La disociación en niños y adolescentes: la variabilidad en la expresión clínica a propósito de dos casos / Dissociation in children and adolescents: the variability in clinical expression in relation to two cases

El término disociación ha pasado de constituir una entidad nosológica a ser relegado a un síntoma, apareciendo disgregado en las diferentes clasificaciones internacionales actuales, lo que lo lleva a ser un concepto teórico, confuso y generador de controversia. El diagnóstico por exclusión que esto implica, hace que sea un trastorno infradiagnosticado en la práctica clínica, lo que trae consigo la escasez de publicaciones, especialmente en población infanto-juvenil. Se debe entender cómo la respuesta a un fenómeno postraumático expresándose clínicamente dependiendo de la propia resiliencia del sujeto. Se exponen dos casos clínicos contrapuestos (disociación mente-mente vs mentecuerpo) que han necesitado ingreso hospitalario. Se precisarían más publicaciones sobre esta patología, para ofrecer a los clínicos un enfoque amplio que facilite el diagnóstico de la disociación como entidad mórbida y no únicamente como diagnóstico de exclusión, así como su tratamiento y pronóstico

The term dissociation has gone from being a nosological conception to being relegated to a symptom, appearing nowadays, disintegrated into different international classifications, which leads to a theoretical, confusing and controversial concept generator. The diagnosis of exclusion that this entails, makes it an underdiagnosed disorder in clinical practice, which brings about the shortage of publications, especially in child population. It should be understood as the response to a post-traumatic phenomenon, variably expressed depending on the resiliency of the subject. We expose two counterposed clinical cases (mind-mind vs mind-body dissociation) that needed hospitalization. More publications focused on this disease are needed to offer clinicians a wide focus to help on diagnosis, treatment and prognosis as a disorder and not being only an exclusion-diagnosis syndrome

[Impulsivity: historical and conceptual review]. / Impulsividad: revisión histórica y conceptual.

There is great confusion about the concept of impulsivity despite its important clinical use. Limits with others symptoms or behaviors, like aggressiveness, are imprecise, and we find no general agreement on the definition of impulsivity in the present literature. From the point of view of neurosciences, adequate identification and measurement of a symptom as impulsivity could increase the validity of syndromic diagnoses, improve the development of animal models and genetic studies, and improve the treatment of several psychiatric disorders. Based on this perspective, the overall goals of this review article are: a) to establish the historical evolution of term, concept and behavior that we presently identify as impulsivity, starting from the classical psychopathology of the will; b) to review several concepts of impulsivity described in the scientific literature, and c) to provide basic guidelines for an operative definition, just as some authors have proposed, to create research lines and understand various discoveries that basic sciences have contributed.