[Psychopathology associated to attention deficit hyperactivity disorder in school age children]. / Psicopatología asociada al trastorno por déficit de atención e hiperactividad en niños de edad escolar.

INTRODUCTION: Attention Deficit Hyperactivity Disorder (ADHD) represents a frequent and highly comorbid disorder in children and adolescents. Comorbidity differs according to ADHD subtype and gender and has been reported to have a direct effect on the severity of ADHD. METHODS: A descriptive, cross-sectional study was designed to determine the patterns of ADHD comorbidity in 102 children, aged 6 to 12 years, who attend the outpatient services of a child psychiatric hospital in Mexico City. The evaluation was performed using the Child Behavior Checklist (CBCL). RESULTS: The sample had about five comorbid disorders. The hyperactive-impulsive subtype had more severe externalizing symptoms, while the combined subtype had a higher severity of anxious depressive symptoms, delinquent behavior and internalized symptoms. Somatic complaints were more frequent in boys. A linear regression analysis showed that the severity of attention problems was influenced by the severity of aggressive behavior. CONCLUSIONS: School age children who came to psychiatric attention services with ADHD are highly comorbid. The comorbidity increases the severity of attention problems, particularly in patients with the hyperactive-impulsive or combined subtypes.

Favorable response to intravenous methylprednisolone and cyclophosphamide in children with severe neuropsychiatric lupus.

OBJECTIVE: To evaluate the effect of intravenous methylprednisolone (IVMP) and cyclophosphamide (IVCy) in children with severe neuropsychiatric (NP) systemic lupus erythematosus (NPSLE). METHODS: We studied 7 consecutive pediatric patients with severe NPSLE. All patients were treated initially with IVMP and IVCy followed by monthly IVCy for at least 3 months, and then every 2 and/or 3 months according to clinical response. Prednisone was given at 1-2 mg/kg during the first month. Laboratory studies included routine laboratory tests, antinuclear antibodies, anti-dsDNA, antiphospholipid antibodies, and complement components C3 and C4. Neurodiagnostic studies included cerebrospinal fluid, magnetic resonance imaging, computed tomography scanning, single photon emission computed tomography and electroencephalography. RESULTS: Three patients had organic brain syndrome with psychosis, 3 had seizures, 1 stroke, 1 cerebral vasculitis, 1 optic neuritis, and 1 transverse myelitis. In 3 of these cases, nervous system involvement was the initial presentation of SLE. Five patients had 2 or more NP manifestations. Most of them were accompanied by general SLE activity. Anticardiolipin antibodies were positive in 3 patients and none was anticoagulated. All patients improved, 6 patients had a complete recovery and 1 patient recovered with minor neurological deficit. All but one improved significantly within the first week of combined IVMP and IVCy. The mean time of follow-up was 37 months (range 8-55). IVCy was well tolerated with minimal side effects. CONCLUSION: Early aggressive treatment with combined IVMP and IVCy followed by monthly IVCy may be an effective therapy for severe NPSLE in children.