniencia de parejas de hombres (N = 848, EEUU, 2016-2017). Se midió la victimización y la comisión de VP durante el último año por medio de la escala IPV-GBM. Quienes negaban haber ejercido VP eran hombres cuyo comportamiento autoinformado contradecía la victimización que declaraba sufrir su pareja. Se detectaron por tipo de VP los correlatos individuales, de pareja y diádicos de la negación de haber perpetrado VP, mediante modelos de interdependencia actor-pareja. Se detectaron 663 (78.2%) perpetradores: en 527 era emocional, en 490 de vigilancia/control y en 267 física/sexual. El 36% de los que perpetraban violencia física/sexual y el 21.43% de vigilancia/control negaban sus actos categóricamente. La depresión se asociaba negativamente a la negación de haber perpetrado violencia de vigilancia/control (razón de probabilidad, 95% IC: 0.91 [0.84, 0.99]) y física/sexual (0.91 [0.83, 0.97]). Las diferencias diádicas en depresión se asociaban a la negación de haber perpetrado violencia emocional (0.95 [0.90, 0.99]). La probabilidad de los usuarios recientes de sustancias de negar la violencia de vigilancia/control era un 46% menor (0.45 [0.32, 0.92]) que la de quienes no consumían. La raza de su pareja y su empleo se asociaban también significativamente con negar que se hubiera cometido violencia emocional. El estudio destaca las complejidades de negar la violencia de pareja, como las diferencias entre tipos de VP...(AU)

Denial of pregnancy and neonaticide: A historical overview and case report.

While denial of pregnancy and neonaticide are rare, they are potentially associated and share some risk factors. Neonaticide has been proposed as the extreme outcome of a denial of pregnancy. However, the process leading to such a possible outcome is not yet fully understood. The primary goal of this essay is to examine the various definitions and ambiguities surrounding the denial of pregnancy. The case of a young woman with a history of two denied pregnancies with diverse characteristics and outcomes, the latest of which resulted in neonaticide, is then reported and examined. A forensic psychiatric evaluation was also performed to reconstruct the woman's mental state at the time of the crime. The forensic pathological analysis of the newborn, abandoned near the sea while still alive, is described. The victim's body showed signs of shaken baby syndrome. We contend that differing levels of awareness during a denial of pregnancy might not be predictive of the potential delivery outcome in terms of threat to the newborn's survival, according to the forensic pathological and psychopathological data of the current case. Early identification of women affected by denial of pregnancy who pose a danger of committing infanticide is hampered by both intrinsic traits (dissimulation, unawareness, low propensity to seek assistance) and environmental factors (isolation, low socioeconomic level, poor education.). A previous history of denial of pregnancy should activate health and support services to reduce the potential risks for the mother and the child.

Atendimento psicossocial à mulher que comete ofensa sexual / Psychosocial attention for women that commit sexual offenses / Atención psicosocial para mujeres que cometen delitos sexuales

Objetivamos apresentar uma proposta de atendimento psicossocial grupal oferecida para mulheres adultas que cometeram ofensa sexual, cuidadoras e mães. A experiência está sendo desenvolvida no Distrito Federal, Brasil, com pessoas do gênero feminino provenientes de encaminhamento judicial. Carece que os profissionais das áreas da justiça, saúde, serviço social e psicologia avancem no estudo e na compreensão desta temática, de modo a pensarem a atuação e o apoio terapêutico a essas mulheres. O modo de atendimento é focal e breve, com ênfase na criação de um ambiente lúdico como facilitador das interações grupais e da discussão sobre os temas: identidade; confiança nas relações afetivas e sociais; vivência pessoal com violência física e sexual; configuração de gênero; e expressão da sexualidade e futuro. A abordagem individual também se baseia no enfoque dos temas mencionados. O oferecimento de ajuda à mulher cuidadora ou à mãe tem participação ativa na interrupção do circuito abusivo sexual, pois essa violência é extremamente ocultada, ocasionando uma prolongada vulnerabilidade para as vítimas. Ressalta-se o valor do texto indicando a descrição de ação voltada para uma população permanentemente não estudada e evitada em seu reconhecimento. Os limites desta proposta encontram-se na falta de outras iniciativas que possibilitem uma discussão sobre essa experiência.(AU)

We aim to present a proposal of a group psychosocial intervention offered for adult female sexual offenders, caregivers, and mothers. The intervention is being developed at Federal District, Brazil, with female people coming from judicial referrals. Professionals in the areas of justice, health, social work, and psychology need to advance in the study and understanding this theme to think about action and therapeutic support for these women. The intervention is a focal and brief approach, with emphasis on the creation of a ludic environment as a facilitator of group interactions and discussion about the themes: identity; trust in affective and social relationships; personal experience with physical and sexual violence; gender configuration; and sexuality expression and future. The individual approach is also based on focusing on these themes. The offering of help to the female caregiver or the mother has an active participation in the interruption of the sexual offense circuit, since this violence is extremely hidden, bringing a prolonged condition of vulnerability to the victims. The value of this text is highlighted indicating the description of an action directed to a population that is permanently not studied and whose recognition is avoided. The limits of this proposal are found in the absence of other initiatives that would allow a discussion about this experience.(AU)

Este texto presenta una propuesta de atención psicosocial grupal destinada a mujeres adultas que han cometido delito sexual, a cuidadoras y madres. La intervención se está desarrollando en el Distrito Federal (Brasil), con personas del género femenino provenientes de remisiones judiciales. Es necesario que los profesionales de las áreas de justicia, salud, trabajo social y psicología avancen en el estudio y comprensión de esta temática para pensar en el desempeño y apoyo terapéutico de estas mujeres. El servicio es enfocado y breve, con énfasis en la creación de un ambiente lúdico como facilitador de interacciones grupales y discusión sobre los temas: identidad; confianza en las relaciones afectivas y sociales; experiencia personal con violencia física y sexual; configuración de género; y expresión de la sexualidad y el futuro. El enfoque individual también se centra en estos temas. La oferta de ayuda a la mujer cuidadora o a la madre es importante para la interrupción del circuito de abuso sexual, ya que esta violencia es extremadamente oculta y provoca una vulnerabilidad prolongada a las víctimas. Se destaca el valor del texto con la descripción de la acción dirigida a una población que no es objeto de estudios ni reconocida. Los límites de esta propuesta se encuentran en la ausencia de otras iniciativas que permitan un debate sobre esta experiencia.(AU)

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

O racismo enraizado nas famílias inter-raciais de São Paulo / Deep-rooted racism in interracial families from São Paulo / Racismo arraigado en las familias interraciales de São Paulo

O racismo estrutural é uma realidade na sociedade brasileira e pode ser manifestado no interior de famílias inter-raciais. As crianças e as pessoas adultas que experienciam sentimentos de aceitação ou de rejeição nas dinâmicas familiares desenvolvem diferentes formas de ver a si mesmas, os outros e o mundo ao redor. Este estudo teve por objetivo avaliar as percepções de suporte emocional, rejeição parental na infância e discriminação cotidiana entre pessoas brancas, pardas e pretas. Participaram 175 pessoas, 80% do gênero feminino, com idade da amostra total variando de 18-39 anos (M = 24; DP = 5,11). Cento e três participantes se identificaram como branca/o, 42, como preta/o e 30, como parda/o. Todos responderam um formulário online composto pela Escala de Lembranças de Práticas Parentais, Escala de Discriminação Cotidiana e questões sociodemográficas. O resultado do teste Manova indicou que não houve diferença estatisticamente significativa entre as pessoas brancas, pardas e pretas em relação ao suporte emocional e à rejeição parental. Quanto à percepção de discriminação, houve diferença estatisticamente significativa nas subescalas de Tratamento Injusto [X²(2) = 17,360; p < 0,001] e Rejeição Pessoal [X²(2) = 27,970; p < 0,001], pessoas pretas apresentaram maiores médias que pardas e brancas, respectivamente. Discute-se a importância de falar sobre racismo nas relações familiares. Espera-se percepções de rejeição parental menor para pessoas brancas e de discriminação cotidiana maior para pardas e pretas.(AU)

Structural racism is a reality in Brazilian society and it can manifest within interracial families. Children and adults who experience feelings of acceptance or rejection in family dynamics develop different forms of seeing themselves, others, and the world around them. This study aimed to analyze perceptions of emotional support, parental rejection in childhood, and everyday discrimination between white, mixed, and black people. The participants were 175 people, 80% women, aged between 18 to 39 years (M = 24; DP = 5.11). A hundred and three participants identified themselves as white, 42 as black, and 30 as mixed. All answered an online form with the Memories on Parenting Practices, Everyday Discrimination Scale, and sociodemographic questions. Results show that the MANOVA test indicated no statistically significant difference between white, black, and mixed people regarding emotional support and parental rejection. Concerning the perception of discrimination, there was a statistically significant difference in the Unfair Treatment [X2(2) = 17.360; p < 0.001] and Personal Rejection [X2(2) = 27.970; p < 0.001] subscales, black people presented higher averages than mixed and white groups, respectively. This study discusses the importance of discussing racism in family relationships. Perceptions of lower parental rejection for white people and higher everyday discrimination for mixed and blacks are expected.(AU)

El racismo estructural es una realidad en la sociedad brasileña y puede manifestarse en familias interraciales. Los niños y los adultos que experimentan sentimientos de aceptación o rechazo en la dinámica familiar desarrollan diferentes formas de verse a sí mismos, a los demás y al mundo que los rodea. Este estudio tuvo como objetivo evaluar las percepciones de apoyo emocional, rechazo de los padres en la infancia y discriminación cotidiana entre personas blancas, mestizas y negras. Participaron 175 personas, 80% mujeres, con una edad de la muestra total de entre 18 y 39 años (M = 24; DE = 5,11). Ciento tres participantes se identificaron como blancos; 42 como negros y 30 como pardos. Todos respondieron un formulario en línea que consta de la Escala de Recuerdo de Prácticas de Crianza, la Escala Discriminación en la Vida Cotidiana y de preguntas sociodemográficas. El resultado de la prueba Manova indicó que no hubo diferencias estadísticamente significativas entre las personas con respecto al apoyo emocional y el rechazo de los padres. En cuanto a la percepción de discriminación, hubo uma diferencia estadísticamente significativa en las subescalas de trato injusto [X2(2) = 17,360; p < 0,001] y rechazo personal [X2(2) = 27,970; p < 0,001], los negros tenían promedios más altos que los pardos y los blancos, respectivamente. Se discute la importancia de hablar de racismo en las relaciones familiares. Se esperan percepciones de menor rechazo de los padres hacia las personas blancas y mayor discriminación diaria hacia los pardos y negros.(AU)

O sexo em psicanálise como ontologia negativa / El sexo en el psicoanálisis como ontología negativa / Sex in psychoanalysis as a negative ontology

RESUMO O objetivo deste artigo é defender a tese de que o sexo em psicanálise apresenta caráter ontologicamente negativo. Desde Freud, sabemos que sexo não se restringe a práticas específicas nem se aferra a objetos predeterminados - sexo é encarado como pulsional; sendo assim, perverso, polimorfo e infantil. Desta feita, trata-se de um objeto não positivado e que se manifesta em fenômenos negativos, como as formações do inconsciente - sexo, inconsciente e não saber estão intimamente associados. O impasse ontológico radical concernente ao sexo compõe os desenvolvimentos lacanianos referentes ao desejo e ao gozo. Ater-se à espécie de negatividade que lhe é própria permite extrair outras consequências do aforismo 'não há relação sexual' - para além da ideia de obstáculo ou impedimento, problematiza-se a face ontológica negativa da não relação, correspondente à ligação entre simbólico e real e que pode ser formalizada no matema S (Ⱥ). O artigo também põe em destaque incidências clínicas desta proposta - reconhecer a irredutibilidade ontológica da negação nos desvia das determinações positivas que sustentam normatizações identitárias em horizonte clínico.

RESUMEN El objetivo de este artículo es defender la tesis de que el sexo en el psicoanálisis tiene un carácter ontológicamente negativo. Desde Freud hemos sabido que el sexo no se limita a prácticas específicas, ni se aferra a objetos predeterminados: el sexo es visto como pulsional; así, perverso, polimorfo e infantil. Esta vez, es un objeto no positivo que se manifiesta en fenómenos negativos, como las formaciones del inconsciente: el sexo, el inconsciente y el no-saber están estrechamente asociados. El impasse ontológico radical sobre el sexo constituye el desarrollo lacaniano sobre el deseo y el goce. Cumplir con su propio tipo de negatividad nos permite extraer otras consecuencias del aforismo 'no hay relación sexual': más allá de la idea de obstáculo o impedimento, el aspecto ontológicamente negativo de la no-relación, correspondiente al vínculo entre lo simbólico y lo real, se problematiza. Este marco teórico se puede formalizar en el matema S (Ⱥ). El artículo también destaca las implicaciones clínicas de esta propuesta: reconocer la irreductibilidad ontológica de la negación nos desvía de las determinaciones positivas que sustentan las normas de identidad en el horizonte clínico.

ABSTRACT The purpose of this article was to defend the thesis that sex in psychoanalysis has an ontologically negative character. Since Freud, we have known that sex is not limited to specific practices or attached to predetermined objects - sex is seen as instinctual; therefore, perverse, polymorphous and childish. In this case, it is a non-positivized object that manifests itself in negative phenomena, such as the formations of the unconscious - sex, unconscious and not-knowing are intimately associated. The radical ontological impasse concerning sex makes up the Lacanian developments concerning desire and jouissance. Keeping to the negativity that is proper to it allows to draw other consequences from the aphorism 'there is no sexual relationship' - in addition to the idea of obstacle or impediment, the negative ontological face of non-relation is problematized, corresponding to the link between symbolic and real, which can be formalized in the matheme S (Ⱥ). The article also highlights clinical incidences of this proposal - recognizing that ontological irreducibility of negation diverts us from positive determinations that support identity norms in the clinical horizon.

Negacionismos, anti-intelectualismo e formação da comunidade científica

No dia 12 de agosto de 2021, o professor e pesquisador Flávio Coelho Edler apresentou a conferência intitulada Negacionismos, anti-intelectualismo e formação da comunidade científica, a convite do Departamento de História da Universidade Estadual de Maringá. Flávio Edler também compõe o grupo de pesquisa “O físico, o mental e o moral na história dos saberes médicos-psicológicos”.

Why are people antiscience, and what can we do about it?

From vaccination refusal to climate change denial, antiscience views are threatening humanity. When different individuals are provided with the same piece of scientific evidence, why do some accept whereas others dismiss it? Building on various emerging data and models that have explored the psychology of being antiscience, we specify four core bases of key principles driving antiscience attitudes. These principles are grounded in decades of research on attitudes, persuasion, social influence, social identity, and information processing. They apply across diverse domains of antiscience phenomena. Specifically, antiscience attitudes are more likely to emerge when a scientific message comes from sources perceived as lacking credibility; when the recipients embrace the social membership or identity of groups with antiscience attitudes; when the scientific message itself contradicts what recipients consider true, favorable, valuable, or moral; or when there is a mismatch between the delivery of the scientific message and the epistemic style of the recipient. Politics triggers or amplifies many principles across all four bases, making it a particularly potent force in antiscience attitudes. Guided by the key principles, we describe evidence-based counteractive strategies for increasing public acceptance of science.

[The invisible pregnancy: Clinical characteristics and perspectives about denial of pregnancy]. / La grossesse invisible : caractéristiques cliniques et perspectives autour du déni de grossesse.

Denial of pregnancy is a public health problem due to maternal, fetal, and neonatal morbidity, affecting both physical and mental health. It generally involves an absence of the physical signals associated with pregnancy such as abdominal swelling, amenorrhea, weight gain, or even perception of fetal movements. Despite the potential consequences for mother and child, there is still little data on its clinical features and the neurocognitive mechanisms involved. In this paper, we provide an update on the clinical, socio-demographic, and psychopathological characteristics of pregnancy denial based on contemporary scientific literature. We first define denial of pregnancy by referring to the history of the concept, previous definitions, and nosographic classifications. We then detail the clinic of denial by distinguishing the physical and psychological symptoms of this disorder, then the socio-demographic, gynecological, and psychiatric characteristics. We describe the consequences of denial on the mother, infant, and the dyad, referring to situations of cryptic neonaticide. Finally, we show the importance of perinatal neuroscience research on maternal interoception to understand the mechanisms involved in denial of pregnancy, and improve their medical management in clinical practice.

Denial of Cerebrovascular Events in a National Clinical Quality Registry for Stroke: A Retrospective Cohort Study.

OBJECTIVES: To investigate cerebrovascular event (CVE) denials reported by registered patients to the Australian Stroke Clinical Registry, and to examine the factors associated with CVE denial. MATERIAL AND METHODS: CVE denials reported from January 1, 2017 to June 30, 2018 were followed up with hospitals to verify their discharge diagnosis. CVE denials were compared with all non-CVE denial registrants and a 5% random sub-sample of non-CVE deniers according to patient and clinical characteristics, quality of care indicators and health outcomes. Multilevel, multivariable logistic regression models were used. Factors explored were age, sex, stroke severity, type of stroke, treatment in a stroke unit, length of stay and discharge destination. Level was defined as hospital. RESULTS: Overall, 339/23,830 (<2%) CVE denials were reported during the 18-month period. Hospitals confirmed 117 (61%) of CVE denials as a verified diagnosis of stroke or transient ischaemic attack (TIA). Compared to non-CVE deniers, CVE deniers were younger, had a shorter median length of stay (four days versus one day) and were more likely to be diagnosed with a TIA (64%) compared to the other types of stroke (11% intracerebral haemorrhage; 20% ischaemic; 5% undetermined). CONCLUSION: Very few patients denied their CVE, with the majority of denials subsequently confirmed as eligible for registry inclusion. Diagnosis of a TIA and shorter length of stay were associated with CVE denial. These findings provide evidence that very few cases are incorrectly entered into a national registry, and highlight the characteristics of those unlikely to accept their clinical diagnosis where further education of diagnosis may be needed.

Are We Getting Less Sexist? A Ten-Year Gap Comparison Analysis of Sexism in a Portuguese Sample.

Widely and slowly, discrimination against women based upon gender has become socially unacceptable. However, less is known about how sexist beliefs have progressed in the last years and if we are responding to this social antagonizing of a sexist discourse. Our goal was to verify the existence of differences in ambivalent sexism and neosexism over a ten-year gap in a Portuguese adult sample and to assess possible modifications in the relationship between the variables. A cross-sectional, correlational study was conducted using two independent groups, with measures taken in 2009 and then in 2019. Both groups were invariant in terms of average age and proportion of sexes. Our results show a decrease in hostile and benevolent forms of sexism, while neosexism remains constant. The relationships between variables suggest that sexist beliefs are changing to accommodate subtler and modernized forms of sexism, like neosexism, that deny the existence of discrimination against women, resent discrimination complaints, and maintain a paternalistic view of women. Neosexism also seems to have a stronger correlation with hostile sexism than with benevolent forms of sexism in the male subsample. This relationship is stronger for the 2019 sample. These relationships suggest that sexism is more deeply rooted than we would like to admit and adapts to social discourse. Despite our best efforts, it is yet to be overcome.

Pregnancy denial: a complex symptom with life context as a trigger? A prospective case-control study.

OBJECTIVE: To identify risk factors for a woman to experience pregnancy denial. DESIGN, SETTING AND POPULATION: A French multicentric prospective case-control study with 71 mother-infant dyads having experienced a pregnancy denial versus a control group of 71 dyads. METHODS: Data were collected in the week after delivery using an observational leaflet and two psychiatric scales (MINI and QSSP). MAIN OUTCOME MEASURES: Statistically significant differences between the two groups regarding social, demographic, medical and psychiatric data. RESULTS: Not being in a stable relationship (odds ratio [OR] 17.18, 95% CI 3.37-87.60]; P < 0.0001), not having a high school diploma (OR 1.11, 95% CI 1.04-1.38]; P < 0.0001) and having a psychiatric history (OR 6.33, 95% CI 1.62-24.76; P = 0.0002) were risk factors to experience pregnancy denial, whereas being older was a protective factor (OR 0.86, 95% CI 0.79-0.93; P = 0.0054) (logistic regression, Wald 95% CI). Other risk factors included late declarations of pregnancy history and past pregnancy denials (case n = 7, 9.7% versus 0% in controls; P = 0.01), past pregnancy denials in the family (case n = 13, 18% versus control n = 4, 5.6%; P = 0.03), and use of a contraceptive method (75% for cases versus 7% in control; P < 0.0001), primarily an oral contraceptive (75%). CONCLUSION: Family or personal history of pregnancy denial should be part of the systematic anamnesis during the first visit of a patient of child-bearing age. Further, our study points out that life context (young age, single status, socio-economic precarity, pill-based contraception) could be a trigger for pregnancy denial in certain women. TWEETABLE ABSTRACT: Life context can be a trigger for pregnancy denial.

Psychological difficulties of LVAD patients and caregivers: A follow up over one year from discharge.

BACKGROUND: After the rehabilitation program, patients with left ventricular assist device (LVAD) are discharged home, but the adaption to the daily life with the implant is challenging, both with practical and psychological consequences. Literature is lacking detailed information about the quality of life of LVAD patients and caregivers after discharge to home. OBJECTIVE: This study aimed at evaluating the post-discharge outcomes of both LVAD patients and their caregivers in terms of quality of life, affectivity, and psychological health. METHODS: In this observational follow-up study, LVAD dyads discharged home from 1 year to 6 years were re-contacted by phone and received by mail an envelope with self-report questionnaires. Responses of 39 complete dyads of patients (mean age 68.59 ± 4.31; males: 92.31%) and their caregivers (mean age 61.59 ± 11.64; males: 17.95%) were analyzed. RESULTS: Patients and caregivers reported the moderate levels of anxiety, depression, and caregiver strain, and Illness denial and conscious avoidance were associated between them. The couples often reported that the LVAD has impairments for their sleep and for their affective-sexual relationship. Caregivers often reported impairment in social life and self-care. DISCUSSIONS: Despite the satisfaction for the medical and territorial assistance, patients showed psychological difficulties such as anxious and depressive symptoms and caregivers tend to neglect themselves. Even after a long time from discharge to home, the psychological distress of LVAD patients and caregivers is still considerable. Structured and continuous psychological interventions are required to support their psychological health overtime after the discharge to home.

Towards a new understanding of pregnancy denial: the misunderstood dissociative disorder.

Pervasive pregnancy denial is a misunderstood reproductive anomaly which compromises the health of both mother and the developing fetus. Because in extreme cases, the death of the neonate at the hands of his/her mother has criminal repercussions, research has attempted to explain the origins of this clinical phenomenon. The purpose of this review is to analyze the evolution of understanding the association between pregnancy denial and neonaticide. This paper identifies the consistent similarities in symptom presentation, particularly dissociation, when a denied pregnancy ends with the death of the newborn. The common thread across the progression of the literature over time serves as a foundation for considering the development of diagnostic criteria for future inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This paper reviews the seminal research from 1969 to current research up to 2020 addressing pregnancy denial and its connection to neonaticide. Peer reviewed and published articles related to key terms around "pregnancy denial," "pregnancy concealment," "neonaticide," and "dissociation" were retrieved from major databases such as PubMed, PsychINFO, JSTOR, ProQEST, ScienceDirect, and Google Scholar. Reference lists of relevant articles were also scanned to search for further papers pertaining to similarities in symptom presentation across demographic profiles. Papers were excluded if they were not available in English, or if they did not contribute to identifying consistencies in clinical presentation when a pregnancy is denied. There are clear repetitive markers that occur across studies which pertain not only to the frequent absence of certain expected indicators of pregnancy, (i.e. no morning sickness, weight gain, or sensations of fetal movement), but also the misattribution of pregnancy-related symptoms, and the consistent experience of a dissociative episode while giving birth that can unintentionally result in neonaticide. This paper concludes that dissociation is a consistently seen symptom in pervasive pregnancy denial. Dissociation, in addition to other commonly seen symptoms across cases, suggests specific diagnostic criteria that lend themselves to inclusion in the Diagnostic and Statistical Manual of Mental Disorders.

O imensurável da experiência do luto materno / The immeasurable experience of maternal grief / Lo inconmensurable del luto materno

Neste trabalho, investigamos a experiência de seis mães enlutadas pela morte de seus filhos. As experiências concretas, tal como descritas pelas mães, nos permitem acompanhar o fenômeno do luto materno. Ao analisar fenomenologicamente o sentido encontrado no âmbito da experiência do luto, precisamos, em um primeiro momento, recuar frente às interpretações correntes sobre o luto, subtraindo a conotação patologizante que muitas vezes é atribuída a essa experiência. Após essa postura metodológica, acompanhamos os vetores internos mobilizadores da experiência do luto e, por fim, alcançamos a dinâmica e a estrutura do próprio fenômeno. Com a análise fenomenológica, constatamos doze unidades de significado presentes no relato das mães enlutadas: a imortalidade por meio de homenagens e comemorações; a eternidade do luto; a saudade e a lembrança; a luta contra o esquecimento; o pedido de ajuda; o ver para além do corpo; o vazio que não se preenche; a vida continua, mesmo que a do filho não; a crença em Deus e no reencontro; o afeto do amor; o inexplicável e imensurável do luto.(AU)

In this paper we investigate the experience of six mother grieving the death of their children. Concrete experiences, as described by the mothers, allow us to follow up the maternal grief phenomenon. Analyzing phenomenologically the meaning we find in the sphere of the grief experience, it is necessary, at first, to recede in the face of the current interpretations over grief, subtracting a pathologizing connotation that is often attributed to the experience. After this methodological approach, we follow the internal mobilizing vectors from the grief experience and finally, we reach the dynamic and the structure of the phenomenon itself. With a phenomenological analysis, we found twelve units of meanings found in the grieving mothers' report: the immortality by using tributes and celebrations; the eternity of mourning; the longing and remembrance; the fight against forgetfulness; the aid request; the vision beyond the body; the emptiness that is not filled; life goes on, even though the child's does not; belief in God and in reunion; the affection of love; the inexplicable and immeasurable mourning.(AU)

En este trabajo investigamos la experiencia de seis madres afligidas por la muerte de sus hijos. Las experiencias concretas, tal como las describen las madres, nos permiten seguir el fenómeno del luto materno. Al analizar fenomenológicamente el significado que está en el contexto de la experiencia del luto, necesitamos, al principio, retirarnos de las interpretaciones actuales del luto, sacando la connotación patológica que a menudo se atribuye a esta experiencia. Después de esta postura metodológica, seguimos los vectores internos movilizando la experiencia del luto y, finalmente, alcanzamos la dinámica y estructura del fenómeno mismo. Con el análisis fenomenológico, llegamos a doce unidades de significado presentes en el informe de madres afligidas: la inmortalidad a través de homenajes y celebraciones; la eternidad del luto; el anhelo y recuerdo; la lucha contra el olvido; la solicitud de ayuda; el verlo más allá del cuerpo; el vacío que no se llena; la vida sigue incluso si la del hijo no; el creer en Dios y en el reencuentro; el afecto del amor; lo inexplicable e inconmensurable del luto.(AU)

Arrancando os olhos: reflexões sobre negacionismo / Gouging out the eyes: reflections on denialism / Arrancando los ojos: reflexiones sobre el negacionismo / Crever les yeux: réflexions sur le negationnisme

O texto visa estudar o negacionismo do ponto de vista psicanalítico. Inicialmente se estudam personagens míticos propondo-se que Liríope, Édipo e Jocasta "fizeram vista grossa" para a realidade. Em seguida são discutidas situações clínicas em que os pacientes deformam a percepção da realidade atacando seu aparelho de percepção, em particular a visão. O estudo clínico se articula com a abordagem do negacionismo social. Propõe-se que, nessas situações, aquilo que se nega é substituído por uma nova realidade baseada em narrativas mentirosas que buscam recuperar mitos ancestrais idealizados. São discutidos também aspectos da formação analítica. O trabalho é concluído alertando-se para o risco de negar os perigos representados pelo negacionismo fanático.

The text aims to study denialism from the psychoanalytic point of view. Initially it is studied mythical characters proposing that Liriope, Oedipus and Jocasta "turn a blind eye" to reality. Next, clinical situations are discussed in which patients deform the perception of reality by attacking their perception apparatus, in particular vision. The clinical study is articulated with the approach of social denialism. It is proposed that situations what are denied are replaced by new realities based on lying narratives that seek to recover idealized ancestral myths. Aspects of the analytic training are also discussed. The work is completed by warning of the risk of denying the dangers posed by the fanatical denialist.

El texto tiene como objetivo estudiar el negacionismo desde un punto de vista psicoanalítico. Inicialmente se estudian personajes míticos, proponiendo que Liríope, Edipo y Yocasta "hacían la vista gorda" a la realidad. A continuación, se discuten situaciones clínicas en las que los pacientes deforman su percepción de la realidad atacando su aparato de percepción, en particular su visión. El estudio clínico se articula con el enfoque del negacionismo social. Se propone que, en estas situaciones, lo negado es reemplazado por una nueva realidad basada en narrativas mentirosas que buscan recuperar mitos ancestrales idealizados. También se discuten aspectos de la formación analítica. El trabajo se concluye alertando sobre el riesgo de negar los peligros que plantea el negacionismo fanático.

Le texte vise à étudier le négationnisme d'un point de vue psychanalytique. Dans un premier temps, des personnages mythiques sont étudiés, proposant que Liríope, Odipe et Jocaste « ont fermé les yeux ¼ sur la réalité. Ensuite, des situations cliniques sont discutées dans lesquelles des patients déforment leur perception de la réalité en attaquant leur appareil de perception, en particulier leur vision. L'étude clinique s'articule avec l'approche du negationnisme social. Il est proposé que, dans ces situations, ce qui est nié soit remplacé par une nouvelle réalité basée sur des récits mensongers qui cherchent à récupérer des mythes ancestraux idéalisés. Les aspects de la formation analytique sont également abordés. L'ouvrage se termine en alertant sur le risque de nier les dangers du déni fanatique.

Covid-19 y gripe de 1918-1919: paralelos históricos, preguntas y respuestas / Covid-19 and the 1918-1919 influenza: historical parallels, questions and answers

Resumen El desarrollo de la pandemia de la covid-19 ha motivado un renovado interés por la gripe de 1918-1919 para buscar elementos que facilitaran la comprensión de la experiencia presente, pero también como oportunidad para reevaluar la grave crisis sanitaria del siglo XX a la luz de lo que estamos viviendo. En este contexto y con ese objetivo se inserta esta reflexión histórica sobre estos dos fenómenos pandémicos, que muestra los paralelismos existentes y la necesidad de una toma de conciencia de que nuestro modelo de sociedad está en crisis y se requiere una transformación profunda.

Abstract The rise of the covid-19 pandemic has led to renewed interest in the 1918-1919 influenza in search of aspects that might help us understand the current situation, but also as an opportunity to re-evaluate the serious twentieth-century health crisis in light of what we are experiencing now. In this context and with that goal, this historical reflection shows the parallels that exist and the need for a realization that our model of society is undergoing a crisis and requires profound transformation.

[Covid-19 and the 1918-1919 influenza: historical parallels, questions and answers]. / Covid-19 y gripe de 1918-1919: paralelos históricos, preguntas y respuestas.

The rise of the covid-19 pandemic has led to renewed interest in the 1918-1919 influenza in search of aspects that might help us understand the current situation, but also as an opportunity to re-evaluate the serious twentieth-century health crisis in light of what we are experiencing now. In this context and with that goal, this historical reflection shows the parallels that exist and the need for a realization that our model of society is undergoing a crisis and requires profound transformation.

El desarrollo de la pandemia de la covid-19 ha motivado un renovado interés por la gripe de 1918-1919 para buscar elementos que facilitaran la comprensión de la experiencia presente, pero también como oportunidad para reevaluar la grave crisis sanitaria del siglo XX a la luz de lo que estamos viviendo. En este contexto y con ese objetivo se inserta esta reflexión histórica sobre estos dos fenómenos pandémicos, que muestra los paralelismos existentes y la necesidad de una toma de conciencia de que nuestro modelo de sociedad está en crisis y se requiere una transformación profunda.