Insecure maternal attachment is associated with depression in ADHD children.

The objective of this study was to analyze the possible association between maternal attachment style and comorbidity associated with childhood ADHD. We evaluated a total of 103 children with ADHD treated at a Child and Adolescent Mental Health Centre and their mothers. Comorbidity was evaluated using the MINI-KID interview. Maternal attachment was evaluated using the Adult Attachment Questionnaire. We considered child variables that could be associated with the clinical course of ADHD, such as symptom severity, age, gender, evolution time, academic level, and current pharmacological treatment; parental variables, such as the mother's psychiatric history, current psychopathology, marital status, academic level, income, and employment, were also considered. We found an association between maternal insecure attachment and comorbid depressive disorder in childhood ADHD. An insecure maternal attachment style must be considered in the assessment and treatment of childhood ADHD with comorbid depression.

Maternal psychiatric history is associated with the symptom severity of ADHD in offspring.

Controversy exists about the role of parent psychopathology in persistence and severity of attention deficit hyperactivity disorder (ADHD) symptoms in their children. Here we aimed to analyse the potential association between the severity of ADHD symptoms in children and the presence of psychiatric and ADHD symptoms in their biological parents. Seventy-three triads of children and their parents who were in active treatment for their diagnosed ADHD were evaluated in our Child and Adolescent Mental Health Centers. The mental health of the parents was also assessed. The general psychopathology of the parents was evaluated using the Symptom Checklist-90-R (SCL-90-R), and symptoms of hyperactivity were examined using the Adult ADHD Self-Report Scale (ASRS v.1.1). The severity of symptoms in children was assessed using the ADHD Rating Scale-IV (ADHD-RS-IV). Variables that could have affected the clinical development of ADHD such as sex, evolution time, age, academic level and the presence of comorbidities were controlled. The severity of the symptoms in children with ADHD was significantly related to the psychiatric history of their mother, the younger age of the child and the presence of a comorbid conduct disorder in the child. We discussed the importance of screening for parental psychopathology in clinical practice.

Curso del trastorno por déficit de atención y/o hiperactividad en una muestra ambulatoria / The course of attention deficit/hyperactivity disorder in an outpatient sample

Introducción: El trastorno por déficit de atención y/o hiperactividad puede ser un trastorno de mal pronóstico y más cuando se asocia a algunos factores de riesgo psicosocial. Objetivo: Detectar variables clínicas y factores de riesgo psicosocial asociados al mal pronóstico del trastorno. Pacientes y métodos: En una muestra de 88 pacientes seguidos en nuestros centros de salud mental infanto-juvenil durante dos o más años, clasificamos los sujetos utilizando la escala de impresión clínica global de mejoría según evolución clínica en tres categorías (mejoría, empeoramiento y sin cambios). Realizamos análisis bivariados y regresión logística univariada para estudiar la asociación entre las variables y el desenlace clínico. Resultados: Los grupos sin cambio y empeoramiento (el 30% de la muestra) presentaban mayor comorbilidad psiquiátrica, mayor porcentaje de individuos con ausencia de tratamiento farmacológico y mayor presencia de los siguientes factores de riesgo social: crianza inadecuada, ambiente sociofamiliar adverso y estrés psicosocial. El mayor grado de asociación se relacionó con la ausencia de tratamiento farmacológico (OR=15,8; IC 95% 2,71 - 92,19, p=0,002) y con presentar dos comorbilidades (OR=4,8; IC 95% 1,02 - 22,64, p=0,047). Conclusiones: En nuestra muestra ambulatoria de TDAH hay un subgrupo que no cambia o empeora. El tratamiento farmacológico, psicológico, la detección y el manejo clínico de la comorbilidad y de algunos de los factores de riesgo psicosocial pueden influir en el curso y evolución del TDAH y por lo tanto es necesario considerarlos en el tratamiento estándar de estos pacientes(AU)

Introduction: Attention Deficit Hyperactivity Disorder may be a disorder of with a poor prognosis and more so when associated with psychosocial risk factors. The aim of this study is to identify clinical and psychosocial risk factors associated with poor prognosis of this disorder. Patients and methods: In a sample of 88 patients was followed up at our Child and Adolescent Mental Health Centres for two or more years. We classified subjects using the Clinical Global Impression Scale of Improvement following the clinical course in three categories (improved, worsened and unchanged). We performed bivariate and univariate logistic regressions to study the association between the variables and outcome. Results: Worsened and unchanged groups (30% of the sample) had more psychiatric comorbidity, a higher percentage of individuals with no drug treatment, and presence of the following social risk factors: inadequate parenting, adverse social and family environment and psychosocial stress. The highest degree of association is related to the absence of drug treatment (OR=15.8, 95% CI 2.71 to 92.19, P=.002) and the presence of two comorbidities (OR=4.8, 95% CI 1.02 to 22.64, P=.047). Conclusions: In our sample of ADHD outpatients, there was a subgroup that was unchanged or worsened. Drug therapy, psychological treatment, detection and clinical management of comorbidity and some of the psychosocial risk factors can influence the course and outcome of ADHD and therefore the standard treatment of these patients needs to be considered(AU)

[The course of attention deficit/hyperactivity disorder in an outpatient sample]. / Curso del trastorno por déficit de atención y/o hiperactividad en una muestra ambulatoria.

INTRODUCTION: Attention Deficit Hyperactivity Disorder may be a disorder of with a poor prognosis and more so when associated with psychosocial risk factors. The aim of this study is to identify clinical and psychosocial risk factors associated with poor prognosis of this disorder. PATIENTS AND METHODS: In a sample of 88 patients was followed up at our Child and Adolescent Mental Health Centres for two or more years. We classified subjects using the Clinical Global Impression Scale of Improvement following the clinical course in three categories (improved, worsened and unchanged). We performed bivariate and univariate logistic regressions to study the association between the variables and outcome. RESULTS: Worsened and unchanged groups (30% of the sample) had more psychiatric comorbidity, a higher percentage of individuals with no drug treatment, and presence of the following social risk factors: inadequate parenting, adverse social and family environment and psychosocial stress. The highest degree of association is related to the absence of drug treatment (OR=15.8, 95% CI 2.71 to 92.19, P=.002) and the presence of two comorbidities (OR=4.8, 95% CI 1.02 to 22.64, P=.047). CONCLUSIONS: In our sample of ADHD outpatients, there was a subgroup that was unchanged or worsened. Drug therapy, psychological treatment, detection and clinical management of comorbidity and some of the psychosocial risk factors can influence the course and outcome of ADHD and therefore the standard treatment of these patients needs to be considered.

Dimensiones sintomáticas del trastorno obsesivo-compulsivo / No disponible

Los actuales estudios factoriales sobre el trastornoobsesivo-compulsivo (TOC) plantean que esta patologíaes una condición clínica heterogénea e identificancuatro dimensiones sintomáticas en niños y adultos:simetría/orden, obsesiones/comprobación, contaminación/limpieza y acumulación. El TOC es un trastornocrónico en el que algunos tipos de síntomas puedencambiar más que otros. El hecho de que los cambiossuelen producirse dentro de la misma dimensión sustentala teoría de que las dimensiones del TOC son temporalmenteestables. Esta revisión incluye apartados relacionadoscon los límites nosológicos del TOC,neurobiología, factores genéticos y ambientales y respuestaal tratamiento. Se aborda la relación entre acontecimientosvitales traumáticos y TOC, incluyendo elhecho de que las relaciones específicas de este campocon las dimensiones sintomáticas del TOC ha sido pocoestudiado. Finalmente hacemos también una breve referenciaa la investigación futura en relación a las dimensionessintomáticas del TOC(AU)

Current factorial studies on obsessive-compulsive disorder(OCD) pose that this pathology is a clinical heterogeneouscondition and identify four dimensions in childrenand adults: symmetry/ order, obsessions/checking,contamination/cleaning and accumulation. OCD is achronic disorder in witch certain tipes of symptoms maychange more than others. The fact that changes oftenoccur within the same dimension, supports the theory thatthe dimensions of TOC are temporarily stable. Thisreview includes paragraphs related to nosologic limits ofOCD, its neurobiology, genetic and enviromental factorsand its response to treatment. Relationships betweenOCD and traumatic life events is adressed, including thefact that the relations of this field with specific symptomaticdimensions of OCD has been poorly studied. Finally,a brief reference to future research in relation to symptomaticdimensions of OCD is made(AU)

¿Será un trastorno bipolar? Controversia acerca de los trastornos bipolares infanto-juveniles / No disponible

Revisamos el trastorno bipolar (TB) infantil y juvenil:diagnóstico, epidemiología, etiología (factores genéticosy ambientales), comorbilidades, curso, suicidio, tratamiento,prevención e investigación futura en el TBpediátrico. El TB de inicio infantil y de la primera adolescenciapuede ser una forma más severa del trastornoque el de inicio en el final de la adolescencia o en laadultez, los subtipos del TB infanto-juvenil puedenentenderse como fenotipos en un continuo o espectrobipolar. Su prevalencia puede estar subestimada. El cursodel trastorno es grave con alto consumo de recursosmédicos y educativos, severo deterioro psicosocial yuna estrecha relación con el fenotipo adulto más grave.A pesar de su carga genética, los factores ambientalesinfluyen decisivamente en la gravedad de la psicopatologíay el curso. El tratamiento combinado con fármacos,psicoeducación y psicoterapia mejora el pronóstico.Se requieren criterios más específicos para los niñosque recojan mejor su fenomenología

We review bipolar disorder (BD) in childhood and adolescence: diagnostic, epidemiology, aetiology(genetic and environmental factors), comorbidities,course, suicide, treatment, outcome and future researchabout pediatric BD. Bipolar disorder with childhood orfirst adolescent onset could be a more severe form ofdisorder than adult or late-adolescence onset BD and wefound that the subtypes of the childhood and adolescentBD could be phenotypes on a continuum or bipolarspectrum. The prevalence may be underestimated. Thecourse of BD is severe with high use of medical andeducational resources and severe psychosocial impairmentand it is also related with the most severe adultphenotype. In spite of its genetic load, the environmentalfactors influence decisively in the severity of thepsychopathology and the course. Combined treatmentwith pharmacotherapy, psychoeducational and psychotherapyapproach improves the outcome. More specificdiagnostic criteria are needed for the children thatbetter fulfill this phenomenology

Perfil de personalidad en una muestra de adolescentes en tratamiento ambulatorio. Estudio preliminar con el MMPI-A / Personality Profile in a sample adolescent outpatients: a prelimnary

Objetivo: Se examina el perfil de personalidad asociado a diferentes diagnósticos clínicos en una muestra de pacientes ambulatorios del Centro de Salud Mental Infanto-Juvenil. Material y métodos: 77 adolescentes entre 13 y 17 años fueron evaluados con el MMPI-A. Hemos realizado un análisis retrospectivo de las historias clínicas para obtener los datos sociodemográficos y clínicos (edad, sexo, cronicidad y diagnóstico CIE-10 y CFTMIA). Mostramos el perfil global y por diagnóstico, los estadísticos descriptivos y comparamos las medias para los diferentes diagnósticos (test de Kruskal- Wallis, Median test, Kolmogorov- Smirnov y test de Mann Whitney) y edades (correlaciones divariadas de Pearson, test de Kruskal- Wallis y test de Mann Whitney). Resultados: El total de la muestra presenta elevaciones moderadas en las escalas de depresión y desviación psicopática. Se asocian diferentes perfiles a cada diagnóstico edad. Los trastornos psicóticos y los trastornos mixtos de la conducta y las emociones muestran un perfil más psicopatológico en las escalas clínicas y mayor deterioro psicosocial reflejado en las escalas de contenido. Los adolescentes más mayores (edades de 16 y 17) tienen puntuaciones más altas que los adolescentes jóvenes (13 a 15 años) en depresión e introversión. Discusión: Los estudios revisados sugieren que hay un sustancial grado de asociación entre el inicio de los trastornos del eje I y la psicopatología del eje II en el final de la adolescencia y el inicio de la primera adultez. Comentamos nuestros resultados y discutimos la asociación entre trastornos mentales en la infancia y adolescencia y alteraciones de la personalidad. Conclusiones: Identificar y tratar con éxito los trastornos en la infancia puede ayudar a reducir el riesgo de desarrollar un trastorno de personalidad adulto. Se necesita más investigación para desarrollar recomendaciones de evaluación y tratamiento para las manifestaciones tempranas de las alteraciones de la personalidad (AU)

Objective: We examined the personality profile associated to diferents diagnoses in a sample of outpatients of the Mental Health Center for Children and adolescents. Method: 77 adolescents with ages from 13 to 17 were assessed with the MMPI-A. We made a prospective analysis of each clinical report to obtain sociodemographic and clinical data (age, gender, cronicity, diagnostic with CIE- 10 and CFTMA).We show the profiles of both the total sample and of each diagnostic cathegory using descriptive statistics and compared means for the diffe- 201 rent diagnoses (using Kruskal- Wallis test, Median test, Mann-Whitney test and Kolmogorov- Smirnov test) and for ages (using Pearson bivariate correlations, Kruskal- Wallis test and Mann- Whitney test). Results: All the sample show moderate elevations in Depression and Psychopatic deviation. Differents profiles are associated to each diagnosis and age: psychotic and mixed disorders of conduct and emotions show more severe psychopathology profile in clinical scales and more psychosocial impairment reflected in content scales. Older adolescents (age 16 and 17) have more elevated and significative scores than younger adolescents (age 13 to 15) in depression and introversion. Discussion: Studies revised suggest a substantial degree of association between early onset axis I disorders and axis II psychopathology in late adolescence and young adults. We comment our results and discuss the association between mental disorders in childhood and adolescence and personality disfunction. Conclusions: Identification and successful treatment of childhood disorders and severe early impairment, may help to reduce the risk of subsequent development of an adult personality disorder. More research is needed to develop assessment and treatment recommendations addressing the early manifestations of personality disturbance (AU)

Personalidad y trastornos de la conducta alimentaria: uso del Mini-Mult en la valoración de pacientes externas con trastorno alimentario / Personality and eating disorders: use of mini -mult in the outpatient assesment of patients with eating disorders

Examinamos características de personalidad de 32 adolescentes con trastorno alimentario (según criterios de la CIE-10) al inicio del tratamiento en el Centro de Salud Mental Infanto-Juvenil. En la admisión se les aplicaron los siguientes cuestionarios: Mini-Mult, EDI, EAT-40, BITE. Analizamos los datos usando el SPSS versión 9.0. Los cuatro grupos muestran perturbaciones importantes demostradas por elevaciones en las escalas 2(D) y 4 (Pd). Las pacientes bulímicas puntúan más alto en las escalas del Mini-Mult. Se discuten los resultados en relación a la investigación revisada (AU)