RESUMO
Problemas internalizantes são frequentes em crianças, mas os ingredientes ativos que tornam uma psicoterapia efetiva são ainda pobremente compreendidos. O objetivo deste estudo foi analisar o processo terapêutico psicodinâmico de um menino em idade escolar que apresentava sintomas internalizantes, cujo tratamento foi interrompido após 22 meses. Os participantes foram o paciente e sua terapeuta. O Child Psychotherapy Q-Set foi utilizado para analisar o processo terapêutico. Os resultados mostraram as características da relação terapeuta-paciente e suas transformações. Fatores como conflitos familiares, aliança terapêutica com os pais, limitação da capacidade de mentalização do menino, contratransferência, habilidades e ajustamento da terapeuta ao paciente tiveram impacto no processo terapêutico, contribuindo para o desfecho observado. Para elucidar questões em aberto acerca da efetividade e mecanismos de mudança da psicoterapia psicodinâmica, e para estabelecimento de uma base de evidências consistente, é imprescindível que se conheça, de fato, o que ocorre e como ocorre no setting clínico.
Internalizing problems are frequent in children, but the active ingredients that make a psychotherapy effective are still poorly understood. This study aimed to analyze the psychodynamic therapeutic process of a school-age boy who presented internalizing symptoms, whose treatment was interrupted after 22 months. Participants were the patient and the therapist. The Child Psychotherapy Q-Set was used to analyze the therapeutic process. The results showed the characteristics of the therapist-patient relationship and its transformations. Factors such as family conflicts, therapeutic alliance with the parents, limitation to the ability to mentor the boy, countertransference, skills, and adjustment of the therapist to the patient impacted the therapeutic process, contributing to the observed outcome. In order to clarify the questions about the effectiveness and mechanisms of change in psychodynamic psychotherapy, and for the establishment of a consistent base of evidence, it is essential to know, in fact, what happens and how it happens in the clinical setting.
Problemas de internalización son frecuentes en niños, pero los ingredientes activos que hacen que una psicoterapia sea efectiva todavía son pobremente comprendidos. El objetivo de este estudio fue analizar el proceso terapéutico psicodinámico de un niño en edad escolar que presentaba síntomas de internalización y cuyo tratamiento fue interrumpido después de 22 meses. Los participantes fueron el paciente y su terapeuta. El Child Psychotherapy Q-Set fue utilizado para analizar el proceso terapéutico. Los resultados mostraron las características de la relación terapeuta-paciente y sus transformaciones. Factores como conflictos familiares, alianza terapéutica con los padres, limitación de la capacidad de mentalización del niño, contratransferencia, habilidades y ajustamiento de la terapeuta al paciente tuvieron impacto en el proceso terapéutico, contribuyendo para el desenlace observado. Para elucidar cuestiones en abierto acerca de la efectividad y de los mecanismos de cambio de la psicoterapia psicodinámica, y para el establecimiento de una base de evidencias consistente, es imprescindible que se sepa, de hecho, qué ocurre y cómo ocurre el setting clínico.
Assuntos
Psicanálise , Criança , Processos PsicoterapêuticosRESUMO
PURPOSE: Our understanding of community-level predictors of individual mental disorders in large urban areas of lower income countries is limited. In particular, the proportion of migrant, unemployed, and poorly educated residents in neighborhoods of these urban areas may characterize group contexts and shape residents' health. METHODS: Cross-sectional household interviews of 7251 adults were completed across 83 neighborhoods of Buenos Aires, Argentina; Medellín, Colombia; São Paulo, Brazil; Lima, Peru; and Mexico City, Mexico as part of the World Mental Health Survey Initiative. Past-year internalizing and externalizing mental disorders were assessed, and multilevel models were used. RESULTS: Living in neighborhoods with either an above-average or below-average proportion of migrants and highly educated residents was associated with lower odds of any internalizing disorder (for proportion migrants: OR 0.75, 95% CI 0.62-0.91 for the bottom tertile and OR 0.79, 95% CI 0.67-0.94 for the top tertile compared to the middle tertile; for proportion highly educated: OR 0.76, 95% CI 0.64-0.90 for the bottom tertile and OR 0.58, 95% CI 0.37-0.90 for the top tertile compared to the middle tertile). Living in neighborhoods with an above-average proportion of unemployed individuals was associated with higher odds of having any internalizing disorder (OR 1.49, 95% CI 1.14-1.95 for the top tertile compared to the middle tertile). The proportion of highly educated residents was associated with lower odds of externalizing disorder (OR 0.54, 95% CI 0.31-0.93 for the top tertile compared to the middle tertile). CONCLUSIONS: The associations of neighborhood-level migration, unemployment, and education with individual-level odds of mental disorders highlight the importance of community context for understanding the burden of mental disorders among residents of rapidly urbanizing global settings.
Assuntos
Transtornos Mentais/epidemiologia , Pobreza/psicologia , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos , Adulto , Argentina/epidemiologia , Brasil/epidemiologia , Cidades/epidemiologia , Colômbia/epidemiologia , Estudos Transversais , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , América Latina/epidemiologia , Masculino , Transtornos Mentais/psicologia , México/epidemiologia , Pessoa de Meia-Idade , Análise Multinível , Peru/epidemiologia , Migrantes/psicologia , Desemprego/psicologia , UrbanizaçãoRESUMO
This study explored the clinical importance of latent impulsivity subtypes within a sample of individuals with substance use disorders (SUDs) and high rates of co-occurring disorders (CODs) receiving residential treatment, aiming to assess the heterogeneity of the associations between SUDs and CODs across such impulsivity subtypes. The abbreviated Barratt impulsiveness scale was used to assess motor and cognitive (attentional and nonplanning) impulsivity, a structured interview for diagnosis of SUD and CODs, and other clinimetric measures for severity of substance use. Latent class analysis was conducted to extract subgroups of impulsivity subtypes and Poisson regression to analyze effects of interactions of classes by CODs on severity of substance use. 568 participants were evaluated. Results featured a four-class model as the best-fitted solution: overall high impulsivity (OHI); overall low impulsivity; high cognitive-low motor impulsivity; and moderate cognitive-low motor impulsivity (MC-LMI). OHI and MC-LMI concentrated on most of the individuals with CODs, and individuals within OHI and MC-LMI showed more severity of substance use. The expression of this severity relative to the impulsivity subtypes was modified by their interaction with internalizing and externalizing CODs in very heterogeneous ways. Our findings suggest that knowing either the presence of trait-based subtypes or CODs in individuals with SUDs is not enough to characterize clinical outcomes, and that the analysis of interactions between psychiatric categories and behavioral traits is necessary to better understand the expressions of psychiatric disorders.
RESUMO
BACKGROUND: Studies conducted mainly in high-income countries have shown that preterm births are associated with increased risk of behavioral problems and psychiatric disorders. The aim of this study was to assess the prevalence of behavioral problems from middle-childhood to early-adolescence according to gestational age at birth in a middle-income setting. METHODS: A population-based birth cohort (n = 4231) in Pelotas, Brazil, was followed-up in several occasions from birth to 11 years. Estimated GA was based on last menstrual period or, when unknown or inconsistent, on the Dubowitz method. Behavioral problems were assessed at 4 (Child Behavior Checklist - CBCL), and at 6 and 11 years (Development and Well-Being Assessment - DAWBA) tool. Maternal socio-economic characteristics and depression at 2, 4 and 6 years post-partum, child perinatal characteristics and breastfeeding duration were used as confounders. Analyses were run by linear and logistic regression. RESULTS: Three thousand two hundred four children had full information on gestational age, CBCL and DAWBA. At 4 years, mean total (42.9 ± 24.0) and mean externalizing (18.8 ± 9.1) CBCL scores were higher among preterm girls born at <34 weeks than among full term girls (33.2 ± 15.1 and 15.0 ± 6.6, respectively). After controlling for confounders the association was no longer significant. At the age of 6 years there was no association between gestational age and behavior, neither in crude nor in adjusted analyses. Odds ratio for any psychiatric disorders at 11 years was 60% (1.6; 1.1-2.1) higher among those born at 34-36 weeks than in full-term children, but the association disappeared in adjusted analyses. CONCLUSION: At this large cohort, behavioral problems from middle-childhood to early-adolescence are more related to family socio-economic characteristics and to other child perinatal conditions than to gestational age at birth.
Assuntos
Transtornos do Comportamento Infantil/etiologia , Idade Gestacional , Doenças do Prematuro/etiologia , Brasil/epidemiologia , Criança , Transtornos do Comportamento Infantil/epidemiologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Modelos Lineares , Modelos Logísticos , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Fatores SocioeconômicosRESUMO
This review will discuss the concept of internalizing disorders. It will describe the two main types of internalizing disorder: depressive and anxiety disorders. It will discuss how they have much in common, but that there are also key differences. The review will use data from modern studies of symptom factor analysis, aetiology, treatment and prognosis to illustrate the commonalities and differences. It will conclude by trying to answer where internalizing disorders should be placed in future diagnostic classification schemes.
Esta revisão discute o conceito de transtornos internalizantes, descrevendo os dois principais tipos deste problema: depressão e ansiedade. Será discutido o quanto eles têm em comum, mas também as principais diferenças entre eles. Para ilustrar estas características em comum e as diferenças, serão usados dados de estudos modernos usando análise fatorial de sintomas, etiologia, tratamento e prognóstico. Na conclusão, será feita uma tentativa de responder a questão onde os problemas internalizantes deveriam ser inseridos nos esquemas futuros de classificação diagnóstica.