RESUMO
BACKGROUND: There are various language adaptations of the Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL). In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation. METHODS: K-SADS-PL was adapted to correspond to DSM-5 categories. All clinicians received training, and a 90% agreement was reached. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters. Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients. RESULTS: A total of 74 subjects were included. The Factor Analysis yielded six factors (Depressive, Stress Hyperarousal, Disruptive Behavioral, Irritable Explosive, Obsessive Repetitive and Encopresis), representing 72% of the variance. Kappa values for inter-rater agreement were larger than 0.7 for over half of the disorders. CONCLUSIONS: The factor structure of diagnoses, made with the instrument was found to correspond to the DSM-5 disorder organization. The instrument showed good construct validity and inter-rater reliability, which makes it a useful tool for clinical research studies in children and adolescents.
Assuntos
Entrevista Psicológica/métodos , Entrevista Psiquiátrica Padronizada/normas , Transtornos do Humor/diagnóstico , Esquizofrenia/diagnóstico , Adolescente , Criança , Transtornos do Comportamento Infantil/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , População , Reprodutibilidade dos Testes , EspanhaRESUMO
Changes to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) incorporate the inclusion or modification of six disorders: Autism Spectrum Disorder, Social Anxiety Disorder, Intermittent Explosive Disorder, Disruptive Mood Dysregulation Disorder, Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder. The objectives of this study were to assess the construct validity and parent-child agreement of these six disorders in the Spanish language Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL-5) in a clinical population of children and adolescents from Latin America. The Spanish version of the K-SADS-PL was modified to integrate changes made to the DSM-5. Clinicians received training in the K-SADS-PL-5 and 90% agreement between raters was obtained. A total of 80 patients were recruited in four different countries in Latin America. All items from each of the six disorders were included in a factor analysis. Parent-child agreement was calculated for every item of the six disorders, including the effect of sex and age. The factor analysis revealed 6 factors separately grouping the items defining each of the new or modified disorders, with Eigenvalues greater than 2. Very good parent-child agreements (r>0.8) were found for the large majority of the items (93%), even when considering the sex or age of the patient. This independent grouping of disorders suggests that the manner in which the disorders were included into the K-SADS-PL-5 reflects robustly the DSM-5 constructs and displayed a significant inter-informant reliability. These findings support the use of K-SADS-PL-5 as a clinical and research tool to evaluate these new or modified diagnoses.
Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno do Espectro Autista/diagnóstico , Transtornos do Comportamento Infantil/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos do Humor/diagnóstico , Pais , Escalas de Graduação Psiquiátrica/normas , Autorrelato/normas , Adolescente , Criança , Chile , Colômbia , Feminino , Humanos , Masculino , México , Reprodutibilidade dos Testes , Esquizofrenia/diagnóstico , UruguaiRESUMO
A total of 1,535 4-12 year-old children were screened with the Conners' rating scales, followed by diagnostic confirmation by the diagnostic interview schedule for children-IV-parent version. The prevalence of ADHD was estimated to be 10.03%, and only 3.9% of children had received medication for the treatment of ADHD symptoms. Prevalence rates and demographic profile of Venezuelan children with ADHD are very similar to those found in samples from other countries. Authorities need to develop public health policies to correctly identify and treat affected subjects. Furthermore, clinicians must actively search for children with ADHD in order to provide the best-available treatment.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estudantes/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Instituições Acadêmicas , Venezuela/epidemiologiaRESUMO
Autism is a complex neurodevelopmental disorder characterized by impairment of social interaction, language, communication, and stereotyped, repetitive behavior. Genetic predisposition to Autism has been demonstrated in families and twin studies. There is evidence (linkage and genetic association, biochemical, neuropathological, functional and cytogenetic) that the gamma-amino-butyric acid receptor beta 3 subunit gene (GABRB3) at 15q11-q13 is a susceptibility candidate gene for Autism. The aim of this exploratory study was to identify new variants of this gene. We performed the molecular analysis (SSCP/Sequencing) of 10 exons and its intronic flanking regions of GABRB3, using a candidate gene screening approach in 18 idiopathic autistic patients. We did not find non-synonymous mutations at the encoding regions, but we identified four SNP (Single Nucleotide Polymorphism). The first one, represented a silent mutation p.P25P in exon la and was found in 33.33% of the patients. The second one: IVS3 + 13C > T (5b far from the intron 5' consensus sequence), was found in 44.44% of the patients, while it was also identified in 16.67% of the controls. Simultaneously, 33.33% of the patients had both variants, and although, 16.67% of the controls also had the same combination of variants, 66.66% of the patients with those alleles had a familiar history of Autism. The third and fourth SNP: IVS5 + 40T > G and IVS-70A > G were identified in two different patients. None of the last three SNPs have been reported at the SNP database (dbSNP). The proximity of SNP: IVS3 + 13C > T with the consensus and interaction sequence with U1 nucleoriboprotein, could disturb the normal splicing of mRNA. This is in agreement with the evidence of lower levels of GABA-A receptors in autistic brains; so, it could be a common variant, that by itself could not cause a phenotypic effect, but joined to other variants with the same gene, in different related genes or with epigenetic changes, could explain the autistic phenotype and its heterogeneity.
Assuntos
Transtorno Autístico/genética , Receptores de GABA-A/genética , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Análise de Sequência de DNARESUMO
El autismoes un trantorno del desarrollo caracterizado por deterioro de la interacción social, la comunicación, y comportamiento estereotipado. Los estudios de familias y gemelos han demostrado predisposición genética al autismo. Existe evidencia (ligamento y asociación genética, bioquímica, anatomopatológica, funcional y citogenética) de que el gen de la subunidad B3 del receptor de GABA-A (GABRB3), en 15q11-q13, es un candidato de susceptibilidad al autismo. Con el objetivo de identificar nuevas variantes en este gen, se estudiaron 18 pacientes con autismo idiopático, utilizando un tamizaje de gen candidato. Se réalizo el análisis molecular (SSCP/secuencuaci¢n) de los 10 exones con sus correspondientes regiones intrónicas flanqueantes, pero se identificaron mutaciones no sinónimas en las regiones codificantes, pero se identificaron 4 polimorfismos de nucleótido simple (SNP). El primer SNP representó una mutación silente p. P25P en el exon 1a, encontrada en 33,33 por ciento de los pacientes. El Segundo SNP: IVS3 + 13C > T (a 5 b de la secuencia consenso 5' del intrón) fue encontrado en 44,44 por ciento de los pacientes, mientras fué indentificado en 16,67 por ciento de los controles. El 33,33 por ciento de los pacientes presentaron simultáneamente ambas variantes, y aunque el 16,67 por ciento de los controles también poseían la misma combinación, el 66,66 por ciento de los pacientes con esos alelos tenían antecedentes familiares de autismo. El tercer y cuarto SNP: IVS5 + 40T > G e IVS7-7OA > G fueron identificados en dos pacientes diferentes. Ninguno de los 3 últimos SNPs ha sido reportado en la base de datos de SNP (dbSNO). La cercanía del SNP: IVS3 + 13C > T con la secuencia consenso y de interación con la nucleorribonucleoproteína U1, pudiera alterar la maduración normal del pre-ARNm, en concordancia con la evidencia de niveles bajos del receptor GABA-A en cerebros de pacientes con autismo, pudiendo entonces tratarse, de una variante común, que por sí sola.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Mutação , Polimorfismo de Nucleotídeo Único , Transtorno Autístico/etiologia , Genética Médica , Medicina , VenezuelaRESUMO
In order to compare and contrast the efficacy of haloperidol, carbamazepine, and valproic acid in the treatment of Sydenham's chorea a prospective study including 18 cases of this disorder was undertaken. Age of patients ranged from 7 to 15 years. Ten children were female and 8 were male. All but one had generalized, either symmetric or asymmetric chorea. The patients were divided in three equal groups, and were given a standardized dose of each of the drugs built-up over a week. Following therapy, the six children receiving valproic acid showed remarkable improvement, without side effects. Five patients receiving carbamazepine showed improvement without side effects. Only three of the patients that received haloperidol improved. In the 4 cases that did not show clinical improvement after one week of treatment, therapy with valproic acid led to disappearance of the symptoms in a lapse that ranged from 4 to 7 days. Recurrence related to discontinuation of treatment was observed in two patients. In view of the present results we recommend valproic acid as the first choice drug to treat Sydenham chorea.
Assuntos
Antidiscinéticos/uso terapêutico , Antimaníacos/uso terapêutico , Carbamazepina/uso terapêutico , Coreia/tratamento farmacológico , Haloperidol/uso terapêutico , Ácido Valproico/uso terapêutico , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Resultado do TratamentoRESUMO
In order to compare and contrast the efficacy of haloperidol, carbamazepine, and valproic acid in the treatment of Sydenham s chorea a prospective study including 18 cases of this disorder was undertaken. Age of patients ranged from 7 to 15 years. Ten children were female and 8 were male. All but one had generalized, either symmetric or asymmetric chorea. The patients were divided in three equal groups, and were given a standardized dose of each of the drugs built-up over a week. Following therapy, the six children receiving valproic acid showed remarkable improvement, without side effects. Five patients receiving carbamazepine showed improvement without side effects. Only three of the patients that received haloperidol improved. In the 4 cases that did not show clinical improvement after one week of treatment, therapy with valproic acid led to disappearance of the symptoms in a lapse that ranged from 4 to 7 days. Recurrence related to discontinuation of treatment was observed in two patients. In view of the present results we recommend valproic acid as the first choice drug to treat Sydenham chorea