RESUMEN
Attention-deficit/hyperactivity disorder (ADHD) affects people of all ages, yet its presentation varies as the person matures and social demands increase from childhood into adulthood. Interestingly, when analyzing the disorder in adults, it is not immediately clear what the 'attention deficit' in the ADHD denomination exactly means. Adults with ADHD have a broad range of difficulties, far beyond an attentional deficit, that impact negatively their social functioning and often lead to failures in all walks of life. Therefore, in this review, I attempt to reconcile the notion of attention deficit with the protean manifestations of ADHD in adults through a proposal that ADHD symptoms have as a common denominator an inattention to the future. I build this construct through a multilayered approach, progressing from the epidemiological and clinical considerations for Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis, to a deeper understanding of the disorder, discussing how these patients fail to anchor the present into the future (i.e., to be attentive to future consequences), thus failing to approximate future goals from present action. Integrating cognitive observations with imaging abnormalities, it is possible to propose that ADHD in adults is perhaps the most prevalent frontal lobe disorder in humans, ultimately impacting upon psychosocial management and treatment strategies.
O transtorno de déficit de atenção/hiperatividade (TDAH) afeta pessoas de todas as idades, embora a apresentação varie de acordo com a maturação cerebral e as demandas sociais, da infância para a idade adulta. Interessantemente, quando se analisa o TDAH em adultos, não fica imediatamente claro o que quer dizer o 'déficit de atenção'. Adultos com TDAH apresentam um conjunto amplo de dificuldades, que vão muito além de um déficit atencional, impactando negativamente seu funcionamento social e levando a fracassos recorrentes em vários aspectos da vida. Nessa revisão eu tento conciliar a noção de deficit de atenção com as complexas manifestações do TDAH em adultos, através da proposição de que os sintomas têm como denominador comum uma desatenção ao futuro. Eu construo esse argumento através de uma abordagem que se inicia com uma revisão dos aspectos clínicos e epidemiológicos até uma compreensão mais profunda do distúrbio, discutindo como esses pacientes têm dificuldade em ancorar o presente no futuro (ou seja, estar atentos às consequências futuras), assim falhando em aproximar objetivos futuros de ações no presente. A partir da integração do contexto cognitivo com alterações de neuroimagem é possível propor que o TDAH em adultos é talvez a forma mais prevalente de doença de lobo frontal em humanos, com impacto no manejo psicossocial e na busca de estratégias terapêuticas.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Humanos , Adulto , Manual Diagnóstico y Estadístico de los Trastornos MentalesRESUMEN
OBJECTIVE: The aim of the present study was to verify the psychometric qualities of the PID-5-FBF in a community sample of Brazilian adults. The internal consistency of the facets and the internal structure of the dimensions were checked. In addition, we verified the correlations between the PID-5-FBF facets and domains with a five-factor model measure. METHODS: The sample of this study consists of the 774 Brazilian adults aged 18 to 73 years (mean 28.9±11.58) who answered the PID-5-FBF and BFI-2S. RESULTS: The alpha values were adequate. The internal structure was similar to the PID-5 original form. All the factors and dimensions of the PID-5-FBF have a negative association with agreeableness, while, on the other hand, all correlations with neuroticism were positive. Neuroticism was the factor with the highest correlation with the PID-5-FBF, and openness was the one with the lowest number of correlations. CONCLUSIONS: This research contributes to adding evidence of validity to the PID-5-FBF in the Brazilian community sample. Our results are important because it is the first study with the PID-FBF in a Brazilian sample.
Asunto(s)
Manual Diagnóstico y Estadístico de los Trastornos Mentales , Inventario de Personalidad , Psicometría , Humanos , Brasil , Adulto , Persona de Mediana Edad , Masculino , Femenino , Adulto Joven , Anciano , Adolescente , Reproducibilidad de los ResultadosRESUMEN
El ser humano está signado por el conflicto, por los deseos contradictorios, por el intercambio nunca simple con los otros. Suponer que el otro debe ser una máquina que siga pautas implica desvitalizarlo, lo que es equivalente al aniquilamiento de lo humano. Las niñas y los niños no tienen que ser encerrados ni con clasificaciones psicopatológicas, ni con medicamentos. Las niñas y los niños tienen que tener un sostén esperanzado por parte del entorno, un suelo a partir del cual puedan desplegar sus alas... Transmitir esperanzas es parte importante de nuestra tarea. Debemos dejar que la vida fluya y aportar para que ese fluir derive en nuevos vuelos AU
The human being is marked by the conflict, the contradictory desires, by the never easy exchange with other people.Supposing that the other person must be a machine which follows guidelines means devitalize him and implies the annihilation of the human being.Girls and boys cannot be bounded, nor with psychopathological classifications either with medicines. Girls and boys must have a hopeful support by their environment, a ground which helps them to open their wings... Giving hope is a very important part of our duty.We must let the life flows and contribute to that flowing leads to new flights AU
L'être humain est marqué par le conflit, par les désirs contradictoires, par l'échange jamais simple avec autrui.Supposer que l'autre doit être une machine qui suit des directives implique de le dévitaliser, ce qui équivaut à l'anéantissement de l'humain.Les filles et les garçons ne doivent pas être enfermés, ni avec des classifications psychopathologiques, ni avec des médicaments.Les filles et les garçons doivent bénéficier du soutien plein d'espoir de leur environnement, d'un terrain à partir duquel ils peuvent déployer leurs ailes...Transmettre l'espoir est une partie importante de notre tâche.Il faut laisser lavie couler et contribuer à ce que ce flux conduise à de nouveaux envols AU
A pessoa humana está marcada pelo conflito, pelos desejos contraditórios, pela troca nunca simples com os outros.Assumir que a outra pessoa deve ser um aparelho que segue directrizes implica desvitalizá-lo, o que equivale à aniquilação do que é humano.As crianças não devem ser trancadas, nem com clasificações psicopatológicas, nem com medicação.As crianças devem ter um apoio esperançoso do seu ambiente, uma base a partir do qual possam abrir suas asas... Transmitir esperanças é uma parte importante da nossa tarefa. Devemos deixar a vida fluir e contribuir para garantir que esse fluxo conduzca a novos voos AU
Asunto(s)
Humanos , Preescolar , Niño , Terapia Psicoanalítica/métodos , Ética Profesional , Trastornos Mentales/diagnóstico , Psicopatología/ética , Manual Diagnóstico y Estadístico de los Trastornos MentalesRESUMEN
BACKGROUND: The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown. METHODS: The study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR-) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR- < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings. RESULTS: Several DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR- values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR- values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties. CONCLUSIONS: The DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.
Asunto(s)
Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastornos Mentales , Humanos , Femenino , Masculino , Estudios Transversales , Adulto Joven , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Brasil/epidemiología , Sensibilidad y Especificidad , Tamizaje Masivo/métodos , Adolescente , AdultoRESUMEN
INTRODUCTION: The aim of the study is to demonstrate the need to apply an assessment methodology in Attention Deficit Hyperactivity Disorder (ADHD) due to the lack of agreement between parents and teachers on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). METHODS: This is a retrospective descriptive study of three years and ten months. The sample was drawn from 640 subjects assessed and diagnosed with ADHD, aged between 8 and 16 years, and with a Total Intellectual Quotient (TQ) between 80 and 120. Subjects underwent a neuropsychological assessment. Certain scales of the questionnaires: Child and Adolescent Assessment System (SENA) and Behavioural Assessment of Executive Function-2 (BRIEF-2), both completed by parents, and the DSM-5 criteria answered by parents and teachers were taken into account. RESULTS: As a result, a low concordance was observed between the observations obtained from the DSM-5 between parents and teachers.
Introducción: El objetivo del trabajo es evidenciar la necesidad de aplicar una metodología de evaluación en el Trastorno por Déficit de Atención e Hiperactividad (TDAH) por la falta de acuerdo entre padres y profesores en los criterios del Manual diagnóstico y estadístico de los trastornos mentales, quinta edición (DSM-5). Métodos: Se trata de un estudio descriptivo retrospectivo de tres años y diez meses. La muestra se extrajo de 640 sujetos evaluados y diagnosticados de TDAH, con edades comprendidas entre 8 y 16 años, y un Cociente Intelectual Total (CIT) entre 80 y 120. A los sujetos se les aplicó una evaluación neuropsicológica. Se tuvieron en cuenta determinadas escalas de los cuestionarios: Sistema de Evaluación de Niños y Adolescentes (SENA) y Evaluación Conductual de la Función Ejecutiva-2 (BRIEF-2), ambos cumplimentados por padres, y los criterios del DSM-5 contestados por padres y profesores. Resultados: Como resultado se observa una baja concordancia entre las observaciones obtenidas del DSM-5 entre padres y profesores.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Niño , Adolescente , Humanos , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/psicología , Estudios Retrospectivos , Pruebas Neuropsicológicas , Encuestas y Cuestionarios , Manual Diagnóstico y Estadístico de los Trastornos MentalesRESUMEN
Current efforts to better understand alcohol use disorder (AUD) have led to revisions of the most used classification systems, the DSM and the ICD. There is scarce information regarding how the latest versions of those two classification systems (DSM-5 and ICD-11) relate to functional characteristics (functional impairment (FI) and subjective distress (SD)) associated with AUD. Aim:To examine how the primary diagnostic system's criteria (DSM) and guidelines (ICD) were related to two functional characteristics (FI and SD) as evidence of these systems' concurrent validity in Argentineans with AUD. Methods:We conducted a cross-sectional correlational study with a clinical sample (n=34) in 2018. Results:AUD's severity was more strongly related to SD than FI. FI was weakly related to the criterion of much time spent usingit. We found weak associations between SD and role impairment, interpersonal problems, tolerance, and physical or psychological problems due to use, withdrawal, and much time spent using. Only one of the ICD guidelines was weakly related to SD, and we found moderate positive correlations between DSM-5 and FI and between DSM-5 and SD. Conclusion:DSM-5 was more accurate than ICD-11 in identifying those with higher levels of FI and SD and, thus, had a greater concurrent validity among a clinical sample of Argentineans with AUD. Our results contribute to a better understanding of the detection of alcohol-related conditions. Keywords:alcohol-related disorders; diagnostic and statistical manual of mental disorders; international classification of diseases;psychological distress
Los esfuerzos por comprender mejor el trastorno por uso de alcohol (TUA) han dado lugar a revisiones de los sistemas de clasificación más utilizados, el DSM y la ICD. Hay escasa información sobre cómo sus últimas versiones (DSM-5 y ICD-11) se relacionan con las características funcionales (deterioro funcional (DF) y angustia subjetiva (AS)) asociadas con el TUA. Objetivo: examinar cómo los criterios de los sistemas de diagnóstico se relacionaron con dos características funcionales (DF y AS) como evidencia de la validez concurrente en argentinos con TUA. Métodos: Realizamos un estudio correlacional-transversal con una muestra clínica (n= 34) en el año 2018. Resultados: La gravedad del AUD estuvo más fuertemente relacionada con la AS que con la DF. El DF se relacionó débilmente con el criterio mucho tiempo dedicado al uso. Se encontraron asociaciones débiles entre AS y deterioro de roles, problemas interpersonales, tolerancia y problemas físicos o psicológicos debido al uso, abstinencia y mucho tiempo dedicado al uso. Sólo una de las guías de la CIE estaba débilmente relacionada con la AS, y encontramos correlaciones positivas moderadas entre el DSM-5 y AS y entre el DSM-5 y DF. Conclusión: El DSM-5 fue más preciso que la CIE-11 para identificar a aquellos con mayores niveles de AS y DF y, por tanto, tuvo una mayor validez concurrente en la población observada. Estos resultados contribuyen a una mejor comprensión de la detección de las condiciones mentales relacionadas con el uso de alcohol. Palabras clave: trastornos relacionados con alcohol; manual diagnóstico y estadístico de los trastornos mentales; clasificación internacional de enfermedades; distrés psicológico
Asunto(s)
Humanos , Masculino , Femenino , Trastornos Relacionados con Alcohol , Distrés Psicológico , Clasificación Internacional de Enfermedades , Manual Diagnóstico y Estadístico de los Trastornos MentalesRESUMEN
PURPOSE: Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth. METHOD: The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables. RESULTS: The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries. CONCLUSIONS: There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.
Asunto(s)
COVID-19 , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Parto , SARS-CoV-2 , Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/diagnóstico , COVID-19/epidemiología , COVID-19/psicología , Femenino , Prevalencia , Parto/psicología , Embarazo , Periodo Posparto , PandemiasRESUMEN
Resumo: Este artigo busca problematizar como o discurso sobre a depressão, nas três primeiras edições do Manual diagnóstico e estatístico de transtornos mentais , efetuou a apropriação da contradição sofrimento-patologia. Para tanto, a análise foi orientada pelos princípios da análise de discurso francesa, de Michel Pêcheux, desenvolvida, no Brasil, por Eni Orlandi. O estudo salienta que: 1) as duas primeiras edições do manual apresentavam a depressão como efeito; a partir da terceira há um entendimento da depressão enquanto causa; 2) nas duas primeiras edições do manual, sofrimento e patologia são um único e mesmo objeto, já na terceira edição ocorre uma cisão entre essas esferas; 3) o mecanismo discursivo da antecipação pode contribuir para a compreensão do processo de apagamento do sujeito da enunciação pelo sujeito do enunciado nos manuais diagnósticos.
Abstract: This paper problematizes how the discourse on depression upheld by the first, second and third editions of the Diagnostic and Statistical Manual of Mental Disorders appropriated the distress-pathology contradiction. Based on the principles of Michel Pêcheux's French Discourse Analysis, developed, in Brazil by Eni Orlandi, the study emphasizes that: 1) the manual's first and second editions understood depression as an effect, whereas the third depicted it as a cause; 2) in the first and second editions distress and pathology were one and the same, but the third edition splits them into two different spheres; 3) anticipation, as a discursive mechanism, can help to comprehend the process by which the subject of enunciation is suppressed by the subject of the statement in the diagnostic manuals.
Résumé : Cet article problématise la façon dont le discours sur la dépression soutenu par les trois premières éditions du Manuel diagnostique et statistique des troubles mentaux s'est approprié la contradiction souffrance-pathologie. Basée sur les principes de l'analyse du discours français de Michel Pêcheux, développée au Brésil par Eni Orlandi, l'étude souligne que : 1) les deux premières éditions du manuel considèrent la dépression comme un effet, alors que la troisième la décrit comme une cause ; 2) dans les deux premières éditions, la souffrance et la pathologie sont une seule et même chose, tandis que la troisième édition sépare ces sphères ; 3) l'anticipation, en tant que mécanisme discursif, peut aider à comprendre les processus par lequel le sujet de l'énonciation est supprimé par le sujet de l'énoncé dans les manuels diagnostiques.
Resumen: Este artículo busca problematizar cómo el discurso sobre la depresión, en las tres primeras ediciones del Manual Diagnóstico y Estadístico de los Trastornos Mentales , se apropió de la contradicción sufrimiento-patología. Para ello, el análisis se guio por los principios del análisis del discurso francés, de Michel Pêcheux, desarrollado por Eni Orlandi en Brasil. El estudio destaca que: 1) las dos primeras ediciones del manual presentaban la depresión como un efecto, a partir de la tercera hay una comprensión de la depresión como causa; 2) en las dos primeras ediciones del manual, el sufrimiento y la patología son un mismo objeto, por otro lado, en la tercera edición hay una escisión entre estas esferas; 3) el mecanismo discursivo de anticipación puede contribuir a la comprensión del proceso de supresión del sujeto de la enunciación por el sujeto del enunciado en los manuales diagnósticos.
Asunto(s)
Humanos , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Depresión/clasificación , Depresión/diagnóstico , Depresión/historia , Patología , Causalidad , Distrés PsicológicoRESUMEN
OBJECTIVES: The most recent DSM-5 (2013) and ICD-11 (2018) diagnostic criteria for posttraumatic stress disorder (PTSD) encompass 20 and six symptoms, respectively, organized in different structures. This study aimed to investigate the dimensions of the Posttraumatic Stress Disorder Checklist 5 (PCL-5) according to the DSM-5's broader definition of PTSD and the ICD-11's narrower approach, as well as to explore an alternative restricted model that retains the core symptoms explicitly related to traumatic experiences. METHODS: Data were gathered from Brazilian employees (n=1,101) who had directly experienced traumatic life events or had been exposed to them because of their work activities. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to evaluate the configural and metric structures of the models. RESULTS: We estimated seven models of the latent structure of PTSD including the four-factor DSM-5 and three-factor ICD-11 PTSD models. Given the lack of evidence of their validity, an alternative 10-symptom model was tested. The final seven-item PTSD model considerably improved estimation of the PTSD construct. This solution showed reliable items with non-redundant content, acceptable fit indices, and satisfactory configural and metric properties. CONCLUSION: The more parsimonious one-dimensional model comprising the core PTSD symptoms has the potential to improve assessment of PTSD.
Asunto(s)
Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/diagnóstico , Clasificación Internacional de Enfermedades , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Análisis Factorial , Análisis de Clases LatentesRESUMEN
OBJECTIVE: Cross-sectional studies show that habitual use of alcohol is associated with severity of alcohol dependence reflected across a range of domains and lower number of detoxifications in multiple settings. In this study, we investigated whether alcohol use disorder (AUD) patients with greater habitual use of alcohol at baseline showed worse outcomes after one year of follow-up. METHODS: A sample of inpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol use disorder (AUD) was assessed at baseline (n = 50) and after one year (n = 30). The Habit, Reward, and Fear Scale (HRFS) was employed to quantify affective (fear or reward) and non-affective (habitual) drives for alcohol use, the Alcohol Dependence Scale (ADS) was used to assess clinical outcomes, and the Depression, Anxiety and Stress Scale (DASS-21) was used to quantify and control for associated affective symptoms. RESULTS: There was a significant reduction in the three HRFS scores at the follow-up. Regression analyses demonstrated that greater habit- and fear-related drives at baseline predicted greater decreases in the ADS scores at the endpoint. However, after controlling for age, sex and affective symptoms, only reward and fear were associated with reductions in ADS scores at the end of one year. Prescriptions of naltrexone and antidepressants/benzodiazepines did not predict decreases in reward and fear-related motivations. CONCLUSION: Although we were unable to confirm that habitual subscores at baseline predict worse long-term outcomes among inpatients with AUD, we found that a greater fear and reward motives for the use of alcohol predicted a greater magnitude of improvement in the AUD symptoms after one year. We hope that these findings will help develop new approaches toward AUD treatment and inform models of addiction research.
Asunto(s)
Alcoholismo , Humanos , Alcoholismo/psicología , Estudios Prospectivos , Motivación , Estudios Transversales , Recompensa , Miedo , Hábitos , Manual Diagnóstico y Estadístico de los Trastornos MentalesRESUMEN
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder of biological origin with a 70 to 80% genetic basis, which affects 5% of children and adolescents and 2.5% of adults, whose main symptoms are inattention, hyperactivity, and impulsivity. For many years it was thought that it only affected children; currently in the DSM 5 it is accepted that it can be diagnosed in adolescents and adults. Treatment must be individualized, the main objectives are to improve the core symptoms of people with ADHD, and their quality of life. The therapeutic approach is psychological, behavioral, and pharmacological. Medications are classified as stimulants and nonstimulants, with stimulants such as methylphenidate, lisdexamfetamine, and dexamphetamine being the first line. Non-stimulants include guanfacine and atomoxetine. Treatment is essential because it improves the quality of life of the person at the family, educational, work, and social levels.
El Trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo de origen biológico con una base genética del 70 al 80%, que afecta al 5% de niños y adolescentes y a un 2.5% de los adultos, cuyos síntomas principales son la inatención, hiperactividad e impulsividad. Por muchos años se pensó que afectaba solo a los niños; actualmente en el DSM 5 se acepta que se puede diagnosticar en adolescentes y adultos. El tratamiento debe ser individualizado, los objetivos principales son mejorar los síntomas centrales de las personas con TDAH, y su calidad de vida. El abordaje terapéutico es psicológico, conductual y farmacológico. Los medicamentos se clasifican en estimulantes y no estimulantes, siendo los de primera línea los estimulantes tales como el metilfenidato, lisdexanfetamina y dexanfetamina. Entre los no estimulantes se cuentan a la guanfacina y atomoxetina. El tratamiento es fundamental porque mejora la calidad de vida de la persona a nivel familiar, educativo, laboral y social.
Asunto(s)
Guanfacina , Calidad de Vida , Adolescente , Adulto , Niño , Humanos , Clorhidrato de Atomoxetina/uso terapéutico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , EscolaridadRESUMEN
Since the release of the third version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), biological psychiatry has been systematically applying its classification reasoning to social phenomena of many natures. From this perspective, the discourse of trauma gained relevance and events of devastating magnitude began to receive neurobehavioral interpretations until finally being recognized less for their cultural and subjective effects than for the physiological changes they cause. By a narrative review, this study aims to analyze the transition of traumatic rationality from the 19th century, when trauma was associated with the cognitive concept of memory, to the 20th century, when this phenomenon was finally attached to neuroscientific research on stress. The plurality of conceptual models and deterministic paradigms can contribute to the fact that trauma research produces multifactorial coping protocols more appropriate to the human experience of post-traumatic suffering.
Desde o lançamento da terceira versão do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-III), a psiquiatria biológica vem sistematicamente aplicando seu raciocínio classificatório a fenômenos sociais de múltiplas naturezas. Nessa perspectiva, ganha relevância o discurso do trauma, pelo qual acontecimentos de magnitude devastadora passaram a receber interpretações neurocomportamentais e foram, finalmente, reconhecidos menos por seus impactos culturais e subjetivos que pelas alterações fisiológicas que propiciam. Apoiado em revisão narrativa, este artigo procurará explorar a transição da racionalidade traumática entre o século XIX, quando o trauma fora concebido em associação ao conceito cognitivo de memória, e o século XX, quando finalmente esse fenômeno foi anexado à pesquisa neurocientífica do estresse. A pluralidade de modelos conceituais e paradigmas determinísticos pode contribuir para que a pesquisa do trauma produza protocolos de enfrentamento multifatoriais mais adequados à experiência humana do sofrimento pós-traumático.
Desde la publicación de la tercera versión del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-III), la psiquiatría biológica ha aplicado sistemáticamente su razonamiento clasificatorio a fenómenos sociales de múltiple naturaleza. Desde esta perspectiva cobra relevancia el discurso del trauma, a través del cual eventos muy devastadores pasaron a tener interpretaciones neuroconductuales y finalmente fueron reconocidos menos por sus impactos culturales y subjetivos que por los cambios fisiológicos que provocan. A partir de una revisión narrativa, este artículo busca explorar la transición del razonamiento traumático entre el siglo XIX, cuando el trauma se concibe en asociación con el concepto cognitivo de memoria, y el siglo XX, cuando este fenómeno se vincula a la investigación neurocientífica sobre estrés. La diversidad de modelos conceptuales y paradigmas deterministas puede contribuir a que la investigación del trauma produzca protocolos de afrontamiento multifactoriales más adecuados a la experiencia humana del sufrimiento postraumático.
Asunto(s)
Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/psicología , Brasil , Manual Diagnóstico y Estadístico de los Trastornos MentalesRESUMEN
As resoluções emitidas pelo Sistema Conselhos são instrumentos essenciais de orientação e promoção de práticas éticas que denotem qualidade técnica no exercício profissional da Psicologia. Dada a complexidade que envolve a elaboração de documentos psicológicos, esta pesquisa teve como objetivo identificar as principais mudanças observadas no texto da recém-publicada Resolução CFP n.º 006/2019 quando comparada à Resolução CFP n.º 007/2003, ambas referidas à elaboração de documentos psicológicos. Trata-se de uma pesquisa descritiva-comparativa de abordagem qualitativa, que utilizou da análise de conteúdo no tratamento e interpretação dos dados oriundos de fonte exclusivamente documental. Os resultados indicaram poucas diferenças qualitativas entre os marcos resolutivos, embora se vislumbre altamente relevante o ganho adquirido com a proibição de escritos descritivos, a exigência de referencial teórico para fundamentar o raciocínio profissional e a obrigatoriedade da devolutiva documental. Entre os achados que ganham notoriedade consta a preocupação com os princípios que regem a elaboração de documentos, cuja apresentação tautológica responde a um cenário político de retrocessos que tem favorecido o desrespeito aos direitos humanos e às minorias.(AU)
Resolutions issued by Sistema Conselhos are essential tools to guide and promote ethical and quality psychology practices. Given the complexity involved in elaborating such documents, this descriptive, qualitative research outlines the main changes in the text of the recently published CFP Resolution no. 006/2019 when compared with CFP Resolution no. 007/2003, both addressing the elaboration of psychological documents. Documentary data was investigated by content analysis. Results indicated few qualitative differences between the analyzed Resolutions, among them the prohibition of descriptive writing, the requirement for a theoretical framework to support professional reasoning, and the obligation to return documents. Concern with the principles that guide document elaboration stands out, responding to a political scenario of major setbacks regarding respect for human rights and minorities.(AU)
Las resoluciones que expide el Sistema Conselhos consisten en instrumentos fundamentales que guían y promueven prácticas éticas respecto a la calidad técnica en el ejercicio profesional de la Psicología. Dada la complejidad que implica la elaboración de documentos psicológicos, esta investigación tuvo como objetivo identificar los principales cambios observados en la Resolución CFP n.º 006/2019, de reciente publicación, en comparación con la Resolución CFP n.º 007/2003, ambas abordan la elaboración de documentos psicológicos. Se trata de una investigación descriptiva-comparativa con enfoque cualitativo, que utilizó el análisis de contenido en el tratamiento e interpretación de datos de fuente exclusivamente documental. Los resultados indicaron pocas diferencias cualitativas entre los marcos resolutivos (aunque el logro de prohibir los escritos descriptivos es muy relevante), la exigencia de un marco teórico para sostener el razonamiento profesional y la devolución obligatoria de los documentos. Entre los hallazgos que cobran notoriedad está la preocupación por los principios que rigen la elaboración de documentos, cuya presentación tautológica responde a un escenario político de retrocesos que ha favorecido la falta de respeto a los derechos humanos y las minorías.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Guías como Asunto , Diagnóstico , Testimonio de Experto , Organización y Administración , Grupo de Atención al Paciente , Satisfacción Personal , Fenómenos Psicológicos , Psicología , Publicaciones , Calidad de la Atención de Salud , Calidad de Vida , Conducta Sexual , Clase Social , Valores Sociales , Transexualidad , Revelación de la Verdad , Orientación Vocacional , Trabajo , Escritura , Conducta y Mecanismos de Conducta , Políticas, Planificación y Administración en Salud , Cooperación Técnica , Certificado de Salud , Actitud del Personal de Salud , Registros , Clasificación Internacional de Enfermedades , Directorio , Carga de Trabajo , Derechos Civiles , Negociación , Comunicación , Artículo de Periódico , Vocabulario Controlado , Declaraciones , Publicación Gubernamental , Mala Conducta Profesional , Autonomía Personal , Normas Jurídicas , Consejos de Salud , Denuncia de Irregularidades , Códigos de Ética , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Grupos Raciales , Documentación , Acuerdos de Cooperación Científica y Tecnológica , Dominios Científicos , Ética en la Publicación Científica , Publicaciones Científicas y Técnicas , Publicaciones de Divulgación Científica , Humanización de la Atención , Acogimiento , Ética Profesional , Fecha de Caducidad de Productos , Informe de Investigación , Participación Social , Escritura Médica , Exactitud de los Datos , Profesionalismo , Control de Formularios y Registros , Ciencia en la Literatura , Estrategias de eSalud , Sociedad Civil , Distrés Psicológico , Atención de Salud Universal , Intervención Psicosocial , Ciudadanía , Análisis de Documentos , Condiciones de Trabajo , Escritura Manual , Humanidades , LenguajeRESUMEN
Este estudo teve como objetivo identificar o risco de desenvolvimento de transtorno de estresse pós-traumático (TEPT), bem como sua associação com pensamentos ou tentativas suicidas e a saúde mental de policiais militares feridos por arma de fogo, na Região Metropolitana de Belém (RMB), nos anos de 2017 a 2019. A pesquisa contou com a participação de 30 entrevistados, que responderam o Inventário Demográfico e a Lista de verificação de TEPT para o DSM-5 (PCL-5). Para análise dos dados, utilizou-se a técnica estatística Análise Exploratória de Dados e a técnica multivariada Análise de Correspondência. Os resultados revelaram a existência de risco de desenvolvimento do transtorno de forma parcial ou total em uma expressiva parcela da população entrevistada, tendo homens como maioria dos sintomáticos, com média de 38 anos, exercendo atividades operacionais e vitimados em via pública quando estavam de folga do serviço. O ferimento deixou a maioria com sequelas, com destaque para dores crônicas, limitações de locomoção e/ou mobilidade e perda parcial de um membro. E, ainda, policiais sintomáticos apresentaram comportamentos suicidas, relatando já terem pensado ou tentado tirar a própria vida. Desta forma, conclui-se que policiais militares são expostos constantemente a traumas inerentes a sua profissão. Quando há ameaça de vida, como nos casos de ferimentos por arma de fogo, são suscetíveis a sequelas físicas decorrente do ferimento, somadas a sequelas mentais tardias, como o surgimento de sintomatologias de TEPT e ideação suicida.(AU)
This study aimed to identify the risk of developing post-traumatic stress disorder (PTSD) and its associations around suicidal thoughts or attempts and mental health in military police officers injured by firearms, in the Metropolitan Region of Belem (RMB), from 2017 to 2019. The research had the participation of 30 respondents who answered the Demographic Inventory and the PTSD checklist for DSM-5 (PCL-5). For data analysis, we used the statistical technique Exploratory Data Analysis and the multivariate technique Correspondence Analysis. The results revealed the existence of risk of developing partial or total disorder in a significant portion of the interviewed population, with men as most of the symptomatic individuals, with mean age of 38 years, developing operational activities and victimized on public roads when they were off duty. The injuries left most of them with sequelae, especially chronic pain, limited locomotion and/or mobility, and partial loss of a limb. In addition, symptomatic officers showed suicidal behavior, such as reporting they had thought about or tried to take their own lives. Thus, we conclude that military policemen are constantly exposed to traumas inherent to their profession. When their lives are threatened, as in the case of firearm wounds, they are susceptible to physical sequelae resulting from the injury, in addition to late mental sequelae, such as the appearance of PTSD symptoms and suicidal ideation.(AU)
Este estudio tuvo como objetivo identificar el riesgo de desarrollo de trastorno de estrés postraumático (TEPT) y sus asociaciones con pensamientos o tentativas suicidas y la salud mental en policías militares heridos por armamiento de fuego, en la Región Metropolitana de Belém (Brasil), en el período entre 2017 y 2019. En el estudio participaron 30 entrevistados que respondieron el Inventario Demográfico y la Lista de verificación de TEPT para el DSM-5 (PCL-5). Para el análisis de datos se utilizaron la técnica estadística Análisis Exploratoria de Datos y la técnica multivariada Análisis de Correspondencia. Los resultados revelaron que existen riesgos de desarrollo de trastorno de estrés postraumático de forma parcial o total en una expresiva parcela de la población de policías entrevistados, cuya mayoría de sintomáticos eran hombres, de 38 años en media, que ejercen actividades operacionales y fueron victimados en vía pública cuándo estaban de día libre del servicio. La lesión dejó la mayoría con secuelas, especialmente con dolores crónicos, limitaciones de locomoción y/o movilidad y la pierda parcial de un miembro. Aún los policías sintomáticos presentaran comportamiento suicida, tales como relataran qué ya pensaron o tentaron quitar la propia vida. Se concluye que los policías militaran se exponen constantemente a los traumas inherentes a su profesión. Cuando existe amenaza de vida, como en los casos de heridas por armamiento de fuego, son expuestos a secuelas físicas transcurridas de la herida, sumado a secuelas mentales tardías, como el surgimiento de sintomatologías de TEPT y la ideación suicida.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Dolor , Heridas y Lesiones , Heridas por Arma de Fuego , Síntomas Psíquicos , Riesgo , Distrés Psicológico , Ansiedad , Trastornos de Ansiedad , Trastornos Fóbicos , Prisiones , Psicología , Conducta Fugitiva , Seguridad , Atención , Trastornos del Sueño-Vigilia , Trastornos por Estrés Postraumático , Suicidio , Intento de Suicidio , Terapéutica , Violencia , Síntomas Conductuales , Horas de Trabajo , Agotamiento Profesional , Adaptación Psicológica , Catatonia , Terapia Cognitivo-Conductual , Salud Laboral , Conducta Autodestructiva , Defensa Civil , Derechos Civiles , Trastorno de Pánico , Sector Público , Cognición , Eficiencia Organizacional , Contusiones , Víctimas de Crimen , Trastornos Relacionados con Sustancias , Ingenio y Humor , Crimen , Alerta en Emergencia , Programa de Protección Civil , Protección Civil , Proceso Legal , Muerte , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Agresión , Depresión , Mareo , Sueños , Alcoholismo , Reacción de Fuga , Prevención de Enfermedades , Vigilancia de la Salud del Trabajador , Vigilancia del Ambiente de Trabajo , Fatiga Mental , Miedo , Catastrofización , Medicalización , Esperanza , Atención Plena , Conducta Criminal , Trastornos Relacionados con Traumatismos y Factores de Estrés , Trauma Psicológico , Abuso Físico , Excitabilidad Cortical , Equilibrio entre Vida Personal y Laboral , Estrés Laboral , Violencia con Armas , Reducción de Desastres , Kinesiofobia , Bienestar Psicológico , Prevención del Suicidio , Prevención de Accidentes , Culpa , Cefalea , Promoción de la Salud , Homicidio , Trastornos del Inicio y del Mantenimiento del Sueño , Satisfacción en el Trabajo , Trastornos MentalesRESUMEN
BACKGROUND: Psychosis presentation can be affected by genetic and environmental factors. Differentiating between affective and non-affective psychosis (A-FEP and NA-FEP, respectively) may influence treatment decisions and clinical outcomes. The objective of this paper is to examine differences between patients with A-FEP or NA-FEP in a Latin American sample. METHODS: Patients from two cohorts of patients with a FEP recruited from Brazil and Chile. Subjects included were aged between 15 and 30 years, with an A-FEP or NA-FEP (schizophrenia-spectrum disorders) according to DSM-IV-TR. Sociodemographic data, duration of untreated psychosis and psychotic/mood symptoms were assessed. Generalized estimating equation models were used to assess clinical changes between baseline-follow-up according to diagnosis status. RESULTS: A total of 265 subjects were included. Most of the subjects were male (70.9 %), mean age was 21.36 years. A-FEP and NA-FEP groups were similar in almost all sociodemographic variables, but A-FEP patients had a higher probability of being female. At baseline, the A-FEP group had more manic symptoms and a steeper reduction in manic symptoms scores during the follow- up. The NA-FEP group had more negative symptoms at baseline and a higher improvement during follow-up. All domains of The Positive and Negative Syndrome Scale improved for both groups. No difference for DUP and depression z-scores at baseline and follow-up. LIMITATIONS: The sample was recruited at tertiary hospitals, which may bias the sample towards more severe cases. CONCLUSIONS: This is the largest cohort comparing A-FEP and NA-FEP in Latin America. We found that features in FEP patients could be used to improve diagnosis and support treatment decisions.
Asunto(s)
Trastornos Psicóticos , Esquizofrenia , Adolescente , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Intervención Educativa Precoz , Femenino , Humanos , América Latina/epidemiología , Masculino , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/terapia , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Esquizofrenia/terapia , Adulto JovenAsunto(s)
Trastorno Bipolar , Trastorno de Personalidad Limítrofe , Trastornos por Estrés Postraumático , Humanos , Trastorno Bipolar/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/complicaciones , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , ComorbilidadRESUMEN
Grief is a normal response following the death of a beloved one. Prolonged grief disorder is defined when grief is intense and has persisted for an atypically long period of time; more than 6 months (ICD-11) or more than 12 months (DSM- 5TR). This article discusses the conceptual distance between this new disorder and that of classical descriptions, as considered in a distinct Section of the DSM-5. These differences suggest disagreements among different working groups for disorders. Freud's perspective on mourning and melancholia (mayor depression disorder) pertains also to a classical scope. The grief work is exemplified with an autobiographical case, that illustrates how borders between normal and pathological grief are blurred. Although a new disorder might assist an ever longer-lived population that becomes widow, the risk is the medicalization of grief.
Asunto(s)
Aflicción , Trastorno de Duelo Prolongado , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Pesar , Clasificación Internacional de EnfermedadesRESUMEN
OBJECTIVE: To seek validity and reliability evidence of the Brazilian version of the City Birth Trauma Scale (BiTS-Br) and establish diagnostic accuracy. METHOD: A total of 343 mothers (up to one year after childbirth, 30.8 years old on average) completed the BiTs-Br and other instruments screening for posttraumatic stress disorder (PTSD), depression, and anxiety for convergent validity analysis. Structural validity was verified using exploratory techniques (principal components analysis), while discriminant validity was checked using the known-groups method and ROC curve. The Structured Clinical Interview for DSM-5 was applied via telephone interviews. Test-retest reliability was obtained in a 15-30-d interval. RESULTS: A two-factor structure was found (birth-related and general symptoms), with excellent test-retest reliability (0.73) and internal consistency (0.91). Moderate/strong associations (>0.62) were found with correlated symptoms and posttraumatic stress. The scale had a diagnostic accuracy of 86.7% and a cutoff point >28 was the most appropriate, with a sensitivity of 72% and specificity of 83%. CONCLUSIONS: BiTS-Br presented excellent psychometric indexes, similar to the original version and other cross-culturally adapted versions. Thus, it can be widely used in scientific research and clinical settings to support the identification and treatment of PTSD.
Asunto(s)
Trastornos por Estrés Postraumático , Adulto , Brasil , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Psicometría , Reproducibilidad de los Resultados , Trastornos por Estrés Postraumático/diagnósticoRESUMEN
OBJECTIVE: Limited prosocial emotions (LPE) has been recently incorporated into international classifications as a specifier for conduct disorder in the DSM-5 and for all disruptive behavioural disorders in the ICD-11. The aims of the current work were to determine (a) the accuracy of each of the characteristics used to assess the LPE specifier and (b) whether the manner in which symptoms group together supports the idea of LPE having core characteristics. METHOD: Trained clinicians conducted interviews and determined LPE characteristics using responses from 74 parent/guardian and child/adolescent participants. RESULTS: The distribution of LPE characteristics among those participants with LPE (n = 13) was compared to those with only one LPE characteristic (n = 11). The proposal of callous lack of empathy (CLE) and shallow deficient affect (SDA) as core characteristics was supported by strong associations with the presence of the LPE specifier, larger specificity, and sensitivity indices than those for unconcerned about performance and lack of remorse or guilt, as well as by a robust aggregation in a latent class analysis. CONCLUSIONS: CLE and SDA could be considered as core characteristics of LPE in children and adolescents.
Asunto(s)
Trastorno de la Conducta , Adolescente , Déficit de la Atención y Trastornos de Conducta Disruptiva , Niño , Trastorno de la Conducta/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Emociones/fisiología , Empatía , HumanosRESUMEN
OBJECTIVE: To investigate whether single nucleotide polymorphisms (SNPs) in the ADGRL3, DRD4, and SNAP25 genes are associated with and predict ADHD severity in families from a Caribbean community. METHOD: ADHD severity was derived using latent class cluster analysis of DSM-IV symptomatology. Family-based association tests were conducted to detect associations between SNPs and ADHD severity latent phenotypes. Machine learning algorithms were used to build predictive models of ADHD severity based on demographic and genetic data. RESULTS: Individuals with ADHD exhibited two seemingly independent latent class severity configurations. SNPs harbored in DRD4, SNAP25, and ADGRL3 showed evidence of linkage and association to symptoms severity and a potential pleiotropic effect on distinct domains of ADHD severity. Predictive models discriminate severe from non-severe ADHD in specific symptom domains. CONCLUSION: This study supports the role of DRD4, SNAP25, and ADGRL3 genes in outlining ADHD severity, and a new prediction framework with potential clinical use.