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2.
Br J Hosp Med (Lond) ; 82(8): 1-2, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34431338

RESUMO

The idea of patients drinking, eating and mobilising (DrEaMing) at 24 hours postoperatively is being used as a marker of functional recovery. This marker of recovery and quality is explored in this article.


Assuntos
Sonhos , Humanos
3.
J Anal Psychol ; 66(3): 399-410, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231887

RESUMO

In the current collective unrest, we and our analysands are living in real time and need vantage points from which to make meaning, as subjective experience of time is collapsing. For many analysands, the past is being relived in the present, with no imaginable future. During the time of COVID-19, dreams are providing a valuable mechanism in working with atemporal emotional trauma, previously uncontextualized. Dream metaphor can provide a transitional space to move around in within the analytic framework. This paper explores a variety of dreams from individual analysands demonstrating different ways of conceptualizing personal and collective experience, bridging between the past, present, and future. Parallels between feeling states related to the current condition and unprocessed implicit memories from the past will be examined, as a vehicle for processing past trauma. Dreams expressing current states of dread for an unimaginable future, as well compensatory dreams showing a hopeful vision of the future will be considered.


Assuntos
COVID-19 , Sonhos , Interpretação Psicanalítica , Terapia Psicanalítica , Trauma Psicológico/terapia , Adulto , Humanos
4.
J Anal Psychol ; 66(3): 506-516, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231897

RESUMO

This paper attempts to read the psychological and emotional impact of the COVID-19 pandemic through the archetypal images contained in patients' dreams. In these dreams, symbols related to the power of nature and to extreme danger are paired with feelings of detachment that seem to point to a traumatic dissociation, due to the archetypal experience that erupts in familiar surroundings. Through the humanization of the ineffable experience, dissociation, which in the beginning of the pandemic showed in high levels of anxiety, panic attacks and depersonalization, can be transformed into the overview needed for the search for meaning. The container for this process of transformation is the analyst, the real, virtual or imagined one, and his or her ability to relate and feel.


Assuntos
COVID-19 , Sonhos , Relações Profissional-Paciente , Interpretação Psicanalítica , Terapia Psicanalítica , Processos Psicoterapêuticos , Adulto , Humanos
5.
JAMA ; 326(1): 56-64, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34228066

RESUMO

Importance: Cytisine is more effective than placebo and nicotine replacement therapy for smoking cessation. However, cytisine has not been tested against the most effective smoking cessation medication, varenicline, which is associated with adverse events known to lead to discontinuation of therapy. Objective: To examine whether standard cytisine treatment (25 days) was at least as effective as standard varenicline treatment (84 days) for smoking cessation. Design, Setting, and Participants: This noninferiority, open-label randomized clinical trial with allocation concealment and blinded outcome assessment was undertaken in Australia from November 2017 through May 2019; follow-up was completed in January 2020. A total of 1452 Australian adult daily smokers willing to make a quit attempt were included. Data collection was conducted primarily by computer-assisted telephone interview, but there was an in-person visit to validate the primary outcome. Interventions: Treatments were provided in accordance with the manufacturers' recommended dosage: cytisine (n = 725), 1.5-mg capsules taken 6 times daily initially then gradually reduced over the 25-day course; varenicline (n = 727), 0.5-mg tablets titrated to 1 mg twice daily for 84 days (12 weeks). All participants were offered referral to standard telephone behavioral support. Main Outcomes and Measures: The primary outcome was 6-month continuous abstinence verified using a carbon monoxide breath test at 7-month follow-up. The noninferiority margin was set at 5% and the 1-sided significance threshold was set at .025. Results: Among 1452 participants who were randomized (mean [SD] age, 42.9 [12.7] years; 742 [51.1%] women), 1108 (76.3%) completed the trial. Verified 6-month continuous abstinence rates were 11.7% for the cytisine group and 13.3% for the varenicline group (risk difference, -1.62% [1-sided 97.5% CI, -5.02% to ∞]; P = .03 for noninferiority). Self-reported adverse events occurred less frequently in the cytisine group (997 events among 482 participants) compared with the varenicline group (1206 events among 510 participants) and the incident rate ratio was 0.88 (95% CI, 0.81 to 0.95; P = .002). Conclusions and Relevance: Among daily smokers willing to quit, cytisine treatment for 25 days, compared with varenicline treatment for 84 days, failed to demonstrate noninferiority regarding smoking cessation. Trial Registration: anzctr.org.au Identifier: ACTRN12616001654448.


Assuntos
Alcaloides/uso terapêutico , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Abandono do Hábito de Fumar/métodos , Vareniclina/uso terapêutico , Adulto , Alcaloides/efeitos adversos , Azocinas/efeitos adversos , Azocinas/uso terapêutico , Sonhos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Quinolizinas/efeitos adversos , Quinolizinas/uso terapêutico , Agentes de Cessação do Hábito de Fumar/efeitos adversos , Resultado do Tratamento , Vareniclina/efeitos adversos
6.
J Anal Psychol ; 66(3): 429-442, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231889

RESUMO

This work originates from reflections on the observation of recurring themes in dreams of patients in psychoanalytic treatment during the most restrictive lockdown period in Italy (March - May 2020). The authors focus on the peculiar dialogic state between consciousness and the unconscious that arose following a collective event such as that of the pandemic, which determined the activation of complex personal nuclei, compensatory effects of the unconscious psyche and new perspective functions. These latter aspects are interpreted with reference to the contributions of Erich Neumann, bringing a new psychological vision of the relationship between Man and Nature in relation to catastrophic events.


Assuntos
COVID-19 , Sonhos , Distanciamento Físico , Interpretação Psicanalítica , Terapia Psicanalítica , Inconsciente Psicológico , Adulto , Humanos , Itália , Telemedicina
7.
BMJ Case Rep ; 14(7)2021 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34312132

RESUMO

Subglottic concretion is a rare and perilous condition usually presenting with existing or impending airway obstruction. Due to long-standing nature of the condition, slow progression of symptoms and rarity of occurrence, the condition is either missed or misdiagnosed. Its resemblance in presentation and symptoms to that of foreign body (FB) bronchus can lead to a diagnostic misadventure. Detailed history, chronology of symptoms and radiological imaging in conjunction with fiberoptic evaluation are keys for establishing correct diagnosis. Treatment outcomes in such cases depend on appropriate management approach with backup plan in tandem. We describe a child with ß thalassemia major with subglottic concretion, which was erroneously diagnosed and managed as a case of subglottic FB due to its classical history and presentation. The aim is to highlight the circumstances leading to this diagnostic misadventure with emphasis on airway management, problems faced and lessons learnt during the same.


Assuntos
Obstrução das Vias Respiratórias , Corpos Estranhos , Talassemia beta , Obstrução das Vias Respiratórias/etiologia , Brônquios/diagnóstico por imagem , Criança , Sonhos , Corpos Estranhos/diagnóstico , Corpos Estranhos/diagnóstico por imagem , Humanos , Talassemia beta/complicações , Talassemia beta/diagnóstico
8.
Am J Infect Control ; 49(10): 1324-1326, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34273465

RESUMO

An outbreak of Klebsiella pneumoniae producing the carbapenemase NDM-1 occurred in our ICU during the last COVID-19 wave. Twelve patients were tested positive, seven remained asymptomatic whereas 5 developed an infection. Resistome and in silico multilocus sequence typing confirmed the clonal origin of the strains. The identification of a possible environmental reservoir suggested that difficulties in observing optimal bio-cleaning procedures due to workload and exhaustion contributed to the outbreak besides the inappropriate excessive glove use.


Assuntos
COVID-19 , Infecções por Klebsiella , Antibacterianos , Proteínas de Bactérias/genética , Surtos de Doenças , Sonhos , Humanos , Unidades de Terapia Intensiva , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Pandemias , SARS-CoV-2 , beta-Lactamases/genética
9.
J Adv Nurs ; 77(11): 4549-4562, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34268797

RESUMO

AIM: This study aimed to explore the experience and management of poor sleep quality in Spanish women with fibromyalgia (FM). DESIGN: This was a qualitative study based on one-to-one interviews. METHODS: Twenty-one adult women diagnosed with FM were recruited from the community between January and March 2020. Data were collected through in-depth semistructured one-to-one interviews, using an interview guide of open questions about the experience and management of poor sleep quality, and were analyzed with thematic qualitative analysis. The symptom management theory was used as a biopsychosocial conceptual framework. RESULTS: The results were organized into two themes: (a) experience of poor sleep quality and (b) management strategies for poor sleep quality. Poor sleep quality was found to be a severe symptom of FM that negatively impacts pain, fatigue, stiffness, mental health, and quality of life. The participants perceived pharmacological treatment to be the main approach of health care professionals for improving sleep, and most did not want this form of treatment. Self-management strategies lack clear beneficial effects on sleep quality. CONCLUSION: Women with FM recognize that they need to receive more information from nurses and allied professions about sleep in the context of FM and how to effectively manage poor sleep quality. IMPACT: This study contributes to a better understanding of how women with FM experience and manage poor sleep quality. More information about management strategies for poor sleep quality from nurses and other health care professionals is needed in women with FM. The results of this study can be applied by nurses and health care professionals, including sleep educators, in the treatment of this patient group.


Assuntos
Sonhos , Fibromialgia , Fibromialgia/terapia , Humanos , Pesquisa Qualitativa , Qualidade de Vida
10.
J Card Surg ; 36(9): 3334-3336, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34101916

RESUMO

Left ventricular free wall rupture (LVFWR) is a rarest but often lethal mechanical complication of acute myocardial infarction (AMI). The mortality rate for LVFWR is described from 75% to 90% and it is the cause for 20% of in-hospital deaths after AMI. Death results essentially from the limited time available for emergent intervention after onset of symptoms. Emergency surgery is indicated and normally the rupture site is easily identified, but it may not be apparent macroscopically, corresponding to transmyocardial or subepicardial dissection with an external rupture far from the infarction site, or already thrombosed and contained. Repair of the ventricular wall is usually achieved either by suturing the edges of the tear or closing it with patches of artificial material or biological tissues, usually using some kind of biological glue. However, several cases of successful conservative management have been described. In this Editorial, I comment on the metanalysis conducted by Matteucci et al, published in this issue of the Journal, including 11 nonrandomized studies and enrolling a total of 363 patients, which brings a great deal of new knowledge that can help not only in the prevention but also in the management of this dreadful complication of AMI.


Assuntos
Ruptura Cardíaca Pós-Infarto , Ruptura Cardíaca , Infarto do Miocárdio , Sonhos , Ruptura Cardíaca/diagnóstico por imagem , Ruptura Cardíaca/etiologia , Ruptura Cardíaca/cirurgia , Ruptura Cardíaca Pós-Infarto/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Infarto do Miocárdio/complicações
11.
J Clin Psychiatry ; 82(3)2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34077033

RESUMO

ß-Blockers (BBs) are prescribed to a wide range of patients with cardiovascular and neuropsychiatric disorders. For more than half a century, BB treatment has been associated with depression as an adverse effect. The evidence in support of this association includes case reports, observational studies, and randomized controlled trials (RCTs). However, a large number of studies that refute the association have also been published. A very large meta-analysis of the psychiatric adverse effects of BBs, as reported in RCTs, was recently published. This meta-analysis found that BBs were not associated with an increased risk of depression or of withdrawal due to depression in comparison with either placebo or active controls. However, BBs were associated with an increased risk of fatigue/tiredness in comparison with placebo as well as in comparison with some groups of active controls. BBs were additionally associated with an increased risk of unusual dreams, relative to placebo. These findings suggest that fatigue/tiredness and unusual dreams may be misinterpreted by patients and clinicians as depression, explaining why BBs have been associated with depression risk. Furthermore, because BBs are commonly prescribed to patients with ischemic heart disease (IHD), and because IHD patients are at increased risk of depression, confounding by indication may explain why some patients treated with BBs later develop depression. These considerations notwithstanding, there are many reasons why the findings of the meta-analysis cannot be taken as reassurance on the subject. As examples, the RCTs in the meta-analysis mostly ascertained depression as a symptom rather than as a clinical diagnosis; and the meta-analysis did not consider risks with specific BBs such as propranolol, which has been strongly associated with the risk of depression in previous studies. In short, the final word, perhaps, remains to be said.


Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Depressão/induzido quimicamente , Sonhos/efeitos dos fármacos , Fadiga/induzido quimicamente , Metanálise como Assunto , Humanos
12.
J Anesth ; 35(4): 576-580, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33950294

RESUMO

Patients frequently report having dreams during general anesthesia, and the dreams are often reported to be pleasant dreams. However, factors associated with the quality of dreams during general anesthesia have not been clarified. The aim of this study was to determine the relationships between the quality of dreams during general anesthesia and perioperative factors. This prospective observational study included patients scheduled for elective surgery under general anesthesia. Preoperative mental status was assessed by the Hospital Anxiety and Depression Scale (HADS). A postoperative interview was carried out in the operating room after recovery from general anesthesia. Dreams and awareness during general anesthesia were assessed by a modified Brice interview. The quality of dreams was classified in accordance with the patient's own opinion as pleasant, indifferent, or unpleasant. A total of 1100 patients were included in the study, and 293 (25.4%) of the patients reported having dreams during anesthesia. Half of the patients who experienced dreams during anesthesia (50.2%, 147/293 patients) reported having a pleasant dream. Multivariate logistic regression analysis revealed that only HADS-depression score of less than 11 was related to pleasant dreams (OR: 3.3 [95% CI 1.3-10.0]).


Assuntos
Anestesia Geral , Sonhos , Anestesia Geral/efeitos adversos , Humanos , Período Pós-Operatório , Estudos Prospectivos
13.
Brain Behav ; 11(6): e02147, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33991066

RESUMO

INTRODUCTION: Following a case study on scopolamine butyl bromide, an anticholinergic drug, we studied the effect of a central anticholinergic drug on post-traumatic stress disorder (PTSD)-related flashbacks and nightmares. METHODS: We administered trihexyphenidyl (TP) to 34 patients with refractory PTSD-related nightmares and flashbacks (open-label trial [n = 22]; single-blind trial [n = 12]), who had previously received psychiatric treatment for approximately 2-15 years, without therapeutic benefits. The effect of TP was determined using the Clinician-Administered PTSD Scale (CAPS) and the Impact of Event Scale-Revised (IES-R). RESULTS: Overall, most patients reported an improvement to none or mild on the CAPS for nightmares (88%) and flashbacks (79%). CONCLUSION: This study is the first to demonstrate the potential efficacy of TP in the treatment of refractory PTSD-related nightmares and flashbacks. Further double-blind, randomized control trials are needed to explore the potential clinical benefits of TP in PTSD.


Assuntos
Preparações Farmacêuticas , Transtornos de Estresse Pós-Traumáticos , Antagonistas Colinérgicos , Sonhos , Humanos , Método Simples-Cego , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Resultado do Tratamento , Triexifenidil
14.
Sleep Med ; 83: 5-12, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33990066

RESUMO

STUDY OBJECTIVES: Disturbing dreams are a common complaint among trauma survivors, but little epidemiological research exists to document the frequency in the general population. In addition, information about their occurrence in diverse adults is lacking. METHODS: Using the Collaborative Psychiatric Epidemiology Surveys we had the unique opportunity to examine disturbing dreams in a diverse sample of adults in the US. Disturbing dreams were measured in three different variables including trauma dreams, dreams of the worst event, and dreams of separation. A fourth variable was created to assess for any disturbing dream reported across the three categories. RESULTS: Disturbing dream prevalence varied in the overall sample (N = 20,013) based on the assessment question. Dreams of trauma was 2.01% in the overall sample, dreams of the worst event was 7.21% and dreams of separation was 1.73%. Prevalence rates of all dream variables varied by racial and ethnic group membership, gender, and age. Odds ratios were also calculated for the three variables of interest by racial and ethnic group with significant differences emerging. Women had significantly higher rates of disturbing dreams in all variables assessed (p < 0.01). Older adults reported significantly lower rates of disturbing dreams compared to younger and middle-aged adults (p < 0.001). CONCLUSIONS: This study establishes prevalence rates for disturbing dreams in a diverse sample of US adults. Understanding the prevalence can aid in reducing barriers to care for evidence-based treatments currently underutilized.


Assuntos
Sonhos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários
16.
Int Clin Psychopharmacol ; 36(4): 221-223, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34030164

RESUMO

This article reports on the treatment of a patient with nightmares who was treated with doxazosin of an alpha 1-adrenergic antagonists. A 71-year-old Japanese major depressive disorder (MDD) woman experienced nightmares after the coronavirus disease 2019 pandemic. She had nightmares about being chased by a coronavirus and catching the corona virus. After adding doxazosin 1 mg daily in the morning, her nightmares led to remission without side effects. We also had a rechallenge regimen with doxazosin. The nightmares ceased on the second night of the rechallenge and did not return with continued treatment. This case report suggests that doxazosin may be a useful therapeutic option to target nightmares in individuals with MDD.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , COVID-19/psicologia , Transtorno Depressivo Maior/tratamento farmacológico , Doxazossina/uso terapêutico , Sonhos/efeitos dos fármacos , Idoso , Feminino , Humanos , SARS-CoV-2
17.
Rev Med Suisse ; 17(740): 1054-1055, 2021 05 26.
Artigo em Francês | MEDLINE | ID: mdl-34042344
18.
Curr Biol ; 31(7): R352-R353, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33848493

RESUMO

The retrospective nature of dream reports represents a challenge to the study of dreams. Two-way, real-time communication between researchers and lucid dreamers immersed in REM sleep offers a new and exciting window into the study of dreams and dreaming.


Assuntos
Sonhos , Sono REM , Encéfalo , Estudos Retrospectivos , Sono
19.
Trends Cogn Sci ; 25(6): 427-428, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33879421

RESUMO

Dreamers were long thought absolutely isolated from the outside world. Yet psychophysiological studies over the past 40 years have firmly established that lucid dreamers can use eye movements to report on their dream content in real time while in rapid eye movement (REM) sleep. We now also know that sensory input is not completely suppresssed during sleep. A recent study by Konkoly et al. illustrates how experimenters can question lucid dreamers during ongoing dreams and asks whether more extended two-way communication during lucid REM sleep dreaming is feasible.


Assuntos
Sonhos , Sono REM , Cognição , Comunicação , Humanos , Sono
20.
Agora (Rio J.) ; 24(1): 82-90, Jan.-Apr. 2021.
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1284997

RESUMO

RESUMO: Apoiado na metapsicologia dos espaços interferentes (Kaës), no sonhar (Bion; Winnicott), nos processos de subjetivação (Roussillon) e na clínica psicanalítica de grupos e instituições (Gaillard; Pinel), o artigo discute o que sofre nas equipes das instituições de cuidado, qual o trabalho necessário para simbolizá-lo e as condições de sustentação e efeitos desse trabalho. Sustenta que a subjetivação da experiência da equipe por um aparelho psíquico grupal opera também sobre o usuário. Engrenagem mister desse processo, o sonhar compartilhado da equipe - sustentado em um espaço onírico comum e compartilhado - é proposto como via fundamental para a realização da tarefa da clínica em instituição.


Abstract: Based on the metapsychology of shared psychic spaces (Kaës), on dreaming (Bion, Winnicott), on the subjectivation process (Roussillon) and on the psychoanalytic clinic of groups and institutions (Gaillard; Pinel), this article discusses what suffers in professional teams at care institutions, which work is necessary to symbolize it and the conditions to sustain it as well as the outcomes of such work. It affirms that the subjectivation of the team's experience by a psychic apparatus of the group also operates on the user. Part of this process, the team's shared dreaming - sustained in a common and shared onyric space - is proposed as a fundamental way to accomplish the clinical task in institutions.


Assuntos
Sonhos , Fortalecimento Institucional , Instituição de Longa Permanência para Idosos
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