RESUMO
El grupo de especial interés en TDAH (GEITADH) expone en este artículo su consenso sobre algoritmos de derivación en la asistencia para el paciente afecto de TDAH. Es un diseño sencillo realizado por un amplio número de profesionales de toda España con el objetivo de poder ser adaptado a necesidades asistenciales locales. Se revisan también otros algoritmos con influencia nacional
The Spanish Especial Interest Group on ADHD (GEITDAH) presents in this article its consensus on pathways for attending ADHD patients. This is a clear and simple consensus in order to facilitate the development of local algoritms inspired on it. Some ADHD algorithms used in the Spanish Health Services are reviewed
Assuntos
Humanos , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Avaliação de Sintomas/métodos , Algoritmos , Programas de Rastreamento/métodos , Encaminhamento e Consulta , Erros de Diagnóstico/prevenção & controle , Capacitação Profissional , Padrões de Prática MédicaRESUMO
In this article, the GEITDAH -the Spanish abbreviation of the Special Interest Group on Attention Deficit Hyper-activity Disorder (ADHD)- presents a consensus reached by experts in the management of ADHD from all over Spain. The consensus concerns fundamental aspects that should be the starting point for future local or regional consensus guides. Another aim of this consensus is also to reduce the amount of variability that occurs in the health care offered to patients with ADHD in our country, as well as to act as a stimulus in educational matters. That fact that it is not very long will make it more popular among greater numbers of people and this will allow these goals to be reached more effectively. The conclusions in the consensus guide have been constructed around an introduction dealing with basic aspects and recommendations for diagnosis, treatment (both pharmacological and psychotherapeutic), patient flow and organisational aspects.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Consenso , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Guias como Assunto , Humanos , Psicoterapia , EspanhaRESUMO
El ronquido habitual es un síntoma de los trastornos de la respiración en el sueño (TRS) presente en cerca del 10% de los niños. La obesidad, los trastornos dismórficos y neuromusculares, y la herencia genética se incluyen en los factores de riesgo para padecer un TRS. Estos TRS presentan muchas complicaciones: problemas conductuales y de aprendizaje, anomalías cardio-vasculares, alteraciones del crecimiento, etc. El diagnóstico adecuado de un TRS en un niño roncador concreto exige una polisomnografía nocturna. Su tratamiento incluye la adeno- tonsilectomía, pero en ocasiones se requieren además otras intervenciones conductuales y farmacológicas (AU)
Habitual snoring is a symptom of sleep-disordered breathing (SDB) and it is reported in about 10% of children. Risk factors for SDB include obesity, dysmorphic and neuromuscular disorders and genetic tendency. There are many complications of SDB: behavioral and learning problems, cardiovascular abnormalities, impaired growth, etc. Classification of SDB in a particular snoring child requires an overnight polysomnography. Its treatment includes removal of adenoid and tonsils, but sometimes other behavioral and/or pharmacological interventions are requiredl aprendizaje, adenoamigdalectomía (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Apneia Obstrutiva do Sono/complicações , Deficiências da Aprendizagem/complicações , Transtornos do Comportamento Infantil/complicações , Ronco/etiologia , Polissonografia , Fatores de Risco , Tonsilectomia , Pólipos Nasais/cirurgiaRESUMO
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Humanos , Masculino , Feminino , Criança , Psicofarmacologia/ética , Transtornos do Neurodesenvolvimento/tratamento farmacológico , Psicotrópicos/uso terapêutico , Psicofarmacologia/tendências , Uso de Medicamentos/éticaRESUMO
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Assuntos
Humanos , Feminino , Pré-Escolar , Transtornos de Ansiedade/psicologia , Terapia Familiar/métodos , Diagnóstico Diferencial , Relações Mãe-Filho , Transtornos do Sono-Vigília/psicologia , Transtornos de Adaptação/psicologiaRESUMO
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Humanos , Masculino , Criança , Síndrome de Asperger/diagnóstico , Transtornos do Neurodesenvolvimento/diagnóstico , Diagnóstico Diferencial , Esquizofrenia Infantil/diagnóstico , Transtorno Bipolar/diagnóstico , Transtornos Globais do Desenvolvimento Infantil/diagnósticoRESUMO
INTRODUCTION: There is wide evidence about dopaminergic and noradrenergic mechanisms in fronto-striatal circuits which are thought to be related with attention deficit hyperactivity disorder (ADHD) neurobiology. That dysfunction may explain core symptoms and part of executive deficits in cognitive functioning. Methylphenidate is effective in alleviating core symptoms, enhancing dopaminergic and noradrenergic biodisponibility. Less evidence in improving executive functions, specially working memory is found. AIMS: To assess if methylphenidate-OROS has a potential effect increasing working memory and attention parameters in ADHD children, and to determine if initial working memory and attention differences between ADHD and control group disappear after one month of daily methylphenidate-OROS treatment. SUBJECTS AND METHODS: Eleven children with ADHD were selected and as control group was chosen eleven children compared in age, intelligence quotient, school grade, and social-demographic status. Neuropsychological battery was administered in naive ADHD patients at three times, before treatment, after the first methylphenidate-OROS dose, and after one month of daily treatment. Simultaneously neuropsychological battery was administered to control group. RESULTS. Statistically significant differences were found in neuropsychological variables of working memory after one month daily treatment with methylphenidate-OROS and attention parameters after only one dose in ADHD group. Differences between naive ADHD and control group in terms of working memory were statistically significant before treatment but not after one month daily treatment. CONCLUSION: Methylphenidate-OROS improves attention achievement after the first dose and working memory after one month of daily treatment.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Metilfenidato/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Criança , Preparações de Ação Retardada , Humanos , Testes NeuropsicológicosRESUMO
El déficit dopaminérgico y noradrenérgico en los circuitos frontoestriatales es considerado como labase bioquímica del trastorno por déficit de atención/hiperactividad (TDAH). Estas alteraciones parecen explicar parte de sus déficit cognitivos, entre los cuales están las funciones ejecutivas. El metilfenidato incrementa la biodisponibilidad dopaminérgica y noradrenérgica en la corteza prefrontal y los ganglios basales. Este hecho supone beneficios inmediatos en el incremento de la atención y un descenso de la impulsividad. Menos documentado está el efecto del metilfenidato sobre las funciones ejecutivas y, en concreto, sobre la memoria de trabajo. Objetivos. Evaluar si el metilfenidato-OROS incrementa el rendimiento de los TDAH en diversos parámetros atencionales y en tareas de memoria de trabajo, y estudiar si las diferencias entre el grupo con TDAH y el grupo control desaparecen tras un mes de tratamiento con metilfenidato-OROS. Sujetos y métodos.Se seleccionaron 11 pacientes con TDAH y 11 sujetos control equiparados en edad, cociente intelectual, años de escolaridad y nivel socioeconómico. Se administró un protocolo neuropsicológico en tres momentos: antes del tratamiento, tras una sola dosis y tras un mes de tratamiento con metilfenidato-OROS. Se administró el mismo protocolo neuropsicológico al grupocontrol. Resultados. Se encontraron diferencias en memoria de trabajo tras un mes de tratamiento y en parámetros atencionales tras una sola toma en el grupo con TDAH. Las diferencias iniciales entre el grupo con TDAH y el grupo control en memoria de trabajo dejaron de ser significativas tras un mes de tratamiento. Conclusión. El metilfenidato-OROS mejora elrendimiento atencional desde la primera dosis y la memoria de trabajo verbal tras un mes de administración diaria
There is wide evidence about dopaminergic and noradrenergic mechanisms in fronto-striatal circuitswhich are thought to be related with attention deficit hyperactivity disorder (ADHD) neurobiology. That dysfunction may explain core symptoms and part of executive deficits in cognitive functioning. Methylphenidate is effective in alleviating coresymptoms, enhancing dopaminergic and noradrenergic biodisponibility. Less evidence in improving executive functions, specially working memory is found. Aims. To assess if methylphenidate-OROS has a potential effect increasing working memory and attention parameters in ADHD children, and to determine if initial working memory and attention differences between ADHD and control group disappear after one month of daily methylphenidate-OROS treatment. Subjects andmethods. Eleven children with ADHD were selected and as control group was chosen eleven children compared in age,intelligence quotient, school grade, and social-demographic status. Neuropsychological battery was administered in naive ADHD patients at three times, before treatment, after the first methylphenidate-OROS dose, and after one month of daily treatment. Simultaneously neuropsychological battery was administered to control group. Results. Statistically significant differences were found in neuropsychological variables of working memory after one month daily treatment with methylphenidate-OROS and attention parameters after only one dose in ADHD group. Differences between naive ADHD and controlgroup in terms of working memory were statistically significant before treatment but not after one month daily treatment. Conclusion. Methylphenidate-OROS improves attention achievement after the first dose and working memory after one month of daily treatment
Assuntos
Humanos , Masculino , Feminino , Criança , Metilfenidato/farmacocinética , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Atenção , Memória , Testes Neuropsicológicos , Estudos de Casos e ControlesRESUMO
Based on the description of a clinical case treated by the authors, and diagnosed of dissociative disorder, a review of the diagnosis of dissociative disorder and its polemics is carried out. The authors discuss concepts such as dissociation and hysteria, their historic evolution and their relationships. Some modern cognitive theories on dissociative disorders and their relationship or opposition to psychodynamic theories are presented. The differences between dissociation and repression with these two different approaches are also mentioned. The authors conclude that at the present time important questions must be solved in the area of dissociative disorders in order to progress in the psychiatric knowledge of dissociative processes.
Assuntos
Transtornos Dissociativos/psicologia , Adulto , Transtornos Dissociativos/diagnóstico , Humanos , Masculino , Repressão Psicológica , Índice de Gravidade de DoençaRESUMO
A partir de la descripción de un caso clínico visto por los autores, con diagnóstico de trastorno disociativo, se realiza una revisión del tema de estos trastornos y de las polémicas que lo acompañan. Se presta atención a los conceptos de disociación e histeria, su evolución histórica y sus relaciones. Se mencionan también algunas teorías explicativas actuales desde el modelo cognitivo y su posible relación u oposición con las teorías psicodinámicas, resaltando la diferencia, desde estos distintos enfoques, entre disociación y represión. En las conclusiones se señala que en el campo de lo disociativo hay todavía problemas importantes a los que enfrentarse para avanzar en el conocimiento psiquiátrico de este grupo de trastornos (AU)
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Assuntos
Masculino , Humanos , Adulto , Transtornos Dissociativos , Repressão Psicológica , Índice de Gravidade de DoençaRESUMO
1. Studies with Single Photon Emission Computed Tomography (SPECT) in schizophrenia research have utilized different approaches to normalization of data, such as cerebellar ratio and whole brain ratio methods, leading to conflicting findings. 2. The authors compared these two methods to test the hypofrontality hypothesis of schizophrenia. 3. Eighteen chronic and medicated DSM-IV schizophrenic patients and 10 healthy controls underwent two SPECT examinations using 99mTc HMPAO as a tracer at baseline and during frontal activation while applying the Wisconsin Card Sorting Test. 4. The hypofrontality hypothesis was supported with both indexes of relative perfusion, although the whole brain ratio method appeared to be more reliable and specific than the cerebellar ratio method. 5. Further studies are required to confirm these preliminary results on the specificity and sensitivity of both methods.
