A Case of Genital Self-Mutilation in a Female-Symptom Choice and Meaning.

Self-mutilation is understood as any willful gesture or alteration of the body tissue without a suicidal intent. The most common self-mutilating gestures are, to a great extent, those that are superficial or moderate, such as cuts, burns, or bites. The most severe, as is the case of genital self-mutilation (GSM), are extremely rare and, in most cases, observed in patients suffering from psychosis. Furthermore, they are mostly reported from a surgical standpoint. Here, we report the case of a 20-year-old female patient who resorted to the emergency department after having amputated her clitoris with surgical scissors. This dramatic gesture, coupled with the patient's narrative, prompted for differential diagnosis between a psychotic syndrome and a severe personality disorder. We propose that, despite the magnitude of the self-harm, it is possible to conceptualize this GSM within a disturbed personality with significant sexuality issues and, therefore, this case report aims to broaden the limits that have been associated with the self-mutilating gestures in borderline personality disorder.

Immune-mediated necrotizing myopathy with anti-signal recognition particle antibodies, in a patient with melanoma treated with BRAF/MEK inhibitors.

The effect of serine/threonine-protein kinase B-Raf/mitogen-activated protein kinase (BRAF/MEK) inhibitors on the immune system is not clearly described, but rare cases of autoimmune phenomena have been reported. The clinical case we present below is the first report of a necrotizing myopathy related to dabrafenib/trametinib treatment. A 48-year-old man started dabrafenib/trametinib for stage IV BRAF-V600E mutated cutaneous melanoma. After the first month, he presented with grade 3 pyrexia (Common Terminology Criteria for Adverse Events [CTCAE] v.5.0.) and increased creatinine-kinase levels. A diagnosis of immune-mediated necrotizing myopathy, antisignal recognition particle (anit-SRP) positive, was made. At disease progression, dabrafenib/trametinib was restarted, triggering a new episode of grade 2 pyrexia and myositis. Treatment was changed to encorafenib/binimetinib without repeating pyrexia or limiting creatinine-kinase elevation, presenting even a loss of anti-SRP antibodies. Given the temporal relationship, the fact that re-exposition induced a new worsening of the myopathy and the loss of the anti-SRP antibodies after changing treatment, we infer that there possibly is a clear relationship between dabrafenib/trametinib treatment and the myopathy.

Parathyroid cyst: differential diagnosis.

Parathyroid cysts are rare lesions of the cervical region and less frequently of the mediastinum. They occur mostly in women and are usually asymptomatic. They generally occur in the fourth and fifth decades of life and mainly are non-functioning. They commonly present as a neck mass that is found incidentally during surgery or in imaging test. Its importance lies in the difficulty in diagnosis, often confusing itself with thyroid pathology. The diagnosis is usually made intraoperatively, confirmed by histopathological examination.The aim of this paper is to report a case of parathyroid cyst that mimics a thyroid nodule.

Surgical treatment of intestinal perforation in Behçet Syndrome: an unusual presentation.

Behçet syndrome is a chronic, recurring, systemic disorder characterized by the histopathologic finding of nonspecific vasculitis in multiple organs. Behçet syndrome involves the gastrointestinal tract in 10-50% of patients; The main sites of involvement are the terminal ileum and cecum. In patients with Behçet syndrome, CT is advocated for early detection of complications as well as for exclusion of other abdominal pathologic conditions but there is no specific exam. The report of histology in conjunction with the clinical history and the presence of oral ulcers, uveitis and suspected cutaneous lesions suggests the diagnosis. The optimal medical treatment of Behçet syndrome has not yet been well established. In rare cases surgery must be required to control the disease. The authors report one case of Behcet Syndrome presenting with intestinal perforation.

A consciência do jovem universitário: O grupo ampliando possibilidades de ser / The young college student’s conscience: The group expanding possibilities of being / La conciencia del joven estudiante universitario: El grupo expandiendo las posibilidades de ser

Este estudo objetivou acompanhar um grupo de psicoterapia breve na abordagem fenomenológico-existencial com adultos jovens universitários e observar como se dá o aumento da consciência de si e o ganho de responsabilização, que permitisse a superação de crises e a elaboração de angústias. Realizou-se uma pesquisa qualitativa, por meio do método fenomenológico, na qual sete universitários participaram de 13 sessões psicoterapêuticas grupais. O processo grupal se mostrou um espaço no qual os participantes puderam compartilhar experiências de vida, compreender-se, aceitar-se e acolher-se mutuamente. Na prática clínica, foi necessário compreender significados e sentimentos dos membros do grupo sobre sua percepção do mundo, entrando na relação terapêutica de forma empática, permitindo que o processo constituísse uma oportunidade de as pessoas se reconhecerem e se colocarem a partir do que sentiam. Durante as sessões, em clima de empatia e coesão entre os participantes, foi possível observar o desenrolar do projeto de ser de cada jovem e as inúmeras autodescobertas que alteraram os níveis de consciência dos jovens participantes, de modo não sequencial e irregular.

This study aimed to follow a brief psychotherapy group, with young undergraduate adults, using the existential-phenomenological approach. It also aimed to observe how the improvement of self-awareness and gains of accountability arise, which allowed overcoming crises and the elaboration of anguish. A qualitative survey was carried out through the phenomenological method, in which seven university students took part in 13 group psychotherapeutic sessions. The group process proved to be a space in which participants could share life experiences, understand each other, accept themselves, and care for each other. In clinical practice, it was necessary to understand group members' meanings and feelings about their perception of the world, entering into the therapeutic relationship in an empathic way, allowing the process to be an opportunity for them to recognize themselves and to talk about how they felt. During the sessions, in an atmosphere of empathy and cohesion between the participants, it was possible to observe the unfolding of each young person's project of being and the innumerable self-discoveries that altered the participants' awareness levels, in a non sequential and irregular way.

El estudio tuvo como objetivo acompañar a un grupo de psicoterapia breve en el enfoque fenomenológico-existencial con jóvenes universitarios y observar cómo hay un aumento de la autoconciencia y la ganancia de responsabilidad, lo que permitió la superación de las crisis y la elaboración de la angustia. Se realizó una investigación cualitativa a través del método fenomenológico, en el que siete estudiantes universitarios participaron en 13 sesiones grupales de psicoterapia. El proceso grupal resultó ser un espacio en el que los participantes podrían compartir experiencias de la vida, entenderse, aceptarse y darse la bienvenida. En la práctica clínica, era necesario comprender los significados y sentimientos de los miembros del grupo sobre su percepción del mundo, entra en la relación terapéutica de una manera empática, permitiendo que el proceso sea una oportunidad para que las personas se reconozcan y se pongan en función de lo que sintieron. Durante las sesiones en un clima de empatía e cohesión entre los participantes, fue posible observar el desarrollo del proyecto de ser de cada joven y los innumerables autodescubrimientos que alteraron los niveles de conciencia de los jóvenes participantes, de manera no secuencial e irregular.

Traumatismo em dente com rizogênese incompleta: caso clínico / Traumatism in tooth with incomplete rizogenesis: clinical case

O traumatismo dentário acontece de maneira frequente, tendo maior prevalência em incisivos centrais, podendo ocorrer de várias formas, acometendo o tecido duro e o tecido de sustentação do dente. A severidade do trauma pode ocasionar um processo degenerativo ou uma lesão irreversível até a mortificação da polpa, por isso deve-se observar o estágio de desenvolvimento do dente para correta terapêutica diante de uma rizogênese completa ou incompleta. A necrose pulpar em um dente com ápice incompleto paralisa o seu processo de desenvolvimento o que torna necessário a realização da apicificação. O objetivo desse presente trabalho é relatar um caso clínico de traumatismo em um dente com rizogênese incompleta e a conduta terapêutica instituída para promover a apicificação do mesmo. Entretanto, Durante o tratamento foi um grande desafio promover o fechamento do ápice que fora paralisado após o trauma. Portanto, foi preciso realizar várias sessões de medicação intracanal com hidróxido de cálcio que é o material mais indicado para induzir a formação de barreira calcificada para fechamento completo do ápice(AU)

The dental trauma occurs frequently, having a higher prevalence in central incisors, and can occur in several ways, affecting the hard tissue and the tooth support tissue. The severity of the trauma can cause a degenerative process or an irreversible lesion until the mortification of the pulp, so the stage of development of the tooth must be observed for correct therapy in the presence of complete or incomplete rhizogenesis. Pulp necrosis in a tooth with an incomplete apex paralyzes its development process, which makes it necessary to perform the inoculation. The objective of this present work is to report a clinical case of trauma in a tooth with incomplete rhizogenesis and the therapeutic conduct instituted to promote the apicification of the same. However, during the treatment it was a great challenge to promote the closure of the apex that had been paralyzed after the trauma. Therefore, it was necessary to perform several intracanal medication sessions with calcium hydroxide, which is the most suitable material to induce the formation of a calcified barrier for complete closure of the apex(AU)

Psicoterapia de grupo com foco na adaptação acadêmica: um experimento com estudantes / Group psychotherapy with focus on academic adaptation: an experimont with students / Psicoterapia de grupo con foco en la adaptación académica: un experimento con estudiantes

O estudo teve foco na adaptação acadêmica para identificar efeitos da psicoterapia de grupo na elaboração do processo de adaptação em estudantes no primeiro ano da universidade. Participaram do estudo 24 estudantes, quatro do sexo masculino e 20 do sexo feminino, com idades entre 18 e 29 anos, do curso de psicologia da Universidade Federal Rural do Rio de Janeiro. Os participantes foram divididos em dois grupos de 12 pessoas, chamados de grupo A e grupo B. O grupo A frequentou 8 sessões de psicoterapia de grupo. O grupo B funcionou como grupo controle. Ambos os grupos responderam o Questionário de Vivências Acadêmicas reduzido ­ QVAr, em dois momentos, no início e no final do período letivo. Os resultados mostraram que o grupo que participou da psicoterapia, ao final do estudo, elevou seu nível de adaptação acadêmica, passando de médio adaptado para bastante adaptado. Enquanto o grupo controle regrediu seu nível de adaptação, indo de bastante adaptado para médio adaptado. Concluiu-se que participação engajada em um grupo psicoterápico auxiliou estudantes a enfrentar seu processo de adaptação acadêmica no 1º ano de graduação.(AU)

The study focused on academic adaptation to identify effects of group psychotherapy in the adaptation process of students in the first year of university. The sample consisted of 24 students, 04 males and 20 females, aged 18 and 29 years old, from the psychology course at the Universidade Federal Rural do Rio de Janeiro. Participants were divided into two groups of 12 people each, called group A and group B. Group A attended 8 group psychotherapy sessions. Group B served as control group. Both groups answered the Academic Experiences Questionnaire reduced - QVAr, on two occasions, one at the beginning and another at end of the school year. The results showed that the group who participated in Psychotherapy, at the end of the study, raised its level of academic adaptation, from medium adapted to quite adapted. While the control group declined on their level of adaptation, going from quite adapted to medium adapted. The study concluded that engaged participation in a psychotherapeutic group helped students to face their academic adaptation process in the 1st year of graduation.(AU)

El estudio se centró en la adaptación académica para identificar efectos de la psicoterapia de grupo en la elaboración del proceso de adaptación de estudiantes del primer año de universidad. La muestra estuvo conformada por 24 estudiantes, 4 hombres y 20 mujeres, de entre 18 y 29 años, de la carrera de psicología de la Universidad Federal Rural de Río de Janeiro. Los participantes fueron divididos en dos grupos de 12 personas, llamados grupo A y B. Los participantes del grupo A asistieron a 8 sesiones de psicoterapia de grupo. El Grupo B sirvió como grupo de control. Ambos grupos respondieron el Cuestionario de Vivencias Académicas reducido­ QVA-r, en dos ocasiones, al principio y al final del año escolar. Los resultados mostraron que el grupo que participó de la psicoterapia al final del estudio, elevó su nivel de adaptación académica, pasando de la categoría de medio adaptado a bastante adaptado. Por su parte, el grupo de control retrocedió en su nivel de adaptación, yendo de la categoría bastante adaptado a medio adaptado. Se concluyó que la participación comprometida en un grupo psicoterapéutico contribuyó a que los estudiantes cumplan con su proceso de adaptación académica en el primero año de la carrera.(AU)

Cross-cultural adaptation of the Operationalized Psychodynamic Diagnosis (OPD-2) in Portugal.

BACKGROUND: The Operationalized Psychodynamic Diagnosis (OPD-2) is internationally established as one of the major instruments available for clinical diagnosis and scientific research, being frequently used as an auxiliary tool in the selection of therapeutic interventions. AIMS: 1) To describe the methodological aspects of the adaptation of the OPD-2 into Portuguese (Portugal and Brazil). 2) To assess inter-rater agreement for the different axes of the instrument when scoring clinical interviews. METHOD: The cross-cultural adaptation involved translation of the instrument by different independent translators, whose versions were compared in discussion groups in order to develop a final Portuguese version. In the presence of discrepancies regarding the translation of original concepts, the authors of the original instrument were contacted for clarification. Five interviews were used to assess inter-rater agreement. Each subject participated in two interviews, conducted by an experienced clinical psychologist. The interviews were recorded, transcribed and then analyzed by the principal investigator and by three independent examiners. RESULTS: Axis IV (Structure) presented the highest inter-rater agreement (78%). Axes I (Experience of illness and prerequisites for treatment) and III (Conflict) showed the lowest inter-rater agreement results (66 and 57.7%, respectively). CONCLUSIONS: Our results point in the same direction as previous studies conducted in other countries. In our sample, the OPD-2 presented an acceptable inter-rater agreement; however, further studies are needed to assess the instrument's reliability.

Cross-cultural adaptation of the Operationalized Psychodynamic Diagnosis (OPD-2) in Portugal / Adaptação transcultural do Diagnóstico Psicodinâmico Operacionalizado (OPD-2) em Portugal

Background: The Operationalized Psychodynamic Diagnosis (OPD-2) is internationally established as one of the major instruments available for clinical diagnosis and scientific research, being frequently used as an auxiliary tool in the selection of therapeutic interventions. Aims: 1) To describe the methodological aspects of the adaptation of the OPD-2 into Portuguese (Portugal and Brazil). 2) To assess inter-rater agreement for the different axes of the instrument when scoring clinical interviews. Method: The cross-cultural adaptation involved translation of the instrument by different independent translators, whose versions were compared in discussion groups in order to develop a final Portuguese version. In the presence of discrepancies regarding the translation of original concepts, the authors of the original instrument were contacted for clarification. Five interviews were used to assess inter-rater agreement. Each subject participated in two interviews, conducted by an experienced clinical psychologist. The interviews were recorded, transcribed and then analyzed by the principal investigator and by three independent examiners. Results: Axis IV (Structure) presented the highest inter-rater agreement (78%). Axes I (Experience of illness and prerequisites for treatment) and III (Conflict) showed the lowest inter-rater agreement results (66 and 57.7%, respectively). Conclusions: Our results point in the same direction as previous studies conducted in other countries. In our sample, the OPD-2 presented an acceptable inter-rater agreement; however, further studies are needed to assess the instrument's reliability (AU)

Introdução: O Diagnóstico Psicodinâmico Operacionalizado (OPD-2) constitui-se internacionalmente como um dos principais instrumentos de diagnóstico clínico e de investigação científica, sendo frequentemente utilizado como uma ferramenta auxiliar na seleção de intervenções terapêuticas. Objetivos: 1) Descrever os aspetos metodológicos do processo de adaptação transcultural do OPD-2 para a língua portuguesa (Portugal e Brasil). 2) Avaliar a concordância inter-avaliadores para os diferentes eixos do instrumento na cotação de entrevistas clínicas. Método: A adaptação transcultural envolveu a tradução do instrumento por vários tradutores independentes. As versões resultantes foram confrontadas em grupos de discussão para a redação da versão final do instrumento em português. Na presença de divergências relacionadas à tradução de alguns conceitos originais, os autores do instrumento original foram contactados para esclarecimento. Para a avaliação da concordância inter-avaliadores, foram utilizadas entrevistas de cinco sujeitos. Cada um dos sujeitos participou de duas entrevistas, conduzidas por uma psicóloga com experiência clínica. As entrevistas foram gravadas, transcritas e posteriormente analisadas pela investigadora principal e por três examinadores independentes. Resultados: O eixo IV (Estrutura) apresentou a maior concordância inter-avaliadores (78%). Os eixos I (Vivência da doença e pré-requisitos para o tratamento) e III (Conflitos) obtiveram a menor concordância inter-avaliadores (66 e 57,7%, respectivamente). Conclusão: Nossos resultados apontam na mesma direção de estudos anteriores realizados em outros países. Na nossa amostra, o instrumento obteve razoável concordância inter-avaliadores, porém novos estudos são necessários para investigar a confiabilidade do instrumento (AU)

Interações mãe-bebê de um e cinco meses: aspectos afetivos, complexidade e sistemas parentais predominantes / Mother-infant (one and five months) interactions: affective aspects, complexity and predominant parental systems

Interações iniciais parecem ser adaptativas, e conhecê-las é fundamental para compreender a ontogênese humana. Este estudo compara dados de observações de díades mãe-bebê, analisando os comportamentos dos parceiros, a complexidade das trocas e seu componente afetivo. Participaram 56 díades (28 com bebês de um mês e 28 com bebês de cinco meses), filmadas em suas casas em situações livres. Foram identificados e analisados episódios de interação. Os resultados indicaram efeito do fator tipo de díade (de bebês de um ou de cinco meses) em quatro variáveis dependentes que indicam complexidade das interações. Diferenças foram observadas nos dois grupos quanto à manifestação de afetividade recíproca dos parceiros. As interações mostram-se predominantemente de tipo face-a face quando os bebês têm um mês e de estimulação por objeto aos cinco meses, indicando assim uma tendência observada em grupos urbanos ocidentais. As manifestações afetivas e a presença de interações que envolvem o sistema de contato corporal levam a que se hipotetize um padrão de autonomia relacional. Os resultados confirmam a literatura quanto à possibilidade de trocas em etapas iniciais do desenvolvimento, e o estudo contribui para o conhecimento de suas características. É destacada a afetividade, e enfatizado seu papel constitutivo nas interações, de fundamental importância no desenvolvimento infantil.

Early interactions seem to be adaptive, it is fundamental to know them in order to understand human ontogenesis. This study compares data of observations of mother-baby dyads, analyzing the behavior of the partners, the complexity of the interchanges and their affective components. The participants were 56 dyads (28 with one-month old babies and 28 with five-month old babies), filmed in their homes in free situations. Interaction episodes were identified and analyzed. The results showed the effect of the factor type of dyad (one or five months-old babies) in four dependent variables that indicate complexity of the interactions. Differences in the manifestation of reciprocal affectivity of the partners were observed in the two groups. The interactions were predominantly face-to-face when the babies are one-month old, and the system of object stimulation is predominant when the babies are five-months old. This indicates a tendency observed in Western urban groups. The affective manifestations and the presence of interactions which are characterized by the system of body contact favor the formulation of a hypothesis of the presence of an autonomous relational pattern. The results confirm the literature about the possibility of interchanges in initial stages of the development, and the study contributes for the knowledge of its characteristics. The affective aspect is stressed, and its constitutive role in interactions is emphasized, assuming its importance in child development.