[Management of agitated, violent or psychotic patients in the emergency department: an overdue protocol for an increasing problem]. / Atención al paciente agitado, violento o psicótico en urgencias: un protocolo pendiente para una patología en aumento.

Patients with extreme agitation, delirium, violent behavior or acute psychosis are frequently evaluated in the emergency departments of general hospitals. However, the traditional infrequency of this type of situation in pediatric emergency services can lead to a certain lack of foresight and efficiency in the initial management of these patients. Because of the current known increase of psychosocial disorders in pediatric emergencies, new pharmacological treatments for juvenile psychotic processes, and particularly the lack of compliance with these treatments, as well as the earlier consumption of ever more varied illicit drugs among young people, the frequency and diversity of this kind of disorder is on the increase. The treatment of agitation, aggression and violence begins with successful management of the acute episode, followed by strategies designed to reduce the intensity and frequency of subsequent episodes. The key to safety is early intervention to prevent progression from agitation to aggression and violence. Consequently, urgent measures designed to inhibit agitation should be adopted without delay by the staff initially dealing with the patient, usually in the emergency unit. Patients with psychomotor agitation disorder (PMAD) may require emergency physical and/or chemical restraints for their own safety and that of the healthcare provider in order to prevent harmful clinical sequelae and to expedite medical evaluation to determine the cause. However, the risks of restraint measures must be weighed against the benefits in each case. This review aims to present the emergency measures to be taken in children with PMAD. The distinct etiological situations and criteria for the choice of drugs for chemical restraint in each situation, as well as the complications associated with certain drugs, are discussed. It is advisable, therefore, that health professionals become familiar with the distinct pharmacological options.

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 de conducta en niños adoptados / No disponible

La adopción de un niño es un sueño hecho realidad, es un acto de entrega generosa a un niño desconocido, pero es un proceso complejo que debe hacerse lentamente y que requiere la adaptación tanto de la familia como del niño. Los niños adoptados, especialmente aquellos que tienen historia de vivencia institucional antes de la adopción, tienen un mayor riesgo de presentar trastornos del desarrollo, de la conducta y del vínculo. Por ello, la conducta, el desarrollo, el apego, el estrés en los padres y las relaciones hijos-padres en estas familias debe ser monitorizada, especialmente durante el periodo preadoptivo y los primeros años postadopción, ofreciendo la posibilidad de acudir a los servicios especializados de Salud Mental a estos niños y sus familias. El objetivo de este artículo es realizar un análisis de los principales problemas que vamos a encontrar en la adopción, así como la revisión de las publicaciones internacionales realizadas en los últimos años sobre la adopción (AU)

The adoption of a small child is a dream come true, it is an act of generosity to an unknown child, but it is an extremely complex process that has to be done slowly and requires the adaptation of both family and kid. Adopted children, especially those with a history of institutional living before adoption, are at greater risk for a range of developmental, behavioral and attachment concerns. As a result, development behavior, attachment, parent stress, and parent-child interactions need to be monitored. Especially during the pre-adoption process and the first few years after the adoption, having during this period the possibility to use especialized services for Mental Health of both families and child. The purpose of this article is to analyze the main problems that we will face with an adoption, as well as the revision of international literature published in the last few years on this subject (AU)

Trastornos de conducta en niños adoptados / Behavior disorder in adopted children

La adopción de un niño es un sueño hecho realidad, es un acto de entrega generosa a un niño desconocido, pero es un proceso complejo que debe hacerse lentamente y que requiere la adaptación tanto de la familia como del niño. Los niños adoptados, especialmente aquellos que tienen historia de vivencia institucional antes de la adopción, tienen un mayor riesgo de presentar trastornos del desarrollo, de la conducta y del vínculo. Por ello, la conducta, el desarrollo, el apego, el estrés en los padres y las relaciones hijos-padres en estas familias debe ser monitorizada, especialmente durante el periodo preadoptivo y los primeros años postadopción, ofreciendo la posibilidad de acudir a los servicios especializados de Salud Mental a estos niños y sus familias. El objetivo de este artículo es realizar un análisis de los principales problemas que vamos a encontrar en la adopción, así como la revisión de las publicaciones internacionales realizadas en los últimos años sobre la adopción (AU)

The adoption of a small child is a dream come true, it is an act of generosity to an unknown child, but it is an extremely complex process that has to be done slowly and requires the adaptation of both family and kid. Adopted children, especially those with a history of institutional living before adoption, are at greater risk for a range of developmental, behavioral and attachment concerns.As a result, development behavior, attachment, parent stress, and parent-child interactions need to be monitored. Especially during the pre-adoption process and the first few years after the adoption, having during this period the possibility to use especialized services for Mental Health of both families and child. The purpose of this article is to analyze the main problems that we will face with an adoption, as well as the revision of international literature published in the last few years on this subject (AU)

Patología psicosomática. Los teatros del alma / Psychosomatic pathology. Theaters of the Soul

Los Trastornos Psicosomáticos son una forma deexpresión, muy frecuente en la etapa infanto-juvenil,de diversas alteraciones emocionales que tienenuna proyección en distintos órganos y aparatos delcuerpo. La psicosomática no sólo expresa un síntomao un grupo de síntomas, sino que remite a unaforma de reaccionar o forma de comportamiento. Enlos Trastornos Psicosomáticos es necesario queconfluyan diversos factores etiopatogénicos. Explicacionespsicodinámicas, psicofisiológicas, e inmunológicasson necesarias para comprender la trasformaciónsimbólica de un conflicto psicológico enuna alteración o lesión orgánica-física. El Cuerpoconstituye en estos trastornos los Teatros del Alma,su representación

Psychosomatic Disorders are an expression wayof diverse emotional alterations which are very frequentin children and have a projection in differentorgans and systems of the body. Psychosomatic notonly expresses a symptom or a group of symptoms,but takes to a form to react or to behave. In the PsychosomaticDisorders it is necessary that diverseetiopathogenic factors come together. Psychodynamic,psychophysiologic, and immunogenic explanationsare necessary to understand the symbolictransformation of a psychological conflict into an organicalteration or into an injury. The Body constitutesin these disorders the Theaters of the Soul, itsrepresentation

Atención al paciente agitado, violente o psicótico en urgencias: un protocolo pendiente para una patología en aumento / Management of agited, violent or psychotic patients in the emergency department: an overdue protocol for an increasing problem

El paciente con extrema agitación, delirio, comportamiento violento o psicosis aguda es un problema de evaluación frecuente en la sala de urgencias de un hospital general. En cambio, en los servicios de urgencias pediátricas, la tradicional infrecuencia de este tipo de cuadros puede conducir a un cierto grado de imprevisión e ineficiencia en la atención inicial a estos casos. El actual incremento conocido de la patología de origen psicosocial en las urgencias pediátricas, las nuevas terapias medicamentosas de los procesos psicóticos juveniles y, más en particular su incumplimiento, así como la aproximación más temprana de nuestros jóvenes al consumo de sustancias adictivas, cada vez más variadas, nos enfrentan a un aumento en la frecuencia y la diversidad de este tipo de crisis. El tratamiento de la agitación, agresión y/o violencia empieza con el tratamiento exitoso del episodio agudo, seguido por estrategias destinadas a reducir la intensidad y frecuencia de los episodios subsiguientes. La clave para la seguridad es intervenir precozmente con objeto de prevenir la progresión de la agitación a agresión y violencia. Por eso, las medidas urgentes, destinadas a inhibir la agitación, deben ser adoptadas sin demora por el personal que atiende primero al paciente, y que suele ser en las unidades de urgencias. Los pacientes en crisis de agitación psicomotriz (CAPM) pueden requerir medidas urgentes de contención física y/o química, para asegurar su propia integridad, la seguridad de sus cuidadores sanitarios, prevenir secuelas clínicas graves y permitir su evaluación clínica para determinar la etiología. Pero los riesgos derivados de las medidas de contención deben conocerse y ser sopesados frente a los beneficios en cada caso. El propósito de este artículo es exponer la actuación urgente que se debe seguir ante un niño con CAPM, intentando definir las distintas situaciones etiológicas y los criterios de elección de medicamentos para el control químico en cada una de ellas, así como advertir de las complicaciones asociadas a los agentes medicamentosos que emplear y de la conveniencia, por tanto, de que los profesionales se familiaricen con las distintas opciones farmacológicas

Patients with extreme agitation, delirium, violent behavior or acute psychosis are frequently evaluated in the emergency departments of general hospitals. However, the traditional infrequency of this type of situation in pediatric emergency services can lead to a certain lack of foresight and efficiency in the initial management of these patients. Because of the current known increase of psychosocial disorders in pediatric emergencies, new pharmacological treatments for juvenile psychotic processes, and particularly the lack of compliance with these treatments, as well as the earlier consumption of ever more varied illicit drugs among young people, the frequency and diversity of this kind of disorder is on the increase. The treatment of agitation, aggression and violence begins with successful management of the acute episode, followed by strategies designed to reduce the intensity and frequency of subsequent episodes. The key to safety is early intervention to prevent progression from agitation to aggression and violence. Consequently, urgent measures designed to inhibit agitation should be adopted without delay by the staff initially dealing with the patient, usually in the emergency unit. Patients with psychomotor agitation disorder (PMAD) may require emergency physical and/or chemical restraints for their own safety and that of the healthcare provider in order to prevent harmful clinical sequelae and to expedite medical evaluation to determine the cause. However, the risks of restraint measures must be weighed against the benefits in each case. This review aims to present the emergency measures to be taken in children with PMAD. The distinct etiological situations and criteria for the choice of drugs for chemical restraint in each situation, as well as the complications associated with certain drugs, are discussed. It is advisable, therefore, that health professionals become familiar with the distinct pharmacological options