Personality Characteristics of Children and Adolescents with Anxiety Disorder from a Maternal Perspective: A Brief Report.

The present study assessed the personality characteristics of children and adolescents with anxiety disorder from a maternal perspective. A total of 48 children and adolescents aged between 8 and 17 years participated in this study, which was organized as follows: a clinical group (24 children and adolescents with anxiety disorders and their respective mothers) and a control group (24 children and adolescents without psychiatric diagnosis and their mothers). The participants were submitted to the WASI, CBCL, MASC-2, and EPQ-J tests and their mothers to the SRQ-20 and PIC-2 tests. The results showed higher rates of internalizing symptoms in the clinical group. In addition, patients showed less interest in hobbies, less adherence to social organizations, impairment in social activities, and commitment to school performance compared to the control group. There was a positive correlation between the mothers' symptoms and each of the following PIC-2 domains: somatic concern (p < 0.01) and psychological discomfort (p < 0.01). In conclusion, youths with AD showed a withdrawn and reserved personality profile, involving distrust of impulses and avoidance of interactions with peers. Furthermore, psychoemotional problems of mothers adversely influenced the perception followed by anxiety and adjustment characteristics. More studies are needed to assess the maternal personality in youths with anxiety.

Impairment in planning tasks of children and adolescents with anxiety disorders.

Anxiety disorders are associated with poor neuropsychological performance in attention and memory. However, little is known about the impact of these difficulties on other cognitive functions, such as planning. The ability to plan, including attention, working memory and set-shifting components, can be assessed by the Tower of Hanoi task (ToH). This study evaluated seventy-one participants, aged from 7-17 years. Thirty-seven subjects met DSM-IV diagnostic criteria for at least one anxiety disorder and 34 individuals comprised the controls. The neuropsychological tests used were: the ToH, a problem-solving task, involves planning ability and other executive functions (working memory, attentional control and cognitive flexibility); for the assessment of processing speed and problem-solving, the Vocabulary/Matrix Reasoning subtests of the Wechsler Abbreviated Scale of Intelligence was used to measure for estimated-IQ in both groups. The groups were compared with a generalized linear model controlling for age, IQ and ADHD comorbidity. Compared with controls, anxiety disorders subjects made more errors and required more time to complete the ToH. Children and adolescents with anxiety disorders have poorer planning ability compared to subjects without anxiety disorders, and the difficulty in planning is affected by interference from other cognitive functions, such as attention, working memory, cognitive flexibility and problems-solutions.

Child-focused treatment of pediatric OCD affects parental behavior and family environment.

This study aimed to investigate the impact of child-focused pediatric OCD treatment on parental anxiety, family accommodation and family environment. Forty-three parents (72.1% female, mean age±SD=43.1±5.6 years) were evaluated at baseline and after their children's (n=33, 54.5% female, mean age±SD=12.9±2.7 years) randomized treatment with Group Cognitive-Behavioral Therapy or fluoxetine for 14 weeks. Validated instruments were administered by trained clinicians. Parents were assessed with the State-Trait Anxiety Inventory (STAI), the Family Accommodation Scale (FAS) and the Family Environment Scale (FES). The Yale-Brown Obsessive-Compulsive Scale was administered to children. Significant findings after the children's treatment include decreased family accommodation levels (participation, modification and distress/consequences domains); increased cohesion and active-recreational components of the family environment. In addition, changes in the FAS distress/consequences and the FES cohesion subscores were correlated with the children's clinical improvement. These results suggest that child-focused OCD treatment may have a positive impact on family accommodation and family environment. Future studies should further clarify the reciprocal influences of pediatric OCD treatment and family factors.

Comparison among clomipramine, fluoxetine, and placebo for the treatment of anxiety disorders in children and adolescents.

OBJECTIVE: The purpose of this study was to test the efficacy of clomipramine and fluoxetine, controlled by placebo, and compare their action in children and adolescents with anxiety disorders. METHOD: Thirty subjects (ages 7-17 years), who were diagnosed with generalized anxiety disorder and/or separation anxiety disorder and/or social phobia, were submitted to a 12 week double-blind, randomized, placebo-controlled trial of clomipramine and fluoxetine. The instruments included: the Schedule for Affective Disorders and Schizophrenia, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, the Clinical Global Impressions, and the Children's Global Assessment Scale. RESULTS: All groups (clomipramine [n=9], fluoxetine [n=10], placebo [n=11]) showed a significant improvement after 12 weeks of treatment. There were significant differences between the fluoxetine and placebo groups in some ratings of anxiety severity and impairment. No significant differences were observed between clomipramine and placebo groups or between fluoxetine and clomipramine groups. CONCLUSIONS: Treatment with placebo showed an unusual high response rate. Clomipramine showed similar efficacy compared with fluoxetine, although it was not superior to placebo.

Group cognitive-behavioral therapy versus sertraline for the treatment of children and adolescents with obsessive-compulsive disorder.

OBJECTIVE: To compare the effectiveness of group cognitive-behavioral therapy (GCBT) and of sertraline in treatment-naïve children and adolescents with obsessive-compulsive disorder. METHOD: Between 2000 and 2002, 40 subjects between 9 and 17 years old were randomized to receive GCBT (n = 20) or sertraline (n = 20). GCBT consisted of a manual-based 12-week cognitive-behavioral protocol adapted for groups, and treatment with sertraline involved medication intake for 12 weeks. Subjects were assessed before, during, and after treatment (at 1, 3, 6, and 9 months after treatment conclusion). Primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale. Repeated-measures analyses of variance were done. RESULTS: Both GCBT and sertraline conditions had significant improvement in obsessive-compulsive disorder symptoms as measured by the Children's Yale-Brown Obsessive-Compulsive Scale after 12 weeks of treatment. After the 9-month follow-up period, subjects in the GCBT condition had a significantly lower rate of symptom relapse than those in the sertraline group. CONCLUSIONS: The treatment with GCBT may be effective in decreasing obsessive-compulsive symptoms in childhood obsessive-compulsive disorder and should be considered as an alternative to either individual cognitive-behavioral therapy or a medication, such as sertraline. Results support the effectiveness and the maintenance of gains of GCBT in the treatment of youngsters with obsessive-compulsive disorder.

Escalas de avaliacao de transtorno obsessivo-compulsivo na infancia e adolescencia / Rating scales for obsessive compulsive disorder in children and adolescents

Instrumentos especificos de avaliacao de sintomas obsessivo-compulsivos (SOC) em criancas e adolescentes sao escassos, sendo derivados de versoes originalmente desenvolvidas para adultos. Vantagens e limitacoes dos principais instrumentos utilizados para avaliacao dos diversos tipos de SOC e sua intensidade, as versoes para criancas do inventario de obsessoes de Leyton de 44 itens e da escala Yale-Brown de obsessoes e compulsoes, sao discutidas. Por fim, ressalta-se a utilizacao da escala global de obsessoes e compulsoes do NIMH como medida secundaria de gravidade de SOC

Sintomas obsessivo-compulsivos e coréia de Sydenham: psicopatologia e sistema imunológico / Obsessive-compulsive symptoms and Sydenham's chorea: psychopathology and immunologic system

Breve revisäo bibliogr fica sobre os aspectos históricos do diagnóstico e tratamento do transtorno obsessivo-compulsivo (TOC) é realizada. O autor destaca a relaçäo existente entre os sintomas obsessivo-compulsivo (SOC), TOC e certas doenças neurológicas que acometem gânglios da base, em especial a coréia de Syndeham (sintoma neurológico presente na febre reum tica). Säo descritos resultados de estudos que servem de base para a ligaçäo entre os SOC, os movimentos coreiformes e os títulos de anticorpos antineuronais

Sintomas obsessivo-compulsivos e coreia de Sydenham: psicopatologia e sistema imunologico

Breve revisao bibliografica sobre os aspectos historicos do diagnostico e tratamento do transtorno obsessivo-compulsivo (TOC) e realizada. O autor destaca a relacao existente entre os sintomas obsessivo-compulsivo (SOC), TOC e certas doencas neurologicas que acometem ganglios da base, em especial a coreia de Sydenham (sintoma neurologico presente na febre reumatica). Sao descritos resultados de estudos que servem de base para a ligacao entre os SOC, os movimentos coreiformes e os titulos de anticorpos antineuronais.

Perfil de uso e abuso de benzodiazepínicos em pacientes psiquiátricos e näo-psiquiatricos / Profile of use and abuse of benzodiazepines in psychiatric and n0n-psychiatric patients

Os autores procuravam registrar um estudo da prevalência e padröes de uso dos benzodiazepínicos em pacientes psiquiátricos e näo-psiquiátricos atendidos ambulatoriamente no complexo hospitalar do Hospital das Clínicas da FMUSP. Através do preenchimento de 351 questionários de auto resposta. elaborado pelos autores, procurou-se avaliar características sócio-demográficas, de padröes de uso e uso concomitante de álcool e benzodiazepínicos dos pacientes. Sob os cuidados dos médicos-residentes dos diversos ambulatórios foi feito o estudo da populaçäo psiquiátrica (n=159), respeitando-se a proporcionalidade do movimento de pacientes de cada clínica pesquisada. Entre os diversos resultados obtidos, destacamos a alta prevalência de uso de benzodiazepínicos na populaçäo geral (21,3 por cento) e na populaçäo psiquiátrica (62,2 por cento). Observamos também padröes de uso diário e de forma crônica mais freqüentes na populaçäo psiquiátrica. Pacientes com transtornos ansiosos apresentavam a mais alta prevalência de uso (88,4 por cento). Foi observada pouca concomitância do uso de álcool e benzodiazepínicos, bem como baixa prevalência de abuso ou aumento progressivo de doses . Estes e outros dados foram comparados com os principais relatos da literatura médica a respeito