Las adicciones a la luz del psicoanálisis, una revisión de literatura

El presente trabajo de grado es una revisión de la literatura que permite hacer un recorrido desde el psicoanálisis acerca de la compleja problemática de las adicciones. Para ello, se revisaron las bases de datos PepWeb, Ebsco, y Jstor, revisando las posiciones del psicoanálisis freudiano, lacaniano y otras corrientes psicoanalíticas respondiendo a las siguientes preguntas de investigación: (a) ¿Cómo se comprenden las adicciones desde un marco de referencia psicoanalítico? (b) ¿Cómo –desde la teoría freudiana y la teoría lacaniana - se aborda la comprensión de la adicción? (c) ¿Qué dice el psicoanálisis contemporáneo sobre ésta problemática? Se abordan temas como la concepción de una adicción desde la perspectiva de Freud y Lacan hasta psicoanalistas contemporáneos, el rol que juega el goce en la adicción y, finalmente, el complejo debate incipiente sobre la legalidad del tóxico. Se encontró que es un campo de constante publicación y es necesario que los clínicos y los psicoanalistas aborden este campo de estudio clínico permanentemente y sigan produciendo investigaciones sobre el fenómeno.

Reduced heart rate responding to trauma reliving in trauma survivors with PTSD: correlates and consequences

The authors investigated whether heart rate (HR) responses to voluntary recall of trauma memories (a) are related to posttraumatic stress disorder (PTSD), and (b) predict recovery 6 months later. Sixty-two assault survivors completed a recall task modeled on imaginal reliving in the initial weeks postassault. Possible cognitive modulators of HR responsivity were assessed; dissociation, rumination, trauma memory disorganization. Individuals with PTSD showed a reduced HR response to reliving compared to those without PTSD, but reported greater distress. Notably, higher HR response but not self-reported distress during reliving predicted greater symptom reduction at follow-up in participants with PTSD. Engagement in rumination was the only cognitive factor that predicted lower HR response. The data are in contrast to studies using trauma reminders to trigger memories, which have found greater physiological reactivity in PTSD. The authors' observations are consistent with models of PTSD that highlight differences between cued or stimulus-driven retrieval and intentional trauma recall, and with E B. Foa and M.J. Kozak (1986) hypothesis that full activation of trauma memories facilitates emotional processing.

Are the NICE guidelines for Obsessive Compulsive Disorder being used in primary care?

This study aims to: 1) assess the proportion of General Practioners (GPs) who are aware of or who have read the National Institute for Health and Clinical Excellence (NICE; 2005a) guidelines for Obsessive Compulsive Disorder (OCD), 2) compare this with the proportion of other mental health disorders found by previous research and 3) establish the prevalence of OCD in primary care. Questionnaires were sent to all GPs (n = 795) and practice managers (n = 157) in Berkshire and Buckinghamshire, South East England. These contained 19 questions and took 5 min to complete. After the first set of responses, larger practices were visited and telephoned to encourage further responses. The response rates were 10.1% from GPs and 19.1% from practice managers. In all, 48.7% of the GPs were aware of the NICE guidelines for OCD and 30.3% reported that they had read them – higher than for Post-Traumatic Stress Disorder, but lower than for depression. Of registered patients, 0.2% were diagnosed with OCD, lower than the 1.1% found in epidemiological studies.

Effects of drugs that potentiate GABA on extinction of positively-reinforced operant behaviour

Extinction following positively reinforced operant conditioning reduces response frequency, at least in part through the aversive or frustrative effects of non-reinforcement. According to J.A. Gray's theory, non-reinforcement activates the behavioural inhibition system which in turn causes anxiety. As predicted, anxiolytic drugs including benzodiazepines affect the operant extinction process. Recent studies have shown that reducing GABA-mediated neurotransmission retards extinction of aversive conditioning. We have shown in a series of studies that anxiolytic compounds that potentiate GABA facilitate extinction of positively reinforced fixed-ratio operant behaviour in C57B1/6 male mice. This effect does not occur in the early stages of extinction, nor is it dependent on cumulative effects of the compound administered. Potentiation of GABA at later stages has the effect of increasing sensitivity to the extinction contingency and facilitates the inhibition of the behaviour that is no longer required. The GABAergic hypnotic, zolpidem, has the same selective effects on operant extinction in this procedure. The effects of zolpidem are not due to sedative action. There is evidence across our series of experiments that different GABA-A subtype receptors are involved in extinction facilitation and anxiolysis. Consequently, this procedure may not be an appropriate model for anxiolytic drug action, but it may be a useful technique for analysing the neural bases of extinction and designing therapeutic interventions in humans where failure to extinguish inappropriate behaviours can lead to pathological conditions such as post-traumatic stress disorder.

Recognition, assessment and treatment of social anxiety disorder: summary of NICE guidance

Social anxiety disorder is one of the most persistent and common of the anxiety disorders, with lifetime prevalence rates in Europe of 6.7% (range 3.9-13.7%).1 It often coexists with depression, substance use disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder.2 It can severely impair a person’s daily functioning by impeding the formation of relationships, reducing quality of life, and negatively affecting performance at work or school. Despite this, and the fact that effective treatments exist, only about half of people with this condition seek treatment, many after waiting 10-15 years.3 Although about 40% of those who develop the condition in childhood or adolescence recover before adulthood,4 for many the disorder persists into adulthood, with the chance of spontaneous recovery then limited compared with other mental health problems. This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on recognising, assessing, and treating social anxiety disorder in children, young people, and adults.5

Hallucinations as a trauma-based memory: implications for psychological interventions

The relationship between hallucinations and life events is a topic of significant clinical importance. This review discusses the extent to which auditory and visual hallucinations may be directly related to traumatic events. Evidence suggests that intrusive images occur frequently within individuals who also report hallucinatory experiences. However, there has been limited research specifically investigating the extent to which hallucinations are the re-experiencing of a traumatic event. Our current theoretical understanding of these relationships, along with methodological difficulties associated with research in this area, are considered. Recent clinical studies, which adopt interventions aimed at the symptoms of post-traumatic stress disorder in people diagnosed with a psychotic disorder, are reviewed. There is a need for the development of evidence-based interventions in this area.

Regurgitated bodies: presenting and representing trauma in 'The Act of Killing'

Focusing on The Act of Killing, this chapter examines how an “ethics of realism” operates on three key cinematic arenas: genre, authorship and spectatorship. As far as genre is concerned, the film’s realist commitment emerges from where it is least expected, namely from Hollywood genres, such as the musical, the film noir and the western, which are used as documentary, that is to say, as a fantasy realm where perpetrators can confess to their crimes without restraints or fear of punishment, but which nonetheless retains the evidentiary weight of the audiovisual medium. Authorship, in turn, translates as Oppenheimer’s unmistakable auteur signature through his role of self-confessed “infiltrator” who disguises as a sympathiser of the criminals in order to gain first-hand access to the full picture of their acts. One of them, the protagonist Anwar Congo, is clearly affected by post-traumatic stress disorder, and his repetitive reliving of his killings is made to flare up in front of the camera so as to bring back the dead to the present time in their material reality, through his own body, including a harrowing scene of the actor’s unpredictable and uncontrollable retching as he re-enacts the killing of his victims through strangulation. Finally, in the realm of spectatorship, the usual process of illusionistic identification on the part of the spectator is turned onto its head by means of disguising these criminals as amateur filmmakers, led to shoot, act within, and then watch their own film within the film so as to force them to experience beyond any illusion the suffering they had caused.

Barn och katastrofer : en systematisk litteraturstudie

Syftet med denna litteraturstudie var att belysa ämnet barn och katastrofer, som hur barn reagerar efter traumatiska händelser, hur de utvecklar Post- Traumatic Stress Disorder (PTSD), hur PTSD behandlas samt hur vårdpersonal kan hjälpa barn på bästa sätt. Studien var en systematisk litteraturstudie. Litteraturen söktes via Elin@dalarna, Pub Med och DOAJ. Sökord som användes för att få fram relevanta artiklar var: ”adaption”, ”care”, ”catastrophe”, ”children”, ”child”, ”disasters”, ”help”, ”natural disaster”, ”PTSD”, ”react”, ”trauma”. Dessa ord användes ett och ett samt i kombination med varandra. De vetenskapliga artiklarna som användes kvalitetsbedömdes med en kombinerad granskningsmall av Forsberg och Wengström (2003) samt Willman och Stoltz (2002) granskningsmallar för kvalitativa och kvantitativa studier. Denna granskning resulterade i ett urval av 16 vetenskapliga artiklar som var publicerade mellan1990 och 2006 och var skrivna på svenska eller engelska. Sökorden fanns med i artikelns titel eller abstract, samt att dess innehåll skulle besvara frågeställningarna som fanns. De studier som granskades i denna uppsats visade att barn reagerar väldigt olika beroende på deras sociala liv och levnadsstandard, samt hur svårt drabbade de blivit av naturkatastrofen. Barns första reaktioner efter en naturkatastrof var ofta ilska och aggressioner över det inträffade, barnen anklagade ofta sig själva för det inträffade. Barn som levde under sociala missförhållande, utan föräldrar, hem och vänner löpte högre risk att få symtom på PTSD, och det var vanligare att flickor fick symtom än pojkar. De vanligaste behandlingsmetoderna för symtom av PTSD var kognitiv beteendeterapi och läkemedel. Den viktigaste hjälpen för barn som upplevt en naturkatastrof var att hjälpa dem tillbaka till det vardagliga livet.

Neurobiology and clinical implications of lucid dreaming

Several lines of evidence converge to the idea that rapid eye movement sleep (REMS) is a good model to foster our understanding of psychosis. Both REMS and psychosis course with internally generated perceptions and lack of rational judgment, which is attributed to a hyperlimbic activity along with hypofrontality. Interestingly, some individuals can become aware of dreaming during REMS, a particular experience known as lucid dreaming (LD), whose neurobiological basis is still controversial. Since the frontal lobe plays a role in self-consciousness, working memory and attention, here we hypothesize that LD is associated with increased frontal activity during REMS. A possible way to test this hypothesis is to check whether transcranial magnetic or electric stimulation of the frontal region during REMS triggers LD. We further suggest that psychosis and LD are opposite phenomena: LD as a physiological awakening while dreaming due to frontal activity, and psychosis as a pathological intrusion of dream features during wake state due to hypofrontality. We further suggest that LD research may have three main clinical implications. First, LD could be important to the study of consciousness, including its pathologies and other altered states. Second, LD could be used as a therapy for recurrent nightmares, a common symptom of depression and post-traumatic stress disorder. Finally, LD may allow for motor imagery during dreaming with possible improvement of physical rehabilitation. In all, we believe that LD research may clarify multiple aspects of brain functioning in its physiological, altered and pathological states.

Clinical correlates of social adjustment in patients with obsessive-compulsive disorder

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

Diagnóstico diferencial do transtorno obsessivo-compulsivo

Obsessive-compulsive disorder (OCD) has clinical features that overlap in various degrees with many other mental disorders. As a result, the differential diagnosis sometimes can be difficult. This review briefly summarizes the phenomenologic similarities and differences between OCD and the following disorders: depression, phobias, hypochondriasis and body dysmorphic disorder, Tourette syndrome and tic disorder, obsessive-compulsive personality disorder, impulse control and eating disorders, generalized anxiety, panic and post-traumatic stress disorders, and delusional and schizophrenic disorders. The accurate diagnosis is essential for adequate treatment planning and management.

Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study

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

Plant derived alkaloid (-)-cassine induces anti-inflammatory and anti-hyperalgesics effects in both acute and chronic inflammatory and neuropathic pain models

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Diagnóstico diferencial da fobia social: Uma revisâo

Social phobia is a common mental disorder that can cause considerable distress and impairment in functioning and quality of life but it is still an underdiagnosed and undertreated disorder. The differential diagnosis is not always simple. because its clinical features overlap with many other mental and non-mental disorders characterized by social avoidance. The aim of this study was to review the literature and discuss the differential diagnosis of social phobia with the following conditions. normal social anxiety (shyness), depressive disorders, alcoholism, body dysmorphic disorder, panic disorder and agoraphobia, simple phobias, generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, delusional disorders and avoidant and schizoid personality disorders. A Medline and Lilacs search was conducted between 1990 and 2002, using the key words social phobia, social anxiety disorder, diagnosis and defferential diagnosis. The accurate diagnosis is very important for the appropriate treatment approach.