Apoyo social e ideación suicida en pacientes con cáncer

El diagnóstico de cáncer ha sido asociado con un alto riesgo de presentar ideación suicida en comparación con la población no oncológica, sin embargo se ha considerado al apoyo social como un factor protector para la ocurrencia de esta conducta. La presente investigación tuvo como objetivo identificar la relación entre el apoyo social percibido y la ideación suicida en 90 pacientes oncológicos adultos en Bogotá, bajo la hipótesis de que a mayor apoyo social percibido, menor presencia de ideación suicida. Se midió la variable de apoyo social a través del cuestionario Duke UNC y la ideación suicida a través de cuatro instrumentos: Escala de Ideación Suicida (SSI), Escala de Desesperanza de Beck (BHS), el ítem 9 del Inventario de Depresión de Beck (BDI-IA) y una entrevista semiestructurada. Los resultados mostraron que no existe relación entre el apoyo social percibido y la ideación suicida. Por otro lado se identificó una prevalencia de suicidio entre 5,6% y 22,77%, confirmando que el paciente con cáncer considera el suicidio y es fundamental evaluar esta variable en esta población. Se considera importante continuar con la realización de investigaciones que permitan generalizar los resultados a la población oncológica colombiana.

Características fenotípicas de personalidad y neuropsicológicas en padres no afectados de pacientes esquizofrénicos

Introducció. Actualment, està àmpliament acceptat que l'esquizofrènia posseeix una etiologia multifactorial i que existeix una complexa interacció entre factors genètics i factors ambientals. Amb l'objectiu de coneixerà quins són els mecanismes etiològics i patofisiològics que determinen el trastorn una part de la investigaci6 s 'ha centrat, en els últims anys, en la detecció de marcadors de vulnerabilitat en subjectes amb risc al trastorn. Aquesta vulnerabilitat, denominada 'esquizotipia', es pot identificar en subjectes clínicament no afectats. Objectiu. L'objectiu d'aquesta investigació s'ha dirigit a intentar contestar a alguns interrogants que encara no tenen resposta. Per exemple, per què alguns familiars, essent portadors del genotip esquizofrènic, no han presentat mai la malaltia?, existeixen formes esquizotípiques de menor risc per a la presentació del trastorn?, poden alguns patrons esquizotípics 'ajudar' a que la vulnerabilitat es mantingui latent i no es manifesti en forma de trastorn? En termes generals, l'estudi s'ha centrat en la identificació de marcadors de vulnerabilitat dels trastorns de l'espectre esquizofrènic en pares no afectats de pacients amb esquizofrènia (subjectes d'edats avançades amb poca probabilitat de presentar el trastorn) comparats amb pares normals de subjectes normals. Metodologia. S' han avaluat 26 parelles de pares no afectats de pacients amb esquizofrènia i 26 parelles de pares normals de subjectes normals (n= 104) en variables de personalitat i comportamentals (esquizotipia psicomètrica -O-LIFE-, trastorns de personalitat -Qüestionari d'avaluació IPDE-, psicopatologia general -SCL-90- i lloc de control -MHLC-) i variables neuropsicològiques (dèficit atencional -CPT-IP-, funció executiva -TMT part B- i memòria i aprenentatge verbal -CVLT-). Resultats. Els pares dels pacients esquizofrènics, comparats amb els controls, mostren significativament puntuacions mes altes al factor d'anhedònia introvertida, al trastorn paranoide de la personalitat i al trastorn per evitació de la personalitat, més característiques de psicopatologia general i un major lloc de control intern relacionat amb la salut. També realitzen mes errors d'omissió en la tasca atencional, presenten una major interferència proactiva al test de memòria i aprenentatge verbal i mostren una tendència a dedicar mes temps a completar la tasca executiva. Els resultats mostren que les associacions entre les variables de personalitat i les neuropsicològiques són de poca magnitud i les diferències entre ambdós grups no segueixen un patró clarament determinat. Conclusions. Els pares dels pacients esquizofrènics presenten més trets esquizotípics negatius que els pares del subjectes normals. L'anhedònia introvertida podria considerar-se com una forma de menor risc a l'esquizofrènia ja que s'evidencia en subjectes (pares) d'edats avançades que ja han superat l'edat de risc i amb poca probabilitat de presentar mai el trastorn. Tanmateix, es confirma que el trastorn paranoide de la personalitat forma part dels trastorns de l'espectre esquizofrènic. Els pares dels pacients atribueixen un major pes i la internalització i al poder dels altres en relació a l'estat de salut, i en general, presenten més característiques psicopatològiques que el grup control. Quant a les variables neuropsicològiques, els pares dels pacients realitzen pitjor la tasca atencional, són més lents en l'anticipació, planificació i flexibilitat de les respostes en el test executiu. Els indicadors de memòria i aprenentatge verbal no discriminen a ambdós grups, i únicament els pares dels pacients presenten una major interferència proactiva. Finalment, el patró de personalitat i el neuropsicològic corresponen a dos fenotips diferents relacionats amb l'esquizofrènia que no es troben íntimament units en subjectes amb aquestes característiques.

Ansiedade, depressão, ideação suicida, coping em idosos institucionalizados e não institucionalizados

O presente estudo teve como objectivo principal comparar idosos institucionalizados e não institucionalizados em termos de depressão, ansiedade, dependência, actividades de lazer, estratégias de coping e ideação suicida. Foi utilizada uma amostra recolhida no Algarve, Alentejo e Grande Lisboa, de 156 idosos, 85 institucionalizados e 71 não institucionalizados, com proporção similar entre os géneros. Foram como instrumentos: Índice de Actividade e Lazer (IAL; Vaz, 2009); Geriatric Depression Scale (GDS; Yesavage, Brink, Rose, Lum, Huang, Adey, et al., 1983), Índice de Barthel (Mahoney & Barthel, 1965), Beck Scale for Suicide Ideation (BSI, Beck, Kovacs, & Weissman, 1979), Inventário de Ansiedade de Beck (BAI; Beck & Steer, 1993) e Brief COPE (Brief COPE; Carver, Scheier, & Weintraub (1989). Os resultados mostraram que os idosos institucionalizados apresentavam um maior índice de dependência, mas não apresentavam maior depressão, solidão, ideação suicida nem menor nível de actividade e lazer. Os idosos com ideação suicida mais elevada apresentavam mais depressão e ansiedade e menos estratégias de coping focadas no problema. Uma auto-percepção de pior saúde e de mais solidão relacionou-se com mais ansiedade e depressão. Uma maior actividade e lazer relacionou-se com mais estratégias de coping focadas no problema, menos ansiedade e menos ideação suicida.

A randomised controlled trial of cognitive behaviour therapy for psychosis in a routine clinical service

Objective: To evaluate CBTp delivered by non-expert therapists, using CBT relevant measures. Methods: Participants (N=74) were randomised into immediate therapy or waiting list control groups. The therapy group was offered six months of therapy and followed up three months later. The waiting list group received therapy after waiting nine months (becoming the delayed therapy group). Results: Depression improved in the combined therapy group at both the end of therapy and follow-up. Other significant effects were found in only one of the two therapy groups (positive symptoms; cognitive flexibility; uncontrollability of thoughts) or one of the two timepoints (end of therapy: PANSS general symptoms, anxiety, suicidal ideation, social functioning, resistance to voices; follow-up: power beliefs about voices, negative symptoms). There was no difference in costs between the groups. Conclusions: The only robust improvement was in depression. Nevertheless, there were further encouraging but modest improvements in both emotional and cognitive variables, in addition to psychotic symptoms.

Progress report from the strategic sanctuary for the destruction of free will

Progress Report from the Strategic Sanctuary for the Destruction of Free Will presents a new work combining film, music and installation that juxtaposes the setting of the institution with the aesthetics of psychedelia.Progress Report from the Strategic Sanctuary for the Destruction of Free Will is an installation, film and sound work that takes over the gallery. Using plain white card, it distorts the structure of the gallery’s architecture, producing a paranoid shrunken space. Inside this space, performers in cardboard costumes re-enact abstracted, broken gestures drawn from video documentation of acid trips, psychedelic dancing, rehab sessions and radical psychotherapy workshops. Progress Report from the Strategic Sanctuary for the Destruction of Free Will has been formed through Pil and Galia Kollectiv’s research into the anti-psychiatry movement, their interests in counter cultural movements and their studies around biopolitics and the proliferation of societal medication. In 1958, having had a life changing experience with LSD, former alcoholic Charles Dederich founded Synanon, a drug rehabilitation program based on residential care and an aggressive form of group therapy called ‘The Game’. The organisation gradually evolved into a controversial alternative community, described in a critical pamphlet as creating Strategic Sanctuaries for the Destruction of Free Will, “a subversive program for mixing delinquents and lefties”. In 1984, anti-psychiatrist R. D. Laing described tranquillizers as chemical straight jackets. With our growing understanding of the plasticity of the brain and the potential to shape it, the tension between liberation and control in the struggle over the mind continues to define our relationship to labour, culture and production. Interrogating these ideas, the exhibition poses the question of whether a collective body can overcome the solipsism of the incommunicable experience of the individual mind.

Experience With Lacosamide in a Series of Children With Drug-Resistant Focal Epilepsy

We report our pediatric experience with lacosarnide, a new antiepileptic drug, approved by the US Food and Drug Administration as adjunctive therapy in focal epilepsy in patients more than 17 years old. We retrospectively reviewed charts for lacosamide use and seizure frequency outcome in patients with focal epilepsy (Wilcoxon signed rank test). Sixteen patients (7 boys) were identified (median dose 275 mg daily, 4.7 mg/kg daily; mean age 14.9 years, range 8-21 years). Patients were receiving a median of 2 antiepileptic drugs (interquartile range [IQR] 1.7-3) in addition to having undergone previous epilepsy surgery (n = 3), vagus nerve stimulation (n = 9), and ketogenic diet (n = 3). Causes included structural (encephalomalacia and diffuse encephalitis, 1 each; stroke in 2) and genetic abnormalities (Aarskog and Rett syndromes, 1 each) or cause not known (n = 10). Median seizure frequency at baseline was 57 per month (IQR 7-75), and after a median follow-up of 4 months (range 1-13 months) of receiving lacosamide, it was 12.5 per month (IQR 3-75), (P < 0.01). Six patients (37.5%; 3 seizure free) were classified as having disease that responded to therapy (>= 50% reduction seizure frequency) and 10 as having disease that did not respond to therapy (<50% in 3; increase in 1; unchanged in 6). Adverse events (tics, behavioral disturbance, seizure worsening, and depression with suicidal ideation in 1 patient each) prompted lacosamide discontinuation in 4/16 (25%). This retrospective study of 16 children with drug-resistant focal epilepsy demonstrated good response to adjunctive lacosamide therapy (median seizure reduction of 39.6%; 37.5% with >= 50% seizure reduction) without severe adverse events. (C) 2011 Elsevier Inc. All rights reserved.

Ideações e tentativas de suicídio em adolescentes com práticas sexuais hetero e homoeróticas

Esta pesquisa, que teve como população-alvo adolescentes com idade entre 12 e 20 anos, residentes em três municípios do interior Paulista, buscou conhecer as associações entre orientação sexual e ideações e tentativas de suicídio. Corroborando com as pesquisas internacionais, evidenciou-se que os não heterossexuais têm mais chances de pensarem e tentarem suicídio, comparativamente aos heterossexuais. Todavia, encontrou-se que, dentre o grupo de adolescentes que se assumiram não heterossexuais, os que estão mais vulneráveis são aqueles que se autodefiniram bissexuais e outros, os quais constituem o grupo de pessoas menos assumidas, dentre os não heterossexuais. do mesmo modo, constatou-se que os respondentes apresentam diversas opiniões e valores homofóbicos, sexistas e heterocentrados, o que revela ser o espaço escolar, onde se encontram esses jovens não heterossexuais, bastante carregado de posicionamentos discursivos discriminatórios. Conclui-se que a questão do suicídio é uma problemática de saúde pública e que a população de jovens não heterossexuais necessita de abordagens específicas para a prevenção e de atenção relativas a essa conduta.

Affective disorders, hospital admissions, and seasonal variation of mania in a subtropical area, southern hemisphere

Hospital admissions (n = 15,450) to a state psychiatric hospital in Botucatu, São Paulo State, Brazil, over a 10-year period (1982-1991) were reviewed. 157 (1%) patients received a probable diagnosis of affective disorder according to DSM-III-R criteria. Among them, 46% had been diagnosed by the staff psychiatrists, and their diagnoses were sustained by the researchers, whereas 54% were diagnosed only by one of the researchers (F.K.C.). These last patients had previously received a diagnosis of paranoid schizophrenia or unspecified psychosis (ICD-9). Most of the patients with affective disorders were bipolar: 72 and 8%, respectively, presented manic and depressive episodes. Thus, only 20% received a diagnosis of major depression. A seasonal pattern in hospital admission was observed only for mania in women, their episodes occurring more often (p < 0.02) in spring and summer. No significant seasonal pattern in hospital admission for depression was found.

Obsessive-compulsive disorder and personality disorder - Evidence from the British National Survey of Psychiatric Morbidity 2000

Background Previous studies indicate that most individuals with obsessive-compulsive disorder (OCD) have comorbid personality disorders (PDs), particularly from the anxious cluster. However, the nature and strength of this association remains unclear, as the majority of previous studies have relied heavily on clinical populations. We analysed the prevalence of screen positive personality disorder in a representative sample of adults with OCD living in private households in the UK. Methods A secondary analysis of data from the 2000 British National Survey of Psychiatric Morbidity. The prevalence of PD, as determined by the SCID-II questionnaire, was compared in participants with OCD, with other neuroses and non-neurotic controls. Within the OCD group we also analysed possible differences relating to sex and subtypes of the disorder. Results the prevalence of any screen positive PD in the OCD group (N = 108) was 74%, significantly greater than in both control groups. The most common screen positive categories were paranoid, obsessive-compulsive, avoidant, schizoid and schizotypal. Compared to participants with other neuroses, OCD cases were more likely to screen positively for paranoid, avoidant, schizotypal, dependent and narcissistic PDs. Men with OCD were more likely to screen positively for PDs in general, cluster A PDs, antisocial, obsessive-compulsive and narcissistic categories. The presence of comorbid neuroses in people with OCD had no significant effect on the prevalence of PD. Conclusions Personality pathology is highly prevalent among people with OCD who are living in the community and should be routinely assessed, as it may affect help-seeking behaviour and response to treatment.

Suicidality in Obsessive-Compulsive Disorder: Prevalence and Relation to Symptom Dimensions and Comorbid Conditions

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Acute psychotic disorders induced by topiramate: report of two cases

Relatamos dois pacientes epilépticos que manifestaram quadro psicótico agudo induzido por topiramato (TPM). Um paciente apresentou agitação psicomotora grave, heteroagressividade, alucinações auditivas e visuais, e delírios de conteúdo paranóide e místico. O outro paciente apresentou agitação psicomotora, despersonalização, desrealização, ansiedade intensa e delírio de que estava perdendo a memória. Ambos os pacientes foram conduzidos ao serviço de emergência e, após a interrupção do TPM em um deles e redução da droga em outro, houve remissão total dos sintomas psicóticos sem necessidade de medicação antipsicótica. Alertamos os clínicos para o risco de surgimento de sintomas psicóticos em pacientes em uso do TPM.

Comorbidity of obsessive-compulsive disorder and personality disorders. A Brazilian controlled study

The aim of this study was to evaluate the presence of personality disorders (PDs) in 40 patients with obsessive-compulsive disorder (DSM-III-R criteria) from the Medical School of Botucatu (UNESP), Sao Paulo, Brazil. It is a case-control study. Patients were 24 women and 16 men, 16-68 years old, referred to our outpatient psychiatric service for treatment. Controls were 40 nonpsychiatric outpatients matched to the cases by sex, age and marital status. The instrument used was the Portuguese version of the Structured Interview for DSM-III-R Personality Disorders (SIDP-R). All interviews (n = 80) were made simultaneously by 2 raters, with independent scoring, so that the interrater reliability of the instrument could also be assessed (kappa statistics). The consensual axis II diagnoses in the OCD group were: avoidant (52.5%, κ = 0.80), dependent (40%, κ = 0.84), histrionic (20%, κ = 0.83), paranoid (20%, κ = 0.74), obsessive-compulsive (17.5%, κ = 0.86), narcissistic (7.5%, κ = 1.00), schizotypal (5%, κ = 0.65), passive-aggressive (5%, κ = 0.79) and self-defeating (5%, κ 0.55). At least one PD diagnosis was made in 70% of the patients, while only 6 controls had a PD diagnosis (p < 0.01). A great deal of diagnostic overlap was found in the OCD group (57.5% had two or more PDs), especially between avoidant and dependent PDs. The features of these two PDs may be secondary to the OCD. The study also suggests that there is not a close relationship between OCD and obsessive-compulsive personality disorder (OCPD). Patients with OCPD or even 3 or 4 O-C traits had significantly less insight into their obsessions and compulsions (p < 0.01).

A interface entre distúrbio obsessivo-compulsivo e esquizofrenia: Desafios da prática clínica

The article discusses the relationship between obsessive-compulsive disorder (OCD) and schizophrenia, based on the report of eight clinical cases. It describes and discusses cases of OCD with poor insight, obsessions that seem paranoid delusions or auditive hallucinations, OCD with transient psychotic reactions, OCD with schizotypal personality disorder and schizophrenia with obsessive-compulsive symptoms.

An exploratory dimensional approach to premenstrual manifestation of obsessive-compulsive disorder symptoms: A multicentre study

Objective: In women with obsessive-compulsive disorder (OCD), symptom severity appears to fluctuate over the course of the menstrual cycle. The objective of this paper was to compare female OCD patients with and without premenstrual worsening of obsessive-compulsive symptoms (OCS), in terms of the clinical characteristics of OCD. Methods: This was a cross-sectional study involving 455 women with OCD, of whom 226 (49.7%) had experienced premenstrual OCS worsening and 229 (50.3%) had not (PMOCS-worse and PMOCS-same groups, respectively). Data were collected with the original and dimensional versions of the Yale-Brown Obsessive-Compulsive Scale, as well as with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Results: We found significant differences between the PMOCS-same and PMOCS-worse groups, the latter showing a higher frequency of suicidal ideation (P<.001), suicide attempts (P=.027), current use of selective serotonin reuptake inhibitors (P=.022), lifetime use of mood stabilisers (P=.015), and sexual/religious obsessions (P<.001; OR. =1.90), as well as higher scores on the BDI (P<.001) and BAI (P<.001). Conclusion: Underscoring the fact that OCD is a heterogeneous disorder, there appears to be a subgroup of female OCD patients in whom the premenstrual period is associated with a higher frequency of sexual/religious obsessions, depression, anxiety, and suicidality. This might be attributable to hormonal fluctuations. Further studies are warranted in order to investigate this hypothesis by evaluating such patients at different phases of the menstrual cycle, as well as measuring hormonal levels. © 2012 Elsevier Inc.

O inconsciente entendido à luz de Gilles Deleuze e Félix Guattari: intersecções entre a psicanálise de Melanie Klein e a esquizoanálise

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)