Mariana Eizirik

Is the α-2A adrenergic receptor gene (ADRA2A) associated with attention-deficit/hyperactivity disorder?

Attention‐Deficit/Hyperactivity Disorder (ADHD) is a complex childhood‐onset psychiatric disorder characterized by marked symptoms of inattention, hyperactivity, and impulsivity. The role of genetic factors in its etiology is strongly supported by family, adoption, and twin studies. Although most of the molecular studies have investigated the dopamine D4 receptor gene (DRD4) and the dopamine transporter gene (DAT1) genes in its etiology, pharmacological and brain imaging evidences seem to indicate that genes of the adrenergic system could also be attractive for association studies. We investigated a sample of 96 Brazilian ADHD children and adolescents and their parents for the ADRA2A MspI polymorphism. Although no association with either MspI allele was observed through the haplotype relative risk (HRR) analysis, effects of the ADRA2A gene on inattention and combined (inattention + hyperactivity/impulsivity) symptom scores were detected (U = 222.5, z = 2.19, P = 0.03; and U = 208.5, z = 2.32, P = 0.02, respectively). Our results suggest that the ADRA2A gene might have a small effect on ADHD susceptibility or that this gene might modulate the severity of the disorder. They are also consistent with the noradrenergic theories of ADHD, suggesting a role for the α2A adrenergic receptors in the disorder.

Factor and Latent Class Analysis of DSM-IV ADHD Symptoms in a School Sample of Brazilian Adolescents

OBJECTIVE To evaluate the validity of the multidimensional construct proposed by DSM-IV for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in a school sample of young Brazilian adolescents. METHOD An instrument including all 18 DSM-IVADHD symptoms was administered to 1,013 students aged 12 to 14 years at 64 state schools by trained research assistants. Each symptom was rated on a Likert scale with five levels of severity (never, almost never, sometimes, frequently, and always). RESULTS Using an exploratory factor analytic approach (principal components analysis), two factors were extracted. Factor I (hyperactivity-impulsivity) comprised eight DSM-IV hyperactive-impulsive symptoms with loadings > or =0.40. Factor II (inattention) included also eight DSM-IV symptoms of inattention. The two factors explained 34% of the total variance and had an interfactor correlation of 0.45. Latent class analysis demonstrated similar classes in males and females, but class structures were markedly different from previous analyses of parent report data. CONCLUSION The findings support the appropriateness of the multidimensional construct introduced by DSM-IV in the diagnosis of ADHD in a different culture but emphasize the possible impact of different reporters on the results of structural model-testing.

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

OBJECTIVE The 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). METHODS Four 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). RESULTS Kappa 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. CONCLUSION These 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.

School dropout and conduct disorder in brazilian elementary school students

Objectives: To evaluate the association between DSM-IV conduct disorder (CD) and school dropout in a sample of students from the third and fourth elementary grades at state schools in the capital of the southernmost state of Brazil. Methods: In this case-control study, students that dropped out of schools (n = 44) and a control group who continued attending schools (n = 44) were assessed for CD and other prevalent mental disorders, using the Schedule for Affective Disorders and Schizophrenia for School Age Children, Epidemiological Version (K-SADS-E). Results: The prevalence of DSM-IV CD was significantly higher in the school-dropout group than in control subjects (P < 0.001), both in the entire sample and in a subsample including only subjects under age 12 years (P = 0.001). Also, the odds ratio (OR) for school dropout was significantly higher in the presence of DSM-IV CD, even after controlling for potential confounding factors (age, estimated IQ, school repetition, family structure, and income) (P < 0.01). Conclusion: Our results extend to children and young adolescents previous findings from studies of older adolescents, suggesting an association between school dropout and CD.

Estimated mental retardation and school dropout in a sample of students from state public schools in Porto Alegre, Brazil

OBJECTIVES: To assess the association between estimated Mental Retardation (MR) and school dropout in a sample of students of the third and fourth grades at state schools in Porto Alegre, the capital of the southernmost state of Brazil. METHOD: In this case - control study, students that dropped out from schools (n=44) and a control group who continued attending schools (n=44) had their intelligence quotient (IQ) determined by the vocabulary and cubes subtests of the Wescheler Intelligence Scale ¾ third edition (WISC¾III). Students with IQ lower than 70 were considered as potential cases of MR. Other prevalent mental disorders in this age range were assessed in both groups using the Schedule for Affective Disorders and Schizophrenia for School¾ Age Children, Epidemiological Version (K-SADS-E). RESULTS: The prevalence of potential MR was significantly higher in the dropped out group than in the control group (p<0.001). Odds ratio for school dropout was significantly higher in the presence of MR even after controlling for potentially confounding factors (age, conduct disorder, grade repetition, family structure and income) (p<0.01). CONCLUSION: Children with IQ lower than 70 (potential MR) were at higher risk for school dropout. These children need to be identified at school and specific educational strategies should be implemented to assure their inclusion in the learning process.

Neuroimagem no transtorno de déficit de atenção/hiperatividade

Espera-se que os estudos de neuroimagem (NI) aprimorem oconhecimento do substrato neuroquimico do TDAH, em ter-mos de regioes anatomicas, metabolismo em regioes cerebraisespecificas, neurotransmissores e associacao com hetero-geneidade genetica. No presente contexto, os estudos em geralseguem tres linhas: cerebro em repouso, cerebro mediante testede desafio e efeito cerebral de psicoestimulante.Atividade cerebral ao longo do desenvolvimento infantilUma das questoes, ao se considerar a neuro-imagem (NI)funcional na infância, e quale o seu padrao normal ao longo dodesenvolvimento. Em funcao das limitacoes eticas, esses da-dos sao escassos e retrospectivos, obtidos a partir de criancascom indicacao clinica de exame de NI ou, eventualmente, decontroles nos estudos de caso-controle.Um estudo com PET analisou imagens cerebrais de 29 paci-entes com idades entre cinco dias e 15 anos, alguns dos quaismedicados. Observou que, a partir dos 24 meses, o fluxo au-menta gradativamente, passando a exceder o encontrado emadultos. A partir dos 9-10 anos, o fluxo diminui gradativamente,readquirindo o padrao adulto no final da segunda decada.

Ausência paterna e sua repercussão no desenvolvimento da criança e do adolescente: um relato de caso

Father absence during child and adolescent development is a complex theme, with several study possibilities. The authors of the present study review the literature on the theme. The influence of father absence on emotional, cognitive and behavioral development is discussed. In these situations, other participation, family environment and social and economic factors are taken into account. The authors present a clinical case in which father absence was an important aspect in the patients life. Psychotherapy allowed for the patients emotions and perceptions associated with father absence to appear.A ausencia paterna durante o desenvolvimento da crianca e do adolescente e um tema complexo, com grandes possibilidades para estudo. E feita uma revisao da literatura a respeito do tema. Discute-se a influencia da ausencia paterna no desenvolvimento emocional, cognitivo e comportamental da crianca e do adolescente. A participacao da mae nessas situacoes, do ambiente familiar como um todo e dos fatores sociais e economicos como mediadores das consequencias da ausencia do pai na vida da crianca sao levados em consideracao. Os autores apresentam o resumo de um caso clinico em que a ausencia do pai e um ponto importante da vida do paciente. Ao longo do atendimento psicoterapico, foram surgindo as percepcoes e emocoes do paciente associadas a ausencia do pai.La ausencia del padre durante el desarrollo del nino y del adolescente es un tema complejo, con muchas posibilidades de estudio. Los autores revisan la literatura sobre el tema, y discuten la influencia de la ausencia del padre en el desarrollo emocional, cognitivo y comportamental. Se toman en cuenta la participacion de la madre en estas situaciones, el ambiente familiar en su totalidad y los factores sociales y economicos como mediadores de las consecuencias de la ausencia del padre en la vida del nino. Los autores presentan el resumen de un caso clinico, en el que la ausencia del padre fue un importante hecho en la vida del paciente. A lo largo de la psicoterapia, aparecieron progresivamente las emociones y percepciones del paciente asociadas a la ausencia del padre.

Contratransferência e trauma psíquico

This article aims at reviewing important aspects of the relationship between countertransference and care of patients who were victims of psychic trauma. The treatment of traumatized patients is a potential source of psychic suffering to their therapists as well, due to the emotional burden involved and to the chances of evoking strong countertransferential reactions. A better understanding of this process could be a valuable contribution to treatment outcome, besides promoting mental health protection and prevention for therapists. Firstly, psychic trauma will be approached from its concept and definitions, including considerations on posttraumatic stress disorder and extending to countertransference reactions and their meaning in the context of traumatic situations. The impact of treating trauma victims will also be discussed through the relevance of vicarious traumatization, a phenomenon whose comprehension has been pointed out as crucial to provide better care to psychological trauma victims.

Trauma and countertransference: development and validity of the Assessment of Countertransference Scale (ACS)

OBJECTIVES The aim of the present study was to investigate the construct validity of the Assessment of Countertransference Scale (ACS) in the context of the trauma care, through the identification of the underlying latent constructs of the measured items and their homogeneity. METHODS ACS assesses 23 feelings of CT in three factors: closeness, rejection and indifference. ACS was applied to 50 residents in psychiatry after the first appointment with 131 victims of trauma consecutively selected during 4 years. ACS was analyzed by exploratory (EFA) and confirmatory (CFA) factor analysis, internal consistence and convergent-discriminant validity. RESULTS In spite of the fact that closeness items obtained the highest scores, the EFA showed that the factor rejection (24% of variance, α = 0.88) presented a more consistent intercorrelation of the items, followed by closeness (15% of variance, α = 0.82) and, a distinct factor, sadness (9% of variance, α = 0.72). Thus, a modified version was proposed. In the comparison between the original and the proposed version, CFA detected better goodness-of-fit indexes for the proposed version (GFI = 0.797, TLI = 0.867, CFI = 0.885 vs. GFI = 0.824, TLI = 0.904, CFI = 0.918). CONCLUSIONS ACS is a promising instrument for assessing CT feelings, making it valid to access during the care of trauma victims.

Father absence and its influence on child and adolescent development: a case report

Father absence during child and adolescent development is a complex theme, with several study possibilities. The authors of the present study review the literature on the theme. The influence of father absence on emotional, cognitive and behavioral development is discussed. In these situations, other participation, family environment and social and economic factors are taken into account. The authors present a clinical case in which father absence was an important aspect in the patients life. Psychotherapy allowed for the patients emotions and perceptions associated with father absence to appear.A ausencia paterna durante o desenvolvimento da crianca e do adolescente e um tema complexo, com grandes possibilidades para estudo. E feita uma revisao da literatura a respeito do tema. Discute-se a influencia da ausencia paterna no desenvolvimento emocional, cognitivo e comportamental da crianca e do adolescente. A participacao da mae nessas situacoes, do ambiente familiar como um todo e dos fatores sociais e economicos como mediadores das consequencias da ausencia do pai na vida da crianca sao levados em consideracao. Os autores apresentam o resumo de um caso clinico em que a ausencia do pai e um ponto importante da vida do paciente. Ao longo do atendimento psicoterapico, foram surgindo as percepcoes e emocoes do paciente associadas a ausencia do pai.La ausencia del padre durante el desarrollo del nino y del adolescente es un tema complejo, con muchas posibilidades de estudio. Los autores revisan la literatura sobre el tema, y discuten la influencia de la ausencia del padre en el desarrollo emocional, cognitivo y comportamental. Se toman en cuenta la participacion de la madre en estas situaciones, el ambiente familiar en su totalidad y los factores sociales y economicos como mediadores de las consecuencias de la ausencia del padre en la vida del nino. Los autores presentan el resumen de un caso clinico, en el que la ausencia del padre fue un importante hecho en la vida del paciente. A lo largo de la psicoterapia, aparecieron progresivamente las emociones y percepciones del paciente asociadas a la ausencia del padre.