Cristina Domínguez Martín

Introducción. La pandemia por COVID-19 ha motivado cambios en la sociedad, afectando a la salud mental de la población, particularmente en la infancia y adolescencia. Los menores con patología psiquiátrica previa pueden mostrar incrementos de su sintomatología (depresión, ansiedad o estrés) tanto durante el confinamiento como de forma persistente una vez concluido éste. Objetivo. Evaluar la sintomatología clínica y el impacto emocional en los menores que acuden a Hospital de día y en sus padres/cuidadores un año después de la finalización del confinamiento por COVID-19. Métodos: Se evaluó la sintomatología clínica (emocional y conductual) durante el confinamiento y/o un año después en 81 familias participantes. Se analizaron las diferencias clínicas entre ambos momentos temporales, en primer lugar, para dos grupos de menores y cuidadores independientes y, en segundo lugar, para un mismo grupo de menores y cuidadores evaluado en ambas ocasiones. Resultados. Los análisis longitudinales mostraron algunas tendencias de incrementos de la sintomatología en las dimensiones de depresión, ansiedad y de control afectivo y conductual en los menores. Sin embargo, estas diferencias significativas en ningún caso pasaron el corte de corrección por comparaciones múltiples. Sus familiares y cuidadores tampoco mostraron cambios significativos en la sintomatología evaluada entre ambos momentos temporales. Discusión: la sintomatología clínica de menores con patología psiquiátrica se ha mantenido un año después del fin del confinamiento por COVID-19. Se debería fomentar el seguimiento regular, una buena comunicación entre padres-hijos y un adecuado apoyo social sobre la díada menor-cuidador para favorecer un manejo emocional adecuado.

Introducción: El Trastorno del espectro autista (TEA) presenta una gran variabilidad clínica. Para conocer mejor esta variabilidad clínica se ha estudiado a nivel genético, neuroimagen y neuropsicológico, sin obtener resultados concluyentes que expliquen esta variabilidad. El estudio de diferentes fenotipos en base a medidas conductuales y cognitivas pretende estudiar las diferencias observadas en la presentación clínica entre los menores con trastorno del espectro autista. Objetivo: Determinar si existen fenotipos basados en el estudio de variables cognitivas y conductuales en pacientes diagnosticados de TEA. Material y métodos: Se evaluaron 56 pacientes menores con diagnóstico de TEA mediante diferentes pruebas psicométricas. Se estudiaron la flexibilidad cognitiva, estereotipias motoras, estereotipias sensoriales, intereses circunscritos, cambios mínimos en rutinas, juego imaginativo y creatividad. Mediante el análisis factorial de estas 7 variables se obtuvieron 3 factores para evaluar los subgrupos del estudio. Resultados: No se encontraron diferencias significativas en las distribuciones de diagnóstico clínico, según criterios DSM-IV-TR, en las diferentes variables. El análisis factorial de las 7 variables y de los 3 factores observaron diferencias en uno de los factores, el F3 que incluía la variable de creatividad y de flexibilidad cognitiva, en el subgrupo de autismo. Conclusiones: No se han encontrado fenotipos en el estudio de variables cognitivas y conductuales de la muestra. Las características estudiadas se ajustan a un modelo dimensional para el TEA. El subgrupo de autismo presenta menor flexibilidad cognitiva y creatividad que los otros subgrupos.

The analysis of the interaction between novelty and relevance may be of interest to test the aberrant salience hypothesis of schizophrenia (SCH). In comparison with other neuroimaging techniques, such as functional magnetic resonance imaging, electroencephalography (EEG) provides high temporal resolution. Therefore, EEG is useful to analyze transient dynamics in neural activity, even in the range of milliseconds. In this study, EEG activity from 31 patients with SCH and 38 controls was analyzed using Shannon spectral entropy (SE) and median frequency (MF). The aim of the study was to quantify differences between distractor (i.e., novelty) and target (i.e., novelty and relevance) tones in an auditory oddball paradigm. Healthy controls displayed a larger SE decrease in response to target stimulus than in response to distractor tones. SE decrease was accompanied by a significant and widespread reduction of MF (i.e., a significant slowing of EEG activity). In comparison with controls, patients showed a significant reduction of changes in SE in response to both target and distractor tones. These differences were also observed in patients that only received a minimal treatment prior to EEG recording. Furthermore, significant changes in SE were inversely correlated to positive and total symptoms severity for SCH patients. Our findings support the notion that SCH is associated with a reduced response to both novelty and relevance during an auditory P300 task.

Spectral entropy (SE), also known as Shannon entropy, is a useful parameter for quantifying the global regularity of the electroencephalographic (EEG) signal. Hence, it is of interest in the assessment of the electrophysiological correlates of cognitive processing in schizophrenia. However, to date, SE has been barely used in studies comparing resting EEG recordings between patients and controls. In this work, we compared SE between resting baseline [−250 0] ms and active task [150 550] ms windows of a P300 task in 31 patients with schizophrenia and 38 controls. Moreover, we also calculated the median frequency (MF) and relative power in each frequency band for these windows to assess the correlates of the possible SE differences. Controls showed a significant (p < 0.0029) SE decrease (i.e., meaning higher signal regularity) from baseline to the active task window at parietal and central electrode sites. This SE decrease from baseline to active conditions was significantly lower in patients. In controls, this SE decrease was accompanied by a statistically significant decrease in MF (i.e., a significant slowing of the EEG activity), not observed in patients. In this latter group, the difference in SE between resting baseline and active task windows was inversely correlated to positive and total symptoms scores, as measured with the positive and negative symptoms scale. Our data support the relevance of SE in the study of cerebral processing in schizophrenia.

Greater intra-subject variability (ISV) in response time is a heritable endophenotype of attention-deficit/hyperactivity disorder (ADHD). Spontaneous low frequency oscillations (LFO: 0.01–0.1 Hz) observed in brain functional magnetic resonance signals might account for such behavioral variability. Recently, we demonstrated that ISV in response time (RT) explained ratings of ADHD symptoms. Building on this finding, here we hypothesized that LFO in RT time series would explain these ratings, both independently and in addition to RT coefficient of variation (CV). To measure RT LFO, we applied Morlet wavelet transform to the previously collected RT data. Our community sample consisted of 98 children (including 66 boys, mean age 9.9 ± 1.4 years), who completed four computer Tasks of Executive Control. Conners’ Parent Rating Scale ratings were obtained. RT LFO of three tasks significantly explained ratings of inattention, hyperactivity and three global Conners’ subscales. In addition, RT LFO during two tasks that included an inhibitory component increased the proportions of variance explained in subscales of both inattention and hyperactivity/impulsivity, beyond the effects of RT-CV. Three specific low frequency bands (Slow-5: 0.01–0.027 Hz; Slow-4: 0.027–0.073 Hz; Slow-3: 0.073–0.20 Hz) were strongly related to the ADHD scales. We conclude that RT LFO predict dimensional ratings of ADHD symptoms both independently and in addition to RTCV. Results suggest that frequency analyses are a suitable methodology to link behavioral responses to putative underlying physiological processes.

ObjectiveTo evaluate the efficacy, safety, and tolerability of fixed-dose agomelatine 25 and 50 mg/d in the treatment of outpatients with obsesive-compulsive disorder (OCD) compared to placebo.MethodIn this 8-week, multicenter, double-blind, parallel-group trial, patients with DSM-IV-defined OCD were randomly assigned (1:1:1) to receive a once-daily dose of agomelatine 25 mg, agomelatine 50 mg, or placebo. The primary efficacy measure was the change from baseline to week 8 in the clinician-rated 17-item Hamilton Depression Rating Scale (HDRS(17)); other efficacy measures were The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression scale. The study was conducted between December 2009 and January 2010.ResultsAgomelatine 25 mg/d was more efficacious based on the HDRS(17) total score (P = .01) compared to placebo throughout the treatment period, whereas for agomelatine 50 mg/d, statistically significant reduction in HDRS(17) total score could be observed from weeks 2 to 6 but not at week 8 (P = .144). A higher proportion of patients receiving agomelatine 25 mg/d showed clinical response (P = .013), clinical remission (P = .07), and improvement according to the Clinical Global Impressions-Improvement scale (P = .065) compared to those receiving placebo. No statistically significant difference between patients receiving agomelatine 50 mg/d compared to placebo on clinical response. Both agomelatine doses were safe and well tolerated, although clinically notable aminotransferase elevations were observed transiently in the agomelatine 50 mg/d group.ConclusionsAgomelatine 50 mg/d provided evidence for its antidepressant efficacy until week 6 and was also safe and well tolerated.

Objective: Individuals with ADHD are often characterized as inconsistent across many contexts. ADHD is also associated with deficits in executive function. We examined the relationships between response time (RT) variability on five brief computer tasks to parents’ ratings of ADHD-related features and executive function in a group of children with a broad range of ADHD symptoms from none to full diagnosis. Methods: We tested 98 children (mean age 9.9 ± 1.4 years; 66 boys) from community clinics on short tasks of executive control (TEC) and the Eriksen Flanker task, while a parent completed the Conners’ Parent Rating Scale and Behavior Rating Inventory of Executive Function. Results: Variability for two of the TEC tasks explained significant proportions of the variance of all five ADHD-related Conners’ subscales and several executive function subscales. By contrast, variability on the flanker task or mean RTs for any task were not associated with any rating scale. Conclusion: The significant dimensional relationships observed between variability measures and parent ratings supported the utility of RT variability as an objective measure in ADHD and aspects of executive functioning that is superior to RT means or accuracy measures.