Introdução: Embora alucinações auditivas sejam consideradas manifestações psicopatológicas, a alucinação musical vem sendo descrita em indivíduos sem antecedentes de psicose e com sintomas otológicos. Assim como ocorre com o zumbido, acredita-se que a perda auditiva seja o principal fator predisponente para o aparecimento da alucinação musical. Até o momento, a alucinação musical tem-se mostrado refratária aos tratamentos usualmente propostos na literatura. Objetivos: 1. Primário: avaliar o efeito do uso de aparelho de amplificação sonora individual, pelo período de um ano, em pacientes com zumbido e alucinação musical, associados à perda auditiva; 2. Secundários: a. avaliar a coexistência de doenças otológicas, neurológicas e psiquiátricas; b. verificar associação entre a melhora do zumbido e a da alucinação musical com uso de aparelho de amplificação sonora individual. Métodos: pela raridade do fenômeno, realizou-se um ensaio clínico não-randomizado que incluiu os primeiros 14 pacientes com zumbido e alucinação musical matriculados no Grupo de Pesquisa em Zumbido do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, adultos, de ambos os gêneros. Todos foram submetidos à avaliação multidisciplinar pela mesma equipe de otorrinolaringologistas, neurologistas e psiquiatras. Todos pacientes tinham critério audiológico para uso de aparelho de amplificação sonora individual e não haviam melhorado dos sintomas com abordagem medicamentosa. O grupo experimental contou com 9 participantes que receberam orientação sobre seus três sintomas auditivos e adaptaram o aparelho de amplificação sonora individual, enquanto o grupo controle contou com 5 participantes que receberam a mesma orientação sobre os sintomas, mas recusaram-se a submeter-se à adaptação do aparelho de amplificação sonora individual. O zumbido foi avaliado antes e após um ano pelo Tinnitus Handicap Inventory e a alucinação musical, pela escala numérica. Resultados: O grau de perda auditiva mostrou-se adequadamente pareado em ambos os grupos, sendo severo a profundo em cerca de 80% dos casos. A avaliação cognitiva mostrou déficit de atenção leve em 33,3% (grupo experimental) e 20% (grupo controle). Atividade epileptiforme esteve presente em 11,1% (grupo experimental) e 20% (grupo controle). A avaliação psiquiátrica evidenciou episódio depressivo em 66,6% (grupo experimental) e 80% (grupo controle), ansiedade generalizada em 11,1% (grupo experimental) e 0% (grupo controle) e ausência de diagnóstico psiquiátrico em 22% (grupo experimental) e 20% (grupo controle). Após um ano, pacientes de ambos os grupos apresentaram melhora do grau de incômodo do zumbido, porém a melhora no grupo experimental foi significativamente maior do que no grupo controle e somente os indivíduos do grupo experimental apresentaram melhora do incômodo com a alucinação musical. Não houve associação entre a melhora do zumbido e da alucinação musical. Conclusão: A alucinação musical, nesta amostra, apresentou-se expressivamente associada ao sexo feminino, aos idosos e à presença dos transtornos de humor. A avaliação multidisciplinar (otológica, psiquiátrica e neurológica) deve ser oferecida a pacientes que apresentem alucinação musical para refinar o diagnóstico. Após um ano de acompanhamento, a amplificação sonora promovida pelo uso de aparelho de amplificação sonora individual, associada à orientação específica sobre zumbido, alucinação musical e perda auditiva foi mais efetiva no controle do zumbido e da alucinação musical que a orientação isolada / Introduction: Although auditory hallucinations are considered psychopathological phenomena, musical hallucinations have been reported in individuals without history of psychosis but with otologic symptoms. As is the case for tinnitus, hearing loss is thought to be the main predisposing factor for the emergence of musical hallucinations. To date, musical hallucinations have remained refractory to the treatment approaches typically recommended in the literature. Objectives: 1. Primary: to assess the effect of one year of hearing aid use in patients with both tinnitus and musical hallucinations associated with hearing loss; 2. Secondary: a. to investigate the coexistence of otologic, neurologic and psychiatric diseases; b. to verify the association between improvement of tinnitus and musical hallucinations using hearing aid. Methods: given the rareness of the phenomenon, a nonrandomized clinical trial was conducted including the first 14 consecutive adult patients of both genders with tinnitus and musical hallucinations enrolled at the Tinnitus Research Group of the Clinicas Hospital of the University of São Paulo School of Medicine. All patients were assessed by the same multidisciplinary team of ENT specialists, neurologists and psychiatrists. All patients met audiologic criteria for use of a hearing aid and had shown no improvement in symptoms after treatment with medications. The experimental group comprised 9 participants who were given counseling on their three auditory symptoms and fitted with hearing aids. The control group comprised 5 subjects given the same counseling but who declined to have hearing aids fitted. Tinnitus was assessed at baseline and again at 1- year follow-up using the Tinnitus Handicap Inventory whereas musical hallucinations were assessed by a numeric scale. Results: The two groups proved suitably matched for deafness, with 80% of the both groups presenting with severe to profound hearing loss. The cognitive assessment revealed mild attention deficit in 33.3% (experimental group) and 20%(control group). Epileptiform activity was detected in 11.1% (experimental group) and 20% (control group). The psychiatric assessment revealed depressive episodes in 66.6% (experimental group) and 80% (control group). Generalized anxiety was found in 11.1% (experimental group) and 0% (control group) and absence of psychiatric diagnoses in 22% (experimental group) and 20% (control group). Patients from both groups showed improved tinnitus handicap grades at 1-year follow-up, although experimental group subjects had a significantly greater improvement than control group subjects. Only individuals from the experimental group improved on musical hallucination handicap. No correlation was found between improvement in tinnitus and improvement in musical hallucinations. Conclusion: In the sample studied, musical hallucination was found in females and elderly adults and was associated with mood disorders. Patients presenting with musical hallucinations should be submitted to a multidisciplinary assessment (otologic, psychiatric and neurologic) to refine the diagnosis. Sound amplification using a hearing aid, combined with specific counseling on tinnitus, musical hallucinations and hearing loss, proved more effective for controlling tinnitus and musical hallucinations after one year than specific counseling alone

No description available.

This study springs from my experience of what I term ‘narrative fracture', a life-hiatus or crisis that derails one's current life pattern and self-identity. It examines the nature of this phenomenon and its possible roots in early infancy and childhood. Three therapeutic modalities: dreams, psychotherapy and autobiographical writing, which were instrumental towards resolution of that narrative fracture for me, are then explored. The study uses first person heuristic methodology because my own experience, and ongoing process towards resolution, lies at the heart of the research. It also, as part of that methodology, draws on the experience of three ‘textual co-researchers' as recorded in their autobiographical writings. Each of the segments of the study, narrative fracture, roots of narrative fracture, and modalities towards resolution, are interrogated from three directions: my autobiographical narrative relating to that segment, and extracts from the other authors' texts of theirs, then examination of these in light of the relevant theory, and finally a reflexive review made of the findings, following thus a pattern, identified by Michelle Davies, of a narrative ‘voice', an interpretive ‘voice' and an unconscious ‘voice'. Most traumatic for me at narrative fracture was loss of self-identity and erupting internal chaos. Psychoanalyst/interpersonal theorist Karen Horney's theories around the formation of a ‘false self' and the related palliative measures of addiction and controlling are my foremost source of understanding here. To discover how self-identity is formed and can potentially be impeded, the mother-baby relationship, the issue of attachment, and the crucial involvement of the body in the infant developmental matrix are explored, principally through the works of Donald Winnicott and John Bowlby; and the related development of ‘affect-regulation' and ‘mentalization' through Peter Fonagy's breakthrough work. Ulric Neisser and Jerome Bruner's theories bring further understanding of development of the self and the socially constructed elements of self-identity. In the process towards ‘reconstruction' Donald Kalsched's theory of the crucial necessity of ‘re-traumatization' is foregrounded, and the study holds this in mind during exploration of the three therapeutic modalities. Neuroscience and brain research also inform this exploration, and a common denominator is found between the three therapeutic modalities via Ernest Hartmann's notion of a ‘continuum' of modes of mental functioning. It is established that the REM programming and reprogramming state, and input from unconscious mental processing are increasingly at work as we operate at the ‘creative'/'dreaming' end of this continuum, and that here psychotherapy, autobiographical writing and dreaming are all shown to be located. Four key points emerge in understanding the impact of these three modalities on healing narrative fracture: the centrality of the relational; the emotions as ‘linchpin'; the power of pattern, metaphor and image; and the potency of the sleeping brain. With its personal accounts, and the new syntheses made between aspects of the different academic fields it mines, this study offers a new perspective on the nature, and lifelong consequences, of early childhood development. It is envisaged that this will provide valuable insight to the burgeoning numbers of quantitative researchers now recognising the need for first person input to their third person research, and to those who are professionally involved in the care of others, as well as to related policy-makers.

As pesquisas que estudam a relação entre fenômenos mediúnicos e saúde mental, embora tenham aumentado nas últimas décadas, ainda não produziram informações suficientes para a consolidação de práticas alternativas às tradicionais. Entretanto, a literatura aponta a necessidade de ampliar os dados por meio de pesquisas que aprofundem nessa temática. Realizou-se um estudo transversal de natureza exploratório-descritiva com abordagem qualitativa dos dados, com objetivo de investigar os significados de alucinação e mediunidade por médiuns de um centro espírita e profissionais da saúde mental de um hospital psiquiátrico de um município paulista. Foram entrevistados 10 médiuns e 10 profissionais de saúde. Utilizou-se como referencial teórico metodológico a abordagem Histórico-Cultural baseada na obra de Vigotski e os Núcleos de Significação de Wanda Aguiar e Sérgio Ozella baseados no referido autor. Foram construídos de três núcleos de significação: \"Entre o real e o imaginário: alterações e perturbações\"; \"Entre o fenômeno e a religião: razão ou loucura\"; e \"Entre o patológico e o espiritual: fenômenos que se relacionam, mas são distintos\". Os resultados demonstram que os médiuns significam a mediunidade com mais precisão do que os profissionais da saúde mental enquanto estes significam a alucinação conceitualmente com mais exatidão. Contudo os significados de alucinação para os médiuns e o de mediunidade para os profissionais não destoam, o que demonstra a disseminação cultural dos conceitos. A maioria dos médiuns e profissionais relataram ter dificuldade para distinguir os fenômenos pesquisados e referiram desconhecer a literatura produzida sobre o tema / Although research about the relationship of mediumic phenomena and mental health has grown in the past decades, it has yet to produce sufficient information for the consolidation of practices alternative to traditional ones. However, literature shows the need to expand data through research that can dive deeper into this topic. This work makes a transversal study of exploratory-descriptive nature, with qualitative approach of data, aiming to explore the meaning of hallucination and mediumship for mediums in a spiritist center and mental health professionals from a psychiatric hospital, in a city in the state of São Paulo. Ten mediums and ten health professionals have been interviewed. As theoretical reference, the Historic-Cultural approach based on Vigotski and the Nuclei of Meanings of Wanda Aguiar and Sérgio Ozella, based also on the said author, have been employed. Three Nuclei of Meanings have been developed: \"Between real and imaginary: alterations and perturbations\"; \"Between phenomenon and religion: reason or insanity\"; and \"Between pathological and spiritual: related but distinct phenomena\". Results show that mediums signify mediumship with more precision when compared to mental health professionals, while the latter signify hallucination conceptually with more accuracy. However, the meanings of hallucination for mediums and mediumship for mental health professionals do not diverge, showing the cultural dissemination of these concepts. Most mediums and mental health professionals report difficulty to distinguish the researched phenomena and claimed to ignore the literature produced about the topic

As pesquisas que estudam a relação entre fenômenos mediúnicos e saúde mental, embora tenham aumentado nas últimas décadas, ainda não produziram informações suficientes para a consolidação de práticas alternativas às tradicionais. Entretanto, a literatura aponta a necessidade de ampliar os dados por meio de pesquisas que aprofundem nessa temática. Realizou-se um estudo transversal de natureza exploratório-descritiva com abordagem qualitativa dos dados, com objetivo de investigar os significados de alucinação e mediunidade por médiuns de um centro espírita e profissionais da saúde mental de um hospital psiquiátrico de um município paulista. Foram entrevistados 10 médiuns e 10 profissionais de saúde. Utilizou-se como referencial teórico metodológico a abordagem Histórico-Cultural baseada na obra de Vigotski e os Núcleos de Significação de Wanda Aguiar e Sérgio Ozella baseados no referido autor. Foram construídos de três núcleos de significação: \"Entre o real e o imaginário: alterações e perturbações\"; \"Entre o fenômeno e a religião: razão ou loucura\"; e \"Entre o patológico e o espiritual: fenômenos que se relacionam, mas são distintos\". Os resultados demonstram que os médiuns significam a mediunidade com mais precisão do que os profissionais da saúde mental enquanto estes significam a alucinação conceitualmente com mais exatidão. Contudo os significados de alucinação para os médiuns e o de mediunidade para os profissionais não destoam, o que demonstra a disseminação cultural dos conceitos. A maioria dos médiuns e profissionais relataram ter dificuldade para distinguir os fenômenos pesquisados e referiram desconhecer a literatura produzida sobre o tema / Although research about the relationship of mediumic phenomena and mental health has grown in the past decades, it has yet to produce sufficient information for the consolidation of practices alternative to traditional ones. However, literature shows the need to expand data through research that can dive deeper into this topic. This work makes a transversal study of exploratory-descriptive nature, with qualitative approach of data, aiming to explore the meaning of hallucination and mediumship for mediums in a spiritist center and mental health professionals from a psychiatric hospital, in a city in the state of São Paulo. Ten mediums and ten health professionals have been interviewed. As theoretical reference, the Historic-Cultural approach based on Vigotski and the Nuclei of Meanings of Wanda Aguiar and Sérgio Ozella, based also on the said author, have been employed. Three Nuclei of Meanings have been developed: \"Between real and imaginary: alterations and perturbations\"; \"Between phenomenon and religion: reason or insanity\"; and \"Between pathological and spiritual: related but distinct phenomena\". Results show that mediums signify mediumship with more precision when compared to mental health professionals, while the latter signify hallucination conceptually with more accuracy. However, the meanings of hallucination for mediums and mediumship for mental health professionals do not diverge, showing the cultural dissemination of these concepts. Most mediums and mental health professionals report difficulty to distinguish the researched phenomena and claimed to ignore the literature produced about the topic

The purpose of this study was to test the hypothesis that the hearing distressing voices simulation training, Developing Empathy for the Lived Experience of Psychiatric Disability: A Simulation of Hearing Distressing Voices (HDVS), developed by Patricia E. Deegan, Ph.D., will affect counseling students’ empathy for clients diagnosed with schizophrenia, as measured by the Jefferson Scale of Empathy – Health Professions Students version (JSE-HPS). The experimental design was a quasi-experimental, one-group, pre-test/ post-test, and the Jefferson Scale of Empathy – Health Professions Students version was used to measure empathy. A total of 55 participants were drawn from a convenience sample of master’s counseling students from CACREP-accredited programs in southern Louisiana and Chicago, Illinois. A two tailed, paired samples t-test revealed that there was a significant difference (pM=116.11, SD=9.76) and post-test empathy scores (M=121.85, SD=8.9). This study suggests the HVDS is an effective tool to assist counseling students with developing empathy, decreasing stigmatizing attitudes, and avoiding disempowerment and marginalization within the counseling relationship.

Background Beliefs about voices, their origin, intent and powerfulness can all impact on the voice hearer, their level of distress and their need for help. Interpersonal difficulties can exacerbate distress and be reflected in the person’s relationship with their voices. Emotion regulation strategies, which may be functional or dysfunctional help the person manage their reaction. This study aims to investigate beliefs about voices, symptoms and interpersonal issues as well as how well these areas predict emotion regulation strategies Methods Two groups of participants (18 with low and 16 with high omnipotence scores) were recruited through their mental health workers. The participants completed six self-report measures that assessed beliefs, emotion regulation strategies, interpersonal difficulties, dimensions of voice hearing and symptoms. Results Omnipotence scores differentiated some of the interpersonal issues and only one symptom subscale (phobic anxiety); those who scored high on the omnipotence subscale experienced more difficulties. For the emotion regulation subscales, lower omnipotence scorers differed significantly from the higher omnipotence scorers, using more external functional and dysfunctional strategies. Regression analysis showed that ‘distress’ incorporating the PSYRATS emotion subscale, the BSI grand total and the IIP-32 total predicted the use of dysfunctional emotion regulation strategies, but omnipotence beliefs did not add much to this. Conclusions Overall voice hearers experience a range of beliefs about their voices. Those with higher omnipotence beliefs find it difficult to socialise, be involved with other people, and are too dependent and caring with reference to other people. Omnipotent beliefs did not, in general, differentiate symptoms or emotion regulation strategies. This would suggest that beliefs may not be what determines distress and subsequent help seeking. Distress and interpersonal issues predict the use of emotion regulation strategies with little being added to the prediction by omnipotent beliefs; this suggests that there may be an alternative to the single symptom approach. Further research is required to assess the contribution made by emotion regulation to the development, maintenance and course of voice hearing. Assessment and interventions with reference to emotion regulation also require investigation.

No description available.

Ever since the birth of the film medium, stories about drugs and addiction have been produced. There is a fascination with the lifestyle, the effects of drugs and the ways in which it can be portrayed on the screen. The thesis starts off by giving an historical context, ranging from the late 19th Century and up until today, describing how the society and the public have treated the subject and how the narrative mirrors these attitudes. The purpose of the thesis is to take a closer look at this recurrent theme. Eleven fictional films produced between the 1980’s and 2000’s have been chosen and psychoanalytical film theory is used to analyze the ways in which the addict is represented; how filmic disgust and the abject makes the characters tread over physical and social boundaries and how the effect of the drug have the character tread over mental boundaries through dreams and hallucinations.

The aim of this study was to explore the experience of hearing voices in the general New Zealand adult population. This included mapping the topography of voices and the impact of the experience on participants’ lives, exploring participants’ explanatory models, investigating coping strategies and support structures, and developing a model of the essence of hearing voices. Quantitative and qualitative analyses of questionnaire (n=154) and interview (n=50) data revealed a great diversity of experiences, both within and among participants. Of all topographical variables significantly related to emotional impact (content, form, duration, intrusiveness and control), voice content was the only significant predictor variable, accurately predicting the emotional response of 93.3% of participants. Overall, participants who valued their voice experiences tended to have spiritual beliefs, a more positive emotional reaction and less contact with mental health services. In contrast, participants who experienced mostly unwanted voices tended to have biological and/or psychological understandings of their voice experiences, a more negative emotional reaction to them, and increased contact with mental health services. Participants reported using a vast array of coping strategies, with varying degrees of success. Individualised techniques were reported to be the most effective, followed by setting aside a time to listen to the voices. In terms of help and support, participants called for a model of intervention that accepted their voice experiences as real, took an holistic approach incorporating contextual, cultural and spiritual factors, and worked with voice-hearers, their families and the public to provide information about voice phenomena and normalise the experience. Using a phenomenological approach, a model of the essential structure of hearing voices is proposed, comprising five components: the content of the voices is personally meaningful to the voice-hearer; the voices have a characterised identity; the person has a relationship with their voices; the experience has a significant impact on the voice-hearer’s life; and the experience has a compelling sense of reality. The implications of this research include validating voice-hearers’ perspectives of the experience, informing clinical work with voice-hearers, and informing the development of local and national-level services, such as a New Zealand Hearing Voices Network.