6 research outputs found
PHARMACOTHERAPY IN CHILDREN WITH LEARNING DISABILITIES
Dijagnoza poremeÄaja uÄenja vrlo je opÄenita, pa stoga i neprecizna, jer se pod njom može skrivati Å”iroki spektar raznih dijagnostiÄkih kategorija iz podruÄja djeÄje i adolescentne psihijatrije. Primjeri su ADHD, specifiÄne smetnje uÄenja, poremeÄaj ponaÅ”anja, mentalna retardacija, depresivni poremeÄaj, reakcija na stres i poremeÄaj prilagodbe, neurotski poremeÄaj, somatoformni poremeÄaj, poremeÄaj privrženosti i drugo. Zbog toga je nužno toÄno postaviti dijagnozu te u dogovoru s roditeljima, djetetom i Å”kolom razraditi plan svladavanja nastavnog programa, a prema potrebi poÄeti i psihoterapiju. Ako spomenuti postupci nisu dostatni, možda Äe biti opravdano ukljuÄiti i medikamentoznu terapiju. NajÄeÅ”Äi razlog poremeÄaju uÄenja je ADHD (F 90), a lijek izbora su psihostimulansi (npr. metilfenidat, dekstroamfetamin, pemolin). Posljednjih godina u terapiji ADHD-a na raspolaganju je i nestimulans atomoksetin ā selektivni inhibitor ponovne pohrane noradrenalina. Za sada ne postoji medikamentozna terapija koja bi bila uÄinkovita kod specifiÄnih smetnji uÄenja (F 81). Ako se iza poremeÄaja uÄenja skriva neki psihijatrijski poremeÄaj, kao npr. neurotski, psihotiÄni, afektivni i dr., uz psihoterapiju se ciljano može davati i lijek za tu bolest (npr. anksiolitik, neuroleptik, antidepresiv, itd.). U nekim kombiniranim sluÄajevima (npr. ADHD i depresivni poremeÄaj itd.) uz npr. psihostimulanse može se istodobno ukljuÄiti i dodatna psihijatrijska medikacija (npr. antidepresiv). Primjena psihijatrijskih lijekova kod djece vrlo je osjetljiv postupak, koji zahtijeva stalno praÄenje uÄinkovitosti terapije, prilagoÄavanje doze i otkrivanje eventualnih nuspojava.Diagnosis of learning disabilities is a general entity and as such is imprecise since it includes a broad spectrum of various diagnostic criteria in the field of child and adolescent psychiatry. For example, it includes ADHD, specific learning disorders, conduct disorders, mental retardation, depressive disorders, stress disorder and adjustment disorders, neurotic and somatoform disorders, attachment disorders etc. For that reason it is crucial to establish a precise diagnosis, make an adequate schooling plan in cooperation with parents, child and school, and start psychotherapy if necessary. If such procedures are not sufficient, medicament therapy may be considered. The most common reason for learning disabilities is ADHD (F90), and in such cases the drugs of choice are psychostimulants (e.g. methylphenidate, dextroamphetamine, pemolin). In the past few years a non-stimulant drug used in the treatment of ADHD is atomoxetine ā selective norepinephrine reuptake inhibitor. At present there is no medical therapy that would be effective in the treatment of specific learning disorders (F81). If there are other psychiatric disorders with ADHD, such as neurosis, psychotic disorder, affective disorder or other, in addition to psychotherapy a specific, targeted drug can be used (e.g. anxiolitic, neuroleptic, antidepressant etc.). In cases of two or more psychiatric disorders (e.g. ADHD and depressive disorder) in addition to psychostimulants other medication can be used simultaneously (e.g. antidepressant). Prescription and usage of psychiatric drugs in children is a very delicate process, which demands continuous monitoring of therapy effectiveness, adjustment of dosage and detection of possible side effects
EPILEPSY AND MENTAL DISORDERS IN CHILDREN AND ADOLESCENTS ā DIFFERENTIAL DIAGNOSTICS
Rad se bavi razlikama izmeÄu epilepsije i mentalnih poremeÄaja u djece i adolescenata kad je simptomatologija tih bolesti sliÄna. PokuÅ”avaju se dati smjernice za Å”to toÄniju dijagnostiku, jer je ona preduvjet ispravnom lijeÄenju. Kao najvažnije dijagnostiÄko sredstvo i dalje se smatra dobro uzeta anamneza te timski rad djeÄjeg psihijatra i neuropedijatra.The paper deals with differences between manifestations of epileptic and mental disorders in children and adolescents in cases when they exhibit similar symptoms. Since the treatment outcome depends almost entirely on the accurate diagnosis, the paper sets out guidelines and main points of differentiation between these phenomena. Detailed anamnesis along with close cooperation between the child psychiatrist and the neuro-pediatrician are considered the cornerstones of the diagnostic procedure
Holistic approach in the treatment of a boy with Touretteās disorder
Touretteov poremeÄaj (TP) neurorazvojni je poremeÄaj s kombiniranim motoriÄkim i vokalnim tikovima. Etiologija bolesti nije jasna,
ali rezultati istraživanja upuÄuju na važnost genetiÄkih faktora. U radu je opisan sluÄaj holistiÄkog pristupa u lijeÄenju desetogodiÅ”njeg
djeÄaka s Touretteovim poremeÄajem. Primijenjena farmakoterapija bila je usmjerena na komorbidna stanja, a ne na same tikove.
Remisija je uslijedila nakon godinu dana lijeÄenja.Touretteās disorder is a neurodevelopmental disorder with combined motor and vocal tics. The etiology of the disease is not clear, but
results suggest the role of genetic factors. The paper describes a case of a holistic approach in the treatment of a ten-year-old boy
with Touretteās disorder. The pharmacotherapy applied was focused on comorbid conditions, and not on the tics. Remission followed
after one year of treatment
Trichotillomania and comorbidity in adolescents: two case reports
Trihotilomanija je relativno rijedak poremeÄaj. U DijagnostiÄkom i statistiÄkom priruÄniku mentalnih poremeÄaja (DSM-V, 2013.)
svrstan je u skupinu s opsesivno-kompulzivnim i njemu srodnim poremeÄajima. Trihilomanija ima i karakteristike poremeÄaja
impulsa i navika. Prvi simptomi trihilomanije najÄeÅ”Äe se pojavljuju u adolescenciji. KliniÄka slika u djece i adolescenata Äesto je
komplicirana postojanjem komorbiditeta. NajÄeÅ”Äe opisivani komorbiditet su anksioznost i depresija iz podruÄja osjeÄaja i
raspoloženja, a rjeÄi su tikovi, hiperkinetski i opsesivno-kompulzivni poremeÄaj, razliÄiti oblici regresivnog ponaÅ”anja i neki drugi.
Prikazana su dva bolesnika kod kojih je prepoznavanje poremeÄaja bilo otežano time Å”to djeca i adolescenti nerado priznaju trihilomaniju,
a daljnje lijeÄenje bilo je dijelom multidisciplinarno i u mnogo Äemu je ovisilo o komorbiditetu. U prvom prikazu etiopatogeneza
je najveÄim dijelom emocionalna. U drugom prikazu prateÄi poremeÄaj je iz skupine neurorazvojnih poremeÄaja. Odabir
psihoterapijske tehnike i Å”iri pristup lijeÄenju u cijelosti su ovisili o komorbiditetu i zahtjevali su suradnju djeÄjeg psihijatra sa
struÄnjacima iz drugih podruÄja pedijatrijske medicine. Mislimo da istraživanja ovog poremeÄaja treba ustrajno i dalje usmjeravati
otkrivanju izravne i druge povezanosti trihilomanije i komorbiditeta, kako bi se omoguÄilo Å”to primjerenije i uÄinkovitije prepoznavanje
i lijeÄenje ovog poremeÄaja.Trichotillomania (TTM) is a relatively rare disorder. In recent editions of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-V, 2013), TTM is classifi ed in the group including obsessive-compulsive and related disorders. TTM also has some
characteristics of the disorders of impulses and habits. Initially, TTM symptoms usually occur during adolescence. The clinical
picture in children and adolescentsis often complicated by the presence of comorbidity. In children and adolescents, the most
common comorbidity is in the domain of aff ect, specifi cally depression and anxiety. Rarely described comorbidities are tics, hyperkinetic
disorder, obsessive-compulsive disorder, various forms of regressive behavior, and some others. In the two cases
reported, recognizing TTM was impeded. Specifi cally, children and adolescentsreluctantly acknowledge TTM, so recognizing
and further treatment was in many ways multidisciplinary and depended on the comorbidity. In the fi rst case, the etiopathogenesis
is mostly emotional. In the second case, the associated disorder is from the group of neurodevelopmental disorders.
The choice of psychotherapeutic techniques and broader approach to the treatment entirely depended on the comorbidity
and also required cooperation of experts from other areas of pediatric medicine. We believe that research should persistently
be focused on discovering direct and other relationships of TTM and comorbidity in order to allow for the most appropriate
and eff ective recognizing and treatment of this disorder
Correlations between attention deficit/hyperactivity disorder, obsessive-compulsive disorder and tics in children and adolescents: case report
Povezanost poremeÄaja nedostatka pozornosti s hiperaktivnoÅ”Äu (ADHD), opsesivno-kompulzivnog poremeÄaja (OKP) i tikova
primarno
se opisuje kroz genetiÄke, neurobioloÅ”ke, neurokognitivne i neurokemijske supstrate smanjene inhibicije motoriÄkog
odgovora.
Komorbiditet ovih poremeÄaja u djece i adolescenata nije rijetkost. U predÅ”kolskoj dobi u naÅ”eg 14-godiÅ”njeg pacijenta
dijagnosticirani su ADHD i tikovi, a potom u desetoj godini i OKP. PoremeÄaji su dijagnosticirani prema kriterijima iz DSM-IV. i uporabom
polustrukturiranih intervjua koji se na njemu temelje. U multimodalnom pristupu lijeÄenju provodili smo kognitivno-bihevioralne
psihoterapijske tehnike, psihoedukaciju i potporu roditelja, terapiju senzorne integracije uz potporu terapijskog psa, neurofeedback
te smo primijenili medikamentoznu terapiju (metilfenidat, fluvoxamin), grupnu terapiju usmjerenu poboljŔanju socijalnih
vjeÅ”tina, izražavanju i razumijevanju emocija i individualizirani pristup u Å”koli uz pomoÄ osobnog asistenta. U raspravi smo opisali
složenost u lijeÄenju kliniÄke slike komplicirane komorbiditetom i emocionalnim distresom te poznate i moguÄe poveznice ovih
poremeÄaja.
LijeÄenje ADHD-a zahtijeva multimodalni pristup i suradnju struÄnjaka razliÄitih profila. IzmeÄu ostalog, pravodobno
prepoznavanje udruženih simptoma i znakova drugih psihijatrijskih poremeÄaja i sagledavanje njihovih poveznica bitno je za sprjeÄavanje
razvoja složenije kliniÄke slike i odreÄivanje terapijskih smjernica. Potrebna su daljnja istraživanja.The relationship between the attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and tics is primarily
discussed through genetic, neurobiological, neurocognitive and neurochemical substrates of reduced impulse control. The
comorbidity of these disorders in children and adolescents is not a rarity. In our 14-year-old patient, ADHD and simple motor tics
were diagnosed at pre-school age and OCD at the age of 10. We diagnosed these disorders by DSM-IV criteria and semi-structured
interviews based on it. In a multimodal treatment we used techniques from cognitive behavioural psychotherapy, psychoeducation
and parental support, sensory integration therapy with a assistance dog, neurofeedback, medication therapy (methylphenidate,
fluvoxamine), group therapy aimed at enhancing social skills and expressing emotions, individualized approach to learning in
school with a personal assistant. We discuss the complexity of treatment of clinical presentation complicated by comorbidity and
emotional distress, and some known and possible links between these disorders. Treatment of ADHD demands multimodal approach
and cooperation of different professionals. Among other things, timely recognition of associated symptoms and other psychiatric
disorders and their linkage is very important to prevent intensification of symptoms and signs of the disorder and to determine
therapeutic guidelines. Further investigation is needed