Historia de la Asociación Española de Psiquiatría del Niño y del Adolescente (AEPNyA) en su setenta aniversario / History of the Spanish Association of Child and Adolescent Psychiatry on its 70th Anniversary

La Asociación española de psiquiatría del niño y del adolescente (AEPNyA) se fundó en Barcelona en el año 1950 como una sociedad médica que tenía como objetivo el estudio de los trastornos psiquiátricos de niños y adolescentes. Su desarrollo corre en paralelo con la de la psiquiatría infantil europea. Los fundadores fueron hombres y mujeres ilustrados, comprometidos con su tiempo y con la salud mental, la educación y los derechos de la infancia. Este artículo aborda los hitos principales de la historia de AEPNyA y distingue tres periodos: los comienzos, la fase de afianzamiento y el tiempo de la madurez. Los autores desean rendir un homenaje a los miembros fundadores y a todos aquellos que han contribuido al desarrollo de la Asociación

The Spanish Association of Child and Adolescent Psychiatry (AEPNyA) was founded in 1950 in Barcelona as a medical society, and was one of the first Societies for Child Psychiatry in Europe. Its founders were learned men and women who were concerned not only with children's psychiatric disorders, but also with their education and rights. The history of child psychiatry in Spain is intertwined with the development of this field throughout Europe. Over the course of its history, the AEPNyA has gone through several stages: its beginnings, its development, and its more established stage. This article pays tribute to the founders of the AEPNyA and to all those that have made a contribution to its development

Perfil y endofenotipos neuropsicológicos en TDAH: Una revisión / Neuropsychological profile and endophenotypes in ADHD: A review

Existe un acuerdo científico generalizado acerca de que un porcentaje elevado de las personas que presentan Trastorno por Déficit de Atención con Hiperactividad (TDAH) tienen también importantes dificultades en su rendimiento psicológico. Esta afirmación cuenta con evidencias cognitivo-conductuales y neurofuncionales. Así, están ampliamente constatados los problemas en el funcionamiento ejecutivo en los pacientes con TDAH, encontrándose, en especial, tamaños de efecto robustos para la memoria de trabajo y la inhibición. En este trabajo se presenta una revisión del perfil neuropsicológico más frecuentemente encontrado en TDAH, y se discuten los distintos modelos explicativos y dificultades en el endofenotipado neuropsicológico

There is a generalized scientific agreement that a high percentage of people with attention deficit hyperactivity disorder (ADHD) also show significant difficulties in neuropsychological performance. There is evidence for both cognitive-behavioral and neurophysiological data. Deficits in executive functioning have been widely observed in ADHD and robust effect sizes for working memory and inhibition are found. In this work, we show a review of the most common neuropsychological profile found in ADHD, and discuss the explanatory models and the difficulties with neuropsychological endophenotypes

Efectividad cognitiva del metilfenidato y de la atomoxetina en el trastorno por déficit de atención con hiperactividad: una revisión / Cognitive effectiveness of methylphenidate and atomoxetine in attention deficit hyperactivity disorder: a review

INTRODUCCIÓN: El Trastorno por Déficit de Atención con Hiperactividad (TDAH) se asocia a importantes déficits en diversos dominios cognitivos. Dicha afirmación cuenta con evidencias cognitivo-conductuales y neurofuncionales. El tratamiento farmacológico indicado en esta población tiene como objetivo fundamental suprimir o reducir la sintomatología nuclear del trastorno. Esta es la diana terapéutica tanto del Metilfenidato como de la Atomoxetina. Ambos actúan sobre la corteza prefrontal y sus conexiones con los ganglios basales, parte del sustrato anatómico de la atención, la actividad motora y el control inhibitorio. Considerando que estas regiones forman parte del conjunto de áreas y circuitos implicados en el procesamiento cognitivo complejo, se puede colegir que los acercamientos farmacológicos eficaces en la mejora de la sintomatología nuclear de este trastorno tendrán un efecto beneficioso sobre la ejecución cognitiva de estos pacientes, y, por extensión, sobre el rendimiento académico. OBJETIVO: Actualizar los conocimientos existentes en neurociencia sobre la repercusión cognitiva de la administración de Metilfenidato y Atomoxetina en población con TDAH. Es un interés central del estudio profundizar en la relación entre sintomatología nuclear, sustrato anatomopatológico y rendimiento cognitivo, con especial referencia a las funciones ejecutivas. MÉTODO: Se ha realizado una exhaustiva revisión bibliográfica en la bases Pubmed, PsycINFO y Medline con las palabras clave: Metilfenidato, Atomoxetina, TDAH, Tratamiento, Evaluación neuropsicológica y Neuropsicología infantil. CONCLUSIONES: El metilfenidato ha mostrado superioridad a la atomoxetina en el control de la sintomatología nuclear. Sin embargo, sobre el funcionamiento cognitivo, y en especial sobre la memoria de trabajo, ambos fármacos muestran efectos beneficiosos comparables

INTRODUCTION: There is growing scientific agreement that attention deficit hyperactivity disorder (ADHD) is associated with significant deficits in several cognitive domains. This assertion has cognitive-behavioral and neurophysiological evidence. Drug therapy is traditionally focused in reducing or eliminating the nuclear symptoms of the disorder (inattention, hyperactivity and impulsivity) to adaptative levels. Methyphenidate (MTF) and Atomoxetine (ATX) are two of the most popular medications for this population. Both act on the prefrontal cortex and its connections to the basal ganglia, circuits related as well to the anatomical substrate of attention, motor activity and inhibitory control. If we consider that these regions are also involved in complex cognitive processing likewise, we can conclude that, the pharmachological approaches that are effective in improving nuclear symptoms of this disorder, will have a beneficial effect on cognitive performance of these patients, and by extension on academic performance. OBJECTIVE: This literature review pretend to update existing knowledge on cognitive impact of methylphenidate or atomoxetine administration in people with ADHD. We aim to deepen in the relationship between nuclear symptoms, pathologic substrate and cognitive performance with special reference to executive functions. METHODS: We have done an extensive literature review in PubMed, PsycINFO and Medline databases with the keywords: Methylphenidate, atomoxetine, ADHD, Treatment, Neuropsychological assessment and child neuropsychology. CONCLUSIONS: methylphenidate has shown superiority to atomoxetine in controlling nuclear symptomatology, however, on cognitive functioning, particularly on working memory, both drugs show comparable beneficial effects in some studies

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Lisdexanfetamine en niños y adolescentes con trastorno por déficit de atención e hiperactividad (TDAH): una revisión sistemática global / Lisdexamfetamine in attention-defitic and hyperactivity disorder (adhd) children and adolescents: a systematic global review

El Trastorno por Déficit de Atención e Hiperactividad (TDAH) es uno de los trastornos más frecuentes en Psiquiatría Infanto-Juvenil, y muy habitualmente requiere tratamiento farmacológico dentro de su plan terapéutico. Dentro de estos, desde hace cerca de un año se dispone en España de la lisdexanfetamina, novedoso tanto por ser una anfetamina como por ser un profármaco. Objetivo: revisar y resumir la evidencia existente sobre lisdexanfetamina y su uso en niños y adolescentes afectos de TDAH. Método: búsqueda bibliográfica exhaustiva en PubMed con los siguientes términos: lisdexamfetamine, OR lisdexamphetamine, OR lisdexanfetamina. Resultados: la lisdexanfetamina es un profármaco seguro, con un perfil de efectos adversos similar al de los otros tratamientos farmacológicos del TDAH conocidos, y muy eficaz para su tratamiento en niños y adolescentes, con un bajo potencial de abuso y uso inadecuado, y una respuesta clínica estable y prolongada a lo largo del día. Limitaciones: Aunque es un fármaco con eficacia y seguridad conocida en sus casi 9 años de comercialización en EEUU y su principio activo fue uno de los primeros en usarse para el tratamiento del TDAH, precisa llevar a cabo estudios prospectivos con horizontes temporales más amplios que los actuales, que contemplen seguridad y eficacia a largo plazo, eficacia frente a otros tratamientos en TDAH, y su uso en el paciente real

Attention Deficit Disorder Hyperactivity Disorder (ADHD) is one of the most common disorders in Child and Adolescent Psychiatry, and very often requires pharmacological intervention in its treatment plan. Among these, lisdexamfetamine is available in Spain since about one year ago, new both as being an amphetamine and as a prodrug. Objective: To review and summarize the evidence on lisdexamfetamine and its use in ADHD children and adolescents. Method: A comprehensive literature search in PubMed was done with the following terms: lisdexamfetamine, OR lisdexamphetamine, OR lisdexanfetamina. Results: Lisdexamfetamine is a prodrug with a safety profile similar to other known ADHD pharmacological treatments, and very effective for ADHD treatment in children and adolescents, with a low potential for abuse or misuse, and a stable clinical response extended along the day. Limitations: Although it is a drug with a known profile of efficacy and security along its nearly 9 years of marketing in the US, it should be necessary to conduct longer-term prospective studies to show more data about its safety and efficacy, efficacy related to other ADHD treatments, and its use in the real patient

Medicación estimulante para el TDAH en el entorno escolar: Metilfenidato 30:70 / Stimulant drugs for ADHD in school settings: methylphenidate 30:70 / Stimulant drugs for ADHD in shool settings: methylphenidate 30/70

El Trastorno por Déficit de Atención e Hiperactividad (TDAH) es uno de los trastornos psiquiátricos más frecuentes en la infancia, con una prevalencia global acumulada de aproximadamente el 5 %. Se caracteriza por la presencia de síntomas como la inatención, impulsividad e hiperactividad. Como consecuencia de estos, los niños con TDAH muestran dificultades en centrar la atención, en el control de sus impulsos y en modular su comportamiento desde edades muy tempranas. La evidencia clínica sugiere que, a menos que se alcance un mínimo de competencia social hacia los 8 años de edad, estos niños tendrán una alta probabilidad de tener dificultades sociales a lo largo de su vida. El tratamiento del TDAH consiste en varias estrategias combinadas (tratamiento multimodal) de las cuales la farmacoterapia ocupa un lugar destacado según las diferentes guías de práctica clínica. En referencia al entorno escolar, los objetivos principales del tratamiento del TDAH se centran en adaptar al niño a los requerimientos sociales y académicos mediante la disminución del impacto de los síntomas nucleares. El metilfenidato para el TDAH ha demostrado su eficacia con un perfil de seguridad adecuado. Su perfil de liberación está correlacionado con su eficacia clínica y por tanto un perfil de liberación que cubra de manera homogénea las 8 horas como el metilfenidato 30/70 es eficaz durante toda la jornada escolar (AU)

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders in childhood, with an overall accumulated prevalence around 5%. It is characterized by the presence of symptoms such as inattention, impulsivity and hyperactivity. Children with ADHD show difficulties from an early age in focusing attention, control of impulsiveness and modulation of behavior. Clinical evidence suggests that, unless they reach a minimum of social competence at 8 years of age, these children will have a high probability of having social difficulties throughout his life. Treatment of ADHD consists of several strategies combined (multimodal treatment), where pharmacotherapy is prominent under different clinical practice guidelines. In the school environment, the goals of ADHD treatment focus on child adaptation to social and academic requirements by reducing the impact of core symptoms. Methylphenidate has proved effective with an adequate safety profile. Their release profile is correlated with the clinical efficacy and hence a release profile uniformly covering the 8 school hours as methylphenidate 30/70 is effective throughout the school day (AU)

ORCID, “en busca del autor”: un sistema de identificación del autor científico / ORCID, “in quest of the author”: a new system for scientific author identification

Desde una revisión bibliográica se presenta de forma resumida y práctica el sistema ORCID (sistema de identiicación del autor cientíico y su investigación): concepto, desarrollo cronológico, funciones y mecanismo de obtención del código personal ORCID (AU)

From a literature review is presented in easy and summary form the ORCID system (system of author identiication and scientiic research): Concept, chronological development, function and mechanism of obtaining personal code ORCID (AU)

Candidate system analysis in ADHD: evaluation of nine genes involved in dopaminergic neurotransmission identifies association with DRD1.

OBJECTIVES: Several pharmacological and genetic studies support the involvement of the dopamine neurotransmitter system in the aetiology of attention-deficit hyperactivity disorder (ADHD). Based on this information we evaluated the contribution to ADHD of nine genes involved in dopaminergic neurotransmission (DRD1, DRD2, DRD3, DRD4, DRD5, DAT1, TH, DBH and COMT). METHODS: We genotyped a total of 61 tagging single nucleotide polymorphisms (SNPs) in a sample of 533 ADHD patients (322 children and 211 adults), 533 sex-matched unrelated controls and additional 196 nuclear ADHD families from Spain. RESULTS: The single- and multiple-marker analysis in both population and family-based approaches provided preliminary evidence for the contribution of DRD1 to combined-type ADHD in children (P=8.8e-04; OR=1.50 (1.18-1.90) and P=0.0061; OR=1.73 (1.23-2.45)) but not in adults. Subsequently, we tested positive results for replication in an independent sample of 353 German families with combined-type ADHD children and replicated the initial association between DRD1 and childhood ADHD (P=8.4e-05; OR=3.67 (2.04-6.63)). CONCLUSIONS: The replication of the association between DRD1 and ADHD in two European cohorts highlights the validity of our finding and supports the involvement of DRD1 in childhood ADHD.

Changes of urine dihydroxyphenylglycol to norepinephrine ratio in children with attention-deficit hyperactivity disorder (ADHD) treated with atomoxetine.

This study investigated changes in the urine dihydroxyphenylglycol to norepinephrine ratio in patients with attention-deficit hyperactivity disorder (ADHD) treated with atomoxetine. The possible relationship with clinical response was also explored. Newly ADHD diagnosed, treatment-naïve children or adolescents were double-blindly randomized (2:1) to atomoxetine (n = 28) or placebo (n = 13). The dihydroxyphenylglycol to norepinephrine ratio decreased in both groups, showing significantly greater changes with atomoxetine than with placebo at week 6 (-42% versus -14%; P = .001), when dosed at 1.2 mg/kg/day, than at week 2 (-20% versus -2%; P = .118) with a dose of 0.5 mg/kg/day. Although the significant dihydroxyphenylglycol to norepinephrine ratio decrease with atomoxetine indicated norepinephrine transporter blockade, no association with ADHD clinical response (ADHD Rating Scale-IV-Parent:Investigator) was found. Therefore, dihydroxyphenylglycol to norepinephrine ratio might be a useful pharmacodynamic/pharmacokinetic biomarker, although not sufficiently sensitive to predict clinical efficacy. It remains a possibility that this ratio might have value to facilitate personalized atomoxetine pharmacotherapy in ADHD patients.

Evaluation of atomoxetine for first-line treatment of newly diagnosed, treatment-naïve children and adolescents with attention deficit/hyperactivity disorder.

OBJECTIVE: To test the hypothesis that first-line treatment with atomoxetine provides superior efficacy than placebo for up to 12 weeks in improving the symptoms of Attention Deficit/Hyperactivity Disorder (ADHD). RESEARCH DESIGN AND METHODS: This double-blind, randomized, placebo-controlled, parallel clinical trial included 151 treatment-naïve children (n = 113) and adolescents (n = 38) with newly diagnosed (< or =3 months) ADHD. Atomoxetine dose was uptitrated from 0.5 to 1.2 mg/kg/day after two weeks. Outcome assessments included the ADHD Rating Scale-IV-Parent-reported Investigator-rated (ADHDRS-IV-Parent:Inv), the Clinical Global Impression of Severity of ADHD (CGI-ADHD-S), and the incidence of adverse events. Mixed-model repeated measures analysis was used to compare scale score changes between groups. CLINICAL TRIAL REGISTRATION: Trial registered at www.clinicaltrials.gov (study internal code: B4Z-XM-LYDM, identifier: NCT00191945). RESULTS: Most patients were male (79.2%), of caucasian origin (96.0%) and severely ill (72.5%). Their mean age was 10.3 years. Atomoxetine-treated patients showed greater reductions from baseline to week 12 of total ADHDRS-IV-Parent:Inv score than placebo-treated patients (least square mean difference: -7.9 [95% CI: -11.0 to -4.8], corresponding to a large effect size of 0.8). Between-group mean differences increased progressively with treatment exposure from week 6 to 12 (-2.7 [-4.9 to -0.6] for total and -1.6 [-2.9 to -0.3] for inattention scores). At the end of the study, 50% of atomoxetine-treated patients (14% with placebo) showed a reduction > or =40% in total ADHDRS-IV-Parent:Inv score, and only 29% (46% with placebo) were severely ill (by CGI-ADHD-S). Treatment-related adverse events were significantly more frequent with atomoxetine (65.0%) than with placebo (37.3%), the most frequent being decreased appetite and somnolence. Only one case of decreased appetite was rated as severe. No patient discontinued treatment because of adverse events. CONCLUSIONS: A continued improvement of symptoms is expectable until 12 weeks in treatment-naïve ADHD patients treated with atomoxetine as first-line medication. Chief limitations are the small, national sample size and the absence of data beyond the 12-week time-point.

Case-control study of six genes asymmetrically expressed in the two cerebral hemispheres: association of BAIAP2 with attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neuropsychiatric disease that persists into adulthood in at least 30% of patients. There is evidence suggesting that abnormal left-right brain asymmetries in ADHD patients may be involved in a variety of ADHD-related cognitive processes, including sustained attention, working memory, response inhibition and planning. Although mechanisms underlying cerebral lateralization are unknown, left-right cortical asymmetry has been associated with transcriptional asymmetry at embryonic stages and several genes differentially expressed between hemispheres have been identified. METHODS: We selected six functional candidate genes showing at least 1.9-fold differential expression between hemispheres (BAIAP2, DAPPER1, LMO4, NEUROD6, ATP2B3, and ID2) and performed a case-control association study in an initial Spanish sample of 587 ADHD patients (270 adults and 317 children) and 587 control subjects. RESULTS: The single- and multiple-marker analysis provided evidence for a contribution of BAIAP2 to adulthood ADHD (p = .0026 and p = .0016, respectively). We thus tested BAIAP2 for replication in two independent adult samples from Germany (639 ADHD patients and 612 control subjects) and Norway (417 ADHD cases and 469 control subjects). While no significant results were observed in the Norwegian sample, we replicated the initial association between BAIAP2 and adulthood ADHD in the German population (p = .0062). CONCLUSIONS: Our results support the participation of BAIAP2 in the continuity of ADHD across life span, at least in some of the populations analyzed, and suggest that genetic factors potentially influencing abnormal cerebral lateralization may be involved in this disorder.

Association study of 10 genes encoding neurotrophic factors and their receptors in adult and child attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood-onset psychiatric disorder that often persists into adolescence and adulthood and is characterized by inappropriate levels of inattention, hyperactivity, and/or impulsivity. Genetic and environmental factors are believed to be involved in the continuity of the disorder as well as in changes in ADHD symptomatology throughout life. Neurotrophic factors (NTFs), which participate in neuronal survival and synaptic efficiency, are strong candidates to contribute to the neuroplasticity changes that take place in the human central nervous system during childhood, adolescence, and early adulthood and might be involved in the genetic predisposition to ADHD. METHODS: We performed a population-based association study in 546 ADHD patients (216 adults and 330 children) and 546 gender-matched unrelated control subjects with 183 single nucleotide polymorphisms covering 10 candidate genes that encode four neurotrophins (NGF, BDNF, NTF3, and NTF4/5), a member of the cytokine family of NTFs (CNTF), and their receptors (NTRK1, NTRK2, NTRK3, NGFR, and CNTFR). RESULTS: The single-marker and haplotype-based analyses provided evidence of association between CNTFR and both adulthood (p = .0077, odds ratio [OR] = 1.38) and childhood ADHD (p = 9.1e-04, OR = 1.40) and also suggested a childhood-specific contribution of NTF3 (p = 3.0e-04, OR = 1.48) and NTRK2 (p = .0084, OR = 1.52) to ADHD. CONCLUSIONS: Our data suggest that variations in NTFs might be involved in the genetic susceptibility to ADHD, support the contribution of the CNTFR locus as a predisposition factor for the disorder, and suggest that NTF3 and NTRK2 might be involved in the molecular basis of the age-dependent changes in ADHD symptoms throughout life span.

Worse quality of life for children with newly diagnosed attention-deficit/hyperactivity disorder, compared with asthmatic and healthy children.

OBJECTIVE: To evaluate the quality of life (QOL) of untreated children with newly diagnosed attention-deficit/hyperactivity disorder (ADHD), compared with asthmatic and healthy children. METHODS: This prospective, case-control study included a group of 120 children, 6 to 12 years of age, with newly diagnosed ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Subjects were matched according to age, gender, and health care area with 2 control groups, ie, 93 asthmatic children and 120 healthy children. Sociodemographic characteristics and Child Health Questionnaire scores were collected. RESULTS: The QOL of children with ADHD was rated worse than that of asthmatic or healthy children for most Child Health Questionnaire domains. The greatest differences were found in behavior, social limitations attributable to physical problems, emotional impact on parents, and family activities. Almost every psychosocial domain was more affected in comparison with asthmatic children and both psychosocial and physical domains in comparison with healthy children. CONCLUSIONS: ADHD interferes with the daily lives of children, parents, and families even more than asthma, primarily in areas related to psychosocial functioning, although evidence of impaired physical functioning also emerged. Delays in recognition, assessment, and management of ADHD may affect negatively the QOL of those children.