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

Validity of proposed DSM-5 ADHD impulsivity symptoms in children

WOS: 000385059900009PubMed ID: 26979524The American Psychiatric Association (APA) working group on Attention-Deficit/Hyperactivity Disorder (ADHD) proposed the inclusion of four new impulsivity symptoms. However, they were not included in DSM-5 due to the lack of sufficient evidence. The aim of this study is to investigate the performance of the proposed four ADHD impulsivity symptoms with respect to: (a) ADHD factor structure; (b) performance in predicting clinical impairment; (c) specificity for ADHD diagnosis and (d) best symptomatic threshold to predict clinical impairment. The sample comprised 416 children (31 ADHD subjects according to both DSM-IV and proposed DSM-5, 20 ADHD subjects according to just one diagnostic system and 365 controls) from 12 schools. Diagnoses were derived using semi-structured interviews and ADHD rating scales. Results from confirmatory factor analysis indicate that addition of the four new impulsivity items provided a slightly better factor structure if compared to models including only 18 items. Regression analyses showed that only one of the new impulsivity symptoms (impatient) was part of the list of best predictors of impairment. None of the four new impulsivity items was specifically associated with ADHD diagnosis. The best cutoff point in the hyperactivity/impulsivity dimension for predicting impairment did not change significantly. Overall, our findings suggest that the determination on how to best capture impulsivity dimension as part of the ADHD construct needs more investigation and that there is not enough evidence to include these four assessed impulsivity symptoms as part of the ADHD criteria.Shire; Eli-LillyEli Lilly; Janssen-CilagJohnson & Johnson USAJanssen Biotech Inc; NovartisNovartisLuis A. Rohde has received honoraria, has been on the speakers' bureau/advisory board and/or has acted as a consultant for Eli-Lilly, Janssen-Cilag, Novartis and Shire in the last 3 years. He receives authorship royalties from Oxford Press and ArtMed. He also received travel awards for taking part of 2014 APA and 2015 WFADHD meetings from Shire. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Janssen-Cilag, Novartis, and Shire. Eyup Sabri Ercan is in charge of the advisory board of Lilly and Janssen-Cilag. The other authors have no biomedical financial interests or potential conflicts of interest to report

The association between psychotic experiences and traumatic life events: the role of the intention to harm

Background Previous work showed traumatic life events (TLE) with intention to harm, like bullying and abuse, to be more strongly associated with psychotic experiences (PE) than other types of trauma, like accidents. However, this association is subject to reporting bias and can be confounded by demographic characteristics and by differences in dose of exposure across different trauma categories. We studied the association between TLE with and without intention to harm and PE, taking into account potential confounders and biases.Methods A total of 2245 children and adolescents aged 6-14 years were interviewed by psychologists. The interview included the presence of 20 PE (both self-report and psychologist evaluation). In addition, parents provided information on child exposure to trauma, mental health and PE.Results Results showed no significant association between TLE without intention to harm only and PE for the three methods of assessment of PE (self-report, parent report and psychologist rating). On the other hand, there was a positive association between PE and TLE in groups exposed to traumatic experiences with intention to harm (with intention to harm only and with and without intention to harm). Results remained significant after controlling for demographic and clinical confounders, but this positive association was no longer significant after adjusting for the number of TLE.Conclusions TLE with intention to harm display a stronger association with PE than TLE without intention to harm, and this difference is likely reducible to a greater level of traumatic exposure associated with TLE with intention to harm

Manic Symptoms in Youth:Dimensions, Latent Classes, and Associations With Parental Psychopathology

Objective: the purpose of the study was to define the latent structure of parent-reported manic symptoms and their association with functional impairment and familial risk in a community sample of Brazilian children. Method: We screened for manic symptoms in a community sample of 2,512 children 6 to 12 years of age. Parents of children with episodes of going abnormally high completed a detailed mania section (n = 479; 19.1%). Confirmatory factor analysis (CFA) tested a solution with Under-Control (UC) and Exuberant (EX) dimensions, investigating the severity (threshold) and factor loading of each symptom. We also used latent class analysis (LCA) to evaluate the latent categorical structure of manic symptoms. Associations of these latent constructs with psychiatric comorbidity, psychosocial impairment, and family history of psychopathology were tested. Results: the 2-dimensional model fit the data well. Only the UC dimension was associated with psychiatric morbidity, psychosocial impairment, and a family history of mania, depression, or suicide attempts. Both UC and EX items discriminated subjects with episodes of going abnormally high, but EX items lay at the mild end of the severity spectrum, whereas UC items lay at the severe end. the LCA yielded a small group of children with high levels of manic symptoms and a distinct profile of psychiatric comorbidity and impairment (high-symptom group). Conclusion: in a large, community-based sample, we found a 2-dimensional latent structure for parent-reported manic symptoms in youth, and demonstrated familial associations between the UC dimension and affective disorders. Both UC and EX items are clinically useful, but their contributions vary with symptom severity.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, São Paulo, BrazilUniv Fed Rio Grande do Sul, BR-90046900 Porto Alegre, RS, BrazilUniv São Paulo, BR-05508 São Paulo, BrazilKings Coll London, London WC2R 2LS, EnglandNIMH, Bethesda, MD USAUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Association between abnormal brain functional connectivity in children and psychopathology: A study based on graph theory and machine learning

Objectives: One of the major challenges facing psychiatry is how to incorporate biological measures in the classification of mental health disorders. Many of these disorders affect brain development and its connectivity.In this study, we propose a novel method for assessing brain networks based on the combination of a graph theory measure (eigenvector centrality) and a one-class support vector machine (OC-SVM).Methods: We applied this approach to resting-state fMRI data from 622 children and adolescents. Eigenvector centrality (EVC) of nodes from positive- and negative-task networks were extracted from each subject and used as input to an OC-SVM to label individual brain networks as typical or atypical. We hypothesised that classification of these subjects regarding the pattern of brain connectivity would predict the level of psychopathology.Results: Subjects with atypical brain network organisation had higher levels of psychopathology (p<0.001). There was a greater EVC in the typical group at the bilateral posterior cingulate and bilateral posterior temporal corticesand significant decreases in EVC at left temporal pole.Conclusions: The combination of graph theory methods and an OC-SVM is a promising method to characterise neurodevelopment, and may be useful to understand the deviations leading to mental disorders.Sao Paulo Research Foundation - FAPESP [2013/10498-6, 2013/00506-1, 2013/08531-5]CAPESCNPq, BrazilCNPq [573974/2008-0]FAPESP [2008/57896-8, 2013/16864-4]CAPES-BrazilCAPES/FAPERGSUniv Fed ABC, Ctr Math Computat & Cognit, Santo Andre, BrazilUniv Fed Sao Paulo UNIFESP, Interdisciplinary Lab Clin Neurosci LiNC, Dept Psychiat, Sao Paulo, BrazilUniv Sao Paulo, Sch Med, Dept Radiol, Sao Paulo, BrazilCNPq, Natl Inst Dev Psychiat Children & Adolescents, Brasilia, DF, BrazilUniv Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Porto Alegre, RS, BrazilUniv Fed Rio Grande do Sul, Dept Psychiat, Porto Alegre, RS, BrazilKings Coll London, Inst Psychiat, Dept Psychosis Studies, London, EnglandUniv Sao Paulo, Inst Math & Stat, Bioinformat Program, Sao Paulo, BrazilUniv Sao Paulo, Sch Med, Dept Psychiat, Sao Paulo, BrazilUniv Sao Paulo, Fac Med, Inst Radiol InRad, Sao Paulo, BrazilUniv Fed Sao Paulo UNIFESP, Interdisciplinary Lab Clin Neurosci LiNC, Dept Psychiat, Sao Paulo, BrazilFAPESP [2013/10498-6, 2013/00506-1, 2013/08531-5]CAPESCNPq, BrazilCNPq [573974/2008-0]FAPESP [2008/57896-8, 2013/16864-4]Web of Scienc