[Features of adolescents hospitalized for a suicide attempt in a general hospital]. / Conducta suicida en niños y adolescentes ingresados en un hospital general. Análisis descriptivo.

BACKGROUND: Worldwide, suicide is the third cause of death among adolescents. AIM: To determine the socio-demographic context and clinical characteristics of children and adolescents hospitalized for suicidal behavior in a general hospital. MATERIAL AND METHODS: Between 2007 and 2009, we evaluated 47 patients with a mean age of 15.3 years (87% women) admitted for suicidal behavior at the Clinical Hospital of the Catholic University of Chile. Demographic data of the participants were registered. Clinical interviews were done by a child and adolescent psychiatrist. RESULTS: Fifty seven percent of patients lived with both parents. Fifty one percent had previous suicide attempts and 68% had a previous psychiatric treatment. The main trigger was a conflict with parents in 66%. The psychiatric diagnoses were major depressive episode in 74.5% and pathological development of personality in 43%. All suicide attempts were with drugs and 6.4% were associated with cuts. Seventeen percent of attempts were classified as medically serious and they were more common in older age groups. Non severe attempts were observed mainly in women (92.3%). Acetaminophen intake was recorded in 8.5% of cases. Admission to hospital increased in the final quarter of the year. High costs of hospitalization were observed associated to stays in high complexity units. CONCLUSIONS: The population studied shows a high incidence of prior suicidal behavior. Most of the studied patients had attempts that were not classified as serious. These occurred predominantly in women in all age ranges. Medically serious suicidal behavior is mainly observed in older adolescents.

Long-term outcomes of psychological interventions on children and young people's mental health: A systematic review and meta-analysis.

BACKGROUND: Over 600 RCTs have demonstrated the effectiveness of psychosocial interventions for children and young people's mental health, but little is known about the long-term outcomes. This systematic review sought to establish whether the effects of selective and indicated interventions were sustained at 12 months. METHOD: We conducted a systematic review and meta-analysis focusing on studies reporting medium term outcomes (12 months after end of intervention). FINDINGS: We identified 138 trials with 12-month follow-up data, yielding 165 comparisons, 99 of which also reported outcomes at end of intervention, yielding 117 comparisons. We found evidence of effect relative to control at end of intervention (K = 115, g = 0.39; 95% CI: 0.30-0.47 I2 = 84.19%, N = 13,982) which was maintained at 12 months (K = 165, g = 0.31, CI: 0.25-0.37, I2 = 77.35%, N = 25,652) across a range of diagnostic groups. We explored the impact of potential moderators on outcome, including modality, format and intensity of intervention, selective or indicated intervention, site of delivery, professional/para-professional and fidelity of delivery. We assessed both risk of study bias and publication bias. CONCLUSIONS: Psychosocial interventions provided in a range of settings by professionals and paraprofessionals can deliver lasting benefits. High levels of heterogeneity, moderate to high risk of bias for most studies and evidence of publication bias require caution in interpreting the results. Lack of studies in diagnostic groups such as ADHD and self-harm limit the conclusions that can be drawn. Programmes that increase such interventions' availability are justified by the benefits to children and young people and the decreased likelihood of disorder in adulthood.

Neurobiologic basis of craving for carbohydrates.

OBJECTIVES: There is a relationship between emotional disorders, obesity, and craving for carbohydrates. This relationship complicates the success of treatments aimed at combatting obesity, which is considered to be the epidemic of the twenty-first century. We conducted a review of the neurobiologic basis for carbohydrate craving, with the hope that this understanding will enable the design of more efficient therapeutic strategies. METHOD: We conducted a non-systematic literature search in PubMed using MeSH. RESULTS: Research on the basis of carbohydrate craving is varied, but may be grouped into five main areas: the serotonergic system, palatability and hedonic response, the motivational system, stress response systems, and gene-environment interaction. CONCLUSIONS: The models that integrate motivational systems with palatability and hedonic response studies are the ones that we believe can best explain both craving for carbohydrates and related addictive phenomena. Research has contributed to a greater understanding of the neurobiologic basis of carbohydrate craving. The latter, in turn, contributes to an understanding of the implications, challenges, and possible therapies that might be put in place to cope with this phenomenon.

Conducta suicida en niños y adolescentes ingresados en un hospital general: Análisis descriptivo / Features of adolescents hospitalized for a suicide attempt in a general hospital

Background: Worldwide, suicide is the third cause of death among adolescents. Aim: To determine the socio-demographic context and clinical characteristics of children and adolescents hospitalized for suicidal behavior in a general hospital. Material and Methods: Between 2007 and 2009, we evaluated 47 patients with a mean age of 15.3 years (87% women) admitted for suicidal behavior at the Clinical Hospital of the Catholic University of Chile. Demographic data of the participants were registered. Clinical interviews were done by a child and adolescent psychiatrist. Results: Fifty seven percent of patients lived with both parents. Fifty one percent had previous suicide attempts and 68% had a previous psychiatric treatment. The main trigger was a conflict with parents in 66%. The psychiatric diagnoses were major depressive episode in 74.5% and pathological development of personality in 43%. All suicide attempts were with drugs and 6.4% were associated with cuts. Seventeen percent of attempts were classified as medically serious and they were more common in older age groups. Non severe attempts were observed mainly in women (92.3%). Acetaminophen intake was recorded in 8.5% of cases. Admission to hospital increased in the final quarter of the year. High costs of hospitalization were observed associated to stays in high complexity units. Conclusions: The population studied shows a high incidence of prior suicidal behavior. Most of the studied patients had attempts that were not classified as serious. These occurred predominantly in women in all age ranges. Medically serious suicidal behavior is mainly observed in older adolescents.

Encopresis: un problema que se oculta / Encopresis: a hidden problem

La encopresis es un problema común en la infancia que se presenta en escenarios pediátricos, psiquiátricos y psicológicos y tiene un impacto significativo en el funcionamiento social y emocional del niño y en su familia.

Delirium en niños y adolescentes / Delirium in children and adolescents

La comprensión del delirium es fundamental en el campo de la psiquiatría infanto-juvenil, pero también en otras especialidades que tratan niños. Estos comienzan bruscamente con alteración de la conciencia, de la memoria, del lenguaje, ideas delirantes durante el curso de una enfermedad, por el uso de sustancias o en el postoperatorio. Es importante la familiarización con los síntomas y tratamiento del delirium en niños y adolescentes así como reconocer el riesgo que conlleva.

El trastorno de ansiedad por separación en la infancia / Separation anxiety disorder in children

La ansiedad por separación es fisiológica entre los 6 meses y 6 años de edad, puede diagnosticarse como un trastorno cuando no es apropiada para el nivel de desarrollo y altera la funcionalidad del niño. Es importante tener presente esta trastorno en la práctica pediátrica, detectar factores de riesgo, diagnosticarlo y tratarlo oportunamente. De esta forma se fomente la autonomía y capacidad de relaciones empáticas del niño.