Miguel Angel Santed Germán

Tratamiento del trastorno por déficit de atención

| Aten Primaria. 2007;39(12):671-4 | 671 Introducción El trastorno por déficit de atención e hiperactividad (TDAH) se conoce desde principios del siglo pasado aunque, inicialmente, centrado en la población infantil, ya que se pensaba que remitía con la edad. La prevalencia en niños en edad escolar es del 3-7% con predominio de varones (2-9:1)1. Las características clínicas de los niños y adolescentes que presentan TDAH, según el DSM-IV-TR1, son: síntomas de desatención y/o hiperactividad/impulsividad que han persistido durante 6 meses y son más frecuentes y graves que los que presentan los individuos de su edad (criterio A), que aparecen antes de los 7 años (criterio B) y se presentan en diferentes ámbitos, como en la casa y el colegio (o en el trabajo si son adultos) (criterio C), que causan alteraciones clínicamente significativas en su funcionamiento social, académico o laboral (criterio D), y no aparecen en el curso de otro trastorno generalizado del desarrollo, esquizofrenia u otro trastorno psicológico y no se explica mejor por otro trastorno mental (criterio E). Existen varios subtipos según predominen unas características u otras los últimos 6 meses. Así, puede predominar el déficit de atención (tipo con predominio de déficit de atención), la hiperactividad-impulsividad (tipo con predominio hiperactivo-impulsivo) o ambos (tipo combinado). Las primeras descripciones del TDAH en adultos no se realizaron hasta mediados de los años setenta del siglo XX. En adultos, esta enfermedad se entiende como un proceso crónico, y tiene que haber sido diagnosticado en el niño a la edad de 7 años. Desde esa edad hay una alteración clínica significativa o un deterioro en alguna área importante de su vida (familiar, laboral o social). En los adultos suelen predominar la inatención y la impulsividad, ya que la hiperactividad suele disminuir con la edad2. Además, el TDAH en adultos se asocia a diferentes trastornos psiquiátricos (el 60-70% de los casos). Los más frecuentes son: trastorno depresivo mayor (28%), trastorno antisocial

Revisiting the concept of severe mental illness: severity indicators and healthcare spending in psychotic, depressive and dissociative disorders

Background The concept of severe mental illness (SMI) has been related to bipolar or psychotic diagnosis, or to some cases of depressive disorders. Other mental health problems such as personality disorders or posttraumatic dissociative conditions, which can sometimes lead to relevant functional impairments, remain separate from the SMI construct. Aims This study aimed to evaluate the clinical severity as well as healthcare spending on dissociative disorders (DDs). This diagnostic group was compared with two other groups usually considered as causing severe impairment and high healthcare spending: bipolar and psychotic disorders, and unipolar depression. Methods From a random sample of 200 psychiatric outpatients, 108 with unipolar depression (N = 45), psychotic/bipolar (N = 31) or DDs (N = 32) were selected for this study. The three groups were compared by the severity of their disorder and healthcare indicators. Results Of the three groups, those with a DD were more prone to and showed higher indices of suicide, self-injury, emergency consultations, as well as psychotropic drug use. This group ranked just below psychotic/bipolar patients in the amount of psychiatric hospitalisations. Conclusions Despite a certain intra-professional stigma regarding DDs, these data supported the severity of these posttraumatic conditions, and their inclusion in the construct of SMI.Abstract Background: The concept of severe mental illness (SMI) has been related to bipolar or psychotic diagnosis, or to some cases of depressive disorders. Other mental health problems such as personality disorders or posttraumatic dissociative conditions, which can sometimes lead to relevant functional impairments, remain separate from the SMI construct. Aims: This study aimed to evaluate the clinical severity as well as healthcare spending on dissociative disorders (DDs). This diagnostic group was compared with two other groups usually considered as causing severe impairment and high healthcare spending: bipolar and psychotic disorders, and unipolar depression. Methods: From a random sample of 200 psychiatric outpatients, 108 with unipolar depression (N = 45), psychotic/bipolar (N = 31) or DDs (N = 32) were selected for this study. The three groups were compared by the severity of their disorder and healthcare indicators. Results: Of the three groups, those with a DD were more prone to and showed higher indices of suicide, self-injury, emergency consultations, as well as psychotropic drug use. This group ranked just below psychotic/bipolar patients in the amount of psychiatric hospitalisations. Conclusions: Despite a certain intra-professional stigma regarding DDs, these data supported the severity of these posttraumatic conditions, and their inclusion in the construct of SMI.

Eating disorders during the adolescence: personality characteristics associated with anorexia and bulimia nervosa

INTRODUCTION Previous studies provide relevant information about the relationship between personality and eating disorders (ED). The involvement of personality factors in the etiology and maintenance of ED indicates the need of emphasizing the study of the adolescents personality when diagnosed of ED. OBJECTIVES The aims of this study were to analyze the adolescents personality profiles that differ significantly in anorexia nervosa (AN) and bulimia nervosa (BN), and to explore the most common profiles and their associations with those subtypes of eating disorders (ED). METHODS A total of 104 patients with AN and BN were studied by means of the Millon Adolescent Clinical Inventory (MACI). RESULTS The personality profiles that differ significantly in both AN and BN were submissive, egotistic, unruly, forceful, conforming, oppositional, self-demeaning and borderline. The most frequent profiles in AN were conforming (33.33%), egotistic (22.72%) and dramatizing (18.18%) while in the case of BN those profiles were unruly (18.42%), submissive (18.42%) and borderline (15.78%). We did not find any associations between the diagnostic subgroup (AN, BN) and the fact of having personality profiles that could become dysfunctional. CONCLUSIONS Bearing in mind these results, it may be concluded that there are relevant differences between personality profiles associated with AN and BN during adolescence, so tailoring therapeutic interventions for this specific population would be important.