Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.744
Filtrar
1.
Res Child Adolesc Psychopathol ; 49(8): 1055-1067, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33742359

RESUMO

COVID-19 underscores the importance of understanding variation in adherence to rules concerning health behaviors. Children with conduct problems have difficulty with rule adherence, and linking early conduct problems with later adherence to COVID-19 guidelines can provide new insight into public health. The current study employed a sample (N = 744) designed to examine the longitudinal consequences of childhood conduct problems (Mean age at study entry = 8.39). The first objective was to link early conduct problems with later adherence to both general and specific COVID-19 guidelines during emerging adulthood (M age = 19.07). The second objective was to prospectively examine how interactional (i.e., callous unemotional traits, impulsivity) and cumulative (i.e., educational attainment, work status, substance use) continuity factors mediated this association. The third objective was to examine differences in sex assigned at birth in these models. Direct associations were observed between childhood conduct problems and lower general, but not specific COVID-19 guideline adherence. Conduct problems were indirectly associated with both general and specific adherence via higher levels of callous unemotional traits, and with specific adherence via higher problematic substance use. No differences in the models were observed across sex assigned at birth. Findings provide insight into both how developmental psychopathology constructs are useful for understanding COVID-19 guideline adherence, and the ways in which conduct problems may shape health outcomes.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/normas , Transtorno da Conduta/psicologia , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , COVID-19/psicologia , Criança , Controle de Doenças Transmissíveis/métodos , Transtorno da Conduta/terapia , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino
2.
Medicine (Baltimore) ; 100(13): e24648, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787573

RESUMO

BACKGROUND: higher level of aggression and antisocial behavior are frequent following head trauma, due to specific brain alterations. Many tests are used to assess this aspect. A descriptive review was conducted on the main tests used to detect the appearance of aggressive dimensions following traumatic brain injury. REVIEW SUMMARY: we searched on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From initial 723 publications, only 7 met our search criteria. Findings showed that various psychometric tools are used to assess aggressiveness and its subdomains, following head trauma. CONCLUSIONS: further investigation are necessary to clarify whether these tools ensure a reliable diagnosis in order to make an early intervention and reduce violent behavior and its development.


Assuntos
Agressão/psicologia , Lesões Encefálicas Traumáticas/psicologia , Transtorno da Conduta/diagnóstico , Testes Psicológicos/normas , Inquéritos e Questionários/normas , Adolescente , Adulto , Criança , Transtorno da Conduta/psicologia , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Psicometria , Reprodutibilidade dos Testes , Adulto Jovem
3.
Drug Alcohol Depend ; 219: 108479, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33444900

RESUMO

BACKGROUND: Social impairments are important features of a substance use disorder diagnosis; and recent models suggest early impairments in socio-cognitive and -affective processes may predict future use. However, no systematic reviews are available on this topic. METHODS: We conducted a systematic review and meta-analyses exploring the association between social-cognitive and -affective processes (empathy, callous-unemotional (CU) traits, theory of mind, and social cognition) and substance use frequency (alcohol, cannabis, general drug use). We examined moderating effects of study design, gender, age, and weather conduct problems were controlled for. We also review brain studies related to social cognition and substance use disorder (SUD) risk. RESULTS: Systematic review suggested a negative association for positively valenced constructs with substance use but mixed results on the negatively valenced construct CU traits. Meta-analyses revealed moderate positive association between CU traits with alcohol and general drug use but no significance with cannabis use. Moderate effect sizes were found for CU traits in youth predicting severity of substance use by late adolescence and significantly accounted for variance independently of conduct problems. Significant moderators included gender proportions, sample type, and age. Neuroimaging meta-analysis indicated 10 coordinates that were different in youth at a high risk/with SUD compared to controls. Three of these coordinates associate with theory of mind and social cognition. CONCLUSION: Socio-cognitive and -affective constructs demonstrate an association with current and future substance use, and neural differences are present when performing social cognitive tasks in regions with strongest associations with theory of mind and social cognition.


Assuntos
Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Cognição , Transtorno da Conduta/psicologia , Emoções , Empatia , Feminino , Humanos , Masculino , Comportamento Problema
4.
Am J Psychiatry ; 178(3): 266-274, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33472389

RESUMO

OBJECTIVE: Treatment of violence in schizophrenia remains a challenging problem, especially in patients with conduct disorder. Previous clinical studies did not select patients on the basis of violence and did not focus on conduct disorder. This study is a head-to-head comparison of clozapine, olanzapine, and haloperidol in the treatment of violent schizophrenia patients with and without conduct disorder. METHODS: Physically assaultive schizophrenia patients (N=99) were randomly assigned to receive clozapine, olanzapine, or haloperidol in a 12-week double-blind trial. They were characterized on the basis of the presence or absence of conduct disorder before age 15. Assaults were recorded; their frequency and severity were scored on the Modified Overt Aggression Scale. Psychiatric symptoms were evaluated through the Positive and Negative Syndrome Scale. RESULTS: Patients with a history of conduct disorder had more frequent and severe assaults than those without conduct disorder during the 12-week trial. Clozapine was superior to haloperidol and olanzapine in reducing assaults; olanzapine was superior to haloperidol. Clozapine's greater antiaggressive efficacy over haloperidol was substantially more pronounced in patients with conduct disorder than in patients without conduct disorder. In patients with conduct disorder, clozapine was four times more likely than haloperidol to result in lower violence; in patients without conduct disorder, it was three times more likely to do so. Olanzapine's superiority over haloperidol was also more pronounced in patients with conduct disorder. CONCLUSIONS: This study is the first to examine the effect of clozapine in violent schizophrenia patients with conduct disorder. When conduct disorder is present, clozapine is the optimal treatment.


Assuntos
Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Transtorno da Conduta/tratamento farmacológico , Haloperidol/uso terapêutico , Olanzapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Violência/prevenção & controle , Adulto , Transtorno da Conduta/complicações , Transtorno da Conduta/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Esquizofrenia/complicações , Violência/psicologia
5.
Int J Psychol ; 56(2): 314-321, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32748423

RESUMO

Trait impulsivity and callous-unemotional traits are associated with behavioural problems among high-risk adolescents. While both are known to influence behaviour, the nature of their expression in high-risk behaviours, particularly those related to inhibitory control, is not well understood. In the current, preliminary study, we examined whether and how these traits predicted deficits in behaviour driven by bottom-up, automatic versus deliberate, top-down inhibitory processes among high-risk adolescents. Two go/no-go task variants, emotional and non-emotional, were used to assess reactive response inhibition, and the Balloon Analogue Risk Task was used to assess the ability to resist deliberate risky choices. The results showed that the two types of self-reported trait measures were differentially associated with performance on the two types of behavioural inhibition tasks. Trait impulsivity predicted non-emotional inhibitory control whereas callous-unemotional traits predicted risky choices. The results also showed that the emotions task elicited slower reaction times and higher false alarm rates than did the letters task, and that participants had greater difficulty inhibiting responses to negatively than to positively valenced no-go stimuli. While preliminary, the results suggest that the interplay between trait impulsivity and callous-unemotional traits is an important determinant of inhibitory behaviour in this high-risk adolescents.


Assuntos
Transtorno da Conduta/psicologia , Emoções/fisiologia , Comportamento Impulsivo/fisiologia , Adolescente , Feminino , Humanos , Masculino
6.
Scand J Psychol ; 62(1): 25-33, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33270925

RESUMO

We investigated ADHD symptoms and CU traits as predictors of violent media use in adolescence, controlling for delinquency and ODD symptoms. The effects on of disinhibition and arousal to negative stimuli, core characteristics of ADHD symptoms and CU traits, and of gender were investigated. At age 15, 88 adolescents, 50 % boys reported on CU traits, ADHD symptoms and delinquency. Parents rated the adolescents' CU traits, ADHD- and ODD symptoms. At age 16, adolescents reported on their media habits and performed tests of disinhibition and arousal to negative stimuli. Boys had higher levels of CU traits and violent media use and girls had higher levels of arousal to negative pictures. CU traits and inattention symptoms predicted violent media use, the latter association applying only to boys, with CU traits being the strongest predictor. Low arousal to threat pictures explained variance in violent media use, above CU traits. Attraction to violent media seems affected by problem behaviors, with CU traits coming forth as especially important.


Assuntos
Agressão/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno da Conduta/diagnóstico , Emoções/fisiologia , Meios de Comunicação de Massa , Comportamento Problema/psicologia , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno da Conduta/psicologia , Feminino , Humanos , Masculino , Pais/psicologia
7.
J Pers Assess ; 103(3): 312-323, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32496826

RESUMO

The factorial structure of the Inventory of Callous Unemotional Traits (ICU) is currently under dispute. The present study aims to test the factorial structure of a Greek adaptation of the ICU by considering item keying variance and examining alternative theoretical and empirically derived models. Additionally, it aims to investigate the nomological network of the ICU subscales, after controlling for item keying variance. The sample consisted of 1536 Greek-Cypriot adolescents, who completed a battery of questionnaires, including the ICU. Results showed that the consideration of item keying variance improved the overall fit of all the examined models and led to significant changes in the predictive validity of the subscales, while method factors presented distinct patterns of associations with external variables. Overall, results suggest that ICU is contaminated by item keying variance, which can be filtered out to provide clinically useful insight into the factorial structure of the ICU.


Assuntos
Comportamento do Adolescente/psicologia , Transtorno da Personalidade Antissocial/psicologia , Transtorno da Conduta/psicologia , Inventário de Personalidade/normas , Adolescente , Emoções , Feminino , Grécia , Humanos , Delinquência Juvenil/psicologia , Masculino , Reprodutibilidade dos Testes , Autoimagem , Autorrelato , Inquéritos e Questionários
8.
Eur Child Adolesc Psychiatry ; 30(6): 885-897, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32476073

RESUMO

Psychopathic tendencies are associated with difficulties in affective theory of mind (ToM), that is, in recognizing others affective mental states. In clinical and non-clinical adult samples, it has been shown that where psychopathic tendencies co-occur with schizophrenia spectrum disorders, the impairing effects of psychopathic tendencies on ToM are attenuated. These effects are yet to be examined in adolescents. We examined if the impairing effect of psychopathic tendencies on affective ToM was attenuated with increasing severity of schizotypal personality disorder (PD) in a sample of 80 incarcerated adolescent boys. We showed that the impairing effect of psychopathic tendencies on the recognition of neutral mental states, but not positive or negative mental states, was evident when the relative severity of schizotypal PD was low. However, with higher scores on both measures, we observed better performance in judging neutral mental states. The preservation of affective ToM in adolescents who show elevations in psychopathic tendencies and schizotypal PD may enable them to manipulate and extort their victims for personal gain. Our results emphasize the need to consider comorbidity in clinical case formulation when working with adolescents with conduct problems and psychopathic tendencies. More broadly, our results also suggest that the pattern of social cognitive abilities associated with co-occurring psychopathology does not always conform to an often-theorized double-dose of deficit hypothesis.


Assuntos
Afeto/fisiologia , Transtorno da Conduta/psicologia , Psicopatologia/métodos , Transtorno da Personalidade Esquizotípica/psicologia , Adolescente , Humanos , Masculino
9.
Am J Psychiatry ; 178(4): 333-342, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32731811

RESUMO

OBJECTIVE: Disrupted reward processing is implicated in the etiology of disruptive behavior disorders (DBDs) and callous-unemotional traits. However, neuroimaging investigations of reward processing underlying these phenotypes remain sparse. The authors examined neural sensitivity in response to reward anticipation and receipt among youths with DBDs, with and without callous-unemotional traits. METHODS: Data were obtained from the Adolescent Brain and Cognitive Development Study (mean age=9.51 years [SD=0.50]; 49% female). Reward-related activation during the monetary incentive delay task was examined across 16 brain regions, including the amygdala, anterior cingulate cortex (ACC), nucleus accumbens (NAcc), and orbitofrontal cortex (OFC). Latent variable modeling was used to examine network-level coactivation. The following diagnostic groups were compared: typically developing youths (N=693) and youths with DBDs (N=995), subdivided into those with callous-unemotional traits (DBD+CU, N=198) and without callous-unemotional traits (DBD only, N=276). RESULTS: During reward anticipation, youths in the overall DBD group (with and without callous-unemotional traits) showed decreased dorsal ACC activation compared with typically developing youths. The DBD-only group exhibited reduced ventral and dorsal striatal activity compared with the DBD+CU and typically developing groups. During reward receipt, youths with DBDs showed increased cortical (e.g., OFC) and subcortical (e.g., NAcc) regional activation compared with typically developing youths. The DBD+CU group demonstrated greater activation in several regions compared with those in the typically developing (e.g., amygdala) and DBD-only (e.g., dorsal ACC) groups. At the network level, the DBD-only group showed reduced anticipatory reward activation compared with the typically developing and DBD+CU groups, whereas youths in the DBD+CU group showed increased activation during reward receipt compared with those in the typically developing group. CONCLUSIONS: These findings advance our understanding of unique neuroetiologic pathways to DBDs and callous-unemotional traits.


Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Transtorno da Conduta/diagnóstico por imagem , Recompensa , Tonsila do Cerebelo/diagnóstico por imagem , Tonsila do Cerebelo/fisiopatologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/fisiopatologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Encéfalo/fisiopatologia , Criança , Transtorno da Conduta/fisiopatologia , Transtorno da Conduta/psicologia , Feminino , Neuroimagem Funcional , Giro do Cíngulo/diagnóstico por imagem , Giro do Cíngulo/fisiopatologia , Humanos , Masculino , Núcleo Accumbens/diagnóstico por imagem , Núcleo Accumbens/fisiopatologia , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiopatologia
10.
Crim Behav Ment Health ; 31(1): 60-76, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33350527

RESUMO

BACKGROUND: Various combinations of childhood conduct problems, callous traits and anxiety may confer increased risk of offending, psychopathic traits and mental disorders. Knowledge of these outcomes in adulthood is limited. AIMS: To compare adult criminal convictions, psychopathy checklist scores and mental disorders between five groups of men, variously defined in childhood by: (1) callous traits, (2) conduct problems, (3) conduct problems and callous traits, (4) conduct problems and callous traits and anxiety or (5) developing typically. METHOD: Teachers rated conduct problems, callous traits and anxiety at ages 6, 10 and 12 years. Criminal convictions from age 12 to 24 were extracted from official records. The Psychopathy Checklist-Revised (PCL-R) and diagnostic interviews were completed at age 33. RESULTS: Relative to the typically developing group, the groups with conduct problems, with and without callous traits and anxiety, showed 5-fold elevations in risks of violent convictions and 3 to 4-fold elevations in risk for antisocial personality disorder, while the groups with conduct problems only and with conduct problems plus callous traits plus anxiety were at increased risk for borderline personality disorder. All risk groups obtained higher PCL-R total scores than the typically developing childhood group. CONCLUSIONS AND IMPLICATIONS: It is widely accepted that childhood conduct problems in boys are associated with increased risks of criminal convictions and poorer mental health, but our findings suggest that teachers can identify different subgroups and these have different trajectories. As some subgroups were small, replication is recommended, but our findings offer preliminary support for trialling specific interventions for at risk boys.


Assuntos
Transtorno da Personalidade Antissocial/psicologia , Ansiedade/psicologia , Transtorno da Personalidade Borderline/psicologia , Transtorno da Conduta/psicologia , Crime , Criminosos/psicologia , Transtornos Mentais/psicologia , Adolescente , Adulto , Agressão , Criança , Comportamento Infantil , Transtorno da Conduta/complicações , Humanos , Masculino , Comportamento Problema , Transtornos Psicóticos , Adulto Jovem
11.
J Pers Assess ; 103(1): 48-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31899957

RESUMO

This study examines the validity of the Personality Assessment Inventory-Adolescent (PAI-A; Morey) in assessing callous-unemotional (CU) traits within two independent samples of at-risk adolescents from a residential intervention program. The study tests the extent to which CU traits are represented within PAI-A scales with respect to empirically- or theoretically-related indicators, such as antisociality, aggression, low warmth, low social connectedness, and subdued internalizing psychopathology. The PAI-A substantive scales statistically accounted for an average of 55.0% of the variance in total scores on the Inventory of Callous-Unemotional Traits (ICU; Frick) across samples. Broadly, PAI-A substantive scales evinced theoretically-consistent relations with CU traits. Consistent with expectations, CU traits were broadly related to PAI-A-assessed constructs of antisocial features, aggression, low warmth and social disconnection, but not to subdued internalizing symptoms. Moreover, some of the PAI-A clinical, treatment consideration, and interpersonal scales or subscales demonstrated differential relations across the traits. Implications for assessment of CU traits using the PAI framework are discussed. Overall, this research adds to the literature on CU traits in broadband personality assessment and provides a foundation for future research on CU traits using the PAI-A.


Assuntos
Agressão/psicologia , Transtorno da Personalidade Antissocial/psicologia , Transtorno da Conduta/psicologia , Mecanismos de Defesa , Delinquência Juvenil/psicologia , Adolescente , Feminino , Humanos , Masculino , Determinação da Personalidade , Adulto Jovem
12.
J Nerv Ment Dis ; 208(12): 989-996, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33003054

RESUMO

The current study was undertaken with the aim of assessing the psychopathological symptoms, personality profile, and hostility in detained adolescents with delinquent behavior. A cross-sectional analytical study was carried out on 50 admitted adolescent delinquents in correctional institutes in the Greater Cairo region of Egypt. Results for delinquent adolescents were compared with age-equivalent adolescents with no history of delinquency. Both groups were subjected to the Adolescent and Adult Psychological State Inventory, Eysenck Personality Questionnaire, Locus of Control scale, and the Hostility and Direction of Hostility Questionnaire (HDHQ). Results concluded that adolescents with delinquent behavior displayed increased rates of psychiatric disorders over the comparative group. Significantly higher scores on the psychoticism, neuroticism, extraversion, and psychopathic deviation subscales and the Locus of Control scale were evident among the adolescent delinquent group compared with their nondelinquent peers. The delinquent group obtained, in general, higher overall scores on the HDHQ questionnaire when compared with the nondelinquent adolescents, while also obtaining higher scores on the paranoid hostility subscale of HDHQ. Acting out hostility scores correlated positively with neuroticism and psychoticism in delinquents. Psychiatric morbidity, extraversion, neuroticism, psychoticism, and increased hostility were found to contribute as major psychosocial factors underlying the psychopathology in detained juvenile delinquents.


Assuntos
Hostilidade , Delinquência Juvenil/psicologia , Transtornos Mentais/epidemiologia , Neuroticismo , Personalidade , Transtornos de Adaptação/epidemiologia , Transtornos de Adaptação/psicologia , Adolescente , Transtorno da Personalidade Antissocial/epidemiologia , Transtorno da Personalidade Antissocial/psicologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Estudos de Casos e Controles , Transtorno da Conduta/epidemiologia , Transtorno da Conduta/psicologia , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Egito/epidemiologia , Extroversão Psicológica , Feminino , Humanos , Controle Interno-Externo , Masculino , Transtornos Mentais/psicologia , Inventário de Personalidade , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
13.
J Child Adolesc Psychopharmacol ; 30(9): 542-548, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32882144

RESUMO

Objectives: Temporal reward discounting impulsivity (TDI) reflects a propensity to choose smaller immediate rather than larger delayed rewards relative to age/IQ-matched peers. Previous work with adults has linked TDI to an increased risk for antisocial behavior but also psychopathology in general. However, little work has examined TDI in adolescents with conduct disorder (CD), or considered whether TDI might be associated dimensionally with traits associated with antisocial behavior, that is, impulsivity, irritability, and/or callous-unemotional traits. In this study TDI was investigated in a large adolescent group with varying levels of antisocial behavior. Methods: Participants consisted of 195 adolescents (67 with CD, 77 in a psychiatric comparison group and 51 typically developing adolescents). Participants performed a temporal discounting task and individual differences were measured through the Connors rating scale for attention-deficit/hyperactivity disorder (impulsivity), Affective Reactivity Index (irritability), and Inventory of Callous-Unemotional traits. Results: The adolescents with CD and those in the psychiatric comparison group showed significantly greater TDI than typically developing adolescents. However, these group differences were abolished when dimensional covariates were included. Irritability was significantly associated with TDI. Conclusions: We conclude that TDI reflects a transdiagnostic form of dysfunction that particularly manifests in adolescents with increased irritability.


Assuntos
Transtorno da Personalidade Antissocial , Transtorno da Conduta , Desvalorização pelo Atraso , Comportamento Impulsivo , Humor Irritável , Adolescente , Transtorno da Personalidade Antissocial/fisiopatologia , Transtorno da Personalidade Antissocial/psicologia , Escalas de Graduação Psiquiátrica Breve , Transtorno da Conduta/fisiopatologia , Transtorno da Conduta/psicologia , Feminino , Humanos , Masculino
14.
Rev. psiquiatr. infanto-juv ; 37(3): 8-19, jul.-sept. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-197398

RESUMO

INTRODUCCIÓN: La hiperfrecuentación en los servicios de urgencias impacta en la calidad asistencial y el consumo de recursos. Los datos disponibles en relación al colectivo infanto-juvenil hiperfrecuentador en urgencias de psiquiatría son escasos, a pesar del aumento de visitas en los últimos años. OBJETIVO: Caracterizar la hiperfrecuentación infanto-juvenil de urgencias de psiquiatría de un hospital terciario durante el año 2017. MÉTODOS: Estudio observacional retrospectivo, diseño caso-control. Se seleccionaron todos los usuarios menores de edad visitados en nuestras urgencias de psiquiatría y de nuestro sector durante el 2017. Se obtuvieron datos sociodemográficos y clínicos mediante explotación de datos asistenciales y revisión de historias clínicas. La hiperfrecuentación se estableció como ≥5 visitas/año. Se realizó un análisis descriptivo univariado y uno comparativo bivariado entre personas hiperfrecuentadoras y no hiperfrecuentadoras. RESULTADOS: La muestra incluyó 550 personas menores de edad, siendo hiperfrecuentadoras un 3,8% (n=21). Las hiperfrecuentadoras fueron de nacionalidad extranjera en mayor proporción (28,6% vs 13,1%, p = 0,04), sin otras diferencias significativas. Entre el colectivo hiperfrecuentador, el trastorno de conducta fue el diagnóstico principal más prevalente (33,3%), recibía tratamiento psicofarmacológico habitual el 100% (antipsicóticos un 95,2%) y existían factores de vulnerabilidad social en una elevada proporción (distocia sociofamiliar 61,8%, institucionalización 48%). CONCLUSIONES: La hiperfrecuentación infanto-juvenil en urgencias de psiquiatría es una realidad. Se trata de una población socialmente vulnerable, altamente medicada y en la que destaca la problemática conductual. Este colectivo requiere de una atención compleja y multidisciplinar, donde los recursos de soporte social juegan un papel clave


INTRODUCTION: Frequent attenders to the emergency department affect quality of care and imply resource overuse. Data regarding child and adolescent psychiatric frequent attendance to the emergency department is scarce, although their number of visits is growing. OBJECTIVE: To characterize child and adolescent frequent attenders in the psychiatric emergency department of Hospital Clínic de Barcelona during the year 2017. METHODS: Retrospective observational study, case-control design. We selected all minors who attended our psychiatric emergency department in 2017 that belonged to our catchment area. We collected sociodemographic and clinical data through automatic extraction and manual review of electronic medical records. Frequent attendance was established as ≥5 visits/year. We performed a descriptive analysis of frequent attenders and a bivariate analysis comparing frequent attenders versus non-frequent attenders. RESULTS: Our sample included 550 children and adolescents, of which 3.8% (n=21) were frequent attenders. There were significantly more foreigners among frequent attenders (28.6% vs 13.1%, p = 0.04), without other differences between groups. Among frequent attenders, conduct disorders were the most prevalent main diagnoses (33.3%), all had at least one psychotropic medication prescribed (antipsychotics in 95.2%) and social vulnerability factors were present for most of them (family conflict in 61.8%, 48% living in residential care institutions). CONCLUSIONS: Child and adolescent frequent attendance to the psychiatric emergency department is a reality. They are a socially vulnerable and highly medicated subgroup, with a preponderance of conduct problems. They are in need of a comprehensive and multidisciplinary approach, were social services are a key feature


Assuntos
Humanos , Feminino , Adolescente , Serviços de Emergência Psiquiátrica/métodos , Vulnerabilidade Social , Readmissão do Paciente/normas , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Estudos de Casos e Controles , Transtorno da Conduta/psicologia , Visita a Consultório Médico/estatística & dados numéricos , Fatores de Tempo , Readmissão do Paciente/estatística & dados numéricos
16.
Alcohol Clin Exp Res ; 44(8): 1658-1665, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32701168

RESUMO

BACKGROUND: Chronic, heavy alcohol use is associated with multiple health problems, including premature death. Further, the clinical presentation of alcohol dependence may differentially affect and predict the long-term health consequences of affected individuals. Subtypes of alcohol dependence based upon treatment intake information can help identify homogenous groups of patients for treatment purposes, but have not been used to predict long-term outcomes. The current study examined mortality in a 36-year posttreatment interval among 4 subtypes of alcohol-dependent patients based upon their initial intake data. METHODS: Extensive baseline data were collected from n = 316 male and female patients receiving inpatient treatment for alcohol dependence between 1980 and 1982. Four alcohol dependent subtypes (Del Boca & Hesselbrock, Alcohol Health Res World, 20:56, 1996) derived from the baseline data were used to examine the 1-year posttreatment drinking status and the risk of death 36 years postdischarge. Public records were used to determine patient deaths in the 36 years since discharge. RESULTS: At the 36-year follow-up interval since discharge, 68.4% of the sample had died. The 4 subtypes were found to be associated with different rates of resumption of regular drinking in the first year posttreatment and a differential risk of mortality. An increased risk for returning to regular drinking (once a week or more) and early death were associated with subtypes defined, in part, by conduct problems and externalizing disorders. Regardless of subtype membership, women had the highest risk of death following treatment. CONCLUSIONS: This study demonstrates the clinical usefulness of subtypes of alcohol dependence for examining different alcohol use outcomes, including predicting mortality. The increased risks for returning to regular drinking once a week or more and early death posttreatment among subtypes associated with conduct problems and externalizing disorders suggest the need for continued monitoring and possible additional intervention postdischarge.


Assuntos
Alcoolismo/classificação , Transtorno da Personalidade Antissocial/psicologia , Transtornos de Ansiedade/psicologia , Transtorno da Conduta/psicologia , Transtorno Depressivo/psicologia , Mortalidade , Adulto , Alcoolismo/psicologia , Alcoolismo/terapia , Comorbidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
17.
Psychiatry Res ; 291: 113271, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32629297

RESUMO

Previous studies have reported associations between the serotonin transporter 5-HTTLPR genotype and antisocial and aggressive traits and between child maltreatment and antisocial traits. However, few studies have examined whether 5-HTTLPR moderates the influence of childhood maltreatment on callous and unemotional traits, a hallmark of psychopathy. Using a prospective cohort design, children with documented cases of maltreatment and matched controls were followed up and interviewed in adulthood. DNA was extracted from blood and saliva (N = 414) and callous-unemotional (CU) traits were assessed. Childhood maltreatment predicted higher CU scores in adulthood, whereas the effect of 5-HTTLPR was not significant. The effect of child maltreatment on CU traits did not differ by genetic risk (high or low activity 5-HTTLPR), whereas controls with the LL genotype had higher CU scores than controls with the SS genotype. Similar results were found for females and White, non-Hispanics, but not for males and Blacks. Variations in 5-HTTLPR did not affect the impact of child maltreatment on CU traits in adulthood. Genetic risk had a stronger effect on adults with lower environmental risk (controls). Having a history of child maltreatment or the LL genotype placed participants at risk for higher levels of callous and unemotional trait scores.


Assuntos
Maus-Tratos Infantis/psicologia , Transtorno da Conduta/genética , Transtorno da Conduta/psicologia , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Adulto , Agressão/psicologia , Criança , Maus-Tratos Infantis/tendências , Pré-Escolar , Transtorno da Conduta/diagnóstico , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
19.
Clin Child Psychol Psychiatry ; 25(4): 1068-1085, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32713184

RESUMO

Difficulties in facial emotion recognition (FER) are associated with a range of mental health and antisocial presentations in adolescents and adults. Externalising behaviours in children are often one of the earliest signs of risk for the development of such difficulties. This article systematically reviews the evidence (from both group and correlational studies) for whether there is a relationship between FER and externalising behaviours in pre-adolescent children (aged 12 and under), both across and within externalising behaviour domains (hyperactivity, conduct problems, callous-unemotional traits, and aggression). Four electronic databases were searched producing 1,296 articles. Articles were included if they used validated measures of FER and externalising behaviours. Sixteen articles met criteria for inclusion in the review. Overall, the results suggested FER problems are present in ADHD, CP and callous-unemotional presentations, and in samples of children with higher levels of externalising problems rather than in community samples. However, there was no consistent evidence for specific emotions being implicated in the studies reviewed. Clinically, the findings suggest that FER difficulties are commonly associated with externalising behaviours, and hence this review offers some support that FER deficits could be a relevant target of intervention for externalising behaviours. However, more longitudinal studies are required, that control for other variables that might underlie FER difficulties (e.g. IQ or basic Theory of Mind abilities), to inform our knowledge of whether FER difficulties are a causal factor in externalising behaviours.


Assuntos
Agressão/psicologia , Transtorno da Conduta/psicologia , Reconhecimento Facial , Comportamento Problema/psicologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/fisiopatologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Criança , Pré-Escolar , Transtorno da Conduta/fisiopatologia , Humanos
20.
Artigo em Inglês | MEDLINE | ID: mdl-32486294

RESUMO

This study examined the levels of agreement between the reports of 207 adolescents with attention-deficit/hyperactivity disorder (ADHD) and their parents regarding the adolescents' callous-unemotional (CU) traits and investigated the factors influencing adolescent-parent agreement. Adolescent-parent agreement about CU traits in three dimensions according to the Chinese version of the Inventory of Callous and Unemotional Traits was examined. The influence of demographic characteristics, comorbid conduct disorder (CD), oppositional defiant disorder (ODD), and ADHD symptoms on adolescent-parent agreement was also examined. The results indicated that adolescent-parent agreement on the CU trait of uncaringness was moderate, whereas agreement on the CU traits of callousness and unemotionality was poor. Adolescent-parent agreement on the three dimensions of CU traits varied depending on the adolescents' sex and comorbid CD and ODD symptoms as well as parental age. Therefore, multiple sources of information are required when assessing the severity of CU traits in adolescents with ADHD. The factors influencing the levels of the agreement should also be considered.


Assuntos
Comportamento do Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Transtorno da Conduta/psicologia , Empatia , Relações Pais-Filho , Pais/psicologia , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/epidemiologia , China , Comorbidade , Transtorno da Conduta/epidemiologia , Emoções , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...