Nuevos tratamientos farmacológicos en el TDAH. A propósito de un caso clínico / New pharmacological treatments for ADHD. A case report

El Trastorno por Déficit de Atención/Hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo más prevalentes en la infancia que frecuentemente se mantiene en la adolescencia y edad adulta. Los psicoestimulantes son generalmente el tratamiento farmacológico de primera línea para el TDAH, aunque alguno de estos pacientes no consiguen una remisión sintomática completa, especialmente los que tienen comorbilidad con el Trastorno Negativista Desafiante (TND). En estos casos, hay cada vez una mayor evidencia de que la combinación de psicoestimulantes y medicamentos no específicos para manejar el TDAH puede ser útil. La Guanfacina de liberación prolongada (GXR, Guanfacine Extended Release), un nuevo fármaco no psicoestimulante que actúa como agonista alfa 2 adrenérgico, ha sido aprobado recientemente por la Agencia Europea de Medicamentos como un nuevo tratamiento para el TDAH. En España se ha empezado a comercializar a finales de enero 2017. El objetivo de este estudio es evaluar la eficacia y tolerabilidad de la GXR administrada conjuntamente con dimesilato de lisdexanfetamina en un paciente con Trastorno por Déficit de atención e Hiperactividad (TDAH) y Trastorno Negativista Desafiante(TND)

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in childhood, which shows diagnostic persistence and morbidity into adulthood. Psychostimulants are generally first-line pharmacotherapy for ADHD, but some patients do not achieve symptomatic remission, especially those who have Oppositional Defiant Disorder (ODD) comorbidity. In those cases, there is growing evidence that a combination of psychostimulants and nonscheduled medications to manage ADHD, may be useful. The alpha-2 adrenergic agonist guanfacine extended release (GXR), a non-stimulant treatment, has recently been approved by the European Medicines Agency (EMA) as new therapeutic option for ADHD. In Spain it has been available from the end of January 2017. The aim of this study is to test the efficacy and tolerability of a combined therapy of psychostimulant (lisdexamfetamine) and GXR in a patient with ADHD and ODD

Comorbidity of oppositional defiant disorder and anxiety disorders in preschoolers / Comorbilidad del trastorno negativista desafiante y los trastornos de ansiedad en preescolares

BACKGROUND: The aim was to study the comorbidity of oppositional defiant disorder (ODD) and anxiety disorders (AD) among preschool children of the general population, and to assess the contribution of comorbidity to the child's functional impairment. METHOD: 622 children were assessed at the ages of 3 and 5, through a diagnostic interview. They were clustered into three diagnostic groups: only ODD, only AD and comorbid ODD+AD. RESULTS: At age 3, ODD was associated with specific phobia, OR = 4.7, 95% CI [1.4, 14.1], and at age 5, with any anxiety disorder, OR=3.9; 95% CI [1.8, 8.4]. ODD at age 3 was predictive of separation anxiety at age 5, OR=4.1; 95% CI [1.2, 14.3]. Comorbid ODD+AD cases showed a higher risk of functional impairment at school and in behavior toward others. Sex and socioeconomic status were not related to the diagnostic group. CONCLUSIONS: ODD+AD comorbidity can be identified in preschool children. Early identification of this association is needed to adequately treat the affected children

ANTECEDENTES: se analiza la comorbilidad entre el trastorno negativista desafiante (TND) y los trastornos de ansiedad (TA) en preescolares de población general, y el deterioro funcional con que se asocian. MÉTODO: 622 niños fueron evaluados a los 3 y los 5 años con una entrevista diagnóstica. Se compararon 3 grupos diagnósticos: únicamente TND, únicamente TA y comorbilidad TND+TA. RESULTADOS: a los 3 años se halló asociación entre TND y fobia específica (OR = 4.7, IC95%: 1.4÷14.1) y a los 5 años entre TND y TA, OR= 3.9; 95% IC [1.8, 8.4]. La presencia de TND a los 3 años fue predictiva de ansiedad de separación a los 5 años (OR = 4.1; IC95%: 1.2÷14.3). La comorbilidad se asoció con mayor deterioro funcional en la escuela y en el comportamiento hacia los demás. Sexo y nivel socioeconómico no se asociaron al grupo diagnóstico. CONCLUSIONES: la comorbilidad TND+TA se puede identificar en edad preescolar. Es necesaria la detección temprana de estos trastornos para el adecuado tratamiento de los niños afectados

A randomized controlled trial of sequentially bilateral prefrontal cortex repetitive transcranial magnetic stimulation in the treatment of negative symptoms in schizophrenia.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has been investigated for its treatment efficacy for the negative symptoms of schizophrenia. Previous studies have targeted the dorsolateral prefrontal cortex (DLPFC), which is associated with the pathophysiology of this disorder. Several rTMS parameters have been explored in the treatment of negative symptoms and include stimulating the left and bilateral DLPFC at several different frequencies and number of sessions. Results of such studies have been inconsistent, while high-frequency rTMS has shown greatest promise. OBJECTIVE/HYPOTHESIS: The objective of this study was to evaluate the efficacy of bilateral high-frequency rTMS in the treatment of negative symptoms in schizophrenia. It was hypothesized rTMS would alleviate negative symptoms in schizophrenia. METHODS: Twenty-five patients were enrolled in this double-blind placebo-controlled randomized trial. Bilateral 20 Hz rTMS was MRI-targeted to the DLPFC at 90% RMT administered daily for 4 weeks for a total of 20 treatments. Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative symptom scale (PANSS), and controlling for depression as measured with the Calgary Depression Scale (CDS) at baseline, 1, 2, 3, 4, and 2 weeks after the treatment course. RESULTS: No significant group or time differences were found on negative symptoms or depressive symptoms after rTMS. Bilateral high-frequency rTMS did not alleviate negative symptoms in patients with schizophrenia. CONCLUSIONS: These findings indicate that such symptoms are unresponsive to rTMS treatment or that more optimized parameters are needed to achieve improved therapeutic efficacy.

Adicción a la cocaína y trastornos de personalidad: un estudio con el MCMI-II / Cocaine addiction and personality disorders: a study with the MCMI-II

En este artículo se lleva a cabo un estudio de los trastornos de personalidad asociados a la adicción a la cocaína. Para ello se contó con una muestra de 60 pacientes cocainómanos, que cumplimentaron el MCMI-II antes del tratamiento, y de 50 sujetos de la población normal con las mismas características demográficas (edad, sexo y nivel socioeconómico). El 36,7% de la muestra clínica (frente al 16% de la muestra normativa) presentaba, al menos, un trastorno de personalidad. Los trastornos de mayor prevalencia entre los cocainómanos fueron el trastorno pasivo-agresivo de la personalidad y el trastorno dependiente de la personalidad (10% cada uno de ellos), seguidos del trastorno obsesivo-compulsivo y el histriónico (6,7% cada uno). Asimismo, el 15%de la muestra clínica presentaba simultáneamente dos o más trastornos. Por último, se comentan las implicaciones de este estudio para la práctica clínica y para las investigaciones futuras (AU)

This paper explores the personality disorders most commonly related to cocaine addiction. The samples used were 60 cocaine-addicted patients, who were assessed with the MCMI-II before treatment, and 50 normative participants from the general population with the same demographic features (age, sex and socioeconomic level). According to the results, 36.7% of the clinical sample (versus 16% of the normative sample) showed at least one personality disorder. The most prevalent disorders in the cocaine sample were Passive-Aggressive Personality Disorder and Dependent Personality Disorder (10% in each case), followed by Obsessive-Compulsive Personality Disorder and Histrionic Personality Disorder (6.7% each). Moreover, 15% of the clinical sample showed more than one personality disorder. Finally, the implications of this study for clinical practice and future research in this field are discussed (AU)

The relationship between personality psychopathology and aggressive behavior in research volunteers.

Theorists and clinicians have long believed that personality psychopathology is a risk factor for aggressive behavior. Previous investigations in this area, however, have provided mixed results. In this study, the relationship between personality psychopathology and aggressive behavior was examined in 137 research volunteers. The influences of gender and coexisting major mental disorders were statistically controlled. Aggressive behavior was associated with criteria for 7 of the 11 personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.). Except for schizoid criteria, all relationships with aggressive behavior were in the positive direction. When all personality disorders were considered simultaneously, paranoid and passive-aggressive criteria were significant predictors of aggressive behavior.

Axis I and personality comorbidity in adolescents with conduct disorder.

This study was undertaken to investigate psychiatric comorbidity in male and female adolescents with conduct disorder diagnoses. Twenty-five hospitalized adolescents (11 females, 14 males) with conduct disorder were evaluated using structured diagnostic interviews for Axis I and personality disorders. The most common Axis I comorbid diagnoses were: depressive disorders (major depression and/or dysthymia), 64 percent; anxiety disorders (separation anxiety disorder, overanxious disorder, panic disorder, obsessive-compulsive disorder, phobias, and/or posttraumatic stress disorder), 52 percent; substance abuse, 48 percent; and attention-deficit hyperactivity disorder, 28 percent. Common Axis II disorders included passive-aggressive personality disorder, 56 percent, and borderline personality disorder, 32 percent. When compared with the male subjects, the females had significantly more total Axis I disorders and a trend toward more total personality disorders, anxiety disorders, depression, and borderline personality disorders. These findings support conduct disorder as a complex illness with extensive Axis I and II involvement as well as some gender differences in presentation.

[Sexual failure expectation syndrome and the modification of behavior]. / Sindrom ozhidaniia seksual'noi neudachi i modifikatsii povedeniia.

Modifications of behavior were examined in 105 men with sexual failure expectation syndrome. Such modifications were revealed in 77 persons. The determinants and sources of behavioral modifications were defined. It has been shown that phenomenology of behavioral modifications is uncertain, being different as regards the complexity and degree of realization. Different variants of behavioral modifications are described: defense, compensatory, controlling oneself, by the detention type, manipulative, and combined. It is recommended that they be taken into consideration with a purpose of forming in patients of constructive behavioral programs.

Non-help-seeking wives of employed alcoholics. A multilevel interpersonal profile.

Interpretation of personality test scores reveals that non-help-seeking wives of employed alcoholics are dominant persons whose ideal self-images are of dependent or masochistic women.

Studies of superobesity: I. Psychological characteristics of superobese patients.

Close study of twelve superobese women revealed the following principal characteristics. None had a serious psychiatric illness, but most showed moderate personality disturbances with predominant passive-aggressive traits. Depressive features, though common, were not severe. Food typically had been used to allay feelings of emotional deprivation present since early childhood and historically associated with the unstable marriages of these patients' parents. The label "oral character" is not sufficient to provide even a capsule description; stubbornness, defiance, needs for autonomy and wariness of entangling relationships as well as conflicts over exhibitionism also were prominent. These characteristics contribute to the traditional reputation of the obese as "difficult" patients and deserve greater attention to help improve the effectiveness both of standard medical management and of psychotherapy.

The treatment of enuresis: an overview.

The treatment of enuresis has had a long and colorful history in world medical literature. Although some reasonable approaches to the problem exist, there are many conflicting theories about its etiology and consequently there are many recommended therapies. A perspective of literature encompassing the diverse fields of psychoanalysis, behavioral psychology, urology, pharmacology and sleep physiology is provided for the psychiatrist consultant dealing with the problem of enuresis.