ABSTRACT
The objective was to compare long-term effects of methylphenidate (MPH) and atomoxetine (ATX) on executive functions (EF) and delay aversion (DAv) in ADHD. A randomized controlled trial was conducted. A comprehensive neuropsychological battery was administered at three moments (Naive, Post-1, Post-2). ADHD participants who showed deficits in the naive evaluation (n = 26) were randomized to receive either MPH (n = 13; Mage = 11 ± 1, MIQ 96 ± 8) or ATX (n = 13; Mage = 10 ± 1, MIQ 106 ± 16.5) optimal dosages. Parallel test forms were administered after three (Post-1) and six months (Post-2) of treatment. A control group (n = 19; Mage = 11 ± 1; MIQ = 106 ± 16.5) performed the neuropsychological battery similarly. Both MPH and ATX significantly improved scores in verbal working memory (vWM) (Naive: p < 0.0001, d = 0.75; Post-1: p = 0.71, d = 0.12), spatial working memory (sWM) (Naive p < 0.0001, d = 0.63; Post-2 p = 0.44; d = 0.03), planning (Naive p < 0.0001, d = 0.54; Post-2 p = 0.6, d = 0.18), decision making (Naive p < 0.001 d = 0.28; Post-1 = 0.06 d = 0.12) and inhibition (Naive <0.0001, d = 0.66; Post-2 p = 0.08, d = 0.00), reaching an improved treatment response after three months of treatment in vWM and after six months in sWM, planning, and inhibition. No beneficial effect on DAv and risk taking was found with MPH and neither with ATX. Long-term treatment in range of optimal clinical dosages with either MPH or ATX improves EF, but not DAv in children with ADHD.
Subject(s)
Adrenergic Uptake Inhibitors/pharmacology , Atomoxetine Hydrochloride/pharmacology , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/physiopathology , Central Nervous System Stimulants/pharmacology , Child Behavior/drug effects , Delay Discounting/drug effects , Executive Function/drug effects , Memory/drug effects , Methylphenidate/pharmacology , Risk-Taking , Adrenergic Uptake Inhibitors/administration & dosage , Atomoxetine Hydrochloride/administration & dosage , Central Nervous System Stimulants/administration & dosage , Child , Delay Discounting/physiology , Female , Follow-Up Studies , Humans , Inhibition, Psychological , Male , Methylphenidate/administration & dosage , Neuropsychological Tests , Treatment OutcomeABSTRACT
AIMS: to determine the characteristics of pediatric patients suffering from eating disorders that were hospitalized at Hospital Universitario de Canarias. MATERIALS AND METHODS: a retrospective study in a cohort of pediatric patients diagnosed with eating disorders and admitted in our area was developed during the last seven years. RESULTS: out of 35 patients in our study, 85.7 % were women, onset average age 13.5. 77.1% of the cases were diagnosed as anorexia nervosa- restrictive type. The most frequent analytical alterations, detected when patients were in hospital, consisted in a drop in plasma levels in retinol binding protein (RBP)- in 57.6% of the cases- and D hypovitaminosis- in 46.9 % of them: the use of high - calories supplements was required in 71.4% of patients during hospitalization. The average weight gain was higher when the body mass index (BMI) was smaller at patient's admission to hospital (p = 0,006). Conclussions: eating disorders are increasing in pediatric age: puberty is a special vulnerable period for its development, as well as medical complications secondary to malnutrition. Admission to hospital is an essential tool for handling many cases; taking the necessary monitoring leading to a weight increase, preventing complications in nutritional support and tackling the underlying psychopathology. Diagnosis and a precocious treatment are crucial to avoid an excessive weight loss and more complications.
Objetivos: determinar las características de los pacientes en edad pediátrica afectados de trastornos de la conducta alimentaria que requirieron ingreso en el Servicio de Pediatría del Complejo Hospitalario Universitario de Canarias (CHUC). Material y método: se realizó un estudio retrospectivo de una cohorte de pacientes pediátricos diagnosticados de trastornos de la conducta alimentaria e ingresados en planta de hospitalización pediátrica durante los últimos siete años. Resultados: de los 35 pacientes de la muestra, un 85,7% fueron mujeres, con una edad media al debut de 13,5 años. En el 77,1% de los casos el diagnóstico principal fue el de anorexia nerviosa de tipo restrictivo. Las alteraciones analíticas más frecuentes detectadas en el momento del ingreso consistieron en descenso de los niveles plasmáticos de proteína fijadora del retinol (RBP), presente en el 57,6% de los casos, e hipovitaminosis D, que en esta muestra estaba presente en el 46,9% de los casos. Se requirió el uso de suplementos hipercalóricos en el 71,4% de los pacientes durante la hospitalización. La ganancia ponderal media durante la estancia fue mayor cuanto menor era el índice de masa corporal (IMC) al ingreso (p = 0,006). Conclusiones: los TCA son enfermedades con incidencia creciente en la edad pediátrica. La pubertad constituye un momento de especial vulnerabilidad para el desarrollo de los TCA (así como de complicaciones médicas secundarias a la desnutrición). En muchos casos el ingreso hospitalario constituye una herramienta necesaria para un correcto manejo, instaurándose las medidas de control necesarias para la recuperación ponderal, la prevención de complicaciones del soporte nutricional y el abordaje de la psicopatología subyacente. El diagnóstico y tratamiento precoz resultan cruciales para evitar una excesiva pérdida ponderal y mayor incidencia de complicaciones.
Subject(s)
Feeding and Eating Disorders/epidemiology , Adolescent , Anorexia Nervosa/epidemiology , Body Mass Index , Child , Cohort Studies , Feeding and Eating Disorders/therapy , Female , Hospitalization/statistics & numerical data , Humans , Male , Puberty/psychology , Retrospective Studies , Spain/epidemiology , Weight GainABSTRACT
Objetivos: determinar las características de los pacientes en edad pediátrica afectados de trastornos de la conducta alimentaria que requirieron ingreso en el Servicio de Pediatría del Complejo Hospitalario Universitario de Canarias (CHUC). Material y método: se realizó un estudio retrospectivo de una cohorte de pacientes pediátricos diagnosticados de trastornos de la conducta alimentaria e ingresados en planta de hospitalización pediátrica durante los últimos siete años. Resultados: de los 35 pacientes de la muestra, un 85,7% fueron mujeres, con una edad media al debut de 13,5 años. En el 77,1% de los casos el diagnóstico principal fue el de anorexia nerviosa de tipo restrictivo. Las alteraciones analíticas más frecuentes detectadas en el momento del ingreso consistieron en descenso de los niveles plasmáticos de proteína fijadora del retinol (RBP), presente en el 57,6% de los casos, e hipovitaminosis D, que en esta muestra estaba presente en el 46,9% de los casos. Se requirió el uso de suplementos hipercalóricos en el 71,4% de los pacientes durante la hospitalización. La ganancia ponderal media durante la estancia fue mayor cuanto menor era el índice de masa corporal (IMC) al ingreso (p = 0,006). Conclusiones: los TCA son enfermedades con incidencia creciente en la edad pediátrica. La pubertad constituye un momento de especial vulnerabilidad para el desarrollo de los TCA (así como de complicaciones médicas secundarias a la desnutrición). En muchos casos el ingreso hospitalario constituye una herramienta necesaria para un correcto manejo, instaurándose las medidas de control necesarias para la recuperación ponderal, la prevención de complicaciones del soporte nutricional y el abordaje de la psicopatología subyacente. El diagnóstico y tratamiento precoz resultan cruciales para evitar una excesiva pérdida ponderal y mayor incidencia de complicaciones (AU)
Aims: to determine the characteristics of pediatric patients suffering from eating disorders that were hospitalized at Hospital Universitario de Canarias. Materials and methods: a retrospective study in a cohort of pediatric patients diagnosed with eating disorders and admitted in our area was developed during the last seven years. Results: out of 35 patients in our study, 85.7 % were women, onset average age 13.5. 77.1% of the cases were diagnosed as anorexia nervosa- restrictive type. The most frequent analytical alterations, detected when patients were in hospital, consisted in a drop in plasma levels in retinol binding protein (RBP)- in 57.6% of the cases- and D hypovitaminosis- in 46.9 % of them: the use of high - calories supplements was required in 71.4% of patients during hospitalization. The average weight gain was higher when the body mass index (BMI) was smaller at patient's admission to hospital (p = 0,006). Conclussions: eating disorders are increasing in pediatric age: puberty is a special vulnerable period for its development, as well as medical complications secondary to malnutrition. Admission to hospital is an essential tool for handling many cases; taking the necessary monitoring leading to a weight increase, preventing complications in nutritional support and tackling the underlying psychopathology. Diagnosis and a precocious treatment are crucial to avoid an excessive weight loss and more complications (AU)
Subject(s)
Adolescent , Child , Humans , Feeding and Eating Disorders/epidemiology , Anorexia Nervosa/epidemiology , Malnutrition/epidemiology , Retrospective Studies , Vitamin D Deficiency/complications , Retinol-Binding Proteins/deficiency , Risk FactorsABSTRACT
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)
Subject(s)
Child , Female , Humans , Male , Child Behavior Disorders , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Attention Deficit and Disruptive Behavior Disorders/etiology , Attention Deficit and Disruptive Behavior Disorders/therapy , Social Behavior Disorders/diagnosis , Social Behavior Disorders/epidemiology , Social Behavior Disorders/etiology , Social Behavior Disorders/therapy , Epidemiological Monitoring/trends , Attention Deficit Disorder with Hyperactivity , Antisocial Personality Disorder , Parent-Child Relations , Violence , Self Concept , Attitude , Education , Risk Factors , Comorbidity , Spain/epidemiologyABSTRACT
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.
Subject(s)
Conduct Disorder , Adolescent , Adolescent Behavior , Aggression , Antisocial Personality Disorder/diagnosis , Antisocial Personality Disorder/epidemiology , Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Authoritarianism , Child , Child Behavior , Child Behavior Disorders/diagnosis , Child, Preschool , Combined Modality Therapy , Comorbidity , Conduct Disorder/diagnosis , Conduct Disorder/epidemiology , Conduct Disorder/etiology , Conduct Disorder/psychology , Conduct Disorder/therapy , Crime , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Executive Function , Humans , Infant , Parent-Child Relations , Parenting , Psychiatric Status Rating Scales , Psychotherapy/methods , Psychotropic Drugs/therapeutic use , Teaching/methods , ViolenceABSTRACT
La estimulación cerebral no invasiva constituye una herramienta prometedora para el desarrollo de nuevos abordajes diagnósticos y terapéuticos en los trastornos psiquiátricos de la infancia. En la actualidad existen dos técnicas de estimulación no invasiva disponibles: la estimulación magnética transcraneal y la estimulación transcraneal de corriente directa. Estas técnicas no invasivas de neuromodulación parecen actuar modulando la plasticidad cerebral, abriendo nuevas esperanzas en el tratamiento de los trastornos de la plasticidad y circuitos cerebrales. Dado que muchos trastornos psiquiátricos infantiles presentan alteraciones en la maduración o en los mecanismos de plasticidad de los circuitos frontoestriatales, y el cerebro en desarrollo presenta mayor capacidad de plasticidad cerebral, la estimulación cerebral no invasiva podría aportar mayores beneficios en esta población que los ya bien conocidos en adultos. Aunque su utilización sigue siendo limitada en niños, existe suficiente evidencia para su uso racional y seguro en esta población. En este trabajo se revisan los principios teóricos de la estimulación cerebral no invasiva y las aplicaciones diagnósticas y terapéuticas en los trastornos psiquiátricos de la infancia, con la finalidad de aportar evidencias para el desarrollo de estas técnicas como nuevos enfoques diagnósticos seguros y fiables, así como nuevas herramientas terapéuticas eficaces en psiquiatría infantil (AU)
Novel diagnostic and therapeutic approaches based on noninvasive brain stimulation offer some promise in the field of childhood psychiatric disorders. There are two primary methods of noninvasive brain stimulation currently available: transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Both noninvasive neuromodulation techniques appear to rely on modulating brain plasticity and thus open new hopes in the treatment of brain circuit and plasticity disorders. Since many childhood psychiatric disorders involve disturbances in the timing or mechanisms of plasticity within frontostriatal circuits, and the developing brain shows a greater capacity of brain plasticity, noninvasive brain stimulation might induce greater benefits in this population than in adults. Although the utilization of TMS and tDCS remains limited in children, there is enough evidence for their rational, safe use in this population. In this paper, we review the principles of noninvasive brain stimulation and the diagnostic and therapeutic applications in childhood psychiatric disorders in order to inform its development into safe and reliable diagnostic and effective therapeutic approaches in pediatric psychiatry (AU)
Subject(s)
Humans , Male , Female , Child , Neurodevelopmental Disorders/therapy , Transcutaneous Electric Nerve Stimulation/methods , Neuronal PlasticityABSTRACT
Novel diagnostic and therapeutic approaches based on noninvasive brain stimulation offer some promise in the field of childhood psychiatric disorders. There are two primary methods of noninvasive brain stimulation currently available: transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Both noninvasive neuromodulation techniques appear to rely on modulating brain plasticity and thus open new hopes in the treatment of brain circuit and plasticity disorders. Since many childhood psychiatric disorders involve disturbances in the timing or mechanisms of plasticity within frontostriatal circuits, and the developing brain shows a greater capacity of brain plasticity, noninvasive brain stimulation might induce greater benefits in this population than in adults. Although the utilization of TMS and tDCS remains limited in children, there is enough evidence for their rational, safe use in this population. In this paper, we review the principles of noninvasive brain stimulation and the diagnostic and therapeutic applications in child-hood psychiatric disorders in order to inform its development into safe and reliable diagnostic and effective therapeutic approaches in pediatric psychiatry.