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1.
Brain Behav Immun ; 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31887416

RESUMO

OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety and/or depression in pediatric populations. However, the response rates are low (approximately 50%). Moreover, SSRI use is frequently associated with adverse events (AE). Currently there are no available biomarkers for treatment response/AE. Identification of biomarkers predicting early response and/or AE could help maximize the benefit-risk ratio for the use of SSRIs, and accelerate matching of treatments to patients. Pro-inflammatory cytokines were proposed as potential biomarkers. METHOD: Ninety-two patients (35 boys and 57 girls) with major depressive disorder and/or anxiety disorders, aged 13.90 ± 2.41 years, were treated with fluoxetine (FLX) for 8 weeks. Plasma concentrations of TNFα, IL-6, and IL-1ß were measured by enzyme linked immunosorbent assays before and after FLX treatment. Clinical response and AE were measured using several clinical scales, including the Clinical Global Impression - improvement, Children's Depression Rating Scale-Revised, the Beck Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, the Columbia suicide severity rating scale, and the Suicide Ideation Questionnaire. RESULTS: IL-6 levels increased after treatment only in the group of children who developed FLX-associated suicidality. CONCLUSION: An increase in IL-6 levels during treatment may be a risk factor for the emergence of FLX-associated suicidality (OR = 1.70). Further studies are necessary to clarify the role and mechanism(s) of this cytokine in the pathogenesis of this life-threatening AE.

2.
Harefuah ; 158(9): 607-611, 2019 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-31507114

RESUMO

INTRODUCTION: Excoriation (Skin-Picking) disorder is a clinically recognized condition which was recently included in the Diagnostic and Statistical manual of the American Psychiatric Association (DSM) - fifth edition, as OCD (obsessive compulsive disorder) related disorder. The disorder's official status has been achieved due to its high frequency and unique clinical picture involving both mental and physical impairment. In this article, we would like to present a concise review of the literature together with an illustrative case. Epidemiological surveys show a prevalence of 3% to 5% for the general population, with heterogeneous gender and age distribution. In recent years the disorder has been categorized under the family of BFRB's (Body Focused Repetitive Behaviours). However, there are some elements associated with movement suppression and tic disorders, as well as disorders belonging to obsessive-compulsive spectrum. The treatment of this disorder may be pharmacological and/or psychological. There is some evidence for the benefit of some SSRI (Selective Serotonin Reuptake Inhibitors) agents as well as for N-Acetyl-Cysteine. Various psychological treatments have been investigated and some of them have proven to be effective. These include cognitive behavioural protocols, some of which have been developed specifically for this disorder.


Assuntos
Transtorno Obsessivo-Compulsivo , Comportamento Autodestrutivo , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Prevalência , Inibidores de Captação de Serotonina
3.
Isr J Health Policy Res ; 8(1): 45, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122285

RESUMO

BACKGROUND: The Galilee Study assessed mental health service needs among Israeli Muslim and Druze adolescents and their mothers. Studies show that mothers of adolescents belonging to the Arab minority have much lower help-seeking rates than Jewish mothers. This paper examines mothers' structural and cultural barriers to help-seeking. METHODS: All 9th grade students living in 5 towns representative of Muslim and Druze localities in northern Israel, were eligible for the study and 1639 (69.3%) obtained parental agreement and participated. Emotional or behavioral problem were assessed in the classroom using the Strengths and Difficulties Questionnaire. A total of 704 adolescent-mother dyads participated in the follow-up, and were interviewed at home, using the Development and Well Being Assessment inventory, the Composite Barriers to Help-Seeking Questionnaire, the General Health Questionnaire - 12, the Subjective Feelings of Discrimination Index and socio-demographic questions. Pearson χ2 test and multivariate binary logistic regressions were performed to analyze mothers' consultation rates by risk factors. Exploratory factor analysis was performed to identify underlying factors and assess construct validity of the Composite Barriers to Help-Seeking Questionnaire, and also mean scores and standard deviations for the distinct scales were calculated. RESULTS: More mothers of adolescents with a mental disorder than those without a mental disorder consulted a professional or school source (39.7% vs. 20.5%; χ2 = 45.636; p = < 0.001). The most important barriers to help-seeking were those related to "Accessibility", followed by barriers related to the belief that "Treatment is detrimental" and to the possibility of "Reprisal by authorities". Barriers related to "Stigma" and "Distrust of professionals" had the lowest means scores. Differences by ethnicity/religion were found. CONCLUSIONS: Structural barriers related to lack of access, were considered the main obstacle to help-seeking in this Israeli Arab minority population. Cultural barriers such as stigma were considered of secondary importance. Structural barriers could be reduced by increasing the number of accessible public mental health clinics in the minority localities, a responsibility of the Ministry of Health and the HMOs. Information campaigns and psychoeducation for parents would help reduce other barriers to mental health treatment.


Assuntos
Comportamento do Adolescente/psicologia , Árabes/psicologia , Comportamento de Busca de Ajuda , Transtornos Mentais/terapia , Adolescente , Comportamento do Adolescente/etnologia , Árabes/estatística & dados numéricos , Feminino , Humanos , Israel/etnologia , Masculino , Transtornos Mentais/etnologia , Transtornos Mentais/psicologia , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Relações Mãe-Filho/etnologia , Relações Mãe-Filho/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Racismo/etnologia , Racismo/psicologia , Racismo/estatística & dados numéricos , Inquéritos e Questionários
4.
Eat Weight Disord ; 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30963421

RESUMO

PURPOSE: The aim of this study was to investigate the predictive value of early changes in depression levels during inpatient treatment of adolescent anorexia nervosa (AN). METHODS: Fifty-six adolescents (88% girls) aged 10-18 years (M = 15.35, SD = 2.23) diagnosed with AN were assessed at admission and 1 month following admission to an inpatient setting. Depression levels and eating disorder symptoms were reported at both assessments. Re-hospitalization within 12 months of discharge was documented using official national records. RESULTS: Whereas depression levels at baseline were found equivalent between subsequently re-hospitalized and non-re-hospitalized patients, at 1 month after admission patients who were later re-hospitalized had higher levels of depression compared to those who were not re-hospitalized. These differences remained significant after controlling for weight gain and anti-depressant medication intake. We additionally found that the proportion of boys in the non-re-hospitalized group was substantially larger than their proportion in the re-hospitalized group. CONCLUSIONS: Our results suggest that depression at the point of hospital admission may not be a reliable predictor of treatment outcomes, and highlight the risk of relapse in AN patients whose depression levels do not alleviate after a month of inpatient treatment. Clinicians should consider providing more adjusted and intensive attention to such patients in their efforts to facilitate remission. LEVEL OF EVIDENCE III: Well-designed cohort study.

5.
Isr J Health Policy Res ; 8(1): 14, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30665458

RESUMO

BACKGROUND: The Galilee Study is the first large epidemiological study to compare correlates of mental disorders between two Arab Palestinian minority groups of adolescents in Israel. METHODS: A two-stage cross-sectional study, carried out between 2012 and 2014, included all 9th grade students from 5 Arab localities, representative of 77% of the Muslim and 100% of Druze citizens in Israel. During the screening stage, 1639 students completed the Strengths and Difficulties Questionnaire in the classroom (response rate = 69.3%). During the follow-up stage, 704 adolescent-mother dyads were interviewed at home; using the Development and Well-Being Assessment, the General Health Questionnaire (GHQ)-12, the Subjective Feeling of Discrimination Index (FDI), and socio-demographic questions (response rate = 84.4%). RESULTS: Prevalence of any disorder, internalizing or externalizing disorders among Muslim adolescents were 19.2, 15.8 and 4.2%, respectively and among Druze adolescents 10.9, 5.9 and 5.5%, respectively. Muslim adolescents were 3.2 times more likely than Druze adolescents to have an internalizing disorder, while Druze were 2 times more likely than Muslim to have an externalizing disorder. Males were at higher risk than females for externalizing disorders in both populations, though among Druze the risk was more striking. Learning disabilities increased the likelihood of having an externalizing disorder in both populations. Risk factors for internalizing disorders among Muslim adolescents were female gender, a very low socio-economic level, few siblings, LD, high maternal GHQ-12 score and high FDI; and for externalizing disorders, male gender, a relatively low socio-economic level but not the lowest, learning disability and high maternal GHQ-12 score. CONCLUSIONS: We found an association between religion/ethnicity and internalizing and externalizing disorders as well as a strong correlation between religion/ethnicity and socio-economic variables. Therefore, we tend to conclude that not religion per se but the multifaceted socio-cultural and economic factors that characterize religious groups are associated with mental disorders. Very low socio-economic level and feeling discriminated which were traits connected only to Muslim adolescents, were associated with internalizing disorders. When preparing preventive measures aimed at furthering mental health among minority adolescents, authorities should focus on improving the socio-economic status of minorities and reducing institutional and personal discrimination. The educational and mental health establishments could undertake measures to improve resilience and coping strategies of Muslim families living in the most adverse conditions, such as providing special support through the school counseling services and coordinating, at the ministerial levels, school and community health services in order to carry out joint preventive programs and referrals to specialist services when needed.


Assuntos
Árabes/estatística & dados numéricos , Transtornos Mentais/diagnóstico , Adolescente , Comportamento do Adolescente , Árabes/psicologia , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Humanos , Israel/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Grupos Minoritários/psicologia , Prevalência
6.
Obes Surg ; 29(4): 1154-1163, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30604077

RESUMO

INTRODUCTION: Adolescent obesity is markedly increasing worldwide and bariatric surgery is emerging as an effective treatment option. However, a subset of patients fails to achieve significant weight loss or show post-surgical weight regain. Efforts have been made to identify different post-surgical weight trajectories and their possible predictors. Furthermore, the role of pre-surgical intervention programs in optimizing post-surgical results has been a subject of debate. OBJECTIVES: This study aimed to evaluate the impact of a 3-month lifestyle-oriented pre-surgical program for adolescent candidates for bariatric surgery on pre-surgical weight loss (body mass index (BMI) on completion - BMI at admission), and to identify predictors of different post-surgical weight loss trajectories. METHODS: Forty-eight adolescent bariatric surgery candidates were enrolled in a lifestyle- and behavior-oriented bariatric program consisting of a 3-month pre-surgical outpatient intervention and a 6-month post-surgical follow-up. RESULTS: Mean BMI decreased by 1.82 points (SD = 1.83) during the program's pre-surgical intervention phase, a 3.8% average drop in participants' BMI; post-surgical weight loss trajectories were significantly associated in a curvilinear model with pre-surgical weight loss; optimal post-surgical results were associated with moderate pre-surgical weight loss, and inversely associated with maternal history of obesity, early-life weight loss attempts, and comorbid learning disorders. CONCLUSIONS: Moderate weight loss in a pre-surgical lifestyle-oriented intervention program predicts optimal post-surgical weight loss. Additionally, by assessing risk factors and pre-surgical weight loss patterns, it may be possible to identify sub-populations of adolescents undergoing bariatric surgery at risk of achieving sub-optimal long-term results.

7.
J Trauma Stress ; 31(1): 64-70, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29388703

RESUMO

Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are frequent sequelae after motor vehicle accidents (MVAs). These two pathologies often have overlapping neurocognitive deficits across several domains, such as attention, memory, and executive functions. The present study was an effort to examine the contribution of gender to these overlapping symptoms. To this end, psychodiagnostic and neuropsychological data were collected on 61 children and adolescents 3 months following MVA. All participants were diagnosed with PTSD, and about half (n = 33) also received a diagnosis of mTBI. Analyses of variance revealed significant interactions between gender and mTBI (ηp2=.15), such that girls with mTBIs preformed significantly worse than noninjured girls on measures of executive functions (Cohen's d = 3.88) and sustained attention (Cohen's d = 3.24). Boys, on the other hand, did not differ significantly on any of those measures, irrespective of TBI injury status. Similarly, comparisons to the normative population revealed that, whereas boys showed impaired neurocognitive performances regardless of TBI status, impaired performances in girls were limited to those cases in which the girls were comorbid for PTSD and mTBI. It appears then that whereas PTSD alone might explain boys' reduced neurocognitive performance, among girls the comorbidity of PTSD and mTBI is required to account for performance deficits.


Assuntos
Acidentes de Trânsito/psicologia , Concussão Encefálica/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Atenção , Concussão Encefálica/etiologia , Criança , Função Executiva , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/etiologia
8.
JMIR Ment Health ; 5(1): e6, 2018 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-29472176

RESUMO

BACKGROUND: The influence of pro-anorexia (pro-ana) websites is debated, with studies indicating both negative and positive effects, as well as significant variation in the effects of different websites for those suffering from eating disorders (EDs) and the general population. Online advertising, known to induce behavioral change both online and in the physical world, has not been used so far to modify the search behavior of people seeking pro-ana content. OBJECTIVE: The objective of this randomized controlled trial (RCT) was to examine if online advertisements (ads) can change online search behaviors of users who are looking for online pro-ana content. METHODS: Using the Bing Ads system, we conducted an RCT to randomly expose the searchers for pro-ana content to 10 different ads referring people to one of the three websites: the National Eating Disorders Association, the National Institutes of Mental Health, and MyProAna. MyProAna is a pro-ana website that was found in a previous study to be associated with less pathological online behaviors than other pro-ana websites. We followed participants exposed and unexposed to the ads to explore their past and future online searches. The ads were shown 25,554 times and clicked on 217 times. RESULTS: Exposure to the ads was associated with a decrease in searches for pro-ana and self-harm content. Reductions were greatest among those referred to MyProAna (reduction of 34.0% [73/215] and 37.2% [80/215] for pro-ana and self-harm, respectively) compared with users who were referred elsewhere (reduction of 15.47% [410/2650] and 3.21% [85/2650], respectively), and with users who were not shown the ads, who increased their behaviors (increase of 57.12% [6462/11,314] and 4.07% [461/11,314], respectively). In addition, those referred to MyProAna increased their search for treatment, as did control users, who did so to a lesser extent. However, users referred elsewhere decreased their searches for this content. CONCLUSIONS: We found that referring users interested in ED-related content to specific pro-ana communities might lessen their maladaptive online search behavior. This suggests that those who are preoccupied with EDs can be redirected to less pathological online searches through appropriate pathways. TRIAL REGISTRATION: ClinicalTrials.gov NCT03439553; https://clinicaltrials.gov/show/NCT03439553 (Archived by WebCite at http://www.webcitation.org/6xNYnxYlw).

9.
J Neural Transm (Vienna) ; 125(7): 1077-1085, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29473112

RESUMO

Disrupted somatosensory processing characterized by over- or under- responsiveness to environmental stimuli plays an important, yet often overlooked, role in typical development and is aberrant in various neurodevelopmental disorders. These dysfunctional somatosensory processes have been conceptualized as an entity termed somatosensory dysregulation (SMD). Since Tourette syndrome (TS) is a prototypical example of developmental psychopathological disorder, we hypothesised that SMD would be a feature found in children suffering from the disorder. Ninety-two subjects representing consecutive admissions to a tertiary paediatric Tourette syndrome clinic were admitted to the study. Comorbid conditions included ADHD, depression, anxiety disorder, and OCD. For purposes of the study, patients completed a battery of self-, caregiver-, and clinician-rated psychological instruments measuring TS core symptoms and comorbidities and quality of life. Sensory modulation was measured by self-report and by objective measures such as stimulation with Von Frey filaments. Almost 50% of the cohort had no SMD. Of the remainder, 14 (15%) had suspected SMD and 32 (34.8%) had SMD. SMD was significantly more common and severe when there were comorbidities. The presence of SMD was associated with more severe impairments in quality of life and less participation in daily activities. The SMD, as measured by subjective measures but not by objective, is probably more associated with central processing rather than peripheral perception.


Assuntos
Transtornos das Sensações/etiologia , Transtornos de Tique/complicações , Adolescente , Criança , Feminino , Humanos , Masculino , Qualidade de Vida , Transtornos das Sensações/fisiopatologia , Transtornos de Tique/fisiopatologia
10.
PeerJ ; 6: e4240, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29340244

RESUMO

Background: Not enough is known about predicting therapeutic response to serotonin-specific reuptake inhibitors, and specifically to fluoxetine. This exploratory study used psychological and biological markers for (retrospective) prediction of treatment-response to fluoxetine in depressed and/or anxious adolescents. Methods: Forty-one consecutive adolescent outpatients with a primary diagnosis of severe affective and/or anxiety disorders were assessed and treated with an open-label 8-week trial of fluoxetine. Type D personality was assessed with the 14-item questionnaire, the DS14. In addition, TNFα, IL-6, and IL-1b were measured pre- and post-treatment. Results: There was an elevation of Type D personality in patients, compared to the adolescent population rate. Post-treatment, 44% of patients were classified as non-responders; the relative risk of non-response for Type D personality patients was 2.8. Binary logistic regression predicting response vs. non-response showed a contribution of initial TNFα levels as well as Type D personality to non-response. Conclusions: In this exploratory study, the most significant contributor to non-response was Type D personality. However, the measurement of Type D was not prospective, and thus may be confounded with psychiatric morbidity. The measurement of personality in psychiatric settings may contribute to the understanding of treatment response and have clinical utility.

11.
Psychiatry Res ; 260: 1-9, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29153958

RESUMO

Environmental, psychological, and biological interactions underlie many psychopathologies. Tourette's Syndrome (TS) has an obvious biological substrate but environmental factors and personality play substantial roles in its expression. We aimed to study the interrelationships between stressful life events, personality traits, tics, and comorbid disorders in children with TS. To this end, 132 children with TS and 49 healthy controls were recruited for the study. Major life events in the 12-months prior to testing and minor life events in the month prior to testing were retrospectively assessed using the Life Experiences Survey (LES) and the Brief Adolescent Life Events Scale (BALES), respectively. Personality was assessed with the Junior Temperament and Character Inventory (JTCI). Tics, obsessive compulsive symptoms, attention deficit and hyperactivity symptoms, anxiety, depression and aggression were assessed by self-report questionnaires and semi-structured interviews. We found that major life events correlated with the severity of tics expression and complexity, and comorbid psychopathology. Minor life events correlated with more severe symptomatology. High levels of harm avoidance were related to more obsessions, anxiety, and depression whereas high levels of self-directedness were protective. To conclude, TS expression in childhood should be understood as the result of an interaction between biological, personality and environmental factors.


Assuntos
Acontecimentos que Mudam a Vida , Personalidade , Tiques/psicologia , Síndrome de Tourette/psicologia , Adolescente , Agressão/psicologia , Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Depressão/psicologia , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/psicologia , Inventário de Personalidade , Psicopatologia , Estudos Retrospectivos , Inquéritos e Questionários
12.
Eat Weight Disord ; 23(5): 645-651, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28710742

RESUMO

OBJECTIVE: To investigate the predictive value of weight restoration trajectories for relapse within the first year after discharge from inpatient treatment among adolescents with AN. METHODS: Forty four inpatient adolescents (5 boys, 39 girls) aged 11-18 (M 14.85, SD 1.87) diagnosed with anorexia were assessed at admission and discharge from a general hospital inpatient ward. Re-hospitalizations within 1 year of discharge were recorded. Factors assessed included 1/BMI at admission, 2/BMI at discharge, 3/percent from target weight (PFTW) at discharge, 4/length of hospitalization, and 5/a weight restoration trajectory measuring weight drops during inpatient weight restoration (rates of negative cubic variation in body weight (NCV). RESULTS: Logistic regression indicated that negative cubic variation rates (NCV) predicted re-hospitalization. PFTW was found only marginally significant. CONCLUSION: Variations in weight restoration during inpatient treatment may be used to identify patients at risk for relapse. NCV can alert clinicians to initiate early relapse prevention interventions before discharge. Level of Evidence Level III, cohort study.


Assuntos
Anorexia Nervosa/terapia , Peso Corporal/fisiologia , Pacientes Internados , Ganho de Peso/fisiologia , Adolescente , Anorexia Nervosa/fisiopatologia , Índice de Massa Corporal , Criança , Feminino , Humanos , Masculino , Alta do Paciente , Prognóstico , Recidiva , Fatores de Risco , Resultado do Tratamento
13.
Psychiatry Res ; 256: 124-129, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28628793

RESUMO

The present study evaluated the self-report version of the Inventory of Callous-Unemotional Traits (ICU-SR) in terms of reliability, concurrent validity, and correlation with salivary oxytocin levels, a potential biomarker of CU traits. 67 socially at-risk male adolescents (mean 16.2 years) completed the ICU-SR, ICU teacher-version (ICU-TR), Strengths and Difficulties Questionnaire, and their medical files were coded for previous antisocial acts using Brown-Goodwin Lifetime Aggression Scale. Salivary samples were assayed for oxytocin. The reliability of ICU-SR was lower (α = 0.71) than ICU-TR (α = 0.86). ICU-SR mean score was significantly lower than ICU-TR (M = 25.29, SD = 8.02; M = 33.14, SD = 9.47). ICU-TR but not ICU-SR, significantly correlated with history of antisocial acts (r = 0.40). Two-way analysis of variance showed a significant effect of conduct disorder and oxytocin on ICU-TR but not ICU-SR [F(1,59) = 6.53; F(1,59) = 6.08], and a significant interaction only for ICU-TR [F(1,59) = 2.89]. Subjective self-reports of CU traits may be less reliable and valid than teachers' reports.


Assuntos
Comportamento do Adolescente/fisiologia , Transtorno da Personalidade Antissocial/metabolismo , Transtorno da Conduta/metabolismo , Ocitocina/metabolismo , Saliva/metabolismo , Autorrelato/normas , Adolescente , Comportamento do Adolescente/psicologia , Transtorno da Personalidade Antissocial/diagnóstico , Transtorno da Personalidade Antissocial/psicologia , Transtorno da Conduta/diagnóstico , Transtorno da Conduta/psicologia , Emoções/fisiologia , Humanos , Masculino , Ocitocina/análise , Inventário de Personalidade/normas , Reprodutibilidade dos Testes , Saliva/química , Adulto Jovem
14.
Isr J Psychiatry Relat Sci ; 54(3): 28-34, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29735810

RESUMO

BACKGROUND: The aim of the current study was to investigate whether the percentage of the discharge weight relative to recommended target weight (PFTW) during inpatient treatment predicts re-hospitalization in adolescent anorexia nervosa (AN). METHOD: 51 hospitalized adolescents with AN were weighed and completed self-reports on admission and discharge. We examined reports regarding rehospitalization within the first year after discharge. RESULTS: 19 patients (37.25%) required re-hospitalization. The proportion of the actual discharge weight relative to target weight (PFTW), previous re-hospitalizations and parental marital status were found to be significant predictors of re-hospitalization. CONCLUSIONS: The study highlights the importance of discharge weight relative to target weight (PFTW) for long-term outcome. Failure to obtain discharge target weight is a significant predictor of re-hospitalization in adolescent AN.


Assuntos
Anorexia Nervosa/terapia , Peso Corporal/fisiologia , Alta do Paciente , Readmissão do Paciente , Adolescente , Criança , Feminino , Humanos , Masculino
15.
Early Interv Psychiatry ; 11(3): 200-207, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-25808049

RESUMO

AIM: Examine changes in core perceptions and thoughts during the weight restoration phase of inpatient treatment for adolescents with anorexia nervosa. METHOD: Forty-four adolescents with anorexia nervosa consecutively admitted (2009-2012) to an inpatient paediatric-psychiatric unit specializing in eating disorders. The programme consisted of a complete inpatient intervention combining weight restoration by structured supervised meals with individual and group cognitive-behavioural therapy, parental training/family intervention and educational activities, followed by a half-way day-treatment weight-stabilizing phase and progressive reintroduction to the community. The study focused on changes from hospital admission to discharge in patients' responses to self-report questionnaires on eating disorder symptoms, depression, anxiety and suicidal ideation. RESULTS: No significant changes in core anorexic thoughts and perceptions as Body dissatisfaction, Drive for thinness, Weight concern and Shape concern were noted. However, a reduction in the general severity of eating disorder symptoms (including Restraint and Eating concern) was observed, mainly related to the treatment structure. Levels of depression significantly decreased but remained within pathological range. We also found a concerning increase in suicidal ideation not correlated with a concomitant increase in depressive symptomatology. CONCLUSIONS: Inpatient treatment of anorexia nervosa in adolescents does not significantly modify core anorexic thoughts and perceptions. This may explain the high relapse rates. Changes in core beliefs may be crucial for recovery and prevention of relapse in anorexia nervosa at this critical age. This study may have clinical implications for the development of better treatment strategies to target the gap between disturbed thoughts and distorted perceptions - the core aspects of anorexia nervosa and physical recovery during and after the weight restoration phase.


Assuntos
Anorexia Nervosa/psicologia , Percepção , Pensamento , Adolescente , Comportamento do Adolescente , Anorexia Nervosa/terapia , Criança , Terapia Combinada , Feminino , Humanos , Pacientes Internados , Masculino , Resultado do Tratamento
16.
Neuropsychology ; 30(7): 800-10, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27548577

RESUMO

OBJECTIVE: Persistent postconcussive symptoms (PPCS) are a set of physical, cognitive, emotional, and behavioral symptoms that often follow mild traumatic brain injury (mTBI). Some of these symptoms also occur in posttraumatic stress disorder (PTSD). The current study examined the unique contribution of mTBI and PTSD to PPCS. The roles of neurocognitive and motivational factors were also addressed. METHOD: Sixty one children and adolescents (ages 6-18), at least 3 months post motor vehicle accident (MVA), participated in the study. All participants were diagnosed with PTSD symptoms. Thirty three participants met mTBI criteria, and 28 did not. Standard instruments for assessment included a semistructured clinical interview, self-report questionnaires, and a neuropsychological evaluation. RESULTS: No differences were found between the mTBI and non-TBI groups on any of the emotional or neurocognitive measures, including PPCS symptoms. Multiple regression analyses revealed that emotional status, such as state anxiety and depression, were the best predictors of PPCS. Furthermore, hierarchical regression analyses revealed a double mediation model, in which suboptimal effort mediated the relationship between neurocognitive performance and PPCS, and emotional status mediated the relationship between suboptimal effort and PPCS. CONCLUSION: These findings underscore the importance of emotional status in the diagnosis of PPCS among children who suffer from PTSD. It is possible that PPCS reflect a more general expression of accident-related emotional distress, rather than being a direct result of the injury. (PsycINFO Database Record


Assuntos
Acidentes de Trânsito/psicologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/psicologia , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Criança , Comorbidade , Feminino , Humanos , Israel , Masculino , Testes Neuropsicológicos/estatística & dados numéricos , Psicometria
17.
J Neural Transm (Vienna) ; 123(11): 1347-1354, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27324805

RESUMO

Pharmacogenetic approach to antidepressant (AD) response is a promising avenue toward individualizing AD treatment. This is particularly relevant in pediatric populations because of concerns about the suicide risk of serotonin selective reuptake inhibitors (SSRIs), resulting in a black-box warning. However, to date, no specific gene or polymorphism has been consistently implicated as a marker of AD side effect (SE) in the pediatric population. The aim of this study was to examine the association between polymorphisms in genes related to the serotonergic system and citalopram SE's in children and adolescents with major depressive disorder (MDD)/dysthymia and/or anxiety disorders. Outpatients (N = 87, 44 % males), aged 7-18 years with a DSM-IV-TR diagnosis of MDD/dysthymia and/or an anxiety disorder were treated in an 8-week open trial with 20-40 mg/day of citalopram. SE's were rated using a questionnaire devised specifically for this study. Association analysis between known/candidate genetic variants in three genes (5-HTR2A, 5-HTR1Dß, 5-HTR2C) and SE's was conducted. Agitation was more common in boys than girls (male:female 42.1 vs. 18.7 %, χ 2 = 5.61, df = 1, p = 0.018). Subjects with 5-HTR1Dß CC genotype showed more agitation vs. both CG and GG genotypes (CC:CG:GG 71.4 vs. 33.3 vs. 18.1 %, χ 2 = 8.99, df = 2, p = 0.011). The 5-HTR1Dß CC genotype was associated with more reports of agitation. It has been suggested that agitation may be an intermediate phenotype to suicidal behavior. Thus, it seems that 5-HTR1Dß polymorphism may be involved in citalopram-related agitation in children and adolescents treated for depression and/or anxiety.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/genética , Citalopram/efeitos adversos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/genética , Inibidores de Captação de Serotonina/efeitos adversos , Adolescente , Criança , Citalopram/uso terapêutico , Transtorno Distímico/tratamento farmacológico , Transtorno Distímico/genética , Feminino , Humanos , Masculino , Variantes Farmacogenômicos , Receptor 5-HT1B de Serotonina/genética , Receptor 5-HT2A de Serotonina/genética , Receptor 5-HT2C de Serotonina/genética , Inibidores de Captação de Serotonina/uso terapêutico , Fatores Sexuais
18.
Psychiatry Res ; 242: 204-209, 2016 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-27289326

RESUMO

The objective of this study was to examine the influence of environmental challenges on tic expression by subjective and objective measures. The study group consisted of 41 children aged 6-18 years (M=10.15, SD=2.73) with a primary diagnosis of Tourette syndrome. Subjective measures included the Functional Assessment Interview developed for this study and three standard validated instruments. The objective measure was a video-recording of the patients in five daily-life situations: watching television, doing homework, being alone, receiving attention when ticcing, and talking to a stranger. In addition, the effect of premonitory urges on assessment of tic expression was evaluated. The associations between the subjective and objective measures of tic expression were moderate to low. A significantly higher number of tics were observed in the television situation, and a significantly lower number in the alone situation, compared to the other situations. Higher levels of premonitory urge were associated with greater awareness of objectively measured tic expression. In conclusion, tic expression is significantly influenced by the environment. Subjective measures of tic expression may be misleading. These results have implications for refining the clinical assessment of tics, improving research methodology, and developing new therapeutic strategies.


Assuntos
Autorrelato , Meio Social , Tiques/fisiopatologia , Síndrome de Tourette/fisiopatologia , Gravação em Vídeo , Adolescente , Conscientização , Criança , Meio Ambiente , Feminino , Humanos , Masculino , Índice de Gravidade de Doença , Trabalho
19.
Eat Behav ; 22: 109-112, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27183245

RESUMO

BACKGROUND: There is a debate about the effects of pro-anorexia (colloquially referred to as pro-ana) websites. Research suggests that the effect of these websites is not straightforward. Indeed, the actual function of these sites is disputed, with studies indicating both negative and positive effects. AIM: This is the first study which systematically examined the differences between pro-anorexia web communities in four main aspects: web language used (posts); web interests/search behaviors (queries); users' self-reported weight status and weight goals; and associated self-reported mood/pathology. METHODS: We collected three primary sources of data, including messages posed on three pro-ana websites, a survey completed by over 1000 participants of a pro-ana website, and the searches made on the Bing search engine of pro-anorexia users. These data were analyzed for content, reported demographics and pathology, and behavior over time. RESULTS: Although members of the main pro-ana website investigated appear to be depressed, with high rates of self-harm and suicide attempts, users are significantly more interested in treatment, have wishes of procreation and reported the highest goal weights among the investigated sites. In contrast, users of other pro-ana websites investigated, are more interested in morbid themes including depression, self-harm and suicide. The percentage of severely malnourished website users, in general, appears to be small (20%). CONCLUSIONS: Our results indicate that a new strategy is required to facilitate the communication between mental health specialists and pro-ana web users, recognizing the differences in harm associated with different websites.


Assuntos
Anorexia/psicologia , Internet , Comportamento Autodestrutivo/psicologia , Depressão/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Estigma Social , Apoio Social , Suicídio/psicologia , Inquéritos e Questionários
20.
J Child Adolesc Psychopharmacol ; 26(8): 727-732, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26771135

RESUMO

OBJECTIVE: In adults there is growing evidence that antidepressant (AD) treatment results in a decline in inflammatory cytokines. This is the first report, to our knowledge, of the relationship between response to selective serotonin reuptake inhibitor (SSRI) treatment for anxiety and/or depression and cytokine levels in children and adolescents. METHODS: Forty-one patients who met Diagnostic and Statistical Manual for Mental Disorders, 4th ed. (DSM-IV) criteria for major depressive disorder (MDD) or anxiety disorders participated in study. Their ages ranged from 9 to 18 (14.12 ± 2.30) years. The patients were treated with fluoxetine for 8 weeks. Plasma concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1ß were measured by enzyme linked immunosorbent assays (ELISA) before and after fluoxetine treatment. Clinical response was measured with several scales, including the Children's Depression Rating Scale-Revised (CDRS-R), the Beck Depression Inventory (BDI), and the Screen for Child Anxiety Related Emotional Disorders (SCARED) Results: The overall response rate was 56%. Antidepressant treatment significantly reduced TNF-α levels (p = 0.037), with no significant changes in the levels of IL-6 and IL-1ß. All three proinflammatory cytokines were significantly (p < 0.05) higher in SSRI-refractory than in SSRI-responsive patients. CONCLUSIONS: Higher levels of TNF-α, IL-6, and IL-1ß might predict nonresponse to fluoxetine treatment in children.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Fluoxetina/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Adolescente , Transtornos de Ansiedade/sangue , Transtornos de Ansiedade/fisiopatologia , Criança , Citocinas/sangue , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/fisiopatologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interleucina-1beta/sangue , Interleucina-6/sangue , Masculino , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue
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