Emotional Fragility Research Articles

Updates in teenage acute intentional self-poisonings

"Abstract: Acute intentional poisonings represent an important part of emergency pediatric pathology, as well as a psychiatric one, with an escalation tendency over the past years. The current paper consists of a descriptive prospective study, which took place over a period of 12 months, and included 342 children within the age range 6-18 years, that presented in the Emergency Unit, being subsequently treated as in-patients of the Pediatric Poisoning Center of “Grigore Alexandrescu” Emergency Clinical Hospital for Children. The number of pediatric acute intentional poisonings hospitalized within the time frame of the study was 819 cases. Of these, 342 were intentional, which constitutes a percentage of 41.75%, and 477 were accidental, i.e. 58.24%. The etiology of the acute intentional poisonings is varied; however, medication (54.38%), ethanol (28.65%) and drugs of abuse (12.28%) were predominant. A higher frequency of acute intentional poisonings was noticed in girls (65.49%) as compared to boys (34.50%), probably due to the particularities the psychological profile of this sex shown at this age, i.e. higher emotional instability and display tendency. Out of the total number of acute intentional poisonings, we identified 20 cases of suicide attempts, which represent 5.83% of the total acute voluntary poisonings. Moreover, some of these cases constitute a repeated suicide attempt. The studied group included 30 cases of chronic substance abuse and 6 chronic alcohol abuse cases, with ages within the 13-17 years range, 12 of which were females and 24 males. Out of the 36 chronic substance/alcohol abuse patients, 4 were social cases. Pediatric acute intentional self-poisonings are an important public health issue, alarming through its consequences and through its hidden neuropsychiatric and behavioral substrate. This is due to the fact that adolescence is a period of marked emotional fragility, sensitive to all sorts of influences. Keywords: self-poisoning, teenager, psychiatric disorders, alcohol, substances of abuse"

Relational dialogue in emotion‐focused therapy

In emotion-focused therapy (EFT) relational processes between the therapist and client are not normally an explicit focus unless the therapist and client encounter difficulties that interfere with therapeutic work. When this does happen, however, relational dialogue (including meta-communication) becomes necessary. We present the principles and stages of the EFT task Relational Dialogue for Alliance Difficulties. After describing this little-known task, we illustrate its application in the successful treatment of a severely socially anxious female client with complex trauma and emotional fragility. Using transcripts and detailed descriptions we highlight the alliance difficulty marker subtype, relational dialogue principles and the stages of EFT alliance difficulty work.

Life on Call: Perspectives of Junior and Senior Internal Medicine Residents.

Models of daytime and nighttime on-call responsibilities for residents vary across internal medicine training programs, but there are few data regarding residents' perceptions of their on-call experiences. The authors sought to understand what residents perceive as the benefits and detriments of 24-hour, in-house call, a perspective instrumental to informing change. The authors conducted in-depth individual interviews and focus groups between December 2018 and March 2019 with 17 internal medicine residents from postgraduate years 1, 2, and 3 at the University of Toronto about their on-call experiences. Using constructivist grounded theory, the authors developed a framework to understand the residents' perceived benefits and drawbacks of 24-hour in-house call. Residents' experiences on call were grouped into 7 themes regarding negative and positive aspects of call. Participants reported multidimensional fatigue related to call, including decision fatigue, emotional fragility and lability, and loss of empathy, and also reported that call adversely affected their personal lives. Residents expressed conflicting opinions as to whether prolonged duty hours affected patient outcomes. In contrast, residents also expressed benefits to call, including that overnight call led to increased autonomy and decision-making skills and provided preparation for future careers as independent internists. They described developing camaraderie and a sense of belonging to a team with coresidents overnight. Lastly, residents described occupying different roles during regular duty hours and while on call-daytime roles revolved around follow-up of previously admitted patients and administrative tasks, while overnight duties centered on initial workup and medical stabilization of referred patients. Understanding the nuanced phenomenon of being on call from the perspective of those who live through it is a critical step in creating evidence-based educational policies. New call models should emphasize resident autonomy and decision making and should include a consideration of residents' perceived differences between daytime and on-call roles.

Emotional-Behavioral Disorders in Healthy Siblings of Children with Neurodevelopmental Disorders.

Background and Objectives: Siblings of disabled children are more at risk of developing mental illnesses. More than 50 international studies show that about 8% of children and adolescents suffer from a mental disorder, which is almost always a source of difficulties both at the interpersonal level (in the family and with peers) and at school. Healthy siblings of children with disabilities are one of the groups most at risk for consequences in psychological health and well-being. As some authors suggest, siblings build their idea of “being people”, in terms of character and personality, by continuously and daily confronting themselves with the theme of disability and a family context subjected to continuous stress. The following contribution aims to compare emotional–behavioral disorders in healthy siblings of children with autism spectrum disorder, in healthy siblings of children with Down’s syndrome and in healthy siblings of children with typical development. Materials and Methods: The results involve 153 children from the region of Campania and their caregivers through the administration of the Strength and Difficulties Questionnaire. Results: From the data, it emerged that siblings of children with autism spectrum disorder and siblings of children with Down’s syndrome have a greater emotional fragility, especially among male subjects. Conclusions: Our results require us to reflect on the clinical and policy measures needed to ensure the well-being of siblings of disabled children, mainly through appropriate sibling coping training.

Role of Metacognition Thinking and Psychological Traits in Breast Cancer Survivorship.

Longer survivorship is possible due to advances enabling early detection and treatment. However, cancer survivors are faced with prognostic uncertainty regarding survival, long-term symptoms, surveillance, and consequences of treatment. This study aimed at investigating emotional traits of women after breast cancer (BC) diagnosis from a three-year perspective of the disease. We intended to examine the emotional trend within longer survivorship after the primary treatment for BC. A sample of 72 women diagnosed with breast cancer (age range 30–55 years) was evaluated based on metacognition (Metacognitive Questionnaire—30 test), psychological distress (Psychological Distress Inventory test), anxiety, stress, and depression (Depression, Anxiety and Stress Scale—21 test). The data analysis applied was descriptive analysis, ANOVA, MANOVA, and ANCOVA comparing MCQ-30 variables and psychological traits (PDI, DASS-21). The results indicated positive recovery after primary care despite emotional fragility in survivorship owing to negative thoughts; correlations among metacognitive factors, anxiety, and distress not only confirmed the negative emotional pattern just after primary care, but also showed women regaining a positive emotional pattern in daily life. The survivors exhibited emotional fragility during certain specific points of time during the course of their survivorship. Based on our findings, the fear of recurrence and cancer-specific psychological treatment is a better framework to boost and improve clinical practice.

Anger, Emotional Fragility, Self-esteem, and Psychiatric Comorbidity in Patients with Hidradenitis Suppurativa/Acne Inversa.

Hidradenitis suppurativa/acne inversa (HS) is one of the most debilitating inflammatory chronic skin diseases and it heavily impairs the emotional and relational life of the patients. Despite its clinical and epidemiological relevance, its psychological correlates are still largely unexplored. The aim of the present study was to investigate the psychological and emotional impact of HS, with a specific focus on psychiatric symptoms, particularly depression, suicidal ideation, self-esteem, anger, and some personality traits. Thirty eight patients diagnosed with HS (HS Group) were compared with a control group of 28 outpatients diagnosed with nevi (N Group) and assessed with psychometric questionnaires (GHQ-28, STAXI-2, BDI-II, BHS, RSES, EF Questionnaire, and I-R Questionnaire). Results showed significant differences between the two groups, with more psychiatric symptoms, lower self-esteem, and higher levels of state anger and of emotional fragility in HS patients. These findings suggest the evidence of a significant psychiatric comorbidity in HS and of a strong emotional impact of the disease.

Climacteric experiences in nurses: Bases for feminine care in the light of Joan Scott [Experiencias climatéricas en enfermeras: Bases para el cuidado femenino a la luz de Joan Scott

The climacteric is a physiological stage in women that is characterized by a series of morphological, functional, psychological and emotional changes of experiences based on the care in the feminine condition. Objectives to describe and analyze the experiences of nurses based on Joan Scott's theory and to consider the basis for care. Qualitative study by means of a life history whose population consisted of ten nurses, an in-depth interview with open questions was used. Results: The following categories were evidenced: (1) Experiencing the climacteric with physical and psychological alterations, (2) Experiencing feelings of sexual inferiority, separation and incomprehension with the couple, (3) Help social networks: family, professional help, peer help, and (4) Transcend from the experiences and the bases for the achievement of a full life towards a model of integral care for women of climacteric age. It is concluded that the uncomfortable experiences of the climacteric compromises family and work interactions. In conjugal life, emotional fragility and incomprehension is still an obstacle for some women; family support provides effective help even in the most difficult moments, when the symptomatology is very intense, the woman requests professional help. For Scott, the woman establishes bonds of cultural identity, social with little understood gender differences. Therefore, the nurse must provide comprehensive and unique care, where the woman achieves a full life, building a "Model of care where strategies of action are developed directed at women in all its spheres.

Trayectorias de inserción profesional de “trans“ migrantes en Francia

Our research questions the trajectories of professional insertion of “trans” migrants who have exercised prostitution in France. For the collection of data, we conducted 26 in- depth interviews and a hundred direct observations between 2014 and 2017. Among the results obtained we found that if there are several professional insertion devices, only a minority of “trans” migrants was able to insert themselves into the labor market due to the presence of multiple obstacles, especially during the stage of professional training ”trans” migrants who were able to enter the labor market had a permanent accompaniment from the associative. The environment mainly, which not only was alert to their situation of economic precariousness and emotional fragility, but also facilitated the meeting between them and some professional training’s centers, and between them and the labor market.

The impact of the hospitalization process on the caregiver of a chronic critical patient hospitalized in a Semi-Intensive Care Unit

Abstract Objective: To understand the impact of the hospitalization process on the family companion of critical patients admitted to a Semi-Intensive Care Unit (SICU). Method: Exploratory research with a qualitative approach, conducted in the months of April to July of 2016 through a semi-structured interview applied to relatives who were accompanying patients hospitalized in an SICU of a high complexity care hospital in Fortaleza. The interviews were submitted to content analysis. Results: Three themes emerged through the perception of the family members, which reveal the companion's functioning during the hospitalization period: emotional, familiar and behavioural. Conclusion: The companion experiences an intense process of suffering and emotional fragility, causing changes in the family organization. The companion, being a caregiver, is subjected to high levels of stress, having to use coping skills, with; spirituality and social media among the most evident. The companion is an integral care unit for the hospitalized patient and a key piece in the humanization process of health.

Psychopathological risk in a sample of immigrant preadolescents in Italy.

Aim of the study is to collect information about emotional features in a sample of immigrant preadolescents in order to identify traits of emotional fragility or psychopathological risk factors. The sample consists of 1206 preadolescents (180 immigrants, 1026 Italian natives) attending the third year of the middle schools. In order to assess anxiety levels and the presence of depressive symptoms the Self- Administered Psychiatric Scale (SAFA-A) and the Children's Depression Inventory (CDI) were administered. Coping strategies and behavior problems were evaluated by the Coping Inventory for Stressful Situation (CISS) and the Youth Self Report scale (YRS). All teachers filled out the Teacher's Report Form (TRF). Parents were asked to fill out a form on social-demographic features and the Multidimensional Scale of Perceived Social Support (MSPSS). Immigration resulted a risk factor for development of anxiety (OR=0,702), depression (OR=0,644), internalizing problems (OR=0,685), behavior problems (OR=0,622) and total problems (OR=0,719). Teachers observed more behavior problems and lower competences in immigrants than natives. Immigrants relied significantly more often on emotion-oriented coping strategies to resolve stressful situation than natives (p=0,045). Analyzing the immigrants sample, second generation children reported significantly higher levels in total competence (school, activity and relationship) than first generation ones (p=<00,1); on the contrary there were no significant differences between the two groups concerning other behavioral and emotional problems or the preferred coping style. Natives' families reported significantly higher levels of perceived support than immigrant ones. Our findings confirms the hypothesis that preadolescent immigrants are more at risk for psychopathological risk factors than native peers.

“Amigos con beneficios”: salud sexual y estilos de apego de hombres y mujeres

Resumen Este estudio pretende analizar las variables relacionadas con la salud sexual de los individuos que pueden tener un impacto negativo en la asunción de riesgos - el uso de preservativo y el consumo de alcohol -; también pretende describir la prevalencia de infecciones de transmisión sexual y los estilos de apego que manifiestan hombres y mujeres en el marco relacional de amigos con beneficios. Para ello, se realiza un estudio transversal descriptivo. La información fue recogida mediante un cuestionario en línea y la escala de evaluación de los estilos de apego de Casullo y Fernández Liporace. En total, una muestra de 119 personas inmersas en una relación sexual casual con un amigo cumplimentaron el cuestionario. En relación a los resultados, casi el 30% de los participantes no han utilizado el preservativo en sus relaciones sexuales aduciendo razones asociadas al displacer e incomodidad; son las mujeres las que más padecen de infecciones de transmisión sexual; el consumo de alcohol ha constituido una práctica habitual en este tipo de relación. Aunque el apego seguro ha sido el más elevado, las mujeres se han mostrado temerosas. Amigos con beneficios puede entrañar graves consecuencias para la salud de los individuos y especialmente para las mujeres. Estos resultados recomiendan que desde la salud pública se preste atención a este novedoso vínculo sexual, así como la puesta en marcha de estrategias de promoción de la salud sexual dirigidas a las prácticas de riesgo de esta relación y a la mayor fragilidad afectiva y sexual de la mujer.

Therapeutic children's book: “I Managed to Overcome my Fears”

The book “I Managed to Overcome my Fears” was written based on the experience of the author. The sleep disorders in children are sometimes emotional fragility of reflection lived at the time. Caused by routine changes or adaptive and considered normal in child development. This book is meant to be a major therapeutic instrument to be used by therapists and other technicians engaged in the mental health of children. It contains the story, therapeutic indications and therapeutic homework. Getting help children overcome the fears that torment sleep, it will be easier with this feature.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

O imaginário coletivo da equipe de enfermagem sobre a interrupção da gestação

Objetivamos investigar o imaginário coletivo de enfermeiras sobre a mulher cuja gravidez foi interrompida, já que o trabalho da enfermagem envolve, além de cuidados técnicos, proximidade inter-humana em situação de fragilidade emocional. Entrevistamos individualmente 16 profissionais, usando o Procedimento Desenhos-Estórias com Tema. Após cada entrevista, redigimos narrativas transferenciais que, com os desenhos-estórias, foram consideradas psicanaliticamente, visando a produção interpretativa de campos de sentido afetivo-emocional. Observamos três campos que permitem a compreensão de que a gravidez interrompida é associada a fantasias de maldade e falta de amor materno, o que pode estar relacionado a eventuais dificuldades no cuidado a estas pacientes.

Assessing families' and patients' attitudes toward brain donation for research purposes in a Brazilian population sample.

The neuropathological examination of postmortem human brain tissue is an essential resource for the definitive diagnosis and research on neurodegenerative diseases. Due to the growing need of donated brains to supply the Brain Banks, the understanding of the factors associated with the consent for the donation in our context is an important aspect of the process of brain donation. The verbal answers and the donation consent rate were evaluated in three groups: 30 relatives of patients who underwent verification of the cause of death, 14 patients assisted at a neurology ambulatory outpatient clinic, and 18 patients' relatives. The donation consent rates were of 46.6, 92.8 and 88.8 %, respectively. The main reasons for refusal were the disagreement with the autopsy, philosophical and religious issues, objections from other family members, and the consideration of the wishes of the deceased. The consent was specially motivated by the interest in the advances of scientific knowledge, altruistic reasons and the personal experiences with the disease. Factors as the emotional fragility at the moment of death, the beliefs, family matters, and the lack of knowledge are key elements in the donation process. Future goals include the establishment of a brain donor program with the support of academic institutions, hospitals, scientists, community, patient's associations and autopsy assistants. Approaching patients and relatives in specialized ambulatories clinic during assistance is probably the most efficient mean of obtaining brains for research.

Negotiating the maze: risk factors for suicidal behavior in chronic pain patients.

Chronic pain disorders can exert major negative effects on virtually every aspect of an individual's life. It is not surprising then that many chronic pain sufferers find themselves at a point of emotional fragility where they experience thoughts of ending their life. Suicidal behavior encompasses a spectrum of experience, from "life weariness" or passive suicidal ideation, to more active suicidal intent and suicide completion. A range of risk factors for suicidal behavior in the general population have been identified, and these apply equally to the chronic pain population: a family history of mental illness, past history of suicide attempts, and the presence of comorbid depression. With regard specifically to chronic pain patients, elevated suicide risk is also associated with severe or recurrent headache, ambiguous diagnoses (psychogenic pain, abdominal pain), and medicolegal issues related to the pain. A number of suggestions for clinicians managing chronic pain patients with regards to managing suicide risk are given.

Why do clinicians exclude anxious clients from exposure therapy?

Despite research demonstrating the effectiveness of exposure therapy for pathological anxiety, this treatment is underutilized by clinicians. Anecdotal evidence and clinical experience suggest that therapists who possess reservations about exposure therapy tend to exclude clients from this treatment based on client characteristics believed to predict worse response. When exceptions are made based on characteristics that do not reliably predict poor outcomes, clients face the opportunity cost associated with investment in less effective treatments. The present investigation assessed therapists' likelihood of excluding clients from exposure due to different client and therapist characteristics. Exposure therapists (N = 182) completed an online survey that included the Therapist Beliefs about Exposure Scale, Anxiety Sensitivity Index-3, and the Broken Leg Exception Scale (BLES), a novel measure assessing the likelihood of excluding clients from exposure based on 25 different client characteristics. The BLES demonstrated good psychometric properties. Client characteristics most likely to result in exclusion from exposure therapy were comorbid psychosis, emotional fragility, and reluctance to participate in exposure. Greater likelihood of excluding clients from exposure was associated with higher therapist anxiety sensitivity and endorsement of negative beliefs about exposure therapy. Clinical and training implications of these findings are discussed.

“Mon triste voyage”: Sentimentality and Autobiography in Gottschalk'sThe Dying Poet

The terms “sentimentalism” and “sensibility” play a central role in contemporary scholarly discourse on literature and intellectual theory in the long nineteenth century. Often used interchangeably, these words identify developments in popular culture and philosophy in which emotions and feelings, as opposed to reason and logic, were seen as the routes to moral and social improvement. In visual, literary, and musical artworks of the era, the emphasis on feeling was frequently connected to a male archetype of the sentimental protagonist, a “dying poet,” marked by several common elements: great creativity, high levels of sensitivity, physical and emotional fragility, significant moments of disappointment, and early (and often self-inflicted) death. The subject of the dead or dying young man assumed critical significance during the 1860s, when so many soldiers were lost during the Civil War.

Suicidal Performances: Voicing Discontent in a Girls’ Dormitory in Kabul

Female suicide in Afghanistan has generally been given economic and psychological explanations. More rarely has its social dimension been analysed. In this paper, I underline the communicative potential of Afghan women's suicide in the 'post-war/reconstruction' context. I highlight its ambiguous symbolic power and its anchorage in the subversive imaginary universe of women's poetic expression. I argue that while reproducing certain cultural ideas about women's inherent emotional fragility, women's suicide also challenges the honour system in powerful ways and opens possibilities for voicing discontent. I qualify female suicide as the 'art of the weak' (De Certeau 1980, 6), a covert form of protest, a performance-in the sense of Bauman (2004)-that builds upon traditional popular 'knowledge' about gender in order to manage the impression of an audience and make women's claims audible.

A cirurgia cardíaca pediátrica sob o olhar dos pais: um estudo qualitativo

Congenital heart defects can often be corrected through surgery, providing for parents to expect a normal life, but the hospitalization experience often early, causes more pain, for which surgery is the worst moment. The aim of this study was to analyze the experience of families of children undergoing cardiac surgery and to identify the coping resources used by the families. A qualitative approach was the metodology of choice for this study, which took place with six semi-structured interviews and 100 hours of observation. Thematic analysis was used to understand the data. The results were categorized into four themes: feelings and emotions facing the illness of the child; heart disease under the watchful mother, mother and child on the ICU and coping resources. The speech of mothers demonstrated the importance of the heart due to its symbolism that enhances their emotional fragility in the face of illness. Religiosity and a solid social network of support were contributing factors for the maintenance of the adaptive behaviors. The presence of mothers in all stages of the child's treatment contributed to minimizing the suffering generated by hospitalization. The experience of families was characterized by ambivalent feelings such as fear of death, guilt and helplessness against the different stages of treatment. The anguish and anxiety prevailed in the face of unknown situations when information were required before therapeutic procedures, hospital routines and the actual life situation of the families.

Negotiations and Love Songs

DOI: 10.1200/JCO.2010.33.5216 It is not uncommon that I lie about what I do for a living. When meeting strangers, basic introductions quickly turn into conversational quicksand for me. Whether posed for identification, categorization, assessment of social status, or to fill an empty conversation, inquiries about work are difficult to avoid. I know that such questions are innocent attempts to situate me somewhere in the atmosphere; we use the occupational compass to direct us toward an identifiable point in each other’s lives. I know this, and yet the job question, when it comes, often has me squirming for answers. My eyes dart away from the pair in front of me expecting a straightforward reply. The question triggers a peculiar type of “flight or fight response,” as if the topic of what I do for a living poses a personal threat. Most of the time I dodge the issue or flee entirely. At other times, I will stay and face the question in the easiest way possible, avoiding the pitfall of pretending to be an accountant in front of the local manager of H&R Block. First, I say I’m a doctor. In response to the inevitable question, “What kind . . . ?” I’ll sometimes blankly respond, “Oh, a general practitioner–a family doctor . . .” After all, I was one of those once, so it’s not really a bold-faced lie. I know about triaging colds and flu, about vaccinating kids and monitoring benign conditions. I know about diagnostic skills at risk of becoming blunted by seeing so many “walking well” and about desperately hoping not to miss a serious illness cloaked in a veneer of nonspecific anxieties and nondescript sensations and pains. But, in truth, I am no longer one of those. When I don’t escape or lie–there is no way to predetermine when the urge for honesty will suddenly strike–I answer, “I’m a cancer specialist,” and then feel the immediate lurch to the edge of a conversational cliff. This answer can be as shocking to my conversation partner as when I passingly ask someone, “How’s it going,” expecting a bland “not bad,” but instead have to respond to, “Oh just horrible–this has been one of the worst weeks of my life.” A momentarily stunned, uncomfortable silence follows. Responses to my profession confession vary and often include vignettes of how the person has been touched by cancer in the present or past, whether through the closest of loved ones or the most distant of acquaintances. When no such vignette is forthcoming, the conversation often turns to “how close ‘they’ are to a cure” or to imaginative hypotheses surrounding etiologies and best preventive methods. The possible collusion of industry and government in preventing the dissemination of a simple, natural cure also comes up commonly. Inevitably, there is a tinge of disbelief: Most people know someone who has been impacted by a malignancy, but have never met someone who deals with the onslaught of disease and despair day in and day out. For most people who are not medical professionals, just surviving an oncology job is cause for admiration and a certain degree of unqualified respect for sticking it out. From many we hear disbelieving comments similar to those that sometimes come from our own patients with whom we share their last hours, in between doses of narcotics or whispered over the hiss of oxygen from nasal prongs, “How do you do this every day?” Our students often have the same questions disguised in medically relevant discussions about treatment protocols, adverse effect management, and breaking bad news. To a very few, in moments when the need to unburden trumps the need to hide, I describe the field of medical oncology with the subtitle, Negotiations and Love Songs, stolen from a Paul Simon album of the same name. We negotiate constantly with patient and disease–with what is realistic, reasonable, possible, and tolerable. We negotiate hope and reality, cure and palliation, how many tests to order, and when to order them. We negotiate the interpretation of disease status, whether of impending threat to health and life or of tenuous and uncertain stability. We negotiate prognosis, time frames, treatment options, lines of therapy, whether clinical trials make sense or are relevant. We negotiate the disease course constantly with patients and their loved ones, individually or in groups. We negotiate the gauntlet of physical and emotional fragility, hypervigilance, symptomatic distress, and existential chaos. We negotiate what we are in control of and what is beyond human control. We are often forced JOURNAL OF CLINICAL ONCOLOGY T H E A R T O F O N C O L O G Y VOLUME 29 NUMBER 6 FEBRUARY 2