RESUMEN

INTRODUCTION: Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. OBJECTIVES: The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. METHODS: This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. RESULTS: Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. CONCLUSION: Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.

Asunto(s)

Conducta Ceremonial , Trastorno Obsesivo Compulsivo , Humanos , Prevalencia , Estudios de Casos y Controles , Trastorno Obsesivo Compulsivo/psicología , Conducta Compulsiva/epidemiología , Conducta Compulsiva/psicología

RESUMEN

BACKGROUND: The relatively isolated atrophy of the temporal lobes leads to a clinical radiological pattern, referred to as the temporal variant of frontotemporal dementia. While semantic dementia and behavioral variant frontotemporal dementia are classically related to this syndrome, the logopenic variant of primary progressive aphasia has been less commonly reported. This case report aims to give a pictorial description of a case in which a patient with asymmetric temporal lobe atrophy presented with the logopenic variant of primary progressive aphasia and complex rituals of cleanliness. CASE PRESENTATION: We report on the case of a 68-year-old, right-handed White woman with complex rituals and progressive speech impairment. The obsessive-compulsive rituals represented an exacerbation of lifelong preoccupations with cleanliness and orderliness that were praised by her relatives. Neuropsychological assessment revealed a striking impairment of language and memory, with relative sparing of tool-use praxis and visuospatial skills. Magnetic resonance imaging and 18fluorodeoxyglucose-positron emission tomography scans showed bilateral asymmetrical temporal lobe atrophy and hypometabolism. A year later, she was still able to entertain conversation for a short while, but her vocabulary and fluency had further declined. Praxis and visuospatial skills remained intact. She did not experience pathological elation, delusions, or hallucinations. The disease followed a relentless progression into a partial Klüver-Bucy syndrome, abulia, and terminal dementia. She died from acute myocardial infarction 8 years after the onset of aphasia. The symptoms and their temporal course supported a diagnosis of logopenic variant of primary progressive aphasia due to asymmetric temporal variant frontotemporal lobar degeneration. CONCLUSIONS: This report gives a pictorial description of a temporal variant of frontotemporal dementia in a patient who presented with worsening of a lifelong obsessive-compulsive disorder and logopenic variant of primary progressive aphasia.

Asunto(s)

Afasia Progresiva Primaria , Demencia Frontotemporal , Anciano , Atrofia/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología

RESUMEN

Resumen En el presente reporte se destaca la importancia de explicar y conocer los orígenes del concepto de "Función de lo real" en la perspectiva de Janet. Esto, dadas sus aplicaciones actuales en el estudio del trastorno obsesivo compulsivo, las psicosis, el trastorno por estrés postraumático y los síntomas disociativos. Se define la "Función de lo real" como la aprehensión de la realidad en todas sus formas, por percepción y acción, que modifica todas las demás operaciones psicológicas. Es entonces el resultados de tres operaciones psicológicas principales, que se encuentran dentro de una jerarquía de funciones organizadas y unidas por la tensión psicológica. Como eje teórico central, es la debilidad de dicha tensión lo que provoca un deterioro de estas operaciones y una pérdida de la función de lo real, originando variados síntomas. El deterioro de dichas operaciones y los síntomas derivados son: La acción voluntaria que lleva a conductas compulsivas. La percepción con creencia reflexiva conduce a síntomas obsesivos y la creencia aseverativa a síntomas psicóticos. Personificación y presentificación, relacionada con lo que actualmente denominamos trauma y síntomas disociativos.

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In the following report the author remarks the importance of explaining and knowing the origins of the concept of "Function of the real" in Janet's perspective. The importance of shed some light on this concept derives from its current applications in the study of obsessive compulsive disorder, psychosis and post-traumatic stress disorder and dissociative symptoms. The "Function of the real" or "Reality function" is defined as the apprehension of reality in all its forms. It is the result of three main psychological operations, which are within a hierarchy of functions organized and united by a property called "psychological tension". The weakness of this tension causes a deterioration of these operations and a loss of the reality function causing, as a consequence, various symptoms. The affected operations and the derived symptoms are: The voluntary action that leads to compulsive behaviors. Perception with reflective belief, which conduces to obsessive symptoms, assertive belief and psychotic symptoms. Personification and presentification, related to what we now call trauma and dissociative symptoms.

Asunto(s)

Humanos , Percepción , Trastornos Psicóticos , Trastornos por Estrés Postraumático , Conducta Compulsiva , Trastornos Disociativos , Trastorno Obsesivo Compulsivo

RESUMEN

BACKGROUND: The US National Institutes of Mental Health Research Domain Criteria (RDoC) seek to stimulate research into biologically validated neuropsychological dimensions across mental illness symptoms and diagnoses. The RDoC framework comprises 39 functional constructs designed to be revised and refined, with the overall goal of improving diagnostic validity and treatments. This study aimed to reach a consensus among experts in the addiction field on the 'primary' RDoC constructs most relevant to substance and behavioural addictions. METHODS: Forty-four addiction experts were recruited from Australia, Asia, Europe and the Americas. The Delphi technique was used to determine a consensus as to the degree of importance of each construct in understanding the essential dimensions underpinning addictive behaviours. Expert opinions were canvassed online over three rounds (97% completion rate), with each consecutive round offering feedback for experts to review their opinions. RESULTS: Seven constructs were endorsed by ≥ 80% of experts as 'primary' to the understanding of addictive behaviour: five from the Positive Valence System (reward valuation, expectancy, action selection, reward learning, habit); one from the Cognitive Control System (response selection/inhibition); and one expert-initiated construct (compulsivity). These constructs were rated to be related differentially to stages of the addiction cycle, with some linked more closely to addiction onset and others more to chronicity. Experts agreed that these neuropsychological dimensions apply across a range of addictions. CONCLUSIONS: The study offers a novel and neuropsychologically informed theoretical framework, as well as a cogent step forward to test transdiagnostic concepts in addiction research, with direct implications for assessment, diagnosis, staging of disorder, and treatment.

Asunto(s)

Conducta Adictiva/fisiopatología , Trastornos Relacionados con Sustancias/fisiopatología , Asia , Australia , Conducta Adictiva/diagnóstico , Conducta Adictiva/psicología , Conducta Adictiva/terapia , Conducta Compulsiva , Toma de Decisiones , Técnica Delphi , Europa (Continente) , Hábitos , Humanos , Inhibición Psicológica , Aprendizaje , National Institute of Mental Health (U.S.) , América del Norte , Recompensa , América del Sur , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Estados Unidos

RESUMEN

El trastorno obsesivo-compulsivo (TOC) es una condición clínica heterogénea que presenta una prevalencia del 2% y causa una gran disfuncionalidad. Se han descrito cuatro dimensiones clínicas en esta entidad: simetría/orden, contaminación/lavado, acumulación y sexual/religiosa/agresión. Presenta una amplia comorbilidad y existe evidencia de diferencias neurobiológicas entre el TOC y los trastornos de ansiedad. El DSM-5 y la CIE-11 reconocen que la psicopatología nuclear en el TOC y trastornos relacionados es la compulsión y no la ansiedad. Se discute la posibilidad de añadir otros especificadores clínicos y se formula la esperanza de que sistemas como el Research Domain Criteria (RDoC), estudios dimensionales y la integración de diversas áreas de investigación marquen un futuro promisorio para estos y otros trastornos psiquiátricos.

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Obsessive-compulsive disorder (OCD) is a heterogeneous clinical condition that presents a prevalence of 2% and causes great dysfunctionality. Four dimensions have been described for this condition: symmetry/order, contamination/washing, hoarding and sexual/religious/aggression. There is broad comorbidity and evidence of neurobiological differences between anxiety disorders and OCD. DSM-5 and ICD-11 recognize that the core psychopathology of OCD and related disorders is compulsion rather than anxiety. The possibility of adding other clinical specifiers is discussed, and perspectives such as the Research Domain Criteria Project (RDoC), dimensional studies and the integration of diverse research areas open a promising future for these and other psychiatric disorders.

RESUMEN

O presente artigo resulta de investigações sobre questões clínicas de difícil abordagem, cuja expressão situa-se na passagem adolescente. Dentre essas questões encontramos uma grande incidência da busca por marcar o corpo, seja num sentido ornamental, com tatuagens e piercings; ou mesmo na produção de auto-incisões na pele. Serão abordados fundamentos em Freud e Lacan para dar conta dessas questões.

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El presente artículo es el resultado de investigaciones sobre cuestiones clínicas difíciles de abordar, cuya expresión se sitúa en el pasaje de la adolescencia. Entre esas cuestiones encontramos una gran incidencia de la búsqueda de marcar el cuerpo, ya sea en un sentido ornamental, con tatuajes y piercings, o en la producción de autoincisiones en la piel. Se abordarán fundamentos en Freud y Lacan para dar cuenta de tales cuestiones.

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This article results from research on clinical issues difficult to approach, which expression is located in the adolescent passage. Among these issues it is found a high incidence of searching for body marks, either in an ornamental sense –with tattoos and piercings– or even in the production of auto-incisions on the skin. These issues will be developed from Freud and Lacan's theories.

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Cet article est le résultat de recherches faites à propos de sujets cliniques difficiles à aborder, manifestations qui se présentent lors du passage à l’adolescence. Le fait de marquer le corps, soit dans un sens ornemental avec des tatouages et des piercings, soit en se scarifiant, compte parmi ces manifestations. Des principes chez Freud et Lacan seront abordés pour traiter ces sujets.

Asunto(s)

Cuerpo Humano , Psicoanálisis

RESUMEN

This study aimed to investigate the phenomenology of obsessive-compulsive disorder (OCD), addressing specific questions about the nature of obsessions and compulsions, and to contribute to the World Health Organization's (WHO) revision of OCD diagnostic guidelines. Data from 1001 patients from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders were used. Patients were evaluated by trained clinicians using validated instruments, including the Dimensional Yale-Brown Obsessive-Compulsive Scale, the University of Sao Paulo Sensory Phenomena Scale, and the Brown Assessment of Beliefs Scale. The aims were to compare the types of sensory phenomena (SP, subjective experiences that precede or accompany compulsions) in OCD patients with and without tic disorders and to determine the frequency of mental compulsions, the co-occurrence of obsessions and compulsions, and the range of insight. SP were common in the whole sample, but patients with tic disorders were more likely to have physical sensations and urges only. Mental compulsions occurred in the majority of OCD patients. It was extremely rare for OCD patients to have obsessions without compulsions. A wide range of insight into OCD beliefs was observed, with a small subset presenting no insight. The data generated from this large sample will help practicing clinicians appreciate the full range of OCD symptoms and confirm prior studies in smaller samples the degree to which insight varies. These findings also support specific revisions to the WHO's diagnostic guidelines for OCD, such as describing sensory phenomena, mental compulsions and level of insight, so that the world-wide recognition of this disabling disorder is increased.

Asunto(s)

Conducta Compulsiva/diagnóstico , Conducta Obsesiva/diagnóstico , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/psicología , Determinación de la Personalidad/normas , Escalas de Valoración Psiquiátrica/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Conducta Compulsiva/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducta Obsesiva/psicología , Trastorno Obsesivo Compulsivo/epidemiología , Adulto Joven

RESUMEN

A proposta desse estudo é trazer outro modo de pensar as compulsões além daquela que as interpreta como algo da ordem de uma subjetividade encapsulada. Esse outro modo consiste em trilhar um caminho que denominamos de fenomenológico-hermenêutico. Acreditamos, com isso, poder abrir a possibilidade de se romper com os modelos previamente legitimados no campo da psicologia. Para tanto, procederemos a uma análise das compulsões nos pressupostos metodológicos da fenomenologia hermenêutica de Heidegger, partindo da ideia de que a existência humana se constrói na articulação copertinente com o mundo e viabilizando, assim, uma interpretação das compulsões no horizonte histórico da técnica.(AU)

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The proposal of this study is to think about another way of thinking the compulsions beyond that which interprets this phenomenon as something on the order of subjectivity. This other way is to follow at a new path that here called phenomenological-hermeneutics. It to begin the templates previously legitimized in the field of psychology. We will review the compulsions and its disorders, inspired by the methodological assumptions of hermeneutics phenomenology of Heidegger. Your idea is that human existence is building in conjunction with the world, thus, an interpretation of the compulsions outside the contours of historical horizon of the technique.(AU)

Asunto(s)

Humanos , Conducta Compulsiva , Psicología , Existencialismo

RESUMEN

A proposta desse estudo é trazer outro modo de pensar as compulsões além daquela que as interpreta como algo da ordem de uma subjetividade encapsulada. Esse outro modo consiste em trilhar um caminho que denominamos de fenomenológico-hermenêutico. Acreditamos, com isso, poder abrir a possibilidade de se romper com os modelos previamente legitimados no campo da psicologia. Para tanto, procederemos a uma análise das compulsões nos pressupostos metodológicos da fenomenologia hermenêutica de Heidegger, partindo da ideia de que a existência humana se constrói na articulação copertinente com o mundo e viabilizando, assim, uma interpretação das compulsões no horizonte histórico da técnica.(AU)

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The proposal of this study is to think about another way of thinking the compulsions beyond that which interprets this phenomenon as something on the order of subjectivity. This other way is to follow at a new path that here called phenomenological-hermeneutics. It to begin the templates previously legitimized in the field of psychology. We will review the compulsions and its disorders, inspired by the methodological assumptions of hermeneutics phenomenology of Heidegger. Your idea is that human existence is building in conjunction with the world, thus, an interpretation of the compulsions outside the contours of historical horizon of the technique.(AU)

Asunto(s)

Humanos , Trastorno de Personalidad Compulsiva , Hermenéutica

RESUMEN

A depressão pós-parto é o transtorno afetivo mais prevalente no puerpério. O seu quadro clínico apresenta algumas peculiaridades sintomatológicas, podendo uma delas ser a presença mais freqüente de obsessões e compulsões. Relatamos seis casos identificados pela análise de prontuários de puérperas atendidas no Programa de Saúde Mental da Mulher do Hospital das Clínicas da Universidade Federal de Pernambuco. Todas elas tinham diagnóstico de depressão através do Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) e apresentavam concomitantemente sintomas obsessivo-compulsivos. Nos relatos, abordamos o período de aparecimento desses sintomas nas mulheres deprimidas, assim como o seu conteúdo, duração e resposta ao tratamento. Em duas mulheres, os sintomas obsessivo-compulsivos precederam os depressivos, e em outras duas, deu-se o inverso. Houve exacerbação de obsessões e compulsões preexistentes em duas puérperas. O conteúdo mais freqüente foi de pensamentos agressivos contra o bebê. Os sintomas tenderam a diminuir juntamente com a melhora da depressão.

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Postpartum depression is the most common affective disorder in the puerperium. There are some particular symptoms in its clinical presentation, and one might be the higher frequency of obsessions and compulsions. We report six cases identified from the analysis of medical charts of puerperal women receiving care at the Women's Mental Health Program, Hospital das Clínicas, Universidade Federal de Pernambuco, Brazil. All the women were diagnosed with postpartum depression using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and had associated obsessive-compulsive symptoms. We report time of onset, topics, course and treatment response of these symptoms. Obsessive-compulsive symptoms preceded depressive symptoms in two women, and were succeeded in two other women. There was exacerbation of preexisting obsessions and compulsions in two puerperal women. The most frequent topic was aggressive thoughts toward the baby. Improvement in depressive symptoms tended to reduce obsessive-compulsive symptoms.