O funcionamento masoquista na relação terapêutica

Pacientes com funcionamento masoquista representam um dos desafios terapêuticos mais difíceis durante a psicoterapia psicodinâmica. O comportamento masoquista pode dominar o campo analítico e causar forte resistência ao progresso do tratamento. Essa resistência pode aparecer tanto nas reações transferenciais do paciente quanto nas reações contratransferenciais e nos enactments do terapeuta. Este trabalho detalha as principais dificuldades na relação terapêutica com pacientes de funcionamento masoquista, ilustradas com material clínico, e revisa os principais cuidados que se devem ter na técnica da psicoterapia de orientação analítica durante o tratamento desses pacientes.Patients with a masochistic expression represent one of the most difficult therapeutic challenges during psychodynamic psychotherapy. The masochistic behavior can dominate the analytical field and cause strong resistance to treatment progress. This resistance can appear in the transferential reactions of the patient as well as in the countertransferential reactions and in the therapist's enactments. This paper details the main difficulties in the therapeutic relationship with patients with a masochistic expression illustrated in clinical material, and reviews the major precautions that should be taken in the technique of psychodynamic psychotherapy for the treatment of these patients

Evaluation of electroconvulsive therapy use at Hospital de Clínicas de Porto Alegre, Brazil

Apesar da eficácia e segurança comprovadas na literatura, a eletroconvulsoterapia (ECT) continua sendo tratamento controverso. Foram revisados os prontuários de 45 pacientes que receberam 54 tratamentos com ECT ao longo de quatro anos (de julho de 1990 a julho de 1994) em nosso serviço e observou-se, em gera l, aumento progressivo do uso do ECT. OS eletrodos utilizados foram sempre bilatera is. Todos os indi víduos, antes do uso do ECT, tiveram pelo menos uma tentativa fracassada de manejo de sua doença com psicofármacos. A indicação de uso mais freqüente foi depressão bipolar e uni polar (36 em 54 séries). seguida de esq ui zofrenia (7 sé ri es). Na maioria dos casos, a ECT estava sendo utili zada pela primeira vez e, em média, após 2,5 internações prévias. Os resultados imediatos dos procedimentos foram : 67% dos pacientes obtiveram esbatimento total sobre a sintomatologia psicótica, 60% sobre os sintomas de conduta e 81 % sobre os riscos. Compli cações graves não fatais ocorreram em apenas uma sé ri e. Conclui-se que a ECT está sendo usada precocemente e, a curto prazo, mostrou- se eficaz principalmente sobre os riscos, tendo baixo índice de complicações na popul ação estudada

A list of land plants of Parque Nacional do Caparaó, Brazil, highlights the presence of sampling gaps within this protected area

Brazilian protected areas are essential for plant conservation in the Atlantic Forest domain, one of the 36 global biodiversity hotspots. A major challenge for improving conservation actions is to know the plant richness, protected by these areas. Online databases offer an accessible way to build plant species lists and to provide relevant information about biodiversity. A list of land plants of “Parque Nacional do Caparaó” (PNC) was previously built using online databases and published on the website "Catálogo de Plantas das Unidades de Conservação do Brasil." Here, we provide and discuss additional information about plant species richness, endemism and conservation in the PNC that could not be included in the List. We documented 1,791 species of land plants as occurring in PNC, of which 63 are cited as threatened (CR, EN or VU) by the Brazilian National Red List, seven as data deficient (DD) and five as priorities for conservation. Fifity-one species were possible new ocurrences for ES and MG states

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.&nbsp; Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities. &nbsp; Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.&nbsp; The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.&nbsp; The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.&nbsp; &nbsp;&nbsp; Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.&nbsp;&nbsp;&nbsp; Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Vivências psíquicas da infância no filme "Onde Vivem Os Monstros"

Introdução: "Onde vivem os monstros" é um conto infantil adaptado para o cinema que aborda diversos aspectos das vivências psíquicas da infância. Os contos infantis têm importante papel na compreensão e elaboração dos conflitos psíquicos. Sendo assim, podem ser utilizados como ponto de partida para explorar diversos temas relacionados ao desenvolvimento psíquico infantil. Objetivos: Este trabalho tem por objetivo partir da estória do filme "Onde vivem os monstros" e abordar alguns aspectos do desenvolvimento psíquico infantil. Métodos: Foram revisados textos de Freud, Klein e outros autores que abordaram temas específicos da infância. Fragmentos do filme foram divididos em primeira, segunda e terceira partes, e, em cada uma dessas partes, foram abordados alguns tópicos, como: complexo de Édipo; agressividade; defesas maníacas; narcisismo infantil; posição esquizoparanoide versus depressiva; princípio do prazer versus princípio de realidade. Considerações finais: A estória narrada no filme pode ser compreendida como uma alegoria do processo de elaboração dos conflitos psíquicos infantis. O contato atento com manifestações artísticas de todas as naturezas enriquece o trabalho de psiquiatras e psicoterapeutas, sendo uma infinita fonte de material a ser explorado sob a perspectiva psicanalítica.Introduction: "Where the wild things are" is a children's story adapted to the movies that approaches some aspects of the psychic experiences during childhood. Children's stories have an important role in the comprehension and elaboration of psychic conflicts. Thus, they can be used as a starting point to explore different issues related to the child's psychic development. Objective: This article's intention is to use the story of the movie "Where the wild things are" to approach some aspects of the child's psychic development. Methods: Freud's and Klein's texts as well as material from authors who also approached specific child issues were reviewed. Movie fragments were divided into beginning, middle and end. In each of these parts, specific topics were discussed, such as Oedipus complex, aggressiveness, manic defenses, child narcissism, paranoid-schizoid versus depressive position and pleasure principle versus reality principle. Final considerations: This story can be understood as an allegory of the process of elaboration of the child's psychic conflicts. Looking closely at all kinds of artistic expressions enriches psychiatrists and psychotherapists work, for they are an infinite source of material to be explored under the psychoanalytical perspective

Vivências psíquicas da infância no filme "Onde Vivem Os Monstros"

Introdução: "Onde vivem os monstros" é um conto infantil adaptado para o cinema que aborda diversos aspectos das vivências psíquicas da infância. Os contos infantis têm importante papel na compreensão e elaboração dos conflitos psíquicos. Sendo assim, podem ser utilizados como ponto de partida para explorar diversos temas relacionados ao desenvolvimento psíquico infantil. Objetivos: Este trabalho tem por objetivo partir da estória do filme "Onde vivem os monstros" e abordar alguns aspectos do desenvolvimento psíquico infantil. Métodos: Foram revisados textos de Freud, Klein e outros autores que abordaram temas específicos da infância. Fragmentos do filme foram divididos em primeira, segunda e terceira partes, e, em cada uma dessas partes, foram abordados alguns tópicos, como: complexo de Édipo; agressividade; defesas maníacas; narcisismo infantil; posição esquizoparanoide versus depressiva; princípio do prazer versus princípio de realidade. Considerações finais: A estória narrada no filme pode ser compreendida como uma alegoria do processo de elaboração dos conflitos psíquicos infantis. O contato atento com manifestações artísticas de todas as naturezas enriquece o trabalho de psiquiatras e psicoterapeutas, sendo uma infinita fonte de material a ser explorado sob a perspectiva psicanalítica.Introduction: "Where the wild things are" is a children's story adapted to the movies that approaches some aspects of the psychic experiences during childhood. Children's stories have an important role in the comprehension and elaboration of psychic conflicts. Thus, they can be used as a starting point to explore different issues related to the child's psychic development. Objective: This article's intention is to use the story of the movie "Where the wild things are" to approach some aspects of the child's psychic development. Methods: Freud's and Klein's texts as well as material from authors who also approached specific child issues were reviewed. Movie fragments were divided into beginning, middle and end. In each of these parts, specific topics were discussed, such as Oedipus complex, aggressiveness, manic defenses, child narcissism, paranoid-schizoid versus depressive position and pleasure principle versus reality principle. Final considerations: This story can be understood as an allegory of the process of elaboration of the child's psychic conflicts. Looking closely at all kinds of artistic expressions enriches psychiatrists and psychotherapists work, for they are an infinite source of material to be explored under the psychoanalytical perspective

O funcionamento masoquista na relação terapêutica

Pacientes com funcionamento masoquista representam um dos desafios terapêuticos mais difíceis durante a psicoterapia psicodinâmica. O comportamento masoquista pode dominar o campo analítico e causar forte resistência ao progresso do tratamento. Essa resistência pode aparecer tanto nas reações transferenciais do paciente quanto nas reações contratransferenciais e nos enactments do terapeuta. Este trabalho detalha as principais dificuldades na relação terapêutica com pacientes de funcionamento masoquista, ilustradas com material clínico, e revisa os principais cuidados que se devem ter na técnica da psicoterapia de orientação analítica durante o tratamento desses pacientes.Patients with a masochistic expression represent one of the most difficult therapeutic challenges during psychodynamic psychotherapy. The masochistic behavior can dominate the analytical field and cause strong resistance to treatment progress. This resistance can appear in the transferential reactions of the patient as well as in the countertransferential reactions and in the therapist's enactments. This paper details the main difficulties in the therapeutic relationship with patients with a masochistic expression illustrated in clinical material, and reviews the major precautions that should be taken in the technique of psychodynamic psychotherapy for the treatment of these patients