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Brazilian Journal of Psychiatry

versão impressa ISSN 1516-4446

Rev. Bras. Psiquiatr. vol.34 no.2 São Paulo jun. 2012 



Affective disorders in childhood and adolescence: diagnosis and treatment



Camila Morelatto de Souza

Psychiatrist; Specialist in Childhood and Adolescence. Researcher at the Chronobiology Laboratory of Hospital de Clínicas de Porto Alegre. Doctoral Student of the Post-Graduation Program in Medical SciencesPsychiatry Universidade Federal do Rio Grande do Sul




Lee Fu-I, Miguel Angelo Boarati, Ana Paula Ferreira Maia et al. Porto Alegre, Artmed, 2012.

The cover designed by Paola Manica in which the central character, a boy, is immersed in a universe of symbols, promptly lead us to the complexity of the book's subject. As has been observed in a long time, but only recently documented, it seems that the first manifestations of affective disorders may occur during childhood, sometimes with pictures that are similar to those seen in adult life, but more often with characteristics of the developmental phase where each individual may be. This heterogeneity in presentation, the presence of symptoms in addition to mood swings and comorbidities, and associated individual and environmental factors, still make from diagnosis and treatment of these conditions, challenges that stimulate the search for knowledge.

Both in the Preface by Professor Ricardo Moreno as well as in the Presentation by Professor Rodrigo Machado-Vieira, we can find the greatest certainty among many questions: that these are diseases potentially devastating in the life of this boy and many others, as well as their families and society. In additional to that, early detection and intervention are the best way to reduce this impact.

Authors are child and adolescent psychiatrists, coordinators, researchers and collaborators of the Program for Management of Affective Disorders (PRATA from Portuguese) of the Psychiatric Service for Childhood and Adolescence (SEPIA from Portuguese) of the Hospital das Clínicas, Faculty of Medicine of Universidade de São Paulo (HC-FM-USP). PRATA was created 20 years ago by Dr. Lee Fu-I, and acts through the services provided by professionals working in several areas of mental health of children and adolescents.

Thus, much clinical experience was accumulated and a valuable data source on affective disorders was created. As the introductory chapter presents, this book highlights the material collected and published from the first National Symposium on Bipolar Disorder in Childhood and Adolescence (2005) and the book Bipolar disorder in childhood and adolescence: clinical features and comorbidities (Artmed, 2009), adding a knowledge update and including chapters on unipolar depression.

The book has 375 pages within 19 chapters organized in five parts. In Part I - Concepts, Historical and Epidemiological Aspects , one can find the account of efforts made, since ancient Greece up to now, in the search for description and understanding of observed manifestations and the establishment of more appropriate diagnostic criteria. The most important epidemiological studies in Brazil and in the world are shown through comparative tables with a critical inquiry made about the methodology used.

Part II - Clinical Aspects and Diagnosis of Affective Disorders in Childhood and Adolescence discusses the clinical manifestations of unipolar depression and bipolar disorder, as well as their comorbidities through a developmental perspective. Special emphasis should be given to examples and illustrative cases rich in details which give the reader the opportunity to compare them with his/her own clinical experience. There is a chapter dedicated to the assessment with a specific focus on bipolar disorder diagnosis and a brief description of the diagnostic tools available.

In Part III, Neurobiological Aspects of Affective Disorders in Childhood and Adolescence, genetic and neuroimaging studies and their search for the disease's early markers are described. The association between chronobiology and mood disorders has a well-deserved chapter, taking from the clock genes and endophenotypes, until the timer system, chronotypes and chronotherapeutic interventions.

Part IV deals with the Psychological Aspects of Language, Learning and Psychosocial Aspects, and finally, Part V , with the Therapeutic Approaches . In Part V , the drugs table that includes dose, indications, side effects and precautions shows to be extremely practical. Considering the complexity of mood disorder pictures, it is complemented by several individual and family psychotherapy approaches, neuropsychological rehabilitation, art therapy and the multidisciplinary work in day hospital.

It was with satisfaction that, as a researcher in the area, I found a good number of pages dealing with the chronobiology concepts and its methods in a comprehensive manner, in addition to studies about the association between affective disorder and factors such as the loss of circadian rhythmicity, the morningness/eveningness dimension (chronotype) and the social jet lag.

Thus, using accessible language, a fluid rhythm and logical organization, this work provides us enough updated information and it does not presume to end this journey, but breaks new ground by bringing up many controversies and questions of the current moment.

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