The prevalence of tic disorders in children and adolescents in Brazil / A prevalência dos transtornos dos tiques em crianças e adolescentes no Brasil

Tourette syndrome (TS) and tic disorders represent events of familiar magnitude characterized by involuntary movements and/or vocalization. To determine the prevalence of TS/tic disorders we studied a sample of 762 subjects (388 M, 374 F), between 1992 and 1997, age 6 to 43 years old, taken out of a population of 10,155 subjects (4,918 M, 5,237 F; age: 3-56 years old). A structured 4-item questionnaire, direct interview (multistaged), >1 yr follow-up, were used. 9,565 subjects (4,614 M, 4,951 F) sent back the questionnaires, 3,354 of these (1,671 M, 1,683 F) with positive answers to tics. 42 subjects (31 M, 11 F, age: 7-21 years old, mean: 11 years old) met the DSM-III-R criteria. The total minimal prevalence of TS is 0.43%, with a 3:1 ratio male/female. The minimal prevalence of chronic tic disorder is 2.27%. The total minimal prevalence for tic disorders at all is 2.91%. No special education students participation.

Síndrome de Tourette e transtornos de tiques representam eventos de magnitude familiar caracterizados por movimentos involuntários e/ou vocalização. Para determinar a prevalência de TS/transtornos de tiques, estudamos uma amostra de 762 indivíduos (286 M, 376 F), entre 1992 e 1997, de 6 a 43 anos de idade, retirados de uma população de 10.155 indivíduos (4.918 M, 5.237 F, idade: 3-56 anos). Questionário de avaliação inicial (4 itens), entrevista direta, follow-up >1 ano, foram utilizados. 9.565 indivíduos (4.614 M, 4.951 F) retornaram seus questionários, 3.354 (1.671 M, 1.683 F), com respostas positivas para tiques. 42 sujeitos (idade 31 M, 11 F, 7-21 anos, média: 11 anos) preencheram os critérios diagnósticos do DSM-III-R. A prevalência total mínima para TS é de 0,43% (3 M:1 F), e para transtornos de tiques crônicos é de 2,27%. A prevalência total mínima para transtornos dos tiques é 2,91%. Nenhuma participação de estudantes de classe especial.

Neurological disorders in children and adolescents.

OBJECTIVE: To ascertain the prevalence of active epilepsy, febrile seizures (FS), cerebral palsy (CP) and tic disorders (TD) in aged 19 years or less. METHODS: This was a cross-sectional observational study conducted as a two-stage door-to-door survey of a stratified randomly selected population in 2003-04. Trained field workers screened the population followed by case examination by the field neurologist. RESULTS: A total of 16979 (male 8898, female 8081) subjects aged <or= 19 years were surveyed. The prevalence rates per 100,000 population of active epilepsy, FS, CP and TD with 95% confidence intervals are 700.87 (580.60-838.68), 1113.14 (960.07-1283.59), 282.70 (CI 208.43-374.82) and 35.34 (12.96-76.92) respectively. Active epilepsy prevalence shows a rising trend and that of other disorders a declining trend with age. Of the epileptics who had brain CT scans, 23.4% showed single or multiple lesions suggestive of neurocysticercosis. Regarding treatment, 23.5% of the epileptics never received any antiepileptic drugs. Among those with history of FS, 9.5% developed epilepsy later on. The prevalence of FS among slum dwellers is lower than in the non-slum population. Among CP cases, 39.6% gave history of birth anoxia, 16.7% kernicterus and 31.3% epilepsy. Prevalence of CP is significantly associated with lower education status. CONCLUSION: The prevalence of CP and TD is lower than reported from western countries. CP prevalence is also comparatively lower than in many community studies from India. Compared to western nations, higher proportion of FS cases develops epilepsy. A third of the CP cases have seizures which is higher than in many Indian studies. Birth anoxia is a common cause of CP and educational underachievement is frequent.

Psychiatric Comorbidity in Korean Children and Adolescents with Attention-Deficit Hyperactivity Disorder: Psychopathology According to Subtype

It is well-known that more than 50% of attention-deficit hyperactivity disorder (ADHD) cases also have comorbid psychiatric disorders. We evaluated the comorbid psychopathology of Korean children and adolescents with ADHD using a standardized diagnostic instrument. The Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-K) was administered and completed in 105 patients who had been referred to the outpatient and inpatient clinics at the Samsung Medical Center from March 2004 to May 2005. All of the cases were diagnosed as ADHD according to DSM-IV criteria. We analyzed their clinical characteristics and psychiatric comorbidities, and assessed the correlation of any comorbidity with gender, age and ADHD subtype. Among our 105 participants, 70 (66.7%) subjects were diagnosed with combined-type ADHD, 22 (21.0%) were the predominantly inattentive type, only 1 (1.0%) was determined to have the predominantly hyperactive-impulsive type of ADHD, and 12 (11.4%) were classified as not otherwise specified (NOS) ADHD. Eighty (76.2%) subjects had at least one comorbid disorder such as oppositional defiant disorder (n = 53, 50.5%), anxiety disorders (n = 35, 33.3%) and affective disorders (n = 15, 14.3%). Our patients ranged in age from five to 16 years. Among the factors including gender, age, and ADHD subtype, ADHD subtype was the only one significant to comorbidity in our study. The results of this study suggest that psychiatric comorbidity in Korean children with ADHD is similar to the results of previous studies in western countries. Out of all the ADHD subtypes, the combined-type group had a significantly higher ratio of comorbid disorders and psychopathologies.

Transtornos do espectro obsessivo-compulsivo e febre reumática: um estudo de transmissão familiar / Obsessive-compulsive spectrum disorders and rheumatic fever: a family study

A febre reumática (FR) é uma doença autoimune causada por anticorpos desenvolvidos contra o estreptococo beta hemolítico do grupo A (SBHGA). Estudos recentes amparam a noção de que a FR esteja associada ao transtorno obsessivo-compulsivo (TOC), independentemente da presença de outras manifestações no sistema nervoso central (ex.: coréia de Sydenham - CS). O TOC freqüentemente surge acompanhado por outros transtornos, como aqueles denominados de transtornos do espectro obsessivo (TEO), entre eles, a síndrome de Tourette (ST), o transtorno de tiques crônicos (TTC) e o transtorno dismórfico corporal (TDC). Alguns deles parecem apresentar uma relação geneticamente determinada. Um subgrupo de TOC é geneticamente relacionado à ST, podendo ser considerado uma expressão fenotípica alternativa de seu genótipo. Um recente estudo de famílias de portadores de TOC encontrou alta freqüência de TDC nos seus familiares de primeiro grau, além de transtornos de tiques. Neste estudo de famílias buscamos verificar a freqüência de TOC e TEO relacionados em familiares de portadores de FR, com ou sem CS e em um grupo controle, na tentativa de determinar se existe agregação familiar desses transtornos em famílias com FR. Foram avaliados 98 probandos e seus 381 familiares de primeiro grau (FPG). Dos 98 probandos, 31 eram portadores de FR sem CS, 28 tinham FR com CS e 39 eram controles sem FR recrutados em um ambulatório de ortopedia. Entrevistadores treinados avaliaram os sujeitos por meio de entrevistas semi-estruturadas (KSADS e SCID). Vinhetas clínicas foram elaboradas e avaliadas por psiquiatras independentes que faziam a melhor estimativa diagnóstica (best estimate diagnosis). Estes avaliadores eram cegos quanto a se os sujeitos eram probandos ou familiares e quanto ao grupo a que pertenciam. As comparações entre as freqüências dos transtornos entre os três grupos foram feitas por meio dos testes de Fisher, qui-quadrado, pelas Equações de Estimação...

Rheumatic fever (RF) is an autoimmune disease caused by antibodies against group A beta hemolytic streptococcus (GABHS). Some studies support the notion that RF be associated with obsessive-compulsive disorder (OCD) independent of its manifestations on the central nervous system (eg., Sydenham’s Chorea - SC). OCD is often accompanied by other disorders, which are known as obsessive-compulsive spectrum disorders (OCSD), such as Tourette syndrome (TS), chronic tic disorder (CTD) and body dysmorphic disorder (BDD). Some of those putative OCSD seem to share a genetic relationship. An OCD subgroup is genetically related to TS, being considered an alternative phenotype. A recent OCD family study found higher rates of BDD and tic disorders among first-degree relatives (FDR) of OCD probands. This is a family study that assessed the frequency of OCD and OCSD in first-degree relatives of RF probands (with and without SC) in order to verify if there was aggregation of those disorders in RF families. We assessed 98 probands and their 381 first-degree relatives. Of the 98 probands, 31 had RF without SC, 28 had RF with SC and 39 were controls without RF recruited in an orthopedic clinic. Trained interviewers assessed subjects with semi-structured interviews (KSADS and SCID). Clinical vignettes were elaborated and evaluated by independent psychiatrists that assigned best estimate diagnosis. These raters were blind to subject status regarding group and if they were probands or relatives. Comparisons between frequencies of disorders were done with Fisher and chi-square tests, generalized estimated equations (GEE), and Kaplan-Meier survival analyses. Results were considered statistically significant if their level of significance was less or equal to 0.05 (p, two-tailed). OCSD combined were more frequent in FDR of RF probands (with or without SC) than in FDR of controls (p=0.03). CTD was more frequent in FDR of SC probands than FDR of controls (p=0.05)...