Evaluación e intervención interdisciplinaria del dolor en Unidades de Cuidado Intensivo

El dolor es un problema importante para los pacientes hospitalizados en las UCI porque genera malestar y distrés. Además, la investigación ha demostrado que en algunos pacientes críticos el dolor agudo puede persistir después de alta y convertirse en crónico. La gestión eficaz del dolor en pacientes críticos requiere un enfoque interdisciplinario, que incorpore la visión y trabajo de expertos que representan una amplia variedad de especialidades clínicas. Así, la utilización de la intervención psicológica en el tratamiento del dolor es una parte integral de un enfoque global. Basado en una revisión de la evidencia científica, se identifican y señalan: (1) los tipos de dolor más comunes; (2) las características del dolor; (3) las patologías más frecuentes asociadas con la presencia de dolor; (4) los procedimientos que generan dolor en la UCI; (5) los métodos de evaluación del dolor; (6) la intervención del mismo y; (7) la contribución del psicólogo en la evaluación y manejo del dolor con el paciente, los familiares y los profesionales de la salud. La revisión realizada indica que los procesos psicológicos influyen tanto en la experiencia del dolor como en los resultados del tratamiento, por lo tanto la integración de los principios psicológicos en el tratamiento del dolor parecen tener potencial mejora de los resultados beneficiando la salud del paciente.

Subchronic 3, 4-methylenedioximethamphetamine (mdma) reverts anxiety induced by chronic mild stress

Here we report the effects of subchronic 3, 4-Methylenedioximethamphetamine (MDMA) on the elevated plus-maze, a widely used animal model of anxiety. Rats exposed to a mild chronic stress (MCS) protocol received intracerebroventricular microinjections of the selective serotonin reuptake inhibitor (SSRI) – fluoxetine (2.0ug/ul) or 3, 4-Methylenedioximethamphetamine (MDMA, 2.0ug/ul) for seven days. On the eighth day rats were tested in the elevated plus-maze. Our results showed that sub-chronic MDMA interacted with MCS leading to a decrease in anxiety-related behaviors including: percentage of open arms entries (F[2,26]=4.00; P=0.031), time spent in the open arms (F[2,26]=3.656; P=0.040) and time spent in the open arms extremities (F[2,26]=5.842; P=0.008). These results suggest a potential effect of MDMA in the reversion of the emotional significance of aversive stimuli.

Contribution from neuropsychology to the study of semantic memory

Semantic memory has been studied from various fields. The first models emerged from cognitive psychology from the hand of the division proposed by Tulving between semantic and episodic memory. Over the past thirty years there have been parallel developments in the fields of psycholinguistics, cognitive psychology and cognitive neuropsychology. The present work is to review the contributions that have emerged within the neuropsychology to the study of semantic memory and to present an updated overview of the points of consensus. First, it is defined the term "semantics" conceptually within the field of neuropsychology. Then, there is a dichotomy that passes through both psychological and neuropsychological models on semantic memory: the existence of modals versus amodal representations. Third, there are  developed the main theoretical models in neuropsychology that emerged in an attempt to explain categoryspecific semantic deficits. Finally, more robust contributions and points that still generate some discussion are reviewed.

Recognition of static and dynamic facial expressions: Influences of sex, type and intensity of emotion

Ecological validity of static and intense facial expressions in emotional recognition has been questioned. Recent studies have recommended the use of facial stimuli more compatible to the natural conditions of social interaction, which involves motion and variations in emotional intensity. In this study, we compared the recognition of static and dynamic facial expressions of happiness, fear, anger and sadness, presented in four emotional intensities (25 %, 50 %, 75 % and 100 %). Twenty volunteers (9 women and 11 men), aged between 19 and 31 years, took part in the study. The experiment consisted of two sessions in which participants had to identify the emotion of static (photographs) and dynamic (videos) displays of facial expressions on the computer screen. The mean accuracy was submitted to an Anova for repeated measures of model: 2 sexes x [2 conditions x 4 expressions x 4 intensities]. We observed an advantage for the recognition of dynamic expressions of happiness and fear compared to the static stimuli (p < .05). Analysis of interactions showed that expressions with intensity of 25 % were better recognized in the dynamic condition (p < .05). The addition of motion contributes to improve recognition especially in male participants (p < .05). We concluded that the effect of the motion varies as a function of the type of emotion, intensity of the expression and sex of the participant. These results support the hypothesis that dynamic stimuli have more ecological validity and are more appropriate to the research with emotions.

Reliability of the Brief Neuropsychological Assessment Instrument Neupsilin

This study aimed to evaluate the reliability of Neupsilin Brief Neuropsychological Assessment Instrument, a brief battery developed in Brazil. Hundred two Brazilian man and women participated, from 18 to 40 years of age. It was evaluated the test-retest reliability of the Neupsilin tasks and the reliability of the correction of the constructional praxis task by different evaluators. The data were analyzed by Spearman’s correlation, intraclass correlation and Cronbach’s alpha. Language, memory, praxis and executive functions presented the highest correlations in the test-retest analyses. The agreement in the correction of the constructional praxis task was moderate to high. The results indicate temporal reliability of Neupsilin tasks and inter-rater agreement in the correction of the constructional praxis task. Suggestions to improve the tasks, the validity and reliability of Neupsilin were presented.

Neurobiology of expectancy effects and omission of reinforcement on behavior

The reinforcement omission effects have been traditionally interpreted in terms of: behavioral facilitation after reinforcement omission induced by primary frustration or behavioral suppression after reinforcement delivery induced by postconsummatory states. The studies reviewed here indicate that amygdala is involved in modulation of these effects. However, the fact that amygdala lesions, extensive or selective, can eliminate, reduce and enhance the omission effects makes it difficult to understand how it is the exact nature of their involvement. The amygdala is related to several functions that depend on its connections with other brain systems. Thus, it is necessary to consider the involvement of a more complex neural network in the modulation of the reinforcement omission effects. The connection of amygdala subareas to cortical and subcortical structures may be involved in this modulation since they also are linked to processes related to reward and expectancy.

TRATAMIENTO COGNITIVO-CONDUCTUAL DEL TRASTORNO DE ESTRÉS POSTRAUMÁTICO CRÓNICO EN UNA VÍCTIMA DE ABUSOS SEXUALES EN LA INFANCIA

Se describe detenidamente un programa de evaluación y tratamiento aplicado a un caso de trastorno de estrés postraumático crónico en una víctima de abusos sexuales en la infancia. La paciente, de 22 años, sufrió abusos sexuales desde los 5 a los 12 años. El tratamiento en sí  relajación, exposición en vivo, exposición en la imaginación y terapia cognitiva) constó de ocho sesiones. La  paciente evolucionó favorablemente tanto al final del tratamiento como, sobre todo,   los seis meses de seguimiento en todas las variables clínicas medidas. Se discuten las  epercusiones clínicas del caso, en especial, la conveniencia de introducir la reestructuración  ognitiva durante la exposición en la imaginación para promover el cambio emocional. 

Impulsivity: A view from the behavioral neuroscience and developmental psychology

Impulsivity has been linked to three main factors: performing without direct involvement of the frontal lobe functions, an increase in the speed of response, and the acquisition of immediate gratification. This behavioral inhibition deficit involves a variety of behaviors including aspects of hyperexcitability, behavioral disinhibition and higher order decision making. Although by tradition, the definition of this executive function has been conceptualized from a psychopathological view, currently, the wide variety of neuropsychological, developmental and animal models assessment techniques encourage us to establish dialogues that integrate the knowledge of these theoretical perspectives for the interpretation and understanding of impulsivity.

Why our brains cherish humanity: Mirror neurons and colamus humanitatem

Commonsense says we are isolated. After all, our bodies are physically separate. But Seneca’s colamus humanitatem, and John Donne’s observation that “no man is an island” suggests we are neither entirely isolated nor separate. A recent discovery in neuroscience—that of mirror neurons—argues that the brain and the mind is neither built nor functions remote from what happens in other individuals. What are mirror neurons? They are brain cells that process both what happens to or is done by an individual, and, as it were, its perceived “reflection,” when that same thing happens or is done by another individual. Thus, mirror neurons are both activated when an individual does a particular action, and when that individual perceives that same action done by another. The discovery of mirror neurons suggests we need to radically revise our notions of human nature since they offer a means by which we may not be so separated as we think. Humans unlike other apes are adapted to mirror interact nonverbally when together. Notably, our faces have been evolved to display agile and nimble movements. While this is usually explained as enabling nonverbal communication, a better description would be nonverbal commune based upon mirror neurons. I argue we cherish humanity, colamus humanitatem, because mirror neurons and our adapted mirror interpersonal interface blur the physical boundaries that separate us.

Behavioral neurosciences in Latin-American psychology journals

Behavioral neurosciences have evolved from other disciplines such as psychology, psychiatry and neurology, becoming a prominent area within general neuroscience. In mainstream psychology, neurosciences currently have an important role. In this paper we documented articles published in four Latin-American psychology journals and we classified these papers as empirical or theoretical. We analyzed the main topics covered in the behavioral neurosciences. Most of reported research used humans and rats as study subjects, although other species have also been used as models. Data suggest behavioral neurosciences currently play a growing and prominent role in Latin American psychology.

Type 2 diabetes; elderly; cognitive deficit; cognitive flexibility; executive functions Resumen

Through meditation, people become aware of what happens in the body and mind, accepting the present experiences as they are and getting a better understanding of the true nature of things. Meditation practices and its inclusion as an intervention technique, have generated great interest in identifying the brain mechanisms through which these practices operate. Different studies suggest that the practice of meditation is associated with the use of different neural networks as well as changes in brain structure and function, represented in higher concentration of gray matter structures at the hippocampus, the right anterior insula, orbital frontal cortex (OFC) and greater involvement of the anterior cingulate cortex (ACC). These and other unrelated studies, shows the multiple implications of the regular practice of mindfulness in the structures and functions of the brain and its relation to certain observable and subjective states in people who practice it. Such evidence enabling the inclusion of mindfulness in psychological therapy where multiple applications have been developed to prove its effectiveness in treating affective and emotional problems, crisis management, social skills, verbal creativity, addiction and craving management, family and caregivers stress of dementia patients and others. However, neuropsychological rehabilitation has no formal proposals for intervention from these findings. The aim of this paper is to propose use of Mindfulness in neuropsychological rehabilitation process, taking the positions and theory of A.R. Luria.

Validación del Cuestionario de Creencias Centrales de los Trastornos de la Personalidad (CCE-TP) en población colombiana

Se construyó un cuestionario para evaluar creencias centrales asociadas con los trastornos de la personalidad, fundamentadas en el Modelo de la Terapia Cognitiva. Se realizó el análisis estructural y la validez de contenido de la prueba en población universitaria de la ciudad de Medellín, Colombia. La muestra fue representativa y elegida al azar a través de un procedimiento polietápico. Un número de 809 estudiantes universitarios contestaron el cuestionario de creencias centrales de los trastornos de la personalidad (CCE-TP). Se realizó un análisis factorial exploratorio de la prueba, reagrupándose los ítems en 14 factores (F) que representan el 61,3% de la varianza. F1: CCE-TP antisocial (8 ítems, a 0,839); F2: CCE-TP esquizotípico/límite (8 ítems, a 0,846); F3: CCE-TP histriónico/patrón seductor (6 ítems, a 0,833); F4: CCE-TP paranoide (6 ítems, a 0,836); F5: CCE-TP por evitación / autopercepción negativa (5 ítems, a 0,755); F6: CCE-TP por dependencia (5 ítems, a 0,797); F7: CCE-TP histriónico/ dependencia emocional (4 ítems, a 0,755); F8: CCETP obsesivo-compulsivo/perfeccionista (4 ítems, a 0,808); F9: CCE-TP por evitación/hipersensible (4 ítems, a 0,766); F10: CCE-TP obsesivo-compulsivo/ crítico frente a los demás (3 ítems, a 0,851); F11: CCE-TP narcisista (4 ítems, a 0,717); F12: CCE-TP pasivo-agresivo / temor a ser dominado (3 ítems, a 0,719); F13: CCE-TP pasivo-agresivo/crítico frente a la autoridad (3 ítems, a 0,685), y F14: CCE-TP esquizoide (2 ítems, a 0,774). El alfa de Cronbach de la prueba fue de 0,931.

Corticosterone plasma concentrations in Carioca High- and Low-Conditioned freezing rats after a fear conditioned task

Our group in the Psychology Department at Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio) developed a rat genetic model of extreme freezing in response to contextual cues in an experimental chamber previously associated with footshock. One of the lines, Carioca High Freezing (CHF), exhibits an enhanced conditioned freezing response, whereas the other line, Carioca Low Freezing (CLF), shows the opposite response. The present study investigated corticosterone concentration between these two lines of animals and a random (RND) line of rats both under basal conditions and test condition after an emotional challenge using a contextual fear conditioning protocol. Comparisons between basal and test plasma corticosterone concentrations suggested differential basal and fear-induced differences between the two lines. The differences between basal conditions is an important and relevant aspect to be considered in behavioral experiments using or assessing stress and could help to understand variability in naïve populations.

Brief neuropsychological assessment of adults post-stroke in the left hemisphere

The neuropsychological assessment investigates cognitive deficits to improve the diagnosis, the prognosis and the rehabilitation of patients. In Brazil, stroke is a major cause of hospitalization and the leading cause of mortality and disability. The stroke in the left hemisphere (LH) is associated with different degrees of loss of language and other cognitive impairments, for example, in the memory. We compared the performance in brief neuropsychological tasks of the left hemisphere poststroke patients, without moderate or severe aphasia, with healthy controls. A list of 135 patients was selected based on inclusion criteria. The study included 15 patients with left stroke, paired by sex, age and education to 30 neurologically healthy adults. The data resulting from application of the Neupsilin Brief Neuropsychological Assessment Instrument were analyzed with the nonparametric Mann-Whitney U. Adults with LH stroke showed a significant reduction in performance when compared to healthy controls on language, working memory and ideomotor praxis, results also found in other studies of patients with left hemisphere stroke

El desarrollo de la atención en estudiantes brasileños de la educación primaria y secundaria

El presente estudio tuvo como objetivo investigar eldesarrollo de la atención en estudiantes de la enseñanzaprimaria y secundaria de la ciudad de Natal (RN),Brasil. Participaron del estudio 561 sujetos, con edadesentre siete y catorce años, que fueron evaluados por elTest de Atención por Cancelación, con el propósito deinvestigar los mecanismos atencionales. En términosde la precisión y la velocidad en las tareas que evalúanla selectividad y alternancia, se constató que la curvade rendimiento de los participantes presentó un patrónascendente en función del nivel de escolaridad. Estavariable fue responsable por los contrastes estadísticamentesignificativos (p < 0.05) con respecto al desempeñode los participantes, lo cual sugiere que el patrónascendente constatado se encuentra apoyado en el nivelde escolaridad y en el desarrollo neurológico. En relacióncon la atención selectiva y alternada, se verificóun aumento significativo en el rendimiento en los tresprimeros grados de la enseñanza primaria. Con respectoa la atención selectiva, se observó estabilización delos resultados en los tres últimos años de la enseñanzasecundaria, lo que apunta al estabelecimiento de unameseta en el desarrollo de este mecanismo atencional.Por otro lado, en relación con la alternancia, no hubouna estabilización en el desempeño, y esto sugiere continuidaddel patrón ascendente, ya que en el grupo deedad en cuestión todavía están por ocurrir importantesprocesos de maduración y de desarrollo neurológico enla atención ejecutiva.