113 research outputs found
Glucagon-Like Peptide-1 Agonists Protect Pancreatic ÎČ-Cells From Lipotoxic Endoplasmic Reticulum Stress Through Upregulation of BiP and JunB
Chronic exposure of pancreatic beta-cells to saturated free fatty acids (FFAs) causes endoplasmic reticulum (ER) stress and apoptosis and may contribute to beta-cell loss in type 2 diabetes. Here, we evaluated the molecular mechanisms involved in the protection of beta-cells from lipotoxic ER stress by glucagon-like peptide (GLP)-1 agonists utilized in the treatment of type 2 diabetes.info:eu-repo/semantics/publishe
Countertransference in the initial care of victims of sexual and urban violence : a qualitative-quantitative research
Objetivo: Avaliar a contratransferĂȘncia dos terapeutas durante o atendimento inicial de pacientes mulheres vĂtimas de violĂȘncia sexual e urbana, investigando a influĂȘncia do gĂȘnero do terapeuta e da natureza e momento do trauma. MĂ©todo: A amostra foi composta por 36 relatos redigidos por mĂ©dicos residentes de psiquiatria do Hospital de ClĂnicas de Porto Alegre, oriundos do atendimento de 36 pacientes. Este estudo utilizou mĂ©todos qualitativos e quantitativos para a anĂĄlise dos seus dados. Os relatos foram classificados em seis grupos, conforme o gĂȘnero do terapeuta e a natureza do trauma. Foi realizada a anĂĄlise de conteĂșdo dos relatos. Associou-se uma anĂĄlise estatĂstica dos dados. Resultados: Houve predomĂnio de sentimentos de aproximação nos terapeutas de ambos os sexos no atendimento de vĂtimas de violĂȘncia sexual. Entre terapeutas mulheres, a natureza do trauma (sexual ou urbano) nĂŁo influenciou os padrĂ”es contratransferenciais (p = 0,7). Entre os terapeutas homens, ao contrĂĄrio, a natureza do trauma influenciou de forma significativa (p = 0,044) o padrĂŁo contratransferencial, havendo um nĂșmero elevado de sentimentos de distanciamento nos relatos de atendimentos de vĂtimas de violĂȘncia urbana. ConclusĂ”es: Houve um predomĂnio de sentimentos de aproximação dos terapeutas de ambos os sexos no atendimento inicial de pacientes vĂtimas de violĂȘncia sexual. Foi observado um predomĂnio de sentimentos de distanciamento nos terapeutas homens que atenderam vĂtimas de violĂȘncia urbana. Mais estudos sĂŁo necessĂĄrios para uma melhor compreensĂŁo das relaçÔes terapĂȘuticas nos atendimentos de vĂtimas de trauma psĂquico.OBJECTIVE: To assess therapists' countertransference during initial care of female victims of sexual and urban violence with the aim of investigating influence of therapist's gender, type and moment of trauma. METHODS: The sample comprised 36 reports written by psychiatry residents at Hospital de ClĂnicas de Porto Alegre based on the care provided to 36 patients. This study used qualitative and quantitative methods of data analysis. Reports were classified into six groups according to therapist's gender and type of trauma. A content analysis and a statistical analysis of the data were performed. RESULTS: Therapists of both genders presented a prevalence of feelings of closeness when providing care to victims of sexual violence. Among female therapists, type of trauma (sexual or urban) did not have an influence on countertransference patterns (p = 0,7). On the other hand, among male therapists, type of trauma had a significant influence (p = 0,044) on countertransference, with a high rate of feelings of distance in reports of care provided to victims of urban violence. CONCLUSIONS: Therapists of both genders presented a prevalence of feelings of closeness when providing initial care to patients victims of sexual violence. Male therapists who provided care to victims of urban violence presented a prevalence of feelings of distance. Further studies are needed for a better understanding of therapeutic relationships in the care of victims of psychic trauma
O ensino da psicoterapia de orientação analĂtica no AmbulatĂłrio Assistencial/PĂșblico de Psiquiatria do Hospital de ClĂnicas de Porto Alegre
O artigo descreve o ensino da psicoterapia de orientação analĂtica (POA) na residĂȘncia em psiquiatria do Hospital de ClĂnicas de Porto Alegre (HCPA). Inicialmente, Ă© realizada uma revisĂŁo da literatura sobre a importĂąncia do ensino da POA nos programas de residĂȘncia mĂ©dica de psiquiatria, seguida do relato da histĂłria da entrada da psicanĂĄlise no Rio Grande do Sul e da evolução do ensino da POA no estado. As questĂ”es metodolĂłgicas e Ă©ticas do ensino da POA na residĂȘncia de psiquiatria do HCPA sĂŁo discutidas, e o atual programa teĂłrico e prĂĄtico Ă© apresentado. Por fim, a possibilidade da integração da pesquisa com a assistĂȘncia e ensino Ă© discutida, e exemplos prĂĄticos desta integração sĂŁo apresentados, juntamente com o protocolo de avaliação e planejamento terapĂȘutico do programa de POA do HCPA
The role of the environment in the spatial dynamics of an extensive hybrid zone between two neotropical cats
Identifying factors that create and maintain a hybrid zone is of great interest to ecology, evolution and, more recently, conservation biology. Here, we investigated the role of environmental features in shaping the spatial dynamics of a hybrid zone between the southern tigrina, Leopardus guttulus, and Geoffroy's cat, L. geoffroyi, testing for exogenous selection as the main force acting on its maintenance. These Neotropical felid species are mainly allopatric, with a restricted area of sympatry in the ecotone between the Atlantic Forest and Pampa biomes. As both biomes have experienced high rates of anthropogenic habitat alteration, we also analysed the influence of habitat conversion on the hybrid zone structure. To do this, we used 13 microsatellite loci to identify potential hybrids and generated ecological niche models for them and their parental species. We compared the influence of variables on parental species and hybrid occurrence and calculated the amount of niche overlap among them. Parental species showed different habitat requirements and predicted co-occurrence was restricted to the forest-grassland mosaic of the ecotone. However, hybrids were found beyond this area, mainly in the range of L. geoffroyi. Hybrids demonstrated higher tolerance to habitat alteration than parental types, with a probability of occurrence that was positively related with mosaics of cropland areas and remnants of natural vegetation. These results indicate that exogenous selection alone does not drive the dynamics of the hybrid zone, and that habitat conversion influences its structure, potentially favouring hybrids over parental species.Fil: Sartor, Caroline CharĂŁo. Universidade Federal do Rio Grande do Sul; BrasilFil: Cushman, Samuel Alan. United States Department of Agriculture; Estados UnidosFil: Wan, Ho Yi. Humboldt State University; Estados UnidosFil: Kretschmer, Rafael. Universidade Federal do Rio Grande do Sul; BrasilFil: Pereira, Javier Adolfo. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Bou, Nadia. Ministerio de Educacion y Cultura.; UruguayFil: Cosse, Mariana. Ministerio de Educacion y Cultura.; UruguayFil: GonzĂĄlez, Susana. Ministerio de Educacion y Cultura.; UruguayFil: Eizirik, Eduardo. Pontificia Universidade CatĂłlica do Rio Grande do Sul; BrasilFil: de Freitas, Thales Renato O.. Universidade Federal do Rio Grande do Sul; BrasilFil: Campos Trigo, Tatiane. Universidade Federal do Rio Grande do Sul; Brasi
DNA methylation profiling identifies epigenetic dysregulation in pancreatic islets from type 2 diabetic patients
The first genome-scale DNA methylation study on pancreatic islets from type 2 diabetic patients identifies disease-associated DNA methylation pattern that translate into aberrant gene expression in novel factors relevant for ÎČ-cell function and survival
Cytokines induce endoplasmic reticulum stress in human, rat and mouse beta cells via different mechanisms
A Missense Mutation in PPP1R15B Causes a Syndrome Including Diabetes, Short Stature, and Microcephaly.
Dysregulated endoplasmic reticulum stress and phosphorylation of eukaryotic translation initiation factor 2α (eIF2α) are associated with pancreatic ÎČ-cell failure and diabetes. Here, we report the first homozygous mutation in the PPP1R15B gene (also known as constitutive repressor of eIF2α phosphorylation [CReP]) encoding the regulatory subunit of an eIF2α-specific phosphatase in two siblings affected by a novel syndrome of diabetes of youth with short stature, intellectual disability, and microcephaly. The R658C mutation in PPP1R15B affects a conserved amino acid within the domain important for protein phosphatase 1 (PP1) binding. The R658C mutation decreases PP1 binding and eIF2α dephosphorylation and results in ÎČ-cell apoptosis. Our findings support the concept that dysregulated eIF2α phosphorylation, whether decreased by mutation of the kinase (EIF2AK3) in Wolcott-Rallison syndrome or increased by mutation of the phosphatase (PPP1R15B), is deleterious to ÎČ-cells and other secretory tissues, resulting in diabetes associated with multisystem abnormalities.This work was supported by the European Union 7th Framework Programme (project BetaBat), the Actions de Recherche ConcertĂ©es de la CommunautĂ© Française, and Fonds National de la Recherche Scientifique (FNRS), Belgium, and by grants from the Agence Nationale pour la Recherche (ANR-09-GENO-021), the European Foundation for the Study of Diabetes/JDRF/Novo Nordisk, the Assistance Publique-HĂŽpitaux de Paris Programme Hospitalier de Recherche Clinique (DIAGENE), the GIS Maladies Rares, and the Wellcome Trust (084812/Z/08/Z). A.T.H. is a Wellcome Trust and National Institute for Health Research senior investigator, and D.R. is a Wellcome Trust Principal Research Fellow. B.A. was supported by an European Molecular Biology Organization Short-Term Fellowship and an FNRS-FRIA fellowship. M.I.-E. is a scientific collaborator of the FNRS. M.D. was supported by a doctoral fellowship from the MinistĂšre de lâEducation Nationale, de lâEnseignement SupĂ©rieur et de la Recherche, France.This is the author accepted manuscript. The final version is available from the American Diabetes Association via http://dx.doi.org/10.2337/db15-047
Ubiquitin Fold Modifier 1 (UFM1) and Its Target UFBP1 Protect Pancreatic Beta Cells from ER Stress-Induced Apoptosis
UFM1 is a member of the ubiquitin like protein family. While the enzymatic cascade of UFM1 conjugation has been elucidated in recent years, the biological function remains largely unknown. In this report we demonstrate that the recently identified C20orf116 [1], which we name UFM1-binding protein 1 containing a PCI domain (UFBP1), andCDK5RAP3 interact with UFM1. Components of the UFM1 conjugation pathway (UFM1, UFBP1, UFL1 and CDK5RAP3) are highly expressed in pancreatic islets of Langerhans and some other secretory tissues. Co-localization of UFM1 with UFBP1 in the endoplasmic reticulum (ER)depends on UFBP1. We demonstrate that ER stress, which is common in secretory cells, induces expression of Ufm1, Ufbp1 and Ufl1 in the beta-cell line INS-1E.siRNA-mediated Ufm1 or Ufbp1knockdown enhances apoptosis upon ER stress.Silencing the E3 enzyme UFL1, results in similar outcomes, suggesting that UFM1-UFBP1 conjugation is required to prevent ER stress-induced apoptosis. Together, our data suggest that UFM1-UFBP1participate in preventing ER stress-induced apoptosis in protein secretory cells
Avaliação da contratransferĂȘncia no atendimento inicial de pacientes vĂtimas de trauma psĂquico
O conceito de contratransferĂȘncia foi introduzido por Freud e ampliado por outros autores, sendo compreendido como as reaçÔes emocionais despertadas pelo paciente no terapeuta. Tem papel central na teoria e na tĂ©cnica psicanalĂticas atuais por ser uma importante ferramenta para o entendimento do mundo interno e das comunicaçÔes do paciente, com influĂȘncia no desenvolvimento da relação terapĂȘutica e no desfecho do tratamento. A partir do reconhecimento da importĂąncia da mente do terapeuta e do campo terapĂȘutico, tem sido discutida a associação entre caracterĂsticas da pessoa real do terapeuta e a forma como Ă© estabelecida a relação com o paciente. Do mesmo modo, caracterĂsticas especĂficas dos pacientes, como ter sido vĂtima de trauma psĂquico, sĂŁo consideradas potenciais desencadeadoras de padrĂ”es contratransferenciais similares. A relevĂąncia do estudo dos sentimentos contratransferenciais despertados no atendimento de vĂtimas de trauma psĂquico se justifica pela grande intensidade destes e pelo potencial destas reaçÔes emocionais se tornarem barreiras para o sucesso do tratamento quando nĂŁo compreendidas pelo terapeuta.Avaliar o padrĂŁo de expressĂŁo da contratransferĂȘncia dos terapeutas durante o atendimento inicial de pacientes mulheres vĂtimas de trauma psĂquico e a sua associação com caracterĂsticas dos terapeutas e das pacientes, tais como o momento da consulta, o gĂȘnero do terapeuta, a natureza do trauma (violĂȘncia sexual ou violĂȘncia urbana) e o momento da violĂȘncia sexual na vida das pacientes. TambĂ©m foi investigada a associação entre o padrĂŁo contratransferencial e a presença de sintomas de Transtorno de Estresse PĂłs-TraumĂĄtico e de sintomas depressivos atuais nas pacientes, escores em rastreamento para transtornos de personalidade e em escala de percepção da gravidade da doença nas pacientes e estilo defensivo utilizado pelas mesmas. Os estudos foram realizados no NĂșcleo de Estudos e Tratamento do Trauma PsĂquico (NETTRAUMA), do Hospital de ClĂnicas de Porto Alegre (HCPA), Brasil. Os terapeutas eram mĂ©dicos residentes do segundo ano de Psiquiatria do HCPA. No primeiro estudo, foi conduzidauma avaliação qualitativa, a anĂĄlise de conteĂșdo, associada a uma anĂĄlise estatĂstica, de 36 relatos de sentimentos contratransferenciais despertados no primeiro atendimento de pacientes mulheres, sendo13 vĂtimas de violĂȘncia sexual na infĂąncia, 15 vĂtimas de violĂȘncia sexual atual, e 8 vĂtimas de violĂȘncia urbana. Os relatos foram classificados em 6 grupos, conforme o gĂȘnero do terapeuta e a natureza do trauma. O segundo estudo teve a participação de 26 terapeutas, 11 homens e 15 mulheres. Foram incluĂdas nesta amostra todas as pacientes mulheres vĂtimas de violĂȘncia sexual, tanto na infĂąncia quanto na idade adulta, atendidas no NET-TRAUMA durante dois anos consecutivos, totalizando 40 pacientes. ApĂłs a primeira consulta com a paciente, era solicitado ao terapeuta que preenchesse a Escala para Avaliação da ContratransferĂȘncia (EACT). Neste mesmo momento, era solicitado Ă paciente que preenchesse os instrumentos referentes aos fatores em estudo: a Escala Davidson de Trauma (EDT), a Standardized Assessment of Personality - Abbreviated Scale (SAPAS), o InventĂĄrio de DepressĂŁo de Beck (BDI), e a versĂŁo em portuguĂȘs do Defense Style Questionaire (DSQ-40). A Escala de ImpressĂŁo ClĂnica Global (CGI) era preenchida apĂłs a consulta de triagem. Na anĂĄlise dos relatos redigidos pelos terapeutas, observou-se predomĂnio de sentimentos de aproximação nos terapeutas de ambos os gĂȘneros no atendimento de vĂtimas de violĂȘncia sexual. Entre terapeutas mulheres, a natureza do trauma (sexual ou urbano) nĂŁo influenciou os padrĂ”es contratransferenciais. Entre os terapeutas homens, a natureza do trauma influenciou de forma significativa a contratransferĂȘncia, havendo um nĂșmero elevado de sentimentos de distanciamento nos relatos de atendimentos de vĂtimas de violĂȘncia urbana em relação Ă queles atendimentos a vĂtimas de violĂȘncia sexual na infĂąncia (p=0,02). No segundo estudo, os terapeutas apresentaram, da mesma forma, mais sentimentos de proximidade em relação Ă s pacientes, que foram maiores no meio e no final das consultas (p<0,001), sem influĂȘncia do gĂȘnero do terapeuta. Em uma sub-amostra estratificada para pacientes atendidas por terapeutas mulheres, identificou-se associação significativa entre maiores escores obtidos pelas pacientes na SAPAS e menos sentimentos de proximidade das terapeutas (p=0,038).Estes estudos evidenciaram um predomĂnio de respostas contratransferenciais de proximidade em terapeutas jovens, no inĂcio da vida profissional, ao longo das primeiras consultas compacientes mulheres vĂtimas de violĂȘncia sexual. Destaca-se a importĂąncia da utilização da contratransferĂȘncia para a melhor compreensĂŁo dos pacientes, o que pode trazer benefĂcios ao tratamento e ao prognĂłstico destes, ressaltando-se a necessidade de que investigaçÔes continuadas sobre o tema sigam sendo desenvolvidas.The concept of countertransference was introduced by Freud and expanded by other authors. It is understood as the emotional reactions triggered by the patient in the therapist. It is pivotal in the current psychoanalytic theory and technique since it is an important tool in understanding the patientâs internal world and reportings, influencing the therapeutic relationship and the outcome of the treatment. From the acknowledgement of the importance of the therapistâs mind and the therapeutic field, there has been a growing debate on the association between characteristics of the real person of the therapist and the way that the relationship with the patient is established. Likewise, specific characteristics of the patients, such as having been victim of a psychological trauma, have been considered potential triggers of similar patterns of countertransferential responses. The relevance of studying the countertransferential feelings triggered when seeing victims of psychological trauma is justified by their high intensity and by the possibility of such emotional reactions becoming barriers for a successful treatment when they are not understood by the therapist.To evaluate the therapistsâ countertransference during the first visit of women victims of psychological trauma, and its association with therapistsâ and patientsâ characteristics, such as the moment within the visit, the gender of the therapist, the nature of the trauma (sexual violence or urban violence) and the time when sexual violence occurred in the patientâs life. The association between countertransference pattern and the presence of Post-Traumatic Stress Disorder symptoms and of depressive symptoms in the patients, scores in a screening of personality disorders and in a scale of perception of disease severity in the patients and the defensive style utilized by them were also investigated. The studies were conducted at the Center for the Study and Treatment of Psychological Trauma (NET-TRAUMA), of Hospital de ClĂnicas de Porto Alegre (HCPA), Brazil. The therapists were second-year Psychiatry residents of HCPA. On the first study, a qualitative evaluation, thecontent analysis, was performed, associated to a statistical analysis, of 36 reports of the countertransferential feelings aroused in the first visit of female patients. Thirteen patients were victims of sexual violence during childhood, 15 were victims of current sexual violence, and 8 were victims of urban violence. The reports were categorized into 6 groups according to the gender of the therapist and the nature of the trauma. Twenty-six therapists (11 males and 15 females) participated in the second study. All women victims of sexual violence, both during childhood and adulthood, seen at the NET-TRAUMA during two consecutive years were included in this sample, which totaled 40. After the patientâs first visit, the therapist was asked to complete the Assessment of Countertransference Scale (ACTS). On the same visit, the patient was asked to complete the instruments regarding the factors in study: the Davidson Trauma Scale (DTS), the Standardized Assessment of Personality - Abbreviated Scale (SAPAS), the Beck Depression Inventory (BDI), and the Brazilian Portuguese version of the Defense Style Questionnaire (DSQ-40). The Clinical Global Impressions Scale (CGI) was completed after the screening visit. In the analysis of the therapistsâ reports, a predominance of feelings of closeness was observed in therapists of both genders when caring for victims of sexual violence. Among female therapists, the nature of the trauma (sexual or urban) did not influence the countertransferential pattern. Among male therapists, the nature of the trauma significantly influenced countertransference, with increased number of feelings of distance toward victims of urban violence compared to victims of sexual violence during childhood (p=0.02). On the second study, the therapists showed, likewise, more feelings of closeness toward the patients, which were higher in the midpoint and in the end of the visits (p<0.001), without influence of the therapists' gender. In a stratified sample of patients seen by female therapists, there was a significant association between higher patientsâ SAPAS scores and less therapistsâ feelings of closeness (p=0.038).These studies have showed a predominance of countertransferential reactions of closeness in young therapists, at the beginning of their professional lives, during the first visit of women victims of sexual violence. The importance of the use of countertransference for theunderstanding of the patients is emphasized, as it can be beneficial for their treatment and prognosis; further investigation on the matter is of interest
Avaliação da contratransferĂȘncia no atendimento inicial de pacientes vĂtimas de trauma psĂquico
O conceito de contratransferĂȘncia foi introduzido por Freud e ampliado por outros autores, sendo compreendido como as reaçÔes emocionais despertadas pelo paciente no terapeuta. Tem papel central na teoria e na tĂ©cnica psicanalĂticas atuais por ser uma importante ferramenta para o entendimento do mundo interno e das comunicaçÔes do paciente, com influĂȘncia no desenvolvimento da relação terapĂȘutica e no desfecho do tratamento. A partir do reconhecimento da importĂąncia da mente do terapeuta e do campo terapĂȘutico, tem sido discutida a associação entre caracterĂsticas da pessoa real do terapeuta e a forma como Ă© estabelecida a relação com o paciente. Do mesmo modo, caracterĂsticas especĂficas dos pacientes, como ter sido vĂtima de trauma psĂquico, sĂŁo consideradas potenciais desencadeadoras de padrĂ”es contratransferenciais similares. A relevĂąncia do estudo dos sentimentos contratransferenciais despertados no atendimento de vĂtimas de trauma psĂquico se justifica pela grande intensidade destes e pelo potencial destas reaçÔes emocionais se tornarem barreiras para o sucesso do tratamento quando nĂŁo compreendidas pelo terapeuta.Avaliar o padrĂŁo de expressĂŁo da contratransferĂȘncia dos terapeutas durante o atendimento inicial de pacientes mulheres vĂtimas de trauma psĂquico e a sua associação com caracterĂsticas dos terapeutas e das pacientes, tais como o momento da consulta, o gĂȘnero do terapeuta, a natureza do trauma (violĂȘncia sexual ou violĂȘncia urbana) e o momento da violĂȘncia sexual na vida das pacientes. TambĂ©m foi investigada a associação entre o padrĂŁo contratransferencial e a presença de sintomas de Transtorno de Estresse PĂłs-TraumĂĄtico e de sintomas depressivos atuais nas pacientes, escores em rastreamento para transtornos de personalidade e em escala de percepção da gravidade da doença nas pacientes e estilo defensivo utilizado pelas mesmas. Os estudos foram realizados no NĂșcleo de Estudos e Tratamento do Trauma PsĂquico (NETTRAUMA), do Hospital de ClĂnicas de Porto Alegre (HCPA), Brasil. Os terapeutas eram mĂ©dicos residentes do segundo ano de Psiquiatria do HCPA. No primeiro estudo, foi conduzidauma avaliação qualitativa, a anĂĄlise de conteĂșdo, associada a uma anĂĄlise estatĂstica, de 36 relatos de sentimentos contratransferenciais despertados no primeiro atendimento de pacientes mulheres, sendo13 vĂtimas de violĂȘncia sexual na infĂąncia, 15 vĂtimas de violĂȘncia sexual atual, e 8 vĂtimas de violĂȘncia urbana. Os relatos foram classificados em 6 grupos, conforme o gĂȘnero do terapeuta e a natureza do trauma. O segundo estudo teve a participação de 26 terapeutas, 11 homens e 15 mulheres. Foram incluĂdas nesta amostra todas as pacientes mulheres vĂtimas de violĂȘncia sexual, tanto na infĂąncia quanto na idade adulta, atendidas no NET-TRAUMA durante dois anos consecutivos, totalizando 40 pacientes. ApĂłs a primeira consulta com a paciente, era solicitado ao terapeuta que preenchesse a Escala para Avaliação da ContratransferĂȘncia (EACT). Neste mesmo momento, era solicitado Ă paciente que preenchesse os instrumentos referentes aos fatores em estudo: a Escala Davidson de Trauma (EDT), a Standardized Assessment of Personality - Abbreviated Scale (SAPAS), o InventĂĄrio de DepressĂŁo de Beck (BDI), e a versĂŁo em portuguĂȘs do Defense Style Questionaire (DSQ-40). A Escala de ImpressĂŁo ClĂnica Global (CGI) era preenchida apĂłs a consulta de triagem. Na anĂĄlise dos relatos redigidos pelos terapeutas, observou-se predomĂnio de sentimentos de aproximação nos terapeutas de ambos os gĂȘneros no atendimento de vĂtimas de violĂȘncia sexual. Entre terapeutas mulheres, a natureza do trauma (sexual ou urbano) nĂŁo influenciou os padrĂ”es contratransferenciais. Entre os terapeutas homens, a natureza do trauma influenciou de forma significativa a contratransferĂȘncia, havendo um nĂșmero elevado de sentimentos de distanciamento nos relatos de atendimentos de vĂtimas de violĂȘncia urbana em relação Ă queles atendimentos a vĂtimas de violĂȘncia sexual na infĂąncia (p=0,02). No segundo estudo, os terapeutas apresentaram, da mesma forma, mais sentimentos de proximidade em relação Ă s pacientes, que foram maiores no meio e no final das consultas (p<0,001), sem influĂȘncia do gĂȘnero do terapeuta. Em uma sub-amostra estratificada para pacientes atendidas por terapeutas mulheres, identificou-se associação significativa entre maiores escores obtidos pelas pacientes na SAPAS e menos sentimentos de proximidade das terapeutas (p=0,038).Estes estudos evidenciaram um predomĂnio de respostas contratransferenciais de proximidade em terapeutas jovens, no inĂcio da vida profissional, ao longo das primeiras consultas compacientes mulheres vĂtimas de violĂȘncia sexual. Destaca-se a importĂąncia da utilização da contratransferĂȘncia para a melhor compreensĂŁo dos pacientes, o que pode trazer benefĂcios ao tratamento e ao prognĂłstico destes, ressaltando-se a necessidade de que investigaçÔes continuadas sobre o tema sigam sendo desenvolvidas.The concept of countertransference was introduced by Freud and expanded by other authors. It is understood as the emotional reactions triggered by the patient in the therapist. It is pivotal in the current psychoanalytic theory and technique since it is an important tool in understanding the patientâs internal world and reportings, influencing the therapeutic relationship and the outcome of the treatment. From the acknowledgement of the importance of the therapistâs mind and the therapeutic field, there has been a growing debate on the association between characteristics of the real person of the therapist and the way that the relationship with the patient is established. Likewise, specific characteristics of the patients, such as having been victim of a psychological trauma, have been considered potential triggers of similar patterns of countertransferential responses. The relevance of studying the countertransferential feelings triggered when seeing victims of psychological trauma is justified by their high intensity and by the possibility of such emotional reactions becoming barriers for a successful treatment when they are not understood by the therapist.To evaluate the therapistsâ countertransference during the first visit of women victims of psychological trauma, and its association with therapistsâ and patientsâ characteristics, such as the moment within the visit, the gender of the therapist, the nature of the trauma (sexual violence or urban violence) and the time when sexual violence occurred in the patientâs life. The association between countertransference pattern and the presence of Post-Traumatic Stress Disorder symptoms and of depressive symptoms in the patients, scores in a screening of personality disorders and in a scale of perception of disease severity in the patients and the defensive style utilized by them were also investigated. The studies were conducted at the Center for the Study and Treatment of Psychological Trauma (NET-TRAUMA), of Hospital de ClĂnicas de Porto Alegre (HCPA), Brazil. The therapists were second-year Psychiatry residents of HCPA. On the first study, a qualitative evaluation, thecontent analysis, was performed, associated to a statistical analysis, of 36 reports of the countertransferential feelings aroused in the first visit of female patients. Thirteen patients were victims of sexual violence during childhood, 15 were victims of current sexual violence, and 8 were victims of urban violence. The reports were categorized into 6 groups according to the gender of the therapist and the nature of the trauma. Twenty-six therapists (11 males and 15 females) participated in the second study. All women victims of sexual violence, both during childhood and adulthood, seen at the NET-TRAUMA during two consecutive years were included in this sample, which totaled 40. After the patientâs first visit, the therapist was asked to complete the Assessment of Countertransference Scale (ACTS). On the same visit, the patient was asked to complete the instruments regarding the factors in study: the Davidson Trauma Scale (DTS), the Standardized Assessment of Personality - Abbreviated Scale (SAPAS), the Beck Depression Inventory (BDI), and the Brazilian Portuguese version of the Defense Style Questionnaire (DSQ-40). The Clinical Global Impressions Scale (CGI) was completed after the screening visit. In the analysis of the therapistsâ reports, a predominance of feelings of closeness was observed in therapists of both genders when caring for victims of sexual violence. Among female therapists, the nature of the trauma (sexual or urban) did not influence the countertransferential pattern. Among male therapists, the nature of the trauma significantly influenced countertransference, with increased number of feelings of distance toward victims of urban violence compared to victims of sexual violence during childhood (p=0.02). On the second study, the therapists showed, likewise, more feelings of closeness toward the patients, which were higher in the midpoint and in the end of the visits (p<0.001), without influence of the therapists' gender. In a stratified sample of patients seen by female therapists, there was a significant association between higher patientsâ SAPAS scores and less therapistsâ feelings of closeness (p=0.038).These studies have showed a predominance of countertransferential reactions of closeness in young therapists, at the beginning of their professional lives, during the first visit of women victims of sexual violence. The importance of the use of countertransference for theunderstanding of the patients is emphasized, as it can be beneficial for their treatment and prognosis; further investigation on the matter is of interest
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