Lúcia Helena Freitas Ceitlin

Serum brain-derived neurotrophic factor in patients with trauma psychopathology

OBJECTIVE Brain-derived neurotrophic factor (BDNF) has an important role in learning, motivation and regulation of mood. The aim of this study was to investigate levels of serum BDNF in patients with trauma psychopathology (acute and post-traumatic stress disorder) when compared to age and gender matched controls. METHOD A consecutive sample of 34 patients was evaluated regarding socio-demographic and clinical variables by means of a standard protocol, Davidson Trauma Scale, Beck Depression Inventory, Clinical Global Impression and the Global Assessment of Functioning. BDNF serum levels were measured right after the intake interview. RESULTS Patients had higher BDNF levels than controls. Those levels, however, were higher right after the traumatic event, decreasing over time. When two groups of patients (recent and remote trauma) were investigated in separate, the recent trauma group (less than 1year since the traumatic event) had higher BDNF than controls, but this effect was not detected in the remote trauma group. The recent and remote trauma groups had different BDNF levels. Those findings persisted, even controlling for symptom severity, use of psychotropic medication, and history of psychiatric disease. CONCLUSIONS As far as we know this is the first report of elevated serum BDNF levels in patients with recent trauma. Based in animal models that implicate BDNF in memory formation and consolidation, higher BDNF in recent PTSD could be related to memory and learning disruption central in PTSD psychopathology.

Confirmatory Factor Analysis of the Parental Bonding Instrument in a Brazilian Female Population

Objective: The Parental Bonding Instrument (PBI) is a widely used measure of parenting. Recent studies have proposed different factor structures. There is a disagreement in the literature about whether the PBI is best used as a two-factor or a three-factor measure. Method: Two hundred and fifty-seven female adults were recruited from a clinical population (139 psychiatric patients and 118 controls) and were requested to complete the PBI. Maximum likelihood confirmatory factor analyses were performed to compare the five different factor structures in terms of model fit. Results: The poorest fit to the data was obtained by the Parker et al. model. The Kendler model was the only model that had an adjusted goodness-of-fit index >0.8 regarding both paternal and maternal PBI. When considering invariance of factor structure across age subgroups, the Kendler model was also the only acceptable model. Conclusion: Three-factor structures are preferable to two-factor structures. The Kendler model was the only one to provide an acceptable fit, but it must be considered that it was a female sample, and when considering gender subgroups other studies have found the same results. Despite the gender limitation, the present study contributes to a better understanding and use of the PBI in Brazilian samples.

Fatores associados a abandono precoce do tratamento em psicoterapia de orientação analítica

Abstract Introduction: The efficacy of psychoanalytic psychotherapy is well established in controlled clinical trials; however, someindividual characteristics that predict better outcomes are yet poorly studied. This study aimed at evaluating the association ofdemographics data, psychiatric diagnosis, clinical impairment, quality of life, aspects of psychotherapy suitability, defensivestyle and dropout before 3 months. Method: A consecutive sample of 56 subjects was evaluated after psychotherapy indication through a standardized protocol,World Health Organization Quality of Life Bref (WHOQOL-Bref), Self Report Questionnaire, Defensive Style Questionnaire,Scale of Defensive Functioning of Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR) andGlobal Assessment of Functioning, and followed for 3 months. Results: Dropout rate was 12.5%. There was no difference between groups in respect to Global Assessment of Functioning, SelfReport Questionnaire and Defensive Style Questionnaire scores. Dropout patients reported to be satisfied with their health,despite psychopathological severity, even when other variables were controlled (p < 0.0001). The group that remained inpsychotherapy was better adjusted before treatment and had average or superior estimated intelligence (p < 0.05). More dropoutpatients presented lower levels of defensive style, by means of the Scale of Defensive Functioning of DSM-IV-TR.

Serum levels of brain-derived neurotrophic factor in acute and posttraumatic stress disorder: a case report study

OBJECTIVE The aim of this study was to evaluate brain-derived neurotrophic factor levels in two patients, one with posttraumatic stress disorder and one with acute stress disorder, before and after treatment, and to compare those levels to those of healthy controls. METHOD Brain-derived neurotrophic factor level, Davidson Trauma Scale, Beck Depression Inventory, Global Assessment of Functioning, and Clinical Global Impression were assessed before and after 6 weeks of treatment. RESULTS Brain-derived neurotrophic factor levels were higher in patients than in matched controls before treatment. After 6 weeks, there was a reduction in symptoms and an improvement in functioning in both cases. At the same time, brain-derived neurotrophic factor levels decreased after treatment, even in case 2, treated with psychotherapy only. CONCLUSIONS These results suggest that serum levels of brain-derived neurotrophic factor, as opposed to what has been described in mood disorders, are increased in posttraumatic stress disorder as well as in acute stress disorder.

Parental bonding and emotional response to trauma: A study of rape victims

Abstract The aim of this study was to examine the impact of parental bonding as a resilience or a risk factor for psychopathology after rape. Women rape victims were assessed regarding the perception of parental bonding in childhood, acute posttraumatic stress disorder symptoms, acute stress disorder (ASD), and clinical severity. The perception of having less affective parents was correlated with severity, and ASD was more frequent in participants with less affectionate and more controlling fathers. Perceived support was associated with clinical impairment. These findings could help in identifying those who need early interventions and highlight the importance of social and emotional support in facing traumatic situations, reinforcing aspects of the parent–child relationship that generate adults more apt to face adverse situations.

Mental states as part of countertransference responses in psychotherapists facing reports of traumatic events of mourning and sexual violence.

Abstract The study aims to compare the mental states and countertransference responses of 92 psychodynamically oriented psychotherapists, male and female, experienced and inexperienced, facing written reports of real patients who experienced traumatic events. Two vignettes were presented: one of a sexual violence, the other the sudden death of a significant person. The Mental States Rating System (MSRS; Bouchard, Picard, Audet, Brisson, & Carrier, 1998), the MSRS Self-Report (Goldfeld & Bouchard, 2004), and the Inventory of Countertransference Behavior (ICB; Friedman & Gelso, 2000) were used. Results showed that the mourning vignette led to more reflective responses (MSRS) and the rape case was associated with more negative countertransference reactions (ICB). Female participants were more reflective (MSRS); male therapists used less mentalized states (MSRS Self-Report) and expressed more negative reactions (ICB) for both scenarios. Experienced therapists showed more positive reactions on the ICB. The construct validity of the instruments is discussed in relation to the findings.

A relação entre os mecanismos de defesa e a qualidade da aliança terapêutica em psicoterapia de orientação analítica

BACKGROUND: The quality of a therapeutic alliance is essential in psychoanalytic psychotherapy and influences the therapeutic process. This study evaluated the relationship between the level of defense mechanisms and the quality of therapeutic alliance established during psychotherapy. METHOD: Patients in psychotherapy and their respective therapists completed the Helping Alliance Questionnaire (patient version and therapist version, respectively). The level of defenses was inferred by the Defensive Functioning Scale proposed in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. RESULTS: There was no association between the quality of therapeutic alliance and the patients level of defense mechanisms in this sample. On the other hand, there was a difference when the therapist version was compared to the patient version: patients established a stronger therapeutic alliance in relation to their therapists. CONCLUSIONS: The lack of influence of defense level in the quality of therapeutic alliance suggests that the therapists training and personal characteristics may lead to the ability of connecting with the patient, despite impairment in their psychic functioning.

The clinical concept of analytic process: a conceptual investigation.

The authors discuss the term ‘analytic process’, confi rming the variability of the meanings ascribed to it. Although all the psychoanalysts of this and previous times acknowledge the existence of something called analytic process, as well as its importance, it has not been possible up to now to establish a consensual defi nition of it. The defi nitions are not only numberless, they also contradict one another. The possible advantages to analytic theory and practice proceeding from a uniform concept are incontrovertible. A review of the subject in the psychoanalytic literature has been performed. A conceptual study concerning the term, carried out among members of a psychoanalytic society affi liated to the IPA is presented, no consensual conceptualization for the term analytic process having been found. The subjects referred to the term as deriving from a variety of elements, some in common, but there was no agreement regarding the elements themselves. There was consensus regarding the role of the analytical relationship in the process, considered fundamental, as well as that of the extent to which the individual life experiences in that relationship defi ne the unique character acquired by the process within it.

Association between childhood trauma and loss of functionality in adult women with fibromyalgia

OBJECTIVE To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression.

Trauma and countertransference: development and validity of the Assessment of Countertransference Scale (ACS)

OBJECTIVES The aim of the present study was to investigate the construct validity of the Assessment of Countertransference Scale (ACS) in the context of the trauma care, through the identification of the underlying latent constructs of the measured items and their homogeneity. METHODS ACS assesses 23 feelings of CT in three factors: closeness, rejection and indifference. ACS was applied to 50 residents in psychiatry after the first appointment with 131 victims of trauma consecutively selected during 4 years. ACS was analyzed by exploratory (EFA) and confirmatory (CFA) factor analysis, internal consistence and convergent-discriminant validity. RESULTS In spite of the fact that closeness items obtained the highest scores, the EFA showed that the factor rejection (24% of variance, α = 0.88) presented a more consistent intercorrelation of the items, followed by closeness (15% of variance, α = 0.82) and, a distinct factor, sadness (9% of variance, α = 0.72). Thus, a modified version was proposed. In the comparison between the original and the proposed version, CFA detected better goodness-of-fit indexes for the proposed version (GFI = 0.797, TLI = 0.867, CFI = 0.885 vs. GFI = 0.824, TLI = 0.904, CFI = 0.918). CONCLUSIONS ACS is a promising instrument for assessing CT feelings, making it valid to access during the care of trauma victims.