Terapias globales, psiquiatras locales: la circulación de tratamientos de shock y su implementación en Rosario, Argentina, 1936-1944 / Global therapies, local psychiatrists: shock treatment circulation and its implementation in Rosario, Argentina, 1936-1944

Resumen El artículo analiza la implementación de los tratamientos biológicos de shock en el Instituto de Psiquiatría de Rosario, Argentina, durante el período de entreguerras. El objetivo es destacar el impacto que un fenómeno global, referido al fortalecimiento de la disciplina y el surgimiento de nuevas terapias, tuvo en un espacio de atención psiquiátrica argentino. Así, se analizará la relevancia que tuvieron las limitaciones presupuestarias, la experimentación de alternativas y la presencia de expertos internacionales en la incorporación de las novedades terapéuticas. Se sostiene que las estrategias desplegadas por el Instituto para implementarlos exponen los matices locales de un fenómeno global, así como su aporte a la experimentación de los tratamientos.

Abstract This article analyses the implementation of biological shock treatments in the Psychiatric Institute of Rosario, Argentina, during the interwar period. The aim is to illuminate the impact that a global phenomenon, referred to the strengthening of the discipline and the emergence of new therapies, had on an Argentinean psychiatric care space. Thus, it will analyse the relevance that budgetary limitations, the experimentation of alternatives and the presence of international experts had in the incorporation of therapeutic novelties. It is argued that the strategies deployed by the Institute to implement them expose the local nuances of a global phenomenon, as well as its contribution to the experimentation of treatments.

Noninvasive Focused Ultrasound for Neuromodulation: A Review.

This article covers noninvasive focused ultrasound (FUS) and its potential for neuromodulation. Although diagnostic uses of ultrasound are well known, its potential to noninvasively alter brain activity is a relatively new subject of research. Low-intensity focused ultrasound (LIFU) is a potential future alternative modality to other noninvasive neuromodulation techniques. This article aims at providing an updated review of the literature related to the role of LIFU in neuromodulation and the progress of animal as well as human research done on this topic. It also includes a critical review of the safety concerns slowing the translation of LIFU research into clinical trials.

The Future of Brain Stimulation Treatments.

Trends in brain stimulation include becoming less invasive, more focal, and more durable with less toxicity. Several of the more interesting new potentially disruptive technologies that are just making their way through basic and sometimes clinical research studies include low-intensity focused ultrasound and temporally interfering electric fields. It is possible, and even likely, that noninvasive brain stimulation may become the dominant form of brain treatments over the next 20 years. The future of brain stimulation therapeutics is bright.

Rebirthing-Breathwork, activation of the autonomic nervous system, and psychophysiological defenses / Rebirthing-Breathwork, ativação do sistema nervoso autónomo, e defesas psicofisiológicas / Rebirthing-Breathwork, activación del sistema nervioso autónomo, y defensas psicofisiológicas

Rebirthing-Breathwork can be described as a technique that uses the breathing rhythm to activate a somaticcognitive cycle. When allowed to unfold, this cycle spontaneously brings unresolved issues to consciousness and leads to their resolution. This is an analytic and interpretative study with the goal to present a theoretical basis for a processing model that the authors are developing to use Rebirthing-Breathwork in the treatment of traumatic stress-related disorders. In this essay we discuss Rebirthing-Breathwork in the light of a theory and an approach developed by Peter Levine and address the role psychophysiological defenses and the autonomic nervous system play in accessing suppressed and traumatic memories. Based on personal and clinical evidence we describe how Rebirthing-Breathwork activates suppressed and traumatic memories; how these activated memories activate one of two types of psychophysiological defenses; and how these defenses can be negotiated by means of mindfulness, embodiment and empowerment, so that the activated memories can be processed.(AU)

Rebirthing-Breathworkpode ser descrito como uma técnica que utiliza o ritmo respiratório para ativar um ciclo cognitivo-somático. Quando permitido o seu desenvolvimento, este ciclo traz questões não resolvidas à consciência, conduzindo-as à sua resolução. Este artigo é um estudo analítico-interpretativo com o objetivo de apresentar a base teórica para um modelo de processamento que está sendo desenvolvido pelos autores para utilização do trabalho respiratório - Rebirthing-Breathwork - no tratamento de transtornos traumáticos relacionados ao estresse. Neste ensaio discutimos o Rebirthing-Breathwork à luz de uma teoria e uma abordagem desenvolvida por Peter Levine e tratamos sobre o papel que as defesas psicofisiológicas e o sistema nervoso autônomo desempenham no acesso a memórias reprimidas e traumáticas. Com base em evidências pessoais e clínicas, descrevemos como o trabalho de Rebirthing-Breathworkativa memórias reprimidas e traumáticas e como essas memórias ativadas, por sua vez, provocam um dos dois tipos de defesas psicofisiológicas. Descrevemos, ainda, como se pode lidar com essas defesas através de mindfulness, de uma melhor conexão com o corpo e empoderamento, a fim de que essas memórias ativadas possam ser processadas.(AU)

El Rebirthing-Breathwork se puede describir como una técnica que usa el ritmo respiratorio para activar un ciclo cognitivo-somático. Cuando el ciclo se desarrolla, espontáneamente lleva a la consciencia problemas no resueltos y los conduce a su resolución. Este es un estudio analítico-interpretativo con el objetivo de presentar una base teórica para el modelo de procesamiento que los autores están desarrollando, cuya finalidad es la utilización del trabajo respiratorio - Rebirthing Breathwork - en el tratamiento de los trastornos traumáticos relacionados con el estrés. En este ensayo discutimos el Rebirthing Breathwork con base en una teoría y un enfoque desarrollado por Peter Levine, y abordamos el papel que desempeñan las defensas psicofisiológicas y el sistema nervioso autónomo en el acceso a memorias reprimidas y traumáticas. Con base en evidencias personales y clínicas, describimos cómo el trabajo de Rebirthing-Breathwork activa memorias reprimidas y traumáticas; cómo estos recuerdos activados, a su vez, activan uno de los dos tipos de defensas psicofisiológicas; y cómo podemos tratar esas defensas por medio del mindfulness, de una mejor conexión con el cuerpo y del empoderamiento, con la finalidad de procesar las memorias activadas.(AU)

Relación terapéutica y tratamientos en postpsiquiatría / Therapeutic relationship and treatments in postpsychiatry

El valor de "verdad" de las narrativas de la psiquiatría moderna, su enfoque centrado en el individuo y en la provisión de tecnología condicionan una relación terapéutica vertical. La postpsiquiatría cuestiona estos presupuestos y propone una relación terapéutica horizontal en la que la voz de los usuarios es crucial, los contextos adquieren mayor protagonismo como fuentes de significación y la ética se coloca por delante de la tecnología (AU)

The value of "truth" in the narratives of modern psychiatry, its focus on the individual and the provision of technology, determine a vertical therapeutic relationship. Post-psychiatry challenges these premises and proposes a horizontal therapeutic relationship where the voice of the users is crucial, the contexts take on a greater role in providing other meanings and ethics is placed before technology (AU)

La psicosomática en el psicoanálisis contemporáneo / Pschosomatics in contemporary psychoanaysis

La autora considera que hoy día la psicosomática está en el centro del campo psicoanalítico. Para ello describe dos funcionamientos psíquicos que conviven: el psiconeurótico o edípico y el no-neurótico, donde estarían, entre otras, las somatosis. A la vez, señala la idea de dos inconscientes: uno reprimido o edípico y otro no reprimido o genuino o propiamente dicho, origen del funcionamiento no-neurótico y residencia de las huellas sensoriales traumáticas primitivas, que no han tenido traducción psíquica y que, al ser investidas por un acontecimiento actual, traumas o duelos, pueden desencadenar, entre otros, un fenómeno somático. También describe el abordaje clínico de estos pacientes, que de entrada suelen exigir el uso de un encuadre creativo, la instrumentación de la contratransferencia y la elaboración de construcciones, ilustrando sus ideas con un material clínico (AU)

The author considers that nowadays psychosomatics is at the core of the psychoanalytic field. She describes two kinds of psychic functioning that coexist: a psycho-neurotic or Oedipal functioning, and another, non-neurotic, where she includes somatosis. Likewise, she puts forward the idea of two unconscious systems: one is repressed or Oedipal, while the other is non-repressed, genuine or the Unconscious proper. The latter constitutes the origin of the non-neurotic functioning and contains primitive, traumatic sensory traces, which haven't been turned into psyche and which, on being invested by a present occurrence: such as traumas or important losses that need to be mourned, may uncham a somatic phenomenon (among others). The author also describes the clinical approach to these patients, who usually demand the use of a creative setting the instrumentation of counter-transference, and the use of constructions. She illustrates these ideas with a clinical material (AU)

Forma focal y de larga evolución del síndrome de la persona rígida / Focal gradual-onset variant of stiff-person syndrome

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Preferencias por las decisiones compartidas en pacientes con depresión / Depressive patients' preferences in shared decision-making / Preferências pelas decisões compartilhadas em pacientes com depressão

This study analyzed the role of psychological processes predicting depressed patients' preferences in clinical decision-making about psychiatric treatment. 462 patients diagnosed with depressive disorders, acute or recurrent, participated in a crosssectional survey. Most participants preferred collaborative-passive or totally passive roles. Results showed no significant differences between acute and recurrent patients in their preference of participation in decision-making, but longer treatment duration was associated with a more passive style. MANCOVA, controlling age, educational level and treatment duration variables, showed that collaborative and passive patients had a greater locus of control focused on their psychiatrist than active patients. Gender differences were found. Men showed greater internal locus of control and psychological reactance, while women showed greater external locus of control focused on chance. Regression analysis indicated that, for men, passive preferred role was explained by external locus centered on their psychiatrist. However, age registered the highest weight for women' passive decision-making, followed by the locus focused on chance, locus focused on the psychiatrist and lower self-efficacy. Our findings suggest the need to study shared decision-making from a differential perspective that involves psychological processes and the impact of these processes in adherence to medical treatments.

En el presente estudio se analizaron los procesos psicológicos asociados con las preferencias de los pacientes con depresión en la toma de decisión sobre su tratamiento psiquiátrico. Participaron 462 pacientes diagnosticados con un trastorno depresivo agudo o recurrente. La mayor parte prefirió asumir un rol colaborativo-pasivo o totalmente pasivo. Los resultados no mostraron diferencias significativas entre pacientes en función de su cronicidad en la preferencia por la toma de decisiones, aunque un mayor tiempo de tratamiento se asoció con un estilo más pasivo. El MANCOVA aplicado al total de participantes, controlando la edad, el nivel educativo y el tiempo de tratamiento, indicó que los pacientes colaborativos y pasivos mostraron mayor locus de control centrado en la confianza en el psiquiatra que los activos. Se encontraron diferencias de género mostrando en los hombres mayor locus de control interno y reactancia psicológica, y en las mujeres, mayor locus centrado en el azar. Los análisis de regresión indicaron que en el caso de los hombres, la preferencia pasiva por la toma de decisión es explicada por el locus centrado en el psiquiatra. Sin embargo, en las mujeres tuvo mayor peso la edad, seguida del locus centrado en el azar, el locus centrado en el psiquiatra y una percepción de menor autoeficacia. Los hallazgos señalan la necesidad de estudiar desde una perspectiva diferencial la participación de los pacientes en la toma de decisión de acuerdo con los procesos psicológicos, así como la repercusión que esta tiene en la adherencia al tratamiento médico.

Neste estudo, analisaram-se os processos psicológicos associados com as preferências dos pacientes com depressão na tomada de decisão sobre seu tratamento psiquiátrico. Participaram 462 pacientes diagnosticados com um transtorno depressivo agudo ou recorrente. A maior parte preferiu assumir um papel colaborativo-passivo ou totalmente passivo. Os resultados não mostraram diferenças significativas entre pacientes em função de sua cronicidade na preferência por tomada de decisões, embora um maior tempo de tratamento tenha sido associado com um estilo mais passivo. O MANCOVA aplicado ao total de participantes, controlando a idade, o nível educativo e o tempo de tratamento, indicou que os pacientes colaborativos e passivos mostraram maior lócus de controle centralizado na confiança no psiquiatra do que os ativos. Constataram-se diferenças de gênero que mostraram nos homens maior lócus de controle interno e reatância psicológica, e, nas mulheres, maior lócus centralizado no aleatório, o lócus centralizado no psiquiatra e uma percepção de menor autoeficácia. Os achados indicam a necessidade de estudar, sob uma perspectiva diferencial, a participação dos pacientes na tomada de decisão de acordo com os processos psicológicos e a repercussão que esta tem na aderência ao tratamento médico.

Secuelas psíquicas en víctimas de accidentes de tráfico: un análisis clínico y pericial a la luz del nuevo baremo español de 2015 / Psychic sequelae of motor accident victims: a clinical and forensic analysis according to the Spanish new compensation standards (2015)

En este estudio se hace una revisión bibliográfica de las principales lesiones y secuelas psíquicas generadas en las víctimas de accidentes de tráfico, así como su mayor o menor prevalencia. Se valora el establecimiento del nexo causal que incluye algunas concausas anteriores, concomitantes y subsiguientes al accidente. Asimismo se analizan los principales factores de vulnerabilidad en el proceso de victimización a nivel biológico, psicológico, psicopatológico y psicosocial. Por último, se hace una valoración pericial de las secuelas psíquicas en las víctimas de accidentes de tráfico en función del nuevo baremo español de 2015. Se señalan en concreto las novedades aportadas por este baremo respecto al anteriormente vigente y se indican, en opinión de los autores, sus principales insuficiencias. Se establecen nuevas líneas de desarrollo para la investigación futura (AU)

The aim of this study is to conduct a literature review on major psychological injuries and sequelae in motor accidents victims and to establish their prevalence rate. The difficulties to establish a direct causal link between such psychological injuries and sequelae in victims and the motor accident in itself are analyzed. Biological and psychological vulnerability and resilience factors are also studied in order to better understand the process of victimization. Likewise the implications for forensic assessments, regarding psychological injuries and sequelae, of the new compensation standards for motor accident victims approved by the Spanish Parliament in 2015 are described. The differences of this compensation table related to the prior one are stressed and the shortcomings of the new standards, in the opinion of the authors, are indicated. Suggestions for further research are commented on (AU)

La medicina personalizada aplicada a la salud mental: la psiquiatría de precisión / Personalised medicine applied to mental health: precision psychiatry

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Protocolo unificado para la evaluación psiquiátrica y psicológica de candidatosa trasplante de órganos y tejidos, PSI-CAT / Unified Protocol for psychiatric and psychological assessment of candidates for transplantation of organs and tissues, PSI-CAT

Introducción. El trasplante es la opción terapéutica que ofrece mayor supervivencia y calidad de vida frente al fallo de un órgano. Los aspectos psiquiátricos y psicológicos de los candidatos a trasplante son relevantes, especialmente en la etapa de evaluación previa, pues la influencia de estos factores puede dificultar la evolución posquirúrgica, tanto en la supervivencia del órgano implantado como en la calidad de vida de la persona trasplantada. Son de especial importancia los factores vinculados a la patología por uso de sustancias, los trastornos psicopatológicos y el soporte psicosocial. Actualmente, existen pocas Guías que orienten sobre la correcta evaluación de los pacientes candidatos a estos procedimientos complejos. Método. Diecinueve psiquiatras y psicólogos clínicos de 6 hospitales públicos de Cataluña realizaron un trabajo sistemático de consenso para llegar al diseño de un protocolo unificado de evaluación psicológica y psiquiátrica. Se implementó un plan de trabajo anual, se definieron objetivos y se realizó una revisión bibliográfica, se discutieron los criterios de inclusión y exclusión, se seleccionaron los cuestionarios y se elaboró la entrevista estructurada. Resultados. Con el cumplimiento del plan de trabajo, se diseñó el Protocolo de Evaluación que se presenta en este artículo. Conclusiones. El trabajo sistematizado y la colaboración intercentros de psiquiatras y psicólogos clínicos ha facilitado homogeneizar y consensuar un protocolo unificado de evaluación (AU)

Introduction. Transplantation is the treatment option that offers improved survival and quality of life as compared to organ failure. Psychiatric and psychological aspects of transplant candidates are important, especially in the pre-assessment stage, as the influence of these factors can hinder post-surgical outcome in both the implanted organ survival and the quality of life of the transplanted person. Of particular importance, are the factors related to pathology due to substance use, psychopathology, and psychosocial support. There are currently few guidelines on the correct evaluation of patients eligible for these complex procedures. Method. Nineteen psychiatrists and clinical psychologists from six public hospitals in Catalonia conducted a systematic consensus to determine the design of a Unified Protocol psychological and psychiatric evaluation. An annual work plan was implemented, during which; the objectives were defined, a literature review was conducted, the inclusion and exclusion criteria were discussed, questionnaires were selected, and a structured interview was developed. Results. With the implementation of the work plan, the Assessment Protocol presented in this article was designed. Conclusions. systematic work and improving cooperation between psychiatrists and clinical psychologists, has led to homogeneity and consensus on a unified evaluation protocol (AU)

Patterns of emotion attribution are affected in patients with schizophrenia

Deficits in facial affect recognition have been repeatedly reported in schizophrenia patients. The hypothesis that this deficit is caused by poorly differentiated cognitive representation of facial expressions was tested in this study. To this end, performance of patients with schizophrenia and controls was compared in a new emotion-rating task. This novel approach allowed the participants to rate each facial expression at different times in terms of different emotion labels. Results revealed that patients tended to give higher ratings to emotion labels that did not correspond to the portrayed emotion, especially in the case of negative facial expressions (p < .001, η2 = .131). Although patients and controls gave similar ratings when the emotion label matched with the facial expression, patients gave higher ratings on trials with "incorrect" emotion labels (ps < .05). Comparison of patients and controls in a summary index of expressive ambiguity showed that patients perceived angry, fearful and happy faces as more emotionally ambiguous than did the controls (p < .001, η2 = .135). These results are consistent with the idea that the cognitive representation of emotional expressions in schizophrenia is characterized by less clear boundaries and a less close correspondence between facial configurations and emotional states (AU)

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Novel neurotherapeutics in psychiatry: use and rationale of transcranial direct current stimulation in major depressive disorder / Novas neuroterapêuticas em psiquiatria: racional e uso da estimulação transcraniana por corrente contínua no transtorno depressivo maior

Background: Transcranial direct current stimulation (tDCS) is a novel non-pharmacological intervention being investigated for the treatment of major depressive disorder (MDD). Objective: To perform an updated review of tDCS for MDD. Method: Systematic review in Medline/PubMed and other databases of all clinical studies evaluating the clinical efficacy of tDCS in MDD, from the first date available to December/2013. Results: Out of 55 articles, 24 were included, being 6 open-label studies; 8 randomized, double-blind, sham-controlled trials; 2 follow-up studies; 2 meta-analyses and 6 case reports. We observed an improvement of 20-40% in depressive symptoms, being slightly better in open studies. Five randomized clinical trials displayed positive results. The meta-analyses presented mixed results; although none included the study of Brunoni et al. (2013) that represents almost 50% of the evaluated sample. Open-label studies and case reports also investigated tDCS in bipolar depression, post-stroke depression and employed different parameters of stimulation. Discussion: TDCS is a novel, promising treatment for MDD. Definite evidence from large, ongoing clinical trials will be available in the next years...

Contexto: A estimulação transcraniana por corrente contínua (ETCC) é uma nova intervenção não farmacológica investigada como tratamento no transtorno depressivo maior (TDM). Objetivo: Apresentar uma revisão atualizada da ETCC no TDM. Método: Revisão sistemática no banco de dados Medline/PubMed e outros de todos os estudos clínicos publicados avaliando a eficácia da ETCC no TDM, da primeira data disponível a dezembro/2013. Resultados : De 55 artigos, 24 foram incluídos, sendo 6 estudos abertos; 8 ensaios clínicos randomizados, duplo-cego, placebo controlados; 2 estudos de seguimento; 2 metanálises e 6 relatos de caso. Observa-se uma melhora de 20-40% nos sintomas depressivos, sendo ligeiramente maior nos estudos abertos. Entre os ensaios controlados, 5 demonstraram eficácia da técnica. As metanálises divergiram quanto aos resultados, mostrando presença e ausência de eficácia e ausência da ETCC. Porém, nenhuma incluiu o estudo de Brunoni et al. (2013), que representa quase 50% da população estudada. Estudos abertos e relatos de caso também investigaram o uso da ETCC na depressão bipolar, na depressão pós-AVC e usaram variações nos parâmetros de estimulação. Conclusões: A ETCC é uma técnica promissora no tratamento da TDM. Evidências definitivas devem estar disponíveis nos próximos anos, com a divulgação de resultados de grandes ensaios clínicos em andamento...

Personality disorder cognitions in the eating disorders.

Patients with eating disorder have relatively high rates of comorbid personality disorder diagnoses, including both anxiety-based personality disorders (obsessive-compulsive and avoidant) and borderline personality disorder. However, there is preliminary evidence that the core cognitions underlying personality pathology in the eating disorders are those related specifically to anxiety. This article builds on that evidence, replicating and extending the findings with a large sample of patients with eating disorder (N = 374). There were no differences in personality disorder cognitions between eating disorder diagnoses. This study also examines the possibility that there are clusters of patients, differentiated by patterns of personality disorder cognition. Affect-related personality disorder cognitions were key to understanding the role of personality pathology in the eating disorders. It is suggested that those cognitions should be considered when planning psychological treatments.

Trastorno de pánico y fibrilación auricular / Panic disorder and atrial fibrillation

Este trabajo analiza la relación bidireccional entre la fibrilación auricular y el trastorno de pánico. El diagnóstico diferencial se plantea frecuentemente en los servicios de urgencias y en la consulta del médico de atención primaria. Diferentes estudios nos hablan de una alta tasa de prevalencia de trastornos de ansiedad en pacientes que han recibido el diagnóstico de fibrilación auricular. Por otra parte, se ha observado que los pacientes con trastornos de ansiedad presentan una mayor prevalencia de enfermedades cardiovascular. Los pacientes con trastorno de pánico presentarán con frecuencia quejas somáticas indicativas de enfermedad cardíaca que es obligatorio descartar mediante pruebas complementarias. El correcto diagnóstico conlleva, además, el tratamiento considerado óptimo para cada afección y, como consecuencia, la reducción del gasto sanitario (AU)

This paper studies the relationship between atrial fibrillation and panic disorder. There are often doubts on the differential diagnosis in emergency services and general medical settings. Panic disorder prevalence rates have been found to be high in patients suffering from atrial fibrillation. Various studies have observed that patients diagnosed with anxiety disorders frequently have higher cardiovascular disease rates compared to the general population. Usually, patients suffering from panic disorder exhibit somatic complaints suggesting coronary disease, such as chest pain or palpitations. The aim is to make the correct diagnosis and treatment for these different illnesses, and to decrease the costs due to misdiagnosis (AU)

Family influence and psychiatric care: physical treatments in Devon mental hospitals, c. 1920 to the 1970s.

'What is it that appears to make the mentally ill so vulnerable to therapeutic experimentation?'(1) One commentator wrote in the 1990s, regarding mental hospitals as repressive, coercive and custodial institutions where medical staff subjected patients to orgies of experimentation. A careful study of surviving documents of the Devon County Lunatic Asylum (DCLA), however, paints a different picture. Rather than medical staff, patients' relatives and the wider community exercised a considerable influence over a patient's hospital admission and discharge, rendering the therapeutic regime in the middle of the 20th century the result of intense negotiations between the hospital and third parties.

Measurement and assessment of somatic symptoms.

Somatic symptoms are common presentations in health settings. They can manifest as symptoms of another underlying mental disorder or be termed as medically unexplained. When they are medically unexplained they are invariably subsumed under the diagnostic categories of somatoform disorders. They are associated with interference in functioning, poor quality of life and are burdensome on health resources. The measurement of these symptoms is essential for understanding the individual and planning treatment. There are various instruments that have somatic symptoms measurement in their items. The tools have included somatic symptoms measurement in measuring general psychopathology, somatic symptoms as part of anxiety and depression, somatic symptoms specifically, and as a screening instrument for somatoform disorders. The advantages and disadvantages of common measures have been discussed. It appears that no one measure fulfils the essential criteria of an ideal measure for somatic symptoms. The measures of somatic symptoms should also be culturally sensitive and serve diagnostic, prognostic and heuristic purposes. These aspects are highlighted in the review.