In regard to mental illness, brain donation is essential for the biological investigation of central pathology. Nevertheless, little is known about the thoughts of people with mental disorders on tissue donation for research. Here, our objective was to understand the attitudes and opinions of people treated for bipolar disorder and their relatives regarding donation in general, and particularly donation for research. This is a qualitative study that used in-depth interviews to determine the thoughts of participants regarding tissue donation for research. Theoretical sampling was used as a recruitment method. Grounded theory was used as a framework for content analyses of the interviews. A semi-structured interview guide was applied with the topics: donation in general; donation for research; mental health and body organs; opinion regarding donation; feelings aroused by the topic. Although all participants were aware of organ donation for transplant, they were surprised that tissue could be donated for research. Nevertheless, once they understood the concept they were usually in favor of the idea. Although participants demonstrated a general lack of knowledge on donation for research, they were willing to learn more and viewed it as a good thing, with altruistic reasons often cited as a motive for donation. We speculate that bridging this knowledge gap may be a fundamental step towards a more ethical postmortem tissue donation process.

Introduction Exercising regularly has benefits for people with bipolar disorder. Nevertheless, as a group, these patients tend to be less physically active than the general population and little is known from the viewpoint of the patients about the barriers and facilitators to such a practice. Objective To know the barriers and facilitators perceived by people with bipolar disorder for the practice of exercise. Methods This study had a descriptive, qualitative, exploratory nature. The investigation method used for data collection was a semi-structured in-depth interview, using grounded theory as theoretical framework. Results The data analysis generated two main areas of interest: adherence to regular physical exercise (barriers and facilitators) and the participants’ exercise history and perception of disease management, as described below. The main findings were: most of our sample did not exercise regularly, nor knew how exercise can positively influence their disorder; with regard to adherence to physical exercise, the presence of symptoms and stigma were the most important barriers to the practice of physical exercise. Social support, especially from family and friends, could be a facilitator to the practice of exercise. Conclusions Even considering the limitations for generalization of qualitative and exploratory studies, understanding perceived barriers and facilitators for the practice of exercise among people who suffer with bipolar disorder may contribute to the promotion of activities in which people with mental illness can participate.

Objectives: To describe the frequency of brain tissue donation for research purposes by families of individuals that committed suicide. Methods: All requests for brain tissue donation to a brain biorepository made to the families of individuals aged 18-60 years who had committed suicide between March 2014 and February 2016 were included. Cases presenting with brain damage due to acute trauma were excluded. Results: Fifty-six cases of suicide were reported. Of these, 24 fulfilled the exclusion criteria, and 11 others were excluded because no next of kin was found to provide informed consent. Of the 21 remaining cases, brain tissue donation was authorized in nine (tissue fragments in seven and the entire organ in two). Conclusions: Donation of brain tissue from suicide cases for research purposes is feasible. The acceptance rate of 42.8% in our sample is in accordance with international data on such donations, and similar to rates reported for neurodegenerative diseases.

Objective This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. Methods The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson’s correlation). Through a principal component exploratory factor analysis, four ISs were identified. Result The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. Conclusion Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Ongoing studies in psychoanalysis have been broad and progressive, and have dealt with a number of different phenomena. Many thus foster the identification of intersubjective aspects that characterize therapeutic relationships today, including enactments. The concept of enactment first appeared in the literature in the mid‐1980s and was defined as a manifestation where, in the analytic situation, both analyst and patient unconsciously ‘play out’ psychic conflicts that must be worked out therapeutically. Resulting from unconscious forces activated mutually by the members of a therapeutic dyad, enactments are characterized by transferential and countertransferential dynamics. They are based on the mechanism of projective identification, which is interpersonal and intersubjective. In preparing the present systematic review, PUBMED, PsycINFO and LILACS databases were consulted, a process that generated a total of 59 articles. This paper gives an account of articles published on enactment, including authors, journals, year, type of study and diagnoses, as well as the gender and age bracket of patients mentioned in the literature investigated. We specifically describe how the authors of the respective articles understand and identify the concept of enactment and how they deal with this phenomenon in their clinical work.

Background: The direct examination of postmortem brain tissue can provide valuable help in refining knowledge on the pathophysiology and genetics of neuropsychiatric disorders. Obtaining postmortem consent for the donation of brain tissue after death by suicide can be difficult, as families may be overwhelmed by a violent and unexpected death. Examining the process of brain donation can inform on how the request can best be conducted, examining the existing barriers and enhancing communication, to the benefit of proxy donors. Methods: This is a qualitative study, in which we employed in-depth interviews to investigate the donation process. Family members of decedents who were eligible for brain tissue donation were asked to consider the donation; irrespective of their decision, they were invited for an interview on the donation process at least 2 months after the suicide. Data collection and analyses were carried out according to a grounded theory framework, and collection, coding, and theorization occurred simultaneously. Findings: Forty-one people participated in this study, 32 family members who had consented to donation and 9 who refused it. Five key themes emerged from our data analysis: the context of the families of potential donors, the invitation to talk to the research team, the experience with the request protocol, the participants' assessment of the experience, and their participation in the study as an opportunity to heal. We arranged the main categories around 3 central stages of the experience described by participants: before the donation request, the request, and after the request. Conclusions: The participants indicated that a brain donation request that is respectful and tactful can be made without adding to the family distress brought on by suicide and is viewed in a highly positive lens in the months following the event. Having an adequate understanding of tissue donation for research was crucial for satisfactory decision-making. Meeting with the donation team was considered a chance to talk to mental health professionals about suicide. Pondering brain donation was seen as an opportunity to transform the meaning of the death and invest it with a modicum of solace for being able to contribute to research.

Prezado editor, Classicamente, o treinamento em psicoterapia psicanalítica está baseado em um tripé proposto por Freud para formação de psicanalistas: aprendizado teórico, supervisão clínica e análi-se/psicoterapia psicanalítica pessoal. Por ser uma atividade realizada de forma isolada, sem que o professor/supervisor esteja presente durante a sessão, não há garantia de que esse aprendizado esteja sendo utilizado na prática clínica do terapeuta em formação. Ademais, a aplicação da técnica psicanalítica também depende de características do paciente: quando o paciente não apresenta capacidade de insight e de abstração ou quando necessita de contenção por parte do terapeuta, o terapeuta tende a utilizar técnicas mais diretivas, abordagens de apoio ou técnicas mistas em sua prática 1,2 . Diante dessas constatações, questiona-se: os psicoterapeutas de um ambulatório de psicoterapia psicanalítica (Contemporâneo -Instituto de Psicanálise e Transdisciplinaridade, Porto Alegre/RS) de fato atuam psicanaliticamente com seus pacientes? Os pacientes dessa instituição propiciam o uso da técnica psicanalítica durante seus atendimentos? O ambulatório em questão agrega uma escola de psicanálise que forma especialistas em psicoterapia psicanalítica com base no tripé acima mencionado.Decidiu-se, então, submeter à análise de pares de juízes 118 sessões dialogadas de pacientes adultos atendidos no referido ambulatório nos últimos cinco anos, cedidas pelos terapeutas (67 sessões, 56,8%) e seus supervisores (51 sessões, 53,2%). Quinze terapeutas e 81 pacientes estão representados nessas sessões. As sessões foram avaliadas por oito juízes (psicólogos especialistas em psicoterapia psicanalítica), independentemente, após treinamento.Utilizou-se o Instrumento para Avaliação de Sessões Psicanalíticas (IASP), o qual apresenta boa confiabilidade e é composto pelos itens: neutralidade do terapeuta, tipo de intervenções utilizadas, uso de interpretações, uso da teoria psicanalítica para compreensão do material, criação de espaços reflexivos e relação terapeuta-paciente 3,4 . A pontuação final da sessão pode variar de 0 a 25 pontos, e sessões com pontuações iguais ou superiores a 13 são consideradas psicanalíticas. O instrumento não mensura a qualidade da sessão e a adequação das intervenções do terapeuta; não há necessariamente correlação entre a aderência à técnica e a qualidade da sessão.Das 118 sessões analisadas, houve concordância em que 106 delas seriam psicanalíticas e que duas não seriam; não houve concordância quanto às demais 10 sessões. Ajustando para Recebido em 28/5/2012 Aprovado em 7/8/2012

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