Thesis(DMed (Psychiatry))-- University of Stellenbosch, 2007. / Alcohol-induced psychotic disorder (also known as alcohol hallucinosis) is a complication of alcohol abuse that requires clinical differentiation from alcohol withdrawal delirium and schizophrenia. Although extensively described, few studies utilized standardized research instruments and brain-imaging has thus far been limited to case reports. The aim of this study was to prospectively compare four population groups (ie. patients with alcohol-induced psychotic disorder, schizophrenia, uncomplicated alcohol dependence and a healthy volunteer group) according to demographic, psychopathological and brainimaging variables utilizing (i) rating scales and (ii) single photon emission computed tomography (SPECT). The third component of the study was designed to investigate the (iii) effect of anti-psychotic treatment on the psychopathology and regional cerebral blood flow (rCBF) before and after six weeks of treatment with haloperidol. Effort was made to ensure exclusion of comorbid medical disorders, including substance abuse. The study provides further supportive evidence that alcohol-induced psychotic disorder can be distinguished from schizophrenia. Statistically significant differences in rCBF were demonstrated between the alcohol-induced psychotic disorder and other groups. Changes in frontal, temporal, parietal, occipital, thalamic and cerebellar rCBF showed statistically significant negative correlations with post-treatment improvement on psychopathological variables and imply dysfunction of these areas in alcohol-induced psychotic disorder. The study was unable to distinguish between pharmacological effects and improvement acccomplished by abstinence from alcohol. / Stellenbosch: Stellenbosch University

Made available in DSpace on 2016-04-04T18:27:34Z (GMT). No. of bitstreams: 1 Ana Paula FPregnolatto.pdf: 230365 bytes, checksum: f0f9540c03031709a2d9741c1eaeeda4 (MD5) Previous issue date: 2005-02-11 / The chronic renal failure is a disease that evolves slowly, gradually and irreversibly causing physical and emotional damage. Studies on the emotional aspects of patients undergoing hemodialysis procedures emphasize that they are a special group among chronic disease patients, because the procedure itself and the individual s dependence on the equipment involved assume great importance on the individual s life. These stressful aspects can, therefore, cause special effects on the emotions and behavior of these patients, overloading the depressive symptoms caused by uremia itself. Among the pathologies and conditions related to emotions, alexithymia stands out. The term been applied to an individual s difficulty to express emotions and affection. Alexithymia and its psychopathological symptoms are considered to have influence on diagnosis, prognosis, and the way a patient can cope with the different forms of treating renal failure. That being so, the evaluation and identification of these aspects can provide a better understanding of them in order to identify and offer to these patients more adequate psychological treatment and a program of prevention and mental health involving patients and the health team. For this study the sample include 48 patients who have been receiving hemodialysis at the hospital of the University School of Medicine in the state of S?o Paulo, Brazil. The sample was stratified according to the type of renal disease presented. The tools used were Identification Form, The Toronto Alexithyimia Scale (TAS) and the Symptoms Evaluation Scale (EAS-40). The sample was distributed like the following: men (60,4%); age between 40 and 59 years of age (58,3%); basic education (50%); retired or on sick leave (47,9%). High blood pressure (41,6%); diabetes mellitus (31,3%); chronic glomerule nephritis (27,1%). Regarding alexithymia 52% of the patients presented scores equal or superior to 74, and 4,2% presented scores equal or inferior to 62. 43,8% of the subjects are on the range between 63 and 73 points. The average score of the sample was 74 and DP 7,52. The results show that patients undergoing hemodialysis present high scores on TAS, regardless of sex, level of education, marital status, occupation, age or diagnosis, and the differences between these variables were not significant. Concerning the psychopathological symptoms, the average score was 0,63 and DP 0,37 , and there were no significant differences between the social and demographic variables. Regarding the association between alexithymia and psychopathological symptoms the results show significant relation between the total scores of TAS and EAS-40; and also between the total score of TAS and Factors 1, 2 and 3 of EAS-40, which fulfill the theoretical expectations. Although further research is needs to identify how these aspects believe in other groups, our finding confirm that alexithymia is related to psychopathological symptoms. / A insufici?ncia renal cr?nica (IRC) ? a uma doen?a de instala??o lenta, gradativa e irrevers?vel das fun??es renais, levando o indiv?duo a ter altera??es f?sicas e emocionais. Estudos sobre os aspectos emocionais de pacientes em hemodi?lise enfatizam que estes comp?em um grupo especial entre os portadores de doen?a cr?nica, pois o tratamento, e a depend?ncia dos equipamentos utilizados assume grande import?ncia na vida da pessoa. Assim, estes aspectos podem acentuar caracter?sticas especiais na sua afetividade e no seu comportamento, salientando que a pr?pria uremia pode produzir sintomas depressivos. Dentre as altera??es e patologias relacionadas ?s emo??es destaca-se a alexitimia, que designa a dificuldade de expressar afetos ou emo??es. Considera-se que a alexitimia e os sintomas psicopatol?gicos podem influenciar no diagn?stico, no progn?stico e na forma de rea??o do sujeito ? modalidade de tratar a insufici?ncia renal. Desta maneira a avalia??o e identifica??o destes aspectos possibilitam uma melhor compreens?o destes visando um tratamento psicol?gico mais adequado a esta popula??o e um trabalho de preven??o e promo??o da sa?de mental com estes pacientes e tamb?m com a equipe. Para este estudo a amostra ? composta de 48 pacientes em hemodi?lise de um hospital escola no interior de S?o Paulo. Esta foi estratificada em fun??o da doen?a renal apresentada. Os materiais utilizados foram ficha de Identifica??o, a Escala de Alexitimia de Toronto (TAS) e a Escala de Avalia??o de Sintomas (EAS-40). Amostra ficou distribu?da com um predom?nio de: pacientes do sexo masculino (60,4%), casados (50%), na faixa et?ria entre 40 e 59 anos de idade (58,3%), com ensino b?sico (50%), aposentados ou afastados do trabalho (47,9%). Quanto ao diagn?stico, 41,6% t?m hipertens?o arterial sang??nea, 31,3% diabetes mellitus e 27,1%, glomerunefrite cr?nica. Quanto ? alexitimia, observou-se que 52% dos participantes apresentaram pontua??o igual ou maior que 74 e que 4,2% obtiveram escore igual ou inferior a 62. E, 43,8% dos sujeitos encontram-se na faixa de 63 a 73 pontos. J? a m?dia geral da amostra foi 74 e DP 7,52. Verificou-se que pacientes submetidos a hemodi?lise apresentam altos escores na TAS, independentemente do sexo, n?vel de escolaridade, estado civil, atividade profissional, idade e hip?tese diagn?stica e que n?o houve diferen?as significantes entre estas vari?veis.Em rela??o aos sintomas psicopatol?gicos a pontua??o m?dia foi de 0,63 e DP 0,37 e tamb?m n?o houve diferen?as significantes nas categorias segundo as vari?veis s?cio-demogr?ficas. Em rela??o ? associa??o entre alexitimia e sintomas psicopatol?gicos averiguou-se correla??o significantes entre os escores totais da TAS e EAS_40 e entre o escore total da TAS e os fatores 1, 2 e 3 da EAS-40, que correspondem a expectativa te?rica. Logo, os resultados deste trabalho confirmam que para esta popula??o a alexitimia se associa com os sintomas psicopatol?gico e a necessidade de futuras pesquisas para conhecermos como estes aspectos se comportam em outras popula??es.

Cette recherche étudie les processus psychopathologiques associés aux comportements se référant au Body Art. Ce travail est centré sur l'approche de pratiques relevant de la modification corporelle (piercing, tatouage, scarification, stretch) et de la pratique de performances (séance de tatouage de plusieurs heures, suspension, play piercing et performance artistique). La méthodologie mixte est axée sur l'évaluation quantitative de variables symptomatologiques, de personnalité, émotionnelles et de variables associées à la dimension « corporelle » au sein d'une population de sujets adultes pratiquant ou non la modification corporelle et/ou la performance. L'évaluation qualitative étudie les productions discursives des individus à travers l'analyse de la structure grammaticale du discours et les thématiques qu'ils abordent. / This research examines psychopathological processes associated with behaviors referring to the Body Art. This work deals with body modification practices (piercing, tattooing, scarification, stretch) and performance (several hours tattoo sessions, suspension, play piercing and artistic performance). The methodology consists on both quantitative and qualitative study. Quantitative evaluation focuses on variables of symptomatology, personality, emotional and variables associated with "body" dimension in a population of adult body artists and non-practicing. Qualitative evaluation examines discursive productions through the analysis of the grammatical structure of the speech and associated topics.

Made available in DSpace on 2016-04-04T18:27:54Z (GMT). No. of bitstreams: 1 Maria Claudia Roberta Tombolato.pdf: 377189 bytes, checksum: 92c0bdaaa746d0e98588e70e405599c4 (MD5) Previous issue date: 2005-02-14 / Brazil has registered more than three millions of undergraduate students, prevailing private schools. A growing demand for this population has been to conciliate studies and work regularly. This search is focused on evaluation of quality of life, psychopathologic symptoms and social-demographic factors of a group of college students that also work. For this, 122 undergraduate student workers and 18 non-workers, of a night Business Administration faculty of a private university, from S. Paulo State, answered three questionnaires: social-demographic questionnary, WHOQOL-bref (Fleck & et al.,2000), and EAS-40 / Symptoms Evaluation Scale (Laloni, 2001). Results showed, in general, differently than expected, that work was not a variable that would distinguish undergraduate worker from non-worker concerning to quality of life level and severity of psychopathologic symptoms, in general. Exceptions were: for women and age between 18 and 22 categories, on physical and ambient domain, and obsessive/compulsive psychopathologic symptom, that showed significant differences. Quality of life and psychopathologic symptoms were negatively correlated among the workers as far as for the non-workers, except on domain 4, in which the correlation coefficient did not reach significant levels although it was negative (r=0,36, p>0,05). So, women and youngers showed to be more susceptible to work, but, in general, work did not show to be a problem for quality of life and psychopathologic symptoms manifestation among undergraduate students. This suggests further studies with these groups to clear up about it. / O Brasil registra mais de tr?s milh?es de estudantes no ensino superior, com presen?a dominante de escolas privadas. Conciliar cotidianamente estudo e trabalho tem sido uma demanda crescente nesta popula??o. Este estudo realizou uma avalia??o de grupos de universit?rios-trabalhadores com respeito ? qualidade de vida, sintomas psicopatol?gicos e alguns fatores s?cio-demogr?ficos. Para isso, 122 estudantes universit?rios trabalhadores e 18 n?o trabalhadores da faculdade noturna de Administra??o de Empresas de uma institui??o privada de ensino superior, no interior do Estado de S?o Paulo, responderam a tr?s instrumentos: Question?rio socio-demogr?fico, WHOQOL-bref (Fleck et al.,2000), e EAS-40/Escala de Avalia??o de Sintomas (Laloni, 2001). Os resultados indicaram que o trabalho, ao contr?rio do que era esperado, n?o se mostrou vari?vel que discrimina universit?rio trabalhador de n?o trabalhador, quanto ? qualidade de vida nem a sintomas psicopatol?gicos, no geral. Apenas nas categorias mulheres e idade entre 18 e 22 anos, os dom?nios f?sico, meio ambiente e sintomas obsessivos/compulsivos apresentaram diferen?as que foram significantes. Uma avalia??o do grau de associa??o da qualidade de vida com sintomas psicopatol?gicos mostrou correla??es negativas significantes tanto para os trabalhadores como para os n?o trabalhadores, exceto pelo dom?nio 4 Ambiente no qual o coeficiente de correla??o n?o chegou a ser significante embora negativo (r=0,36, p>0,05). Enfim, as mulheres e os mais jovens apontaram ser mais suscet?veis ao trabalho que, por?m, n?o se mostrou ser um problema para a qualidade de vida e manifesta??o de sintomas psicopatol?gicos do universit?rio de uma maneira geral, sugerindo que se realizem futuras pesquisas com estes grupos que possam trazer maior esclarecimento a respeito.

The aim of this study is to discover nonverbal, bodily gesture and contextual cues indicating self-conscious emotions and use these clues to examine personal differences and psychopathological symptoms. Moreover, possible effects of cultural differences on self-conscious emotions&rsquo / recognition and their relation to psychopathology are meant to be discussed. To achieve aforementioned goals, the study is partitioned into three separate but interdependent phases. The aim of the study is scale adaptation for which the State Shame and Guilt Scale, Test of Self-Conscious Affect-3, Guilt- Shame Scale, State-Trait Anxiety Inventory, and Beck Depression Inventory are applied to a group of 250 university students. The second study&rsquo / s objective is to determine the nonverbal expressions used in recognition of self-conscious emotions. To meet this goal, 5 TAT cards, whose compatibility with the research questions is verified, are applied to 45 university students in separate sessions by using close ended questions. In the third part of the study, 9 TAT cards, which include clues about recognition and nonverbal expressions of self-conscious emotions, adapted corresponding scales, and a psychopathological symptoms measuring scale (SCL-90) in self-report format are applied on a group of 250 university students. Factor and correlation analyses done in the first part reveal that adapted scales are reliable and valid, while group comparisons and measurements of the second part indicate differences in emotions. Findings reveal that shame can be recognized by nonverbal expressions whereas for guilt contextual clues are facilitated. In the third part, group comparisons and regression analyses, which are done in order to reveal self-conscious emotions&rsquo / recognition and their significant relationships with psychopathology, display that state self-conscious emotions and shame-proneness have very important roles on psychopathology. All these findings are discussed in the light of cultural effects.

I) Hintergrund Die chronische Hepatitis-C-Infektion stellt global ein wesentliches Gesundheitsproblem dar. Diese Virusinfektion kann bei unbehandelten Patienten zur Leberzirrhose und im weiteren Verlauf bis hin zur Entwicklung eines hepatozellulären Karzinoms führen. Die einzige Behandlungsoption mit der Aussicht auf dauerhafte Viruselimination besteht in modernen Kombinationstherapien, die das Zytokin Interferon alfa enthalten. Wesentliche Merkmale sind – neben inzwischen sehr hohen Ansprechraten – eine Behandlungsdauer zwischen 24 und 48 Wochen, hohe Therapiekosten und ein Nebenwirkungsprofil, das sowohl somatische als auch psychopathologische Symptome umfassen kann. II) Untersuchungsgegenstand und Fragestellungen Sowohl die chronische Virusinfektion an sich als auch die aktuell verfügbaren Therapieverfahren bergen ein erhebliches psychisches Belastungspotential. Hauptgegenstand dieser Dissertation ist die Erfassung der psychologischen Aspekte der Erkrankung und der psychischen und psychopathologischen Nebenwirkungen einer Interferonbehandlung. Wesentliche bearbeitete Fragestellungen sind: - Welchen Belastungsfaktoren sind Hepatitis-C-Patienten bereits ohne aktuelle antivirale Interferontherapie ausgesetzt bzw. welche psychopathologischen Symptome zeigen diese Patienten? - Wie ist der zeitliche Verlauf psychopathologischer Symptome bei Hepatitis-C-Patienten vor, während und nach einer antiviralen Therapie? - Wie wirksam und wie sicher ist eine medikamentöse Behandlung der Interferon-induzierten Depression mit selektiven Serotonin-Wiederaufnahmehemmern (SSRI) unter Fortführung der antiviralen Therapie? III) Patienten und Methoden Studienteilnehmer waren Hepatitis-C-Patienten, die sich ambulant vorstellten bzw. in unsere Ambulanz überwiesen wurden und die jeweiligen Einschlusskriterien erfüllten. Zu den wichtigsten verwendeten psychometrischen Selbstbeurteilungsskalen zählen: HADS (Depressivität, Angst), SCL-90-R (psychopathologische Symptome), SF-36 (Lebensqualität) und FKV (Krankheitsverarbeitung). IV) Wesentliche Forschungsergebnisse Bereits ohne Einfluss des Zytokins Interferon bestehen starke Krankheits-assoziierte psychische bzw. psychosoziale Belastungen der Patienten, die sich in einem erhöhten Depressionsrisiko ausdrücken. Die erhobenen Depressionsscores stehen in signifikantem Zusammenhang mit der Erkrankungsdauer und den individuell bestehenden Optionen und Erfolgsaussichten einer antiviralen Interferontherapie. Prospektive Erfassungen der Auftretenshäufigkeit klinisch relevanter Interferon-assoziierter Depressionen ergeben Raten von ca. 30 %. Diese Größenordnung wurde sowohl in einer eigenen prospektiven Studie als auch im Rahmen einer vorgestellten Übersichtsarbeit bestätigt. Die Umstellung der verwendeten Formulierung des Medikaments von herkömmlichem Interferon alfa auf die pegylierte Variante brachte keine Verbesserung der Verträglichkeit z.B. im Hinblick auf die interferonassoziierte Depression. Ein rechtzeitiges Erkennen der entsprechenden Symptome vorausgesetzt, ist die antidepressive Behandlung der Interferon-assoziierten Depression mit Hilfe von selektiven Serotonin-Reuptake-Inhibitoren auch ohne generelle Prophylaxe sehr effektiv und sicher möglich. V) Diskussion Empfohlen wird ein engmaschiges psychometrisches Monitoring aller Hepatitis-C-Patienten im Therapieverlauf. Ausführliche Aufklärung, enger Arzt-Patienten-Kontakt während der Therapie, sowie die Betreuung durch einen festen Ansprechpartner während der bis zu einem Jahr dauernden Therapie sind wichtige Rahmenbedingungen für eine solche Behandlung. Für die medikamentöse Behandlung der Interferon-induzierten Depression gilt: Bei besonderer Indikation (z.B. Interferon-assoziierte Depression bei früheren Therapieversuchen) sollte eine SSRI-Sekundärprophylaxe in Betracht gezogen werden. Ansonsten ist eine entsprechende SSRI-Intervention beginnend mit dem Einsetzen einer klinisch relevanten Depression ausreichend.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-09-09T18:37:34Z No. of bitstreams: 2 Dissertação - Rafaella Eloy de Novaes - 2016.pdf: 2466871 bytes, checksum: ad896ee1f5b9e01584149ff6cc518e09 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-12T14:18:38Z (GMT) No. of bitstreams: 2 Dissertação - Rafaella Eloy de Novaes - 2016.pdf: 2466871 bytes, checksum: ad896ee1f5b9e01584149ff6cc518e09 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-12T14:18:38Z (GMT). No. of bitstreams: 2 Dissertação - Rafaella Eloy de Novaes - 2016.pdf: 2466871 bytes, checksum: ad896ee1f5b9e01584149ff6cc518e09 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-04-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This research deals with the relationship between experiences of suffering of people diagnosed with mental illness and clinical conditions and/or psychopathological categories through narratives. Embasa up in the theoretical and methodological formulations of the field of Anthropology of Health and of Disease undertaken by Das, Kleinman and Lock (1997), Das (2015), Good (1994), Kleinman (1988) and other like Bruner (1986) and Garro and Mattingly (2000). Its empirical indentation is composed by professionals, trainees and users/patients of the Center for Psychosocial Care II (CAPS II), located in the administrative region of Taguatinga, in the Distrito Federal. Field observations were made in the own CAPS and open interviews with users/patients, professionals and trainees. Basically, the search was guided from the following questions: What the people who are in the condition of users/patients of CAPS II Taguatinga tell how the experiences of suffering that led to that mental health service? How these narratives are appropriate by professionals and trainees of CAPS II Taguatinga? What Anthropology has to say about the mode of appropriation of suffering in the biomedical paradigm? It is argued that the appropriation of suffering narratives by clinical conditions and/or psychopathological categories dilutes complex experiences of social suffering in medical questions and/or psychological and hides deep relations between those experiences and historical and social processes broader. / Esta pesquisa trata da relação entre experiências de sofrimento de pessoas diagnosticadas com adoecimento mental e as condições clínicas e/ou categorias psicopatológicas por meio de narrativas. Embasa-se nas formulações teórico-metodológicas do campo da Antropologia da Saúde e da Doença empreendidas por Das, Kleinman e Lock (1997), Das (2015), Good (1994), Kleinman (1988) e outros como Bruner (1986) e Garro e Mattingly (2000). Seu recorte empírico é composto por profissionais, estagiários e usuários/pacientes do Centro de Atenção Psicossocial II (CAPS II), localizado na região administrativa de Taguatinga, no Distrito Federal. Foram feitas observações de campo no próprio CAPS e entrevistas abertas com usuários/pacientes, profissionais e estagiários. Basicamente, a pesquisa orientou-se a partir dos seguintes questionamentos: O que as pessoas que estão na condição de usuárias/pacientes do CAPS II de Taguatinga narram como as experiências de sofrimento que as conduziram àquele serviço de saúde mental? Como essas narrativas são apropriadas por profissionais e estagiários do CAPS II de Taguatinga? O que a Antropologia tem a dizer sobre o modo de apropriação do sofrimento no paradigma biomédico? Argumenta-se que a apropriação de narrativas de sofrimento mediante condições clínicas e/ou categorias psicopatológicas, dilui complexas experiências de sofrimento social em questões de ordem médica e/ou psicológica e oculta as relações profundas existentes entre aquelas experiências e processos históricos e sociais mais amplos.

L’objectif de cette recherche est d’étudier, chez l’adolescent, les mécanismes psychopathologiques et psychologiques impliqués dans la co-occurrence de comportements antisociaux et de conduites de consommation et responsables de la « pathologisation » de la consommation de substances psychoactives, par l’adoption conjointe d’une approche centrée sur la personne et centrée sur les variables et la mise en place d’un dispositif d’étude multi-échantillons. Ainsi, cette recherche comporte trois volets : 1) une étude en milieu scolaire menée auprès de 1025 collégiens âgés de 12 ans à 16 ans, 2) une étude en milieu psychiatrique menée auprès de 168 adolescents suivis ou hospitalisés pour un trouble externalisé ou internalisé, âgés de 12 ans à 18 ans, et 3) une étude en addictologie menée auprès de 43 adolescents abuseurs/dépendants à une substance psychoactive, âgés de 12 ans à 18 ans. Un protocole d’évaluation pluri-source (adolescents, parents, enseignants) a permis d’évaluer les comportements antisociaux, les conduites de consommation, les conduites à risques, les troubles et symptômes externalisés et internalisés (et les antécédents de troubles), la personnalité, le stress perçu et les stratégies de coping de ces adolescents. Ce dispositif a permis de montrer que les adolescents les plus susceptibles d’associer ces deux comportements et d’adopter des conduites de consommation à risques présentent des difficultés à la fois relationnelles (faible coopération, trouble oppositionnel avec provocation, faible transcendance), émotionnelles (symptômes dépressifs, troubles internalisés, intolérance à la frustration, stress perçu dans le domaine scolaire ou dans la relation aux parents, stratégies d’adaptation dysfonctionnelles) et comportementales (forte recherche de nouveauté, comorbidité TDAH/TOP). La pathologisation des conduites de consommation relèvent d’enjeux similaires à l’adoption de conduites de consommation à risques. Néanmoins, le risque de pathologisation serait d’autant plus important que les enjeux émotionnels et relationnels relèvent de manifestations tempéramentales (faible dépendance à la récompense sociale). En termes de prévention des conduites de consommation à l’adolescence et de leur pathologisation, il paraît primordial de bien distinguer ces différents niveaux de vulnérabilité (psychopathologique, psychologique, tempéramentaux, adaptatif). / This work aims to study, among adolescents, the psychopathological and psychological mechanisms involved in the co-occurrence of antisocial behaviors and psychoactive substance use and in the “pathologizing” of psychoactive substance use through a person-centered and a variable-centered approach and based on a multi-sample plan. This research focus on: 1) 1 025 middle and high school students aged between 12 to 16 years old, 2) 168 inpatients and outpatients adolescents aged between 12 to 18 years old, and 3) 43 psychoactive substance abusers/dependent adolescents aged between 12 and 18 years. A multi-source assessment (adolescents, parents, teachers) was used to collect information about adolescents’ antisocial behaviors, psychoactive substance use, risk-taking behaviors, past and present externalized and internalized disorders and symptoms, personality, perceived stress and coping strategies. The results show that adolescents are most likely to associate antisocial behaviors and psychoactive substances use and to have a risky psychoactive substance use when they present both relational problems (low cooperation, oppositional defiant disorder, low transcendence), emotional difficulties (depressive symptoms, internalizing disorder, intolerance to frustration, perceived stress in school and in relationships with parents, dysfunctional coping strategies) and behavioral dysregulation (high novelty seeking, ADHD/ODD comorbidity). Mechanisms involved in the pathologizing of psychoactive substance use are similar to the adoption of risky psychoactive substance use. Nevertheless, the risk of pathologizing is all the more important when emotional and relational problems are temperamental expression (low social reward dependence). In terms of prevention of risky psychoactive substance use in adolescence and of its pathologizing, it seems important to distinguish between these different levels of vulnerability (psychopathological, psychological, temperamental, adaptative).

Made available in DSpace on 2016-04-04T18:29:32Z (GMT). No. of bitstreams: 1 Jena Hanay Doutorado.pdf: 721081 bytes, checksum: 65f8d839cf686774d38170e56199f048 (MD5) Previous issue date: 2006-12-18 / Evaluates depression, anxiety, psychopathologic symptoms, alexithymia and defensive style of grade III obese patients, before and after bariatric surgery, as well as estimates the level of association among such variables. Methodological study design was correlational crosssectional type. 65 patients took part in the study (Group 1: surgical candidates vs. Group 2: postoperative patients), mainly females (92,3%), who answered the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Symptoms Assessment Scale (EAS- 40), and the version in Portuguese of The Toronto Alexithymia Scale (TAS-26) and of the Defensive Style Questionnaire (DSQ-40). Gr 1 showed mild anxiety and depression levels and Gr 2 minimum level (respectively, p< 0,001 e p< 0,01). The total average score for EAS- 40 and F2 and F3 (obesity-compulsion and somatization) were higher in Gr 1 when compared to Gr 2 (repetitively, p< 0,005, p< 0,005 e p< 0,001). On TAS, the total average score for F1 (ability to identify and describe feelings and distinguish them from bodily sensations) were higher in Gr 1 than in Gr 2 (respectively, p< 0,01 e p< 0,005). According to DSQ-40, there was a tendency for an immature defensive style in Gr 1 in comparison to Gr 2 (p< 0,02). In relation to the association between the variables and BMI, the correlations were negative for Gr 1 and F2 of TAS (daydreaming, p < 0,05) and for the mature factor of DSQ- 40 and Gr 2 (p < 0,05), which shows a trend towards a more mature and adaptive style in Gr 2. Correlations were positive and significant in relation to immature defenses - acting out (Gr 1: p<0,005 and Gr 2: p<0,05) and in the autistic fantasy in Gr 1 (p<0,05). The results show the psychological status of the participants, who are apt for bariatric surgery and point to a decrease in psychopathological symptoms proportional to weight loss after surgery. / Avalia depress?o, ansiedade, sintomas psicopatol?gicos, alexitimia e o estilo defensivo de pacientes obesos grau III, antes e depois de cirurgia bari?trica, e estima o grau de associa??o entre essas vari?veis. O delineamento metodol?gico foi correlacional de tipo cross-sectional. Participaram do estudo 65 pacientes (Gr 1: pr?-cir?rgico vs. Gr 2: p?scir?rgico), predominantemente do sexo feminino (92,3%), que responderam o Invent?rio de Depress?o de Beck (BDI), o Invent?rio de Ansiedade de Beck (BAI), a Escala de Avalia??o de Sintomas (EAS-40), a Vers?o em Portugu?s da Escala de Alexitimia de Toronto (TAS-26) e a Vers?o em Portugu?s da Defensive Style Questionnaire (DSQ-40). O Gr 1 apresentou n?vel de depress?o e ansiedade leve e o Gr 2 n?vel m?nimo (respectivamente, p< 0,001 e p< 0,01). O escore m?dio total da EAS-40 e de F2 e F3 (obsessividade-compulsividade e somatiza??o) foram mais elevados no Gr 1 quando comparados aos do Gr 2 (respectivamente, p< 0,005, p< 0,005 e p< 0,001). Na TAS, o escore m?dio total e de F1 (habilidade de identificar e descrever sentimentos e distingui-los de sensa??es corporais) foram maiores no Gr 1 do que no Gr 2 (respectivamente, p< 0,01 e p< 0,005). De acordo com o DSQ-40, houve tend?ncia a um estilo defensivo imaturo no Gr 1 quando comparado ao Gr 2 (p< 0,02). Em rela??o ? associa??o das vari?veis com o IMC, as correla??es foram negativas no Gr 1 e o F2 da TAS (sonhar acordado, p < 0,05) e no fator maduro do DSQ-40 e o Gr 2 (p < 0,05), apontando uma propens?o de estilo mais maduro e adaptativo no Gr 2. As correla??es foram positivas e significantes nas defesas imaturas acting out (Gr 1: p<0,005 e Gr 2: p<0,05) e na fantasia aut?stica no Gr 1 (p<0,05). Os resultados mostram o modo de funcionamento psicol?gico dos participantes aptos ? cirurgia bari?trica e assinalam uma diminui??o da sintomatologia psicopatol?gica na propor??o da perda de peso ap?s a cirurgia.

Les troubles du sommeil en général et les cauchemars en particulier sont souvent associés aux troubles psychopathologiques et physiques. Ils font partie des plus importantes et fréquentes plaintes rapportées par les patients souffrant de trouble stress post-traumatique et leurs liens avec la sévérité de ce dernier se précisent de plus en plus. L’objectif général de notre thèse est d’apporter des précisions sur les aspects cliniques, psychopathologiques et psychophysiologiques concernant les cauchemars dans le contexte particulier et spécifique du trouble stress post-traumatique, et de préciser les apports thérapeutiques d’un traitement centré sur les cauchemars à travers une étude de cas. Pour ce faire, nous avons choisi de procéder à des évaluations psychopathologiques au moyen d’auto-questionnaires (IES-R, HAD, PSQI, PSQI-A, NDQ et DES), d’entretiens structurés (MINI et CAPS) et d’enregistrements psychophysiologiques sur un échantillon de 21 patients souffrant de cauchemars dans un contexte de TSPT, hospitalisés dans une unité de soins spécialisés en psychotraumatologie et une évaluation d’un suivi thérapeutique d'un patient reçu dans un centre de soin spécialisé à Paris. Les principaux résultats de notre recherche montrent que la sévérité du TSPT est très fortement et positivement associée à la sévérité des cauchemars post-traumatiques et soulignent que la détresse liée aux cauchemars explique mieux la sévérité du TSPT que la fréquence des cauchemars. Nos résultats ont également permis de vérifier ce qui a été rapporté dans la littérature scientifique, à savoir la présence d’importantes comorbidités. En revanche, pour ce qui est des évaluations psychophysiologiques du sommeil, aucun élément pertinent ne ressort de l’analyse des enregistrements polysomnographiques, et aucun des paramètres étudiés n’a été corrélé ni avec la fréquence des cauchemars, ni avec la détresse liée aux cauchemars. Enfin, l’étude de cas a permis d’évaluer les bénéfices thérapeutiques attendus d’un nouveau traitement psychothérapeutique centré sur les cauchemars, dont les résultats montrent une réduction significative de la sévérité des cauchemars, accompagnée d’une réduction de la sévérité du TSPT ainsi qu’une amélioration proportionnelle de la qualité du sommeil. En conclusion, les résultats de notre recherche convergent avec ceux retrouvés dans des études antérieures et soulignent l’importance clinique et psychopathologiques des cauchemars et leur implication dans la sévérité du trouble stress post-traumatique. / Sleep disorders in general and nightmares in particular are often associated with psychopathological and physical disorders. They are among the largest and the most frequent complaints reported by patients with PTSD and their links with the severity are now more specified. The overall objectives of this thesis are to shed light on the clinical, psychopathological and psychophysiological aspects of nightmares in the specific context of PTSD, and also to clarify the therapeutic contributions of nightmares centered treatment through a case study. In order to achieve these objectives, a sample of 21 patients suffering from posttraumatic nightmares and hospitalized in a specialized psychotraumatology unit of care were assessed using self-administered questionnaires (IES-R, HAD, PSQI, PSQI-A, NDQ and DES), structured interviews (MINI and the CAPS) and psychophysiological recordings. In parallel, another patient coming from a specialized psychotraumatology center in Paris was carefully monitored in regards of his therapeutic evolution while receiving the Imagery Rehearsal Therapy program on an individual basis. The main results of this research show that the severity of PTSD is strongly and positively associated with the severity of post-traumatic nightmares and that the distress related to nightmares better explains the severity of PTSD that the frequency of nightmares does. The results also confirmed what has been reported in the scientific literature, namely the presence of significant comorbidities. However and in terms of psychophysiological assessments of sleep, no significant results were found in the analysis of polysomnographic recordings, and none of the studied parameters were correlated with the frequency and/or the distress related to nightmares. Finally, the case study was successfully used to evaluate the expected therapeutic benefits of a relatively new psychotherapeutic treatment focusing on nightmares and the results show a significant reduction in the severity of nightmares, accompanied by a reduction in the severity of PTSD and a proportional improvement in sleep quality. In conclusion, the results of this research are consistent with those found in previous studies and underscore the clinical and psychopathological importance nightmares and their involvement in the severity of PTSD