Prevalencia del trastorno negativista desafiante en España / Prevalence of oppositional defiant disorder in Spain

Introducción: El trastorno negativista desafiante (TND) se caracteriza por un patrón de comportamiento negativista, desafiante, desobediente y hostil, dirigido a las figuras de autoridad. El TND es uno de los motivos más frecuentes de consulta clínica en salud mental durante la infancia y adolescencia. Presenta gran morbilidad y disfuncionalidad, mostrando repercusiones futuras si no es tratado de forma temprana. Objetivo: Determinar la tasa de prevalencia de TND en escolares de 6-16 años de Castilla y León (España). Material y métodos: Estudio epidemiológico poblacional, con diseño muestral polietápico estratificado, proporcional y por conglomerados. Muestra analizada: 1.049 sujetos. Casos definidos según criterios DSM-IV. Resultados: La prevalencia de TND es 5,6% (IC 95%: 4,2-7%). Prevalencia género masculino = 6,8%; femenino = 4,3%. Prevalencia educación secundaria = 6,2%; educación primaria = 5,3%. No existen diferencias significativas en función del sexo, edad, tipo de centro, ni por zona sociodemográfica. La prevalencia de TND sin considerar deterioro funcional aumentaría al 7,4%. Los casos de TND presentan significativamente peores resultados académicos (resultados académicos globales, lectura, matemáticas y expresión escrita) y peor conducta en clase (relación con compañeros, respeto a las normas, destrezas de organización, realización de tareas académicas e interrupción de la clase). Conclusiones: Castilla y León presenta una tasa de prevalencia de TND levemente superior a la observada en publicaciones internacionales. En función de su distribución por edad, morbilidad y repercusión clínica disfuncional, parece necesaria una planificación sanitaria que incida en un diagnóstico temprano e intervención preventiva (AU)

Introduction: Oppositional defiant disorder (ODD) is characterized by a pattern of negative, defiant, disobedient and hostile behavior toward authority figures. ODD is one of the most frequent reasons for clinical consultation on mental health during childhood and adolescence. ODD has a high morbidity and dysfunction, and has important implications for the future if not treated early. Objective: To determine the prevalence of ODD in schoolchildren aged 6-16 years in Castile and Leon (Spain). Material and methods: Population study with a stratified multistage sample, and a proportional cluster design. Sample analyzed: 1,049. Cases were defined according to DSM-IV criteria. Results: An overall prevalence rate of 5.6% was found (95% CI: 4.2%---7%). Male gender prevalence = 6.8%; female = 4.3%. Prevalence in secondary education = 6.2%; primary education = 5.3%. No significant differences by gender, age, grade, type of school, or demographic area were found. ODD prevalence without considering functional impairment, such as is performed in some research, would increase the prevalence to 7.4%. ODD cases have significantly worse academic outcomes (overall academic performance, reading, maths and writing), and worse classroom behavior (relationship with peers, respect for rules, organizational skills, academic tasks, and disruption of the class). Conclusions: Castile and Leon has a prevalence rate of ODD slightly higher to that observed in international publications. Depending on the distribution by age, morbidity and clinical dysfunctional impact, an early diagnosis and a preventive intervention are required for health planning (AU)

Functional impairment associated with symptoms of oppositional defiant disorder in preschool and early school boys and girls from the general population / Deterioro funcional asociado a los síntomas del trastorno negativis-ta desafiante en niños y niñas de 3 a 7 años de la población general

Objetivo: Explorar si los síntomas y el diagnóstico de Trastorno Negativista Desafiante (TND), según los criterios diagnósticos DSM-IV, se asocian al mismo nivel de deterioro funcional en niños y niñas de la población general en los primeros años escolares. Método: Se aplicó un cuestionario de cribado a una muestra de 852 escolares de tres a siete años de edad. Un total de 251 familias fueron evaluadas con entrevista diagnóstica y con las medidas de deterioro funcional. Resultados: Los síntomas de TND y el diagnóstico son igualmente prevalentes en los niños y en las niñas, pero las niñas de entre 3 y 5 años presentaron una mayor prevalencia de diagnóstico subumbral de TND. No hubo diferencias significativas entre niños y niñas en el uso de servicios de salud, ni en el tratamiento recibido, ni en la carga familiar asociada a los síntomas o al diagnóstico de TND. Aunque el diagnóstico de TND no se asoció a un mayor deterioro funcional por sexo, los síntomas individuales y el diagnóstico subumbral se asociaban con mayor deterioro funcional en los niños que en las niñas. Conclusión: La "oposicionalidad" pueden estar midiendo variables diferentes en niños y en niñas, y esta posibilidad se debe tener en cuenta para identificar correctamente este problema en cada sexo

Objective: To explore whether the symptoms and diagnosis of Oppositional Defiant Disorder (ODD), as defined in the DSM-IV, are equally impairing for girls and boys from the general population in the early school years. Method: A sample of 852 three to seven-year-old schoolchildren were screened out for a double-phase design. A total of 251 families were assessed with a diagnostic interview and with measures of functional impairment. Results: ODD symptoms and diagnosis were equally prevalent in boys and girls, but three- to five-year-old girls had a higher prevalence of subthreshold ODD. There were no significant differences between boys and girls in the impact on use of services, treatment received and family burden associated with ODD symptoms and diagnosis. Although diagnosis of ODD was not associated with higher functional impairment by sex, individual symptoms and subthreshold diagnosis were more impairing for boys than for girls. Conclusion: Oppositionality may be measuring different things for boys and girls, and this possibility must be taken into account with a view to the correct identification of this problem in each sex

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations / Antipsicóticos atípicos no tratamento da agressividade patológica em crianças e adolescentes: revisão da literatura e recomendações clínicas

Objective: To review the literature about the use of atypical antipsychotics in the treatment of pathological aggression in children and adolescents. Method: The databases MEDLINE, SciELO, and LILACS were searched for publications in Portuguese or English from 1992 to August 2011 using the following keywords: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behavior, aggression, and violent behavior. Results: Sixty-seven studies of good methodological quality and clinical interest and relevance were identified. Studies including children and adolescents were relatively limited, because few atypical antipsychotics have been approved by the Food and Drug Administration (FDA). All the medications included in this review (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole and clozapine) have some effectiveness in treating aggression in children and adolescents, and choices should be based on clinical indications and side effects. Conclusions: There are few studies about the effectiveness and safety of atypical antipsychotics for the pediatric population, and further randomized controlled studies with larger groups of patients and more diagnostic categories, such as severe conduct disorder and oppositional defiant disorder, should be conducted to confirm the results reported up to date and to evaluate the impact of long-term use.

Objetivo: Realizar uma revisão sistemática da literatura científica sobre o uso de antipsicóticos atípicos (APAs) no tratamento da agressividade patológica em crianças e adolescentes. Método: Foi realizada busca eletrônica nas bases de dados MEDLINE, SciELO e LILACS, de 1992 a agosto 2011, considerando artigos publicados em língua inglesa e portuguesa. Foram utilizadas associações das seguintes expressões: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behaviour, aggression e violent behavior. Resultados: Foram identificados 67 artigos de boa qualidade metodológica, de relevância e interesse clínico para o tema em foco. De modo geral, os estudos são relativamente limitados para esta faixa etária, resultado do fato de poucos APAs terem sido aprovados pela Food and Drug Administration (FDA). Dentre as medicações consideradas nesta revisão (risperidona, olanzapina, quetiapina, ziprazidona, aripiprazol e clozapina), todas elas podem ter alguma efetividade no tratamento da agressividade em crianças e adolescentes, ficando a escolha baseada na indicação clínica e perfil de efeitos colaterais. Conclusão: O número ainda limitado de estudos acerca da efetividade e segurança na população pediátrica demanda pesquisas futuras com grupos maiores de pacientes e com mais categorias diagnósticas (como, por exemplo, as formas graves de transtorno de conduta e transtorno desafiador de oposição), desenhadas de forma randomizada e controlada. Assim poderão ser confirmados os achados até o momento e o impacto do uso em longo prazo.

The relationship of intimate partner aggression to head injury, executive functioning, and intelligence.

Measures of head injury, executive functioning, and intelligence were given to a community sample composed of 102 male perpetrators of intimate partner aggression (IPA) and 62 nonaggressive men. A history of head injury and lower mean score on a measure of verbal intelligence were associated with the frequency of male-perpetrated physical IPA as reported by male perpetrators and their female partners. Lower mean scores on a measure of verbal intelligence also predicted frequency of psychological IPA perpetration. Using the perpetrator subtypes outlined by Holtzworth-Munroe et al. (2000), analyses revealed that compared with other groups, the most severely aggressive subtypes (i.e., borderline-dysphoric and generally violent-antisocial) were the most likely to report a history of head injury and to have significantly lower mean scores on a neuropsychological test of verbal intelligence. The possible role of neuropsychological factors in IPA perpetration and implications for prevention and intervention programs are discussed.

Trastornos de personalidad en fumadores y no fumadores de la población general / Personality disorders in smokers and nonsmokers of general population

El objetivo de este estudio fue evaluar y comparar la presencia de trastornos de la personalidad en una muestra de 202 fumadores que acuden a un tratamiento psicológico para dejar de fumar y de 211 no fumadores de la población general. Se utilizó el “Inventario clínico multiaxial de Millon-II” (MCMI-II; Millon, 1997). Los resultados muestran que los fumadores puntúan significativamente más que los no fumadores en la escala fóbica, la escala histriónica y la escala pasivo-agresiva. En cambio, los no fumadores destacan en la escala compulsiva. Se encontró que los fumadores puntúan más que los no fumadores en la escala de ansiedad, en la escala histeriforme y en la escala de neurosis depresiva, así como en la escala de sinceridad y de alteración. Esta relación se mantuvo una vez controlado el efecto del sexo y la edad de los sujetos. Concluimos que ciertos tipos de trastornos de la personalidad sí son más frecuentes en población fumadora, en concreto, el histriónico, el fóbico y el pasivo-agresivo. Los restantes subtipos necesitarían de una mayor investigación (AU)

The aim of the study was to assess and compare the presence of personality disorders in a sample of 202 smokers who underwent psychological treatment to stop smoking and a sample of 211 nonsmokers from the general population. For the evaluation of the personality disorders we used the Spanish version of the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1997). The results show that smokers obtain higher scores than nonsmokers in the phobic scale, the histrionic scale and the passive - aggressive scale. On the other hand, nonsmokers score higher in the compulsive scale. We found that smokers score higher than nonsmokers in anxiety scale, in somatoform scale and in dysthymic disorder, as well as in sincerity and in alteration scales. This relationship was kept after controlling the effect of the gender and age of the subjects. We concluded that some personality disorders, in particular, the histrionic, the avoidant, and the passive-aggressive, are more frequent in smokers. Future research is needed for the other subtypes

Trastorno negativista desafiante: aspectos relacionados con el sexo y el evaluador / Oppositional deflant disorder: aspects related to sex differences and informant

Introducción. El trastorno negativista desafiante (TND) es uno de los trastornos externalizantes más prevalentes, con una tasa global del 2-16%. El TND, junto con el déficit de atención/hiperactividad y el trastorno de conducta, es una de las causas principales de derivación a los servicios especializados de neuropediatría y psiquiatría infantil. Aunque el trastorno tiene una relevancia clínica considerable, existe cierta incertidumbre con relación a los aspectos clave de su conceptualización y prevalencia tanto en la niñez como en la adolescencia. Desarrollo. Se revisan los estudios realizados sobre la prevalencia del TND y se analizan los aspectos relacionados con las diferencias según el sexo y en función del evaluador, debido a que en la actualidad los datos disponibles con relación a estos factores son escasos e inconsistentes. Conclusiones. Los índices de prevalencia del TND presentan una gran variabilidad dependiendo de la metodología utilizada y del evaluador (padres frente a maestros). La mayoría de estudios sugieren que el TND es más común en niños que en niñas, aunque algunos autores señalan que esto puede deberse a ciertos sesgos metodológicos. Se propone validar una escala de TND que tenga en cuenta el nivel de desarrollo del sujeto (edad), sexo y ambiente (AU)

Introduction. Oppositional defiant disorder (ODD) is one of the most common externalizing disorders in childhood. ODD prevalence global rates vary from 2% to 16%. Along with conduct disorder and attention deficit disorder, ODD is one of the leading reasons for referral to neuropediatric and psychiatric services. Even though ODD has recognized clinical importance, key aspects of its conceptualization and prevalence in childhood and adolescence remain uncertain. Development. We examine previous research findings of ODD prevalence and analyze sex differences and differences according to informants. Conclusions. ODD prevalence rates present high variability. A number of studies suggest that ODD is more common in boys than in girls. Nevertheless, some authors point that this sex differences may be due to methodological bias. We recommend the validation of an ODD scale that has into consideration the following aspects: level of the subject’s development (age), gender and environment. (AU)

Passive-aggressive (negativistic) personality disorder: a population-based twin study.

The objective of this study was to investigate the familial aggregation of passive aggressive personality disorder (PAPD), and explore issues regarding PAPD raised by the DSM-IV Personality Disorder Work Group. Two thousand seven hundred and ninety-four Norwegian twins from the population-based Norwegian Institute of Public Health Twin Panel were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV). Because of the rarity of the twins meeting full diagnostic criteria for PAPD a dimensional representation of the disorder was used for the analyses. Overlap with other axis II disorders was assessed by polychoric correlations, while familial aggregation was explored by structural equation twin models. Overlap was highest with paranoid (r = 0.52) and borderline personality disorder (r = 0.53), and lowest with schizoid (r = 0.26). Significant familial aggregation was found for PAPD. The twin correlations and parameter estimates in the full model indicated genetic and shared environmental effects for females, and only shared environmental effects for males, but the prevalence of endorsed PAPD criteria in this community sample was too low to permit us to conclude with confidence regarding the relative influence of genetic and shared environmental factors on the familial aggregation of PAPD.

A psychometric typology of U.K. domestic violence offenders.

A number of studies have described subtypes of domestically violent men, and the heterogeneity of domestically violent men is well established. The aim of the current study was to investigate the distribution of subtypes using psychometric measures in convicted domestically violent offenders in England. Four subtypes of offenders were identified: low pathology, borderline, narcissistic, and antisocial. These subtypes were broadly comparable with the family-only, dysphoric/borderline, and generally violent/antisocial types proposed by Holtzworth-Munroe and Stuart. The majority of the sample (60%) best fit the generally violent/antisocial profile. However, the reliance on psychometric measurement and lack of corroborative evidence from partners means that further research is necessary to test these findings.

Amistad vs. Agresividad en adolescentes / Friendship versus Aggressiveness

Este trabajo presenta un Experimento Pedagógico realizado con adolescentesagresivos, en forma de Programa de Intervención que toma como dispositivopara operar el Grupo Formativo, método que propone la Metodología de losProcesos Correctores Comunitarios.En el mismo se muestra el inicio del proceso de cambio en la manifestación de dichas conductas. El eje temático del programa es la amistad, potenciada como sentimiento y como valor hasta convertirse en una vía para enfrentar la agresividad en los adolescentes que la han asumido. La metodología empleada muestra la integración de técnicas y análisis cuantitativos y cualitativosEl Grupo Formativo en tanto dispositivo para operar, se utiliza en su funcióncorrectora transformadora y se constituye así en el método educativo esencial. Se logró estimular las potencialidades creadoras y movilizar los recursos humanos de los y las adolescentes objeto de estudio, desde el valor amistad; pues tomaron conciencia de las afectaciones que la agresividad tiene sobre sus relaciones vinculares, la comunicación con sus iguales y con los adultos que los rodean, así como su autoestima, sus proyectos de crecimiento personal, entre otros aspectos(AU)

Passive-aggressive personality disorder: the demise of a syndrome.

This article presents an explanation and critique of the rationale for dropping passive-aggressive personality disorder (PAPD) from DSM-IV. The clinical and research literature on PAPD is reviewed along with the historical changes in definition, diagnostic criteria, and usage. PAPD can be reliably diagnosed, is fairly prevalent, and has good internal consistency. Because PAPD is no less valid than other personality disorders, and describes clinical phenomena that are unique among personality disorders, we recommend the reinstatement of PAPD in the official diagnostic nomenclature.

Frequency of personality disorders in two age cohorts of psychiatric inpatients.

OBJECTIVE: The authors examined the frequency of DSM-III-R personality disorders in adolescent and young adult psychiatric inpatients. METHOD: Structured diagnostic interviews were reliably performed with a series of 255 consecutively admitted inpatients (138 adolescents and 117 young adults). RESULTS: Most personality disorders were diagnosed in similar frequencies in the two study groups. Passive-aggressive personality disorder was diagnosed with lower frequency and dependent personality disorder with higher frequency in the young adult than in the adolescent group. CONCLUSIONS: The isomorphism of relative frequencies among psychiatric inpatients suggests that what is seen in adolescents are valid forms of most adult personality disorders.

Investigation into the relationship between personality traits and OCD: a replication employing a clinical population.

The relationship between obsessional personality traits and Obsessive Compulsive Disorder (OCD) has long been the subject of debate. Although clinicians have asserted for nearly a hundred years that such a relationship exists, empirical investigations have failed to provide consistent support; however, none of these empirical investigations have undertaken analyses that control for the effect of mood variables. Employing a non-clinical sample, Rosen and Tallis (1995) [Behaviour, Research and Therapy, 4, 445-450] found that when mood variables are taken into account, a unique relationship between obsessional traits and obsessional symptoms emerges. A replication was undertaken on a large group of individuals with OCD. After the effects of depression and anxiety were removed from a correlational analysis, obsessional symptoms were found to be significantly associated with obsessional and passive aggressive traits. Obsessive Compulsive Disorder was not associated with any other grouping of traits as specified in the DSM-III-R (Axis II) classification system.

Violencia en la familia: el maltrato a la mujer / Violence in the family: the battered woman

La violencia intrafamiliar es muy común, sobre todo la dirigida contra la mujer. En este trabajo se revisa la prevalencia del maltrato a la mujer en México, así como los factores socioculturales, conyugales e individuales relacionados con ese fenómeno. Se proponen algunas técnicas y recursos comunitarios que pueden ser útiles en el tratamiento de estos casos. Todo médico debe investigar el origen de las lesiones, así como la posible existencia de violencia en la familia de su paciente para lograr su mejor identificación y tratamiento

Aggressive behaviour in a small rural community in Jamaica: The report of a cooperative epidemiological study

Several incidents of aggressive behaviour in a rural community in Jamaica were investigated by a team of workers each of whose contributions enabled a composite picture of the incidents to be built up. Social and economic factors as well as the influence of close kin marriages were considered to be important causes of these incidents. Recommenations based on the investigating team's appraisal of the situation were made. Such an epidemiological study could not have been undertaken without the cooperation and special skills of the individual members of the team. (AU)