Developmental psychopathology of children and adolescents with Tourette syndrome – impact of ADHD

Background: In Tourette syndrome (TS) as a neurodevelopmental disorder not only the tics but also the comorbid conditions change with increasing age. ADHD is highly comorbid with TS and usually impairs psychosocial functioning more than the tics. Its impact on further comorbidity during development is important for clinical practice and still a matter of debate. Method: Aspects of developmental psychopathology considering the impact of ADHD were examined by logistic regression (year wisely) in a cross-sectional sample of children and adolescents (n = 5060) from the TIC database. Results: In TS+ADHD (compared to TS-ADHD) higher rates of comorbid conditions like OCD, anxiety disorders, CD/ODD and mood disorders were found in children (5–10 years). In adolescents (11–17 years) higher comorbidity rates in TS+ADHD remained only for CD/ODD and mood disorders. Accordingly, for OCD and anxiety disorders there was a steeper year wise increase of these comorbidities in TS-ADHD while it was a similar for CD/ODD and mood disorders in TS-ADHD as well as TS+ADHD. Conclusion: Children with TS+ADHD have more comorbidities than the TS-ADHD group, whereas in both adolescent groups this did no longer hold for OCD and anxiety disorders. These findings indicate that in TS comorbid ADHD is associated with high rates of externalizing and internalizing problems, whereas TS without ADHD is associated only with internalizing problems in adolescence

Tic disorders and ADHD: answers from a world-wide clinical dataset on Tourette syndrome

Abstract Background: Tourette syndrome (TS) is a neurodevelopmental disorder with frequent comorbidity with Attention Deficit-Hyperactivity Disorder (ADHD). The impact of this association is still a matter of debate. Method: Using the TIC database containing 6,805 cases, the clinical differences were ascertained between subjects with and without ADHD. Results: The reported prevalence of ADHD in TS was 55%, within the range of many other reports. If the proband was diagnosed with ADHD, a family history of ADHD was much more likely. ADHD was associated with earlier diagnosis of TS and a much higher rate of anger control problems, sleep problems, specific learning disability, OCD, Oppositional-defiant disorder, mood disorder, social skill deficits, sexually inappropriate behaviour, and self-injurious behaviour. Subjects with seizures and with Developmental Coordination Disorder also had high rates of ADHD. Anxiety disorder, however, was not more frequent. Preliminary data suggest that most behavioural difficulties in ADHD are associated with the Combined or Hyperactive-Impulsive Subtypes of ADHD. Every large site (>200 cases) had a significantly increased rate of anger control problems in cases with ADHD. Conclusion: Subjects with TS have high rates of ADHD and complex associations with other disorders. Clinically the findings confirm other research indicating the importance of ADHD in understanding the behavioural problems often associated with the diagnosis of TS. Additional ADHD comorbidity should be taken into account in diagnosis, management, and training

Efectividad de una guía de diagnósticos de enfermería para el registro en pacientes con cardiopatias lima 2014

Los registros de enfermería son actualmente más importantes que nunca, debido al aumento de las situaciones médico-legales, frente a las cuales es indispensable contar con un respaldo del trabajo realizado, respaldo que, idealmente, debe favorecer la comunicación entre los componentes del equipo de salud; utilizando un lenguaje estandarizado al momento de registrar las acciones en las notas de enfermería. Es por ello la importancia de este estudio, que tiene como objetivo Determinar la efectividad de una guía de diagnósticos de enfermería para el registro en pacientes con cardiopatías, aplicado a los enfermeros del servicio de tórax y cardiovascular del Instituto Nacional de Salud del Niño. El presente estudio es de tipo cuantitativo, nivel aplicativo, de corte transversal y utiliza el método cuasiexperimental. La población estuvo conformada por 13 enfermeros asistenciales del servicio y la unidad de análisis la conformaron las notas de enfermería registradas en las historias clínicas de los pacientes con cardiopatías del Servicio de Cirugía de Tórax y Cardiovascular. Las técnicas utilizadas fueron la observación y una encuesta, y los instrumentos una Guía de Diagnósticos de Enfermería y una Escala de Likert Modificada. Los resultados encontrados revelan que la guía de diagnósticos de enfermería es efectiva dado que sus 4 dimensiones fueron registrados en un 82.41% en las notas de enfermería, y los enfermeros estuvieron de acuerdo en su utilización en el servicio según la encuesta de opinión aplicada, con lo cual se aceptan la hipótesis de estudio.Tesi