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      Estudo exploratório com indivíduos com depressão por meio do Rorschach, Sistema Compreensivo Translated title: Un estudio exploratorio en los pacientes con depresión por el Sistema Comprensivo del Rorschach Translated title: An exploratory study in patients with depression by the Rorschach Comprehensive System

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          Abstract

          Realizou-se estudo exploratório com indivíduos diagnosticados com depressão. Participaram 79 adultos caracterizados como: G1, depressivos unipolares (n=38); G2, depressivos com deslizes cognitivos (n=25); e G3, não depressivos com transtornos mentais (n=16). A análise descritiva e comparativa entre grupos considerou as seguintes variáveis do Rorschach: capacidade de produção, R; foco de atenção, Lambda; tipo de adaptação/vivência, EB; índice de depressão, DEPI. Para diagnóstico, usou-se entrevista Clínica Psiquiátrica, SCID-I e II. Médias de R encontradas foram: G1=24,0; G2=20,0; G3=26,0. Médias de Lambda: G1=0,96; G2=1,21; G3=1,10. O EB tipo ambigual predominou nos grupos. Diferenças no DEPI para o G1 foram: sombreado vista [FV+VF+V>0], p=0,016; cor acromática [SumC’>2], p=0,009; índice de egocentrismo [EGO<.33], p=0,0002. Os dados indicaram autocrítica negativa, baixa autoestima e sofrimento elevado no grupo de depressivos unipolares. Os depressivos com deslizes cognitivos apresentaram foco de atenção mais restrito. Todos os grupos demonstraram boa capacidade de produção, entretanto com limitação crônica de algumas habilidades adaptativas.

          Translated abstract

          Estudio exploratorio se llevó a cabo en los pacientes diagnosticados con depresión. Setenta y nueve adultos participaron caracterizados como: [G1] depresivo unipolar (n=38); [G2] con resbalones cognitivos de depresión (n=25), y [G3] no deprimidos con trastornos mentales (n=16). El análisis descriptiva y comparativa entre grupos consideraron variables de Rorschach: la capacidad de producción, R; el enfoque de la atención, lambda; Tipo de Vivencia, EB; y el índice de depresión, DEPI. Para el diagnóstico fueron utilizada la entrevista Clínica Psiquiátrica, SCID-I y II. Las medias de R fueron: G1=24,0; G2=20,0; G3=26,0. Las medias de Lambda: G1=0,96; G2=1,21; G3=1,10. El tipo EB ambigual predominó en todos los grupos. Las diferencias en la DEPI para G1 fueron sombreadas vista [FV+VF+V>0], p=0,016; color acromático [SumC’>2], p=0,009; y el egocentrismo [EGO<.33], p=0,0002. Los datos indicaron autocrítica y auto-estima baja y el sufrimiento mayor en el grupo de depresión unipolar. La depresión con resbalones cognitivas mostró más estrecho foco de atención. Todos los grupos demostraron adecuada capacidad de producción, sin embargo la limitación crónica de algunas habilidades de adaptación.

          Translated abstract

          An exploratory study was conducted in patients diagnosed with depression. Seventy-nine adults participated characterized as: G1, unipolar depressive (n=38); G2, with depressive cognitive slips (n=25), and G3, nondepressed with mental disorders (n=16). A descriptive and comparative analysis between groups considered Rorschach variables: production capacity, R; focus of attention, lambda; EB style and the Depression Index, DEPI. The Structured Clinical Interview for DSM, SCID-I and II was used for the assessment of the sample. Means of R were: G1=24.0, G2=20.0, G3=26.0. Averages for Lambda: G1=0.96, G2=1.21, G3=1.10. The EB ambigual type prevailed in all the groups. Differences in DEPI for G1 were: shaded view [FV+VF+V>0], p=0.016; achromatic color [SumC’>2], p=0.009, and egocentricity index [EGO<.33], p=0,0002. The data indicated negative self-criticism, low selfesteem and suffering higher in the group of unipolar depressive. The depression with cognitive slips showed more restricted focus of attention. All groups demonstrated adequate production capacity, however chronic limitation of adaptive skills.

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          The validity of individual Rorschach variables: Systematic reviews and meta-analyses of the comprehensive system.

          We systematically evaluated the peer-reviewed Rorschach validity literature for the 65 main variables in the popular Comprehensive System (CS). Across 53 meta-analyses examining variables against externally assessed criteria (e.g., observer ratings, psychiatric diagnosis), the mean validity was r = .27 (k = 770) as compared to r = .08 (k = 386) across 42 meta-analyses examining variables against introspectively assessed criteria (e.g., self-report). Using Hemphill's (2003) data-driven guidelines for interpreting the magnitude of assessment effect sizes with only externally assessed criteria, we found 13 variables had excellent support (r ≥ .33, p 50), 17 had good support (r ≥ .21, p .05), and 12 had no construct-relevant validity studies. The variables with the strongest support were largely those that assess cognitive and perceptual processes (e.g., Perceptual-Thinking Index, Synthesized Response); those with the least support tended to be very rare (e.g., Color Projection) or some of the more recently developed scales (e.g., Egocentricity Index, Isolation Index). Our findings are less positive, more nuanced, and more inclusive than those reported in the CS test manual. We discuss study limitations and the implications for research and clinical practice, including the importance of using different methods in order to improve our understanding of people.
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            Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders.

            Until recently it was believed that no more than 1% of the general population has bipolar disorder. Emerging transatlantic data are beginning to provide converging evidence for a higher prevalence of up to at least 5%. Manic states, even those with mood-incongruent features, as well as mixed (dysphoric) mania, are now formally included in both ICD-10 and DSM-IV. Mixed states occur in an average of 40% of bipolar patients over a lifetime; current evidence supports a broader definition of mixed states consisting of full-blown mania with two or more concomitant depressive symptoms. The largest increase in prevalence rates, however, is accounted for by 'softer' clinical expressions of bipolarity situated between the extremes of full-blown bipolar disorder where the person has at least one manic episode (bipolar I) and strictly defined unipolar major depressive disorder without personal or family history for excited periods. Bipolar II is the prototype for these intermediary conditions with major depressions and history of spontaneous hypomanic episodes; current evidence indicates that most hypomanias pursue a recurrent course and that their usual duration is 1-3 days, falling below the arbitrary 4-day cutoff required in DSM-IV. Depressions with antidepressant-associated hypomania (sometimes referred to as bipolar III) also appear, on the basis of extensive international research neglected by both ICD-10 and DSM-IV, to belong to the clinical spectrum of bipolar disorders. Broadly defined, the bipolar spectrum in studies conducted during the last decade accounts for 30-55% of all major depressions. Rapid-cycling, defined as alternation of depressive and excited (at least four per year), more often arise from a bipolar II than a bipolar I baseline; such cycling does not in the main appear to be a distinct clinical subtype - but rather a transient complication in 20% in the long-term course of bipolar disorder. Major depressions superimposed on cyclothymic oscillations represent a more severe variant of bipolar II, often mistaken for borderline or other personality disorders in the dramatic cluster. Moreover, atypical depressive features with reversed vegetative signs, anxiety states, as well as alcohol and substance abuse comorbidity, is common in these and other bipolar patients. The proper recognition of the entire clinical spectrum of bipolarity behind such 'masks' has important implications for psychiatric research and practice. Conditions which require further investigation include: (1) major depressive episodes where hyperthymic traits - lifelong hypomanic features without discrete hypomanic episodes - dominate the intermorbid or premorbid phases; and (2) depressive mixed states consisting of few hypomanic symptoms (i.e., racing thoughts, sexual arousal) during full-blown major depressive episodes - included in Kraepelin's schema of mixed states, but excluded by DSM-IV. These do not exhaust all potential diagnostic entities for possible inclusion in the clinical spectrum of bipolar disorders: the present review did not consider cyclic, seasonal, irritable-dysphoric or otherwise impulse-ridden, intermittently explosive or agitated psychiatric conditions for which the bipolar connection is less established. The concept of bipolar spectrum as used herein denotes overlapping clinical expressions, without necessarily implying underlying genetic homogeneity. In the course of the illness of the same patient, one often observes the varied manifestations described above - whether they be formal diagnostic categories or those which have remained outside the official nosology. Some form of life charting of illness with colored graphic representation of episodes, stressors, and treatments received can be used to document the uniquely varied course characteristic of each patient, thereby greatly enhancing clinical evaluation.
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              Confiabilidade da "Entrevista Clínica Estruturada para o DSM-IV - Versão Clínica" traduzida para o português

              OBJETIVOS: Verificar a confiabilidade da "Entrevista Clínica Estruturada para o DSM-IV - Versão Clínica (SCID-CV)" traduzida para o português. MÉTODOS: Foram submetidos, a duas entrevistas independentes (teste-reteste), 45 pacientes psiquiátricos em seguimento no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP/USP). Os dados foram analisados pelo Coeficiente Kappa (K). RESULTADOS: O Kappa ponderado foi excelente (Kw=0,83). A confiabilidade foi estatisticamente significante em transtorno do humor (K=0,87); transtornos psicóticos (K=0,90); transtornos relacionados ao uso de substância (K=0,76); transtornos de ansiedade (K=0,61); e nas categorias diagnósticas específicas analisadas, exceto em agorafobia sem história de transtorno do pânico (K=-0,04). CONCLUSÕES: A SCID-CV traduzida e adaptada para o português apresenta, em geral, boa confiabilidade, mas a ausência de questões e critérios diagnósticos específicos no próprio instrumento em diagnósticos, como agorafobia sem história de transtorno de pânico, diminuiu sua confiabilidade.
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                Author and article information

                Journal
                avp
                Avaliação Psicológica
                Aval. psicol.
                Universidade São Francisco; Pós-Graduação Stricto Sensu em Psicologia (Campinas, SP, Brazil )
                1677-0471
                2175-3431
                August 2014
                : 13
                : 2
                : 157-166
                Affiliations
                [02] orgnameUniversidade Federal de São Paulo
                [01] orgnameUniversidade Metodista de São Paulo
                Article
                S1677-04712014000200003 S1677-0471(14)01300200003
                a7e2f69f-62c1-4ae4-895c-d1bb7765fbeb

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : March 2013
                : December 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 10
                Product

                SciELO Periódicos Eletrônicos em Psicologia

                Categories
                Artigos

                teste de rorschach,rorschach test,psychological assessment,depression,avaliação psicológica,depressão,prueba de rorschach,evaluación psicológica,depresión

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