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1.
Adv Exp Med Biol ; 1191: 187-196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002930

RESUMO

Under the partial influences of paradigm shift form category to dimension, the Diagnostic and Statistical Manual of Mental Disorder (DSM) was revised to the fifth edition (DSM-5); however, due to the lack of consistent biological makers and processes and the restricted availability of dimensional meta-structure, the revisions for the DSM-5 were based on a combination of categorical and dimensional approaches. Anxiety disorders were more clearly and consistently defined in the DSM-5 with the removal of obsessive compulsive, acute stress, and post-traumatic stress disorders. Differences between the childhood and adulthood categories of anxiety disorders were decreased, and overall, the symmetrical classification of anxiety subtypes was increased, since separation anxiety disorder and selective mutism were considered anxiety disorders, not neurodevelopmental disorders. Additionally, based on growing evidence, agoraphobia is distinct from panic disorder. Next, considering cultural syndromes including taijin kyofusho, khyal cap, trung gio attacks, and ataque de nervios, cultural influences are considered a significant factor for definitions and presentations of anxiety disorders. Controversies in the DSM-5 criteria for anxiety disorders are lowering the diagnostic thresholds of anxiety disorders and limiting the dichotomous view of anxiety and depression when defining generalized anxiety disorder. Further studies of alternative approaches to the restrictions of the DSM-5 criteria of anxiety disorders, including transdiagnostic specifiers and dimensional assessment tools, may be required.


Assuntos
Transtornos de Ansiedade/classificação , Transtornos de Ansiedade/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Fatores Etários , Ansiedade/complicações , Ansiedade/psicologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Depressão/complicações , Depressão/psicologia , Humanos , Transtornos de Estresse Pós-Traumáticos/classificação , Transtornos de Estresse Pós-Traumáticos/diagnóstico
2.
Adv Exp Med Biol ; 1191: 331-346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002936

RESUMO

Many pharmacological treatments were proved effective in the treatment of panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD); still many patients do not achieve remission with these treatments. Neurostimulation techniques have been studied as promising alternatives or augmentation treatments to pharmacological and psychological therapies. The most studied neurostimulation method for anxiety disorders, PTSD, and OCD was repetitive transcranial magnetic stimulation (rTMS). This neurostimulation technique had the highest level of evidence for GAD. There were also randomized sham-controlled trials indicating that rTMS may be effective in the treatment of PTSD and OCD, but there were conflicting findings regarding these two disorders. There is indication that rTMS may be effective in the treatment of panic disorder, but the level of evidence is low. Deep brain stimulation (DBS) was most studied for treatment of OCD, but the randomized sham-controlled trials had mixed findings. Preliminary findings indicate that DBS could be affective for PTSD. There is weak evidence indicating that electroconvulsive therapy, transcranial direct current stimulation, vagus nerve stimulation, and trigeminal nerve stimulation could be effective in the treatment of anxiety disorders, PTSD, and OCD. Regarding these disorders, there is no support in the current literature for the use of neurostimulation in clinical practice. Large high-quality studies are warranted.


Assuntos
Transtornos de Ansiedade/terapia , Terapia por Estimulação Elétrica , Eletroconvulsoterapia , Transtorno Obsessivo-Compulsivo/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Rev Med Suisse ; 16(681): 301-306, 2020 Feb 12.
Artigo em Francês | MEDLINE | ID: mdl-32049450

RESUMO

In the context of liaison psychiatry, potentially traumatic somatic situations at the psychic level are frequent. They can be grouped into three broad categories: 1) psychotrauma in connection with a medical event ; 2) traumatic event at the origin of somatic management ; 3) traumatic event prior to somatic management. It is important to know the possible clinical reactions after a traumatic event. In the immediate aftermath of trauma, a clinical assessment is recommended to allow early identification of subjects at risk of developing post-traumatic stress disorder (PTSD). Pharmacological and non-pharmacological interventions should be considered to prevent or to treat the installation of PTSD with the aim of also improving the somatic prognosis.


Assuntos
Psiquiatria , Trauma Psicológico , Transtornos de Estresse Pós-Traumáticos/psicologia , Humanos , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/terapia
4.
Z Psychosom Med Psychother ; 66(1): 5-19, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32066355

RESUMO

Level of personality functioning (OPD-2) and the symptom severity of posttraumatic stress disorder - a cohort study Objectives: To investigate the affirmed correlation between the level of personality functioning (OPD-2, Axis IV "Structure") and the symptom severity of posttraumatic stress disorder based on clinical routine data was the main goal of this study. Method: Cross-sectional data was acquired between 2013 and 2016 using random samples of standardized questionnaires in the trauma outpatient clinic of the Department of Psychosomatics and Psychotherapy, University Hospital in Münster, Germany. The German version of the PDS (Ehlers et al. 1996) measured the symptoms and the severity of PTSD, level of personality functioning was assessed by the OPD-SFK (Ehrenthal et al. 2015) Results: Level of personality functioning in OPD-SFK and the severity of posttraumatic symptoms are significantly correlated to each other. The less the functioning of the psychic structure the more the symptom severity shows up. The results were confirmed with different sets of predictors in our statistical models. Conclusions: The level of the personality functioning (OPD-2) is related to the severity of posttraumatic symptoms. Whether a low-level personality functioning is a disposal for PTSD or more likely a result of a traumatic life event, should be discussed.


Assuntos
Personalidade , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Estudos de Coortes , Estudos Transversais , Alemanha , Humanos , Trauma Psicológico/complicações , Trauma Psicológico/psicologia , Transtornos de Estresse Pós-Traumáticos/complicações
6.
Medicine (Baltimore) ; 99(1): e18614, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895815

RESUMO

This study included 1456 men and 1411 women who were trauma-exposed and underwent routine health examinations in a community epidemiological investigation. The participants completed the posttraumatic stress disorder (PTSD) Check List-Civilian Version (PCL-C) for PTSD and medical examinations to detect metabolic syndrome. Adjustments for age, marriage, exercise, education, cigarette smoking, cancer, stroke, angina, and thyroid disease were performed. The relationship between PTSD and metabolic syndrome and each of its components was analyzed by multiple logistic regression.In women, PTSD was associated with metabolic syndrome (OR = 1.53, 95% CI = 1.01-1.95, P = .047) and the high-density lipoprotein cholesterol component (OR = 1.98, 95% CI = 1.04-2.12, P = .002). In men, PTSD was related to the hypertension component of metabolic syndrome (OR = 0.54, 95% CI = 0.31-0.92, P = .023). There was also a relationship between PTSD severity and metabolism (OR = 1.141, 95% CI = 1.002-1.280, P = 0.037) in women, and PTSD was inversely associated with the hypertension component (OR = 0.54, 95% CI = 0.31-0.92, P = .023) in men.PTSD was related to metabolic syndrome only in women. We plan to further research the mechanism of sex differences and dyslipidemia.


Assuntos
Síndrome Metabólica/etiologia , Transtornos de Estresse Pós-Traumáticos/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
7.
Zhonghua Yi Xue Za Zhi ; 100(1): 32-36, 2020 Jan 07.
Artigo em Chinês | MEDLINE | ID: mdl-31914555

RESUMO

Objective: To investigate the correlation between social support, resilience, self-esteem and post-traumatic stress disorder (PTSD) in intensive care unit (ICU) nurses. Methods: A total of 717 ICU nurses from 24 provinces conducted these questionnaires (Chinese version of Impact of Event Scale-Revised(IES-R), Social Support Rate Score(SSRS), Cannor-Davidson Resilience(CD-RISC) and Self-Esteem Scale(SES)). There were 101 males and 616 females, with an average age of (30±5) years. With the aim to investigate PTSD impact factors, the ICU nurses were divided into the PTSD positive group (IES-R>35) and PTSD negative group (IES-R<35). The correlation between IES-R and other scales were analyzed with linear regression analysis. Results: In this investigation, 414 nurses were screened with PTSD and 303 nurses without. IES-R score was negatively correlated with SSRS, CD-RISC and SES (r=-0.275, -0.202, -0.709, all P<0.05). Multivariate regression analysis showed that ICU clinical experience was an independent risk factor for PTSD, and SES Score, SSRS Score and physical health status were protective factors. SES partially mediated the association of SSRS with IES-R, and the mediating effect were 51.5%. The area under characteristic curve (ROC) showed that SSRS score, CD-RISC score, SES score and PTSD risk score Logit (P) for prediction of PTSD was 0.629, 0.604, 0.831 and 0.848, respectively. Conclusions: Social support, physical health and self-esteem are protective factors of PTSD, while ICU clinical experience is a risk factor. SES partially mediated the association of SSRS with IES-R.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Análise de Regressão , Apoio Social , Inquéritos e Questionários
8.
JAMA Netw Open ; 3(1): e1919935, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995212

RESUMO

Importance: Understanding suicide ideation (SI) during combat deployment can inform prevention and treatment during and after deployment. Objective: To examine associations of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day SI among a representative sample of US Army soldiers deployed in Afghanistan. Design, Setting, and Participants: In this survey study, soldiers deployed to Afghanistan completed self-administered questionnaires in July 2012. The sample was weighted to represent all 87 032 soldiers serving in Afghanistan. Prevalence of lifetime, past-year, and 30-day SI and mental disorders was determined. Logistic regression analyses examined risk factors associated with SI. Data analyses for this study were conducted between August 2018 and August 2019. Main Outcomes and Measures: Suicide ideation, lifetime and 12-month stressors, and mental disorders were assessed with questionnaires. Administrative records identified sociodemographic characteristics and suicide attempts. Results: A total of 3957 soldiers (3473 [weighted 87.5%] male; 2135 [weighted 52.6%] aged ≤29 years) completed self-administered questionnaires during their deployment in Afghanistan. Lifetime, past-year, and 30-day SI prevalence estimates were 11.7%, 3.0%, and 1.9%, respectively. Among soldiers with SI, 44.2% had major depressive disorder (MDD) and 19.3% had posttraumatic stress disorder in the past 30-day period. A series of analyses of the 23 grouped variables potentially associated with SI resulted in a final model of sex; race/ethnicity; lifetime noncombat trauma; past 12-month relationship problems, legal problems, and death or illness of a friend or family member; and MDD. In this final multivariable model, white race/ethnicity (odds ratio [OR], 3.1 [95% CI, 1.8-5.1]), lifetime noncombat trauma (OR, 2.1 [95% CI, 1.1-4.0]), and MDD (past 30 days: OR, 31.8 [95% CI, 15.0-67.7]; before past 30 days: OR, 4.9 [95% CI, 2.5-9.6]) were associated with SI. Among the 85 soldiers with past 30-day SI, from survey administration through 12 months after returning from deployment, 6% (5 participants) had a documented suicide attempt vs 0.14% (6 participants) of the 3872 soldiers without SI. Conclusions and Relevance: This study suggests that major depressive disorder and noncombat trauma are important factors in identifying SI risk during combat deployment.


Assuntos
Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Ideação Suicida , Suicídio/psicologia , Adaptação Psicológica , Adulto , Campanha Afegã de 2001- , Fatores Etários , Feminino , Humanos , Masculino , Militares/estatística & dados numéricos , Resiliência Psicológica , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Suicídio/estatística & dados numéricos , Adulto Jovem
9.
Lancet ; 395(10220): 273-284, 2020 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-31928765

RESUMO

BACKGROUND: Hong Kong has been embroiled in increasingly violent social unrest since June, 2019. We examined the associated population mental health burden, risk factors, and health-care needs. METHODS: In a population-based prospective cohort, adult participants aged 18 years or older were assessed at nine timepoints from 2009. Probable depression was measured using the Patient Health Questionnaire-9 (score ≥10) and suspected post-traumatic stress disorder (PTSD) by the PTSD Checklist-Civilian Version (score ≥14), plus direct exposure to traumatic events related to the ongoing social unrest. We used multivariable logistic regression to identify factors associated with both outcomes, adjusting for doctor-diagnosed depression or anxiety disorders before the unrest. On the basis of routine service statistics and respondents' intention to seek professional care, we projected the number of additional ambulatory specialist psychiatric visits required. FINDINGS: After the two baseline surveys, we followed up random subsets of 1213-1736 adults at each timepoint. Probable depression was reported by 11·2% (95% CI 9·8-12·7) of participants in 2019, compared with 1·9% (1·6-2·1) during 2009-14 and 6·5% (5·3-7·6) in 2017 after the Occupy Central Movement and before the current unrest. Prevalence of suspected PTSD in 2019 was estimated to be 12·8% (11·2-14·4). Age, sex, educational attainment, or household income were not associated with either outcome, whereas heavy social media use (≥2 h per day) was associated with both. Political attitude or protest participation was not associated with probable depression, but neutrality towards the extradition bill approximately halved the risk of suspected PTSD. Family support mitigated against probable depression. We estimated that the mental health burden identified would translate into roughly an excess 12% service requirement to the public sector queue or equivalent. INTERPRETATION: We have identified a major mental health burden during the social unrest in Hong Kong, which will require substantial increases in service surge capacity. Health-care and social care professionals should be vigilant in recognising possible mental health sequelae. In a world of increasing unrest, our findings might have implications for service planning to better protect population mental health globally. FUNDING: Research Grants Council, University Grants Committee of Hong Kong, Hong Kong Jockey Club Charities Trust.


Assuntos
Depressão/epidemiologia , Exposição à Violência/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Distúrbios Civis/psicologia , Feminino , Hong Kong , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Índice de Gravidade de Doença , Mídias Sociais/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
11.
Lancet Psychiatry ; 7(2): 173-190, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31981539

RESUMO

BACKGROUND: Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs). METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611. FINDINGS: Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0·31, 95% CI 0·04 to 0·57, I2=49·4%). No differences in response to intervention were seen in women reporting intimate partner violence for PTSD (eight interventions, n=1436; dSMD 0·14, 95% CI -0·06 to 0·33, I2=42·6%), depression (12 interventions, n=2940; 0·10, -0·04 to 0·25, I2=49·3%), and psychological distress (four interventions, n=1591; 0·07, -0·05 to 0·18, I2=0·0%, p=0·681). INTERPRETATION: Psychological interventions treat anxiety effectively in women with current or recent intimate partner violence exposure in LMICs when delivered by appropriately trained and supervised health-care staff, even when not tailored for this population or targeting intimate partner violence directly. Future research should investigate whether adapting evidence-based psychological interventions for CMDs to address intimate partner violence enhances their acceptability, feasibility, and effectiveness in LMICs. FUNDING: UK National Institute for Health Research ASSET and King's IoPPN Clinician Investigator Scholarship.


Assuntos
Transtornos de Ansiedade/terapia , Transtorno Depressivo/terapia , Países em Desenvolvimento/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Psicoterapia/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/terapia , Estresse Psicológico/terapia , Feminino , Humanos
12.
Am J Clin Hypn ; 62(1-2): 95-117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31265370

RESUMO

This article explores how hypnotic strategies can be used within a polyvagal science framework to help create more secure attachment within the therapeutic relationship, as well as within the client in terms of ego-state relationships. Principles of safety and connection are emphasized, along with specific strategies to access the attachment circuits of the ventral vagal system, including the necessity of being present with the client without agenda. Uses of hypnosis related to safety and connection and methods to work with the center core self to facilitate empowerment, self-cohesion, and conflict-free experience are also reviewed. From an ego-state therapy perspective, a discussion of hypnosomatic approaches to connect with preverbal, nonverbal, and somatic aspects of self to accomplish developmental repair and facilitate secure attachment is also offered, along with case examples. A three-step model, which attempts to integrate polyvagal, somatic, and hypnotic approaches, is offered by the author to help structure corrective experiences for clients with trauma.


Assuntos
Ego , Hipnose , Relações Profissional-Paciente , Encéfalo/fisiopatologia , Humanos , Modelos Psicológicos , Apego ao Objeto , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/terapia , Aliança Terapêutica
13.
F1000Res ; 82019.
Artigo em Inglês | MEDLINE | ID: mdl-31824654

RESUMO

Fear is a highly adaptive emotion that has evolved to promote survival and reproductive fitness. However, maladaptive expression of fear can lead to debilitating stressor-related and anxiety disorders such as post-traumatic stress disorder. Although the neural basis of fear has been extensively researched for several decades, recent technological advances in pharmacogenetics and optogenetics have allowed greater resolution in understanding the neural circuits that underlie fear. Alongside conceptual advances in the understanding of fear memory, this increased knowledge has clarified mechanisms for some currently available therapies for post-traumatic stress disorder and has identified new potential treatment targets.


Assuntos
Medo , Transtornos de Estresse Pós-Traumáticos , Humanos , Memória
14.
Adv Gerontol ; 32(4): 492-501, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31800175

RESUMO

The study involving 317 former combatants aged 24 to 69 years was conducted. The aim of the study was to determine the regularities of the age dynamics of stress-induced pathology of combatants to develop the concept of their accelerated aging as a final component of the consequences of combat stress. It turned out that in relation to the period of influence of factors of combat stress and age, first manifests the pathology of the musculoskeletal system, gastrointestinal tract and arterial hypertension, then-cardiovascular disease associated with atherosclerosis. The formation of post-traumatic stress disorder occurred in 289 (91,2%) cases, and the chronic pain syndromes of different localization and different origin - in 192 (60,6%) at different times of the post-war period. But it is post-traumatic stress disorder in combination with chronic pain were decisive in the overall severity of the state of combatants, changes in indicators of free radical oxidation and an increase in biological age. It is proposed to consider accelerated aging, which is formed on the basis of the consequences of severe stress effects, as an independent disease.


Assuntos
Envelhecimento , Doença Crônica , Distúrbios de Guerra , Veteranos , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Dor Crônica/etiologia , Distúrbios de Guerra/complicações , Gastroenteropatias/etiologia , Humanos , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/etiologia , Veteranos/estatística & dados numéricos
15.
Soins Gerontol ; 24(140): 36-40, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31806177

RESUMO

Behavioural disorders in residential care facilities for dependent seniors are particularly common in residents with Alzheimer's and related diseases. Verbal agitation is one of the most disruptive behavioural disorders. The use of techniques from Eye Movement Desensitisation and Reprocessing therapy in gerontology, its applications and research perspectives may be illustrated.


Assuntos
Dessensibilização e Reprocessamento através dos Movimentos Oculares , Transtornos de Estresse Pós-Traumáticos , Humanos , Psicoterapia , Transtornos de Estresse Pós-Traumáticos/terapia
16.
Rev. psicanal ; 26(3): http://revista.sppa.org.br/index.php/RPdaSPPA/article/view/472/492, dez. 2019.
Artigo em Português | LILACS | ID: biblio-1050551

RESUMO

Para Ferenczi, em grande sintonia com o pensamento de Freud, a introjeção foi inicialmente um conceito fundamental no desenvolvimento psíquico da criança e indispensável para diferenciar o funcionamento neurótico de outras patologias. Além disso era uma noção essencial para teorizar a dinâmica transferencial na relação analítica. No entanto, ao final de sua obra, ao reavaliar a importância do trauma, da confusão de línguas entre o adulto e a criança e entre o analista e o paciente, ao conceitualizar as noções de identificação com o agressor e de introjeção do sentimento de culpa nas síndromes pós-traumáticas e, principalmente, ao sublinhar a importância decisiva que adquire a desmentida e a cisão do Ego na dinâmica do trauma, Ferenczi modifica e enriquece enormemente sua primeira contribuição. Justamente sua última contribuição à psicanálise, refletida nas derradeiras notas do Diário clínico, é um neologismo interessante que Ferenczi define como intropressão, consistindo na tentativa de conjugar a introjeção com os efeitos violentos suscitados na mente da criança em decorrência da irrupção inesperada do Superego parental e dos adultos em geral. Esta dinâmica, além disso, lamentavelmente não deixa de estar presente em algumas modalidades patológicas da relação analítica. Esta última concepção de Ferenczi foi continuada e completada de maneira brilhante por Abraham e Torok em seu conceito do crime da introjeção, a que se dedica a última parte do presente trabalho (AU)


To Ferenczi, whose thinking was largely in line with that of Freud, introjection was initially a fundamental concept in the psychic development of the child and was necessary to distinguish the neurotic functioning from other pathologies. Furthermore, introjection was a crucial notion for the theorization of the transference dynamics in the analytic relationship. However, in his final works, Ferenczi modified and expanded his first contribution, since he reassessed the importance of trauma and the confusion of tongues between the adult and the child and between the analyst and the patient; he conceptualized the notions of identification with the aggressor and of introjection of the guilt feeling in posttraumatic disorders and also underlined the decisive importance that disavowal and ego-splitting have in the dynamics of trauma. In his last contribution to psychoanalysis, condensed in the notes of his Clinical Diary, Ferenczi presented indeed an interesting neologism that he defined intropression, consisting in the attempt to combine introjection with the violent effects arisen in the child's mind after the unexpected irruption of the parental Superego and of adults in general. That dynamics is unfortunately present in some pathological modalities of the analytic relationship. The latter notion introduced by Ferenczi was brilliantly developed and completed by Abraham and Torok in their concept of crime of introjection to which the last part of this paper is dedicated


Para Ferenczi, muy en sintonía con el pensamiento de Freud, la introyección fue inicialmente un concepto fundamental en el desarrollo psíquico del niño e indispensable para diferenciar el funcionamiento neurótico de otras patologías. Además resultaba una noción esencial para teorizar la dinámica transferencial en la relación analítica. Sin embargo, al final de su obra, al revalorizar la importancia del trauma, de la confusión de lenguas entre el adulto y el niño y entre el analista y el paciente, al conceptualizar las nociones de identificación con el agresor y de introyección del sentimiento de culpa en los síndromes post-traumáticos y sobre todo al subrayar la importancia decisiva que adquiere el desmentido y la escisión del yo en la dinámica del trauma, Ferenczi modifica y enriquece enormemente su primera aportación. Precisamente, su última contribución al psicoanálisis, reflejada en las postreras notas del Diario clínico es un neologismo interesante que Ferenczi define como intropresión y que era el intento de conjugar la introyección con los efectos violentos que suscita en la irrupción inesperada del super yo parental y de los adultos en general en la mente del niño. Esta dinámica además, no deja de estar presente lamentablemente en algunas modalidades patológicas de la relación analítica. Esta última concepción de Ferenczi fue continuada y completada brillantemente por Abraham y Torok en su concepto del crimen de la introyección, al que se dedica la última parte del presente trabajo


Assuntos
Transtornos Relacionados a Trauma e Fatores de Estresse , Transtornos de Estresse Pós-Traumáticos , Culpa
17.
Ann Agric Environ Med ; 26(4): 579-584, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31885231

RESUMO

INTRODUCTION: Emergency medical system (EMS) workers are exposed to traumatic events that may lead to posttraumatic stress disorder (PTSD). OBJECTIVES: The purpose of this study was to explore and discuss the relationship between peritraumatic distress (PD) and elevated posttraumatic stress symptoms (PTSS) in EMS employees. MATERIAL AND METHODS: A cross-sectional study including 100 EMS employees was conducted. Demographic and occupational data were collected for each subject. The Polish version of the Impact of Event Scale-Revised (IES-R) was used to evaluate PTSS and the Polish version of the Peritraumatic Distress Inventory (PDI) was used to determine the level of PD experienced during and immediately after a traumatic event. RESULTS: The highest scores indicative of distress were obtained on the negative emotions subscale, and the lowest on the loss of control and arousal (LCA) subscales. A strong positive correlation was found between the severity of PD and PTSS. Among the PDI subscales, the severity of PTSS was most strongly correlated with LCA, and had the weakest correlation with sense of threat. The optimal PDI cut-off score for predicting elevated PTSS was 19. CONCLUSIONS: PD is strongly related to elevated PTSS and serves as a useful tool for screening EMS workers at risk of developing PTSD. Individuals with PDI scores of 19 or higher are good candidates for specialist consultations aimed at detecting and treating elevated PTSS.


Assuntos
Pessoal de Saúde/psicologia , Estresse Ocupacional/complicações , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Polônia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico , Adulto Jovem
18.
Soins ; 64(841): 9-11, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31864517

RESUMO

Post-traumatic stress disorder is an adjustment disorder combining psychological and physical symptoms. Faced with the pain associated with post-traumatic stress disorder, it is important to know how to differentiate between the pain linked to the physical injury at the time of the traumatic event and the psychogenic pain. Identifying these pains and studying their aetiology, combined with an assessment of the patient's psychological state and life history, enables multi-disciplinary care to be put in place to improve the patient's prognosis and can help to improve recognition of these disorders.


Assuntos
Dor/epidemiologia , Transtornos Psicofisiológicos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Humanos , Dor/psicologia
19.
Rev Infirm ; 68(256): 37-39, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31870479

RESUMO

When subjected to potentially traumatic events, children can develop psychological trauma with varying levels of severity. For preventive and therapeutic purposes, these psychological traumas must be assessed and managed by psychologists and/or psychiatrists who are well-trained and experienced.


Assuntos
Trauma Psicológico , Transtornos de Estresse Pós-Traumáticos , Criança , Família , Humanos , Psicologia da Criança
20.
J Forensic Nurs ; 15(4): 222-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31764526

RESUMO

PURPOSE: The current study tests associations between reporting sexual victimization to a healthcare provider, campus authority, police, or social contact, and emotional well-being among college women. METHODS: Data from 2,162 women who participated in the 2015 College Student Health Survey at 17 colleges in Minnesota was used. Analyses tested associations between reporting sexual assault to formal or informal resources and diagnosis with anxiety, depression, panic attacks, and posttraumatic stress disorder, as well as self-rated health. RESULTS: Significantly higher rates of all four diagnoses were observed among those who reported to formal resources (e.g., healthcare provider, police) compared with those who reported to informal resources (i.e., friends, family). However, no differences were seen in self-rated physical or mental health. CONCLUSIONS: Expansion of trauma-informed healthcare services and advocacy efforts is recommended to optimally support students who report sexual assault experiences.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Estudantes , Adolescente , Adulto , Ansiedade/epidemiologia , Vítimas de Crime/psicologia , Depressão/epidemiologia , Feminino , Nível de Saúde , Humanos , Minnesota/epidemiologia , Transtorno de Pânico/epidemiologia , Delitos Sexuais/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Inquéritos e Questionários , Universidades , Adulto Jovem
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