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      La baraja del Joker: factores desencadenantes de la conducta agresiva en el paciente con afección pseudobulbar Translated title: The Joker's deck: factors triggering the aggressive behavior on a patient with a pseudobulbar affect

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          Abstract

          RESUMEN Introducción y objetivos: La trama del Joker nos muestra el surgimiento del antihéroe a partir de Arthur, un individuo con un trastorno llamado afectación pseudobulbar, con antecedentes de abandono y abuso físico severo y maltrato con probable traumatismo encefálico, que vive sin vínculos sociales, carente de afecto, como cuidador primario de una familiar dependiente enteramente de él; el protagonista se mueve en un ambiente adverso, hostil en el que la sociedad que espera que él se comporte como si no tuviera ningún trastorno. un comportamiento normal”. Material y métodos: Sin recursos y rechazado por su medio, resulta colateralmente afectado por la reducción de presupuesto para terapia y medicamentos. Resultados: En un momento decisivo, convergen los diferentes detonantes de sus manifestaciones psicopatológicas que dan paso a la transformación del joker y paradójicamente lo llevarán a ser aceptado socialmente. Joker nos invita a reflexionar sobre la importancia de a los programas de salud mental, los valores humanos, la cultura de la Paz y el buen trato como pilares fundamentales para promover la salud mental en la sociedad. Conclusiones: El presente artículo tiene por objetivo el revisitar la fisiopatología de la afección pseudobulbar y establecer los aspectos clínicos, familiares, ambientales y socioculturales potencialmente asociados a la conducta destructiva de Joker

          Translated abstract

          ABSTRACT Introduction: The plot of the Joker shows us the emergence of the antihero from Arthur, an individual with a pseudobulbar disorder, a history of abandonment and severe physical abuse and abuse with probable brain trauma, living without social ties, lacking affection, as a primary caregiver of a relative dependent entirely on him; the protagonist moves in an adverse, hostile environment in which the society that expects him to behave as if he had no disorder. normal behavior. Material and methods: Without resources and rejected by its means, it is collaterally affected by the reduction of budget for therapy and medications. Results: At a decisive moment, the different triggers of his psychopathological manifestations converge that give way to the transformation of the joker and paradoxically lead him to be socially accepted. Joker invites us to reflect on the importance of mental health programs, human values, the culture of Peace and good treatment as fundamental pillars to promote mental health in society. Conclusions: This article aims to revisit the pathophysiology of the pseudobulbar condition and establish the clinical, family, environmental and sociocultural aspects potentially associated with Joker's destructive behavior.

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          Most cited references22

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          Social determinants of mental health

          A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk. The poor and disadvantaged suffer disproportionately, but those in the middle of the social gradient are also affected. It is of major importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family building and working ages, and through to older age. Action throughout these life stages would provide opportunities for both improving population mental health, and for reducing risk of those mental disorders that are associated with social inequalities. As mental disorders are fundamentally linked to a number of other physical health conditions, these actions would also reduce inequalities in physical health and improve health overall. Action needs to be universal: across the whole of society and proportionate to need. Policy-making at all levels of governance and across sectors can make a positive difference.
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            Stress duration modulates the spatiotemporal patterns of spine formation in the basolateral amygdala.

            It has long been hypothesized that morphological and numerical alterations in dendritic spines underlie long-term structural encoding of experiences. Here we investigate the efficacy of aversive experience in the form of acute immobilization stress (AIS) and chronic immobilization stress (CIS) in modulating spine density in the basolateral amygdala (BLA) of male rats. We find that CIS elicits a robust increase in spine density across primary and secondary branches of BLA spiny neurons. We observed this CIS-induced spinogenesis in the BLA 1 d after the termination of CIS. In contrast, AIS fails to affect spine density or dendritic arborization when measured 1 d later. Strikingly, the same AIS causes a gradual increase in spine density 10 d later but without any effect on dendritic arbors. Thus, by modulating the duration of immobilization stress, it is possible to induce the formation of new spines without remodeling dendrites. However, unlike CIS-induced spine formation, the gradual increase in spine density 10 d after a single exposure to AIS is localized on primary dendrites. Finally, this delayed induction of BLA spinogenesis is paralleled by a gradual development of anxiety-like behavior on the elevated plus-maze 10 d after AIS. These findings demonstrate that stressful experiences can lead to the formation of new dendritic spines in the BLA, which is believed to be a locus of storage for fear memories. Our results also suggest that stress may facilitate symptoms of chronic anxiety disorders like post-traumatic stress disorder by enhancing synaptic connectivity in the BLA.
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              Cities and Mental Health

              More than half of the global population currently lives in cities, with an increasing trend for further urbanization. Living in cities is associated with increased population density, traffic noise and pollution, but also with better access to health care and other commodities.
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                Author and article information

                Journal
                rmc
                Revista de Medicina y Cine
                Rev Med Cine
                Universidad de Salamanca (Salamanca, Salamanca, Spain )
                1885-5210
                September 2020
                : 16
                : 3
                : 165-174
                Affiliations
                [1] Mérida Yucatán orgnameUniversidad Marista de Mérida Mexico
                Article
                S1885-52102020000300004 S1885-5210(20)01600300004
                10.14201/rmc2020163164174
                cb17f688-d4d0-4ffa-bf81-7cd32d1a32e6

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

                History
                : 30 October 2019
                : 02 December 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 10
                Product

                SciELO Spain

                Categories
                Originales

                afección pseudobulbar,psicopatología,mental health,pseudobulbar affect,salud mental,physical abuse,abuso físico,physchopathology

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