Maus-tratos na infância e coping no curso do transtorno bipolar

• Ano de defesa: 2011
• Autor(a) principal: Daruy Filho, Ledo
• Orientador(a): Grassi-Oliveira, Rodrigo
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre
• Palavras-chave em Português: PSICOLOGIA COGNITIVA; NEUROCOGNIÇÃO; TRANSTORNO BIPOLAR; ESTRESSE; CRIANÇAS - MAUS TRATOS; TRAUMAS PSICOLÓGICOS
• Link de acesso: http://hdl.handle.net/10923/4994

Inside the model of allostatic load in Bipolar Disorder (BD), stress response represents a important role on the course of disease. Psychosocial stressors, such negative life events and childhood maltreatment (CM) are some of variables that through neurophysiological and neuropsychological mechanisms moderate BD severity and impairment. When submitted to a stressor, a person uses strategies to manage the problem. This process, dependent of cognitive processes especially executive functioning, we called coping. Coping can be problem focused, with attempt to act directly on the source of stress to change it (by problem solving or cognitive reappraisal), or emotional focused when, in a other way, person uses efforts to only regulate the emotional distress caused by stressor. Exposition to chronic or severe stress – such as CM – is associated to neurofunctional impairments linked to prefrontal cortex and amygdala, from which coping depends. Impairment in the way how this individuals will deal with new stressors will increase their allostatic load, promoting direct impact on the course of BD. The objectives of this dissertation are to answer three questions: (a) How exposure to abuse or neglect in childhood impacts the course of BD? (b) What the more recent developments regarding coping in BD? (c) What is the impact of exposure to CM in ways and styles of coping in patients with BD? To answer them, three papers are presented. The first one presents a comprehensive systematic review of the impact of the CM on the course of BD. Paper selection was performed in Medline and ISI database from March to July 2010, searching empirical papers where CM is a predictor variable on the course of BD. 342 papers were identified and screened, and 18 were selected to systematic review. The synthesis of this studies confirms the hypothesis that the disorder is worse in individuals exposed to CM.Maltreatment predict a pattern of disease characterized by early onset, rapid cycling, recurrence, comorbidities, high severity of symptoms, poor response to treatment and great number of hospitalizations and suicide attempts. The second paper presents a theoretical model for coping in BD. In this model coping emerge as a process dependent of cognitive functions, particularly executive functioning. Neuroanatomical and neuropsychological abnormalities associated with BD affect mechanisms an adequate selection of coping strategies. Thus, the ability of individuals to reduce their own stress burden is impaired, increasing vulnerability to stressful life events and negatively affecting the course of BD. The last paper provides empirical results of the impact of CM in the coping of bipolar patients. Thirty BD type 1 euthymic women were selected and had their strategies and coping styles accessed respectively through the brazilian versions of Ways of Coping Scale (EMEP) and Brief COPE. Presence of CM was measured by the Childhood Trauma Questionnaire Questionnaire (QUESI/CTQ). The results of this study confirm the hypothesis that traumatic events occurred during childhood cause negative interference on the way that individuals cope with stressful situations. BD patients submitted to CM, especially physical and emotional neglect and physical abuse, have a preference for emotional focused coping, linked to an avoidant behavior in relation the stressor, thus less resolute and adaptive. In agreement with our theoretical model, using adaptive coping, in particular those associated with cognitive reappraisal or problem solving, was less frequent in the group subjected to CM. Concluding, the exposure to CM influences the process underlying stress in BD, suggesting coping as another predictor of vulnerability to a worse course of illness.In a hypothetical stressful situation in the future, this patients will experience it in a more negative and deleterious pattern, increasing the allostatic load of that event. This dissertation shows CM as a vulnerability factor for a pernicious course of BD, and as predictor of coping styles and strategies less adaptive. Finally, it provided a theoretical framework presenting coping as a moderator of BD outcome.