Orientador: Guita Grin Debert / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias Humanas / Made available in DSpace on 2018-08-08T09:47:02Z (GMT). No. of bitstreams: 1 Silva_AngeloAugustoda_M.pdf: 205227 bytes, checksum: a90ee24c9c1dc0f0ec0d1f921904787b (MD5) Previous issue date: 2007 / Resumo: A pesquisa teve como objetivo inicial apreender as re-configurações dos saberes e práticas médico-psiquiátricas, no contexto atual de expansão da procura e oferta desses serviços e de uma rebiologização nas explicações destes saberes. Paradoxalmente os "fenômenos não explicados organicamente" constituem um grande desafio ao campo e são descritos frequentemente pelo fenômeno de "somatização", nome dado a um programa de pesquisa e atendimento à  população e objeto dessa pesquisa. Se no referido contexto o trato a estes sofrimentos a partir de uma visão organicista e unidirecional mostra-se insuficiente, a incorporação de psicoterapias e da psicanálise no tratamento cotidiano da clientela também não se mostra isenta de dificuldades e dilemas. Buscou-se compreender também como a própria classificação e elaboração do diagnóstico e prognóstico são realizadas segundo as representações e visão de mundo dos profissionais do programa, estreitamente coadunada com a visão psicologizante de Pessoa, configurando universos de valor diversos que são fundamentais de serem apreendidos para melhor compreensão e reflexão das questões e dificuldades em jogo no atendimento / Abstract: The aim of this research is to capture the re-configurations of the several kinds of medical and psychiatric knowledge and practices in the current context of demand and offer enlargement of those services and also of a re-biologization of the explanations related to this kind of knowledge. In a paradoxical way, the phenomena which are not explained in an organic way constitutes themselves a great challenge and are often described by the "somatization" phenomenon, name attributed to a research and support program to the population, and also the purpose of this study. If in the context mentioned, the treatment of these sufferings from an organicist and unidirectional point of view proves to be insufficient, an incorporation of psychotherapies and psychoanalysis in the daily treatment of clients also presents difficulties and dilemmas. We tried to understand how the very classification and elaboration of diagnosis and prognosis are made according to the representations and perspectives of the professionals of the program, strictly linked to their psychological view of the world, setting up universes with different values which have to be captured in order to find a better understanding about the issues and difficulties in the treatment / Mestrado / Mestre em Antropologia Social

Le but de cette étude empirique est d'étudier les relations entre les facteurs de stress, le coping (stratégies d’adaptation), le burnout, les maladies somatiques, la dépression, la performance, l'engagement organisationnel et l’intention de départ avec une référence particulière aux différents types d'universités dans différents segments démographiques au Pakistan. Dans cette étude, nous avons d'abord cherché à comprendre la relation entre quatre principaux facteurs de stress (la surcharge de travail, l’ambiguïté des rôles, le conflit de rôle et la conciliation travail-famille) qui conduisent au burnout (l'épuisement émotionnel et la dépersonnalisation). De plus, nous avons cherché à identifier la relation entre le burnout et ses conséquences (la somatisation, la dépression, la performance, l’engagement organisationnel et l’intention de départ). Au cœur de notre modèle se trouve l’effet modérateur des stratégies d'adaptation sur les relations étudiées. Ces mécanismes sont notamment la planification proactive, le soutien du supérieur, le soutien des collègues, le soutien social général, la réinterprétation positive, l'adaptation par évitement, le fait de s’adresser au Dieu et le changement d’idées.Nous avons utilisé un design de recherche quantitatif et transversal pour recueillir des données sur un échantillon de 450 membres du personnel académique dans les universités privées, publiques et semi-publiques de la province du KPK au Pakistan Le nombre total des questionnaires pris en compte pour l'analyse est de 274. L'analyse préliminaire des données, exploratoire puis confirmatoire a montré que nos données étaient quasi normales et que nos variables possédaient de bonnes propriétés psychométriques. Nous avons testé nos hypothèses de recherche au moyen de modèles de régression structurels en utilisant AMOS et de régressions hiérarchiques multiples en utilisant SPSS. Les résultats ont révélé que la conciliation travail-famille, l’ambiguïté des rôles et la surcharge de travail avaient un impact positif significatif sur le burnout. Les résultats ont également démontré que le burnout avait un impact positif significatif sur la somatisation, la dépression et l’intention de départ et un impact négatif significatif sur l'engagement organisationnel et la performance.La majorité des hypothèses relatives à l’effet modérateur du soutien social et des mécanismes d'adaptation n'a pas été confirmé par nos résultats. Contrairement à nos hypothèses, planification proactive, le soutien du supérieur, le soutien social général, et le changement d’idées se sont avérés être des stratégies d'adaptation non-efficaces. Malgré ses limites, cette thèse apporte d’importantes contributions académiques et méthodologiques ainsi que des implications managériales. Quelques suggestions pour des recherches futures ont également été faites à la fin. / The purpose of this quantitative study is to investigate the relationships between stressors, coping, burnout, somatic ill health, depression, performance, organizational commitment and turnover intentions with particular reference to different demographic segments in different types of universities of Pakistan. In this context firstly we aimed to understand the relationships between four main stressors (Work Overload, Role Ambiguity, Role Conflict and Work-life Imbalance) and Burnout (Emotional Exhaustion and Depersonalization). Moreover, we aimed to identify the relationship between burnout and its consequences i.e. Somatization, Depression, Performance, Organizational Commitment and Turnover Intentions. At the core of our model was the moderating impact of coping strategies on the relationships mentioned above. These coping mechanisms included Proactive Planning, Boss Support, Colleague Support, General Social Support, Turning To God, Positive Reinterpretation, Avoidance and Mind Deviation. The quantitative and cross sectional survey research design was used to collect data based on a sample of 450 academic staff in private, public and semi-government universities of the KPK province of Pakistan The total questionnaires considered for analysis were 274. The preliminary data analysis, EFAs and CFAs demonstrated that our data was quasi normal and our variables possessed good psychometric properties. We tested our research hypotheses through structured regression models in AMOS and multiple hierarchical regression using SPSS. The results revealed that Work-Life Imbalance, Role Ambiguity and Work Overload showed significant positive impact on burnout. Results also demonstrated that burnout had a significant positive impact on Somatization, Depression and Turnover Intentions and a significant negative impact on Organizational Commitment and Performance. The Majority of the hypotheses related to moderating impact of social support and coping mechanisms were not supported by our results. Contrary to our hypotheses, Proactive Planning, Boss Support, General Social Support and Mind Deviation proved to be non-effective coping strategies. Despite of its limitations, this thesis has made some important academic and methodological contributions along with managerial implications. Few suggestions for future research have been also made at the end.

This is a study conducted in Zimbabwe which compared a group of 50 zvirvere zvechivanhu patients and a group of 50 non-patients in age, sex, marital status, level of education and claims of spirit possession. Claims of spirit possessions and types of spirits, as pointed out by Bennel (1982), were used as symptoms of zvirwere zvechivanhu. The two groups were also compared in symptom dimensions of the SCL-90-R used in the study. The SCL-90-R, developed by Derogatis (1975), is a 90-item symptom check list used to screen people for psychological problems reflected in the nine symptom dimensions of somatization, obsessive/ compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism and in the three global scores of Global Severity Index, Positive Symptom Distress Index and Positive Symptom Total. The subjects were chosen from two different sites, using a systematic sampling method. Three statistical methods were used to analyze the data. The Chi-square was used to analyze data on descriptive variables. The T-test and 2 x 2 analysis of variance were used to analyze the data on symptom dimensions and global scores. The study had one main hypothesis and nine subhypotheses. The main hypothesis was that zvirwere zvechivanhu patients were significantly different from the non-patients on the overall global scores. The nine subhypotheses stated that the patient and non-patient groups were significantly different in the nine separate symptom dimensions. The study concluded that the zvirwere zvechivanhu patients were significantly different from the non-patients in the overall global scores. In the nine separate symptom dimensions, it was concluded that the two groups were the same in all except the somatization and obsessive/compulsive system dimensions.

L’invalidité attribuable à la douleur représente un problème important en raison de ses coûts personnels, financiers et sociétaux. L’effort scientifique mène à l’identification des facteurs de risque pour l’évolution de la douleur vers un état qui mine la capacité de la personne affligée à vaquer à ses occupations fondamentales. Cet effort met en relief le rôle déterminant que jouent les facteurs psychosociaux à chaque stade de l’évolution vers l’invalidité en raison de la douleur. Parmi les facteurs mis en cause, se trouvent les difficultés psychologiques (dépression, anxiété, somatisation, trouble de la personnalité, catastrophisme et évitement de l’activité), l’insatisfaction au travail et le contexte de réclamation. Forts de cette connaissance, les pays industrialisés se dotent de lignes directrices pour la prise en charge de la douleur aiguë dans le but de réduire les coûts, tant pour la personne que pour la société. Vingt ans après la parution des premiers guides de pratique, et la publication subséquente de dizaines d’autres guides véhiculant essentiellement les mêmes informations, les médecins peinent toujours à appliquer les recommandations. À partir des données probantes issues de la littérature scientifique, le présent ouvrage propose une synthèse critique des résultats pour pousser la réflexion et faire avancer la démarche dans le sens d’une réduction des coûts personnels, financiers et sociétaux. / Disability due to pain is a significant problem owing to its personal, financial and societal costs. Scientific efforts are aimed towards the identification of the risk factors for the development of pain leading to a state which undermines the afflicted person’s ability to attend to his/her basic functions. These efforts highlight the key role that psycho-social factors play in each stage of the progression towards disability due to pain. Among the influencing factors are psychological difficulties (depression, anxiety, somatization, personality disorder, catastrophization and activity avoidance), dissatisfaction at work and the compensation context. In light of this awareness, industrialized countries have instituted policies for the management of acute pain with the aim of reducing costs, both for the patient and for society. Twenty years after the appearance of the first clinical practice guidelines and the subsequent publication of numerous other guides propounding essentially the same information, physicians are still struggling to apply the recommendations. Relying on the evidence from the scientific literature, this study proposes a critical synthesis of the results to provoke thought and to advance the process towards a reduction in the personal, financial and societal costs of pain.

La prise en charge des adolescents auteurs d’actes transgressifs consiste à assurer la relance du processus de subjectivation entravé par le processus adolescent et les traumas infantiles. Les transformations liées à l’adolescence laissent les jeunes sujets aux prises avec une excitation désorganisatrice ou absente et une souffrance non reconnue, qui se manifestent dans des somatisations et des agirs répétitifs. Ces modalités d’expression de la souffrance sur la scène institutionnelle sont en attente d’une réponse de l’environnement. L’organisation du dispositif de prise en charge permet la relance des processus adolescent et de subjectivation et apporte une réponse à la souffrance des adolescents :- s’il prend les caractéristiques du rite d’initiation (contention dans un espace en vue d’une réinsertion dans la société après avoir subi des transformations).- s’il permet un emboîtement d’enveloppes (intrainstitutionnelles ou interinstitutionnelles) contenantes et pare-excitantes, utilisées par les adolescents pour suppléer aux défaillances de certaines fonctions de leur appareil psychique (espace psychique élargi).- s’il propose un accompagnement caractérisé par le « vivre avec » et le « faire avec ». Ces modalités d’intervention favorisent les processus de transformations psychiques grâce aux réponses apportées par les professionnels, et, autorisent les adolescents à trouver-créer ce dispositif pour construire leur avenir (notion de contenir). Dans ce cadre, l’enfermement sert de médiation éducative et thérapeutique. La place du psychologue, dans le « vivre avec », favorise la mise en sens des projections des adolescents et une restitution auprès d’eux de leurs vécus internes matérialisant une continuité psychique entre la réalité externe et la réalité interne. Dans sa fonction de réceptivité et de présence, il assure la réappropriation des vécus projetés et de la groupalité interne. / The care of teenage authors of transgressive acts consists in ensuring the revival of the subjectivation process hampered by the adolescent process and the infantile traumas. The transformations that adolescence involves let the young people in the grip of a disorganising or inexistant excitation and a denied distress they express through somatizations and repetitive passages to the act. These means of suffering expression on the institutional scene are expecting an environment answer. The organisation of the care plan reactivates both the adolescent and subjectivation processes and responds to the suffering of the young:- if it has the features of the initiation rite (the contention aims at a reinsertion into society after transformations occurred).- if it allows a stacking of the envelopes (intrainstitutional or interinstitutional) which have containing and counter-excitation functions, and that adolescents employ for filling the deficiences of some of their psyche functions (enlarged psychic space).- if it provides a support made with the « vivre avec » and the « faire avec ». These terms of intervention facilitate the psychic transformations processes thanks to the support professionnals provide and permit the adolescents to find-create this mechanism for building their future (notion of contain). In this context, the contention means educative and therapeutic mediation. The function of the psychologue, in the « vivre avec », helps in giving a meaning to the projections of the adolescents and a restitution to them of their internal experiences materializing a psychic continuity between external reality and internal reality. As part of his receptivity and presence functions, he ensures reappropriation of the projected experiences as well as the internal groupality.

ANTECEDENTES: Sintomas somatoformes são freqüentes e estão associados com sofrimento mental na população geral e em diversos níveis de atenção. Grande parte da interações que subjazem a estas associações são pouco conhecidas ou mesmo desconhecidas. OBJETIVOS E MÉTODOS: A partir de revisão bibliográfica, investigar: a) a história dos quadros clínicos de somatização; b) suas diversas categorias segundo conceitos contemporâneos psiquiátricos e não-psiquiátricos (transtornos somatoformes, transtornos dissociativos-conversivos, síndrome da fadiga crônica, fibromialgia, síndrome do cólon irritável etc.); c) fatores associados e hipóteses etiológicas para estes fenômenos. Através de dados provenientes do Estudo de Área de Captação do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Andrade et al., 1994) - um estudo transversal de morbidade física e psiquiátrica que entrevistou uma amostra representativa dos bairros paulistanos de Vila Madalena e Jardim América - explorar a prevalência e classificação de sintomas físicos relatados, em especial aqueles sem explicação médica (SEM). Avaliar através de regressão logística as associações entre: a) síndromes somatoformes e variáveis demográficas; b) síndromes somatoformes e uso de medicamentos e serviços de saúde; c) sintomas físicos de qualquer tipo (QT) e SEM com variáveis demográficas; e d) sintomas físicos QT e SEM com transtornos mentais. Pesquisar, através de análise de classes latentes de respostas dicotômicas para a presença ou não de 36 sintomas físicos SEM: a) agrupamento de indivíduos em classes (análise de aglomeração, ou cluster); e b) agrupamento de sintomas em dimensões (análise fatorial). Foram realizadas 1.464 entrevistas com o Composite International Diagnostic Interview (CIDI), entrevista estruturada diagnóstica para transtornos mentais, incluindo transtornos somatofomes e dissociativos; e um caderno de variáveis demográficas, doenças físicas crônicas, uso de serviços médicos ou psicológico e consumo de medicamentos. RESULTADOS: Ausência de associação entre síndomes somatoformes e variáveis demográficas. Associação entre síndromes somatoformes e maior uso de serviços de saúde e de medicamentos. Associação de características demográficas com certos sintomas físicos QT e SEM. Sintomas físicos QT e SEM estão associados com transtornos mentais de uma forma geral. Alguns sintomas físicos (desmaios, dispnéia, dores no peito, dores nos membros, formigamento, metrorragia, fraqueza muscular, nó na garganta, poliúria, taquicardia e tonturas) encontram-se associados com vários dos transtornos mentais testados. Os indivíduos se aglomeraram em duas classes, uma pauci- e outra polissintomática; a classe polissintomática se mostrou associada com doenças físicas, transtornos mentais e uso de serviços de saúde. Os sintomas se agruparam em um único fator, indicando a existência de uma dimensão de somatização na população geral. / BACKGROUND: Somatoform symptoms are frequent and are associated with mental distress in several settings and in the general population. Many of these interactions are not well understood or not understood at all. OBJECTIVE AND METHODS: Based on bibliographical research, to investigate: a) the history of somatization-related illnesses; b) its many categories according to contemporary psychiatric and non-psychiatric concepts (somatoform disorders, dissociative-conversive disorders, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome etc.); c) associated factors and etiological hypothesis for these phenomena. Using data available from the University of São Paulo Institute of Psychiatry Epidemiologic Catchment Area Study (Andrade et al., 1994) - a cross-sectional survey of physical and psychiatric morbidity which interviewed a representative sample of São Paulo city boroughs of Vila Madalena and Jardim América - to explore the prevalence and classification of reported physical symptoms in general, and specifically those which are medically unexplained (MU). To appraise, using logistic regression, the following associations: a) somatoform syndromes and demographic variables; b) somatoform syndromes and use of medication and health services; c) MU symptom and any type (AT) of symptom with demographic variables; and d) MU and AT physical symptoms with mental disorders. To probe, through latent class analysis of yes or no answers for 36 MU physical symptoms: grouping of subjects in classes (cluster analysis); and b) grouping of symptoms in dimensions (factor analysis). One-thousand, four-hundred and sixty-four interviews were performed using the Composite International Diagnostic Interview (CIDI), structured diagnostic interview for mental disorders, including somatoform and dissociative disorders; and a form of demographic variables, chronic physical diseases, use of medical and psychological services and medication intake. RESULTS: No association between somatoform syndromes and demographic variables. Association between somatoform syndromes and increased use of services and medication intake. Association between demographic variables and certain MU/AT symptoms. Physical symptoms AT/MU are associated with mental disorders, in general. Some physical symptoms (fainting, dyspnea, chest pain, arm or leg pain, tingling, heavy menses, muscle weakness, lump in throat, polyuria, palpitations and dizziness) are associated with many of the studied mental disorders. Subjects were clustered into two classes, with low and high symptom scoring; the high scoring class was associated with physical diseases, mental disorders, use of health services and medication intake. Symptoms were grouped into one single factor, pointing to the existence of a somatization dimension in the general population.

Submitted by Cristiane Oliveira (cristiane.oliveira@fgv.br) on 2011-05-18T15:06:11Z No. of bitstreams: 1 71070100701.pdf: 1065077 bytes, checksum: af869b88cf592cce1617c4f69902d716 (MD5) / Approved for entry into archive by Gisele Isaura Hannickel(gisele.hannickel@fgv.br) on 2011-05-18T15:16:24Z (GMT) No. of bitstreams: 1 71070100701.pdf: 1065077 bytes, checksum: af869b88cf592cce1617c4f69902d716 (MD5) / Approved for entry into archive by Gisele Isaura Hannickel(gisele.hannickel@fgv.br) on 2011-05-18T15:17:05Z (GMT) No. of bitstreams: 1 71070100701.pdf: 1065077 bytes, checksum: af869b88cf592cce1617c4f69902d716 (MD5) / Made available in DSpace on 2011-05-18T15:19:26Z (GMT). No. of bitstreams: 1 71070100701.pdf: 1065077 bytes, checksum: af869b88cf592cce1617c4f69902d716 (MD5) Previous issue date: 2011-02-25 / Care experience in Programa de Atendimento e Estudos de Somatização do Departamento de Psiquiatria da UNIFESP/ HSP and scientific literature show that somatizing patients tend to establish an expensive relationship to hospital organization, increasing material and emotional costs. From the case study of Hospital São Paulo (HSP) and the Universidade Federal de São Paulo (UNIFESP), this work analyzed, qualitatively, which factors these organization’s culture offer to its community to allow them to build and to integrate social representations on psychic and somatic issues. Through psycossociologic methods analyses, it was noted that these organizations do not provide a culture that would help its members to deal with the anguish roused by the medical task, while dealing with somatization disorder patients. This task usually waves the possibility of death, determining hypochondria as its main anguish. / A experiência do Programa de Atendimento e estudos de Somatização do Departamento de Psiquiatria da UNIFESP/HSP e a literatura científica mostram que os pacientes somatizadores tendem a estabelecer com a organização hospitalar uma relação muito dispendiosa, tanto do ponto de vista da relação que mantem com seus profissionais quanto com relação ao volume de recursos materiais que consomem. a partir do estudo de caso do Hospital São Paulo e da Universidade Federal de São Paulo, o presente estudo analisou qualitativamente que elementos a cultura das organizações oferece a seus membros para que eles construam, coletivamente, representações sociais acerca do psíquico e do somático, e que elementos oferece para que tais representações sejam integradas, articuladas ou cindidas coletivamente por seus membros. Tendo concluído, através da análise das instâncias propostas pela metodologia psicossociológica, que as organizações analçisadas não dispõem de uma cultura que favoreça, através das representaçoes sociais, a articulação e integração psíquica das angústias despertadas pela tarefa médica em geral, e tampouco pelas angústias despertadas pelos pacientes somatizadores. Tarefa que constantemente acena a possibilidade da morte, determinando como angústia central despertada, a hipocondria.

ANTECEDENTES: Sintomas somatoformes são freqüentes e estão associados com sofrimento mental na população geral e em diversos níveis de atenção. Grande parte da interações que subjazem a estas associações são pouco conhecidas ou mesmo desconhecidas. OBJETIVOS E MÉTODOS: A partir de revisão bibliográfica, investigar: a) a história dos quadros clínicos de somatização; b) suas diversas categorias segundo conceitos contemporâneos psiquiátricos e não-psiquiátricos (transtornos somatoformes, transtornos dissociativos-conversivos, síndrome da fadiga crônica, fibromialgia, síndrome do cólon irritável etc.); c) fatores associados e hipóteses etiológicas para estes fenômenos. Através de dados provenientes do Estudo de Área de Captação do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Andrade et al., 1994) - um estudo transversal de morbidade física e psiquiátrica que entrevistou uma amostra representativa dos bairros paulistanos de Vila Madalena e Jardim América - explorar a prevalência e classificação de sintomas físicos relatados, em especial aqueles sem explicação médica (SEM). Avaliar através de regressão logística as associações entre: a) síndromes somatoformes e variáveis demográficas; b) síndromes somatoformes e uso de medicamentos e serviços de saúde; c) sintomas físicos de qualquer tipo (QT) e SEM com variáveis demográficas; e d) sintomas físicos QT e SEM com transtornos mentais. Pesquisar, através de análise de classes latentes de respostas dicotômicas para a presença ou não de 36 sintomas físicos SEM: a) agrupamento de indivíduos em classes (análise de aglomeração, ou cluster); e b) agrupamento de sintomas em dimensões (análise fatorial). Foram realizadas 1.464 entrevistas com o Composite International Diagnostic Interview (CIDI), entrevista estruturada diagnóstica para transtornos mentais, incluindo transtornos somatofomes e dissociativos; e um caderno de variáveis demográficas, doenças físicas crônicas, uso de serviços médicos ou psicológico e consumo de medicamentos. RESULTADOS: Ausência de associação entre síndomes somatoformes e variáveis demográficas. Associação entre síndromes somatoformes e maior uso de serviços de saúde e de medicamentos. Associação de características demográficas com certos sintomas físicos QT e SEM. Sintomas físicos QT e SEM estão associados com transtornos mentais de uma forma geral. Alguns sintomas físicos (desmaios, dispnéia, dores no peito, dores nos membros, formigamento, metrorragia, fraqueza muscular, nó na garganta, poliúria, taquicardia e tonturas) encontram-se associados com vários dos transtornos mentais testados. Os indivíduos se aglomeraram em duas classes, uma pauci- e outra polissintomática; a classe polissintomática se mostrou associada com doenças físicas, transtornos mentais e uso de serviços de saúde. Os sintomas se agruparam em um único fator, indicando a existência de uma dimensão de somatização na população geral. / BACKGROUND: Somatoform symptoms are frequent and are associated with mental distress in several settings and in the general population. Many of these interactions are not well understood or not understood at all. OBJECTIVE AND METHODS: Based on bibliographical research, to investigate: a) the history of somatization-related illnesses; b) its many categories according to contemporary psychiatric and non-psychiatric concepts (somatoform disorders, dissociative-conversive disorders, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome etc.); c) associated factors and etiological hypothesis for these phenomena. Using data available from the University of São Paulo Institute of Psychiatry Epidemiologic Catchment Area Study (Andrade et al., 1994) - a cross-sectional survey of physical and psychiatric morbidity which interviewed a representative sample of São Paulo city boroughs of Vila Madalena and Jardim América - to explore the prevalence and classification of reported physical symptoms in general, and specifically those which are medically unexplained (MU). To appraise, using logistic regression, the following associations: a) somatoform syndromes and demographic variables; b) somatoform syndromes and use of medication and health services; c) MU symptom and any type (AT) of symptom with demographic variables; and d) MU and AT physical symptoms with mental disorders. To probe, through latent class analysis of yes or no answers for 36 MU physical symptoms: grouping of subjects in classes (cluster analysis); and b) grouping of symptoms in dimensions (factor analysis). One-thousand, four-hundred and sixty-four interviews were performed using the Composite International Diagnostic Interview (CIDI), structured diagnostic interview for mental disorders, including somatoform and dissociative disorders; and a form of demographic variables, chronic physical diseases, use of medical and psychological services and medication intake. RESULTS: No association between somatoform syndromes and demographic variables. Association between somatoform syndromes and increased use of services and medication intake. Association between demographic variables and certain MU/AT symptoms. Physical symptoms AT/MU are associated with mental disorders, in general. Some physical symptoms (fainting, dyspnea, chest pain, arm or leg pain, tingling, heavy menses, muscle weakness, lump in throat, polyuria, palpitations and dizziness) are associated with many of the studied mental disorders. Subjects were clustered into two classes, with low and high symptom scoring; the high scoring class was associated with physical diseases, mental disorders, use of health services and medication intake. Symptoms were grouped into one single factor, pointing to the existence of a somatization dimension in the general population.

Abstract Somatization is a widespread phenomenon causing subjective suffering and disability. The aim of the study was to assess somatization disorder (SD) and somatization symptoms among young adult population and their associations with sociodemographic factors, alexithymia and temperament as well as psychiatric comorbidity. Various suggestions have been presented to operationalize somatization but none of them has been shown to be superior to others. In this study two definitions were used: SD by DSM-III-R classification diagnostic criteria and "somatization" meaning four or more symptoms of the 35 symptoms of DSM-III-R SD criteria. The study population was a subsample of the Northern Finland Birth Cohort 1966 (NFBC 1966), consisting of cohort members living in Oulu (N = 1,609) on January 1st 1997. The NFBC 1966 is a general population birth cohort of 12,058 live-born children covering 96.3% of all deliveries in the catchment area. The best-estimated procedure was used for assessment of psychiatric morbidity including SD and somatization. Data were collected from the Finnish Hospital Discharge Register and from all available outpatient and inpatient records. Data on education were gathered from Statistics Finland. Other sociodemographic variables, alexithymia and temperament scores were drawn from questionnaires of the field study conducted in 1997 and from earlier follow-up studies. The prevalence of SD was 1.1% (N = 18). Of the subjects 6.1% (N = 97) had somatization. The female-to-male ratio was 5:1 and 6:1, respectively. SD was not recognized by any of the treating physicians, at least not documented in case notes. The observed occurrences of SD and somatization were at a level comparable with earlier international population studies. Somatization did not associate with depression or alexithymia, and neither could a characteristic temperament profile be recognized. Somatization was associated with psychological distress. These results indicate a need for training physicians to recognize SD and somatization and its comorbidity. This will have implications both for psychiatry and other medical specialties regarding collaboration and underlines the importance of liaison-psychiatry at general hospitals. The results suggest a need for more studies about the etiology and development of SD and somatization. / Tiivistelmä Somatisaatio on yleinen ilmiö, josta aiheutuu subjektiivista kärsimystä ja toimintakyvyn laskua. Tämän tutkimuksen tarkoitus oli arvioida somatisaatiohäiriön ja somatisaatio-oireilun yleisyyttä nuorilla aikuisilla sekä näiden ilmiöiden yhteyttä sosiodemografisiin tekijöihin, aleksitymiaan, temperamenttiin ja psykiatriseen sairastavuuteen. Somatisaation käsitteellistämiseksi on esitetty useita vaihtoehtoja mutta mikään niistä ei ole osoittautunut muita paremmaksi. Tässä tutkimuksessa käytetiin kahta määritelmää: DSM-III-R -diagnoosiluokituksen mukaista somatisaatiohäiriön diagnoosia tai somatisaatio-oireilua, jossa esiintyy neljä tai useampia DSM-III-R:n 35 somatisaatiohäiriön oireesta. Tutkimusaineiston muodostivat Pohjois-Suomen vuoden 1966 syntymäkohortin ne jäsenet, jotka asuivat Oulussa 1. tammikuuta 1997 (N =  1,609). Alkuperäinen kohortti koostuu 12,058 elävänä syntyneestä tutkittavasta, mikä kattaa 96.3 % kaikista synnytyksistä Pohjois-Suomessa. Niin kutsutun best-estimated -menettelyn avulla arvioitiin tutkittavien psykiatrista sairastavuutta mukaan lukien somatisaatiohäiriö ja -oireilu. Tietoa kerättiin sairaaloiden poistoilmoitusrekisteristä. Avohoidon sairauskertomustieto koottiin kattavasti. Koulutusasteesta saatiin tieto Tilastokeskukselta. Muita sosiodemografisia tekijöitä, aleksitymiaa ja temperamenttia arvioitiin vuoden 1997 kenttätutkimuksen ja aiempien seurantatutkimusten tietojen avulla. Somatisaatiohäiriön esiintyvyys oli 1.1 % (N =  18). Somatisaatio-oireita todettiin 6.1 % (N =  97) tutkittavista. Naisten osuus oli somatisaatiohäiriössä 5:1 ja somatisaatio-oireilussa 6:1. Osoittautui, että lääkärit eivät tunnistaneet somatisaatiohäiriötä, ainakaan sitä ei oltu kirjattu sairauskertomuksiin. Havaitut somatisaatiohäiriön ja -oireilun esiintyvyydet ovat sopusoinnussa aiempien kansainvälisten tutkimusten kanssa. Somatisaatio-oireilu ei liittynyt masennukseen tai aleksitymiaan eikä somatisaatio-oireilusta kärsiville tutkittavilla todettu tyypillistä temperamenttiprofiilia. Somatisaatio liittyi psyykkiseen stressiin. Johtopäätöksenä voidaan todeta, että lääkäreille tulisi tarjota koulutusta somatisaatiohäiriön ja -oireilun tunnistamisessa. On tärkeää tunnistaa somatisaatio ja siihen liittyvä oheissairastavuus. Havainnot korostavat yleissairaaloiden yhteistyöpsykiatrian ja muiden erikoisalojen yhteistyön merkitystä somatisaatiosta kärsivien potilaiden tutkimuksessa ja hoidossa. Somatisaatiohäiriön ja -oireilun etiologian ja kehittymisen selvittämiseksi tarvitaan uusia tutkimuksia.

Mémoire en recherche-création / Sōma, c’est le temps de l’inscription de l’écrit sur et dans le corps, c’est le temps de la somatisation, de la révélation de l’affect comme symptôme, du corps qui réplique à la violence extérieure. C’est également un recueil de fragments qui se suivent comme tant de scènes et qui, à la manière d’un « corps sans organes », se lient les uns aux autres selon des connexions productives, « des circuits de conjonctions, des étagements et des seuils, des passages et des distributions d’intensité, des territoires et des déterritorialisations […] ». Un peu comme chez Collobert, l’aventure des fragments s’inscrit avant tout dans un parcours phénoménologique, dans les moyens que se donne le texte pour traduire l’expérience corporelle de la souffrance. Dans Sōma, la narration oscille entre le passé, temps de l’enfermement, de la maladie, des premiers balbutiements de l’écriture, et le présent de l’écriture, source de maux comme de soulagement, qui préside à la création du recueil. Grâce à l’enchevêtrement de ces deux temps narratifs, le je poétique explore les différents états du corps féminin souffrant, qu’il s’agisse de souffrance physique comme de souffrance psychologique. « Corps là, noué aux mots » : plasticité de l’écriture et voilement du je dans Dire II de Danielle Collobert interroge d’abord la plasticité à l’œuvre dans le recueil Dire II de Danielle Collobert. Grâce à une étude approfondie du concept de plasticité tel qu’explicité par la philosophe Catherine Malabou, qui emprunte la notion à Hegel, il nous est permis d’en dégager quelques fonctions : potentiel de donation et d’explosion de la forme, du corps et du sujet. Formellement à l’œuvre dans le recueil à l’étude, ces fonctions innervent et décrivent la nature scripturaire du passage de Dire I à Dire II et qualifient, avec justesse, les métamorphoses internes qui ont lieu dans Dire II. Ces fonctions s’incarnent concrètement grâce à un changement de paradigme textuel : la parataxe remplace la phrase longue, l’horizontalité laisse place à la verticalité, les vers deviennent de plus en plus hachurés, le sujet morphologique semble progressivement disparaître. Ce dernier point ouvre la réflexion sur le second pan principal de l’essai, soit, le voilement du je au sein du recueil. Intrinsèquement reliée à la question de la plasticité, l’apparition et la disparition du sujet poétique soulèvent celle de l’assujettissement, c’est-à-dire de la formation du sujet qui, elle aussi, s’inscrit sous le signe de la plasticité puisque le sujet poétique est en constant devenir, il n’est jamais stable, pareil et identique à lui-même. Les métamorphoses ainsi que les différents états du sujet mènent à une étude approfondie des liens qui existent entre celui-ci et son corps, dont la représentation hante le texte. Examinant les liens entre texte, sujet et corps, l’essai esquissera, notamment grâce à l’apport de Maurice Blanchot, Évelyne Grossman, Gilles Deleuze de Jacques Derrida, une pensée de l’écriture comme souffrance corporelle, de la souffrance comme inscription textuelle. / Sōma is the time of an inscription of the text on and in the body, it is the time of somatization, of the revelation of the affect as a symptom, of the body responding to external violence. It is also a collection of fragments which follow one another like so many scenes and which, like a body without organs, are linked to each other according to productive connections, " circuits of conjunctions, stages and thresholds, passages and distributions of intensity, territories and deterritorializations […]2 ". A bit like with Collobert, the adventure of fragments is first and foremost part of a journey towards a phenomenological writing, in the means that the text gives itself to translate the bodily experience of suffering. In Sōma, the narration oscillates between the past, a time of confinement, illness, the beginning of writing, and the present of writing, a source of pain and relief, which governs the creation of the collection. Through the entanglement of these two narrative tenses, the poetic subject explores the different states of the suffering female body, whether it is physical suffering or psychological suffering. " Body There, Tied to Words " : Plasticity of Writing and Veiling of the I in Dire II by Danielle Collobert first questions the plasticity at work in Danielle Collobert's Dire II. Thanks to an indepth study of the concept of plasticity as explained by the philosopher Catherine Malabou, who borrows the notion from Hegel, we are able to identify some functions: potential for donation and explosion of form, the body and the subject. Formally at work in the work under study, these functions innervate and describe the scriptural nature of the passage from Dire I to Dire II and aptly qualify the internal metamorphoses that take place in Dire II. These functions are concretely embodied thanks to a change of textual paradigm: the parataxis replaces the long sentence, horizontality gives way to verticality, the lines become more and more hatched, the morphological subject seems to gradually disappear. This last point opens the reflection on the second main part of the essay, that is, the veiling of the I within the collection. Intrinsically linked to the question of plasticity, the appearance and disappearance of the poetic subject raises that of subjugation, that is to say of the formation of the subject which, too, is inscribed under the sign of plasticity since the poetic subject is in constant evolution: it is never stable, the same and identical to itself. The metamorphoses as well as the different states of the subject lead to an indepth study of the links that exist between him and his body, the representation of which haunts the text. Examining the links between text, subject and body, the essay will sketch, thanks in particular to the contributions of Maurice Blanchot, Évelyne Grossman, Gilles Deleuze and Jacques Derrida, a thought of writing as bodily suffering, of suffering as textual inscription.