Three-year prevalence of self-harm behaviors among the reasons for emergency visits of children and adolescents.

Self-harm in the paediatric population is an emerging problem that has been associated with disability and an increased risk of suicide. The objective of the study is to analyse the prevalence of self-harming behaviour as a reason for paediatric emergency consultations.

Prevalencia a 3 años de las conductas autolesivas entre los motivos de consulta a urgencias en población infantojuvenil / Three-year prevalence of self-harm behaviors among the reasons for emergency visits of children and adolescents

INTRODUCCIÓN: Las conductas autolesivas en población pediátrica son un problema emergente que se ha asociado a la discapacidad y un mayor riesgo de muerte por suicidio. El objetivo del estudio es analizar la prevalencia de las con­ductas autolesivas entre los motivos de consulta a urgencias pediátricas. MATERIAL Y MÉTODO: Se analizaron 566 episodios clínicos cuyo principal motivo de consulta estaba relacionado con un problema de salud mental, entre las 122.985 consultas a urgencias de pediatría entre 2015-2017. Psiquiatras exper­tos los agruparon en el Grupo CA (conductas autolesivas) y Grupo PS (otra psicopatología). Variables clínicas y sociode­mográficas se extrajeron de los informes de alta a partir de hojas de registro específicas. RESULTADOS: El Grupo CA incluyó el 20,5 % de las con­sultas a urgencias por algún problema de salud mental. Las conductas autolesivas más frecuentes fueron las sobreingestas medicamentosas (38,8 %) y los cortes (24,1 %). En relación al Grupo PS, el Grupo CA presentaba un porcen­taje mayor de chicas, una edad media más alta y más an­tecedentes psiquiátricos (p < 0,001). Además, este grupo presentó un mayor porcentaje de diagnósticos al alta de trastornos afectivos y posibles trastornos de la personali­dad (p < 0,001). CONCLUSIONES: La prevalencia de conductas autolesivas entre las consultas a urgencias pediátricas es alta. Se observan especialmente en chicas adolescentes y muestran una mayor complejidad clínica. La detección y atención adecuada de es­tas conductas con programas especializados puede ayudar a prevenir el deterioro del funcionamiento psicosocial y detec­tar precozmente el debut de trastornos psiquiátricos

INTRODUCTION: Self-harm in the paediatric population is an emerging problem that has been associated with disability and an increased risk of suicide. The objective of the study is to analyse the prevalence of self-harming behaviour as a reason for paediatric emergency consultations. MATERIALS AND METHODS: 122,985 paediatric emergency consultations during the years 2015-2017 were reviewed. Of these, 566 clinical episodes with a psychopathological prob­lem as the main reason for consultation were analysed. Ex­pert psychiatrists grouped them into Group CA (self-harming behaviour) and Group PS (other psychopathology). Clinical and sociodemographic variables were taken from the dis­charge reports and transferred to specific record sheets. RESULTS: During the period analysed, a progressive de­crease in the age of patients attending the paediatrics emer­gency room for a psychopathological problem was observed (p < 0.001). Of these, 20.5% consulted for self-harming be­haviour. Group CA had more of psychiatric medical history, an older mean age and were mostly female (p < 0.001). Among self-harming behaviour, the most frequent were medication overdose (38.8%) and cuts (24.1%). At discharge, this group had a higher percentage of diagnoses of affective disorders and possible personality disorders (p < 0.001). CONCLUSIONS: The prevalence of self-harm as the reason for consultation in emergency services is high in the paediatric population and adequate attention should be paid to it, especially for adolescent girls. To prevent the functional deterioration associated with these behaviours, implementing programmes for early detection and intervention and referral to specialised treatment should be considered

Validación al español de la ADHD Rating Scale (ADHD-RS) en adultos: relevancia de los subtipos clínicos / Spanish validation of the adult Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS): relevance of clinical subtypes

Introducción. El trastorno por déficit de atención e hiperactividad (TDAH) tiene una prevalencia de entre el 2,5 y el 4% de la población general adulta. La Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS) es una escala autoinformada de 18 ítems para la evaluación de los síntomas del TDAH en adultos. El objetivo del presente estudio es realizar la validación de la versión española de la ADHD-RS. Material y método. Se incluyó una muestra de 304 adultos con TDAH y 94 controles sanos sin TDAH. El diagnóstico de TDAH se evaluó con la Entrevista Clínica Estructurada para el DSM-IV (SCID-I) y la Entrevista Diagnóstica para TDAH en Adultos de Conners para el DSM-IV (CAADID-II). Para determinar la validez interna de la estructura de 2 dimensiones de la ADHD-RS se realizó un análisis factorial exploratorio. Los coeficientes α se realizaron como medida de la consistencia interna de las dimensiones consideradas. Mediante un estudio de regresión logística se evaluó el modelo en términos de especificidad, sensibilidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Resultados. La media de edad de los participantes fue de 33,29 años (DE=10,50), con un 66% de hombres (sin diferencias entre los 2 grupos). El análisis factorial se realizó con un análisis de componentes principales seguido de una normalización por la rotación varimax. La medida de Kaiser-Meyer-Olkin para el test de adecuación de muestras fue de 0,868 (notable) y el test de esfericidad de Bartlett fue 2 (153)=1.835,76, p<0,0005, indicando que el análisis factorial es adecuado. Este modelo de 2 factores explica el 37,8% de la varianza. El coeficiente α de los 2 factores es 0,84 y 0,82. La estrategia original proponía un punto de corte de 24: sensibilidad (81,9%), especificidad (74,7%), VPP (50,0%), VPN (93,0%), coeficiente kappa 0,78 y área bajo la curva (AUC) 0,89. La nueva estrategia de puntuación sugerida por nuestro grupo propone diferentes puntos de corte según las diferentes presentaciones clínicas de TDAH. El punto de corte para la presentación combinada de TDAH es 24: sensibilidad (81,9%), especificidad (87,3%), VPP (78,6%), VPN (89,4%), coeficiente kappa 0,88 y AUC 0,94, mientras que el punto de corte para la presentación predominante con falta de atención sería 21: sensibilidad (70,2%), especificidad (76,1%), VPP (71,7%), VPN (74,8%), coeficiente kappa 0,88 y AUC 0,94. Conclusiones. La versión española de la ADHD-RS es una escala válida para discriminar correctamente adultos con TDAH de personas sin TDAH. La nueva propuesta de puntuación sugiere la relevancia de las presentaciones clínicas en los diferentes puntos de corte seleccionados (AU)

Introduction. Adult attention deficit hyperactivity disorder (ADHD) has a prevalence between 2.5% and 4% of the general adult population. Over the past few decades, self-report measures have been developed for the current evaluation of adult ADHD. The ADHD-RS is a 18-items scale self-report version for assessing symptoms for ADHD DSM-IV. A validation of Spanish version of the ADHD-RS was performed. Material and method. The sample consisted of 304 adult with ADHD and 94 controls. A case control study was carried out (adult ADHD vs. non ADHD). The diagnosis of ADHD was evaluated with the Structured Clinical Interview for DSM-IV (SCID-I) and the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-II). To determinate the internal validity of the two dimensions structure of ADHD-RS an exploratory factor analysis was performed. The α-coefficients were taken as a measure of the internal consistency of the dimensions considered. A logistic regression study was carried out to evaluate the model in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV). Results. Average age was 33.29 (SD=10.50) and 66% of subjects were men (there were no significant differences between the two groups). Factor analysis was done with a principal component analysis followed by a normalized varimax rotation. The Kaiser-Meyer-Olkin measure of sampling adequacy tests was .868 (remarkable) and the Bartlett's test of sphericity was 2 (153)=1,835.76, P<.0005, indicating the appropriateness of the factor analysis. This two-factor model accounted for 37.81% of the explained variance. The α-coefficient of the two factors was .84 and .82. The original strategy proposed 24 point for cut-off: sensitivity (81.9%), specificity (74.7%), PPV (50.0%), NPV (93.0%), kappa coefficient .78 and area under the curve (AUC) .89. The new score strategy proposed by our group suggests different cut-off for different clinical presentations. The 24 point is the best cut-off for ADHD combined presentation: sensitivity (81.9%), specificity (87.3%), PPV (78.6%), NPV (89.4%), kappa coefficient .88 and AUC .94, and 21 point is the best cut-off for ADHD predominantly inattentive presentation: sensitivity (70.2%), specificity (76.1%), PPV (71.7%), NPV (74.8%), kappa coefficient .88 and AUC .94. Conclusions. In this study, the Spanish version of the ADHD-RS is a valid scale to discriminate between ADHD adults and controls. The new proposed score strategy suggests the relevance of clinical presentations in the different cut-offs selected (AU)

Spanish validation of the adult Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS): relevance of clinical subtypes. / Validación al español de la ADHD Rating Scale (ADHD-RS) en adultos: relevancia de los subtipos clínicos.

INTRODUCTION: Adult attention deficit hyperactivity disorder (ADHD) has a prevalence between 2.5% and 4% of the general adult population. Over the past few decades, self-report measures have been developed for the current evaluation of adult ADHD. The ADHD-RS is a 18-items scale self-report version for assessing symptoms for ADHD DSM-IV. A validation of Spanish version of the ADHD-RS was performed. MATERIAL AND METHOD: The sample consisted of 304 adult with ADHD and 94 controls. A case control study was carried out (adult ADHD vs. non ADHD). The diagnosis of ADHD was evaluated with the Structured Clinical Interview for DSM-IV (SCID-I) and the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-II). To determinate the internal validity of the two dimensions structure of ADHD-RS an exploratory factor analysis was performed. The α-coefficients were taken as a measure of the internal consistency of the dimensions considered. A logistic regression study was carried out to evaluate the model in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV). RESULTS: Average age was 33.29 (SD=10.50) and 66% of subjects were men (there were no significant differences between the two groups). Factor analysis was done with a principal component analysis followed by a normalized varimax rotation. The Kaiser-Meyer-Olkin measure of sampling adequacy tests was .868 (remarkable) and the Bartlett's test of sphericity was 2 (153)=1,835.76, P<.0005, indicating the appropriateness of the factor analysis. This two-factor model accounted for 37.81% of the explained variance. The α-coefficient of the two factors was .84 and .82. The original strategy proposed 24 point for cut-off: sensitivity (81.9%), specificity (74.7%), PPV (50.0%), NPV (93.0%), kappa coefficient .78 and area under the curve (AUC) .89. The new score strategy proposed by our group suggests different cut-off for different clinical presentations. The 24 point is the best cut-off for ADHD combined presentation: sensitivity (81.9%), specificity (87.3%), PPV (78.6%), NPV (89.4%), kappa coefficient .88 and AUC .94, and 21 point is the best cut-off for ADHD predominantly inattentive presentation: sensitivity (70.2%), specificity (76.1%), PPV (71.7%), NPV (74.8%), kappa coefficient .88 and AUC .94. CONCLUSIONS: In this study, the Spanish version of the ADHD-RS is a valid scale to discriminate between ADHD adults and controls. The new proposed score strategy suggests the relevance of clinical presentations in the different cut-offs selected.

[Neurotrophic factors and their importance in attention deficit hyperactivity disorde]. / Factores neurotróficos y su trascendencia en el trastorno por déficit de atención/hiperactividad.

The existing literature that reports findings linked with the involvement of neurotrophic factors in attention deficit hyperactivity disorder (ADHD) is reviewed. Neurotrophins, a family of neurotrophic factors, are a kind of proteins that are specific to the nervous system and play an essential role in neuron survival, differentiation and proliferation during the development of the central and peripheral nervous system. These molecules stimulate axonal growth and exert an influence on the connections with the target tissue in order to establish the synaptic connections. The study of neurotrophins in ADHD, a neurodevelopmental disorder, is of interest mainly due to the functions that these proteins perform in the central nervous system. Studies on animal, pharmacological and molecular genetic models yield evidence that relates neurotrophins with the disorder. This work reviews the results from the studies conducted to date on ADHD and neurotrophic factors, especially brain-derived neurotrophic factor (BDNF). Thus, although pharmacological studies suggest that the response to atomoxetine in adults with ADHD is not directly mediated by the effect on the BDNF, reductions in BDNF levels in the plasma of adult patients with ADHD have been reported. Further studies with broader samples and greater control of environmental factors that can regulate neurotrophin expression, such as diet, physical exercise and situations of social risk, are needed to be able to determine the role they play in the aetiology of ADHD.

TITLE: Factores neurotroficos y su trascendencia en el trastorno por deficit de atencion/hiperactividad.Se revisa la bibliografia existente sobre los hallazgos de la implicacion de los factores neurotroficos en el trastorno por deficit de atencion/hiperactividad (TDAH). Las neurotrofinas, una familia de factores neurotroficos, son un tipo de proteinas especificas del sistema nervioso con un papel esencial en la supervivencia, diferenciacion y proliferacion neuronal durante el desarrollo del sistema nervioso central y periferico. Estas moleculas estimulan el crecimiento axonal e influyen en las conexiones con el tejido diana para el establecimiento de las conexiones sinapticas. El interes por el estudio de las neurotrofinas en el TDAH, un trastorno del neurodesarrollo, deriva principalmente de las funciones que estas proteinas ejercen en el sistema nervioso central. Existen evidencias derivadas de estudios en modelos animales, farmacologicos y de genetica molecular que relacionan a las neurotrofinas con el trastorno. En el presente trabajo se revisan los resultados de los estudios realizados hasta el momento sobre TDAH y factores neurotroficos, principalmente factor neurotrofico derivado de cerebro (BDNF). Asi, aunque estudios farmacologicos sugieren que la respuesta a la atomoxetina en adultos con TDAH no esta directamente mediada por el efecto sobre el BDNF, se han descrito disminuciones en los niveles plasmaticos de BDNF en pacientes adultos con TDAH. Se requieren estudios con muestras mas amplias y mayor control de factores ambientales que pueden regular la expresion de la neurotrofinas, como la dieta, el ejercicio fisico y situaciones de riesgo social, con el fin de determinar el papel de estas en la etiologia del TDAH.

Emotional lability: the discriminative value in the diagnosis of attention deficit/hyperactivity disorder in adults.

OBJECTIVE: The aim of this study is to assess the discriminative value of emotional lability (EL) in the diagnosis of adults with ADHD. METHODS: A group of adults who met ADHD DSM-IV diagnostic criteria (n=589), a clinical control group (n=138) and a community control group (n=98) were compared in EL scores. SCID-I, SCID-II and CAADID were used to select subjects. The specific subscale on EL of the Conners Adult ADHD Rating Scale (CAARS) was used to evaluate EL. RESULTS: An analysis of the covariance was carried out in order to explore the association between EL, ADHD and comorbidity. The group factor (ADHD, clinical or community group) and the comorbidity factor (presence or absence of other psychiatric disorders different from ADHD) showed to be significant on EL intensity (group: F=81.78 p=0.000; comorbidity: F=25.48 p=0.000). However, no significant differences were found in the group × comorbidity interaction (F=1.006, p=0.366). EL showed a sensitivity of 87.1% and a specificity of 46.6% in discriminating between ADHD patients and subjects with other psychiatric disorders. CONCLUSION: EL is specifically related to ADHD and this association is not explained for the presence of other psychiatric disorders. The presence of comorbid disorders is only related to a major intensity of EL.

Factores neurotróficos y su trascendencia en el trastorno por déficit de atención/hiperactividad / Neurotrophic factors and their importance in attention deficit hyperactivity disorder

Se revisa la bibliografía existente sobre los hallazgos de la implicación de los factores neurotróficos en el trastorno por déficit de atención/hiperactividad (TDAH). Las neurotrofinas, una familia de factores neurotróficos, son un tipo de proteínas específicas del sistema nervioso con un papel esencial en la supervivencia, diferenciación y proliferación neuronal durante el desarrollo del sistema nervioso central y periférico. Estas moléculas estimulan el crecimiento axonal e influyen en las conexiones con el tejido diana para el establecimiento de las conexiones sinápticas. El interés por el estudio de las neurotrofinas en el TDAH, un trastorno del neurodesarrollo, deriva principalmente de las funciones que estas proteínas ejercen en el sistema nervioso central. Existen evidencias derivadas de estudios en modelos animales, farmacológicos y de genética molecular que relacionan a las neurotrofinas con el trastorno. En el presente trabajo se revisan los resultados de los estudios realizados hasta el momento sobre TDAH y factores neurotróficos, principalmente factor neurotrófico derivado de cerebro (BDNF). Así, aunque estudios farmacológicos sugieren que la respuesta a la atomoxetina en adultos con TDAH no está directamente mediada por el efecto sobre el BDNF, se han descrito disminuciones en los niveles plasmáticos de BDNF en pacientes adultos con TDAH. Se requieren estudios con muestras más amplias y mayor control de factores ambientales que pueden regular la expresión de la neurotrofinas, como la dieta, el ejercicio físico y situaciones de riesgo social, con el fin de determinar el papel de éstas en la etiología del TDAH (AU)

The existing literature that reports findings linked with the involvement of neurotrophic factors in attention deficit hyperactivity disorder (ADHD) is reviewed. Neurotrophins, a family of neurotrophic factors, are a kind of proteins that are specific to the nervous system and play an essential role in neuron survival, differentiation and proliferation during the development of the central and peripheral nervous system. These molecules stimulate axonal growth and exert an influence on the connections with the target tissue in order to establish the synaptic connections. The study of neurotrophins in ADHD, a neurodevelopmental disorder, is of interest mainly due to the functions that these proteins perform in the central nervous system. Studies on animal, pharmacological and molecular genetic models yield evidence that relates neurotrophins with the disorder. This work reviews the results from the studies conducted to date on ADHD and neurotrophic factors, especially brain-derived neurotrophic factor (BDNF). Thus, although pharmacological studies suggest that the response to atomoxetine in adults with ADHD is not directly mediated by the effect on the BDNF, reductions in BDNF levels in the plasma of adult patients with ADHD have been reported. Further studies with broader samples and greater control of environmental factors that can regulate neurotrophin expression, such as diet, physical exercise and situations of social risk, are needed to be able to determine the role they play in the aetiology of ADHD (AU)

Validez de criterio y concurrente de la versión española de la Conners Adult ADHD Diagnostic Interview for DSM-IV / Criterion and concurrent validity of Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID) Spanish version

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno neuropsiquiátrico frecuente en la edad adulta. Su diagnóstico requiere realizar una evaluación retrospectiva de los síntomas durante la infancia, evaluar la continuidad de los mismos en la edad adulta y realizar un diagnóstico diferencial. Por estos motivos, el diagnóstico de TDAH en adultos supone un proceso complejo que precisa de instrumentos de evaluación efectivos. Objetivo. Analizar la validez de criterio de la versión española de la entrevista semiestructurada CAADID y la validez de concurrente comparándola con escalas de gravedad del TDAH. Método. Se realizó un estudio observacional de casos y controles en el que participaron un total de 691 sujetos, evaluados a nivel ambulatorio en el marco de un programa especializado en el TDAH de adultos. Resultados. Se observó una sensibilidad del 98,86%, una especificidad del 67,68% un valor predictivo positivo del 90,77% y un valor predictivo negativo 94,87% La precisión diagnóstica fue de 91,46%. El índice de concordancia Kappa entre el patrón oro (entrevista clínica abierta) y la CAADID fue de 0,74. La validez concurrente reflejó una correcta correlación con la escala WURS (r=0,522 p<0,01), con la ADHD Rating Scale (r=0,670 p<0,01) y con la CAARS tanto en su versión autoreportada (r=0,656 p<0,01) como en la del observador (r=0,514 p<0,01). Conclusiones. La CAADID es una herramienta diagnóstica válida y útil para evaluar el TDAH en adultos siendo de utilidad para la práctica clínica diaria y en el ámbito de la investigación(AU)

Introduction. Attention deficit-hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in adulthood. Its diagnosis requires a retrospective evaluation of ADHD symptoms in childhood, the continuity of these symptoms in adulthood, and a differential diagnosis. For these reasons, diagnosis of ADHD in adults is a complex process which needs effective diagnostic tools. Aim. To analyse the criterion validity of the CAADID semi-structured interview, Spanish version, and the concurrent validity compared with other ADHD severity scales. Methods. An observational case-control study was conducted on 691 patients with ADHD. They were out-patients treated in a programme for adults with ADHD in a hospital. Results. A sensitivity of 98.86%, specificity 67.68%, positive predictive value 90.77% and a negative predictive value 94.87% were observed. Diagnostic precision was 91.46%. The kappa index concordance between the clinical diagnostic interview and the CAADID was 0.88. Good concurrent validity was obtained, the CAADID correlated significantly with WURS scale (r=0.522, P<.01), ADHD Rating Scale (r=0.670, P<.0.1) and CAARS (self-rating version; r=0.656, P<.01 and observer-report r=0.514, P<.01). Conclusion. CAADID is a valid and useful tool for the diagnosis of ADHD in adults for clinical, as well as for research purposes(AU)

Criterion and concurrent validity of Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID) Spanish version.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in adulthood. Its diagnosis requires a retrospective evaluation of ADHD symptoms in childhood, the continuity of these symptoms in adulthood, and a differential diagnosis. For these reasons, diagnosis of ADHD in adults is a complex process which needs effective diagnostic tools. AIM: To analyse the criterion validity of the CAADID semi-structured interview, Spanish version, and the concurrent validity compared with other ADHD severity scales. METHODS: An observational case-control study was conducted on 691 patients with ADHD. They were out-patients treated in a program for adults with ADHD in a hospital. RESULTS: A sensitivity of 98.86%, specificity 67.68%, positive predictive value 90.77% and a negative predictive value 94.87% were observed. Diagnostic precision was 91.46%. The kappa index concordance between the clinical diagnostic interview and the CAADID was 0.88. Good concurrent validity was obtained, the CAADID correlated significantly with WURS scale (r=0.522, P<.01), ADHD Rating Scale (r=0.670, P<.0.1) and CAARS (self-rating version; r=0.656, P<.01 and observer-report r=0.514, P<.01). CONCLUSION: CAADID is a valid and useful tool for the diagnosis of ADHD in adults for clinical, as well as for research purposes.

OROS methylphenidate for the treatment of adults with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioral disorders in childhood. It continues into adulthood in up to 65% of patients. Methylphenidate (MPH) is one of the most commonly used pharmacological treatments for ADHD. The osmotic-release oral system (OROS) formulation of MPH is an extended-release pharmaceutical form that delivers MPH in a controlled manner over a 12-h period, allowing management of symptoms for a full day. OROS-MPH has many advantages over immediate-release MPH, such as avoiding clinical rebound, being easy to take, increasing treatment adherence and reducing the risk of abuse. OROS-MPH has been approved in the USA and Europe for the treatment of ADHD in children, but it has only been approved for the treatment of adults in the USA and Canada. This review summarizes evidence from various clinical studies assessing the efficacy and safety of OROS-MPH in different clinical samples of adults with ADHD, including samples with the most common comorbidities found in ADHD patients. The studies are classified according to their design characteristics as randomized, controlled trials or open trials. Data on dosing, treatment adherence and other clinical parameters relevant for the use of OROS-MPH in adults with ADHD are also reported and discussed.