A utilização do Método de Rorschach no diagnóstico diferencial da Esquizofrenia e Transtorno Dissociativo de Identidade
DOI:
https://doi.org/10.1590/0102.3772e3521Palavras-chave:
Esquizofrenia, Transtorno dissociativo de identidade, Trauma, RorschachResumo
O objetivo deste artigo foi investigar a prevalência do Transtorno Dissociativo de Identidade (TDI) em dez pacientes diagnosticados com esquizofrenia com característica paranóide, com base no Método de Rorschach. Foram registrados indicadores ou sintomas psicológicos que caracterizaram o diagnóstico diferencial desses pacientes, analisadas diferenças clínicas específicas e verificado o enquadramento dos dados obtidos, com a aplicação da Técnica de Rorschach. Para fins de diagnóstico diferencial, observou-se que dois pacientes apresentaram sintomas diferenciais aos da esquizofrenia, sendo que um deles apresentou sintomas dissociativos, não sendo confirmada a prevalência do TDI entre os esquizofrênicos. No caso da esquizofrenia e do TDI, devido à s características similares que apresentam, avaliações multidisciplinares são indicadas para se fazer o diagnóstico diferencial entre eles.
Downloads
Referências
Amato, D., Beasley, C. L., Hahn, M. K., & Vernon, A. C. (2016) Neuroadaptations to antipsychotic drugs: Insights from pre-clinical and human post-mortem studies. Neuroscience and Biobehavioral Reviews, 76(Pt. B), 317-335.
Asher, L., Fekadu, A., & Hanlon, C. (2018) Global mental health and schizophrenia. Current Opinion in Psychiatry, 31(3), 193-199.
American Psychiatric Association. (2014). Manual diagnóstico e estatístico de transtornos mentais - 5ª Ed.. Porto Alegre: Artmed.
Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014). Dispelling myths about dissociative identity disorder treatment: an empirically based approach. Psychiatry, 77(2), 169-189.
Braun, B. G. (1990). Multiple personality disorder: An overview. American Journal of Occupational Therapy , 44(11), 978-983.
Carretoni Filho, H., & Prebianchi, H. B. (1999). Exame clínico psicológico (Anamnese; 2 ed). São Paulo: Casa do Psicólogo.
Cordeiro, Q., Silva, R. T., & Vallada, H. (2012). Association study between the rs165599 catechol-O-methyltransferase genetic polymorphism and schizophrenia in a Brazilian sample. Arquivos de Neuro-psiquiatria, 70(12), 913-916.
Dell, P. F. (2002). Dissociative phenomenology of dissociative identity disorder. The Journal of Nervous and Mental Disease, 190(1), 10-15.
Dorahy, M. J., Brand, B. L., Sar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., Middleton, W. (2014) Dissociative identity disorder: An empirical overview. The Australian and New Zealand Journal of Psychiatry, 48(5), 402-417
Elis, O., Caponigro, J. M., & Kring, A. M. (2013). Psychosocial treatments for negative symptoms in schizophrenia: Current practices and future directions.Clinical Psychology Review, 33(8), 914-928.
Finsaas, M. C., Bufferd, S. J., Dougherty, L. R., Carlson, G. A., & Klein, D. N. (2018). Preschool psychiatric disorders: Homotypic and heterotypic continuity through middle childhood and early adolescence. Psychological Medicine, 16, 1-10.
Freud, S. (1996). O Ego e o ID. In. J. Strachey (Ed. e Trans.), Edição STANDARD Brasileira das Obras Psicológicas Completas (Vol. XIX). Rio de Janeiro: Imago. (Trabalho original publicado em 1923)
Gacono, C. B., Loving Jr., J. L., & Bodholdt, R. H. (2001) The Rorschach and psychopathy: Toward a more accurate understanding of the research findings. Journal of Personality Assessment, 77(1), 16-38
Gentile, J. P., & Dillon, K. S. (2013). Psychotherapy and pharmacotherapy for patients with dissociative. Innovations in Clinical Neuroscence , 10(2), 22-29.
Gibson, L. E., Alloy, L. B., & Ellman, L. M. (2016) Trauma and the psychosis spectrum: A review of symptom specificity and explanatory mechanisms. Clinical Psychology Review, 49, 92-105
Haddock, D. B. (2001). Dissociative identity disorder. Sourcebook. New York: McGraw-Hill.
Howes, O. D., McCutcheon, R., Owen, M. J., & Murray, R. M. (2016). The role of genes, stress, and dopamine in the development of schizophrenia. Biological Psychiatry, 81(1), 9-20.
Kar, N., Barreto, S., & Chandavarkar, R. (2016) Clozapine monitoring in clinical practice: Beyond the mandatory requirement. Clinical Psychopharmacology and Neuroscience, 14(4), 323-329
Kendler, K. S. (2016) phenomenology of schizophrenia and the representativeness of modern diagnostic criteria. JAMA Psychiatry, 73(10), 1082-1092
Kihlstrom, J. F., Glisky, M. L., & Angiulo, M. J. (1994). Dissociative tendencies and dissociative disorders. Journal of Abnormal Psychology, 103(1), 117-124.
Kluft, R. P. (1991). Clinical presentations of multiple personality disorder. Psychiatric Clinics of North America, 14(3), 605-629.
Kluft, R. P. (2000). The psychoanalytic psychotherapy of Dissociative Identity Disorder in the context of trauma therapy. Psychoanalytic Inquiry. 20, 259-86.
Kumar, H. B. K., Castellani, C., Maiti, S., O’Reilly, R., & Singh, S. M. (2013). Search for missing schizophrenia genes will require a new developmental neurogenomic perspective. Journal of Genetics, 92(2), 335-340.
Lakshmanan, M. N., Meier, S. L. C., Meier, R. S., & Lakshmanan, R. (2010). An archetype of the collaborative efforts of psychotherapy and psychophar macology in successfully treating dissociative identity disorder with comorbid bipolar disorder. Psychiatry, 7(7), 33-37.
Leonard, D., & Tiller, J. (2016). Dissociative identity disorder (DID) in clinical practice - What you don't see may hurt you. Australas Psychiatry, 24(1), 39-41.
Lewis, D. O., Yeager, C. A., Swica, Y., Pincus, J. H., Lewis, M., & Psych, F. R. C. (1997). Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder. The American Journal of Psychiatry, 154(12), 1703-1710.
Ma, C., Gu, C., Huo, Y., Li, X., & Luo, X.J. (2018). The integrated landscape of causal genes and pathways in schizophrenia. Translational Psychiatry, 8(1), 67
Maramai, S., Gemma, S., Brogi, S., Campiani, G., Butini, S., Stark, H., & Brindisi, M. (2016) dopamine d3 receptor antagonists as potential therapeutics for the treatment of neurological diseases Frontiers in Neuroscience, 10, 451.
Mihura, J. L., Bombel, G., Dumitrascu, N., Roy, M., & Meadows, E. A. (2018). why we need a formal systematic approach to validating psychological tests: The case of the Rorschach Comprehensive System Journal of Personality Assessment, 3, 1-19.
Moskowitz, A. (2011). Schizophrenia, trauma, dissociation, and scientific revolutions. Journal of Trauma & Dissociation, 12, 347-357.
Negro Júnior, P. J., Palladino-Negro, P., & Louzã, M. R. (1999). Dissociação e transtornos dissociativos: Modelos teóricos. Revista Brasileira de Psiquiatria, 21(4), 1-24.
Organização Mundial da Saúde. (1993). Classificação de transtornos mentais e de comportamento da CID-10. Descrições Clínicas e Diretrizes Diagnósticas. Porto Alegre: Artes Médicas.
Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford.
Putnam, F. W. (1992). Manual for the dissociative experiences scale. New Yok: National Institute of Mental Health.
Ribáry, G., Lajtai, L., Demetrovics, Z., & Maraz, A. (2017). Multiplicity: An explorative interview study on personal experiences of people with multiple selves. Frontiers in Psychology , 13, 8, 938.
Rich, R. (2005). Got Parts? An insider’s guide to managing life successfully with Dissociative Identity Disorder. New York: Loving Healing Press.
Salamon, S., Santelmann, H., Franklin, J., & Baethge, C. (2018). Test-retest reliability of the diagnosis of schizoaffective disorder in childhood and adolescence - A systematic review and meta-analysis. Journal of Affective Disorders, 230, 28-33.
Schimmenti, A. (2017). Elena: A case of dissociative identity disorder from the 1920s. Bulletin of the Menninger Clinic, 81(3), 281-298.
Schmitt, A., Reich-Erkelenz, D., Gebicke-Härter, P., & Falkai, P. (2012). Transcriptome studies in the context of disturbed connectivity in schizophrenia. Revista de Psiquiatria Clínica, 40(1), 10-15.
Sims, A. (1988). Symptoms in the mind. London: Ballière Tindall.
Van der Hart, O. (2012). The use of imagery in phase 1 treatment of clients with complex dissociative disorders. European Journal of Psychotraumatology, 3, 10.3402/ejpt.v3i0.8458.
Vaz, C. E. (1997). O Rorschard. Teoria e Desempenho (3a ed.). São Paulo: Manole.
Vila, D., & Lunazzi, H. (2010). Especificidad de la respuesta contaminada en Rorschach. II Congreso Internacional de Investigación y Práctica Profesional en Psicología XVII . Jornadas de Investigación Sexto Encuentro de Investigadores en Psicología del MERCOSUR. Buenos Aires. Recuperado de www.aacademica.org/000-031/928.pdf
Vita, A., & Barlati, S. (2018) Recovery from schizophrenia: is it possible? Current Opinion in Psychiatry, 31(3), 246-255
Yu, J., Ross, C. A., Keyes, B. B., Li, Y., Dai, Y., Zhang, T., Xiao, Z. (2010). Dissociative disorders among chinese inpatients diagnosed with schizophrenia. Journal of Trauma & Dissociation, 11, 358-372.
Zimerman, D. E. (1999). Fundamentos Psicanalíticos. São Paulo: Artmed.
