Comparative study of adolescents with and without ADHD / Perfiles de personalidad: estudio comparativo de adolescentes con y sin TDAH

Abstract Introduction Although an association between attention deficit hyperactivity disorder (ADHD) and personality disorders has been observed in adult population, no descriptions in Chilean adolescents have been reported. Objective To explore personality profiles in Chilean adolescent patients diagnosed with ADHD. Method Non-experimental, comparative design, convenience sample with 61 adolescent patients (13-19 years old) diagnosed with ADHD who completed the Millon Adolescent Clinical Inventory (MACI) questionnaire. Results compared parameters for the Chilean adolescent population and patients in the study. Attending psychiatrists completed a medical history file (comorbidities, pharmacological treatment and factors associated with mental health). Multivariate statistics, cluster analyses, and means comparison analyses were performed. This project was approved by the Ethics Committee of the University of Chile. Results The personality profile of female adolescent patients with ADHD resembles that of the general female population, while the profile of the male patients is similar to that of the patient's parameter group. Cluster analysis identified two personality sub-profiles: 25% of the subjects belonged to cluster 1, which was characterized by higher scores for different personality traits, expressed concerns, and clinical syndromes, compared with subjects from cluster 2. There were no differences regarding gender, ADHD clinical presentation, use of medication, adverse childhood experiences (ACEs), type of school, grade retention, or, applicable only to the female group, comorbidities in belonging to cluster 1. Only the presence of comorbidity in male subjects was associated with cluster 1 membership. Discussion and conclusion Adolescent patients diagnosed with ADHD differed significantly in some personality traits when compared to Chilean parameters for the MACI. Of the adolescents studied, 25% have maladaptive personality characteristics.

Resumen Introducción Aún cuando en población adulta se ha observado una asociación entre el trastorno por déficit de atención con hiperactividad (TDAH) y el trastorno de personalidad, no se han reportado descripciones similares en población chilena. Objetivo Explorar perfiles de personalidad en adolescentes chilenos consultantes diagnosticados con TDAH. Método Diseño no experimental, comparativo y de muestra intencionada con 61 adolescentes consultantes diagnosticados con TDAH (13-19 años), que respondieron el inventario clínico de personalidad para adolescentes de Millon (MACI). Los resultados comparan los parámetros poblacionales de adolescentes no consultantes y consultantes chilenos con los resultados de los pacientes del estudio. Psiquiatras tratantes completaron las fichas de registro (comorbilidad, tratamiento farmacológico y determinantes asociados a salud mental). Se utilizaron estadísticos multivariados de aglomeración, análisis de clúster y análisis de diferencias de medias. Proyecto aprobado por el Comité de Ética de la Universidad de Chile. Resultados El perfil de personalidad de las mujeres consultantes con TDAH se asemeja al grupo de adolescentes chilenas no consultantes y el de los hombres, al perfil de consultantes. El análisis de clúster identificó dos subperfiles de personalidad. El 25% de los sujetos perteneció al clúster 1, que se caracteriza por puntajes más altos para diferentes rasgos de personalidad, preocupaciones expresadas y síndromes clínicos, comparado con los sujetos pertenecientes al clúster 2. Sólo la presencia de comorbilidad en hombres se asoció a la pertenencia al clúster 1, sin encontrarse diferencia por sexo, tipo de TDAH, uso de fármacos, experiencias adversas tempranas, tipo de colegio, repetición de grado escolar y diagnósticos comórbidos, sólo en el caso de las mujeres. Discusión y conclusión Los adolescentes consultantes con TDAH se diferencian significativamente en algunos rasgos de personalidad al compararlos con los parámetros poblacionales chilenos para el MACI. El 25% de los adolescentes estudiados tienen características desadaptativas de personalidad.

Operative Treatment of Knee Cartilage Injuries: A Review of the Current Literature on Non-Cell-Based and Cell-Based Therapies.

Aims: Cartilage is frequently damaged through injury and disease but shows little or no capacity for repair. Injuries that extend to the subchondral level show some capacity for repair due to the release of bone marrow derived mesenchymal stem cells. Focal articular cartilage defects are challenging clinical problems that may progress to more generalised lesions. We reviewed the literature to analyse the results of available noncell- based and cell-based strategies for the repair of articular cartilage defects in the knee. Study design: Review Article Place and Duration of Study: University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, United Kingdom Methodology: We reviewed the literature to identify studies on the use of non-cellbased and cell-based strategies for the repair of articular cartilage defects in the knee. Results: Repair techniques that do not utilise cell therapy include bone marrow stimulating techniques such as microfracture that is effective in small well-contained lesions and has the advantages of being performed arthroscopically as a single stage and cheaper costs compared to cell-based therapies. It also associated with no donor site morbidity unlike mosaicplasty, and perichondrial or periosteal grafting. The evidence suggests that none of the techniques described above consistently produce durable results. There are encouraging mid-term results with Autologous Matrix Induced Chondrogenesis (AMIC) procedures in small number of patients. Although microfracture is appropriate for smaller cartilage defects, Autologous Chondrocyte Implantation (ACI) and Matrix-carried Autologous Chondrocyte Implantation (MACI), as well as other cell carrier systems, are currently used to treat larger full thickness chondral defects in the knee. Although the results are fairly similar, MACI and procedures using other cell carrier systems are amenable to be performed arthroscopically or through a more limited approach. There are a small number of studies using mesenchymal stem cells with promising early results bur further in vitro and in vivo studies are needed before this treatment becomes more routinely available. Conclusion: Focal articular cartilage defects are challenging clinical problems that progress to more generalised lesions. Only cartilage injuries that extend to the subchondral level show some capacity for repair due to the release of bone marrow derived mesenchymal stem cells. Bone marrow stimulating techniques such as microfracture are effective in small well-contained lesions (<2cm2) and have the advantages of being performed arthroscopically as a single stage and cheaper costs compared to cell-based therapies. Mosaicplasty, and perichondrial or periosteal grafting are associated with donor site morbidity. Longer term studies on AMIC may help define the role for this procedure. The best form of non-cell-based treatment for focal articular cartilage defects in the long term is still unknown. ACI and MACI, as well as other cell carrier systems, are currently used in clinical practice to treat larger full thickness chondral defects in the knee. There are a small number of studies using mesenchymal stem cells and further in vitro and in vivo studies are needed before this treatment is optimised.

Detección y descripción de rasgos psicopáticos en adolescentes utilizando el MACI / Screening and describing psychopathic traits in adolescents using the MACI

Este estudio reporta las características psicométricas de las dos escalas de Psicopatía del MACI y evalúa su utilidad para pesquisar y describir a adolescentes con alta psicopatía. Cuatro grupos representantes del continuo adaptación-desadaptación social respondieron el MACI y un autorreporte de comportamiento social adolescente. El análisis factorial de las escalas determinó estructuras de dos y tres factores, respectivamente, que son respaldadas por los modelos de psicopatía de Hare y de Cookie y Michie. Un algoritmo desarrollado con las puntuaciones de estas escalas identificó y permitió caracterizar un grupo de 49 jóvenes (11.2 % de la muestra) con alta psicopatía. Se discuten las características psicométricas y la utilidad de estas escalas para identificar a adolescentes con perfiles psicopáticos.

This study reports psychometric characteristics for two Psychopathy scales developed with the MACI and assess their utility for screening and describing high psychopathic adolescents. Four groups representing the social adjustment and maladjustment continue answered the MACI and a self report about adolescent social behaviour. A factorial analysis of the psychopathy scales determined structures formed by two and three factors which are supported by the models of psychopathy presented by Hare and by Cookie and Michie. An algorithm developed with these scales-scores identified and allowed to characterize a group of 49 adolescents (11.2 % of the sample) with high psychopathy. Psychometric characteristics and the utility of these two scales for identifying adolescents with psychopathic profiles are discussed.

Características psicopatológicas de un grupo de adolescentes con obesidad que ingresa a un programa de terapia nutricional / Psychopathological characteristics of a group of adolescents with obesity that entered into a nutritional therapy program

La obesidad es actualmente el principal problema nutricional de la población chilena. Afecta a un 32 por ciento de los adolescentes y se ha asociado con: discriminación, baja autoestima, matonaje escolar, dificultades sociales, fracaso escolar y comorbilidad de salud mental (hasta un 58 por ciento, principalmente manifestaciones internalizantes). Son escasos los estudios de personalidad en población infantojuvenil con obesidad, encontrándose asociaciones con narcisismo y descontrol de impulsos. Dado que la personalidad es un determinante profundo de pensamientos y comportamiento, esperamos que el estudio de la personalidad nos entregue una mejor comprensión de la obesidad. Nuestro objetivo es describir la psicopatología y rasgos de personalidad en un grupo de adolescentes mujeres con obesidad que ingresan a tratamiento nutricional. Se realizó un estudio clínico descriptivo y transversal, de 22 pacientes de sexo femenino, entre 13 y 19 años que ingresaron a tratamiento en dos centros del Departamento Oriente de la Facultad de Medicina de la Universidad de Chile. Se aplicó a las participantes una entrevista estructurada (MINI- Kids) para evaluar diagnósticos del Eje I y un test autoaplicado para evaluar características de personalidad (MACI, validado para población adolescente chilena y utilizado en estudios previos). Los resultados derivados de la aplicación del MACI se observó que el 68,2 por ciento de las pacientes evaluadas presentó rasgos de personalidad “prominentes”, y de este grupo el rasgo más frecuentemente encontrado corresponde a “Egocéntrico”, seguido por los rasgos “Histriónico”, “Rudo” y “Conformista”. Se evaluaron además los rasgos más frecuentes que se presentaban bajo el corte mínimo, los cuales fueron: tendencia límite (10 pacientes), introversión y autopunitivo (8 pacientes) e inhibido (7 pacientes)...

Obesity is the main nutritional problem of Chilean population, being 32 percent of chilean adolescents obese. It has been associated with: discrimination, low self-esteem, bullying, social difficulties, school failure and mental health comorbidity (up to 58 percent, mainly internalizing events). There are only a few studies about personality in obese children and adolescents, and those studies have found associations with narcissism and impulsivity. Given that personality is deep determinant in thoughts and behavior, we expect that the study of personality would give us a better understanding of obesity. Our main target is to describe the psychopathology and personality traits in a group of female adolescents with obesity that entered into nutritional treatment. We conducted a descriptive clinical study of 22 female patients between 13 and 19 years old who iniciated treatment in two centers from the East Department of the University of Chile Medical School. A structured interview (MINI-Kids) was applied to the participants to evaluate Axis I diagnoses, and a self-administered test was used to evaluate personality characteristics (MACI, validated in chilean adolescents, used in previous studies). In the results from the implementation of MACI test we observed that 68.2 percent of patients showed “prominent” traits, and from this group the most frequent feature founded was “Egotistic” followed by the features “Dramatizing”, “Unruly” and “Conforming” We also evaluated the traits that were presented under the lower limit, which were: borderline tendency (10 patients), introversive and self-demeaning (8 patients) and inhibited (7 patients). In addition 77.3 percent of the patients studied met criteria for at least one Axis I diagnosis (17 adolescents), half of them with a depressive disorder and 45 percent with comorbidity. The patients studied have features in common, and this work presents a first approach from the child and adolescent mental health...

Relativismo cultural del Modelo de Personalidad de Millon en América Latina: Un estudio con adolescentes / Cultural relativity of the Millon's Personality Model in Latin-America: A study with adolescents

Este estudio profundiza el análisis estadístico e interpretativo de cuatro patrones de personalidad del Inventario Clínico para Adolescentes de Millon (MACI-Millon, 1993). Estos patrones (Sumiso, Dramatizador, Egoísta y Conformista) han presentado un comportamiento no acorde con la teoría, en estudios realizados con adolescentes latinoamericanos. Se informa una revisión de los datos del estudio de baremación chilena del MACI, desarrollado con una muestra de 807 adolescentes, de 13 a 19 años, diferenciada por sexo y dicotomizada en dos grupos: no-consultantes (200 hombres y 206 mujeres) y consultantes (212 hombres y 189 mujeres) que contestó el MACI y el Inventario Multifásico de la Personalidad de Minnesota para Adolescentes (MMPI-A). Un conjunto de análisis de validez diagnóstica determinó que las escalas MACI diferenciaban de modo inverso a lo esperado teóricamente y estableció puntajes de corte óptimos entre los dos grupos. La comparación, mediante las escalas clínicas del MMPI-A, entre los grupos de funcionamiento sano y funcionamiento alterado creados por la segmentación de la muestra según el puntaje de corte de cada escala, indicó que estas escalas presentaban el comportamiento contra-teórico observado previamente. Estos resultados son discutidos considerando el síndrome cultural individualismo - colectivismo y los rasgos personales colectivistas que se presentan preferentemente en los grupos de adolescentes latinoamericanos. También se ofrecen criterios de interpretación clínica para estas escalas que integran características específicas relacionadas con la interacción social afectiva (escalas Dramatizador y Egoísta) y el respeto a las normas grupales (escalas Sumiso y Conformista) que se presentan preferentemente en la cultura latinoamericana.

This article deepens on the statistical and interpretative analysis done with four personality patterns from the Millon Adolescent Clinical Inventory (MACI - Millon, 1993). These patterns (Submissive, Dramatizing, Egotistic, and Conforming) have presented, in different studies done with Latin-American adolescent samples,a psychometric behaviour different from the one we shall expect in agreement with Millon's theory. To do this, the data from the MACI's Chilean normative study was revised deeply. A sample of 807 adolescents, aged 13 through 19, divided by sex and also divided into a non consulting group (200 males and 206 females), and a clinical group (212 males and 189 females), was selected. All participants responded the MACI and the Minnesota Multiphasic Person ality Inventory for Adolescents (MMPI-A, Butcheret al., 1992). With the MACI scales data, a serie of statistical analysis for diagnostic validity (Hsu, 2002) that included Cohen's effect size (d),a percentage of non-overlap of the two distributions (U1), areas under receiver operating characteristic (ROC) curves, and sensibility and specificity analysis, were run through successive stages. First, results confirmed that the scales Submissive, Dramatizing, Egotistic and Conforming scored significantly higher in the non-consulting groups than they did in the consulting groups, this finding confirmed that Submissive, Dramatizing, Egotistic and Conforming scales presented a counter-theory behaviour. Second, the same set of analysis allowed to determine cutting point scores that had the capability for discriminating among participants coming from the non-consulting and the consulting groups. Later, the MMPI-A clinical scales data were analysed through a set of MANOVAS and ANOVAS drawing significant differentiation between the healthy functioning and disorderly functioning groups that were created by dividing the sample on the basis of cutting point scores from each scale. These analyses also confirmed the counter-theory behavior for the scales Submissive, Dramatizing, Egotistic and Conforming found in previous studies in Latin-America. Results showed that healthy functioning groups had higher MACI scores and MMPI-A scores around T 50, which indicated a healthy functioning; vice versa disordered functioning groups presented lower MACI scores and MMPI-A scores around or higher than T 60, which is an indicator of pathological functioning. The interpretation of these results was done considering the cultural syndrome of individualism and collectivism which reflects shared attitudes, beliefs, norms, roles and values among people belonging to a specific cultural group. According to Triandis (2001), the central theme shared by collectivist individuals is the conception of themselves as aspects of groups or collectivities, on the other hand, the individualism central theme is the conception of the individuals as autonomous from groups. Collectivist adolescents are likely to define themselves by giving priority to in-group goals, they pay less attention to internal than external processes as determinant of social behavior, and they define the relationship with the in-group members as communal. Collectivist personal traits, affect the personality functioning of adolescents coming from Latin-American countries in two aspects: They are reflected in elevations of the Dramatizing and Egotistic scales by integrating specific characteristics related to externalized, affective and warm social interactions; also they are reflected in elevations of the Submissive and Conforming scales by emphasizing specific characteristics related to the respect for the group norms and rules and keeping group harmony. At the end of the study, a bipolar clinical interpretation criteria, that includes the possibility of pathological functioning in very low and very high scores, is offered for each scale to be used as a guide for interpreting these MACI scores in the context of adolescence within the Latino-American culture.

Normas chilenas para el MACI: una integración de criterios categoriales y dimensionales / Chilean norms for MACI: an integration of categorical and dimensional criteria

Este estudio desarrolló normas chilenas para el Inventario Clínico para Adolescentes de Millon (MACI)utilizando una muestra de baremación diferenciada por sexo y dicotomizada en dos grupos, no-consultantes(200 hombres y 206 mujeres) y consultantes (212 hombres y 189 mujeres), que respondió el MACI y elMMPI-A. Con los datos MACI se desarrolló un conjunto de análisis estadísticos de validez diagnóstica en etapas sucesivas que dio lugar a la categorización de las escalas MACI en Acordes con la Teoría (AT), Contra-Teóricas (CT) y No-Diferenciadoras, y a la determinación de puntajes de corte entre funcionamiento sano y alterado. Para las escalas AT y CT se diseñó una escala de baremación de 100 puntos cuyo puntaje central (PT 50) correspondió al puntaje de corte de cada escala. Las escalas ND fueron baremadas en percentiles. La discusión de resultados analiza aspectos psicométricos y de evaluación clínica considerando el contexto latinoamericano y la integración de estos resultados en el modelo teórico de Millon.

This study aimed at building Chilean normative criteria for the Mllon Adolescent Clinical Inventory (MACI) using a normative sample divided by sex, and into a non-consulting group (200 males and 206 females), and a clinical group (212 males and 189 females) that answered the MACI and the MMPI-A. Using MACI scales data, a set of statistical analysis for diagnostic validity were run through successive stages. Results indicated that MACI scales could be classified into Agreement with Theory (AT), Counter-Theory (CT); and Non-Discriminative (ND) scales; also a cutting point score between healthy functioning and disordered functioning was determined. To build norms for the AT and CT scales, a 100-point measuring scale that had the cutting-point score as the central score (PT 50) was used. Percentile norms were built for the ND scales. Discussion refers to psychometric and clinical assessment features attending to Latin-American cultural context and their integration into the Mllon's theoretical model.