L’être filial vit l’aban/don, bloqué dans l’avoir qui fixe le Moi, et l’échange malmène la Différence de génération et de sexe. La menace pèse sur la filiation en hyper/modernité, et la cruauté pulsionnelle d’appropriation dé/filialise le nom propre. L’infans est paradoxal et appelle la culture comme nature, il affronte la violence de celui qui donne sous couvert de gratuité, par l’acte de nomination. Dans la chose donnée, Mauss dégage un tiers, un autre, et Derrida déconstruit ce qui assimile le don à l’échange. Le don est engagement responsable et non pas sacrifice ni oblation douteuse, reçu, approuvé du legs des générations précédentes, et transmis par une mémoire trans/générationnelle. Lacan sépare le sujet du leurre du Moi, et valorise l’imaginaire retrouvé dans le rêve, reflet de ce que le sujet aurait accumulé d’angoisses et d’espérances, déguisées personnages et objets d’amour ou de haine auxquels les affects s’attachent. Ils font son symptôme, jouissance et symbole. La fiction, vérité du sujet-en-dette, identité mouvante, n’est pas reconnue tant qu’il vit le drame du narcissisme. Interpréter ce qui m’arrive, ouvre à la parole, à l’amour dans la défaite du désir et dans la distance, quand la vérité d’un par/don, redoublement du don premier, sur/vient. Le sujet retrouve le style qui préserve la promesse, qui seule, attire. Le Négatif (l’excès, la sur/prise, la mort d’autrui, l’Absent) fonde-t-il une anthropologie du don ? Le traduire en récit, est Vie : le symptôme, chair du sujet, répond à la Voix qui résonne dans le temps de l’histoire et qui le convoque : « Me voici ». / The filial being is captured by the ego’s possessiveness and left to its own devices. The Difference in generation and sex is exposed to exchange. In hyper-modern times, filiation is threatened and the drive of appropriation dis/owns the proper noun. The infans is paradoxical and naturally turns to culture for help. He faces the violence of those who donate, under cover of gratuitousness, via the act of naming. Mauss speaks of “another other” involved in giving and Derrida deconstructs the notion that assimilates donation to exchange. Giving is a responsible commitment. It is neither a sacrifice nor a suspicious oblation, but that which is received and approved from the legacy of former generations, and transmitted by Memory across the generations. Lacan separates the subject from the deceptive ego and enhances the value of dreams, reflecting accumulated fears and hopes in the guise of characters, objects of love or hate, to which the subject is attached. They are his symptom, jouissance and symbol. Fiction, the truth of the in/debted subject, an identity that is far from static, is unrecognized as long as he is trapped by narcissism. Interpreting what befalls us opens us up to the word, to love, as desire fails and distance sets in. Then and only then, for/giving, a new form of the first gift, a/rises unexpectedly, and the subject can find the style that preserves the promise which, alone, attracts. Does the Negative (excess, surprise, the other’s death, the Absent) set the cornerstone of an anthropology of giving? Trans/lating, or re/telling is Life. The Voice echoing in the temporality of history, calls the symptom, or the flesh of the subject, and it answers: “Here I am.”

Os acontecimentos que perturbam a relação da criança com a escrita não estão exclusivamente circunscritos pelos processos linguísticos, cognitivos e pedagógicos implicados na aquisição. Esta pesquisa pretendeu problematizar as concepções pretensamente científicas que enquadram os problemas na escrita das crianças como manifestações de dislexia. A clínica psicanalítica dá o testemunho de que há uma articulação entre este fenômeno e o sujeito que se institui na escrita. Este trabalho fez um caminho pela psicanálise de orientação lacaniana, através de sua teoria e de sua clínica, para discutir qual é o estatuto deste fenômeno que se dá a ver na escrita da criança. A idéia de sujeito que permite esta leitura não é a de sujeito epistêmico, aquele que conhece. Será aquela formulada pela psicanálise: o sujeito é entendido como resposta do real, não é mais produto exclusivo do funcionamento simbólico, é assim que o sujeito efeito (e não causa) do jogo significante, e situado fora da cadeia que sustenta o funcionamento simbólico- foi considerado nessa pesquisa. Estudou-se ainda as construções conceituais de sintoma e escrita na psicanálise. Este caminho apresentou a articulação do gozo na produção de escrita e foi preciso explicar as relações entre significante e letra, noções em psicanálise que não se confundem com a letra alfabética, o caractere, nem com o escrever referido a produção de texto, mas que exatamente por não se confundirem, são importantes para que se decida um modo de abordagem da escrita que inclua o sujeito como elemento da discussão. Se o desligamento do significante mostra o gozo na escrita, os fenômenos clínicos ali presentes são tecidos também como dinâmica gozosa, e portanto, em relação à economia de gozo do falasser. Para abordar a escrita da criança em tempos de aquisição é preciso ter clara a idéia de que esta não é representação da fala, mas que, entre elas, a articulação é moebiana. Há gozo na escrita, o que o gozo aí engendra e também o que o engendra aí a clínica vai responder. Será preciso dar tratamento ao que resta. É nesse sentido que os impasses aos quais um sujeito se submete e que perturbam sua escrita são matéria para o psicanalista. / The events that disturb the relationship of a child with writing are not exclusively limited to the linguistic, cognitive and pedagogical processes implied in the acquisition of this skill. This study aimed at problematizing the supposedly scientific concepts that frame the problems of children´s writing, such as dyslexia. Clinical psychoanalytical data show that there is an articulation between this phenomenon and the subject that is being written about. This study made its way using Lacanian-oriented psychoanalysis, through its theory and its clinic, to discuss the statute of this phenomenon that can be seen in the writing of a child. The idea of subject that permits this reading is not that of an epistemological subject, the one that knows. It is the one formulated by psychoanalysis: the subject as an answer of the real, it is no longer the exclusive product of symbolic functioning, this is how the subject - effect (and not cause) of the meaningful game, and situated outside the chain that sustains the symbolic functioning was considered in this study. Also studied were the conceptual constructions of symptom and writing in psychoanalysis. This path presented the articulation of satisfaction from the production of writing and it was necessary to explain the relationship between meaning and letter, notions that in psychoanalysis are not to be confused with the letter of the alphabet, the character, nor even with the writing referring to the production of the text, but which precisely because they are not to be confused, are important to deciding on the approach to be used in writing, which includes the subject as an element of the discussion. If the detachment of meaning shows the jouissance in writing, the clinical phenomena that are present are also woven as the dynamic of jouissance and, therefore, in relation to the frugality of jouissance of the falasser. To broach the writing of the child in times of acquisition it is necessary to clearly understand that this is not a representation of speech, but rather that between them, the articulation is moebian. There is jouissance in writing, what the satisfaction engenders there, and also what engenders it there will be answered by the clinic. It will be necessary to treat what remains. It is in this sense that the impasses to which a person submits himself and which disturb his writing are material for the psychoanalyst.

Increasing symptom awareness, encouraging help-seeking, and facilitating timely referral are key for improving cancer outcomes, particularly for cancers such as oesophageal and gastric (stomach), where five-year survival is less than 20%. In this research, I used multiple methods to explore factors that influence timely diagnosis of these cancers from a patient's perspective, with a particular focus on health literacy (accessing, understanding and using health information, and navigating healthcare systems). I started by exploring current knowledge in this field before conducting a systematic review investigating health literacy in the timely diagnosis of symptomatic cancer. Literature was searched from January 1990-May 2017 using six bibliographic databases. I screened 2304 titles/abstracts, assessed 26 full-text papers and included three, although they were methodologically weak, therefore limiting the conclusions. To examine pathways to diagnosis for oesophageal and gastric cancer, I conducted a questionnaire study of newly diagnosed patients across two hospitals in the East and North East of England. 127 participants were recruited (39.6% recruitment rate), aged 44-96 (median 71); 102 male (80%). Most had oesophageal cancer (n=102, 80%); 64 (50%) of the total cohort were late-stage at diagnosis. Common pre-diagnostic symptoms varied between cancers (oesophageal: difficulty swallowing (n=66, 65%), painful swallowing (n=55, 54%); gastric: fatigue/tiredness (n=20, 80%), weight loss (n=13, 52%)). The questionnaire included two domains (engagement, understanding) of the Health Literacy Questionnaire with participants demonstrating high health literacy (mean 4.18 and 4.28, score 1-5). The median time from noticing the trigger symptom (prompting help-seeking) to diagnosis was 81 days (IQR 45-137.5, n=107). Twenty-six participants were purposively sampled, from questionnaire respondents, for face-to-face interviews (aged 55-88, 18 male, 15 with oesophageal cancer). I undertook thematic analysis to explore participant accounts of their pathways to diagnosis, identifying that the symptom nature was important for appraisal, while health literacy ability influenced the health system interval. Descriptions of 'heartburn', 'reflux' and 'indigestion' differed between participants, suggesting these terms may introduce uncertainty in relation to symptom experience. This is the first study to explore the role of health literacy in the timely diagnosis of symptomatic cancer, and pathways to diagnosis for oesophageal and gastric cancers, from a patient's perspective. Findings provide important insights for the development of targeted awareness campaigns and strategies enhancing GP symptom exploration.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-11-30T11:23:28Z No. of bitstreams: 1 Heloisa Cardoso da Silva_.pdf: 8623559 bytes, checksum: 6749e453879e4f8e25a55c01c95c71e3 (MD5) / Made available in DSpace on 2015-11-30T11:23:28Z (GMT). No. of bitstreams: 1 Heloisa Cardoso da Silva_.pdf: 8623559 bytes, checksum: 6749e453879e4f8e25a55c01c95c71e3 (MD5) Previous issue date: 2014-08-21 / Nenhuma / Esta dissertação de mestrado trata dos sintomas psicofuncionais em bebês de mães com indicadores de depressão e tem a psicanálise como referencial teórico. Assim, ela é composta por dois artigos, um teórico e um empírico. No artigo teórico, intitulado "Depressão e Maternidade à Luz da Psicanálise: Uma Revisão Sistemática da Literatura", realizou-se um levantamento da produção científica nacional sobre depressão e maternidade, com embasamento psicanalítico, no período de janeiro de 2003 a janeiro de 2014. Os resultados evidenciaram a escassez de estudos sobre depressão materna e sintomas precoces em bebês, justificando a pesquisa apresentada no artigo empírico. No artigo empírico, intitulado “Sintomas Psicofuncionais e Depressão Materna: Um Estudo Qualitativo”, realizou-se um estudo de casos múltiplos, com o objetivo de compreender a manifestação de sintomas psicofuncionais em bebês com seis a 12 meses, cujas mães apresentassem indicadores de depressão materna. Participaram do estudo três duplas mãe-bebê, e os achados apontaram que, nesse contexto, as mães encontram dificuldades no exercício da maternidade e nas tarefas que ela exige, levando os bebês a se defenderem precocemente, expressando seu sofrimento através do sintoma. Portanto, espera-se que este trabalho contribua para a compreensão e o desenvolvimento científico na área estudada, fomentando futuras pesquisas e subsidiando a construção de estratégias preventivas e promotoras de saúde junto a mães e bebês. / This dissertation deals with psychofunctional symptoms in babies of mothers with depression indicators, and has psychoanalysis as theoretical framework. Thus, it’s composed of two articles, a theoretical and an empirical. In the theoretical article, entitled "Depression and Motherhood Based on Psychoanalysis: A Systematic Review of the Literature", a survey of national scientific production on depression and motherhood was carried out, with psychoanalytic framework, in the period from January 2003 to January 2014. The results showed the shortage of studies on maternal depression and early symptoms in babies, justifying the research presented in the empirical article. In empirical article, entitled "Psychofunctional Symptoms and Maternal Depression: A Qualitative Study", it was performed a study of multiple cases, with the objective of comprehending the manifestation of psychofunctional symptoms in infants between six and 12 months, whose mothers present maternal depression indicators. Participated in this study three mother-infant pairs, and the finding showed that, in this context, mothers encounter difficulties in the exercise of motherhood and the tasks that it requires, leading babies to defend themselves precociously, expressing their suffering through the symptoms. Therefore, it's hoped that this work will contribute to the understanding and scientific development in the studied area, fostering further researches and subsidizing the construction of preventive and health-promoting strategies together with mothers and babies.

Made available in DSpace on 2016-04-27T18:12:19Z (GMT). No. of bitstreams: 1 TATIANA DE ABREU CASTRO GONCALVES.pdf: 377802 bytes, checksum: 8ec3e475c53649916a77f1cab70a68fa (MD5) Previous issue date: 2007-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: In the field of Speech Therapy, there are few epidemiologic researches, especially those which investigate issues related to the singing voice. Aim: This study related a choral group s vocal symptoms and their probable causes, according to gender and vocal classification. Methods: The subjects of this study were 143 choral singers (58,7% female and 41,3% male) from a University in the City of São Paulo. Subjects age varied between 18 and 45 years, and subjects had different vocal classifications. The participants answered a questionnaire that was adapted from the one proposed by GUERRA (2005), which included, questions which enabled the characterization of the group, questions that evaluated the presence of vocal symptoms, and their likely causes, in the singers opinions. The data was analyzed considering numeric values and percentage, of the following: most frequent vocal symptoms and related causes according to gender (male x female); most frequent symptoms and related causes in sopranos and altos; most frequent symptoms and related causes in tenors and bases; overall symptoms and their related causes; and most frequent symptoms in spoken voice, singing voice, and both. In order to perform the statistical analysis, the SPSS (Statistical Package for Social Sciences) version 13.0 was used, and the level of significance was established at 5% (0.050). In addition, the Mann- Whitney; Test was used to analyze possible differences between gender and vocal classification, and Spearman s correlation test was used to verify the relationship between vocal symptoms and their possible causes. Results: From the subjects amongst the male gender, 25% did not mention any of the listed symptoms, as well as 22.9% of the female subjects did not mention any of the above mentioned symptoms. The symptoms that were most mentioned were phlegm/secretion, (44,6%, both for male and female), followed by hoarseness (22,9% for female and 26,8% for male) and dry cough (20,5% for female and 14.3% for male). When comparing gender, there was significant difference (p=0,015) in favor of male subjects, with regards to weak voice. With regards to vocal classification, dry throat and dry mouth, differentiate altos and sopranos. Amongst the causes, that were most mentioned by the group, as those which could possibly explain the occurrence of the referred symptoms, were: flu (50,8%), intense use of the singing voice (42,4%) and allergies (41,6%). Conclusions: The vocal symptoms which were most frequently mentioned were phlegm/secretion, hoarseness and wet cough. Hoarseness was the symptom most mentioned in spoken voice, while phlegm/secretion was the most common in singing voice, or both. When corelating with gender, the symptom of weak voice was present in favor of male subjects, and when co-relating vocal classification, the symptoms of dry throat and dry mouth were most common amongst the altos. The subjects showed previous knowledge when relating symptoms to possible causes. Amongst these, the most commonly mentioned were flu, intensive voice usage and allergy. Intense singing and spoken voice usage, respiratory infections, allergies and digestive issues were specifically related to hoarseness / Introdução: Na Fonoaudiologia, são poucas as pesquisas epidemiológicas, principalmente as que investigam as questões com a voz cantada. Objetivo: Este estudo correlacionou os sintomas vocais e suas possíveis causas, de acordo com o sexo e a classificação vocal, em um grupo de coralistas da Cidade de São Paulo. Método: Participaram 143 coralistas (58,7% mulheres e 41,3% homens) de uma universidade da Cidade de São Paulo com idade entre 18 e 45 anos e de classificação vocal diversa. Os participantes responderam a um questionário adaptado da proposta de GUERRA (2005), que incluiu, além de questões de caracterização do grupo, as que tinham como proposta levantar a presença de sintomas vocais e as possíveis causas na opinião dos coralistas. Os dados foram analisados considerando o levantamento numérico e percentual, conforme a ocorrência de: sintomas e causas que mais aparecem segundo o sexo (homens x mulheres); sintomas e causas mais freqüentes em sopranos e contraltos; sintomas e causas mais freqüentes em tenores e baixos; sintomas em geral e causas; e sintomas vocais mais freqüentes na voz falada, cantada e em ambas. Para a análise estatística foi utilizado o programa SPSS (Statistical Package for Social Sciences) versão 13.0. Adotou-se o nível de significância de 5% (0,050), para a aplicação dos testes estatísticos deste estudo. Para a análise das possíveis diferenças entre o sexo e classificação vocal foi utilizado o Teste de Mann-Whitney; e a análise de correlação de Spearman foi utilizada com o intuito de verificar o nível de relacionamento entre sintomas vocais e possíveis causas. Resultados: Dentre os homens, 25% referiram não sentir nenhum dos sintomas mencionados, enquanto que 22,9% das mulheres não mencionaram nenhum deles. Os sintomas mais referidos foram pigarro/secreção (44,6%, tanto para mulheres quanto para homens), seguido de rouquidão (22,9% para as mulheres e 26,8% para os homens) e tosse seca (20,5% para o sexo feminino e 14,3% para o sexo masculino). Na comparação referente ao sexo, houve diferença significante (p=0,015) a favor dos homens no que se refere à presença da voz fraca. Na comparação referente à classificação vocal, garganta seca e boca seca, diferenciaram-se contraltos de sopranos. Dentre as causas, as mais mencionadas pelo grupo, como possíveis para explicar os sintomas referidos, foram: gripe (50,8%), uso intenso de voz cantada (42,4%) e quadro de alergia (41,6%). Conclusão: Os sintomas vocais mais mencionados foram pigarro/secreção, rouquidão e tosse com secreção. O sintoma de rouquidão foi o mais mencionado como presente na voz falada, enquanto que pigarro/secreção, na voz cantada ou em ambas as situações. Na correlação com a variável sexo, o sintoma de voz fraca esteve presente a favor dos homens; e na correlação com a classificação vocal, os sintomas de garganta e boca secas estiveram mais presentes entre as contraltos. Os participantes demonstraram conhecimento ao relacionar os sintomas assinalados e suas possíveis causas. Dentre estas, as mais citadas foram gripe, uso intensivo da voz e alergia. Especificamente relacionadas ao sintoma de rouquidão foram citadas as causas de uso intenso da voz (falada e cantada), infecção respiratória, alergia e problemas digestivos

L'objectif principal de ma thèse est l’exploration de l’impact clinique d’une perturbation du système circadien chez les patients cancéreux. J’ai démontré une relation robuste entre le rythme d'activité-repos et survie, symptômes et qualité de vie. J’ai mis en évidence et caractérisé la dynamique du système circadien des patients sous chimiothérapie. J’ai montré qu’une bonne tolérance conditionnait l’efficacité de la chronothérapie. Ces résultats me conduisent à proposer de cibler le système circadien pour améliorer les symptômes des patients et l’efficacité des traitements anticancéreux. / The circadian timing system controls several temporal aspects of physiology and behaviour in laboratory animals and humans. The disruption of the circadian timing system results in the occurrence of alterations at various levels of organisation: central coordination, circadian physiology, molecular clocks and signalling pathways. In particular, a circadian disruption induced by long-haul flights across several time-zones or by shift work is associated with the appearance of systemic symptoms, such as fatigue, mood disorders and appetite loss. These symptoms, related to circadian disruption, are also frequently found in cancer patients, as a consequence of their neoplastic disease or its treatment. My PhD work is part of the research regarding the role of the circadian timing system in the development of the symptoms associated with cancer and its treatment, in tumor progression and in patients’ survival. Its perspective is to identify novel therapeutic options. In particular, the general objectives of this thesis consist in the definition of the relationships between symptoms and circadian function of patients before and during chemotherapy, and in the quantification of the clinical impact of circadian disruption on quality of life and survival. I have focused in particular on patients with metastatic colorectal cancer, third cancer for incidence and mortality. These studies confirm the role of the circadian timing system in the occurrence of systemic symptoms in cancer patients, without treatment or during it. This study is currently ongoing in collaboration with the NIH in the United States. In conclusion, this work leads me to propose an innovative therapeutic approach aimed at shielding and/or restoring the integrity of the circadian timing system. This novel strategy should improve the therapeutic index of chemotherapy, by increasing its efficacy and decreasing its toxicity, still reducing the occurrence of symptoms, preserving the quality of life and prolonging the survival of cancer patients. The implementation of this strategy relies on the non-invasive monitoring of biomarkers of the circadian timing system and on the personalization of chronotherapy delivery.

Background. Lung cancer is the leading cause of cancer deaths worldwide. Low survival rates have been attributed to delays to diagnosis, and some patients report having symptoms for several months before presenting to health services. Strategies are needed to encourage timely help-seeking. The Web is increasingly used as a health information source. Aim. The aim of this thesis is to explore whether the Web plays a role in help-seeking behaviour of people with lung cancer prior to diagnosis, and how the Web can be utilised to encourage earlier presentation to health services for symptomatic people. Systematic review. To begin, I carried out a systematic review of the literature (N=34), which highlighted a scarcity of research on Web use for symptom appraisal among cancer populations. Mixed-methods study. I conducted a survey with recently diagnosed (6 months or less) lung cancer patients (N=113). Based on survey responses, I purposively selected a sub-sample of patients and their family/friends ("proxies") for semi-structured interviews (N=33). In the survey, 20.4% of participants reported they or proxies had researched their condition online before the diagnosis. Interview results suggest perceived impacts of online information on symptom appraisal, forming the decision to seek help, and on interactions with healthcare professionals. Intervention development and evaluation. Based on my findings, I developed a Web-based intervention. The intervention provides tailored information about lung cancer, and uses components based on the Theory of Planned Behaviour ("TPB-components") to encourage earlier help-seeking. This intervention was tested in an online feasibility study (N=130), and subsequently in an online randomised controlled trial (N=212) with a factorial design to test main and interaction effects of tailoring and TPB-components. The feasibility study and first trial helped identify methodological issues which were addressed in a second trial with a mixed factorial design. This trial (N=253) indicated that the self-reported likelihood of visiting a doctor increased significantly by 11.8% from before to after viewing study information (p < 0.001), but no effects of tailoring or TPB-components were found. When examining only those aged ≥50 years, who are at highest risk of lung cancer, those receiving tailored information reported an increase of 13.2% in likelihood of seeking help, compared to 3.2% in the untailored group (p=0.01). Participants aged 50+ receiving the TPB-component reported a larger increase (13.8%) than those who did not receive the TPB-component (5.2%), but this did not meet the significance criterion (p=0.054). Conclusions. According to patients' perceptions, the Web can impact on processes in the appraisal, help-seeking and diagnostic interval leading up to diagnosis. Presentation of information about symptoms and risk factors online can produce significant effects on self-reported likelihood of seeking help. These findings indicate that there is potential for the Web to be utlised in the endeavour to educate the public about symptoms and to promote earlier presentation to health services, but due to small effects and differential dropout in this study, further research is required.

nÃo hà / Este trabalho dissertativo se insere no campo da formaÃÃo do analista, a qual, con-forme convencionado, fundamenta-se em trÃs condiÃÃes: anÃlise pessoal, estudo da teoria e supervisÃo ou controle clÃnico. Contudo, essas trÃs condiÃÃes esbarram jus-tamente no que Freud asseverou acerca das trÃs profissÃes impossÃveis â analisar, educar e governar. De modo efetivo, hà demanda por formaÃÃo, e essa, grosso mo-do, vem se realizando a partir da lÃgica de uma profissÃo sob os auspÃcios de uma instituiÃÃo psicanalÃtica. A histÃria do movimento psicanalÃtico, inicialmente com Freud e depois com Lacan, reflete as lutas em torno da concepÃÃo do ato de institu-ir, revelando as contradiÃÃes emanadas do processo de formaÃÃo do profissional analista. Trata-se de pesquisa imanente aos textos de Freud e Lacan, portanto uma pesquisa bibliogrÃfica, cotejados com escritos de outros autores que trataram sobre os conflitos que cercam a questÃo da formaÃÃo. O trajeto tem como lastro as elabo-raÃÃes de Lacan sobre o conceito de Escola e a teoria dos discursos, a partir da li-gaÃÃo que ele estabeleceu entre o discurso do analista, do universitÃrio e do mestre aos trÃs impossÃveis de Freud: analisar, educar e governar. Esse conceito foi desen-volvido para contemplar os diferentes laÃos sociais na fala do sujeito no dispositivo analÃtico e transposto para o campo da formaÃÃo psicanalÃtica, considerando que essa tem uma anÃlise como conditio sine qua non. Lacan liga a noÃÃo de sintoma em Freud a Marx e concebe que o sintoma à efeito do real. AlÃm do sintoma, cate-gorias como tempo e dinheiro sÃo somadas à discussÃo, pois sÃo condiÃÃes para uma anÃlise. A categoria dinheiro à tratada a partir de Freud, com aportes de Marx e Simmel. Por um lado, a relaÃÃo sintoma-saber-verdade transparece, sob o discurso do analista, a partir da extraÃÃo de gozo no real, dimensÃo alinhada ao impossÃvel, seguindo Lacan; por outro lado, a psicanÃlise padece do sintoma na formaÃÃo do analista como uma profissÃo, pois se trata de um laÃo social impossÃvel de ser geri-do sob o discurso do capitalista, porquanto esse subsume o sujeito no objeto, como objeto de consumo. Essa incompatibilidade lÃgica transparece na prÃtica como um permanente impasse: esse serà o ponto essencial a ser tratado ao longo da presen-te pesquisa.

Made available in DSpace on 2016-04-28T20:38:34Z (GMT). No. of bitstreams: 1 Francisco Gomes de Almeida Garzon.pdf: 698751 bytes, checksum: dc24488fdb66c5ba72009523ae523a5e (MD5) Previous issue date: 2012-11-09 / This master s degree dissertation refers to a possibility of human subjectivity constitution through violence, excessive pathos. According to the position of Fundamental Psychopathology, pathos constitutes the human, in the measure that psychism is a reply to the incidence of pathos. Research was conducted whereof the clipping of a clinical case, considering the possibility of the violence to constitute symptomatic expression of pathos, either for the repetition of the pathogenic scene or through the way of the symptom. Facing the unbearable character of pathos excessive by definition - the capacity of complex symbolic creation, to suture the mark of the trauma, could remain disengaged. The present research is destined to investigate the possibility of considering the repetition of the violence suffered for the subject as being a symptom of this subject, as well as investigating ahead on the nature of this symptom towards the given nature of pathos, excessively terrifying. The clinical case that motivates the present research offers subsidies to think the question. We cogitate if the patient, in the observed case, offers himself to violence as in a species of sacrifice, writing repeatedly in his body a pledge, order of recognition, petition and repetition that informs and certifies the impossibility to deal with the uncommon violence of pathos that reached him. His acts, that victimize himself in repeated situations of violence practiced by the other (Other), would configure the impossibility towards symptom? / A presente Dissertação de Mestrado diz respeito a uma possibilidade de constituição do sujeito diante da violência, pathos excessivo. Segundo a posição da Psicopatologia Fundamental, pathos constitui o sujeito, na medida em que o psiquismo é uma resposta à incidência do pathos. Pretendemos investigar, a partir do recorte de um caso clínico, a possibilidade da violência constituir expressão sintomática de pathos, seja pela repetição da cena patogênica ou pela via do sintoma. Diante do caráter inefável de pathos excessivo - a capacidade de simbolização complexa, a suturar a marca do trauma, poderia restar comprometida. A presente pesquisa destina-se a investigar a possibilidade de se considerar a repetição da violência sofrida pelo sujeito como sendo um sintoma deste sujeito, assim como investigar sobre a natureza deste sintoma diante da obviedade de pathos, excessivamente aterrador. O caso clínico que motiva a presente pesquisa oferece subsídios para pensarmos a questão. Cogitamos se o paciente, no caso observado, se oferece à violência como em uma espécie de sacrifício, escrevendo repetidamente em seu corpo um manifesto, pedido de reconhecimento, petição e repetição que informa e atesta sua impossibilidade de lidar com a violência descomunal do pathos que o atingiu. Seus atos, que o vitimam em repetidas situações de violência praticada pelo outro (Outro), configurariam o impossível do sintoma diante do excesso do excesso (excesso de pathos), do irrepresentável?

Background and Objectives: Alterations in the habitual sleep/wake patterns of women with breast cancer and their informal caregivers may be concurrently exacerbated and co-vary during the patient’s treatment. The current study set out to longitudinally ex-plore sleep-wake patterns of patient-caregiver dyads in the context of adjuvant chemotherapy (CTh) for breast cancer. Taking into consideration the complexity of mechanisms interfering with a care dyad’s sleep, diverse sleep-impairing factors were also investigated. Design and Methods: Descriptive, observational, repeated-measures dyadic study. Forty eight newly diagnosed women receiving outpatient adjuvant CTh for early stage breast cancer (stage I-IIIA) and their nominated primary informal caregiver completed self-reported sleep measures at pre-treatment (week prior to CTh), post-CTh cycle 1, post-CThC4, and approximately 30 days after the end of CTh (total of =6 cycles received). Additional data on the dyads’ sleep hygiene practices (SH), patient physical burden, caregiving burden (CRACB), psychological burden (PSYCH), nocturnal sleep disturbances (SDSTRB), and maladaptive coping strategies were collected at each assessment point. Results: Prior to CTh, 65% of dyads consisted of at least one poor sleeper, a rate further increasing to approximately 88% at CThC4. Multivariate hierarchical linear modelling revealed curvilinear trajectories for most dyads’ sleep/wake parameters that nevertheless reached significance (p<.05) for patients only. In both groups, sleep/wake impairment reached its peak at mid-treatment (CThC4); yet, patients consistently reported significantly more sleep problems than their carers. Partial convergence also emerged as suggested by positive correlations and no between-groups differences in daily disturbance, daytime napping duration, total sleep time, and overall sleep/wake impairment at pre-treatment. At CThC4, rates of change in sleep latency and daytime napping duration were also similar. In exploratory analyses, increased CRACB, poor SH, and SDSTRB consistently predicted poorer outcomes in the dyad members’ own sleep-wake patterns. Cross-partner effects most frequently emerged with regard to the dyads’ PSYCH, as well as for CRACB. Among the most interesting findings, increased patient PSYCH adversely affected caregiver perceived sleep quality and daytime napping. Reversely, increased CRACB was related to worse patient sleep quality, reduced sleep time, and difficulty to fall asleep. Some links might be suggested for own poor sleep hygiene and worse partner outcomes on daytime functioning, sleep efficiency, or wake after sleep onset. Conclusions and Future Implications: This is one of the first studies to show that a dyadic approach in the assessment of sleep/wake patterns in patients with breast cancer and their informal carers is a promising method to enhance exploration of potentially concurrent sleep/wake-impairment and associations with sleep-impairing factors that may co-vary in dyad members. Replication of the current findings in future dyadic sleep research is warranted. Meanwhile, clinicians will need to engage in concurrent systematic and ongoing sleep assessments that synthesise and contrast data to establish a care dyad’s level of sleep quality.