Executive Functioning in Children and Adolescents with ADHD and Disruptive Behavior Disorders.

Objective: The goal was to compare the impairment on executive functions in children and adolescents with attention deficit hyperactivity disorder (ADHD) alone and with comorbid oppositional defiant disorder (ODD), conduct disorder (CD), or both (ADHD+ODD+CD). Design: A total of 162 patients were diagnosed with the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), and the results of their performances in Behavior Rating Inventory of Executive Function (BRIEF) and the Tower of London (ToLo) were compared. Results: Patients with only ADHD showed less impairment in the BRIEF domains and were younger than those with ADHD+CD; the latter group showed a better performance in the time-related domains of ToLo. Patients with ADHD+ODD+CD did not present a consistently worse cognitive performance. Conclusion: The cognitive performance of patients with ADHD and externalizing disorders seems to vary according to the types of specific comorbid diagnoses, rather than the number of externalizing comorbidities.

Lesiones autoinfligidas con fines no suicidas según el DSM-5 en una muestra clínica de adolescentes mexicanos con autolesiones / DSM-5 Non-Suicidal Self-Injury Criteria in a Clinical Sample of Self-Harming Mexican Adolescents

RESUMEN Introducción: El diagnóstico de lesiones autoinfligidas con fines no suicidas (NSSI) propuesto por el DSM-5 requiere estudios de validez en poblaciones diferentes de las europeas. Los objetivos del presente estudio fueron determinar la frecuencia de este diagnóstico en una muestra de adolescentes mexicanos con autolesiones y examinar las variables asociadas. Métodos: Se revisaron 585 expedientes clínicos de adolescentes con historia de autolesiones que acudieron a un hospital público en la Ciudad de México entre los arios 2005 y 2012. Un grupo de expertos estableció el diagnóstico según el DSM-5. Se compararon las características clínicas y demográficas de los pacientes con y sin NSSI. Resultados: Se diagnosticó NSSI en 351 pacientes con autolesiones (60%). Las razones principales de que no se diagnosticaran fueron haber realizado un intento suicida -criterio A, 158 sujetos (26,87%)- o que otro diagnóstico explicara las autolesiones -criterio F, 60 sujetos (10,25%)-. El grupo con NSSI incluyó una mayor proporción de varones (el 26,5 frente al 16,2%) y de pacientes con trastornos de conducta (el 28,5 frente al 13,7%); también se observó que estos pacientes solicitaban atención psiquiátrica debido a las autolesiones con mayor frecuencia (el 31,9 frente al 14,1%). Las características clínicas asociadas incluyeron trastorno de conducta (OR = 2,51; IC95%, 1,62-3,90), trastorno de personalidad (OR = 0,56; IC95%, 0,33-0,97), hospitalización (OR = 0,23; IC95%, 0,16-0,33), síntomas depresivos (OR = 0,60; IC95%, 0,42-0,85), síntomas de ansiedad (OR = 2,08; IC95%, 1,31-3,31) y autolesionarse para influir en otros (OR = 2,19; IC95%, 1,54-3,11). Conclusiones: Más de la mitad de los adolescentes con autolesiones de la población clínica cumplen los criterios diagnósticos de NSSI del DSM-5. Existen características clínicas y demográficas que pueden asociarse con este diagnóstico.

ABSTRACT Introduction: The DSM-5 diagnostic criteria for non-suicidal self-injury (NSSI) needs to be validated in non-European populations. The aims of this study were to determine how common NSSI was in a sample of self-harming Mexican adolescents and examine the associated variables. Methods: We examined the medical records of 585 adolescents with a history of self-injurious behaviour who attended a public hospital in Mexico City from 2005 to 2012. A group of experts established the diagnosis according to the DSM-5. The clinical and demographic characteristics of patients with and without NSSI were compared. Results: NSSI was diagnosed in 351 patients (60%) with evidence of self-harm. The main reasons for not being diagnosed were a previous suicide attempt (criterion A, 158 subjects [26.87%]) and another diagnosis that better explained the self-injurious behaviour (criterion F, 60 subjects [10.25%]). The NSSI group had a higher proportion of males (26.5% vs 16.2%) and patients with behavioural disorders (28.5% vs 13.7%). These patients were also found to seek psychiatric support in relation to their self-harm more frequently (31.9% vs 14.1%). The associated clinical characteristics included behavioural disorder (OR=2.51; 95% CI, 1.62-3.90), personality disorders (OR=0.56; 95% CI, 0.33-0.97), hospital admission (OR=0.23; 95% CI, 0.16-0.33), depressive symptoms (OR=0.60; 95% CI, 0.42-0.85), anxiety symptoms (OR=2.08; 95% CI, 1.31-3.31) and self-harming to influence others (OR=2.19; 95% CI, 1.54-3.11). Conclusions: More than half of the adolescents in the clinical sample with self-injury met DSM-5 criteria for NSSI. There are clinical and demographic characteristics which may be associated with this diagnosis.

DSM-5 Non-Suicidal Self-Injury Criteria in a Clinical Sample of Self-Harming Mexican Adolescents. / Lesiones autoinfligidas con fines no suicidas según el DSM-5 en una muestra clínica de adolescentes mexicanos con autolesiones.

INTRODUCTION: The DSM-5 diagnostic criteria for non-suicidal self-injury (NSSI) needs to be validated in non-European populations. The aims of this study were to determine how common NSSI was in a sample of self-harming Mexican adolescents and examine the associated variables. METHODS: We examined the medical records of 585 adolescents with a history of self-injurious behaviour who attended a public hospital in Mexico City from 2005 to 2012. A group of experts established the diagnosis according to the DSM-5. The clinical and demographic characteristics of patients with and without NSSI were compared. RESULTS: NSSI was diagnosed in 351 patients (60%) with evidence of self-harm. The main reasons for not being diagnosed were a previous suicide attempt (criterion A, 158 subjects [26.87%]) and another diagnosis that better explained the self-injurious behaviour (criterion F, 60 subjects [10.25%]). The NSSI group had a higher proportion of males (26.5% vs 16.2%) and patients with behavioural disorders (28.5% vs 13.7%). These patients were also found to seek psychiatric support in relation to their self-harm more frequently (31.9% vs 14.1%). The associated clinical characteristics included behavioural disorder (OR=2.51; 95% CI, 1.62-3.90), personality disorders (OR=0.56; 95% CI, 0.33-0.97), hospital admission (OR=0.23; 95% CI, 0.16-0.33), depressive symptoms (OR=0.60; 95% CI, 0.42-0.85), anxiety symptoms (OR=2.08; 95% CI, 1.31-3.31) and self-harming to influence others (OR=2.19; 95% CI, 1.54-3.11). CONCLUSIONS: More than half of the adolescents in the clinical sample with self-injury met DSM-5 criteria for NSSI. There are clinical and demographic characteristics which may be associated with this diagnosis.

Manifestaciones clínicas y tratamiento del trastorno bipolar en niños y adolescentes, una actualización basada en la evidencia / Clinical manifestations and treatment of bipolar disorder (BPD) in children and adolescents, an evidence-based up-to-date approximation

The phenomenology of pediatric bipolar disorder is different from the classical presentation of this disorder in adults as indicated by high rates of psychotic symptoms, episodes and rapid cycling, longer duration of episodes and the presence of subsindromatic symptoms for long periods. The long-term outcome of patients with pediatric onset is worse than those with adult onset. In the last decade, pharmacological research has increased, showing that the response to treatment in children and adolescents is different from that of adults, being better with the combination of psychotropic drugs. Psychosocial interventions involve psychoeducation and skills training can be an alternative treatment for children and adolescents at risk for bipolar disorder.

La fenomenología del trastorno bipolar pediátrico es distinta a la presentación clásica de este trastorno en adultos como lo indican las altas tasas de síntomas psicóticos, episodios de ciclaje rápido, alta duración de los episodios, así como la presencia de síntomas subsindromáticos por períodos largos. El pronóstico de los pacientes que inician la enfermedad durante la infancia y/o adolescencia es peor que para aquellos que la inician en la vida adulta. En la última década se ha incrementado la investigación farmacológica para este trastorno, los ensayos clínicos han mostrado que la respuesta de niños y adolescentes es distinta a la de los adultos, ofreciéndose mejores resultados con la combinación de psicofármacos. Las intervenciones psicosociales involucran a la psicoeducación y el entrenamiento en habilidades, pueden ser una alternativa de tratamiento para los niños y adolescentes con riesgo de desarrollar un trastorno bipolar.