Pour Freud et Lacan, la psychose n'est pas un état déficitaire. Le texte de Schreber demeure un traité paradigmatique, aujourd'hui encore inégalé.Le délire paranoïaque est une tentative de guérison pour le premier. Un essai de rigueur pour le second. Reste la question épineuse du transfert psychotique. Freud ne croit pas le psychotique capable de transfert analytique, Lacan pense au début que le transfert est susceptible de provoquer un déclenchement, et que, par ailleurs, le psychotique a l'objet a dans sa poche. Freud continua à recevoir des psychotiques tout en dissuadant ses disciples de le faire. Lacan, qui connut la psychose avant la psychanalyse, avance que le psychanalyste ne doit pas reculer devant la psychose. Le sujet psychotique qui reste en dehors de tout lien social établi peut-il être accueilli par le discours analytique ? C'est cela que nous examinons dans cette thèse. Si le sujet ne guérit pas de sa psychose, peut-il inventer dans la cure des suppléances pour y faire face ? Il n’existe pas de solution générale, mais une approche des contingences. Pas de garantie donc, mais peut-être le désir de l'analyste… / For Freud and Lacan psychosis is not a deficiency. Nowadays, Schreber’s text still remains an unequalled paradigmatic treatise. For Freud, paranoid delirium is an attempt at recovery, and for Lacan it is an attempt to analyze severe logic. The thorny question of psychotic transference still remains. Freud does not believe that a psychotic patient is capable of analytical transference. Lacan thinks that at the beginning, the transference is likely to provoke a trigged of, furthermore the psychotic has the object a in his pocket. Freud continued seeing psychotic patients even though he dissuaded his students from doing so. Lacan, who psychosis before psychoanalysis, suggests that the analyst should not draw back in the face of psychosis. Can the psychotic subject, which stays out of every social bond established, be received by analytical speech? This is what we examine throughout the thesis. If the subject is not cured of his psychosis, can he invent substitutes within the treatment in order to deal with it? Thus, there is no general solution but rather a contingency approach which can betaken. There is no guarantee but there might be the analyst’s desire…

Cette thèse a pour objectif de montrer l’importance du rythme comme socle thérapeutique dans la prise en charge de la psychose infantile. Le rythme sera abordé selon deux points de vue :D’une part, comme élément communicationnel originaire entre l’enfant et la mère, il permet les premières associations de sens et par là, des mises en forme initiales (représentation de chose) du contact avec l’altérité. Les continuités et discontinuités dans le contact avec l’extérieur peuvent devenir, grâce à la régularité et la répétition qui constituent le rythme, des présences et des absences.D’autre part, l’articulation interne du rythme nous révèle une structure ternaire codifiée par les chiffres (1-0-1). Le chiffre Un est entendu comme une présence et le chiffre Zéro comme une presentia in absentia. Cette structure permettrait la négativation de la présentation pulsionnelle et l’introduction de l’enfant dans les préambules de la figuration moïque et la triangulation oedipienne. / The aim of this study is to demonstrate the importance of rhythm in the treatment of infantile psychosis. This rhythm is studied from two perspectives.First, as the first means of communication between mother and child, rhythm enables children to experience their first sensory associations and thus to structure their first representations of contact with otherness. Continuity and discontinuity with otherness could become presences and absences, thanks to the regularity and repetition inherent in the rhythm.Secondly, the inner speech of this rhythm reveals a ternary structure codified by the digital sequence (1-0-1). 1 is understood as a presence, 0 as a presentia in absentia.This structure would allow the negativation of the inner drive representation and would introduce the child to the preambles of Ego and Oedipus triangulation.

Os transtornos psicoticos, de um modo geral, e em especial a esquizofrenia, exercem um impacto patente na qualidade de vida do individuo com estes sintomas, afetando seu bemestar, sua ocupacao profissional e sua relacao com a comunidade. Quanto mais cedo se inicia o tratamento, mais breve pode ocorrer a reintegracao dessa pessoa na sociedade, porem sua eficacia depende do diagnostico precoce para que seja possivel a intervencao caso a caso. O estudo do Rorschach, como instrumento de investigacao da personalidade, pode auxiliar neste processo devido ao seu amplo escopo de aplicacoes. A maior parte dos estudos sobre as pessoas com sintomas psicoticos trata da esquizofrenia, porem poucas publicacoes pesquisaram os pacientes ainda proximos ao surto e com efeito minimo da medicacao, alem de poucos estudos estabelecerem a comparacao com um grupo de individuos normais. A presente pesquisa propos-se a enfocar estes dois aspectos: o estudo de individuos proximos ao surto psicotico que os levou a procurar pela primeira vez uma instituicao de saude e sua comparacao com um grupo controle. Assim, o grupo experimental foi composto de vinte pessoas que procuraram uma instituicao de saude entre maio de 2004 e marco de 2005 e que moravam ha pelo menos 6 meses na area delimitada pelo projeto. Os participantes do grupo controle foram pareados individualmente por vizinhanca, faixa etaria e sexo; desta forma concentrando-os em regioes geograficas relevantes e demograficamente representativas para a comparacao. A coleta de dados foi realizada em duas entrevistas, a primeira para familiarizacao do participante com a pesquisadora e a segunda para a aplicacao do Rorschach. A analise dos dados se deu quantitativamente, segundo o Sistema Frances. O Metodo de Rorschach mostrou-se sensivel a diferencas entre os dois grupos estudados. Os resultados obtidos com os sujeitos do grupo experimental, em relacao ao grupo controle, foram significativos quanto ao menor percentual de respostas de forma bem vista, menor quantidade de respostas de tonalidade e menor percentual de respostas de conteudo animal. A analise destes indices em conjunto com outros fatores do Rorschach sugeriu uma dificuldade maior das pessoas com sintomas psicoticos no contato com os outros decorrente da introjecao inadequada de estereotipos sociais, da nao diferenciacao entre realidade interna e externa e de um processo de identificacao fragilizado permeado pela angustia de desintegracao. Este projeto esta associado a um projeto maior intitulado Estudos de Casos Incidentes (Primeiro Contato com Servicos de Saude) de Psicoses Funcionais no Brasil, que esta sendo realizado por equipe do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC FMUSP), na tentativa de caracterizar, acompanhar e comparar os casos de transtornos psicoticos na cidade de Sao Paulo com um estudo semelhante feito em Londres, Reino Unido / The psychotic disorders, as a whole, and specially schizophrenia, inflict an evident impact upon one\'s life quality with such symptoms, affecting his well-being, professional affairs and relationship with the community. The earlier treatment starts, the sooner this person can be reintegrated into society, albeit it\'s effectiveness depends upon early diagnosis for intervention to be possible on a case by case basis. The study of Rorschach as an instrument for personality assessment can help on this process due to its wide scope of applications. Most researches about individuals with psychotic symptoms are about schizophrenia, however only few publishings have studied patients still near the psychotic episode and under minimal medication, and few researches established a comparative study between afflicted population and healthy one. The current research aim was twofold in the study of individuals near the psychotic episode which resulted in his first-admission in a mental health care facility and comparison with control group. Thus, experimental group consisted of twenty individuals that were first admitted to a mental health care service between may (2004) and march (2005), that have lived in the research delimited area for at least 6 months. Control group participants were likened by neighborhood, age range and gender; this way concentrating them on both demographically representative and relevant geographic regions for comparison. Data was obtained by means of two interviews, being the first one in order to familiarize participant and researcher, and the second one to administer Rorschach test. Only quantitative analysis was performed, scored according to the French System. Rorschach Method presented sensibility to discrepancies among both researched groups. There was statistically significant differences between experimental group and comparison group with regard to lower percentage of good quality form responses, lower scores of shading responses, lower percentage of animal responses. The analisys of those three items along with other Rorschach scores suggests that people with psychotic symptoms present greater difficulties to relate with others due to introjection of inadequate social stereotypes, no differentiation from internal and external reality, and weakened identification process permeated by desintegration anguish. This project is associated to a larger project entitled Estudos de Casos Incidentes (Primeiro Contato com Servicos de Saude) de Psicoses Funcionais no Brasil, which is being conducted by the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC FMUSP) research team, in an attempt to profile, study and compare psychosis affliction cases in Sao Paulo city with similar studies being carried in London, United Kingdom

Essa pesquisa interroga a respeito do exercício da prática clínica quando seus fundamentos, conceitos e teorias próprios não estão referidos aos espaços tradicionais de tratamento, como é o caso da prática do Acompanhamento Terapêutico. Trata-se de um levantamento bibliográfico das articulações teórico-práticas realizadas pelos pesquisadores brasileiros que escreveram sobre o tema do AT e posteriormente um recorte específico dos trabalhos que se situam no campo da psicanálise, tendo a finalidade de reunir a produção teórica desta prática e analisá-la. A pesquisa se propõe a oferecer um panorama do campo mostrando como e em que momento histórico o AT surgiu, quais as elaborações teóricas embasaram seu fazer e como a psicanálise contribui para este trabalho. Como conseqüência a disponibilização do conjunto de material produzido neste campo pode contribuir na elaboração de uma posição ou um lugar teórico sobre o AT. O AT surgiu no campo da saúde mental no momento histórico conhecido como Reforma Psiquiátrica, visto que se caracteriza pela aproximação à loucura e por seus novos modos de tratamento. Por ter surgido neste espaço as teorizações no campo se enquadram, em sua maioria, nos enfoques da reabilitação psicossocial e da psicanálise. De acordo com o material bibliográfico pesquisado é possível afirmar que O AT seria definido por uma prática e não por uma abordagem teórica, já que a rigor, não há uma teorização acerca do AT, pois seus autores importaram conceitos de diferentes correntes com bases epistemológicas distintas. O AT pode ser sustentado teoricamente a partir dos preceitos que orientam a clínica psicanalítica com as psicoses, compreendido como uma oferta clínica que sustenta saídas e promove a circulação. É, assim, portanto que o AT propicia em ato uma aproximação e experimentação de laços sociais, ou seja, possibilidades de encontro com efeitos de real. Conclui-se que o AT não é uma prática psicanalítica, no entanto, ao ser desempenhado por um psicanalista, alguns lugares lhe são possíveis, podendo se prestar a ser suporte das identificações imaginárias, ser secretário do alienado até contribuir para a construção do sinthome, que se referem às posições que o AT pode se colocar na transferência / This research delves into the clinical practice when its foundations, concepts and theories do not refer to the traditional spaces of treatment, as is the case with the practice of Therapeutic Acompaniment . It deals with a bibliographical research of the theoreticalpractical articulation by Brazilian researchers who write about Therapeutic Acompaniment and subsequently with a specific section of the psychoanalysis work, with the goal of assembling the theoretical product of this practice and analyzing it. The research intends to offer a view of the field showing how and at what point in history Therapeutic Acompaniment came to be, what theoretical elaborations founded its application and how psychoanalysis contributes to this work. As a consequence, the availability of the set of materials produced in this filed may contribute to the elaboration of a position or a theoretical space regarding Therapeutic Acompaniment. Therapeutic Acompaniment emerged in the mental health field at a historic moment known as the Psychiatric Reform, given that it is characterized by its affinity to insanity and by its new treatment methods. Having arised in this space, most theorizations in the field conform to the focus on psychosocial rehabilitation and psychoanalysis. According to the bibliographical material researched, it is possible to state that Therapeutic Acompaniment would be defined by a practice and not by a theoretical approach, since, strictly, there is no theorization regarding Therapeutic Acompaniment, since its authors imported concepts from different trends, with different epistemological bases. Therapeutic Acompaniment can be theoretically support from the precepts that guide the psychoanalytic clinic of psychosis, understood as a clinical practice that sustains egress and promotes circulation. Therefore Therapeutic Acompaniment provides an approximation and experimentation of social links, that is, possibilities of encounters with effects of the real. In conclusion, although Therapeutic Acompaniment is not a psychoanalytical practice, when it is used by a psychoanalyst it may find its space; it may provide support for imaginary identifications, function as secretary of the insane, and contribute to the construction of the sinthome, spaces which refer to the positions Therapeutic Acompaniment may assume during transference

While a correlation between suffering from psychosis and an increased risk of engaging in aggressive behaviours has been established, many factors have been explored which may contribute to increasing this risk. Patients with a diagnosis of psychosis have been shown to have significant difficulties in facial affect recognition (FAR) and some authors have proposed that this may contribute to increasing the risk of displaying aggressive or violent behaviours. A systematic review of the current evidence regarding the links between facial affect recognition and aggression was conducted. Results were varied with some studies providing evidence of a link between emotion recognition difficulties and aggression, while others were unable to establish such an association. Results should be interpreted with some caution as the quality of included studies was poor due to small sample sizes, insufficient power and limited reporting of results. Adequately powered, randomised controlled studies using appropriate blinding procedures and validated measures are therefore required. There is a substantial evidence base demonstrating difficulties in emotional perception in patients with psychosis, with evidence suggesting a relationship with reduced social functioning, increased aggression and more severe symptoms of psychosis. In this review we aim to review this field to assess if there is a causal link between facial affect recognition difficulties and psychosis. The Bradford Hill criteria for establishing a causal relationship from observational data were used to generate key hypotheses, which were then tested against existing evidence. Where a published meta-analysis was not already available, new meta-analyses were conducted. A large effect of FAR difficulties in those with a diagnosis of psychosis, with a small to moderate correlation between FAR problems and symptoms of psychosis was found. Evidence was provided for the existence of FAR problems in those at clinical high risk of psychosis, while remediation of psychosis symptoms did not appear to impact FAR difficulties. There appears to be good evidence of the existence of facial affect recognition difficulties in the causation of psychosis, though larger, longitudinal studies are required to provide further evidence of this.

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Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-11-01T17:04:03Z No. of bitstreams: 1 Dagmara Yuki Vieira Tomotani Myrria.pdf: 459997 bytes, checksum: 4be48f7f2c71d7bfa5a4df3684befad5 (MD5) / Made available in DSpace on 2016-11-01T17:04:03Z (GMT). No. of bitstreams: 1 Dagmara Yuki Vieira Tomotani Myrria.pdf: 459997 bytes, checksum: 4be48f7f2c71d7bfa5a4df3684befad5 (MD5) Previous issue date: 2016-09-16 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The dissertation Um olhar sobre a clínica da psicose: transferência e pré-conceito [A look at the clinic of psychosis: transference and pre-concept] aims to discuss the riddle presented to the analyst when facing the Clinic of Psychosis. In treating Lucius, the clinical case of this work, the analyst noted the existence of a type of patient transfer which was manifested by loaning the analyst's image to attempt to invest libido in the external world. The dissertation construction process begins with a rescue of the writings of Freud, Lacan and Aulagnier about paranoia; passing to an elaboration on the absence of the gaze in psychosis, and then unrolling the construction of the concept of transference in it. At the end of the research, a new chapter was inserted because another enigma arose during this journey: the existence in the analyst of a pre-concept related to psychosis, which is portrayed from an ideal which is subject to subsequent developments and crossings in this clinic. Through Fundamental Psychopathology and Clinical Method, this research worked with the singular that emerged in the clinic, which, somehow, was revealed as a pathos in need of a logos / A dissertação Um olhar sobre a clínica da psicose: transferência e pré-conceito tem como objetivo discutir o enigma apresentado à analista diante da Clínica da Psicose. No tratamento destinado a Lúcius, caso clínico desta dissertação, a analista constatou a existência de um tipo de transferência do paciente que tinha por manifestação o empréstimo da imagem da analista como tentativa de investir libido no mundo externo. O processo de construção da dissertação inicia-se com um resgate dos escritos de Freud, Lacan e Aulagnier sobre a paranoia, passando para a elaboração sobre a ausência de olhar na psicose e desenrolando na construção do conceito de transferência na mesma. Ao final da pesquisa, um novo capítulo foi inserido, pois outro enigma surgiu durante esse caminho: a existência de um pré-conceito da analista em relação à psicose, o qual é retratado a partir de um ideal passível de consequentes desdobramentos e atravessamentos nesta clínica. Por meio da Psicopatologia Fundamental e do Método Clínico, esta pesquisa trabalhou com o singular emergido na clínica, que, de alguma forma, se revelou como um pathos necessitado de um logos

A pesquisa tem por objetivo geral construir um mapeamento dos principais discursos diagnósticos pós-lacanianos que se circulam no Brasil. Um primeiro objetivo específico desta tese é distinguir a racionalidade subjacente comum a diferentes autores. O segundo objetivo específico é realizar uma breve indicação dos elementos conceituais que se destacam em cada discurso, um destaque que nos revelas as chaves para abrir o debate a ser realizado mais adequadamente nas considerações finais. A justificativa desta pesquisa reside na possibilidade de oferecer ao campo da psicanálise uma inédita visão de conjunto do universo diagnóstico pós-lacaniano. Neste intuito, nossa tese possui uma primeira parte que tem função histórica de situar o campo em debate e refazer os primeiros passos de construção do pensamento diagnóstico em Lacan, assim oferecemos as condições prévias para acompanhar a subsequente discussão pós-lacaniana. Optamos por realizar esta apresentação histórica, pois a hipótese com a qual trabalhamos é que alguns fundamentos do período nascente da obra lacaniana, da década de trinta e quarenta, retornam como questão no debate pós-lacaniano. Na sequencia, temos dois grupos discursivos que trabalham diretamente ligados ao texto de Lacan. O primeiro grupo de autores representa a visão da diagnóstica clássica, pois faz uma redescrição das três estruturas clínicas (neurose, psicose e perversão) e adota esta racionalidade como modelo diagnóstico padrão da obra lacaniana; já o segundo grupo de autores defende a necessidade de reformulações na diagnóstica lacaniana, pois postula a insuficiência do modelo das estruturas clínicas; tais autores estão unidos pela hipótese de que a obra de Lacan possui rupturas conceituais determinantes para uma reacomodação diagnóstica. Por fim, os dois últimos capítulos de nossa tese define um terceiro grupo discursivo que não extrai sua interpretação diretamente do texto de Lacan, mas sim de um diagnóstico social sobre o declínio da função paterna na atualidade, donde cada autor fará sua hipótese para um novo sujeito contemporâneo. Enquanto resultado adicional desta pesquisa, verificamos que as problemáticas clínicas da esfera do Eu retornam ao campo lacaniano de modo direto ou indireto. Como conclusão constatamos que o tema do declínio da função paterna, o desentendimento acerca do alargamento conceitual da categoria de psicose (através da psicose ordinária e psicose compensada) e, por fim, o uso variável da noção de suplência, são os principais elementos dos discursos pós-lacanianos que nos dão as chaves para o debate diagnóstico na atualidade / This research aims to map the main discourses of post-lacanian diagnosis that spread in Brazil. This thesis first specific objective is to differentiate the underlying rationality common to different authors. The second specific objective is to make a brief indication of the conceptual elements that stand out in each discourse. This reveals the keys to open the debate to be more adequately done in our closing remarks. The justification of this research resides in the possibility of offering to the psychoanalytic field an original overview of the post-lacanian diagnostic universe. In order to do so, we first locate historically the field at issue and remake the first steps of Lacans diagnostic thought. This subsidies the ensuing post-lacanian debate. Our hypothesis is that some fundamentals of the first part of the lacanian oeuvre, comprising the 1930s and the 1940s, return in the form of a question in the post-lacanian debate. We present then two discursive groups that are directly related to the lacanian text. The first group of authors represents the classic diagnostic view, since they do a redescription of the three clinic structures (neurosis, psychosis and perversion) and adopt this rationale as the standard diagnostic model in the lacanian oeuvre. The second group of authors defends the necessity of reformulations in lacanian diagnostic, postulating the insufficiency of the clinic structures model. These authors gather around the hypothesis that the lacanian oeuvre has conceptual ruptures that are decisive for diagnostic reaccommodation. The two last chapters define a third discursive group that does not extract its interpretation directly from lacanian text, but from a social diagnosis about the decline of the paternal function nowadays. Each author will hypothesize about a new contemporary subject. As an additional result, we found that the clinical problematic of the Ego returns to the lacanian field both direct and indirectly. We conclude that the main elements of the post-lacanian discourses that grant us the keys to the nowadays diagnostic debate are 1) the decline of the paternal function; 2) the misunderstanding regarding the broadening of the category of psychosis (ordinary psychosis and compensation psychosis) and 3) the variable use of the notion of supplant

Diploma thesis "Social Work with People with Schizophrenia" deals with global life - sustaining situation of people who have in some part of their lives the experience with schizophrenia or with some similar disease from the same range. Theoretical part of this work presents basic facts about schizophrenia - about the course of this disease and about the treatment possibilities and also tries to outline - how are the possibilities of "successive care" it means the care which people with schizophrenia can find after their hospitalization after they enter the psychiatric care and start to use medicine and start attending psychotherapy. One of the aims of this thesis is to map how the real possibilities are for the people with schizophrenia after they return after their psychotic episode to "regular" life and try to live normally how to work, start relationships, engage in their hobbies etc.

INTRODUCTION: In psychosis, low engagement with mental health services is both prevalent and frequently associated with negative outcome. The overarching objective of this thesis was to investigate the role of psychological variables in service engagement in people with psychosis. A systematic review was conducted to examine the evidence for clinical and psychological correlates of engagement. An empirical study sought to investigate the association between engagement and psychological variables of a relational nature (i.e. mentalizing and interpersonal functioning). METHODS: A systematic search strategy across four electronic databases yielded seventeen journal articles. For the empirical study, forty-two people with multiple-episode psychosis completed self-report measures of service engagement, symptoms, mentalizing and interpersonal functioning, within a cross-sectional design. RESULTS: The review found relatively robust evidence supporting the association between engagement and numerous clinical variables. Eleven psychological variables were revealed as significant correlates of service engagement, encompassing developmental, individual and relational factors. Assessment of quality and risk of bias highlighted a number of limitations within included studies. In the empirical study, greater cognitive/disorganization symptomology was predictive of lower service engagement. Service engagement was significantly correlated with mentalizing, but not with interpersonal functioning. The relationship between cognitive/disorganized symptomology and engagement was not mediated by mentalizing performance. CONCLUSION: Numerous psychological variables are associated with service engagement, which has the potential to inform clinical practice in view of enhancing engagement. Qualitative and longitudinal studies with both service user and provider samples are required to capture the contextual information surrounding fluctuations in levels of engagement.