Internet, video game and mobile phone addiction in children and adolescents diagnosed with ADHD: A case-control study. / Adicción a Internet, videojuegos y teléfonos móviles en niños y adolescentes: Un estudio de casos y controles.

The use of new technologies has become widespread worldwide. There is increasing concern about "Internet addiction disorder" (IAD), "Internet gaming disorder" (IGD), and "Mobile phone addiction" (MPA). Attention Deficit Hyperactivity Disorder (ADHD) has been associated with IAD and IGD. However, evidence is lacking about the relationship between ADHD and MPA. Naturalistic case-control study. 112 patients (51 children with and 61 children without ADHD) between 7 and 17 years old were compared regarding IAD, IGD, and MPA. We used the TEA questionnaire for the assessment of executive function and ADHD (ATENTO), and the ADITEC questionnaire to get gender-differentiated information for IAD, IGD, and MPA. Female children scored higher on MPA (Mean ± Standard Deviation, M ± SD) (25.93 ±  17.64 vs. 14.77 ±  19.43, p=0.03), while male children scored higher on IGD (30.09 ± 21.65 vs. 12.51 ± 16.61, p < 10^-3). Severity of hyperactivity/impulsivity and IGD were moderately correlated (r=0.349, p=0.013), but the correlation disappeared after controlling for the impact on the social domain as measured by the ATENTO questionnaire (r=171, p=0.250). Most parents are concerned that their children may be addicted to IAD/IGD/MPA. Female gender is associated with MPA, while male gender is associated with IGD. ADHD is a risk factor for developing IAD and IGD. Combined type and predominantly hyperactive/impulsive ADHD are each associated with IGD. Good social adjustment protects against developing IGD. There are gender vulnerabilities for IAD/IGD/MPA. ADHD is a risk factor for IGD, but good social adjustment buffers this association.

El uso de las nuevas tecnologías se ha generalizado a nivel mundial. Hay una creciente preocupación respecto del «trastorno de adicción a Internet¼ (TAI), el «trastorno de juego en Internet¼ (TJI) y la «adicción al teléfono móvil¼ (ATM). El trastorno por el déficit de atención con hiperactividad (TDAH) se ha asociado con el TAI y el TJI. Sin embargo, falta evidencia sobre la relación entre el TDAH y la ATM. Estudio naturalista de casos y controles. Comparación de 112 pacientes (51 niños con el TDAH y 61 niños sin el TDAH) con edades entre 7-17 años respecto del TAI, el TJI y la ATM. Utilizamos el cuestionario de TEA para evaluar la función ejecutiva y el TDAH (ATENTO) y el cuestionario ADITEC para obtener información diferenciada por género para el TAI, el TJI y la ATM. Las niñas obtuvieron puntuaciones más altas en la ATM (desviación típica ± media, DT ± M) (25,93 ± 17,64 vs. 14,77 ± 19,43, p = ,03), mientras que los niños obtuvieron puntuaciones más altas en el TJI (30,09 ± 21,65 vs. 12,51 ± 16,61, p < 10

Adicción a Internet, videojuegos y teléfonos móviles en niños y adolescentes: Un estudio de casos y controles / Internet, video game and mobile phone addiction in children and adolescents diagnosed with ADHD: A case-control study

El uso de las nuevas tecnologías se ha generalizado a nivel mundial.Hay una creciente preocupación respecto del «trastorno de adicción aInternet» (TAI), el «trastorno de juego en Internet» (TJI) y la «adicciónal teléfono móvil» (ATM). El trastorno por el déficit de atención conhiperactividad (TDAH) se ha asociado con el TAI y el TJI. Sin embargo, falta evidencia sobre la relación entre el TDAH y la ATM. Estudionaturalista de casos y controles. Comparación de 112 pacientes (51 niños con el TDAH y 61 niños sin el TDAH) con edades entre 7-17 añosrespecto del TAI, el TJI y la ATM. Utilizamos el cuestionario de TEApara evaluar la función ejecutiva y el TDAH (ATENTO) y el cuestionario ADITEC para obtener información diferenciada por género para elTAI, el TJI y la ATM. Las niñas obtuvieron puntuaciones más altas enla ATM (desviación típica ± media, DT ± M) (25,93 ± 17,64 vs. 14,77 ±19,43, p = ,03), mientras que los niños obtuvieron puntuaciones másaltas en el TJI (30,09 ± 21,65 vs. 12,51 ± 16,61, p < 10-3). Hubo una correlación moderada entre la gravedad de hiperactividad/impulsividady el TJI (r = ,349, p = ,013), pero la correlación desapareció después decontrolar por el impacto en el ámbito social según las mediciones delcuestionario ATENTO (r = 171, p = ,250). A la mayoría de los padres lespreocupa que sus hijos puedan tener el TAI, el TJI o la ATM. El génerofemenino está asociado con la ATM, mientras que el género masculinoestá asociado con el TJI. El TDAH es un factor de riesgo para el desarrollo del TAI y el TJI. El TDAH del tipo combinado y de predominiode hiperactividad/impulsividad están asociados con el TJI. Un buenajuste social protege contra el desarrollo del TJI. Hay vulnerabilidadesde género para el TAI, el TJI y la ATM. El TDAH es un factor de riesgopara el TJI, pero un buen ajuste social amortigua esta asociación. (AU)

The use of new technologies has become widespread worldwide.There is increasing concern about “Internet addiction disorder”(IAD), “Internet gaming disorder” (IGD), and “Mobile phone addiction” (MPA). Attention Deficit Hyperactivity Disorder (ADHD) hasbeen associated with IAD and IGD. However, evidence is lacking aboutthe relationship between ADHD and MPA. Naturalistic case-controlstudy. 112 patients (51 children with and 61 children without ADHD)between 7 and 17 years old were compared regarding IAD, IGD, andMPA. We used the TEA questionnaire for the assessment of executivefunction and ADHD (ATENTO), and the ADITEC questionnaire toget gender-differentiated information for IAD, IGD, and MPA. Femalechildren scored higher on MPA (Mean ± Standard Deviation, M ± SD)(25.93 ± 17.64 vs. 14.77 ± 19.43, p=0.03), while male children scoredhigher on IGD (30.09 ± 21.65 vs. 12.51 ± 16.61, p<10-3). Severity of hyperactivity/impulsivity and IGD were moderately correlated (r=0.349,p=0.013), but the correlation disappeared after controlling for the impact on the social domain as measured by the ATENTO questionnaire(r=171, p=0.250). Most parents are concerned that their children maybe addicted to IAD/IGD/MPA. Female gender is associated with MPA,while male gender is associated with IGD. ADHD is a risk factor fordeveloping IAD and IGD. Combined type and predominantly hyperactive/impulsive ADHD are each associated with IGD. Good socialadjustment protects against developing IGD. There are gender vulnerabilities for IAD/IGD/MPA. ADHD is a risk factor for IGD, butgood social adjustment buffers this association. (AU)

A proposal for using the ratio of attempted to completed suicides across several countries worldwide.

Completed suicide (CS) is a leading cause of death worldwide and its rates are available for most developed countries. On the other hand, attempted suicide (AS) is a risk factor for CS but there are limited data on its rates in various countries. In constructing a ratio for AS/CS rates, most would agree that for CS, the denominator should be the annual suicide rate (per 100 000). As for the ratio's numerator (AS) per 100 000, there are three possible calculations: (1) annual prevalence from population surveys, (2) annual prevalence from national clinical registers or (3) lifetime prevalence from population surveys. We think that the first possibility would probably be the best choice but, unfortunately, surveys providing the annual prevalence of AS are lacking for most countries. Annual prevalence from national registers is also lacking for most countries and is contaminated by under-reporting. Therefore, in this editorial, we are left with only the last option, a ratio for lifetime prevalence of AS (per 100 000) divided by annual rate of CS (per 100 000). This ratio for AS/CS rates appears to differ substantially across countries worldwide but presents no big regional differences other than two remarkable exceptions, one per continent. In Europe, Spain and France had greater ratios (174.4 and 152.5, respectively) than Italy (64.1). In Asia/Pacific, New Zealand has a higher ratio (345.9) compared with China (75.8) and Japan (76.9). The ratio for AS/CS rates could be a good index for implementing evidence-informed decision-making regarding suicidal behaviour (SB) among health service managers, and for helping them in the allocation of health resources for the prevention of SB.

Further evidence of DEPDC7 DNA hypomethylation in depression: A study in adult twins.

Late and early stressful factors have widely been recognized to play a role in the aetiology of depression. Recent research indicates that such adverse environmental stimuli may alter gene expression in humans via epigenetic modifications. While epigenetic changes such as DNA methylation are likely involved in these processes, it is still unknown what specific genomic loci may be hyper- or hypo-methylated in depression. The association between depressive symptoms during the last 30 days (Brief Symptom Inventory [BSI]) and peripheral-blood DNA methylation levels at genomic loci previously reported as epigenetically altered in saliva and brain of depressive patients was evaluated in a community sample of 34 adult Caucasian MZ twins (17 pairs). Intrapair DNA methylation differences in an intron of DEPDC7 (chr11:33040743) were associated with intrapair differences in current depressive symptoms. Accordingly, a site-specific 10% DNA hypomethylation in a co-twin would correlate with a current depressive symptom score around 3.1 BSI points above the score of his/her less-depressed co-twin. These findings indicate that DEPDC7 hypomethylation in peripheral blood DNA may be associated with recent depressive symptomatology, in line with previous results.

Tratamiento farmacológico estimulante del TDAH / Stimulant drug treatment

El trastorno por déficit de atención e hiperactividad (TDAH) es el trastorno del neurodesarrollo más frecuente en la infancia. Es un trastorno cognitivo-conductual con una base genética y neurobiológica (neuroanatómica, neuroquímica y neuropsicológica) bien establecida y una sintomatología clínica muy heterogénea aunque identificable a través de unos síntomas nucleares de inatención, que evolucionan a lo largo de la vida. Debe ser considerado un problema de primer nivel individual (académicas, laborales y sociales) y socioeconómico ( elevado riesgo de abuso de sustancias, exclusión social e incluso criminalidad). Por tanto, su diagnóstico y tratamiento precoz son de vital importancia en el pronóstico a largo plazo del mismo. El tratamiento debe ser individualizado y ajustarse a las necesidades del individuo según su edad, gravedad de los síntomas, repercusión funcional e incluso preferencias del paciente y su familia. Sin embargo, diversos estudios demuestran que, de forma aislada y salvo excepciones, el tratamiento farmacológico tanto con psico-estimulantes como con fármacos no estimulante es el más eficaz. Los psico-estimulantes tienen un tamaño de efecto mayor que los no psico-estimulantes y un porcentaje de éxito entre el 70-80% de los pacientes en los que se inicia, mostrando eficacia y seguridad contrastada desde hace muchos años. las formas de liberación prolongada son, a priori, nuestra primera elección pues facilitan el cumplimiento terapéutico con un efecto más estable a lo largo del día y menor riego de abuso. En este artículo revisaremos las características, indicaciones, dosis y efectos adversos del tratamiento farmacológico del TDAH con psicoestimulantes (metilfenidato, lisdexanfetamina, etc.) (AU)

Attention Deficit Hyperactivity Disorder (ADHD) is the most frequent childhood and adolescence neurodevelopment disorder. ADHD is a neurocognitive disorder with a well-established genetic and neurobiological basis (neuroanatomical, neurochemical, and neuropsychological). The core behavioral symptoms of ADHD are inattention, hyperactivity, and impulsivity which evolve over the life. Considering the individual (academic, job, social) and socioeconomic consequences (e.g. risk of substance abuse, social exclusion, or even criminality), ADHD should be considered a mayor health issue. Therefore an early diagnosis and treatment are of primary importance to make long-term prognosis even better. Treatment should be individualized and adjusted to the individual characteristics (age, severity of symptoms, functional impairment, or the preferences of the patient or their relatives). Multimodal treatment is often the best way to treat, being pharmacological intervention with stimulants or non-stimulants drugs, the treatment of choice in children and adolescents with ADHD. Stimulants have a larger effect size than non-stimulants, being around 70-80% responders and the safety profile is acceptable and widely known for years. The use of extended-release formulations are preferable due to several advantages such as a lower risk of abuse, easy dosing and administration, lower patient variability and uniform action throughout the day. The current study reviews the characteristics, indications, doses, and side effects of stimulants on ADHD (AU)

A combined high CYP2D6-CYP2C19 metabolic capacity is associated with the severity of suicide attempt as measured by objective circumstances.

This study examined, for the first time, whether a high CYP2D6-CYP2C19 metabolic capacity combination increases the likelihood of suicidal intent severity in a large study cohort. Survivors of a suicide attempt (n=587; 86.8% women) were genotyped for CYP2C19 (*2, *17) and CYP2D6 (*3, *4, *4xN, *5, *6, *10, wtxN) genetic variation and evaluated with the Beck Suicide Intent Scale (SIS). Patients with a high CYP2D6-CYP2C19 metabolic capacity showed an increased risk for a severe suicide attempt (P<0.01) as measured by the SIS-objective circumstance subscale (odds ratio (OR)=1.37; 95% confidence interval (CI)=1.05-1.78; P=0.02) after adjusting for confounders (gender, age, level of studies, marital status, mental disorders, tobacco use, family history of suicide, personal history of attempts and violence of the attempt). Importantly, the risk was greater in those without a family history of suicide (OR=1.82; CI=1.19-2.77; P=0.002). Further research is warranted to evaluate whether the observed relationship is mediated by the role of CYP2D6 and CYP2C19 involvement in the endogenous physiology or drug metabolism or both.

Medicalization, wish-fulfilling medicine, and disease mongering: toward a brave new world?

Western societies are characterized by a growing medicalization of life events, such as pregnancy, aging, or even death. Three concepts -medicalization, wish-fulfilling medicine, and disease mongering- are key in understanding the current practise of Medicine. Quite surprisingly, not a single study has addressed the relationship between all three of these concepts. The term medicalization expanded under the open-ended concept of health developed by the World Health Organization in 1946. One of the consequences of medicalization is the transition from patients to clients. Physicians are under increasing pressure to meet the insatiable demands of their clients. The term wish-fulfilling medicine refers to the increasing tendency of medicine to be used to fulfill personal wishes (i.e. enhanced work performance). The insatiable demand for healthcare is troublesome, particularly in Europe, where the welfare states are more and more under pressure. Finally, the term disease mongering refers to attempts by pharmaceutical companies to artificially enlarge their "markets" by convincing people that they suffer from some sickness and thus need medical treatment. Typical examples of disease mongering are social anxiety disorder, low bone mineral density, and premature ejaculation. Currently, some Public Health Services could be on the brink of collapse as they "navigate" between the scarce resources available and the users' insatiable health demands. Therefore, it appears necessary to generate clear-cut Public Health Services Port-folios.

Medicalization, wish-fulfilling medicine, and disease mongering: Toward a brave new world? / Medicalización, medicina del deseo e invención de enfermedades: ¿hacia un mundo feliz?

Western societies are characterized by a growing medicalization of life events, such as pregnancy, aging, or even death. Three concepts -medicalization, wish-fulfilling medicine, and disease mongering- are key in understanding the current practise of Medicine. Quite surprisingly, not a single study has addressed the relationship between all three of these concepts. The term medicalization expanded under the open-ended concept of health developed by the World Health Organization in 1946. One of the consequences of medicalization is the transition from patients to clients. Physicians are under increasing pressure to meet the insatiable demands of their clients. The term wish-fulfilling medicine refers to the increasing tendency of medicine to be used to fulfill personal wishes (i.e. enhanced work performance). The insatiable demand for healthcare is troublesome, particularly in Europe, where the welfare states are more and more under pressure. Finally, the term disease mongering refers to attempts by pharmaceutical companies to artificially enlarge their "markets" by convincing people that they suffer from some sickness and thus need medical treatment. Typical examples of disease mongering are social anxiety disorder, low bone mineral density, and premature ejaculation. Currently, some Public Health Services could be on the brink of collapse as they "navigate" between the scarce resources available and the users’ insatiable health demands. Therefore, it appears necessary to generate clear-cut Public Health Services Port-folios (AU)

Las sociedades occidentales se caracterizan por una creciente medicalización de la vida cotidiana (p. ej., embarazo, envejecimiento y muerte). Tres conceptos-medicalización, medicina del deseo e invención de enfermedades- son fundamentales para entender la práctica actual de la Medicina. Resulta sorprendente que la relación entre los 3 términos apenas haya recibido atención en la comunidad científica. El término medicalización se expandió bajo el paraguas del concepto de salud ilimitado desarrollado por la Organización Mundial de la Salud en 1946. Una de las consecuencias de la medicalización es la transición de pacientes hacia clientes. Los médicos están cada vez bajo una mayor presión por parte de las insaciables demandas de salud de sus clientes. El término medicina del deseo hace referencia precisamente a la tendencia creciente a usar la Medicina para satisfacer los deseos personales (p. ej. aumento del rendimiento laboral). Esta insaciable demanda de salud es problemática, particularmente en Europa, donde los Sistemas de Salud Públicos están bajo una presión creciente. Finalmente, el término «invención de enfermedades» se refiere a los intentos de la industria farmacéutica para aumentar de manera artificial sus «mercados» al convencer a la gente (clientes) que sufren una enfermedad (previamente inexistente), para la cual necesitan un tratamiento. Algunos ejemplos de este último término son la fobia social o la eyaculación precoz. En la actualidad, algunos Servicios Públicos de Salud podrían estar cerca del colapso económico derivado de unos recursos cada vez más escasos y una demanda (deseos) de salud cada vez más insaciable. Por lo tanto, parece necesaria la creación de carteras de salud claramente definidas en aquellos países con Sistemas de Salud Públicos (AU)

Attempted and completed suicide: not what we expected?

BACKGROUND: Suicide attempters and suicide completers are two overlapping but distinct suicide populations. This study aims to present a more accurate characterization by comparing populations of suicide attempters and completers from the same geographical area. METHODS: Samples and procedure: All cases of attempted suicide treated at the emergency room of the Corporacio Sanitària i Universitària Tauli Parc de Sabadell in 2008 (n=312) were compared with all completed suicides recorded in the same geographical area from 2008 to 2011 (n=86). Hospital and primary care records were reviewed for sociodemographic and clinical variables. STATISTICAL ANALYSIS: Chi-square, ANOVA, and Mann-Whitney U tests were used to identify characteristics related to suicide completion. RESULTS: Compared to suicide attempters, suicide completers were more likely to be male (73.3% vs. 37.8%; p<0.001), pensioners (73.7% vs. 23.4%; p<0.001), and people living alone (31.8% vs. 11.4%; p=0.006). Suicide completers more frequently presented somatic problems (71.7 vs. 15.7; p<0.001), Major Depressive Disorder (54.7% vs. 27.9%; p<0.001), and made use of more lethal methods (74.1 vs. 1.9; p<0.001). Suicide completers were more likely to have been followed by a primary care provider (50.0% vs. 16.0%; p<0.001). 92.3% of the suicides committed were completed during the first or second attempt. LIMITATIONS: Suicide completers were not evaluated using the psychological autopsy method. CONCLUSIONS: Despite presenting a profile of greater social and clinical severity, suicide completers are less likely to be followed by Mental Health Services than suicide attempters. Current prevention programs should be tailored to the specific profile of suicide completers.

Machine learning and data mining: strategies for hypothesis generation.

Strategies for generating knowledge in medicine have included observation of associations in clinical or research settings and more recently, development of pathophysiological models based on molecular biology. Although critically important, they limit hypothesis generation to an incremental pace. Machine learning and data mining are alternative approaches to identifying new vistas to pursue, as is already evident in the literature. In concert with these analytic strategies, novel approaches to data collection can enhance the hypothesis pipeline as well. In data farming, data are obtained in an 'organic' way, in the sense that it is entered by patients themselves and available for harvesting. In contrast, in evidence farming (EF), it is the provider who enters medical data about individual patients. EF differs from regular electronic medical record systems because frontline providers can use it to learn from their own past experience. In addition to the possibility of generating large databases with farming approaches, it is likely that we can further harness the power of large data sets collected using either farming or more standard techniques through implementation of data-mining and machine-learning strategies. Exploiting large databases to develop new hypotheses regarding neurobiological and genetic underpinnings of psychiatric illness is useful in itself, but also affords the opportunity to identify novel mechanisms to be targeted in drug discovery and development.

Cost-efficiency of laboratory testing among psychiatric inpatients.

BACKGROUND: A set of tests to rule out medical conditions among psychiatric inpatients is still to be defined. A first step in this direction is to determine the utility of lab tests commonly used by psychiatrists. METHODS: Biochemical tests have been routinely performed on inpatients in a psychiatric hospitalization unit from 2006 to 2009. This study examines the prevalence of abnormal values in 1,278 laboratory tests performed on 894 patients. The number of subjects screened and the direct expenditure needed to find results outside the normal range were computed. Differences in clinical profiles were compared between diagnostic groups according to main diagnosis. RESULTS: We found high rates of seropositive patients for human immunodeficiency virus (14.3%) and hepatitis B virus (15.7%). Most patients met at least one criteria of metabolic syndrome (67.6%). The detection of hepatic abnormalities was very efficient (65.71%), particularly for patients diagnosed with alcohol use disorders. CONCLUSIONS: The cost-efficiency of lab tests in psychiatric units is greatly variable. Though results of this study may not be generalized due to the different prevalence of medical conditions, the methodology can be easily implemented across psychiatric services. Cost-effectiveness and costbenefit analyses are warranted.

[Electronic calendar as an organization element in Internal Medicine services]. / Los calendarios electrónicos como herramientas de organización de los servicios de Medicina Interna.

The growing volume of information and introduction of new technologies in the Internal Medicine hospital department mare making the traditional updating «methods¼ of knowledge and organization obsolete. The development of new tools could help the management of information and organization of the medical departments is outdated. Electronic calendar such as the Google calendar facilitate adequate coordination among health care professionals. Our experience suggests that the Google calendar is a simple and useful tool that helps planning and organization of the clinical, educational, and research activities of the different medical departments, limits loss of information and improves efficacy with a close to zero cost of infrastructure.

Los calendarios electrónicos como herramientas de organización de los servicios de Medicina Interna / Electronic calendars as an organization element in Internal Medicine services

El volumen creciente de información y la introducción de las nuevas tecnologías en los servicios hospitalarios de Medicina Interna hacen que los «métodos» tradicionales de actualización de conocimientos y organización se hayan quedado obsoletos. El desarrollo de nuevas herramientas podría ayudar en la gestión de la información y organización de los servicios médicos. Los calendarios electrónicos como el Google calendar facilitan la coordinación de los profesionales de la salud. Nuestra experiencia sugiere que Google calendar es una herramienta que facilita la organización de la actividad asistencial, docente y de investigación de los servicios médicos, limita la pérdida de información, y mejora su eficiencia con un coste de infraestructura prácticamente nulo(AU)

The growing volume of information and introduction of new technologies in the Internal Medicine hospital department mare making the traditional updating «methods» of knowledge and organization obsolete. The development of new tools could help the management of information and organization of the medical departments is outdated. Electronic calendars such as the Google calendar facilitate adequate coordination among health care professionals. Our experience suggests that the Google calendar·is a simple and useful tool that helps planning and organization of the clinical, educational, and research activities of the different medical departments, limits loss of information and improves efficacy with a close to zero cost of infrastructure(AU)

Endofenotipos y conductas suicidas / Endophenotypes and suicide behaviour

Introducción. Estudios recientes sugieren que las conductas suicidas tendrían una predisposición genética independiente del aumento de riesgo suicida asociado al diagnóstico de enfermedades mentales como los trastornos afectivos, la esquizofrenia, o la dependencia de alcohol. Dada la heterogeneidad de las conductas suicidas y la complejidad de su herencia, parece necesario el uso de fenotipos intermedios demostrables que permitan establecer una ligazón entre los genes y las conductas suicidas (endofenotipos).El principal objetivo es revisar cuales son los endofenotipos candidatos para las conductas suicidas. Métodos. Se realiza una revisión no sistemática de la bibliografía publicada en MEDLINE en los idiomas inglés, francés y español. Los términos de búsqueda usados fueron endofenotipos y conductas suicidas. Conclusiones. Los principales endofenotipos candidatos provienen de áreas como la neuropsicología (toma de decisiones, funciones ejecutivas), los rasgos de personalidad(impulsividad, agresividad y neuroticismo), la neuroquímica(5-HIAA en líquido cefalorraquídeo) y los estudios de neuroimagen (el metabolismo de la amígdala cerebral medido a través de Resonancia Magnética Funcional y el metabolismo de la corteza pre-frontal medido a través de Tomografía por Emisión de Positrones) (AU)

Background. Recent studies have suggested that genetic predisposition to suicidal behavior may be independent of the risk of suicide associated to mental disorders, such as affective disorders, schizophrenia or alcohol dependence. Given the suicidal behavior heterogeneity and its hereditary complexity, the need to find demonstrable intermediate phenotypes that may make it possible to establish links between genes and suicide behaviors (endophenotypes) seems to be necessary. The main objective is to review which are the candidate endophenotypes of suicidal behaviors. Methods. We carried out a non-systematic review of all published literature in English, French and Spanish in MEDLINE. The search terms were endophenotypes and suicide behaviors. Conclusions. The main candidate endophenotypes of suicidal behaviors are neuropsychological (decision making, executive functions), personality traits (impulsivity, aggressiveness, and neuroticism), neurochemistry (5-HIAAin CNS) and neuroimaging (fMRI of cerebral amygdala or PET of prefrontal cortex metabolism) (AU)

Endophenotypes and suicide behaviour.

BACKGROUND: Recent studies have suggested that genetic predisposition to suicidal behavior may be independent of the risk of suicide associated to mental disorders, such as affective disorders, schizophrenia or alcohol dependence. Given the suicidal behavior heterogeneity and its hereditary complexity, the need to find demonstrable intermediate phenotypes that may make it possible to establish links between genes and suicide behaviors (endophenotypes) seems to be necessary. The main objective is to review which are the candidate endophenotypes of suicidal behaviors. METHODS: We carried out a non-systematic review of all published literature in English, French and Spanish in MEDLINE. The search terms were endophenotypes and suicide behaviors. CONCLUSIONS: The main candidate endophenotypes of suicidal behaviors are neuropsychological (decision-making, executive functions), personality traits (impulsivity, aggressiveness, and neuroticism), neurochemistry (5-HIAA in CNS) and neuroimaging (fMRI of cerebral amygdala or PET of prefrontal cortex metabolism).

Severity of personality disorders and suicide attempt.

OBJECTIVE: Severity of personality disorders (PDs) may be more useful in estimating suicide risk than the diagnosis of specific PDs. We hypothesized that suicide attempters with severe PD would present more attempts and attempts of greater severity/lethality. METHOD: Four hundred and forty-six suicide attempters were assessed. PD diagnosis was made using the International Personality Disorder Questionnaire--Screening Questionnaire. PDs were classified using Tyrer and Johnson's classification of severity (no PD, simple PD, diffuse PD). Severity/lethality of attempts was measured with the Suicide Intent Scale, Risk-Rescue Rating Scale and Lethality Rating Scale. RESULTS: Attempters with severe (diffuse) PD had more attempts than the other groups. After controlling for age and gender, this difference remained significant only for the younger age group and women. There was no relationship between severity of PDs and severity/lethality of attempts. CONCLUSION: Younger female attempters with severe PD are prone to repeated attempts. However, the severity of PD was not related to the severity/lethality of suicide attempts.

The factor structure of the General Health Questionnaire (GHQ): a scaled version for general practice in Spain.

BACKGROUND: The 28-item version of the General Health Questionnaire (GHQ-28) developed by Goldberg and Hillier in 1979 is constructed on the basis of a principal components analysis of the GHQ-60. When used on a Spanish population, a translation of the GHQ-28 developed for an English population may lead to worse predictive values. METHODS: We used our Spanish sample to replicate the entire process of construction of the GHQ-28 administered in a primary-care setting. RESULTS: Two shorter versions were proposed: one with six scales and 30 items, and the other with four scales and 28 items. CONCLUSIONS: The resulting GHQ-28 was a successful adaptation for use on the Spanish sample. When compared with the original version, only 21 items were the same. Moreover, contrary to the English version, which groups sleep problems and anxiety in the same scale, a scale with items related exclusively to 'Sleep disturbances' was found.

[Paroxetine treatment for children and adolescents with anxiety disorders]. / Paroxetina en los trastornos de ansiedad en niños y adolescentes.

BACKGROUND: Paroxetine has become an effectiveness treatment in anxiety disorders in adults. Despite the fact that this is an especially prevalent psychiatrist disorder in children and adolescents, there are very few studies in this population. This study examines the effectiveness of paroxetine in children and adolescents with anxiety disorders. METHODOLOGY: Fifteen children and adolescents with ICD-criteria for anxiety disorder were selected. Anxiety measurement was taken with STAI scale and was filled out before treatment and 6 months later (mean). We have used descriptive parameters and t Student test for the analysis of dependent samples. Statistic work was done with SPSS 8.0. RESULTS: On first testing, the mean score for State Factor was 41.8 (ds: 5.9) and on second after treatment- it was 24.66 (ds: 9.8). Trait Factor was 43.53 (ds: 8.27) on first testing and 25 (ds: 8.91) on second. These differences in mean scores for both State and Trait factors were significant (alpha=0.05, p= 0.000). CONCLUSIONS: Our results support the hypothesis of clinical improvement at Anxiety Disorders in children and adolescent using Paroxetine. It seems logical to continue the study increasing sample size and evaluation time.

Paroxetina en los trastornos de ansiedad en niños y adolescentes / Paroxetine treatment for children and adolescents with anxiety disorders

Introducción. Aun cuando en sujetos adultos se ha confirmado la efectividad de la paroxetina en los trastornos de ansiedad, existen pocos estudios al respecto en niños y adolescentes, a pesar de ser un grupo de patologías psiquiátricas especialmente prevalentes en dicha población. Este estudio examina la efectividad de la paroxetina en la población infantojuvenil. Metodología. Estudio prospectivo de 15 niños y adolescentes con criterios CIE-10 del espectro de los trastornos de ansiedad. La medición de la ansiedad se realizó mediante la escala STAI (Estado y Rasgo), siendo administrada una primera vez previa prescripción de la paroxetina y un segundo retest a los 6 meses (media). Se emplean para su presentación parámetros descriptivos y para su análisis estadístico la prueba de la 't' de Student para medias de muestras dependientes. La explotación estadística se realizó con el programa SPSS 8.0.Resultados. La media de puntuaciones obtenida en el factor Estado de la escala STAI en la primera administración fue de 41,8 (DE 5,9), frente a una media en la segunda medición de 24,66 (DE 9,8).Asimismo, en la valoración del factor Rasgo se observan diferencias entre la primera administración del test (media: 43,53, DE 8,27) y el retest (media: 25, DE 8,91). Dichas diferencias de medias, tanto en factor Rasgo como en Estado, fueron significativas (alfa = 0,05, p= 0,000).Conclusiones. Los resultados apoyan la hipótesis de la mejoría clínica de los trastornos ansiosos con paroxetina también en población infantojuvenil. Parece, por tanto, adecuado continuar los estudios ampliando la muestra elegida y su evaluación en el tiempo (AU)