Irritability in children and adolescents: past concepts, current debates, and future opportunities

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.

A randomized double-blinded trial of chloral hydrate with or without hydroxyzine versus placebo for pediatric dental sedation

Chloral hydrate and hydroxyzine are a drug combination frequently used by practitioners to sedate pediatric dental patients, but their effectiveness has not been compared to a negative control group in humans. The aim of this crossover, double-blinded study was to evaluate the effect of these drugs compared to a placebo, administered to young children for dental treatment. Thirty-five dental sedation sessions were carried out on 12 uncooperative ASA I children aged less than 5 years old. In each session patients were randomly assigned to groups P (placebo), CH (chloral hydrate 75 mg/kg) and CHH (chloral hydrate 50 mg/kg plus hydroxyzine 2.0 mg/kg). Vital signs and behavioral variables were evaluated every 15 min. Comparisons were statistically analyzed using Friedman and Wilcoxon tests. P, CH and CHH had no differences concerning vital signs, except for breathing rate. All vital signs were in the normal range. CH and CHH promoted more sleep in the first 30 min of treatment. Overall behavior was better in CH and CHH than in P. CH, CHH and P were effective in 62.5 percent, 61.5 percent and 11.1 percent of the cases, respectively. Chloral hydrate was safe and relatively effective, causing more satisfactory behavioral and physiological outcomes than a placebo.

A associação hidrato de cloral- hidroxizina tem sido utilizada na clínica odontológica para sedar crianças, mas sua efetividade ainda não foi comparada a um controle negativo em humanos. O objetivo deste estudo prospectivo foi avaliar o efeito dessas drogas, comparadas a um placebo, em crianças submetidas a tratamento odontológico. Trinta e cinco sessões de sedação foram realizadas em 12 crianças menores de 5 anos, não cooperativas, ASA classe I. Em cada sessão os pacientes foram aleatoriamente alocados para os grupos P (placebo), CH (hidrato de cloral 75 mg/kg) e CHH (hidrato de cloral 50 mg/kg mais hidroxizina 2,0 mg/kg). Sinais vitais e comportamento foram avaliados a cada 15 min, e comparados pelos testes de Friedman e Wilcoxon. Os grupos não apresentaram diferenças quanto às variáveis fisiológicas, exceto a freqüência respiratória. Todos sinais vitais registrados estiveram dentro de faixa aceitável. CH e CHH promoveram mais sono nos primeiros 30 min de tratamento. O comportamento geral foi melhor em CH e CHH do que em P. CH, CHH e P foram efetivos em 62,5 por cento, 61,5 por cento e 11,1 por cento dos casos, respectivamente. O hidrato de cloral foi seguro e relativamente efetivo, levando a resultados fisiológicos e comportamentais melhores que o placebo.

Excessive crying and irritability in infants due to drugs

This study was performed to see the extent and magnitude of drug induced excessive crying in infants and to know the causative drugs, from July 2005 to June 2006. It is a prospective and descriptive study. All children under 1 year of age, who presented with excessive crying of recent onset as the main complaint and were receiving some medicines were included in the study. After getting detailed history [particularly drug history], the problem was explained to the parents, the suspected drug was stopped and the patients were called back for follow up after 48-96 hours. If the crying had not stopped, the diagnosis was reconsidered and patient was excluded from study analysis. If the crying had stopped, it was assumed that the drug was the cause of excessive crying. All the included patients were studied for age, diagnosis, month of the year, geographical origin and the causative drugs. A total of 227 patients were included in the analysis; out of this, 44 [19.38%] were less than imonth of age while 183 patients [80.62%] were above 1 month, 143 patients were suffering from upper respiratory infection and 78 from wheezy chest. Majority of the patients presented during winter months. About 3/4th of the patients were from D. I. Khan district but the remaining 1/4th were from nearby and remote districts like Mianwali and Layyah. Most frequent causative drug was Rondec-D drops [Abbot] in 13o patients. Other drugs were various cough preparations, promethazine [Phenergan], brochodilators, anti-emetics, metronidazole, anti-histamines, various herbal preparations, phenolbarbitone and various anti-diarrhoeals in a decreasing order of frequency. This problem can be reduced by avoiding these medicines in below 1-2 years of age. It is therefore recommended that these above drugs should not be promoted for use in infants and Rondec-D drops and other similar preparations may be withdrawn from the market

Depresión y trastorno de la alimentación / Depression and eating disorders

Los trastornos de la alimentación coexisten frecuentemente con los trastornos depresivos aún cuando la naturaleza de la asociación es todavía controvertida. Las 3 hipótesis fundamentales plantean que los trastornos de la alimentación son pirmarios y la sintomatología depresiva es una consecuencia de ellos, que a la inversa son fenómenos secundarios a un trastorno primario del humor, o bien que ambos tipos de trastornos comparten una multiplicidad de factores que los determinan a ambos. La alta prevalencia de depresión y suicidio en los pacientes con trastornos de la conducta alimentaria, sumando a la alta frecuencia de depresión en las familias de estos pacientes, son una fuerte evidencia de que ambos podrían ser trastornos relacionados. El estudio de los marcadores biológicos ha demostrado una sorprendente similitud entre depresión y trastornos de alimentación. En ambos se ha encontrado evidencia consistente de hipofunción serotoninérgica central, similar respuesta en el test de supresión de dexametasona y efectividad de la luminoterapia tanto para los síntomas depresivos como para los trastornos de la conducta alimentaria. Otro elemento que sugiere una íntima relación entre ambos trastornos es la efectiva respuesta a antidepresivos tricíclicos, inhibidores de la MAO y serotoninérgicos selectivos en el control de los trastornos de la conducta alimentaria que ha sido ampliamente reportada en la literatura. La idea de que la AN y la BN forman parte de un conjunto de trastornos relacionados con hipofunción serotoninérgica parece ser la mejor explicación de los aspectos biológicos involucrados en la génesis de estos trastornos, aspectos que sin embargo deben ser evaluados en el conjunto de factores psicológicos, biográficos y socioculturales que determinan los problemas de salud mental