Mood disorders in childhood and adolescence

The identification and treatment of mood disorders in children and adolescents has grown over the last decades. Major depression is one of the most common and debilitating disorders worldwide, imposing a massive burden to the youth population. Bipolar disorder is being increasingly recognized as having its roots early in life, and its presentation during childhood and adolescence has been submitted to extensive research. This review aims to highlight clinical aspects of the current knowledge on mood disorders in the pediatric population, presenting updated information on epidemiology, diagnostic procedures, and management strategies. Limitations of available evidence and future directions of research in the field are also discussed.Universidade Federal do Rio Grande do Sul Hospital de Clinicas de Porto Alegre Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Child and Adolescent Psychiatry UnitUNIFESP, Department of Psychiatry Child and Adolescent Psychiatry UnitSciEL

Adolescent adaptive behavior profiles in Williams–Beuren syndrome, Down syndrome, and autism spectrum disorder

Background Adaptive behavior can be impaired in different neurodevelopmental disorders and may be influenced by confounding factors, such as intelligence quotient (IQ) and socioeconomic classification. Our main objective was to verify whether adaptive behavior profiles differ in three conditions—Williams Beuren syndrome (WBS), Down syndrome (DS), and autism spectrum disorder (ASD), as compared with healthy controls (HC) and with each other. Although the literature points towards each disorder having a characteristic profile, no study has compared profiles to establish the specificity of each one. A secondary objective was to explore potential interactions between the conditions and socioeconomic status, and whether this had any effect on adaptive behavior profiles. Methods One hundred and five adolescents were included in the study. All adolescents underwent the following evaluations: the Vineland Adaptive Behavior Scale (VABS), the Wechsler Intelligence Scale for Children (WISC), and the Brazilian Economic Classification Criteria. Results Our results demonstrated that the WBS group performed better than the DS group in the communication domain, β = −15.08, t(3.45), p = .005, and better than the ASD group in the socialization domain, β = 8.92, t(−2.08), p = .013. The DS group also performed better than the ASD group in socialization, β = 16.98, t(−2.32), p = .024. IQ was an important confounding factor, and socioeconomic status had an important effect on the adaptive behavior of all groups. Conclusions There is a heterogeneity regarding adaptive behavior profiles in WBS, DS, and ASD. These data are important to better design specific strategies related to the health and social care of each particular group

Methylphenidate use in children with attention deficit hyperactivity disorder

O Boletim Brasileiro de Avaliação de Tecnologias em Saúde (BRATS), em matéria sobre as evidências científicas da eficácia e segurança do metilfenidato para o transtorno de déficit de atenção e hiperatividade (TDAH), gerou controvérsias sobre sua metodologia. Considerando a relevância do BRATS para a saúde pública no Brasil, realizou-se análise crítica dessa matéria ao refazer a busca do BRATS e discutir sua metodologia e achados. Foram respondidas duas perguntas: o BRATS incluiu todas as referências disponíveis na literatura? As conclusões refletiram os textos revisados? Identificou-se que o BRATS não incluiu todas as referências da literatura sobre o tema e que as conclusões propostas estão diferentes dos resultados dos artigos escolhidos pelos próprios autores do BRATS. Os artigos selecionados pelos autores do BRATS apontam para a eficácia e segurança do uso do metilfenidato. Entretanto, a conclusão final dos autores não reflete isso e não deveria ser usada como referência para orientar decisões sobre o uso do metilfenidato.A Brazilian Health Technology Assessment Bulletin (BRATS) article regarding scientific evidence of the efficacy and safety of methylphenidate for treating attention deficit hyperactivity disorder (ADHD) has caused much controversy about its methods. Considering the relevance of BRATS for public health in Brazil, we critically reviewed this article by remaking the BRATS search and discussing its methods and results. Two questions were answered: did BRATS include all references available in the literature? Do the conclusions reflect the reviewed articles? The results indicate that BRATS did not include all the references from the literature on this subject and also that the proposed conclusions are different from the results of the articles chosen by the BRATS authors themselves. The articles selected by the BRATS authors showed that using methylphenidate is safe and effective. However, the BRATS final conclusion does not reflect the aforementioned and should not be used to support decisions on the use of methylphenidate

Schedule for affective disorders and schizophrenia for school-age children - present and lifetime version (K-SADS-PL), DSM-5 update : translation into Brazilian Portuguese

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Volumetric and neurochemical evaluation of the left dorsolateral prefrontal cortex in pediatric patients with major depressive disorder: a study using Proton Magnetic Resonance Spectroscopy

A Ressonância Magnética e a Espectroscopia por Ressonância Magnética de Hidrogênio têm sido empregadas em estudos anatômicos e neuroquímicos do Transtorno Depressivo Maior (TDM). Dezenove crianças com TDM e 24 controles saudáveis foram avaliados em um magneto de 1,5 Tesla (Philips Intera 8.1.1.). Em comparação aos controles saudáveis, crianças com TDM apresentaram: menores volumes de hipocampo esquerdo; e no voxel único em CPFDL esquerdo: menores níveis dos compostos de colina, e maiores níveis de mio-inositol em CPFDL esquerdo. Menores níveis dos compostos de colina podem refletir uma diminuição da renovação de membranas. Maiores níveis de mio-inositol podem representar uma alteração no sistema de segundos mensageiros intracelularesMagnetic resonance imaging and proton magnetic resonance spectroscopy have been applied to anatomical and neurochemical studies of Major Depressive Disorder (MDD). Nineteen children with MDD and 24 healthy controls were evaluated on a 1.5 Tesla (Philips Intera 8.1.1.) MRI. Compared to healthy controls, children with MDD presented: smaller left hippocampal volumes; and lower levels of choline-containing-compounds and higher myo-inositol levels in the left DLPFC. Lower levels of choline-containing-compounds in pediatric patients with MDD may reflect lower cell membrane turn-over. Higher myo-inositol levels in MDD may represent a disturbed secondary messengers syste

Volumetric and neurochemical evaluation of the left dorsolateral prefrontal cortex in pediatric patients with major depressive disorder: a study using Proton Magnetic Resonance Spectroscopy

A Ressonância Magnética e a Espectroscopia por Ressonância Magnética de Hidrogênio têm sido empregadas em estudos anatômicos e neuroquímicos do Transtorno Depressivo Maior (TDM). Dezenove crianças com TDM e 24 controles saudáveis foram avaliados em um magneto de 1,5 Tesla (Philips Intera 8.1.1.). Em comparação aos controles saudáveis, crianças com TDM apresentaram: menores volumes de hipocampo esquerdo; e no voxel único em CPFDL esquerdo: menores níveis dos compostos de colina, e maiores níveis de mio-inositol em CPFDL esquerdo. Menores níveis dos compostos de colina podem refletir uma diminuição da renovação de membranas. Maiores níveis de mio-inositol podem representar uma alteração no sistema de segundos mensageiros intracelularesMagnetic resonance imaging and proton magnetic resonance spectroscopy have been applied to anatomical and neurochemical studies of Major Depressive Disorder (MDD). Nineteen children with MDD and 24 healthy controls were evaluated on a 1.5 Tesla (Philips Intera 8.1.1.) MRI. Compared to healthy controls, children with MDD presented: smaller left hippocampal volumes; and lower levels of choline-containing-compounds and higher myo-inositol levels in the left DLPFC. Lower levels of choline-containing-compounds in pediatric patients with MDD may reflect lower cell membrane turn-over. Higher myo-inositol levels in MDD may represent a disturbed secondary messengers syste

Cardiovascular risk factors in outpatients with bipolar disorder : a report from the Brazilian Research Network in Bipolar Disorder

Objective: Bipolar disorder (BD) is associated with significant morbidity and mortality due to comorbid general medical conditions, particularly cardiovascular disease. This study is the first report of the Brazilian Research Network in Bipolar Disorder (BRN-BD) that aims to evaluate the prevalence and clinical correlates of cardiovascular risk factors among Brazilian patients with BD. Methods: A cross-sectional study of 159 patients with DSM-IV BD, 18 years or older, consecutively recruited from the Bipolar Research Program (PROMAN) in Sa˜o Paulo and the Bipolar Disorder Program (PROTAHBI) in Porto Alegre. Clinical, demographic, anthropometric, and metabolic variables were systematically assessed. Results: High rates of smoking (27%), physical inactivity (64.9%), alcohol use disorders (20.8%), elevated fasting glucose (26.4%), diabetes (13.2%), hypertension (38.4%), hypertriglyceridemia (25.8%), low HDL-cholesterol (27.7%), general (38.4%) and abdominal obesity (59.1%) were found in the sample. Male patients were more likely to have alcohol use disorders, diabetes, and hypertriglyceridemia, whereas female patients showed higher prevalence of abdominal obesity. Variables such as medication use pattern, alcohol use disorder, and physical activity were associated with selected cardiovascular risk factors in the multivariable analysis. Conclusion: This report of the BRN-BD provides new data regarding prevalence rates and associated cardiovascular risk factors in Brazilian outpatients with BD. There is a need for increasing both awareness and recognition about metabolic and cardiovascular diseases in this patient population