RESUMO

Objective: Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset BD. We sought to investigate the frequency of affective and psychotic symptoms observed during the first manic episode in adolescents. Methods: Forty-nine adolescents with bipolar I disorder (DSM-IV criteria) were admitted to a psychiatric hospital during their first acute manic episode. Assessment for current psychiatric diagnosis was performed by direct clinical interview and the DSM-IV version of the Diagnostic Interview for Children and Adolescents (DICA). Results: Teenage inpatients with BD consistently exhibited typical manic features, such as euphoria, grandiosity, and psychomotor agitation. In addition, disorganization and psychotic symptoms were present in 82 and 55% of the total sample, respectively. There was no significant difference in symptoms between early- and late-adolescent subgroups. Remarkably, most patients (76%) reported previous depressive episode(s); of these, 47% had prominent psychotic features in the prior depressive period. Conclusion: These findings suggest that disorganization and psychotic symptoms during the first manic episode are salient features in adolescent-onset BD, and that psychotic depression frequently may precede psychotic mania. Nevertheless, differential diagnosis with schizophrenia should be routinely ruled out in cases of early-onset first psychotic episode.

Assuntos

Humanos , Masculino , Feminino , Criança , Adolescente , Transtornos Psicóticos/diagnóstico , Transtorno Bipolar/psicologia , Sintomas Afetivos/diagnóstico , Transtornos Psicóticos/psicologia , Sintomas Afetivos/psicologia

RESUMO

OBJECTIVE: Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset BD. We sought to investigate the frequency of affective and psychotic symptoms observed during the first manic episode in adolescents. METHODS: Forty-nine adolescents with bipolar I disorder (DSM-IV criteria) were admitted to a psychiatric hospital during their first acute manic episode. Assessment for current psychiatric diagnosis was performed by direct clinical interview and the DSM-IV version of the Diagnostic Interview for Children and Adolescents (DICA). RESULTS: Teenage inpatients with BD consistently exhibited typical manic features, such as euphoria, grandiosity, and psychomotor agitation. In addition, disorganization and psychotic symptoms were present in 82 and 55% of the total sample, respectively. There was no significant difference in symptoms between early- and late-adolescent subgroups. Remarkably, most patients (76%) reported previous depressive episode(s); of these, 47% had prominent psychotic features in the prior depressive period. CONCLUSION: These findings suggest that disorganization and psychotic symptoms during the first manic episode are salient features in adolescent-onset BD, and that psychotic depression frequently may precede psychotic mania. Nevertheless, differential diagnosis with schizophrenia should be routinely ruled out in cases of early-onset first psychotic episode.

Assuntos

Sintomas Afetivos/diagnóstico , Transtorno Bipolar/psicologia , Transtornos Psicóticos/diagnóstico , Adolescente , Sintomas Afetivos/psicologia , Criança , Feminino , Humanos , Masculino , Transtornos Psicóticos/psicologia

RESUMO

INTRODUCTION: Depressive and manic episodes of bipolar disorder can interact with sleep complaints, followed by a worsened psychiatric condition. The aim of this study was to examine the interaction of sleep disorders with bipolar disorder in youths during depressive and manic episodes. METHODS: The target population was children and adolescents drawn from the Children and Adolescents Affective Disorder Program. Clinical assessment for current psychiatric diagnosis was done by direct clinical interview, Diagnostic Interview for Children and Adolescents (DSM-IV), and best-estimated clinical consensus. We applied sleep questionnaires from which we obtained sleep and daytime complaints during manic and depressive episodes. All statistical tests of significance were done using 2-tailed tests with α = 0.05. RESULTS: Participants in this study comprised 29 children (age = 10 ± 3 years, boys = 23) and 43 adolescents (age = 15 ± 2.4 years, boys = 30). Sleep complaints were observed in 66.4% of participants during manic episodes and 52.3% during depressive episodes. 37.9% of patients had sleep complaints in both episodes. Time in bed was longer during depressive episodes than manic episodes (p = 0.01). We found a high prevalence of nocturnal enuresis in depressive episodes in children and adolescents, which was statistically significant compared with manic episodes (p < 0.05). Unrested sleep was higher in adolescents in both episodes, and it was statistically significant during manic episodes (p < 0.05). CONCLUSION: According to our analyses, the minority of patients had sleep complaints in both episodes. Our data showed that nocturnal enuresis occurred more frequently during depressive than manic episodes. Further research is necessary to understand the implications of these data.

RESUMO

Abstract Introduction: Disorders of circadian rhythms have been reported in studies of both depressed children and of depressed adolescents. The aim of this study was to evaluate whether there is a relationship between the 24-hour spectral power (24h SP) of the activity/rest rhythm and the clinical course of depression in adolescents. Methods: Six 14 to 17-year-old adolescents were recruited for the study. They were all suffering from major depressive disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria, as identified by the Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version (K-SADS-PL). Depressive symptoms were assessed using the Children's Depression Rating Scale - Revised (CDRS-R) and clinical evaluations. Locomotor activity was monitored over a period of 13 consecutive weeks. Activity was measured for 10-minute periods using wrist-worn activity monitors. All patients were prescribed sertraline from after the first week up until the end of the study. Results: We found a relationship between high CDRS values and low 24-hour spectral power. Conclusions: The 24h SP of the activity/rest rhythm correlated significantly (negatively) with the clinical ratings of depression.

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Resumo Introdução: Distúrbios do ritmo circadiano têm sido relatados em estudos com crianças e adolescentes deprimidos. O objetivo deste estudo foi avaliar se existe relação entre a potência espectral de 24 horas do ritmo de atividade e repouso e sintomas clínicos de depressão em adolescentes. Métodos: Seis adolescentes com idade entre 14 e 17 anos foram recrutados para o estudo. Eles foram diagnosticados com depressão maior de acordo com os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 4ª edição (DSM-IV), identificados utilizando-se o instrumento Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version (K-SADS-PL). Os sintomas depressivos foram avaliados pelo questionário Children's Depression Rating Scale - Revised (CDRS-R) e por avaliações clínicas. A atividade motora foi monitorada por um período de 13 semanas consecutivas e registrada a cada 10 minutos utilizando-se monitores de atividades usados no pulso. Todos os pacientes utilizaram o antidepressivo sertralina começando após a primeira semana até o final do estudo. Resultados: Foi observada uma relação entre escores altos no CDRS-R e valores baixos de potência espectral de 24 horas no ritmo de atividade e repouso. Conclusão: A potência espectral de 24 horas do ritmo de atividade e repouso apresentou uma correlação significativa (negativa) com os sintomas clínicos de depressão.

Assuntos

Humanos , Masculino , Feminino , Adolescente , Ritmo Circadiano , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/terapia , Atividade Motora , Escalas de Graduação Psiquiátrica , Descanso , Actigrafia

RESUMO

OBJECTIVES: Few studies have examined pediatric mental health services for early-onset bipolar disorder (BD). The goal of this study was to describe diagnostic pathways and manic dimensions in BD among referred children and adolescents. METHODS: Data were obtained from a review of the charts of 814 subjects, 2 to 17 years of age, with a complaint of mood disturbances who were referred between 2003 and 2012 to a university-based child and adolescent clinic that specializes in mood disorders. After screening, eligible participants (N=494) were systematically assessed and followed to determine diagnoses on the basis of criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision in accordance with the best-estimate approach. Manic symptoms were subjected to principal component analysis to investigate the dimensional bipolar profile of the sample. RESULTS: Among the total help-seeking sample, approximately one third of the participants dropped out at intake and, after an average follow-up of 1.7 years, one third had been determined to meet criteria for BD and one third did not fulfill operational criteria for BD. The diagnostic status was changed in 35% of patients: approximately 10% were false positive (going from any bipolar diagnosis to a nonbipolar diagnosis) and approximately 25% were false negative (going from a nonbipolar diagnosis to any bipolar diagnosis). Most patients who converted to a bipolar diagnosis were initially labeled with major depressive disorder or attention-deficit/hyperactivity disorder and had a longer follow-up period. Relevant manic dimensions were elation, grandiosity, and disruption, which explained 41.4% of total variance. CONCLUSIONS: Regular reappraisal and follow-up of children and adolescents with mood disturbances provides a window for detection of BD (eg, of core manic dimensions). A coordinated and hierarchical connection among pediatric mental health services with different degrees of specialization is recommended.

Assuntos

Serviços de Saúde do Adolescente/estatística & dados numéricos , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/fisiopatologia , Serviços de Saúde da Criança/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Transtornos do Humor/diagnóstico , Centros Médicos Acadêmicos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino

RESUMO

OBJECTIVES: To investigate the association between sleep complaints and suicidal behaviors among severely depressed children and adolescents. METHODS: The sample was 214 youths (56.1% males, mean age 12.5 years) with diagnosis of DSM-IV major depressive disorder consecutively recruited from a university-based outpatient clinic specialized in mood disorders. The structured interview for children and adolescents was applied to participants. The Children's Depression Rating Scale-revised version-scored the severity of depression, and the Children's Global Assessment Scale assessed the global functioning. Subgroups of patients were compared for psychopathological association by means of logistic regression, in accordance with presence and absence of sleep complaints and suicidality. RESULTS: The frequency of sleep complaints and suicidal behaviors was, respectively, 66.4% and 52.3%, and both symptoms were observed in 37.9% of patients. Initial insomnia was the most frequent manifestation (58%), followed by night awakening (36%), daytime sleepiness (31%), and early awakening (29.9%). Significant association between sleep disturbance and suicidal behavior was found (odds ratio range of 2.3-10.8). CONCLUSION: Sleep disturbances are potential warning manifestations of suicidal behaviors in depressed youth. Possibly, the severity of the active affective episode likely underlies in both sleep complaints and suicidal behaviors among depressed underage patients.

Assuntos

Depressão , Transtornos do Sono-Vigília , Suicídio/psicologia , Adolescente , Criança , Estudos Transversais , Depressão/complicações , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Escalas de Graduação Psiquiátrica , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/psicologia , Estatísticas não Paramétricas

RESUMO

Abstract Background Thought and language disorders are main features of adults with schizophrenia and bipolar disorders however studies on such abnormalities are scant in young patients with very early onset psychosis (VEOS). The aim of the present study is to assess the relationship between language and thought disorders in patients with very early onset schizophrenia (SCZ), schizoaffective disorders (SCA) and bipolar disorders (BD). Method Forty-one patients (18 SCZ, 16 BD, and 7 SCA) with mean age less than 15 years old were assessed through a series of neurocognitive and psycholinguistic tests, including the Thought, Language and Communication Scale (TLC). Results SCZ group performed worse in all tests as well as the TLC, followed by SCA and BD groups respectively. Thought disorders were related to deficits in executive functioning and semantic processing, and the metaphors’ test was the best predictor of TLC functioning. Discussion TD in SCZ, SCA and BD are one of the most important features in patients with VEOS and that the evaluation of metaphor comprehension can be an important instrument in the early detection of this disorder.

RESUMO

INTRODUCTION:: Disorders of circadian rhythms have been reported in studies of both depressed children and of depressed adolescents. The aim of this study was to evaluate whether there is a relationship between the 24-hour spectral power (24h SP) of the activity/rest rhythm and the clinical course of depression in adolescents. METHODS:: Six 14 to 17-year-old adolescents were recruited for the study. They were all suffering from major depressive disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria, as identified by the Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version (K-SADS-PL). Depressive symptoms were assessed using the Children's Depression Rating Scale - Revised (CDRS-R) and clinical evaluations. Locomotor activity was monitored over a period of 13 consecutive weeks. Activity was measured for 10-minute periods using wrist-worn activity monitors. All patients were prescribed sertraline from after the first week up until the end of the study. RESULTS:: We found a relationship between high CDRS values and low 24-hour spectral power. CONCLUSIONS:: The 24h SP of the activity/rest rhythm correlated significantly (negatively) with the clinical ratings of depression.

Assuntos

Ritmo Circadiano , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/terapia , Atividade Motora , Actigrafia , Adolescente , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Descanso

RESUMO

BACKGROUND: Recent studies suggest that risperidone long-acting injection (RLAI) may be considered for controlling mood episodes in bipolar disorder patients who have relapsed due to medication nonadherence or failure to respond to standard therapies. Currently, no study has reported the usefulness of RLAI in youths with bipolar disorder. The aim of this study was to evaluate short-term effects of RLAI in the naturalistic treatment of early-onset bipolar disorder and its role in symptomatic remission and adherence to treatment. METHOD: Nineteen early-onset bipolar disorder outpatients receiving RLAI were observed in a 6-month naturalistic study at the outpatient clinic of the Child and Adolescent Affective Disorders Program at the Institute of Psychiatry of the University of São Paulo, São Paulo, Brazil. All patients met DSM-IV criteria for bipolar disorder. Clinical response to RLAI was evaluated using the Children's Global Assessment Scale (CGAS) and Clinical Global Impressions scale (CGI) across 3 time periods: index time (T0), 8 weeks after (T1), and 24 weeks after (T2). These subjects were recruited from May 2008 to December 2009. RESULTS: Patients receiving RLAI presented considerable improvement in global functioning (CGAS: T0 = 20.6; T1 = 42.9; and T2 = 49.2) and clinical severity (CGI: T0 = 5.9; T1 = 3.9; and T2 = 3.4). Global CGI mean scores of clinical improvement were 2.2 at T1 and 2.4 at T2. There were no significant changes in laboratory measurements and weight throughout follow-up. CONCLUSIONS: RLAI was shown to be an alternative treatment for youths with bipolar disorder failing to respond to prior medication trials or with adherence problems. Further blind, randomized controlled studies are necessary to confirm these initial findings. TRIAL REGISTRATION: Sistema Nacional de Informaçoes Sobre Ética em Pesquisa Envolvendo Seres Humanos-Commisão Nacional de Ética em Pesquisa identifier: CAAE 0709.0.015.000-06.

Assuntos

Criança , Humanos , Masculino , Transtorno Bipolar/complicações , Síndrome de Tourette/complicações , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Quimioterapia Combinada , Risperidona/uso terapêutico , Síndrome de Tourette/tratamento farmacológico , Ácido Valproico/uso terapêutico

RESUMO

OBJECTIVE: To compare clinical characteristics of major depressive disorder symptoms between children and adolescents. METHOD: The subjects were 58 patients of a Child and Adolescent Affective Disorder Clinic consecutively admitted during a six-month period. Children aged 5-9 years old and adolescents from 10-17 years old currently meeting DSM-IV criteria diagnosis of major depressive disorder were chosen. Current MDD diagnosis and depressive psychopathology were assessed by a clinical interview and the Diagnostic Interview for Children and Adolescents-DSM-IV version. The Children's Depression Rating Scale-Revised Version and the Children Global Assessment Scale rated the severity and global functioning of major depressive disorder. RESULTS: The most common depressive symptoms were: anhedonia (72.4%), depressed mood (72.4%), decreased concentration (62.1%), and irritability (58.6%). The intensity of depressive episodes of this sample ranged from mild to moderate. Fifty percent reported thoughts of death, and 29.3% presented a variety of psychotic symptoms. When compared with children, adolescents reported a significantly more depressed mood (p = 0.043), lower self-esteem (p = 0.002), and had more difficulty concentrating (p = 0.020). Female adolescents had lower self-esteem (p = 0.003), and male adolescents showed more decreased concentration (p = 0.016). CONCLUSION: This study suggests that age and gender differences might influence the clinical presentation of major depressive disorder in children and adolescents. Further studies with larger samples are needed.

Assuntos

Transtorno Depressivo Maior/diagnóstico , Transtornos Psicóticos/diagnóstico , Suicídio/psicologia , Adolescente , Fatores Etários , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade , Criança , Pré-Escolar , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Transtornos do Humor/psicologia , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/psicologia , Distribuição por Sexo , Fatores Sexuais , Classe Social , Tentativa de Suicídio/psicologia

RESUMO

OBJECTIVE: To compare clinical characteristics of major depressive disorder symptoms between children and adolescents. METHOD: The subjects were 58 patients of a Child and Adolescent Affective Disorder Clinic consecutively admitted during a six-month period. Children aged 5-9 years old and adolescents from 10-17 years old currently meeting DSM-IV criteria diagnosis of major depressive disorder were chosen. Current MDD diagnosis and depressive psychopathology were assessed by a clinical interview and the Diagnostic Interview for Children and Adolescents-DSM-IV version. The Children’s Depression Rating Scale-Revised Version and the Children Global Assessment Scale rated the severity and global functioning of major depressive disorder. RESULTS: The most common depressive symptoms were: anhedonia (72.4 percent), depressed mood (72.4 percent), decreased concentration (62.1 percent), and irritability (58.6 percent). The intensity of depressive episodes of this sample ranged from mild to moderate. Fifty percent reported thoughts of death, and 29.3 percent presented a variety of psychotic symptoms. When compared with children, adolescents reported a significantly more depressed mood (p = 0.043), lower self-esteem (p = 0.002), and had more difficulty concentrating (p = 0.020). Female adolescents had lower self-esteem (p = 0.003), and male adolescents showed more decreased concentration (p = 0.016). CONCLUSION: This study suggests that age and gender differences might influence the clinical presentation of major depressive disorder in children and adolescents. Further studies with larger samples are needed.

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OBJETIVO: Comparar as características clínicas de transtorno depressivo maior entre crianças e adolescentes. MÉTODO: Amostra constituída de 58 sujeitos admitidos consecutivamente em um serviço especializado em transtornos do humor na infância e adolescência durante um período de 6 meses. Foram considerados crianças sujeitos com idade entre 5 e 9 anos, e adolescentes aqueles com idade entre 10 e 17 anos. Todos os participantes preenchiam diagnóstico de transtorno depressivo maior seguindo os critérios de DSM-IV. O diagnóstico de transtorno depressivo maior e avaliação de aspectos psicopatológicos foram realizados por entrevista clínica direta e aplicação de entrevista de apoio ao diagnóstico. O funcionamento global e a gravidade dos sintomas depressivos foram mensurados através de versões adaptadas de Children’s Depression Rating Scale-Revised Version e Children Global Assessment Scale. RESULTADOS: Os sintomas depressivos mais freqüentes foram: anedonia (72,4 por cento), humor depressivo (72,4 por cento), diminuição de concentração (62,1 por cento) e irritabilidade (58,6 por cento). A intensidade do episódio depressivo dessa amostra variou de leve a moderada. Cinqüenta por cento relataram pensamentos mórbidos e 29,3 por cento apresentaram sintomas psicóticos variados. Quando comparados com crianças, adolescentes apresentaram significativamente mais humor depressivo (p = 0,043), baixa auto-estima (p = 0,002) e mais dificuldade de concentração (p = 0,020). As adolescentes femininas tinham mais baixa auto-estima (p = 0,003) e os masculinos mostraram mais diminuição de concentração (p = 0,016). CONCLUSÃO: Esse estudo sugere que idade e gênero poderiam influenciar na apresentação clínica de transtorno depressivo maior em crianças e adolescentes. Estudos com amostra mais representativa serão necessários.

Assuntos

Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Transtorno Depressivo Maior/diagnóstico , Transtornos Psicóticos/diagnóstico , Suicídio/psicologia , Fatores Etários , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Métodos Epidemiológicos , Transtornos do Humor/psicologia , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/psicologia , Distribuição por Sexo , Fatores Sexuais , Classe Social , Tentativa de Suicídio/psicologia

Assuntos

Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Síndrome Maligna Neuroléptica/tratamento farmacológico , Adolescente , Transtorno Bipolar/complicações , Humanos , Masculino , Síndrome Maligna Neuroléptica/etiologia , Olanzapina

Assuntos

Adolescente , Humanos , Masculino , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Síndrome Maligna Neuroléptica/tratamento farmacológico , Transtorno Bipolar/complicações , Síndrome Maligna Neuroléptica/etiologia

Assuntos

Transtorno Bipolar/complicações , Síndrome de Tourette/complicações , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Criança , Quimioterapia Combinada , Humanos , Masculino , Risperidona/uso terapêutico , Síndrome de Tourette/tratamento farmacológico , Ácido Valproico/uso terapêutico

RESUMO

OBJECTIVE: This study describes the clinical phenomenology and family history of preschool age onset Bipolar Disorder (BD). METHODS: Eight children and adolescents out of 118 cases (6.78%), both genders, meeting current DSM-IV criteria diagnosis of BD were described. The clinical assessment, CBCL, DICA-IV and CGAS were performed directly with each patient and their parents. RESULTS: Most (87.5%) presented classical symptoms of mania: euphoria, grandiosity, irritability, psychomotor agitation and agitated sleep or, in the same proportion, sleeplessness. Hyperactivity and increase of energy were found in all eight cases. The clinical course varied from a rapid, ultra-rapid, ultradian cycle to a continued pattern. Five out of eight children (62.5%) presented aggressiveness toward others and one deliberate self-harm. Most (87.5%) had psychiatric family history. The average number of medications used during their life was 4.5 drugs. LIMITATION: The small sample and retrospective reports of the first manic symptoms in three of the cases (cases V, VI and VII). CONCLUSION: An important incidence of classical manic features was found in very young children. The clinical course tended to be continuous, and preschool BD seems to have a strong association with affective disorder family history.

Assuntos

Transtorno Bipolar/diagnóstico , Antimaníacos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Brasil , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Masculino

Assuntos

Masculino , Feminino , Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/diagnóstico

Assuntos

Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/diagnóstico

RESUMO

O transtorno do humor bipolar de início na infância e adolescência tornou-se um grande desafio aos profissionais que atendem a essa população, bem como a quem se dedica a estudá-la com mais profundidade. Primeiramente, isso se deve à dificuldade em se fechar o diagnóstico clínico e também em se estabelecer uma terapêutica medicamentosa eficaz, segura e permanente. Diferenças no padrão de ciclagem, predominância de fases mistas, gravidade das crises e a necessidade de se utilizar associações farmacológicas tornam o tratamento do transtorno bipolar de início precoce bastante complexo, exigindo uma gama maior de possibilidades terapêuticas. O caso apresentado relata a experiência com o uso da quetiapina em um paciente com o diagnóstico clínico de transtorno do humor bipolar de início na infância e adolescência, que começou aos 12 anos, e cuja resposta aos diferentes esquemas se mostrou insatisfatória. O uso da quetiapina mostrou-se eficaz no controle da crise e na estabilização do humor neste caso.

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Bipolar disorder in children and adolescents has become a great challenge for professionals who work with this type of patients, as well as for researchers interested in studying it in depth. Firstly, diagnostic assessment is difficult; secondly, to establish a safe, long-term and effective treatment is challenging. Different cycling patterns, predominance of mixed episodes, severity of symptoms and need of polypharmacy makes the treatment of child and adolescent bipolar disorder very complex and requiring a wider range of therapeutic resources. The present case reports a successful use of quetiapine for a bipolar adolescent diagnosed at the age of 12 years who had been unsuccessfully treated using many therapeutic options. Quetiapine showed efficacy in both acute and prophylactic treatment of early-onset bipolar disorder.