¿Estamos (los psiquiatras infantiles) patologizando la infancia? / [Are we (child psychiatrists) pathologizing childhood?].

Child psychiatry is a young discipline with great potential. Comparing the current resources that we had a few decades ago the contrast is marked. Our discipline has had a great development. The current psychiatric thinking cannot be defined based on one main theory to which all psychiatrists adhere. There is a theoretical pluralism where different models coexist in tension. The child psychiatrist requires conducting diagnostic regardless of their frame of reference without polarizing the field because not only is required to make a psychiatric diagnosis but also requires an understanding of the unique problems of the patient. Currently we have two methods of assessment and diagnosis of children with psychiatric disorders: 1) the phenomenological method (derived from DSM), and 2) the traditional method (dynamic). The best is to make use of all available resources and clinical tools. The use of psychotropic drugs in clinical practice in children and adolescents has been installed as a controversial issue in our society. These debates have great difficulty crossing ideological and clinical arguments. It is appropriate to put in discussion the use of drugs. It is remarkable the therapeutic potential of psychotropics but we must also keep in mind the great business environment underlying our practice.

Evaluación de la validez de los diagnósticos DSM IV realizados con un Instrumento Estructurado, el NIMH DISC-IV, en la Ciudad de Buenos Aires / Evaluation of the validity of diagnostic interview schedule for children IV (DISC IV) in the city of Buenos Aires

La epidemiología de los trastornos psiquiátricos de niños y adolescentes ha recibido poca atención en nuestro país, Uno de los problemas relacionados con el escaso desarrollo de investigación epidemiológica en Argentina está ligado a la no disponibilidad de entrevistas diagnósticas estructura das testeadas localmente. Objetivos: el objetivo fue realizar un estudio de validación DISC IV (versión en español), administrada por encuestadores legos en la ciudad de Buenos Aires. Métodos: la muestra fue obtenida del Hospital de Niños "Ricardo Gutiérrez" de la Ciudad de Buenos Aires. Dos grupos de participantes fueron incluidos en el estudio, un grupo con resultado positivo a la administración del DISC y otro grupo equivalente con resultado negativo. Los psiquiatras administraron nuevamente el DISC una semana más tarde y a continuación realizaron una entrevista clínica di agnóstica semiestructurada 116 participantes completaron las evaluaciones y formaron parte de la muestra. Resultados: la sensibilidad fue de 81,5 por ciento y la especificidad de 66,1 por ciento. La reproducibilidad test-retest fue moderada (Kappa 0,46 error standard 0,09). Conclusiones: en líneas generales, el DISC administrado por encuesta dores legos demostró poseer buena capacidad para discriminar entre jóvenes que padecen trastornos psiquiátricos y jóvenes sanos. La confiabilidad fue de moderada a buena, tanto para la presencia de algún trastorno psiquiátrico en forma global como para los trastornos del estado de ánimo en particular, mientras que para los trastornos de ansiedad y los trastornos de conducta resultó muy pobre.

The epidemiology of psychiatric disorders in children and adolescents has received little attention in Argentina. One of the problems related to the scarcity of such epidemiological research is linked to the lack of availability of diagnostic interview instruments which have been locally validated. Objectives: The object of the study was to conduct a validation study of the DISC IV (Spanish version), administered by lay interviewers in the City of Buenos Aires. Methods: The sample was obtained from the Hospital de Niños "Ricardo Gutierrez" in the City of Buenos Aires. Lay interviewers administered the DISC IV to 116 youngsters. Then psychiatrists re-administered the DISC IV a week later and immediately afterwards conducted a semi-structured diagnostic clinical interview. Participant in the sample ranged in age from 9 to 17. Results: The sensitivity was 81.5 percent and the specificity 66, 1 percent. The test-re test reliability was reasonable (Kappa 0.46 standard error 0.09). Conclusions: In general, the DISC administered by the non-professional interviewer was demonstrated to have the ability to discriminate between youngsters who suffer from psychiatric disorders and healthy youngsters. The confidence level was from moderate to good for the presence of a general psychiatric disorder as well as for disorders of specific states of mind, but for anxiety disorders and behaviour disorders the confidence level was poor.