Guilherme Polanczyk

Adverse Childhood Experiences and Adult Risk Factors for Age-Related Disease Depression, Inflammation, and Clustering of Metabolic Risk Markers

OBJECTIVEnTo understand why children exposed to adverse psychosocial experiences are at elevated risk for age-related disease, such as cardiovascular disease, by testing whether adverse childhood experiences predict enduring abnormalities in stress-sensitive biological systems, namely, the nervous, immune, and endocrine/metabolic systems.nnnDESIGNnA 32-year prospective longitudinal study of a representative birth cohort.nnnSETTINGnNew Zealand.nnnPARTICIPANTSnA total of 1037 members of the Dunedin Multidisciplinary Health and Development Study. Main Exposures During their first decade of life, study members were assessed for exposure to 3 adverse psychosocial experiences: socioeconomic disadvantage, maltreatment, and social isolation.nnnMAIN OUTCOME MEASURESnAt age 32 years, study members were assessed for the presence of 3 age-related-disease risks: major depression, high inflammation levels (high-sensitivity C-reactive protein level >3 mg/L), and the clustering of metabolic risk biomarkers (overweight, high blood pressure, high total cholesterol, low high-density lipoprotein cholesterol, high glycated hemoglobin, and low maximum oxygen consumption levels.nnnRESULTSnChildren exposed to adverse psychosocial experiences were at elevated risk of depression, high inflammation levels, and clustering of metabolic risk markers. Children who had experienced socioeconomic disadvantage (incidence rate ratio, 1.89; 95% confidence interval, 1.36-2.62), maltreatment (1.81; 1.38-2.38), or social isolation (1.87; 1.38-2.51) had elevated age-related-disease risks in adulthood. The effects of adverse childhood experiences on age-related-disease risks in adulthood were nonredundant, cumulative, and independent of the influence of established developmental and concurrent risk factors.nnnCONCLUSIONSnChildren exposed to adverse psychosocial experiences have enduring emotional, immune, and metabolic abnormalities that contribute to explaining their elevated risk for age-related disease. The promotion of healthy psychosocial experiences for children is a necessary and potentially cost-effective target for the prevention of age-related disease.

How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment

BACKGROUNDnMost information about the lifetime prevalence of mental disorders comes from retrospective surveys, but how much these surveys have undercounted due to recall failure is unknown. We compared results from a prospective study with those from retrospective studies.nnnMETHODnThe representative 1972-1973 Dunedin New Zealand birth cohort (n=1037) was followed to age 32 years with 96% retention, and compared to the national New Zealand Mental Health Survey (NZMHS) and two US National Comorbidity Surveys (NCS and NCS-R). Measures were research diagnoses of anxiety, depression, alcohol dependence and cannabis dependence from ages 18 to 32 years.nnnRESULTSnThe prevalence of lifetime disorder to age 32 was approximately doubled in prospective as compared to retrospective data for all four disorder types. Moreover, across disorders, prospective measurement yielded a mean past-year-to-lifetime ratio of 38% whereas retrospective measurement yielded higher mean past-year-to-lifetime ratios of 57% (NZMHS, NCS-R) and 65% (NCS).nnnCONCLUSIONSnProspective longitudinal studies complement retrospective surveys by providing unique information about lifetime prevalence. The experience of at least one episode of DSM-defined disorder during a lifetime may be far more common in the population than previously thought. Research should ask what this means for etiological theory, construct validity of the DSM approach, public perception of stigma, estimates of the burden of disease and public health policy.

ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis

BACKGROUNDnPrevious studies have identified significant variability in attention-deficit / hyperactivity disorder (ADHD) prevalence estimates worldwide, largely explained by methodological procedures. However, increasing rates of ADHD diagnosis and treatment throughout the past few decades have fuelled concerns about whether the true prevalence of the disorder has increased over time.nnnMETHODSnWe updated the two most comprehensive systematic reviews on ADHD prevalence available in the literature. Meta-regression analyses were conducted to test the effect of year of study in the context of both methodological variables that determined variability in ADHD prevalence (diagnostic criteria, impairment criterion and source of information), and the geographical location of studies.nnnRESULTSnWe identified 154 original studies and included 135 in the multivariate analysis. Methodological procedures investigated were significantly associated with heterogeneity of studies. Geographical location and year of study were not associated with variability in ADHD prevalence estimates.nnnCONCLUSIONSnConfirming previous findings, variability in ADHD prevalence estimates is mostly explained by methodological characteristics of the studies. In the past three decades, there has been no evidence to suggest an increase in the number of children in the community who meet criteria for ADHD when standardized diagnostic procedures are followed.

Attention-Deficit/Hyperactivity Disorder in a Diverse Culture: Do Research and Clinical Findings Support the Notion of a Cultural Construct for the Disorder?

There is still some debate in the literature whether Attention-Deficit Disorder/Hyperactivity (ADHD) is best conceptualized as a biological disorder or if it is best understood as a cultural construct. This review aims to contribute to disentangle this issue assessing clinical and research data on ADHD in a complete diverse culture from a developing country. We performed a systematic computerized review of the literature on ADHD in Brazil. All investigations were included if dealing with ADHD prevalence, etiology, symptomatological construct, or treatment. Findings were compared to those from studies in developed countries. The prevalence rates of ADHD (5.8% using DSM-IV criteria, 1.5% using ICD-10), the bi-dimensional factor construct extracted from factor analyses (inattention and hyperactivity/impulsivity), the pattern of ADHD comorbidity in clinical samples, the family genetic data suggesting a 39% family transmission in clinical samples and the role of some potential candidate genes in dopaminergic and noradrenergic systems, as well as data on the efficacy of methylphenidate in the disorder are all very similar to findings from developed countries. Taken together, these findings suggest that ADHD is not a cultural construct, reinforcing the importance of applying similar research methodology in different cultures to make findings comparable.

Transtorno de déficit de atenção/hiperatividade

Introducao As primeiras referencias aos transtornos hipercineticos na literatura medica apareceram no meio do seculo XIX. Entretanto, sua nomenclatura vem sofrendo alteracoes continuas. Na decada de 40, surgiu a designacao “lesao cerebral minima”, que, ja em 1962, foi modificada para “disfuncao cerebral minima”, reconhecendo-se que as alteracoes caracteristicas da sindrome relacionam-se mais a disfuncoes em vias nervosas do que propriamente a lesoes nas mesmas. Os sistemas classificatorios modernos utilizados em psiquiatria, CID-10 e DSM-IV, apresentam mais similaridades do que diferencas nas diretrizes diagnosticas para o transtorno, embora utilizem nomenclaturas diferentes (transtorno de deficit de atencao/hiperatividade no DSMIV e transtornos hipercineticos na CID-10). Os estudos nacionais e internacionais situam a prevalencia do transtorno de deficit de atencao/hiperatividade (TDAH) entre 3% e 6%, sendo realizados com criancas em idade escolar na sua maioria. O impacto desse transtorno na sociedade e enorme, considerando-se seu alto custo financeiro, o estresse nas familias, o prejuizo nas atividades academicas e vocacionais, bem como efeitos negativos na auto-estima das criancas e adolescentes. Estudos tem demonstrado que criancas com essa sindrome apresentam um risco aumentado de desenvolverem outras doencas psiquiatricas na infância, adolescencia e idade adulta. A presente atualizacao busca uma revisao critica dos elementos essenciais referentes ao diagnostico e as abordagens terapeuticas do TDAH. Uma revisao mais completa (porem menos atualizada) incluindo dados epidemiologicos, etiologicos, relacionados ao substrato neurobiologico e de evolucao do transtorno podem ser encontrados em Rohde et al. (1998). No presente artigo, o termo crianca sera utilizado englobando a faixa etaria da infância e adolescencia, a menos que seja indicado o contrario.

Violência sexual e sua prevalência em adolescentes de Porto Alegre, Brasil

OBJETIVO: Verificar a prevalencia da exposicao a violencia sexual entre adolescentes estudantes de escolas estaduais. METODOS: Foram selecionadas 52 escolas estaduais de Porto Alegre, RS, Brasil, com ensino fundamental completo, por meio de um processo de amostragem aleatoria, estratificada de acordo com o tamanho das escolas. Foi selecionada, em cada escola, uma turma de oitava serie por sorteio aleatorio e foram incluidos todos os adolescentes presentes nas salas de aula que consentiram em participar do estudo. Foi utilizado o instrumento Triagem da Exposicao de Criancas a Violencia na Comunidade para identificar jovens que foram vitimas, testemunhas ou que conheciam vitimas de atos de violencia sexual. RESULTADOS: Foram incluidos 1.193 adolescentes, representando 10,3% dos alunos matriculados na oitava serie da rede estadual da cidade. Vinte e sete (2,3%) adolescentes relataram ter sido vitimas de violencia sexual, 54 (4,5%) ter sido testemunhas de algum tipo de violencia sexual e 332 (27,9%) relataram conhecer alguem que tenha sido vitima de violencia sexual. CONCLUSOES: A exposicao a violencia sexual pelas tres formas de contato relatadas mostrou-se frequente entre os adolescentes estudados. Sao necessarios estudos que abordem a violencia sexual como um fenomeno social amplo, com multiplos fatores associados, amparando estrategias comunitarias de prevencao e de tratamento.

No significant association between response to methylphenidate and genes of the dopaminergic and serotonergic systems in a sample of Brazilian children with attention‐deficit/hyperactivity disorder

Few studies on pharmacogenetics of Attention‐Deficit/Hyperactivity Disorder (ADHD) have been conducted. Most of them evaluated dopaminergic genes resulting in positive and negative findings. We assessed effects of polymorphisms in candidate dopaminergic (DRD4, DAT1) and serotonergic genes (HTR1B, HTR2A, and 5‐HTT) on the response to treatment in 111 patients for whom methylphenidate (MPH) was prescribed. Outcome measures (Swanson, Nolan, and Pelham scale—version IV, Children Global Assessment Scale, Barkleys Stimulants Side Effects Rating Scale) were assessed at baseline and 1 month after the intervention. No significant association was detected between polymorphisms assessed and both response and side effects to MPH. Prospective multi‐site controlled studies with larger sample sizes are needed in order to disentangle the role of candidate genes in response to ADHD treatment.

A common haplotype at the dopamine transporter gene 5′ region is associated with attention‐deficit/hyperactivity disorder

The dopamine transporter (DAT) is the major site of methylphenidate action, which is one of the main drugs used to treat attention‐deficit/hyperactivity disorder (ADHD). Most association studies with ADHD focused in a VNTR at the 3′‐untranslated region of the gene (3′UTR) presenting conflicting results. However, the most common explanation to inconsistent results is variable linkage disequilibrium with an adjacent functional variant, just a few number of DAT1 studies have reported LD structure across the gene. In this study, we screened 16 polymorphisms across the DAT1 gene to understand LD structure in a Brazilian sample of families with ADHD probands and to verify if there were evidence for a biased transmission of alleles and haplotypes from parents to their 243 children with ADHD. In the DSM‐IV combined subtype, we observed a preferential transmission of the haplotype A/C/C/C/A derived from five SNPs (rs2550948, rs11564750, rs261759, rs2652511, rs2975223) in 5′ region (P correctedu2009=u20090.018) and no association with any allele/haplotype at the 3′ region of the gene, including the 3′ VNTR and the VNTR of intron 8. These results suggest a role for the promoter region in ADHD susceptibility and that allele heterogeneity should be highly considered in DAT1 gene association studies highlighting the importance of this gene in the genetics of the disorder.

Further evidence of the involvement of alpha-2A-adrenergic receptor gene (ADRA2A) in inattentive dimensional scores of attention-deficit/hyperactivity disorder

Further evidence of the involvement of alpha-2A-adrenergic receptor gene (ADRA2A) in inattentive dimensional scores of attention-deficit/hyperactivity disorder

Interrater agreement for the schedule for affective disorders and schizophrenia epidemiological version for school-age children (K-SADS-E)

OBJECTIVEnThe main objective of this study was to assess the interrater agreement for the Schedule for Affective Disorders and Schizophrenia Epidemiological version for School-Age Children (K-SADS-E).nnnMETHODSnFour interviewers being trained with the K-SADS-E scored independently 29 videotaped interviews performed with psychiatric outpatients in the ADHD Outpatient Clinic at Hospital de Clínicas de Porto Alegre. Interrater agreement analysis was performed using the kappa coefficient (k).nnnRESULTSnKappa coefficients were.93 (p<.001) for affective disorders,.9 (p<.001) for anxiety disorders,.94 (p<.001) for attention-deficit/hyperactivity disorders and disruptive behavior disorders.nnnCONCLUSIONnThese findings suggest an excellent interrater agreement for the diagnosis of several mental disorders in childhood and adolescence by the Brazilian Portuguese version of the K-SADS-E.