Psicofarmacología en niños y adolescentes:Un manual para el clínico.

Sin resumen

Psicofarmacología en niños y adolescentes:Un manual para el clínico.

Sin resumen

Improving estimation of the prognosis of childhood psychopathology; combination of DSM-III-R/DISC diagnoses and CBCL scores [IF: 2.7]

Objective: To compare the predictive validity of the clinical-diagnostic and the empirical-quantitative approach to assessment of childhood psychopathology, and to investigate the usefulness of combining both approaches. Method: A referred sample (N=96), aged 6 to 12 years at initial assessment, was followed up across - on average - a period of 3.2 years. It was assessed to what extent DISC/DSM-III-R diagnoses - representing the clinical-diagnostic approach, and CBCL scores - representing the empirical-quantitative approach, predicted the following signs of poor outcome: outpatient/inpatient treatment, or parents' wish for professional help for the child at follow-up, disciplinary problems in school, and police/judicial contacts. Results: Both diagnostic systems added significantly to the prediction of poor outcome, and neither of the two systems was superior. Use of both systems simultaneously provided the most accurate estimation of the prognosis, reflected by the occurrence of future poor outcome. Even diagnostic concepts that are generally regarded as relatively similar, such as ADHD (DSM) and attention problems (CBCL), or conduct disorder (DSM) and delinquent behavior (CBCL), appeared to differ in their ability to predict poor outcome. Conclusions: The present study supports the use of the empirical-quantitative approach and the clinical-diagnostic approach simultaneously, both in research and in clinical settings, to obtain a comprehensive view of the prognosis of psychopathology in children. © Association for Child Psychology and Psychiatry, 2004

Heritability of attention problems in children II: longitudinal results from a study of twins age 3 to 12.

this paper we present data of large samples of twin families, with an equal number of girls and boys. The well-known gender difference with boys displaying more OA and AP was observed at each age. Even at the age of 3, boys display more OA problems than girls. Clinical studies have indicated that severe problem behavior can be identified in very young children (see for review, Campbell, 1995; Keenan & Wakschlag, 2000; Shaw, Owens, Giovannelli, & Winslow, 2001) and that the onset of ADHD is during the pre-school period (Barkley, Fisher, Edelbrock, & Smallish, 1990; Table 6 Top part includes percentages of total variances (diagonal) and covariances (off-diagonal) explained by additive genetic, genetic dominance, and unique environmental components based on best fitting models. Percentages for boys and girls are reported below and above diagonal, respectively. Lower part includes correlations calculated for additive genetic, genetic dominance, and unique environmental sources of variance between different ages. Correlations for boys and girls are reported below and above diagonal, respectively Relative proportions of variance and covariance BoysnGirls A% D% E% OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 50n41 73 79 75 22n33 17 13 14 28n26 10 8 11 AP 7 59 33n57 50 53 31 39n16 31 28 10 28n27 19 19 AP 10 86 31 41n48 47 6 51 31n25 32 8 18 28n27 21 AP 12 71 24 31 40n54 16 55 45 30n18 13 21 24 30n28 Correlations between different ages BoysnGirls ADE OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 1.00 .60 .66 .57 1.00 .30 .16 .20 1.00 .15 .12 .14 AP 7 .57 1.00 .62 .57 .41 1.00 .99 1.00 .15 1.00 .46 .41 AP 10 .68 .56 1.00 .61 .08 .94 1.00 1.00 .11 .42 1.00 .50 AP 12 .49 .42 .53 1.00 .20 .98 .99 1.00 .14 .45 .58 1.00 ..

Increased Activity Imbalance in Fronto-Subcortical Circuits in Adolescents with Major Depression

BACKGROUND: A functional discrepancy exists in adolescents between frontal and subcortical regions due to differential regional maturational trajectories. It remains unknown how this functional discrepancy alters and whether the influence from the subcortical to the frontal system plays a primacy role in medication naïve adolescent with major depressive disorder (MDD). METHODOLOGY/PRINCIPAL FINDINGS: Eighteen MDD and 18 healthy adolescents were enrolled. Depression and anxiety severity was assessed by the Short Mood and Feeling Questionnaire (SMFQ) and Screen for Child Anxiety Related Emotional Disorders (SCARED) respectively. The functional discrepancy was measured by the amplitude of low-frequency fluctuations (ALFF) of resting-state functional MRI signal. Correlation analysis was carried out between ALFF values and SMFQ and SCARED scores. Resting brain activity levels measured by ALFF was higher in the frontal cortex than that in the subcortical system involving mainly (para) limbic-striatal regions in both HC and MDD adolescents. The difference of ALFF values between frontal and subcortical systems was increased in MDD adolescents as compared with the controls. CONCLUSIONS/SIGNIFICANCE: The present study identified an increased imbalance of resting-state brain activity between the frontal cognitive control system and the (para) limbic-striatal emotional processing system in MDD adolescents. The findings may provide insights into the neural correlates of adolescent MDD

Cerebrospinal Fluid Space Alterations in Melancholic Depression

Melancholic depression is a biologically homogeneous clinical entity in which structural brain alterations have been described. Interestingly, reports of structural alterations in melancholia include volume increases in Cerebro-Spinal Fluid (CSF) spaces. However, there are no previous reports of CSF volume alterations using automated whole-brain voxel-wise approaches, as tissue classification algorithms have been traditionally regarded as less reliable for CSF segmentation. Here we aimed to assess CSF volumetric alterations in melancholic depression and their clinical correlates by means of a novel segmentation algorithm (‘new segment’, as implemented in the software Statistical Parametric Mapping-SPM8), incorporating specific features that may improve CSF segmentation. A three-dimensional Magnetic Resonance Image (MRI) was obtained from seventy patients with melancholic depression and forty healthy control subjects. Although imaging data were pre-processed with the ‘new segment’ algorithm, in order to obtain a comparison with previous segmentation approaches, tissue segmentation was also performed with the ‘unified segmentation’ approach. Melancholic patients showed a CSF volume increase in the region of the left Sylvian fissure, and a CSF volume decrease in the subarachnoid spaces surrounding medial and lateral parietal cortices. Furthermore, CSF increases in the left Sylvian fissure were negatively correlated with the reduction percentage of depressive symptoms at discharge. None of these results were replicated with the ‘unified segmentation’ approach. By contrast, between-group differences in the left Sylvian fissure were replicated with a non-automated quantification of the CSF content of this region. Left Sylvian fissure alterations reported here are in agreement with previous findings from non-automated CSF assessments, and also with other reports of gray and white matter insular alterations in depressive samples using automated approaches. The reliable characterization of CSF alterations may help in the comprehensive characterization of brain structural abnormalities in psychiatric samples and in the development of etiopathogenic hypotheses relating to the disorders

Brief report: Comorbid psychiatric disorders of autistic disorder

The behavioral and/or psychiatric symptoms in autistic people as described above have been viewed by many professionals dealing with autistic populations as “associated features of autism” that may result from these individuals' inability to cope with the environmental demands and physical discomfort. Traditionally, in treating individuals with autism, special education intervention including behavioral modifications has been the main emphasis. Such an approach has made some progress in milder and uncomplicated cases of autism. However, if many of these behavioral and/or psychiatric symptoms in those with more severe associated features can be viewed as symptoms of various comorbid psychiatric disorders, there are data suggesting that with an appropriate evaluation, predrug workups, a specific diagnosis, and multiple measures of outcome, pharmacotherapy can be a safe and efficacious adjunct treatment for some symptoms in autistic persons. Nevertheless, the data presented here were obtained mainly from autistic children. A great deal of work remains to be done Future research should put more emphasis on developing agreeable, reliable, and valid diagnostic instruments for identifying comorbid psychiatric disorders in autistic people. Future research should also emphasize employing a randomized double-blind placebo-controlled crossover design, as well as involving multicenters and using uniformed diagnostic criteria to study autistic adolescents and adults.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44613/1/10803_2005_Article_BF02172004.pd

European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment

To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce