Introduction

Joseph Pratt, a sanatorium doctor, at the beginning of the 20th century began to organize groups of patients in order to transmit information about their illness, observing that those who came had a better evolution. In the twenties, Jacob L. Moreno, would make the leap towards mental health, transferring the group format to the treatment of mental disorders. At the same time, Lazell and Marsh began to carry out psychoeducational groups with admitted schizophrenic patients.

Objectives

Present experience of a psychotherapeutic group in a brief psychiatry hospitalization unit.

Methods

Non-directional, voluntary group, with daily frequency and 30 minutes duration. Between 8-15 patients participated. Participation in the group required compliance with 2 rules: respecting word turns and speaking from one's own experience. The sessions were organized in three parts, 1. Opening of the group: the rules are remembered and we welcome new patients. 2. Group: dialogue between patients 3. Group closure: summary of the session and dismissal of discharge patients.

Results

The following topics were addressed: - The experience of admission; traumatic vs restorative. - The difficulties they expected to encounter after discharge. - Aspects related to family bonding, between equals and couples. As difficulties we find: - The heterogeneity in the symptoms of the patients. - Voluntary participation in the group. - Conflicts reactive to non-compliance with the rules.

Conclusions

Group therapies in brief hospitalization units have great therapeutic potential.

Introduction

Patients with dissociative identity disorder (DID) present two or more identities, where one of them is the main one. Although it is a widely questioned diagnosis, it is currently found in the main DSM-5 and ICD-10 diagnostic manuals.

Objectives

Present a case of dissociative identity disorder.

Methods

46-year-old woman who attended the CSM referred for her MAP due to anxiety-depressive symptoms. Throughout the interviews the patient brings up to 4 identities with alterations in memory, consciousness, multiple dissociative symptoms, sound thinking, constant fluctuations in mood. She is separated, has two children, takes care of them, although she is not able to maintain work functionality.

The patient is seen once a week for 45 minutes. Psychotherapeutic treatment is carried out, the objective of which is to establish a safe therapist-patient bond to favor the integration of their parts, and pharmacological treatment, which was carried out with haloperidol, lorazepam and desvenlafaxine.

Results

Throughout sessions, the anxious symptoms diminished, being able to carry out psychotherapeutic work. Dissociative symptoms were slightly reduced, partially integrating some of the identities. There was a slight stabilization in mood and decrease in psychotic symptoms.

Conclusions

There is no well-established treatment for DID. Combined therapy (psychotherapy and pharmacological) may be an option for these patients. The therapeutic framing of the sessions, working the link, and the low-dose antipsychotic treatment were favorable.

Introduction

Perinatal grief is the reaction to the death of a loved one in the perinatal period (according to the WHO, it ranges from 22 weeks of gestation to the 1st week of postnatal life). Despite the fact that perinatal grief presents a set of distinctive characteristics, it is not recognized as a differentiated entity in the main diagnostic manuals (DSM-5 and ICD-11). There are a number of characteristics that make perinatal grief a different grief reaction.

Characteristics that make perinatal grief a different grief reaction:
General characteristics: Proximity between the beginning and the end of life, the lack of religious rituals that legitimize the loss.

Physiopathological characteristics; The gestational hormone increase act in the brain favoring emotional bonding with the child and facilitating care, sustained modifications in the gabaergic, endorphinic and nitrinergic synapses in the mothers' brains. Increased physical activity of the fetus during the third trimester increases the mother's basal metabolism and changes her emotional reaction.

Clinical characteristics; feelings of guilt, loneliness and detachment, irritability, dissociative symptoms, concern dead son and angry reactions.

Objectives

Search for the specific characteristics of perinatal grief and the importance of its therapeutic approach.

Methods

Literature review using pubmed database and scientific dissemination articles.

Results

Between 10 and 50% of mothers who suffer perinatal grief develop depression disorder, 50% have anxiety disorders that usually reappear with the possibility of a new pregnancy, and between 5 and 25% are diagnosed with post-traumatic stress disorder.

Conclusions

Perinatal grief has characteristics that differentiate it from other grief reactions; mental health professionals must attend to and understand these specificities in order to attend it.

Introduction

.Ayahusca has potential therapeutic beneffits.

Objectives

Expose the potential beneffits of ayahuasca from neuropharmacology and clinical existing evidence.

Methods

A literature review was carried out in the databases pubmed, clinical key and texts of scientific dissemination.

Results

There´s scientific literature about the potential therapeutic use of ayahuasca in dependencies, anxiety symtoms and depression, near death experiences and terminal illnesses. Possible benefit is postulated in impulsivity and personality disorders. It induces an introspective state, triggered by thoughts, emotions and autobiographical memories, which promotes reflection on personal issues, allowing new perspectives on certain life issues. It is common for users to describe it as analogous to a psychotherapeutic intervention. 5HTA2 agonists stimulate the expression of genes that encode transcription factors such as c-fos, egr 1, egr 2 and brain-derived neurotrophic factor (BDNF), which influence neuronal plasticity and are associated with cognitive aspects such as memory and attention. MAOIs and 5HT2A agonism have anxiolytic and antidepressant effects. Sigma -1 agonism promotes neuroplasticity. Decrease and remission in the consumption of alcohol and cocaine has been reported in patients with abuse and dependence. There has been significant decrease in depressive symptomatology, in observational studies, cases and controls and double blind compared with placebo. Improvement in different domains measured with mindfulness scales, similar to those observed in meditators, suggests an association between mindfulness techniques and experiences with ayahuasca.

Conclusions

There is existing evidence about potential therapeutical uses of ayahuasca. More studies are needed with biger samples, to establish it´s clinical use.

Introduction

Patients with dissociative identity disorder (DID) present two or more identities. Although it is a widely questioned diagnosis, it is currently found in the main DSM-5 and ICD-10 diagnostic manuals. So far there is no standard psychopharmacological treatment for people with this pathology.

Objectives

Describe the pharmacological treatment associated with the clinical evolution of a patient with DID.

Methods

Follow-up was carried out in a mental health center for a year, undergoing psychopharmacological and psychotherapeutic treatment. The information is taken from the medical history.

Results

The patient presents with anxious and depressive symptoms. She was referred from primary care with 50mg sertraline without response. Dose was increased to 100mg without response. New management started with desvenlafaxine 100mg, associated with lorazepam, partially reducing the symptoms. Later, the patient presented self-referentiality, sounding of thought, began to describe frequent memory losses and a rebound in anxiety-depression symptoms, increasing the dose of desvenlafaxine to 200mg and introducing haloperidol to 1.5mg. Three months later, she presented showing another identity, active, aggressive, pythiatic, without evident anxious symptoms that she previously presented in a marked way. Desvenlafaxine was adjusted to 100mg and haloperidol to 0.5mg every 12 hours. The patient evolved favorably, decreasing anxiety, depressive symptoms and memory loss, in addition to disappearing psychotic symptoms. This treatment was sustained, keeping the patient psychopathological and functional stability and allowing a psychotherapeutic approach.

Conclusions

Treatment with desvenlafaxine and haloperidol was favorable to maintain clinical stability and allow other therapeutic approaches.High dose of antidepressant could favor the expression of another identity of the patient.