RESUMO
INTRODUCTION: The COVID-19 pandemic had significant repercussions for the everyday life and public health of society. Healthcare professionals were particularly vulnerable. Here, we interviewed medical residents about their lived experiences during the pandemic to offer a phenomenological analysis. To this end, we discuss their pandemic experiences considering Jaspers' "limit situation" concept - that is, a radical shift from their everyday experiences, to one causing them to question the basis of their very existence. METHODS: We interviewed 33 medical residents from psychiatry and other specialties from the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) who either (a) worked directly with COVID-19 patients or (b) provided psychiatric care to other healthcare professionals. Semi-structured interviews were developed using the Inductive Process to Analyze the Structure of lived Experience (IPSE). RESULTS: The descriptions of the lived experiences of medical residents during the pandemic were organized into four content themes: (a) existential defense, (b) limit situations during the COVID-19 pandemic, (c) changes in lived experience, and (d) new world meanings through lived experience. CONCLUSION: During the COVID-19 pandemic, medical residents experienced what can be thought of as a "limit situation," as they encountered the healthcare delivery challenges coupled with the social isolation imposed by the COVID-19 pandemic. These challenges included fear of infection and potential death, uncertainty about the future, and the emotional overload caused by the sharp increase in patient deaths. That said, after facing such a limit situation, residents reported feeling strengthened by this experience. This is consistent with the notion that when confronted with limit situations, we draw on our resources to overcome adversity and, in turn, reap existential gains. Health care providers might use these experiences to energize their own professional approach.
Assuntos
COVID-19 , Internato e Residência , Médicos , Brasil , COVID-19/psicologia , Acontecimentos que Mudam a Vida , Médicos/psicologia , Psiquiatria , Entrevistas como Assunto , Existencialismo/psicologia , Mecanismos de Defesa , Ansiedade/psicologia , Humanos , Masculino , FemininoRESUMO
Este artigo apresenta uma proposta fenomenológica estrutural de psicologia do desenvolvimento dos primeiros 12 meses de vida. A literatura clássica fenomenológica fomenta, neste artigo, um aprofundamento da compreensão antropológica piagetiana do desenvolvimento. As descrições minuciosas de Jean Piaget do desenvolvimento de seus três filhos foram utilizadas como paradigma para a apresentação de uma proposta de como a temporalidade se apresenta nos 12 primeiros meses de vida. Ao constatarmos uma temporalidade em expansão, porém imatura, aprofundamos a compreensão do papel vital do contato interpessoal no primeiro ano de vida como fator constituinte de uma estrutura psíquica saudável.
This article presents a structural phenomenological proposal of developmental psychology of the first 12 months of life. In this article, the classical phenomenological literature fosters a deepening of Piagetian anthropological understanding of development. Jean Piaget's detailed descriptions of the development of his three children acted as a paradigm for the presentation of a proposal of how temporality presents itself in the first 12 months of life. When we see an expanding but immature temporality, we deepen our understanding of the vital role of interpersonal contact in the first year of life as an essential factor of a healthy psychic structure.
Este trabajo presenta una propuesta fenomenológica estructural de psicología del desarrollo de los primeros 12 meses de vida. La literatura clásica fenomenológica fomenta, en este trabajo, una profundización de la comprensión antropológica piagetiana del desarrollo. Las descripciones minuciosas de Jean Piaget del desarrollo de sus tres hijos fueron utilizadas como paradigma para la presentación de una propuesta de como la temporalidad se presenta en los 12 primeros años de vida. Al constatar una temporalidad en expansión, aunque inmatura, profundizamos la comprensión del papel vital del contacto interpersonal en el primer año de vida como factor constituyente de una estructura psíquica saludable.
Cet article présente une proposition phénoménologique structurelle de la psychologie du développement des 12 premiers mois de la vie. La littérature phénoménologique classique promeut, dans cet article, un approfondissement de la compréhension anthropologique piagétienne du développement. Les descriptions détaillées de Jean Piaget sur le développement de ses trois enfants ont servi de paradigme à une proposition sur comment la temporalité se présente au cours des 12 premiers mois de la vie. Lorsque nous voyons une temporalité en expansion mais immature, nous approfondissons notre compréhension du rôle vital du contact interpersonnel au cours de la première année de la vie en tant que facteur constitutif d'une structure psychique saine.
Assuntos
Psicologia do Desenvolvimento , Teoria Psicológica , Psicopatologia , Desenvolvimento InfantilRESUMO
OBJECTIVES: To review data from randomized controlled trials (RCTs) assessing the comparative efficacy of carbamazepine and lithium in treatment of acute manic and maintenance phase of bipolar disorder (BD). DESIGN: RCTs were identified through a search strategy that included: electronic databases, reference cross-checking, hand search of non-indexed publications, and book chapters on the treatment of BD comparing carbamazepine with lithium. Outcomes investigated were antimanic effect, trial withdrawal, relapse, hospitalization, need for rescue medication, and presence of adverse effects. Selection of studies and data analysis were performed independently by authors. Whenever possible, data from trials were combined through meta-analyses. Relative risks (RR) were estimated for dichotomous data. RESULTS: In acute mania, carbamazepine was similar to lithium on the following outcomes: trial withdrawal due to adverse effects, number of participants with at least one adverse effect, improvement in the Clinical Global Impression (CGI). In acute mania, carbamazepine was associated with fewer trial withdrawals. In maintenance treatment, carbamazepine was similar to lithium in relapses and hospitalization, but there were fewer trial withdrawals due to adverse effects on lithium. CONCLUSION: This review suggests that carbamazepine might be comparable to lithium in terms of efficacy and safety, and therefore a valuable option in the treatment of both manic and maintenance phases.