Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

BACKGROUND: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.

Trastorno por déficit de atención con o sin hiperactividad: evaluación en la consulta pediátrica / No disponible

El trastorno por déficit de atención con o sin hiperactividad (TDAH) constituye el principalproblema de la salud mental infantil. Su curso crónico, la repercusión que tiene sobreel desarrollo personal y familiar y su alta prevalencia hacen de este trastorno un hecho únicoen pediatría de Atención Primaria, neuropediatría, psiquiatría infantil, así como en elmedio no sanitario, especialmente el educativo.En este artículo se comentan las formas clínicas y la evaluación que es posible llevar acabo ante una sospecha inicial en la consulta del pediatra, haciendo hincapié en las evidenciasque permiten llegar a un diagnóstico de certeza, primer paso para el tratamientoadecuado del paciente

The attention-deficit/hyperactivity disorder (ADHD), with or without hyperactivity, isthe most important mental health problem in childhood. The fact that its evolution ischronic, that it affects the child’s and family development and that it has a high prevalence,causes this disorder to be unique in pediatric primary care, child neurology, and childpsychiatry, besides in non-medical environments, specially education.This paper mentions the different clinical presentations of ADHD and the possible evaluationto be carried-out when first suspected at the pediatrician’s office, making emphasison the evidences that allow us to reach a certain diagnosis, which is the first step for anadequate treatment of the patient

Comentarios y contribuciones

Comentários ao trabalho de Joseph Sandler: Algunas notas sobre identificación proyectiva

O ego e o Id cinquenta anos depois

Aspectos que influíram no pensamento básico de várias escolas analíticas através de conceitos de identificação, fantasia inconsciente e relação objetal; situa desenvolvimentos anteriores, valorizando a relação entre a teoria estrutural e as relações de objeto, focalizando duas direções: a) desenvolvimento de uma psicologia uni-pessoal baseada na relação objetal-anobjetal 2) desenvolvimento de uma psicologia interpessoal de relação objetal