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What Is It Like to Be in Alcohol Addiction Recovery? A Dialectical Phenomenological Analysis. 酗酒戒毒是一种怎样的体验?辩证现象学分析》。
IF 1.9 3区 医学 Q3 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-05-16 DOI: 10.1159/000538267
Victor Monteiro, Lucas Bloc, Guilherme Messas

Introduction: Currently, there is no scientific consensus on the concept of alcohol addiction recovery beyond substance use control. This conceptual issue challenges the implementation of therapeutic strategies and mental health policies that are unrestricted to symptomatic remission. Aiming to contribute to its definition, this study aimed to examine the recovery experience of individuals with alcohol addiction using dialectical phenomenological psychopathology (DPP) as a theoretical and methodological framework.

Methods: A dialectical phenomenological analysis was conducted through an examination of online interviews with eight Brazilian, São Paulo state citizens who were self-declared to be undergoing alcohol addiction recovery (or who declared that they had completely recovered).

Results: Participants' reports generated eight categories that were subdivided into two groups. The first group indicated experiential elements of recovery, such as changes in self-relation, changes in interpersonal relations, and changes in time relations, giving new meanings to suffering and alcohol use, and recovery as a continuous process. The second group referred to how the participants interpreted recovery according to their worldviews: as a spiritual experience, moral reformation, and mentality change.

Conclusion: These categories can be understood through the lens of DPP as a process of change in the subjects' being in the world, characterized by the continued management of their existential imbalances in the dimensions of spatiality, temporality, selfhood, and intersubjectivity. The results are preliminary when it comes to conceptualizing recovery but may help future studies to develop recovery-oriented therapeutic strategies.

导言:目前,科学界对酗酒成瘾康复的概念还没有达成超越药物使用控制的共识。这一概念问题对不局限于症状缓解的治疗策略和心理健康政策的实施提出了挑战。本研究以辩证现象学精神病理学(DPP)为理论和方法框架,旨在研究酒瘾患者的康复经历,从而为其定义做出贡献:方法:通过对八名巴西圣保罗州公民的在线访谈进行辩证现象学分析,这些人自我宣称正在进行酒瘾康复(或宣称已经完全康复):参与者的报告共分为八类,又细分为两组。第一组指出了戒酒的经验要素,如自我关系的变化、人际关系的变化和时间关系的变化,赋予痛苦和饮酒新的意义,以及戒酒是一个持续的过程。第二组指的是参与者如何根据自己的世界观来解释康复:作为一种精神体验、道德改造和心态变化:通过 DPP 的视角,可以将这些类别理解为受试者在世界中的存在变化过程,其特点是在空间性、时间性、自我性和主体间性等维度上持续管理其存在的不平衡。这些研究结果在概念化康复方面是初步的,但可能有助于未来的研究制定以康复为导向的治疗策略。
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引用次数: 0
Disembodiment and Affective Resonances in Esketamine Treatment of Depersonalized Depression Subtype: Two Case Studies. Esketamine 治疗人格解体抑郁症亚型中的非人格化和情感共振:两个案例研究。
IF 1.9 3区 医学 Q3 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-08-22 DOI: 10.1159/000539714
Pietro Sarasso, Martina Billeci, Irene Ronga, Fabiola Raffone, Vassilis Martiadis, Gilberto Di Petta

Introduction: Dissociative experiences are considered undesirable ketamine's adverse events. However, they might be crucial for ketamine's antidepressant effects, at least in some depression subtypes. Current understandings of ketamine's therapeutic potentials converge on the so-called "relaxed prior hypothesis," suggesting that glutamatergic blockage up-weights bottom-up surprising somatosensory/affective states. As a result, ketamine improves short-term plasticity in depression by enhancing sensitivity to interoceptive signals.

Methods: We selected 2 case studies for their paradigmatic description of "depersonalized depression" (Entfremdungsdepression) symptoms. Patients were included in a 6-month-long esketamine program for treatment resistant depression, during which we collected their spontaneous experience with esketamine. According to a neurophenomenological approach, we combined subjective reports from unstructured clinical interviews and the review of previous objective neuroimaging results and neurocomputational models to unveil the relation between esketamine antidepressant effects and interoceptive sensitivity.

Results: According to our clinical observations, esketamine-induced dissociation might be particularly effective in the depersonalized depression subtype, in which interoceptive awareness and interaffectivity are particularly compromised. Ketamine and esketamine's dissociative effects and particularly disembodiment might suspend previously acquired patterns of feeling, sensing, and behaving.

Conclusions: Coherently with previous research, we suggest that esketamine-induced disembodiment allows for a transient window of psychological plasticity and enhanced sensitivity, where the body recovers its permeability to affective affordances.

简介分离体验被认为是氯胺酮的不良反应。然而,至少在某些抑郁症亚型中,它们可能是氯胺酮抗抑郁效果的关键。目前对氯胺酮治疗潜能的理解趋同于所谓的 "放松先验假说",即谷氨酸能阻断自下而上的令人惊讶的躯体感觉/情感状态。因此,氯胺酮可通过提高对感受间信号的敏感性来改善抑郁症患者的短期可塑性:我们选择了两个病例进行研究,因为它们对 "人格解体抑郁症"(Entfremdungsdepression)症状进行了典型描述。患者参加了为期6个月的埃斯氯胺酮治疗抗药性抑郁症项目,在此期间,我们收集了他们使用埃斯氯胺酮的自发体验。根据神经现象学方法,我们将非结构化临床访谈中的主观报告与之前的客观神经影像学结果和神经计算模型相结合,揭示了埃斯氯胺酮抗抑郁效果与感知间敏感性之间的关系:根据我们的临床观察,艾司氯胺酮诱导的解离可能对人格解体抑郁症亚型特别有效,因为在这种抑郁症亚型中,感知间意识和感知间作用力特别脆弱。氯胺酮和艾司氯胺酮的解离作用,尤其是解体作用,可能会暂停先前获得的感觉、知觉和行为模式:与之前的研究一致,我们认为,氯胺酮诱导的失神作用允许短暂的心理可塑性和敏感性增强,身体在此过程中恢复了对情感承受能力的渗透性。
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引用次数: 0
Temperament Traits in Pediatric Obsessive-Compulsive Disorder in Relation to Tourette Syndrome and Attention-Deficit Hyperactivity Disorder. 小儿强迫症的气质特征与图雷特综合征和注意力缺陷多动障碍的关系。
IF 1.9 3区 医学 Q3 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-01-29 DOI: 10.1159/000535658
Jessica Szu-Chi Cheng, Elissa Khalil, Masoud Salehi, Lauren Mulcahy, Isabella Yiru Xie, Hasti Hadizadeh, Marco A Grados

Introduction: Pediatric obsessive-compulsive disorder (OCD), attention-deficit hyperactivity disorder (ADHD), and Tourette syndrome (TS) are often concurrent. This study explores the temperament profile of complex OCD phenotypes.

Methods: A clinical registry recorded demographic data, psychiatric diagnoses, and temperament traits, including novelty seeking (exploratory behaviors), harm avoidance (fear of uncertainty), reward dependence (sentimentality), and persistence (perseverance). Temperament data were accrued from the Junior Temperament and Character Inventory (JTCI). Participants were divided into (1) OCD only; (2) OCD+ADHD or TS; and (3) OCD+ADHD+TS to compare temperament.

Results: Participants include 126 youths with OCD (61.9% male, 88.9% white) between the ages 6 and 18 years (12.7 ± 3.1). Among the three groups, the complex neurodevelopmental disorder group OCD+ADHD+TS expresses the highest novelty seeking and lowest persistence. Harm avoidance is increased in all groups compared to reference controls, irrespective of concurrent ADHD or TS. For the OCD+ADHD+TS group, contamination and washing symptoms have higher novelty seeking (p < 0.01), while counting and ordering have lower novelty seeking (p < 0.05). Harm avoidance is increased with aggressive, somatic, and checking symptoms in OCD only (p < 0.01), while persistence is increased with repeating and counting symptoms in the comorbid groups (OCD+ADHD or TS, OCD+ADHD+TS).

Discussion/conclusion: The complex subtype, OCD+ADHD+TS, is associated with high novelty seeking and low persistence, while high harm avoidance is linked to pediatric OCD irrespective of ADHD or TS co-occurrence. In sum, pediatric OCD with ADHD and TS confers a unique temperament profile, further refining complex phenotypes of pediatric OCD for future research.

导言:小儿强迫症(OCD)、注意力缺陷多动障碍(ADHD)和抽动秽语综合征(TS)常常同时存在。本研究探讨了复杂强迫症表型的气质特征:临床登记册记录了人口统计学数据、精神病诊断和气质特征,包括求新(探索行为)、避害(对不确定性的恐惧)、奖励依赖(多愁善感)和坚持(毅力)。气质数据来自青少年气质和性格量表(JTCI)。将参与者分为:(1) 强迫症患者;(2) 强迫症+ADHD或TS患者;(3) 强迫症+ADHD+TS患者,以比较他们的气质:参与者包括126名患有强迫症的青少年(61.9%为男性,88.9%为白人),年龄在6至18岁之间(12.7 ± 3.1)。在三个组别中,复杂神经发育障碍组 OCD+ADHD+TS 表现出最高的新奇寻求性和最低的持久性。与参照对照组相比,无论是否同时患有多动症(ADHD)或创伤后应激障碍(TS),所有组别的伤害回避都有所增加。在强迫症+多动症+TS组中,污染和清洗症状具有较高的寻求新奇性(p <0.01),而计数和排序具有较低的寻求新奇性(p <0.05)。仅在强迫症组中,攻击性、躯体性和检查症状会增加伤害回避(p <0.01),而在合并症组(强迫症+多动症或TS,强迫症+多动症+TS)中,重复和计数症状会增加持续性:讨论/结论:复杂亚型(强迫症+ADHD+TS)与高求新和低持续性相关,而高伤害回避与小儿强迫症相关,与ADHD或TS共存无关。总之,伴有多动症和TS的小儿强迫症具有独特的气质特征,为今后的研究进一步完善了小儿强迫症的复杂表型。
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引用次数: 0
Are Traumatic Disintegration, Detachment, and Dissociation Separate Pathogenic Processes Related to Attachment Trauma? A Working Hypothesis for Clinicians and Researchers 创伤性解体、分离和解离是与依恋创伤相关的独立致病过程吗?临床医生和研究人员的工作假设
IF 3.6 3区 医学 Q3 PSYCHIATRY Pub Date : 2023-12-08 DOI: 10.1159/000535191
B. Farina, Claudio Imperatori
Background: Despite its high prevalence in all psychiatric disorders and its widely demonstrated clinical relevance as a marker of both clinical severity and poorer treatment response, a scientifically validated definition of dissociation remains controversial, and the understanding of its pathogenesis is still somewhat lacking. Furthermore, although most clinicians commonly refer to dissociation as a single unitary concept, the empirical evidence strongly supports the paucity of a one-dimensional approach to dissociation. Summary: Resonating with the clinical and neuroscientific data on this topic, this article aimed to provide a working hypothesis, suggesting that the wide variety of psychopathological phenomena that are currently improperly lumped into the category of dissociation are in fact produced by at least three different pathogenic processes involved in developmental trauma, namely, traumatic disintegration, detachment responses, and dissociation. Key Messages: This hypothesis should, therefore, be considered a starting point for a better understanding of the complex manifestations and processes that currently overly, attributed to dissociation per se.
背景:尽管它在所有精神疾病中都有很高的患病率,并且作为临床严重程度和治疗反应较差的标志被广泛证明具有临床相关性,但对分离的科学验证定义仍然存在争议,对其发病机制的理解仍然有所欠缺。此外,尽管大多数临床医生通常将分离作为一个单一的概念,但经验证据强烈支持一维分离方法的缺乏。摘要:根据关于这一主题的临床和神经科学数据,本文旨在提供一个有效的假设,表明目前被不恰当地归为分离类别的各种精神病理现象实际上是由至少三种不同的与发育性创伤有关的致病过程产生的,即创伤性解体、脱离反应和分离。因此,这一假设应该被视为一个起点,以便更好地理解目前过度归因于解离本身的复杂表现和过程。
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引用次数: 0
Automatic diagnosis of schizophrenia and attention deficit hyperactivity disorder in rs-fMRI modality using convolutional autoencoder model and interval type-2 fuzzy regression. 基于卷积自编码器模型和区间2型模糊回归的rs-fMRI模式自动诊断精神分裂症和注意缺陷多动障碍
IF 1.9 3区 医学 Q3 PSYCHIATRY Pub Date : 2023-12-01 Epub Date: 2022-11-12 DOI: 10.1007/s11571-022-09897-w
Afshin Shoeibi, Navid Ghassemi, Marjane Khodatars, Parisa Moridian, Abbas Khosravi, Assef Zare, Juan M Gorriz, Amir Hossein Chale-Chale, Ali Khadem, U Rajendra Acharya

Nowadays, many people worldwide suffer from brain disorders, and their health is in danger. So far, numerous methods have been proposed for the diagnosis of Schizophrenia (SZ) and attention deficit hyperactivity disorder (ADHD), among which functional magnetic resonance imaging (fMRI) modalities are known as a popular method among physicians. This paper presents an SZ and ADHD intelligent detection method of resting-state fMRI (rs-fMRI) modality using a new deep learning method. The University of California Los Angeles dataset, which contains the rs-fMRI modalities of SZ and ADHD patients, has been used for experiments. The FMRIB software library toolbox first performed preprocessing on rs-fMRI data. Then, a convolutional Autoencoder model with the proposed number of layers is used to extract features from rs-fMRI data. In the classification step, a new fuzzy method called interval type-2 fuzzy regression (IT2FR) is introduced and then optimized by genetic algorithm, particle swarm optimization, and gray wolf optimization (GWO) techniques. Also, the results of IT2FR methods are compared with multilayer perceptron, k-nearest neighbors, support vector machine, random forest, and decision tree, and adaptive neuro-fuzzy inference system methods. The experiment results show that the IT2FR method with the GWO optimization algorithm has achieved satisfactory results compared to other classifier methods. Finally, the proposed classification technique was able to provide 72.71% accuracy.

如今,世界上有许多人患有脑部疾病,他们的健康处于危险之中。迄今为止,已经提出了许多诊断精神分裂症(SZ)和注意缺陷多动障碍(ADHD)的方法,其中功能磁共振成像(fMRI)模式被医生认为是一种流行的方法。本文提出了一种采用新的深度学习方法的静息状态功能磁共振成像(rs-fMRI)模式的SZ和ADHD智能检测方法。加州大学洛杉矶分校的数据集包含SZ和ADHD患者的rs-fMRI模式,已用于实验。FMRIB软件库工具箱首先对rs-fMRI数据进行预处理。然后,使用具有所提出层数的卷积自编码器模型从rs-fMRI数据中提取特征。在分类步骤中,引入区间2型模糊回归(IT2FR)方法,并采用遗传算法、粒子群算法和灰狼优化(GWO)技术对其进行优化。此外,将IT2FR方法的结果与多层感知器、k近邻、支持向量机、随机森林和决策树以及自适应神经模糊推理系统方法进行了比较。实验结果表明,与其他分类器方法相比,结合GWO优化算法的IT2FR方法取得了满意的结果。最后,所提出的分类技术能够提供72.71%的准确率。
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引用次数: 0
Contents Vol. 56, No. 6, 2023 目录 第 56 卷第 6 期,2023 年
IF 3.6 3区 医学 Q3 PSYCHIATRY Pub Date : 2023-12-01 DOI: 10.1159/000535111
Joachim Klosterkötter, L. Fleck, A. Fuchs, M. H. Kaess, Bern, M. Kaur, NC Greensboro, M. Sanches, TX Houston, P.K.H. Mo, G.Y.K. So, Z. Lu, W. W. Mak, Hong Kong
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引用次数: 0
Front & Back Matter 正面和背面
IF 3.6 3区 医学 Q3 PSYCHIATRY Pub Date : 2023-05-31 DOI: 10.1159/000531326
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引用次数: 0
Prelims 预备考试
IF 3.6 3区 医学 Q3 PSYCHIATRY Pub Date : 2023-03-03 DOI: 10.1159/000529565

Psychopathology 2023;56:1–4
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引用次数: 0
Front & Back Matter 正面和背面
IF 3.6 3区 医学 Q3 PSYCHIATRY Pub Date : 2023-03-01 DOI: 10.1159/000529990
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引用次数: 0
Homo œconomicus: A Key for Understanding Late Modernity Narcissism? Homo œconomicus:理解晚期现代性自恋的一把钥匙?
IF 3.6 3区 医学 Q3 PSYCHIATRY Pub Date : 2023-01-01 DOI: 10.1159/000525678
Giovanni Stanghellini

This paper describes the form that narcissism takes in contemporary society in the light of Homo œconomicus - a concept developed by philosopher Foucault to describe a key figure of late modernity: the entrepreneur of himself whose core values are utility (every action must be directed towards production) and optimization (what costs more than it produces is a dead branch to be cut). Homo œconomicus is the subject of so-called "achievement society." Its imperative is summed up in the formula "You can!" that generates heavy constraints because it is introjected as "If I can, then I must!," and self-coercion is more fatal than hetero-coercion because no resistance can be put up against oneself. He is also the subject of the "society of the spectacle" in which a part of the world represents itself in front of the rest of the world and shows itself to be superior to it. The spectacle is not simply a set of images, but a type of social relationship between people mediated by images, generating alienation from oneself and from the Other. Using Homo œconomicus as a grid for understanding contemporary pathological forms of narcissism, I describe the values and the life-world of narcissistic persons including the ways they experience time, space, others, and their own body. I finally suggest a therapeutic of this form of existence based on the recognition of its value-structure.

本文从Homo œconomicus的角度描述了自恋在当代社会中的表现形式。Homo œconomicus是哲学家福柯(Foucault)提出的一个概念,用来描述晚期现代性的一个关键人物:自我企业家,其核心价值观是效用(每一个行动都必须以生产为导向)和优化(成本大于产出的东西是一个可以砍掉的死枝)。Homo œconomicus是所谓的“成就社会”的主体。它的命令性可以用“你可以!”这个公式来概括,这个公式产生了很大的约束,因为它被注入了“如果我可以,那么我必须!”自我强迫比异性强迫更致命,因为你无法对自己进行抵抗。他也是“景观社会”的主体,在这个社会中,世界的一部分在世界其他部分面前表现自己,并表现出自己比世界其他部分优越。景观不仅仅是一组图像,而是一种以图像为媒介的人与人之间的社会关系,产生了与自我和他者的异化。以Homo œconomicus作为理解当代自恋病理形式的网格,我描述了自恋者的价值观和生活世界,包括他们体验时间、空间、他人和自己身体的方式。最后,我提出了一种基于对其价值结构认识的治疗方法。
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引用次数: 4
期刊
Psychopathology
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