Relationship between hair cortisol concentrations and cognitive functioning in adolescents with ADHD.

Background: Our study aimed to explore whether the hair cortisol concentration (HCC), a measure of long-term cortisol output, is associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD). We further aimed to test the potential moderating effects of sex and childhood maltreatment.Methods: In this cross-sectional study, fifty-three adolescents with ADHD were studied. The ADHD Rating Scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory and executive functioning) were identified by confirmatory factor analysis. A 3-cm hair sample from the posterior vertex region of the head was obtained. HCCs were determined by a high-sensitivity enzyme immunoassay kit. Multiple linear regression analyses were used to explore the association between HCCs and either cognitive performance or ADHD severity while adjusting for sex, childhood maltreatment and the ADHD-RS total score.Results: Sex moderated the relationship between HCCs and attention/memory confirmatory factor analysis (CFA) scores, with better performance in boys with higher HCCs. HCCs were not associated with executive functioning or ADHD symptoms. Childhood maltreatment was associated with inattention symptoms in adolescents with ADHD.Conclusions: Our study suggests that HCCs are positively associated with attention and memory performance in adolescents with ADHD, with a moderating effect of sex (the relationship is strongest in boys).

We studied the relationship between cortisol and cognition in adolescents with ADHD.Hair cortisol concentrations (HCCs) were determined.We explored the moderating effects of sex and childhood trauma.Sex moderated the relationship between HCCs and attention and memory.Childhood trauma did not moderate the relationship between HCCs and cognition.

COVID-19 Pandemic Has Changed the Psychiatric Profile of Adolescents Attempting Suicide: A Cross-Sectional Comparison.

The COVID-19 pandemic is having a major impact on the mental health of adolescents, leading to suicidal behaviors. However, it remains to be clarified whether the COVID-19 pandemic has changed the psychiatric profile of adolescent suicide attempters. METHODS: a retrospective observational analytical study was conducted to assess age, gender and clinical characteristics of adolescents attempting suicide during the year before and the year after the global lockdown. RESULTS: ninety adolescents (12-17 y.o.) were recruited consecutively from February 2019 to March 2021 at the emergency ward for having attempted suicide. Fifty-two (57.8%) attended before the lockdown (pre-pandemic group) and thirty-eight (42.2%) the year after (pandemic group). There were significant differences in diagnostic categories between the periods (p = 0.003). Adjustment and conduct disorders were more frequent in the pre-pandemic group, while anxiety and depressive disorders were more prevalent during the pandemic. Although the severity of suicide attempts did not show significant differences between the two study periods (0.7), the generalized linear model showed that the suicide attempt severity was significantly associated with current diagnosis (p = 0.01). CONCLUSIONS: the psychiatric profile of adolescents attempting suicide was different before and during the COVID-19 pandemic. During the pandemic, the proportion of adolescents with a prior psychiatric history was lower, and most of them were diagnosed with depressive and anxiety disorders. These diagnoses were also associated with a greater severity in the intentionality of suicide attempt, regardless of the study period.

Contexto familiar y desarrollo infanto-juvenil: el papel de la interacción filio-parental en la salud mental / Context familiar i desenvolupament infantil i juvenil: el paper de la interacció filioparental en la salut mental / Family context and child and adolescent development: the role of child-parent interaction in mental health

El presenteestudio explora la relación entre prácticas educativas parentales y/o estilos educativos parentales sobre conductasinternalizantes y externalizantes. Se evaluaron las prácticas educativas parentales en una muestra constituida por 43niños y adolescentes de 7-14 años, los estilos educativos parentales y la psicopatología mediante el APQ y el CBCL, res-pectivamente. Los resultados sugieren que menor implicación parental, elevada inconsistencia en la disciplina y uso decastigo corporal se relacionan con conductas externalizantes. Asimismo, los estilos educativos autoritarios, permisivosy/o negligentes se relacionan con conductas internalizantes y externalizantes. En conclusión, se manifiesta la relevan-cia de promocionar prácticas educativas parentales adaptativas, contribuyendo en la implementación de programasespecíficos basados en la evidencia para progenitores.(AU)

Thepresent study explores the relationship between parental educational practices and/or parental educational styles oninternalizing and externalising behaviours. Parental educational practices, parental educational styles, and psycho-pathology were assessed in a sample consisted of 43 children and adolescents aged between 7-14 years using theAPQ and the CBCL, respectively. The results suggest that less parental involvement, high inconsistency in discipline,and use of corporal punishment are related to externalising behaviours. Likewise, authoritarian, permissive, and/ornegligent educational styles are related to internalising and externalising behaviours. In conclusion, the relevance ofpromoting adaptive parental educational practices, contributing to the implementation of specific evidence-basedprogrammes for parents, is evident.(AU)

Aquest estudi explora la relació entre pràctiques educatives parentals i/o estils educatius parentals sobre conduc-tes internalitzants i externalitzants. Es van avaluar les pràctiques educatives parentals, els estils educatius parentalsi la psicopatologia en una mostra constituïda per 43 nens i adolescents de 7 a 14 anys mitjançant l’APQ i el CBCL,respectivament. Els resultats suggereixen que menor implicació parental, elevada inconsistència a la disciplina i úsde càstig corporal es relacionen amb conductes externalitzants. Així mateix, els estils educatius autoritaris, permis-sius i/o negligents es relacionen amb conductes internalitzants i externalitzants. En conclusió, es manifesta la relle-vància de promocionar pràctiques educatives parentals adaptatives, contribuint a la implementació de programesespecífics basats en l’evidència per a progenitors.(AU)

Stress-related biomarkers and cognitive functioning in adolescents with ADHD: Effect of childhood maltreatment.

Our study aimed to explore whether stress-related hormones (hypothalamic-pituitary-adrenal [HPA] axis hormones and prolactin) are associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD) and to test the potential moderating effect of childhood maltreatment. Seventy-six adolescents with ADHD were studied. The ADHD rating scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory as well as executive functioning) were identified by confirmatory factor analysis. Stress-related hormone levels were assessed at the clinic (plasma prolactin and cortisol levels and salivary cortisol levels) before cognitive testing and at home for two consecutive days (cortisol awakening response [CAR] and diurnal cortisol slope). Multiple linear regression analyses were used to explore the association between hormone levels and ADHD severity or cognitive functioning while adjusting for sex and childhood maltreatment. Regarding hormonal measurements obtained at the clinic, female sex moderated the relationship between salivary cortisol levels and executive functioning, whereas childhood maltreatment moderated the relationship between salivary cortisol levels and inattention symptoms of patients with ADHD. Prolactin levels were not associated with cognitive functioning or the severity of ADHD. Regarding HPA axis measurements performed at home, lower cortisol levels at awakening were associated with poorer executive functioning. Neither CAR nor the cortisol diurnal slope were associated with cognitive functioning or ADHD severity. Our study suggests that HPA axis hormone levels are associated with the severity of cognitive and inattention symptoms of patients with ADHD and that childhood maltreatment and sex exert distinct moderating effects depending on the symptom type.

Cognitive biases are associated with clinical and functional variables in psychosis: A comparison across schizophrenia, early psychosis and healthy individuals.

OBJECTIVE: We investigated the presence of cognitive biases in people with a recent-onset psychosis (ROP), schizophrenia and healthy adolescents and explored potential associations between these biases and psychopathology. METHODS: Three groups were studied: schizophrenia (N=63), ROP (N=43) and healthy adolescents (N=45). Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQ). Positive, negative and depressive symptoms were assessed with the PANSS and Calgary Depression Scale (ROP; schizophrenia) and with the CAPE-42 (healthy adolescents). Cannabis use was registered. The association between CBQ and psychopathology scales was tested with multiple linear regression analyses. RESULTS: People with schizophrenia reported more cognitive biases (46.1±9.0) than ROP (40±5.9), without statistically significant differences when compared to healthy adolescents (43.7±7.3). Cognitive biases were significantly associated with positive symptoms in both healthy adolescents (Standardized ß=0.365, p=0.018) and people with psychotic disorders (ß=0.258, p=0.011). Cognitive biases were significantly associated with depressive symptoms in healthy adolescents (ß=0.359, p=0.019) but in patients with psychotic disorders a significant interaction between schizophrenia diagnosis and CBQ was found (ß=1.804, p=0.011), which suggests that the pattern differs between ROP and schizophrenia groups (positive association only found in the schizophrenia group). Concerning CBQ domains, jumping to conclusions was associated with positive and depressive symptoms in people with schizophrenia and with cannabis use in ROP individuals. Dichotomous thinking was associated with positive and depressive symptoms in all groups. CONCLUSIONS: Cognitive biases contribute to the expression of positive and depressive symptoms in both people with psychotic disorders and healthy individuals.

Theory of Mind (ToM) Performance in High Functioning Autism (HFA) and Schizotypal-Schizoid Personality Disorders (SSPD) Patients.

The similarities between high functioning autism (HFA) and schizotypal-schizoid personality disorder (SSPD) in terms of social cognition and interpersonal deficits may lead to confusion in symptom interpretation, and consequently result in misdiagnosis. Thus, this study aims to investigate differences in mentalizing with particular interest on the socio-cognitive and socio-affective dimensions. Three Advanced Theory of Mind (ToM) tests were applied in 35 patients with HFA, 30 patients with SSPD and 36 healthy controls. Individuals with HFA showed greater impairment and no dissociation between affective and cognitive ToM components. Conversely, SSPD individuals displayed less difficulties but greater impairments on the cognitive component. Beyond the replicability of ToM impairment in HFA individuals, our findings suggest more impaired cognitive ToM in SSPD participants which further support the sequence of mentalizing development build upon different chronological stages.

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in childhood (5.3% to 7.1% worldwide prevalence), with substantial overall financial burden to children/adolescents, their families, and society. The aims of this study were to describe the clinical characteristics of children and adolescents with ADHD in Spain, estimate the associated direct/indirect costs of the disorder, and assess whether the characteristics and financial costs differed between children/adolescents adequately responding to currently available pharmacotherapies compared with children/adolescents for whom pharmacotherapies failed. METHODS: This was a multicenter, cross-sectional, descriptive analysis conducted in 15 health units representative of the overall Spanish population. Data on demographic characteristics, socio-occupational status, social relationships, clinical variables of the disease, and pharmacological and non-pharmacological treatments received were collected in 321 children and adolescents with ADHD. Direct and indirect costs were estimated over one year from both a health care system and a societal perspective. RESULTS: The estimated average cost of ADHD per year per child/adolescent was €5733 in 2012 prices; direct costs accounted for 60.2% of the total costs (€3450). Support from a psychologist/educational psychologist represented 45.2% of direct costs and 27.2% of total costs. Pharmacotherapy accounted for 25.8% of direct costs and 15.5% of total costs. Among indirect costs (€2283), 65.2% was due to caregiver expenses. The total annual costs were significantly higher for children/adolescents who responded poorly to pharmacological treatment (€7654 versus €5517; P = 0.024), the difference being mainly due to significantly higher direct costs, particularly with larger expenses for non-pharmacological treatment (P = 0.012). CONCLUSIONS: ADHD has a significant personal, familial, and financial impact on the Spanish health system and society. Successful pharmacological intervention was associated with lower overall expenses in the management of the disorder.

Improvement in cognitive abilities following cabergoline treatment in patients with a prolactin-secreting pituitary adenoma.

Hyperprolactinaemia may affect sexual and reproductive functioning. However, recent studies suggest that increased prolactin levels may also have negative effects on cognition. We aimed to study whether the reduction in prolactin levels by cabergoline in patients with hyperprolactinaemia is followed by an improvement in cognitive tasks. We studied seven patients with hyperprolactinaemia caused by a prolactinoma that had an indication to start treatment with cabergoline. All patients were assessed twice (baseline and 6-12 months after cabergoline treatment) with a cognitive battery. Plasma prolactin levels were determined. We found a significant improvement in the speed of processing, working memory, visual learning and reasoning and problem-solving domains after cabergoline treatment. Improvements in speed of processing and reasoning and problem solving were greater in patients with baseline prolactin levels above the median. In summary, a reduction in prolactin levels by cabergoline in patients with hyperprolactinaemia is followed by an improvement in cognitive abilities. This finding suggests that prolactin may be involved in cognitive processes, although cabergoline could also have procognitive effects that are independent of prolactin changes. Further clinical trials are needed to confirm the potential cognitive-enhancement properties of cabergoline in patients with chronic hyperprolactinaemia.

Mental Health Emergencies in Paediatric Services: Characteristics, Diagnostic Stability and Gender differences.

INTRODUCTION: Child and adolescent psychiatric emergencies have increased in recent years. The main objective of our study is to analyze sociodemographic and clinical characteristics of psychiatric emergencies under 18 years old that came to our hospital. Secondary objectives were to study diagnostic stability made in the emergency department and undertake a gender analysis. METHODS: Descriptive cross-sectional study of patients attending the pediatric emergency department who required consultation to psychiatry service during 2010 and 2011, comparing data with two previous cross-sectional cuts (2002-2003 and 2006-2007). Then we track the diagnoses assigned during a year. Statistical analysis was descriptive. We also include a gender analysis. RESULTS: We analyzed 328 episodes corresponding to 179 different patients (average age 14.48). We detected a progressive increase of prevalence of psychiatric emergencies from 2002 to 2011. Diagnostic distribution showed a significant association of Behavioral Disorders with males and an association of Self-injured Behaviors and Eating Disorders with females. The admission rate was 18.5%. One-year diagnostic outcomes showed differences comparing to emergency diagnosis. CONCLUSIONS: Increase and complexity of psychiatric consultations in Pediatric Emergency Department requires a greater coordination and training of these services to enhance patients care. Emergency visit could mean the entrance of complex and severe patients to a specialized care. Our results detect gender differences: more Behavioral Disorders, Psychosis and Substance Use Disorders in males and Self-Injury and Eating Behavior Disorders in females.

Urgencias Psiquiátricas en Pediatría: características, estabilidad diagnóstica y diferencias de género / Mental Health Emergencies in Paediatric Services: Characteristics, Diagnostic Stability and Gender differences

Introducción. Existe una tendencia en los últimos años al aumento de las urgencias infanto-juveniles por motivos psiquiátricos. El objetivo principal del estudio fue analizar las características sociodemográficas y clínicas en las urgencias psiquiátricas de los menores de 18 años. Como objetivos secundarios, estudiamos la estabilidad diagnóstica y realizamos un análisis de género. Metodología. Estudio transversal descriptivo de pacientes que consultaron entre 2010 y 2011 al servicio de urgencias pediátricas por motivos psiquiátricos. Comparamos con dos cortes previos (2002-2003 y 2006-2007) y realizamos un seguimiento al año de los diagnósticos asignados. Estadística descriptiva, incluyendo un análisis comparativo de género. Resultados. Se analizaron 328 episodios (179 pacientes, edad media 14,48 años). Se detecta un incremento de prevalencia de 2002 a 2011. La distribución de diagnósticos por género muestra una asociación significativa de la alteración conductual con el masculino y de las conductas autolesivas y los trastornos alimentarios con el femenino. La tasa de ingreso fue del 18,5%. Tras revisar el diagnóstico al año de seguimiento, muestra diferencias con respecto a la orientación diagnóstica en urgencias. Conclusiones. El incremento de las consultas psiquiátricas urgentes en pediatría requiere una mayor coordinación y formación de los servicios para mejorar y adaptarse a esta emergencia. La consulta urgente supone la puerta de entrada a la atención psiquiátrica especializada de pacientes complejos y graves. Existen diferencias de género relevantes: se observan más trastornos conductuales, psicosis y trastornos por uso de substancias en el género masculino y más conductas autolesivas y trastornos alimentarios en el femenino

Introduction. Child and adolescent psychiatric emergencies have increased in recent years. The main objective of our study is to analyze sociodemographic and clinical characteristics of psychiatric emergencies under 18 years old that came to our hospital. Secondary objectives were to study diagnostic stability made in the emergency department and undertake a gender analysis. Methods. Descriptive cross-sectional study of patients attending the pediatric emergency department who required consultation to psychiatry service during 2010 and 2011, comparing data with two previous cross-sectional cuts (2002-2003 and 2006-2007). Then we track the diagnoses assigned during a year. Statistical analysis was descriptive. We also include a gender analysis. Results. We analyzed 328 episodes corresponding to 179 different patients (average age 14.48). We detected a progressive increase of prevalence of psychiatric emergencies from 2002 to 2011. Diagnostic distribution showed a significant association of Behavioral Disorders with males and an association of Self-injured Behaviors and Eating Disorders with females. The admission rate was 18.5%. One-year diagnostic outcomes showed differences comparing to emergency diagnosis. Conclusions. Increase and complexity of psychiatric consultations in Pediatric Emergency Department requires a psiquiágreater coordination and training of these services to enhance patients care. Emergency visit could mean the entrance of complex and severe patients to a specialized care. Our results detect gender differences: more Behavioral Disorders, Psychosis and Substance Use Disorders in males and Self-Injury and Eating Behavior Disorders in females

The MABIC project: An effectiveness trial for reducing risk factors for eating disorders.

Challenges in the prevention of disordered eating field include moving from efficacy to effectiveness and developing an integrated approach to the prevention of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. This effectiveness trial tested whether this program has effects when previously trained community providers in an integrated approach to prevention implement the intervention. The research design involved a multi-center non-randomized controlled trial with baseline, post-test and 1-year follow-up measures. The sample included girls in the 8th grade from six schools (n = 152 girls) in a city near Barcelona (intervention group), and from eleven schools (n = 413 girls) in four neighboring towns (control group). The MABIC risk factors of disordered eating were assessed as main outcomes. Girls in the intervention group showed significantly greater reductions in beauty ideal internalization, disordered eating attitudes and weight-related teasing from pretest to 1-year follow-up compared to girls in the control group, suggesting that this program is effective under real-world conditions.

Telephone Management Program for Patients Discharged From an Emergency Department After a Suicide Attempt: A 5-Year Follow-Up Study in a Spanish Population.

AIM: In a previous controlled study, the authors reported on the significant beneficial effects of a telephone intervention program for prevention of suicide attempts by patients for up to 1 year. This study reports the 5-year follow-up data. Outcomes were number of recurrences and time to recurrence. METHOD: The intervention was carried out on patients discharged from the emergency room (ER) following attempted suicide (Sabadell). It consisted of a systematic, 1-year telephone follow-up program: after 1 week, and thereafter at 1-, 3-, 6-, 9-, and 12-month intervals to assess the risk of suicide and encourage adherence to treatment. The population in the control group (Terrassa) received treatment as usual after discharge, without additional telephone contact. RESULTS: The effect of reattempt prevention observed in the first year was not maintained over the long term. CONCLUSION: A telephone management program for patients discharged from an ER after attempted suicide could be considered a useful strategy in delaying further suicide attempts and reducing the rate of reattempts in the first year. However, results showed that the beneficial effects were not maintained at the 5-year follow-up.

Neurotrophin blood-based gene expression and social cognition analysis in patients with autism spectrum disorder.

Autism spectrum disorders (ASD) comprise neurodevelopmental disorders with clinical onset during the first years of life. The identification of peripheral biomarkers could significantly impact diagnosis and an individualized, early treatment. Although the aetiology of ASD remains poorly understood, there is increasing evidence that neurotrophins and their receptors represent a group of candidate genes for ASD pathophysiology and biomarker research. Total messenger RNA (mRNA) from whole blood was obtained from adolescents and adults diagnosed as ASD (n = 21) according to DSM-IV criteria and confirmed by the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R) algorithms, as well as healthy controls (n = 10). The mRNA expression of neurotrophins (BDNF, NT3 and NT4) and their receptors (TrkA, TrkB and p75 (NTR) ) was determined by quantitative real-time polymerase chain reaction (qRT-PCR). Moreover, social cognition abilities of ASD patients and controls were determined according to three Theory of Mind (ToM) tests (Reading the Mind in the Eyes, Faux pas, and Happé stories). The NT3 and NT4 mRNA expression in the whole blood was significantly lower in ASD compared to healthy controls, while p75(NTR) was higher (P < 0.005). In addition, lower scores in three of the ToM tests were observed in ASD subjects compared to controls. A significant (P < 0.005) ToM impairment in Happé stories test was demonstrated in ASD. Nevertheless, no correlations were observed between neurotrophins and their receptors expressions and measures of ToM. Given their potential as peripheral blood-based biomarkers, NT3, NT4 and p75 (NTR) mRNA expression patterns may be useful tools for a more personalized diagnostics and therapy in ASD. Further investigations with larger numbers of samples are needed to verify these results.

Recomendaciones del GEITDAH en el tratamiento nutricional del déficit de atención con y sin hiperactividad (TDAH) / Recommendations on the nutritional treatment of attention deficit hyperactivity disorder (ADHD)

El grupo GEITDAH (Grupo de Especial Interés en el Trastorno por Déficit de Atención/Hiperactividad) presenta en este artículo un consenso de expertos de toda España sobre el tratamiento nutricional del TDAH. El tratamiento del trastorno por déficit de atención con o sin hiperactividad (TDAH) debe ser multimodal. El tratamiento nutricional es suplementario y comienza a haber pruebas científicas de su eficacia. Las intervenciones dietéticas pueden tener pequeños efectos beneficiosos en los síntomas del TDAH. La controvertida eliminación de aditivos artificiales, conservantes, colorantes y azúcares ha sido bien estudiada, y no tiene suficiente soporte científico por el momento para su recomendación generalizada como tratamiento eficaz del TDAH. Tampoco el empleo adicional de Acetil-L Carnitina con metilfenidato. Los suplementos de hierro o zinc deben suministrarse en los pacientes con TDAH con deficiencias conocidas. En este momento los hallazgos de los ensayos controlados aleatorizados son demasiado limitados y no apoyan de forma definitiva hasta la fecha el uso habitual en la práctica clínica de los ácidos grasos esenciales (omega-3 y 6) como tratamiento primario o suplementario en los niños con TDAH. Aunque, parecen aliviar síntomas relacionados con el TDAH, al menos en algunos niños, y los beneficios son mayores en el colegio que en casa

In this article, the GEITDAH -the Spanish abbreviation of the Special Interest Group on Attention Deficit Hyper-activity Disorder (ADHD)- presents a consensus about nutritional treatment for ADHD reached by experts in the management of ADHD from all over Spain. The ADHD treatment should be multimodal.Nutritional treatment is supplementary and there is some begining evidence of modest efficacy. Dietary interventions can have little beneficial effects in ADHD symptomatology. The controversial restricted elimination of food additives, preservatives, artificial food colours and refined sugar from diet is good studied. Present findings do not support to date the positive recommendation of its use as an appropriate treatment in ADHD. Neither do they support Acetyl-L Carnitine supplementation to augment methylphenidate. Iron and zinc should be supplemented in selected patients with know deficiencies. Current findings from randomized trials are limited and have not consistently supported the generalized clinical use of PUFA supplements (omega-3 fatty acids) as a primary or supplementary treatment for children with ADHD

A school-based program implemented by community providers previously trained for the prevention of eating and weight-related problems in secondary-school adolescents: the MABIC study protocol.

BACKGROUND: The prevention of eating disorders and disordered eating are increasingly recognized as public health priorities. Challenges in this field included moving from efficacy to effectiveness and developing an integrated approach to the prevention of a broad spectrum of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. The main aim of this effectiveness trial protocol is to test whether this program has effects when incorporating an integrated approach to prevention and when previously-trained community providers implement the intervention. METHODS/DESIGN: The research design involved a multi-center non-randomized controlled trial with baseline, post and 1-year follow-up measures. Six schools from the city of Sabadell (close to Barcelona) participated in the intervention group, and eleven schools from four towns neighboring Sabadell participated in the control group. A total of 174 girls and 180 boys in the intervention group, and 484 girls and 490 boys in the control group were registered in class lists prior to baseline. A total of 18 community providers, secondary-school class tutors, nurses from the Catalan Government's Health and School Program, and health promotion technicians from Sabadell City Council were trained and delivered the program. Shared risk factors of eating and weight-related problems were assessed as main measures. DISCUSSION: It will be vital for progress in disordered eating prevention to conduct effectiveness trials, which test whether interventions are effective when delivered by community providers under ecologically valid conditions, as opposed to tightly controlled research trials. The MABIC project will provide new contributions in this transition from efficacy to effectiveness and new data about progress in the integrated approach to prevention. Pending the results, the effectiveness trial meets the effectiveness standards set down by the Society for Prevention Research. This study will provide new evidence to improve and enhance disordered eating prevention programs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN47682626.

Effectiveness of a telephone management programme for patients discharged from an emergency department after a suicide attempt: controlled study in a Spanish population.

OBJECTIVE: To determine the effectiveness over one year of a specific telephone management programme on patients discharged from an emergency department (ED) after a suicide attempt. We hypothesized that the programme will reduce the percentage of patients re-attempting suicide and delay the time between attempts. DESIGN: A multicentre, case-control, population-based study. The effect of the 1-year intervention on the main outcome measures was evaluated with respect to a 1-year baseline period and a control group. SETTING: Two hospitals with distinct catchment areas in Catalonia (Spain). PARTICIPANTS: A total of 991 patients discharged from the ED of either hospital after a suicide attempt during the baseline year and the intervention year. INTERVENTION: The intervention was carried out on patients discharged from the ED for attempted suicide (Sabadell). It consisted of a systematic, one-year telephone follow-up programme: after 1 week, thereafter at 1, 3, 6, 9 and 12-month intervals, to assess the risk of suicide and increasing adherence to treatment. The population in the control group (Terrassa) received treatment as usual after discharge, without additional telephone management. MAIN OUTCOME MEASURES: Time elapsed between initial suicide attempt and subsequent one, and changes in the annual rate of patients who reattempted suicide in the year of the intervention and the preceding one. RESULTS: The telephone management programme delayed suicide reattempts in the intervention group compared to the baseline year (mean time in days to first reattempt, year 2008=346.47, sd=4.65; mean time in days to first reattempt, year 2007=316.46, sd=7.18; P<0.0005; χ²=12.1, df=1) and compared to the control population during the same period (mean time in days to first reattempt, treatment period=346.47, sd=4.65; mean time in days to first reattempt, pre-treatment period=300.36, sd=10.67; P<0.0005; χ²=16.8, df=1). The intervention reduced the rate of patients who reattempted suicide in the experimental population compared to the previous year (Intervention 6% (16/296) v Baseline 14% (39/285) difference 8%, 95% confidence interval 2% to 12%) and to the control population (Intervention 6% (16/296) v Control 14% (31/218) difference 8%, -13% to -2%) LIMITATIONS: One of the main obstacles was the difficulty to contact all patients within the established deadlines. Another limitation of our study was that patients under the age of 18 underwent an intensive intervention in the day hospital, although their number was very small (13/319 in 2008) and did not significantly influence the results. But the main limitation of our study was that it was performed within the EAAD project. This project includes a comprehensive multilevel intervention practically in the same experimental area and aimed at an early diagnosis and treatment of depression, which is the main psychiatric disorder associated with suicide. Moreover, longer-term studies should be encouraged to determine whether such interventions really reduce suicide CONCLUSION: A telephone management programme for patients discharged from an ED after a suicide attempted would be a useful strategy in delaying further suicide attempts and in reducing the rate of reattempts, which is known as the highest risk factor for suicide completion.

Bases genéticas del trastorno por déficit de atención/hiperactividad / Genetic bases of attention deficit hyperactivity disorder

Objetivo. Realizar una actualización del principal grupo de genes que se ha relacionado con la susceptibilidad al trastorno por déficit de atención/hiperactividad (TDAH) o con la respuesta farmacológica a distintos fármacos utilizados en el tratamiento del TDAH, en diversos estudios de asociación y metaanálisis. Desarrollo. Diferentes estudios han avalado la importancia de la carga genética en la susceptibilidad a presentar TDAH. Los trabajos realizados señalan genes del sistema dopaminérgico como el gen que codifica para el transportador de dopamina (DAT1 o SLC6A3) y para el receptor D4 de dopamina (DRD4); del sistema noradrenérgico, como el gen codificante del receptor adrenérgico α2A (ADRA2A), el gen COMT que codifica para la enzima catecol-O-metiltransferasa y el gen que codifica para latrofilina 3 (LPHN3), como genes candidatos a participar en la susceptibilidad al TDAH, implicados en la respuesta farmacológica así como en el riesgo de presentar trastornos de conducta asociados. Por otra parte, los genes implicados en la regulación del metabolismo de los fármacos utilizados en el tratamiento a TDAH, tales como el gen CYP2D6 y el gen CES1, participan en la eficiencia y la tolerancia a estos psicofármacos. Conclusiones. Aunque en los últimos años se ha incrementado el número de estudios farmacogenéticos realizados acerca del TDAH, los resultados obtenidos son dispares entre ellos. Son necesarios estudios integradores y metaanalíticos para poder desarrollar un tratamiento más personalizado del TDAH (AU)

Aims. The purpose of this study is to update the information available on the main group of genes that have been related with a susceptibility to attention deficit hyperactivity disorder (ADHD) or with the pharmacological response to different drugs used in the treatment of ADHD, in a number of different association and meta-analysis studies. Development. Different studies have provided evidence of the importance of the genetic load in the susceptibility to ADHD. The work carried out to date point to genes in the dopaminergic system, such as the gene that codes for the dopamine transporter (DAT1 or SLC6A3) and for the dopamine receptor D4 (DRD4); in the noradrenergic system, like the gene coding for the adrenergic alpha-2A receptor (ADRA2A), the COMT gene, which codes for the enzyme catechol-Omethyltransferase and the gene that codes for latrophilin 3 (LPHN3), as genes that are candidates for playing a part in the susceptibility to ADHD, and being involved in the pharmacological response as well as in the risk of presenting associated behavioural disorders. On the other hand, the genes involved in regulating the metabolism of the drugs used in the treatment of ADHD, such as the gene CYP2D6 and gene CES1, play a role in the efficiency and tolerance of these psychopharmaceuticals. Conclusions. Although in recent years there has been an increase in the number of pharmacogenetic studies conducted on ADHD, findings differ significantly from one study to another. Integrating and meta-analytical studies are needed to be able to develop a more personalised treatment for ADHD (AU)

Algoritmos de derivación del TDAH: Consenso Geitadh / ADHD Algorithms for clinical pathways: GEITDAH consensus

El grupo de especial interés en TDAH (GEITADH) expone en este artículo su consenso sobre algoritmos de derivación en la asistencia para el paciente afecto de TDAH. Es un diseño sencillo realizado por un amplio número de profesionales de toda España con el objetivo de poder ser adaptado a necesidades asistenciales locales. Se revisan también otros algoritmos con influencia nacional

The Spanish Especial Interest Group on ADHD (GEITDAH) presents in this article its consensus on pathways for attending ADHD patients. This is a clear and simple consensus in order to facilitate the development of local algoritms inspired on it. Some ADHD algorithms used in the Spanish Health Services are reviewed

Consenso del GEITDAH sobre el trastorno por déficit de atención/hiperactividad / GEITDAH consensus on attention deficit hyperactivity disorder

El GEITDAH, Grupo de Especial Interés en el Trastorno por Déficit de Atención/Hiperactividad (TDAH), presenta en este artículo un consenso de expertos de toda España sobre el manejo del TDAH. Se han consensuado aspectos básicos que deberían ser el punto de partida para futuros consensos locales o regionales. Es también un objetivo de este consenso disminuir la variabilidad en la asistencia que se da en nuestro país al TDAH y servir de estímulo para fines docentes. Su reducida extensión permitirá una mayor difusión a fin de lograr todos estos fines de forma más efectiva. Las conclusiones del consenso se han articulado en torno a una introducción sobre aspectos básicos y recomendaciones para: diagnóstico, tratamiento (farmacológico y psicoterapéutico), flujo de pacientes y aspectos organizativos (AU)

In this article, the GEITDAH –the Spanish abbreviation of the Special Interest Group on Attention Deficit Hyperactivity Disorder (ADHD)– presents a consensus reached by experts in the management of ADHD from all over Spain. The consensus concerns fundamental aspects that should be the starting point for future local or regional consensus guides. Another aim of this consensus is also to reduce the amount of variability that occurs in the health care offered to patients with ADHD in our country, as well as to act as a stimulus in educational matters. That fact that it is not very long will make it more popular among greater numbers of people and this will allow these goals to be reached more effectively. The conclusions in the consensus guide have been constructed around an introduction dealing with basic aspects and recommendations for diagnosis, treatment (both pharmacological and psychotherapeutic), patient flow and organisational aspects (AU)

Differences between prepubertal- versus adolescent- onset bipolar disorder in a Spanish clinical sample.

OBJECTIVE: To examine patients attended and diagnosed with bipolar disorder (BD) at a child and adolescent psychiatry service; to record age of diagnosis and age of onset, and to study clinical differences between prepubertal and adolescent onset groups. METHODS: All patients currently attended for BD type I, type II or non specified BD were reviewed and divided into two age groups: prepubertal onset (beginning before age 13) and adolescent onset (beginning at or above age 13). RESULTS: The sample were 43 patients with BD. Fourteen (32.6%) with prepubertal onset and 29 (67.4%) with adolescent onset. Time between onset of symptoms and diagnosis was longer in the prepubertal onset group (1.2 years versus 0.8 years respectively, P = .05). Patients with prepubertal onset BD more frequently presented previous symptoms such as irritability and conduct problems and had a higher rate of comorbidity (more frequently attention-deficit/hyperactivity disorder-ADHD). The adolescent onset group more often presented psychotic symptoms. CONCLUSION: The clinical characteristics of patients with bipolar disorder differ according to whether onset is prepubertal or adolescent.