ABSTRACT
Abstract Introduction Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability. Methods The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators. Results Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior. Conclusions Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Irritable Mood , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Mood Disorders/diagnosis , Problem Behavior , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Outpatient Clinics, Hospital , Irritable Mood/physiology , Reproducibility of Results , Factor Analysis, Statistical , Diagnosis, Differential , Tertiary Care CentersABSTRACT
Abstract: Objective: This study aims to generate evidence on intellectual development disorders (IDD) in Mexico. Materials and methods: IDD disease burden will be estimated with a probabilistic model, using population-based surveys. Direct and indirect costs of catastrophic expenses of families with a member with an IDD will be evaluated. Genomic characterization of IDD will include: sequencing participant exomes and performing bioinformatics analyses to identify de novo or inherited variants through trio analysis; identifying genetic variants associated with IDD, and validating randomly selected variants by polymerase chain reaction (PCR) and sequencing or real-time quantitative PCR (qPCR). Delphi surveys will be done on best practices for IDD diagnosis and management. An external evaluation will employ qualitative case studies of two social and labor inclusion programs for people with IDD. Conclusions: The results will constitute scientific evidence for the design, promotion and evaluation of public policies, which are currently absent on IDD.
Resumen: Objetivo: Esta investigación busca generar evidencia sobre trastornos del desarrollo intelectual (TDI) en México. Material y métodos: La carga de la enfermedad por TDI se estimará con un modelo probabilístico usando encuestas poblacionales. Se estimarán costos directos e indirectos de gastos catastróficos de familias con un integrante conTDI. La caracterización genómica deTDI incluirá secuenciar exomas, realizar análisis bioinformático para identificar variantes de novo o heredadas a través de análisis de tríos, identificar variantes genéticas asociadas con TDI, y validar variantes aleatoriamente seleccionadas con reacción en cadena de polimerasa y secuenciación o qPCR. Se harán encuestas Delphi sobre mejores prácticas de diagnóstico y manejo de TDI. Una evaluación externa empleará estudios cualitativos de caso de dos programas de inclusión social y laboral para personas con TDI. Conclusiones: Los resultados serán evidencia científica que podrá ser la base para el diseño, promoción y evaluación de políticas públicas, actualmente ausentes para TDI.
Subject(s)
Humans , Intellectual Disability/diagnosis , Intellectual Disability/economics , Intellectual Disability/genetics , Intellectual Disability/therapy , Genetic Variation , Catastrophic Illness/economics , Surveys and Questionnaires , Cost of Illness , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/economics , Attention Deficit and Disruptive Behavior Disorders/genetics , Attention Deficit and Disruptive Behavior Disorders/therapy , Costs and Cost Analysis , Genomics , Pediatric Obesity/diagnosis , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/therapy , MexicoABSTRACT
Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.
Subject(s)
Adolescent , Child , Humans , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Bipolar Disorder/diagnosis , Irritable Mood , Mood Disorders/diagnosis , Anger , Attention Deficit and Disruptive Behavior Disorders/therapy , Bipolar Disorder/therapy , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Irritable Mood/drug effects , Mood Disorders/therapy , Psychiatric Status Rating ScalesABSTRACT
El Trastorno de Desatención e Hiperactividad (TDHA) esposiblemente la patología infantil que más auge ha adquiridoen las dos últimas décadas. Este trastorno es considerado,en muchos casos, una problemática social, tanto por sucada vez mayor prevalencia, como por el involucramientode distintos sectores en la misma. Ello ha llevado a queexista una fuerte presión desde la institución escolar y enalgunos casos también de la familia para que esta patologíainfantil encuentre una rápida resolución mediante el usode psicofármacos. En la actualidad, sin embargo, se hapuesto en duda los fundamentos científicos que muestranuna prevalencia elevada para este trastorno hasta alcanzar,en algunos casos, el 20% del total de población infantil.Ello conlleva a la discusión acerca de si es posible sosteneral TDHA como una entidad diagnóstica independiente, osi solo se trata de un conjunto de síntomas relativamenteindependientes entre sí
The disorder of inattention and hyperactivity is arguablythe child pathology more boom has acquired in the past twodecades, considered in many cases a real social problem, its increasing prevalence, both sectors that are involved with regard to the same. This hasled to that there is strong pressure from the school and in some cases also the family sothat this child pathology find a quick resolution through the use of psychoactive drugs.However, it should be questioned about the scientific foundations who claim a high andbelief so high prevalence for this pathology, reaching almost, in some cases, 20 per cent.Alternatively, if it is possible to hold to the TDHA as an independent diagnosed entity, orif it is only a relatively independent symptoms set with each other
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Attention Deficit and Disruptive Behavior Disorders/classification , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Attention Deficit Disorder with HyperactivityABSTRACT
OBJECTIVE: To examine the factor structure of the Rutter Teacher Questionnaire in Portuguese primary school children. METHOD: The Rutter Teacher Questionnaire, a 26-item scale covering a variety of behavioral problems, was completed by teachers of 877 children, aged 6 to 11 years. Data were subjected to factor analysis using the principal components solution with varimax rotation. RESULTS: The factorial analysis in total sample revealed three factors explaining 38.88 percent of the total variance. The factors contained items representing hyperactivity/conduct (Factor 1), anxious/depressive (Factor 2) and truancy/stealing (Factor 3). The highest correlations between factors scores were for Factor 1 and Factor 3. These Factors scores were higher in boys than girls and correlated with lower social class. All three Factors scores correlated with school performance. The comparison between separate factorial structures for the samples of boys and girls revealed a considerable overlap. CONCLUSIONS: The pattern of the items contained on Factor 1 appears to be related with the category of hyperkinetic conduct disorder used by the International Classification of Diseases-10. Results suggest that the Portuguese language version of the Rutter Teacher Questionnaire possesses good psychometric properties and may be considered a useful instrument for measuring children's behavior problems.
OBJETIVO: Analisar a estrutura fatorial do Questionário de Rutter para Professores numa amostra de crianças portuguesas do 1º Ciclo do Ensino Básico. MÉTODO: O questionário, constituído por 26 itens que avaliam problemas do comportamento, foi preenchido pelos professores de 877 crianças (6-11 anos). As respostas foram sujeitas a uma análise fatorial, por meio do método de componentes principais com rotação ortogonal varimax. RESULTADOS: Na amostra total, a estrutura fatorial resultou em três fatores que explicam 38,88 por cento da variância total e que foram denominados: problemas de hiperatividade/conduta (Fator 1), ansiedade/depressão (Fator 2) e vadiagem/furto (Fator 3). A correlação entre os fatores 1 e 3 foi a mais elevada. As pontuações fatoriais foram significativamente mais elevadas nos rapazes do que nas raparigas e apresentaram uma relação inversa com a classe social e com o rendimento escolar. As estruturas fatoriais realizadas separadamente para rapazes e raparigas revelaram grandes similitudes. CONCLUSÕES: Os itens do Factor 1 parecem relacionar-se com o distúrbio hipercinético da conduta proposto pela Classificação Internacional de Doenças-10. Os resultados sugerem que a versão portuguesa do Questionário de Rutter para Professores apresenta parâmetros psicométricos adequados, podendo ser útil na avaliação dos problemas de comportamento das crianças.
Subject(s)
Child , Female , Humans , Male , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Child Behavior Disorders/diagnosis , Surveys and Questionnaires , Factor Analysis, Statistical , Portugal , Psychometrics , Socioeconomic Factors , Students , TranslatingABSTRACT
BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is associated with school failure. Inattention has been mainly implicated for this association. Oppositional-defiant disorder's (ODD) impact on academic performance remains controversial, because of the high comorbidity between ODD and ADHD. OBJECTIVE: To understand the role of inattention (IN), hyperactivity (H/I) and ODD in school failure. METHOD: Parents and teachers filled out SNAP-IV questionnaires for 241 / 6th grade students. The associations of the scores of oppositional-defiant (OP), H/I and IN symptoms with school year failure were calculated. RESULTS: IN was strongly correlated with school failure. H/I and OP were not associated with school failure, when controlled for IN. CONCLUSION: OP and H/I symptoms do not play an important role in school failure, when controlled for IN symptoms. Our study supports the cross-cultural role of IN as a major predictor of school failure.
Transtorno do déficit de atenção e hiperatividade (TDAH) está fortemente correlacionado a fracasso escolar. Desatenção (DA) parece ser primordialmente responsável por essa associação. A influência de transtorno desafiador de oposicão (TDO) sobre o desempenho acadêmico continua a ser controversa, principalmente devido à alta comorbidade entre TDO e TDAH. OBJETIVO: Entender melhor o papel da DA, hiperatividade/impulsividade (H/I) e sintomas opositivo-desafiadores (OP) no fracasso escolar. MÉTODO: Duzentos e quarenta e um estudantes da 6ª série foram avaliados com os questionários de Swanson, Nolan e Pelham (SNAP-IV), preenchidos pelos pais e professores. As associações entre as sub-escalas de OP, H/I e DA, com o número de notas "I" ("insuficiente") e com reprovação escolar foram calculadas. RESULTADOS: Sintomas OP não foram correlacionados com o número de notas "I", após o controle para a sua associação com H/I e DA. DA se associou com fracasso escolar. H/I não se correlacionou com fracasso escolar, uma vez controlada a sua associação com DA. CONCLUSÃO: OP e H/I não exercem papel importante no fracasso escolar, uma vez controladas as suas associações com DA. Esse estudo ressalta, em amostra brasileira, o papel transcultural da DA como ameaça ao bom desempenho escolar. A associação entre transtornos do aprendizado e sintomas de DA precisa ser mais extensamente investigada.
Subject(s)
Child , Female , Humans , Male , Attention Deficit Disorder with Hyperactivity/complications , Attention Deficit and Disruptive Behavior Disorders/complications , Learning Disabilities/etiology , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Surveys and QuestionnairesABSTRACT
Estudou-se a associação entre transtornos psiquiátricos e eventos traumáticos ocorridos na infância predominantes na literatura. Com o objetivo de avaliar a presença de certo transtorno psiquiátrico - Transtorno de Déficit de Atenção e Comportamento Disruptivo - TDACD - e certo evento traumático - abuso físico - foi investigada a população constituída de crianças entre três e doze anos, nos meses de outubro de 2006 a abril de 2007, referenciadas ao Serviço de Psiquiatria do Hospital Universitário Pedro Ernesto - UERJ, na cidade do Rio de Janeiro. Através de um estudo seccional encontrou-se relação de presença entre TDACD e abuso físico (OR=3,02; 95 porcento IC=1,05-9,02) e entre abuso físico e sexo masculino (OR=5,43; p=.001). Encontrou-se, também, uma relação de temporalidade entre TDACD e abuso físico (66,6 porcento). Este achado sugere que as crianças com TDACD provocam mais atitudes violentas nos pais/cuidadores. Propõem-se mudanças na direção do tratamento das crianças com TDACD, que além do diagnóstico precoce, os pais/cuidadores devem ser incluídos na proposta terapêutica, com intervenções e encaminhamentos adequados. Sugerimos a continuidade dos estudos sobre as relações do TDACD com o abuso físico em crianças.
Between 2006 and 2007 we studied the mental disorders more frequently associated with traumatic events in children. The study population was between three and twelve years old, referred to assistance at Psychiatry's service of the University Hospital Pedro Ernesto - UERJ. Our objective was to evaluate the presence of certain mental disorders - Attetion Deficit Disorder and Disruptive Behavior (ADDDB) - and certain traumatic events - physical abuse - developed during childhood. We found a presence relation between deficit disorder and disruptive behavior group and physical abuse (OR=3,02; 95 percent IC=1,05-9,02) and physical abuse and male sex (OR=5,43; p=.001). We found, also, a temporal relation between ADDDB and physical abuse (66,6 percent). Our findings suggest that children with ADDDB provoke more violent atitudes in fathers/caretakers. We suggest changes in the treatment for the children with ADDDB. In this population, finding a positive relation between mental disorders and trauma emphasizes the need of intensifying early diagnosis and treatment, demanding adequate intervention and referral. We suggest the further studies about the relation between ADDDB and physical abuse in chilfren.
Subject(s)
Child, Preschool , Child , Child Abuse , Early Diagnosis , Parents/psychology , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit Disorder with Hyperactivity/therapy , Mental Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/psychology , Attention Deficit and Disruptive Behavior Disorders/therapy , Life Change EventsABSTRACT
Os autores examinam a influência dos transtornos de oposição e desafio (TOD), de conduta (TC) e de personalidade anti-social (TPAS) ao longo da vida do indivíduo com TDAH. Os principais achados mostram que o TDAH é modulado por essas comorbidades e que seu prognóstico é modificado dependendo da presença ou não desses transtornos. O transtorno de oposição e desafio intensificaria as características de impulsividade e isolacionismo do TDAH, porém não acarretaria em um aumento na incidência de TPAS na vida adulta. Já o TC associado ao TDAH implica um aumento significativo na impulsividade e agressividade, estando associado significativamente a TPAS e um pior prognóstico. A diferenciação entre os diferentes transtornos e seu correto diagnóstico é essencial para o tratamento adequado do TDAH. Futuros estudos precisam determinar se o tratamento do TDAH produziria uma mudança significativa no prognóstico desse grupo de pacientes.
The authors examine the influence of oppositional defiant disorder (ODD), conduct disorder (CD) and anti-social personality disorder (ASPD) on attention deficit/hyperactivity disorder (ADHD) across life span. The findings showed that ADHD is modulated by this comorbidities and ADHD prognosis is modified depending on the presence or the absence of those disorders. ODD intensifies ADHD impulsivity and isolationism, but does not lead to an increase in the prevalence of ASPD in adulthood. Otherwise, CD associated with ADHD increases significantly the levels of impulsivity and aggressiveness, is associated with ASPD and a poor outcome. The appropriate approach to ADHD must be based on the correct diagnosis of different comorbidities to predict the outcomes. Further studies are needed to investigate if the treatment of ADHD can produce a significant improvement on the outcomes of this group of patients.
Subject(s)
Humans , Child , Adolescent , Adult , Antisocial Personality Disorder , Comorbidity , Conduct Disorder , Attention Deficit Disorder with Hyperactivity/diagnosis , Aggression/psychology , Behavioral Symptoms , Social Isolation/psychology , Prognosis , Attention Deficit and Disruptive Behavior Disorders/diagnosisABSTRACT
OBJECTIVE: To examine prospectively usefulness of Early Childhood Inventory-4 (ECI-4) in identifying attention deficit-hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). METHOD: A sample of children <6 years of age were evaluated in school settings with ECI-4 and results compared with those of Conners Rating Scales-Revised (CRS-R) 6 months later. Sample consisted of 34 healthy children (20 boys, 14 girls) prospectively followed-up. RESULTS: Frequency of children fulfill DSM-IV AD-HD criteria in ECI-4 parent scale was 17 percent, and in teacher scale was 32 percent. Frequency of children fulfill DSM-IV AD-HD criteria in parent CRS-R was 20 percent, and for teacher questionnaire was 23 percent. Correlations were significant among teacher ECI-4 and both teacher and parent CRS-R scales. Sensitivity and specificity of teacher and parent ECI-4 scales were not good. Frequency of ODD identified in parent ECI-4 scale was 5 percent, and for teacher 17 percent. Frequency of ODD in CRS-R for parents and teachers questionnaires was 17 percent. CD was not identified by parents in ECI-4 scale, but in teacher scale frequency was 14 percent. CONCLUSION: These facts support partially the use of ECI-4 screening of ADHD in Spanish-speaking preschool children.
OBJETIVO: Examinar prospectivamente la utilidad del Inventario Temprano de la Niñez-4 (Early Childhood Inventory-4, ECI-4) para identificar el trastorno por déficit de atención-hiperactividad (TDAH), el trastorno desafiante-oposicional (TDO) y el trastorno de conducta (TC). MÉTODO: Una muestra de niños <6 años fue evaluada con el ECI-4 en un ambiente escolar y los resultados comparados con los de las Escalas de Conners (Conners Rating Scales-Revised, CRS-R) 6 meses mas tarde. La muestra consistió de 34 niños (20 niños, 14 niñas) seguidos prospectivamente. RESULTADOS: La frecuencia de niños que llenaron los criterios del DSM-IV para TDAH en la escala para padres del ECI-4 fue 17 por ciento, mientras que en la escala para maestros fue 32 por ciento. La frecuencia de niños que llenaron los criterios del DSM-IV para TDA-H en la escala para padres CRS-R fue 20 por ciento, en la escala para maestros fue 23 por ciento. Se hallaron correlaciones significativas entre la escala para maestros del ECI-4 y las escalas para maestros y para padres de CRS-R. La sensibilidad y la especificidad de las escalas para maestros y padres del ECI-4 no fueron alentadoras. La frecuencia del TDO identificada en la escala para padres del ECI-4 fue 5 por ciento y en la escala para maestros fue 17 por ciento. La frecuencia del TDO en la escala para padres y para maestros CRS-R fue 17 por ciento. El TC no fue identificado por los padres con la escala del ECI-4, pero en la escala para maestros, la frecuencia fue de 14 por ciento. CONCLUSION: Los resultados obtenidos apoyan parcialmente el uso de las escalas de tamizaje del ECI-4 para encontrar TDAH, TDO y TC en preescolares mexicanos.
Subject(s)
Child, Preschool , Female , Humans , Male , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Psychiatric Status Rating Scales , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Comorbidity , Conduct Disorder/diagnosis , Conduct Disorder/epidemiology , Epidemiologic Methods , Mass Screening , Mexico/epidemiology , Pilot Projects , Sensitivity and SpecificityABSTRACT
O diagnóstico do transtorno de déficit de atenção e hiperatividade (TDAH) e do transtorno de oposição desafiante (TOD) em adultos carece de instrumentos adequados. Esta investigação visa avaliar a confiabilidade entre observadores das seções do K-SADS-E adaptadas para os diagnósticos destes transtornos em adultos. As adaptações realizadas se limitaram ao direcionamento das perguntas ao próprio paciente, investigação do início dos sintomas em um período mais tardio e abordagem de sintomas próprios de adultos. Seis avaliadores treinados pontuaram 16 entrevistas gravadas. Os coeficientes Kappa foram de 1,00 para o diagnóstico de TDAH no passado, 0,91 para o subtipo no passado, 1,00 para diagnóstico de TDAH atual e 0,95 para o subtipo atual. Os coeficientes Kappa para o TOD foram de 1,00 para o diagnóstico no passado e 0,89 para o diagnóstico atual. Todos os coeficientes tiveram um p<0,001. Os resultados demonstram excelente concordância para os diagnósticos de TDAH e TOD em adultos utilizando a forma adaptada da versão em português do K-SADS-E.
Subject(s)
Adult , Female , Humans , Male , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Surveys and Questionnaires/standards , Reproducibility of ResultsABSTRACT
El desarrollo de las habilidades sociocognitivas en los niños tiene su base en las prácticas de crianza familiar, en los estilos de resolución de problemas entre sus miembros y en las estrategias autorregulatorias de la dinámica familiar. En este estudio se compararon las habilidades cognitivas infantiles para la solución de problemas interpersonales en niños con y sin conductas disruptivas de zonas socialmente vulnerables de Mendoza - Argentina y se exploraron las características familiares de ambos grupos de niños. Se evaluó a. 60 niños de ambos sexos, entre 8 y 10 años de edad: 30 con Conductas Disruptivas y 30 sin ellas, para la detección de los niños con y sin conductas disruptivas se utilizó la Guía de Observación Comportamental para niños (Ison y Fachinelli, 1993). Las habilidades sociocognitivas infantiles fueron evaluadas por medio del EVHACOSPI (García Pérez y Magaz Lago, 1998) y se entrevistó a los padres de los niños para obtener información sobre las características familiares. Los resultados mostraron que los niños con conductas disruptivas presentaron mayor dificultad para definir una situación problema, para elegir alternativas adecuadas y tomar decisiones pertinentes, en comparación con los niños sin ellas. En las familias de niños con conductas disruptivas predominó un estilo vincular agresivo, conductas negligentes físicas y psicoafectivas y disciplina parental rígida. Nuestros resultados muestran que los modelos familiares disfuncionales favorecen la aparición y mantenimiento de déficits en ciertas habilidades sociocognitivas implicadas en la autorregulación de la conducta infantil. El detectar estos déficits posibilita diseñar programas psicoeducativos tendientes a la prevención de futuros desajustes psicosociales
Subject(s)
Aptitude , Child , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/psychology , FamilySubject(s)
Humans , Male , Female , Child, Preschool , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Attention Deficit and Disruptive Behavior Disorders/therapy , Severity of Illness Index , Mental Disorders , Physical Examination , PsychopharmacologyABSTRACT
Background: There is a 7 percent up to 32 percent prevalence of psychiatric problems in the pediatric population. Aim: To study the epidemiological features of children and adolescents attended in a psychiatric outpatient clinic. Material and methods: All admissions to a psychiatric outpatient clinic, of people aged 18 years old or less, during 1998, were reviewed. The causes of consultation and the diagnoses were classified according to diagnostic manuals (ICPC-WONCA and DSM-IV respectively), by three experienced psychiatrists. Results: The files of 376 patients were reviewed (200 males, mean age of females 12 years old, mean age of males 10.5 years old). Seventy three percent consulted spontaneously. The main causes of consultation were anxiety disorders and adolescence problems (28 percent). The main diagnoses were attention deficit disorder and disruptive behavior, adaptative problems, mood and anxiety disorders. There were gender differences in the diagnoses. Women attended a mean of 6.3 sessions and men attended a mean of 4 sessions. Fifty nine percent abandoned treatment. Conclusions: There is a limited access to mental health care. The low compliance with treatments must be studied and improved
Subject(s)
Humans , Male , Adolescent , Female , Anxiety Disorders , Seasonal Affective Disorder , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Adjustment Disorders/epidemiology , Anxiety Disorders , Outpatients , Psychotherapy , Prevalence , Seasonal Affective Disorder , Health Facilities, Proprietary , Adaptation, Psychological , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Age Distribution , Sex Distribution , Adjustment Disorders/diagnosisABSTRACT
Se presentan los hallazgos relacionados con los factores de comorbilidad del trastorno por déficit de atención con hiperactividad. Actualmente se propone un diagnóstico diferencial por paciente para identificar los síntomas de comorbilidad que pueden causar confusión en el diagnóstico. Se revisan las investigaciones en torno a la relación entre trastorno por déficit de atención y los siguientes sistemas de comorbilidad: trastorno disocial, trastorno negativista, desafiante y trastorno del estado de ánimo. Se menciona en la etiología: resistencia generalizada a la hormona tiroidea y anormalidades en los neurotransmisores. Se propone un tratamiento combinando metalfenidato y terapia cognitivoconductual. Se enuncian los efectos prospectivos del trastorno por déficit de atención con personalidad antisocial, abuso de drogas y delincuencia.
Subject(s)
Morbidity , Adolescent , Substance-Related Disorders , Juvenile Delinquency , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Child , Anxiety Disorders , HostilityABSTRACT
El síndrome de déficit atencional (SDA) se considera dentro de los trastornos del desarrollo. Ellos son desviaciones en el desarrollo infantil que exceden el rango normal de variación, porque ocurren en un tiempo, una secuencia o un grado no esperado para la edad del niño o etapa de su desarrollo