Enthusiasmos in thinking of ancient Greece. - This disertation thesis analyzes the issue of enthusiasm in the context of thinking of the Ancient and Classical Greece. In a theoretical manner also tries to gain an insight into the semantical structure of enthusiasm basing on historical excursus (the Ancient Age, the Classial Age) to support its historical transformation. It was enthusiasmos and the way o mantical explanation, which enabled the poets to create pieces of art and gave rise to performing and poetry art. This thesis aims to explore the philosophical reflection of enthusiasm, because the gift of divine presence itself, such as the inspired poetic speech, was in the Archaic period certainly guarantee of the truthfulness, but in the Classical period, was all the more reason for doubt and questions. Selected works by prominent authors of ancient mindset are systematically analyzed in the context of enthusiasm.

Made available in DSpace on 2016-03-22T17:26:46Z (GMT). No. of bitstreams: 1 capa final rosana.pdf: 15525 bytes, checksum: fab2d4afcfe9faedc9db870806e272cd (MD5) Previous issue date: 2012-07-12 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Objective: The purpose of this study was to clarify the effect of imune response in diferente mood episodes. Methods: This report is part of a cross-sectional population-based study including 1560 individuals 18 to 35 year-old living in the urban area of Pelotas, RS (Brazil). We randomly selected 241 subjects from the population-based study. The diagnostic of current depression, mania or mixed episode was made using the Mini International Neuropsychiatric Interview 5.0 (MINI). Serum levels of IL-1b were measured using a commercial available immunoassay kit. Results: In the present work we found 110 (45.6%) patients with no current mood episode, 15 (6.2%) patients in maniac episodes, 91 (37.8%) patients with current depression and 25 (10.4%) patients in a mixed states. Socio-demographic variables like ethnicity and years in school were not significantly different between the groups. Regarding the cytokine measurements, patients in maniac and depressive episodes had similar levels of IL-1b (8.85 and 8.90 pg/mL, respectively) when compared to the group with no mood episodes (10.24 pg/mL). However, patients in mixed states had an increase (13.19 pg/mL) in IL-1b levels (P=0.09) when compared to the other groups. Discussion: These results suggest that mixed mood episodes are associated with higher levels of IL-1b. This pro-inflammatory state might underlie the symptom severity and the poor outcome observed in these patients / Nos últimos anos as doenças psiquiátricas foram as doenças que mais aumentaram na população mundial (Andlin-Sobocki et al., 2005). Estima-se que os transtornos de humor serão o grupo de doenças com maior custo absoluto nos próximos anos, conjuntamente com as patologias demenciais (Andlin-Sobocki et al., 2005). Apesar dos recentes progressos alcançados, as bases etiológicas dos transtornos de humor permanecem pouco elucidadas e a terapia não tem sido totalmente eficaz, com apenas 60% dos pacientes sendo responsivos aos fármacos existentes no mercado (Gareri et al., 2000). Além disso, o diagnóstico dos transtornos de humor é feito basicamente pela observação clínica do paciente, sendo muitas vezes falho e ineficaz. Desta maneira, a identificação de marcadores biológicos preditivos ou com valor diagnóstico para estas doenças pode representar um importante avanço no diagnóstico e tratamento dos transtornos de humor

Made available in DSpace on 2016-04-28T20:38:53Z (GMT). No. of bitstreams: 1 Roberto Kirschbaum.pdf: 937728 bytes, checksum: 89aa9c74ca98c54a3a3e700fa65730da (MD5) Previous issue date: 2014-06-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In this research we want to examine the challenges and therapeutic possibilities in the analysis of melancholic narcissistic neuroses. For that, we ll first go over some conceptions of melancholy along History, arriving at the psychoanalytical conception, chiefly with Freud and Karl Abraham. These psychoanalysts locate melancholia among the narcissistic affections, so we ll follow examining post-freudian and contemporary authors and their approach to narcissism, amongst them Klein, Riviere and Rosenfeld. We ll try to focus, on the one hand, the factors that hamper the treatment of these affections, in special the patients difficulty with the work of mourning, and the negative therapeutic reaction; on the other hand, the elements that constitute or contribute to their therapy. The objective of this research is an enrichment of the comprehension of the metapsychology of melancholy, needed, among other reasons, due to a theoretical and clinical empoverishment that happened with the replacement of the term melancholy by the term depression, mainly in the second half of the 20th century. We propose that this enrichment in the comprehension of the melancholic clinical picture could be helpful in the treatment of narcissistic affections, that include many of the cases being recently diagnosed as depression. Our starting point will be the report of a case of melancholy, where the transferencial relationship raised questions to the analyst, such as: what are the specific defences and resistances in these cases, and how do these impact in the transference-countertransference? If the melancholic suffers from inertia, how to avoid that the analysis of melancholy suffers the same problem? What are the limits to the treatment of melancholy? What are its ways of treatment? How to help the melancholic to develop or recover the capacity to do the work of mourning, and the capacity to love? / Nesta pesquisa propomo-nos a examinar os desafios e possibilidades na análise das neuroses narcísicas melancólicas. Para isto, serão primeiramente resgatadas algumas concepções de melancolia ao longo da história, chegando-se à concepção psicanalítica, principalmente com Freud e Karl Abraham. Estes psicanalistas situam a melancolia entre as afecções narcísicas, portanto seguiremos fazendo articulações com autores pós-freudianos e contemporâneos que abordam o narcisismo, dentre eles Klein, Riviere e Rosenfeld. Procuraremos dar enfoque, por um lado, aos fatores que dificultam a clínica dessas afecções, em especial a dificuldade dos pacientes em realizar o trabalho de luto e a reação terapêutica negativa; por outro lado, aos elementos que compõem ou favorecem sua terapêutica. O objetivo desta pesquisa é um enriquecimento da compreensão da metapsicologia do melancólico, necessária, entre outras razões, em contrapartida ao empobrecimento teórico e clínico ocorridos com a substituição do termo melancolia pelo termo depressão, principalmente a partir de meados do séc. XX. Postulamos que esse enriquecimento na compreensão do quadro melancólico poderá ser de ajuda no exercício da clínica das afecções narcísicas, que incluem muitos dos casos recentemente diagnosticados como de depressão. Partiremos do relato de um caso clínico de quadro melancólico, cuja relação transferencial suscitou questionamentos ao terapeuta, tais como: quais são as defesas e as resistências específicas nestes quadros, e como impactam na transferência-contratransferência? Se o melancólico padece de inércia, como evitar que a análise da melancolia também padeça do mesmo mal? Quais os limites da clínica da melancolia? Quais são as vias terapêuticas? Como ajudar o melancólico a desenvolver ou recuperar a capacidade de realizar o trabalho de luto e a capacidade de amar?

A investigação da fisiopatologia do transtorno bipolar em pacientes no início da doença é uma estratégia para evitar um potencial efeito de confusão associado à duração da doença, presença de múltiplos episódios de alteração do humor e tratamento medicamentoso. Nosso objetivo foi investigar, in vivo, metabólitos neuronais do hipocampo de portadores de transtorno afetivo bipolar (TAB) usando a espectroscopia por ressonância magnética de próton (1H-ERM) logo após o seu primeiro episódio de mania. Para isso, foram estudados cinqüenta e oito pacientes com TAB tipo I, classificados de acordo com os critérios do DSM-IV (APA, 2000), após o primeiro episódio de mania e 27 indivíduos saudáveis utilizando a 1H-ERM com um aparelho Philips Achieva de 3T. Voxels com 30X15X15 mm foram posicionados no hipocampo em ambos os lados do cérebro e o sinal foi adquirido utilizando uma sequência PRESS com TE = 35ms e TR = 2000ms. A análise dos dados foi realizada utilizando o programa LC Model. Os níveis de N-acetil-aspartato, compostos de colina, mio-inositol, creatina e glutamina + glutamato (Glx) foram comparados entre os grupos e não foram encontradas diferenças estatisticamente significativas entre eles. Esses achados sugerem que no início do curso do TAB não há alterações no metabolismo neuronal ou vulnerabilidade no hipocampo após o primeiro episódio maníaco / The investigation of the pathophysiology of bipolar disorder in patients at disease onset is a strategy to avoid a potential confounding effect associated with disease duration, presence of multiples mood episodes and pharmacological treatment. Our purpose was to investigate, in vivo, neuronal metabolites in the hippocampus of bipolar disorder (BD) patients using proton magnetic resonance spectroscopy (1H-MRS) soon after their first manic episode. We studied fifty-eight BD I patients meeting DSM-IV (APA, 2000) criteria following their first episode of mania and 27 healthy subjects using 1H-MRS with a 3.0 T Philips Achieva scanner. Voxels with 30X15X15 mm were placed in the hippocampus on both sides of the brain and the signal was collected using a PRESS sequence with TE = 35ms and TR = 2000ms. Data analysis was performed using the LC Model software. N- Acetyl-Aspartate, choline compounds, myo-inositol, creatine and glutamine + glutamate (Glx) levels were compared between the groups and no statistically significant differences were found. These results suggest that early in the course of BD there are no alterations in neuronal metabolism or vulnerability in the hippocampus after the first manic episode

O Estresse precoce pode ocasionar graves consequências na vida adulta. Entre pacientes com Transtorno Afetivo Bipolar sua ocorrência ainda carece de ser avaliada em estudos ampliados que contemplem sua complexidade de maneira mais abrangente, considerando fatores pessoais, ambientais e psicossociais. Com o objetivo de investigar e ampliar a compreensão da relação entre o Estresse precoce, sintomas do humor (depressão e mania), estratégias de enfrentamento e ideação suicida em pacientes com Transtorno Afetivo Bipolar em um serviço comunitário no interior de São Paulo, desenvolveu-se um estudo transversal, analítico, exploratório, de abordagem quantitativa, utilizando os instrumentos: entrevista clínica para confirmação diagnóstica, de acordo com os critérios do DSM-IV; questionário sociodemográfico, de condições clínicas e de saúde, Escala de Depressão de Hamilton (HAM-D); Escala de Mania (YOUNG); Escala de ideação suicida (BSI); Escala de modos de enfrentamento de problemas (EMEP) e Questionário sobre Traumas na Infância (CTQ). Utilizou-se estatística descritiva e analítica, realizando-se testes Qui-quadrado, com coeficiente de correlação de Pearson e regressão logística, considerando níveis de significância de 0,05. Obteve-se aprovação do Comitê de Ética em Pesquisa e a amostra foi de conveniência não probabilística com 50 pacientes com TAB. Prevaleceram mulheres (66,0%), com idade média de 42,7 anos (dp +12,3), 56,0% possuíam ensino médio, 44,0% eram casados ou com companheiro fixo, 90,0% moravam com a família, 88,0% tinham religião, 60,0% estavam afastados ou desempregados, 74,0% viviam com renda mensal de até um salário mínimo, 48,0% tiveram tentativas de suicídio, 58,0% passaram por internações psiquiátricas prévias, 84,0% não praticavam atividade física e 56,0% possuíam comorbidades. A prevalência de Estresse precoce foi de 68,0%, não houve associação estatisticamente significativa entre Estresse precoce, sintomas do humor, estratégias de enfrentamento e ideação suicida entre pacientes com TAB em seguimento em um serviço comunitário. Possivelmente, tais resultados reflitam o impacto que as ações de apoio e suporte social oferecidas pelo CAPS e pela família tem proporcionado a estes pacientes. Os resultados deste estudo indicaram alta prevalência de Estresse precoce que, embora não associado com as demais variáveis, mostra-se relevante na vida destes pacientes. Estudos sobre o Estresse precoce e TAB, relação entre serviço/paciente/família e estratégias de enfrentamento no contexto comunitário podem indicar melhores formas de tratamento e implementação de políticas públicas que garantam melhor qualidade de vida a estes pacientes / Early stress can have serious consequences in adult life. Among patients with Bipolar Affective Disorder, its occurrence still needs to be evaluated in expanded studies that contemplate its complexity in a more comprehensive way, considering personal, environmental and psychosocial factors. With the objective of investigating and broadening the understanding of the relationship between early stress, mood symptoms (depression and mania), coping strategies and suicidal ideation in patients with Bipolar Affective Disorder in a community service in the interior of São Paulo, a cross-sectional, analytical, exploratory, quantitative approach using the instruments: clinical interview for diagnostic confirmation, according to DSM-IV criteria; sociodemographic questionnaire, clinical and health conditions, Hamilton Depression Scale (HAM-D); Mania Scale (YOUNG); Suicidal ideation scale (BSI); Scale of problem coping modes (EMEP) and Trauma Questionnaire in Childhood (CTQ). Descriptive and analytical statistics were used, with Chi-square tests, with Pearson correlation coefficient and logistic regression, considering levels of significance of 0.05. Approval was obtained from the Research Ethics Committee and the sample was of non-probabilistic convenience with 50 patients with BAD. Prevalence of women (66.0%), mean age 42.7 years (dp +12.3), 56.0% had a high school education, 44.0% were married or had a fixed partner, 90.0% lived with the family, 88.0% had religion, 60.0% were retired or unemployed, 74.0% lived with monthly income of up to one minimum wage, 48.0% had attempted suicide, 58.0% had psychiatric hospitalizations 84.0% did not practice physical activity and 56.0% had comorbidities. The prevalence of early stress was 68.0%; there was no statistically significant association between early stress, mood symptoms, coping strategies, and suicidal ideation among patients with BD at follow-up at a community service. These results may reflect the impact that the support and social support actions offered by the CAPS and the family have provided to these patients. The results of this study indicated a high prevalence of early stress that, although not associated with the other variables, is shown relevant in the life of these patients. Studies on early stress and BD, relationship between service / patient / family and coping strategies in the community context may indicate better ways of treatment and implementation of public policies that guarantee a better quality of life for these patients

A investigação da fisiopatologia do transtorno bipolar em pacientes no início da doença é uma estratégia para evitar um potencial efeito de confusão associado à duração da doença, presença de múltiplos episódios de alteração do humor e tratamento medicamentoso. Nosso objetivo foi investigar, in vivo, metabólitos neuronais do hipocampo de portadores de transtorno afetivo bipolar (TAB) usando a espectroscopia por ressonância magnética de próton (1H-ERM) logo após o seu primeiro episódio de mania. Para isso, foram estudados cinqüenta e oito pacientes com TAB tipo I, classificados de acordo com os critérios do DSM-IV (APA, 2000), após o primeiro episódio de mania e 27 indivíduos saudáveis utilizando a 1H-ERM com um aparelho Philips Achieva de 3T. Voxels com 30X15X15 mm foram posicionados no hipocampo em ambos os lados do cérebro e o sinal foi adquirido utilizando uma sequência PRESS com TE = 35ms e TR = 2000ms. A análise dos dados foi realizada utilizando o programa LC Model. Os níveis de N-acetil-aspartato, compostos de colina, mio-inositol, creatina e glutamina + glutamato (Glx) foram comparados entre os grupos e não foram encontradas diferenças estatisticamente significativas entre eles. Esses achados sugerem que no início do curso do TAB não há alterações no metabolismo neuronal ou vulnerabilidade no hipocampo após o primeiro episódio maníaco / The investigation of the pathophysiology of bipolar disorder in patients at disease onset is a strategy to avoid a potential confounding effect associated with disease duration, presence of multiples mood episodes and pharmacological treatment. Our purpose was to investigate, in vivo, neuronal metabolites in the hippocampus of bipolar disorder (BD) patients using proton magnetic resonance spectroscopy (1H-MRS) soon after their first manic episode. We studied fifty-eight BD I patients meeting DSM-IV (APA, 2000) criteria following their first episode of mania and 27 healthy subjects using 1H-MRS with a 3.0 T Philips Achieva scanner. Voxels with 30X15X15 mm were placed in the hippocampus on both sides of the brain and the signal was collected using a PRESS sequence with TE = 35ms and TR = 2000ms. Data analysis was performed using the LC Model software. N- Acetyl-Aspartate, choline compounds, myo-inositol, creatine and glutamine + glutamate (Glx) levels were compared between the groups and no statistically significant differences were found. These results suggest that early in the course of BD there are no alterations in neuronal metabolism or vulnerability in the hippocampus after the first manic episode

O Estresse precoce pode ocasionar graves consequências na vida adulta. Entre pacientes com Transtorno Afetivo Bipolar sua ocorrência ainda carece de ser avaliada em estudos ampliados que contemplem sua complexidade de maneira mais abrangente, considerando fatores pessoais, ambientais e psicossociais. Com o objetivo de investigar e ampliar a compreensão da relação entre o Estresse precoce, sintomas do humor (depressão e mania), estratégias de enfrentamento e ideação suicida em pacientes com Transtorno Afetivo Bipolar em um serviço comunitário no interior de São Paulo, desenvolveu-se um estudo transversal, analítico, exploratório, de abordagem quantitativa, utilizando os instrumentos: entrevista clínica para confirmação diagnóstica, de acordo com os critérios do DSM-IV; questionário sociodemográfico, de condições clínicas e de saúde, Escala de Depressão de Hamilton (HAM-D); Escala de Mania (YOUNG); Escala de ideação suicida (BSI); Escala de modos de enfrentamento de problemas (EMEP) e Questionário sobre Traumas na Infância (CTQ). Utilizou-se estatística descritiva e analítica, realizando-se testes Qui-quadrado, com coeficiente de correlação de Pearson e regressão logística, considerando níveis de significância de 0,05. Obteve-se aprovação do Comitê de Ética em Pesquisa e a amostra foi de conveniência não probabilística com 50 pacientes com TAB. Prevaleceram mulheres (66,0%), com idade média de 42,7 anos (dp +12,3), 56,0% possuíam ensino médio, 44,0% eram casados ou com companheiro fixo, 90,0% moravam com a família, 88,0% tinham religião, 60,0% estavam afastados ou desempregados, 74,0% viviam com renda mensal de até um salário mínimo, 48,0% tiveram tentativas de suicídio, 58,0% passaram por internações psiquiátricas prévias, 84,0% não praticavam atividade física e 56,0% possuíam comorbidades. A prevalência de Estresse precoce foi de 68,0%, não houve associação estatisticamente significativa entre Estresse precoce, sintomas do humor, estratégias de enfrentamento e ideação suicida entre pacientes com TAB em seguimento em um serviço comunitário. Possivelmente, tais resultados reflitam o impacto que as ações de apoio e suporte social oferecidas pelo CAPS e pela família tem proporcionado a estes pacientes. Os resultados deste estudo indicaram alta prevalência de Estresse precoce que, embora não associado com as demais variáveis, mostra-se relevante na vida destes pacientes. Estudos sobre o Estresse precoce e TAB, relação entre serviço/paciente/família e estratégias de enfrentamento no contexto comunitário podem indicar melhores formas de tratamento e implementação de políticas públicas que garantam melhor qualidade de vida a estes pacientes / Early stress can have serious consequences in adult life. Among patients with Bipolar Affective Disorder, its occurrence still needs to be evaluated in expanded studies that contemplate its complexity in a more comprehensive way, considering personal, environmental and psychosocial factors. With the objective of investigating and broadening the understanding of the relationship between early stress, mood symptoms (depression and mania), coping strategies and suicidal ideation in patients with Bipolar Affective Disorder in a community service in the interior of São Paulo, a cross-sectional, analytical, exploratory, quantitative approach using the instruments: clinical interview for diagnostic confirmation, according to DSM-IV criteria; sociodemographic questionnaire, clinical and health conditions, Hamilton Depression Scale (HAM-D); Mania Scale (YOUNG); Suicidal ideation scale (BSI); Scale of problem coping modes (EMEP) and Trauma Questionnaire in Childhood (CTQ). Descriptive and analytical statistics were used, with Chi-square tests, with Pearson correlation coefficient and logistic regression, considering levels of significance of 0.05. Approval was obtained from the Research Ethics Committee and the sample was of non-probabilistic convenience with 50 patients with BAD. Prevalence of women (66.0%), mean age 42.7 years (dp +12.3), 56.0% had a high school education, 44.0% were married or had a fixed partner, 90.0% lived with the family, 88.0% had religion, 60.0% were retired or unemployed, 74.0% lived with monthly income of up to one minimum wage, 48.0% had attempted suicide, 58.0% had psychiatric hospitalizations 84.0% did not practice physical activity and 56.0% had comorbidities. The prevalence of early stress was 68.0%; there was no statistically significant association between early stress, mood symptoms, coping strategies, and suicidal ideation among patients with BD at follow-up at a community service. These results may reflect the impact that the support and social support actions offered by the CAPS and the family have provided to these patients. The results of this study indicated a high prevalence of early stress that, although not associated with the other variables, is shown relevant in the life of these patients. Studies on early stress and BD, relationship between service / patient / family and coping strategies in the community context may indicate better ways of treatment and implementation of public policies that guarantee a better quality of life for these patients

Introduction: There remains a lack of theoretical models which can adequately account for the key features of bipolar disorders (Power, 2005). Objectives: Firstly, to test the predictions made by the SPAARS model that mania is predominantly characterised by the coupling of happiness with anger, while depression (unipolar and bipolar) primarily comprises of a coupling between sadness and disgust. Secondly, to investigate and compare the coping strategies employed to regulate positive and negative emotion between bipolar, unipolar and control groups. Design: A cross sectional design was employed to examine the differences within and between the bipolar, unipolar and control groups in the emotions experienced and the strategies used to regulate emotion. Data were analysed using ANOVAs. Method: Psychiatric diagnoses in the clinical groups were confirmed using the SCID. Current mood state was measured using the BDI-II, STAI and the MAS. The Basic Emotion Scale was used to explore the emotional profiles and the Regulation of Emotion Questionnaire was used to measure coping strategies. Results: The results confirmed the predictions made by the SPAARS model about the emotions in mania and depression. Elevated levels of disgust were also found in the bipolar group generally. The clinical groups used internal dysfunctional strategies more often than the controls for negative emotion. The bipolar group used external dysfunctional strategies more frequently than the controls for positive emotion. Conclusion: The results support the predictions made by the SPAARS model and suggest that disgust plays a key role in bipolar disorder. Strengths and limitations are discussed and suggestions for future research are explored.

Although psychological research into manic experiences is increasing, it remains an underresearched phenomenon. In particular, there is a dearth of qualitative research exploring these experiences in a clinical sample of people diagnosed with Bipolar Disorder. This study examined six participants’ experiences of mania using Interpretative Phenomenological Analysis. Through semi-structured interviews, the participants provided detailed accounts of how they made sense of and experienced their manic states. Three master themes were described: “A mixed relationship with mania,” “A separate and controlled self”, and “The struggle to be different.” The first master theme explored the participants’ mixed and ambivalent relationship with their manic experiences. These were viewed as both alluring and dangerous, but overall the perceived costs had outweighed the benefits, for all but one of the participants. Most participants described losses in relation to giving up their manic experiences, as well as losses related to the destructive consequences of their episodes. The second master theme examined perceptions of mania as a separate, uncontrollable phenomenon, over which they had little influence. It was hypothesised that these explanations served to relieve these participants from underlying negative emotions, such as guilt, regret, shame and selfstigma. The third master theme described how manic experiences had represented struggles to be different. These included a struggle against society; a struggle to experience a preferred self; and a struggle to access very unique experiences or abilities. A number of issues were discussed in relation to the above themes. These included positive and conflicting appraisals of high moods; loss; entrapment and helplessness; ambivalence; negative moral emotions and a preferred manic identity. A range of therapeutic approaches were suggested as potentially helpful for some of these issues. These included Motivational Interviewing, Narrative, Constructivist and Compassion therapies. Additionally, the findings of the study provided support for existing therapies for Bipolar Disorder; particularly Cognitive-Behavioural Therapy (CBT) and Interpersonal & Social Rhythm Therapy (IPSRT).

Background: Exercise is recommended as a non-pharmacological intervention for individuals with a bipolar disorder diagnosis (BDD). Although physical activity can be beneficial for reducing depressive symptoms, there is preliminary evidence that high-intensity exercise can exacerbate (hypo)mania-related symptoms. Risks associated with other forms of exercise remain unknown. Method: To investigate the potential risks and benefits of low-intensity exercise, non-clinical participants were asked to either copy repetitive movements (n = 20), copy variable movements (n = 20) or watch variable movements (n = 21), following approach motivation induction. Hypomania-like symptoms, positive affect and approach motivation were measured pre-, during and post-task. Trait behavioural activation system (BAS) sensitivity was measured as a moderating factor. Results: There were no group differences in symptom change over time. BAS sensitivity did not moderate this relationship. Limitations: A predominantly student population with low average trait BAS sensitivity was studied. The reliability and validity of the approach motivation induction, mania measure and physical activity task are uncertain. Conclusions: It is unclear whether different types of low-intensity exercise are of risk or benefit for individuals prone to (hypo)mania. This area requires further investigation.