Trastorno por Déficit de Atención con Hiperactividad: Ritmo Circanual en el Mes de Nacimiento

Estudiamos la existencia de ritmo circanual en el mes de nacimiento en participantes con trastorno de déficit de atención e hiperactividad (TDAH) y analizamos la asociación entre meses de nacimiento y TDAH. La muestra incluye 10978 participantes (1778 TDAH / 9200 no TDAH), entre 3 y 18 años, reclutados mediante muestreo consecutivo de primeras consultas atendidas en salud mental entre 1992 y 2021. Los participantes con TDAH presentan un ritmo circanual significativo en los meses de nacimiento, con una acrofase en octubre. Nacer en el último cuatrimestre del año incrementa significativamente la probabilidad de ser diagnosticado TDAH, controlando el efecto de sexo y edad. Con el transcurso de los meses del año, existe una tendencia lineal creciente significativa de ser diagnosticado de TDAH, no observada en población general, ni en casos sin TDAH. Es necesario tener precaución en el diagnóstico y tratamiento de los niños nacidos en los últimos meses del año, que, por su mayor inmadurez en comparación con los demás niños de la clase, pudieran ser diagnosticados y tratados erróneamente como TDAHAttention Deficit Hyperactivity Disorder: Circannual Rhythm in the Month of Birth. We studied the existence of circanual rhythm in the month of birth in participants with attention deficit hyperactivity disorder (ADHD) and analyzed the association between months of birth and ADHD. We analyzed 10,978 participants (1,778 ADHD/9,200 non-ADHD), aged 3 to 18 years. A consecutive sample of first visits to mental health between 1992 and 2021 is used. Participants with ADHD exhibit a significant circannual rhythm in the months of birth, with an acrophase in October. Being born in the last quarter of the year significantly increases the probability of being diagnosed with ADHD, controlling for the effect of sex and age. As the months of the year go by, there is a significant increasing linear trend of being diagnosed with ADHD, which is not observed neither in general population nor in cases without ADHD. Caution is necessary in diagnosis and treatment of children born in the last months of year, who, due to their greater immaturity compared to the other children in class, could be misdiagnosed and treated as ADH

Rasgos de personalidad en adolescentes con trastorno por déficit de atención con hiperactividad

Background. There are few studies linking personality and Attention Deficit Hyperactivity Disorder (ADHD) in adolescents. Research objective: to study differences between cases with ADHD and the general population in personality prototypes (PRP) derived from the Millon Clinical Inventory for Adolescents (MACI). Material and Method. Analytical observational design. Random sampling in the general population (n = 461) and consecutive of patients with ADHD evaluated according to DSM-5 criteria (n = 85), in adolescents between 13 and 17 years old. Measurement instruments: MACI and Adolescent Symptom Inventory. Results: ADHD presents a significantly higher mean in Doleful, Forceful, Unruly, Oppositional, Self-demeaning and Borderline PRP and the general population in Submissive and Conforming PRP. The PRP model that best predicts ADHD includes male sex and the Forceful, Borderline, Submissive and Self-demeaning PRP. The model classifies 82.4% of the cases. Conclusion. ADHD cases have differential PRP in comparison with the general population, which invites their clinical study and therapeutic intervention. The study offers a novel image of PRP in ADHD and opens new lines of research that include personality when explaining the heterogeneity of the disorder.Antecedentes. Existen pocos estudios que relacionen personalidad y trastorno por déficit de atención con hiperactividad (TDAH) en adolescentes. Objetivo: estudiar diferencias entre casos con TDAH y población general en prototipos de personalidad (PRP) derivados del Inventario clínico para adolescentes de Millon (MACI). Material y Método: Diseño observacional analítico. Muestreo aleatorio en población general (n = 461) y consecutivo de pacientes con TDAH valorados según criterios DSM-5 (n = 85), en adolescentes entre 13 y 17 años. Instrumentos de medida: MACI y Adolescent Symptom Inventory. Resultados: los PRP Pesimista, Rudo, Rebelde, Oposicionista, Autopunitivo y Límite presentan una media significativamente mayor en TDAH y los PRP Sumiso y Conformista, en población general. El modelo de PRP que mejor predice TDAH está conformado por tener sexo masculino y los PRP Rudo, Límite, Sumiso y Autopunitivo, clasificando el 82.4% de los casos. Conclusión: Los casos de TDAH tienen PRP diferenciales con la población general que invitan a su estudio clínico e intervención terapéutica. El estudio ofrece una imagen novedosa de los PRP en casos de TDAH y abre nuevos caminos de investigación que incluyan la personalidad al explicar la heterogeneidad del trastorno

Rasgos de personalidad en adolescentes con trastorno por déficit de atención con hiperactividad

Background. There are few studies linking personality and Attention Deficit Hyperactivity Disorder (ADHD) in adolescents. Research objective: to study differences between cases with ADHD and the general population in personality prototypes (PRP) derived from the Millon Clinical Inventory for Adolescents (MACI). Material and Method. Analytical observational design. Random sampling in the general population (n = 461) and consecutive of patients with ADHD evaluated according to DSM-5 criteria (n = 85), in adolescents between 13 and 17 years old. Measurement instruments: MACI and Adolescent Symptom Inventory. Results: ADHD presents a significantly higher mean in Doleful, Forceful, Unruly, Oppositional, Self-demeaning and Borderline PRP and the general population in Submissive and Conforming PRP. The PRP model that best predicts ADHD includes male sex and the Forceful, Borderline, Submissive and Self-demeaning PRP. The model classifies 82.4% of the cases. Conclusion. ADHD cases have differential PRP in comparison with the general population, which invites their clinical study and therapeutic intervention. The study offers a novel image of PRP in ADHD and opens new lines of research that include personality when explaining the heterogeneity of the disorder.Antecedentes. Existen pocos estudios que relacionen personalidad y trastorno por déficit de atención con hiperactividad (TDAH) en adolescentes. Objetivo: estudiar diferencias entre casos con TDAH y población general en prototipos de personalidad (PRP) derivados del Inventario clínico para adolescentes de Millon (MACI). Material y Método: Diseño observacional analítico. Muestreo aleatorio en población general (n = 461) y consecutivo de pacientes con TDAH valorados según criterios DSM-5 (n = 85), en adolescentes entre 13 y 17 años. Instrumentos de medida: MACI y Adolescent Symptom Inventory. Resultados: los PRP Pesimista, Rudo, Rebelde, Oposicionista, Autopunitivo y Límite presentan una media significativamente mayor en TDAH y los PRP Sumiso y Conformista, en población general. El modelo de PRP que mejor predice TDAH está conformado por tener sexo masculino y los PRP Rudo, Límite, Sumiso y Autopunitivo, clasificando el 82.4% de los casos. Conclusión: Los casos de TDAH tienen PRP diferenciales con la población general que invitan a su estudio clínico e intervención terapéutica. El estudio ofrece una imagen novedosa de los PRP en casos de TDAH y abre nuevos caminos de investigación que incluyan la personalidad al explicar la heterogeneidad del trastorno

Trends in Psychiatric Hospitalization of Children and Adolescents in Spain between 2005 and 2015

Eating disorders are on top of chronic conditions in children and adolescents, and the most severe cases may require hospitalization. Inpatient psychiatric treatment is one of the most expensive ones and therefore the efforts when treating eating disorders should focus on avoiding and shortening admissions, as well as preventing readmissions. Advances in of eating disorders treatment lie in an accurate knowledge of those patients requiring admission. This study examined the Conjunto Mínimo Básico de Datos—the largest public hospitalization database in Spain—to estimate the prevalence of eating and other psychiatric disorders during childhood and adolescence. It is a cross-sectional study of the hospital discharges in Castilla y León (Spain) from 2005 to 2015, in which patients under 18 years old with a psychiatric diagnosis at discharge were selected. Trends in the rates of hospitalization/1000 hospitalizations per year were studied by joinpoint regression analysis. Conclusions: eating disorders were the only group that presented an upward and continuous trend throughout the study period. This statistically significant increase showed an annual change of 7.8%

Hospitalization and Socio-Health Care for Dementia in Spain

Dementias are brain diseases that affect long-term cognitive and behavioral functions and cause a decrease in the ability to think and remember that is severe enough to disturb daily functioning. In Spain, the number of people suffering from dementia is rising due to population ageing. Reducing admissions, many of them avoidable, would be advantageous for patients and care-providers. Understanding the correlation of admission of people with dementia and its trends in hospitalization would help us to understand the factors leading to admission. We conducted a cross-sectional study of the hospital discharge database of Castilla y León from 2005 to 2015, selecting hospitalizations for dementia. Trends in hospitalizations by year and age quartiles were studied by joinpoint regression analysis. 2807 out of 2,717,192 total hospitalizations (0.10%) were due to dementias; the main groups were degenerative dementia (1907) followed by vascular dementia (607). Dementias are not a major cause of hospitalization, but the average stay and cost are high, and many of them seem avoidable. Decreasing trends were detected in hospitalization rates for all dementias except for the group of mild cognitive impairment, which grew. An increasing–decreasing joinpoint detected in 2007 for vascular dementia and the general downward hospitalization trends for most dementias suggest that socio-health measures established since 2007 in Spain might play a key role in reducing hospitalizations

Validez de un modelo reducido de items del DSM-IV según respuesta de padres y profesores en el diagnóstico del trastorno por déficit de atención con hiperactividad combinado.

Main Objective: To look for a reduced model of symptoms of the attention deficit hyperactivity disorder combined type (ADHD-C), that shows suitable levels of criterion validity for the diagnostic of the disease. Methods: Epidemiological study. Sample of 1095 children between 6 and 16 years. First stage: psicometric study using ADHD RS-IV answered by parents (P) and teachers (T). ADHD is suspected when both questionnaires are over 90th percentile. Second stage: Clinical interview DISC-IV (DSM-IV) only in those selected cases to confirm ADHD-C. Logistic regression is implemented to find the most parsimonious model to predict ADHD-C. Results: The model that predicts clinical ADHD-C consists of 8 of the 36 items of the ADHD RS-IV answered by P and T. If we consider the Odds Ratio obtained by regression, the items present a ranking of: 15 T> 1 P> 16 T> 12 P> 17 P> 10 P> 14 P> 4 T. The model has criterion validity for symptomatic ADHD-C (sensitivity: 97.9%. Specificity: 93.8%. Likelihood ratio: 16.02). Conclusions: It is possible to reduce the list of symptoms of ADHD-C with good criterion validity, removing redundant items and keeping those that provide greater discrimination between ADHD-C and the general population.Objetivo: Buscar un modelo reducido de síntomas del Trastorno por Déficit de Atención con Hiperactividad Combinado (TDAH-C), que presente adecuada validez de criterio para el diagnóstico del trastorno.Metodología: Contexto de estudio epidemiológico. Muestra de 1095 casos entre 6 y 16 años [4.38 % TDAH-C].  Selección de casos con  primera fase psicométrica de sospecha TDAH-C que requiere que ADHD RS-IV, implementado por padres (PA) y profesores (PR), supere el PC 90. Segunda fase: Los casos seleccionados se evalúan mediante entrevista clínica modelo DISC-IV (DSM-IV) para confirmar TDAH-C. Se implementa regresión logística para buscar modelo parsimonioso de ítems que permita predecir TDAH-C.Resultados: El modelo de ítems que permite predecir TDAH-C  contiene 8 de  36 ítems del  ADHD RS-IV contestados por PA y PR. Considerando odss ratio del modelo de regresión logística, los ítems del ADHD RS-IV presentan un ranking de 15PR > 1PA > 16PR > 12PA > 17PA > 10PA > 14PA > 4PR. El modelo presenta validez de criterio para TDAH-C clínico (sensibilidad: 97.9 %. Especifidad: 93.8%. Razón de verosimilitud: 16.02).Conclusiones: Es posible  reducir la lista de síntomas de TDAH-C con buena validez de criterio, manteniendo los que proporcionan mayor discriminación entre  TDAH-C y población general