Intento de suicidio vía ingesta de fármacos en niños / Suicide attempts secondary to self-inflicted drug poisoning

Suicide attempts in children are an important worldwide cause of morbidity and mortality and an emerging reason for admission in Pediatric Critical Care. Objective: Identify the epidemiologic and clinical characteristics of patients with drug poisoning with a suicide purpose as an admission cause in a Chilean Pediatric Intensive Care Unit (PICU). Design: Retrospective observational study. Setting: 14 beds PICU of a tertiary care public teaching hospital in Santiago de Chile. Material and Method: All patients admitted to the PICU between January 2005 and December 2008 for self-inflicted drug poisoning with an expressed intention of suicide were included. Analysis of the PICU clinical chart was performed with sampling on an excel data base. For seasonal distribution we used statistical analysis Xil. Results: 178 of 3045 PICU admissions were diagnosed as drug poisoning (5,8 percent), 108 of them for suicide attempts (60,6 percent).The number of annual patients increased, with highest incidence in spring and autumn and lowest in winter. Mean and median age was 13 years, 8,4 percent less than 12 years. 88,9 percent were females. They used polipharmacy in 57 percent. Drugs were taken from home. Antidepressants and sedatives were the most often used. An underlying psychiatric condition was present in 100 cases (92,6 percent). Associated factors were family disfunction, school problems, abuse and violation and bullying. Mean PICU stay was 1,46 days with 16,7 percent requiring transient mechanical ventilation No death was reported in this serie. Conclusions: The number of cases of suicide attempt via drug ingestion as a motive for admission in PICU is increasing, causing a raising number of short and transient admissions, more in spring less in winter. Risk factors were mostly an underlying psychiatric disorder and family disfunction.

Introducción: El intento de suicidio en pediatría, via ingestión de fármacos, es una importante causa de mor-bimortalidad en el mundo y un creciente motivo de ingreso a cuidados intensivos. Objetivo: Identificar las características clínicas y epidemiológicas de los pacientes con intoxicación por fármacos con un intento de suicidio, como causa de ingreso a una Unidad de Cuidados Intensivos Pediátricos en Chile (UC1P). Diseño: Estudio retrospectivo observacional. Pacientes y Método: UClP de 14 camas críticas en un hospital pediátrico de Santiago. Se incluyeron todos los pacientes ingresados a la UClP debido a intento de suicidio por ingestión de fármacos, entre enero 2005 a diciembre 2008. Resultados: 178 de 3 045 egresos se debieron a intoxicación por fármacos (5,8 por ciento) ,108 de ellos por intento de suicidio (60,6 por ciento). La tendencia observada es a un incremento anual, con mayor incidencia en primavera y otoño, y menor en invierno. La media y mediana de edad fue de 13 años, 8,4 por ciento menor de 12 años. 88,9 por ciento fueron mujeres, Se utilizó polifarmacia en un 57 por ciento con fármacos disponibles en el hogar. Antidepresivos y sedantes fueron los más usados. Patología psiquiátrica de base se diagnosticó en un 92,6 por ciento de los casos. Factores asociados fueron disfunción familiar, problemas en el colegio, abuso y violación, bullying. La estadía promedio en UClP fue de 1,5 días, requiriendo un 16,7 por ciento ventilación mecánica transitoria. No hubo fallecidos en esta serie. Conclusiones: El intento de suicidio por ingestión de fármacos como motivo de ingreso a UClP ha aumentado, requiriendo estadías cortas y transitorias, mayormente en primavera y menos en invierno. Factores asociados fueron patología psiquiátrica de base y disfunción familiar.

Síndrome de Asperger en la edad adulta. A propósito de un caso / Asperger's disorder in adulthood. A case report

El síndrome de Asperger (SA) es un trastorno generalizado del desarrollo que implica alteraciones cualitativas de la comunicación, de la interacción social e intereses y actividades restringidos y repetitivos, sin retraso en la adquisición del lenguaje. A pesar de que es un trastorno que se inicia en la infancia, el diagnóstico puede no realizarse hasta etapas posteriores. El caso corresponde a un hombre de 21 años, diagnosticado de trastorno esquizoafectivo (TE), que es derivado a la Unidad Hospitalaria de Rehabilitación (UHR) para estudio diagnóstico dadas las características atípicas del cuadro. La exploración psicopatológica evidencia alteraciones en el área de las relaciones sociales, psicomotricidad y comunicación iniciadas en la infancia. Estos datos, junto con los resultados de las pruebas biomédicas y psicodiagnósticas realizadas, orientan hacia la existencia de un diagnóstico dual de SA y TE. La presencia de síntomas comunes entre SA y otras enfermedades psiquiátricas, así como la posible existencia de comorbilidad, puede llevar a un diagnóstico tardío o erróneo

Asperger’s disorder is a pervasive development disorder. It involves qualitative disorders in social relationship and communication as well as restricted and repetitive interests and activities, with no delay in language acquisition. Although Asperger’s disorder is an illness that begins in childhood, its diagnosis may frequently not be done until later stages. The case presented is about a 21 year old man with a diagnosis of schizoaffective disorder who, after several admissions, was sent to the Rehabilitation Hospital Unit for stabilization and diagnostic study given the atypical features of his case. The psychopathological examination showed disorders in social relationships, psychomotricity and communications that had begun in his childhood. All these data, and the results of the biomedical and psychological diagnostic tests oriented us towards the presence of a dual diagnosis of Asperger’s disorder and schizoaffective disorder. The presence of common symptoms between the AD and other psychiatric diseases as well as the possible existence of comorbidity may lead to an incorrect or late diagnosis

Asperger's disorder in adulthood: a case report.

Asperger's disorder is a pervasive development disorder. It involves qualitative disorders in social relationship and communication as well as restricted and repetitive interests and activities, with no delay in language acquisition. Although Asperger's disorder is an illness that begins in childhood, its diagnosis may frequently not be done until later stages. The case presented is about a 21 year old man with a diagnosis of schizoaffective disorder who, after several admissions, was sent to the Rehabilitation Hospital Unit for stabilization and diagnostic study given the atypical features of his case. The psychopathological examination showed disorders in social relationships, psychomotricity and communications that had begun in his childhood. All these data, and the results of the biomedical and psychological diagnostic tests oriented us towards the presence of a dual diagnosis of Asperger's disorder and schizoaffective disorder. The presence of common symptoms between the AD and other psychiatric diseases as well as the possible existence of comorbidity may lead to an incorrect or late diagnosis.

Sustained and selective attention deficits as vulnerability markers to psychosis.

The first descriptions of schizophrenia emphasized attention problems patients with schizophrenia have but recent results evidence that other psychotic disorders share them. We compared the performance in sustained and selective attention between psychotic patients (P), their healthy first degree relatives (R) and healthy volunteers (C) to prove whether these alterations could be an endophenotype of vulnerability to psychosis. We also compared the performance of schizophrenic patients (SZP) and that of patients with other functional psychoses (OP) in order to prove whether these alterations are specific of any psychotic disorder. Seventy-six P, 70 R and 39 C were included in the study. A selective attention index, comprising TMT A and B and Stroop Test, and a sustained attention index comprising the Continuous Performance Test were calculated. We conducted an univariant general linear model to compare three group performances in these indexes, with age, sex and years of education as a covariables. We found significant differences between the indexes when we compared P, R and C. No differences in performance were found between SZP and OP. Our data showed that sustained and selective attention alterations could be a vulnerability factor to psychotic disorders in general, but they were not specific of schizophrenia.