Abstract The traumatic event produces intolerable excitations to the psychic apparatus that searches to relief them through the production of symptoms. When established, patients with post-traumatic stress disorders (PTSD) and complex post-traumatic stress disorder (CPTSD) may experience flashbacks, somatizations, negative emotions about themselves, and difficulty in social contact. This work seeks to understand how the psychodynamic functioning of women victims of interpersonal and urban violence, diagnosed with these disorders, is organized, identifying traumatic experiences, ways of interpersonal relationships, conflicts and psychic structures and use of defense mechanisms, and for peculiarities that may differentiate these disorders. The qualitative transversal method was used through the content analysis of clinical interviews based on the Operationalized Psychodynamic Diagnosis (OPD-2). The sample of this study consisted of five women with PTSD and five with CPTSD. The following categories were created: reasons for seeking care, symptoms and desire for treatment, traumatic developmental events, and characteristics of the psychic functioning. Early trauma generates psychic organizations with greater disintegration. A new traumatic event destabilizes the psychic organization and intensifies symptoms. Relationships were marked by dependence and isolation. Participants with CPTSD presented tendency to disintegration related to the object relation regulation and the psychic conflict was of Individuation versus Dependence, with more primitive flaws in object representations, existential need for the other and direct discharge of impulses. Participants with PTSD had moderate to low level of object relation integration and the conflict was need to be care of versus self-sufficiency, with self-representations being fragile and with reduced capacity to manage impulses. Thus, it could be observed that OPD-2 is capable of assessing in a broad and deep way patients with traumatic disorders, in addition to identifying essential peculiarities to guide health professionals towards treatment in the search for better quality of life for patients.

Abstract Objective To analyze associations between attempted suicide and childhood trauma. Methods A seven month comparative case-control study (28 subjects – patients with suicide attempt; 56 controls – patients without suicide attempt). The following instruments were used: Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), and Medical Outcomes Study (MOS). Results The group with suicide attempt had significantly higher scores for some variables: emotional abuse (p < 0.001), physical abuse (p < 0.001), emotional neglect (p < 0.001), and physical neglect (p < 0.001). Conclusions The results suggest that variables related to previous trauma may influence future suicide attempts. The adoption of preventive and therapeutic actions related to mistreatments during child development is a crucial factor in reduction of suicide risk.

Resumo Objetivo Verificar a associação entre os níveis de fator neurotrófico derivado do cérebro (brain-derived neurotrophic factor [BDNF]) e transtorno de estresse agudo (TEA) em pacientes que sofreram trauma físico. Métodos Os dados foram coletados em um hospital de emergência de Porto Alegre, Rio Grande do Sul, Brasil. Os participantes eram maiores de 18 anos, vítimas de trauma físico e estavam hospitalizados por um período mínimo de 48 horas. Um total de 117 pacientes hospitalizados que concordaram em participar da pesquisa foram agrupados de acordo com o turno de realização da coleta de sangue (38 sujeitos no turno da manhã e 79 sujeitos no turno da tarde), tiveram seus níveis de BDNF medidos e responderam a outros questionários. Os entrevistados também foram agrupados por idade em três faixas etárias: 18-30, 31-50 e 51-70 anos. Resultados Encontramos uma diferença significativa na distribuição de BDNF entre os turnos, sendo que o grupo da tarde apresentou níveis maiores de BDNF (U = 1906,5, p = 0,018). Houve diferença entre o grupo de 18-30 anos e o de 51-70 anos no turno da tarde (Umanhã = 1107, pmanhã = 0,575; Utarde = 7175, ptarde = 0,028). Conclusões A população cuja coleta ocorreu à tarde apresentou valores significativamente maiores de BDNF em relação à coleta do turno da manhã. Esta mesma população apresentou menores níveis dessa neurotrofina quando associada com os subtipos A1, A2 e A de TEA. É possível hipotetizar que os menores valores de BDNF aferidos na coleta do turno da manhã se devam a uma resposta ao ciclo circadiano do cortisol, cuja ação inibe a expressão de neurotrofinas séricas.

Abstract Objective To assess the association between brain-derived neurotrophic factor (BDNF) levels and acute stress disorder (ASD) in patients who have suffered physical trauma. Methods Data were collected at an emergency hospital in Porto Alegre, state of Rio Grande do Sul, southern Brazil. Participants were over 18 years of age, victims of physical trauma, and had been hospitalized for a minimum of 48 hours. A total of 117 hospitalized patients who agreed to participate in the research were grouped according to the shift in which blood was collected (38 subjects from the morning shift and 79 from the afternoon shift), had their BDNF levels measured and responded to other questionnaires. Respondents were further grouped by age into three ranges: 18-30, 31-50 and 51-70 years. Results We found a significant difference in the distribution of BDNF between the two shifts in which blood samples were collected, with the afternoon group having higher BDNF levels (U = 1906.5, p = 0.018). A difference was observed only between the 18-30 group and the 51-70 group in the afternoon shift (Umorning = 1107, pmorning = 0.575; Uafternoon = 7175, pafternoon = 0.028). Conclusions The population whose blood samples were collected in the afternoon showed significantly higher values of BDNF compared to those of the morning shift. This same population presented lower BDNF levels when associated with ASD subtypes A1, A2, and A. We hypothesize that the lower values of BDNF measured in the morning shift were due to a response to the circadian cycle of cortisol, whose action inhibits the expression of serum neurotrophins.

Resumo Introdução: A violência doméstica por parceiro íntimo contra as mulheres causa danos físicos e psicológicos às vítimas. A relevância deste tópico é indiscutível, e é necessário identificar em mais detalhe como essas mulheres sofrem violência, uma vez que esses fatores têm implicações clínicas consideráveis. Objetivo: Desenvolver uma versão em português do Módulo de Avaliação da Violência Doméstica, adaptado do Eixo I do Diagnóstico Psicodinâmico Operacionalizado (Operationalized Psychodynamic Diagnosis – OPD-2), considerando a validade de conteúdo e as características psicométricas. Método: A adaptação transcultural foi baseada nas diretrizes para o processo de adaptação transcultural de medidas de autorrelato. As entrevistas clínicas do OPD foram gravadas e transcritas. Essas entrevistas foram analisadas por dois juízes independentes treinados no OPD-2. Resultados: A amostra foi composta por 56 mulheres vítimas de violência doméstica, com idade média de 30,07 anos (desvio padrão = 9,65). A versão adaptada demonstrou validade de conteúdo e boas características psicométricas. A avaliação da equivalência semântica levou em consideração as referências psicodinâmicas, utilizando as mesmas ideias do instrumento original. A confiabilidade entre os juízes foi substancial (k = 0,63), e o alfa de Cronbach para a nova versão indica boa confiabilidade. Conclusão: O OPD-2 oferece um diagnóstico psicodinâmico da vítima que complementa o diagnóstico nosológico tradicional, particularmente no contexto de violência doméstica com a adaptação do Eixo I. Certos vieses poderiam ter sido prejudiciais aos aspectos deste estudo, mas foram controlados. O objetivo do estudo foi alcançado e o Módulo foi adaptado com sucesso para o português do Brasil. Os resultados estão alinhados com os do estudo original.

Abstract Introduction: Intimate partner domestic violence against women causes physical and psychological harm to victims. The relevance of this topic is indisputable and there is a need to identify in greater detail how these women experience violence, since these factors have considerable clinical implications. Objective: To develop a Portuguese version of the Module for Assessment of Domestic Violence, adapted from Axis I of the Operationalized Psychodynamic Diagnosis (OPD-2), considering content validity and psychometric characteristics. Method: Cross-cultural adaptation was based on guidelines for the process of cross-cultural adaptation of self-report measures. OPD clinical interviews were recorded and transcribed. These interviews were analyzed by two independent judges trained in the OPD-2. Results: The sample comprised 56 women who had been victims of domestic violence, with a mean age of 30.07 years (standard deviation = 9.65). The adapted version has content validity and good psychometric characteristics. Evaluation of semantic equivalence took into account the psychodynamic references, using the same ideas as the original instrument. Interexaminer reliability between the judges was substantial (k = 0.63) and Cronbach's alpha for the new version indicates good reliability. Conclusion: The OPD-2 offers a psychodynamic diagnosis of the victim that complements traditional nosological diagnosis, particularly in the context of domestic violence with the adaptation of Axis I. Certain biases could have been detrimental to aspects of this study, but they were controlled. The study objective was achieved and the Module was successfully adapted to Brazilian Portuguese. The results are in line with those of the original study.

Resumo Introdução O Diagnóstico Psicodinâmico Operacional (OPD-2) é uma ferramenta operacional de avaliação diagnóstica multiaxial e planejamento terapêutico. Esta revisão sistemática buscou analisar estudos empíricos que utilizassem o OPD como instrumento; além de identificar os estudos, foram verificados os tópicos e resultados de pesquisa que utilizaram empiricamente o OPD. Método Foram incluídos os artigos, dissertações e teses empíricas dos últimos cinco anos (2012 a 2017) que abordaram ou utilizaram o instrumento OPD. A estratégia de busca incluiu o cruzamento dos descritores “Operacionalizado e Psicodinâmico e Diagnóstico”, do Portal de Periódicos CAPES, nas bases de dados do PubMed, Google Scholar, ResearchGate, publicado em inglês, português ou espanhol nos últimos cinco anos. Resultados A busca resultou em um total de 189 artigos, mas apenas 20 foram incluídos. Os estudos selecionados trataram da validade e confiabilidade do instrumento, processo terapêutico e análise de resultados, avaliação de diferentes transtornos mentais e estudos comparativos com diferentes instrumentos ou técnicas. Um notável esforço científico no desenvolvimento de dados mais consistentes sobre o diagnóstico psicodinâmico. Conclusão Demonstrou-se que a OPD é uma ferramenta clínica essencial em relação à compreensão dimensional do sujeito e em pesquisas científicas. No entanto, o número de produções sobre o assunto ainda não é significativo, os métodos são diversos, mas os dados estão crescendo, como: a aplicabilidade em diferentes contextos, diferentes patologias, promover maior visibilidade com maior representatividade de profissionais que possuem conhecimento do instrumento.

Abstract Introduction The Operationalized Psychodynamic Diagnosis (OPD-2) is an operational multiaxial diagnostic assessment and treatment planning tool. This systematic review sought to analyze empirical studies that used the OPD as an instrument. In addition to identifying the studies, we analyzed the topics covered and the results of research that used the OPD empirically. Method Articles, dissertations and empirical theses that mentioned or used the OPD instrument in the last five years (2012-2017) were included in this review. The strategy included searching with combinations of the descriptors “Operationalized and psychodynamic and diagnosis” from the Portal de Periódicos CAPES on the PubMed, Google Scholar, and ResearchGate databases for work published in English, Portuguese or Spanish in the last five years. Results The search returned a total of 189 papers, but only 20 were included. The studies selected discussed the validity and reliability of the instrument, the therapeutic process and analysis of outcomes, assessment of different mental disorders, and also included studies comparing different instruments and techniques. Considerable scientific effort has evidently been dedicated to accumulating more consistent data on psychodynamic diagnosis. Conclusion It was demonstrated that the OPD is an essential clinical tool for dimensional comprehension of the subject and for scientific research. However, the number of publications on the subject is not yet significant and the methods employed are diverse. Nevertheless, there is a growing body of data on topics such as applicability in different contexts and to different pathologies, promoting greater visibility and with greater representativeness of professionals who have experience with the instrument.