Resentment: neurosciences applied to psychoanalysis, a transdisciplinary theoretical essay

With this article we aim to present a transdisciplinary conception of the relationship between neuroscience and psychoanalysis, especially Kleinian, in the field of epiphenomenos linked to resentment, its meaning and fundamental mechanisms of a psychoanalytic and biological nature. The article is the result of a theoretical-qualitative study based on the experience of the authors, some with more than 30 years of clinical experience in the area of mental health, psychoanalysis and neuroscience, added to a bibliographic review that consists mainly of books in the field of psychoanalysis, analysis and Freudian psychoanalysis, Kleinian and Jungian, a total of 21 books researched, as well as articles in the field of neuroscience. Researched in the PubMed, Medline and Scielo databases in the period between 2000 and 2020. Epistemological trimming involves elements such as objectual relationship, neurotransmitters, structures and neural circuits involved in the phenomenon of resentment. Texts that were outside the qualitative and transdisciplinary scope of the study of the text were excluded. We use the intuitive-interpretative method whose conclusion reinforces the viability of the understanding of psychoanalytic phenomena such as psychic determinism and object relations via intersection with neurobiological mechanisms that are developed through mental operations (mentalization), and psychopharmacological intervention and neuromodulation by transcranian magnetic stimulation, thus expanding knowledge on the subject for the areas in question.

“It Will Help You Repent”

This chapter explores The question of whether prison inmates suffering from attention-deficit/hyperactivity disorder (ADHD) should be administered a psychopharmacological intervention (methylphenidate) for their condition. The theoretical starting point for the discussion is the communicative theory of punishment, which understands criminal punishment as a form of secular penance. Viewed through the lens of the communicative theory, the provision of pharmacological treatment to offenders with ADHD need not necessarily be conceived of as an alternative to punishment, but as an aid to achieving the penological ends of secular penance. The criminal justice system punishes offenders who commit offences prohibited under the criminal law, and the hope is that this will lead them to become repentant, to start reforming themselves, and to reconcile with those whom they wronged. However, the neurophysiological obstacles associated with severe ADHD present serious obstacles to achieving repentance and self-reform. As a remedy, the chapter proposes that to achieve those aims, criminal offenders diagnosed with ADHD should be offered the option to undergo pharmacological treatment. This proposal is defended from the objection that secular penance made possible by methylphenidate is less authentic.

Reform and revolution in the context of critical psychiatry and service user/survivor movements

Among the outcomes of Szasz’s work on mental illness as “myth” is the development of critical psychiatry, which seeks to bridge an apparent chasm between psychiatry as social control and as a necessary psychopharmacological intervention. Some central tenets of critical psychiatry emerged from 1960s’ challenges to authoritative bodies. One aspect of its networks is patients’ narratives, which highlight how psychiatry has both harmed and helped them, and provide more nuanced and complex understandings of critiques than antipsychiatry activists generally offer. Patients’ experiences present deep challenges to Szasz’s individualism, particularly with respect to epistemic and ethical practices in psychiatry. Evidence of what it means to be a subject/agent undergirds a less idealized understanding than Western individualism typically theorizes. We are all always socially situated. In psychiatric practice, patients’ voices and social situatedness require a particular approach to being epistemically and ethically responsible.

The agitated patient; need for mechanical restraint and prevention measures in relation to psychiatric diagnosis

IntroductionPsychomotor agitation is a common psychiatric emergency in our environment that can occur in a wide clinical spectrum. Both the agitation itself as the procedures for their control, carry an implicit risk to patient safety and health workers.ObjectiveTo describe the prevention measures used in patients requiring mechanical restraint in relation to diagnosis of psychiatric disorders.Material and methodsThis is a naturalistic descriptive study. Mechanical restraints made in brief psychiatric hospitalization units of “Hospital del Mar” between January of 2013 to March of 2015, were analyzed by diagnosis. Proportions of the prevention intervention performed by nurses in each episode were compared. The groups of prevention interventions done were: “verbal approach”, “environmental measures”, “psychopharmacological intervention”, “observation increase” and “inability for applying any measure because unpredictability”.ResultsA total of 2986 mechanical restraints were done in brief hospitalization units. Among the results, we find that verbal approach measure was use in 77.23% of patient with personality disorders. Environmental measures were used in 40% of the total of restraints. The most of psychopharmacological intervention was done in alcohol intoxication (50%) and then in psychotic spectrum (42.01%). The inability for applying measures was greater in alcohol intoxication (45.4%).ConclusionSome of the results of this study are interesting and consistent with clinical practice (for example, effectivity of pharmacological intervention in psychosis and bipolar disorders, as well verbal approach in anxiety, etc.), we can predict the usefulness of measures applied to prevent a mechanical restraint. Further research is needed in this topic.Disclosure of interestL. Galindo is a Rio-Hortega-fellowship – (ISC-III; CM14/00111).

Personality and Personality Disorder

Personality disorders are difficult to distinguish from normal variations in personality traits. They tend to be under-diagnosed because of a focus on overt symptoms such as dépression or anxiety rather than on psychosocial or interpersonal dysfunction. There is also a danger of overdiagnosis, which has emerged from epidemiological research in which criteria have been too broad. The DSM-5 definitions of personality disorder are rather complex, both in their traditional form, and in an altérative model now included in Section III of the manual: many clinicians find them difficult to apply. There is also a tendency to favor diagnoses of mood disorders that are believed to be susceptible to psychopharmacological intervention.

Hemicrania Continua Headache in a Veteran with Posttraumatic Stress Disorder and Major Depressive Disorder without Traumatic Brain Injury

Hemicrania continua is a headache characterized by chronic unremitting unilateral pain associated with ipsilateral autonomic findings. This type of headache responds to high-flow oxygen and indomethacin. This case report describes a male veteran with posttraumatic stress disorder (PTSD) and major depressive disorder who suffers from comorbid hemicrania continua. The psychiatric symptoms were recalcitrant to psychopharmacological intervention. However, when the patient's hemicrania continua was treated appropriately, the patient's psychiatric symptoms also abated. This case demonstrates the need to address physical comorbidities that may exacerbate psychiatric disorders, such as PTSD.