The Irritable Infant in the Neonatal Intensive Care Unit: Risk Factors and Biomarkers of Gastroesophageal Reflux Disease.

OBJECTIVES: To determine risk factors for arching/irritability in high-risk infants and examine the significance of comorbidity and gastroesophageal reflux (GER) characteristics. STUDY DESIGN: Retrospective analysis of 24-hour pH-impedance studies of symptomatic infants in a neonatal intensive care unit (ICU) (n = 516, 30.1 ± 4.5 weeks of gestation, evaluated at 41.7 ± 3.2 weeks postmenstrual age) was conducted. Comparisons were made between infants with >72 vs ≤72 arching/irritability events per day. We characterized risk factors for arching/irritability along with clinical, pH-impedance, and outcome correlates. RESULTS: Of 39 973 arching/irritability events and 42 155 GER events, the averages per day were 77.6 ± 41.0 and 81.7 ± 48.2, respectively. Acid reflux and impedance bolus characteristics were not significantly different between infants with >72 and ≤72 arching/irritability events (P ≥ .05). The odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for postmenstrual age and weight at evaluation were significant for risk factors of preterm birth (2.3 [1.2-4.4]), moderate or severe neuropathology (2.0 [1.1-3.6]), and presence of oral feeding at testing (1.57 [1.07-2.30]). CONCLUSIONS: Acid GER disease is unlikely the primary cause of arching/irritability and empiric treatment should not be used when arching/irritability is present. Prematurity and neurologic impairment may be more likely the cause of the arching/irritability. Arching/irritability may not be a concern in orally fed infants.

Behavioral self-regulation in pediatric bipolar disorder and healthy offspring of bipolar patients.

OBJECTIVES: This study investigated behavioral self-regulation problems using the Children's Hostility Inventory (CHI) in pediatric bipolar disorder (PBD), healthy offspring of bipolar disorder patients (HOBD), and healthy controls (HC) without previous history of psychiatric disorders. METHODS: The CHI was administered to 41 consecutive children and adolescents diagnosed with PBD, to 16 HOBD, and to 22 HC. The inventory assessed irritability, expression, hostility, and aggression and was completed by the children with the help of their mothers. Adolescents and their respective parents were interviewed separately using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: All subscales of the CHI presented statistically significant differences, except for the subscale assessing feelings of suspicion. Pairwise comparisons revealed consistently significant differences between the PBD group and controls, indicating more self-regulation difficulties in the PBD group, represented by high levels of hostility and aggressive behavior. There were no significant differences between the PBD and HOBD groups. CONCLUSIONS: Future studies should further investigate if such behavior is state-dependent or a trait of bipolar juvenile expression. Expression of hostility and irritability should be considered relevant targets in psychosocial approaches addressing this population.

Population size regulation is density-dependent in Rhodnius prolixus (Hemiptera: Reduviidae) through an irritability mechanism

BACKGROUND Physical factors can determine the level of triatomine abundance, but do not regulate their population densities, and neither do natural enemies. OBJECTIVES To identify the processes associated with density-dependent triatomine population regulation. METHODS We set-up a laboratory experiment with four interconnected boxes; the central box harbored Rhodnius prolixus bugs and one hamster. Stage 5 and adult densities of 10, 20, 30, 40, and 60 bugs per hamster, were replicated four times (except the density of 60 bugs). Hamster's irritability and several triatomine responses were measured: feeding, development time and longevity, mortality, fecundity, dispersal, and the net reproductive value (R o ). FINDINGS Density had a statistically significant effect on irritability, but not on the percent of bugs feeding. Density was significant on blood meal size ingested in bugs that did not move between boxes, but not significant when the bugs moved. Density and irritability affected the proportion of stage 5 nymphs molting, and the proportion of adult bugs dying per day and over a three-week period. There was a highly significant effect of density and irritability on R o . MAIN CONCLUSIONS We showed that a density-dependent mechanism, acting through the irritability of the host, seems the most plausible process regulating populations in triatomines.

Behavioral self-regulation in pediatric bipolar disorder and healthy offspring of bipolar patients

Objectives: This study investigated behavioral self-regulation problems using the Children's Hostility Inventory (CHI) in pediatric bipolar disorder (PBD), healthy offspring of bipolar disorder patients (HOBD), and healthy controls (HC) without previous history of psychiatric disorders. Methods: The CHI was administered to 41 consecutive children and adolescents diagnosed with PBD, to 16 HOBD, and to 22 HC. The inventory assessed irritability, expression, hostility, and aggression and was completed by the children with the help of their mothers. Adolescents and their respective parents were interviewed separately using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Results: All subscales of the CHI presented statistically significant differences, except for the subscale assessing feelings of suspicion. Pairwise comparisons revealed consistently significant differences between the PBD group and controls, indicating more self-regulation difficulties in the PBD group, represented by high levels of hostility and aggressive behavior. There were no significant differences between the PBD and HOBD groups. Conclusions: Future studies should further investigate if such behavior is state-dependent or a trait of bipolar juvenile expression. Expression of hostility and irritability should be considered relevant targets in psychosocial approaches addressing this population.

Factores asociados y propiedades psicométricas de la versión en español del Test Breve de Irritabilidad (BITe) en población paraguaya / Associated factors and psychometric properties of the Spanish version of the Brief Irritability Test (BITe) in Paraguayan population

Antecedentes: La irritabilidad, como síntoma transdimensional, está presente en varios trastornos mentales. Este estudio investigó las propiedades psicométricas de la versión española del Test Breve de Irritabilidad (BITe). Sujetos y métodos: el reclutamiento se realizó a través de una encuesta en línea lanzada a través de las redes sociales comunes (Facebook, Twitter) y aplicaciones de mensajería (WhatsApp, Telegram) del 1 al 31 de mayo de 2022. Los sujetos incluidos fueron personas ≥ 18 años de edad de ambos sexos 1920 individuos fueron calificados para el analisis de validacion. El BITe ha sido traducido al español y validado mediante análisis factorial confirmatorio. Los participantes también han sido puntuados con el Cuestionario de Agresión (AQ). Resultados: la prueba de Kaiser-Meyer-Olkin (KMO) fue adecuada (KMO=0,880) y la esfericidad se probó significativamente (p<0,001). El análisis confirmatorio que garantiza que la escala es unidimensional. El ajuste del modelo fue bueno, según todos los índices de ajuste. El alfa de Cronbach también garantiza una excelente consistencia interna (α=0,91). Las calculadoras entre las dos escalas (BITe y AQ) han mostrado una buena convergencia (r=0,512; p<0,001). Conclusiones: La versión en español del BITe es una escala unidimensional de cinco elementos tipo Likert que muestra buena validez interna y alta confiabilidad, lo que implica que esta versión tiene excelentes propiedades psicométricas tanto para hombres como para mujeres hispanohablantes.

Background: Irritability, as a trans dimensional symptom, is present in several mental disorders.This study investigated the psychometric properties of the Spanish version of the Brief Irritability Test (BITe). Subjects and Methods: The recruitment has been performed through an online survey launched through common social media (Facebook, Twitter) and messaging apps (WhatsApp, Telegram) from 1st to 31st May 2022. Subjects included were individuals ≥18 years old of age of both sexes. 1920 individuals were rated for the validation analysis. The BITe has been translated into Spanish and validated through confirmatory factor analysis. Participants have been also scored with the Aggression Questionnaire (AQ). Results: Kaiser-Meyer-Olkin (KMO) test was adequate (KMO=0.880) and sphericity tested significantly (p<0.001). The confirmatory analysis confirmed that the scale is one- imensional. The model adjustment was good, according to all fit indices. Cronbach's alpha also confirmed an excellent internal consistency (α=0.91). Scores between the two scales (the BITe and the AQ) have shown a good convergence (r=0.512; p<0.001). Conclusions: The Spanish version of the BITe is a unidimensional scale of five Likerttype items that shows good internal validity and high reliability, which implies that this version has excellent psychometric properties for both male and female Spanish-speakers

Brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression during the COVID-19 pandemic: a randomised controlled trial protocol.

BACKGROUND: The COVID-19 pandemic has had major impacts in many different spheres, including mental health. Children and adolescents are especially vulnerable because their central nervous system is still in development and they have fewer coping resources than do adults. Increases in the prevalence of depressive and anxiety symptomatology have been reported worldwide. However, access to mental health care is limited, especially for the paediatric population and in low- and middle-income countries. Therefore, we developed a brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression. The aim of this proposed study is to test the efficacy of the intervention. METHODS: We will conduct a two-arm, parallel randomised controlled trial involving children and adolescents (8-11 and 12-17 years of age, respectively) with symptoms of anxiety, depression or both, according to the 25-item Revised Child Anxiety and Depression Scale (t-score > 70). A total of 280 participants will be randomised to the intervention group or the active control group, in a 1:1 ratio. Those in the intervention group will receive five weekly sessions of cognitive-behavioural therapy via teleconference. The sessions will focus on stress responses, family communication, diaphragmatic breathing, emotions, anger management, behavioural activation and cognitive restructuring. Participants in both groups will have access to 15 videos covering the same topics. Participant-guardian pairs will be expected to attend the sessions (intervention group), watch the videos (control group) or both (intervention group only). A blinded assessor will collect data on symptoms of anxiety, depression and irritability, at baseline, at the end of the intervention and 30 days thereafter. Adolescents with access to a smartphone will also be invited to participate in an ecological momentary assessment of emotional problems in the week before and the week after the intervention, as well as in passive data collection from existing smartphone sensors throughout the study. DISCUSSION: Internet-delivered interventions play a major role in increasing access to mental health care. A brief, manualised, internet-delivered intervention might help children and adolescents with anxiety or depressive symptomatology, even outside the context of the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT05139433. Registered prospectively in November 2021. Minor amendments made in July 2022.

Corrigendum: Parental psychological control: Maternal, adolescent, and contextual predictors.

[This corrects the article DOI: 10.3389/fpsyg.2021.712087.].

Validation of an irritability measure in preschoolers in school-based and clinical Brazilian samples.

The Affective Reactivity Index (ARI) is an irritability measure with good psychometric properties. However, there are no published studies in preschool children, an important population in which to differentiate normative from non-normative irritability. The goal of this study was to validate the ARI in preschoolers. Two samples were included: a school-based sample (N = 487, mean age = 57.80 ± 7.23 months, 52.8% male) and a clinical sample of children with Attention Deficit Hyperactivity Disorder (ADHD; N = 153, mean age = 60.5 ± 7.6 months, 83.7% males). Confirmatory factor analysis assessed ARI unidimensionality. ARI criterion validity was tested through comparison to other scales measuring irritability, related constructs, and other aspects of psychopathology. Test-retest reliability was assessed in the school-based sample. Analyses confirmed a single-factor structure and good internal consistency. The ARI showed stronger correlations with irritability measures than with measures of other constructs. In the clinical sample, ADHD children with comorbid disruptive behavior disorders had higher ARI scores than those without this comorbidity. In the school-based sample, test-retest reliability was moderate. This is the first study to demonstrate ARI validity and reliability in preschoolers. The scale performed well in both school-based and clinical samples. Having a concise and validated irritability measure for preschoolers may facilitate both clinical assessment and research on early irritability.

Peri-Ictal and Para-Ictal Psychiatric Phenomena: A Relatively Common Yet Unrecognized Disorder.

Patients with epilepsy can experience different neuropsychiatric symptoms related (peri-ictal) or not (interictal) with seizures. Peri-ictal symptoms can precede (pre-ictal) or follow (post-ictal) the seizure, or even be the expression of the seizure activity (ictal). Neuropsychiatric symptoms, such as irritability and apathy, are among the most frequent pre-ictal manifestations. Ictal fear is reported by around 10% of patients with focal seizures, and sometimes can be difficult to differentiate from panic attacks. Post-ictal anxiety, mood and psychotic symptoms are also frequently reported by patients. Peri-ictal phenomena can occur as isolated symptom or as a cluster of symptoms, sometimes resembling a full-blown psychiatric syndrome. Actually, peri-ictal and interictal neuropsychiatric manifestations seem to be closely associated.

Parental Psychological Control: Maternal, Adolescent, and Contextual Predictors.

Parental psychological control (PC) hinders the development of autonomy, identity formation, and the attainment of self-determination and individuation of adolescents. The aim of this study was to deepen the understanding of which conditions increase the risk of the use of maternal PC by simultaneously considering the contribution of adolescent temperament, maternal separation anxiety, and adolescents' perception of interparental conflict. A correlational study involving a sample of 106 Chilean adolescent-mother dyads was done. Adolescents were, on average, 15.42 years old (SD = 1.09) and 77% male. Mothers were, on average, 45.46 years old (SD = 6.39). We administered self-report questionnaires to the adolescent measuring effortful control and frustration as temperamental dimensions, along with the perception of interparental conflict. Mothers reported on their separation anxiety. Both the adolescents and their mothers reported on the use of maternal PC. Adolescents reported higher levels of maternal PC than their mothers did. All predictors were associated with PC reports. Higher levels of maternal anxiety about adolescent distancing, inter-parental conflict, and adolescent frustration were associated with higher reported levels of PC. In contrast, higher levels of adolescent effortful control were associated with lower levels of maternal PC. Finally, when maternal separation anxiety and inter-parental conflict were high there was a higher use of maternal PC. The present findings inform on how adolescent's self-regulatory skills could reduce the risk of being exposed to maternal PC. And highlight the importance of using a systemic and interactional conceptualization when trying to understand their use.

La enfermedad y sus causas en el siglo XIX chileno: La mirada del doctor Guillermo Blest / Disease and its causes in 19th century Chile: Dr. Guillermo Blest's view

Resumen Este artículo analiza el pensamiento médico del doctor Guillermo Blest, expuesto tanto en los informes médicos que envió a las autoridades de gobierno como en un escrito que publicó en 1828 titulado "Ensayo sobre las causas más comunes y activas de las enfermedades que se padecen en Santiago de Chile con indicaciones de los mejores medios para evitar su destructora influencia". En ellos, Blest presenta los principios de irritabilidad (Broussais) y excitabilidad (Brown) como elementos centrales para explicar las causas de las enfermedades. Asimismo, se observa la pervivencia de la teoría miasmática que coexiste con dichos principios explicativos, lo que le permite a Blest configurar un cuadro explicativo de la enfermedad.

Abstract This article aims to analyze the medical thought of Doctor Guillermo Blest, exposed both in the medical reports that he sent to the government authorities and in a document that he published in 1828 entitled "Assay on the most common and active causes of the diseases that are suffered in Santiago de Chile with indications of the best means to avoid its destructive influence". In them, Blest presents the principles of irritability (Broussais) and excitability (Brown) as central elements to explain the causes of diseases. Likewise, the miasmatic theory coexists with these explanatory principles, allowing Blest to configure an explanatory panorama of the disease.

Determinación de la estabilidad e irritabilidad del hidrolizado de sericina / Determination of the stability and irritability of the sericin hydrolyzate

RESUMEN La sericina es una proteína globular que se obtiene a partir de los capullos del gusano de seda Bombyx mori y tiene aplicaciones en la industria farmacéutica, alimentaria y cosmética. El objetivo de este trabajo fue determinar la estabilidad e irritabilidad dérmica y oftálmica del hidrolizado de sericina (líquido). 3 lotes producidos a escala piloto se almacenaron en frascos de polietileno de alta densidad en diferentes condiciones de temperatura: 40±2 °C por 6 meses y temperatura hasta los 30 °C durante 18 meses. Se hizo una evaluación fisicoquímica y microbiológica a tiempo inicial y 1, 2, 3, 6 meses (acelerada) y 3, 6, 9, 12, 18 meses (anaquel). Se llevaron a cabo los estudios toxicológicos correspondientes a productos con fines cosméticos. Se constató que las características organolépticas, densidad, el pH, la concentración de proteínas y la identidad de los lotes en las dos condiciones de temperaturas y no hubo variación significativa en el tiempo del estudio. Se definió el tiempo de vida útil del producto en 18 meses. Se concluyó que el hidrolizado de sericina en frascos de polietileno de alta densidad es estable a temperaturas hasta 30 °C durante 18 meses y no clasificó como irritante dérmico, ni oftálmico.

SUMMARY Sericin is a globular protein that is obtained from the cocoons of the Bombyx mori silkworm and has applications in the pharmaceutical, food and cosmetic industries. The objective of this work was to determine the stability and dermal and ophthalmic irritability of the sericine hydrolyzate (liquid). 3 batches produced on a pilot scale were stored in high density polyethylene bottles under different temperature conditions: 40 ± 2 °C for 6 months and temperature up to 30 °C for 18 months. A physical-chemical and microbiological evaluation was performed at initial time and 1, 2, 3, 6 months (accelerated) and 3, 6, 9, 12, 18 months (shelf). Toxicological studies corresponding to products for cosmetic purposes were performed. It was found that the organoleptic characteristics, density, pH, protein concentration and the identity of the lots in the two temperature conditions, there was no significant variation in the study time. The shelf life of the product was defined in 18 months. It was concluded that the sericin hydrolyzate in high density polyethylene bottles is stable at temperatures up to 30 °C for 18 months and this product did not classify as dermal or ophthalmic irritant.

Irritabilidad como síntoma transdiagnóstico / Irritability as a transdiagnostic Symptom

Resumen. La irritabilidad es un síntoma transdiagnóstico que atraviesa la barrera de las patologías internalizantes y externalizantes. Se define como un umbral bajo para experimentar la ira en respuesta a la frustración y es uno de los síntomas más comunes en niños y adolescentes. Las conductas relacionadas con la ira apropiadas para el desarrollo tienden a reflejar frustración en contextos esperados, mientras que la irritabilidad crónica es inapropiada para la situación. La presentación de la irritabilidad, crónica o episódica, es crucial para comprender su significado psicopatológico, en particular porque las estructuras de la irritabilidad episódica y crónica son separables y permanecen estables a lo largo del tiempo. Existen varios estudios acerca de la irritabilidad en patologías como trastorno afectivo bipolar y trastorno de desregulación disruptiva del estado del ánimo, en ambos casos es importante plantearse como punto de partida la identificación de la episodicidad. La irritabilidad también se encuentra presente en el trastorno de personalidad límite observándose dentro de una inestabilidad afectiva debida a una reactividad notable del estado de ánimo. Estas emociones tienen un correlato anatómico relacionado con deficiencias de los circuitos frontolímbicos. Para el manejo de la irritabilidad en las distintas patologías, la evidencia del tratamiento incluye terapia cognitivo conductual, intervención de los padres, mindfulness, pero existe una necesidad apremiante de investigación sobre el tratamiento farmacológico complementario.

Irritability is a transdiagnostic symptom that crosses the barrier between internalizing and externalizing pathologies. It is defined as a low threshold to experience anger in response to frustration and it is one of the most common symptoms in children and adolescents. Behaviors related to appropriate developmental anger tend to reflect frustration in expected contexts, while chronic irritability is inappropriate to the situation. The presentation of irritability, chronic or episodic, is crucial to understanding its psychopathological meaning, particularly because the structures of episodic and chronic irritability are separable and remain stable over time. There are several studies about irritability in pathologies such as bipolar affective disorder and disruptive mood dysregulation disorder, in both cases it is important to consider the identification of episodicity as a starting point. Irritability is also present in borderline personality disorder, where it is expressed as an affective instability due to a remarkable reactivity of the state of mind. These emotions have been anatomically related to deficiencies of the frontolimbic circuits. For the management of irritability in different patholo-gies, the evidence includes cognitive behavioral therapy, parental intervention, mindfulness, but there still is a pressing need for research on complementary pharmacological treatment.

Estudio de tolerancia local de la vacuna antimeningocóccica VA-MENGOC-BC® en ratas Sprague Dawley. Evaluación a los 24 y 36 meses en estante / Local tolerance study of the VA-MENGOC-BC® antimeningococcal vaccine in Sprague Dawley rats. Evaluation at 24 and 36 months of shelf

La meningitis meningocóccica continua siendo un problema de salud en diferentes países y para la prevención de esta enfermedad se han obtenido diferentes vacunas. La vacuna VA-MENGOC-BC® ha constituido ser eficaz y segura en la prevención de la meningitis meningocóccica contra los serogrupos B y C. Esta ha demostrado buena estabilidad en el tiempo sin cambiar su calidad como producto; fue conservada a estante durante 24 y 36 meses a temperaturas de 4 a 8 °C. Se evaluó su posible potencial toxicológico a través de un estudio de tolerancia local en ratas Sprague Dawley para extender su vida útil. Los animales inmunizados se observaron diariamente para evaluar síntomas locales y sistémicos de toxicidad. Se realizaron evaluaciones del peso corporal, consumo de agua y alimento, termometría, musculometría e irritabilidad dérmica por el método de Draize. Se realizaron estudios anatomopatológicos periódicos para observar posibles efectos adversos. No se observaron síntomas de toxicidad ni muertes. No se encontraron diferencias entre los grupos experimentales en cuanto al peso corporal, el consumo de agua y de alimentos, no se evidenció fiebre, ni irritabilidad local. Anatomopatológicamente a nivel del punto de inoculación se observaron procesos granulomatosos de tipo macrofágicos característicos en las vacunas que contienen hidróxido de aluminio. Estos resultados permitieron concluir que la vacuna VA-MENGOC-BC® que permaneció en estante durante 24 y 36 meses no evidenció efectos adversos locales, ni sistémicos en las ratas(AU)

Meningococcal meningitis continues to be a health problem in different countries and different vaccines have been obtained for the prevention of this disease. VA-MENGOC-BC® vaccine has been effective and safe in the prevention of meningococcal meningitis against serogroups B and C. This has shown good stability over time without changing its quality as a product; it was stored on a shelf for 24 and 36 months at temperatures of 4 to 8 °C. Their possible toxicological potential was evaluated through a local tolerance study in Sprague Dawley rats. Immunized animals were observed daily to evaluate local and systemic toxicity symptoms. Body weight, water and feed intake, thermometry, musculometry were performed and dermal irritability by the Draize method. Anatomopathological studies to observe possible adverse effects were made. No symptoms of toxicity or deaths were observed. No differences were found between the experimental groups in terms of body weight, water and food consumption, no fever or local irritability was evident. Anatomopathologically no lesions of diagnostic value were observed, at the site of inoculation, granulomatous processes of macrophagic type characteristic in vaccines containing aluminum hydroxide were observed. These results allowed us to conclude that the VA-MENGOC-BC® vaccine that remained on the shelf for 24 and 36 months did not show any local or systemic effects in rats(AU)

Factores asociados a irritabilidad en adultos con episodio depresivo en Lima Metropolitana / Factors associated to irritability in adults with depressive episode in Metropolitan Lima

Objetivo: Determinar factores sociodemográficos y clínicos asociados a la presencia de irritabilidad en adultos con episodio depresivo (ED) en Lima Metropolitana. Materiales y Métodos: Estudio observacional, correlacional, transversal, utilizando la base de datos de adultos desde los 18 años del Estudio Epidemiológico de Salud Mental de Lima Metropolitana y Callao del año 2012, en una muestra probabilística multietápica de 4445 adultos. Los instrumentos usados fueron una ficha de datos sociodemográficos, MINI (Entrevista Neuropsiquiátrica Internacional), Cuestionario de Salud Mental de Colombia (modificado), Índice de Calidad de Sueño de Pittsburgh, EMBU modificado y Cuestionario de Experiencias Tempranas Adversas. Se utilizó estadística descriptiva, regresión simple y multivariada para estimar la prevalencia de adultos con irritabilidad en episodio depresivo (IED) y determinar la asociación entre IED y variables independientes. Resultados: La prevalencia de IED fue de 34,9%. Se halló asociación estadísticamente significativa con: menor edad de inicio del ED, mayor severidad del ED, presencia de trastorno de ansiedad generalizada, abuso/dependencia de alcohol, algunos síntomas depresivos (autorreproches, problemas de concentración e indicadores suicidas), conductas violentas, menor calidad de sueño, estilos de crianza de sobreprotección y favoritismo, y presencia de eventos adversos antes de los 18 años. Conclusiones: Varias características y factores diferencian la depresión con irritabilidad de la que carece de este síntoma. La posibilidad de que la irritabilidad llegue a ser considerada como un especificador del episodio depresivo, contribuiría a desarrollar estrategias para su más precisa identificación y manejo clínico.

Objective: To determine factors associated to the presence of irritability in adults with depressive episode (DE) in Metropolitan Lima in 2012. Materials and methods: Database of the Epidemiological Study of Metropolitan Lima and Callao, carried out in 2012, was used to make an observational, correlational, cross-sectional study. A multistage probabilistic sample of 4445 adults of 18 years and older. The instruments were: MINI (International Neuropsychiatric Interview), Mental Health Questionnaire of Colombia (modified), modified brief EMBU, a questionnaire of adverse early experiences, Pittsburgh Sleep Quality Index and a sociodemographic data sheet. Descriptive statistics, simple and multivariate regression were used to estimate prevalence of adults with irritability in depressive episode (IDE) and to determine the association between IDE and independent variables. Results: The prevalence of IDE was 34.9%. A statistically significant association was found with: early age of onset of DE, greater severity of DE, presence of generalized anxiety disorder (GAD), abuse/dependence on alcohol, some depressive symptoms (such as self-reproach, concentration problems and suicidal indicators), violent behaviors, a lower quality of sleep, parenting styles of overprotection and favoritism, and the presence of adverse events before the age of 18. Conclusions: The possibility that irritability may be considered as a specifier of the depressive episode, would contribute to the development of strategies for its identification and clinical management.

Brazilian Portuguese version of the Anger Rumination Scale (ARS-Brazil) / Versão em português brasileiro da Escala de Ruminação de Raiva (ARS-Brasil)

Abstract Objective To describe the cross-cultural adaptation of the Anger Rumination Scale (ARS) for use in Brazil. Methods The cross-cultural adaptation followed a four-step process, based on specialized literature: 1) investigation of conceptual and item equivalence; 2) translation and back-translation; 3) pretest; and 4) investigation of operational equivalence. Results A final Brazilian version of the instrument (ARS-Brazil) was defined and is presented. Pretest results revealed that the instrument was generally well understood by adults as well as indicated a few modifications that were included in the final version presented here. Conclusion The Brazilian Portuguese version of the ARS seems to be very similar to the original ARS in terms of conceptual and item equivalence, semantics, and operational equivalence, suggesting that future cross-cultural studies may benefit from this early version. As a result, a new instrument is now available for the assessment of rumination symptoms of anger and irritability for adults in community, clinical, and research settings.

Resumo Objetivo Descrever a adaptação transcultural da Escala de Ruminação de Raiva (Anger Rumination Scale, ARS) para uso no Brasil. Método A adaptação transcultural seguiu um processo de quatro etapas baseado em literatura especializada: 1) investigação da equivalência conceitual e dos itens; 2) tradução e retrotradução; 3) pré-teste; e 4) investigação da equivalência operacional. Resultados Uma versão final brasileira do instrumento, denominada ARS-Brasil, foi obtida e é apresentada. Os resultados do pré-teste demonstraram que a escala foi predominantemente bem entendida entre adultos, e indicaram algumas modificações que foram incluídas na versão final. Conclusão A versão da ARS adaptada para o português brasileiro mostra-se muito similar à versão original da ARS no que diz respeito à equivalência conceitual e dos itens, semântica e equivalência operacional, sugerindo que futuros estudos transculturais poderiam se beneficiar desta primeira versão. Como resultado, um novo instrumento está agora disponível para a avaliação de sintomas de ruminação da raiva e da irritabilidade para adultos, em contextos comunitário, clínico e de pesquisa.

Association between irritability and bias in attention orienting to threat in children and adolescents.

BACKGROUND: Irritability, a frequent complaint in children with psychiatric disorders, reflects increased predisposition to anger. Preliminary work in pediatric clinical samples links irritability to attention bias to threat, and the current study examines this association in a large population-based sample. METHODS: We studied 1,872 children (ages 6-14) using the Development and Well-Being Assessment (DAWBA), Childhood Behavior Checklist (CBCL), and dot-probe tasks. Irritability was defined using CBCL items that assessed temper tantrums and hot temper. The dot-probe task assessed attention biases for threat-related (angry face) stimuli. Multiple regression analysis was used to assess specificity of associations to irritability when adjusting for demographic variables and co-occurring psychiatric traits. Propensity score matching analysis was used to increase causal inference when matching for demographic variables and co-occurring psychiatric traits. RESULTS: Irritability was associated with increased attention bias toward threat-related cues. Multiple regression analysis suggests associations between irritability and threat bias are independent from demographic variables, anxiety, and externalizing traits (attention-deficit/hyperactivity, conduct, and headstrong/hurtful), but not from broad internalizing symptoms. Propensity score matching analysis indicated that this association was found for irritable versus nonirritable groups matched on demographic and co-occurring traits including internalizing symptoms. CONCLUSIONS: Irritability in children is associated with biased attention toward threatening information. This finding, if replicated, warrants further investigation to examine the extent to which it contributes to chronic irritability and to explore possible treatment implications.

Discriminating Between Bipolar Disorder and Major Depressive Disorder.

Rates of misdiagnosis between major depressive disorder and bipolar disorder have been reported to be substantial, and the consequence of such misdiagnosis is likely to be a delay in achieving effective control of symptoms, in some cases spanning many years. Particularly in the midst of a depressive episode, or early in the illness course, it may be challenging to distinguish the 2 mood disorders purely on the basis of cross-sectional features. To date, no useful biological markers have been reliably shown to distinguish between bipolar disorder and major depressive disorder.

Bioanálisis predictivo de tolerancia dérmica de cosméticos para bebés in vivo / Predictive bioanalysis of skin tolerance of cosmetics for babies in vivo

Objetivo: prever el riesgo potencial de irritabilidad dérmica de una crema y una loción para bebés, con el fin de obtener el registro sanitario y disminuir la eventualidad de riesgo para la salud. Métodos: se realizó el bioanálisis predictivo de tolerancia dérmica in vivo en conejos, a través de un estudio de tipo exploratorio clínico cualitativo e histopatológico, basado en el enfoque de la ley del Arte para explicar el riesgo/efectividad comparable en humanos. Se aplicó la técnica de exposición aguda simple (prueba parche oclusivo) en seis conejos, por cada producto. Se estimaron los efectos dérmicos mediante una escala de valores que define la probabilidad de inseguridad atribuible por la exposición al cosmético, según prueba de toxicidad dérmica de la Organización para la Cooperación Económica y Desarrollo 2004 (OCED), con ciertas modificaciones por los autores. Resultados: en el bioanálisis se encontró cierta irritabilidad dérmica en la piel de los conejos al aplicarles el cosmético en una dosis única por 92 días. El estudio clínico se complementó con el análisis histopatológico de una muestra de piel irritada y no mostró cambios significativos a los observados. Conclusiones: el bioanálisis clínico e histopatológico permite inferir una irritabilidad dérmica entre insignificante y leve, lo que sugiere la necesidad de mejorar la formulación de los cosméticos estudiados para obtener el registro sanitario, y así alertar tempranamente al productor y a la comunidad de la seguridad y eficacia de los productos(AU)

Objective: to prevent the potential risk of dermal irritability from a cream and a lotion for babies, in order to obtain health registration and to reduce possible health risks. Methods: in vivo predictive bioanalysis of dermal tolerance carried out in rabbits through a qualitative and histopathological clinical exploratory-type study, based on the Lex Artis approach to explain the comparable risk/effectiveness in humans. There was applied the single acute exposure technique (occlusive patch test) in six rabbits to test each product. Dermal effects were then measured in a value scale defining the cosmetic exposure-attributed unsafeness probabilities, according to the dermal toxicity test of the Organization for Economic Cooperation and Development, with some modifications by the authors. Results: the bioanalysis found some dermal irritability in the rabbits' skin after using the single dose of cosmetic for 92 days. The clinical study was supplemented with the histopathological analysis of a sample of irritated skin, without significant changes other than those observed. Conclusions: the clinical and hisopathological analysis showed mild to negligible dermal irritability, which indicates the need for improvements to the formulation of the studied cosmetics in order to obtain the health registration and thus to early advise the manufacturer and the community about the safety and efficacy of products(AU)

Toxicidad aguda oral e irritabilidad de la mucosa oral con una formulación de tabletas de Tamarindus indica L / Acute oral toxicity and irritability of the oral mucosa with a tablet formulation of Tamarindus indica L

In this study, the possible preclinical toxic effects of the Tamarindus indica L tablets were evaluated by the acute oral toxicity (AOT) and oral mucosa irritation (OMI), adapting guideline OECD 423 and ISO 10993-10, respectively. The AOT was evaluated, using the Class Toxocity Method in Sprague Dawley females rats and the OMI was assessed in sirian hamsters, according to the acute exposure method. Any sign of toxicity were not observed in the study. No animal death was occurring and the body weight increase in the two experimental groups was not statistically different. Slight irritation of the oral mucosa of the animals was observed, but this fact didn't impede them to feed appropriately and they body weight increase normally during the assay. Tamarind tablets were framed as non toxic substance and they produce a “light irritability” of the oral mucosa.

En este trabajo se evaluó a nivel preclínico, los posibles efectos tóxicos de las tabletas de Tamarindus indica L. Se ensayó la toxicidad aguda oral, por el método de las clases de toxicidad, en ratas hembras de la línea Sprague Dawley y la irritabilidad de la mucosa oral en Hamster sirio, según las normas OECD 423 y ISO 10993-10, respectivamente. Durante el estudio de toxicidad aguda, no se observaron signos de toxicidad, ni muerte. El peso corporal en ambos grupos experimentales aumentó y no fue diferente estadísticamente. En el estudio de irritabilidad, se observó una ligera irritación en la mucosa de los biomodelos. Esto no les impidió alimentarse adecuadamente y se observó un incremento del peso corporal de ambos grupos experimentales. Se determinó que las tabletas producen una irritabilidad “leve” de la mucosa oral y no clasifican como tóxicas según las normas internacionales de referencia.