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Clinicians and researchers have identified a pattern of "mixed" symptoms that are sometimes exhibited by individuals with bipolar spectrum disorders (BSDs). However, the criteria for these mixed states as outlined by the American Psychological Association have been criticized for being too stringent for most individuals that experience impairing episodes of mixed symptomatology (e.g., Akiskal, 1996). Mixed states are associated with a more impairing course of illness and suicidality. More research is needed on mixed states, and there is particularly little evidence for risk factors in recent-onset samples. The aims of this study were to 1) examine the prevalence of mixed states in a sample of individuals with recent-onset bipolar spectrum disorders, 2) examine the symptom structure of hypomanic and depressive episodes, and 3) examine some of the risk factors associated with mixed states. Participants in sample 1 were adolescents, initially aged 14-19, selected for exhibiting either moderate or high Behavioral Approach System (BAS) risk for first onset of BSDs. Participants in sample 2 were 18-24 year old undergraduates from Temple University recruited for having a bipolar spectrum diagnosis. Mixed states captured 37.10% of all episodes examined in sample 1, yet only 13 (10.48%) of these episodes met available research criteria for mixed mood episodes. Factor analysis yielded two adequate models that fit the data; one model had two factors that aligned with traditional depressive and hypomanic symptomatology, and another model had three factors that aligned with hypothesized overactivity, inhibited depression, and irritable risk taking components of bipolar disorder. Latent class analysis allowed for examining observed patterns of responses within individuals, and then grouping heterogeneous groups of individuals into classes based on similarities on dimensions of interest, performance within dimensions, or both (Nylund, Bellmore, Nishina, & Graham, 2007). The latent class analysis showed that three classes best defined bipolar spectrum individuals in sample 1: low impulsivity, aggressive, and substance problems classes were obtained. The `aggressive' class was significantly more likely than the `low impulsivity' class to experience any mixed symptomatology, although a continuous measure of mixed symptoms did not yield significant differences between classes. Overall, the results from the current study support findings suggesting that mixed mood states are more commonly experienced than originally believed. These results extend previous studies to include individuals with bipolar spectrum disorders, not solely bipolar I and II disorders. These findings also suggest that non-treatment-seeking samples may have different types of mixed mood states than those seeking treatment. These findings add support to the literature that individuals with BSDs and comorbid substance use diagnoses are at increased risk for chronic illness, and show that these individuals are also more likely to experience mixed mood states than those without comorbid substance use diagnosis. Treatment providers should be aware of the complications that are inherent in bipolar individuals with comorbid substance diagnoses, as they are more likely to experience more episodes as well as mixed symptoms. / Psychology

Made available in DSpace on 2016-03-22T17:26:20Z (GMT). No. of bitstreams: 1 Karen Jansen 2.pdf: 601451 bytes, checksum: e84f12927abaa8f47025474e4930cc3b (MD5) Previous issue date: 2009-10-30 / Objective: To evaluate the prevalence of mania and hypomania episode, as well as associated factors, comorbidities, and quality of life among young from 18 to 24 years old the city of Pelotas, RS. Method: This cross-sectional population-based, which was included to a larger study that evaluated Health Behaviors among young from 18 to 24 years old in the city of Pelotas . The sample selection was through conglomerates, and mania e hypomania episode were assessed using a standardized diagnostic interview short, Mini International Neuropsychiatric Interview (MINI), consistent with the DSM-IV and ICD-10. Results: The sample was 1560 young adults. In this, the prevalence of mania or hypomania episode the lifetime were 7,5% and 5,3%, respectively. The young with mania episode showed more prevalence to anxiety, suicide risk and substance abuse. In addition to minor index to quality of life in all domain of SF- 36 (p<0,001). Conclusion: The high prevalence of mania/hypomania episode in young population, associated to co-morbities disorders indicates that THB can being subdiagnostics. While the decline in the quality of life explain the injury in the person life with such pathology / Objetivo: Avaliar a prevalência de episódio de mania e hipomania, bem como, fatores associados, comorbidades e o impacto na qualidade de vida entre jovens de 18 a 24 anos da cidade de Pelotas, RS. Método: Trata-se de um estudo transversal de base-populacional, no qual a seleção amostral foi realizada por conglomerados e os episódios de mania e hipomania foram avaliados através de uma entrevista diagnóstica padronizada breve, Mini Internacional Neuropsychiatric Interview (MINI), compatível com os critérios do DSM-IV e CID-10. Além disso, foi aplicado um questionário com dados sócio-demográficos, e os instrumentos ASSIST e SF-36. Resultados: A amostra foi composta por 1560 jovens. Destes, a prevalência de episódios de mania ou hipomania ao longo da vida foi de 7,5% e 5,3%, respectivamente. Os jovens com episódio de mania apresentaram maior prevalência de transtornos de ansiedade, risco de suicídio e abuso de substâncias, além de menores níveis de qualidade de vida em todos os domínios do SF-36 (p<0,001). Conclusão: A alta prevalência de episódios de mania/hipomania na população de jovens, associada aos transtornos co-mórbidos indica que os THB podem estar sendo subdiagnosticados. Enquanto, o declínio na qualidade de vida demonstra o prejuízo na vida do individuo com tal patologia

E' possibile approfondire la conoscenza del pensiero senecano tenendo conto delle conoscenze mediche del filosofo. L'influenza della scuola medica Pneumatica, di ispirazione stoica, consente di dimostrare che le passioni come l'ira non sono per Seneca solo malattie dell'anima, ma sindromi psicofisiche che coinvolgono tutti i livelli dell'individuo, alla luce di un monismo corpo- anima possibile solo alla luce delle dottrine Pneuamtiche. Malattie come la mania e la melancolia, inoltre, hanno un decorso particolare che oltre ad influenzare la visione senecana dell'ira, permette anche di comprendere il carattere apparentemente incoerente di alcuni personaggi delle tragedie (Clitennestra, Atreo, Fedra e Medea), che possono essere considerati traduzioni drammaturgiche di sindromi maniaco- depressive. / It's possible to deepen our knowledge of Senecan thought by considering his medical knowledge. The influence of the Pneumatic school, inspired by Stoic philosophy, makes possible to show that passions like anger are for Seneca not only soul diseases, but also a kind of psycho- physical syndrome that concerns every aspect of the individual in the light of a psycho- physical monism that is possible to understand only through the Pneumatic doctrines. Diseases like mania and melancholy, moreover, have a peculiar development which, influencing Senecan view of anger, let us understand the apparently incoherent features of some characters of the tragedies (Clitaemestra, Atreus, Phaedra, Medea) who can be considered dramatic translations of manic- depressive syndromes

[pt] Prejuízo de insight costuma ser reportado no Transtono Bipolar (TB), sobretudo quando os pacientes viram para o pólo maníaco do transtorno. Essa falha na consciência verbal dos déficits, sinais e sintomas do transtorno pode vir acompanhada de uma forma de insight implícito, que é a demonstração indireta de algum nível de conhecimento sobre a doença ou uma deficiência com perda parcial ou total de reconhecimento verbal. Dois estudos foram conduzidos para verificar as relações entre as formas de insight explícito e implícito no TB. Para isso, foi utilizado um modelo teórico conhecido como The Cognitive Awareness Model (CAM), que permite investigar dissociações nos padrões de consciência implícita e explícita. No primeiro estudo, os participantes foram avaliados em relação à uma série de variáveis clínicas, incluindo uma medida de insight explícito, além de uma medida de insight implícito com estímulos ligados à depressão e à mania. No segundo estudo, os participantes foram igualmente testados em relação às variáveis clinicas, incluindo uma medida de insight explícito, além de uma medida de insight implícito com estímulos ligados à condição de saudável e doente. Os resultados de ambos os estudos apontaram para diferenças nas medidas de insight explícito entre os grupos de maníacos e eutímicos, e demonstraram diferenças no tempo médio de reação para auto-associações implícitas para condição. A partir desses resultados, pode-se sugerir que os pacientes em mania se autoavaliam explicitamente de forma similar aos pacientes em eutimia, o que pode trazer prejuízos na adesão ao tratamento, ao passo que os pacientes bipolares apresentaram uma forma de insight implícito tanto para os sintomas quanto para a condição de doente avaliadas. / [en] Lack of insight is usually reported in Bipolar Disorder (TB), especially when patients have seen the manic pole of the disorder. This lack of verbal awareness of deficits, signs and symptoms of the disorder may be accompanied by an implicit insight, which is the indirect demonstration of some level of knowledge about the disease or a disability with partial or total loss of verbal recognition. Two studies were conducted to verify the relationships between explicit and implicit forms of insight into TB. For this, a theoretical model known as The Cognitive Awareness Model (CAM) was used, which allows to investigate dissociations in the patterns of implicit and explicit consciousness. In the first study, participants were assessed for a number of clinical variables, including an explicit insight measure, as well as an implicit insight measure with depression and mania-related stimuli. In the second study, participants were also tested for clinical variables, including an explicit insight measure, as well as an implicit insight measure with stimuli linked to healthy and ill status. The results of both studies pointed to differences in measures of explicit insight between the manic and euthymic groups and demonstrated differences in mean reaction time for implied self-associations for condition. From these results, it can be suggested that patients in mania explicitly self-evaluate in a similar way to patients in euthymia, which can lead to impairment in adherence to treatment, whereas bipolar patients presented an implicit insight for symptoms and for the patient s condition evaluated.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fatty acids (FA) are constituent important of the neuronal phospholipids membranes and they carry out important functions in the development and function of the brain During the last decades changes were observed in the feeding habits of western countries, with an increase of the trans FA and omega-6 (n-6) and detriment of omega-3 fatty acids (n-3) consumption, contributing to increase the oxidative stress (OS) generation and development of neuropsychiatric disorders. The influence of FA supplementation containing n-6 (soybean oil-SO), trans (hydrogenated vegetable fat-HVF) and n-3 (fish oil-FO) on behavioral parameters and OS were studied in an animal model of mania. Rats were orally treated for 8 weeks with suspensions of SO, HVF and FO in place of drinking water, and treated with seven daily administrations of amphetamine (AMPH-mg/kg, ip) or vehicle, in the last week of oral treatment. Locomotor activity, vitamin C (VIT C) levels, protein oxidation and mitochondrial slices in striatum and cortex were evaluated. HVF supplemented rats showed an increase in the locomotor activity, higher levels of carbonyl protein in the cortex, and lower mitochondrial viability in the striatum and cortex, showing harmful effects per se. AMPH treatment increased the locomotor activity of all groups, but this effect showed greater intensity in the rats orally treated with HVF (456%). Similarly, AMPH increased the carbonyl protein levels in striatum (39.5%) and cortex (78%) of the animals orally treated with HVF, while SO and FO prevented it in the cortex. AMPH treatment decreased the mitochondrial viability in cortex and striatum of supplemented rats with all the FA; however the HVF group showed greater damage (46 and 44% of viability in the striatum and cortex, respectively). AMPH reduced the VIT C plasma levels of the HVF and SO groups (22.5 and 22.4% respectively), and this antioxidant parameter has not been changed in the FO treated rats. Here, we suggest that the trans FA contained in the HVF may increase the oxidative damages per se, leaving the rats more vulnerable to AMPH damage. FA n-3 contained in the FO showed subtle protecting effects, which were observed by preservation of the VIT C levels and lower levels of carbonyl protein in the cortex. Further studies should be conducted to evaluate the influence of the trans fatty acids consumption on neuronal activity, and consequently on the susceptibility to psychiatric disorders development among them the bipolar disorder. / Ácidos graxos (AG) são constituintes importantes das membranas fosfolipídicas neuronais e desempenham importantes funções no desenvolvimento e funcionamento do cérebro. Durante as últimas décadas foram observadas mudanças nos hábitos alimentares de países ocidentais, com aumento do consumo de AG trans e ômega-6 (n-6) em detrimento do consumo de ácidos graxos ômega-3 (n-3), cujas conseqüências podem estar relacionadas a um aumento dos danos oxidativos, facilitando o desenvolvimento de doenças neuropsiquiátricas. A influência da suplementação com AG n-6 (óleo de soja-OS), trans (gordura vegetal hidrogenada-GVH) e n-3 (óleo de peixe-OP) sobre parâmetros comportamentais e de estresse oxidativo (EO) foram estudados em um modelo animal de mania. Ratos tratados oralmente com suspensões de OS, GVH e OP, junto à água de beber durante 8 semanas, receberam nos últimos sete dias administrações diárias de anfetamina (ANF-4mg/kg, ip) ou veículo. Atividade locomotora, os níveis de vitamina C (VIT C) plasmático, marcadores de oxidação de proteínas e a viabilidade de fatias do estriado e córtex foram determinados. Animais suplementados com GVH mostraram um aumento da atividade locomotora, maior nível de proteínas carbonil no córtex, e menor viabilidade nas fatias do estriado e córtex, demonstrando efeitos prejudiciais per se. O tratamento com ANF aumentou a atividade locomotora dos animais de todos os grupos experimentais, porém este efeito mostrou maior intensidade nos animais que receberam a suplementação com GVH (456%). Semelhante, a ANF aumentou a carbonilação de proteínas no estriado (39.5%) e córtex (78%) dos animais suplementados com GVH, enquanto OS e OP preveniram o dano causado pela ANF no córtex. O tratamento com ANF diminuiu a viabilidade mitocondrial nos tecidos cerebrais de todos os grupos, entretanto o grupo suplementado com GVH apresentou maiores danos (46 e 44% de viabilidade no estriado e córtex, respectivamente). A ANF diminuiu os níveis de VIT C no plasma dos animais suplementados com OS e GVH (22.5 e 22.4%, respectivamente), e este parâmetro antioxidante não foi alterado nos ratos tratados com OP. Os resultados do presente estudo sugerem que os ácidos graxos trans presentes na GVH podem aumentar os danos oxidativos per se, deixando os animais mais expostos aos danos da ANF. A suplementação com ácidos graxos n-3 presentes no OP mostraram efeitos protetores sutis, representados pela preservação dos níveis de VIT C plasmático e menor oxidação de proteínas no córtex. Maiores estudos devem ser realizados para determinar a influência do consumo de ácidos graxos trans sobre a atividade neuronal, e conseqüentemente sobre a suscetibilidade para o desenvolvimento de desordens psiquiátricas entre estas, o transtorno bipolar.

Bipolar mood disorder has been traditionally researched, explored, and explained from a modernistic, psychiatric perspective. The purpose of this study is to explicate an alternative description for bipolar mood disorder, from a postmodern perspective. The widely accepted psychiatric knowledge focuses on the signs and symptoms of the disorder, pharmacological treatments, and manualised psychotherapies. This thesis shifts the focus from an intrapsychic, deficit perspective towards one which is inclusive of surrounding discourses and patterned relationships. The social constructionist research approach is followed, utilising vignette and thematic analyses for textual deconstruction and reconstruction. In addition to these data analyses, discourses were analysed using the actual text of the co-researchers. This allowed for a thorough explication of the ways in which discourses shape the construct bipolar mood disorder. From these analyses, emergent themes were then distilled and compared to the existing body of literature in the bipolar mood spectrum field of study. Process models were generated to depict the various pertinent aspects of the social construction of bipolar mood disorder. This research has value for the treating professional, allowing for a broader, more inclusive discourse perspective to add to the already established medical model view. Further, this research gives credence to the voice of the person who has been diagnosed with the illness. This research may also contribute to the epistemological debates within modernist and postmodernist paradigms. Key words: Bipolar mood disorder, medical model, pharmacology, mania, depression, psychiatry, psychotherapy, titrating power relations, expert, problem determined systems, belonging, problems of therapy and therapeutic problems, vignette analysis, people as meaning generating beings, context, reflexivity, self-reflection, multiple realities, positivism, social constructionist epistemology, qualitative research, process model. / Psychology / D. Litt. et Phil. (Psychology)

Les médecins et les biologistes de l'époque classique, qu'il s'agisse des Hippocratiques ou d'Aristote, décrivent et expliquent les altérations du raisonnement d'un point de vue physiologique et tentent d¤établir une typologie des troubles qui affectent la psukhè et les phrenes en distinguant diverses pathologies spécifiques telles que la mania, l'épilepsie et la mélancolie. Méthode et raisonnement tendent vers la rationalité, ils peuvent paraître en opposition avec le discours platonicien et les descriptions du théâtre tragique qui attribuent une origine divine aux troubles de la raison. Chez Platon, la mania, qu'elle soit érotique, poétique, mantique ou télestique est présentée comme un bienfait pour les personnes qui en sont atteintes, tandis que dans la tragédie, les troubles de la raison sont décrits comme une altération des phrenes et associés à la souffrance et à la destruction. Ces ensembles documentaires soulignent que la « folie » est polymorphe et qu'il n'existe pas de représentation unifiée du délire. Cependant, entre eux, des accords existent dans les domaines de la description des symptômes de certaines affections, notamment de la mania, comme du vocabulaire employé pour dire les troubles de la raison. Il semble que ces discours soient issus d¤une base de croyances communes dont ils développent un aspect spécifique, nous permettant ainsi de restituer une représentation de la « folie » ordinaire, représentation certes incomplète et imparfaite, mais qui tente d¤être la plus proche possible des réalités socioculturelles et des mentalités de cette l¤époque

本研究所針對的並非是家用電玩的內容本身，而針對的是那些家用電玩的熱衷者如何進行打電玩這樣一種行動。因此本研究試圖就打電動此行動本身進行實證性研究。以個人的行動出發，在研究對象上所側重的是那些對電玩投入大量的時間與精力的玩家。對於這些長時間專注於電玩上的人，是否清楚自身行動選擇的意義，在這當中的行動背後的意義為何。 / 但在研究中發現，對於這些遊戲熱衷者而言，當他們投注在當中的時間越來越多時，電玩對他們來說已不再是閒暇時所進行的活動，而是作為他們日常生活中慣習的一部份，成為他們每日的例行事項。另一方面，在這些電玩熱衷者的行動中可以明顯的發現到工具理性式的思維，把電玩當作是可以計算的對象一般不斷的進行計算。可以發現，這樣例行的義務與理性的計算使得這些人在玩電玩時，愈加的脫離了遊戲原本的意義。於是在這種工具理性式的思維背後，所顯現出來的就是在當中的慾望壓抑的過程。而重點在於說，當他們進行遊戲的過程時，這樣的工具理性作為一種手段，就是以慾望壓抑的展現作為他的趨力。