Content agreement of depressive symptomatology in children and adolescents: a review of eighteen self-report questionnaires.

Identifying major depression in children and adolescents is more challenging than in adults. Questionnaires are often used for screening or guiding clinical assessment. Several instruments of different lengths are used as equivalent measures in diagnostic decisions. In this paper, we explore to what extent 18 commonly used depression scales for children and adolescents explore depression clinical symptoms as established by standard DSM-5 diagnosis criteria. We analyzed scale content adequacy by examining the overlap between scale contents and consensus clinical symptoms, the diagnostic time frame for active symptom assessment, and readability for the target age group. The 18 scales encompassed 52 distinct symptoms. These scales included just 50% of clinical symptoms required for diagnosis. The content overlap was low; on average, 29% of symptoms coincide across scales. Half of the scales did not use the standard period for active symptom appraisal, and some did not include a period for assessment. The reading levels on six scales were inappropriate for the scale's target population age group. The substantial heterogeneity in defining the depressive syndrome, the low overlap among scales, different periods of a positive diagnosis, and mismatch of reading competence for detecting may lead to heterogeneity in clinical diagnoses when using different scales. Improving the content of self-report in terms of homogeneity of diagnostic criteria would lead to better diagnostic decisions and patient management.

Investigación traslacional en psiquiatría: el marco Research Domain Criteria (RDoC) / Translational research in psychiatry: The Research Domain Criteria Project (RDoC)

Pese al éxito (o consenso) conseguido en la homogeneización de criterios clínicos por los sistemas de clasificación psiquiátrica categoriales (DSM y CIE), su validez y utilidad, clínica y en investigación, son cuestionables. En este artículo de revisión presentamos el marco Criterios de Investigación por Dominios (Research Domain Criteria, RDoC) como una alternativa para la investigación traslacional en psiquiatría. El marco de investigación traslacional RDoC sistematiza dianas y métodos de investigación en psiquiatría. RDoC parte de un catálogo de bases neurofuncionales de la conducta y plantea la psicopatología como la expresión fenotípica de las alteraciones en dichas funciones. Estas se clasifican en 5sistemas psicobiológicos. Los constructos funcionales se validan mediante evidencia proveniente de estudios básicos en 7 niveles de análisis: genes, moléculas, células, circuitos nerviosos, fisiología, conducta y autoinformes. Frente a los sistemas categoriales centrados en el diagnóstico, RDoC propone centrar el estudio de la psicopatología como correlato de alteraciones funcionales detectables, biológicas y comportamentales. RDoC es un marco de investigación que vincula el sustrato biológico con las manifestaciones fenotípicas, para llegar a una nosología psiquiátrica útil para guiar el tratamiento. Pese a que los hallazgos de RDoC no articulan un modelo concreto de guía para la práctica clínica, es un sistema de transición útil para crear hipótesis de investigación clínica, básica y epidemiológica

Despite the consensus achieved in the homogenization of clinical criteria by categorical psychiatric classification systems (DEM and CIE), they are criticized for a lack of validity and inability to guide clinical treatment and research. In this review article we introduce the Research Domain Criteria (RDoC) framework as an alternative framework for translational research in psychiatry. The RDOC framework systematizes both research targets and methodology for research in psychiatry. RDoC is based on a catalogue of neurobiological and neurocognitive evidence of behaviour, and conceives psychopathology as the phenotypic expression of alterations of functional domains that are classified into 5psychobiological systems. The RdoC framework also proposes that domains must be validated with evidence in 7levels of analysis: genes, molecules, cells, nerve circuits, physiology, behaviour and self-reports. As opposed to categorical systems focused on diagnosis, RDoC focuses on the study of psychopathology as a correlate of detectable functional, biological and behavioural disruption of normal processes. In order to build a useful psychiatric nosology for guiding clinical interventions, the RDoC research framework links the neurobiological basis of mental processes with phenotypical manifestations. Although the RDoC findings have not yet been articulated into a specific model for guiding clinical practice, they provide a useful transition system for creating clinical, basic and epidemiological research hypotheses

Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review.

BACKGROUND: Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence. METHODOLOGY: A systematic review of PubMed (1946-2017) and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria. RESULTS: Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences. LIMITATIONS: Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability. CONCLUSION: Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved.

Sleep alterations in pediatric bipolar disorder versus attention deficit disorder.

Bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD) share numerous clinical features, which can make the differential diagnosis challenging. Studies conducted in adults suggest that patients with BD and ADHD have different sleep patterns. However, in pediatric populations, data on these potential differences are scant. The present preliminary study was conducted to identify potential differences in sleep alterations among youths diagnosed with BD or ADHD compared to healthy controls (HC). A total of 26 patients diagnosed with BD (n = 13) or ADHD (n = 13) were compared to 26 sex- and age-matched HC ([HCBD], n = 13, and [HCADHD], n = 13). All participants underwent polysomnography. The mean duration of stage N2 sleep was shorter in the BD group than in controls (HCBD). The BD group also had higher (non-significant) REM density (REMd) scores than controls while mean REMd scores were lower in the ADHD group versus controls. Compared to the ADHD group, the BD group presented a shorter N2 stage, a longer first REM sleep duration (R1), and greater REMd. According to our findings, these three variables-N2 stage, REMd, and R1-appear to differentiate patients with BD from those with ADHD and from HC.

Translational research in psychiatry: The Research Domain Criteria Project (RDoC). / Investigación traslacional en psiquiatría: el marco Research Domain Criteria (RDoC).

Despite the consensus achieved in the homogenization of clinical criteria by categorical psychiatric classification systems (DEM and CIE), they are criticized for a lack of validity and inability to guide clinical treatment and research. In this review article we introduce the Research Domain Criteria (RDoC) framework as an alternative framework for translational research in psychiatry. The RDOC framework systematizes both research targets and methodology for research in psychiatry. RDoC is based on a catalogue of neurobiological and neurocognitive evidence of behaviour, and conceives psychopathology as the phenotypic expression of alterations of functional domains that are classified into 5psychobiological systems. The RdoC framework also proposes that domains must be validated with evidence in 7levels of analysis: genes, molecules, cells, nerve circuits, physiology, behaviour and self-reports. As opposed to categorical systems focused on diagnosis, RDoC focuses on the study of psychopathology as a correlate of detectable functional, biological and behavioural disruption of normal processes. In order to build a useful psychiatric nosology for guiding clinical interventions, the RDoC research framework links the neurobiological basis of mental processes with phenotypical manifestations. Although the RDoC findings have not yet been articulated into a specific model for guiding clinical practice, they provide a useful transition system for creating clinical, basic and epidemiological research hypotheses.

Monitorización del riesgo cardiovascular y metabólico en niños y adolescentes en tratamiento antipsicótico: un estudio descriptivo transversal / Cardiovascular and metabolic monitoring of children and adolescents on antipsychotic treatment: a cross-sectional descriptive study

Antecedentes. El control cardiovascular y metabólico en pacientes que toman antipsicóticos es fundamental y adquiere una especial relevancia en la edad pediátrica, por ser pacientes más vulnerables y porque cada vez se prescriben fármacos de este tipo en más ocasiones. Objetivo. Describir el grado de cumplimiento de las recomendaciones de control de parámetros cardiovasculares y metabólicos en un grupo de niños y jóvenes en tratamiento antipsicótico. Método. Se trata de un estudio descriptivo transversal en el que se comparan un grupo de 220 pacientes de 8-17 años, diagnosticados de trastorno mental (TM) y en tratamiento antipsicótico, con otro grupo de referencia constituido por 199 individuos asmáticos no expuestos a antipsicóticos del mismo grupo de edad. Los datos se extrajeron de la historia clínica informatizada ECAP en el año 2013. Resultados. La edad de los niños se sitúa entre los 8 y 17 años. La media de edad es de 12 años. La risperidona es el antipsicótico pautado más frecuentemente (62,7%). El porcentaje de registro de peso, talla, índice de masa corporal (IMC) y presión arterial (PA) es de aproximadamente un 50% en los pacientes del grupo TM. En el grupo TM se observa un mayor registro de los parámetros físicos de control cardiovascular (peso, talla, IMC y PA) en comparación con el grupo Asma. En conjunto, se registran más los parámetros físicos que los parámetros bioquímicos. Conclusiones. Este estudio evidencia la necesidad de seguir insistiendo en la monitorización de los parámetros cardiovasculares y metabólicos en los niños y jóvenes en tratamiento con antipsicóticos (AU)

Background. Cardiovascular and metabolic monitoring of patients on antipsychotic medication is essential. This becomes more important in those of paediatric age, as they are more vulnerable, and also because prescriptions of this kind of drugs are still increasing. Aim. To evaluate the monitoring of cardiovascular and metabolic risk factors in a group of children and young people on antipsychotic medication. Method. A descriptive cross-sectional study was conducted in which a group of 220 patients aged 8-17 years, diagnosed with a mental disorder and on antipsychotic treatment. They were compared to a control group of 199 asthmatic patients not exposed to antipsychotic drugs. Data was extracted from the computerised clinical history ECAP in 2013. Results. The mean age of the children was 12 years (8-17). Risperidone (67%) was the most frequent treatment. The recording of Body Mass Index (BMI) and blood pressure (AP) was 50% in Mental Disorder (MD) patients. A higher number of cardiovascular monitoring physical parameters (weight, height, BMI and BP) were observed in the MD group compared to the control Asthma control group. Altogether, more physical parameters than biochemistry parameters were recorded. Conclusions. This study shows that the recording of cardiovascular parameters and metabolic studies needs to be improved in children and adolescents on treatment with antipsychotics (AU)

Cardiovascular and metabolic monitoring of children and adolescents on antipsychotic treatment: A cross-sectional descriptive study. / Monitorización del riesgo cardiovascular y metabólico en niños y adolescentes en tratamiento antipsicótico: un estudio descriptivo transversal.

BACKGROUND: Cardiovascular and metabolic monitoring of patients on antipsychotic medication is essential. This becomes more important in those of paediatric age, as they are more vulnerable, and also because prescriptions of this kind of drugs are still increasing. AIM: To evaluate the monitoring of cardiovascular and metabolic risk factors in a group of children and young people on antipsychotic medication. METHOD: A descriptive cross-sectional study was conducted in which a group of 220 patients aged 8-17 years, diagnosed with a mental disorder and on antipsychotic treatment. They were compared to a control group of 199 asthmatic patients not exposed to antipsychotic drugs. Data was extracted from the computerised clinical history ECAP in 2013. RESULTS: The mean age of the children was 12 years (8-17). Risperidone (67%) was the most frequent treatment. The recording of Body Mass Index (BMI) and blood pressure (AP) was 50% in Mental Disorder (MD) patients. A higher number of cardiovascular monitoring physical parameters (weight, height, BMI and BP) were observed in the MD group compared to the control Asthma control group. Altogether, more physical parameters than biochemistry parameters were recorded. CONCLUSIONS: This study shows that the recording of cardiovascular parameters and metabolic studies needs to be improved in children and adolescents on treatment with antipsychotics.

Comorbilidad entre el trastorno del espectro autista y el espectro de la esquizofrenia. A propósito de un caso / Comorbidity between autism spectrum disorder and schizophrenia spectrum. A case report

Los trastornos del espectro de la esquizofrenia incluyen un abanico de disfunciones cognoscitivas y emocionales que abarcan alteraciones en la percepción, del pensamiento inferencial, del lenguaje y la comunicación, del comportamiento, de la afectividad, la fluidez y productividad del pensamiento y el habla, de la capacidad hedónica, de las funciones ejecutivas. Algunos de estos síntomas se solapan con los contemplados en el espectro autista. Establecer el diagnóstico diferencial y/o la comorbilidad puede resultar complicado, especialmente en personas adultas con trastorno del espectro autista con buen funcionamiento en el área intelectual y del lenguaje. En este artículo, presentamos un caso de un paciente de 28 años con una amplia trayectoria psiquiátrica, diagnosticado de trastornos del espectro de la esquizofrenia y sospechas de un posible trastorno del espectro autista que nos permite analizar y revisar el solapamiento y las diferencias entre ambos diagnósticos (AU)

The schizophrenia spectrum disorders include a wide variety of cognitive and emotional dysfunctions. These can cause some alterations in the perception of the inferential thinking, in the language and communication, in the behaviour, in the affectivity, in the thinking and language fluency and production, as well as in hedonic capacity and executive functions. Some of these symptoms overlap those in the autism spectrum. Establishing the differential diagnosis and/or the comorbidity could be really complex, especially among adults, who suffer the autism spectrum disorder but having a good functioning in the intellectual and language area. Through this article, the specific case is presented of a patient aged 28 who suffers a wide trajectory of psychiatric symptoms. He was diagnosed with a schizophrenia spectrum disorders and some suspicion of a possible autism spectrum. An analysis and review is presented on the overlapping symptoms and the differences that exist between both diagnoses (AU)

Sleep study in Disruptive Mood Dysregulation Disorder and Bipolar children.

INTRODUCTION: Decreased need for sleep has been proposed as a core symptom of mania and it has been associated with the pathogenesis of Bipolar Disorder. The emergence of Disruptive Mood Dysregulation Disorder (DMDD) as a new diagnostic has been controversial and much has been speculated about its relationship with the bipolar spectrum. REM sleep fragmentation could be a biomarker of affective disorders and it would help us to differentiate them from other disorders. METHOD: Polysomnographic cross-sectional study of children with DMDD, bipolar disorder and Attention Deficit Hyperactivity Disorder (ADHD). All participants underwent a psychiatric semi-structured interview to obtain the diagnosis, comorbidities and primary sleep disorders. DMDD’s sample was performed following DSM5 criteria. GOALS: Perform polysomnography in a sample of bipolar, DMDD and ADHD children and compare their profiles to provide more evidence about the differences or similarities between bipolar disorder and DMDD. RESULTS: Bipolar group had the highest REM density values while ADHD had the lowest. REM density was not statiscally different between bipolar phenotypes. REM density was associated with antidepressant treatment, episodes of REM and their interaction. REM latency was associated with antipsychotic treatment and school performance. Bipolar patients had higher scores on the depression scale than DMDD and ADHD groups. CONCLUSIONS: No significant differences between the two compared affective disorders were found. However there were differences in REM density between bipolar and ADHD groups. REM sleep study could provide a new theoretical framework to better understand the pathogenesis of pediatric bipolar disorder.

Estudio del sueño en niños con Trastorno de Disregulación Disruptivo del Estado de Ánimo y Bipolares / Sleep study in Disruptive Mood Dysregulation Disorder and Bipolar children

Introducción. La disminución de la necesidad de sueño ha sido propuesta como síntoma nuclear de manía y ha sido relacionada con la etiopatogenia del Trastorno Bipolar. La irrupción del Trastorno de Disregulación Disruptivo del Estado de Ánimo (TDDEA) como nueva categoría diagnóstica en el DSM5 ha sido controvertida y mucho se ha especulado acerca de su relación con el espectro bipolar. La fragmentación del sueño REM podría ser un biomarcador de los trastornos afectivos y ayudarnos a diferenciarlos de otros trastornos. Metodología. Estudio transversal polisomnográfico en niños con TDDEA, bipolaridad y con Trastorno por Déficit de Atención e Hiperactividad (TDAH). A todos los participantes se les realizó una entrevista psiquiátrica semi-estructurada para la obtención del diagnóstico, la detección de posibles comorbilidades y de los trastornos primarios del sueño. La obtención de la muestra TDDEA se realizó siguiendo los criterios recomendados por el DSM5. Objetivos. Realizar un estudio polisomnográfico en una muestra de niños TDDEA, Trastorno Bipolar Pediátrico (TBP) y TDAH y comparar sus perfiles, para aportar mayor evidencia acerca de las diferencias o semejanzas entre el TBP y el TDDEA. Resultados. El grupo bipolar presentó los valores más altos de densidad REM mientras que el grupo TDAH presentó los más bajos. La densidad REM no presentó diferencias estadísticamente significativas entre los distintos fenotipos bipolares. La densidad REM se asoció con el tratamiento antidepresivo, los episodios de REM y su interacción. La latencia REM se asoció con el tratamiento antipsicótico y el rendimiento escolar. Los pacientes bipolares presentaron mayores puntuaciones en la escala de depresión que los grupos TDDEA y TDAH. Conclusiones. No se encontraron diferencias significativas entre los dos trastornos afectivos comparados aunque sí se hallaron diferencias en la densidad REM entre los grupos bipolar y TDAH. El estudio del sueño REM podría proporcionar un nuevo marco teórico para comprender mejor la etiopatogenia del trastorno bipolar pediátrico

Introduction. Decreased need for sleep has been proposed as a core symptom of mania and it has been associated with the pathogenesis of Bipolar Disorder. The emergence of Disruptive Mood Dysregulation Disorder (DMDD) as a new diagnostic has been controversial and much has been speculated about its relationship with the bipolar spectrum. REM sleep fragmentation could be a biomarker of affective disorders and it would help us to differentiate them from other disorders. Method. Polysomnographic cross-sectional study of children with DMDD, bipolar disorder and Attention Deficit Hyperactivity Disorder (ADHD). All participants underwent a psychiatric semi-structured interview to obtain the diagnosis, comorbidities and primary sleep disorders. DMDD’s sample was performed following DSM5 criteria. Goals. Perform polysomnography in a sample of bipolar, DMDD and ADHD children and compare their profiles to provide more evidence about the differences or similarities between bipolar disorder and DMDD. Results. Bipolar group had the highest REM density values while ADHD had the lowest. REM density was not statiscally different between bipolar phenotypes. REM density was associated with antidepressant treatment, episodes of REM and their interaction. REM latency was associated with antipsychotic treatment and school performance. Bipolar patients had higher scores on the depression scale than DMDD and ADHD groups. Conclusions. No significant differences between the two compared affective disorders were found. However there were differences in REM density between bipolar and ADHD groups. REM sleep study could provide a new theoretical framework to better understand the pathogenesis of pediatric bipolar disorder