Temperament and character traits in children and adolescents with major depressive disorder: a case-control study.

OBJECTIVES: To evaluate temperament and character traits using the Junior Temperament and Character Inventory (JTCI) in children and adolescents with major depressive disorder (MDD) in comparison with healthy control subjects (HC), and to verify if comorbidity with disruptive behavioral disorders and being currently depressed influence JTCI scores. METHODS: A case-control study comprising 41 MDD children/adolescents matched to 40 HC by gender and age (8-17years). All participants were assessed diagnostically with the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime (K-SADS-PL). Temperament and character traits were measured with the parent and child versions of JTCI, and depression was evaluated with the Children's Depression Rating Scale (CDRS). RESULTS: According to child and parent data, MDD subjects had significantly higher scores on harm avoidance and novelty seeking, and lower scores on reward dependence, persistence, self-directedness and cooperativeness compared with HC. According to parent data only, MDD subjects significantly differed from HC on self-transcendence (lower spirituality scores and higher fantasy scores). Comorbidity with disruptive behavioral disorders exerted influence on almost all dimensions, in general increasing the mean differences between MDD and HC subjects. Also, being currently depressed did not influence the results, except for reward dependence according to parent data. LIMITATIONS: The cross-sectional nature of the study and its limited sample size. CONCLUSIONS: MDD children/adolescents have a different temperament and character profile compared to HC subjects. This study supports previous findings of trait-like characteristics of harm avoidance and self-directedness.

Lifetime psychopathology among the offspring of Bipolar I parents.

BACKGROUND: Recent studies have demonstrated high rates of psychopathology in the offspring of parents with bipolar disorder. The aim of this study was to identify psychiatric diagnoses in a sample of children of bipolar parents. METHOD: This case series comprised 35 children and adolescents aged 6 to 17 years, with a mean age of 12.5 ± 2.9 years (20 males and 15 females), who had at least one parent with bipolar disorder type I. The subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL). Family psychiatric history and demographics were also evaluated. RESULTS: Of the offspring studied, 71.4% had a lifetime diagnosis of at least one psychiatric disorder (28.6% with a mood disorder, 40% with a disruptive behavior disorder and 20% with an anxiety disorder). Pure mood disorders (11.4%) occurred less frequently than mood disorders comorbid with attention deficit hyperactivity disorder (17.1%). Psychopathology was commonly reported in second-degree relatives of the offspring of parents with bipolar disorder (71.4%). CONCLUSIONS: Our results support previous findings of an increased risk for developing psychopathology, predominantly mood and disruptive disorders, in the offspring of bipolar individuals. Prospective studies with larger samples are needed to confirm and expand these results.

Lifetime psychopathology among the offspring of Bipolar I parents

BACKGROUND: Recent studies have demonstrated high rates of psychopathology in the offspring of parents with bipolar disorder. The aim of this study was to identify psychiatric diagnoses in a sample of children of bipolar parents. METHOD: This case series comprised 35 children and adolescents aged 6 to 17 years, with a mean age of 12.5 + 2.9 years (20 males and 15 females), who had at least one parent with bipolar disorder type I. The subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL). Family psychiatric history and demographics were also evaluated. RESULTS: Of the offspring studied, 71.4 percent had a lifetime diagnosis of at least one psychiatric disorder (28.6 percent with a mood disorder, 40 percent with a disruptive behavior disorder and 20 percent with an anxiety disorder). Pure mood disorders (11.4 percent) occurred less frequently than mood disorders comorbid with attention deficit hyperactivity disorder (17.1 percent). Psychopathology was commonly reported in second-degree relatives of the offspring of parents with bipolar disorder (71.4 percent). CONCLUSIONS: Our results support previous findings of an increased risk for developing psychopathology, predominantly mood and disruptive disorders, in the offspring of bipolar individuals. Prospective studies with larger samples are needed to confirm and expand these results.

Panorama da saúde mental no Estado de São Paulo: leitos psiquiátricos e assistência extra-hospitalar / Overview of mental health in the State of São Paulo: psychiatric beds and community-based care

Introdução: o Estado de São Paulo conta atualmente com 41.055.761 milhões de habitantes, o que representa mais de um quinto da população do Brasil. Durante os últimos anos a assistência à saúde mental tem passado por importantes mudanças estruturais. Medidas governamentais associadas a iniciativas dos profissionas de saúde e dos usuários dos serviços e de seus familiares levaram à transformação de um modelo hospitalocêntrico e anacrônico em um modelo de atenção voltado às intervenções extra-hospitalares e comunitárias. Objetivos: Verificar a quantidade de leitos psiquiátricos existentes no Estado e sua distribuição em cada uma das regiões e saúde e avaliar quantitativamente os serviços extra-hospitalares de atenção à saúde mental, com pelo menos uma equipe mínima, no Estado de São Paulo, com exceção da capital. Método: com relação aos leitos psiquiátricos avaliaram-se os dados iniciais obtidos pela realização do PNASH/Psiquiatria (Programa nacional de avaliação dos serviços hospitalares) - 2005. Em estudo transversal incluindo as unidades extra-hospitalares de saúde mental com equipe mínima, foi utilizado um questionário semi-estruturado desenvolvido especificamente para este fim, aplicado aos diretores de cada serviço, por auditores estaduais treinados previamente. Resultados: o número de leitos psiquiátricos no Estado totaliza 13.622, sendo 13.190 em hospitais psiquiátricos e 432 em hospitais gerais, representando 3,4 leitos/10.000 hab. Foram avaliados 585 serviços extra-hospitalares de saúde mental, sendo a maioria UBS com equipe de saúde mental. Conclusão: não foi constatada uma correspondência entre o número de leitos e de unidades de saúde mental e a população das regiões avaliadas. No entanto, observou-se a presença de algumas medidas que refletiram em mudanças visando uma melhoria da atenção à saúde mental.

Clinical, laboratory, psychiatric and magnetic resonance findings in patients with Sydenham chorea.

The objective of this study was to determine the clinical and laboratory characteristics, psychiatric manifestations and magnetic resonance imaging (MRI) findings in children and adolescents with Sydenham chorea (SyC). The imaging examination was repeated 1 year after the acute phase of SyC. There were 19 patients with a mean age of 11.7 years and a predominance of females (79%);68% had generalized chorea and 53% moderate chorea. SyC presented as an isolated manifestation in 74%. No association between SyC and obsessive-compulsive disorder was found. Mental health problems were present in 45% of the patients. MRI analysis revealed persistent alterations in the caudate nucleus in three patients (16%), who presented recurrent episodes of chorea during the study. In one patient, MRI revealed the presence of nodular heteropathy close to the caudate nucleus region. We conclude that attention problems can be associated with acute clinical features of SyC and persistent alterations in the basal nuclei, evidenced by MRI, can be found in some patients who tend to suffer prolonged attacks and a greater number of recurrences.