Neurodevelopmental disorders-the history and future of a diagnostic concept
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This article describes the history of the diagnostic class of neurodevelopmental disorders (NDDs) up to DSM-5. We further analyze how the development of genetics will transform the classification and diagnosis of NDDs. In DSM-5, NDDs include intellectual disability (ID), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Physicians in German-, French- and English-speaking countries (eg, Weikard, Georget, Esquirol, Down, Asperger, and Kanner) contributed to the phenomenological definitions of these disorders throughout the 18th and 20th centuries. These diagnostic categories show considerable comorbidity and phenotypic overlap. NDDs are one of the chapters of psychiatric nosology most likely to benefit from the approach advocated by the National Institute of Mental Health's Research Domain Criteria project. Genetic research supports the hypothesis that ID, ASD, ADHD, schizophrenia, and bipolar disorder lie on a neurodevelopmental continuum. The identification of recurrently observed copy number variants and disruptive gene variants in ASD (eg, CDH8, 16p11.2, SCN2A) led to the adoption of the genotype-first approach to characterize individuals at the etiological level.
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Este artículo describe la historia de la clase diagnóstica de los trastornos del neurodesarrollo (TND) hasta el DSM-5. Además se analiza cómo el desarrollo de la genética transformará la clasificación y el diagnóstico de los TND. En el DSM-5, los TND incluyen la discapacidad intelectual (DI), los trastornos del espectro autista (TEA) y el trastorno por déficit de atención / hiperactividad (TDAH). Los médicos en países de habla alemana, francesa e inglesa (por ejemplo, Weikard, Georget, Esquirol, Down, Asperger y Kanner) contribuyeron a las definiciones fenomenológicas de estos trastornos a lo largo de los siglos XVIII y XX. Estas categorías diagnósticas muestran una importante comorbilidad y superposición fenotípica. Los TND constituyen uno de los capítulos de la nosología psiquiátrica que tienen más probabilidades de beneficiarse con el enfoque recomendado por el proyecto Research Domain Criteria (Criterios de Dominio de Investigación) del Instituto Nacional de Salud Mental. La investigación genética respalda la hipótesis de que la DI, el TEA, el TDAH, la esquizofrenia y el trastorno bipolar se encuentran en un continuo del neurodesarrollo. La identificación y observación repetida de variaciones en el número de copias y variaciones de genes disruptivos en el TEA (p. Ej., CDH8, 16p11.2, SCN2A) condujeron a la adopción de un enfoque primariamente genético para la caracterización etiológica de los sujetos.

Dans cet article qui décrit l'histoire de la classe diagnostique des troubles neurodéveloppementaux (TND) jusqu'au DSM-5, nous analyserons comment les progrès de la génétique vont transformer leur classification et leur diagnostic. Dans le DSM-5, les TND comprennent les handicaps intellectuels (HI), les troubles du spectre de l'autisme (TSA) et le déficit de l'attention/hyperactivité (TDAHA). Ce sont des médecins issus de pays germanophones, francophones et anglophones (comme Weikard, Georget, Esquirol, Down, Asperger et Kanner) qui ont participé à la définition phénoménologique de ces troubles, du XVIIIe au XXe siècle. On observe dans ces catégories diagnostiques une comorbidité et un chevauchement des phénotypes très importants. En termes de nosologie psychiatrique, les TND seraient les plus susceptibles de bénéficier de l'approche défendue par le NIMH (National Institute of Mental Health) : le projet Research Domain Criteria (Critères des domaines de recherche). Selon la recherche génétique, le HI, les TSA, le TDAHA, la schizophrénie et les troubles bipolaires appartiendraient à un continuum neurodéveloppemental. L'idée d'une caractérisation étiologique des individus en passant d'abord par la génétique est venue de l'observation répétée au sein des TSA de variations du nombre de copies et de variations génétiques perturbatrices (par exemple CDH8, 16p11.2, SCN2A).

'Dementia praecocissima': the Sante De Sanctis model of mental disorder in child psychiatry in the 20th century.

The aim of this article is to describe the nosographical contribution of the Italian psychiatrist Sante De Sanctis (1862-1935) to early twentieth-century child psychiatry. De Sanctis first proposed the category of 'dementia praecocissima' in 1906, and it was recognized by Kraepelin. Dementia praecocissima has its roots in a theoretical and methodological conception of mental disorder based on 'psycho-physical proportionalism' and the 'law of circle'. This article deals with De Sanctis's model, which has so far been neglected by historiographers; it shows the pioneering role that this Italian psychiatrist played in child psychiatry in Italy.

[Children's Psychiatric Hospital Dr. Juan N. Navarro: 50 years of attention to the mental health of children and adolescents in Mexico]. / Hospital Psiquiátrico Infantil Dr. Juan N. Navarro: 50 años de atención a la salud mental de niños y adolescentes en México.

The activities concerning mental health care of psychiatric disorders during more than 50 years of service (1966-2016) at the Children's Psychiatric Hospital "Dr. Juan N. Navarro" (HPI), as well as the progressive development of teaching and research, have contributed to its positioning as a leading institution in medical care of high specialization. This has been possible through the training of human resources that focus the quality of care to the children and their families. The hospital has progressed towards diagnostic and therapeutic care of outpatients through the creation of specialized clinics (emotions, behavior, development, adolescence, among others) and the development of more actualized and integral therapeutic programs (behavioral psychotherapy, cognitive behavioral, psychodynamic; individual, group, family, etc.). In the field of education, the hospital has been the most important institution in the training of child psychiatrists in Mexico and its recognition as a research interdisciplinary center has grown.

Resumen: La atención de la salud mental y de los trastornos psiquiátricos de niños y adolescentes a lo largo de 50 años de servicio (1966-2016) en el Hospital Psiquiátrico Infantil Dr. Juan N. Navarro (HPI), y el desarrollo progresivo de la enseñanza y la investigación han contribuido al posicionamiento de éste como institución líder en la atención médica de alta especialidad. El hospital ha evolucionado en la atención diagnóstica y terapéutica de pacientes ambulatorios a través de la creación de clínicas especializadas y del desarrollo de programas terapéuticos cada vez más actualizados e integrales (psicoterapia conductual, psicoterapia cognitivo-conductual, y psicodinámica en modalidad individual, grupal y familiar, etc). En el ámbito de la enseñanza, el hospital ha sido la sede más importante en la formación de psiquiatras infantiles en México, con un progresivo reconocimiento como un centro de investigación interdisciplinaria.

[Processes of attention to children and adolescents under 20 years in La Castañeda: evolution of the concept of childhood in psychiatry]. / Procesos de atención a menores de 20 años en La Castañeda: evolución del concepto de infancia en psiquiatría.

Today, there is evidence that shows that children and adolescents can experience developmental problems and psychiatric disorders. This was possible because of two main reasons, the evolution of the concept of infancy and the progress made in medical and psychiatric diagnostic classification. This manuscript offers a glance to early psychiatric attention in Mexico, particularly the care processes provided to 36 children and adolescents under twenty, admitted in the mental asylum La Castañeda, during the first half of the XX century. Admission causes, length of stay, diagnosis, treatment and discharge motives, are some of the aspects described in this study. Finally, it also reflects about the challenge it is for a child psychiatric hospital nowadays, with such a history, to become an innovative institution able to claim a place in the medical field in favor of those minors that can barely defend themselves.

Resumen: Existe evidencia de que los niños y adolescentes pueden presentar problemas del desarrollo y trastornos psiquiátricos. Lo anterior es consecuencia del concepto de infancia y del refinamiento de las clasificaciones diagnósticas médico-psiquiátricas. Este artículo ofrece una mirada sobre los procesos de atención psiquiátrica brindados a 36 niños y adolescentes admitidos en el Manicomio La Castañeda en la primera mitad del siglo XX. Motivo de ingreso, tiempo de estancia, diagnósticos establecidos, tratamiento y motivo de egreso son algunos de los aspectos que se describen. Finalmente, se reflexiona sobre la existencia de un hospital psiquiátrico infantil, que siendo testimonio del pasado, tiene al mismo tiempo el desafío de convertirse en una institución innovadora; sitio que en el ámbito de las especialidades médicas reclama la psiquiatría infantil a favor de los menores que difícilmente pueden abogar por sí mismos.

Higiene mental infantil y psicoanálisis en la clínica de conducta, Santiago de Chile, 1936-1938 / Child mental hygiene and psychoanalisis at the clinic of conduct, Santiago de Chile, 1936-1938

Tomando en cuenta la importancia del estudio situado en historia de las ciencias, en este artículo se explora una temprana iniciativa de higiene mental infantil en Chile que aun no ha sido abordada por la literatura especializada: la Clínica de Conducta, fundada en Santiago en 1936 como parte de la Escuela Especial de Desarrollo, la cual había sido creada por la Reforma Educacional de 1928. La Clínica de Conducta puso en marcha un programa estatal de higiene mental infantil que incluía como referencia central al psicoanálisis, en un periodo en que no era habitual encontrarlo en la bibliografía médica local. Se analizará aquí el contexto de creación de estos servicios, así como los modos en que la higiene mental y el psicoanálisis fueron apropiados y utilizados en una institución cuyo principal interés no era la defensa o legitimación de una teoría, sino el abordaje de problemáticas sociales como la delincuencia y la educación infantil. Aparecen así algunas características de la historia de los saberes psi en Chile, mostrando cómo se despliegan en el escenario de problemáticas sociales y cómo se vinculan con el devenir de otras disciplinas y prácticas como la criminología y la pedagogía (AU)

Taking stance in a situated perspective, this article looks into one of the first Chilean state initiatives aimed at the study and care of child psyche. This institution that has not yet been explored by specialized literature: the Clinic of Conduct, founded in the city of Santiago in 1936 as part of the Special School of Development, which was created in the context of a the Educational Reform of 1928. The Clinic of Conduct launched a state managed mental hygiene programme that included psychoanalysis as its main reference at a time when psychoanalysis was not yet a regular reference in the local medical world. We are thus interested in analysing context in which this initiatives were created and the ways in which mental hygiene and psychoanalysis were appropriated and used in an institution in which the principal interest was not the defence or legitimation of a singular theory, but the approach to specific social problems such as child delinquency and education. Some characteristics of the history of psy knowledges in Chile emerge from this study, showing how they unfold on the scenario of social problems and how they relate to other disciplines and practices such as criminology and pedagogy (AU)

Hospital Psiquiátrico Infantil Dr. Juan N. Navarro: 50 años de atención a la salud mental de niños y adolescentes en México / Children's Psychiatric Hospital Dr. Juan N. Navarro: 50 years of attention to the mental health of children and adolescents in Mexico

Resumen: La atención de la salud mental y de los trastornos psiquiátricos de niños y adolescentes a lo largo de 50 años de servicio (1966-2016) en el Hospital Psiquiátrico Infantil Dr. Juan N. Navarro (HPI), y el desarrollo progresivo de la enseñanza y la investigación han contribuido al posicionamiento de éste como institución líder en la atención médica de alta especialidad. El hospital ha evolucionado en la atención diagnóstica y terapéutica de pacientes ambulatorios a través de la creación de clínicas especializadas y del desarrollo de programas terapéuticos cada vez más actualizados e integrales (psicoterapia conductual, psicoterapia cognitivo-conductual, y psicodinámica en modalidad individual, grupal y familiar, etc). En el ámbito de la enseñanza, el hospital ha sido la sede más importante en la formación de psiquiatras infantiles en México, con un progresivo reconocimiento como un centro de investigación interdisciplinaria.

Abstract: The activities concerning mental health care of psychiatric disorders during more than 50 years of service (1966-2016) at the Children's Psychiatric Hospital "Dr. Juan N. Navarro" (HPI), as well as the progressive development of teaching and research, have contributed to its positioning as a leading institution in medical care of high specialization. This has been possible through the training of human resources that focus the quality of care to the children and their families. The hospital has progressed towards diagnostic and therapeutic care of outpatients through the creation of specialized clinics (emotions, behavior, development, adolescence, among others) and the development of more actualized and integral therapeutic programs (behavioral psychotherapy, cognitive behavioral, psychodynamic; individual, group, family, etc.). In the field of education, the hospital has been the most important institution in the training of child psychiatrists in Mexico and its recognition as a research interdisciplinary center has grown.

The psychologist, the psychoanalyst and the 'extraordinary child' in postwar British science fiction.

A sudden influx of portrayals of 'extraordinary children' emerged in British science fiction after the Second World War. Such children both violated and confirmed the new set of expectations about ordinary childhood that emerged from the findings of developmental psychologists around the same time. Previous work on extraordinary children in both science fiction and horror has tended to confine the phenomenon to an 'evil child boom' within the American filmmaking industry in the 1970s. This article suggests that a much earlier trend is visible in British postwar science fiction texts, analysing a cluster of novels that emerged in the 1950s: Arthur C. Clarke's Childhood's End (1953), William Golding's Lord of the Flies (1954) and John Wyndham's The Midwich Cuckoos (1957). It will be argued that the groups of extraordinary children in these novels both tap into newer child-centred assertions about the threats posed by abnormal childhood, underwritten by psychology and psychoanalysis, and represent a reaction to an older progressive tradition in which children were envisaged as the single hope for a utopian future. This article will ultimately assert that the sudden appearance of extraordinary children in science fiction reflects a profound shift in assessment criteria for healthy childhood in Britain from the 1950s onwards, an issue that had become vitally important in a fledgling social democracy.

Constitutional Therapy and Clinical Racial Hygiene in Weimar and Nazi Germany.

The paper examines the history of constitutional therapy in Weimar and Nazi Germany. Focusing on Walther Jaensch's "Institute for Constitutional Research" at the Charité in Berlin, it shows how an entrepreneurial scientist successfully negotiated the changing social and political landscape of two very different political regimes and mobilized considerable public and private resources for his projects. During the Weimar period, his work received funding from various state agencies as well as the Rockefeller foundation, because it fit well with contemporary approaches in public hygiene and social medicine that emphasized the need to restore the physical and mental health of children and youths. Jaensch successfully positioned himself as a researcher on the verge of developing new therapies for feeble-minded people, who threatened to become an intolerable burden on the Weimar welfare state. During the Nazi period, he successfully reinvented himself as a racial hygienist by convincing influential medical leaders that his ideas were a valuable complement to the negative eugenics of Nazi bio-politics. "Constitutional therapy," he claimed, could turn genetically healthy people with "inhibited mental development" (geistigen Entwicklungshemmungen) into fully productive citizens and therefore made a valuable contribution to Nazi performance medicine (Leistungsmedizin) with its emphasis on productivity.

A expansão das classificações psiquiátricas nos últimos 30 anos e suas repercussões na psiquiatria infantil: o caso do Transtorno Bipolar em crianças e adolescentes / The expansion of psychiatric classifications in the last 30 years and its consequences in pediatric psychiatry: the case of bipolar disorder in children and adolescents

O diagnóstico do transtorno bipolar na infância só foi recentemente reconhecido na psiquiatria infantil, particularmente nos Estados Unidos. Até meados do século vinte não se acreditava que crianças pré-púberes pudessem apresentar sintomatologia compatível com esse diagnóstico, que foi descrito pela primeira vez por Emil Kraepelin no final do século XIX, com o nome de Psicose Maníaco-Depressiva. O termo Transtorno Bipolar foi usado em substituição à psicose maníaco-depressiva na passagem da segunda edição do manual diagnóstico e estatístico norte americano, DSM II, para o DSM III, em 1980. Entre 1994 e 2004 o número de crianças que receberam esse diagnóstico nos Estados Unidos sofreu aumento de 40 vezes, representando a maior bolha diagnóstica desde a primeira edição do DSM. Esse fenômeno resulta da modificação dos critérios diagnósticos pra o transtorno bipolar dos adultos, que são transpostos para a infância modificando seu pilar, que é a alternância entre estados opostos de humor, em um quadro crônico, não mais de depressão e euforia, mas agora de irritabilidade. Isso não aconteceu da mesma forma em outros países, onde as taxas de prevalência são infinitamente menores. No Brasil esses dados são ainda escassos. Nosso objetivo primário com esta pesquisa foi averiguar se o debate acerca do transtorno bipolar na infância é conhecido pelos psiquiatras infantis brasileiros e de que maneira essa discussão se reflete na prática clínica no Brasil. Essa avaliação foi realizada através da aplicação de entrevistas semiestruturadas a 20 psiquiatras infantis, localizados em cinco cidades de grande porte nos principais centros de formação e pesquisa do País. Pode ser constatado que os centros de pesquisa especializados no diagnóstico do transtorno bipolar na infância brasileiros repetem o modelo norte-americano, encontrando taxas muito próximas às encontradas naquele país, enquanto que serviços cujo atendimento não é organizado em função dos diagnósticos (CAPSi, por exemplo) apresentam um quadro bem diferente. O principal fator determinante desse cenário é a transposição da lógica da pesquisa, com suas escalas e instrumentos diagnósticos, para o campo complexo da prática clínica cotidiana, reproduzindo um modelo de avaliação descontextualizada e que desvaloriza a história pessoal da criança. Esta tese contribui para a ampliação do conhecimento sobre como parte importante dos psiquiatras infantis brasileiros lidam com a questão do transtorno bipolar na infância

Historia del trastorno autista / History of the autistic disorder

El autismo es un trastorno neuropsicológico que comenzó a diagnosticarse hace relativamente pocas décadas. En 1943, Leo Kanner lo describió por primera vez, suponiendo el inicio del estudio clínico de un síndrome que, hasta ese momento, era desconocido. No obstante, hay evidencias que indican que el trastorno ha existido siempre y son diversas las publicaciones que así lo evidencian. Desde los años 60 hasta la actualidad, se han realizado multitud de investigaciones y aportaciones procedentes de diversas disciplinas que reflejan la enorme complejidad del trastorno. El objetivo de este teabajo es hacer un recorrido histórico que permita conocer cuál ha sido el devenir del estudio clínico y evolutivo del trastorno autista hasta la actualidad. Con esta finalidad, se destacan los momentos más significativos que han contribuido a definir el autismo tal y como se conoce en la actualidad(AU)

The autism is a disorder neuropsicológico that began to be diagnosed relatively a few decades ago. In 1943, Leo Kanner described it for the first time, supposing the beginning of the clinical study of a syndrome that, up to this moment, was not known. Nevertheless, there are evidences that indicate that the disorder has existed always and there are diverse the publications that like that demonstrate it. From the 60s up to the current importance, there have been realized multitude of investigations and contributions proceeding from diverse disciplines that reflect the enormous complexity of the disorder. The aim of this teabajo is to do a historical tour that allows to know which has been to develop of the clinical and evolutionary study of the autistic disorder up to the current importance. With this purpose, are outlined the most significant moments that have helped to define the autism as it is known at present(AU)

El impacto de Emilio Mira en la Psiquiatría Infantil / The impact of Emilio Mira in Infantile Psychiatry

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