Introdução: A automutilação é definida como qualquer comportamento intencional envolvendo agressão direta ao próprio corpo sem intenção consciente de suicídio. As formas mais frequentes de automutilação são cortar a própria pele, queimar-se, bater em si mesmo, morder-se e arranharse. Alguns pacientes apresentam rituais de automutilação e passam muito tempo pensando em como executá-la, lembrando sintomas compulsivos, porém com intenso componente de impulsividade. O DSM-IV classifica a automutilação como um dos critérios de diagnósticos para transtornos do controle dos impulsos não classificados em outro local ou Transtorno de Personalidade Borderline. O DSM-V propõe que a automutilação seja uma entidade diagnóstica à parte. A falta de homogeneidade na descrição da automutilação dificulta as pesquisas, tanto epidemiológicas como clínicas. A melhor caracterização clínica e psicopatológica da automutilação é fundamental para que intervenções terapêuticas mais efetivas possam ser desenvolvidas, incluindo novas abordagens psicofarmacológicas. Os objetivos deste estudo foram: fazer uma descrição clínica dos pacientes que procuram tratamento, tendo como principal queixa a automutilação e comparar estes com pacientes com Transtorno Obsessivo-Compulsivo (TOC) quanto a características compulsivas e impulsivas. Métodos: 70 pacientes foram avaliados, sendo 40 pacientes com automutilação e 30 pacientes com TOC. Todos estes pacientes foram avaliados de forma direta com os instrumentos: Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica (SCID-I); Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica, adaptada para Transtornos de Controle de Impulsos; Entrevista Clínica Estruturada para Transtornos de Eixo II, versão clínica (SCID-II); Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS); Escala Dimensional para Avaliação de Presença e Gravidade de Sintomas Obsessivo-Compulsivos (DY-BOCS); Escala para Avaliação da Presença e Gravidade de Fenômenos Sensoriais da Universidade de São Paulo (USP-SPS); Questionários de História de Traumas; Escala de Comportamento de Automutilação (FASM); e Barrat Impulsivity Scale (BIS-11). Para comparação das variáveis categóricas, foi utilizado o teste qui-quadrado e para variáveis contínuas, o test-t. Para análise multivariada, foram utilizados os testes ANCOVA ou Regressão Logística Linear. Foi considerado, para todos os testes, o nível de significância 5%. Resultados: A média de idade dos pacientes avaliados foi de 29 anos. Quanto às características clínicas dos pacientes com automutilação, estes iniciaram o comportamento em média aos 17 anos de idade, e apresentavam cinco tipos diferentes de automutilação em média. Os comportamentos mais frequentes foram: cortar a pele (90%), cutucar ferimentos (75%), bater em si mesmo (67,5%). Os motivos mais frequentemente relacionados à automutilação foram para: parar sentimentos ruins (75%), aliviar sensação de vazio (70%), se castigar (70%), sentir algo, mesmo que fosse dor (47,5%) e sentir-se relaxado (40%). Na comparação entre os grupos com automutilação e TOC, quanto às comorbidades do Eixo I, o grupo com automutilação apresentou mais comorbidades com depressão (92,5%, p=0,03) e bulimia (25%, p<0,001). O grupo com TOC apresentou mais fobia social (40%, p<0,001). Os pacientes do grupo com TOC tiveram maior gravidade em todas as medidas do Y-BOCS (média: 26, p<0,001) e DY-BOCS (média 23,1, p=0,01). No grupo com automutilação, 60% dos pacientes referiram a automutilação associada a fenômenos sensoriais. Este grupo teve mais relato de fenômenos sensoriais referente à \"sensação de incompletude\" (45%, p=0,007) e \"sensação de energia interna\" (57,5%, p=0,001). O transtorno de personalidade mais prevalente em ambos os grupos foi Transtorno de Personalidade Obsessivo-Compulsiva. O grupo com automutilação apresentou maior prevalência de Transtorno de Personalidade Histriônica (22,5 %, p=0,02) e Transtorno de Personalidade Borderline (15%, p=0,04). A gravidade da impulsividade foi maior no grupo com automutilação segundo as medidas da BIS-11 para características motoras (média 26,6, p=0,002) e dificuldade para planejamento (média 31, p=0,014). Conclusão: A automutilação e o TOC são transtornos heterogêneos que compartilham características compulsivas e impulsivas. Na automutilação, o componente impulsivo é maior e no TOC, a compulsividade é maior quando comparamos estes dois grupos. Entretanto, a automutilação esteve associada à ocorrência de fenômenos sensoriais, apontando também para a presença de aspectos compulsivos nestes quadros. O Transtorno de Personalidade Borderline não é regra entre os pacientes com automutilação. Outros transtornos de personalidade, inclusive cluster C como o Transtorno de Personalidade Obsessivo-Compulsiva, também podem estar presentes entre pacientes com automutilação, assim como com TOC. Os pacientes adultos com automutilação apresentam este comportamento desde a adolescência e os tipos de automutilação apresentados por estes são de moderada a grave intensidade, além de associarem diferentes tipos de automutilação. Isto evidencia a necessidade de desenvolvimento de instrumentos diagnósticos mais precisos para identificação e tratamento precoce específico para estes quadros, evitando a cronicidade dos mesmos / Introduction: Non-suicidal self-injury (NSSI) is defined as a deliberate and voluntary physical self-injury without any conscious suicidal intent. Common forms of NSSI include cutting, burning, scratching, hitting, biting and interfering with wound healing. Some patients spend a lot of time thinking about how to perform their act doing it always the same way. They remember compulsive symptoms with intense component of impulsivity. The DSM-IV classifies NSSI as one diagnostic criteria for impulsive control disorders not elsewhere classified or as borderline personality disorder. The DSM-V proposes that the NSSI should be classified as a different disorder. The lack of a singular meaning for NSSI makes difficult the clinical and epidemiological researches about the subject. A better clinical and psychopathological definition for NSSI is crucial for the development of more effective therapeutic interventions, including new psychopharmacological treatment. The objective of this study is to describe the clinical features of patients seeking treatment for NSSI and compare their compulsive and impulsive features with patients with Obsessive Compulsive Disorder (OCD). Methods: 70 patients were interviewed, 40 patients who specifically sought treatment for NSSI and 30 patients who sought treatment for OCD. Standardized instruments were used: Structured Clinical Interview for Diagnosis of Axis I, according to DSM-IV and for impulse-control disorders, Structured Clinical Interview for Axis II Disorders (Clinical Version (SCID-II)), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS); Dimensional Yale- Brown Obsessive-Compulsive Scale (DY-BOCS), University of São Paulo Sensory Phenomena Scale (USP-SPS); Trauma History Questionnaire; Functional Assessment of Self-Mutilation (FASM) and Barratt Impulsivity Scale, version-11 (BIS -11). To compare categorical variables the chi-square test was applied. For continuous variables, t-test was applied. For multivariate analysis, the ANCOVA test or Logistic Regression were applied when required. A significance level of 5% was applied for all statistical tests. Results: The mean age of patients was 29 years. The NSSI began at 17 years old, and had 5 different types of NSSI on average. The more common behaviors were: cutting the skin (90%), pick at a wound (75%), beat himself (67.5%). The most often reasons for NSSI were to: stop bad feelings (75%), relieve feeling numb or empty (70%), punish himself (70%), feel something, even if it was pain (47.5%) and feel relaxed (40%). In the comparison between NSSI and OCD groups, the NSSI group presented more axis I comorbidities with depression (92.5%, p = 0.03) and bulimia (25%, p <0.001). The OCD group showed more social phobia (40%, p <0.001). The OCD group had higher severity in all measures of the Y-BOCS (mean: 26, p <0.001) and DY-BOCS (mean 23.1, p = 0.01). In the NSSI group, 60% of the patients reported NSSI associated with sensory phenomena. This group had more reports of sensory phenomena related to the \"incompleteness\" (45%, p = 0.007) and \"internal energy\" (57.5%, p = 0.001). The most prevalent personality disorder in both groups was Obsessive-Compulsive Personality Disorder. The NSSI group had higher prevalence of Histrionic Personality Disorder (22.5%, p = 0.02) and Borderline Personality Disorder (15%, p = 0.04). The severity of impulsivity was higher in the NSSI group according to the measures of the BIS-11 for motor impulsivity (mean 26.6, p = 0.002) and non-planning impulsivity (mean 31, p= 0.014). Conclusion: NSSI and OCD are heterogeneous disorders that share compulsive and impulsive features. In NSSI, the impulsive component is stronger and in OCD the compulsive is stronger when comparing both groups. However, NSSI was associated with the occurrence of sensory phenomena which evidence the presence of compulsive aspects. The borderline personality disorder is not a rule among patients with NSSI. Other personality disorders, including cluster C personality disorders, may also be present among patients with NSSI and OCD, as well. Adult patients with NSSI started this behavior during adolescence. The NSSI symptoms presented were moderate to severe, different types of NSSI were also involved. These results highlights the needs for development of more accurate diagnostic tools for early identification and specific treatment of the NSSI, avoiding chronicity

Dadas a elevada prevalência e os grandes prejuízos sociais, familiares e pessoais que caracterizam o envolvimento patológico com jogos de azar, torna-se necessária a investigação sistemática de fatores de vulnerabilidade e de resistência que possam influir no desenvolvimento de tais condições. Uma das principais estratégias utilizadas para a profilaxia e tratamento dessas formas de envolvimento patológico tem sido a investigação dos componentes biológico-genéticos do Jogo Patológico (JP). O presente estudo objetivou investigar a associação de polimorfismos de genes candidatos do sistema serotonérgico e JP em pares de irmãos discordantes para este diagnóstico. Participaram do estudo 140 pares de irmãos discordantes para o diagnóstico de JP pelos critérios do Manual Diagnóstico e Estatístico da Associação Psiquiátrica Americana, DSM-IV. Foram genotipados os seguintes polimorfismos de genes que codificam: o transportador da serotonina (polimorfismo 5HTTLPR-l/s), o receptor serotoninérgico subtipo 1B (5HT1B G861C), e o receptor serotoninérgico subtipo 2A (polimorfismos 5HT2A T102C e C516T). Na análise estatística observou-se uma maior distribuição do alelo C do polimorfismo T102C do gene 5HT2A no grupo de irmãos com o diagnóstico de JP (p<0,01), sugerindo uma possível contribuição desse alelo na predisposição ao JP. Entretanto, faz-se necessária a investigação desses polimorfismos em amostras independentes envolvendo o fenótipo JP para a confirmação dos achados apresentados nesse trabalho. Uma análise preliminar dos haplótipos (102 e 516) apresentou resultados inconclusivos. É interessante notar que há associação entre esse polimorfismo e manifestações psiquiátricas outras que não o JP. / The high prevalence and the great social, familial and personal hazards that appear along with the occurrence of pathological involvement in gambling makes it necessary to systematically investigate vulnerability and resilience factors that may influence the development of such a condition. One of the main strategies in prevention and treatment of these pathological behaviors has been the investigation of the biological-genetic basis of pathological gambling (PG). The present study aimed to determine any association between candidate gene polymorphisms of the serotoninergic system and the occurrence of PG in sib-pairs discordant for this diagnosis. One hundred and forty (140) PG-discordant sib-pairs were evaluated by the Diagnostic and Statistical Manual from the American Psychiatric Association (DSM-IV), who had already been previously genotyped in other studies. We genotyped the polymorphisms which codified: the serotonin transporter (5HTTLPRl/ s polymorphism), the serotonergic receptor subtype 1B (5HT1B G861C polymorphism), and the serotonergic receptor subtype 2A (T102C and C516T polymorphisms). Statistical analysis revealed a greater distribution of the C allele of the T102C polymorphism of the 5HT2A gene in the gambling sib group (p<0,01), suggesting a possible contribution of this allele in the predisposition for PG. Nevertheless, it is necessary to further investigate these polymorphisms in independent samples involving PG phenotype for the adequate confirmation of such findings. A preliminary analysis of the haplotypes (102 and 516) show inconclusive results. It is noteworthy that there are previous associations between this polymorphism and psychiatric manifestations other than PG.

Although research has demonstrated that some adults with psychopathic traits show better executive functioning and higher intelligence that make them “successful”, there has been very minimal research testing whether similar distinctions can be made in samples of youth with elevated CU traits. Utilizing a sample of 1216 male adolescent first-time offenders, the current study examined whether executive functioning, intelligence and/or impulse control would moderate the relationship between CU traits and antisocial outcomes. The current study also examined whether CU traits were more strongly associated with a number of positive adjustment indicators at higher levels of the moderators. Results did not support successful psychopathy conceptualizations for youth with CU traits. Unlike findings in adult psychopathy research, adolescents high on CU traits who were also of higher intelligence engaged in more aggressive acts. The current findings also indicated that none of the proposed moderators influenced the relationship between CU traits and the positive adjustment indicators.

The hypotheses investigated were (1) as measured by a test of impulse control, elopers are more impulsive than non-elopers, and (2) as measured by a test of impulse control, males are more impulsive than females. The Self-Report Test of Impulse Control (STIC) and the Barratt Impulsiveness Scale (BIS) were administered to 76 female and 40 male patients at the time of admission to an open psychiatric hospital. Of these, 20 females and 10 males eloped. The first hypothesis was only partially supported. The second hypothesis was not supported. The BIS was found to be a potential predictor of elopers. The data also suggested that males elope later than females.

Examination of goal-directed aiming tasks has revealed that rapid, discrete human action is amendable to online control. This control affords humans a margin of error in movement planning and execution as well as a means of acquiring their goals when the body and/or the environment are extrinsically perturbed. For over a century, the models of online movement control that have best described the trajectories and outcomes of goal-directed reaches hold that these movements are composed of two distinct components. The first component moves the limb from its resting position towards the target. The second component is a corrective movement that is formed on the basis of a visual referencing of the moving limb and target positions. As such, the temporal and spatial characteristics of these discrete movement changes have been attributed to the limits of visual information processing. Furthermore, the absence of any discrete movement changes in the portions of movements outside of the temporal and spatial limits of vision led many investigators to conclude that first component impulses are ballistic and uncontrollable. However, recent studies involving environmental perturbation and within-subject trial-to-trial spatial variability analyses have evidenced that initial impulses are privy to online control. Because the corrections made early in movement impulses occur quicker than purely afferent visual information can be processed this form of control has been attributed to the use of forward anticipatory processes. The four studies presented here examine the nature of initial impulse control through kinematic analyses of reaches made to targets against various combinations of limb, target, and environment perturbations. This was done in order to evaluate anticipatory control's relationship with visually-regulated control and the relative influence the two processes have on the movement trajectory and performance outcome. The first study examined target-directed reaches made against illusory moving background and target relocation perturbations. The results showed the presence of early anticipatory and late visually-regulated control. Non-interactive main effects of the two perturbations on outcome accuracy revealed that the processes operate independently. The second study tested the applicability of an air discharging stylus as a tool for perturbing reach velocities. The results showed that the stylus effectively perturbed limb velocity and highlighted the presence of a limb forwarding response to either an advancing or hindering perturbation. The findings evidence the non-specific nature of anticipatory control responses. The third study examined reaches made against combinations of actual limb velocity and target position perturbations. The interactive effect of the two perturbations on reach trajectories and outcome accuracy indicated that the perturbations were salient enough to prompt parallel operation of the two control processes. Again, the control of initial movement portions was highlighted by non-specific responses to the perturbations. The fourth study examined reaches made against combinations of illusory and actual perturbations to both the anticipatory and visually-regulated control processes. Interestingly, performers withheld responses to the illusory perturbation unless they were also responding to an actual perturbation. This finding suggests that anticipatory control responses are biased during movement preparation. Furthermore, combined illusory and actual perturbations to target position had interactive effects on visually regulated control. Overall, the studies evidence that target-directed movements are mediated by two modes of control. There is an anticipatory mode of control that operates continuously and, given that reaches are made within the spatial and temporal limits of visual processing, there is also a feedback driven discrete mode of control that overlaps with the continuous mode. / Thesis / Doctor of Philosophy (PhD)

No description available.

Mobile electronic devices such as smartphones are playing an increasingly pervasive role in our daily activities. A growing body of literature is beginning to investigate how mobile technology habits might relate to individual differences in cognitive traits. The present study is an investigation into how individual differences in intertemporal preference, impulse control, and reward sensitivity, are predictive of the degree to which people engage with their smartphones, in two separate experiments. Experiment 1 utilized behavioral and self-reported measures for each of the aforementioned cognitive traits to examine their relationships with Mobile Technology Engagement (MTE) as defined in Wilmer & Chein (2016). The results replicated earlier work demonstrating that mobile technology engagement is positively correlated with a tendency to discount delayed rewards. A positive relationship was also observed between MTE and reward sensitivity. In an attempt to investigate the neural origins of the relationship observed in Experiment 1, Experiment 2 examined the association between mobile technology usage and white matter connectivity from the ventral striatum (vSTR) to the ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC), pathways that have been previously implicated as biological markers for individual differences in intertemporal preference. Regression analyses revealed that both pathways predicted delay discounting performance, but only vSTR-vmPFC predicted mobile technology engagement. Taken together, the results of these two experiments provide important foundational evidence for both neural and cognitive factors that predict how individuals engage with mobile technology. / Psychology

No description available.

O amor patológico caracterizado pelo comportamento de prestar cuidados e atenção ao parceiro, de maneira repetitiva e desprovida de controle, em um relacionamento amoroso é um quadro pouco estudado cientificamente, apesar de não ser raro e de gerar sofrimento importante. Com o intuito de compreender os aspectos clínicos e de personalidade associados ao amor patológico, os seguintes fatores foram analisados: impulsividade, personalidade, satisfação com o relacionamento amoroso, estilo de amor e tipo de apego. Além de revisar a literatura, os dados obtidos, por meio da aplicação de vários instrumentos em 50 sujeitos com amor patológico e 39 sujeitos saudáveis evidenciaram que indivíduos com amor patológico apresentam alta impulsividade (p<0.001; Escala de Impulsividade de Barratt), elevada auto-transcendência, isto é, senso de fazer parte de uma realidade maior (p<0.001; Inventário de Temperamento e Caráter), e manutenção de relacionamento amoroso com baixa qualidade (p<0.001; Escala de Avaliação do Relacionamento Adaptada). Assim, essa população necessita, por parte dos centros de tratamento especializados, de avaliação e abordagem terapêutica efetivas, as quais devem contemplar as características clínicas e de personalidade específicas dessa condição / Pathological love characterized by the behavior of providing repetitive and uncontrolled care and attention to the partner in a romantic relationship is a rarely studied condition, despite not being rare and causing suffering. In order to know the clinical and personality aspects associated with pathological love, the following factors were analyzed: impulsivity, personality, satisfaction with romantic relationship, love style, and type of attachment. Besides revisiting the literature, the data obtained from the application of various instruments in 50 subjects with pathological love and 39 healthy subjects showed that individuals with pathological love present higher impulsivity (p<0.001; Barratt Impulsiveness Scale), elevated selftranscendence, that is, hold sense of communion with a wider reality (p<0.001; Temperament and Character Inventory) and keep dissatisfactory romantic relationships (p<0.001; Adapted Relationship Assessment Scale). Hence, this population needs effective assessment and therapeutic strategies, which must take into account the specific clinical and personality characteristics of the condition

A Compra Compulsiva (CC) está atualmente classificada como um transtorno do controle dos impulsos não classificados em outro local (TCI). A prevalência das CC é estimada em cerca de 5% da população geral e é identificada com maior frequência no gênero feminino. O comportamento repetitivo e crônico do comportamento de gastar descontroladamente gera consequênias negativas ao indivíduo, além dos elevados índices de comorbidades com transtorno de humos, ansiedade e outros TCIs, o que contribui para manter a divergência existente sobre a classificação da CC. Tem sido proposto que CC deve ser classificada como um TCI, ou como uma sub-síndrome do transtorno afetivo bipolar (TAB), ou ainda como uma variante do transtorno obsessivo-compulsivo (TOC) semelhante ao armazenamento compulsivo. O objetivo deste estudo é investigar qual classificação pode ser mais adequada para a CC. Para isso, adotamos duas abordagens: a primeira abordagem é a investigação das categorias diagnósticas para identificar as comorbidades psiquiátricas; a segunda abordagem refere-se as dimensões psicopatológicas em que comparamos impulsividade, sintomas obsessivo-compulsivos, instabilidade afetiva e armazenamento em pacientes com CC, TOC e TAB. Foram selecionados 80 pacientes (24 CC, 35 TOC e 21 TAB que não estivessem em mania nem hipomania) primeiramente foram avaliados de acordo com o SCID-CV e da seção especial para TCI e depois responderam os questionários de autopreenchimento. Realizamos duas análises: categorial e dimensional. Na análise categorial houve um equilibrio de associação entre os três grupos diagnósticos, e as comorbidades psiquiátricas apresentadas pelos três grupos diagnósticos foram congruentes com as descritas na literatura. Na análise dimensional os pacientes de CC apresentaram escores significativamente mais altos em todas as medidas de impulsividade e na aquisição, mas não nas outras sub-dimensões do armazenamento compulsivo, amontoamento e dificuldade em descartar. Pacientes bipolares pontuaram mais na dimensão mania da escala SCI-MOODS. Pacientes com TOC pontuaram mais nos sintomas obsessivo-compulsivos, e principalmente nas dimensões contaminação/lavagem e checagem da escala Pádua Inventory; no entanto, eles não apresentaram maior pontuação em nenhuma dimensão do armazenamento compulsivo. Um modelo discriminante foi construído com essas variáveis e classificou corretamente os pacientes de CC (79%), TOC (77%) e TAB (71%). Considerando os resultados da análise categorial cada um dos transtornos apresentou uma agregação categorial distinta, e na análise dimensional os pacientes com CC revelaram ter aquisição impulsiva, assemelhando-se aos TCI ao invés de TOC ou TAB. Sintomas maníacos foram bem distintos nos pacientes bipolares, assim como pacientes com TOC apresentaram mais obsessão e compulsão. Sintomas de armazenamento com exceção da aquisição não foram particularmente associados a qualquer grupo diagnóstico / Compulsive Buying (CB) is currently classified as an impulse control disorder not elsewhere classified (ICD). The prevalence of CB is estimated at around 5% of the general population and is identified with greater frequency in females. The chronic repetitive behavior and the behavior of spending wildly generates negative consequences to the individual, in addition to high rates of comorbidity with mood disorder, anxiety and other ICDs, which helps to maintain the existing disagreement on the classification of CB. It has been proposed that CB should be classified as an ICD, or as a sub-syndrome of bipolar disorder (BD), or as a variant of obsessive-compulsive disorder (OCD), similar to compulsive hoarding. The aim of this study is to investigate which classification is best suited for CB. For this, we adopt two approaches: the first approach is the investigation of the diagnostic categories to identify psychiatric comorbidities, the second approach refers to the psychopathological dimensions in which we compared impulsivity, obsessive-compulsive symptoms, affective instability and hoarding in patients with CB, OCD and BD. We selected 80 patients (24 CB, 35 OCD and 21 BD who were not in mania or hypomania) were first evaluated according to the SCID-CV and the special section to TCI, then answered the self-report questionnaires. We performed two analyses: categorical and dimensional. In categorical analysis, there was a balance of association between the three diagnostic groups, and psychiatric comorbidities by the three diagnostic groups were consistent with those described in the literature. In dimensional analysis of CB patients, there were significantly higher scores in all measures of impulsivity and the acquisition, but not in other sub-dimensions of the compulsive hoarding, clutter and difficulty discarding. Bipolar patients scored higher on the mania dimension from the SCI-MOODS scale. OCD patients scored higher on obsessive-compulsive symptoms, and, particularly, higher on the contamination/washing and checking dimensions from the Padua Inventory scale; however, they did not score higher on any hoarding dimension. A discriminant model built with these variables correctly classified patients of CB (79%), OCD (77%) and BD (71%). Considering the results of categorical analysis, each of the disorders presented a distinct clustering categorical, and dimensional analysis in patients with CB reported having impulsive acquisition, resembling the TCI instead of OCD or BD. Manic symptoms were distinctive of BD patients, and patients with OCD were distinctive obsession and compulsion. Hoarding symptoms other than acquisition were not particularly associated with any diagnostic group