Flora de la Barra

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the biological treatment of paraphilias

Abstract Objectives. The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment and management of paraphilia, with a focus on the treatment of adults males. Because such treatments are not delivered in isolation, the role of specific psychosocial and psychotherapeutic interventions was also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients with paraphilia. The aim of these guidelines is to improve the quality of care and to aid physicians in clinical decisions. Methods. The aim of these guidelines was to bring together different views on the appropriate treatment of paraphilias from experts representing different continents. To achieve this aim, an extensive literature search was conducted using the English language literature indexed on MEDLINE/PubMed (1990–2009 for SSRIs) (1969–2009 for antiandrogen treatments), supplemented by other sources, including published reviews. Results. Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability and feasibility. Conclusions. An algorithm was proposed with six levels of treatment for different categories of paraphilias.

Prevalence of child and adolescent mental disorders in Chile: a community epidemiological study

BACKGROUND  In Latin America, there is limited research on the prevalence of mental disorders in children and adolescents. This Chilean survey is the first national representative survey in the Latin American region to examine the prevalence of diagnostic and statistical manual-IV (DSM-IV) psychiatric disorders in the region in children and adolescents. METHODS  Subjects aged 4-18 were selected using a stratified multistage design. The diagnostic interview schedule for children version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses of affective, anxiety, conduct and substance use disorders, and supplemented with questionnaires examining family risk factors, family income, and service utilization. The parent or the primary caretaker was interviewed for children, aged 4-11, using the DISC-IV; however, adolescents, aged 12-18, were directly interviewed. RESULTS A sample of 1558 children and adolescents was evaluated. Using the most stringent DISC-IV impairment algorithm, the prevalence rate for any psychiatric disorders was 22.5% (19.3% for boys and 25.8% for girls). The prevalence rate was higher among the children, aged 4-11, in comparison with adolescents, aged 12-18 (27.8% and 16.5%, respectively). Less than half of the subjects in need of services sought some form of assistance. Nearly a quarter of those using services did not present with a psychiatric diagnosis in the past year. Comorbidity was found in 24.8% of those with a disorder, but only 6.3% had three or more diagnoses. CONCLUSIONS The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to reevaluate mental health services provided to children and adolescents in Latin America.

Prevalence of child and adolescent psychiatric disorders in Santiago, Chile: A community epidemiological study

PurposeTo determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in Santiago, Chile, as part of a national sample.MethodSubjects aged 4–18 were selected using a stratified multistage design. First, ten municipalities/comunas of Santiago were selected; then the blocks, homes, and child or adolescent to be interviewed were chosen. Psychology graduate students administered the Spanish-language, computer-assisted version of DISC-IV that estimated DSM-IV 12-month prevalence.ResultsA total of 792 children and adolescents were evaluated, with a participation rate of 76.7%. The most stringent impairment DSM-IV DISC algorithm for psychiatric disorders revealed a prevalence of 25.4% (20.7% for boys and 30.3% for girls). The majority of the diagnoses corresponded to anxiety and affective disorders. Prevalence was higher in children aged 4–11 (31.9%) than in adolescents aged 12–18 (18.2%). This difference was mainly accounted for by disruptive disorders in the younger age group. Anxiety disorders had the highest prevalence, although impairment was low. In contrast, most children and adolescents with affective disorders were impaired.ConclusionsIn Santiago, the prevalence of psychiatric disorders in children and adolescents was high. This study helps raise awareness of child and adolescent mental health issues in Spanish-speaking Latin America and serves as a basis for improving mental health services.

The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescent sexual offenders with paraphilic disorders

Abstract The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment of adolescents with paraphilic disorders who are also sexual offenders or at-risk of sexual offending. Psychotherapeutic and psychosocial treatments were also reviewed. Adolescents with paraphilic disorders specifically present a different therapeutic challenge as compared to adults. In part, the challenge relates to adolescents being in various stages of puberty and development, which may limit the use of certain pharmacological agents due to their potential side effects. In addition, most of the published treatment programmes have used cognitive behavioural interventions, family therapies and psychoeducational interventions. Psychological treatment is predicated in adolescents on the notion that sexually deviant behaviour can be controlled by the offender, and that more adaptive behaviours can be learned. The main purposes of these guidelines are to improve the quality of care and to aid physicians in their clinical decisions. These guidelines brought together different expert views and involved an extensive literature research. Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for efficacy, safety, tolerability and feasibility. An algorithm is proposed for the treatment of paraphilic disorders in adolescent sexual offenders or those who are at risk.

Estudio de salud mental en dos cohortes de niños escolares de Santiago occidente. I: Prevalencia y seguimiento de problemas conductuales y cognitivos

Objetivos. Las necesidades insatisfechas de atencion en salud mental infantil hacen necesarios estudios epidemiologicos longitudinales que sirvan de base para realizar programas preventivos efectivos. El objetivo de este estudio fue obtener prevalencia de problemas conductuales en escolares desde 1o a 6o basico y estudiar la concordancia entre informantes. Metodo. Se evaluo una muestra de 1279 ninos de 1o basico y 535 ninos que permanecieron en las mismas escuelas sin repetir curso, mediante cuestionarios aplicados a sus profesores y padres en 1o y 6o basico, y se midio la autoestima reportada por los ninos en 6o basico. Resultados. La prevalencia de problemas conductuales, emocionales y/o cognitivos segun los profesores fue alrededor del 40%, mientras que los padres registraron cerca de un 10%. La baja autoestima segun los ninos fue de magnitud intermedia. La concordancia entre padres, profesores y ninos fue baja, pero produjo informacion complementaria para conocer el desarrollo y la salud mental de los ninos. La muestra de ninos seguidos tuvo menor prevalencia de problemas desde 1o basico comparada con los ninos que no estuvieron disponibles para reevaluacion. Los ninos con problemas conductuales tuvieron tasas mas altas de repitencia. Segun los profesores, los ninos hombres tuvieron mas desobediencia / agresion, defict cognitivo, hiperactividad y problemas de concentracion que las ninas. Las tasas de prevalencia se mantuvieron estables segun distintas profesoras entre 1o y 6o basico, mientras que los padres encontraron disminucion de problemas en 6o basico. Conclusiones. Se efectuo el primer estudio longitudinal de salud mental en escolares chilenos, mostrando alta magnitud y persistencia de problemas conductuales, emocionales y cognitivos entre 1o y 6o basico segun los profesores, mientras que los padres muestran prevalencia menor y una mejor evolucion. Se discuten las implicancias y el posible aporte al diseno y planificacion de programas preventivos de educacion y salud mental

Efectividad de una Estrategia Conductual Para el Manejo de la Agresividad en Escolares de Enseñanza Básica

Se presentan los resultados preliminares de la aplicacion de una estrategia de prevencion de conductas disruptivas y agresivas en cuatro cursos de primero basico de escuelas municipalizadas de una comuna de la Region Metropolitana. Se aplico el Programa del Juego del Buen Comportamiento (JBC) durante primero y segundo basico (grupo en estudio) y se lo comparo con un grupo no intervenido, de iguales caracteristicas (grupo control) de acuerdo al perfil de riesgo psicosocial (Indice de Vulnerabilidad Escolar, JUNAEB, 2000). Se describe y fundamenta el programa del Juego del Buen Comportamiento y se presenta la comparacion de los resultados del primer cohorte de seguimiento realizado a ambos grupos a fines del primero y segundo basico.

Estudio de salud mental en dos cohortes de niños escolares de Santiago Occidente. III: predictores tempranos de problemas conductuales y cognitivos

Introduccion. Se revisan estudios predictivos longitudinales referidos a salud mental de los ninos, enfatizando que son muy escasos en Latinoamerica. Objetivos. Estudiar la continuidad de problemas conductuales y cognitivos de una poblacion de ninos escolares y detectar predictores tempranos en 1o basico para los problemas observados en 6o basico. Sujetos y Metodo. Se utilizo un formato epidemiologico evolutivo para obtener las calificaciones de padres y profesores respecto a las conductas agresividad/desobediencia, timidez, deficits cognitivos/concentracion, inmadurez emocional e hiperactividad en los ninos de 1o basico. Los alumnos fueron reevaluados en 6o basico para determinar el curso evolutivo y predictores tempranos para las evoluciones conductuales adversas. En la segunda evaluacion se midio tambien autoestima. Se evaluaron 1279 ninos en 1o basico; 535 estudiantes que permanecieron en las mismas escuelas sin repetir curso fueron reevaluados en 6o basico. Resultados. Mediante regresiones logisticas se demostro estabilidad y continuidad de los problemas senalados por padres y profesores. Varias conductas desadaptativas tempranas predijeron problemas posteriores. La desobediencia /agresion, hiperactividad y opinion de mala conducta registradas por el profesor aumentaron el riesgo para multiples problemas posteriores. Conclusiones. La deteccion de problemas conductuales y cognitivos en 1o basico predijo problemas en 6o basico y entrego informacion importante para el desarrollo de intervenciones preventivas

Salud mental infanto-juvenil en Chile y brechas de atención sanitarias

Psychiatric disorders that appear during childhood or adolescence should be a public health priority. Aim: To report the results of a national representative survey in the Latin American region examinig the prevalence of DSM-IV psychiatric disorders in children and adolescents. Material and Methods: Subjects aged 4 to 18 years were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses, and was supplemented with questionnaires examining family riskfactors, socioeconomic status and service use. Results: A sample of1558 children and adolescents (51% males) was evaluated. Fifty three percent of the sample were children aged 4 to 11 years and the rest were adolescents aged 12 to 18 years. The prevalence rate for any psychiatric disorder without impairment was 38.3% (33.5% for boys and 43.3% for girls). The prevalence rate was higher among children as compared to adolescents (42.9% and 33.2%, respectively). A third of participants receiving a diagnosis sought some form of assistance. Nearly a quarter of those using services, did not have a psychiatric diagnosis in the past year. Comorbidity was found in 27% of those with a disorder, but only 7% had three or more diagnoses. Conclusions: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to re-evaluate mental health services provided to children and adolescents in our countryBACKGROUND Psychiatric disorders that appear during childhood or adolescence should be a public health priority. AIM To report the results of a national representative survey in the Latin American region examining the prevalence of DSM-IV psychiatric disorders in children and adolescents. MATERIAL AND METHODS Subjects aged 4 to 18 years were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses, and was supplemented with questionnaires examining family risk factors, socioeconomic status and service use. RESULTS A sample of 1558 children and adolescents (51% males) was evaluated. Fifty three percent of the sample were children aged 4 to 11 years and the rest were adolescents aged 12 to 18 years. The prevalence rate for any psychiatric disorder without impairment was 38.3% (33.5% for boys and 43.3% for girls). The prevalence rate was higher among children as compared to adolescents (42.9% and 33.2%, respectively). A third of participants receiving a diagnosis sought some form of assistance. Nearly a quarter of those using services, did not have a psychiatric diagnosis in the past year. Comorbidity was found in 27% of those with a disorder, but only 7% had three or more diagnoses. CONCLUSIONS The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to re-evaluate mental health services provided to children and adolescents in our country.

Estudio de salud mental en dos cohortes de niños escolares de Santiago occidente: II: Factores de riesgo familiares y escolares

Introduccion. El desarrollo patologico del nino puede conceptualizarse como una desadaptacion social frente a las tareas tempranas. Se han identificado factores protectores que pueden influir positivamente en el desarrollo y factores de riesgo para la aparicion de psicopatologia. Estan presentes en la familia, el nino mismo, en el colegio como institucion, los profesores, el grupo de pares, y la comunidad. Objetivos. Estudiar la estabilidad y los cambios de las opiniones de los profesores sobre rendimiento, conducta, necesidad de servicios especiales de los ninos y de algunas variables de la familia en una muestra de escolares seguidos entre 1 y 6 basicos. Metodologia. Se evaluaron 535 ninos, entrevistando a padres y profesores. Se calculo razon de disparidad e intervalos de confianza para determinar las diferencias entre los ninos con y sin problemas en ambos momentos del estudio. Resultados. Se observo aumento de la mayoria de los problemas percibidos por los profesores: ninos con mal rendimiento academico y mala conducta, necesidades insatisfechas de reforzamiento, curso diferencial, evaluacion por Trastorno de Aprendizaje, Trastorno conductual e Hiperactividad. La ausencia del padre en el hogar aumenta, mientras que la enfermedad mental familiar y enfermedad cronica del nino disminuyen en 6 basico. El factor protector participacion de la familia en la red social aumento en 6 basico. Conclusiones. Se observo persistencia de los problemas en el tiempo e insuficiente resolucion de las necesidades especiales. Se senala la importancia de incorporar programas de prevencion en las clases de 1 y 2 basicos, lo que permitiria mejorar la salud mental de los escolares y derivar en forma mas precisa a los servicios especializados.

Epidemiología de trastornos mentales infanto juveniles en la Provincia de Cautín

BACKGROUND The knowledge about prevalence of psychiatric disorders in all age groups is fundamental to plan an adequate mental health care. AIM To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in the province of Cautin, Chile. MATERIAL AND METHODS Subjects aged between 4 and 18 years were selected in an aleatory stratified multistage fashion. As part of a national sample, four counties in Cautín were selected, then blocks, homes and the child or adolescent to be interviewed. Psychology graduate students applied the Spanish computer version of DISC-IV, as well as a questionnaire on family risk factors, socioeconomic index and service use. RESULTS A sample of 272 children and adolescents was evaluated, obtaining 93,4% of participation. Using the most stringent impairment algorithm, the prevalence rate for any psychiatric disorder was 16.8%, being 16.5% in boys and 17.1% in girls and mainly explained by anxiety and affective disorders. Prevalence was practically the same in the group aged 4 to 11 years than in those aged 12 to 18 years (16.7% and 16.8% respectively). Prevalence of anxiety disorders was the highest, but less associated with impairment. On the other hand, all children and adolescents with affective disorders were impaired. CONCLUSIONS The prevalence of psychiatric disorders in Cautín is high in children and adolescents.