[Sickle cell disease as a public health problem in Brazil]. / A anemia falciforme como problema de Saúde Pública no Brasil.

Sickle cell anemia is the most prevalent hereditary disease in Brazil. However, the Brazilian literature registers no investigations into the public health aspects of the disease. This present study investigates the way of life of 80 adult patients (49 women and 31 men) with a diagnosis of sickle cell anemia, at a blood center in Brazil. The late diagnosis of the disease was one of the most significant aspects observed in this group of patients. It was also observed that the dominant problem faced by adult patients with sickle cell anemia is of an economic nature, mainly due to lack of professional opportunities. However, patients can well undertake economic activities under adequate medical supervision, according to their own limitations and potentialities. The psychotherapeutic orientation was well accepted by patients regardless of sex. It is concluded that there exists need for the establishment of community programs for early diagnosis and medical, social and psychological orientation for sickle cell anemia patients in Brazil.

Acute enactment as a 'resource' in disclosing a collusion between the analytical dyad.

The author discusses various aspects of the function of enactment in analytical practice, reviewing the concept, then describing a borderline patient with whom the analytic process seemed to be developing productively. Following a change in the setting, an intense, acute enactment took place. Understanding this led to observation of an unconscious collusion, in which a symbiotic relationship had been established between the patient, the analyst and his family, as a chronic enactment. This relationship had prevented the analyst from touching on highly destructive unconscious fantasies and archaic traumatic situations. Comprehension of the enactment enabled the collusion to be dissolved. The author suggests that, besides the resistance aspect, the collusion may have been useful in strengthening the patient's mental mechanisms and trust in the analytical work, which required some time. The acute enactment arose, unveiling the collusion, when the patient and the analyst felt able to face the terrible feelings related to the triangular situation. He speculates that both enactments may occur in the analysis of these kinds of patients, as part of the 'natural history' of the analytical process, and their function is to relive archaic experiences in the analysis, also with the aim of working them through. Finally, the author proposes a classification of enactments: normal, pathological, acute and chronic.

[Family characteristics of youngsters attempting suicide in Campinas, Brazil: a comparative study with normal and psychiatric youngsters]. / Características das famílias de jovens que tentaram suicído em Campinas, Brasil: um estudo comparativo com jovens normais e psiquiátricos.

A clinical-epidemiological study of the type of case-control, in which the group of cases was made up of 50 youngsters, between 12 and 27, who had attempted suicide some days before, was carried out. This group was matched by age, sex and social-economic level with two control groups. One was made up of 50 normal youngsters (each pair selected at random, in the same district where the case lived), and the other one made up of 50 youngsters who had come for their first psychiatric visit, and had no suicidal antecedents. When the three groups were compared, it was noticed that the suicidal group revealed: a deeper parental gap, these gaps manifested earlier, the relationship between parents was worse. There was a higher rate of somatic and mental diseases and alcoholism, and the family had more legal problems. Three criteria for broken homes were used, and in all of them the proportion of the suicidal groups was much higher. These data were discussed together with clinical results with the finality of suggesting that such family traits hinder the normal separation-individuation phase, keeping the patient at symbiotic regressive phases, which are intensified at adolescence. The breaking up or threat of breaking up of these symbiotic connections (commonly with sexual partners) leads to sexual acting out and suicidal attempts.

[Suicide and adolescence. II. Psychosocial factors and clinical aspects]. / Suicídio e adolescência. II. Fatores psico-sociais e aspectos clínicos.

In this study, that follows another one, where the normal characteristics of adolescence that may influence suicidal behavior were focalised, a critical review of the psycho-social elements involved in the matter is done; attention is also given to the clinical picture. The family influences are very important and frequently we find antecedents of suicidal behavior in parents or in near relatives. The homes are usually unhappy with a father absent or "feeble". It is not rare the presence of a dominant-rejecting mother. The home is poor in love expressions, and the intra and extra family reactions tend to lead to the youth social isolation. With the changes that normally happens in adolescence, the repressed aggressive impulses increase and tend for discharge at this phase, but usually the youth turns them against himself. The emergent genital sexuality is also perceived as threatening by the parents. Though lacking more detailed studies, it seems that families of suicidal adolescents are very similar to the families of depressive ones. In females, cultural influences such as greater tolerance to suicidal attempts behavior, perhaps explain the higher incidence of this behavior. Men usually use violent methods for consumating the suicide, and often their mental status is more severe than in females. The precipitant factors vary a lot but they usually give evidence of a conflictive situation. It is suspected that often the patient unconsciously puts himself in the difficult situation. The influence of mental illness in the suicidal behavior of adolescents is complicated by several classificatory systems and the possibility of considering abnormal aspects that normally occur during adolescence. In the clinical picture is important to consider the patient report about his suicidal thoughts. The evaluation of the defences, the intensity of the conflict and the suicidal ideas involved, will determine our conduct. An important feature is that, in adolescents, depressive symptoms usually occur as "equivalents". The prognostic is worse when it is impossible to modify family relationships and when social life continues unpoverished. In 40% of the cases a new suicide attempt is done, and the risk is greater during the year that follows the first attempt. Prevention may be done by trying to understand and discuss adolescents problems with them in their peer groups. Public campaigns and courses with moral appeals should be avoided because they increase feelings of guilt. Special attention has to be given in each case to social and family situations. An early diagnosis by pediatricians, clinicians, teachers and law authorities is very important. To do this work they need to have instruction about the adolescence developments.

Caracteristicas das familias de jovens que tentaram suicidio en Campinas, Brasil: um estudo comparativo com jovens normais e psiquiatricos. / Family characteristics of youngster who attempted suicide in Campinas, Brazil: a comparative study with normal and psichiatric sbjects

Foi realizado um estudo clinico-epidemiologico, tipo caso-controle em que o grupo de casos foi constituido por 50 jovens que haviam tentado suicidio.Esse grupo foi pareado quanto a idade, sexo e nivel socio-economico com dois grupos controle: um de jovens supostamente normais e outro de jovens que vinham a consulta psiquiatrica, sem antecedentes suicidas. Constatou-se maior proporcao de lares desfeitos ou perturbados no grupo suicida, em relacao aos grupos controle.Os pacientes suicidas tendiam a perder figuras parentais mais precocemente que os grupos controle sendo essa perda significativa no caso de separacoes dos pais, mas nao no caso de mortes.Os pais dos jovens suicidas eram mais doentes, apresentavam mais alcoolismo, relacionavam-se pior entre si, e tinham mais problemas com a policia e a justica, que os pais dos jovens dos grupos controle

Suicídio e adolescÛncia. II. Fatores psico-sociais e aspectos clínicos. / [Suicide and adolescence. II. Psychosocial factors and clinical aspects]

In this study, that follows another one, where the normal characteristics of adolescence that may influence suicidal behavior were focalised, a critical review of the psycho-social elements involved in the matter is done; attention is also given to the clinical picture. The family influences are very important and frequently we find antecedents of suicidal behavior in parents or in near relatives. The homes are usually unhappy with a father absent or [quot ]feeble[quot ]. It is not rare the presence of a dominant-rejecting mother. The home is poor in love expressions, and the intra and extra family reactions tend to lead to the youth social isolation. With the changes that normally happens in adolescence, the repressed aggressive impulses increase and tend for discharge at this phase, but usually the youth turns them against himself. The emergent genital sexuality is also perceived as threatening by the parents. Though lacking more detailed studies, it seems that families of suicidal adolescents are very similar to the families of depressive ones. In females, cultural influences such as greater tolerance to suicidal attempts behavior, perhaps explain the higher incidence of this behavior. Men usually use violent methods for consumating the suicide, and often their mental status is more severe than in females. The precipitant factors vary a lot but they usually give evidence of a conflictive situation. It is suspected that often the patient unconsciously puts himself in the difficult situation. The influence of mental illness in the suicidal behavior of adolescents is complicated by several classificatory systems and the possibility of considering abnormal aspects that normally occur during adolescence. In the clinical picture is important to consider the patient report about his suicidal thoughts. The evaluation of the defences, the intensity of the conflict and the suicidal ideas involved, will determine our conduct. An important feature is that, in adolescents, depressive symptoms usually occur as [quot ]equivalents[quot ]. The prognostic is worse when it is impossible to modify family relationships and when social life continues unpoverished. In 40

of the cases a new suicide attempt is done, and the risk is greater during the year that follows the first attempt. Prevention may be done by trying to understand and discuss adolescents problems with them in their peer groups. Public campaigns and courses with moral appeals should be avoided because they increase feelings of guilt. Special attention has to be given in each case to social and family situations. An early diagnosis by pediatricians, clinicians, teachers and law authorities is very important. To do this work they need to have instruction about the adolescence developments.

Características das famílias de jovens que tentaram suicído em Campinas, Brasil: um estudo comparativo com jovens normais e psiquiátricos. / [Family characteristics of youngsters attempting suicide in Campinas, Brazil: a comparative study with normal and psychiatric youngsters]

A clinical-epidemiological study of the type of case-control, in which the group of cases was made up of 50 youngsters, between 12 and 27, who had attempted suicide some days before, was carried out. This group was matched by age, sex and social-economic level with two control groups. One was made up of 50 normal youngsters (each pair selected at random, in the same district where the case lived), and the other one made up of 50 youngsters who had come for their first psychiatric visit, and had no suicidal antecedents. When the three groups were compared, it was noticed that the suicidal group revealed: a deeper parental gap, these gaps manifested earlier, the relationship between parents was worse. There was a higher rate of somatic and mental diseases and alcoholism, and the family had more legal problems. Three criteria for broken homes were used, and in all of them the proportion of the suicidal groups was much higher. These data were discussed together with clinical results with the finality of suggesting that such family traits hinder the normal separation-individuation phase, keeping the patient at symbiotic regressive phases, which are intensified at adolescence. The breaking up or threat of breaking up of these symbiotic connections (commonly with sexual partners) leads to sexual acting out and suicidal attempts.

Suicídio e adolescÛncia. II. Fatores psico-sociais e aspectos clínicos / [Suicide and adolescence. II. Psychosocial factors and clinical aspects]

In this study, that follows another one, where the normal characteristics of adolescence that may influence suicidal behavior were focalised, a critical review of the psycho-social elements involved in the matter is done; attention is also given to the clinical picture. The family influences are very important and frequently we find antecedents of suicidal behavior in parents or in near relatives. The homes are usually unhappy with a father absent or [quot ]feeble[quot ]. It is not rare the presence of a dominant-rejecting mother. The home is poor in love expressions, and the intra and extra family reactions tend to lead to the youth social isolation. With the changes that normally happens in adolescence, the repressed aggressive impulses increase and tend for discharge at this phase, but usually the youth turns them against himself. The emergent genital sexuality is also perceived as threatening by the parents. Though lacking more detailed studies, it seems that families of suicidal adolescents are very similar to the families of depressive ones. In females, cultural influences such as greater tolerance to suicidal attempts behavior, perhaps explain the higher incidence of this behavior. Men usually use violent methods for consumating the suicide, and often their mental status is more severe than in females. The precipitant factors vary a lot but they usually give evidence of a conflictive situation. It is suspected that often the patient unconsciously puts himself in the difficult situation. The influence of mental illness in the suicidal behavior of adolescents is complicated by several classificatory systems and the possibility of considering abnormal aspects that normally occur during adolescence. In the clinical picture is important to consider the patient report about his suicidal thoughts. The evaluation of the defences, the intensity of the conflict and the suicidal ideas involved, will determine our conduct. An important feature is that, in adolescents, depressive symptoms usually occur as [quot ]equivalents[quot ]. The prognostic is worse when it is impossible to modify family relationships and when social life continues unpoverished. In 40

of the cases a new suicide attempt is done, and the risk is greater during the year that follows the first attempt. Prevention may be done by trying to understand and discuss adolescents problems with them in their peer groups. Public campaigns and courses with moral appeals should be avoided because they increase feelings of guilt. Special attention has to be given in each case to social and family situations. An early diagnosis by pediatricians, clinicians, teachers and law authorities is very important. To do this work they need to have instruction about the adolescence developments.

Caracteristicas das familias de jovens que tentaram suicidio en Campinas, Brasil: um estudo comparativo com jovens normais e psiquiatricos. / Family characteristics of youngster who attempted suicide in Campinas, Brazil: a comparative study with normal and psichiatric sbjects

Foi realizado um estudo clinico-epidemiologico, tipo caso-controle em que o grupo de casos foi constituido por 50 jovens que haviam tentado suicidio.Esse grupo foi pareado quanto a idade, sexo e nivel socio-economico com dois grupos controle: um de jovens supostamente normais e outro de jovens que vinham a consulta psiquiatrica, sem antecedentes suicidas. Constatou-se maior proporcao de lares desfeitos ou perturbados no grupo suicida, em relacao aos grupos controle.Os pacientes suicidas tendiam a perder figuras parentais mais precocemente que os grupos controle sendo essa perda significativa no caso de separacoes dos pais, mas nao no caso de mortes.Os pais dos jovens suicidas eram mais doentes, apresentavam mais alcoolismo, relacionavam-se pior entre si, e tinham mais problemas com a policia e a justica, que os pais dos jovens dos grupos controle

A importancia da identificacao das reacoes de aniversario. / The importance of identification of birthday reactions

A partir do relato de casos clinicos, o autor enfatiza a importancia das reacoes de aniversario e de sua identificacao no trabalho do psicoterapeuta, do clinico e do profissional de saude mental. Exemplifica-se sua importancia como auxiliar diagnostico na compreensao dinamica e na luta contra as resistencias. Sao tambem discutidas as formas de identificacao e analisadas as formulacoes teoricas explicativas

Jovens que tentam suicidio. Antecedentes morbitos e de condutas autodestrutivas. Um estudo comparativo com jovens normais e com problemas mentais (II). / Young subjects who attempt suicide. Morbid and auto-destructive antecedents. A comparative study with normal young subjects and with mental problems (II)

E efetuado um estudo clinico-epidemiologico do tipo caso-controle em que 50 jovens que haviam tentado suicidio recentementes sao comparados com dois grupos-controle: un constituido por 50 jovens supostamente normais e outro 50 jovens que vinham a consulta psiquiatrica. Verificou-se que os jovens suicidas apresentaram maior proporcao de doencas psicossomaticas, internacao em hospital geral e uso de alcool e drogas em relacao a ambos os grupos-controle. Quanto a tratamentos e internacoes psiquiatricas, os grupos suicida e psiquiatrico se igualaram. Quanto a doencas somaticas, cirurgias anteriores e acidentes nao se encontraram diferencas significativas, mas o estudo clinico de alguns casos mostrou maior propensao a acidentes.O grupo suicida apresentou uma proporcao significativamente maior de comportamentos suicidas nas familias e ambiente e perdas por morte no ano anterior