ABSTRACT
Background: Suicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth. Methods: To test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period. Discussion: This study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America. Clinical trial registration: https://clinicaltrials.gov/, NCT05453370.
ABSTRACT
Mental disorders affect approximately 10-15% of children and adolescents worldwide. In South America these numbers are probably higher due to poverty and adverse life events that frequently affect this region. The availability of qualified services and well-trained professionals to care for those children are by far insufficient. The aim of this study was to assess and describe child and adolescent psychiatry (CAP) training in Brazil, Argentina, Uruguay, and Chile, to support the development and strengthen training standards. The coordinators of CAP residency programs in Brazil, Argentina, Uruguay, and Chile were invited to answer an online questionnaire about the characteristics of their training programs. Twelve programs from Brazil, three programs from Chile, two from Argentina, and one from Uruguay completed the questionnaires. In the last three countries, CAP is recognized as an independent specialty, while in Brazil it is considered a subspecialty of psychiatry. None of the countries have a national guideline for CAP residency training. Recently, there has been an increase in the number of professionals interested in pursuing a formal CAP training. This is the first study aiming to evaluate the current scenario of CAP training in South America. The results point to a great potential in the evaluated programs, but also to the need for homogeneous criteria for CAP training and evaluation of residents. A more efficient communication among programs would be an enriching strategy for their development, which may be facilitated by the results of this study.
Subject(s)
Adolescent Psychiatry/education , Child Psychiatry/education , Adolescent , Argentina , Brazil , Child , Chile , Female , Humans , Male , UruguayABSTRACT
O presente estudo busca identificar as contribuições da parceria e as consequências da separação entre a psicanálise e a pedopsiquiatria. Os conceitos de narcisismo e de autoerotismo foram peças-chave para o surgimento e legitimação da pedopsiquiatria como especialidade médica distinta da psiquiatria do adulto. Em um contexto no qual o discurso psiquiátrico vigente defende um referencial essencialmente empirista em detrimento do diálogo com abordagens psicodinâmicas, verifica-se que a rejeição da psicanálise promove a desnaturação da pedopsiquiatria, já que transtornos mentais infantis são reduzidos a disfunções puramente neurológicas.
The present study seeks to identify the contributions of the partnership between psychoanalysis and Child and Adolescent Psychiatry as well as the consequences of their separation. The concepts of narcissism and autoeroticism were fundamental for the emergence and legitimation of child and adolescent psychiatry as a medical specialty distinct from adult Psychiatry. In a context in which the current psychiatric discourse defends an essentially empiricist base to the detriment of the dialogue with psychodynamic approaches, it is verified that the rejection of psychoanalysis promotes the denaturation of Child and Adolescent Psychiatry, since the child mental illness are reduced to purely neurological dysfunctions.
La présente étude a cherché à identifier les contributions du partenariat entre psychanalyse et pédopsychiatrie ainsi que les conséquences de leur séparation. Les concepts de narcisisme et de autoerotisme ont joué un rôle fondamental pour l'émergence et la legitimation de la pédopsychiatrie en tant que specialité médicale distincte de la psychiatrie de l'adulte. Dans un contexte dans lequel le discours psychiatrique actuel défend un referenciel essentielment empiriste au detriment du dialogue avec les approches psychodynamiques, nous avons vérifié que le rejet de la psychanalyse promeut la dénaturation de la pédopsychiatrie, puisque les maladies mentales infantiles sont réduites à des dysfonctionements purement neurologiques.
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Introducción: Se implementan actualmente nuevos modelos de hospitalización psiquiátrica infantojuvenil, para hacer frente a la creciente demanda de recursos de atención psiquiátrica intensiva requeridos por esta población. Objetivo: Identificar las características clínicas y demográficas de los niños y adolescentes con diagnóstico psiquiátrico hospitalizados en Salas de Pediatría de un Hospital General Pediátrico. Metodología: Estudio descriptivo, retrospectivo de corte transversal, en base a historias clínicas de 180 casos hospitalizados en el periodo enero-agosto del año 2015.Variables: Edad, sexo, procedencia, motivo de ingreso, diagnóstico psiquiátrico, tipo de patología psiquiátrica, medicación, servicio desde el cual se indicó la evaluación psiquiátrica, días de hospitalización, seguimiento y derivación. Resultados: En el periodo de estudio se identificaron 180 pacientes hospitalizados con uno o más diagnósticos psiquiátricos, de los cuales 67.2% eran del sexo femenino. La mediana de la edad fue de 13 años. De un total de 387 diagnósticos constatados, los seis diagnósticos psiquiátricos más frecuentes fueron: los diferentes tipos de maltrato infantil (42,89%), los trastornos depresivos (21,71%), los intentos suicidas (8,27%), el trastorno adaptativo (4,39%) y el trastorno por estrés post traumático (4,13%). El 56% presentó comorbilidad de dos o más diagnósticos psiquiátricos. La internación fue indicada principalmente desde las Salas de Urgencias (67,3%). El 54,4% (98/180) estuvo hospitalizado de 1 a 3 días. En el 47,2% de los casos se indicó psicofarmacoterapia. Conclusión: Se registró mayor frecuencia de diagnóstico psiquiátrico en adolescentes y en el sexo femenino. La sospecha de abuso sexual infantil representó un frecuente motivo de ingreso. Las distintas formas de maltrato Infantil, los trastornos depresivos y los intentos suicidas, al constituir los diagnósticos psiquiátricos más frecuentes, requieren parámetros de evaluación y tratamiento específicos y efectivos para su adecuado manejo multidisciplinario. Las Salas de Urgencias Pediátricas cumplen un importante rol como puerta de entrada de estos pacientes al sistema de salud y al continuum de servicios de atención a la salud mental.
Introduction: New models of child and adolescent psychiatric hospitalizations are currently being implemented to meet the growing demand for intensive psychiatric care resources required by this population. Objective: To identify the clinical and demographic characteristics of children and adolescents with psychiatric diagnosis hospitalized on the Pediatric Service of a General Pediatric Hospital. Materials and Methods: This was a descriptive, retrospective cross-sectional study, based on the clinical histories of 180 hospitalized cases during January-August of 2015. Variables: Age, sex, place of origin, reason for admission, psychiatric diagnosis, type of psychiatric pathology, medication, clinical service from which the psychiatric evaluation was initiated, hospitalization days, follow-up and referral. Results: During the study period, 180 hospitalized patients were identified with one or more psychiatric diagnoses, of which 67.2% were female. The median age was 13 years. Of a total of 387 diagnoses found, the six most frequent psychiatric diagnoses were: different types of child abuse (42.89%), depressive disorders (21.71%), suicide attempts (8.27%), adaptive disorders (4.39%) and post traumatic stress disorder (4.13%). 56% had two or more comorbid psychiatric diagnoses. The hospitalization was initiated mainly from the Emergency Department (67.3%). 54.4% (98/180) were hospitalized for 1 to 3 days. In 47.2% of cases, psychopharmacotherapy was indicated. Conclusion: There was a higher frequency of psychiatric diagnoses in adolescents and in the female sex. Suspicion of child sexual abuse represented a frequent reason for admission. The different forms of child abuse, depressive disorders and suicide attempts, as they constitute the most frequent psychiatric diagnoses, require specific and effective evaluation and treatment parameters for their adequate multidisciplinary management. The Pediatric Emergency Department plays an important role as a gateway for these patients into the health system and the mental health care services continuum.
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Resumen: El programa de Educación Médica Continua (EMC) de SOPNIA consiste en actividades científicas orientadas a la actualización permanente en Neurología y Psiquiatría de niños y adolescentes. Está dirigido a socios SOPNIA, médicos especialistas en Neurología Pediátrica, Psiquiatría de la Infancia y Adolescencia y médicos especialistas certificados de especialidades afines (1).Este programa desde el año 2014 inicia cursos de capacitación de post grado vía e-learning, ya que este sistema permite flexibilidad de tiempo, mayores oportunidades para acceso, favorece el desarrollo de competencias y destrezas específicas como el estudio autorregulado, con una modalidad 100% on-line a través de nuestra plataforma vía página web de SOPNIA. Se analiza experiencia realizada.
The continued medical education program (EMC) of SOPNIA consists of scientific activities aimed at updating physicians on pediatric neurology and psychiatry. It is aimed at SOPNIA members, specialists in pediatric neurology, child and adolescent psychiatry and certified physicians of related medial specialties.Since 2014, this program began graduate training via e-learning, for this system allows time flexibility, greater access opportunity, favors the development of specific skills and competencies such as self-regulated study, with a 100% online mode through our platform via SOPNIA website. We analyze our experience.
Subject(s)
Humans , Child , Adolescent , Pediatrics , Education, Distance , Education, Medical, Continuing , NeurologyABSTRACT
OBJECTIVE: The aims of this study were (1) to assess obsessive-compulsive symptoms (OCS) dimensionally in a school-aged community sample and to correlate them with clinical and demographical variables; (2) to determine a subgroup with significant OCS ("at-risk for OCD") using the Child Behavior Checklist (CBCL-OCS) and (3) to compare it with the rest of the sample; (4) To review the CBCL-OCS subscale properties as a screening tool for pediatric OCD. METHODS: Data from the Brazilian High Risk Cohort were analyzed. The presence and severity of OCS were assessed through the CBCL-OCS subscale. DSM-IV psychiatric diagnoses were obtained by the Developmental and Well-Being Assessment. Behavioral problems were assessed using the Strengths and Difficulties Questionnaire, the Youth Strengths Inventory, and the CBCL internalizing and externalizing behavior subscales. RESULTS: A total of 2512 (mean age: 8.86 ± 1.84 years; 55.0% male) children were included. Moderate correlations were found between OCS severity and functional impairment (r = 0.36, p < 0.001). Children with higher levels of OCS had higher rates of psychiatric comorbidity and behavioral problems (p < 0.001). A score of 5 or higher in the CBCL-OCS scale determined an "at-risk for OCD" subgroup, comprising 9.7% of the sample (n = 244), with behavioral patterns and psychiatric comorbidities (e.g., tics [odds ratios, OR = 6.41, p < 0.001]), anxiety disorders grouped [OR = 3.68, p < 0.001] and depressive disorders [OR = 3.0, p < 0.001] very similar to those described in OCD. Sensitivity, specificity, positive predictive value, and negative predictive value of the CBCL-OCS for OCD diagnosis were, respectively, 48%, 91.5%; 15.1%, and 98.2%. CONCLUSIONS: The dimensional approach suggests that the presence of OCS in children is associated with higher rates of comorbidity, behavioral problems, and impairment. The "at-risk for OCD" group defined by the CBCL revealed a group of patients phenotypically similar to full blown OCD.
Subject(s)
Checklist/statistics & numerical data , Child Behavior Disorders/physiopathology , Obsessive-Compulsive Disorder/diagnosis , Problem Behavior/psychology , Anxiety Disorders/diagnosis , Brazil , Child , Child Behavior Disorders/epidemiology , Comorbidity , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Male , Obsessive-Compulsive Disorder/epidemiology , Obsessive-Compulsive Disorder/physiopathology , Psychiatric Status Rating Scales/statistics & numerical dataABSTRACT
Pediatric-onset obsessive-compulsive disorder (OCD) is underdiagnosed, and many affected children are untreated. The present study seeks to evaluate the presence and the clinical impact of OCD and obsessive-compulsive symptoms (OCS) in a large sample of school-age children. In Phase I, we performed an initial screening using the Family History Screen (FHS). In Phase II, we identified an "at-risk" sample, as well as a randomly selected group of children. A total of 2,512 children (6-12 years old) were assessed using the FHS, the Development and Well-Being Assessment (DAWBA), the Strengths and Difficulties Questionnaire (SDQ), and the Child Behavior Checklist (CBCL). Data analyses included descriptive and multivariate analytical techniques. 2,512 children (mean age: 8.86 ± 1.84 years; 55.0% male) were categorized into one of the three diagnostic groups: OCD (n = 77), OCS (n = 488), and unaffected controls (n = 1,947). There were no significant socio-demographic differences (age, gender, socioeconomic status) across groups. The OCS group resembled the OCD on overall impairment, including school problems and delinquent behaviors. However, the OCD group did have significantly higher rates of several comorbid psychiatric disorders, including separation anxiety, generalized anxiety, and major depressive disorder, than OCS or unaffected controls. Moreover, the OCD group also scored higher than the SDQ, as well as on each of CBCL items rated by the parent. Our findings suggest that there is a psychopathological continuum between OCS and OCD in school-aged children. The presence of OCS is associated with functional impairment, which needs further investigation in longitudinal studies.
Subject(s)
Child Behavior Disorders/diagnosis , Depressive Disorder, Major/epidemiology , Mental Disorders/epidemiology , Obsessive-Compulsive Disorder/epidemiology , Brazil/epidemiology , Case-Control Studies , Child , Child Behavior Disorders/epidemiology , Child Behavior Disorders/psychology , Comorbidity , Cross-Sectional Studies , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Female , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Multivariate Analysis , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/psychology , Psychiatric Status Rating Scales , Schools , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
Se realizó un estudio observacional, descriptivo y transversal en el Hospital Infantil Norte Docente "Dr. Juan de la Cruz Martínez Maceira" de la provincia de Santiago de Cuba en el 2010, a fin de describir los factores relacionados con la conducta suicida en 26 de 31 adolescentes de 11 a 17 años, atendidos en dicha institución durante ese período. Se halló que el grupo más afectado fue el de 14-15 años, con primacía del sexo femenino. Entre los factores de riesgo predominantes figuraron, por citar los principales en la casuística: los maltratos físicos y psicológicos como las humillaciones efectuadas por los propios padres; la falta de redes de apoyo familiar en la mayoría de ellos; la ausencia de solución de sus problemas; la ingestión de medicamentos para suicidarse, fundamentalmente psicofármacos, así como la depresión y el consumo de alcohol como antecedentes patológicos familiares.
An observational, descriptive and cross sectional study was carried out in "Dr. Juan de la Cruz Martínez Maceira" Teaching Northern Pediatric Hospital from Santiago de Cuba province in 2010, in order to describe the factors related to the suicidal behavior in 26 of 31 adolescents from 11 to 17 years, assisted in this institution during that period. It was found that the most affected group was that of 14-15 years, with prevalence of the female sex. Among the predominant risk factors there were, as the main ones in the case material: the physical and psychological abuses as the humiliations carried out by parents; the lack of family support groups in most of them; the absence of solution to their problems; the drugs ingestion to commit suicide, fundamentally psychodrugs, as well as depression and the alcohol consumption as family pathological history.
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OBJECTIVE: To determine whether children with attention deficit hyperactivity disorder (ADHD) and mild intellectual disability (ID) are a clinically distinct ADHD subgroup. STUDY DESIGN: This was a cross-sectional study comparing clinical characteristics (ADHD subtypes, total number of symptoms, and rates of common comorbidities) between children with ADHD and mild ID and those with ADHD and IQ test scores >70, and also between children with ADHD and ID and a general population sample of children with ID alone. The sample comprised a clinical sample of children with ADHD with ID (n = 97) and without ID (n = 874) and a general population sample of children with ID and without ADHD (n = 58). RESULTS: After correcting for multiple statistical tests, no differences were found between the 2 ADHD groups on any measure except the presence of conduct disorder (CD) symptoms and diagnoses. Children with ADHD and ID had higher rates of both (OR, 2.38; 95% CI, 1.71-3.32 and OR, 2.69; 95% CI, 1.69-4.28, respectively). Furthermore, children with ADHD and ID had significantly higher rates of oppositional defiant disorder (OR, 5.54; 95% CI, 2.86-10.75) and CD (OR, 13.66; 95% CI, 3.25-57.42) symptoms and a higher incidence of oppositional defiant disorder diagnoses (OR, 30.99; 95% CI, 6.38-150.39) compared with children with ID without ADHD. CONCLUSION: Children with ADHD and mild ID appear to be clinically typical of children with ADHD except for more conduct problems. This finding has implications for clinicians treating these children in terms of acknowledging the presence and impact of ADHD symptoms above and beyond ID and dealing with a comorbid CD.
Subject(s)
Attention Deficit Disorder with Hyperactivity/complications , Intellectual Disability/complications , Adolescent , Attention Deficit Disorder with Hyperactivity/diagnosis , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Intellectual Disability/diagnosis , Intelligence Tests , Longitudinal Studies , Male , Regression AnalysisABSTRACT
Se destaca el rol de la epidemiología evolutiva científica para la comprensión de las causas de trastornos psiquiátricos, factores de riesgo, estrategias preventivas y monitoreo de eficacia de los tratamientos. Se resumen estudios de edad de comienzo de los trastornos psiquiátricos, factores de riesgo y protectores, causas de trastornos y solución de controversias acerca de cambios seculares en la prevalencia. Se destacan aspectos que deben tomarse en cuenta en investigaciones futuras.
The role of developmental scientific epidemiology in understanding causes and risk for psychiatric disorders, proposing preventive strategies and monitoring treatment efficacy is stressed. Studies of age of onset of disorders, risk and protective factors, causal research, solving controversies about secular changes in prevalence are summarized. Aspects that need to be highlighted in future developments are outlined.
Subject(s)
Humans , Child , Adolescent , Adolescent Psychiatry , Child Psychiatry , Developmental Disabilities/epidemiology , Epidemiologic Studies , Mental Disorders/epidemiology , Age Factors , Biological Evolution , Risk FactorsABSTRACT
The aims of this revision is to update information on epidemiology of child and adolescent psychiatric disorders, including studies done in Spanish speaking and Latin American countries. Current points of view and evidence for transcultural validity of nosological constructs in child and adolescent psychiatry are reviewed. Evidence derived from structured interviews and combined categorical and dimensional approaches are shown. Prevalence reports vary from five to 22 percent, depending on the methodology, type of interview, sample and inclusion of impairment criteria. A national study was done in Great Britain, showing 9, 7 percent prevalence. In the USA, there are several regional and some collaborative studies, and a national study of adolescents has started. In Puerto Rico, a prevalence of l9,8 percent was reported, which was adjusted to 6, 9 percent adding impairment criteria. In Taubaté, Brazil, 12,7 percent full diagnoses and 3,5 percent) sub-syndromatic diagnoses were found. In México City, 39,9 percent psychiatric disorders were reported, » of which were mild, II moderate and 1/5 severe. In Chile, a study in Santiago schoolchildren showed 15, 7 percent>, measured by a clinical interview using ICD-10 syndromatic and impairment criteria. Co morbidity studies are commented. Usefulness of epidemiology in studying prevalence, health burden, service needs, use and barriers to care is summarized. The importance of having this type of information for the design of preventive and treatment programmers is analyzed.
El objetivo de esta revisión es actualizar la información sobre epidemiología de trastornos psiquiátricos en niños y adolescentes, incluyendo estudios realizados en países de habla hispana y latinoamericanos. Se revisan los puntos de vista actuales y la evidencia de validez transcultural de los constructos nosológicos en psiquiatría del niño y adolescentes. Se muestra la evidencia surgida de entrevistas estructuradas y de enfoques combinados dimensionales/categoriales. Las cifras de prevalencia varían entre 5 a 22 por ciento, dependiendo de la metodología, tipo de entrevista, muestras e inclusión del criterio de discapacidad. Un estudio a nivel nacional efectuado en la Gran Bretaña, mostró 9,7 por ciento de trastornos psiquiátricos en niños y adolescentes. En EE UUse han efectuado varios estudios regionales, algunos colaborativos, y se ha iniciado el primer estudio nacional en adolescentes. En Puerto Rico se reportó una prevalencia de 19, 8 por ciento, que se ajustó a 6,9 por ciento al añadir el criterio de impedimento. En Taubaté, Brazil, se encontraron 12,7 por ciento de diagnósticos completos y 3,5 por ciento subsindromaticos. En Ciudad de México se informó un 39,9 por ciento) de trastornos psiquiátricos, » de los cuales eran leves, la 1/2 moderados y 1/5 graves. En Chile, un estudio de niños escolares de Santiago mostró 15,7 por ciento de prevalencia, medida con una entrevista clínica y utilizando criterios CIE-10 sindromáticos y de impedimento. Se resume la utilidad de la epidemiología para estudiar la prevalencia, carga de salud, necesidad y uso de servicios. Se comenta la importancia de contar con este tipo de información para diseñar programas de prevención y tratamiento.
Subject(s)
Humans , Male , Adolescent , Female , Child , Adolescent Psychiatry , Child Psychiatry , Mental Disorders/epidemiology , PrevalenceABSTRACT
Intensive short stay psychiatric hospitalization modality within a private general hospital is discussed as a part of a continuum of care for severe cases undergoing a decompensation of their illness. Diagnosis and treatment of 38 children and adolescents is described. Results and follow up are reported. All acute crisis were resolved and some new diagnoses were formulated. Patients received treatment for their acute symptoms, and started treatment for their core disorders. Coordinations for continuation of ambulatory treatment were implemented. Lessons learned from the experience and implications for future treatment programs are discussed.
Se analiza una modalidad de tratamiento intensivo de hospitalización psiquiátrica de corta estadía en un hospital general privado, como una parte del tratamiento de casos graves que están sufriendo una descompensación de su enfermedad. Se describe el diagnóstico y tratamiento de 38 niños y adolescentes. Se informan los resultados y el seguimiento. Todas las crisis agudas fueron resueltas y se formularon algunos diagnósticos nuevos. Los pacientes recibieron tratamientos para sus síntomas agudos e iniciaron tratamientos para sus enfermedades de base. Se implementaron coordinaciones para la continuación del tratamiento ambulatorio. Las lecciones aprendidas de la experiencia y sus implicaciones para planes de tratamiento futuros son discutidas.