Showing papers in "Revista De Psiquiatria Do Rio Grande Do Sul in 2007"

Primates and philosophers: how morality evolved

Abstract: A publicação, em 1859, da obra seminal de Charles Darwin (1809-1882) “A Origem das Espécies”, afetou de forma drástica nossa visão de mundo. Com ela, completava-se a demolição do mito de que seríamos o centro do universo, iniciada três séculos atrás com a demonstração de que o sol, e não a Terra, era o centro de nosso sistema solar. A elucidação dos fundamentos do processo evolucionário, que culminou recentemente com a chamada “revolução molecular”, deixou claro que a nossa irmandade com os outros seres vivos não é mais uma alegoria, mas uma fria constatação científica. Com isso, ficava abalada uma tradição judaico-cristã de milênios, de que o mundo fora criado para nos servir e que éramos completamente distintos dos animais, seres sem alma. Essas considerações foram determinadas pela leitura da excelente obra de Frans de Waal. O livro compõe-se de uma Introdução (11 páginas) feita pelos editores da Série do Centro Universitário para Valores Humanos da Universidade de Princeton, Stephen Macedo e Josiah Ober, seguida por três grandes subdivisões. Na Parte I, o autor, membro do Departamento de Psicologia da Universidade de Emory, em Atlanta, EUA, apresenta um resumo de seus estudos de várias décadas sobre o comportamento de primatas, especialmente do chimpanzé (gênero Pan) e do macaco sul-americano Cebus. O eixo mestre deste primeiro ensaio é um ataque decidido ao que ele denominou “Teoria do Verniz”, segundo a qual os seres humanos seriam basicamente maus, e a moralidade humana apenas uma fina camada de verniz desenvolvida pela cultura sobre um conteúdo anti-social, amoral e egoísta. Ao contrário, argumenta ele, uma visão evolucionária da ética permite vislumbrar suas raízes em nossos parentes biológicos mais próximos, como os chimpanzés, nos quais se observa empatia (a condição de poder se colocar na posição de outro ser), simpatia (resposta afetiva ao sofrimento dos outros), comportamento de consolo, gratidão, imparcialidade e preocupação com a comunidade. Em três apêndices, ele considera: a) antropomorfismo e antropo-negação (o perigo de transferir a outros características humanas, ou a fobia para evitar isto); b) sobre se os grandes macacos têm uma teoria da mente; e c) direitos dos animais. No total, são 78 páginas.

Aspectos epidemiológicos da depressão pós-parto em amostra brasileira

Abstract: INTRODUCTION: Psychiatric symptoms are frequent in the postpartum period, a moment marked by hormonal alterations and changes in social character, family organization and women's identity. The Edinburgh Postnatal Depression Scale (EPDS) is a self-reporting instrument to track depression after pregnancy, unfortunately not always properly supported by health care professionals. This study aimed at verifying the prevalence of postpartum depression in women receiving care at basic health units. METHODS: Cross-sectional study including 292 women in the postpartum period (from day 31 to 180) who answered the EPDS questionnaire. Cut-off point < 12 for EPDS depression was used. RESULTS: A total of 115 women (39.4%) had scores < 12 in EPDS, classified as depressive; 177 (60.6%) had scores < 12 and were not considered depressive. Women with lower education, higher number of pregnancies, higher parity, higher number of live children and shortest relationship time had more depression. CONCLUSION: High frequency of postpartum depression is associated with social factors, which shows the importance of health care professionals in early detection of depression, with the aid of instruments such as EPDS, due to its efficacy and practicability.

O exercício físico no tratamento da depressão em idosos: revisão sistemática

Abstract: OBJECTIVES: To review the literature on the (I) possible protective effect of physical activity on the incidence of depression, and (II) on the efficacy of physical exercise as a therapeutic intervention in depression. METHODS: Systematic review of ISI, PubMed, LILACS and SciELO articles in English and Portuguese from January 1993 to May 2005 using the keywords "depression," "elderly," and "exercise." Articles assessing the effect of physical exercise in the elderly with clinical diseases or that used depression scales only for initial diagnosis were excluded. RESULTS: We found 155 articles, 22 of which met the inclusion criteria. Other eight studies were included after a manual search. Cross-sectional studies (n = 8) used only self-evaluation questionnaires to measure the levels of physical activity. Longitudinal studies (n = 22) also used digital pedometer, direct measurements of oxygen consumption and physical exercise as methodological intervention. The studies meeting the first objective pointed to an inverse relationship between physical activity and changes in levels of depression. The studies that used physical activity as a therapeutic intervention in depression found divergent results and pointed to the interference of physiological and psychological factors on this relation. CONCLUSION: There are two aspects involved in the role of physical activity and exercise in the treatment of depression. Depression decreases the practice of physical activities; physical activity may be useful in the treatment and prevention of depression in the elderly.

Prevalência de depressão em idosas participantes da Universidade para a Terceira Idade

Abstract: BACKGROUND: Studies have suggested that aging is associated with depression. However, elderly can present absence or low prevalence of depressive symptoms when they participate in group activities of permanent education. OBJECTIVE: To investigate the intensity and prevalence of depressive symptoms in elderly women attending the University of the Third Age (UNITI) at Universidade Federal do Rio Grande do Sul. To verify whether participation time in UNITI improves the mood and characteristics of participants before and after entering UNITI. METHOD: One hundred and three UNITI students participated in the study. The Geriatric Depression Scale (GDS) and a form of sociodemographic data were used, investigating the participation time in UNITI and its relation with depressive symptoms, the role of UNITI in the improvement in the mood and characteristics of participants before and after entering this institution. A convenience sample was used. RESULTS: Absence of depressive symptoms were observed in the GDS of the sample under investigation (mean = 2.65; standard deviation = 2.42). Of all elderly women, 80.6% presented normal scores in the GDS and none presented severe depression. There was significant difference between depression and participation time in UNITI ? 1 year (p 1 year. It also suggests that attending a university of the third age brings improvements to the elderly people.

Elaboração da versão em português do Psychotherapy Process Q-Set

Abstract: INTRODUCTION: In Brazil, psychotherapy research is in its early development; there are no systematic studies of the therapeutic process, and there are few available measurement instruments for researchers interested in this field. OBJECTIVE: To develop a Portuguese version of the Psychotherapy Process Q-Set. METHOD: The development of a Portuguese version of the Psychotherapy Process Q-Set involved four stages: translation, back translation, evaluation of semantic equivalence and discussion of the results by the authors. Five raters were trained to apply the instrument. During the training, a field diary was used to record difficulties identified in task execution and to subsidize complementary data. Thereafter, the Psychotherapy Process Q-Set was applied to seven sessions of a short-term psychodynamic psychotherapy to examine agreement between referees. RESULTS: The Portuguese version of the Psychotherapy Process Q-Set presented good semantic equivalence with the original. The assessment of interrater reliability had a satisfactory result. It is worth stressing that applying the Psychotherapy Process Q-Set requires study, time and reflection. The discussion with raters pointed to the need of reviewing the application manual concerning the clinical examples. This will be performed in the near future to minimize the discrepancies observed in the understanding of some concepts and to better adjust them to the Brazilian reality. CONCLUSION: This study provides a Portuguese version of the Psychotherapy Process Q-Set, a versatile instrument that can be used in different contexts to quantitatively describe the therapeutic process of different psychotherapies in clinically significant terms.

Avaliação da qualidade de vida geral de agentes comunitários de saúde: a contribuição relativa das variáveis sociodemográficas e dos domínios da qualidade de vida

Abstract: OBJECTIVE: This study aimed at evaluating the relative contribution of each life quality domain (physical, psychological, social relationships and environment) and of sociodemographic variables to overall quality of life of community health agents from a municipality located in the State of Parana, Brazil. METHODS: A descriptive and cross-sectional study was carried out using a quantitative approach. The sample was composed of 169 agents (86.2% of the total). The World Health Organization Quality of Life Instrument Bref was used as a generic instrument to evaluate quality of life. Correlation tests and multivariate linear regression were used, considering a significance level of 5%. RESULTS: None of the sociodemographic variables significantly interfered with overall quality of life. Among the four domains, the physical domain contributed the most to overall quality of life, followed by the psychological and environment domains, all of them accounting for 47.9% of variance. The domain of social relationships did not show significant contribution to overall quality of life. CONCLUSION: It was observed that variance of overall quality of life was not completely explained by sociodemographic variables neither by quality of life domains. Thus, more attention should be given by researchers to different forms of understanding quality of life, especially research methods and interdisciplinary evaluation.

Sintomas depressivos e eventos estressores em crianças e adolescentes no contexto de institucionalização

Abstract: Introduction: The present study examined the manifestation of depressive symptoms, as well as frequency and impact of stressful events in institutionalized and non-institutionalized children and adolescents. Method: A total of 257 youths, of both genders, aged 7-16 years were included in this study. Of these, 130 lived in protection youth shelters and 127 lived with their families in the metropolitan area of Porto Alegre. All participants were attending 1st to 8th grades of public elementary schools located in low-income neighborhoods. Children's Depression Inventory and Stressful Events in Childhood and Adolescence Inventory were used.

A apologia do consumo de bebidas alcoólicas e da velocidade no trânsito no Brasil: considerações sobre a propaganda de dois problemas de saúde pública

Abstract: Traffic accidents, which are often associated with speeding, and the problems associated with consumption of alcoholic beverages are two major public health concerns in Brazil. These problems may be associated, as in the case of drunk driving, but they also occur independently. Commercial advertising is one of the factors that have an impact on these issues. The influence of advertising on many health issues, including alcohol consumption and traffic safety plays a role that has been continuously investigated and understood. Public and private sectors in Brazil have an influence on the advertising regulation, which is still mainly performed by industry self-regulation. This paper presents a general framework on the subject. In addition, faced with the social and economic hazards resulting from alcohol consumption and traffic accidents, it discusses the role of communication means, its social responsibility and the limits of self-regulation.

Avaliação de resultados da psicoterapia psicanalítica

Abstract: INTRODUCTION: This article reports a retrospective cohort investigation, which assessed the effectiveness of psychoanalytic psychotherapy in adult patients at a community health center in the city of Porto Alegre, Brazil. METHODs: The sample was composed of 34 patients, who were divided into two groups: group 1, 17 patients who underwent treatment for up to 11 months (mean 6.4 months) and group 2, 17 patients who underwent psychotherapy for 1 year or longer (mean 24.7 months). The patients were contacted after their psychotherapeutic treatment was over, in average 20.9 months (group 1) and 29.9 months (group 2). Instruments used were semi-structured interview, effectiveness questionnaire and global assessment of functioning scale. Independent experts applied the global assessment of functioning scale in the initial interview (carried out by the psychotherapist and found in the institution's files), as well as in the follow-up interview. RESULTS: The patients significantly improved their global functioning, when initial assessment was compared to psychotherapy follow-up (p < 0.001), regardless of treatment group. Patients and experts considered psychotherapy satisfactory. However, the experts' opinion was not related to the patients' opinion. CONCLUSIONS: Psychoanalytic psychotherapy was effective in the studied sample. Length of psychotherapy, when assessed alone, was not a decisive factor for treatment outcome, i.e., other factors should also be taken into account when assessing outcomes, such as therapeutic relationship, quality of object relations, self-awareness potential and reaction to interpretations. Most patients were found to be satisfied with outcomes in a shorter time than their psychotherapists would consider optimal.

Factors related to early dropout in psychoanalytic psychotherapy

Abstract: Introduction: The efficacy of psychoanalytic psychotherapy is well established in controlled clinical trials; however, someindividual characteristics that predict better outcomes are yet poorly studied. This study aimed at evaluating the association ofdemographics data, psychiatric diagnosis, clinical impairment, quality of life, aspects of psychotherapy suitability, defensivestyle and dropout before 3 months. Method: A consecutive sample of 56 subjects was evaluated after psychotherapy indication through a standardized protocol,World Health Organization Quality of Life Bref (WHOQOL-Bref), Self Report Questionnaire, Defensive Style Questionnaire,Scale of Defensive Functioning of Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR) andGlobal Assessment of Functioning, and followed for 3 months. Results: Dropout rate was 12.5%. There was no difference between groups in respect to Global Assessment of Functioning, SelfReport Questionnaire and Defensive Style Questionnaire scores. Dropout patients reported to be satisfied with their health,despite psychopathological severity, even when other variables were controlled (p < 0.0001). The group that remained inpsychotherapy was better adjusted before treatment and had average or superior estimated intelligence (p < 0.05). More dropoutpatients presented lower levels of defensive style, by means of the Scale of Defensive Functioning of DSM-IV-TR.

Características de personalidade e depressão em idosas da Universidade para a Terceira Idade (UNITI/UFRGS)

Abstract: INTRODUCTION: Personality aspects have been mentioned as factors that may contribute for the development of depression in old age. This study aimed at examining the influence of personality in the onset of depressive symptoms in elderly women. METHOD: The study had a cross-sectional design and included 103 elderly women, aged between 60-86 years and with minimum schooling level of 7 years, attending the University for the Third Age (UNITI/UFRGS), using a convenience sample. All the participants signed a consent form and provided answers about sociodemographic information, personality factors (Factor Personality Inventory - FPI) and depression (Geriatric Depression Scale - GDS). RESULTS: Presence of two groups (clusters) with distinct personality characteristics was observed: one more preoccupied with the others (cluster 1) and the other more self-concerned (cluster 2). Although both groups did not meet the criteria for depression, there was a significant difference in total GDS score, in which the group more preoccupied with the others (cluster 1) presented more depressive symptoms. CONCLUSIONS: The study indicates an association between personality dimensions and depression in elderly women. The elderly women in cluster 1, who were more devoted to the others, more deferential, organized, persistent and interactive, presented more depressive symptoms in relation to those in cluster 2, who were more self-centered, less interactive and less dominant. Others studies are suggested.

Evidências sobre a terapia cognitivo-comportamental no tratamento de obesos com transtorno da compulsão alimentar periódica

Abstract: OBJECTIVES: To investigate evidence of the efficacy of cognitive-behavioral therapy in the treatment of obese patients with binge eating disorder. METHOD: This review included clinical trials and meta-analyses published in all languages from January 1980 to February 2006. Studies assessing the efficacy of cognitive-behavioral therapy associated with medication, cognitive-behavioral therapy in self-help manuals, case reports or series and letters to editors were excluded. The following electronic databases were used: MEDLINE, PsycINFO, Embase, LILACS and Cochrane Library. Search strategies also included consulting the references of selected articles and chapters of specialized books. RESULTS: Two open and 15 controlled clinical trials were included. The primary outcome in most studies was binge eating. In general, the clinical trials suggest that cognitive-behavioral therapy results in significant improvement in binge eating and other psychopathological symptoms related to binge eating disorder. However, no substantial weight loss was reported. CONCLUSIONS: Available evidence suggests that cognitive-behavioral therapy is an effective intervention method for psychological aspects of binge eating disorder, although its efficacy in body weight reduction and long-term maintenance of results still needs further investigation.

Adaptação transcultural multicêntrica da sexta versão da Escala de Gravidade de Dependência (ASI6) para o Brasil

Abstract: 1 Centro de Pesquisa de Droga e Alcool, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS. 2 Departamento de Psiquiatria, University of Pennsylvania, Filadelfia, EUA. 3 Departamento de Psicobiologia, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP. 4 Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ. 5 Instituto de Psiquiatria, Escola de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, SP. Financiamento: Este estudo foi apoiado pela Secretaria Nacional Antidrogas (SENAD), GPPG-HCPA no 05-460. Projeto aprovado pelo Comite de Etica.

Depressão e suas implicações no aleitamento materno

Abstract: OBJECTIVE: This study aimed at verifying the incidence of depressive symptoms in a group of mothers of children between 12 and 16 months in the municipality of Sao Leopoldo (RS, Brazil) and their associations with breast feeding and overall child development. METHOD: This study included 263 mothers who delivered at a hospital providing services to a population of low socioeconomic level. Depressive symptoms were assessed using Beck Depression Inventory. RESULTS: It was observed that 35.7% of mothers presented depressive symptoms. As to classification, 18.3% had mild, 11% moderate and 6.5% severe depression. Mothers without partners (prevalence ratio - PR = 1.70; IC95% = 1.20-2.38) and mothers from non-nuclear families presented more depressive symptoms (PR = 1.38; IC95% = 0.99-1.92). Exclusive breast feeding at 6 (PR = 1.86; IC95% = 0.94-3.68) and 12 months (PR = 1.80; IC95% = 1.26-2.58) was more frequent in the group of mothers without depressive symptoms. CONCLUSION: More attention should be given to women's mental health, considering the high prevalence of depressive symptoms in this population and the strong association with less breastfeeding time.

Avaliação das habilidades de vida independente e comportamento social de pacientes psiquiátricos desospitalizados

Abstract: INTRODUCAO: Este estudo teve como objetivo avaliar o comportamento social e as habilidades de vida independente de um grupo de pacientes psiquiatricos antes de sua saida do hospital e 2 anos apos a sua transferencia para as residencias terapeuticas. METODO: Estudo de corte transversal, realizado em duas etapas distintas, antes e depois, utilizando-se, como instrumentos, as escalas Independent Living Skills Survey e Social Behavior Scale. RESULTADOS: A maioria dos pacientes era do sexo masculino (58,7%), com medias de idade e tempo de internacao iguais a 57,5±11,8 anos e 29,8±10,2 anos; 54,6% tinham diagnostico de esquizofrenia; 25,3%, de deficiencia mental; e o restante, de categorias varias. Houve melhora significativa no comportamento social e no grau de autonomia dos pacientes (p <0,05) ao se comparar os escores dos pacientes nas escalas, nas fases 1 e 2. As variaveis que mais se associaram com o escore de evolucao foram idade, tempo de internacao e nivel inicial de funcionamento dos pacientes. DISCUSSAO: As limitacoes no funcionamento social e no grau de autonomia dos pacientes, na primeira fase do estudo, nao foram incompativeis com a convivencia na comunidade. Os pacientes apresentaram evolucao satisfatoria no comportamento social e nas habilidades cotidianas ao longo de 2 anos, de acordo com os escores de evolucao medidos pelas duas escalas.

Prevalência de transtorno depressivo maior em centro de referência no tratamento de hipertensão arterial

Abstract: OBJECTIVE: To investigate the prevalence of major depression disorders in hypertensive patients enrolled in a university reference center for treatment of hypertension and other cardiovascular risk factors. METHODS: Cross-sectional, descriptive study of a representative randomized sample of patients, obtained according to a systematic protocol, among individuals enrolled for continuous treatment at the Hypertension League of Universidade Federal de Goias. The Beck Depression Inventory was administered to detect depressive symptoms, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders for diagnostic classification of major depressive disorders. Two groups were formed, one with patients with major depressive disorder, called study group, and another with patients without major depression, called control group. Sociodemographic variables, blood pressure and plasma biochemistry were evaluated at the time of data collection. RESULTS: A total of 285 patients were evaluated and results indicated a 20% prevalence of major depression in the population included in the study. Mean age was significantly lower for the study group, in which female patients were predominant. Regular physical activity was significantly lower among patients in the study group, and higher diastolic blood pressure values as well as cholesterolemia were also found in this group. CONCLUSIONS: These results show a higher prevalence of major depressive disorder among these hypertensive patients, compared with the general population. More attention should be paid to establishing an adequate diagnosis for depressive disorders in hypertensive patients, both in primary care facilities and in outpatient clinics.

Síndrome de Ekbom acompanhada de automutilação

Abstract: Delusional parasitosis (or Ekbom’s syndrome) is a rare condition, in which the patient has a strong conviction that he or she isinfested by small parasites or organisms These delusions are often so intense that they lead the patient to self-mutilation W e reporta case of a 67-year-old man, socially isolated, single, with delusional parasitosis in the perineal area, culminating in self-m utilationlesions Keywords: Paranoid disorders, delusions, self-mutilation, Ekbom’s syndrome Introducao A sindrome de Ekbom – delirio de infestacaoparasitaria, neurodermia parasitofobica, acarofobia ou,como o proprio Ekbom chamou, dermatozoenwahn (delirio dermatozoico) – vem sendo relatada e estudadadesde o seculo XIX 1-4 Porem, foi em 1938 que essemedico austriaco relatou uma serie de casos de umadoenca psiquiatrica, acometendo principalmentemulheres na idade senil ou pre-senil Os pacientesapresentavam uma ideia delirante e persistente de quevermes e microbios os infestavam e saiam pela pele

The emotional impact of bariatric surgery in patients with morbid obesity

Abstract: Bariatric surgery has been used for health recovery and weight loss. In many cases, however, abrupt weight loss produces psychiatric symptoms, such as depression, anxiety, use of drugs, behavioral changes and suicidal ideation, among other situations, all related to the emotional changes faced by the patient in his new physical and chemical state. This study aimed at analyzing hopes, fantasies, results, difficulties, and frustrations present after a surgical procedure. This case report resulted from the data collected from six patients being followed at a public hospital in Santa Catarina, Brazil, who developed symptoms of psychic suffering after the bariatric surgery. Each patient participated in two sessions of semi-structured interviews. This research was approved by the ethics committee of Universidade de Joinville. Results show that psychological changes resulting from the bariatric surgery were remarkable. In some cases, patients expressed expectations beyond weight loss, such as resolution of marital and interpersonal conflicts, as well as changes in stable personality traits. Use of substances (alcohol and tobacco) associated with risk behavior (extra-marital relationships and dangerous driving) was also detected. The problem of obesity was evidenced as part of a complex situation that involves both physical and mental status, and its solution sometimes exposes the patient's difficulties and psychological limitations.

Reforma psiquiátrica no Rio Grande do Sul: uma análise histórica, econômica e do impacto da legislação de 1992

Abstract: The authors present an analysis of the psychiatric reform in Rio Grande do Sul, Brazil, using a historical perspective and an approach by three trends: institutional psychiatry; developments in the extra-hospital area; and policies of health implemented along the years. Based on the references adopted, the experience in Brazil and in Rio Grande do Sul was reviewed using the following sources: MEDLINE and Lilacs databases and official documents from the Brazilian Health Ministry and from the Health State Secretary. Nowadays, 14 years after the promulgation of State Law 9716, which refers to the psychiatric reform in Rio Grande do Sul and determines the progressive replacement of psychiatric hospitals by a network of full mental health care, the number of psychiatric beds was reduced in 35% and the proposal of an "alternative" care network to the mentally ill was not implemented as recommended, neither in an equal form. Bearing in mind that the present challenges, such as the phenomenon of the "revolving door" and the chronicle patient, show the necessity of extending primary and secondary care. The experience in Rio Grande do Sul brings into debate the possibility of changing the strategy, so that, instead of trying to structure "a system inside the system," as is placed today, more benefits can be drawn from the integration of mental health with the main programs in the Brazilian Unified Health System (SUS), such as Family Health Program (PSF) and Community Health Agents Program (PACS).

Impacto dos transtornos depressivos e ansiosos sobre as manifestações da menopausa

Abstract: OBJETIVO: Determinar, pela primeira vez, em uma amostra ambulatorial brasileira, o impacto dos diagnosticos psiquiatricos sobre os sintomas da menopausa presentes no indice de menopausa de Blatt-Kupperman (B-K). METODOS: Avaliamos consecutivamente, atraves do instrumento diagnostico estruturado MINI 4.4 e da entrevista psiquiatrica tradicional, mulheres (n = 86) em atendimento no ambulatorio de menopausa do Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. As pacientes incluidas no estudo (n = 48) foram avaliadas pela escala B-K ate 6 meses antes ou depois da entrevista pelo MINI e divididas em dois grupos: o grupo com algum transtorno depressivo-ansioso (GTDA) (n = 26) e o grupo-controle (GC) (n = 22). RESULTADOS: O GTDA apresentou uma pontuacao significativamente maior do que o GC na escala de B-K (22,6 versus 13,7). Entre os sintomas significativamente mais intensos no GTDA estao parestesia e melancolia. Alem disso, observamos que as pacientes do GTDA queixavam-se de um maior numero de sintomas do que as pacientes do GC (6,8 vs. 4,8). Entre os sintomas significativamente mais relatados no GTDA, estao parestesia, fraqueza e melancolia. CONCLUSAO: Apesar da limitacao da pequena amostra, pudemos observar o significativo vies dos transtornos depressivos e ansiosos sobre as pacientes em tratamento por queixas referentes a menopausa. Por esse motivo, o perfil sintomatico de cada paciente deve ser sempre observado, evitando o ginecologista basear-se na intensidade global dos sintomas do B-K para decidir sobre o tratamento.

Contratransferência no atendimento inicial de vítimas de violência sexual e urbana: uma pesquisa qualitativa/quantitativa

Abstract: OBJETIVO: Avaliar a contratransferencia dos terapeutas durante o atendimento inicial de pacientes mulheres vitimas de violencia sexual e urbana, investigando a influencia do genero do terapeuta e da natureza e momento do trauma. METODO: A amostra foi composta por 36 relatos redigidos por medicos residentes de psiquiatria do Hospital de Clinicas de Porto Alegre, oriundos do atendimento de 36 pacientes. Este estudo utilizou metodos qualitativos e quantitativos para a analise dos seus dados. Os relatos foram classificados em seis grupos, conforme o genero do terapeuta e a natureza do trauma. Foi realizada a analise de conteudo dos relatos. Associou-se uma analise estatistica dos dados. RESULTADOS: Houve predominio de sentimentos de aproximacao nos terapeutas de ambos os sexos no atendimento de vitimas de violencia sexual. Entre terapeutas mulheres, a natureza do trauma (sexual ou urbano) nao influenciou os padroes contratransferenciais (p = 0,7). Entre os terapeutas homens, ao contrario, a natureza do trauma influenciou de forma significativa (p = 0,044) o padrao contratransferencial, havendo um numero elevado de sentimentos de distanciamento nos relatos de atendimentos de vitimas de violencia urbana. CONCLUSOES: Houve um predominio de sentimentos de aproximacao dos terapeutas de ambos os sexos no atendimento inicial de pacientes vitimas de violencia sexual. Foi observado um predominio de sentimentos de distanciamento nos terapeutas homens que atenderam vitimas de violencia urbana. Mais estudos sao necessarios para uma melhor compreensao das relacoes terapeuticas nos atendimentos de vitimas de trauma psiquico.

Intervenção psicoterápica de grupo com pais e bebês: relato de um caso

Abstract: OBJECTIVES: To demonstrate the efficacy of a psychotherapeutic group intervention (reflective operational group), in which parents and infants are seen concomitantly. METHODS: In a case report of a female infant who presented aggressiveness, aspects of the psychotherapeutic intervention are discussed. RESULTS: There was resolution of symptoms, and healthy aspects of the mother-infant interaction were reestablished. DISCUSSION: In the reported case, the reflective operational group was fundamental to symptom improvement presented by a mother-infant dyad, helping the mother and the baby change dysfunctional aspects of their interaction. CONCLUSIONS: In spite of the good results for this family, further studies are needed to assess the efficacy of the reflective operational group.

Review of the book entitled Manual de terapias cognitivo-comportamentais

Abstract: Keith. S. Dobson, PhD, e professor titular e diretorde Psicologia Clinica do Departamento de Psicologiada Universidade de Calgary, em Alberta, Canada. Epesquisador nas areas de depressao e psicoterapiacognitivo-comportamental, com mais de uma centenade publicacoes. No presente livro, por ele organizado,uma versao atualizada da primeira edicao de 1988,Dobson reune os trabalhos de 23 autores da area dapsicoterapia cognitivo-comportamental. Os autoressao provenientes de renomados centros academicosdos Estados Unidos, Canada e Inglaterra. Entre eles,podemos destacar Aaron T. Beck e Robert J. DeRubeis,da Universidade da Pensilvânia; Albert Ellis, doInstituto Albert Ellis de Terapia ComportamentalRacional-Emocional de Nova York; Larry E. Bleutler,Roslyn Caldwell, Joan Davdson T. Mark Harwood eJacqueline B. Persons, da Universidade da California;Windy Dryden, da Universidade de Londres; e Kirk R.Blanstein e Zindel V. Segal, da Universidade deToronto.Como pesquisador e clinico no campo daspsicoterapias cognitivo-comportamentais, Dobsonteve a oportunidade, nas ultimas duas decadas, detestemunhar o crescimento da riqueza clinica, assimcomo dos avancos na avaliacao da eficacia de seusmodelos de intervencao, como menciona em seuprefacio. O editor salienta a importância das inovacoesdas psicoterapias cognitivo-comportamentais e refereque o livro reflete esse crescimento. O objetivo da obrae o de abordar as terapias cognitivo-comportamentais apartir de uma perspectiva teorica, fugindo do modelode livro em que os transtornos psiquiatricos servemcomo organizador para a exposicao de tratamentosdiferenciados. A ideia e a de explorar o crescimento dosvarios modelos cognitivo-comportamentais,fornecendo um arcabouco conceitual atualizado aosleitores interessados.Dobson considera como psicoterapia cognitivo-comportamental aquela intervencao que se baseia nomodelo mediacional, ou seja, em que uma mudancacognitiva deva mediar ou levar a uma mudancacomportamental. Destaca que algumas psicoterapiastem enfoque mais cognitivista, outras maiscomportamentalistas, mas que todas buscammudancas adaptativas e que a avaliacao de resultadossegue sendo fundamental. Dobson reconhece aconsideravel resistencia para a implementacao depraticas psicoterapicas de base empirica, mas apoia o

Inimputabilidade: estudo dos internos do Instituto Psiquiátrico Forense Maurício Cardoso

Abstract: INTRODUCTION: This study analyzed the profile of nonimputable inmates at Instituto Psiquiatrico Forense Mauricio Cardoso. METHODS: Between April and August 2005, a total of 617 patients were selected for inclusion in the study. RESULTS: Data analysis revealed that the inmates presented the following characteristics: mean age of 43.22 years, male (91.3%), defined profession (73.2%), completed elementary school (74.6%); without a partner (83.2%), crime against a person was the felony that generated nonimputability (62.1%), criminal records (58.3%), minimal sentence time was 1.76 years, serving it in criminal commitment (91.4%), mean time in prison of 9.33 years, under regime of progressive release (81.5%), previous hospitalization in other psychiatric institutions (55.2%), no previous probation measure (83.3%), diagnosis of schizophrenia and other psychotic disorders (61.4%). The following variables were statistically significant: among inmates with previous hospitalization, 61.9% had criminal history; and the higher the inmates' schooling level, the lower the level of criminal relapse. Results showed a predominance of inmates with criminal records in patients with disorders related to substances (56.5%) and personality disorder (59.7%). It was also verified that 60.8% of those who committed crimes against a person were alcohol addicts, establishing a relation between violent criminality and disorders caused by substance misuse. CONCLUSIONS: Based on the analysis of the medical records of 617 inmates at Instituto Psiquiatrico Forense Mauricio Cardoso, this study aimed at presenting a map of individuals considered nonimputable in Rio Grande do Sul.

Percepção de qualidade de vida de pessoas com fibrose cística: um estudo sobre a adequação dos instrumentos de medida

Abstract: INTRODUCTION: Quality of life (QOL) assessment in cystic fibrosis is as important as the assessment of the patient's health status. However, there are controversies on QOL concepts and theories. METHOD: Eleven Brazilian patients with cystic fibrosis, 18 years or older, answered questions suggested by the World Health Organization to explore the concept of QOL. The grounded theory approach provided the basis for this study and the data were qualitatively analyzed. RESULTS: Although the diversity of domains valued by the participants is in agreement with the multidimensional nature of QOL, there are some domains missing in the scales. CONCLUSIONS: No currently available scale comprises all aspects ranked as important by the patients. This underscores the importance of idiosyncratic and cultural aspects on QOL in cystic fibrosis. Clarifying the relationship between health and QOL still relies on further research.

Balzacian PTSD: diagnostic considerations

Abstract: Rodrigo Grassi-Oliveira, Departamento de Pos-Graduacao em Psicologia, Faculdade de Psicologia, PUCRS, Av. Ipiranga, 6681, Predi o 11, Sala 933,Partenon, CEP 90619-900, Porto Alegre, RS. E-mail: rodrigo_grassi@terra.com.brCopyright © Revista de Psiquiatria do Rio Grande do Sul – SPRS Recebido em 29/08/2007. Aceito em 30/08/2007.

Distribuição de transtornos alimentares em indivíduos com diabetes melito do tipo 1 e do tipo 2: descrição de dois casos

Abstract: The presence of changes in eating behavior seems to be increased in diabetes mellitus (DM). However, the distribution of varied categories of eating disorders tends to be distinguished according to the physiopathology of diabetes. The objective of this report is to discuss two distinct cases of eating disorders in type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Patient A is a 19-year-old female who has had T1DM since she was 13 years old. She presented prominent depressive symptoms and 2 years ago she started presenting binge eating episodes followed by self-induced vomits and insulin omission to avoid weight gain. Due to this behavior, she had several hospitalizations associated with worse glycemic control. After treatment with fluoxetine, there was remission of eating psychopathology and improvement in DM control. Patient B is a 42-year-old female who has had T2DM for 6 years. She has grade II obesity and had been showing, even before the diagnosis of T2DM, binge eating episodes in the absence of compensatory behaviors that jeopardized the metabolic control of DM. She started a treatment with fluoxetine up to 60 mg/day, with remission of binge eating, weight loss and reduction in glycosylated hemoglobin. The incidence of eating disorders in T1DM seems to be associated with an increase in concern with body shape and the possibility of insulin omission as a compensatory behavior. In T2DM, obesity seems to be one of the factors associated with the development of eating psychopathology.

A imagem do psiquiatra em filmes ganhadores do Prêmio da Academia entre 1991 e 2001

Abstract: OBJECTIVES: This study aims at describing characters portraying psychiatrists in Academy Award winning films from 1991 to 2001, and determining whether these plots disseminate negative messages or idealized portrayal of practitioners, like some previous movie productions. METHOD: Dramatic characterization analysis was performed. Movies produced before 1991 with similar characters and dramatic situations were identified to compare themes and messages concerning psychiatry. RESULTS: Nine films were selected, 17 characters were analyzed. "The Silence of the Lambs" associates psychiatry and madness, brightness and madness, analysis and cannibalism. According to "The Madness of King George," "Good Will Hunting" and "Girl, Interrupted," the ideal professional has modern ideas, background similar to his/her patient, informal posture and demonstrates emotion. "Shakespeare in Love" suggests the association between psychiatry and magic. "As Good as it Gets" presents a positive representation of psychiatric medication. "Shine" and "Beautiful Mind" stress the importance of family in patient's recovery. "Blue Sky" has a negative portrayal of psychiatry. CONCLUSIONS: These plots recognize the value of psychiatry, but present a battle between traditional and unorthodox approach, formal and informal professionals. They propose that a psychiatrist should be someone "out of the box" and exceptionally talented to be able to understand and treat another human being. The criticisms and negative images about psychiatry presented in the plots may be a consequence of a deep rooted stigma against professionals and patients dealing with mental disorders.

Psicoterapia psicanalítica breve

Abstract: O livro em questão é o resultado de uma vida de trabalho dedicada ao estudo, pesquisa, exercício e ensino nas áreas de Psiquiatria e Psicanálise. Em vista disso, oferece uma ampla revisão dos principais autores e estudos internacionais da área. Ademais, expõe aos leitores a experiência clínica e acadêmica do Professor Theodor Lowenkron, cuja culminância é representada por sua inovadora contribuição ao conhecimento e à práxis psicanalíticos: a Psicoterapia de Crise. Theodor Lowenkron é Mestre e Doutor em Psiquiatria pela UFRJ e Livre Docente em Psiquiatria pela UNIRIO. Ele é Professor Associado de Psiquiatria e Saúde Mental da Faculdade de Medicina da UFRJ e Professor do Programa de Pós-Graduação stricto sensu em Psiquiatria, Psicanálise e Saúde Mental da UFRJ. Também é membro efetivo da Sociedade Brasileira de Psicanálise do Rio de Janeiro e Coordenador da Comissão de Pesquisa e Universidade da Associação Brasileira de Psicanálise. A obra, uma segunda edição escrita em linguagem clara e concisa, é de fácil leitura, conquanto essas características não a tornem menos densa e consistente. Ao mesmo tempo, é sumamente esclarecedora, devido especialmente à sua solidez acadêmica e à sua grande abrangência. Dessa forma, consegue tornar acessível, ao leitor sem formação psicanalítica, complexas teorias e operadores conceituais, apresentando-os de forma didática e coerente. O autor inicia seu trabalho com uma revisão dos métodos de psicoterapia breve de orientação psicodinâmica que vêm sendo utilizados por profissionais do mundo todo. Com isso, Lowenkron abrange criticamente várias correntes de pensamento, a partir de Freud, e seus comentários transitam por nomes como Sandor Ferenczi, Otto Rank e Franz Alexander. É fácil perceber a preocupação analítica do autor de não destacar uma dada vertente teórica ou clínica em detrimento de outras. Em consonância com essa postura, apresenta as pesquisas desenvolvidas em grandes centros mundiais, como a Clínica Tavistok de Londres, a Universidade de Harvard e a Universidade McGill, destacando os trabalhos de Michael Balint,