Factores psicosociales asociados a la reincidencia de intentos de suicidio en pacientes con enfermedad mental atendidos en el Hospital Mental de Antioquia, Colombia, 2014-2016

Objetivo: Este estudio buscó analizar el comportamiento de factores psicosociales (características sociodemográficas, diagnóstico principal, método de intento, cognición y comportamiento) en relación con el número de intentos de suicidio en pacientes con diagnóstico de enfermedad mental, atendidos en el Hospital Mental de Antioquia, entre los años 2014 y 2016, además de evaluar la relación asociativa de dichos factores en la reincidencia por intento. Metodología: Estudio de corte transversal, que analiza, en 248 personas con diagnóstico de afecciones mentales, la asociación mencionada. Para ello, se describe, primero, el perfil sociodemográfico y clínico; luego, se construye un modelo de regresión logística multivariada, para evaluar la asociación de factores psicosociales con el riesgo de reincidencia por intento. Resultados: La población se caracterizó, principalmente, por ser joven (12-20 años) y de género femenino (62,9 %), siendo la reincidencia del 40 %. Entre los hallazgos de mayor relevancia se informa que se presenta una mayor proporción de consumo de sustancias psicoactivas y bajo apoyo familiar/social en pacientes con cuatro episodios respecto a quienes tuvieron un intento. Los predictores explicativos del riesgo de reincidencia por intento de suicidio fueron el trastorno depresivo recurrente, escaso seguimiento psiquiátrico y el uso de métodos de menor letalidad (corte de muñecas). Conclusión: Los resultados son claves en el marco de la prevención del suicidio, en tanto identifican factores que contribuyen al aumento del número de intentos y su reincidencia, y coincide con la ventana temporal de inicio de vigilancia del evento en el sistema colombiano.

Objective: This study sought to analyze psychosocial factors (sociodemographic characteristics, primary diagnosis, method of the attempt, cognition, and behavior) in relation to the number of suicide attempts in patients with a diagnosed mental illness who received care at Hospital Mental de Antioquia, from 2014 to 2016. We also had the objective of evaluating the associative relationship of such factors in recurrence per attempt. Methodology: Cross-sectional study that analyzes the abovementioned association in 248 people with diagnosed mental disorders. To this end, we first describe the sociodemographic and clinical profile; then, a multivariate logistic regression model is constructed to assess the association of psychosocial factors with the risk of recurrence per attempt. Results: The population was mainly young (12-20 years old) and female (62.9%), with a recurrence rate of 40%. Among the most relevant findings, there is a higher proportion of psychoactive substance use and low family/social support in patients with four episodes compared to those with one attempt. Predictors explaining the risk of suicide attempt recurrence were recurrent depression, little psychiatric follow-up, and the use of less lethal methods (wrist cutting). Conclusion: These results are key in the context of suicide prevention, as they identify factors that contribute to an increased number of suicide attempts and their recurrence, and they coincide with the time window for beginning surveillance of events in the Colombian system.

Objetivo: Este estudo procurou analisar o comportamento de fatores psicossociais (características sociodemográficas, diagnóstico principal, método de tentativa, cognição e comportamento) em relação com o número de tentativas de suicídio em pacientes com diagnóstico de doença mental, atendidos no Hospital Mental de Antioquia, entre os anos 2014 e 2016, além de avaliar a relação associativa de tais fatores na reincidência por tentativa. Metodologia: Estudo de corte transversal que analisa em 248 pessoas com diagnóstico de doenças mentais, a referida associação. Para tanto, descreve-se, primeiro, o perfil sociodemográfico e clínico; depois, constrói-se um modelo de regressão logística multivariada, para avaliar a associação de fatores psicossociais com o risco de reincidência por tentativa. Resultados: A população caracterizou-se, principalmente, por ser jovem (12-20 anos) e de gênero feminino (62,9%), sendo a reincidência do 40%. Entre os resultados de maior relevância encontra-se uma maior proporção de consumo de substâncias psicoativas e pouco apoio familiar/social em pacientes com quatro episódios em relação com aqueles que tiveram uma tentativa. Os preditores explicativos do risco de reincidência por tentativa de suicídio foram o transtorno depressivo recorrente, escasso acompanhamento psiquiátrico e o uso de métodos de menor letalidade (corte dos pulsos). Conclusão: Os resultados são chaves no marco da prevenção do suicídio, pois identificam fatores que contribuem para o aumento do número de tentativas e sua reincidência, e coincide com uma janela temporal de início de vigilância do evento no sistema colombiano.

Psychiatric beds and prison populations in 17 Latin American countries between 1991 and 2017: rates, trends and an inverse relationship between the two indicators.

BACKGROUND: In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America. METHODS: We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela. RESULTS: The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median -35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship -2.70 (95% CI -4.28 to -1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates -2.37 (95% CI -3.95 to -0.8; p = 0.006). CONCLUSIONS: Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.

1324 prison suicides in 10 countries in South America: incidence, relative risks, and ecological factors.

PURPOSE: Although suicide rates of prison populations and incidence factors have been reported for high-income countries, data from low- and middle-income regions are lacking. The purpose of the study was to estimate suicide rates among prison populations in South America, to examine prison-related factors, and to compare suicide rates between prison and general populations. METHODS: In this observational study, we collected the numbers of suicides in prison, rates of prison occupancy, and incarceration rates from primary sources in South America between 2000 and 2017. We compared suicide rates among prisoners with incidence rates in the general populations by calculating incidence rate ratios. We assessed the effect of gender, year, incarceration rates and occupancy on suicide rates in the prison populations using regression analyses. RESULTS: There were 1324 suicides reported during 4,437,591 person years of imprisonment between 2000 and 2017 in 10 South American countries. The mean suicide rate was 40 (95% CI 16-65) per 100,000 person years for male and female genders combined. The pooled incidence rate ratio of suicide between prison and general populations was 3.9 (95% CI 3.1-5.1) for both genders combined, 2.4 (95% CI 1.9-3.1) for men and a higher ratio in women (13.5, 95% CI 6.9-26.9). High occupancies of prisons were associated with lower incidence of suicide (ß = - 58, 95% CI - 108.5 to - 7.1). CONCLUSIONS: Suicides during imprisonment in South America are an important public health problem. Suicide prevention strategies need to target prison populations.

Evaluating empathy in Colombian ex-combatants: Examination of the internal structure of the Interpersonal Reactivity Index (IRI) in Spanish.

The Republic of Colombia has a long-standing history of internal armed conflict, further complicated by the ideological assumptions underlying their war. In recent years, its government designed the Program for Reincorporation to Civilian Life (Programa para la Reincorporación a la Vida Civil, PRVC), aiming demobilization of thousands of insurgents who were involved in guerilla and paramilitary forces. One PRVC goal involves the psychological characterization of its reincorporated members, aiming the informed design of effective and efficacious interventions to improve their adjustment. We are interested in the examination of empathy in this population. Empathy refers to the ability to predict, understand, and experience other's feelings. Empathy appears to have an effect on level of aggressive behavior. The Interpersonal Reactivity Index (IRI; Davis, 1980, 1983) is a well-established 28-item self-report tool for the assessment of empathy, including 4 scales: Perspective Taking, Fantasy, Empathic Concern, and Personal Distress. Versions in Spanish were validated in Spain and Chile, but no norms for Colombians exist. We examined the factorial structure of the IRI in a sample of 548 (83.4% males) members of the PRVC. Ten items with low factor loadings were eliminated following a series of confirmatory factor analyses (CFA). The final 4-factor model (Model 2) reached an acceptable fit (e.g., CFI = .898). A second-order CFA demonstrated that empathic concern correlated too high with a common "empathy" latent factor. With these results at hand, our 18-item IRI version in Spanish achieved a factorial structure comparable to that previously validated for Spanish speakers from other countries. (PsycINFO Database Record

[Dementia and mild cognitive impairment in Parkinson's disease: a review]. / Demencia y deterioro cognitivo leve en la enfermedad de Parkinson: una revision.

INTRODUCTION. The cognitive disorders in Parkinson's disease (PD) have traditionally been associated with the presence of dementia in later stages of the disease. Recent studies, however, consider that cognitive impairment can appear as of early stages. Knowing the cognitive profile of PD furthers our understanding of the clinical phenotype, making it easier to reach a timely diagnosis and favouring intervention on the symptoms from the initial stages. AIM. To present a review of the literature on mild cognitive impairment (MCI) and dementia associated with PD. DEVELOPMENT. Several studies report that patients with PD who have a prolonged time to progression develop dementia. Yet, there have also been reports claiming that, as of the early stages, patients can present subtle cognitive alterations known as MCI. The initial neuropsychological profile is mainly of a non-amnesic type, characterised by executive dysfunction, alterations affecting attention, operative memory deficit and faulty retrieval of information. When patients develop dementia, disorders will arise in the storage of information, in semantic fluency, and in visuospatial and visuoperceptual skills. Currently there are criteria available for diagnosing the MCI and dementia associated with PD, as well as valid reliable instruments for detecting those disorders. CONCLUSIONS. Cognitive symptoms are frequent in PD. From the initial stages of the disease onwards patients may present MCI that is mainly characterised by a fronto-subcortical cognitive profile, whereas dementia usually develops at later stages, when a pattern of posterior cortical cognitive disorder is also observed.

TITLE: Demencia y deterioro cognitivo leve en la enfermedad de Parkinson: una revision.Introduccion. Clasicamente, las alteraciones cognitivas en la enfermedad de Parkinson (EP) se han asociado a la presencia de demencia en etapas tardias de la enfermedad; sin embargo, estudios recientes consideran que el deterioro cognitivo puede aparecer desde etapas tempranas. Conocer el perfil cognitivo de la EP contribuye a la comprension del fenotipo clinico, facilita el diagnostico oportuno y favorece la intervencion de los sintomas desde estadios iniciales. Objetivo. Presentar una revision de la bibliografia del deterioro cognitivo leve (DCL) y demencia asociados a la EP. Desarrollo. Diversos estudios indican que los pacientes con EP que tienen un tiempo de evolucion prolongado de la enfermedad desarrollan demencia. Sin embargo, tambien se ha descrito que, desde etapas tempranas, los pacientes pueden presentar sutiles alteraciones cognitivas conocidas como DCL; el perfil neuropsicologico inicial es principalmente de tipo no amnesico, caracterizado por disfuncion ejecutiva, alteraciones atencionales, deficit de la memoria operativa y fallas en la recuperacion de la informacion. Cuando los pacientes desarrollan demencia, surgen alteraciones en el almacenamiento de la informacion, en la fluidez semantica y en las habilidades visuoespaciales y visuoperceptuales. En la actualidad, existen criterios disponibles para el diagnostico de DCL y demencia asociados a la EP, e instrumentos validos y fiables para la deteccion de dichas alteraciones. Conclusiones. Los sintomas cognitivos son frecuentes en la EP; desde las etapas iniciales de la enfermedad, los pacientes pueden presentar DCL caracterizado principalmente por un perfil cognitivo frontosubcortical, mientras que la demencia suele desarrollarse en etapas tardias, cuando se añade un patron de alteracion cognitiva cortical posterior.

Demencia y deterioro cognitivo leve en la enfermedad de Parkinson: una revisión / Dementia and mild cognitive impairment in Parkinson’s disease: a review

Introducción. Clásicamente, las alteraciones cognitivas en la enfermedad de Parkinson (EP) se han asociado a la presenciade demencia en etapas tardías de la enfermedad; sin embargo, estudios recientes consideran que el deterioro cognitivo puede aparecer desde etapas tempranas. Conocer el perfil cognitivo de la EP contribuye a la comprensión del fenotipo clínico, facilita el diagnóstico oportuno y favorece la intervención de los síntomas desde estadios iniciales. Objetivo. Presentar una revisión de la bibliografía del deterioro cognitivo leve (DCL) y demencia asociados a la EP. Desarrollo. Diversos estudios indican que los pacientes con EP que tienen un tiempo de evolución prolongado de la enfermedad desarrollan demencia. Sin embargo, también se ha descrito que, desde etapas tempranas, los pacientes pueden presentar sutiles alteraciones cognitivas conocidas como DCL; el perfil neuropsicológico inicial es principalmente de tipo no amnésico, caracterizado por disfunción ejecutiva, alteraciones atencionales, déficit de la memoria operativa y fallas en la recuperación de la información. Cuando los pacientes desarrollan demencia, surgen alteraciones en el almacenamiento de la información, en la fluidez semántica y en las habilidades visuoespaciales y visuoperceptuales. En la actualidad, existen criterios disponibles para el diagnóstico de DCL y demencia asociados a la EP, e instrumentos válidos y fiables para la detección de dichas alteraciones. Conclusiones. Los síntomas cognitivos son frecuentes en la EP; desde las etapas iniciales de la enfermedad, los pacientes pueden presentar DCL caracterizado principalmente por un perfil cognitivo frontosubcortical, mientras que la demencia suele desarrollarse en etapas tardías, cuando se añade un patrón de alteración cognitiva cortical posterior (AU)

Introduction. The cognitive disorders in Parkinson’s disease (PD) have traditionally been associated with the presence of dementia in later stages of the disease. Recent studies, however, consider that cognitive impairment can appear as of early stages. Knowing the cognitive profile of PD furthers our understanding of the clinical phenotype, making it easier to reach a timely diagnosis and favouring intervention on the symptoms from the initial stages. Aim. To present a review of the literature on mild cognitive impairment (MCI) and dementia associated with PD. Development. Several studies report that patients with PD who have a prolonged time to progression develop dementia. Yet, there have also been reports claiming that, as of the early stages, patients can present subtle cognitive alterations known as MCI. The initial neuropsychological profile is mainly of a non-amnesic type, characterised by executive dysfunction, alterations affecting attention, operative memory deficit and faulty retrieval of information. When patients develop dementia, disorders will arise in the storage of information, in semantic fluency, and in visuospatial and visuoperceptual skills. Currently there are criteria available for diagnosing the MCI and dementia associated with PD, as well as valid reliable instruments for detecting those disorders. Conclusions. Cognitive symptoms are frequent in PD. From the initial stages of the disease onwards patients may present MCI that is mainly characterised by a fronto-subcortical cognitive profile, whereas dementia usually develops at later stages, when a pattern of posterior cortical cognitive disorder is also observed (AU)

Tracking the Cognitive, Social, and Neuroanatomical Profile in Early Neurodegeneration: Type III Cockayne Syndrome.

Cockayne syndrome (CS) is an autosomal recessive disease associated with premature aging, progressive multiorgan degeneration, and nervous system abnormalities including cerebral and cerebellar atrophy, brain calcifications, and white matter abnormalities. Although several clinical descriptions of CS patients have reported developmental delay and cognitive impairment with relative preservation of social skills, no previous studies have carried out a comprehensive neuropsychological and social cognition assessment. Furthermore, no previous research in individuals with CS has examined the relationship between brain atrophy and performance on neuropsychological and social cognition tests. This study describes the case of an atypical late-onset type III CS patient who exceeds the mean life expectancy of individuals with this pathology. The patient and a group of healthy controls underwent a comprehensive assessment that included multiple neuropsychological and social cognition (emotion recognition, theory of mind, and empathy) tasks. In addition, we compared the pattern of atrophy in the patient to controls and to its concordance with ERCC8 gene expression in a healthy brain. The results showed memory, language, and executive deficits that contrast with the relative preservation of social cognition skills. The cognitive profile of the patient was consistent with his pattern of global cerebral and cerebellar loss of gray matter volume (frontal structures, bilateral cerebellum, basal ganglia, temporal lobe, and occipito-temporal/occipito-parietal regions), which in turn was anatomically consistent with the ERCC8 gene expression level in a healthy donor's brain. The study of exceptional cases, such as the one described here, is fundamental to elucidating the processes that affect the brain in premature aging diseases, and such studies provide an important source of information for understanding the problems associated with normal and pathological aging.

[Diagnostic validity of attention deficit/hyperactivity disorder: from phenomenology to neurobiology (II)]. / Validez del diagnostico de trastorno por deficit de atencion/hiperactividad: de lo fenomenologico a lo neurobiologico (II).

The diagnostic criteria for the attention deficit/hyperactivity disorder (ADHD) were defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fourth version. ADHD is a neuro-psychiatric disorder associated with impairments in everyday life and behavioral dysregulation (i.e. inattention, hyper-activity and impulsivity), and it has showed empirical evidence from clinical, pharmacological, and psychometric studies. Nevertheless, the role of neurobiological impairments in the presentation of the symptoms remains unclear. For this paper, the authors reviewed Spanish and English literature that support the neurobiological validity of the disorder, aimed to present evidence associated with its cognitive and behavioral phenotype (e.g. in: neuropsychology, electrophysiology, structural and functional magnetic resonance imaging, neurochemistry and genetics). Additionally, an integrative theoretical clinical and scientific proposal is presented. Finally, the introduction of neurobiological marker as part of the definitive diagnosis is suggested, as a started point for the identification of therapeutic targets.

Validez del diagnóstico de trastorno por déficit de atención/hiperactividad: de lo fenomenológico a lo neurobiológico (II) / Diagnostic validity of attention deficit/hyperactivity disorder: from phenomenology to neurobiology (II)

El trastorno por déficit de atención/hiperactividad (TDAH), definido por el Manual diagnóstico y estadístico de los trastornos mentales, cuarta edición, se refiere a una alteración neuropsiquiátrica de inicio en la infancia o adolescencia relacionada con la aparición de síntomas de inatención o hiperactividad-impulsividad y la presencia de alteraciones funcionales en la vida cotidiana. Esta clasificación ha permitido que el TDAH tenga suficientes evidencias clínicas y psicométricas, de acuerdo con los análisis de la conducta y los cambios con el uso de los medicamentos. Sin embargo, aún no se ha podido determinar con precisión el papel de las alteraciones neurobiológicas en su presentación. En este artículo se revisan estudios que apoyan la validez neurobiológica del TDAH, relacionados con las alteraciones neuropsicológicas y con marcadores electrofisiológicos, de las señales de resonancia magnética funcional, de modificaciones en la neuroquímica y de predisposición genética, a través de datos que permiten detallar objetiva y cuantitativamente el fenotipo conductual y cognitivo de los niños y jóvenes adultos con TDAH, y, a su vez, ofrecer una propuesta teórica integrativa que favorezca el análisis clínico y científico del trastorno. Finalmente, esta revisión documental discute algunos elementos hacia los cambios futuros que permitan introducir algunos de estos marcadores neurobiológicos como parte del diagnóstico del trastorno y de la orientación hacia unas estrategias terapéuticas más sólidas (AU)

The diagnostic criteria for the attention deficit/hyperactivity disorder (ADHD) were defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fourth version. ADHD is a neuropsychiatric disorder associated with impairments in everyday life and behavioral dysregulation (i.e. inattention, hyperactivity and impulsivity), and it has showed empirical evidence from clinical, pharmacological, and psychometric studies. Nevertheless, the role of neurobiological impairments in the presentation of the symptoms remains unclear. For this paper, the authors reviewed Spanish and English literature that support the neurobiological validity of the disorder, aimed to present evidence associated with its cognitive and behavioral phenotype (e.g. in: neuropsychology, electrophysiology, structural and functional magnetic resonance imaging, neurochemistry and genetics). Additionally, an integrative theoretical clinical and scientific proposal is presented. Finally, the introduction of neurobiological marker as part of the definitive diagnosis is suggested, as a started point for the identification of therapeutic targets (AU)

Potential cognitive endophenotypes in multigenerational families: segregating ADHD from a genetic isolate.

Endophenotypes are neurobiological markers cosegregating and associated with illness. These biomarkers represent a promising strategy to dissect ADHD biological causes. This study was aimed at contrasting the genetics of neuropsychological tasks for intelligence, attention, memory, visual-motor skills, and executive function in children from multigenerational and extended pedigrees that cluster ADHD in a genetic isolate. In a sample of 288 children and adolescents, 194 (67.4%) ADHD affected and 94 (32.6%) unaffected, a battery of neuropsychological tests was utilized to assess the association between genetic transmission and the ADHD phenotype. We found significant differences between affected and unaffected children in the WISC block design, PIQ and FSIQ, continuous vigilance, and visual-motor skills, and these variables exhibited a significant heritability. Given the association between these neuropsychological variables and ADHD, and also the high genetic component underlying their transmission in the studied pedigrees, we suggest that these variables be considered as potential cognitive endophenotypes suitable as quantitative trait loci (QTLs) in future studies of linkage and association.

El N200: una señal electrofisiológica asociada con el control inhibitorio como candidato a endofenotipo del trastorno por déficit de atención/hiperactividad familiar / N200: an electrophysiological signal associated with inhibitory control, as an endophenotype candidate in attention deficit hyperactivity disorder

Introducción. El N200 (N2) es un componente electrofisiológico relacionado con el análisis de desajustes perceptuales y con el reconocimiento de una señal de parada (control inhibitorio); neuroanatómicamente, se ha asociado con estructuras orbitofrontales derechas. Su modulación se ha estudiado con tareas de tipo go/no go y de detención de respuesta –Stop Signal Task (SST)–. Desarrollo. Durante la realización de la SST en sujetos con trastorno por déficit de atención/hiperactividad (TDAH) se han identificado diferencias en la amplitud del N2 respecto a los controles. Por otra parte, múltiples estudios han informado de que el TDAH tiene una alta heredabilidad, con ligamientos a varios loci de susceptibilidad. Por lo anterior, se reconoce que el control inhibitorio, específicamente la modulación del N2, es un rasgo cuantitativo que pudiera expresarse de forma diferente en los miembros de familias de afectados con TDAH y no afectados, así como en los sujetos no afectados de la población general, y ser un candidato a endofenotipo del trastorno. Esta hipótesis se ha corroborado en 141 familias del aislado genético de Antioquia, en las que se han identificado diferencias en esta señal eléctrica al comparar miembros de familias de afectados y no afectados, y estos dos grupos con no afectados de la población general. Conclusiones. Estos hallazgos sugieren que el N2 es una señal electrofisiológica modulada por los fallos en el control inhibitorio en los sujetos con TDAH y, en este sentido, podría usarse como candidato en la búsqueda de endofenotipos en la forma familiar de este trastorno (AU)

Introduction. N200 (N2) is an electrophysiological component related with the analysis of perceptual disruptions and with the recognition of a stop signal (inhibitory control); neuroanatomically, it has been associated with right-hand orbitofrontal structures. Its modulation has been studied with go/no go-type tasks and the Stop Signal Task (SST). Development. While the SST is being carried out in subjects with attention deficit hyperactivity disorder (ADHD), differences in the amplitude of the N2 have been observed in comparison to control subjects. Moreover, a number of studies have reported that ADHD has a high degree of inheritability, with linkages to several susceptibility loci. From all this, it is acknowledged that inhibitory control, and more particularly N2 modulation, is a quantitative trait that may be expressed in different ways in the members of families with and without ADHD, as well as in unaffected subjects from the general population, while also being a candidate as an endophenotype of the disorder. This hypothesis has been confirmed in 141 families with the genetic isolate of Antioquia, in which differences have been identified in this electrical signal on comparing the members of affected and unaffected families and these two groups with unaffected members of the general population. nclusions. These findings suggest that N2 is an electrophysiological signal that is modulated by faulty inhibitory control in subjects with ADHD and, in this respect, could be used as a candidate in the search for endophenotypes in the familial form of this disorder (AU)

[N200: an electrophysiological signal associated with inhibitory control, as an endophenotype candidate in attention deficit hyperactivity disorder]. / El N200: una senal electrofisiologica asociada con el control inhibitorio como candidato a endofenotipo del trastorno por deficit de atencion/hiperactividad familiar.

INTRODUCTION: N200 (N2) is an electrophysiological component related with the analysis of perceptual disruptions and with the recognition of a stop signal (inhibitory control); neuroanatomically, it has been associated with right-hand orbitofrontal structures. Its modulation has been studied with go/no go-type tasks and the Stop Signal Task (SST). DEVELOPMENT: While the SST is being carried out in subjects with attention deficit hyperactivity disorder (ADHD), differences in the amplitude of the N2 have been observed in comparison to control subjects. Moreover, a number of studies have reported that ADHD has a high degree of inheritability, with linkages to several susceptibility loci. From all this, it is acknowledged that inhibitory control, and more particularly N2 modulation, is a quantitative trait that may be expressed in different ways in the members of families with and without ADHD, as well as in unaffected subjects from the general population, while also being a candidate as an endophenotype of the disorder. This hypothesis has been confirmed in 141 families with the genetic isolate of Antioquia, in which differences have been identified in this electrical signal on comparing the members of affected and unaffected families and these two groups with unaffected members of the general population. CONCLUSIONS: These findings suggest that N2 is an electrophysiological signal that is modulated by faulty inhibitory control in subjects with ADHD and, in this respect, could be used as a candidate in the search for endophenotypes in the familial form of this disorder.

Capacidad intelectual y función ejecutiva en niños intelectualmente talentosos y en niños con inteligencia promedio / Intellectual ability and executive function in intellectually gifted children and children with average intelligence

El objetivo del presente estudio fue analizar las relaciones, por comparación y correlación, entre las dimensiones de función ejecutiva (FE) y capacidad intelectual (CI) en niños con talento excepcional (NTE) y niños con inteligencia promedio (NIP), de 7 a 11 años de edad, de la ciudad de Medellín, Colombia. Se seleccionó una muestra no aleatoria de 62 niños y se conformaron dos grupos independientes, de acuerdo con la CI. Se les administraron pruebas de FE. Según los resultados, los NTE tuvieron una ejecución significativamente más alta en la TFV-fonológica (p < 0,05), con un tamaño del efecto medio (0,65). Únicamente, se encontró una correlación estadísticamente significativa pero baja (r = 0,267, p = 0,03) entre TFV-fonológica y el CIV. Se concluyó que la FE parece ser una actividad cognitiva no relacionada con las mediciones de la CI...

Objective: To analyze the relationship, by comparison and correlation, between executive function (EF) and intellectual capacity (IC) in clever children (CC) and Average Intelligence Quotient children (AIQC), aged 7 to 11 years, and living in Medellín - Colombia. Patients and Methods: a non-randomized sample of 62 children was selected. The sample was constituted by two independent groups, according the IC. EF tasks were administered to both groups. Results: CC had statistically significant higher performance on phonological verbal fluency test (PVFT) (p < 0,05), with a modest effect size (0,65). A statistically significant, but low (r = 0,267, p = 0,03), correlation between PVF and verbal IQ was found. Conclusion: EF appeared as a non IQ-related ability...

[Utility of the Wender-Utah rating scale and the checklists for the diagnosis of familial attention deficit hyperactivity disorder in adults. Convergent and concurrent validities]. / Utilidad de la escala Wender-Utah y de las escalas de sintomas para el diagnostico del trastorno por deficit de atencion/hiperactividad familiar en adultos. Validez convergente y concurrente.

INTRODUCTION: Standard questionnaires to characterize familial attention deficit hyperactivity disorder (ADHD) of adults have been studied in some studies. AIM: To observe convergent and concurrent validity of four standard rating scales to quantify the familial ADHD symptoms of adults. PATIENTS AND METHODS: The sample was constituted by the 392 adults; aged 18 through 84 years, belonging to 141 Antioquian families with multiple ADHD affected members, who fulfilled by self-report the Wender-Utah Rating Scale and the ADHD checklist; and, beside, answered a questionnaire asking for current and past ADHD symptoms, in a neurological interview. Correlation analyses were done. Sensitivity and specificity for ADHD diagnosis were also determined. RESULTS: Significant and over 0.6 correlations were observed between scales that explored past ADHD symptoms. Distant cut-off points for 90% sensitivity and specificity were observed for all questionnaires. The best LR+ (12.15) was found for the report of 5 or more past hyperactivity-impulsivity symptoms; follow by the report of 7 or more past ADHD symptoms (6.92). CONCLUSIONS: Cut-off points should be taken with caution when these rating scales were used for adult ADHD screening. Psychometric properties do not allow using these scales as substitution of structured clinical interview for the gold standard ADHD diagnosis in adults.

Utilidad de la escala Wender-Utah y de las escalas de síntomas para el diagnóstico del trastorno por déficit de atención/hiperactividad familiar en adultos. Validez convergente y concurrente / Utility of the Wender-Utah Rating Scale and the checklists for the diagnosis of familial attention deficit hyperactivity disorder in adults. Convergent and concurrent validities

Introducción. El uso de los cuestionarios para caracterizar el trastorno por déficit de atención/hiperactividad (TDAH) familiar del adulto ha sido estudiado por múltiples autores. Objetivo. Observar la validez convergente y concurrente de cuatro instrumentos estandarizados para cuantificar los síntomas del TDAH familiar del adulto. Pacientes y métodos. La muestra estuvo constituida por los 392 adultos de 18 a 84 años de edad, pertenecientes a 141 familias antioqueñas con múltiples afectados de TDAH, quienes respondieron mediante autoinforme los cuestionarios retrospectivos de Wender-Utah y la lista de síntomas de TDAH; además, contestaron en la entrevista neurológica el cuestionario del número de síntomas de TDAH presentados en el pasado y los síntomas actuales. Se hizo análisis de correlación de las puntuaciones y se calculó la sensibilidad y especificidad de los instrumentos para el diagnóstico de TDAH. Resultados. Se observaron correlaciones significativas y mayores de 0,6 entre los cuestionarios que exploraron síntomas de TDAH del pasado. Los cuestionarios tuvieron puntos de corte distantes para la sensibilidad y especificidad del 90%. La mejor razón de verosimilitud positiva (12,15) se encontró para el informe de cinco o más síntomas de hiperactividadimpulsividad en el pasado, seguido del informe de siete o más síntomas de TDAH en el pasado (6,92). Conclusiones. Para el uso de cualquiera de estos instrumentos en el rastreo de adultos con sospecha de TDAH, se debe ser cauteloso con los puntos de corte. El comportamiento psicométrico no permite su utilización en reemplazo de la entrevista estructurada como técnica de referencia del diagnóstico de TDAH del adulto (AU)

Introduction. Standard questionnaires to characterize familial attention deficit hyperactivity disorder (ADHD) of adults have been studied in some studies. Aim. To observe convergent and concurrent validity of four standard rating scales to quantify the familial ADHD symptoms of adults. Patients and methods. The sample was constituted by the 392 adults; aged 18 through 84 years, belonging to 141 Antioquian families with multiple ADHD affected members, who fulfilled by self-report the Wender-Utah Rating Scale and the ADHD checklist; and, beside, answered a questionnaire asking for current and past ADHD symptoms, in a neurological interview. Correlation analyses were done. Sensitivity and specificity for ADHD diagnosis were also determined. Results. Significant and over 0.6 correlations were observed between scales that explored past ADHD symptoms. Distant cut-off points for 90% sensitivity and specificity were observed for all questionnaires. The best LR+ (12.15) was found for the report of 5 or more past hyperactivity-impulsivity symptoms; follow by the report of 7 or more past ADHD symptoms (6.92). Conclusions. Cut-off points should be taken with caution when these rating scales were used for adult ADHD screening. Psychometric properties do not allow using these scales as substitution of structured clinical interview for the gold standard ADHD diagnosis in adults (AU)