Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O Transtorno do estresse pós-traumático (TEPT) é um transtorno mental que ocorre em resposta a um evento traumático que coloca em risco a vida do indivíduo ou de outras pessoas. O TEPT no período pós-parto foi documentado pela primeira vez em 1978. Porém, há poucos estudos sobre o tema, principalmente em gestantes de alto risco materno e fetal. Visando preencher essa lacuna, essa dissertação tem por objetivo estimar a magnitude de TEPT no período pós-parto em uma maternidade de alto risco fetal no município do Rio de Janeiro e identificar subgrupos vulneráveis ao transtorno. Trata-se de um estudo transversal, cuja população de estudo foi composta por 456 mulheres que tiveram o parto no Instituto Fernandes Figueira e realizaram a consulta de revisão pós-parto entre fevereiro e julho de 2011. Casos suspeitos de TEPT foram identificados por meio de dois instrumentos: Trauma History Questionnaire (THQ) utilizado para a captação de situações potencialmente traumáticas ao longo da vida e Post-Traumatic Stress Disorder Checklist (PCL-C) para rastreio de sintomas de TEPT. A prevalência agregada de TEPT no período pós-parto foi de 9,4%. Subgrupos considerados vulneráveis foram: mulheres com três ou mais partos anteriores (15,1%), com o recém-nascido com APGAR menor ou igual a 7 no primeiro minuto (13,6%), com histórico de psicopatologia anterior (29,0%) ou concomitante à gestação (36,7%), com depressão pós-parto (31,5%), mulheres que sofreram violência física (19,8%) e psicológica (11,6%) perpetrada por parceiro íntimo durante a gestação, mulheres que sofreram abuso sexual na infância (25,7%) e com histórico de 5 ou mais situações traumáticas anteriores (25,9%). A elevada prevalência de TEPT encontrada entre as mulheres entrevistadas pode ser, em parte, atribuída às particularidades da população assistida nessa instituição, de reconhecido risco materno e fetal. A alta prevalência de casos suspeitos de depressão pós-parto entre as mulheres com suspeição de TEPT é um fator de preocupação adicional, já que dificulta o manejo clínico dos casos e afasta a mulher e a criança dos serviços de saúde. TEPT no período pós-parto não é um evento raro e merece atenção. Rápido diagnóstico e tratamento são fundamentais para a melhor qualidade de vida da mãe tornando-a apta aos cuidados do recém-nascido. / The Posttraumatic Stress Disorder (PTSD) is a mental disorder that occurs in response to a traumatic event which endangers the life of the individual or of other people. There are few studies on this topic, especially in pregnant women with high maternal and fetal risk. Thinking of filling this gap, this study aims at estimating the magnitude of PTSD postpartum period in a maternity with high fetal risk and identifying vulnerable subgroups. This is a cross-sectional study conducted at Instituto Fernandes Figueira (IFF), with 456 women who delivered at the IFF and were underwent postpartum review between February and July 2011. Suspected cases of PTSD were identified through two instruments: Trauma History Questionnaire used for capturing potentially lifelong traumatic situations and Post - Traumatic Stress Disorder Checklist-Civilians in screening for PTSD symptoms. The aggregate prevalence of PTSD postpartum period was 9,4%. Groups were considered vulnerable: Women with three or more previous deliveries (18,9%), with the newborn with less or equal to 7 APGAR (13,6%) , with a history of previous (29,0%) or concurrent psychopathology pregnancy (36,7%), with postpartum depression (31,5%), woman who have suferred physical (19,8%) and psychological (11,6%) violence perpetrated by intimate partner during pregnancy, women who have experienced childhood sexual abuse (25.7%) and with a history of 5 or more previous traumatic situations (25,9%). The high prevalence of PTSD found among the interviewed women can be partly attributed to the particularities of the patients attended at this institution. The high prevalence of suspected postpartum depression among women with suspected PTSD cases is an additional point of concern, as it complicates the clinical management of cases and keeps the women and the children away from health services. The results indicate that the occurrence of PTSD in the postpartum period is not a rare event and deserves attention, as well as other mental health problems in the postpartum period. Quick diagnosis and treatment are key to better quality of life of the mother making it able to care of the newborn.

Este trabalho pretende apontar o acometimento do transtorno do estresse pós-traumático em policiais militares do Estado do Rio de Janeiro. Para isso, a autora utiliza sua experiência como psicóloga da PMERJ há 11 anos e descreve inúmeras situações sobre o cotidiano na referida corporação, os desafios de pesquisar a instituição onde trabalha, descreve como funciona o serviço de psicologia e como, a partir do lugar de psicóloga militar, enxerga o homem policial militar, sua identidade e a instituição Polícia Militar. É contextualizado o cenário de violência e criminalidade encontrado pelos policiais de nosso Estado nos últimos anos e são abordados aspectos da formação desses profissionais de segurança pública, que incluem a construção da negação do medo no exercício da atividade laboral e a aderência a um padrão de homem destemido e forte em todos os momentos. Há a tentativa de demonstrar como essas construções contribuem para o adoecimento psíquico desses trabalhadores, por impedi-los de se dar conta de suas fragilidades e limitações, estando sempre em busca de alcançar o padrão do super-homem valorizado como ideal. Discute-se o adoecimento mental entre policiais, especialmente o transtorno do estresse pós-traumático como um problema de saúde pública para além dos muros da PMERJ. São apresentadas as diretrizes atuais em nosso país no tocante a esta temática e por fim são descritas duas estórias detalhadas de policiais militares para ilustrar como a profissão pode atravessar a vida desses trabalhadores, de forma a modificá-las profundamente. / This thesis intends to point out the involvement of the post-traumatic stress disorder in Rio de Janeiro State Military Police (PMERJ). For this, the author uses her experience as a psychologist at PMERJ for 11 years and describes numerous situations on daily life in that corporation, the challenges of researching the institution where she works, describes the psychology service and how, from the place of military psychologist, military policeman sees the man, his identity and the institution Military Police. It contextualizes the scene of violence and crime found by the police in our state in recent years and discusses aspects of the formation of these public safety professionals, which include the construction of fear of denial in the exercise of labor activity and adherence to a standard of fearless and strong man at all times. There is an attempt to demonstrate how these constructs contribute to mental illness among these workers, by preventing them from realizing their weaknesses and limitations, and is always looking to achieve the standard of superman valued as ideal. It discusses mental illness among policemen, especially the post-traumatic stress disorder as a public health problem beyond the walls of PMERJ. Current guidelines are presented in our country with regard to this issue and finally two detailed stories of military police illustrate how the profession can permeate the life of these workers in order to modify them deeply.

At my place of work, we are considering the possibility of spiritual service inception within the Czech Republic Police force. One of our models, which we stem from, is the Czech Army Military Chaplaincy. We, therefore, go into the history of its inception and its current activities, at a fairly great length. Furthermore, we have mapped the Czech Republic Police activities, whose character matches the activities of the military chaplains. By comparison and evaluation of the researched information, we will set the possibility and desirability of chaplaincy and spiritual service within the Czech Republic Police. Basic and key information was acquired by study of the literature and of the official internet sources. The additional and clarifying information was acquired through personal discussion and communication with professionals in various related fields.

O transtorno de estresse pós-traumático (TEPT) tem um impacto negativo na vida de seus portadores. Conhecer os traços de personalidade mais preponderantes nas pessoas com TEPT pode auxiliar no sucesso do tratamento, tornando possível planejar intervenções mais adequadas. A terapia cognitivo-comportamental (TCC) é considerada um dos tratamentos mais eficazes para este transtorno; entretanto, nem todos aqueles que completam a terapia evoluem para uma melhora significativa. Uma das razões pode ser encontrada nas características individuais de personalidade de cada pessoa. Portanto, o presente estudo busca explorar a relação existente entre os domínios e traços de personalidade que estão associados à melhora do paciente que realizou a TCC. Método: 66 pacientes com diagnóstico de TEPT, segundo o DSM-IV-TR, com idade entre 18 e 60 anos participaram do estudo. Instrumentos: Para avaliar os traços de personalidade foi utilizado o instrumento NEO-PI-R. Para avaliar a gravidade e melhora da doença foi utilizada a escala de Impressão Clínica Global (CGI). Procedimento: Os pacientes passaram por avaliação psiquiátrica para assegurar o diagnóstico de TEPT. Após aceitarem participar do estudo, responderam ao NEO-PI-R e foram avaliados por médicos quanto a gravidade da doença, utilizando o CGI. Os participantes passaram por 13 sessões de TCC realizadas por profissionais devidamente treinados. Ao final, foram reavaliados para verificar se houve melhora após tratamento. Resultados: Quanto ao perfil de personalidade 71,2% apresentaram neuroticismo (N) alto, 75,8% relataram escore elevado em extroversão (E) e 45,5% eram baixos em conscienciosidade (C). Já os traços amabilidade (A) e abertura para experiência (O) apresentaram pontuações na média. As análises também demonstraram que os participantes que apresentavam o domínio de personalidade denominado consicienciosidade (C) foram associados ao resultado favorável do tratamento. Estima-se que a chance de melhora cresça 3,77 vezes se o paciente apresentar esse traço, quando comparado com os demais que não possuem essa característica. Duas facetas (assertividade e ações variadas) também foram correlacionadas com a melhora no tratamento. Conclusão: Embora a amostra do presente estudo seja limitada, os resultados apontam para a importância de se avaliar a personalidade do paciente. Acessar a personalidade é importante com a finalidade de tentar predizer qual o melhor tipo de tratamento terapêutico para cada um. As terapias breves (frequentemente administradas nos hospitais públicos) possuem um tempo limitado de tratamento, de modo que informações sobre as variáveis de personalidade podem ser particularmente muito útil / The Post-Traumatic Stress Disorder (PTSD) has a negative impact on the patients lives. Get to know their personality traits can help on the treatment success, by making possible to plan most appropriate interventions. Cognitive-Behavioral Therapy (CBT) is considered a first line treatment for PTSD. However, treatment response is not universal. One reason may be found in personality characteristics. The present study aims at investigating the association between personality dimensions and traits associated with improvement of patients who underwent CBT. Method - 66 PTSD patients diagnosed according to the DSM-IV-TR criteria were included in the study. The patients included were aged 18 to 60 years old. Instruments - We employed the NEO-PI-R instrument for the evaluation of personality dimensions and the Clinical Global Impressions Scale (CGI) for evaluation of clinical outcome. Procedure - Patients were assessed by Psychiatrists to ensure the diagnosis of PTSD. After accepting to participate of the study, they answered the NEO-PI-R Scale and were assessed by doctors to know the disease severity, using the CGI scale. Participants underwent 13 CBT sessions and were reassessed at the end of treatment. Results - The personality profile showed that 71.2% were high in neuroticism (N) and 75.8 reported low Extraversion. 45.5 were low in conscientiouness and the Agreableness (A) and openess (O) factors presented average scores. The analysis also showed that patients presenting the Conscientiousness (C) personality dimension showed a higher chance of improvement (OR=3.77). Two facets other dimensions (Assertiveness and Varied Actions) were also associated with better clinical outcome. Conclusion - determining predictors of outcome such as a patient\'s personality dimensions may point to the use of therapeutic treatment options with the higher odds of success, without too much therapeutic treatment experimentation. As therapies become briefer, information on personality variables may be particularly useful

M.Cur. / Die idee waarmee hierdie studie 'n aanvang geneem het, het ontstaan vanuit my waarneming dat al hoe meer polisiebeamptes opgeneem word in die psigiatriese kliniek waar ek, die navorser werksaam is. Hierdie polisiebeamptes vertel 'n storie van blootstelling aan talle traumatiese situasies in die beoefening van hul beroep, waar geweld, misdaad, lewensgevaar en die dood vir hulle bekende verskynsels is. Maar dit lei dikwels tot depressie, alkoholmisbruik en aggressie by die polisiebeamptes. Hierdie probleme word, volgens polisiebeampes, dikwels vererger deur 'n autokratiese bestuurstelsel in die SAPD, swak salarisse, 'n lae status in die gemeenskap en ontoereikende fasiliteite. Die winde van politieke verandering wat sedert 2 Februarie 1990 deur Suid-Afrika waai, verg van polisiebeamptes om sekere fundamentele aanpassings te maak en 'n nuwe benadering tot polisiering te volg. Hierdie aanpassings word dikwels as moeilik ervaar. Die gesinne van polisiebeamptes word dikwels direk geaffekteer deur al die genoemde faktore, in die sin dat, die polisiebeampte se manier van "dink en wees" as polisiebeampte, sy interaksie met sy gesin beInvloed. Ek het dus gewonder hoe die gesinne van polisiebeamptes dit beleef wanneer 'n lid van die gesin werksaam is as 'n polisiebeampte in 'n hoe-risiko metropolitaanse area in Gauteng. Geen studie is voorheen hieroor uitgevoer nie. Om hierdie vraag te beantwoord, het ek van 'n verkennende, beskrywende, kontekstuele en kwalitatiewe navorsingsontwerp gebruik gemaak in die uitvoering van hierdie studie. Semigestruktueerde, fenomenologiese onderhoude is gevoer met agt vroue van polisiebeamptes, werksaam by 'n geIdentifiseerde polisiestasie in Gauteng. Die vroue is volgens die sneeubalmetode geselekteer. Dit is gedoen nadat die nodige ingeligte toestemming van hulle verkry is. Stappe is deurgaans deur die studie geneem om vertrouenswaardigheid te verseker, volgens Guba se model. Daar is ook verseker dat hierdie studie op 'n etiese wyse uitgevoer is, deurdat ek myself laat lei het deur die Suid-Afrikaanse Verpleegstersvereniging se standaarde vir verpleegkundige navorsers. Die meta-teoretiese aannames wat hierdie studie rig, is verkry uit die Verplegingsteorie vir Mensheelheid, waarvolgens die mens 'n geestelike wese is wat op 'n gentegreerde, biopsigososiale wyse binne die gesin en gemeenskap funksioneer. Data is ontleed volgens die metodes van Tesch en die dienste van 'n onafhanklike kodeerder is verkry. Sodoende is ooreenstemming bereik oor die kategoriee en subkategoried van temas wat die storie van die vroue so akkuraat as moontlik sou kon beskryf. Die resultate het daarop gedui dat gebroke interaksie dikwels in die gesinne van polisiebeamptes vookom. Hierdie interaksie word gekenmerk deur oppervlakkige, konkrete kommunikasie, aggressie en fisiese, sowel as emosionele afwesigheid van die polisiebeampte in die gesin. Die vrou neem dikwels sekere rolle in die verhouding aan en ervaar emosies van pyn, alleenheid, woede, verwerping, vrees en onsekerheid. Riglyne is beskryf wat moontlik kan lei tot die ondersteuning van die gesinne van polisiebeamptes, deur die psigiatriese verpleegspesialis. Voorstelle vir die aanwending van die resultate in die verpleegonderwys, -praktyk en —navorsing is gemaak. Daar word tot die gevolgtrekking gekom dat die verkenning en beskrywing van die beleweniswereld van die gesinne van polisiebeamptes, die psigiatriese verpleegspesialis instaat kan stel om die gesinne te ondersteun in die mobilisering van hulpbronne en die gesin te fasiliteer in die bevordering, handhawing en herstel van gesinsgeestesgesondheid as 'n integrale deel van gesondheid.

Le Trouble de Stress Post-Traumatique (TSPT) est une pathologie qui se développe chez des sujets exposés à des événements traumatiques. Cette pathologie est caractérisée par des reviviscences du traumatisme induisant des troubles anxieux invalidants et durables. Ces reviviscences, provoquées par des indices de rappel, sont à l'origine des fréquentes rechutes qui caractérisent le TSPT. La dépendance aux drogues d'abus est également caractérisée par une hyperréactivité aux indices de rappel qui est responsable du désir irrépressible de drogue ou " craving " et des nombreuses rechutes après abstinence. Nous avons fait l'hypothèse que cette susceptibilité aux indices environnementaux, commune aux deux pathologies, pourrait être due à un découplage des systèmes monoaminergiques induit par l'exposition à des conditions intenses, drogues d'abus ou traumatisme. Les données de cette thèse montrent que notre modèle animal de traumatisme (le Single Prolonged Stress) reproduit chez les individus vulnérables les symptômes de la pathologie, et une réactivité aux indices de rappel. Nos données indiquent également qu'un traumatisme induit, chez les individus vulnérables, une désensibilisation comportementale et une sensibilisation noradrénergique corticale, supportant l'hypothèse de découplage monoaminergique. Enfin, nous avons développé une nouvelle approche thérapeutique, le " remodelage émotionnel " capable de diminuer durablement les symptômes de type TSPT. Les résultats obtenus dans cette thèse, soutiennent l'hypothèse de bases physiologiques communes entre le TSPT et l'addiction, et proposent de nouvelles approches thérapeutiques pour ces deux pathologies. / Post-Traumatic Stress disorder (PSTD) appears on a part of individuals exposed to traumatic events. This pathology is characterized by frequent re-experiencing of the traumatic event inducing disabling and long-lasting anxiety disorders. These flashbacks, triggered by reminder cues, are responsible for the frequent relapses that characterize PTSD. Addiction to drugs of abuse is also characterized by a hyper reactivity to reminder cues which is responsible for drug craving and relapses. We hypothesized that such a susceptibility to environmental cues, common to both pathologies, could be due to an uncoupling of monoaminergic systems induced by exposure to intense conditions (trauma or drugs). Data from this thesis showed that our animal model of PTSD (the Single Prolonged Stress) reproduced PTSD-like symptoms on vulnerable rats, and reactivity to reminder cues. Our data also showed that trauma induced a behavioral desensitization and a cortical noradrenergic sensitization, in vulnerable traumatized rats, supporting the hypothesis of monoaminergic uncoupling. Finally, we developed a new therapeutic approach, the "emotional remodeling" which was shown to durably decrease PTSD-like symptoms. The results obtained in this thesis support the hypothesis of common physiological basis between PTSD and drug addiction, and offer new therapeutic approaches for these two pathologies.

Dreaming is a complex, multimodal and sequentially organized model of the waking world (Metzinger, 2003). Nightmares are a category of dreams involving threatening scenarios, anxiety and other negative emotions (Hartmann, 1998; Nielsen & Levin, 2007). Dreams and nightmares are explored in this present thesis in the light of psychology and modern cognitive neuroscience as to their nature, function and neural correlates. The three main dream theories and their leading investigations are reviewed to evaluate their evidence and overall explanatory power to account for the function of dreams and nightmares. Random Activation Theories (RATs) claim dreams are biological epiphenomena and by-products of sleep underlying mechanisms (Crick & Mitchison, 1983; Flanagan, 1995, 2000a, 2000b, Hobson & McCarley, 1997). Mood regulation theories consider that the psychological function of dreams is to regulate mood and help with the adaptation of individuals to their current environment such as solving daily concerns and recovery after trauma exposure (Hartmann, 1996; Levin, 1998; Stickgold, 2008; Kramer, 1991a, 1991b, 2014). Threat Simulation Theories of dreams present the evolutionary function for dreaming as a simulating off-line model of the world used to rehearse threatening events encountered in the human ancestral environment (Revonsuo, 2000a). With the threat-simulation system, threats were likely to be recognized and avoidance skills developed to guarantee reproductive success. TST consider nightmares to reflect the threat-simulation system fully activated (Revonsuo, 2000a). Supported by a robust body of evidence TST is concluded to be the most plausible theory at the moment to account as a theoretical explanation of dreams and nightmares

D.Litt et Phil. / For over a decade, from the late 1970's to October 1992, a war raged in Mozambique that resulted in what has been described as, one of the "most terrible genocides in the history of Africa". Over 4 million people were displaced during this war. Conservative estimates put the number of Mozambicans who sought refuge in South Africa at 250 000. This study examines the trauma created by the war, and its psycho-social outcomes, from the perspective of women refugees who came to settle in villages in the Nkomazi region of Mpumalanga province, in South Africa. Posttraumatic stress disorder, the concept which dominates research in the field of trauma studies, was based on research with male war veterans in western industrial societies. Recently a body of work has emerged which questions the validity of applying posttraumatic stress disorder to contexts of massive social conflict, and its utility in cross cultural contexts. This body of work suggests that an understanding of extreme trauma and its outcomes requires careful consideration of the social and cultural dimensions of trauma. The inclusion of a cultural formulation in the latest edition of the Diagnostic and Statistical Manual for Mental Disorder, DSM-IV, reinforces a growing acknowledgement amongst mental health researchers of the influence of culture on mental health and disorder. The gaps in research on African women survivors of war and the lack of standardised assessment tools, makes this an exploratory study which uses qualitative research methods. Unstructured interviews were conducted with 30 Mozambican women refugees to explore their experiences and definitions of trauma, the psycho-social outcomes of the trauma, and coping and survival in the aftermath of the war. The magnitude of the trauma evident in the research findings called for a conceptual definition which reflects multiple risks and the interdependence of social and individual trauma. Thematic analysis and qualitative coding of the interview data revealed clinically well defined posttraumatic stress disorder symptoms and locally specific discourses of suffering framed by cultural beliefs, social practices and historical experiences. Their testimony and observations in the field, revealed that the survivors demonstrated a capacity to survive and reconstruct their lives. Their coping strategies and survival tactics were fundamentally shaped by socio-historical experiences and the limits and possibilities contained in the recovery environment. The results of this study suggest an approach to examining the complex relationship between trauma and its consequences, which abstracts neither trauma nor its victims from cultural and social-historical contexts.

M.A. / The goal of the present study was to investigate the relationship between trait anxiety, years of service and posttraumatic stress disorder in the South African Police Service. This study was regarded as important because posttraumatic stress can have a significant influence on the personal life and work-related performance of police officers. One hundred and twenty white, male police officers volunteered to participate in the study. A structural model of the relationships between trait anxiety, years of service and posttraumatic stress was postulated. The model specified that trait anxiety and years of service influence posttraumatic stress both individually and jointly. Trait anxiety is operationalised by means of the IPAT Anxiety Scale and posttraumatic stress disorder by means of the Posttraumatic Stress Disorder Interview Schedule. The fit of the postulated model with the observed data was investigated by means of structural equation modelling. The results indicated that the postulated model showed an acceptable fit with the observed data. The estimated parameters of the model indicated that the subscales of the IPAT Anxiety Scale and the Posttraumatic Stress Disorder Interview Schedule are good indicators of their respective constructs. It was further shown that trait anxiety and years of service have a significant influence on posttraumatic stress disorder. The results support those of previous studies where it was shown that these variables can influence posttraumatic stress disorder. The present study emphasizes that trait anxiety may predispose police officers to the development of trait anxiety. The study also shows that if police officers are exposed to extended periods of traumatic experiences, they run the risk of developing posttraumatic stress disorder.

M.A. / The present study was undertaken in an attempt to understand and ascertain the relation between personality traits and posttraumatic stress (PTSD) in the South African Police Service (SAPD) leading to chronic illness and work-related dysfunctions. The specific hypothesis for this study will show that by means of the Comrey Personality Scales (CPS) a statistic significant distinction between police officers with PTSD and police officers without PTSD exists. The testing of the hypothesis entailed a group of 120 functional police officers that consists of white, male nonofficers. They worked in the Pretoria area of the SAPD. The PTSD status of the subjects was assessed by means of the PTDS Interview Guide of Watson, Juba, Manifold, Kucala and Anderson (1991). Police officers that met the criteria for PTSD by means of the PTSD Interview Guide were place in one group (PTSD-group, n = 414. Police officers that did not meet the criteria were placed in another group (Non-PTSD-group, n = 79). Personality traits were measured by means of the CPS. There was a significant difference between the personality traits of the PTSDgroup in comparison with the Non-PTSD-group. The PTSD-group appears to be more compulsive and ordered, more introspective, more neurotic, more sensitive and more defensive in comparison with the Non-PTSD-group. It is postulated that these personality traits can possibly cause policemen to be more susceptible for the development of PTSD.