Nonsuicidal self-injury (NSSI) is prevalent and affects mainly the youth population. It is prospectively associated with suicide attempts, making it a target for suicide prevention. Recently, several studies have investigated neural pathways of NSSI using neuroimaging. However, there is a lack of systematized appraisal of these findings. This systematic review aims to identify and summarize the main neuroimaging findings of NSSI in youth. We followed PRISMA statement guidelines and searched MEDLINE, APA PsycInfo, and Google Scholar databases for neuroimaging studies, irrespective of imaging modality, specifically investigating NSSI in samples with a mean age of up to 25 years old. Quality assessment was made using the Newcastle–Ottawa and Joanna Briggs Institute scales. The initial search retrieved 3030 articles; 21 met inclusion criteria, with a total of 938 subjects. Eighteen studies employed functional neuroimaging techniques such as resting-state and task-based fMRI (emotional, interpersonal exposure/social exclusion, pain, reward, and cognitive processing paradigms). Three studies reported on structural MRI. An association of NSSI behavior and altered emotional processing in cortico-limbic neurocircuitry was commonly reported. Additionally, alterations in potential circuits involving pain, reward, interpersonal, self-processing, and executive function control processes were identified. NSSI has complex and diverse neural underpinnings. Future longitudinal studies are needed to understand its developmental aspects better.
Por muitos anos, o Transtorno de Personalidade Borderline (TPB) foi considerado como uma condição de saúde mental intratável. No entanto, diversos tratamentos desenvolvidos nas últimas décadas, como a Terapia Comportamental Dialética (DBT), o Tratamento Baseado na Mentalização (MBT) e a Psicoterapia Focada na Transferência (TFP) provaram o contrário. O problema do ponto de vista de saúde pública é que a disponibilidade dessas intervenções é limitada. Nesse contexto de alta demanda de profissionais treinados, o Bom Manejo Clínico (GPM) e outras abordagens generalistas surgiram. Este artigo revisa a estrutura e os principais fundamentos do GPM que orientam os clínicos não especialistas a planejar um tratamento baseado na medicalização do transtorno, no gerenciamento de caso e em intervenções psicoterapêuticas de suporte. Nós também ilustramos a abordagem com um exemplo de caso e, finalmente, apresentamos desenvolvimentos mais recentes, como a integração de GPM com a DBT e o GPM para adolescentes (GPM-A).
Nonsuicidal self-injury is a common development among adolescents that varies in severity, frequency, and associated psychiatric vulnerability. A key challenge is to understand how clinicians can identify those at greater risk, specifically for transition to suicide attempts. Shared functions (eg, to escape negative emotions) and risk factors in selected domains (eg, exposure to self-harm in others, impulsivity, cannabis and other drug use, diminished social connections, and history of bullying) between self-injury and suicide can explain this association and guide interventions. General guidelines for nonsuicidal self-injury and comorbid suicidal behavior in youth include mapping its predisposing factors and psychological functions, assessing severity and acute risk, and elucidating context (eg, interpersonal stressors). No medication has proven effective in reducing self-harm. Outpatient psychological treatment is the first option to address relevant emotional, behavioral, and interpersonal vulnerabilities, and evidence-based treatments can be effective (eg, dialectical behavior therapy, mentalization-based treatment, and cognitive-behavioral therapy). [ Psychiatr Ann. 2022;52(8):311–317.]
Physical distancing is a vital health measure to prevent pathogens from spreading during pandemics. Many factors, including personality characteristics, may influence the ability to adhere to these mitigation measures. However, no longitudinal research has studied temperament dimensions influencing physical distancing. Therefore, we aimed to investigate if childhood temperament dimensions as predictors of later difficulty in physical distancing during the COVID-19 pandemic. This study used data from the Brazilian High-Risk Cohort Study (BHRC). Five temperament dimensions were assessed at baseline with the self-report version of the Early Temperament Questionnaire-Revised Version (EATQ-R): effortful control (EC), fear, frustration, shyness, and surgency. In addition, the Coronavirus Health Impact Survey (CRISIS) Youth Self-Report assessed the difficulty in physical distancing during the COVID-19 pandemic, ten years after baseline. The factor structure of EATQ-R was generated by confirmatory factor analysis, and logistic regression models were used to determine temperament associations with difficulty distancing. Effortful control dimension emerged as a factor associated with lower levels of perceived difficulty in adhering to physical distancing (OR = 0.823, 95% CI: 0.691–0.979, p < 0.029). Therefore, EC trait can be a potential target for early intervention strategy for increasing adherence to safety measures during pandemics.
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