RESUMO
INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is the most frequent neurodevelopmental disorder and must be considered a public health priority because of its functional repercussions in school, family, and social settings. Health empowerment is an innovative model of care for patients with chronic diseases based on self-management education. Our goal is to evaluate the effectiveness of empowerment using coaching within a multimodal treatment plan in paediatric patients with ADHD. MATERIAL AND METHODS: Descriptive open prospective study. We included children between 6 and 12 years old belonging to patient association in a suburban area of the Region of Madrid. We evaluated the situation before and after 5 cost-free coaching sessions using the Conners Questionnaire, Dundee difficult times of day scale, and satisfaction scales. RESULTS: We included 49 patients (73.5% males) with an average age of 8.5 years. The ADHD hyperactive-impulsive subtype was present in 63.3% and 77.6% had some type of comorbidity. All were treated with methylphenidate and their clinical course was poor. Clinical improvements were observed in 79.6% with a 34.6% mean reduction in symptoms (SD 11.1), and improvements remained stable at 6 months follow-up after coaching. We reached a satisfaction level of 7.8 out of 10 (SD 1.7), and 95.9% of the participants recommended this treatment to other families. CONCLUSIONS: Our results provide information on the potential benefits of coaching as complementary treatment for ADHD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapias Complementares/métodos , Poder Psicológico , Psicoterapia/métodos , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Terapia Combinada , Feminino , Humanos , Masculino , Metilfenidato/uso terapêutico , Projetos Piloto , Estudos Prospectivos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
INTRODUCTION: Although methylphenidate (MPH) used for treatment of attention deficit hyperactivity disorder (ADHD) are considered safe in healthy children and adolescents in the short and medium term, there is a widespread concern about long-term cardiovascular safety. MATERIAL AND METHODS: Interventional, prospective, longitudinal and comparative study with a crossover design to evaluate the cardiovascular impact of the treatment with MPH in healthy children and adolescents diagnosed with ADHD. A protocol for the cardiovascular evaluation was established at a basal point, after the first and the second year of the beginning with treatment based on the monitoring of blood pressure (BP) and echocardiographic follow-up of the systolic and diastolic functions, and structural cardiac properties. RESULTS: 73 patients completed the study, with an average age of 9⯱â¯2.6 years, 75.3% were male and the majority were thin (64.4%). We found an increase in Systolic and Diastolic BP of 3.7⯱â¯9â¯mmHg (Pâ¯=â¯0.004) and 2⯱â¯11,5â¯mmHg respectively. There were no severe cardiovascular events. We didn't find any echocardiographic alterations namely on the structural properties or parameters of systolic function. Regarding diastolic function, a significant increase in the isovo-lumic relaxation time (IVRT) (Pâ¯=â¯0.046) and deceleration time (Pâ¯=â¯0.016) was observed. However, no significant alterations in the parameters related to distensibility of the LV neither in the early diastolic pressure were found. CONCLUSION: Further studies are needed to evaluate the impact of psychostimulants as a modifiable long-term Cardiovascular Risk Factor.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Metilfenidato , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/efeitos adversos , Criança , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Metilfenidato/efeitos adversos , Estudos ProspectivosRESUMO
INTRODUCTION: Although methylphenidate (MPH) used for treatment of Attention deficit hyperactivity disorder (ADHD) are considered safe in healthy children and adolescents in the short and medium term, there is a widespread concern about long-term cardiovascular safety. MATERIAL AND METHODS: Interventional, prospective, longitudinal and comparative study with a crossover design to evaluate the cardiovascular impact of the treatment with MPH in healthy children and adolescents diagnosed with ADHD. A protocol for the cardiovascular evaluation was established at a basal point, after the first and the second year of the beginning with treatment based on the monitoring of Blood pressure (BP) and echocardiographic follow-up of the systolic and diastolic functions, and structural cardiac properties. RESULTS: 73 patients completed the study, with an average age of 9+/- 2.6 years, 75.3% were male and the majority were thin (64.4%). We found an increase in Systolic and Diastolic BP of 3.7±9mmHg (P).004) and 2±11,5mmHg respectively. There were no severe cardiovascular events. We didn't find any echocardiographic alterations namely on the structural properties or parameters of systolic function. Regarding diastolic function, a significant increase in the isovolumic relaxation time (IVRT) (P=.046) and deceleration time (P=.016) was observed. However, no significant alterations in the parameters related to distensibility of the LV neither in the early diastolic pressure were found. CONCLUSION: Further studies are needed to evaluate the impact of psychostimulants as a modifiable long-term Cardiovascular Risk Factor.
RESUMO
El objetivo del estudio fue determinar el consumo de psicoestimulantes en estudiante de la Universidad San Francisco Xavier de Chuquisaca. Se recolectaron los datos mediante encuestas aplicadas a 331 estudiantes. El estudio reveló el psicoestimulante de mayor consumo con 31,88% el café y la coca cola con 26,65%, en su mayoría fueron consumidos con fines académicos. En los efectos secundarios, la sed se estableció como el más frecuente en estudiantes con 30,74%, seguido por cefalea con 27,56% y el cansancio en 14,84%. Se concluye que el café se determina como psicoestimulante menor más consumido en épocas de actividad académica y la sed como el efecto secundario más frecuente.
The objective of the study was to determine the consumption of psychostimulants in a student at the San Francisco Xavier de Chuquisaca University. The data were collected through surveys applied to 331 students. The study revealed the psychostimulant with the highest consumption with 31.88%, coffee and coca cola with 26.65%, most of which were consumed for academic purposes. Regarding side effects, thirst was established as the most frequent in students with 30.74%, followed by headache with 27.56% and fatigue in 14.84%. It is concluded that coffee is determined as the minor psychostimulant most consumed in times of academic activity and thirst as the most frequent side effect.
Assuntos
Coca , Café , Fadiga , População , Efeito Rebote , Inquéritos e QuestionáriosRESUMO
El cociente Theta-Beta (T/B) del electroencefalograma cuantificado (EEGQ) de los pacientes con trastorno por déficit de atención e hiperactividad (TDAH) constituye una variable del EEG característica del trastorno primario con una precisión global del 89%. El objetivo de este estudio es medir el cociente T/B de una población de con TDAH y los efectos del tratamiento farmacológico con psicoestimulantes y no psicoestimulantes sobre el cociente T/B. La muestra estaba formada por 85 sujetos de entre 6 y los 18 años (68 niños y 17 niñas) con el diagnóstico de TDAH de subtipo inatento y combinado, según los criterios del DSM-V. Se les realizó un EEGQ con medición del cociente T/B antes y después de 6 meses de tratamiento con fármacos psicoestimulantes y no psicoestimulantes. Se compararon ambos grupos mediante la prueba de rangos con signo de Wilcoxon para muestras relacionadas. En el 86% de los casos el cociente T/B fue elevado respecto de los valores normales para la edad. La reducción en el cociente T/B fue significativa en el grupo tratado con psicoestimulantes aunque la reducción con los no psicoestimulantes no fue significativa. En conclusión, se confirma la elevación del cociente T/B en los pacientes con TDAH. Los fármacos psicoestimulantes disminuyen de forma significativa el cociente T/B elevado en los pacientes con TDAH tras 6 meses de tratamiento.
Theta-Beta (T / B) ratio of the quantified electroencephalogram (EEGQ) in patients with attention deficit hyperactivity disorder (ADHD) constitutes a characteristic EEG variable of the primary disorder with an overall accuracy of 89%. The objective of this study was to measure the T/B ratio in a sample of patients with ADHD and the effects of the treatment with psychostimulants and non-psychostimulants on the T/B ratio. The sample consisted of 85 children between 6 and 18 years (68 males and 17 females) with the diagnosis of the inattentive and combined subtype of ADHD, according to the criteria of the DSM-V. An EEGQ was performed with measurement of the T/B ratio before and after 6 months of treatment with psychostimulant and non-psychostimulant drugs. Both groups were compared using the Wilcoxon signed range test for related samples. The results showed that 86% of the cases had a T/B ratio above the normal values for the age of them. The reduction in the T/B ratio was statistically significant in the group of patients treated with psychostimulants. The reduction of non-psychostimulants was not significant. In conclusion, we confirmed the high T/B ratio in patients with ADHD. Psychostimulant drugs decrease the elevated T/B ratio in patients with ADHD after 6 months of treatment.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Ritmo Teta/fisiologia , Ritmo beta/fisiologia , Eletroencefalografia/métodos , Estimulantes do Sistema Nervoso Central/uso terapêutico , Valores de Referência , Fatores Etários , Resultado do Tratamento , Estatísticas não ParamétricasRESUMO
El Síndrome X Frágil (SXF) es la principal causa heredada de Discapacidad intelectual (DI) y Trastorno del espectro autista (TEA). Se caracteriza por presentar un fenotipo conductual asociado a hiperactividad, déficit atencional, impulsividad, ansiedad, trastornos conductuales, espectro autista y retraso global del desarrollo. No existe actualmente un tratamiento farmacológico para el trastorno genético de base. El tratamiento farmacológico se focaliza en los síntomas que interfieren con la calidad de vida y aprendizaje, entre ellos la irritabilidad e hiperactividad. OBJETIVO: Evaluar cambios conductuales a través de la escala conductual ABC, de pacientes masculinos con diagnóstico de SXF tratados con psicoestimulantes y/o antipsicóticos en comparación a controles. MÉTODO: Se evalúa a 40 pacientes hombres con diagnóstico de SXF entre los años 2014 y 2017. Se utiliza la evaluación de la conducta mediante el puntaje en la subescala de irritabilidad e hiperactividad de la encuesta ABC-C y el registro de fármacos indicados. Se compara la sintomatología conductual en pacientes que no utilizan fármacos, aquellos que utilizan antipsicóticos, los que usan psicoestimulantes y pacientes tratados con ambos fármacos. RESULTADOS: La mediana de edad fue de 15,1 (±9,3) años. Del total de pacientes, el 42,5% reportó uso de fármacos, de éstos el 35% utilizó psicoestimulantes, 35% antipsicóticos y 30% la combinación de ambos. Se observa que solo el grupo que recibe tratamiento con psicoestimulantes y antipsicóticos en forma simultánea presenta diferencias con el subgrupo sin tratamiento farmacológico. CONCLUSIONES: En más de la mitad de nuestros pacientes se decide no utilizar tratamiento farmacológico. Sin embargo, dichos pacientes igualmente presentan sintomatología de irritabilidad e hiperactividad. Los pacientes que recibieron terapia asociada de psicoestimulantes y antipsicóticos presentan puntajes significativamente más altos en la escala de irritabilidad que aquellos que no recibieron tratamiento farmacológico. Este grupo, que constituye el 12,5% del total de la muestra, presenta un fenotipo conductual que genera mayores dificultades en la calidad de vida del paciente y su entorno.
Fragile X Syndrome (FXS) is the main inherited cause of Intellectual Disability and Autism Spectrum Disorder. It characteristically presents as a behavioral phenotype asso- ciated with hyperactivity, attention deficit, impulsivity, anxiety, behavioral disorders, autistic spectrum and global developmental delay. There is currently no pharmacological treatment for the underlying genetic disorder. Pharmacological treatment targets symptoms that interfere with quality of life and learning, including irritability and hyperactivity.OBJECTIVE: To evaluate behavioral changes through the ABC behavioral scale of male patients diagnosed with FXS treated with psychostimulants and / or antipsychotics compared to controls. METHOD: 40 male patients with a diagnosis of FXS between 2014 and 2017 were evaluated. The behavioral assessment was done by scoring the irritability and hyperactivity subscale of the ABC-C survey and by registering the prescribed drug. Behavioral symptomatology was compared in patients who do not use drugs, those who use antipsychotics, those who use psychostimulants and patients treated with both drugs. RESULTS: The median age was 15.1 (± 9.3) years. Of the total of patients, 42.5% were prescribed drugs, of these 35% used psychostimulants, 35% antipsychotics and 30% the combination of both. It was observed that the group that received treatment with both psychostimulants and antipsychotics simultaneously presented differences with the subgroup without pharmacological treatment.CONCLUSIONS: In more than half of our patients no pharmacological treatment is prescribed. However, these patients also show symptoms of irritability and hyperactivity. Patients who received associated therapy of psychostimulants and antipsychotics have significantly higher scores on the irritability scale than those who did not receive pharmacological treatment. This group, which constitutes 12.5% of the total sample, has a behavioral phenotype that generates greater difficulties in the patient's quality of life and their environment.
Assuntos
Humanos , Masculino , Criança , Adolescente , Adulto Jovem , Antipsicóticos/uso terapêutico , Síndrome do Cromossomo X Frágil/psicologia , Síndrome do Cromossomo X Frágil/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Humor Irritável , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários , Lista de Checagem , Comportamento ProblemaRESUMO
El trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo crónico, complejo y multifactorial asociado con elevadas tasas de concurrencia con otros trastornos psiquiátricos, junto con problemas y repercusiones en diferentes áreas del funcionamiento del individuo. El TDAH no es exclusivo de la edad infanto-juvenil, estimándose una persistencia del 40-60% en la edad adulta, de modo que entre 2.5 y 5% de adultos continúan presentando este trastorno. La adolescencia es una etapa en la que se producen grandes y continuos cambios y que se asocia con una menor adherencia al tratamiento, una mayor vulnerabilidad a la aparición de problemas académicos, más conductas de riesgo, el inicio en el consumo de sustancias y la aparición de otros trastornos comórbidos. Se produce también la transición a los servicios o unidades de adultos, siendo necesaria una mayor coordinación entre los servicios infanto-juveniles y de adultos para asegurar una continuidad de la intervención en una etapa d e la vida en la que el paciente es especialmente vulnerable. Como en el caso de los niños y adolescentes, el tratamiento recomendado en el adulto con TDAH es el abordaje multimodal y multidisciplinar, que combina la medicación con estrategias psicológicas o psicosociales, como la psicoeducación, la terapia cognitivo conductual o el coaching, adaptadas a las necesidades individuales de cada paciente. Los fármacos psicoestimulantes son considerados de primera elección en adultos por las guías clínicas.
Attention deficit hyperactivity disorder (ADHD) is a chronic, complex and multifactorial neurodevelopmental disorder associated with high rates of concurrent psychiatric disorders, along with problems and complications on different areas of individual functioning. ADHD is not exclusively a childhood disorder, 40-60% persisting into adulthood with an estimated prevalence of 2.5-5%. Adolescence is a stage where great and continuous changes occur, associated with a lower adherence to treatment, a greater vulnerability to the emergence of academic problems, more risk-behaviors, the onset of substance use and higher rates of other comorbid disorders. The transition to adult services or units also occurs at this stage, requiring greater coordination between child/adolescent and adult services to ensure continuity of care in a phase of life in which the patient is particularly vulnerable. As in the case of children and adolescents, the recommended treatment for adults with ADHD is the multimodal and multidisciplinary approach, that combines medication with psychological or psychosocial strategies, such as psycho-education, cognitive behavioral therapy or coaching, adapted to the individual needs of each patient. Clinical guidelines recommend psycho-stimulant drugs as first-line treatments for adult patients with ADHD.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transição para Assistência do Adulto/normas , Cooperação e Adesão ao Tratamento/psicologia , Planejamento de Assistência ao Paciente/normas , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , ComorbidadeRESUMO
Resumen: Este artículo propone un abordaje complejo y posthumanista a los diversos modos mediante los cuales niñas, niños y psicofármacos se co-afectan, determinando diversos devenires ontológicos a partir de esta interacción, en el nicho provisto por dos escuelas ubicadas en la zona oriente de Santiago de Chile. A partir de los resultados de una praxiografía que se extendió por ocho meses con niñas y niños de 9 y 10 años, se sostiene que es necesario pensar esta relación entre niñas, niños y psicofármacos desde coordenadas distintas a las provistas por las tesis de la medicalización. Esto, en tanto ellas reducen y achatan la noción de subjetividad a una posesión interna del individuo, y a una separación radical con el mundo, sostenida en una discutible idea de excepcionalismo humano. En respuesta a esta idea de subjetividad, se propone otra que permite un abordaje diferente al problema, en tanto es una subjetividad entendida en sus aspectos procesales, dinámicos, y últimamente sostenido en base a entramados con el mundo y con la medicación.
Abstract: This article advances a posthumanist and complex approach to the different ways in which children and psychostimulants can co-affect each other, enabling different ontological becomings thanks to the processes of coming together that took place in the niche provided by two schools located in East Side of Santiago, Chile. Grounded in the results of an 8-months praxiography with children aged 9 and 10-years old, I argue for the need of new coordinates to reflect upon these interactions, coordinates different to those granted by the medicalization thesis. This, inasmuch as their approach tends to flatten and reduce the subjectivity of the medicated child to an inner essence, radically separated from the world, which is sustained under a disputed idea of human expectionalism. In respond to this, I advance an idea of subjectivity which is relational, processual and sustained on entanglements with the world and with the medication.
Resumo: Este artigo propõe uma abordagem complexa e pós-humanista aos vários modos pelos quais meninos, meninas e psicofármacos se co-afetam, determinando diferentes devires ontológicos dessa interação, no nicho prestado por duas escolas localizadas na zona oriente de Santiago do Chile. A partir dos resultados de uma praxiografía que durou oito meses com meninas e meninos com idade entre 9 e 10 anos, argumenta-se que é necessário pensar sobre a relação entre crianças e psicofármacos a partir de coordenadas diferentes das previstas pelas teses da medicalização. Neste aspecto, estas teses reduzem e achatam a noção de subjetividade a uma posse interna do indivíduo, e uma separação radical do mundo, realizada em uma ideia discutível do excepcionalismo humano. Em resposta a esta idéia de subjetividade, propõe-se uma abordagem diferente para o problema, a partir de uma subjetividade entendida em seus aspectos processuais, dinâmicos e, finalmente, sustentada com base nas associações com o mundo e com a medicação.
RESUMO
INTRODUCCIÓN El presente estudio busca comenzar un abordaje inicial del fenómeno del consumo de Modafinilo en profesionales de la Salud Mental en Chile y los factores precipitantes que promueven el consumo de esta sustancia psicoestimulante. OBJETIVOS: Realizar una revisión bibliográfica respecto del consumo de Psicoestimulantes en Profesionales de la Salud Mental; identificar el psicoestimulante de más fácil acceso; buscar y contactar a profesionales de la salud mental del SSMC que consuman activamente Modafinilo e Identificar los posibles factores precipitantes asociados al consumo de Modafinilo. MATERIAL Y MÉTODOS: Reporte de caso y análisis de discurso de una entrevista en profundidad, identificando las categorías centrales que estructuran la experiencia del profesional respecto de su consumo. RESULTADOS Y DISCUSIÓN: De acuerdo al análisis de la entrevista, podemos destacar cuatro factores que desencadenan el consumo habitual de la sustancia psicoestimulante: la narcolepsia, sobrecarga laboral, sobrecarga emocional y el fácil acceso al Modafinilo. CONCLUSIONES: La bibliografía existente es muy escasa; este estudio se constituye como una primera aproximación al abordaje de este tema a nivel nacional; la sobrecarga emocional cobra gran importancia ya que complementa la dependencia fisiológica; los estados emocionales que generan y mantienen el consumo en el profesional se ven asociados a eventos ambientales, y la dependencia psicológica es una realidad inseparable de la dependencia fisiológica.
BACKGROUND: The present study aims to start an initial approach to the phenomenon of Modafinil use in mental health professionals in Chile, and the precipitating factors that promote the consumption of this psychostimulant substance. OBJETIVES: To carry out a bibliographic review regarding the use of Psychostimulants in Mental Health Professionals; to identify the most easily accessible psychostimulant; to find and contact mental health professionals who actively consume Modafinil and to identify the possible precipitating factors associated with consumption of Modafinil. METHODS: Case report and discourse analysis of an in-depth interview, identifying the central categories that structure the professional's experience regarding their consumption. RESULTS AND DISCUSSION: According to the analysis of the interview, we can highlight four factors that trigger the habitual consumption of the psychostimulant substance: Narcolepsy, work overload, emotional overload and easy access to Modafinil. CONCLUSIONS: The existing literature is very scarce; this study constitutes a first approach of this topic at national level; emotional overload is of great importance since it complements the physiological dependence; the emotional states that generate and maintain consumption in the professional are seen associated with environmental factors, and psychological dependence is an inseparable reality of physiological dependence.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Saúde Mental , Modafinila/administração & dosagem , Estimulantes do Sistema Nervoso Central/administração & dosagem , Automedicação , Fatores Desencadeantes , Entrevistas como Assunto , Carga de Trabalho , Transtornos Relacionados ao Uso de Substâncias , Dependência Psicológica , Uso de Medicamentos , Narcolepsia/tratamento farmacológicoRESUMO
O estudo da dependência de substâncias psicoativas apresentou grandes avanços conceituais nas últimas décadas. A evolução dos conceitos foi paralela às evidências científicas que têm revelado os aspectos comportamentais e os mecanismos neurais envolvidos nesse fenômeno. Contudo, um grande desafio que permanece na pesquisa sobre a dependência de substâncias psicoativas é a identificação de quais fatores são responsáveis pela transição do uso controlado para o uso compulsivo. Está demonstrado que muitas variáveis interagem para influenciar a probabilidade de que qualquer indivíduo inicie o uso abusivo de substâncias psicoativas ou se torne dependente. Nos últimos anos, o estresse tem sido destacado como um fator importante na iniciação, manutenção e recaída da utilização de substâncias psicoativas. Neste trabalho analisamos os conceitos e teorias da farmacodependência e as principais evidências comportamentais pré-clínicas que demonstram a relação entre estresse e a vulnerabilidade ao abuso e dependência de psicoestimulantes.
The investigation of the mechanisms of drug abuse and addiction showed great advances in the last decades. New concepts emerged from the scientific evidences on behavioral and neural aspects of this phenomenon. However, the biggest challenge for the future is the identification of which risk factors are implicated in the transition from controlled to compulsive drug use. Stress has been pointed as an important factor related to initiation, maintenance and relapse to drug use. In the present paper we discuss the concepts and theories of drug addiction, and the main behavioral pre-clinical evidences showing the relationship between stress and psychostimulant addiction.
Assuntos
Psicotrópicos , Transtornos Relacionados ao Uso de Substâncias , Estresse FisiológicoRESUMO
O tratamento farmacológico do transtorno do déficit de atenção com hiperatividade (TDAH) em adultos inclui o uso de psicoestimulantes, antidepressivos e atomoxetina, sendo o primeiro considerado a indicação de primeira escolha. A eficácia do metilfenidato foi demonstrada em adultos quando se empregavam doses maiores, proporcionalmente similares àquelas usadas em estudos em crianças. O perfil de eventos adversos do metilfenidato, incluindo aqueles relativos ao sistema cardiovascular, parece bastante seguro.
Pharmacotherapy of attention-deficit/hyperactivity disorder in adulthood includes psychostimulants, antidepressants and atomoxetine, the first of them being considered the first choice. Methylphenidate efficacy has been demonstrated in adults when higher doses were used, in a proportionate similar way to what has been described in children. Methylphenidate profile of adverse events, including cardiovascular ones, seems to be safe.
Assuntos
Humanos , Adulto , Antidepressivos/uso terapêutico , Comorbidade , Metilfenidato/administração & dosagem , Metilfenidato/efeitos adversos , Metilfenidato/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Brasil , Resultado do TratamentoRESUMO
Psicoestimulantes (PSE), estabilizadores del ánimo (EA) y benzodiacepinas (BDZ) son psicofármacos frecuentemente utilizados en psiquiatría infantojuvenil y cuya indicación ha aumentado considerablemente en los últimos años. Los PSE son empleados principalmente en el déficit atencional, siendo la terapia de primera línea en pacientes sin comorbilidad. Modafinilo y anfetaminas serían igualmente efectivos y se utilizan con similar frecuencia en muchos países sin embargo existe evidencia de mayores riesgos con anfetaminas. Otros fármacos como atomoxetina, a-agonistas, bupropión y antidepresivos tricíclicos (imipramina) se utilizan como tratamiento de segunda o tercera línea. Los EA son especialmente útiles en el tratamiento del trastorno bipolar (TB) y se consideran agentes de primera línea: litio, ácido valproico (sodio divalproex) y algunos antipsicóticos atípicos. Otros EA que han demostrado efectividad en TB son lamotrigina, carbamazepina, oxcarbamazepina y topiramato. Las DBZ han sido poco estudiadas en población infantojuvenil, pero su uso no es infrecuente. Si bien no son una indicación de primera línea en trastornos de ansiedad, están indicadas como tratamiento adyuvante especialmente diazepam. Fluracepam tiene un rol en el tratamiento de insomnio en mayores de 15 años. Aunque el tratamiento de elección de muchas patologías de psiquiatría infantojuvenil es claro en diversas guías clínicas, la complejidad terapéuticas de estos pacientes muchas veces hace necesario el uso de psicofármacos de segunda o tercera línea, muchos de ellos no aprobados por la Food and Drug Administration. Es estos casos cobra vital importancia el seguimiento estricto, con especial cuidado en los efectos colaterales, que pueden ser nocivos para el desarrollo del paciente.
Psycho stimulants (PSE), mood stabilizers (ME) and benzodiazepines (BDZ) are psychotropics frequently used in children and adolescents psychiatry and their indication has increased considerably in the last year. The PSAE are used mainly in attentional deficits being first-line treatment in patients without co-morbidity. Modafinil and amphetamines are supposed to be equally effective and used with similar frequency in many countries, however there is evidence of bigger risk with amphetamines. Other drugs such as Atomoxetine, a-agonist, bupropion, tricyclic antidepressants (imipramine) are used as second or third line treatment. The ME are especially useful as treatment of bipolar disorder (BD); lithium, divalproex sodium and some atypical antipsychotics are considered first line treatment. Other ME that have showed effectiveness in TB are lamotrigine, carbamazepine, oxcarbamazepina and topiramate. The BDZ haven´t been studied too much in young population, however its uses not uncommon. Although it is not a first line indication in anxiety disorders they are indicated as adjunctive treatment, especially diazepam. Fluracepam has a role in the treatment of insomnia in children over 15 years. While the treatment of choice for many pathologies of juvenile psychiatry is clear in several clinical guidelines, the therapeutic complexity of these patients often requires the use of psychopharmacology of 2nd or 3rd line, many of them not approved by the Food and Drug Administration in these cases is of vital importance a strict monitoring, with particular attention to side effects, which can be harmful to the patients development.