Síndrome de Rapunzel: atadura sicológica y simulación orgánica / Rapunzel syndrome: psychological bondage and organic simulation

Introducción. El síndrome de Rapunzel es una entidad infrecuente, que se presenta como un tricobezoar a causa de una aglomeración de cabello acumulado dentro del tracto gastrointestinal, por lo que simula otras patologías quirúrgicas. Caso clínico. Paciente femenina de 10 años de edad, con tricotilomanía y tricofagia, dolor abdominal y síntomas inespecíficos de obstrucción intestinal de ocho meses de evolución. Al examen físico se encontró abdomen con distensión y masa palpable en epigastrio y mesogastrio. La ecografía permitió hacer el diagnóstico de tricobezoar gástrico extendido hasta el intestino delgado, por lo que se llevó a cirugía para gastrotomía y se extrajo el tricobezoar, con evolución satisfactoria de la paciente. El abordaje integral permitió conocer la atadura sicológica por posible maltrato infantil. Resultado. La paciente tuvo una evolución satisfactoria y se dio egreso al quinto día de hospitalización. Actualmente se encuentra en seguimiento por sicología, siquiatría infantil y pediatría. Discusión. El caso clínico denota la importancia en reconocer situaciones de presentación infrecuente en pediatría, que puedan estar asociadas a alteraciones sicológicas o presunción de maltrato infantil y que se presenten como una condición orgánica recurrente que simule otras patologías abdominales frecuentes en la infancia. El retraso diagnóstico puede conducir a un desenlace no deseado con complicaciones. Conclusión. Se hace mandatorio el manejo integral del paciente pediátrico y aumentar la sensibilidad para reconocer situaciones de presunción de maltrato infantil, sobre todo en pacientes con una condición orgánica quirúrgica recurrente.

Introduction. Rapunzel syndrome is an uncommon condition that manifests as trichobezoars, which are hair bundles in the stomach or small intestine that can mimics other surgical illnesses. Multiple complications can arise from delayed diagnosis and treatment. Clinical case. A 10-year-old female patient with trichotillomania and trichophagia, with abdominal pain and nonspecific symptoms of intestinal obstruction of eight months of evolution. Physical examination revealed epigastric tenderness and a solid mass was palpable in the mesogastric and epigastric region. An abdominal ultrasound showed gastric trichobezoar that extended into the small intestine. A gastrotomy was performed and the trichobezoar was extracted with satisfactory evolution of the patient. The comprehensive approach allowed knowing the psychological bond due to possible child abuse. Results. The patient had a satisfactory evolution and was discharged on the fifth day of hospitalization. He is currently being monitored by psychology, child psychiatry and pediatrics. Discussion. This clinical case highlights the importance of recognizing situations that seldom present in pediatrics, which may have a psychological aspect due to the presumption of child abuse, and which present as a recurrent organic condition simulating other frequent abdominal pathologies in childhood; all of which may lead to an unwanted outcome due to diagnostic delay. Conclusion. The comprehensive management of the pediatric patient is mandatory to recognize situations of presumed child abuse, in the face of a recurrent surgical conditions.

Espectro clínico de la Encefalitis Autoinmune no NMDAR en pediatría

En este trabajo se realizó una revisión narrativa de los principales hallazgos en la literatura médica sobre las manifestaciones clínicas de la encefalitis autoinmune pediátrica (EAP) no mediada por anticuerpos anti receptor del ácido N-metil-D-aspartato (NMDAR). Las EAP que se destacaron se asocian con anticuerpos específicos como el complejo de canales de potasio dependiente de voltaje, la decarboxilasa del ácido glutámico, el receptor del ácido alfa-amino-3-hidroxi-5-metil-4-isoxazolpropiónico y el receptor ácido-gamma-aminobutírico. El diagnóstico de esta patología es un desafío en pediatría debido a la complejidad de las manifestaciones psiquiátricas y neurológicas generadas por la afectación de la corteza, el sistema límbico, el tallo cerebral, los ganglios basales y el cerebelo. A su vez, la comprensión de sus síntomas permite identificar la superposición en las presentaciones clínicas entre los diferentes tipos de EAP y el diagnóstico diferencial con otras enfermedades inflamatorias del cerebro, infecciones, enfermedades metabólicas y trastornos psiquiátricos. El conocimiento biomédico y la sospecha clínica de las EAP no NMDAR establece un campo de investigación que crece en neuropsiquiatría y favorece el diagnóstico y tratamiento de las encefalitis subdiagnosticadas.

This work presents a narrative review of the main findings in the medical literature on the clinical manifestations of pediatric autoimmune encephalitis (PAE) not mediated by anti-N-methyl-Daspartate acid receptor (NMDAR) antibodies. Prominent PAEs are associated with specific antibodies, such as the voltage-gated potassium channel complex, glutamic acid decarboxylase, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, and alpha-amino -3-hydroxy-5. -methyl-4-isoxazolepropionic acid receptor. -gamma-aminobutyric. Diagnosis of this pathology is a challenge in pediatrics due to the complexity of psychiatric and neurological manifestations generated by involvement of cortex, limbic system, brainstem, basal ganglia and cerebellum. In turn, understanding its symptoms allows identifying the overlap in clinical presentations between the different types of PAE and the differential diagnosis with other inflammatory diseases of the brain, infections, metabolic diseases and psychiatric disorders. Biomedical knowledge and clinical suspicion of non-NMDAR PAE establishes a growing field of research in neuropsychiatry and favors the diagnosis and treatment of underdiagnosed encephalitides.

The Visible and Less Visible in the Suffering of a Conversion Disorder in Children and Adolescents. A Qualitative Study of Illness Explanatory Models Presented to Caregivers of Children and Adolescents with Conversion Disorder. / Lo visible y lo menos visible en el padecimiento de un trastorno conversivo en niños y adolescentes. Un estudio cualitativo sobre los modelos explicativos de la enfermedad que ofrecen los cuidadores de niños y adolescentes con trastorno conversivo.

BACKGROUND: Conversion disorder is a challenge for clinicians due to the conceptual gaps as regards its pathogenesis, the way in which it converges with other psychiatric disorders, and the lack of approaches to the experiences of both patients and family members with the disease. OBJECTIVE: To describe Explanatory Models (EM) offered to caregivers of paediatric patients with conversion disorder who attended the Hospital de la Misericordia. METHODS: A qualitative study was conducted with a convenience sample of 10 patients who attended the Hospital de La Misericordia, ¿Bogota? between May 2014 and April 2015. The tool used was an in-depth interview applied to parents and/or caregivers. RESULTS: Caregivers have different beliefs about the origin of the symptoms, especially considering sickness, magical-mystical factors, and psychosocial factors. The symptoms are explained in each case in various ways and there is no direct relationship between these beliefs, the pattern of symptoms, and help-seeking behaviours. Symptomatic presentation is polymorphous and mainly interferes in the patient's school activities. The medical care is perceived as relevant, and psychiatric care as insufficient. Among the therapeutic routes, consultations with various agents are described, including medical care, alternative medicine, and magical-religious approaches. CONCLUSIONS: EMs in conversion disorder are varied, but often include magical-religious elements and psychosocial factors. The underlying beliefs are not directly related to help-seeking behaviours or other variables.

Urgencias psiquiátricas en niños y adolescentes / Psychiatric Emergencies in Children and Adolescents

Introducción: Las urgencias psiquiátricas en la edad pediátrica constituyen un problema de salud pública. Objetivo: Describir las urgencias psiquiátricas y la conducta seguida, en el momento de su evaluación, en pacientes atendidos en consulta de urgencia. Métodos: Estudio observacional, descriptivo y transversal, en 340 pacientes examinados en el Hospital Pediátrico "Juan Manuel Márquez", de enero a abril de 2019. Se utilizó un instrumento validado en estudios anteriores y se realizó entrevista a pacientes y familiares. El procesamiento y análisis de los datos se realizó con el SPSS 21 y estadígrafos descriptivos. Para la comparación de frecuencias observadas y esperadas de una variable se empleó la prueba binomial, y la Ji-cuadrada, con una probabilidad de 0,5 por ciento. Resultados: El 53,8 por ciento de los pacientes declararon entre 15 y 19 años; 50,3 por ciento varones. El 61,2 por ciento presentaban antecedentes patológicos psiquiátricos y 40,3 por ciento procedía de medios familiares problemáticos. Entre los principales motivos de consulta destacaron la conducta suicida y el consumo de sustancias psicoactivas. El 25 por ciento de los pacientes requirió hospitalización, el resto se derivó a la atención ambulatoria. En más de 60 por ciento se utilizaron psicofármacos. Conclusiones: Predominaron en el estudio los adolescentes, masculinos, con antecedentes patológicos personales de enfermedad psiquiátrica, procedentes de medios familiares conflictivos, con diagnóstico de trastornos del comportamiento, conducta suicida, trastornos afectivos, psicosis y trastornos adictivos; entre estos últimos, se diagnosticó la patología dual. Solo la cuarta parte requirió hospitalización y en la mayoría se usaron psicofármacos (AU)

Introduction: Psychiatric emergencies in pediatric age constitute a public health problem. Objective: To describe the psychiatric emergencies and the behavior followed, at the time of their evaluation, in patients attended in an emergency consultation. Methods: Observational, descriptive and cross-sectional study in 340 patients examined at Juan Manuel Márquez Pediatric Hospital, from January to April 2019. An instrument validated in previous studies was used and interviews were conducted with patients and relatives. Data processing and analysis was performed with SPSS 21 and descriptive statistics were used. For the comparison of observed and expected frequencies of a variable, the binomial test and the Chi-square, with a probability of 0.5 percent were used. Results: 53.8 percent of patients were between 15 and 19 years old, and 50.3 percent were male. 61.2 percent had a psychiatric pathological history and 40.3 percent came from problematic family environments. Among the main reasons for consultation were suicidal behaviour and the consumption of psychoactive substances. 25 pecent of patients required hospitalization, the rest were referred to outpatient care. Psychotropic drugs were used in more than 60 percent. Conclusions: In the study predominated adolescents, males, with a personal pathological history of psychiatric illness, from conflictive family environments, diagnosed with behavioral disorders, suicidal behavior, affective disorders, psychosis and addictive disorders; among the latter, dual pathology was diagnosed. Only a quarter required hospitalization and most used psychotropic drugs(AU)

Use of routine health records to study mental health care of Brazilian children / Assistência à saúde mental de crianças brasileiras utilizando dados ambulatoriais

ABSTRACT Objective To investigate the clinical epidemiological characteristics of a large data set of visits to outpatient children mental health services in Brazil, as well as to identify relevant relationships between age, sex and three common mental disorders in childhood: pervasive developmental disorders, ADHD, and mild depressive disorders. Methods We extracted data from the Ambulatorial Information System (SIA) part of a public repository, Datasus, regarding child outpatient mental health services in Brazil, from 2008 to 2012. We performed an analysis of the number of visits per one hundred thousand inhabitants and further analyses with logistic regressions for ADHD (F90.0), Pervasive Developmental Disorders (F84.0-F84.9), and Mild Depressive Episode (F32.0) as outcomes, controlling for age, year of the visit, number of new CAPSI stratified by region. Results Attention-deficit hyperactivity disorder (ADHD) was the most common condition identified across the country. The analyses by region showed a high number of visits due to mental retardation in the Northeast and depressive episodes in the South. Regressions showed that older children are less likely to visit outpatient services with a diagnosis of ADHD (F90.0). Conclusions Our analysis shows the conditions which cause the most burden to the child psychiatry outpatient centers in Brazil and relevant differences between regions. This information has immediate use for the training of staff and allocation of resources in each region.

RESUMO Objetivo Investigar as características clínico-epidemiológicas, em uma grande base de dados, dos atendimentos ambulatoriais em saúde mental de crianças no Brasil e identificar relações relevantes entre idade, sexo e três transtornos mentais comuns na infância: transtorno invasivo do desenvolvimento, distúrbio da atividade e da atenção e transtorno depressivo leve. Métodos Extraímos dados públicos de atendimento ambulatorial de crianças no Brasil, oriundos do Sistema de Informação Ambulatorial (SIA), parte do sistema Datasus, de 2008 a 2012. Realizamos análises das taxas de atendimento por 100 mil habitantes e análises posteriores, com regressões logísticas, para transtorno de atenção e hiperatividade (F90.0), transtorno pervasivo do desenvolvimento (F84.0-F84.9) e transtorno depressivo leve (F32.0), controlando por idade e ano da consulta, e estratificando por região. Resultados Transtorno de atenção e hiperatividade foi a condição que mais gerou consultas em todo o país. Analisando por região, encontramos uma taxa elevada de visitas por retardo mental na região Nordeste e episódios depressivos leves na região Sul. As regressões mostraram que crianças mais velhas tinham menos probabilidade de ser consultadas por transtorno da atividade e da atenção (F90.0). Conclusões Nossas análises mostram os padrões das condições psiquiátricas que geram maior demanda nos serviços ambulatoriais de atendimento em psiquiatria infantil e as significativas diferenças regionais. Essas informações podem subsidiar agentes administrativos na tomada de decisão sobre alocação de recursos e treino de equipes em cada região.

Percepción de los usuarios sobre el acompañamiento del Servicio de Salud Mental del Hospital Infantil Dr. Robert Reid Cabral durante la pandemia de la COVID-19, entre diciembre del año 2020 y marzo del año 2021 / User's perception of the accompaniment by the Mental Health Service of the Dr. Robert Reid Cabral Children's Hospital during the COVID-19 pandemic, from December 2020 & March 2021

Introducción: a finales del año 2019 el mundo se enfrentó al SARS-CoV-2, coronavirus causante de la COVID-19 y declarada pandemia en marzo del 2020. En este contexto, los servicios de salud han necesitado reorganizar, diseñar estrategias o interrumpir sus servicios de rutina, y muchos dejaron de brindar atención a las personas en tratamiento contra enfermedades de salud mental y condiciones crónicas. Asimismo, muchos trabajadores de la salud que suelen brindar esta atención fueron redirigidos a la respuesta de COVID-19. Material y Métodos: se realizó un estudio observacional, descriptivo y transversal, con el objetivo de estudiar la percepción de los usuarios sobre el acompañamiento del Servicio de Salud Mental del Hospital Infantil Dr. Robert Reid Cabral durante la pandemia de la COVID-19, entre diciembre 2020 y marzo 2021. La población estuvo conformada por un total de 237 pacientes, de la cual un 19 % fue incluido en la investigación final. Discusión: más de la mitad de los usuarios del servicio de Salud Mental de nuestro Hospital percibió el acompañamiento recibido como bueno. Esto coincide con otros estudios internacionales que igualmente han utilizado herramientas como telesalud para mantener el contacto y la atención con los pacientes. No encontramos diferencias significativas en la cantidad de pacientes con contactos positivos confirmados entre sus convivientes y las alteraciones en los patrones de sueño, alimentación y conducta, en comparación con aquellos que no tuvieron un contacto positivo confirmado entre sus convivientes. Conclusiones: la oferta de acceso a servicios de salud a distancia resulta ser una buena alternativa para ofrecer a los pacientes y a sus familias, brindar una atención oportuna a los conflictos presentados, y, cuando es implementada apropiadamente, las familias beneficiadas perciben como bueno el servicio ofrecido.

Introduction: At the end of 2019, the world faced SARS-CoV-2, the coronavirus that causes COVID-19, declared a pandemic in March 2020. In this context, health services have needed to reorganize, design strategies or interrupt their services routine, and many stopped providing care to people being treated for mental health illnesses and chronic conditions. Additionally, many healthcare workers who typically provide this care were redirected to the COVID-19 response. Material and methods: An observational, descriptive and cross-sectional study was carried out, with the aim of studying the perception of users about the follow-up of the Mental Health Service of the Dr. Robert Reid Cabral Children's Hospital during the COVID-19 pandemic, between December 2020 and March 2021. The population consisted of a total of 237 patients, of which 19% were included in the final investigation. Discussion: More than half of the users of the Mental Health service of our Hospital perceived the accompaniment received as good. This coincides with other international studies that have also used tools such as telehealth to maintain contact and care with patients. A single review study recorded the perception of the users interviewed towards the remote mental health care service, where they qualify it, in general terms, as good, which coincides with our results. We found no significant differences in the number of patients with confirmed positive contacts between their partners and alterations in sleep, eating and behavior patterns, compared to those who did not have a confirmed positive contact between their partners. A single review study recorded the perception of the users interviewed towards the remote mental health care service, where they qualify it, in general terms, as good, which coincides with our results. Conclusions: The offer of access to remote health services turns out to be a good alternative to offer patients and their families, provide timely attention to the conflicts presented, and, when properly implemented, the beneficiary families perceive the offered service as good.

[Level of training in autistic spectrum disorders among hospital paediatricians]. / Nivel formativo sobre trastornos del espectro autista (TEA) entre los pediatras de atención hospitalaria.

BACKGROUND: Training in autistic spectrum disorders is crucial in order to achieve an early diagnosis. However, the number of papers describing this training is limited. This study describes this level of knowledge among paediatricians from tertiary care hospitals in different regions of Spain and detects areas that need improvement. MATERIAL AND METHOD: A total of one hundred and fifty-seven (157) paediatricians working in tertiary healthcare hospitals located in three different regions in Spain consented to complete an online questionnaire divided in three sections (socio-demographic, knowledge about childhood autism, and opinion). Data were analysed using SPSS version 15. RESULTS: The total mean score of participating paediatricians in the questionnaire was 20.34 (± 2.43 SD) out of a total possible score of 23. Approximately two-thirds (65%) of paediatricians scored more or equal to the mean score. The knowledge gap was found to be higher with symptoms of repetitive behaviour patterns, concept of autism, and comorbidity, with no statistical significance. There were no differences in paediatrician scores within different socio-demographic groups. Just under two-thirds (64%) of paediatricians subscribed to the opinion that their own knowledge about autism is limited, and there is a significant lack of knowledge about facilities in every region. CONCLUSIONS: There is a sufficient level of knowledge about autism among paediatricians in tertiary healthcare, although a lack of awareness about the management of these patients, with poor coordination between the different specialists that are involved in their treatment. Efforts should focus on achieving a better coordination between these specialists, and update the knowledge gaps identified.

[Prevalence and Associated Factors of Mental Disorders in Colombian Child Population, the 2015 National Mental Health Survey]. / Prevalencia y factores asociados a trastornos mentales en la población de niños colombianos, Encuesta Nacional de Salud Mental (ENSM) 2015.

INTRODUCTION: The 2015 National Mental Health Survey aimed to expand our knowledge about the real mental state of children in Colombia, taking into account the fact that most mental disorders in adults begin during childhood or adolescence. It is essential to have an improved knowledge of the magnitude of this issue and to design timely interventions that reduce long term complications. OBJECTIVE: The aim of the study was to determine the prevalence of the disorders in the last 12 months and 30 days according to the DSM-IV, as well as to collect data about social and demographic variables. METHODS: The structured Diagnostic Interview Schedule for Children (DISC-P), which provides DSM-IV diagnoses, was applied to carers of non-institutionalised children between 7 and 11 years old. The disorders evaluated included: major depressive disorder, dysthymia, generalised anxiety disorder, separation anxiety disorder, attention deficit hyperactivity disorder in its three kinds (mixed, inattentive, and hyperactive), oppositional defiant disorder, and conduct disorder. The instrumentation was computer-assisted. RESULTS: Prevalences of the disorders are present both in the last 30 days and in the last 12 months. In general, there is a prevalence of any of the disorders of 3% (95% CI, 2.2-4.0) in the last 30 days, and 4.7% (95% CI, 3.6-6.2) in the last 12 months. When evaluated individually, attention deficit hyperactivity disorder is the most frequent disorder, with a prevalence of 2.3% and 3.0% in the last 30 days and the last 12 months, respectively. In addition, the disorders that are known to frequently begin during childhood are the most common disorders in the age group studied, with a prevalence of 2.5% in the last 30 days and 3.2% in the last year. CONCLUSIONS: The 2015 National Mental Health Survey provides precise information about the real mental situation in children between the ages of 7 and 11 years in Colombia, compared with past epidemiological studies in the country, which were restricted to specific populations. By improving the reliability on knowledge about mental disorders in children, it will be possible to design more appropriate and precise strategies for prevention, diagnosis, and treatment.

Síndrome de Alicia en el país de las maravillas secundario a consumo de montelukast. Presentación de caso / Alice in wonderland syndrome secondary to medication with montelukast. Case presentation

RESUMEN La condición neurológica definida por la aparición de alteraciones en la percepción, usualmente interpretada como fenómenos extraños de metamorfosis y despersonalización, se reconoce como síndrome de Alicia en el país de las maravillas. Se presenta el caso de una paciente femenina de 9 años de edad, con el diagnóstico de síndrome de Alicia en el país de las maravillas secundario a medicación crónica con montelukast. El diagnóstico del síndrome psiquiátrico se realizó teniendo en consideración los antecedentes patológicos personales y el examen físico. El síndrome de Alicia en el país de las maravillas tiene un carácter benigno, sumamente infrecuente, y aunque su etiología no es del todo conocida, su aparición como reacción adversa a medicamentos es una opción que debe ser siempre considerada por el médico actuante (AU).

ABSTRACT The neurological condition defined by the appearance of alterations in perception usually interpreted as strange phenomena of metamorphosis and depersonalization is recognized as Alice in wonderland syndrome. The case of a 9-year-old female patient is presented, with the diagnosis of Alice in Wonderland syndrome secondary to chronic medication with montelukast. The diagnosis of the psychiatric syndrome was made taking into account personal pathological history and physical examination. Alice in Wonderland syndrome has a benign, extremely rare character and although its etiology is not fully known, its appearance, as an adverse reaction to medications, is an option that should always be considered by the acting physician (AU).

Características comportamentais e emocionais de crianças escolares / Behavioral and emotional characteristics of school children

Objetivo: Identificar e analisar características comportamentais e emocionais de crianças escolares do ensino público. Métodos: Trata-se de um estudo descritivo de delineamento transversal. Para a coleta dos dados aplicou-se o Questionário de Capacidades e Dificuldades (Strenghts and Difficulties Questionnaire), que permite aos pais e professores a identificação das características do desenvolvimento socioemocional das crianças. Resultados: Entre os 387 alunos avaliados, a média de idade encontrada foi de 3,7 anos, com discreto predomínio masculino de 51,7%. A porcentagem de crianças na categoria de desenvolvimento anormal foi de 7,8%. Os cinco eixos mensurados pelo instrumento apresentaram desenvolvimento normal. Conclusão: Evidenciou-se que as crianças possuem desenvolvimento satisfatório e possivelmente uma boa saúde mental. (AU)

Objective: To identify and to analyze behavioral and emotional characteristics of public school children. Methods: This is a descriptive cross-sectional study. For data collection we applied the Strenghts and Difficulties Questionnaire of Capacities and Difficulties, which allows parents and teachers to identify the characteristics of their children's social and emotional development. Results: Among the 387 students evaluated, the average age found was 3.7 years, with a slight male predominance of 51.7%. The percentage of children in the abnormal development category was 7.8%. The five axes measured by the instrument showed normal development. Conclusion: It was evidenced that children have satisfactory development and possibly good mental health. (AU)

Objetivo: Analizar las características conductuales y emocionales de los niños de escuelas públicas. Métodos: Este es un estudio descriptivo de corte transversal. Para la recolección de datos, aplicamos el Cuestionario de Fortalezas y Dificultades de Capacidades y Dificultades, que permite a los padres y maestros identificar las características del desarrollo social y emocional de sus hijos. Resultados: Entre los 387 estudiantes evaluados, la edad promedio fue de 3.7 años, con un ligero predominio masculino del 51.7%. El porcentaje de niños en la categoría de desarrollo anormal fue del 7,8%. Los cinco ejes medidos por el instrumento mostraron un desarrollo normal. Conclusion: Se evidenció que los niños tienen un desarrollo satisfactorio y posiblemente una buena salud mental. (AU)

Os primórdios da psiquiatra infantil e seus reflexos no Brasil / The beginnings of the Child Psychiatry and its reflexes in Brazil

A psiquiatria infantil é um ramo de especialidade médica bastante recente desenvolvida entre o final do século XIX e o início do século XX. No Brasil esta disciplina desenvolveu-se a partir de meados do século XX inicialmente vinculada a pediatria e a psicanálise. Assim este artigo tem por finalidade demonstrar a constituição da psiquiatria infantil, a partir de um vértice histórico, e seus reflexos no Brasil. Para tal foram analisados os marcos que delimitaram descobertas e ampliações conceituais constitutivos da psiquiatria infantil durante os séculos XIX e XX. Na sequência, apresenta-se os acontecimentos mais relevantes que delimitam o surgimento da psiquiatria infantil no Brasil, para finalmente destacar que esta disciplina sofreu direta influência da educação, da pediatria e da psicanálise durante seu processo de constituição no país, influência que perdurou até o início da década de 1980.

Child Psychiatry is a very recent branch of medical specialty forged between the late nineteenth andearly twentieth centuries.In Brazil this discipline developed from the middle of the twentieth century initially linked to Pediatrics and Psychoanalysis.Thus, this article aims to demonstrate the constitution of Child Psychiatry, from a historical pointof view, and its reflexes in Brazil.To this end, the frameworks that delimited the discoveries and conceptual expansions that constituted Child Psychiatry during the nineteenth and twentieth centuries were analyzed.Afterwards, we present the most relevant events that determine the emergence of child psychiatry in Brazil, to finally point out that this discipline was directly influenced by Education, Pediatrics and Psychoanalysis during its constitution process in the country, an influence that lasted until the early 1980s.

Atuação do enfermeiro no atendimento ao público infantojuvenil em sofrimento mental: Uma revisão integrativa / Nurses' performance in the care of children and adolescents in mental suffering: An integrative review / Actuación del enfermero en la atención al público infantojuvenil en sufrimiento mental: Una revisión integrativa

CONTEXTO: A qualidade da assistência de enfermagem em saúde mental é essencial na vida das crianças e adolescentes. OBJETIVO: Descrever a atuação do enfermeiro no cuidado ao público infantojuvenil em sofrimento mental. MÉTODO: Revisão integrativa da literatura nas bases de dados BVS e EBSCO, a partir de descritores selecionados. A amostra constituiu-se de 15 artigos, publicados entre 2013 a 2017, disponíveis na íntegra e nos idiomas português, inglês e espanhol. RESULTADOS: A atuação do enfermeiro perpassa pela gestão e organização do cuidado e considera o olhar individualizado e respeitoso. Busca-se a promoção da autonomia e ressocialização desses jovens e suas famílias, a partir da inclusão do familiar/cuidador no planejamento do cuidado. CONCLUSÃO: O olhar ampliado e a variedade de intervenções desempenhadas pelo enfermeiro torna sua prática complexa e fundamental para a qualidade de vida desses jovens. O diferencial em sua atuação está no conhecimento aberto, reflexivo e cientificamente embasado.

BACKGROUND: The quality of nursing care in mental health is essential in the lives of children and adolescents. AIM: To describe the nurse's role with the child and adolescent public in mental suffering. METHOD: Integrative literature review on the VHL and EBSCO databases, from selected descriptors. The sample consisted of 15 articles, published between 2013 and 2017, available in full electronic form and in the Portuguese, English and Spanish languages. RESULTS: Nurses work through the management and organization of care and consider the individualized and respectful look. What is sought is the promotion of the autonomy and resocialization of these young people and their families, from the inclusion of the caregiver in the planning of care. CONCLUSION: The expanded look and variety of interventions performed by nurses makes their practice complex and fundamental to the quality of life of these young people. The differential in its performance lies in open, reflective and scientifically grounded knowledge.

CONTEXTO: La calidad de la asistencia de enfermería en salud mental es esencial en la vida de los niños y adolescentes. OBJETIVO: Describir la actuación del enfermero en el cuidado al público infantojuvenil en sufrimiento mental. MÉTODOLOGÍA: Revisión integrativa de la literatura en las bases de datos BVS y EBSCO, a partir de descriptores seleccionados. La muestra consistió en 15 artículos publicados entre 2013 a 2017, totalmente disponible electrónicamente en portugués, inglés y español. RESULTADOS: La actuación del enfermero pasa por la gestión y organización del cuidado y considera la mirada individualizada y respetuosa. Se busca la promoción de la autonomía y resocialización de estos jóvenes y sus familias, a partir de la inclusión del familiar / cuidador en la planificación del cuidado. CONCLUSIÓN: La mirada ampliada y la variedad de intervenciones desempeñadas por el enfermero hacen su práctica compleja y fundamental para la calidad de vida de esos jóvenes. El diferencial en su actuación está en el conocimiento abierto, reflexivo y científicamente embasado.

Behavior Disorders: knowledge and actions of health professionals and social work / Trastornos de la Conducta: conocimiento y acciones de los profesionales de la salud y asistencia social / Transtornos do Comportamento: conhecimentos e ações de profissionais de saúde e assistência social

ABSTRACT Objective: to identify the knowledge of professionals of mental health services and social work on Behavior Disorders (BD) in childhood and adolescence, and to analyze their actions in care for children and adolescents with such disorders. Method: a qualitative, descriptive-exploratory study with 13 professionals from two mental health services and two tutorial councils. The data were collected in interviews and submitted to thematic content analysis. Results: three categories emerged from the interviews: "Knowledge about behavior disorders", which defines BD as deviations from normality and lack of limits. "Integrated and group care", which explains the integrated, multidisciplinary and group actions. "Specialized and legal care", which explains the actions through specialized, medical and judicial care. Final considerations: the results point out weaknesses and knowledge gaps of professionals, causing potential harm in the programming of effective actions, such as identification, referral and therapeutic planning.

RESUMEN Objetivo: identificar los conocimientos de los profesionales de los servicios de salud mental y asistencia social en Trastornos de la Conducta (TC) en la infancia y la adolescencia, y analizar sus acciones en la atención a niños y adolescentes con tales trastornos. Método: estudio cualitativo, descriptivo-exploratorio con 13 profesionales de dos servicios de salud mental y dos consejos de tutoría. Los datos fueron recolectados en entrevistas y sometidos a análisis de contenido temático. Resultados: de las entrevistas surgieron tres categorías: "Conocimiento sobre trastornos de conducta", que define la TC como desviaciones de la normalidad y la falta de límites. "Atención integrada y grupal", que explica las acciones integradas, multidisciplinares y grupales. "Atención especializada y jurídica", que explica las acciones a través de la atención especializada, médica y judicial. Consideraciones finales: los resultados señalan las debilidades y las brechas de conocimiento de los profesionales, causando un daño potencial en la programación de acciones efectivas, como la identificación, la referencia y la planificación terapéutica.

RESUMO Objetivo: identificar o conhecimento dos profissionais de serviços de saúde mental e assistência social sobre os Transtornos de Comportamento (TC) na infância e adolescência, e analisar suas ações na atenção a crianças e adolescentes com tais transtornos. Método: estudo qualitativo, descritivo-exploratório com 13 profissionais de dois serviços de saúde mental e dois conselhos tutelares. Os dados foram coletados em entrevistas e submetidos à análise de conteúdo temático. Resultados: três categorias emergiram das entrevistas: "Conhecimentos acerca dos transtornos de comportamento", que define os TC como desvios da normalidade e falta de limites. "O cuidado integrado e em grupo", que explica as ações integradas, multidisciplinares e através de grupos. "O cuidado especializado e jurídico", que explica as ações através do cuidado especializado, medicamentoso e judicial. Considerações finais: os resultados apontam fragilidades e lacunas de conhecimento dos profissionais acarretando potenciais prejuízos na programação de ações eficazes, como identificação, encaminhamento e planejamento terapêutico.

Auditory training methods in children with psychiatric diagnosis: an integrative literature review / Métodos de treinamento auditivo em crianças com diagnóstico psiquiátrico: revisão integrativa da literatura

ABSTRACT Purpose: to identify auditory training approaches used in the pediatric population with psychiatric diagnoses and to characterize the contexts in which the intervention took place, as well as protocols and discernment of the results. Methods: a search was carried out in four databases, using the fixed terms "auditory training" OR "auditory rehabilitation". Regarding the sampling, there was a considerable range of diagnoses, signs and symptoms, including the most common ones. Articles published until August 2018 whose population did not present hearing loss were selected; articles whose subjects had made use of any personal sound amplification products, presented otitis or had any isolated diagnosis of auditory processing disorder, were excluded. Results: 16 articles out of the 103 references found, met the inclusion criteria. The samplings studied were children and adolescents with learning, language or reading disorders, dyslexia, attention deficit hyperactivity disorder, autism spectrum disorder and schizophrenia. The bottom-up intervention and the combined approach (bottom-up and top-down), in the formal context, were the most frequent approaches, whose results led to the improvement in linguistic, metalinguistic and auditory skills. The amount and frequency of sessions, as well as their duration varied. Conclusion: the heterogeneity of auditory training techniques diversified the results. However, it seems there is a potential for recommending auditory training in the reviewed population.

RESUMO Objetivo: identificar as abordagens de treinamento auditivo utilizadas na população infantil com diagnósticos psiquiátricos, caracterizar os contextos de intervenção, protocolos e discernimento dos desfechos. Métodos: busca realizada em quatro bases de dados, utilizando as expressões fixas "auditory training" OR "auditory rehabilitation" e, quanto à amostragem, variaram-se aos mais comuns diagnósticos, sinais e sintomas. Foram selecionados artigos publicados até agosto de 2018, com população sem perda auditiva e excluídos artigos com amostra com uso de dispositivos de amplificação sonora, otites ou diagnóstico isolado de Transtorno do Processamento Auditivo. Resultados: foram identificadas 103 referências, dentre as quais 16 preencheram os critérios de inclusão. As amostragens estudadas foram de crianças e adolescentes com distúrbios de aprendizagem, linguagem e leitura, dislexia, transtorno do déficit de atenção e hiperatividade, transtorno do espectro autista e esquizofrenia. As intervenções com a abordagem bottom-up e combinada (bottom-up e top-down), no contexto formal, foram as mais frequentes, cujos resultados direcionaram a melhora em habilidades auditivas, linguísticas e metalinguísticas. O número e frequência de sessões, assim como, a duração (tempo) foram diversificadas. Conclusão: a heterogeneidade das técnicas de treinamento auditivo diversificou os resultados, entretanto, parece existir um potencial para recomendação do treinamento auditivo na população abordada.

Adolescente con autolesiones no suicidas en un entorno de adversidad psicosocial / Adolescent with non-suicidal self-harm in a psychosocial adversity environment

Las conductas lesivas no suicidas suponen un problema sanitario de creciente importancia, con una prevalencia en muestras comunitarias de adolescentes del 15-20 %. Las autolesiones pueden tener un significado diverso; se clasifican en intrapersonales o interpersonales; son un factor de riesgo y evolutivo, con inicio en la adolescencia temprana. Se presenta el caso de una adolescente de 12 años con factores de riesgo psicosociales, que acudió a la consulta por cortes autoinfligidos en los brazos y las piernas, realizados con una cuchilla de afeitar, detectados en el colegio. Se intervino potenciando la autoestima y en regulación de emociones con intervención multidisciplinar (sistema educativo, servicios sociales, psiquiatría infantojuvenil y pediatría), con una evolución positiva. Es vital su detección y abordaje con el paciente y su familia para evitar riesgos futuros, especialmente, de patología psíquica. La intervención se realiza desde la Atención Primaria, pero precisa la colaboración de otros profesionales.

Non-suicidal harmful behaviors pose a health problem of increasing importance, with a prevalence in community samples of adolescents of 15-20 %. Self-harm can have adverse meaning, qualifying in intrapersonal or interpersonal; they are a risk and evolutionary factor, with an age of onset in early adolescence. We present the case of a 12-year-old adolescent with psychosocial risk factors, who went to the consultation for self-cuts in arms and legs, made with a razor, detected in the school. It was enhanced her self-steem an guided in regulation of emotions with multidisciplinary intervention (educational system, social services, infantile-juvenile Psychiatry and Pediatrics), with a positive evolution. It is vital to detect and approach this issue with the patient and the family to avoid future risks, especially psychic pathology. The intervention is done from Primary Care, but it is necessary the collaboration of other professionals.

[Psychiatric Disorders in Pediatric Patients With Systemic Lupus Erythematosus in a Reference Hospital]. / Trastornos psiquiátricos en pacientes pediátricos con lupus eritematoso sistémico en un hospital de referencia.

OBJECTIVE: To describe the psychiatric manifestations in pediatric patients with systemic erythematous lupus seen in the Fundación Hospital de la Misericordia. METHODS: Observational descriptive study. Medical charts and test results of inpatients and outpatients between 2007 and2013 were reviewed; 39 patients were selected. SPSS 19 was used for statistical analysis. Statistical significance was considered with P=.05. RESULTS: Mean age was 13.7 (2.33), with 78.9% female. The most frequent psychiatric manifestation was anxiety (52.6%), followed by adjustment disorder and depression (36.8% each one), psychosis (10%), conversion disorder (7.9%), and obsessive compulsive disorder (5.3%). The mean SLICC score was 2.76 (2.8), and the mean SLEDAI score was 20.81 (20.82). Antinuclear antibodies were positive in 81.25%. Neuropsychiatric lupus was diagnosed in 65.8% of patients; seizures were observed in 23.7%, headache in 36.8%, stroke in 13.2%, vasculitis, chorea 5.3%, and meningitis 5.3% of patients. The mean time from lupus diagnosis was 20.47 (22.2) months, with the shortest period for adjustment disorder and the longest period in patients with conversion disorder (pseudo-seizures) being 15 months and 31 months, respectively. The highest SLEDAI score was in patients with psychosis (35.5 [16.21] vs 19.08 [13.72]; P=.032), and also the highest disease damage (SLICC, 4.25 [4.03] vs 2.58 [2.67]; P=.27) in comparison with the other manifestations. CONCLUSIONS: The most frequent psychiatric manifestations were anxiety, depression, and adjustment disorder, with a higher frequency than other studies, and with lupus activity principally in patients with psychosis.

Validación del M-CHAT-R/F como instrumento de tamizaje para detección precoz en niños con trastorno del espectro autista / M-CHAT-R/F validation as a screening tool for early detection in children with autism spectrum disorder

INTRODUCCIÓN: El tamizaje de los Trastornos del Espectro Autista (TEA) mediante el Modified Chec klist for Autism in Toddlers - Revised with Follow Up (M-CHAT-R/F) aumenta la detección precoz, posibilitando intervenciones tempranas y mejorando el pronóstico. Este instrumento es parte del algoritmo de manejo ante la sospecha de TEA en diversas guías clínicas. El objetivo fue realizar la validación concurrente, discriminante y el análisis de confiabilidad del M-CHAT-R/F en una pobla ción chilena. PACIENTES Y MÉTODO: Esta es la segunda etapa de la adaptación transcultural, de diseño transversal. Se aplicó M-CHAT-R/F a una muestra de 20 niños con sospecha de TEA y 100 niños de control sano seleccionados al azar, de 16-30 meses de edad. Se aplicó Autism Diagnostic Observation Schedule (ADOS-2), considerado como referencia, a los 20 pacientes de la muestra clínica, a 20 niños de la muestra de control sano y a aquellos casos de la muestra de control sano con M-CHAT-R/F po sitivo. Se calculó alfa de Cronbach, análisis de correlación de M-CHAT-R/F y ADOS-2 y sensibilidad y especificidad. RESULTADOS: En el grupo de control sano, M-CHAT-R/F resultó alterado en 2 pacien tes, siendo uno positivo y otro negativo para TEA con ADOS-2. En muestra clínica el M-CHAT-R/F fue positivo en todos, con test de ADOS-2 negativo en 3 casos. La confiabilidad Alfa del M-CHAT- R/F fue =0,889, la sensibilidad y especificidad discriminante de 100 y 98% y la concurrente 100% y 87,5% respectivamente. CONCLUSIÓN: M-CHAT-R/F en su versión chilena resultó fiable, sensible y específico de manera similar al original, lo cual abre la posibilidad de su utilización en población clínica y para investigación. La validación es un proceso continuo que se debe profundizar.

INTRODUCTION: Screening for Autism Spectrum Disorders (ASD) using the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) increases early detection, allowing early interventions and improving prognosis. This tool is part of the management in case of suspected ASD in several clinical guidelines. The objective of this article was to conduct the concurrent and discrimi nant validation and the reliability analysis of M-CHAT-R/F in the Chilean population. PATIENTS AND METHOD: This is the second stage of the cross-cultural adaptation of cross-sectional design. M-CHAT- R/F was applied to a sample of 20 children with suspected ASD and 100 randomly selected healthy control children, aged between 16-30 months. Autism Diagnostic Observation Schedule (ADOS-2), considered as reference, was applied to the 20 patients of the clinical sample, to 20 children of the healthy control sample and to those cases of the healthy control sample with M-CHAT-R/F positive. Cronbach alpha was calculated, as well as M-CHAT-R/F and ADOS-2 correlation, sensitivity, and specificity analyses. RESULTS: In the healthy sample, M-CHAT-R/F was positive in two patients, with one of them positive and the other one negative for ASD with ADOS-2 test. In the clinical sample, M- CHAT-R/F was positive in all cases, three of them were negative in the ADOS-2 test. The Alfa relia bility of M-CHART-R/T was 0,889, the discriminant sensitivity and specificity were 100% and 98%, and the concurrent ones were 100% and 87.5% respectively. CONCLUSIONS: The Chilean M-CHAT- R/F version was reliable, sensitive and specific, similar to the original test, which opens the possibility for its use in clinical samples and for research. Validating M-CHAT-R/F is an ongoing process which must be further developed.

Prevalencia de trastornos mentales en menores de edad atendidos en un hospital psiquiátrico departamental / Prevalence of mental disorders in children treated in a public psychiatric hospital

RESUMEN Objetivo Determinar la prevalencia de los trastornos mentales presentados en menores de edad en un hospital psiquiátrico departamental. Método Estudio de prevalencia de periodo. Se empleó una base de datos secundaria suministrada por el Hospital Psiquiátrico Universitario del Valle (HPUV) de Santiago de Cali, proveniente del registro de la historia clínica sistematizada correspondiente al año 2014. La población estuvo conformada por los pacientes menores de edad que consultaron durante el periodo, se utilizó la totalidad de los registros disponibles en la base de datos. Resultados Del total de consultas atendidas se encontró que el 35,7% (755) correspondía al sexo femenino y el 64,3% al masculino (1 361). El principal diagnostico psiquiátrico atendido en esta población fue el episodio depresivo con 11,6% seguido por los trastornos mixtos de la conducta y de las emociones con un 8,5%. Conclusiones La evolución en el tiempo de la salud mental no ha cambiado significativamente. La pasada encuesta nacional de salud mental 2015 presenta resultados similares al encontrado en el presente estudio, particularmente en la región pacífica, donde la depresión y trastornos de conducta son más prevalentes.(AU)

ABSTRACT Objective To determine the prevalence of mental disorders in children treated at a regional psychiatric hospital. Materials and Methods Period prevalence study. A secondary database was supplied by the Hospital Psiquiátrico Universitario del Valle (HPUV) of Santiago de Cali. This database came from the systematized clinical history of the year 2014. The population consisted of underage patients who consulted during the period. All the records available in the database were used. Results Of the total number of children who visited the clinic, 35.7% (755) were females and 64.3% were males (1 361). The main psychiatric diagnosis observed in this population was depressive episode (11.6%), followed by mixed behavioral and emotional disorder (8.5%). Conclusions The evolution of mental health over time has not changed significantly. The 2015 National Mental Health Survey presents similar results to those found in this study, particularly in the Pacific region, where depression and behavioral disorders are more prevalent.(AU)

O pediatra deve investigar sintomas de transtornos obsessivos compulsivos em crianças com dificuldades alimentares? / Should pediatricians investigate the symptoms of obsessive-compulsive disorder in children with feeding difficulties?

RESUMO Objetivo: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. Métodos: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação "transtorno obsessivo compulsivo" e "picky eating/dificuldade alimentar". Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. Resultados: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. Conclusões: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas.

ABSTRACT Objective: To review current evidence on the relationship between obsessive-compulsive disorder and feeding difficulties. Methods: Review the Science Direct and PubMed databases between 2007 and 2017 in English, Portuguese and Spanish. The search terms, used in association, were "obsessive compulsive disorder" and "picky eating/feeding difficulty". Cohort, case control and cross sectional studies were included that analyzed children, adolescents and/or adults of any sample size from any country in the world. Opinion articles were excluded. Results: Around 245 articles were selected, and only 4 were included in this review, according to previous criteria. Results from the studies essentially described that there is indeed a difference in "picky" behaviors between subjects with and without obsessive-compulsive disorder. Patients with obsessive-compulsive disorder tend to have exacerbated symptoms of disgust, anxiety and a higher eating behavior inflexibility score. Conclusions: Obsessive-compulsive disorder and feeding difficulties patients share common symptoms. The present study alerts health professionals who follow patients with feeding difficulties as to the importance of investigating possible psychiatric comorbidities.

Psicodinâmica contemporânea em pedopsiquiatria - abordagens Integrativas / Contemporary psychodynamics in child psychiatry - integrative approaches

A prática clínica em pedopsiquiatria reveste-se de desafios na compreensão e abordagem clínica dos pacientes e do seu contexto. Desta forma, o pedopsiquiatra de hoje em dia tem a necessidade de integrar múltiplas vertentes de conhecimento na sua formação e na sua prática numa formulação biopsicossocial. No entanto, cada um dos elementos desta tríada possui raízes históricas e uma série de premissas e referenciais teóricos diferentes, tornando-se, muitas vezes, dificultada a sua conjugação. Existe, portanto, uma necessidade de integrar perspetivas relacionais terapêuticas contemporâneas numa ótica de harmonização e como informadoras da atividade clínica em psiquiatria da infância e da adolescência. Os autores propõem uma revisão conceptual sobre o papel do paradigma psicodinâmico contemporâneo na pedopsiquiatria, com uma orientação para a prática clínica e flexível na compreensão e intervenção.(Aut)

Clinical practice in child and adolescent psychiatry is full of challenges in the clinical understanding and management of our patients and their contexts. The child psychiatrists of today feel a growing need to integrate information from multiple fields of knowledge in their education and in their clinical practice, under a biopsychosocial formulation. However, each of the elements of this triad has different premises, historic backgrounds and theoretical referentials, frequently making their conjugation a very difficult task. Therefore, it is necessary to integrate contemporary relational therapeutic approaches under the scope of a more flexible and informed child psychiatry clinical practice. The authors suggest a conceptual review about the role of a contemporary psychodynamic paradigm in child psychiatry, with a useful clinical practice orientation and with flexibility both in understanding and intervention.(Aut)