DSM-5 Non-Suicidal Self-Injury Criteria in a Clinical Sample of Self-Harming Mexican Adolescents. / Lesiones autoinfligidas con fines no suicidas según el DSM-5 en una muestra clínica de adolescentes mexicanos con autolesiones.

INTRODUCTION: The DSM-5 diagnostic criteria for non-suicidal self-injury (NSSI) needs to be validated in non-European populations. The aims of this study were to determine how common NSSI was in a sample of self-harming Mexican adolescents and examine the associated variables. METHODS: We examined the medical records of 585 adolescents with a history of self-injurious behaviour who attended a public hospital in Mexico City from 2005 to 2012. A group of experts established the diagnosis according to the DSM-5. The clinical and demographic characteristics of patients with and without NSSI were compared. RESULTS: NSSI was diagnosed in 351 patients (60%) with evidence of self-harm. The main reasons for not being diagnosed were a previous suicide attempt (criterion A, 158 subjects [26.87%]) and another diagnosis that better explained the self-injurious behaviour (criterion F, 60 subjects [10.25%]). The NSSI group had a higher proportion of males (26.5% vs 16.2%) and patients with behavioural disorders (28.5% vs 13.7%). These patients were also found to seek psychiatric support in relation to their self-harm more frequently (31.9% vs 14.1%). The associated clinical characteristics included behavioural disorder (OR=2.51; 95% CI, 1.62-3.90), personality disorders (OR=0.56; 95% CI, 0.33-0.97), hospital admission (OR=0.23; 95% CI, 0.16-0.33), depressive symptoms (OR=0.60; 95% CI, 0.42-0.85), anxiety symptoms (OR=2.08; 95% CI, 1.31-3.31) and self-harming to influence others (OR=2.19; 95% CI, 1.54-3.11). CONCLUSIONS: More than half of the adolescents in the clinical sample with self-injury met DSM-5 criteria for NSSI. There are clinical and demographic characteristics which may be associated with this diagnosis.

Sex Differences in Severity, Social Functioning, Adherence to Treatment, and Cognition of Adolescents with Schizophrenia.

Background. Previous studies have reported sex differences in the clinical presentation and outcome of adult patients with schizophrenia; the aim of present study was to compare the clinical characteristics, social functioning, adherence to treatment, and cognition of adolescents with this diagnosis in a six-month followup. Methods. A total of 87 adolescents with a DSM-IV diagnosis of schizophrenia or schizophreniform disorder were evaluated with the Positive and Negative Symptoms Scale (PANSS), the Matrics Consensus Cognitive Battery (MCCB), Personal and Social Performance Scale (PSP), and the Rating of Medication Influences (ROMI). Results. Both groups showed a similar improvement in all PANSS factors and in the PSP scores during the followup. Males better adhered to treatment. Females displayed better results in the area of social cognition (F = 6.3, df = 2,52, and p = 0.003) and attention/vigilance (F = 8.3, df = 2,51, and p = 0.001). Conclusions. Male and female adolescents showed similar clinical presentation and functioning but a different pattern of cognitive improvement and adherence to treatment. This trial is registered with Clinicaltrials.gov II3/02/0811. .

Frecuencia de autolesiones y características clínicas asociadas en adolescentes que acudieron a un hospital psiquiátrico infantil / Epidemiology and clinical characteristics of self-harm in adolescents attending a child psychiatric hospital

Introduction Although studies of self-harm in adolescents have pointed to psycho-pathology as a risk factor, the information on the phenomenon in clinical population of Mexican adolescents is scarce. Methods This study examined demographic and clinical characteristics, as well as types, frequency and reasons for self-harm in 556 adolescents attending a child psychiatric hospital from 2005 to 2011 through record review. Results High frequencies of female gender, low socioeconomic status, family violence and sexual abuse history were found. The most common diagnoses were affective disorders, conduct disorders and substance abuse. Self-cutting was the most used method and the main reasons for self-harm included low frustration tolerance, attention seek, and symptoms of anxiety and mood disorders. An increase in cases was observed over time, particularly in patients with mood disorders and/ or substance abuse. Conclusions Self-harm in adolescents with psychopathology has increased and is frequently associated with depressive and conduct disorders. It is important to determine the presence of self-harm in the assessment of these patients.

Introducción Aunque los estudios de autolesiones en adolescentes han señalado a la psicopatología como un factor de riesgo, existe poca información del fenómeno en población clínica en México. Método El presente estudio examinó las características demográficas y clínicas, así como los tipos, frecuencia y motivos para autolesionarse de 556 adolescentes que acudieron a un hospital psiquiátrico infantil de 2005 a 2011 por medio de la revisión de su expediente. Resultados Dentro de las características que se encontraron con mayor frecuencia fueron el sexo femenino, el nivel socioeconómico bajo, la violencia intrafamiliar y el antecedente de abuso sexual. Los diagnósticos más frecuentes fueron los trastornos afectivos, los trastornos de conducta y el abuso de sustancias. El corte fue el método más empleado y los principales motivos para autolesionarse incluían la baja tolerancia a la frustración, el llamar la atención de otros, los síntomas afectivos y ansiosos. Se observó un incremento de casos a lo largo del tiempo, en particular aquellos asociados a trastornos afectivos y abuso de sustancias. Conclusiones Las autolesiones en adolescentes con psicopatología se han incrementado y están frecuentemente asociadas a trastornos depresivos y de conducta. Es importante determinar la presencia de autolesiones durante la evaluación inicial de estos pacientes.

Conocimientos y creencias sobre el trastorno por déficit de atención con hiperactividad en maestros de tres países latinoamericanos / Knowledge and beliefs about the attention deficit hyperactivity disorder in teachers from three Latin American countries

Background Attention deficit/hyperactivity disorder (ADHD) is a health problem that affects school functioning. To recognize the teachers' knowledge and beliefs (KB) about ADHD is important for the development of psychoeducative and training strategies for teachers. There are few Latin American reports about the teachers' KB and none comparing them among different countries. Objective To evaluate and compare the teachers' KB about ADHD in Mexico, Dominican Republic (DR) and Bolivia. Methods Previous verbal informed consent, the teacher's version of CASO-TDAH, a self-report document that was constructed based on other instruments, was applied. The answers were examined with descriptive statistics. Results 311 public and private school teachers were evaluated, 192 (61.7%) from DR, 84 (27%) from Mexico and 35 (11.3%) from Bolivia; 79.3% of them considered ADHD as a disease. Most of the sample considered the psychologist as the competent health professional for its diagnosis and treatment. Combined treatment was the most frequently identified as the ideal (44.1%). Regarding their KB about the pharmacological treatment, only 14.7% identified the drug as the main component of the multimodal treatment. The teachers recognized the treatment effects on the social and academic functioning. Differences were found among teachers from the three countries regarding the importance of drug treatment or the need for multimodal treatment. Conclusions Teachers identify ADHD as a disease, albeit without a clear recognition of its biological components. There were differences among countries, which should be taken into account in the design of the local health psychoeducation and attention programs.

Antecedentes El trastorno por déficit de atención con hiperactividad (TDAH) es un problema de salud que afecta el funcionamiento escolar de quienes lo padecen. Comprender los conocimientos y creencias (CC) de los maestros resulta fundamental para el desarrollo de estrategias psicoeducativas y de capacitación para los docentes. Son pocos los reportes en Latinoamérica sobre los CC en los maestros y ninguno que compare reportes en más de un país. Objetivo Evaluar y comparar los CC de los maestros de niños y adolescentes en tres países latinoamericanos (México, República Dominicana [RD] y Bolivia). Método Previo consentimiento verbal informado, se aplicó la versión para maestros de la Cédula de Autorreporte sobre el TDAH (CASO TDAH), que fue construida a partir de otros instrumentos. Se examinaron las respuestas con estadística descriptiva y comparativa. Resultados Se evaluaron 311 profesores de escuelas públicas y privadas, 192 (61,7%) de RD, 84 (27%) de México y 35 (11.3%) de Bolivia. El 79.3% consideró el TDAH como una enfermedad; la mayor parte de la muestra consideró al psicólogo como el profesional de salud indicado para su diagnóstico y tratamiento. El tratamiento combinado fue el más frecuentemente señalado como el ideal (44.1%). Con respecto a sus CC acerca del tratamiento farmacológico, sólo el 14.7% señaló al fármaco como el componente más importante del tratamiento integral. Los maestros reconocieron los efectos del tratamiento en el funcionamiento social, además del académico. Sin embargo, existieron diferencias entre países con respecto al grado de impacto del mismo o la necesidad de tratamiento combinado. Conclusiones Los maestros identificaron al TDAH como una enfermedad, aunque el reconocimiento de sus aspectos biológicos no fue claro. Existen diferencias por país que deben ser tomadas en cuenta en los diseños de los programas locales de atención a la salud.