Brazilian Journal of Psychiatry, Volume: 35 Supplement 1, Published: 2013
  • Advances and perspectives in child and adolescent psychiatry Editorials

    Kieling, Christian; Polanczyk, Guilherme V.
  • Perspectives on child and adolescent psychiatry from Brazil Editorials

    Rapoport, Judith L.
  • Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice Update Articles

    Salum, Giovanni Abrahão; DeSousa, Diogo Araújo; Rosário, Maria Conceição do; Pine, Daniel Samuel; Manfro, Gisele Gus

    Abstract in English:

    The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.
  • Mood disorders in childhood and adolescence Update Articles

    Rocha, Thiago Botter Maio; Zeni, Cristian Patrick; Caetano, Sheila Cavalcante; Kieling, Christian

    Abstract in English:

    The identification and treatment of mood disorders in children and adolescents has grown over the last decades. Major depression is one of the most common and debilitating disorders worldwide, imposing a massive burden to the youth population. Bipolar disorder is being increasingly recognized as having its roots early in life, and its presentation during childhood and adolescence has been submitted to extensive research. This review aims to highlight clinical aspects of the current knowledge on mood disorders in the pediatric population, presenting updated information on epidemiology, diagnostic procedures, and management strategies. Limitations of available evidence and future directions of research in the field are also discussed.
  • Irritability in children and adolescents: past concepts, current debates, and future opportunities Update Articles

    Krieger, Fernanda Valle; Leibenluft, Ellen; Stringaris, Argyris; Polanczyk, Guilherme V.

    Abstract in English:

    Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.
  • Developments and challenges in the diagnosis and treatment of ADHD Update Articles

    Dias, Taciana G. Costa; Kieling, Christian; Graeff-Martins, Ana Soledade; Moriyama, Tais S.; Rohde, Luis A.; Polanczyk, Guilherme V.

    Abstract in English:

    Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, often associated with other psychiatric comorbidities, functional impairments, and poor long-term outcomes. The objective of this selected review is to describe current advances and challenges in the diagnosis and treatment of ADHD. The disorder is associated with neurobiological underpinnings and is highly heterogeneous in various aspects, such as symptom profiles, cognitive impairments, and neurobiological and genetic features. The efficacy and safety of short-term pharmacological treatments across the life cycle is well studied, but further research investigating long-term treatment, impact of treatment in preschoolers, and non-pharmacological interventions is needed. Future research is also needed to better characterize the neurodevelopmental pathways of the disorder, linking clinical and neurobiological information, less investigated populations, and new interventions.
  • Use of psychoactive substances by adolescents: current panorama Update Articles

    Lopes, Gabriel M.; Nóbrega, Brunno Araújo; Del Prette, Giovana; Scivoletto, Sandra

    Abstract in English:

    Adolescence is a period of vulnerability to substance use disorders (SUDs). Epidemiological studies indicate that about 23% of Brazilian adolescents use drugs, with alcohol being the most widely consumed substance. The etiology of SUDs is complex, influenced by an interaction of genetic risk, individual development, environmental factors, context of use, and substance used. Clinicians should consider diagnostic criteria and be aware of behavioral changes that may indicate drug use and its consequences in various aspects of adolescent life. Identification and treatment of comorbid conditions is critical to the management of SUDs in this age group. Interventions should restrict access to drugs and facilitate prompt recognition of initial use, preventing progression to serious patterns of abuse or dependence. Intervention should be broad, including academic and occupational activities as well as social relationships and leisure, which are critical to the reestablishment of normal adolescent development.
  • Autism spectrum disorders: an overview on diagnosis and treatment Update Articles

    Brentani, Helena; Paula, Cristiane Silvestre de; Bordini, Daniela; Rolim, Deborah; Sato, Fabio; Portolese, Joana; Pacifico, Maria Clara; McCracken, James T.

    Abstract in English:

    Pervasive developmental disorders are now commonly referred to as autism spectrum disorders (ASDs). ASDs present with a range of severity and impairments, and often are a cause of severe disability, representing a major public health concern. The diagnostic criteria require delays or abnormal functioning in social interaction, language, and/or imaginative play within the first 3 years of life, resulting in a deviation from the developmental pattern expected for the age. Because establishing a diagnosis of ASD is possible as early as 18-24 months of age, clinicians should strive to identify and begin intervention in children with ASD as soon as signs are manifest. Increasing efforts are underway to make ASD screening universal in pediatric healthcare. Given the crucial importance of early identification and multiple modalities of treatment for ASD, this review will summarize the diagnostic criteria, key areas for assessment by clinicians, specific scales and instruments for assessment, and discussion of evidence-based treatment programs and the role of specific drug therapies for symptom management.
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