ATTENTION DEFICIT DISORDER/HYPERKINETIC DISORDER IN CHILDREN AND ADOLESCENTS

Sindrom poremećaja pozornosti s hiperaktivnošću ili bez nje je neurobiološki poremećaj karakteriziran trijasom simptoma: hiperkinezom, poremećajem pozornosti i impulzivnošću uz sekundarne simptome: poremećajem učenja, smetnjama ponašanja i nedostatkom samopoštovanja. Vrlo često prisutni su i blaži neurološki simptomi. Etiologija poremećaja je nepoznata, no najvjerojatnije je riječ o više bioloških i psihosocijalnih uzroka. Prevalencija se kreće od 3-10% djece školske dobi. Poremećaj je češći u dječaka nego u djevojčica, kako u kliničkom (9:1) tako i u epidemiološkom uzorku (4:1). Veliki problem u djece i adolescenata s poremećajem pozornosti/hiperaktivnosti je komorbiditet, jer čak dvije trećine djece imaju barem još jedan dijagnosticirani psihijatrijski poremećaj, najčešće onaj ponašanja, opozicijsko-prkosni i poremećaj učenja, ali i poremećaje govora i komunikacije, anksiozni poremećaj, poremećaj raspoloženja, Tourettov sindrom ili tikove. Komorbiditet je značajan, jer komplicira dijagnostički proces i ima uvelike utječe na tijek, prognozu i terapiju. Tretman hiperkinetskog poremećaja je višedimenzionalan i kombinira psihosocijalne i farmakološke intervencije, pa se mora započeti što ranije. Uz kognitivno-bihevioralni tretman medikamentozno liječenje danas zauzima značajno 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 –1438AG 5HT2Ar genotypes did not significantly affect PSL. However, significantly higher PSLs were observed in subjects with »cc« genotype of a218c TPH and subjects with »4« genotype of uVNTR MAOA. In addition, when TPH-cc and MAOA-4 were combined as »high 5HT« genotypes, a correlative increase in PSL was observed with the increase in the number of »high 5HT« 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 specifičnosti 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 poremećaja. Za isti poremećaj daju se različiti lijekovi, a isti lijekovi učinkoviti su za različite poremećaje. Indikacije za uvođenje lijeka zbog psihičkog poremećaja u djece strogo su određene, ako se druge metode nisu se pokazale učinkovite. Farmakoterapija u djece dio je složenog i sveobuhvatnog liječenja koje uključuje i druge metode. Psihofarmaci se uvijek daju u suglasnosti s roditeljima, kojima treba objasniti terapijske ciljeve, ograničenja i moguće 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 poremećaja i smetnji ponašanja nisu registrirani u našoj zemlji. U radu je prikazana psihofarmakoterapija psihotičnog poremećaja, depresivnog poremećaja, mentalne retardacije, pervazivnih razvojnih poremećaja, hiperkinetskog poremećaja, poremećaja ponašanja, opsesivno kompulzivnog poremećaja, 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 poremećaja pozornosti s hiperaktivnošću ili bez nje je neurobiološki poremećaj karakteriziran trijasom simptoma: hiperkinezom, poremećajem pozornosti i impulzivnošću uz sekundarne simptome: poremećajem učenja, smetnjama ponašanja i nedostatkom samopoštovanja. Vrlo često prisutni su i blaži neurološki simptomi. Etiologija poremećaja je nepoznata, no najvjerojatnije je riječ o više bioloških i psihosocijalnih uzroka. Prevalencija se kreće od 3-10% djece školske dobi. Poremećaj je češći u dječaka nego u djevojčica, kako u kliničkom (9:1) tako i u epidemiološkom uzorku (4:1). Veliki problem u djece i adolescenata s poremećajem pozornosti/hiperaktivnosti je komorbiditet, jer čak dvije trećine djece imaju barem još jedan dijagnosticirani psihijatrijski poremećaj, najčešće onaj ponašanja, opozicijsko-prkosni i poremećaj učenja, ali i poremećaje govora i komunikacije, anksiozni poremećaj, poremećaj raspoloženja, Tourettov sindrom ili tikove. Komorbiditet je značajan, jer komplicira dijagnostički proces i ima uvelike utječe na tijek, prognozu i terapiju. Tretman hiperkinetskog poremećaja je višedimenzionalan i kombinira psihosocijalne i farmakološke intervencije, pa se mora započeti što ranije. Uz kognitivno-bihevioralni tretman medikamentozno liječenje danas zauzima značajno 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