Tratamento do transtorno de ansiedade social em crianças e adolescentes

BACKGROUND: Social anxiety disorder is a debilitating, highly prevalent disorder in children and adolescents with lifetime prevalence rates, according to DSM-IV criteria, ranging from 0.7% to 3.5%. If left untreated, it can interfere with emotional, social, and school functioning. OBJECTIVE: To evaluate the current evidence for efficacy and effectiveness of pharmacological and psychotherapeutic interventions in the treatment of social anxiety disorder in children and adolescents. METHODS: Searches were undertaken through PubMed, Lilacs, PsycINFO and Cochrane Library until august 2006, using the terms "social anxiety disorder" OR "social phobia" AND "child*" AND "adolesc*". RESULTS: Several treatment modalities, including psychotherapeutic and pharmacological treatments have been proposed for the treatment of this disorder. Cognitive-behavioral therapy and pharmacotherapy, mainly with selective serotonin reuptake inhibitors, are the treatments of choice for social anxiety disorder in this age. CONCLUSION: Although several treatments have been proposed, further studies are necessary to improve outcomes in affected children and adolescents with social anxiety disorder.CONTEXTO: Transtorno de ansiedade social é um transtorno incapacitante e altamente prevalente em crianças e adolescentes ao longo da vida, de acordo com os critérios do DSM-IV, variando de 0,7% a 3,5%. Se não tratado, pode interferir no funcionamento emocional, social e escolar. OBJETIVOS: Avaliar a evidência atual para a eficácia e efetividade de intervenções farmacológicas e psicoterápicas no tratamento do transtorno de ansiedade social na infância e na adolescência. MÉTODOS: Pesquisas foram realizadas por meio do PubMed, Lilacs, PsycINFO e Cochrane Library até agosto de 2006 usando os termos "social anxiety disorder" OR "social phobia" AND "child*" AND "adolesc*". RESULTADOS: Várias modalidades de tratamento, incluindo tratamentos psicoterápicos e farmacológicos, têm sido propostas para o tratamento desse transtorno. Terapia cognitivo-comportamental e farmacoterapia, principalmente com inibidores seletivos da recaptação de serotonina, são o tratamento de escolha para o transtorno de ansiedade social nessa idade. CONCLUSÕES: Embora vários tratamentos tenham sido propostos, estudos adicionais são necessários para melhorar os desfechos em crianças e adolescentes afetados com transtorno de ansiedade social

Cortical and subcortical brain structure in generalized anxiety disorder : findings from 28 research sites in the ENIGMA-Anxiety Working Group

The goal of this study was to compare brain structure between individuals with generalized anxiety disorder (GAD) and healthy controls. Previous studies have generated inconsistent findings, possibly due to small sample sizes, or clinical/analytic heterogeneity. To address these concerns, we combined data from 28 research sites worldwide through the ENIGMA-Anxiety Working Group, using a single, pre-registered mega-analysis. Structural magnetic resonance imaging data from children and adults (5–90 years) were processed using FreeSurfer. The main analysis included the regional and vertex-wise cortical thickness, cortical surface area, and subcortical volume as dependent variables, and GAD, age, age-squared, sex, and their interactions as independent variables. Nuisance variables included IQ, years of education, medication use, comorbidities, and global brain measures. The main analysis (1020 individuals with GAD and 2999 healthy controls) included random slopes per site and random intercepts per scanner. A secondary analysis (1112 individuals with GAD and 3282 healthy controls) included fixed slopes and random intercepts per scanner with the same variables. The main analysis showed no effect of GAD on brain structure, nor interactions involving GAD, age, or sex. The secondary analysis showed increased volume in the right ventral diencephalon in male individuals with GAD compared to male healthy controls, whereas female individuals with GAD did not differ from female healthy controls. This megaanalysis combining worldwide data showed that differences in brain structure related to GAD are small, possibly reflecting heterogeneity or those structural alterations are not a major component of its pathophysiology

Mega-analysis methods in ENIGMA : the experience of the generalized anxiety disorder working group

The ENIGMA group on Generalized Anxiety Disorder (ENIGMA-Anxiety/GAD) is part of a broader effort to investigate anxiety disorders using imaging and genetic data across multiple sites worldwide. The group is actively conducting a mega-analysis of a large number of brain structural scans. In this process, the group was confronted with many methodological challenges related to study planning and implementation, between-country transfer of subject-level data, quality control of a considerable amount of imaging data, and choices related to statistical methods and efficient use of resources. This report summarizes the background information and rationale for the various methodological decisions, as well as the approach taken to implement them. The goal is to document the approach and help guide other research groups working with large brain imaging data sets as they develop their own analytic pipelines for mega-analyses

Alterations in microRNA of extracellular vesicles associated with major depression, attention-deficit/hyperactivity and anxiety disorders in adolescents

Extracellular vesicles (EVs) are present in numerous peripheral bodily fluids and function in critical biological processes, including cellto-cell communication. Most relevant to the present study, EVs contain microRNAs (miRNAs), and initial evidence from the field indicates that miRNAs detected in circulating EVs have been previously associated with mental health disorders. Here, we conducted an exploratory longitudinal and cross-sectional analysis of miRNA expression in serum EVs from adolescent participants. We analyzed data from a larger ongoing cohort study, evaluating 116 adolescent participants at two time points (wave 1 and wave 2) separated by three years. Two separate data analyses were employed: A cross-sectional analysis compared individuals diagnosed with Major Depressive Disorder (MDD), Anxiety disorders (ANX) and Attention deficit/Hyperactivity disorder (ADHD) with individuals without psychiatric diagnosis at each time point. A longitudinal analysis assessed changes in miRNA expression over time between four groups showing different diagnostic trajectories (persistent diagnosis, first incidence, remitted and typically developing/control). Total EVs were isolated, characterized by size distribution and membrane proteins, and miRNAs were isolated and sequenced. We then selected differentially expressed miRNAs for target prediction and pathway enrichment analysis. In the longitudinal analysis, we did not observe any statistically significant results. In the cross-sectional analysis: in the ADHD group, we observed an upregulation of miR-328-3p at wave 1 only; in the MDD group, we observed a downregulation of miR-4433b-5p, miR-584-5p, miR-625-3p, miR-432-5p and miR-409-3p at wave 2 only; and in the ANX group, we observed a downregulation of miR-432-5p, miR-151a-5p and miR-584-5p in ANX cases at wave 2 only. Our results identified previously observed and novel differentially expressed miRNAs and their relationship with three mental health disorders. These data are consistent with the notion that these miRNAs might regulate the expression of genes associated with these traits in genome-wide association studies. The findings support the promise of continued identification of miRNAs contained within peripheral EVs as biomarkers for mental health disorders

Cognitive-Behavioral Group Therapy Techniques in Panic Disorder Patients with Residual Symptoms: 2-Year Follow-Up

Objetivo: Avaliar a utilização das técnicas aprendidas durante a terapia cognitivo-comportamental em grupo (TCCG) para pacientes com transtorno de pânico (TP) que apresentam sintomas residuais em até 2 anos após o término do tratamento. Méto-dos: Um total de 64 pacientes completou o protocolo de 12 sessões de TCCG, e 62 (97%) foram encontrados para avaliação 2 anos após o término da terapia. As medidas de desfecho foram avaliadas pelos seguintes instrumentos: Impressão Global Clínica (CGI), Inventário de Pânico e Escala Hamilton para Ansiedade. O uso das técnicas foi avaliado através de entrevista semi-estruturada nas avaliações de seguimento, sendo classificadas em: (a) respiração diafragmática; (b) relaxamento muscular; (c) técnica cognitiva; e (d) exposição. Resultados: Considerando os 62 pacientes avaliados no seguimento, 39 (63%) preencheram o critério de remissão (CGI ? 2 e ausência de ataques de pânico) no primeiro ano e 35 (57%) no segundo ano de seguimento. A despeito dos critérios de remissão, um número grande de pacientes (87%) continuava a utilizar as técnicas aprendidas durante a terapia 1 a 2 anos após o término do protocolo. A técnica mais utilizada em ambos os períodos de seguimento foi a respiração diafragmática. Conclusões: Os resultados sugerem que a TCCG é eficaz para pacientes com sintomas residuais de TP. O uso das técnicas aprendidas durante as 12 sessões foi evidenciado em até 2 anos após o término do tratamento, sugerindo benefícios em longo prazo das habilidades desenvolvidas na TCCG.Objective: To evaluate the techniques learned by patients with panic disorder (PD) and residual symptoms after cognitive-behavioral group therapy (CBGT) up to a 2-year follow-up. Methods: Sixty-four PD patients were treated with a 12-session CBGT and 62 (97%) were followed for 2 years after the end of the treatment. Outcomes were evaluated by Clinical Global Impression (CGI), Panic Inventory, and Hamilton Anxiety Scale. The tools used by patients were assessed through a semi-structured interview and classified as follows: (a) diaphragmatic breathing, (b) muscle relaxation; (c) cognitive technique; and (d) exposure. Results: Of the 62 patients assessed at the follow-up, 39 (63%) met the remission criteria (CGI ? 2 and no panic attacks) in the first year and 35 (57%) in the second year of follow-up. Despite meeting the remission criteria, 87% of patients kept using the tools learned in CBGT up to 2 years after the treatment. Diaphragmatic breathing was the most used technique in both periods. Conclusion: The results of the present study suggest that CBGT is efficacious for patients with residual symptoms of PD. The techniques learned during the 12 therapy sessions are used by the patients up to 2 years after the treatment, suggesting long-term benefits of the skills learned at CBGT protocols

Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. the etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundacao de Amparo a Pesquisa do Estado do Rio Grande do Sul (FAPERGS)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPERGSFundo de Incentivo a Pesquisa - Hospital de Clinicas de Porto Alegre - FIPE-HCPAUniv Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Anxiety Disorders Outpatient Program Child & Adol, Porto Alegre, RS, BrazilUniv Fed Rio Grande do Sul, Grad Program Med Sci Psychiat, Porto Alegre, RS, BrazilConselho Nacl Desenvolvimento Cientif & Tecnol CN, Natl Sci & Technol Inst Dev Psychiat Children & A, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Child & Adolescent Psychiat Unit, São Paulo, BrazilNIMH, Intramural Res Program Emot & Dev Branch, Bethesda, MD 20892 USAUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Child & Adolescent Psychiat Unit, São Paulo, BrazilWeb of Scienc

Confiabilidade em validade convergente da Childhood Anxiety Sensitivity Index em crianças e adolescentes

OBJECTIVE: The purpose of this study was to examine the reliability and the convergent validity of the Children Anxiety Sensitivity Index (CASI) with DSM-IV anxiety disorder symptoms, by comparison with the Screen for Child Anxiety Related Emotional Disorders (SCARED), in a community sample of Brazilian children and adolescents. METHODS: Children and adolescents from five schools were selected from a larger study that aimed to assess different aspects of childhood anxiety disorders. All participants completed the CASI and the SCARED. RESULTS: This study supported the reliability of the CASI total score. Girls reported higher total anxiety sensitivity scores than boys and there were no differences in total anxiety sensitivity scores between children and adolescents. This study showed moderate to high correlations between the CASI scores with SCARED scores, all correlations coefficients being positive and significant. CONCLUSIONS: Our findings demonstrate an appropriate reliability and evidence of convergent validity in the CASI in a sample of Brazilian children and adolescents.OBJETIVO: O objetivo deste estudo foi examinar a confiabilidade e a validade convergente da Children Anxiety Sensitivity Index (CASI) com sintomas de transtornos de ansiedade de acordo com o DSM-IV, por meio da comparação com a Screen for Child Anxiety Related Emotional Disorders (SCARED). MÉTODOS: Crianças e adolescentes provenientes de cinco escolas foram selecionados de uma amostra de um estudo maior que avaliava diferentes aspectos dos transtornos de ansiedade. Todos os participantes completaram a CASI e a SCARED. RESULTADOS: Esse estudo demonstrou a confiabilidade do escore total da CASI. Meninas apresentaram escores de sensibilidade à ansiedade mais altos do que meninos e não houve diferença nos escores totais de sensibilidade de ansiedade entre crianças e adolescentes. Esse estudo encontrou correlações de moderada a alta entre os escores da CASI e os escores da SCARED, sendo todas as correlações positivas e significativas. CONCLUSÕES: Nossos achados demonstraram uma confiabilidade apropriada e evidência de validade convergente da CASI em uma amostra de crianças e adolescentes brasileiros.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulInstitute of Developmental Psychiatry for Children and AdolescentUniversidade Federal de São Paulo (UNIFESP)UNIFESP, PsiquiatriaSciEL