Assuntos
Encéfalo/diagnóstico por imagem , Transtornos Mentais/diagnóstico por imagem , Neuroimagem/métodos , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Humanos , Imageamento por Ressonância Magnética/métodos , Transtornos Mentais/fisiopatologia , Rede Nervosa/diagnóstico por imagem , Vias Neurais/diagnóstico por imagemAssuntos
Humanos , Encéfalo/diagnóstico por imagem , Neuroimagem/métodos , Transtornos Mentais/diagnóstico por imagem , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Imageamento por Ressonância Magnética/métodos , Transtornos Mentais/fisiopatologia , Rede Nervosa/diagnóstico por imagem , Vias Neurais/diagnóstico por imagemRESUMO
OBJECTIVE: The few studies applying single-voxel ¹H spectroscopy in children and adolescents with bipolar disorder (BD) have reported low N-acetyl-aspartate (NAA) levels in the dorsolateral prefrontal cortex (DLPFC), and high myo-inositol / phosphocreatine plus creatine (PCr+Cr) ratios in the anterior cingulate. The aim of this study was to evaluate NAA, glycerophosphocholine plus phosphocholine (GPC+PC) and PCr+Cr in various frontal cortical areas in children and adolescents with BD. We hypothesized that NAA levels within the prefrontal cortex are lower in BD patients than in healthy controls, indicating neurodevelopmental alterations in the former. METHOD: We studied 43 pediatric patients with DSM-IV BD (19 female, mean age 13.2 ± 2.9 years) and 38 healthy controls (19 female, mean age 13.9 ± 2.7 years). We conducted multivoxel in vivo ¹H spectroscopy measurements at 1.5 Tesla using a long echo time of 272 ms to obtain bilateral metabolite levels from the medial prefrontal cortex (MPFC), DLPFC (white and gray matter), cingulate (anterior and posterior), and occipital lobes. We used the nonparametric Mann-Whitney U test to compare neurochemical levels between groups. RESULTS: In pediatric BD patients, NAA and GPC+PC levels in the bilateral MPFC, and PCr+Cr levels in the left MPFC were lower than those seen in the controls. In the left DLPFC white matter, levels of NAA and PCr+Cr were also lower in BD patients than in controls. CONCLUSIONS: Lower NAA and PCr+Cr levels in the PFC of children and adolescents with BD may be indicative of abnormal dendritic arborization and neuropil, suggesting neurodevelopmental abnormalities.
Assuntos
Ácido Aspártico/análogos & derivados , Transtorno Bipolar/metabolismo , Química Encefálica , Córtex Pré-Frontal/crescimento & desenvolvimento , Prótons , Adolescente , Ácido Aspártico/química , Ácido Aspártico/metabolismo , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/fisiopatologia , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Glicerilfosforilcolina/química , Glicerilfosforilcolina/metabolismo , Humanos , Inositol/química , Inositol/metabolismo , Espectroscopia de Ressonância Magnética , Masculino , Fosfocreatina/química , Fosfocreatina/metabolismo , Fosforilcolina/química , Fosforilcolina/metabolismo , Córtex Pré-Frontal/químicaRESUMO
OBJECTIVE: We compared temperament and character traits in children and adolescents with bipolar disorder (BP) and healthy control (HC) subjects. METHOD: Sixty nine subjects (38 BP and 31 HC), 8-17 years old, were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime. Temperament and character traits were measured with parent and child versions of the Junior Temperament and Character Inventory. RESULTS: BP subjects scored higher on novelty seeking, harm avoidance, and fantasy subscales, and lower on reward dependence, persistence, self-directedness, and cooperativeness compared to HC (all p < 0.007), by child and parent reports. These findings were consistent in both children and adolescents. Higher parent-rated novelty seeking, lower self-directedness, and lower cooperativeness were associated with co-morbid attention-deficit/hyperactivity disorder (ADHD). Lower parent-rated reward dependence was associated with co-morbid conduct disorder, and higher child-rated persistence was associated with co-morbid anxiety. CONCLUSIONS: These findings support previous reports of differences in temperament in BP children and adolescents and may assist in a greater understating of BP children and adolescents beyond mood symptomatology.
Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Caráter , Determinação da Personalidade , Temperamento , Adolescente , Criança , Comorbidade , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , PsicometriaRESUMO
OBJECTIVE: This secondary analysis evaluated the efficacy of modafinil in children and adolescents by subtype of attention-deficit/hyperactivity disorder (ADHD) using pooled data from 3 double-blind, placebo-controlled studies. STUDY DESIGN: The patients were boys and girls age 6 to 17 years. ADHD subtype diagnoses (ie, inattentive, hyperactive-impulsive, combined) were based on criteria published in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Patients received modafinil (170 to 425 mg) or placebo once daily for 7 to 9 weeks. Efficacy assessment used the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) School and Home Versions, Clinical Global Impression of Improvement scale (CGI-I), and Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S). RESULTS: A total of 638 patients received modafinil (n = 423) or placebo (n = 215). The inattentive, hyperactive-impulsive, and combined subtypes included 187 (30%), 27 (4%), and 403 (65%) patients, respectively. Modafinil (vs placebo) significantly improved mean total scores for the ADHD-RS-IV School and Home Versions for the inattentive (change from baseline: School, modafinil, -15.7, placebo, -7.1; Home, modafinil, -13.8, placebo, -5.9) and combined subtypes (School, -16.5 vs -8.8; Home, -15.7 vs -7.6). Modafinil was associated with greater improvements on the CGI-I and improved CPRS-R:S subscale scores in inattentive and combined subtypes. CONCLUSIONS: Modafinil improved ADHD symptoms and behaviors in patients with the inattentive and combined subtypes as determined by teachers, investigators, and parents.