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1.
J Pers Med ; 11(3)2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33808804

RESUMO

BACKGROUND: We have investigated the distribution of the Th1, Th2 and Th17 subsets in circulating CD4+ T lymphocytes and their naïve (TN), effector (TE), central (TCM) and effector memory (TEM) activation/differentiation stages in patients with major depressive disorder (MDD). METHODS: Thirty MDD patients and 30 healthy controls were studied. The counts of circulating CD4+ T lymphocytes and their distribution on the TN, TE, TCM and TEM activation/differentiation stages were analyzed by polychromatic flow cytometry. The intracytoplasmic interferon gamma (IFNγ), interleukin (IL)-4, IL-17A and tumor necrosis factor alpha (TNF-alpha) and membrane CD28 expression were also measured. The serum IFNγ, IL-4, Il-17A and TNF-alpha were measured by Luminex, respectively. RESULTS: MDD patients had normal counts of CD4+ T lymphocytes and of their TN, TCM and TEM subsets but increased number and percentage of TE CD4+ subset. CD4+ T lymphocytes had significantly enhanced percentage of cells that express IL-17 and TNF-alpha explained by the expansions found in the TN, TCM and, TEM and TCM, TEM and TE activation/differentiation stages, respectively. A selective increase in the percentages of TCM and TEM expressing IFNγ was also observed. We found a significant correlation between the percentages of CD4+ T lymphocytes expressing IFNγ and TNF-alpha in these patients. MDD patients showed increased serum levels of IL-17 and TNF-alpha, but normal IFNγ and IL-4 concentration. LIMITATIONS: the cross-sectional nature of the study could be considered a limitation. CONCLUSIONS: MDD patients have abnormal circulating CD4+ T lymphocytes with expansion of the IL-17 and TNF-alpha expressing cells as well as increased levels of circulating IL-17 and TNF-alpha.

2.
Psiquiatr. biol. (Internet) ; 27(3): 130-133, sept.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198681

RESUMO

OBJETIVO: Describir un caso clínico de arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía (CADASIL), un trastorno monogénico que causa ataques isquémicos transitorios recurrentes, accidentes cerebrovasculares lacunares, deterioro cognitivo, trastornos psiquiátricos, epilepsia y migrañas, diagnóstico que se pudo considerar tras la presencia de síntomas maniformes. CASO CLÍNICO: Describimos el caso clínico de un paciente varón de 57 años que fue diagnosticado inicialmente con trastorno bipolar tras iniciar con sintomatología maniforme. Sin embargo, al analizar los antecedentes personales médicos y apoyados en la prueba de neuroimagen, se consideró el diagnóstico de CADASIL. RESULTADOS: En las pruebas de neuroimagen se observaron las lesiones características del CADASIL, lo que, unido a los antecedentes personales y familiares, orientó el diagnóstico. CONCLUSIONES: En pacientes con sintomatología afectiva de inicio tardío, leucoencefalopatía en pruebas de neuroimagen, antecedentes familiares de accidente cerebrovascular, migraña o deterioro cognitivo se debería considerar el diagnóstico diferencial con CADASIL


OBJECTIVE: To describe a clinical case of autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a monogenic disorder that causes recurrent transient ischemic attacks, lacunar stroke, cognitive impairment, psychiatric disorders, epilepsy and migraines; a diagnosis that could be considered after the presence of symptoms of mania. CLINICAL CASE: We describe the case of a 57-year-old male patient who was initially diagnosed with bipolar disorder after debuting with manic symptoms. However, after analyzing his medical history and supported by neuroimaging, the diagnosis of CADASIL was considered. RESULTS: In neuroimaging, the characteristic lesions of CADASIL were observed, which, together with the personal and family history, guided the diagnosis. CONCLUSIONS: In patients with late-onset affective symptoms, leukoencephalopathy in neuroimaging, family history of stroke, migraine or cognitive impairment, the differential diagnosis with CADASIL should be considered


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Bipolar/etiologia , CADASIL/diagnóstico por imagem , CADASIL/complicações , Imagem por Ressonância Magnética
6.
J Atten Disord ; 24(10): 1462-1470, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28095738

RESUMO

Objective: ADHD adults exhibit deficits in emotion recognition, regulation, and expression. Emotional intelligence (EI) correlates with better life performance and is considered a skill that can be learned and developed. The aim of this study was to assess EI development as ability in ADHD adults, considering the effect of comorbid psychiatric disorders and previous diagnosis of ADHD. Method: Participants (n = 116) were distributed in four groups attending to current comorbidities and previous ADHD diagnosis, and administered the Mayer-Salovey-Caruso Emotional Intelligence Test version 2.0 to assess their EI level. Results: ADHD adults with comorbidity with no previous diagnosis had lower EI development than healthy controls and the rest of ADHD groups. In addition, ADHD severity in childhood or in adulthood did not influence the current EI level. Conclusion: EI development as a therapeutic approach could be of use in ADHD patients with comorbidities.

7.
Am J Ther ; 27(4): e346-e355, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31082829

RESUMO

BACKGROUND: Regarding the treatment of patients with resistant schizophrenia, different options exit, although they are supported by limited evidence. In this study, antipsychotic polypharmacy, comprising 1200 mg of amisulpride and 600 mg of quetiapine, was used. Clinical change evaluation was performed using neurocognitive evaluations. STUDY QUESTION: The use of amisulpride and quetiapine will imply a clinical improvement in patients affected by schizophrenia, which will be specially reflected in a cognitive improvement. STUDY DESIGN: Naturalistic and prospective study. Twenty-six patients were applied and assessed by a battery of neurocognitive evaluations since the pretreatment baseline until 6-month treatment. The patients had no biological response to medication, high social maladjustment, and a long clinical history of the disease. Kane and Brenner criteria for treatment-resistant schizophrenia were applied to choose the subjects. MEASURES AND OUTCOMES: The cognitive improvement will imply a significant betterment, from the pretreatment baseline until 6-month treatment, in the following cognitive tests: Stroop Test, WAIS Coding Subtest, and Comprehensive Trail Making Test (CTMT). An improvement in the Calgary Depression Scale, Simpson-Angus Scale, and Visual Analogue Scale (EVA) will also be observed. This scales were been used during the baseline, 3 months after, and then, 6 months. RESULTS: Subjects, after 6-month treatment with amisulpride and quetiapine, did show statistically significant differences in the assessed areas: WAIS Coding Subtest (P < 0.001), CTMT A and B (CTMT A P < 0.034; CTMT B P < 0.000), and Stroop Tests: Word (P < 0.001), Word-Color (P < 0.007), and Interference (P < 0.039). Furthermore, they showed a statistically significant difference in the Calgary Depression Scale (P < 0.002), Simpson-Angus Scale (P < 0.019), and EVA (P < 0.001). CONCLUSIONS: The results of this report show a cognitive and clinical improvement in refractory patients after the administration of amisulpride and quetiapine.

8.
Dev Biol ; 458(2): 200-214, 2020 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-31738910

RESUMO

Much of boundary formation during development remains to be understood, despite being a defining feature of many animal taxa. Axial patterning of Hydra, a member of the ancient phylum Cnidaria which diverged prior to the bilaterian radiation, involves a steady-state of production and loss of tissue, and is dependent on an organizer located in the upper part of the head. We show that the sharp boundary separating tissue in the body column from head and foot tissue depends on histone acetylation. Histone deacetylation disrupts the boundary by affecting numerous developmental genes including Wnt components and prevents stem cells from entering the position dependent differentiation program. Overall, our results suggest that reversible histone acetylation is an ancient regulatory mechanism for partitioning the body axis into domains with specific identity, which was present in the common ancestor of cnidarians and bilaterians, at least 600 million years ago.


Assuntos
Padronização Corporal/fisiologia , Hydra/crescimento & desenvolvimento , Hydra/metabolismo , Acetilação , Animais , Diferenciação Celular , Cnidários/metabolismo , Cabeça/crescimento & desenvolvimento , Histonas/genética , Hydra/genética , Regeneração , Transdução de Sinais , Proteínas Wnt/metabolismo , beta Catenina/metabolismo
9.
Psiquiatr. biol. (Internet) ; 26(3): 123-126, sept.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-191665

RESUMO

Se ha descrito que los medicamentos antiinflamatorios no esteroideos (AINE) tienen la capacidad para inducir o agravar cuadros psiquiátricos como los trastornos de ansiedad, la depresión o los trastornos psicóticos. Por otra parte, el trastorno bipolar inducido por sustancias o medicamentos es un trastorno del estado de ánimo que se caracteriza por una brusca aparición de los síntomas como consecuencia de la intoxicación, abstinencia o exposición a una sustancia capaz de inducir una sintomatología específica, concretamente, una elevación persistente en el estado de ánimo o irritabilidad que puede ir acompañado de un estado de ánimo deprimido o un interés o placer disminuido en la mayoría de las actividades. Describimos el caso clínico de una paciente que fue diagnosticada de trastorno bipolar inducido por medicamentos tras haber recibido tratamiento en las semanas previas con celecoxib


Non-steroidal anti-inflammatory drugs (NSAIDs) have the ability to induce or aggravate psychiatric conditions such as anxiety, depression or psychotic disorders. On the other hand, substance/medication-induced bipolar disorder is a mood disorder characterized by a sudden onset of symptoms as a result of intoxication, abstinence or exposure to a substance capable of inducing a specific symptomatology, specifically, a persistent elevation in mood or irritability that may be accompanied by a depressed mood or decreased interest or pleasure in most activities. We describe the clinical case of a patient who was diagnosed with medication-induced bipolar disorder after receiving treatment in the previous weeks with celecoxib


Assuntos
Adulto , Humanos , Feminino , Transtorno Bipolar/induzido quimicamente , Celecoxib/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Dor Crônica/tratamento farmacológico , Celecoxib/uso terapêutico
10.
Cureus ; 11(1): e3916, 2019 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-30931187

RESUMO

Tumor necrosis factor receptor-1 associated periodic syndrome (TRAPS) is a very rare, hereditary, auto-inflammatory disorder caused by a genetic mutation within the tumor necrosis factor receptor superfamily member one-A (TNFRSF1A) gene, resulting in unregulated, systemic inflammation. We will present a patient who suffered through years of multiple medical problems of unknown etiology and will describe the process leading to the diagnosis of TRAPS. It is important to consider this syndrome as a rare but probable diagnosis in patients who lack a unifying explanation for multiple inflammatory symptoms.

11.
Actas Esp Psiquiatr ; 47(1): 16-22, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30724327

RESUMO

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder1 and consists in a persistent pattern of inattention and / or hyperactivity - impulsivity that interferes with the functioning or development of the person who suffers from it. Because it is a disorder that is present since childhood, the treatment of these patients should be multimodal, and it should include doctors, therapists, teachers and parents2. The choice of a pharmacological treatment adjusted to the specific needs of the patient optimizes the results of the intervention programs. In 1997, the National Institute of Mental Health (NIMH) started the study of multimodal treatment of attention deficit hyperactivity disorder (MTA), and this constitutes a landmark in the history of treatment research in child psychopathology. MTA is the largest study of its kind ever undertaken. In the present article we intend to review the existing clinical evidence about the results of the MTA from the nineties to the current date.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Terapia Combinada , Humanos , Resultado do Tratamento
12.
Actas esp. psiquiatr ; 47(1): 16-22, ene.-feb. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-182174

RESUMO

El Trastorno por Déficit de Atención e Hiperactividad (TDAH) se enmarca dentro de los trastornos del neurodesarrollo 1 y consiste en un patrón persistente de inatención, hiperactividad y/o impulsividad que interfiere con el funcionamiento o el desarrollo de la persona que lo padece. Es un trastorno que se encuentra presente desde la infancia y el tratamiento de estos pacientes debe ser multimodal, y debe incluir a médicos, terapeutas, profesores y padres2. La elección de un tratamiento farmacológico ajustado a las necesidades específicas del paciente, permite optimizar los resultados de los programas de intervención. En 1997 el Instituto Nacional de Salud Mental (NIMH, por sus siglas en inglés) inicia el estudio de tratamiento multimodal del trastorno por déficit de atención con hiperactividad (MTA según sus siglas en inglés) y éste constituye un hito en la historia de la investigación del tratamiento en la psicopatología infantil. Se trata del mayor estudio longitudinal de este tipo, con datos de seguimiento hasta nuestros días. En el presente artículo de revisión se revisan las evidencias clínicas existentes acerca de los resultados del MTA desde los años noventa hasta la fecha actual


Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder1 and consists in a persistent pattern of inattention and / or hyperactivity - impulsivity that interferes with the functioning or development of the person who suffers from it. Because it is a disorder that is present since childhood, the treatment of these patients should be multimodal, and it should include doctors, therapists, teachers and parents2. The choice of a pharmacological treatment adjusted to the specific needs of the patient optimizes the results of the intervention programs. In 1997, the National Institute of Mental Health (NIMH) started the study of multimodal treatment of attention deficit hyperactivity disorder (MTA), and this constitutes a landmark in the history of treatment research in child psychopathology. MTA is the largest study of its kind ever undertaken. In the present article we intend to review the existing clinical evidence about the results of the MTA from the nineties to the current date


Assuntos
Humanos , Criança , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapia Combinada , Resultado do Tratamento
13.
J Atten Disord ; 23(9): 1007-1016, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28974134

RESUMO

OBJECTIVE: In this multicenter, cross-sectional study, we aimed to investigate the quality of life (QoL) and the neuropsychological and clinical characteristics of adults with ADHD with different developmental pathways. METHOD: Our study sample included 25 control (healthy) participants, 31 patients with newly diagnosed ADHD without comorbidities (ADHD-C-D), 31 with newly diagnosed ADHD with comorbidities (ADHD+C-D), and 29 with previously diagnosed ADHD with comorbidities (ADHD+C+D). RESULTS: Compared with controls, ADHDs had little differences in the attentional performance but showed higher impulsivity, more severe symptoms of depression and anxiety, and lower QoL. The ADHD+C-D group showed more severe symptoms of depression and anxiety than the ADHD+C+D group ( p = .037 and p = .008, respectively), and poorer QoL in the psychological health sphere ( p = .003). CONCLUSION: Differences between ADHD and control subjects were particularly remarkable in mood symptoms and QoL. Previous diagnosis might have a positive impact on mood symptoms and QoL in ADHD adults.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Qualidade de Vida , Adulto , Transtornos de Ansiedade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Comorbidade , Estudos Transversais , Humanos
14.
Repert. med. cir ; 28(2): 81-90, 2019. Il., tablas
Artigo em Inglês, Espanhol | LILACS, COLNAL | ID: biblio-1009882

RESUMO

Como profesionales estamos inmersos en las discusiones de coyuntura política y en América Latina las familias homoparentales han comenzado poco a poco a ser el foco central de las investigaciones científicas desde diferentes disciplinas, por lo anterior se identificó la necesidad de conocer la literatura sobre familias homoparentales. Objetivo: determinar las temáticas principales reportadas por investigadores latinoamericanos durante los últimos cinco años. Metodología: revisión integrativa de la literatura científica (revisión crítica) en bases de datos electrónicas. Se aplicaron 6 criterios de selección para una masa documental de 83 artículos, se priorizaron 21 que fueron leídos a profundidad. Resultados: los intereses más recurrentes en las investigaciones se enfocan en establecer la capacidad de las parejas homosexuales para ser madres/padres, y determinar si son familias que cuentan con una red social débil o fuerte, particularidades de su día a día, detección de vulneración de derechos y las implicaciones negativas o positivas que pueden darse en el desarrollo de los niños y niñas. Conclusión: al parecer no hay afectaciones negativas en su desarrollo psicológico, su desempeño académico no tiene diferencias particulares con sus compañeros. En contraposición, se ha encontrado que son más tolerantes con las diferencias, más permisivos con el establecimiento de roles de género, tienen un menor nivel de prejuicios, manejan un alto nivel de resiliencia y en general distan de un sistema heteronormativo dominante.


As professionals, we are involved in discussions of political juncture and homoparental families have gradually become the focus of scientific research in various disciplines in Latin America, thus, we identified the need to review the literature on this topic. Objective: to determine the main subjects reported by Latin American researchers during the last five years. Methodology: a comprehensive review of the scientific literature (critical review) found in electronic databases. Six selection criteria were applied obtaining a total of 83 articles; 21 of these articles were prioritized and read using an in-depth reading style. Results: the most recurrent research interests focus on establishing if homosexual couples are able to become mothers/fathers, and determining if these families count with a strong or weak social network, particularities of their daily life, identifying if their rights are being violated and the negative or positive implications on the development of the boys and girls. Conclusion: apparently there are no negative impacts on their psychological development and their academic performance is not particularly different to the one of their peers. Conversely, it has been found they are more tolerant of differences, more permissive with gender role identity, exhibit lower levels of prejudice, manage a high level of resilience and in general they go beyond a dominant heteronormative system.


Assuntos
Humanos , Poder Familiar , Adoção , América Latina
15.
Curr Psychiatry Rep ; 20(11): 100, 2018 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-30221318

RESUMO

PURPOSE OF REVIEW: Extensive research has been conducted on attention-deficit/hyperactivity disorder (ADHD) in children and adults; however, less is known about ADHD during the transition from childhood to adulthood. Transitional aged youth (TAY) with ADHD represents a particularly vulnerable population as their newfound independence and responsibility often coincides with the development of comorbid disorders. The purpose of this review is to provide an update on the evaluation, diagnosis, and treatment of TAY-ADHD. RECENT FINDINGS: Recent studies discovering ADHD symptoms emerging in TAY call the classification of ADHD as a disorder necessarily developing in childhood into question. TAY-ADHD are also shown to be vulnerable to academic and social impairments, increased risky behavior, and comorbid psychiatric disorders. Due to the risk of stimulant diversion in TAY, providers are advised to take precaution when prescribing medication to this population. Recent studies demonstrating the efficacy of psychotherapy in conjunction with non-stimulant or extended release stimulant medication provide a feasible alternative. This review highlights research on the course and evaluation of ADHD, impairments and comorbidities specific to TAY, and treatments tailored to address the unique challenges associated with TAY-ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Comorbidade , Humanos , Psicoterapia , Adulto Jovem
16.
J Med Internet Res ; 20(5): e205, 2018 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-29807880

RESUMO

BACKGROUND: The contents of traditional communication media and new internet social media reflect the interests of society. However, certain barriers and a lack of attention towards mental disorders have been previously observed. OBJECTIVE: The objective of this study is to measure the relevance of influential American mainstream media outlets for the distribution of psychiatric information and the interest generated in these topics among their Twitter followers. METHODS: We investigated tweets generated about mental health conditions and diseases among 15 mainstream general communication media outlets in the United States of America between January 2007 and December 2016. Our study strategy focused on identifying several psychiatric terms of primary interest. The number of retweets generated from the selected tweets was also investigated. As a control, we examined tweets generated about the main causes of death in the United States of America, the main chronic neurological degenerative diseases, and HIV. RESULTS: In total, 13,119 tweets about mental health disorders sent by the American mainstream media outlets were analyzed. The results showed a heterogeneous distribution but preferential accumulation for a select number of conditions. Suicide and gender dysphoria accounted for half of the number of tweets sent. Variability in the number of tweets related to each control disease was also found (5998). The number of tweets sent regarding each different psychiatric or organic disease analyzed was significantly correlated with the number of retweets generated by followers (1,030,974 and 424,813 responses to mental health disorders and organic diseases, respectively). However, the probability of a tweet being retweeted differed significantly among the conditions and diseases analyzed. Furthermore, the retweeted to tweet ratio was significantly higher for psychiatric diseases than for the control diseases (odds ratio 1.11, CI 1.07-1.14; P<.001). CONCLUSIONS: American mainstream media outlets and the general public demonstrate a preferential interest for psychiatric diseases on Twitter. The heterogeneous weights given by the media outlets analyzed to the different mental health disorders and conditions are reflected in the responses of Twitter followers.


Assuntos
Comunicação , Meios de Comunicação de Massa/tendências , Transtornos Mentais/diagnóstico , Mídias Sociais/tendências , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia
17.
BMC Psychiatry ; 18(1): 40, 2018 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-29422022

RESUMO

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.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Cuidadores/economia , Criança , Estudos Transversais , Demografia , Emprego/economia , Feminino , Humanos , Masculino , Espanha/epidemiologia
18.
J Atten Disord ; 22(10): 911-923, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-26246588

RESUMO

OBJECTIVE: To characterize differences in presentation, diagnosis, and management of children/adolescents with ADHD in six European countries. METHOD: Physicians abstracted clinical records for patients aged 6 to 17 years, diagnosed from 2004 to 2007 and treated for ≥2 years. Documentation included impairment due to core ADHD symptoms and additional ADHD symptoms/behaviors at diagnosis, diagnostic approach, and treatment modality. RESULTS: Study included 779 patients treated by 340 physicians. Prevalence of ADHD subtypes (inattention, hyperactivity/impulsivity, or combined) was similar across countries. Mean scores for core and noncore symptom impairment varied and were highest in Italy and the United Kingdom. Variability was noted in diagnostic approach; 95% of physicians in the Netherlands used Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria versus 10% in Germany. Differences were reported for initial treatment modality, treatment switching, and physician-reported treatment outcomes. CONCLUSION: European countries varied in diagnostic approaches and practice management of children/adolescents with ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Europa (Continente) , Feminino , Humanos , Comportamento Impulsivo/fisiologia , Masculino , Padrões de Prática Médica , Estudos Retrospectivos , Resultado do Tratamento
19.
Neuropsychiatr Dis Treat ; 13: 947-958, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28408828

RESUMO

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and negatively impacts caregivers' lives. Factors including barriers to accessing care, dissatisfaction with support services, and lack of caregiver resources may contribute to this. OBJECTIVES: To report caregivers' experiences of ADHD diagnosis, behavioral therapy (BT), and supportive care for children/adolescents with ADHD. METHODS: The Caregiver Perspective on Pediatric ADHD (CAPPA) survey included caregivers of children/adolescents (6-17 years) from ten European countries who were currently receiving/had received ADHD pharmacotherapy in the previous 6 months. Caregivers reported experiences of obtaining an ADHD diagnosis, access to BT, availability of caregiver resources, and level of health care/school support. Pan-EU and country-specific descriptive statistics are reported; responses were compared across countries. RESULTS: Of 3,616 caregivers, 66% were female. Mean age of children/adolescents was 11.5 years; 80% were male. Mean time from the first doctor visit to diagnosis was 10.8 (95% confidence interval 10.2, 11.3) months; 31% of caregivers reported the greatest degrees of difficulty in obtaining an ADHD diagnosis; 44% of children/adolescents did not receive BT. Forty-seven percent of caregivers reported that sufficient resources were available, 44% were "very satisfied"/"satisfied" with medical care, and 50% found health care providers "very supportive"/"somewhat supportive". Mainstream schools were attended by 82% of children/adolescents. Of those, 67% of caregivers thought schools could help more with the child/adolescent's ADHD and 48% received extra help/special arrangement. Results varied significantly between countries (P<0.001, all parameters). CONCLUSION: Almost a third of caregivers reported a high degree of difficulty in obtaining an ADHD diagnosis for their child/adolescent, less than half felt that sufficient resources were available, and gaps in support from health care providers/schools were identified. Findings underscore the need to improve access to diagnosis and provision of supportive services to enable better standards of care, and potentially reduce the impact of child/adolescent ADHD on caregivers' lives.

20.
J Clin Psychopharmacol ; 37(3): 315-322, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28383364

RESUMO

BACKGROUND: A 12-month, open-label extension study assessed the long-term safety and tolerability of lisdexamfetamine dimesylate (LDX) in adults with binge eating disorder (BED). METHODS: Adults (aged 18-55 y) with BED who completed 1 of 3 antecedent studies were enrolled in a 52-week, open-label extension study (dose optimization, 4 weeks [initial titration dose, 30-mg LDX; target doses, 50- or 70-mg LDX]; dose maintenance, 48 weeks). Safety evaluations included the occurrence of treatment-emergent adverse events (TEAEs), vital sign and weight assessments, and Columbia-Suicide Severity Rating Scale responses. RESULTS: Of the 604 enrolled participants, 599 (521 women and 78 men) comprised the safety analysis set, and 369 completed the study. Mean (SD) LDX exposure was 284.3 (118.84) days; cumulative LDX exposure duration was 12 months or longer in 344 participants (57.4%). A total of 506 participants (84.5%) reported TEAEs (TEAEs leading to treatment discontinuation, 54 [9.0%]; severe TEAEs, 42 [7.0%]; serious TEAEs, 17 [2.8%]). Treatment-emergent adverse events reported in greater than or equal to 10% of participants were dry mouth (27.2%), headache (13.2%), insomnia (12.4%), and upper respiratory tract infection (11.4%). Mean (SD) changes from antecedent study baseline in systolic and diastolic blood pressure, pulse, and weight at week 52/early termination (n = 597) were 2.19 (11.043) and 1.77 (7.848) mm Hg, 6.58 (10.572) beats per minute, and -7.04 (7.534) kg, respectively. On the Columbia-Suicide Severity Rating Scale, there were 2 positive responses for any active suicidal ideations; there were no positive responses for suicidal behavior or completed suicides. CONCLUSIONS: In this 12-month, open-label, extension study, the long-term safety and tolerability of LDX in adults with BED were generally consistent with its established profile for attention-deficit/hyperactivity disorder.


Assuntos
Transtorno da Compulsão Alimentar/tratamento farmacológico , Inibidores da Captação de Dopamina/farmacologia , Dimesilato de Lisdexanfetamina/farmacologia , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Adulto , Inibidores da Captação de Dopamina/administração & dosagem , Inibidores da Captação de Dopamina/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Dimesilato de Lisdexanfetamina/administração & dosagem , Dimesilato de Lisdexanfetamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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