Prevalencia de síntomas gastrointestinales en trastornos del espectro del autismo: un metaanálisis / Prevalence of gastrointestinal symptoms in autism spectrum disorder: A meta-analysis

Introducción: Se ha descrito una elevada prevalencia de síntomas gastrointestinales (GI) en los niños y adolescentes con trastornos del espectro del autismo (TEA). Además, se ha relacionado la presencia de dichos síntomas con mayor gravedad de la clínica TEA. Sin embargo, la frecuencia de síntomas GI en niños y adolescentes con TEA es muy variable a lo largo de los estudios y no se conoce su verdadera prevalencia. Por tanto, el objetivo del presente trabajo fue estimar la prevalencia de síntomas GI en niños y adolescentes con TEA. Material y método: Se realizó un metaanálisis siguiendo las directrices PRISMA. Se llevó a cabo una búsqueda sistemática rápida de nuevos estudios clínicos y observacionales desde agosto de 2012 en PubMed. Los análisis estadísticos se realizaron con el software R. Resultados: De 91 artículos potencialmente elegibles, solo 8 cumplieron nuestros criterios de inclusión. La prevalencia de síntomas GI osciló entre el 0 y el 69%, con una prevalencia general estimada del 33% (IC del 95%: 13-57%), cifra superior a la reportada por un metaanálisis previo para la población general pediátrica. Esta diferencia es todavía mayor al comparar específicamente los estudios que emplean la versión pediátrica del cuestionario ROMA III (QPGS-ROME III). Conclusiones: Estos resultados confirman la hipótesis de que existe una prevalencia superior de síntomas GI funcionales en el TEA frente a sus coetáneos neurotípicos. (AU)

Introduction: A high prevalence of gastrointestinal (GI) symptoms has been described in children and adolescents with autism spectrum disorder (ASD). In addition, there is evidence that presence of GI symptoms is associated to greater severity of ASD. However, the frequency of GI symptoms in children and adolescents with ASD varies widely across studies, and their true prevalence is unknown. Therefore, the objective of this study was to estimate the prevalence of GI symptoms in children and adolescents with ASD. Material and method: We conducted a meta-analysis following the PRISMA guidelines. We carried out a rapid systematic search for recent clinical and observational studies published from August 2012 in PubMed. The statistical analyses were performed with the software R. Results: Of 91 potentially eligible articles, only 8 met our inclusion criteria. The prevalence of GI symptoms ranged between 0% and 69%, with an estimated general prevalence of 33% (95% CI, 13%-57%), higher than that reported by a previous meta-analysis for the general paediatric population. This difference is even greater in the specific comparison of studies that applied the paediatric version of the ROME III questionnaire (QPGS-ROME III). Conclusions: The results confirmed the hypothesis that there is a higher prevalence of functional GI symptoms in paediatric patients with ASD compared to their neurotypical peers. (AU)

Prevalence of gastrointestinal symptoms in autism spectrum disorder: A meta-analysis.

INTRODUCTION: A high prevalence of gastrointestinal (GI) symptoms has been described in children and adolescents with autism spectrum disorder (ASD). In addition, there is evidence that presence of GI symptoms is associated to greater severity of ASD. However, the frequency of GI symptoms in children and adolescents with ASD varies widely across studies, and their true prevalence is unknown. Therefore, the objective of this study was to estimate the prevalence of GI symptoms in children and adolescents with ASD. MATERIAL AND METHOD: We conducted a meta-analysis following the PRISMA guidelines. We carried out a rapid systematic search for recent clinical and observational studies published from August 2012 in PubMed. The statistical analyses were performed with the software R. RESULTS: Of 91 potentially eligible articles, only 8 met our inclusion criteria. The prevalence of GI symptoms ranged between 0% and 69%, with an estimated general prevalence of 33% (95% CI, 13%-57%), higher than that reported by a previous meta-analysis for the general paediatric population. This difference is even greater in the specific comparison of studies that applied the paediatric version of the ROME III questionnaire (QPGS-ROME III). CONCLUSIONS: The results confirmed the hypothesis that there is a higher prevalence of functional GI symptoms in paediatric patients with ASD compared to their neurotypical peers.

Relationship of DRD5 and MAO-B VNTR polymorphisms with paranoid and antisocial personality disorders in polydrug users.

Although multiple studies have shown the role genetics plays in personality disorders and in addictions, few have studied the genetic aspects of their comorbidity. Here, we carried out a cross-sectional study in a sample comprising 303 Caucasian polydrug-consuming patients. The presence of personality disorders was evaluated using the International Personality Disorder Examination, and genes related to dopamine, serotonin and monoamine oxidase (MAO) were genotyped. A significant relationship was observed between the bp 279 DRD5 variable number of tandem repeat (VNTR) polymorphism and paranoid personality disorder OR 95 % CI = 2.186 1.074 ; 4.449 ; p = 0.006 . The bp 182 OR 95 % CI = 0.407 0.178 ; 0.931 ; p = 0.033 and bp 184 OR 95 % CI = 0.391 0.188 ; 0.813 ; p = 0.012 alleles of the MAOB VNTR were also associated with antisocial personality disorder. Among patients with addictions, paranoid personality disorder should also be considered in addition to the importance of antisocial and borderline personality disorders. The higher frequency of the bp 279 DRD5 VNTR allele found in patients with paranoid personality disorder, as well as the associations between alleles of the MAOB VNTR and antisocial personality disorder, support the monoaminergic bases of these personality disorders, especially when dealing with patients with addictions.

Creation of the TXP parenting questionnaire and study of its psychometric properties. / Creación y estudio de las propiedades psicométricas del cuestionario de socialización parental TXP.

Parenting is linked to conduct disorders (CD) and substance related disorders (SRD) in adolescents, but with differences according to cultural context. A questionnaire with two versions (parenting questionnaire TXP-A for adolescents and TXP-C  for primary caregivers) was designed using the Delphi method to evaluate parenting practices related to CD and SRD in a Spanish population. It was validated in a community sample of 631 adolescents aged between 14 and 16 and their caregivers. Results suggest a 29-item TXP-A questionnaire with bifactorial structure: affection-communication and control-structure, with high internal (Cronbach’s alpha=0.89) and test-retest (intraclass correlation coefficient=0.94) reliabilities. Both factors are related to SRD (r=0.273, p<0.001) and with most of the psychopathological dimensions studied. The total score and affection-communication are related to dissocial disorder (t=3.259, p=0.001) and its severity (r=-0,119; p=0.003). Inter-observer reliability between adolescents and caregivers is low, in part because the 16-item TXP-C has a different bifactorial structure: affection-communication and prosocial values. TXP-C’s internal (Cronbach’s alpha=0.87) and test-retest (intraclass correlation coefficient=0.94) reliabilities are high. The total score and affection-communication were related to dissocial disorder (t=2.586; p=0.010) but TXP-C did not discriminate according to SRD. In conclusion, the TXP-A questionnaire for adolescents seems to be a reliable, valid and unbiased instrument that evaluates the perception of parenting practices, relating higher affection-communication and control-structure to less psychopathology and alcohol and drug use. TXP-C also seems to be reliable and unbiased, but shows less evidence of validity regarding substance use and psychopathology. .

El estilo parental de socialización se relaciona con trastornos de conducta (TC) y trastornos relacionados con sustancias (TRS) en adolescentes, con diferencias según el contexto cultural. Se diseñó mediante método Delphi un cuestionario con dos versiones (Cuestionario de socialización parental TXP-A para adolescentes y TXP-C para cuidador principal) para evaluar en población española las prácticas de socialización parental relacionadas con TC y TRS. Se validó en una muestra comunitaria de 631 adolescentes entre 14 y 16 años y sus cuidadores. Los resultados recomiendan un cuestionario TXP-A de 29 ítems y estructura bifactorial: afecto-comunicación y control-estructura, mostrando alta fiabilidad interna (alfa de Cronbach=0,89) y test-retest (coeficiente de correlación intraclase=0,94). Ambos factores correlacionan con TRS (r=0,273; p<0,001) y con la mayoría de las dimensiones psicopatológicas estudiadas. La puntuación total y afecto-comunicación se relacionan con el trastorno disocial (t=3,259; p=0,001) y su gravedad (r=-0,119; p=0,003). La fiabilidad interjueces entre adolescentes y cuidadores es baja, en parte porque el TXP-C, de 16 ítems, presenta una estructura bifactorial diferente: afecto-comunicación y valores prosociales. La fiabilidad interna (alfa de Cronbach= 0,87) y test-retest (coeficiente de correlación intraclase=0,94) del TXP-C son altas. La puntuación total y afecto-comunicación se relacionan con el trastorno disocial (t=2,586; p=0,010) pero no discrimina según el TRS. En conclusión, el cuestionario TXP-A para adolescentes parece un instrumento fiable, válido y sin sesgos que evalúa la percepción de las prácticas de socialización parental, relacionando mayores puntuaciones en afecto-comunicación y control-estructura con menor psicopatología y consumo de alcohol y drogas. El TXP-C también parece fiable y sin sesgos, pero muestra menos evidencias de validez respecto al consumo de sustancias y la psicopatología.

Creación y estudio de las propiedades psicométricas del cuestionario de socialización parental TXP / Creation of the TXP parenting questionnaire and study of its psychometric properties

El estilo parental de socialización se relaciona con trastornos de conducta (TC) y trastornos relacionados con sustancias (TRS) en adolescentes, con diferencias según el contexto cultural. Se diseñó mediante método Delphi un cuestionario con dos versiones (Cuestionario de socialización parental TXP-A para adolescentes y TXP-C para cuidador principal) para evaluar en población española las prácticas de socialización parental relacionadas con TC y TRS. Se validó en una muestra comunitaria de 631 adolescentes entre 14 y 16 años y sus cuidadores. Los resultados recomiendan un cuestionario TXP-A de 29 ítems y estructura bifactorial: afecto-comunicación y controlestructura, mostrando alta fiabilidad interna (alfa de Cronbach = 0,89) y test-retest (coeficiente de correlación intraclase = 0,94). Ambos factores correlacionan con TRS (r = 0,273; p < 0,001) y con la mayoría de las dimensiones psicopatológicas estudiadas. La puntuación total y afectocomunicación se relacionan con el trastorno disocial (t = 3,259; p = 0,001) y su gravedad (r = -0,119; p = 0,003). La fiabilidad interjueces entre adolescentes y cuidadores es baja, en parte porque el TXP-C, de 16 ítems, presenta una estructura bifactorial diferente: afecto-comunicación y valores prosociales. La fiabilidad interna (alfa de Cronbach = 0,87) y test-retest (coeficiente de correlación intraclase = 0,94) del TXP-C son altas. La puntuación total y afecto-comunicación se relacionan con el trastorno disocial (t = 2,586; p = 0,010) pero no discrimina según el TRS. En conclusión, el cuestionario TXP-A para adolescentes parece un instrumento fiable, válido y sin sesgos que evalúa la percepción de las prácticas de socialización parental, relacionando mayores puntuaciones en afecto-comunicación y control-estructura con menor psicopatología y consumo de alcohol y drogas. El TXP-C también parece fiable y sin sesgos, pero muestra menos evidencias de validez respecto al consumo de sustancias y la psicopatología

Parenting is linked to conduct disorders (CD) and substance related disorders (SRD) in adolescents, but with differences according to cultural context. A questionnaire with two versions (parenting questionnaire TXP-A for adolescents and TXP-C for primary caregivers) was designed using the Delphi method to evaluate parenting practices related to CD and SRD in a Spanish population. It was validated in a community sample of 631 adolescents aged between 14 and 16 and their caregivers. Results suggest a 29-item TXP-A questionnaire with bifactorial structure: affection-communication and control-structure, with high internal (Cronbach's alpha = 0.89) and test-retest (intraclass correlation coefficient = 0.94) reliabilities. Both factors are related to SRD (r = 0.273, p < 0.001) and with most of the psychopathological dimensions studied. The total score and affection-communication are related to dissocial disorder (t = 3.259, p = 0.001) and its severity (r = -0,119; p = 0.003). Inter-observer reliability between adolescents and caregivers is low, in part because the 16-item TXP-C has a different bifactorial structure: affection-communication and prosocial values. TXP-C's internal (Cronbach’s alpha=0.87) and test-retest (intraclass correlation coefficient=0.94) reliabilities are high. The total score and affection-communication were related to dissocial disorder (t = 2.586; p = 0.010) but TXP-C did not discriminate according to SRD. In conclusion, the TXP-A questionnaire for adolescents seems to be a reliable, valid and unbiased instrument that evaluates the perception of parenting practices, relating higher affection-communication and control-structure to less psychopathology and alcohol and drug use. TXP-C also seems to be reliable and unbiased, but shows less evidence of validity regarding substance use and psychopathology

The importance of socio-legal interventions in the case management of a severe dual pathology program: our 6 years’ experience

Interest in studying dual diagnosis comorbidity between mental disorders and addictions is increasing, but so far has focused only on epidemiological, clinical and prognostic aspects (Szerman et al, 2013). However, the socio-legal needs of these patients must also be assessed, especially if we are to address the problem using a holistic case management approach, as in the case of other serious mental disorders such as schizophrenia (Nordén, Eriksson, Kjellgren & Norlander, 2012). The Severe Dual Pathology Program (SDPP) at the Provincial Hospital of Castellón Consortium (Spain) began in 2008 and so far has treated 293 patients. The intervention model is integrated, both medically and socially and is based on case management; the inclusion criteria is a score of under 30 on the Global Assessment of Functioning (GAF) scale at admission which must have improved to over 50 for the patient to be discharged. 81.2 % of the patients we have treated so far were male, and most referrals were made from the Emergency Mental Health Unit (32.4 %), followed by the Unit of Addictive Behavior (23.5 %), and the Mental Health Units (15 %). The most prevalent diagnosis at the time of starting the program was schizophrenia (46.8 %), followed by personality disorder (11.3 %), schizoaffective disorder (8.5 %), and bipolar disorder (7.5 %). The majority of patients were polydrug addicts (49.5 %) or addicted to alcohol (27.9 %)

Trastorno por déficit de atención con hiperactividad y trastorno bipolar en gemelas dicigóticas. A propósito de un caso / Attention deficit disorder with hyperactivity and bipolar disorder. A case report of dizygotic twins

Desde que Wozniak et al describieran una elevada incidencia de trastorno bipolar (16%) entre los niños y adolescentes diagnosticados de trastorno por déficit de atención con hiperactividad (TDAH) ha existido un interés creciente en el estudio y la descripción de ambas afecciones. Al mismo tiempo todavía hay cierta confusión (y posible desconocimiento por parte de los profesionales) a la hora de realizar un correcto diagnóstico diferencial. En este sentido, se ha tratado de esclarecer la relación entre ambas enfermedades, tanto desde el aspecto clínico como genético, como también se ha validado los diagnósticos y se ha tratado de definir los síntomas característicos. Presentamos el caso de dos hermanas gemelas dicigóticas que pone de manifiesto, por un lado, que ambas enfermedades están relacionadas y, por otro, la condición de heredabilidad del trastorno bipolar. Además, consideramos un hallazgo clínico destacable la clínica compatible con TDAH en una niña con síndrome de Turner

Since Wozniak et al reported a high prevalence rate (16%) of bipolar disorder (BP) among children and adolescents diagnosed with attention-deficit-hyperactivity-disorder (ADHD), interest in the study and description of both disorders has inreased. At the same time, there is some confusion (and possibly some lack of awareness among psychiatrists) surrounding correct differential diagnosis between these disorders. Attempts have been made to clarify the relationship (both clinical and genetic) between these two disorders. Equally, the diagnoses have been validated and the characteristic symptoms have been defined. We report the cases of two dizygotic twin sisters, which reveal the existence of the above-mentioned associations and the role of inheritability in BP. In addition, we believe that the presence of an ADHD in a child with Turner syndrome child is highly unusual (AU)