Deep brain stimulation in obsessive-compulsive disorder: Results from meta-analysis.

The aim of this work is to investigate the effectiveness of Deep Brain Stimulation (DBS) in patients with severe Obsessive Compulsive Disorder (OCD) who are resistant to pharmacological treatments, focusing on obsessive compulsive, depressive and anxiety symptoms as well as global function. A systematic review and meta-analysis including 25 studies (without language restrictions) from between 2003 and 2020 was performed. A total of 303 patients were evaluated twice (before and after DBS). After DBS treatment OCD patients with resistance to pharmacological treatments showed a significant improvement of obsessive-compulsive symptoms (25 studies; SMD=2.39; 95% CI, 1.91 to 2.87; P<0.0001), depression (9 studies; SMD= 1.19; 95%CI, 0.84 to 1.54; P<0.0001), anxiety (5 studies; SMD=1.00; 95%CI, 0.32 to 1.69; P=0.004) and functionality (7 studies; SMD=-3.51; 95%CI, -5.00 to -2.02; P=0.005) measured by the standardized scales: Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Global Assessment of Function (GAF). Publication bias were discarded by using funnel plot. The main conclusions of this meta-analysis highlight the statistically significant effectiveness of DBS in patients with severe OCD who are resistant to conventional pharmacological treatments, underlying its role in global functioning apart from obsessive-compulsive symptoms.

A Narrative Review about Autism Spectrum Disorders and Exclusion of Gluten and Casein from the Diet.

OBJECTIVE: Autism spectrum disorders (ASDs) appear in the early stages of neurodevelopment, and they remain constant throughout life. Currently, due to limitations in ASDs treatment, alternative approaches, such as nutritional interventions, have frequently been implemented. The aim of this narrative review is to gather the most relevant and updated studies about dietary interventions related to ASDs etiopathogenesis. RESULTS: Our literature search focused on the gluten- and casein-free (GFCF) diet. The literature found shows the inexistence of enough scientific evidence to support a general recommendation of dietary intervention in children with ASD. Protocols and procedures for assessing risk and safety are also needed. Future lines: Prospective and controlled research studies with larger sample sizes and longer follow-up times are scarce and needed. In addition, studies considering an assessment of intestinal permeability, bacterial population, enzymatic, and inflammatory gastrointestinal activity are interesting to identify possible responders. Besides brain imaging techniques, genetic tests can also contribute as markers to evaluate the comorbidity of gastrointestinal symptoms.

Behavioural Difficulties in Children and Adolescents with Mental Disorders under Extreme Situations.

In 2020, the Governments of many countries maintained different levels of confinement of the population due to the pandemic that produced the COVID-19. There are few studies published on the psychological impact in the child and adolescent population diagnosed with mental disorders, especially during the home confinement stage. Explanatory models based on socio-demographic and clinical variables provide an approximation to level changes in different dimensions of behavioural difficulties. A categorical-response logistic ordinal regression model, based on a cross-sectional study with 139 children and adolescents diagnosed with mental disorders is performed for each dimension under analysis. Most of the socio-demographic and clinical explanatory variables considered (24 of 26) were significant at population level for at least one of the four dimensions of behavioural difficulties (15 response variables) under analysis. Odds-ratios were interpreted to identify risk or protective factors increasing or decreasing severity in the response variable. This analysis provides useful information, making it possible to more readily anticipate critical situations due to extreme events, such as a confinement, in this population.

Influence of a Combined Gluten-Free and Casein-Free Diet on Behavior Disorders in Children and Adolescents Diagnosed with Autism Spectrum Disorder: A 12-Month Follow-Up Clinical Trial.

The use of alternative interventions, such as gluten-free and casein-free (GFCF) diets, is frequent due to limited therapies for Autism Spectrum Disorder (ASD). Our aims were to determine the influence of a GFCF diet on behavior disorders in children and adolescents diagnosed with ASD and the potential association with urinary beta-casomorphin concentrations. Thirty-seven patients were recruited for this crossover trial. Each patient consumed a normal diet (including gluten and casein) for 6 months and a GFCF diet for another 6 months. The order of the intervention (beginning with normal diet or with GFCF diet) was assigned randomly. Patients were evaluated at three time-points (at the beginning of the study, after normal diet and after GFCF diet). Questionnaires regarding behavior and autism and dietary adherence were completed and urinary beta-casomorphin concentrations were determined at each time-point. No significant behavioral changes and no association with urinary beta-casomorphin concentrations were found after GFCF diet. A 6-month GFCF diet do not induce significant changes in behavioral symptoms of autism and urinary beta-casomorphin concentrations. Further studies with a long follow-up period similar to ours and including placebo and blinding elements are needed to identify better those respondents to GFCF diets.

Sex-specific cognitive abnormalities in early-onset psychosis.

OBJECTIVES:: Brain maturation differs depending on the area of the brain and sex. Girls show an earlier peak in maturation of the prefrontal cortex. Although differences between adult females and males with schizophrenia have been widely studied, there has been less research in girls and boys with psychosis. The purpose of this study was to examine differences in verbal and visual memory, verbal working memory, auditory attention, processing speed, and cognitive flexibility between boys and girls. METHODS:: We compared a group of 80 boys and girls with first-episode psychosis to a group of controls. RESULTS:: We found interactions between group and sex in verbal working memory (p = 0.04) and auditory attention (p = 0.01). The female controls showed better working memory (p = 0.01) and auditory attention (p = 0.001) than males. However, we did not find any sex differences in working memory (p = 0.91) or auditory attention (p = 0.93) in the psychosis group. CONCLUSIONS:: These results are consistent with the presence of sex-modulated cognitive profiles at first presentation of early-onset psychosis.

Sex-specific cognitive abnormalities in early-onset psychosis

Objectives: Brain maturation differs depending on the area of the brain and sex. Girls show an earlier peak in maturation of the prefrontal cortex. Although differences between adult females and males with schizophrenia have been widely studied, there has been less research in girls and boys with psychosis. The purpose of this study was to examine differences in verbal and visual memory, verbal working memory, auditory attention, processing speed, and cognitive flexibility between boys and girls. Methods: We compared a group of 80 boys and girls with first-episode psychosis to a group of controls. Results: We found interactions between group and sex in verbal working memory (p = 0.04) and auditory attention (p = 0.01). The female controls showed better working memory (p = 0.01) and auditory attention (p = 0.001) than males. However, we did not find any sex differences in working memory (p = 0.91) or auditory attention (p = 0.93) in the psychosis group. Conclusions: These results are consistent with the presence of sex-modulated cognitive profiles at first presentation of early-onset psychosis.

Oxidative stress and antioxidant parameters in patients with major depressive disorder compared to healthy controls before and after antidepressant treatment: results from a meta-analysis.

OBJECTIVE: To investigate the role of oxidative stress and antioxidants in depression. DATA SOURCES: We searched the literature without language restrictions through MEDLINE/PubMed, Cochrane Library, Fisterra, and Galenicom from database inception until December 31, 2013, supplemented by a hand search of relevant articles. Search terms included (1) oxidative stress, antioxidant*, nitrosative stress, nitrative stress, nitro-oxidative stress, free radical*, and names of individual oxidative stress markers/antioxidants and (2) depression and related disorders and antidepressant. STUDY SELECTION: Included were studies in patients with depression comparing antioxidant or oxidative stress markers with those in healthy controls before and after antidepressant treatment. DATA EXTRACTION: Two authors independently extracted the data for antioxidant or oxidative stress markers. Standardized mean differences (SMDs) ± 95% confidence intervals (CIs) for results from ≥ 3 studies were calculated. DATA SYNTHESIS: Altogether, 29 studies (N = 3,961; patients with depression = 2,477, healthy controls = 1,484) reported on the oxidative stress marker malondialdehyde (MDA) and total nitrites, the antioxidants uric acid and zinc, or the antioxidant-enhancing enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX). When patients with depression were compared with healthy controls, depression was associated with higher oxidative stress MDA levels (8 studies; n = 916; SMD = 1.34; 95% CI, 0.57 to 2.11; P < .001), lower antioxidant uric acid (4 studies; n = 512; SMD = -0.64; 95% CI, -1.22 to -0.06; P = .030) and zinc levels (13 studies; n = 2,002; SMD = -0.66; 95% CI, -0.98 to -0.34; P < .0001), and higher antioxidant-enhancing enzyme SOD levels (11 studies; n = 902; SMD = 0.62; 95% CI, 0.07 to 1.17; P = .028), while differences in total nitrites and CAT and GPX were nonsignificant. Antidepressant treatment, which significantly reduced Hamilton Depression Rating Scale scores (24.6 ± 0.7 to 16.2 ± 1.6; SMD = 2.65; 95% CI, 1.13 to 4.15; P = .00065), reduced MDA (4 studies; n = 194; SMD = -1.45; 95% CI, -2.43 to -0.47; P = .004) and increased uric acid (3 studies; n = 212; SMD = 0.76; 95% CI, 0.03 to 1.49; P = .040) and zinc levels (3 studies; n = 65; SMD = 1.22; 95% CI, 0.40 to 2.04, P = .004), without differences in MDA (P = .60), uric acid (P = .10), and zinc (P = .163) levels compared to healthy controls. CONCLUSIONS: Results suggest that oxidative stress plays a role in depression and that antidepressant activity may be mediated via improving oxidative stress/antioxidant function.

Lisdexanfetamine en niños y adolescentes con trastorno por déficit de atención e hiperactividad (TDAH): una revisión sistemática global / Lisdexamfetamine in attention-defitic and hyperactivity disorder (adhd) children and adolescents: a systematic global review

El Trastorno por Déficit de Atención e Hiperactividad (TDAH) es uno de los trastornos más frecuentes en Psiquiatría Infanto-Juvenil, y muy habitualmente requiere tratamiento farmacológico dentro de su plan terapéutico. Dentro de estos, desde hace cerca de un año se dispone en España de la lisdexanfetamina, novedoso tanto por ser una anfetamina como por ser un profármaco. Objetivo: revisar y resumir la evidencia existente sobre lisdexanfetamina y su uso en niños y adolescentes afectos de TDAH. Método: búsqueda bibliográfica exhaustiva en PubMed con los siguientes términos: lisdexamfetamine, OR lisdexamphetamine, OR lisdexanfetamina. Resultados: la lisdexanfetamina es un profármaco seguro, con un perfil de efectos adversos similar al de los otros tratamientos farmacológicos del TDAH conocidos, y muy eficaz para su tratamiento en niños y adolescentes, con un bajo potencial de abuso y uso inadecuado, y una respuesta clínica estable y prolongada a lo largo del día. Limitaciones: Aunque es un fármaco con eficacia y seguridad conocida en sus casi 9 años de comercialización en EEUU y su principio activo fue uno de los primeros en usarse para el tratamiento del TDAH, precisa llevar a cabo estudios prospectivos con horizontes temporales más amplios que los actuales, que contemplen seguridad y eficacia a largo plazo, eficacia frente a otros tratamientos en TDAH, y su uso en el paciente real

Attention Deficit Disorder Hyperactivity Disorder (ADHD) is one of the most common disorders in Child and Adolescent Psychiatry, and very often requires pharmacological intervention in its treatment plan. Among these, lisdexamfetamine is available in Spain since about one year ago, new both as being an amphetamine and as a prodrug. Objective: To review and summarize the evidence on lisdexamfetamine and its use in ADHD children and adolescents. Method: A comprehensive literature search in PubMed was done with the following terms: lisdexamfetamine, OR lisdexamphetamine, OR lisdexanfetamina. Results: Lisdexamfetamine is a prodrug with a safety profile similar to other known ADHD pharmacological treatments, and very effective for ADHD treatment in children and adolescents, with a low potential for abuse or misuse, and a stable clinical response extended along the day. Limitations: Although it is a drug with a known profile of efficacy and security along its nearly 9 years of marketing in the US, it should be necessary to conduct longer-term prospective studies to show more data about its safety and efficacy, efficacy related to other ADHD treatments, and its use in the real patient

Weight gain and increase of body mass index among children and adolescents treated with antipsychotics: a critical review.

We performed an updated review of the available literature on weight gain and increase of body mass index (BMI) among children and adolescents treated with antipsychotic medications. A PubMed search was conducted specifying the following MeSH terms: (antipsychotic agents) hedged with (weight gain) or (body mass index). We selected 127 reports, including 71 intervention trials, 42 observational studies and 14 literature reviews. Second-generation antipsychotics (SGAs), in comparison with first-generation antipsychotics, are associated with a greater risk for antipsychotic-induced weight gain although this oversimplification should be clarified by distinguishing across different antipsychotic drugs. Among SGAs, olanzapine appears to cause the most significant weight gain, while ziprasidone seems to cause the least. Antipsychotic-induced BMI increase appears to remain regardless of the specific psychotropic co-treatment. Children and adolescents seem to be at a greater risk than adults for antipsychotic-induced weight gain; and the younger the child, the higher the risk. Genetic or environmental factors related to antipsychotic-induced weight gain among children and adolescents are mostly unknown, although certain genetic factors related to serotonin receptors or hormones such as leptin, adiponectin or melanocortin may be involved. Strategies to reduce this antipsychotic side effect include switching to another antipsychotic drug, lowering the dosage or initiating treatment with metformin or topiramate, as well as non-pharmacological interventions. Future research should avoid some methodological limitations such as not accounting for age- and sex-adjusted BMI (zBMI), small sample size, short period of treatment, great heterogeneity of diagnoses and confounding by indication.

Prevalencia de alteraciones de la conducta alimentaria, trastornos gastrointestinales e infecciones recurrentes en niños afectos de Trastornos del Espectro Autista (TEA) en comparación con sus hermanos sanos / Prevalence of feeding disorders, gastrointestinal disorders and recurrent infections in children with Autism Spectrum Disorders (ASD) compared with their healthy siblings

Introducción: Los Trastornos del Espectro Autista (TEA) están constituidos por un grupo heterogéneo de procesos neurobiológicamente diversos, que se caracterizan por la existencia de déficit en múltiples áreas funcionales. Una de las áreas de interés creciente es la relacionada con la alimentación. La causa de las alteraciones en el desarrollo del área alimentaria del niño autista no está clara y de momento no existe acuerdo para definir el carácter primario o secundario de estas alteraciones. Objetivo: Analizar los hábitos alimentarios, antecedentes de trastornos intestinales, alergias e infecciones recurrentes en una población de niños y adolescentes con TEA. Sujetos y métodos: Estudio de diseño transversal y retrospectivo de casos y controles. La muestra está compuesta por 138 sujetos: 84 niños y adolescentes afectos de TGD según criterios del DSM-IV y 54 controles escogidos entre los hermanos de los anteriores. Se diseñó un cuestionario específico para este estudio que fue cumplimentado por los padres. Resultados: Al comparar los hábitos alimentarios de los niños autistas con los controles, vemos que los niños autistas presentan más dificultades en la incorporación de alimentos sólidos, de absorber con pajita, retraso evolutivo para beber en vaso, incorporación de alimentos nuevos, dificultades en la masticación, mayores rechazos alimentarios y conductas de pica. Las diferencias en infecciones recurrentes o trastornos gastrointestinales no fueron estadísticamente significativas. Conclusión: Los niños y adolescentes afectos de trastorno autista presentan más alteraciones en el desarrollo del área alimentaria que sus hermanos sanos. Las alteraciones encontradas no se corresponden con una mayor frecuencia de trastornos gastrointestinales ni alergias

Introduction: Autism Spectrum Disorders (ASD) are a heterogeneous group of different neurobiological processes, which are characterized by the existence of deficits in multiple functional areas. One area of growing concern is that related to the diet. The cause of the alterations in the development of the feeding area in autistic children is unclear, and there is currently no agreement to define the primary or secondary nature of these alterations. Aim: To analyze feeding habits, history of intestinal disorders, allergies and recurrent infections in a population of children and adolescents with ASD. Subjects and methods: A cross-sectional design and retrospective case-control study was made. The sample comprised 138 subjects: 84 children and adolescents suffering from ASD (DSM-IV criteria) and 54 controls (brothers of the sample subjects). A questionnaire was designed specifically for this study that was completed by parents. Results: When comparing the feeding habits of children with autism and controls, we see that autistic children have more difficulties in: incorporating solid foods, absorb with straw, developmental delay to drink from a cup, incorporating new foods, difficulties chewing food, more rejections and pica behavior. Differences in recurrent infections or gastrointestinal disorders were not statistically significant. Conclusion: Children and adolescents suffering from autistic disorders have more alterations in the development of the feeding area that their siblings. These alterations do not correspond to a higher frequency of gastrointestinal disorders and allergies

Environmental stress but not subjective distress in children or adolescents with alopecia areata.

OBJECTIVE: Alopecia areata (AA) has been considered a psychosomatic disease. This case-control study tries to determine whether environmental adverse conditions are associated with AA and to describe the subjective and physiological state of the patients. METHODS: A series of 31 children or adolescents with AA (16 boys and 15 girls; aged 12.2±3.8 years [range, 7-19]) were compared with both 23 patients of similar demographic characteristics undergoing a chronic illness (epilepsy) and 25 healthy siblings (HS) of the AA patients. The research protocol included assessment, by interview with the mother, of stressful life events in the 12 months previous to the AA onset and of developmental and family conditions, as well as self-rating instruments for anxiety, depression and family functioning. Some neuroendocrine and immunological parameters were also measured. Logistic regression analyses were used to confirm independent associations with AA. RESULTS: In contrast with their HS, AA patients experienced more stressful life events and showed higher 24-h urinary excretion of catecholamines. In contrast with epilepsy patients, AA patients were more likely the member of a single-parent family and perceived less expressiveness within their family. On the other hand, the three groups showed no significant differences in anxiety and depression scores. CONCLUSION: Alopecia areata is a complex skin disorder in juvenile patients whose conscious experience of distress is often absent and that might be precipitated by stressful life events in individuals under the influence of defective family functioning or biological vulnerability.

Winter birth excess in schizophrenia and in non-schizophrenic psychosis: sex and birth-cohort differences.

OBJECTIVE: Despite the fact that association between winter birth excess and schizophrenia in the northern Hemisphere is well established, possible sex or birth-cohort differences in this winter birth excess remain unclear. We aimed to evaluate sex and birth-cohort differences in the seasonal birth distribution of patients with schizophrenia or non-schizophrenic psychosis. METHOD: The sample included 321 ICD-10 schizophrenia and 294 non-schizophrenic psychosis patients consecutively admitted into a psychiatric hospitalization unit in Granada, southern Spain, during a nine-year period (1998-2006). The distribution of births among the general population born over the same period as the patients was calculated. RESULTS: Among schizophrenia males (n=258), it was possible to demonstrate that the observed proportion of winter birth (December, January or February) was significantly higher than expected. Among schizophrenia females (n=63), although proportions were as in males and the effect size of the difference between observed and expected winter births was not lower than for men, only a statistical trend could be demonstrated. Among patients with non-schizophrenic psychosis, the observed proportion of winter birth was significantly higher than expected in women, but not in men. The sex-adjusted proportion of winter birth among schizophrenia patients born in the 1940's (a time period characterized by poor economy and widespread food restrictions because of the Spanish post-civil-war period) was significantly higher than among those born later; a difference that does not occur among patients with a non-schizophrenic psychosis. CONCLUSIONS: Among schizophrenia patients born in winter there appear to be slight sex-differences and strong birth-cohort differences, possibly due to epidemiological factors such as poverty or maternal nutritional deprivation. Epidemiological findings related to winter birth excess among patients with schizophrenia must be identified in longitudinal studies.