Daniel Segenreich

Adaptação transcultural para o português da escala Adult Self-Report Scale para avaliação do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos

The criteria listed in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) from the American Psychiatric Association are the most used ones for the diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD) being based on field studies with children and adolescents. The Adult Self-Report Scale (ASRS, version 1.1) was developed to adapt those symptoms to an adult life context. The present study consisted of a transcultural adaptation of the original instrument in English into a final version to be used in Brazil. Results indicated a satisfactory equivalence between versions, with some modifications being done after debriefing, supporting the importance of this step in studies like this.

Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorders

OBJECTIVE According to studies of prevalence, up to 70% of adults with attention deficit/hyperactivity disorder have at least one psychiatric comorbidity, which leads to diagnostic and therapeutic difficulties as well as more severe functional impairment. There is a paucity of data on the comorbidity of attention deficit/hyperactivity disorder and eating disorders. The objective of this study was to review the literature regarding the attention deficit/hyperactivity disorder/eating disorders comorbidity, performing a critical analysis of relevant data. METHOD Articles in Medline, Lilacs, SciELO, ISI and PsycINFO databases from 1980 up to 2008, were searched. The references from the articles were used as additional sources of data. RESULTS Fourteen articles were found: five prevalence studies, four case reports, three case-control studies, one symptom-assessment study of attention deficit/hyperactivity disorder and eating disorders, and one article regarding possible causes of the association between attention deficit/hyperactivity disorder and eating disorders. These articles suggested that adult women with attention deficit/hyperactivity disorder are at higher risk of developing eating disorders, especially bulimia nervosa. Bulimia Nervosa rates found in attention deficit/hyperactivity disorder groups ranged from 1% to 12%, versus 0% to 2% in control groups. CONCLUSIONS Although there seems to be a relationship between attention deficit/hyperactivity disorder and eating disorders, the reduced number of studies available, with various methodologies, and small sample sizes limit the generalization of the findings.

Transtornos alimentares comórbidos em uma amostra clínica de adultos com transtorno do déficit de atenção com hiperatividade

Although comorbidity between attention-deficit/hyperactivity disorder (ADHD) and eating disorders (ED) is relevant for clinical treatment, it is seldom investigated. METHODS: 86 DSM-IV attention deficity hyperactivity disorder patients out of 107 self-referred adults in a specialized center for attention deficity hyperactivity disorder were interviewed using SCID-R to evaluate the lifetime prevalence of ED and other comorbid conditions. RESULTS: Nine attention deficity hyperactivity disorder patients had comorbid eating disorders; binge eating disorder (BED) was the most common diagnosis. The group with eating disorders presented a higher prevalence of other comorbid disorders (p=0.02). No significant differences were found on gender, age at assessment, schooling level and type of attention deficity hyperactivity disorder between groups. CONCLUSION: Attention deficity hyperactivity disorder clinical samples may have a high prevalence of BED comorbidity. Patients with attention deficity hyperactivity disorder and eating disorders may have a different comorbid profile.

Painel brasileiro de especialistas sobre diagnóstico do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos

Present difficulties in the diagnosis of attention-deficit/hyperactivity disorder in adults have prompted Brazilian specialists involved in research in this area to make a consensus to be used in the country. A non-systematic preliminary review was repeatedly evaluated by all authors, who added new material, commented and corrected parts of the text for 6 months through electronic mail and a further meeting sponsored by the Brazilian Association of Attention-Deficit Disorder. The preliminary version was publicly presented during the annual congress of the Associacao Brasileira de Psiquiatria (Brazilian Association for Psychiatry) for appraisal and suggestions from participants in order to prepare the final version.Considerando-se as dificuldades atuais do diagnostico do transtorno do deficit de atencao/hiperatividade em adultos, foram reunidos especialistas brasileiros que fazem pesquisas nesta area, de modo a produzir diretrizes de consenso para uso no pais. Foi realizada uma revisao nao-sistematica preliminar e concebido um texto inicial, que foi repetidamente avaliado e editado pelos autores, com acrescimos e correcoes ao longo de 6 meses, atraves de correio eletronico e de uma reuniao posterior, patrocinada pela Associacao Brasileira do Deficit de Atencao. A versao preliminar foi apresentada publicamente durante o congresso anual da Associacao Brasileira de Psiquiatria, com comentarios e sugestoes dos participantes, para a redacao da versao final.

Multilevel analysis of ADHD, anxiety and depression symptoms aggregation in families

A strong genetic role in the etiology of attention-deficit hyperactivity disorder (ADHD) has been demonstrated by several studies using different methodologies. Shortcomings of genetic studies often include the lack of golden standard practices for diagnosis for ADHD, the use of categorical instead of a dimensional approach, and the disregard for assortative mating phenomenon in parents. The current study aimed to overcome these shortcomings and analyze data through a novel statistical approach, using multilevel analyses with Bayesian procedures and a specific mathematical model, which takes into account data with an elevated number of zero responses (expected in samples with few or no ADHD symptoms). Correlations of parental clinical variables (ADHD, anxiety and depression) to offspring psychopathology may vary according to gender and type of symptoms. We aimed to investigate how those variables interact within each other. One hundred families, comprising a proband child or adolescent with ADHD or a typically developing child or adolescent were included and all family members (both biological parents, the proband child or adolescent and their sibling) were examined through semi-structured interviews using DSM-IV criteria. Results indicated that: (a) maternal clinical variables (ADHD, anxiety and depression) were more correlated with offspring variables than paternal ones; (b) maternal inattention (but not hyperactivity) was correlated with both inattention and hyperactivity in the offspring; (c) maternal anxiety was correlated with offspring inattention; on the other hand, maternal inattention was correlated with anxiety in the offspring. Although a family study design limits the possibility of revealing causality and cannot disentangle genetic and environmental factors, our findings suggest that ADHD, anxiety and depression are variables that correlate in families and should be addressed together. Maternal variables significantly correlated with offspring variables, but the paternal variables did not.

Eficácia da bupropiona no tratamento do TDAH: uma revisão sistemática e análise crítica de evidências

OBJETIVOS: Revisar de modo sistematico o uso da bupropiona no tratamento do Transtorno do Deficit de Atencao (TDAH). FONTES DE DADOS: Revisao de literatura de 1990 a 2003 atraves de pesquisa no Medline e Lilacs. RESULTADOS: Foram obtidos quatro estudos com criancas e adolescentes, sendo um deles com amostra apresentando comorbidade com depressao. Foram obtidos cinco estudos com adultos, sendo um com amostra apresentando comorbidade com abuso de substância, um com depressao e um com transtorno bipolar. CONCLUSOES: As limitacoes metodologicas de todos os estudos atualmente disponiveis na literatura nao permitem avaliar o grau de eficacia da bupropiona em comparacao aos medicamentos de primeira linha (estimulantes), apesar da diferenca significativa em relacao ao placebo. Ha, entretanto, indicacoes de um tamanho de efeito inferior aquele observado com estes ultimos. Os estudos apontam para um perfil satisfatorio de eventos adversos.

Validação semântica da versão em língua portuguesa do Questionário de Qualidade de Vida em Adultos (AAQoL) que apresentam transtorno de déficit de atenção/hiperatividade (TDAH)

INTRODUCAO: O transtorno de deficit de atencao/hiperatividade (TDAH) em adultos esta associado as piores medicoes de qualidade de vida, tanto em amostras clinicas como em epidemiologicas, e sua avaliacao e importante para entender a extensao do transtorno nas diferentes areas da vida dos pacientes. Nao ha nenhuma ferramenta em portugues para avaliar a qualidade de vida em adultos que apresentam TDAH. OBJETIVOS: Desenvolver uma versao em lingua portuguesa do Adult ADHD Quality of Life Questionnaire (AAQoL) para ser utilizado no Brasil. METODOS: Cinco etapas consecutivas que incluem traducao, versao para a lingua de origem, avaliacao da equivalencia semântica, discussao com os pacientes e controles e definicao da versao final. RESULTADOS: Apos todas as etapas, a versao final foi escolhida levando em conta varios aspectos, inclusive semelhanca com a versao original, facilidade de compreensao e nivel de equivalencia semântica de 29 termos. CONCLUSAO: A versao em lingua portuguesa do AAQoL fornecera medicoes de qualidade de vida similar a versao original.

Brazilian consensus of specialists on the diagnosis of attention-deficit/hyperactivity disorder in adults

Present difficulties in the diagnosis of attention-deficit/hyperactivity disorder in adults have prompted Brazilian specialists involved in research in this area to make a consensus to be used in the country. A non-systematic preliminary review was repeatedly evaluated by all authors, who added new material, commented and corrected parts of the text for 6 months through electronic mail and a further meeting sponsored by the Brazilian Association of Attention-Deficit Disorder. The preliminary version was publicly presented during the annual congress of the Associacao Brasileira de Psiquiatria (Brazilian Association for Psychiatry) for appraisal and suggestions from participants in order to prepare the final version.Considerando-se as dificuldades atuais do diagnostico do transtorno do deficit de atencao/hiperatividade em adultos, foram reunidos especialistas brasileiros que fazem pesquisas nesta area, de modo a produzir diretrizes de consenso para uso no pais. Foi realizada uma revisao nao-sistematica preliminar e concebido um texto inicial, que foi repetidamente avaliado e editado pelos autores, com acrescimos e correcoes ao longo de 6 meses, atraves de correio eletronico e de uma reuniao posterior, patrocinada pela Associacao Brasileira do Deficit de Atencao. A versao preliminar foi apresentada publicamente durante o congresso anual da Associacao Brasileira de Psiquiatria, com comentarios e sugestoes dos participantes, para a redacao da versao final.

Validade de constructo e confiabilidade da versão em língua portuguesa do Questionário de Qualidade de Vida em Adultos que apresentam TDAH (AAQoL)

INTRODUCAO: Diversos estudos demonstram que o transtorno de deficit de atencao/hiperatividade (TDAH) em adultos esta relacionado a piores medicoes de qualidade de vida. OBJETIVO: Avaliar a validade e confiabilidade de constructo da versao em lingua portuguesa do questionario de qualidade de vida em adultos com TDAH (AAQoL). METODOS:Foram incluidos neste estudo adultos com idade entre 18 e 60 anos. Eles foram divididos em tres grupos de acordo com o diagnostico: a) individuos com TDAH com base nos criterios do DSM-IV; b) individuos abaixo do limite de TDAH; c) grupo controle de comparacao que nao apresenta TDAH. Foram aplicados os seguintes questionarios: ASRS, SF-36 e AAQoL. A primeira parte do estudo avaliou a validacao de constructo do instrumento e a segunda parte testou sua confiabilidade. RESULTADOS: Os grupos TDAH, TDAH abaixo do limite e controle abrangeram 29, 18 e 29 individuos, respectivamente. Considerando todos os tres grupos, encontramos uma correlacao negativa entre o numero de sintomas (ASRS) e a pontuacao total do AAQoL. O grupo TDAH apresentou os piores niveis de qualidade de vida quando comparado com o grupo controle. No geral, as pontuacoes do AAQoL tiveram correlacao significativa com as da SF-36. Os resultados indicaram altos niveis de coerencia interna e confiabilidade dos testes e retestes. CONCLUSAO: O constructo do AAQoL apresentou altos niveis de coerencia interna dos itens, estabilidade e validade de constructo.

Usefulness of serotoninergic challenge with oral citalopram

OBJECTIVE Challenge tests designed to evaluate serotoninergic pathways have widely used intravenous citalopram. Oral citalopram has also been used, but unsatisfactory results were obtained with a dose of 20 mg. The objective of this study was to determine whether a higher oral dose would reproduce similar to those described for intravenous administration. To that end, we evaluated cortisol, growth hormone and prolactin levels. METHOD Eight healthy male volunteers were evaluated in a randomized crossover challenge test with 40 mg of oral citalopram or placebo. RESULTS Cortisol levels increased at 2-4h after the oral citalopram intake, with a small amplitude peak occurring in two-thirds of the subjects. Levels of prolactin and growth hormone remained unchanged throughout the study. CONCLUSION The use of oral citalopram might present an alternative in serotoninergic challenge tests, but higher doses are required.