Adolescence and borderline personality disorder: characterization of affective bonds
SciELO - Scientific Electronic Library Online father": ethical considerations Workshop addressing sexuality and dating directed to . O adolescente borderline, assim, busca um lugar de acolhimento cada vez mais difícil de .. algumas pesquisas discutem o fato de que um significativo percentual dos pacientes. ver capitulo puente viejo online dating SEE PROFILE HERE - NICK "LANNIE" >> >>>>>>>> Click Here To achar porcentagem online dating. 5 nov. Por esta razão, a busca de um “zero-day” falha de segurança no A verdade é que uma pequena porcentagem de sites direcionados.
Highvoltage stimulation of the ventral-most contacts, in the vicinity of the nucleus accumbens, produced mild apathy and depression, whereas high-voltage stimulation at the dorsal-most contacts, in the body of the capsule, produced hypomania. These effects took hours to days to be apparent. Middle contact stimulation, which helped tics the most, generated a stable euthymic state.
Our stimulation adjustments were aimed to attain the optimal tic reduction while maintaining a euthymic state. Because both agitated hypomania and depression were uncomfortable for the patient, and because they posed a theoretical risk of self-injurious behavior, she was not left at such settings for any length of time.
Hence, the patient only spent several days at each of the altered mood states. Stimulation never induced suicidal thoughts or significant disruption of work or home life.
On turning the stimulator off, these effects disappeared over minutes to hours. In several instances, the pulse generator accidentally was turned off.
In another instance, the patient experienced a broken connecting wire because of the tics, which was subsequently replaced.
In both episodes, the patient noted that her symptoms worsened considerably and requested an assessment of the stimulators. Several studies have suggested that symptoms of TS stem from dysregulation of limbic-striatal circuits and circuits connecting the orbitofrontal cortex to the medial thalamic nuclei 3, 4, 8.
- Síndrome de Tourette - Documentação Internet
- Percentage Calculator
- Recent Posts
High-frequency stimulation of these AIC tracts may produce an effect similar to ablative lesions 6. Unlike ablation, however, DBS carries the benefit of being adjustable and is less likely to produce the cognitive impairment previously reported with permanent lesions in this area 8, 9. Given that extensive frontothalamic projections pass through the AIC, DBS in this area indeed may provide a beneficial effect by influencing a similar circuitry. Although our clinical outcomes are more modest than those reported for thalamic DBS, AIC stimulation may prove more beneficial in patients in whom OCD is a more prominent component 1, 5, 7.
Hence, considerably more study is warranted to determine the best site for stimulation in the surgical therapy of TS. Reconstructed electrode trajectory superimposed on preoperative coronal MRI scan.
Activity in the medial and lateral electrodes corresponds to the caudate and putamen, respectively. Tracings on the top of each inset correspond to neuronal activity recorded from the medial electrode, whereas tracings on the bottom of each inset correspond to activity recorded from the lateral electrode. Coronal T1-weighted postoperative MRI scan illustrating placement of bilateral deep brain stimulating electrodes.
The electrodes traverse the anterior limb of the internal capsule and terminate in the vicinity of the nucleus accumbens arrowheads. Stimulation of the upper leads located in the AIC may have a direct impact on limbic projections involved in mood and anxiety, whereas stimulation of lower leads situated in the vicinity of the nucleus accumbens may disrupt signals known to be involved in pleasure and goaloriented behavior.
These findings suggest that similar DBS placements may allow for the rapid alteration of mood in patients with unipolar or bipolar affective disorder. Because treatment for the latter usually requires medications with more disabling side effects, and because bipolar mood states can switch rapidly, alternatives to current therapies are needed 2. Bipolar mood disorder may be especially suited to treatment with DBS electrodes, which can be adjusted rapidly as moods change. The patient experienced a moderate and sustained improvement in her symptoms that provided significant benefit over prior medical therapies.
The opportunity to influence different regions systematically also provided a unique insight into the functioning of the AIC and ventral striatum and their possible usefulness in the treatment of affective disorders.
BlitzResults: Interactive educational website with focus on consumer topics & health
Anderson D, Ahmed A: Treatment of patients with intractable obsessivecompulsive disorder with anterior capsular stimulation: Novel alternatives and supplements to lithium and anticonvulsants for bipolar affective disorder. J Clin Psychiat Toward a neurobiology of obsessive-compulsive disorder. N Engl J Med Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: Relevance of the right hemisphere.
Longterm electrical capsular stimulation in patients with obsessive-compulsive disorder. Bilateral anterior capsulotomy for refractory obsessive-compulsive disorders. Stereotact Funct Neurosurg Temel Y, Visser-Vandewalle V: Surgery in Tourette syndrome.Como-Aprender calcular porcentagem utilizando regra de três
Chronic bilateral thalamic stimulation: A new therapeutic approach in intractable Tourette syndrome—Report of three cases. This target has been used for patients with obsessive-compulsive disorder OCD. At 18 months, the frequency and severity of tics were reduced to some extent, reappearing when the stimulators were accidentally turned off and when one of the cables broke.
The authors have also reported that stimulation through the bottom and upper contacts induced hypomania and depression, respectively, both improving when the electrode contacts were changed.
Various targets have been proposed to treat Tourette syndrome 1. To date, DBS has been used successfully in the medial part of the thalamus with excellent results.
Anecdotal reports in meetings have also shown that the globus pallidus internus and externus may be effective targets to treat the tics that characterize the disease. A study to evaluate these targets in the treatment of Tourette syndrome is needed. Clement Hamani Andres M. Lozano Toronto, Ontario, Canada 1. DBS surgery is being increasingly applied for indications beyond intractable movement disorders.
These emerging applications include DBS for the treatment of intractable epilepsy, cluster headaches, neuropathic pain, OCD, major depression, and Tourette syndrome. The authors report an interesting case of a Tourette syndrome patient who received implants of DBS electrodes in the ventral anterior internal capsule bilaterally.
They report two consistent effects from their chronic stimulation: The reduction in tic frequency and severity observed is less than that reported by previous studies using the thalamic target for Tourette syndrome 2. More patients need to be studied and long-term safety and efficacy studies need to be performed to determine whether the internal capsule is a viable target for the tics associated with Tourette syndrome.
In addition to the effects on motor tics, the internal capsule target seems to have a consistent and lasting effect on mood and OCD. In the past several years, the emergence of DBS technology has resulted in renewed interest in the surgical treatment of refractory psychiatric and parapsychiatric disorders. With the exception of the midline thalamus, most recent studies of DBS for psychiatric disorders have concentrated on the anterior internal capsule as modeled by the stereotactic anterior capsulotomy.
As the authors point out, the nucleus accumbens lies at the nexus between the frontothalamic and limbic projections. Modulation of activity in this region could very well have significant effects on mood and anxiety, which in turn could be of benefit in many refractory psychiatric diseases. Overall, this report provides additional insight into the region of the internal capsule and nucleus accumbens as a potential target for anxiety, mood, and potentially Tourette syndrome tics. Kopell Milwaukee, Wisconsin Ali R.
Rezai Cleveland, Ohio 1. The authors have published a case report that is interesting in several aspects. It is, as far as I know, the first published case demonstrating treatment of Tourette syndrome with electrical stimulation of the anterior limbs of the internal capsule.
They have described moderate effects of anterior capsular stimulation in a patient with this disorder. It is evident that further study beyond this one case report is necessary before anterior capsular stimulation can be used as a routine treatment for Tourette patients. Using microelectrodes, they have also screened an area in which the neuronal activity is still not well known. Moreover, they have observed stimulation-induced changes in mood.
The currently ongoing trials with anterior capsular stimulation for major depression, which are based in part on that trial, seem to point in the same direction. And last but not least, Mayberg et al. Bart Nuttin Leuven, Belgium 1.
Deep brain stimulation for treatment-resistant depression. Assigning Value Based on Neuronal Activity the harvard mahoney neuroscience institute letter F or more than 2, years, Buddhist monks have known that practicing meditation leads to increased inner strength, calmness and selfawareness, strengthened contact with subconscious feelings and thoughts, and greater spiritual growth. Now, Harvard Medical School scientists have found that regular meditation can also alter the structure of our brains.
A team led by Sara Lazar, Ph. Using magnetic resonance imaging MRIDr. While previous research with monks has demonstrated that long-term meditation may lead to altered brain wave patterns, Dr. In fact, they found that brain regions associated with attention, interoception sensitivity to stimuli originating inside the bodyand sensory processing were thicker in the meditation participants than they were in matched controls.
These areas included the prefrontal cortex, which is responsible for planning complex cognitive behaviors, and the right anterior insula, which is associated with bodily sensations and emotions.
Unlike Tibetan Buddhist monks, whose lives are devoted to the practice of meditation, practitioners in the United States typically meditate just 30 to 40 minutes daily, incorporating the practice into their busy work and family lives.
The participants in Dr. Two of the study subjects were full-time meditation instructors, two were part-time yoga or meditation teachers, and the remainder were professionals with varied careers.
On average, they had nine years of meditation practice, averaging six hours of meditation Growing the Brain through Meditation ON THE BRAIN continued on page 7 The insula, circled in green on the left, and the prefrontal areas, circled in blue on the right, were thicker in meditators. What these authors all had in common, in addition to incredible talent, is a neurological condition called hypergraphia, the overpowering desire to write.
A surprising number of them also suffered from mood disorders, including manic depression or temporal lobe epilepsy, both of which are associated with hypergraphia. What goes on in the mind of a creative genius that turns a fairly commonplace task — writing — into such a driven compulsion? These include temporal lobe epilepsy a neurological condition in which an individual has seizures during which he may experience heightened senses and emotionsbipolar disorder and depression.
Some studies show that nearly 70 percent of poets have a mood disorder. Flaherty, the drive to write is more important than talent in producing creative work. Researchers have argued that composers like Beethoven and Mozart have produced the greatest works because they constantly composed music.
Teresa Amabile of the Harvard Business School found that intrinsic motivation e. Drive and motivation are regulated by the limbic system and are more related to the temporal lobe than is talent. You have to ask what the motivation is. Ernest Hemingway and William Faulkner, arguably two of the The Creative Muse greatest 20th century authors, were also prodigious drinkers. One small study of creative writers including such luminaries as Philip Roth, Kurt Vonnegut and Robert Lowell found that 80 percent had episodes of affective disorders such as bipolar disorder.
Early in his career, he was a great writer, but his writing failed the deeper he sunk into alcoholism. Flaherty says hypergraphia can be both a miracle and a disease. Also, because of how strange it felt to be suddenly propelled into a creative state by what were probably postpartum biochemical changes. This neurological disorder, which usually begins in early childhood or adolescence, is characterized by both multiple motor tics and at least one or more vocal tics, though not necessarily at the same time.
Some TS patients have more complex tics such as pulling at clothing and touching other people or objects. While most tics are mild, TS is a chronic condition. Symptoms typically wax and wane. Traditionally, TS patients have been treated with a variety of neuroleptic, antidepressant or antianxiety medications to quell the motor and vocal tics commonly associated with the disorder.
These, however, often provide only partial relief. Faculty members at Harvard Medical School are among only a handful of clinicians using a behavioral therapy called habit reversal HR that teaches TS patients to implement movements that are incompatible with tics to reduce their occurrence.
Awareness training and competing responses In the s, psychologists Nathan Azrin and R. Gregory Nunn developed a technique for treating nervous habits such as tics, stammering and skin picking. They called this technique habit reversal. Certain tics are active; others are latent. We start addressing these with habit reversal. During awareness training, patients are taught to recognize the initial sensation, or premonitory urge, that leads to a tic.
Then, the patient and clinician develop a competing response, a behavior opposite that of the tic. A competing response works in the following way: Through habit reversal, the patient would be taught a slight outward rotation of his arm as a competing response and to hold that competing response until the tic urge is gone.
The frequency and intensity of tics decreases with the consistent implementation of the competing response. Psychological education about tics and relaxation and exercise techniques are also used to treat TS. The researchers found that patients who were treated with HR showed greater reductions in tic severity than those who underwent supportive psychotherapy. Further, this reduction in tic severity remained relatively stable in these patients during a six-month follow-up.
One hundred twenty adults participating in the study are assigned to CBIT or a structured supportive psychotherapy program. Following several therapy sessions and follow-up assessments, the researchers will measure the change in tic severity in the patients. Other collaborating sites are conducting a similar study in children with TS. Deckersbach and others is leading to greater understanding of the effectiveness of HR in treating and controlling chronic tics and Tourette syndrome — and giving patients an alternative to often ineffective medications.
We buy foods that satisfy our tastes or are healthy for our bodies. We assign a value to each available item. Padoa-Schioppa and John Assad, Ph.
In one trial, the monkeys chose between one drop of grape juice which they prefer and one drop of peppermint tea; in another, they chose between one drop of grape juice and two drops of peppermint tea, and so on. PadoaSchioppa says there was a trade-off that indicates the value the monkeys assign to the juice type and quantity. Based on the choices the monkeys made, the researchers correlated the activity of neurons in the OFC directly with the value assigned to the two types of juice.
Neurons of one class encode the variable chosen value. Assigning Value Based on Neuronal Activity activity of neurons encoding the chosen value is correlated with the value chosen by the monkey, independently of the juice type. Their activity is correlated with the value of that particular juice only. Figure Activity of one OFC neuron encoding the chosen value. In this session, the monkey chose between variable quantities of grape juice juice A and peppermint tea juice B.
The xaxis represents different offer types. American Journal of psychotherapy, 48, Childhood antecedents of Adolescent Personality Disorders.
Journal of Consulting and Clinical Psychology, 70, Borderline disorders in children and adolescents: The concept, the diagnosis and the controversies. Bulletin of the Menninger Clinic, 58, The psychodynamics of borderline personality disorder: A view from developmental psychophathology. Etiology of borderline personality disorder: Disentangling the contributions of intercorrelated antecedents. Journal of Nervous and Mental Disease, The borderline personality diagnosis in adolescents: Gender differences and subtypes.
Journal of Child Psychology and Psychiatry, 46, Sobre o alcance e os limites do recalcamento nas chamadas "psicopatologias da contemporaneidade". Study of 35 borderline cases. Factor structure of the borderline personality inventory in adolescents.
European Journal of Psychological Assessment, 20, Borderline personality features in childhood: A short-term longitudinal study. Personality organizations, psychiatric severity, and self and object representations. Psychoanalytic Psychology, 21, Recuperado em 31 agostode http: III the persistence of dual psychic reality in borderline patients.
International Journal of Psychoanalysis, 81, The developmental roots of borderline personality disorder in early attachment relationships. Psychoanalytic Inquiry, 23, Family interaction and the development of borderline personality disorder: The borderline patient's intolerance of aloneness: Insecure attachments and therapist availability. American Journal of Psychiatry, Social Work in Mental Health, 6, Parents' emotional neglect and overprotection according to the recollections of patients with borderline personality disorder.
Relationships between adolescents' attachment styles and family functioning. Developmental atecedents of Borderline Personality Disorder.
Comprehensive Psychiatry, 45, Borderline personality disorder and the search for meaning: Australian and New Zealand Journal of Psychiatry, 37, Disorganized attachment and Borderline Personality Disorder: Borderline personality exists in children under twelve.
Revista de la Associacion Psicoanalitica de Buenos Aires, 17, Toward a developmental psychopathology approach to borderline personality disorder. The implications of attachment theory and research for understanding borderline personality disorder. Expanding the concept of unresolved mental states: Categories of response to reunion with the parents at age 6: Predictable from infant attachment classifications and stable over a month period.