Manejo y comorbilidades de los trastornos bipolares en la infancia y adolescencia

The diagnosis and treatment of bipolar disorders (BPD) in children is currently one of the biggest challenges and area of controversy in the field of child psychiatry. Bipolar disorders encompass several affective disorders that involve alterations in the degree of activity, content and form of thinking that are characterized by biphasic episodes of mood. This group of disorders affect approximately 1% of the world population and begin in youth (the average age of onset of ~20 years). However, in some studies a delay of 5 years has been observed since the presentation of symptoms at the beginning of the treatment. Currently, the diagnosis of TBP in children and adolescents should be based on the same set of symptoms applied to adults, as well as the general principles of the treatment. The research carried out around this disorder has resulted in changes in the conceptualization and approach of this pathology, now conceived as a group of disorders that share changes in mood and other cardinal symptoms, of a chronic and progressive nature that impacts in a negative way in those who suffer them. Key words: Bipolar disorder; childhood; mania; hypomania; depression.

Catatonia

Catatonia is a syndrome, not a discrete illness, and was first recognized by Kahlbaum in the 19th century. Catatonia is underdiagnosed and often goes unrecognized despite its clinical significance and treatment implications. The syndrome’s motor symptoms include muteness, rigidity, and stupor. Catatonia has been associated with various psychiatric, medical, and neurologic disorders and is no longer only considered a subtype of schizophrenia. There is no known etiology, but its rapid improvement with benzodiazepines suggests that γ-aminobutyric acid (GABA), an inhibitory neurotransmitter, is involved. Patients displaying catatonic symptoms should have a comprehensive evaluation to rule out medical and neurologic causes and to assess hydration and nutritional status. Patients can have significant nursing care needs, and some might need tube feedings. Benzodiazepines are the first-line treatment, with electroconvulsive therapy reserved for those who fail to respond or have an inadequate response to benzodiazepines. Psychiatrists and other clinicians should understand the diagnosis and treatment of catatonia. This review contains 4 tables and 52 references Key words: bipolar disorder, catatonia, delirium, GABA, glutamate, major depressive disorder, schizophrenia

Reviewing the diagnostic validity and utility of mixed depression (depressive mixed states)

ObjectiveTo review the diagnostic validity and utility of mixed depression, i.e. co-occurrence of depression and manic/hypomanic symptoms.MethodsPubMed search of all English-language papers published between January 1966 and December 2006 using and cross-listing key words: bipolar disorder, mixed states, criteria, utility, validation, gender, temperament, depression-mixed states, mixed depression, depressive mixed state/s, dysphoric hypomania, mixed hypomania, mixed/dysphoric mania, agitated depression, anxiety disorders, neuroimaging, pathophysiology, and genetics. A manual review of paper reference lists was also conducted.ResultsBy classic diagnostic validators, the diagnostic validity of categorically-defined mixed depression (i.e. at least 2–3 manic/hypomanic symptoms) is mainly supported by family history (the current strongest diagnostic validator). Its diagnostic utility is supported by treatment response (negative effects of antidepressants). A dimensionally-defined mixed depression is instead supported by a non-bi-modal distribution of its intradepression manic/hypomanic symptoms.DiscussionCategorically-defined mixed depression may have some diagnostic validity (family history is the current strongest validator). Its diagnostic utility seems supported by treatment response.