Anorexia nervosa in childhood and adolescence: from symptom identification to hospitalization

Introdução – É amplamente reconhecida a importância da intervenção precoce na anorexia nervosa. Os dados disponíveis na literatura evidenciam que uma duração prolongada de doença não tratada está associada a um pior prognóstico nas perturbações da alimentação e da ingestão e que a gravidade da doença à data do diagnóstico, é preditiva do seu outcome. Objetivos – Geral: estudar o tempo de doença não tratada, numa amostra de crianças/adolescentes que estiveram internados com o diagnóstico de anorexia nervosa. Específicos: descrever o percurso percorrido desde a identificação dos primeiros sintomas até ao internamento, nomeadamente no que respeita ao seguimento em consultas das diversas especialidades, à realização de exames complementares de diagnóstico, à presença de comorbilidades e às terapêuticas estabelecidas previamente ao internamento. Método – Após obtenção do consentimento informado para participação no estudo procedeu-se à consulta dos processos clínicos de uma amostra de crianças/adolescentes internados num serviço de pedopsiquiatria no período compreendido entre janeiro de 2018 e dezembro de 2019 (n=37). Para recolha dos dados foi utilizada uma grelha construída tendo em consideração os objetivos definidos. Foi realizada uma análise estatística univariada, procurando descrever as ações empreendidas no tempo de doença não tratada, os seguimentos e plano terapêutico prévios ao internamento, o tempo decorrido desde a identificação de sintomas até ao internamento e a sua duração. Por último, procurou-se compreender de que forma tinham sido articulados os seguimentos nas diferentes consultas. Resultados e Discussão – Os resultados mostraram que dos 37 casos que constituíram a amostra, em cinco não ocorrera qualquer contacto com um profissional de saúde até à data de internamento; apenas 16 casos estavam referenciados à consulta de dietética/nutrição e só 15 casos tinham um plano alimentar estabelecido previamente ao internamento. Apenas dois casos eram seguidos em equipa multidisciplinar constituída por pediatra, pedopsiquiatra, psicólogo e dietista/nutricionista. Conclusão – Na amostra apenas uma minoria dos casos estava a ser seguida por uma equipa multidisciplinar. Estes dados reforçam a necessidade de uma melhor articulação entre os serviços de saúde mental e as restantes áreas de intervenção nas perturbações da alimentação e da ingestão.ABSTRACT - Introduction – The importance of early intervention in anorexia nervosa is widely recognized. The data available in the literature shows that a prolonged duration of untreated disease is associated with a worse prognosis and that the severity of the disease at the time of diagnosis is predictive of its outcome. Objectives – To study the time of untreated disease in a sample of children/adolescents who were hospitalized with the diagnosis of anorexia nervosa. Specifically, to clarify the path from the identification of first symptoms to hospitalization regarding follow-up consultations and their management, the performance of complementary diagnostic tests, the presence of comorbidities, and the duration of hospitalization. Methods – Once the informed consent to participate in this study was signed, we gathered information from clinical files and the hospital’s clinical database regarding children and adolescents with the diagnosis of anorexia nervosa admitted to the child and adolescent psychiatry ward from January 2018 until December 2019. A descriptive statistical analysis of the sample was performed, trying to identify the course of action taken between the identification of symptoms and the search for consultation, the type of consultations to which the family resorted, the therapeutic plan implemented prior to hospitalization, and throughout the hospitalization. Finally, we tried to understand how several health professionals managed the follow-ups. Results/Discussion – In our sample (n=37), five cases had no contact with a health professional before hospitalization. Only 16 cases were referred to dietary/nutrition consultation and only 15 cases had a diet plan established prior to hospitalization. Of the 37 cases, only two were referred to a multidisciplinary team composed of pediatric, child, and adolescent psychiatrists, psychologists, and dietitians/nutritionists. Conclusion – In our sample, only a minority of cases were being followed by a multidisciplinary team prior to hospitalization. These data reinforce the need for better articulation between mental health services and other areas of intervention regarding eating disorders.info:eu-repo/semantics/publishedVersio

From first symptoms to hospitalization for nervous anorexia: which resources do parents seek and how do they perceive them?

Objetivos – Identificar os vários recursos utilizados pelos pais de crianças com anorexia nervosa, após a identificação dos primeiros sintomas dos filhos; caracterizar os intervalos temporais entre a identificação de sintomas nos filhos, o pedido de ajuda, o acesso ao apoio e a necessidade de internamento; identificar os recursos que os pais consideram como estando em falta. Método – Recurso a um inquérito semiestruturado, anónimo, em formato digital, dirigido aos pais de crianças internadas com o diagnóstico de anorexia nervosa na Unidade de Internamento de Pedopsiquiatria de um hospital da área urbana do centro de Portugal, entre janeiro de 2018 e dezembro de 2019. Os resultados foram analisados estatisticamente com recurso ao Excel. Resultados – Os técnicos de saúde foram identificados como os recursos utilizados com maior frequência para obter informação ou apoio emocional. Dentro dos apoios técnicos, o pediatra assistente e o médico de família foram os recursos considerados como mais acessíveis. Apenas 18,2% dos pais referiram que os filhos tinham um acompanhamento prolongado (há mais de seis meses) antes de serem internados. Em relação aos recursos que os pais identificaram como tendo estado em falta, 84,8% dos pais destacaram a necessidade de apoio psicológico/psiquiátrico para eles próprios. Discussão – Este trabalho evidenciou a existência de um período de tempo longo entre a identificação dos primeiros sintomas de doença e a tomada de decisão de pedir uma avaliação técnica. Conclusão – Existem ainda graves falhas na deteção precoce de crianças e adolescentes com anorexia nervosa. Nesse sentido, é necessário otimizar a deteção precoce e a referenciação por parte dos técnicos a quem estas famílias estão a recorrer em primeira linha, nomeadamente aos médicos de família.ABSTRACT - Aim of the study – To identify different resources used by parents of children suffering from nervous anorexia, after acknowledging the first symptoms; to characterise periods of time between first symptoms acknowledgment in their children, help request, access to support, and hospitalisation; to identify resources missed by parents. Methods – Anonymous semi-structured online survey to parents of children suffering from nervous anorexia hospitalised in a Unit for Child Psychiatry at an urban hospital in the central area of Portugal, from January 2018 to December 2019. Statistical analysis of results done through an Excel spreadsheet. Results – Health professionals were identified as the most frequently used resource for information or emotional support. Among these professionals, family doctors and paediatricians were considered the most accessible resources. Only 18.2% of parents stated that their children had prolonged medical support (over six months) before being hospitalised. As to resources indicated by parents as missing, 84.8% pointed to psychological or psychiatric support for themselves. Discussion – This study has highlighted the existence of a long period of time between the acknowledgment of the first symptoms of the disease and the decision-making of requiring a technical assessment. Conclusion – There are still some serious flaws in the early diagnosis of children and adolescents suffering from nervous anorexia. Therefore, it seems crucial to maximise early diagnosis and referral by health professionals, notably family doctors, whom these families contact first-hand.info:eu-repo/semantics/publishedVersio

The Lockdown Impact on the Relations between Portuguese Parents and Their 1- to 3-Year-Old Children during the COVID-19 Pandemic

Funding Information: In Portugal, during the first lockdown, with few exceptions, families with children under 12 years old were given a choice. One parent could suspend his/her professional activity temporarily and receive financial support from the National Social Security System []. Most families, especially those with little children, chose this option. Publisher Copyright: © 2022 by the authors.Many countries have applied mandatory confinement measures in response to the COVID-19 pandemic, such as school and kindergarten closures, which confined families to their homes. The study concerns the impacts of the first COVID-19 lockdown on the relationships between Portuguese parents and their children, in a non-clinical population composed of fathers and mothers of children between the ages of 12 months and 3 years and 364 days. An online questionnaire (set by the research team) and the Parenting Daily Hassles Scale (PDHS) concerning the confinement period were applied between 17 June and 29 July 2020. To assess the impacts of the lockdown, outcomes regarding the impacts perceived by the parents, the potential regression in the development of children, and the willingness to promote changes in family routines in the future, were considered. Of the total sample (n = 1885), 95.4% of the parents (n = 1798) said that, after confinement, the relationship with their children had improved or remained similar to the pre-confinement period; 97.3% (n = 1835) noticed positive changes in the development of their children, and 63.7% (n = 1200) noted that the relationships with their children during the confinement period would lead to some changes in family routines in the future. Multivariate regression analyses showed that most of the sociodemographic variables chosen were not associated with the outcomes. However, significant levels of pressure over parenting and parental overload (reported by high scores in the PDHS intensity and frequency scales), challenging behaviors of the children, and the impacts they had on parental tasks had negative influences on the studied outcomes. On the contrary, the number of adults living with their children, the perceptions regarding the development of their children, and sharing new experiences with them were significant factors for positively-perceived impacts on the relationships between them or in the desire to bring about changes in family routines in the future. The impacts of the lockdown on the relationships between parents and children aged between 1 and 3 years old were more dependent on relational aspects and on the parents’ sense of competence in exercising parental functions. We conclude that, despite the increased demands imposed by the lockdown, nearly all of the parents evaluated the quality of the relationship with their children as positive after this period.publishersversionpublishe

Cognitive behavioral therapyof children and adolescentes with attention-decifit hyperactivity disorder

Revista de Psicologia da Criança e do Adolescente. - ISSN 1647-4120. - V. 10, n. 2 (2019).- p. 323-332.Pensar em psicoterapia como estratégia de intervenção terapêutica com crianças ou adolescentes com o diagnóstico de Perturbação de Hiperatividade e Défice de Atenção (PHDA), pela natureza da sintomatologia desta entidade, pode parecer quase um contrassenso. Sabe-se que a desatenção, a hiperatividade e a impulsividade que aracterizam o quadro na infância se mantêm em cerca de 50 a 80 % na idade adulta tendo um impacto importante em variados domínios da vida do indivíduo. Tem havido uma grande evolução dos conhecimentos acerca da etiologia, diagnóstico e tratamento, mas mantém-se a preocupação acerca das crianças e adolescente que, apesar do tratamento farmacológico, mantêm sintomatologia residual. Neste ponto, as intervenções psicossociais, onde se inclui a terapia cognitivo comportamental, têm conquistado terreno. Foi realizada uma pesquisa bibliográfica na base de dados PubMed com os termos Perturbação de Hiperactividade e Défice de Atenção, Terapia cognitivo-comportamental, psicoterapia, crianças e adolescentes. Os resultados sugerem que a terapia cognitivo-comportamental para a PHDA em crianças e adolescentes é útil como estratégia de intervenção terapêutica psicossocial e que existem benefícios clínicos para esta população. As intervenções terapêuticas psicossociais, onde se inclui a terapia cognitivo comportamental, são importantes co-adjuvantes à terapêutica farmacológica na PHDA nas crianças e adolescentes. É necessária mais investigação científica sobre a sua eficácia.Thinking about psychotherapy as a therapeutic intervention strategy with children or adolescents with the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), due to the nature of the symptomatology of this entity, may seem almost a contradiction. It is known that the inattention, hyperactivity and impulsivity that characterize ADHD in childhood remain at about 50 to 80% in adulthood and have an important impact on various domains of the individual’s life. There has been a great evolution of knowledge about etiology, diagnosis and treatment, but the concern remains about how children and adolescents that, despite the pharmacological treatment, maintain residual symptomatology. At this point, psychosocial interventions, including cognitive behavioral therapy, has gained ground. A bibliographic review was carried out through the research in the PubMed database, using the following keywords: “attention-deficit/hyperactivity disorder”, “Cognitive Behavioral Therapy”, “psychotherapy”, “children” and “adolescents”. The results suggest that the cognitive behavioral therapy for ADHD in children and adolescents is usefull as strategy of psychosocial therapeutic intervention and that they experienced clinical benefit. Psychosocial therapeutic interventions, including cognitive behavioral therapy, are an important coadjuvant to pharmacological therapeutics in ADHD in children and adolescents. More scientific research is needed on its effectiveness

The Lockdown Impact on the Relations between Portuguese Parents and Their 1- to 3-Year-Old Children during the COVID-19 Pandemic

Many countries have applied mandatory confinement measures in response to the COVID-19 pandemic, such as school and kindergarten closures, which confined families to their homes. The study concerns the impacts of the first COVID-19 lockdown on the relationships between Portuguese parents and their children, in a non-clinical population composed of fathers and mothers of children between the ages of 12 months and 3 years and 364 days. An online questionnaire (set by the research team) and the Parenting Daily Hassles Scale (PDHS) concerning the confinement period were applied between 17 June and 29 July 2020. To assess the impacts of the lockdown, outcomes regarding the impacts perceived by the parents, the potential regression in the development of children, and the willingness to promote changes in family routines in the future, were considered. Of the total sample (n = 1885), 95.4% of the parents (n = 1798) said that, after confinement, the relationship with their children had improved or remained similar to the pre-confinement period; 97.3% (n = 1835) noticed positive changes in the development of their children, and 63.7% (n = 1200) noted that the relationships with their children during the confinement period would lead to some changes in family routines in the future. Multivariate regression analyses showed that most of the sociodemographic variables chosen were not associated with the outcomes. However, significant levels of pressure over parenting and parental overload (reported by high scores in the PDHS intensity and frequency scales), challenging behaviors of the children, and the impacts they had on parental tasks had negative influences on the studied outcomes. On the contrary, the number of adults living with their children, the perceptions regarding the development of their children, and sharing new experiences with them were significant factors for positively-perceived impacts on the relationships between them or in the desire to bring about changes in family routines in the future. The impacts of the lockdown on the relationships between parents and children aged between 1 and 3 years old were more dependent on relational aspects and on the parents’ sense of competence in exercising parental functions. We conclude that, despite the increased demands imposed by the lockdown, nearly all of the parents evaluated the quality of the relationship with their children as positive after this period