Homicidal/violent thoughts, suicidal ideation and violent behavior in adolescents with social phobia in Metropolitan Lima, Perú.

INTRODUCTION: Social phobia and violent behavior are both important mental health problems among adolescent populations in different parts of the world. This study attempts to evaluate possible connections between social phobia, homicidal/violent thoughts, suicidal ideation, and subsequent violent behavior among adolescents living in the metropolitan area of Lima, Perú. METHODS: A sample of 991 adolescents, part of the 2002 Epidemiological Study in Metropolitan Lima, conducted by the National Institute of Mental Health "Honorio Delgado-Hideyo Noguchi" (INSM "HD-HN") was studied. Social phobia was diagnosed on the basis of clinical assessment and the use of MINI, and suicidal ideation, homicidal/violent thoughts, and violent behavior were identified through the Mental Health Questionnaire. Odds ratio (OR) statistical analyses adjusted by logistic regression controlling for age and gender were performed. RESULTS: Variables associated with social phobia were homicidal thoughts in the last month (OR: 5.19, confidence interval [CI] at 95% 4.95-5.40), an impulse to hit known (OR: 1.56; 95% CI, 1.53-1.59) and unknown (OR: 3.98, 95% CI,3.89-4.07) persons, the wish to take revenge for a past offense (OR: 2.60, 95% CI 2.54-2.64), getting involved in fights with different kinds of weapons (OR: 1,78, 95% CI 1.70-1.87), suicidal ideation throughout lifetime (OR: 4.74, 95% CI 4.65-4.83), and life prevalence of suicidal attempt (OR: 5.39, 95% CI 5.23-5.55). DISCUSSION: Social phobia in adolescents of this Peruvian sample seems to be closely associated with both homicidal/violent thoughts, violent behavior, and suicidal ideation.

Estudio fenomenológico en 90 pacientes menores de 18 años con trastorno obsesivo compulsivo / Phenomenological study in 90 patients younger than 18 years old with obsessive compulsive disorder

Objetivo: Determinar manifestaciones clínicas del trastorno obsesivo compulsivo en niños y adolescentes peruanos. Materiales y Metodos: Se presenta un estudio fenomenológico en 90 pacientes menores de 18 años con diagnóstico de trastorno obsesivo compulsivo en Psiquiatria de Niños y Adolescentes de 3 hospitales de Lima, desde enero del 2000 hasta enero del 2003. El diagnóstico se realizó usando los criterios de DSM IV. Se clasificó el tipo de obsesiones y compulsiones con la lista de chequeo de la escala de Yale Brown. La gravedad del cuadro clínico se midió con la escala del Yale Brown para niños y con la Escala de Funcionamiento Global. Se determinó la incidencia de trastorno obsesivo compulsivo entre los familiares de primer grado, mediante la entrevista clínica a los padres y hermanos.resultados: El 62.2 por ciento fueron varones y el 37.8 por ciento mujeres; la edad promedio fue de 13.72 años +- 2.61 años. La edad de inicio promedio fue de 11.5 años +- 2.78. El valor promedio del C- YBOCS al momento del diagnóstico fue 25.44 +- 6.24 (trastorno obsesivo compulsivo severo); mientras que el valor promedio de funcionamiento global fue 60-51. El 78 por ciento de pacientes tuvo un episodio único de enfermedad, con un tiempo promedio de enfermedad de 16 meses. Las obsesiones más frecuentes fueron las de agresión (66 por ciento), las de contaminación (60 por ciento) y las de contenido sexual (28 por ciento). Las compulsiones más comunes fueron: limpieza (57 por ciento), rituales involucrando a otros (28 por ciento) y los rituales de repetición (24 por ciento). Más del 72 por ciento de pacientes tenian por lo menos dos obsesiones y dos compulsiones. El 27.5 por ciento de los pacientes tenian por lo menos un pariente de primer grado con trastorno obsesivo compulsivo. conclusión: La mayoria de manifestaciones clínicas del trastorno obsesivo compulsivo en niños y adolescentes peruanos son similares a las encantaradas por otros autores en otros contextos.

Objective: Determine clinical demonstrations ofthe Obsessive Compulsive Disorder (OCD) in children and Peruvian adolescents. Material and Methods: It is presented a phenomenological study in 90 patients youngerthan 18 years old with obsessive compulsive disorder diagnosis in children and adolescents psychiatry in Lima, since January 2000 to January 2003. The diagnosis was made using DSM-IV criteria. It was classitied the type of obsessions and compulsions using the check list from the Yale Brown scale. The severity of the disorder was valued using the Child Yale Brown scale and Global scale. It was determined incidence among tirst grade relatives, by means of interviewing parents and brothers. Results: The 62 percent were male and the 38 percent female. The average age was 13.7 years old +- 2.6 years. The beginning age of the disorder was 11.5 years old +- 2.9. The Vale Brown scale middle value at the moment of the diagnosis was 25.4 +- 6.2 (Severe obsessive compulsive disorder); while the global functioning middle value was 60 - 51. The 78 percent from these patients had an unique episode of iIIness, with an iIIness average time of 16 month. The most frequent obsessions were aggressions obsessions (66 percent), contamination obsessions (60 percent) and sexual content obsessions (28 percent). The most frequent compulsions were cleanness compulsions (57 percent), rituals which involved others persors (28 percent), and repetition rituals (24percent). More than 72 percent of these patients had at least two obsessions and two compulsions. The 27.5 percent from these patients had at least one first grade relative with obsessive compulsive disorder diagnosis. Conclusion: The majority clinical demonstrations of the obsessive compulsive disorder in children and Peruvian adolescents are similar to the found by other authors in other contexts.