Attentional disorders in patients with complex partial epilepsy

A study of concentrated attention patterns in epileptic patients was conducted with the objectives: characterization of the patients' epileptic condition; assessment of the concentrated attention levels in epileptic and nonepileptic individuals; comparison of the attention levels of the two groups. An evaluation was performed of 50 adult outpatients with complex partial seizures and 20 non-epileptic individuals (comparative group) at the Neuroepilepsy Ambulatory Unit, State University of Campinas SP, Brazil. Method: characterization of seizure types, frequency and duration; concentrated attention assessment (Concentrated Attention Test - Toulouse-Piéron); comparison of the epileptic with non-epileptic individuals. Results: A statistically significant difference was observed between the groups with regard to Correct Response, Wrong Response and No Response. A difference was observed in relation to Time, but it was statistically insignificant. The epileptic patients presented inferior cognitive performance in relation to concentrated attention when compared with the non-epileptic individuals, findings compatible with the clinical complaints.

Distúrbio de hiperatividade e déficit de atenção na síndrome de apnéia obstrutuiva do sono: Há melhora com tratamento cirúrgico?

Neuropsychological disorders are frequently associated with obstructive ventilatory disorders (OVD). Aim: To analyze the incidence of neuropsychological disorders in Brazilian children with OVD, using a screening questionnaire and to compare the answers given before and after surgery. Patients and Methods: We studied 30 children with clinical diagnosis of OVD. The children were divided into 3 groups: group I, children aged 4 to 7; group II, from 8 to 10; and group III, children over 11. The applied questionnaires were answered by the parents or tutors, and comprised 30 questions, 10 for each disorder: attention deficit, hyperactivity and impulsivity. The children were diagnosed with one of the disorders when presented 3 or more positive answers. The follow up interview occurred 6 months after adenotonsillectomy. Results: There was a predominance of male gender (60.6%) over female gender (39.4%). Group II presented the highest number of significant changes, with reductions raging from 87.5% to 33.3% of patients with attention deficit, 75% to 50% of the hyperactive patients, and 50% to 33% of the impulsive patients. Conclusion: There was neuropsychological improvement after the surgery, which occurred mainly in the children from group II. More interaction among health professionals is necessary when diagnosing and following up similar cases.

Síndrome das pernas inquietas: Diagnóstico e tratamento. Opinião de especialistas Brasileiros

This article contains the conclusions of the November 17-18, 2006 meeting of the Brazilian Study Group of Restless Legs Syndrome (GBE-SPI) about diagnosis and management of restless legs syndrome (RLS). RLS is characterized by abnormal sensations mostly but not exclusively in the legs which worsen in the evening and are improved by motion of the affected body part. Its diagnosis is solely based on clinical findings. Therapeutic agents with efficacy supported by Class I studies are dopamine agonists, levodopa and gabapentine. Class II studies support the use of slow release valproic acid, clonazepan and oxycodone. The GBE-SPI recommendations for management of SPI are sleep hygiene, withdrawal of medications capable of worsening the condition, treatment of comorbidities and pharmacological agents. The first choice agents are dopaminergic drugs, second choice are gabapentine or oxycodone, and the third choice are clonazepan or slow release valproic acid.

Desempenho em consciência fonológica, memória operacional, leitura e escrita na dislexia familial

Background: familial dyslexia. Aim: to characterize and compare the phonological awareness, working memory, reading and writing abilities of individuals whose family members are also affected. Method: in this study 10 familial nuclei of natural family relationship of individuals with dyslexia were analyzed. Families of natural individuals living in the west region of the state of São Paulo were selected. Inclusion criteria were: to be a native speaker of the Brazilian Portuguese language, to have 8 years of age or more, to present positive familial history for learning disabilities, That is, to present at least one relative with difficulties in learning. Exclusion criteria were: to present any neurological disorder genetically caused or not, in any of the family members, such as dystonia, extra pyramidal diseases, mental disorder, epilepsy, attention deficit and hyperactivity disorder (ADHA); psychiatric symptoms or conditions; or any other pertinent conditions that could cause errors in the diagnosis. As for the diagnosis of developmental dyslexia, information about the familial history of the adolescents and children was gathered with the parents, so that a detailed pedigree could be delineated. Neurological, psychological, speech-language, and school performance evaluations were made with the individuals and their families. Results: the results of this study suggest that the dyslexic individuals and their respective relatives, also with dyslexia, presented lower performances than the control group in terms of rapid automatic naming, reading, writing and phonological awareness. Conclusion: deficits in phonological awareness, working memory, reading and writing seem to have genetic susceptibility that possibly determine, when in interaction with the environment, the manifestation of dyslexia.

Obsessive-compulsive disorder: Influence of age at onset on comorbidity patterns

Purpose: This study investigates the influence of age at onset of OCS on psychiatric comorbidities, and tries to establish a cut-off point for age at onset. Methods: Three hundred and thirty OCD patients were consecutively recruited and interviewed using the following structured interviews: Yale-Brown Obsessive Compulsive Scale; Yale Global Tic Severity Scale and the Structured Clinical Interview for DSM-IV. Data were analyzed with regression and cluster analysis. Results: Lower age at onset was associated with a higher probability of having comorbidity with tic, anxiety, somatoform, eating and impulse-control disorders. Longer illness duration was associated with lower chance of having tics. Female gender was associated with anxiety, eating and impulse-control disorders. Tic disorders were associated with anxiety disorders and attention-deficit/hyperactivity disorder. No cut-off age at onset was found to clearly divide the sample in homogeneous subgroups. However, cluster analyses revealed that differences started to emerge at the age of 10 and were more pronounced at the age of 17, suggesting that these were the best cut-off points on this sample. Conclusions: Age at onset is associated with specific comorbidity patterns in OCD patients. More prominent differences are obtained when analyzing age at onset as an absolute value. © 2008 Elsevier Masson SAS. All rights reserved.

Adverse drug reaction as cause of hospital admission of elderly people: a pilot study

The objective of this study was to estimate the prevalence of adverse drug reactions (ADR) related to hospital admission of elderly people, identifying the use of potentially inappropriate medication (PIM), the ADR and the risk factors associated with the hospitalization. A cross-sectional study was conducted in a private hospital of São Paulo State, Brazil. All patients aged ≥ 60 years, admitted in the general practice ward in May 2006 were interviewed about the drugs used and the symptoms/complaints that resulted in hospitalization. More than a half (54.5 %) of elderly hospitalizations were related with ADR. The therapeutic classes involved with ADR were: cardiovascular (37.7 %), central nervous (34.6 %) and respiratory (5.7 %). The ADR observed were disorders in circulatory (28.4 %), digestive (20.0 %) and respiratory (18.9 %) tracts. 27 elderly had made PIM and in 20 of them this was the cause of hospitalization. Polypharmacy was an ADR risk factor (p = 0.021).These data allows the healthcare professionals upgrade, qualifying them in pharmcovigilance.

Hallazgos de neuroimagen y desempeño ortográfi co de estudiantes con trastorno por défi cit de atención con hiperactividad según la semiología de los errores

Aim: To characterize, compare and classify the performance of students with attention deficit-hyperactivity disorder (ADHD) according to the semiology of errors and to describe the neuroimaging findings in these students. Methods: We evaluated 36 primary school boys and girls aged between 8 and 11 years old in the 3 rd to 5 th grades. The children were divided in two groups. Group I consisted of 18 students with an interdisciplinary diagnosis of ADHD (60% boys and 40% girls). Group II consisted of 18 children with good academic performance, paired by gender, age and grade with children in group I. The collective and individual versions of the Pro-ortografia spelling tests were applied. Results: Statistically significant differences were found in almost all the tests of the individual and collective versions of the spelling evaluation, with children with ADHD showing a higher average number of errors. Neuroimaging examinations indicated that 81% of the students in GI showed hypoperfusion in the frontal lobe, 7% had hypoperfusion of the thalamus and basal ganglia, 6% showed hypoperfusion in the basal ganglia only and 6% showed hypoperfusion in the left and right frontal lobes. Conclusions: Children with ADHD demonstrated poorer knowledge of the use of spelling rules in Brazilian Portuguese, which could be related to changes in blood flow in the frontal lobe, parietal lobe, thalamus and basal ganglia. These changes could cause a lack of attention, affecting phonological working memory and the planning of writing. © 2011 AELFA.

Processamento auditivo comportamental e eletrofisiológico em crianças com Transtorno de Déficit de Atenção com Hiperatividade (TDAH)

Pós-graduação em Fonoaudiologia - FFC

A avaliação do pensamento lógico em pacientes com TDAH - Transtorno de Déficit de Atenção com ou sem hiperatividade

Pós-graduação em Pediatria - FMB

Avaliação neuropsicológica atencional de crianças com distúrbios do sono

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A criança hiperativa, a família, o discurso científico e a psicanálise

Pós-graduação em Psicologia - FCLAS

A vigilância punitiva: a postura dos educadores no processo de patologização e medicalização da infância

Pós-graduação em Psicologia - FCLAS

Qualidade de vida, avaliação cognitiva e comportamental de prematuros de muito baixo peso com idade entre cinco e oito anos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise molecular de pacientes com síndromes de Smith-Magenis

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Contribuições da análise do comportamento na avaliação e no tratamento de crianças com transtorno do déficit de atenção e hiperatividade

Transtorno do Déficit de Atenção e Hiperatividade (TDAH) é um fenômeno estudado em diversos países, composto de sintomas de desatenção, imperatividade e impulsividade, ocorre na infância podendo persistir até a idade adulta. Este transtorno causa prejuízos nas áreas acadêmicas, sociais e ocupacionais, reduz a auto-estima, pode evoluir para delinqüência, uso de drogas e álcool, gera estresse nas famílias, tem alto custo financeiro e impacto social. O diagnóstico é feito com base em critérios clínicos adotados pelo DSM IV e o tratamento indicado combina farmacoterapia e psicoterapia. Considerando-se que TDAH é um transtorno de desenvolvimento de autocontrole e que estudos sugerem que autocontrole pode ser adquirido em condições de treino, torna-se relevante a realização de pesquisas aplicadas utilizando princípios da análise do comportamento, para minimizar prejuízos e contribuir para melhoria de qualidade de vida de portadores de TDAH. Este estudo objetivou verificar a eficácia do uso de esquemas de reforçamento diferencial de outro comportamento (DRO) e de atraso de reforço na instalação e/ ou aumento de comportamentos de autocontrole em um menino de 9 anos diagnosticado com TDAH, que faz uso de medicamento. O participante foi exposto ao procedimento de treino de autocontrole, realizou tarefas, durante as quais, caso se comportasse como combinado, recebia reforço. Ao final de cada sessão, trocava os reforços por brinquedos e poderia escolher reservá-los para obter reforços de maior valor. O procedimento foi dividido em sete etapas: (1) entrevista com a neuropediatra; (2) análise do prontuário e convocação; (3) entrevista inicial com responsáveis; (4) visita à escola e entrevista com professores; (5) sessões de observação direta (linha de base, habituação às regras, instalação, manutenção, fading e avaliação da estabilidade); (6) followp-up; e (7) encerramento. Realizaram-se 18 sessões de observação direta, gravadas em vídeo e transcritas para a elaboração de um sistema de categorias de comportamentos para análise. Os resultados foram analisados por meio da comparação entre relatos de entrevistas, resultados de instrumentos padronizados e categorias de comportamentos observados. Identificou-se que os comportamentos de autocontrole do participante se ampliaram e generalizaram para outros contextos, durante as sessões e em domicílio, conforme os relatos dos pais e da professora da escola atual, e registro de observação direta da terapeuta-pesquisadora. Verificou-se que a utilização de esquema de reforçamento DRO com disponibilidade limitada pode favorecer o aumento de comportamentos de autocontrole e generalizações em crianças com TDAH.