[Treatment adherence and effectiveness of extended-release antipsychotics in a hospital setting]. / Adherencia y efectividad de fármacos antipsicóticos de liberación prolongada en el ámbito hospitalario.

Schizophrenia is a chronic mental disorder that affects young patients in which antipsychotic treatment is essential for sympto- matic control and preventing progression. The high rate of relapse in these patients (10%) is mainly due to the abandonment of the medication. It is necessary to find tools to increase adherence. The long acting injectable antipsychotics (depot antipsychotics) represent a useful alternative in the recent years, since there is great evidence that they improve therapeutic compliance. OBJECTIVE: To evaluate the effectiveness and adherence to pharmacological treatment with depot antipsychotics in patients with psychotic disorders. METHODOLOGY: A retrospective longitudinal observational study was performed on a population of 89 subjects from Hospital Universitario Fundación Alcorcón (HUFA) with psychotic disorders, who received depot antipsychotics since September 2015 until June 2017. The incidences of new symptomatic episodes (assessed as visits to Emergency Department, general hospital admissions and psychiatric admissions) were compared at 6, 12, 24 months before and 6, 12, 14 months after the start of the depot treatment. RESULTS: There is a significant reduction in the relative risk of general and psychiatric admissions with all depot antipsychotics. Paliperidone Palmitate is superior to the others, being the only one that reduces the number of visits to general Emergencies. Aripiprazole only decreased the relative risk of psychiatric admissions. The depot antipsychotics used had a high adherence (73%). Among the causes of non-adherence to treatment (23%), the most important is non-compliance with the prescribed regimen. CONCLUSION: Depot antipsychotics are an effective alternative to improve therapeutic adherence in patients with psychotic disorders, which means a lower incidence of symptoms and lower hospital requirements.

Amygdala Abnormalities in Adults With ADHD.

OBJECTIVE: The suggested neurobiological bases of ADHD focus on the amygdala as a center of emotions processing. Therefore, we hypothesize that patients with ADHD will show an irregular pattern of emotional-related activity of the amygdala region as well as some structural abnormalities. METHOD: Nine adult patients with ADHD and nine group-matched healthy volunteers were studied using a 1.5-T magnetic resonance imaging (MRI) scanner. Morphometric measurements were obtained manually, and they were later processed and compared. Absolute volumes of several structures and nuclei were calculated with FSL-FIRST. For the functional magnetic resonance examination, a set of two paradigms was prepared, using a block design, incorporating images of the International Affective Picture System (IAPS). The patients were unmedicated at the time of the MRI scan. RESULTS: Negative correlation was found between the right amygdala volume and Barrat's impulsivity scores ( r = -.756, p = .018). The age of patients did not turn out to be a significant factor. No significantly higher activation areas were found in patients with unpleasant content images. For the left amygdala, an Region Of Interest (ROI)-based analysis showed moderately higher level of activation in the patients than in the controls with pleasant content images. CONCLUSION: Patients with ADHD tend to have smaller amygdala volumes. ADHD patients presented less activation in the area of the left frontal pole than the controls. There was no amygdala activation stated when presenting the pleasant images. Whereas bigger activation of the left amygdala was found in patients while presenting them unpleasant images. These results might suggest that lower emotional processing and less control of impulsivity is associated with dysfunctional amygdala in ADHD patients.

[Inverse correlation between psychotic disorders and tumor development]. / Correlación inversa entre trastornos psicóticos y el desarrollo de tumores.

Patients suffering from psychotic disorders have an increased morbidity compared with control population. Moreover, these patients are prone to habits such as smoking or obesity, which in fact are risk factors for developing neoplasias. OBJECTIVE: The current study is aimed to determine the prevalence of oncologic processes (lung, colon and prostate cancer) among patients diagnosed with psychotic disorders. METHODS: A total of 365 patients from the Hospital Universitario Fundación Alcorcón (HUFA) were included in the study. All of them were diagnosed with a psychotic disorder from 2013 to 2016. RESULTS: Studying the prevalence of oncologic processes (lung, colon and prostate cancer) between both groups revealed a significant reduction in patients diagnosed with a psychotic disorder compared with the control populations (p-value <0,05). CONCLUSIONS: Even though patients diagnosed with a psychotic disorder have a considerable morbidity and several risk factors related with the development of neoplasias, we can conclude that these patients are less likely to suffer from the aforementioned types of cancer.

Psiquiatría psicosomática del niño y adolescente con enfermedades crónicas digestivas / Psychosomatic psychiatry of the child and adolescent with chronic digestive diseases

Las enfermedades crónicas infantiles influyen negativamente en el desarrollo psicológico. Los niños y adolescentes con enfermedades crónicas digestivas presentan de forma predominante síntomas ansiosos y depresivos. Factores ambientales como el manejo de la sintomatología, la influencia de la respuesta de los pares o de la propia familia pueden determinar el manejo que de la enfermedad tenga el paciente. Estos aspectos son muy relevantes en enfermedades como la Enfermedad de Crohn, la Colitis Ulcerosa, el Dolor Abdominal Recurrente y los Vómitos Psicógenos. Los factores psicológicos que afectan a enfermedades médicas y/o la presencia comórbida de patología mental disminuyen la calidad de vida de estos pacientes afectando también al sistema familiar. La medicina psicosomática aborda estos aspectos de dichas patologías ayudando al paciente y a sus familias. Un abordaje integral por parte digestivo y de salud mental incrementa la salud percibida de los niños y adolescentes con patología digestiva crónica

Chronic childhood diseases negatively influence on the child's psychological development. Children and adolescents with chronic digestive diseases have predominantly anxious and depressive symptoms. Environmental factors such as management of gastrointestinal symptoms, the influence of the response of peers or family itself can determine the handling of the disease. These aspects are very important in diseases like Crohn's disease, ulcerative colitis, recurrent abdominal pain and psychogenic vomiting. Psychological factors affecting medical conditions and / or the presence of comorbid mental illness diminish the quality of life of these patients also the family system is affecting. Psychosomatic medicine addresses these aspects of these diseases helping patients and their families. A comprehensive approach to improving gastrointestinal and psychiatric symptoms increases the perceived health of children and adolescents with chronic digestive diseases

Psiquiatría psicosomática del niño y adolescente con enfermedades crónicas: enfermedades renales / Children and Adolescent Psychomatic Psychiatry: Kidney Diseases

Las enfermedades crónicas infantiles tienen una gran influencia no sólo en lo físico, sino también en el desarrollo psicológico de los niños y adolescentes. Las enfermedades renales son frecuentes en este grupo de edad, presentan fundamentalmente síntomas ansiosos y depresivos, baja autoestima, además de los efectos secundarios de la inmunosupresión. Debido a que son patologías de características crónicas, con gran impacto de los procedimientos diagnósticos y terapéuticos y el alto riesgo de hospitalizaciones para recibir el tratamiento idóneo, conllevan una alteración del funcionamiento (social, familiar, escolar) habitual de los niños y adolescentes. Por lo que es importante, un abordaje multidisciplinar en estos casos, debido a la influencia de los factores psicológicos para minimizar el impacto de la patología, mejorar el curso y la adherencia terapéutica en este tipo de enfermedades de características crónicas

Chronic childhood diseases have a major influence not only physically, but also in the psychological development of children and adolescents. Kidney disease is common in this age group basically have anxious and depressive symptoms , low self-esteem , in addition to the side effects of immunosuppression. Because features are chronic diseases with great impact of diagnostic and therapeutic procedures and the high risk of hospitalization to receive the best treatment, involve an alteration of the normal functioning of children and adolescents (social, family, school). So it is important a multidisciplinary approach in these cases, because the influence of psychological factors to minimize the impact of the disease, improve the course and adherence in such chronic diseases features

A guide to psychopharmacological treatment of patients with intellectual disability in psychiatry.

Background Subjects with intellectual disability are at increased risk of having comorbid psychiatric disorders and worse response to psychotherapeutic and psychopharmacological treatment interventions. On the other hand, available data on best treatment approach in this population are scarce and lack scientific evidence due to methodological limitations. The present study aims to perform a systematic review of the literature to facilitate the use of psychotropic drugs in clinical practice and better establish future research targets in this field. Objectives To review the available psychopharmacological strategies for patients with intellectual disabilities, psychiatric disorders, and behavioural disturbances. Serve as a quick guide for clinicians working in the field of intellectual disability. Methods We conducted a selective evidence-based review of the literature using Pubmed and EMBASE databases and selected most recent and relevant papers for this review. Results There are several available psychotropic drugs for the treatment of patients with intellectual disability and comorbid psychiatric disorders, although scientific evidence is limited. Treatment should be individualized according to risk-benefit balance. Discussion Further studies are needed and new available drugs should be considered to gain knowledge in effectiveness of different therapeutic approaches available in this population.

[Scales for internet addiction in spanish population: A proposal]. / Propuesta de escalas en población española para adicción a internet.

New technologies and internet use have generated such an intimated bound between users and their devices that an increasing preoccupation about problematic use and addiction has raised. Prevalence studies warn about values higher than 5% in the most restrictive studies. There are many differences in the study of this phenomenon attending to the methodology, conceptualization, object of study, device, or even on-line or off-line use. This lack of consensus has generated a number of scales. An article as the present one proposing a minimum set of scales seems necessary. This article refers to some scales which seem adequate for Spanish population due to their easy application, their validity and their extension of use. We present the validated translations for the YIAT20 and the MPPUSA. We have also done a translation where it was not available a Spanish version for the CIAS and Ko's criteria.

Understanding the direct and indirect costs of patients with schizophrenia.

BACKGROUND: Schizophrenia is a disabling mental disorder with high prevalence and that usually  requires long-term follow-up and expensive lifelong treatment. The cost of schizophrenia treatment consumes a significant amount of the health services' budget in western countries. OBJECTIVE: The aim of the study was to find out about the costs related to schizophrenia across different european countries and compare them. RESULTS: Schizophrenia treatment costs an estimated 18 billion euros annually worldwide. The direct costs associated with medical help are only part of the total expenditure. The indirect costs are an equally (or even more)important part of the total cost. These expenses are related to the lack of productivity of schizophrenic patients and the cost that relatives have to bear as a result of taking care of their affected relatives. CONCLUSIONS: Although data on the cost of schizophrenia may vary slightly between different european countries, the general conclusion that can be drawn is that schizophrenia is a very costly disorder. Not only because of direct costs related to medical procedures, but also due to the non-medical (indirect) costs. Together this suggests the need to investigate cost-efficient strategies that could provide a better outcome for schizophrenic patients, as well as the people who care for them.

Consenso del GEITDAH sobre los trastornos de conducta en niños y adolescentes / GEITDAH consensus on conduct disorders in children and adolescents

El Grupo de Especial Interés en el Trastorno por Déficit de Atención/Hiperactividad (GEITDAH) presenta en este artículo un consenso de expertos de toda España sobre los trastornos de conducta en niños y adolescentes. A partir del trabajo inicial del equipo de la Unidad de Paidopsiquiatría del Hospital Quirón-Teknon de Barcelona, se han consensuado aspectos básicos que podrían ser el punto de partida para futuros consensos. Ha sido también objetivo prioritario del trabajo actualizar en los trastornos de conducta en niños y adolescentes los criterios del Manual diagnóstico y estadístico de los trastornos mentales, quinta edición, y su comorbilidad con el trastorno por déficit de atención/hiperactividad (AU)

In this paper, the Special Interest Group on Attention Deficit Hyperactivity Disorder (GEITDAH, from its name in Spanish) presents a consensus reached by experts from all over Spain on conduct disorders in children and adolescents. Following the initial work by the team at the Pedopsychiatry Unit at the Quirón-Teknon Hospital in Barcelona, agreements have been reached on a number of basic aspects that could be the starting point for future consensuses. A top priority aim of the work was also to update the criteria in the Diagnostic and statistical manual of mental disorders, fifth edition, for conduct disorders in children and adolescents, together with their comorbidity with attention deficit hyperactivity disorder (AU)

[GEITDAH consensus on conduct disorders in children and adolescents]. / Consenso del GEITDAH sobre los trastornos de conducta en niños y adolescentes.

In this paper, the Special Interest Group on Attention Deficit Hyperactivity Disorder (GEITDAH, from its name in Spanish) presents a consensus reached by experts from all over Spain on conduct disorders in children and adolescents. Following the initial work by the team at the Pedopsychiatry Unit at the Quiron-Teknon Hospital in Barcelona, agreements have been reached on a number of basic aspects that could be the starting point for future consensuses. A top priority aim of the work was also to update the criteria in the Diagnostic and statistical manual of mental disorders, fifth edition, for conduct disorders in children and adolescents, together with their comorbidity with attention deficit hyperactivity disorder.

TITLE: Consenso del GEITDAH sobre los trastornos de conducta en niños y adolescentes.El Grupo de Especial Interes en el Trastorno por Deficit de Atencion/Hiperactividad (GEITDAH) presenta en este articulo un consenso de expertos de toda España sobre los trastornos de conducta en niños y adolescentes. A partir del trabajo inicial del equipo de la Unidad de Paidopsiquiatria del Hospital Quiron-Teknon de Barcelona, se han consensuado aspectos basicos que podrian ser el punto de partida para futuros consensos. Ha sido tambien objetivo prioritario del trabajo actualizar en los trastornos de conducta en niños y adolescentes los criterios del Manual diagnostico y estadistico de los trastornos mentales, quinta edicion, y su comorbilidad con el trastorno por deficit de atencion/hiperactividad.

Correlation between amygdala volume and impulsivity in adults with attention-deficit hyperactivity disorder.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a chronic neurobiological disorder with childhood onset and persistence through adolescence and adulthood. ADHD patients frequently show exaggerated emotional responses. The amygdala plays an important role in emotion processing and in the activation of the frontal lobe. We hypothesised that smaller amygdala volumes in ADHD patients would be associated with less control of impulsivity and emotional instability. METHODS: We studied nine adult patients with ADHD and nine group-matched healthy volunteers using a 1.5 T magnetic resonance imaging scanner. We manually obtained morphometric measurements, which were later processed and compared. RESULTS: Significant negative correlation between the right amygdala volume and Barratt's impulsivity scores was observed (r=-0.756, p=0.018). No correlation was found between impulsivity scores and the volume of the left amygdala. Age was not found to be a contributor of the results. CONCLUSIONS: Smaller amygdala volumes have been observed in patients with ADHD. Our results suggest that greater emotional processing and less control of impulsivity are associated with smaller amygdala volumes in ADHD patients. Furthermore, the right amygdala would play a bigger role in impulsivity and behaviour control than the left amygdala. Further studies involving larger samples of adult patients with ADHD and using multimodal designs are needed.

[Hyperprolactinemia and selective serotonin reuptake inhibitors. A narrative review of the literature]. / Hiperprolactinemia asociada al uso de antidepresivos inhibidores de la recaptación de serotonina. Una revisión narrativa de la literatura.

A large number of scientific papers have reported the relationship between the development of hyperprolactinemia and the use of psychotropic drugs, especially the role of antipsychotics which are antidopaminergic drugs. However, less information is known about the role of antidepressants in the development of hyperprolactinemia, specially the selective reuptake inhibitors (SSRIs). The prevalence of hyperprolactinemia as a pharmacological side effect of SSRIs is still unknown, despite the widespread use over the last decade. The aim of this review is to explore the relationship between hyperprolactinemia and SSRIs.

[HYPERPROLACTINEMIA AND SELECTIVE SEROTONIN REUPTAKE INHIBITORS. A NARRATIVE REVIEW OF THE LITERATURE]. / Hiperprolactinemia asociada al uso de antidepresivos inhibidores de la recaptación de serotonina. Una revisión narrativa de la literature.

A large number of scientific papers have reported the relationship between the development of hyperprolactinemia and the use of psychotropic drugs, especially the role of antipsychotics which are antidopaminergic drugs. However, less information is known about the role of antidepressants in the development of hyperprolactinemia, specially the selective reuptake inhibitors (SSRIs). The prevalence of hyperprolactinemia as a pharmacological side effect of SSRIs is still unknown, despite the widespread use over the last decade. The aim of this review is to explore the relationship between hyperprolactinemia and SSRIs.

Recomendaciones del GEITDAH en el tratamiento nutricional del déficit de atención con y sin hiperactividad (TDAH) / Recommendations on the nutritional treatment of attention deficit hyperactivity disorder (ADHD)

El grupo GEITDAH (Grupo de Especial Interés en el Trastorno por Déficit de Atención/Hiperactividad) presenta en este artículo un consenso de expertos de toda España sobre el tratamiento nutricional del TDAH. El tratamiento del trastorno por déficit de atención con o sin hiperactividad (TDAH) debe ser multimodal. El tratamiento nutricional es suplementario y comienza a haber pruebas científicas de su eficacia. Las intervenciones dietéticas pueden tener pequeños efectos beneficiosos en los síntomas del TDAH. La controvertida eliminación de aditivos artificiales, conservantes, colorantes y azúcares ha sido bien estudiada, y no tiene suficiente soporte científico por el momento para su recomendación generalizada como tratamiento eficaz del TDAH. Tampoco el empleo adicional de Acetil-L Carnitina con metilfenidato. Los suplementos de hierro o zinc deben suministrarse en los pacientes con TDAH con deficiencias conocidas. En este momento los hallazgos de los ensayos controlados aleatorizados son demasiado limitados y no apoyan de forma definitiva hasta la fecha el uso habitual en la práctica clínica de los ácidos grasos esenciales (omega-3 y 6) como tratamiento primario o suplementario en los niños con TDAH. Aunque, parecen aliviar síntomas relacionados con el TDAH, al menos en algunos niños, y los beneficios son mayores en el colegio que en casa

In this article, the GEITDAH -the Spanish abbreviation of the Special Interest Group on Attention Deficit Hyper-activity Disorder (ADHD)- presents a consensus about nutritional treatment for ADHD reached by experts in the management of ADHD from all over Spain. The ADHD treatment should be multimodal.Nutritional treatment is supplementary and there is some begining evidence of modest efficacy. Dietary interventions can have little beneficial effects in ADHD symptomatology. The controversial restricted elimination of food additives, preservatives, artificial food colours and refined sugar from diet is good studied. Present findings do not support to date the positive recommendation of its use as an appropriate treatment in ADHD. Neither do they support Acetyl-L Carnitine supplementation to augment methylphenidate. Iron and zinc should be supplemented in selected patients with know deficiencies. Current findings from randomized trials are limited and have not consistently supported the generalized clinical use of PUFA supplements (omega-3 fatty acids) as a primary or supplementary treatment for children with ADHD

Case Report: "ADHD Trainer": the mobile application that enhances cognitive skills in ADHD patients.

We report the case of a 10 year old patient diagnosed with attention deficit hyperactivity disorder (ADHD) and comorbid video game addiction, who was treated with medication combined to a novel cognitive training method based on video games called TCT method. A great risk of developing video game or internet addiction has been reported in children, especially in children with ADHD. Despite this risk, we hypothesize that the good use of these new technologies might be useful to develop new methods of cognitive training. The cognitive areas in which a greater improvement was observed through the use of video games were the visuospatial working memory and fine motor skills. TCT method is a cognitive training method that enhances cognitive skills such as attention, working memory, processing speed, calculation ability, reasoning, and visuomotor coordination. The purpose of reviewing this case is to highlight that regular cognitive computerized training in ADHD patients can improve some of their cognitive symptoms and can help treating video game addition.

Trastorno por déficit de atención e hiperactividad y nuevas tecnologías / Attention deficit hyperactivity disorder and new technologies

En los últimos años ha surgido un creciente interés por las nuevas tecnologías, por la rapidez con la que se han instaurado entre la población general, y entre la población infanto juvenil en particular. El trastorno por déficit de atención es el trastorno psiquiátrico más importante en la etapa infanto juvenil, por la gran comorbilidad que puede presentar con otros trastornos psiquiátricos. La mayoría de los estudios sugieren que los niños con trastorno por déficit de atención e hiperactividad, son especialmente vulnerables a desarrollar adicciones a nuevas tecnologías. El objetivo del presente artículo es realizar una revisión bibliográfica de los artículos realizados sobre nuevas tecnologías y TDAH, con la finalidad de conocer más datos sobre la incidencia de comorbilidades entre ambos, los riesgos y los posibles beneficios de las nuevas tecnologías, y profundizar en una adecuada orientación terapéutica acerca del uso de nuevas tecnologías en población infanto juvenil con TDAH. Se postulan hipótesis biológicas, ambientales y neuropsicológicas para explicar esta comorbilidad. A pesar de la comorbilidad existente, algunos estudios apuntan a que un uso racional y adecuado de las mismas, puede contribuir a mejorar algunos de sus síntomas cardinales. Existen estudios que demuestran que videojuegos diseñados específicamente para mejorar la atención, pueden mejorar el déficit de atención en niños con TDAH. Las áreas que mayor mejoría experimentan a través del uso de videojuegos son la memoria de trabajo visuoespacial y la psicomotricidad fina

In the last years, a great interest in research of technologies has been conducted. New technologies can cause problems in the general population and especially in the childhood and adolescent population. The attention deficit disorder (ADHD) is the most important psychiatric disorder in childhood and adolescent stage. An important co morbidity between ADHD and psychiatric disorders has been reported in previous research. Most studies suggest that children with ADHD are especially vulnerable to develop addictions to new technologies. The aim of this paper is to make a review about ADHD and new technologies papers, in order to study the co morbidity between this disorders, the risks and benefits of new technologies, and to know therapeutic guidance about the use of new technologies in child and adolescent population with ADHD

Algoritmos de derivación del TDAH: Consenso Geitadh / ADHD Algorithms for clinical pathways: GEITDAH consensus

El grupo de especial interés en TDAH (GEITADH) expone en este artículo su consenso sobre algoritmos de derivación en la asistencia para el paciente afecto de TDAH. Es un diseño sencillo realizado por un amplio número de profesionales de toda España con el objetivo de poder ser adaptado a necesidades asistenciales locales. Se revisan también otros algoritmos con influencia nacional

The Spanish Especial Interest Group on ADHD (GEITDAH) presents in this article its consensus on pathways for attending ADHD patients. This is a clear and simple consensus in order to facilitate the development of local algoritms inspired on it. Some ADHD algorithms used in the Spanish Health Services are reviewed

Metilfenidato de liberación prolongada 50/50 (medikinet(R)) dos veces al día, estudio abierto prospectivo / Extended realease methylphenidate (medikinet(R)) twice a day, a prospective open trial

Se presenta el primer estudio publicado en menores de 18 años (x=13,6; rango:10-16) en el que metilfenidato de liberación prolongada 50/50 de 8 horas de duración (medikinet(R)) es usado en dos tomas al día. En el contexto de un estudio abierto prospectivo, a 60 derivaciones consecutivas candidatas a tomar estimulantes de 8 a 21 horas pero que no podían tomar metilfenidato de acción inmediata, se les ofreció tomar dos dosis de medikinet(R): una dosis fija de 30 mg en desayuno (8:00 h) y otra en la tarde (15:00h) que podía ser de10 mg (n=34) ó 20 mg (n=6) con el objetivo de valorar eficacia y tolerancia. No hubo diferencias entre los 40 pacientes incluidos y los 20 no incluidos en el estudio. Los pacientes eran casos moderados-severos (Conners de Profesores superior a 45). A las 8 semanas se alcanzó remisión parcial en el 27,5% (desaparición de al menos el 25% de síntomas iniciales) y remisión completa en el 63% de pacientes (sindrómica en el 12,5%, sintomática en el 25% y funcional en el 22,5%). También se logró reducir la sintomatología de forma estadísticamente significativa (p<0,05) hasta puntos inferiores a los de población normal, para todas las subescalas de la escala de Eyberg, Conners de Padres y Profesores (excepto para la subescala de conducta del Conners de Profesores). Debido a la aparición de insomnio, 2 pacientes tuvieron que reducir dosis medikinet(R) de la tarde a 10 mg y 3 lo suspendieron por la tarde

The first study in which an 8 hours extended release methylphenidate 50/50 (medikinet(R)) is given twice a day to children is presented. As an open prospective study 60 consecutive admissions to a child psychiatric consultation that need methylphenidate from 8 to 21 hours and were not suitable to be given a short action methylphenidate (4 hours), where offered medikinet(R) twice a day with the following posology: a fixed dose of 30 mg in breakfast (8:00 hours) and either 10 mg (n=34) or 20 mg (n=6) at evening (15:00 hours). There were no significant differences between the 40 patients included in the study and the 20 patients that refused medikinet(R) twice a day. Patients were either moderate or severe in symptoma tology according to the 20 items Conners Scale for teachers (>45). At week 8 complete remission were reached for 63% patients (syndromic one for 12.5% , symptomatic one for 25% and functional one for 22,5%) Furthermore, 27,5% reached partial remission (decrease of at least 25% of symptoms). Scores in all subscales for Eyberg, Conners (Parents and Teachers) were reduced till level of normal population (except for conduct subscale of Teachers') in a statistical significant level (p<0.05). Due to insomnia 2 patients reduced doses of 50/50- MTF to 10 mg and 3 drew up medikinet in the evening

Consenso del GEITDAH sobre el trastorno por déficit de atención/hiperactividad / GEITDAH consensus on attention deficit hyperactivity disorder

El GEITDAH, Grupo de Especial Interés en el Trastorno por Déficit de Atención/Hiperactividad (TDAH), presenta en este artículo un consenso de expertos de toda España sobre el manejo del TDAH. Se han consensuado aspectos básicos que deberían ser el punto de partida para futuros consensos locales o regionales. Es también un objetivo de este consenso disminuir la variabilidad en la asistencia que se da en nuestro país al TDAH y servir de estímulo para fines docentes. Su reducida extensión permitirá una mayor difusión a fin de lograr todos estos fines de forma más efectiva. Las conclusiones del consenso se han articulado en torno a una introducción sobre aspectos básicos y recomendaciones para: diagnóstico, tratamiento (farmacológico y psicoterapéutico), flujo de pacientes y aspectos organizativos (AU)

In this article, the GEITDAH –the Spanish abbreviation of the Special Interest Group on Attention Deficit Hyperactivity Disorder (ADHD)– presents a consensus reached by experts in the management of ADHD from all over Spain. The consensus concerns fundamental aspects that should be the starting point for future local or regional consensus guides. Another aim of this consensus is also to reduce the amount of variability that occurs in the health care offered to patients with ADHD in our country, as well as to act as a stimulus in educational matters. That fact that it is not very long will make it more popular among greater numbers of people and this will allow these goals to be reached more effectively. The conclusions in the consensus guide have been constructed around an introduction dealing with basic aspects and recommendations for diagnosis, treatment (both pharmacological and psychotherapeutic), patient flow and organisational aspects (AU)

Atomoxetina: luces y sombras / Atomoxetine: lights and shadows

La atomoxetina es un inhibidor de la recaptación de noradrenalina que está siendo estudiada para usarse en el tratamiento del trastorno de déficit de atención con hiperactividad (TDAH) en España. Hasta ahora se han publicado diversos estudios abiertos así como aleatorizados, doble ciego y controlados con placebo, en niños y adolescentes y en adultos. Presentamos sus propiedades farmacológicas y sus indicaciones, así como los datos publicados sobre su eficacia en TDAH y trastornos comórbidos, y revisamos críticamente su perfil de efectos adversos y cuestiones sobre su seguridad

Atomoxetine is a noradrenaline reuptake inhibitor that is being studied for use in the treatment of attention-deficit/hyperactivity disorder (ADHD) in Spain. To date, a variety of open-label, randomized, double-blind, placebo-controlled trials in children, adolescents and adults have been published. We present the pharmacological properties and indications of atomoxetine and discuss published evidence on its efficacy in ADHD and comorbid disorders. The adverse effects profile and safety concerns of this drug are critically reviewed