Eloisa Helena Rubello Valler Celeri

Pharmacogenetics of Risperidone and Cardiovascular Risk in Children and Adolescents

Objective. To identify the frequency of obesity and metabolic complications in child and adolescent users of risperidone. Potential associations with clinical parameters and SNPs of the HTR2C, DRD2, LEP, LEPR, MC4R, and CYP2D6 genes were analyzed. Methods. Samples from 120 risperidone users (8–20 years old) were collected and SNPs were analyzed, alongside assessment of chronological and bone ages, prescribed and weight-adjusted doses, use of other psychotropic drugs, waist circumference, BMI z-scores, blood pressure, HOMA-IR index, fasting levels of serum glucose, insulin, cholesterol, triglycerides, transaminases, and leptin. Results. Thirty-two (26.7%) patients were overweight and 5 (4.2%) obese. Hypertension was recorded in 8 patients (6.7%), metabolic syndrome in 6 (5%), and increased waist circumference in 20 (16.7%). The HOMA-IR was high for 22 patients (18.3%), while total cholesterol and triglycerides were high in 20 (16.7%) and 41 (34.2%) patients, respectively. SNP associations were found for LEP, HTR2C, and CYP2D6 with BMI; CYP2D6 with blood pressure, ALT, and HOMA-IR; HTR2C and LEPR with leptin levels; MC4R and DRD2 with HOMA-IR; HTR2C with WC; and LEP with ALT. Conclusions. Although not higher than in the general pediatric population, a high frequency of patients was overweight/obese, with abnormalities in metabolic parameters and some pharmacogenetic associations.

Cognitive and behavioral heterogeneity in genetic syndromes

OBJECTIVE this study aimed to investigate the cognitive and behavioral profiles, as well as the psychiatric symptoms and disorders in children with three different genetic syndromes with similar sociocultural and socioeconomic backgrounds. METHODS thirty-four children aged 6 to 16 years, with Williams-Beuren syndrome (n=10), Prader-Willi syndrome (n=11), and Fragile X syndrome (n=13) from the outpatient clinics of Child Psychiatry and Medical Genetics Department were cognitively assessed through the Wechsler Intelligence Scale for Children (WISC-III). Afterwards, a full-scale intelligence quotient (IQ), verbal IQ, performance IQ, standard subtest scores, as well as frequency of psychiatric symptoms and disorders were compared among the three syndromes. RESULTS significant differences were found among the syndromes concerning verbal IQ and verbal and performance subtests. Post-hoc analysis demonstrated that vocabulary and comprehension subtest scores were significantly higher in Williams-Beuren syndrome in comparison with Prader-Willi and Fragile X syndromes, and block design and object assembly scores were significantly higher in Prader-Willi syndrome compared with Williams-Beuren and Fragile X syndromes. Additionally, there were significant differences between the syndromes concerning behavioral features and psychiatric symptoms. The Prader-Willi syndrome group presented a higher frequency of hyperphagia and self-injurious behaviors. The Fragile X syndrome group showed a higher frequency of social interaction deficits; such difference nearly reached statistical significance. CONCLUSION the three genetic syndromes exhibited distinctive cognitive, behavioral, and psychiatric patterns.

Violência doméstica e risco para problemas de saúde mental em crianças e adolescentes

A literatura demonstra que sofrer violencia domestica na infância e juventude e um risco para o desenvolvimento das psicopatologias. Este estudo utilizou o Strenghts and Difficulties Questionnarie(SDQ) e encontrou prevalencia de 65,5% de possibilidades de problemas de saude mental em criancas e adolescentes (4-16 anos), vitimas de violencia domestica, acompanhados em Servicos de Referencia, todos residentes em um municipio brasileiro. O resultado encontrado foi considerado elevado, se comparado a populacao geral. A violencia domestica foi observada como fator de risco para problemas de saude mental nas criancas e adolescentes estudados, agravada pelo uso preocupante de bebida alcoolica pelo responsavel, ou este estar fora do processo produtivo. Nao foram encontrados fatores de protecao efetivos, principalmente em relacao a rede de protecao. Esses resultados sinalizam a necessidade de implementacao de mecanismos que avaliem a efetividade de programas especificos nas areas de saude mental e violencia domestica.

Clozapine in Severe Conduct Disorder

METHOD An open, naturalistic observational study design was used, in which a sample of seven boys between 10 and 14 years of age was assessed over 26 weeks. RESULTS The subjects were all diagnosed with conduct disorder (CD) and exhibited high levels of aggression that were refractory to psychosocial approaches (parent counseling, school counseling, and psychotherapy) and to more than three pharmacological treatments. Levels of aggression, side effects, and hematological parameters were evaluated weekly. Clinical response was evaluated using the standardized instruments Clinical Global Impressions (CGI) and Child Behavior Check List (CBCL) 6-18 before starting medication and after 26 weeks. CONCLUSION We observed good tolerability of clozapine in doses from 100 to 600 mg/day with no significant side effects or hematological changes. The CGI and CBCL 6-18 scales indicated that clozapine led to a marked control of symptoms.

Corrigendum to “Pharmacogenetics of Risperidone and Cardiovascular Risk in Children and Adolescents”

[This corrects the article DOI: 10.1155/2016/5872423.].

Evidence of Validity of the Autism Mental Status Examination (AMSE) in a Brazilian Sample

This study investigated the psychometric properties of the Autism Mental Status Examination (AMSE) in a Brazilian sample of children and adolescents with autism spectrum disorder (ASD). A sample of 260 children and adolescents, comprising 56 (21.5%) females and 204 (78.5%) males, was assessed. The participants were submitted to both the childhood autism rating scale (CARS-BR) and the AMSE. The CARS-BR was used to estimate ASD severity and the cutoff point on the AMSE. Spearman’s correlation test was employed to determine the correlation between the AMSE and CARS-BR scales. The cutoff values were calculated using the ROC (receiver operating characteristic) curve, identifying the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The homogeneity of the items of the AMSE was determined using Cronbach´s alpha. The AMSE exhibited good internal consistency (0.74), sensitivity (0.91) and specificity (0.98); and high correlation with the CARS-BR (ρ = 0.91, p < 0.01). Preliminary results showed that the AMSE is a tool with good psychometric properties for ASD screening.

The analyst's desire in the clinic of anorexia

El presente trabajo trata de la cuestion del deseo del analista en el tratamiento psicoanalitico de la anorexia. Con ese objetivo, analizamos elementos importantes para el establecimiento de la situacion psicoanalitica con estos pacientes - tales como la busqueda por la muerte y la eleccion de la recusa a alimentarse como una forma de control de la demanda del Otro - para asi poder discutir la funcion del deseo del analista en esa clinica. Recusando una categorizacion estructural de la anorexia y tambien la definicion de un modelo de tratamiento, encontramos en los casos de la joven de Agouleme de Charcot y de Sidonie, paciente de M. Mannoni, salidas subjetivas posibles para ese embarazo psicopatologico, alcanzados a traves de la funcion del deseo del analista.

El deseo del psicoanalista en el tratamiento psicoanalítico de la anorexia

El presente trabajo trata de la cuestion del deseo del analista en el tratamiento psicoanalitico de la anorexia. Con ese objetivo, analizamos elementos importantes para el establecimiento de la situacion psicoanalitica con estos pacientes - tales como la busqueda por la muerte y la eleccion de la recusa a alimentarse como una forma de control de la demanda del Otro - para asi poder discutir la funcion del deseo del analista en esa clinica. Recusando una categorizacion estructural de la anorexia y tambien la definicion de un modelo de tratamiento, encontramos en los casos de la joven de Agouleme de Charcot y de Sidonie, paciente de M. Mannoni, salidas subjetivas posibles para ese embarazo psicopatologico, alcanzados a traves de la funcion del deseo del analista.

O desejo do analista na clínica da anorexia

El presente trabajo trata de la cuestion del deseo del analista en el tratamiento psicoanalitico de la anorexia. Con ese objetivo, analizamos elementos importantes para el establecimiento de la situacion psicoanalitica con estos pacientes - tales como la busqueda por la muerte y la eleccion de la recusa a alimentarse como una forma de control de la demanda del Otro - para asi poder discutir la funcion del deseo del analista en esa clinica. Recusando una categorizacion estructural de la anorexia y tambien la definicion de un modelo de tratamiento, encontramos en los casos de la joven de Agouleme de Charcot y de Sidonie, paciente de M. Mannoni, salidas subjetivas posibles para ese embarazo psicopatologico, alcanzados a traves de la funcion del deseo del analista.

P01-245 - Besides a waiting room: playroom as a diagnostic and therapeutic resource before psychiatric consultation

Objectives To evaluate the diagnostic and therapeutic applications of playrooms implemented in care services of childrens health, while waiting for a consultation appointment. Methods A playroom was developed in a child psychiatry outpatient service in a University Hospital, where spontaneous approaches, without educational or psycho-specific directing, were conducted by members of a multidisciplinary team of this service. The children had their attitudes and behaviors observed by these professionals during the playful waiting time in the playroom. Therefore, all observations have been used in subsequent discussions with the professional directly responsible for the childs care, in order to enrich and supplement the cases supervision. Results In spite of the spread of the playrooms, there are few studies about them, their objectives and key aspects for their creation and maintenance. It not only adds new elements to those given by family, teachers and patients, but also allows a free observation of the latent unspoken aspects that emerge during play and complement or even change the caregiver first impressions. Conclusion The experience of a playroom implemented in a child psychiatry outpatient service in a University Hospital agrees with the studies that indicate that through playful-creative activities children can make discoveries their own way, develop relationships and elaborate affective aspects of their psychic space. Rescue strategies in spontaneous play are essential elements for the childrens integral development, creativity, learning and socialization. Above all, playrooms also have a therapeutic and diagnostic role in childrens care.