Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

BACKGROUND: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.

Trastornos neuropsiquiátricos en la epilepsía con punta-onda continua durante el sueño lento (EPOCS) / Neuropsychiatry disorders in epilepsy with continuous spikes and waves during slow-wave sleep

La epilepsia con punta-onda continua durante el sueño lento (EPOCS) es un síndrome epiléptico que resulta de la asociación de varios tipos de crisis epilépticas parciales y/o generalizadas durante el sueño con un patrón electroencefalográfico característico (complejos de punta-onda continuos) junto con ausencias atípicas en vigilia1. Es conocido en la bibliografía que los síntomas psíquicos que aparecen en la epilepsia son muy abundantes2. La asociación entre psicosis y epilepsia es un hecho que ha sido reconocido desde antiguo2. Así, acompañando al cuadro clínico epiléptico, pueden existir otros trastornos neuro-psiquiátricos asociados, tales como: Trastornos del lenguaje, disminución más o menos marcada del cociente intelectual (CI)3, trastornos de conducta con hiperactividad4, sintomatología psicótica5, etc. A continuación se describen dos casos clínicos de EPOCS en los que junto a la clínica epiléptica existen hallazgos neuro-psicopatológicos comórbidos que siguen un curso independiente a las crisis

Epilepsy with continuous spikes and waves during slow-wave sleep is an epileptic syndrome that results from the association of various types of partial seizures and / or generalized during sleep with an EEG pattern typical (spike-wave complexes continued) with atypical absence in waking1. It is known in the literature that psychological symptoms that appear in epilepsy are most abundant2. The association between psychosis and epilepsy is a fact that has been recognized since antiquity2. Thus, accompanying clinical epileptic, there may be other associated neuro- psychiatric disorders such as disorders of language, more or less pronounced decrease of CI3, conduct disorder with hyperactivity4, psychotic symptoms5, etc. Here are two clinical cases in which epilepsy with continuous spikes and waves during slow-wave sleep by the clinical findings are neuro-epileptic comorbid psychopathology following an independent course to the crisis

[Psychiatric morbidity associated to enuresis in children]. / Morbilidad psiquiátrica asociada a enuresis infantil.

AIMS: The objective of the study was to know the clinical and epidemiological features, including associated psychiatric morbidity, of the children seeking help for enuresis in a public child and adolescent mental health unit. SUBJECTS AND METHOD: Within an exploratory, retrospective, and observational study, we reviewed the clinical charts of all the children (N= 2,315) attending the unit during a five-year period (January 1992-December 1997), collecting information on gender, age, type of enuresis, associated psychiatric morbidity, and social and family characteristics. Both the enuresis and the associated psychiatric disorders were diagnosed according to the DSM-IV criteria. RESULTS: Enuresis was the reason for admission in 230 children (9.9%), whose mean (+/- SD) age was 9.0 (+/- 2.9) years (range: 5-18). The condition of single-parent family, the perception of economic difficulties, and a poor academic achievement were not associated to any type of enuresis. A 19.5 per cent of the patients with enuresis presented a co-morbid psychiatric disorder, which was significantly associated to both male gender in subjects younger than 9 and enuresis of the type secondary or mixed. DISCUSSION: Most children with enuresis referred for psychiatric consultation do not present an associated psychiatric disorder. Our results on children with enuresis, in a clinical sample, are similar to those of previous studies conducted in the general population. This may mean that these patients are sent to child psychiatry services for reasons of traditional health delivery uses rather than for their psychopathological characteristics.