RESUMO
OBJECTIVES: Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that consists of applying a weak electric current over the scalp to modulate cortical excitability. tDCS has been extensively investigated in adults with psychiatric disorders. The aim of this study was to review the current literature regarding the use of tDCS in children and adolescents with psychiatric disorders. METHODS: We searched MEDLINE and EMBASE databases for studies evaluating the safety and efficacy of tDCS in children and adolescents from age 0 to 18 years with psychiatric disorders. RESULTS: We found six studies that evaluated patients with different psychiatric disorders, with diverse study designs and stimulation parameters, including three small randomized clinical trials (RCTs), one evaluating childhood-onset schizophrenia, one RCT with patients with autism spectrum disorders (ASD), and one study in attention-deficit/hyperactivity disorder (ADHD); three open-label studies, two evaluating patients with ASD, and one study of feasibility of the technique in children and adolescents with language disorders and diverse psychiatric disorders, including ASD, intellectual disability, and ADHD. We also found three studies of dosage considerations in the general pediatric population. The technique was well tolerated, with no reports of serious side effects. CONCLUSION: Preliminary research suggests that tDCS may be well tolerated and safe for children and adolescents with psychiatric and neurodevelopmental disorders. Nevertheless, because the literature regarding tDCS in child and adolescent psychiatry is scarce and there exist limited numbers of randomized controlled trials, it is not possible to draw definite conclusions. Future studies should investigate the technique with regard to specific psychiatric conditions in comparison with standard treatments. In addition, long-term efficacy and safety should be monitored.
Assuntos
Transtornos Mentais/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Adolescente , Psiquiatria do Adolescente/métodos , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Espectro Autista/terapia , Criança , Psiquiatria Infantil/métodos , Pré-Escolar , Humanos , Transtornos Mentais/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Esquizofrenia Infantil/terapia , Estimulação Transcraniana por Corrente Contínua/efeitos adversosRESUMO
The authors report the means to manage the psychotic child throughout the out patients consult approaching directly the modalities of interpersonal relationships between the child and his family. The therapeutic plan includes an educational and formative program designed especifically, taking into consideration the needs and potencialties of each child and acting psychotherapeutically through a modality of individual psycotherapy directed to estimulate the psychological functions which are responsible of the development of the mental autorepresentation (ego boundaries). The treatment program is an adaptation of the one utilized for the management of autistic children in an institution for psychotic children. The type of individual psychotherapy is a modification of Des Lauriers' therapy, developed by him for the management of schizophrenic adolescents and adapted by Ward in 1969 to be applied to the psychotic child in the mentioned institution. The authors present the application and obtained results with the use of this therapy in the treatment of a psychotic girl.
Assuntos
Terapia Comportamental/métodos , Transtornos Psicóticos/terapia , Fatores Etários , Transtorno Autístico/terapia , Psiquiatria Infantil , Pré-Escolar , Feminino , Humanos , México , Esquizofrenia Infantil/terapiaAssuntos
Serviços Comunitários de Saúde Mental , Anamnese , Esquizofrenia , Doença Aguda , Adolescente , Adulto , Negro ou Afro-Americano , Atitude do Pessoal de Saúde , Doença Crônica , Escolaridade , Feminino , Humanos , Masculino , Anamnese/métodos , New York , Ocupações , Porto Rico/etnologia , Tratamento Domiciliar , Esquizofrenia/diagnóstico , Esquizofrenia/terapia , Esquizofrenia Infantil/diagnóstico , Esquizofrenia Infantil/terapia , Ajustamento Social , Estresse Psicológico , População BrancaRESUMO
Over the years, a wide range of treatment efforts have been made with these patients in a variety of clinical settings. Review of the data indicates that, in general, a probing, interpretative approach has led to increased anxiety, aggravation of symptoms and deterioration of adaptation. A practical, forthright, supportive approach with parents along with ego-supportive therapy for the patient that includes special education and appropriate recreational and work activities has been most effective. In those cases in which withdrawal into mutism and only sensuous play has occured by the age of 5 years response to treatment has been minimal. Periodic separation from the family is often indicated for both, patient and family.