6 research outputs found
ATTENTION DEFICIT DISORDER/HYPERKINETIC DISORDER IN CHILDREN AND ADOLESCENTS
Sindrom poremeÄaja pozornosti s hiperaktivnoÅ”Äu ili bez nje je neurobioloÅ”ki poremeÄaj karakteriziran trijasom simptoma: hiperkinezom, poremeÄajem pozornosti i impulzivnoÅ”Äu uz sekundarne simptome: poremeÄajem uÄenja, smetnjama ponaÅ”anja i nedostatkom samopoÅ”tovanja. Vrlo Äesto prisutni su i blaži neuroloÅ”ki simptomi. Etiologija poremeÄaja je nepoznata, no najvjerojatnije je rijeÄ o viÅ”e bioloÅ”kih i psihosocijalnih uzroka. Prevalencija se kreÄe od 3-10% djece Å”kolske dobi. PoremeÄaj je ÄeÅ”Äi u djeÄaka nego u djevojÄica, kako u kliniÄkom (9:1) tako i u epidemioloÅ”kom uzorku (4:1). Veliki problem u djece i adolescenata s poremeÄajem pozornosti/hiperaktivnosti je komorbiditet, jer Äak dvije treÄine djece imaju barem joÅ” jedan dijagnosticirani psihijatrijski poremeÄaj, najÄeÅ”Äe onaj ponaÅ”anja, opozicijsko-prkosni i poremeÄaj uÄenja, ali i poremeÄaje govora i komunikacije, anksiozni poremeÄaj, poremeÄaj raspoloženja, Tourettov sindrom ili tikove. Komorbiditet je znaÄajan, jer komplicira dijagnostiÄki proces i ima uvelike utjeÄe na tijek, prognozu i terapiju. Tretman hiperkinetskog poremeÄaja je viÅ”edimenzionalan i kombinira psihosocijalne i farmakoloÅ”ke intervencije, pa se mora zapoÄeti Å”to ranije. Uz kognitivno-bihevioralni tretman medikamentozno lijeÄenje danas zauzima znaÄajno mjesto u terapiji.Attention deficit/hyperactivity disorder (ADHD) is a neurobiological disorder characterized with three core symptoms: hyperkinesis, attention deficit and impulsivity and secondary symptoms like learning disorders, behavioural disturbances and low self esteem. Soft neurological signs are very often present. The aetiology of the disorder is not yet well known and there are probably more neurobiological and psychosocial aetiological factors. The prevalence is 3-10% of school-age children. There is a greater incidence in boys than in girls with the ratio 9:1 in clinical, and 4:1 in epidemiological samples. Comorbidity is a major problem among children with ADHD, and two thirds of them have at least one more diagnosed psychiatric disorder, most often a conduct disorder, oppositional defiant disorder and learning disorder, but also disorders of speech and communication, anxiety disorders, mood disorders, tic disorders such as Sy Tourette s. Comorbidity is very important because it makes the diagnostic process more complicated, and has implications for the course, prognosis and treatment. Treatment of ADHD is multidimensional and combines psychosocial and pharmacological interventions, and it should start as early as possible. Today, cognitive behavioural treatment and drug treatment are most important in therapy
Hyperserotonemia in Autism: The Potential Role of 5HT-related Gene Variants
Increased platelet serotonin level (PSL) has been consistently found in a portion of autistic patients. Suggested mechanisms
for hyperserotonemia in autism have been increased synthesis of serotonin (5HT) by tryptophan hydroxylase
(TPH), increased uptake into platelets through 5HT transporter (5HTt), diminished release from platelets through 5HT2A
receptor (5HT2Ar) and decreased metabolism by monoamine oxydase (MAOA). The allelic influence of genes, encoding
the mentioned 5HT elements, on PSL was investigated in 63 autistic subjects. Our study shows that 5HTt-LPR and
ā1438AG 5HT2Ar genotypes did not significantly affect PSL. However, significantly higher PSLs were observed in subjects
with Ā»ccĀ« genotype of a218c TPH and subjects with Ā»4Ā« genotype of uVNTR MAOA. In addition, when TPH-cc and
MAOA-4 were combined as Ā»high 5HTĀ« genotypes, a correlative increase in PSL was observed with the increase in the
number of Ā»high 5HTĀ« genotypes. These results suggest a possible synergistic effect of genes regulating 5HT synthesis/
degradation in dysregulation of the peripheral 5HT homeostasis of autistic patients
PSYCHOPHARMACOTHERAPY IN NEUROPEDIATRY
U radu je prikazana primjena psihofarmaka u neuropedijatriji koja ima brojne specifiÄnosti u odnosu na primjenu psihofarmaka u odraslih, ali i u odnosu na primjenu drugih lijekova u pedijatriji. Lijekovima djelujemo na simptome, a ne na uzroke poremeÄaja. Za isti poremeÄaj daju se razliÄiti lijekovi, a isti lijekovi uÄinkoviti su za razliÄite poremeÄaje. Indikacije za uvoÄenje lijeka zbog psihiÄkog poremeÄaja u djece strogo su odreÄene, ako se druge metode nisu se pokazale uÄinkovite. Farmakoterapija u djece dio je složenog i sveobuhvatnog lijeÄenja koje ukljuÄuje i druge metode. Psihofarmaci se uvijek daju u suglasnosti s roditeljima, kojima treba objasniti terapijske ciljeve, ograniÄenja i moguÄe nuspojave. Antipsihotici, antidepresivi i psihostimulansi snižavaju prag za konvulzije, dok ga sedativi i anksiolitici podižu. Vrlo mali broj antipsihotika i antidepresiva deklariran je za primjenu u djece, a psihostimulansi koji se propisuju kod hiperkinetskog poremeÄaja i smetnji ponaÅ”anja nisu registrirani u naÅ”oj zemlji. U radu je prikazana psihofarmakoterapija psihotiÄnog poremeÄaja, depresivnog poremeÄaja, mentalne retardacije, pervazivnih razvojnih poremeÄaja, hiperkinetskog poremeÄaja, poremeÄaja ponaÅ”anja, opsesivno kompulzivnog poremeÄaja, enureze i enkopreze.This paper is a short overview of psychopharmacotherapy in neuropediatry which has specific differences both regarding adult psychopharmacotherapy and other pharmacotherapies in children. Psychoactive drugs act on symptoms and not on the cause of the disorder. Different drugs are useful for the same disorders, and the same drugs are useful for different disorders. Indications for medication for psychiatric disorders in children are strictly set when other therapies are not useful. Psychopharmacotherapy in children is almost always part of complex treatment including other methods. Psychopharmacotherapy must be applied only in agreement with parents and the parents must be aware of the therapy aims, limitations and side effects. Antipsychotic drugs, antidepressants and psychostimulants lower the seizure threshold while antianxiety drugs increase the threshold. Only a small number of antipsychotic drugs and antidepressants are declared and approved for children. Furthermore, psychostimulant drugs used for hyperactivity disorder and conduct disorder treatment are not approved in Croatia at all. This paper reviews psychopharmacotherapy in children with psychotic disorders, depressive disorders, mental retardation, pervasive developmental disorder, children with hyperactivity disorder, conduct disorder, obsessive compulsive disorder, and children with enuresis and encopresis
ATTENTION DEFICIT DISORDER/HYPERKINETIC DISORDER IN CHILDREN AND ADOLESCENTS
Sindrom poremeÄaja pozornosti s hiperaktivnoÅ”Äu ili bez nje je neurobioloÅ”ki poremeÄaj karakteriziran trijasom simptoma: hiperkinezom, poremeÄajem pozornosti i impulzivnoÅ”Äu uz sekundarne simptome: poremeÄajem uÄenja, smetnjama ponaÅ”anja i nedostatkom samopoÅ”tovanja. Vrlo Äesto prisutni su i blaži neuroloÅ”ki simptomi. Etiologija poremeÄaja je nepoznata, no najvjerojatnije je rijeÄ o viÅ”e bioloÅ”kih i psihosocijalnih uzroka. Prevalencija se kreÄe od 3-10% djece Å”kolske dobi. PoremeÄaj je ÄeÅ”Äi u djeÄaka nego u djevojÄica, kako u kliniÄkom (9:1) tako i u epidemioloÅ”kom uzorku (4:1). Veliki problem u djece i adolescenata s poremeÄajem pozornosti/hiperaktivnosti je komorbiditet, jer Äak dvije treÄine djece imaju barem joÅ” jedan dijagnosticirani psihijatrijski poremeÄaj, najÄeÅ”Äe onaj ponaÅ”anja, opozicijsko-prkosni i poremeÄaj uÄenja, ali i poremeÄaje govora i komunikacije, anksiozni poremeÄaj, poremeÄaj raspoloženja, Tourettov sindrom ili tikove. Komorbiditet je znaÄajan, jer komplicira dijagnostiÄki proces i ima uvelike utjeÄe na tijek, prognozu i terapiju. Tretman hiperkinetskog poremeÄaja je viÅ”edimenzionalan i kombinira psihosocijalne i farmakoloÅ”ke intervencije, pa se mora zapoÄeti Å”to ranije. Uz kognitivno-bihevioralni tretman medikamentozno lijeÄenje danas zauzima znaÄajno mjesto u terapiji.Attention deficit/hyperactivity disorder (ADHD) is a neurobiological disorder characterized with three core symptoms: hyperkinesis, attention deficit and impulsivity and secondary symptoms like learning disorders, behavioural disturbances and low self esteem. Soft neurological signs are very often present. The aetiology of the disorder is not yet well known and there are probably more neurobiological and psychosocial aetiological factors. The prevalence is 3-10% of school-age children. There is a greater incidence in boys than in girls with the ratio 9:1 in clinical, and 4:1 in epidemiological samples. Comorbidity is a major problem among children with ADHD, and two thirds of them have at least one more diagnosed psychiatric disorder, most often a conduct disorder, oppositional defiant disorder and learning disorder, but also disorders of speech and communication, anxiety disorders, mood disorders, tic disorders such as Sy Tourette s. Comorbidity is very important because it makes the diagnostic process more complicated, and has implications for the course, prognosis and treatment. Treatment of ADHD is multidimensional and combines psychosocial and pharmacological interventions, and it should start as early as possible. Today, cognitive behavioural treatment and drug treatment are most important in therapy