Atividade e psicoterapia: um recurso técnico de ampliação da consciência

O objetivo desta pesquisa é o de descrever as bases teóricas que fundamentam a utilização da atividade em Psiquiatria e na Psicologia Dinâmica como o recurso terapêutico. Damos ênfase as possibilidades que esta utilização apresenta na ampliação da consciência, que consideramos como essencial no processo de intervenção psicoterápica. Em psiquiatria, abordamos a evolução da compreensão do papel da atividade no processo terapêutico e relacionamos tal compreensão às transformações do conceito de doença mental que foram concomitantemente tendo lugar nesta área. Para tanto, descrevemos duas linhas de trabalho especificamente vinculadas à questão da atividade: a Terapia Ocupacional e a Arte terapia. Abordamos, também, as diferentes formas de utilização da atividade como recurso terapêutico na Psicologia Dinâmica. Procuramos identificar em cada uma das teorias estudadas, - na Psicanálise, no Psicodrama, na Gestalt Terapia e na psicologia Analítica - a forma de utilização da atividade, sempre relacionando a à compreensão de ser humano e à compreensão dos objetivos do processo terapêutico por elas explicitados. Concluímos que no estágio atual da utilização da atividade como recurso psicoterápico, não podemos descartar em totalidade nenhuma das contribuições desenvolvidas até o momento, pois se algumas nos oferecem fundamentação sobre as vantagens da atividade enquanto fazer organizador e socializante, outras nos oferecem fundamentação sobre seus efeitos no psiquismo em termos de integração de conteúdos inconscientes à consciência: dos aspectos recalcados, dos papéis introjetados, dos sentimentos e formas de lidar com o mundo (em sua intencional idade), dos aspectos do inconsciente pessoal e do inconsciente coletivo não necessariamente recalcados, mas em forma de potencialidades de ser.

Literatura e cinema: representações do feminino em Washington Square, Daisy Miller e The Europeans

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Memoria se deseja, o resto se ouça ou veja: considerações sobre um poema de Frederico Barbosa .(2010)

In Frederico Barbosa’s poem “Memoria se”, the memory experience is marked in the body, which means that the memory is not only recorded on the lyrical person unconsciousness, but it is also something that, as an insignia, presents itself and becomes dense as permanence in this lyrical person body. The poet is heir of what may be called “tradition of rigour,” consequently, a discussion of his poetics aspects must consider the inventiveness and the dialogue with other texts, not only those from the canon but also those from the popular repertory that Frederico Barbosa assimilates and recreates.

A construção do herói vitoriano sob a ótica do enunciador do século XIX: ideologia e simbologia

In this paper the figure of Alice from the book Alice in Wonderland (1865) by Lewis Carroll will be analyzed from Tim Burton’s sight in the adaptation for the movies (2010), noticing his analysis of a Victorian argument and his emphasis to a construction of a heroine with a characterization in the female pattern at the present time, considering the structures of the unconsciousness that allowed the character to obtain the wisdom, courage and the capacity to decide its own destiny.

[Acute pericardial tamponade in cardiac echinococcosis]

An echinococcal cyst of the heart is a rare cause of acute cardiac tamponade. We report on a 24 year old male from the Kosovo who was brought in an emergency state from a provincial hospital complaining of severe dyspnea, thoracic pain, dizziness, and a short period of unconsciousness. Surgical decompression had to be performed urgently, because the pericardium could not be punctuated due to the position of the hydatid cyst. The differential diagnosis was cardiac tumor or echinococcal cyst. Because of a negative result of a test for anti-echinococcal antibodies (indirect haemagglutination) and no eosinophilia (5%), the diagnosis of hydatid cyst was at first discarded. Later on, the test for anti-echinococcal antibodies became positive and a marked eosinophilia (59%) was manifest. In combination with a typical appearance in the echocardiograph and NMR, the diagnosis of a cardiac hydatid cyst was made. After preoperative treatment with albendazole, the cyst was sterilized with a 20% NaCl solution and the contents evacuated. The therapy with albendazole was continued. When last seen eight months after the first incidence, the patient was well except some degree of dyspnea on exertion. As a differential diagnosis of a cardiac tumor, a hydatid cyst should be taken into account in patients from an area where Echinococcus granulosus is endemic. A negative test on antiechinococcal antibodies and the absence of eosinophilia do not rule out echinococcosis.

Alfaxalone versus alfaxalone-dexmedetomidine anaesthesia by immersion in oriental fire-bellied toads (Bombina orientalis)

OBJECTIVE To determine a dexmedetomidine concentration, to be added to an alfaxalone-based bath solution, that will enhance the anaesthetic and analgesic effects of alfaxalone; and to compare the quality of anaesthesia and analgesia provided by immersion with either alfaxalone alone or alfaxalone with dexmedetomidine in oriental fire-bellied toads (Bombina orientalis). STUDY DESIGN Pilot study followed by a prospective, randomized, experimental trial. ANIMALS Fourteen oriental fire-bellied toads. METHODS The pilot study aimed to identify a useful dexmedetomidine concentration to be added to an anaesthetic bath containing 20 mg 100 mL(-1) alfaxalone. Thereafter, the toads were assigned to one of two groups, each comprising eight animals, to be administered either alfaxalone (group A) or alfaxalone-dexmedetomidine (group AD). After immersion for 20 minutes, the toads were removed from the anaesthetic bath and the righting, myotactic and nociceptive reflexes, cardiopulmonary variables and von Frey filaments threshold were measured at 5 minute intervals and compared statistically between groups. Side effects and complications were noted and recorded. RESULTS In the pilot study, a dexmedetomidine concentration of 0.3 mg 100 mL(-1) added to the alfaxalone-based solution resulted in surgical anaesthesia. The toads in group AD showed higher von Frey thresholds and lower nociceptive withdrawal reflex scores than those in group A. However, in group AD, surgical anaesthesia was observed in two out of eight toads only, and induction of anaesthesia was achieved in only 50% of the animals, as compared with 100% of the toads in group A. CONCLUSIONS AND CLINICAL RELEVANCE The addition of dexmedetomidine to an alfaxalone-based solution for immersion anaesthesia provided some analgesia in oriental fire-bellied toads, but failed to potentiate the level of unconsciousness and appeared to lighten the depth of anaesthesia. This limitation renders the combination unsuitable for anaesthetizing oriental fire-bellied toads for invasive procedures.

Alfaxalone-butorphanol-dexmedetomidine anaesthesia in striped skunks (Mephitis mephitis ) undergoing skin biopsy: two cases

Skunks are becoming increasingly popular as pets. As such, they often undergo a variety of surgical procedures. Two pet skunks undergoing a dermatological examination, including skin biopsy, were anaesthetised with a combination of dexmedetomidine (0.02 mg/kg), butorphanol (0.3 mg/kg), and alfaxalone (4 mg/kg), all administered intramuscularly. Anaesthesia was characterised by rapid onset, absence of detectable side effects and fast recovery after atipamezole administration. Biopsies and toe-pinch did not elicit cardiorespiratory responses, nor did it result in movements or lightening of the anaesthetic depth. Both skunks recovered uneventfully, and showed normal appetite and regular defecation within eight hours following surgery. However, both the animals experienced mild hypothermia at recovery. The dexmedetomidine-alfaxalone-butorphanol combination produced satisfactory anaesthesia in the two skunks, object of this report. This anaesthetic protocol may be used in this species to provide immobility, myorelaxation, unconsciousness and analgesia during skin biopsy or other minor surgical procedures.

Risk of severe hypoglycemia in sulfonylurea-treated patients from diabetes centers in Germany/Austria: how big is the problem? which patients are at risk?

BACKGROUND We investigated the rate of severe hypoglycemic events and confounding factors in patients with type-2-diabetes treated with sulfonylurea (SU) at specialized diabetes centers, documented in the German/Austrian DPV-Wiss-database. METHODS Data from 29,485 SU-treated patients were analyzed (median[IQR] age 70.8[62.2-77.8]yrs, diabetes-duration 8.2[4.3-12.8]yrs). The primary objective was to estimate the event-rate of severe hypoglycemia (requiring external help, causing unconsciousness/coma/convulsion and/or emergency.hospitalization). Secondary objectives included exploration of confounding risk-factors through group-comparison and Poisson-regression. RESULTS Severe hypoglycemic events were reported in 826(2.8%) of all patients during their most recent year of SU-treatment. Of these, n = 531(1.8%) had coma, n = 501(1.7%) were hospitalized at least once. The adjusted event-rate of severe hypoglycemia [95%CI] was 3.9[3.7-4.2] events/100 patient-years (coma: 1.9[1.8-2.1]; hospitalization: 1.6[1.5-1.8]). Adjusted event-rates by diabetes-treatment were 6.7 (SU + insulin), 4.9 (SU + insulin + other OAD), 3.1 (SU + other OAD), and 3.8 (SU only). Patients with ≥1 severe event were older (p < 0.001) and had longer diabetes-duration (p = 0.020) than patients without severe events. Participation in educational diabetes-programs and indirect measures of insulin-resistance (increased BMI, plasma-triglycerides) were associated with fewer events (all p < 0.001). Impaired renal function was common (N = 3,113 eGFR ≤30 mL/min) and associated with an increased rate of severe events (≤30 mL/min: 7.7; 30-60 mL/min: 4.8; >60 mL/min: 3.9). CONCLUSIONS These real-life data showed a rate of severe hypoglycemia of 3.9/100 patient-years in SU-treated patients from specialized diabetes centers. Higher risk was associated with known risk-factors including lack of diabetes-education, older age, and decreased eGFR, but also with lower BMI and lower triglyceride-levels, suggesting that SU-treatment in those patients should be considered with caution. This article is protected by copyright. All rights reserved.

The New England society orations; addresses, sermons, and poems delivered before the New England society in the city of New York, 1820-1885,

I. Hopkins, W. R. Beginnings of the New England society of New York, 1884. Spring, G. A tribute to New England, 1820. Remarks on the charges made by the Rev. Gardiner Spring, D. D., against the religion and morals of the people of Boston and its vicinity, 1821. Romeyn, J. B. The duty and reward of honouring God, 1821. Whelpley, P. M. "The memory of the just is blessed." 1822. Knapp, S. L. Address, 1829. Bacon, L. Address, 1838. Winthrop, R. C. Address, 1839. Hadduck, C. R. The elements of national greatness, 1841. Cheever, G. B. The elements of national greatness, 1842. Choate, R. The age of the Pilgrims the heroic period of our history, 1843. Webster, D. The landing at Plymouth. 1843. Marsh, G. P. Address, 1844. Upham, C. W. The spirit of the day and its lessons, 1846.--II. Hall, J. P. Discourse, 1847. Bushnell, H. The founders, great in their unconsciousness, 1949. Webster, D. The Constitution and the union, 1850. Hillard, G. S. The past and the futur

Female Exiles in Language: Reading for New Poetic Subjects in Modern and Contemporary Feminist Experimental Poetry

Thesis (Ph.D.)--University of Washington, 2016-06

The use of anticholinergic agents to treat excessive oropharyngeal and tracheal secretions in palliative care

Palliative care involves a multi-professional team approach to the provision of active, holistic care for patients and their families when the patient's disease is no longer responsive to curative treatment. Patient care encompasses medical and pharmacological intervention for symptom control, together with psychological, spiritual and social support for patients and families. Care is provided by teams in hospice, hospital or community environments. Although traditionally associated with providing care for cancer patients, palliative care services are increasingly providing for patients with non-malignant disease. Symptoms commonly associated with terminal phase of disease include pain, nausea, agitation, respiratory symptoms and general fatigue. During the last few days of life, patients may become weak, resulting in difficulty taking oral medication and have periods of unconsciousness. Some patients may require drug administration via subcutaneous infusion. A proportion of patients may develop difficulty clearing respiratory secretions causing a characteristic ‘death rattle’, which although not generally considered to be distressing for the patient, is often treated with a variety of anticholinergic drugs in an attempt to reduce the ‘noisy breathing’ for the benefit of relatives and others who may be closely associated with the patient.This study examined treatment of death rattle in two Hospices focusing on objective and subjective outcome measures in order to determine the efficacy of anticholinergic regimens in current use. Qualitative methods were employed to elicit attitudes of professionals and carers working closely with the patient. The number of patients recruited and monitored were small, many confounding factors were identified which questioned firstly the clinical rationale for administering anticholinergic drugs routinely to treat death rattle and secondly, the ethics of administering drug regimens to patients to treat death rattle with the primary aim of relieving distress for others. Ethnical issues, including those of consent are discussed in relation to their impact on the methodology of end of life studies in medicines management in palliative care.

Processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance

Résumé : Malgré le fait que la vaccination soit reconnue comme l’une des mesures de santé publique les plus efficaces, elle est perçue comme non sécuritaire et non nécessaire par un nombre grandissant de parents. Dans ce contexte, la compréhension du processus décisionnel des parents par rapport à la vaccination de leur enfant serait aidante. Le but de cette étude est d’explorer le processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance, soit la génération X ou Y. Une étude de cas descriptive et comparative a été réalisée avec des entrevues semi-structurées ainsi qu’une analyse des sources d’informations consultées par les participantes. Les mères ont été sélectionnées selon leur intention de vaccination pour leur enfant. Les données ont été codifiées et analysées de façon systématique et rigoureuse au niveau intra-cas et inter-cas, co-analysées et ensuite validées avec les participantes. Quatre mères dans chaque génération ont été interviewées, dont trois participantes par génération à deux reprises. Le processus décisionnel est similaire d’une génération à l’autre. Les composantes du processus sont l’attitude initiale envers la vaccination, le processus cognitif, la recherche d’information, la décision, l’acte et l’évaluation rétrospective de l’expérience vécue. Toutes ces composantes sont influencées par des facteurs intrinsèques et extrinsèques. Certaines trouvailles de cette étude ont peu été documentées dans la littérature telles que la perception positive envers la vaccination, l’inconscience du processus, l’importance du déclencheur et le fait de saisir le moment opportun. Malgré la rigueur de cette étude, la principale limite est la saturation des données qui n’a possiblement pas été atteinte pour tous les aspects du processus décisionnel. Même si la norme sociale est favorable à la vaccination, aucune participante n’avait consciemment réfléchi à l’immunisation de son enfant jusqu’à ce qu’un déclencheur soit introduit. Ceci soulève l’enjeu et l’impact de la transmission de l’information adéquate, au moment opportun, et du soutien donné aux parents qui naviguent dans ce processus.

Can we predict agitation in patients with suicide attempts in the emergency department?

Background: The agitation in patients presenting to the emergency department (ED) after suicide attempts is common and an important problem. Objective: To establish whether we can predict agitated patients among suicide attempt patients in ED. Methods: This is a cross-sectional observational study of adult suicide attempt events in ED. Information was collected prospectively on a specially designed data-collection form. Patients aged 16 years old and above who presented to the ED for care due to suicide attempts were included in the study. Suicide attempts were grouped as aggressive and non-aggressive attempts. Results: A total of 533 patients were included. Forty-three of these patients had agitation in ED (8%). Non-aggressive suicide attempts were referred to psychiatry services more than aggressive ones (73.6%, n=345 vs 32.8%, n=21, P<0.0001). Agitation in ED and being male increased aggressive suicide attempt risk 3.5 (95% CI:1.6-7.6) and 3.2 times (95% CI:1.8-5.5), respectively. Agitation was statistically more frequent among these patients: those on antidepressant overdose, with previous suicide attempt; with aggressive suicide attempt; and those with confusion; and unconsciousness (P<0.05). Conclusion: Patients who attempted suicide and whose risk of harm to others included those with: antidepressant overdose, aggressive suicide attempt and the unconscious. Response teams should be prepared for these subgroups.

Cartas imaginarias a Freud y otros ensayos

"Las cinco cartas imaginarias a Freud recogidas en este libro son su columna vertebral y los efectos que producirán en la comunidad psicoanalítica están aún por verse. Pero las cartas no agotan los aportes de esta obra. Alberto Fergusson, médico, psiquiatra y psicoanalista, tiene toda una historia vital dedicada al estudio y el tratamiento de pacientes psicóticos. En los años ochenta creó el Instituto de Autorrehabilitación Acompañada, inspirado en las premisas del freudomarxismo de la Escuela de Frankfurt y en el mal llamado "movimiento antipsiquiátrico" (mal llamado en la medida en que no se opone a la psiquiatría, sino más bien a una mala práctica psiquiátrica) y en los trabajos y experiencias de Laing, Cooper, Basaglia y Szasz. La materialización de los conceptos del Instituto se produjo en una singular experiencia denominada Fungrata, pero conocida en el mundo académico y profesional como "La granja". Esa institución, pionera en nuestro país, sigue produciendo asombro en varias partes del mundo por haber llegado, desde ya hace décadas, adonde muchos otros dispositivos dedicados a la intervención psicosocial con pacientes psicóticos hoy aspiran llegar". (Extracto del "prólogo") Miguel Gutiérrez-Peláez

El concepto de sublimación en psicoanálisis, una revisión de literatura

Este trabajo es una revisión de literatura que abarca una serie de artículos disponibles en la base de datos de la Universidad del Rosario, publicados entre los años 2006- 2016. En total se revisaron 52 artículos. Se presenta el concepto de sublimación según el psicoanálisis, el cual ha sido investigado en áreas como la religión, la filosofía, el arte, la cultura y en algunos casos en donde este se evidencia; finalmente se presentan conclusiones sobre dicho concepto durante últimos 10 años.