Psicopatología de los adolescentes residentes en hogares funcionales que precisan hospitalización psiquiátrica / Psychopathology of adolescents living in foster care who require a psychiatric hospitalization

INTRODUCCIÓN: Los adolescentes residentes en Hogares Funcionales presentan más riesgo de presentar Trastorno disocial y consumo de tóxicos. MÉTODO: Se estudió una muestra compuesta por todos los 431 adolescentes (12 y 17 años, 50,1% varones) que requirieron hospitalización en la Unidad de Psiquiatría Infanto-Juvenil del Hospital Universitario Basurto a lo largo de 68 meses consecutivos. Analizamos las características diferenciadoras respecto al motivo de ingreso, diagnóstico psiquiátrico, consumo de tabaco, alcohol y drogas, antecedentes psiquiátricos personales y familiares entre aquellos adolescentes ingresados que residían en hogares funcionales y los que residían con sus familias. RESULTADOS: El motivo más frecuente de ingreso para el total de la muestra fue alteración de la conducta (60,7% para los menores residentes en hogares funcionales y 33% para los residentes con familia de origen), seguidos de descompensación psicótica (24,7%) para residentes en hogares funcionales, y trastorno de la conducta alimentaria (16,4%) para los residentes con sus familias (p < 0,001). El diagnóstico psiquiátrico al alta más frecuente en ambos grupos fue trastorno psicótico (39,3% y 28,9%), siendo el trastorno disocial (37,1%) más prevalente en los adolescentes de hogares funcionales (p < 0,001). Los residentes en hogares funcionales consumían más tabaco (59,6%) (p < 0,001), cannabis (50,6%) (p < 0,001), anfetaminas (15,7%) (p < 0,01) y cocaína (14,6 %) (p < 0,05), y tenían más antecedentes de tratamiento psiquiátrico previo (p < 0,05) y antecedentes familiares psiquiátricos (p < 0,001). CONCLUSIONES: Los adolescentes que residen en hogares funcionales y precisan una hospitalización psiquiátrica representan un grupo de población en mayor riesgo de presentar trastorno disocial, consumir tabaco, cannabis y otras sustancias y poseer más antecedentes familiares psiquiátricos

INTRODUCTION: adolescents living in Foster care show high risk of conduct disorder and drug use. METHOD: A sample comprised by all 431 adolescents (ages 12-17, 50,1% men) admitted at the Child and Adolescent Psychiatric Inpatient Unit of Hospital Universitario Basurto during a period of 68 months was collected. Reason for admission, psychiatric diagnosis, tobacco, alcohol and drug use, personal and family psychiatric history were studied comparing those adolescents who live in Foster care with those living with their families. RESULTS: The most common reason for admission was behavioral problems (60.7% in those living in foster care and 33% in those living with their families), followed by psychotic symptoms (24.7%) for adolescents in foster care, and eating disorders (16.4%) for those living with their families (p < 0.001). The most frequent psychiatric diagnosis at discharge was in both groups psychotic disorder (39.3%, 28.9%); and conduct disorder (37.1%) was more prevalent in adolescents in foster care (p < 0.001). Those adolescents in Foster care smoke more frequently (59.6%) (p < 0.001), and use cannabis (50.6%) (p < 0.001), amphetamines (15.7%) (p < 0.01), and cocaine (14.6 %) (p < 0.05) also more frequently. They had had more previous psychiatric treatments (p < 0.05) and more psychiatric disorders in their families (p < 0.001). CONCLUSIONS: Adolescents in Foster Care who are admitted to inpatient psychiatric units are a group at a high risk of conduct disorder, tobacco, cannabis and drug use, and have more frequent history of psychiatric disorders in their families

Adopción y alteraciones de conducta en la adolescencia. Estudio en población hospitalaria / Adoption and behavioural disturbances in adolescence. A hospital patient sample

INTRODUCCIÓN: En las últimas décadas se han incrementado las adopciones en el mundo occidental. Se ha descrito que los adolescentes adoptados están sobrerrepresentados en los servicios de salud mental y que consultan con mayor frecuencia por trastornos de externalización. Planteamos un estudio para valorar la proporción de adolescentes adoptivos y la presencia de conductas externalizantes en una muestra hospitalaria. MÉTODOS: Se recogen prospectivamente los datos de todos los ingresos de adolescentes (12-17 años) hospitalizados en la Unidad de Hospitalización Infanto-Juvenil, que atiende a todo el territorio de Bizkaia, durante 56 meses (n = 431). Dividimos la muestra en adoptados (2,6%) y no adoptados (97,4%), y comparamos las siguientes variables: edad media al ingreso, sexo, motivo de ingreso, ingresos previos, diagnóstico al alta, consumo de tóxicos y resultados de la Overt Aggression Scale al ingreso. RESULTADOS: Los adolescentes adoptados están sobrerrepresentados en nuestra muestra (2,84% vs. 0,6% en la población general; p < 0,001). Comparándolos con el subgrupo de no adoptivos, ingresan significativamente más jóvenes (14,09 vs. 15,21 años; p = 0,017) y tienden a hacerlo más frecuentemente por alteraciones de conducta (63,6% vs. 38,1%; p = 0,086). CONCLUSIONES: Los adolescentes adoptados presentan más ingresos y lo hacen a una edad más temprana, datos que indican una mayor gravedad de la afección de estos adolescentes o una menor capacidad de contención de las familias adoptivas. Además, observamos que tienden a ingresar más por alteraciones conductuales, sin existir diferencias significativas en los diagnósticos al alta, lo que sugiere una tendencia a expresar la sintomatología de forma más externalizadora

INTRODUCTION: The number of adoptions has increased in the Western world in recent decades. An over-representation in mental health services and an increased risk of displaying behavioural disorders has been reported among adopted adolescents. In this study, we aim to assess the proportions of adopted and non-adopted adolescents and the presence of externalizing disorders in an inpatient setting. METHODS: Prospective data were collected over 56 months (n = 431) from all adolescent admissions (12-17 years of age) to the Child and Adolescent's Inpatient Psychiatric Unit, which serves the Biscay province (Basque Country, Spain). The sample was divided into adopted (2.6%) and non-adopted adolescents (97.4%), and the following variables were compared: age, gender, cause of admission, prior admissions, main diagnosis, drug use and Overt Aggression Scale score at admission. RESULTS: Adopted adolescents were over-represented in our sample (2.84% vs. 0.6% in the general population of Biscay, P<0.001). Compared to the non-adopted, age at admission was significantly lower (14.09 vs. 15.21 years old, P=.017) and they showed a statistical tendency to be admitted more frequently for behavioural disorders (63.6% vs. 38.1%, P=0.086). CONCLUSIONS: The over-representation and the earlier age at admission suggest that the conditions of adopted adolescents are more serious and-or adoptive families are less able to manage them. The data also show that they tend to be admitted more for behavioural disorders, whilst no significant differences in the diagnosis on discharge were found, which suggests that they tend to externalise their symptoms more

[Adoption and behavioural disturbances in adolescence. A hospital patient sample]. / Adopción y alteraciones de conducta en la adolescencia. Estudio en población hospitalaria.

INTRODUCTION: The number of adoptions has increased in the Western world in recent decades. An over-representation in mental health services and an increased risk of displaying behavioural disorders has been reported among adopted adolescents. In this study, we aim to assess the proportions of adopted and non-adopted adolescents and the presence of externalizing disorders in an inpatient setting. METHODS: Prospective data were collected over 56 months (n=431) from all adolescent admissions (12-17 years of age) to the Child and Adolescent's Inpatient Psychiatric Unit, which serves the Biscay province (Basque Country, Spain). The sample was divided into adopted (2.6%) and non-adopted adolescents (97.4%), and the following variables were compared: age, gender, cause of admission, prior admissions, main diagnosis, drug use and Overt Aggression Scale score at admission. RESULTS: Adopted adolescents were over-represented in our sample (2.84% vs. 0.6% in the general population of Biscay, P<.001). Compared to the non-adopted, age at admission was significantly lower (14.09 vs. 15.21 years old, P=.017) and they showed a statistical tendency to be admitted more frequently for behavioural disorders (63.6% vs. 38.1%, P=.086). CONCLUSIONS: The over-representation and the earlier age at admission suggest that the conditions of adopted adolescents are more serious and-or adoptive families are less able to manage them. The data also show that they tend to be admitted more for behavioural disorders, whilst no significant differences in the diagnosis on discharge were found, which suggests that they tend to externalise their symptoms more.

Tratamiento hospitalario de los trastornos de la conducta alimentaria. El modelo de la Unidad de hospitalización psiquiátrica infanto-juvenil de Basurto / No disponible

No disponible

Patología postraumática en la infancia y adolescencia / No disponible

No disponible

PET y SPECT: últimos avances en Psiquiatría Infantil

En la última década se puede observar un cambio significativo en las pautas de tratamiento farmacológico para los casos diagnosticados de psicosis Infantiles, en la USMI Virgen del Rocío. Este cambio se ha realizado de forma cautelosa, pasando de un uso importante de las moléculas clásicas (Tiorizacina y Haloperidol) a la utilización paulatina los antippicóticos atípico. Quizá la conclusión más globalizadora sería que se observa una actitud de continua búsqueda de nuevas posibilidades de tratamiento lo que conlleva la necesidad de mantenerse atentos y conocer los avances en psicofarmacología que nos permitan ofrecer la mejor posibilidad terapeútica para los niños y adolescentes afectos de trastornos tan graves como son la esquizofrenia cuadros psicóticos. Gracias al desarrollo de las técnicas de neuroimagen funcional, en especial PET y SPECT, se ha incrementado en los últimos años el conocimiento sobre diversas patologías psiquiátricas de inicio en la infancia y adolescencia de entre las que destacamos el grupo de las psicosis infantiles, el trastorno obsesivo-compulsivo, el trastorno por déficit de atención con hiperactividad y los trastornos afectivos. En este artículo hacemos un breve repaso a los últimos avances acontecidos en este campo referentes a los trastornos anteriormente enumerados (AU)

Síndrome de Charles Bonnet en la infancia como reacción de duelo / Charles Bonnet syndrome in child hood as a grief reaction

Se presenta el caso de una niña ciega que padece una reacción de duelo al fallecimiento de su abuelo presentando, entre otros síntomas, alucinaciones visuales. Este fenómeno (presencia de alucinaciones visuales en un sujeto sin trastorno mental ni alteración de la conciencia y generalmente con deficiencia visual) se denomina Síndrome de Charles Bonnet. Presentamos el caso no solamente por su singularidad, en especial por lo infrecuente de su presentación en la infancia, sino además como debate etiopatogénico del Síndrome (AU)

Objeto transicional y fetiche en el trastorno de identidad sexual en el niño / Tansitional object and fetish in childhood gender identity disorder

El Trastorno de identidad sexual se caracteriza por la presentación de una discrepancia persistente entre el sexo biológico propio y la identidad genérica nuclear. Ello conlleva a estos sujetos un malestar intenso con respecto a su propio sexo y su deseo de pertenecer al sexo opuesto, llegando incluso a la afirmación de que se pertenece a este último. Las tasas de prevalencia e incidencia de este trastorno en niños y adolescentes es aún desconocida, en buena medida por falta de estudios epidemiológicos al respecto. El trastorno de identidad sexual es una entidad compleja, en cuya génesis se involucran diversos factores, entre ellos los de tipo psicodinámico. Presentamos dos casos clínicos de trastorno de identidad sexual en la infancia en los que se analizan los aspectos psicodinámicos de su etiopatogenia, haciendo especial énfasis en el papel del objeto transicional y el objeto fetiche (AU)

Neuroimagen funcional en las psicosis infantiles / Functional neuroimaging in child-hood Psychoses

Gracias al desarrollo de las técnicas de neuroimagen funcional, en especial PET y SPECT, se ha incrementado en los últimos años el conocimiento sobre diversas patologías, entre ellas las psicosis. En el campo de las psicosis infantiles, dos han sido los trastornos más estudiados: la esquizofrenia de inicio precoz y el autismo infantil. Merced a las investigaciones desarrolladas con estas nuevas tecnologías hemos llegado a incrementar nuestro conocimiento sobre las áreas cerebrales posiblemente implicadas en la fisiopatología de estos trastornos. Además, las aplicaciones de las técnicas de neuroimagen funcional al estudio de receptores en el SNC asociados a las hipótesis etiopatogénicas de estas patologías han abierto un nuevo campo de investigación prometedor. Hoy disponemos de un mayor conocimiento, gracias al PET y al SPECT, de la farmacodinamia de los principios activos que en la clínica demuestran actividad terapéutica. Es muy posible que gracias a este más profundo conocimiento del mecanismo de acción de estas sustancias lleguemos a comprender mejor la etiopatogenia del autismo o de la esquizofrenia, además de poder desarrollar en un futuro fármacos más eficaces para su tratamiento (AU)

Diagnóstico diférencial entre trastorno esquizofrénico en la infancia y la adolescencia y esquizofrenia de inicio muy precoz / Diferential diagnosis between child-hood and adolescent schizophrenia disorder and very early onset schizophrenia

El trastorno esquizotípico del niño y el adolescente y la esquizofrenia de inicio en la infancia (especialmente la de inicio muy precoz) representan dos entidades en truchas ocasiones extremadamente difíciles de diferenciar.Ambos son trastornos de inicio precoz e insidioso, que suelen presentar disfunciones del desarrollo previas. La clínica, de tipo psicótica en los dos casos, es en general equivalente en cuanto a los trastornos sensoperceptivos o del pensamiento que pueden presentar, radicando la diferenciación únicamente en la cuantía de los síntomas. Y, finalmente, ambas entidades tienen un curso crónico. Esta semejanza tan extrema refleja la cercanía dimensional de estos dos trastornos, por lo que abogamos por encuadrarlos ambos dentro del más amplio concepto de "Trastornos del espectro esquizofrénico" (AU)

[Differential characteristics of families of adolescents and young adults that have attempted suicide]. / Aspectos diferenciales de las familias de adolescentes y jóvenes adultos que realizan tentativas de suicidio.

INTRODUCTION: Families of adolescent and young adult suicide attempters are studied to analyze their role in these extremely dangerous behaviors. METHOD: 72 adolescents and young adults (aged 15-24) who have made a suicide attempt and 72 normal controls matched by sex, age and marital status, are studied in a case-control design. Several aspects of each family are explored: composition, degree of stability in parental couple, type of relationships among the members, labor status of parents and medical-psychiatric and legal family history. RESULTS AND CONCLUSIONS: Only parameters analyzing parents-offspring interactions can differentiate both groups. Keep an unsatisfactory relation with any of the living parents are the family factors which place the young or adolescent subject in risk of making a suicide attempt in our surrounding.

Abnormal renal vascular reactivity to acetylcholine and nitroprusside in aging rats.

1. The actions of acetylcholine (ACh), CaCl2 and nitroprusside (NP) were studied in aortic strips and in the perfused kidneys from adult (4-6 months old) and aging (23-24 months old) rats. 2. ACh and CaCl2 produced a dose-related relaxation in aortic strips from adult and old rats; maximal responses to both vasodilators were significantly reduced (ACh: adult = 66.4 +/- 6.1%, Old = 27.1 +/- 5.7%, P < 0.001; CaCl2: adult = 75.6 +/- 3.9%, Old = 54.1 +/- 4.1%, P < 0.01) in aortas from old rats. NP-evoked relaxation was not significantly different between the two groups. 3. In kidneys from adult rats, ACh produced dose-related decreases in renal perfusion pressure (RPP), whereas, in kidneys from old rats, ACh produced a dose-related decrease at low doses, and biphasic responses (vasodilatation followed by vasoconstriction) at medium to high doses, with a reduced vasodilator component. Vasodilator response to ACh to the highest dose; ACh; adult = 78.7 +/- 2.8%, Old = 40.6 +/- 2.6%, P < 0.001). In kidneys from adult rats, NP produced a dose-related decrease in RPP. However, in kidneys from old rats, NP produced vasoconstriction at low doses, biphasic responses at medium doses (vasoconstriction followed by vasodilation), and vasodilation at the highest dose. 4. The results of the present study demonstrated that: (a) The isolated perfused kidney from aging rats had a dual response (with an important vasoconstrictor component) to ACh and NP, which may be due to the release of a nonprostanoid vasoconstrictor or to abnormalities in the renal vascular smooth muscle. In contrast, in aortic-strips from old and adult rats, these agents only caused relaxation; (b) aging is accompanied by reduced endothelium-dependent relaxation both in large arteries and in resistance vessels; and (c) large arteries from aging rats require a higher concentration of extracellular calcium to stabilize the membrane of smooth muscle cells.

Effects of methimazole in the early and established phases of NG-nitro-L-arginine methyl ester hypertension.

In the present study we evaluated the effects of methimazole, an antithyroid drug, on blood pressure and other variables in the early and established phases of hypertension induced by the inhibition of nitric oxide synthesis with the oral administration of NG-nitro-L-arginine methyl ester (L-NAME), 75 mg/100 ml in the drinking water. Moreover, we also evaluated the acute pressor effect of L-NAME on systemic blood pressure in control and rats treated chronically with methimazole, administered via drinking water (30 mg/100 ml). Oral administration of methimazole maintained the blood pressure of L-NAME-treated rats at normal levels 25 days after induction of hypertension. However, after 25 days of methimazole treatment in rats made hypertensive with L-NAME (for 25 days), high blood pressure was similar in methimazole-treated and non-treated L-NAME rats, despite the fact that a hypothyroid state had been achieved in the methimazole-treated rats. Acute intravenous injection of L-NAME caused a similar increase in mean arterial pressure in control and methimazole-treated rats at the lowest dose; however, smaller pressor responses were observed with increasing doses in hypothyroid rats. These results clearly demonstrate that hypothyroidism induced by methimazole prevents, but does not reverse, L-NAME hypertension and reduces the acute pressor responsiveness to L-NAME administration.

Renal vascular reactivity to ATP in hyper- and hypothyroid rats.

The effects of adenosine triphosphate (ATP) on the renal vasculature of isolated kidneys from control, hyper- and hypothyroid rats were characterized. ATP responsiveness was evaluated in basal tone and in raised tone (phenylephrine 10(-6) M) preparations. These responses were compared with those obtained with barium chloride or sodium nitroprusside (SNP), used respectively as nonreceptor agonist for vasoconstriction or vasodilation. In preparations at basal tone, ATP produced dose-related vasoconstriction, which was increased in hyperthyroid kidneys, and was severely attenuated in kidneys from hypothyroid rats. In raised tone preparations from control rats ATP produced a dual response: vasoconstriction at low doses, which declined with increasing doses to give way to vasodilator responses; biphasic responses were found in some kidneys. Hyperthyroid kidneys showed increased pressor responses and a vasodilator response similar to those seen in kidneys from control rats. However, in hypothyroid kidneys the vasodilator response was abolished. The responses to barium chloride and to SNP were significantly increased and decreased in hyper- and hypothyroid kidneys, respectively; vasoconstrictor responses to SNP were also found in hypothyroid kidneys. Hence the abnormal responses to ATP observed in both thyroid dysfunctions may be partially explained by unspecific alterations in the contractile machinery of the renal vasculature in these kidneys. However, ATP responsiveness (vasoconstriction at low tone and vasodilation at raised tone) was more severly affected in hypothyroid kidneys, suggesting that purinergic (P2X and P2Y) receptor activity may be decreased in these organs.

Vascular reactivity and flow-pressure curve in isolated kidneys from rats with N-nitro-L-arginine methyl ester-induced hypertension.

OBJECTIVES: The purpose of this study was to determine the contribution of the functional changes in resistance vessels to the hypertension induced by chronic nitric oxide synthase inhibition in rats. Another goal of this study was to evaluate whether this model of hypertension is accompanied by changes in the activity of endothelium-derived hyperpolarizing factor (EDHF). METHODS: Hypertension was induced by long-term (6 weeks) oral administration of N-nitro-L-arginine methyl ester (L-NAME; 75 mg/100 ml in the drinking fluid). Vascular reactivity to vasoconstrictors (phenylephrine and barium chloride) and vasodilators (acetylcholine and nitroprusside) and the flow-pressure curve were examined in isolated perfused kidneys preparations. Vascular reactivity to vasoconstrictors and the flow-pressure curve were studied under basal conditions or after the infusion of L-arginine (100 mumol/l). The activity of EDHF was evaluated by comparing the dose-response curves for acetylcholine obtained in potassium chloride- and phenylephrine-preconstricted preparations. RESULTS: Kidneys from L-NAME-induced hypertensive rats showed increased sensitivity to vasoconstrictors with a greater duration of the pressor responses at high doses and markedly up-shifted flow-pressure curve in comparison with that obtained in control kidneys. These differences disappeared when the kidneys from control and L-NAME-treated rats were infused with L-arginine. The kidneys from L-NAME-treated rats also showed a decreased responsiveness to acetylcholine with an augmented reactivity to nitroprusside. The acetylcholine dose-response curve was reduced in control preparations and greatly attenuated in L-NAME-treated preparations when the renal vasculature was preconstricted with potassium chloride. CONCLUSIONS: The changes in vascular reactivity observed in L-NAME-induced hypertensive rats may play an important role in the pathogenesis of this type of hypertension. Moreover, it is also suggested that long-term nitric oxide inhibition may be associated with increased activity of EDHF.

Endothelium-dependent and endothelium-independent vasodilation in hyperthyroid and hypothyroid rats.

The effects of hyper- and hypothyroidism on the vasorelaxing responses to acetylcholine (ACh), sodium nitroprusside (NP), and CaCl2 were investigated in aortic strips and isolated perfused kidneys. The renal vascular reactivity to ACh and NP was increased in hyperthyroid rats, whereas the concentration-response curve to ACh in hypothyroid rats was flattened. In the renal vasculature from hypothyroid rats, NP produced a dual response: vasoconstriction at low doses and vasodilation at medium to high doses. Aortic strips from hyperthyroid rats showed an increased response to ACh without significant differences between hypothyroid and control groups. Aortic strips from all three experimental groups showed a similar relaxing response to CaCl2. These results indicate that: (1) the raised arterial pressure of hyperthyroid rats is not associated with a reduced endothelium-dependent and calcium-induced vasodilation, and (2) the changes in responsiveness to vasodilators in resistance vessels from hyper- and hypothyroid rats may play a role in the increased and decreased peripheral vascular resistances, respectively, previously reported in such animals.

Effects of chronic increased salt intake on nitric oxide synthesis inhibition-induced hypertension.

OBJECTIVE AND METHOD: Experimental evidence suggests that endogenous nitric oxide plays an important role in the homeostatic response to an increase in sodium intake. In the present study we evaluated the influence of a high sodium intake (1% NaCl as drinking water) on arterial hypertension induced by long-term (6-7 weeks) inhibition of nitric oxide synthesis [NG-nitro-L-arginine methyl ester (L-NAME), 75 mg/100 ml in the drinking fluid] in rats. RESULTS: Treatment with L-NAME induced progressive elevations in tail-cuff systolic blood pressure, but there were no differences between rats drinking tap water and rats drinking 1% NaCl. Direct measurement of blood pressure at the end of the treatment confirmed the hypertension and the lack of differences between the two groups treated with L-NAME. Metabolic studies performed at the end of L-NAME treatment showed a reduced glomerular filtration rate and elevated urinary excretion of immunoreactive endothelin in the two hypertensive groups treated with L-NAME. Drinking intake, diuresis and natriuresis were significantly higher only in the L-NAME group drinking 1% NaCl. Both groups treated with L-NAME showed an accelerated and increased diuretic and natriuretic response to an isotonic 0.9% NaCl load (2.5 ml/100 g body weight, intraperitoneally). At the end of the study ventricular hypertrophy was observed in both L-NAME groups. CONCLUSION: The present results indicate that the time-dependent elevation in blood pressure produced by long-term inhibition of nitric oxide production is not affected by an increased sodium intake. However, salt supplementation induced the development of a polyuria and polydipsia syndrome in rats treated with L-NAME. The elevated excretion of endothelin in both groups treated with L-NAME suggests the possible participation of endothelin in the development of L-NAME hypertension.