Psychology and psychoanalysis in Brazil - From cultural syncretism to the collapse of liberal individualism

This paper focuses first on cultural syncretism, used to characterize Brazilian culture. The other aspect of this socially and racially blended culture is the unfinished assimilation of liberalism in politics and the economy, which defines Brazilian society. The increased assimilation and dissemination of psychology may be linked with these in cultural and social aspects. During the military period (1964-1974) the major expansion in university-level studies in psychology contributed ideologically to the dissemination of psychology throughout Brazilian society. This introduced a type of psychology that was related primarily to clinical practice and developed in opposition to social work practice. This paper examines the ideological bases for this conflict between clinical and social work. Criteria for understanding the cultural dissemination of psychoanalysis are then discussed, and it is argued that cultural incorporation of psychoanalysis involves the development of discourse complexes to reflect particular aspects of Brazilian society. The criteria (a non-totalitarian society and the displacement of a magical and religious interpretation of mental disturbance by psychiatric interpretation) are evaluated in relation to the peculiarities of Brazilian syncretism. The paper argues that cultural syncretism and the incomplete assimilation of liberal ideology must be included as criteria in understanding the particular cultural incorporation of psychoanalysis in Brazil.

Amerindian anthropology and cultural psychology: Crossing boundaries and meeting otherness` worlds

Addressing integrative possibilities between psychology and anthropology, this paper aims to design conceptual linkages between semiotic-cultural constructivist psychology and the anthropological theory of Amerindian perspectivism. From the psychological view, it is the interdependence between the structural and processual dimensions of the personal culture that makes parallels with Amerindian perspectivism fruitful. This anthropological frame proposes an experiment with native conceptions, which I argue similar to what Baldwin (1906) called sembling. Hence, it can be considered an active imitation of otherness` viewpoint in order to approach indigenous worlds. It is supposed that this procedure leads to the emergence of new symbolic elements configuring the cultural action field of each agency in interaction. It is proposed that ""making-believe`` the Amerindian is convergent with the dialogic-hermeneutic approach of semiotic-cultural constructivism. As a result of the present integrative effort, is designed a meta-model that multiplies the genetic process of concrete symbolic objects.

Instrumental activities of daily living performance in healthy and cognitively intact seniors from a Brazilian sample and its relation to age and other socio-demographic variables

Background: Studies on functional capacity in community-dwelling older people have shown associations between declines in instrumental activities of daily living (IADL) and several factors. Among these, age has been the most consistently related to functional capacity independent of other variables. We aimed at evaluating the performance of a sample of healthy and cognitively intact Brazilian older people on activities of daily living and to analyze its relation to social-demographic variables. Methods: We conducted a secondary analysis of data collected for previous epidemiological studies with community-dwelling subjects aged 60 years or more. We selected subjects who did not have dementia or depression, and with no history of neurological diseases, heart attack, HIV, hepatitis or arthritis (n = 1,111). Functional capacity was assessed using the Brazilian version of the Older American Resources and Services Questionnaire (BOMFAQ). ADL performance was analyzed according to age, gender, education, and marital status (Pearson's chi(2), logistic regression). Results: IADL difficulties were present in our sample, especially in subjects aged 80 years or more, with lower levels of education, or widowed. The logistic regression analysis results indicated that "higher age" and "lower education" (p <= 0.001) remained significantly associated with IADL difficulty. Conclusions: Functional decline was present in older subjects even in the absence of medical conditions and cognitive impairment. Clinicians and researchers could benefit from knowing what to expect from older people regarding IADL performance in the absence of medical conditions.

Anemia and dementia among the elderly: the Sao Paulo Ageing & Health Study

Background: Anemia and dementia are common diseases among the elderly, but conflicting data are available regarding an association between these two conditions. We analyzed data from the Sao Paulo Ageing & Health Study to address the relationship between anemia and dementia. Methods: This cross-sectional observational study included participants aged 65 years and older from a deprived area of the borough of Butantan, Sao Paulo, Brazil. Data about demographics, education, income, and cognitive and daily life function were collected, as well as blood samples. Anemia and dementia were defined according to WHO and DSM-IV criteria, respectively. Results: Of the 2267 subjects meeting the inclusion criteria, 2072 agreed to participate in the study; of whom 1948 had a valid total blood count and were included in the analysis. Anemia was diagnosed in 203 (10.2%) participants and dementia in 99 (5.1%). The frequency of anemia was higher in patients with dementia according to univariate analysis (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17-3.41, p = 0.01), but this association was not present after adjusting for age (OR = 1.33, 95% CI = 0.76-2.33, p = 0.32). Further multivariate adjustment did not change the results. Conclusion: Although anemia and dementia are frequent disorders in older people, we found their relationship to be mediated exclusively by aging in this low-income population from Sao Paulo.

Relationships between gender, age, family conditions, physical and mental health, and social isolation of elderly caregivers

Background: In an aging population an increasing number of elderly caregivers will be called upon to provide care over a long period, during which time they will be burdened both by caregiving and by the physiological effects of their own aging. Among them there will be more aged male caregivers, who will probably be less prepared than women to become caregivers. The aim of this study was to investigate the relationship between caregivers' gender, age, family income, living arrangements and social support as independent variables, and depressive symptoms, comorbidities, level of frailty, grip strength, walking speed and social isolation, as dependent variables. Methods: 176 elderly people (123 women) were selected from a sample of a population-based study on frailty (n = 900), who had cared for a spouse (79.3%) and/or parents (31.4%) in the past five years (mean age = 71.8 +/- 4.86 years; mean monthly family income in minimum wages = 4.64 +/- 5.14). The study used questionnaires and self-report scales, grip strength and walking speed tests. Results: 65% of participants evaluated caregiving as being very stressful. Univariate analyses of regression showed low family income as a risk factor for depression; being female and low perceived social support as a risk for comorbidities; being 80 years of age and above for low grip strength; and being male for social isolation indicated by discontinuity of activities and social roles. In multivariate analyses of regression, poverty arose as a risk factor for depression and being female for comorbidities. Conclusions: Gender roles, age, income and social support interacted with physical and emotional health, and with the continuity of social participation of elderly caregivers. Special attention must be given to male caregivers.

Mini-Mental State Examination performance in frail, pre-frail, and non-frail community dwelling older adults in Ermelino Matarazzo, Sao Paulo, Brazil

Background: Frailty in older adults is a multifactorial syndrome defined by low metabolic reserve, less resistance to stressors, and difficulty in maintaining organic homeostasis due to cumulative decline of multiple physiological systems. The relationship between frailty and cognition remains unclear and studies about Mini-Mental State Examination (MMSE) performance and frailty are scarce. The objective was to examine the association between frailty and cognitive functioning as assessed by the MMSE and its subdomains. Methods: A cross-sectional population-based study (FIBRA) was carried out in Ermelino Matarazzo, a poor subdistrict of the city of Sao Paulo, Brazil. Participants were 384 community dwelling older adults, 65 years and older who completed the MMSE and a protocol to assess frailty criteria as described in the Cardiovascular Health Study (CHS). Results: Frail older adults had significantly worse performance on the MMSE (p < 0.001 for total score). Linear regression analyses showed that the MMSE total score was influenced by age (p < 0.001), education (p < 0.001), family income (p < 0.001), and frailty status (p < 0.036). Being frail was associated more significantly with worse scores in Time Orientation (p < 0.004) and Immediate Memory (p < 0.001). Conclusions: Our data suggest that being frail is associated with worse cognitive performance, as assessed by the MMSE. It is recommended that the assessment of frail older adults should include the investigation of their cognitive status.

Mini-Mental State Examination sentence writing among community-dwelling elderly adults in Brazil: text fluency and grammar complexity

Background: In normal aging, the decrease in the syntactic complexity of written production is usually associated with cognitive deficits. This study was aimed to analyze the quality of older adults' textual production indicated by verbal fluency (number of words) and grammatical complexity (number of ideas) in relation to gender, age, schooling, and cognitive status. Methods: From a probabilistic sample of community-dwelling people aged 65 years and above (n = 900), 577 were selected on basis of their responses to the Mini-Mental State Examination (MMSE) sentence writing, which were submitted to content analysis; 323 were excluded as they left the item blank or performed illegible or not meaningful responses. Education adjusted cut-off scores for the MMSE were used to classify the participants as cognitively impaired or unimpaired. Total and subdomain MMSE scores were computed. Results: 40.56% of participants whose answers to the MMSE sentence were excluded from the analyses had cognitive impairment compared to 13.86% among those whose answers were included. The excluded participants were older and less educated. Women and those older than 80 years had the lowest scores in the MMSE. There was no statistically significant relationship between gender, age, schooling, and textual performance. There was a modest but significant correlation between number of words written and the scores in the Language subdomain. Conclusions: Results suggest the strong influence of schooling and age over MMSE sentence performance. Failing to write a sentence may suggest cognitive impairment, yet, instructions for the MMSE sentence, i.e. to produce a simple sentence, may limit its clinical interpretation.