The RBP's mission in the continuing medical education

Universidade de São Paulo Departamento de PsiquiatriaDuke University Departamento de Psicologia e NeurociênciaUniversidade Federal doRio de Janeiro Instituto dePsiquiatria Departamento de Psiquiatria e Medicina LegalUniversidade de São Paulo Faculdade de Medicina Instituto de PsiquiatriaUniversidade Federal do Rio Grande do Sul Departamento de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUNIFESP, Depto. de PsiquiatriaSciEL

Irritability in children and adolescents:past concepts, current debates, and future opportunities

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.</p

Is It Worthy to Take Account of the “Guessing” in the Performance of the Raven Test? Calling for the Principle of Parsimony for Test Validation

The present study compares the fit of two- and three-parameter logistic (2PL and 3PL) models of item response theory in the performance of preschool children on the Raven’s Colored Progressive Matrices. The test of Raven is widely used for evaluating nonverbal intelligence of factor g. Studies comparing models with real data are scarce on the literature and this is the first to compare models of two and three parameters for the test of Raven, evaluating the informational gain of considering guessing probability. Participants were 582 Brazilian’s preschool children (Mage = 57 months; SD = 7 months; 46% female) who responded individually to the instrument. The model fit indices suggested that the 2PL fit better to the data. The difficulty and ability parameters were similar between the models, with almost perfect correlations. Differences were observed in terms of discrimination and test information. The principle of parsimony must be called for comparing models

Young adult mental health and functional outcomes among individuals with remitted, persistent and late-onset ADHD

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with mental health problems and functional impairment across many domains. However, how the longitudinal course of ADHD affects later functioning remains unclear. Aims: To disentangle how ADHD developmental patterns are associated with young adult functioning.Methods: The Environmental Risk (E-Risk) Longitudinal Twin Study is a population-based cohort of 2,232 twins born in England and Wales in 1994-1995. We assessed ADHD in childhood at ages 5, 7, 10, and 12 and in young adulthood at age 18. We examined three developmental patterns of ADHD from childhood to young adulthood— remitted, persistent, and late–onset ADHD— and compared these groups to one another and to non-ADHD controls on age-18 functioning. We additionally tested whether group differences were due to childhood IQ, childhood conduct disorder, or familial factors shared between twins. Results: Compared to individuals without ADHD, those with remitted ADHD showed poorer physical health and socioeconomic outcomes in young adulthood. Individuals with persistent or late-onset ADHD showed poorer functioning across all domains including mental health, substance use, psychosocial, physical health, and socioeconomic outcomes. Overall, these associations were not explained by childhood IQ, childhood conduct disorder or shared familial factors.Conclusions: Long-term associations of childhood ADHD with adverse physical health and socioeconomic outcomes underscore the need for early intervention. Young adult ADHD showed stronger associations with poorer mental health, substance use, and psychosocial outcomes, emphasizing the importance of identifying and treating adults with ADHD

Evaluation of the Persistence, Remission, and Emergence of Attention-Deficit/Hyperactivity Disorder in Young Adulthood

Importance  Attention-deficit/hyperactivity disorder (ADHD) is now recognized to occur in adulthood and is associated with a range of negative outcomes. However, less is known about the prospective course of ADHD into adulthood, the risk factors for its persistence, and the possibility of its emergence in young adulthood in nonclinical populations.Objective  To investigate childhood risk factors and young adult functioning of individuals with persistent, remitted, and late-onset young adult ADHD.Design, Setting, and Participants  The study sample was the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of 2232 twins born in England and Wales from January 1, 1994, to December 4, 1995. Evaluation of childhood ADHD (ages 5, 7, 10, and 12 years) included prenatal and perinatal factors, clinical characteristics, and aspects of the family environment. Among participants aged 18 years, ADHD symptoms and associated impairment, overall functioning, and other mental health disorders were examined. Data analysis was conducted from February 19 to September 10, 2015.Main Outcomes and Measures  Attention-deficit/hyperactivity disorder according to DSM-IV diagnostic criteria in childhood and DSM-5 diagnostic criteria in young adulthood.Results  Of 2232 participants in the E-Risk Study, 2040 were included in the present analysis. In total, 247 individuals met diagnostic criteria for childhood ADHD; of these, 54 (21.9%) also met diagnostic criteria for the disorder at age 18 years. Persistence was associated with more symptoms (odds ratio [OR], 1.11 [95% CI, 1.04-1.19]) and lower IQ (OR, 0.98 [95% CI, 0.95-1.00]). At age 18 years, individuals with persistent ADHD had more functional impairment (school/work: OR, 3.30 [95% CI, 2.18-5.00], home/with friends: OR, 6.26 [95% CI, 3.07-12.76]), generalized anxiety disorder (OR, 5.19 [95% CI, 2.01-13.38]), conduct disorder (OR, 2.03 [95% CI, 1.03-3.99]), and marijuana dependence (OR, 2.88 [95% CI, 1.07-7.71]) compared with those whose ADHD remitted. Among 166 individuals with adult ADHD, 112 (67.5%) did not meet criteria for ADHD at any assessment in childhood. Results from logistic regressions indicated that individuals with late-onset ADHD showed fewer externalizing problems (OR, 0.93 [95% CI, 0.91-0.96]) and higher IQ (OR, 1.04 [95% CI, 1.02-1.07]) in childhood compared with the persistent group. However, at age 18 years, those with late-onset ADHD demonstrated comparable ADHD symptoms and impairment as well as similarly elevated rates of mental health disorders.Conclusions and Relevance  We identified heterogeneity in the DSM-5 young adult ADHD population such that this group consisted of a large, late-onset ADHD group with no childhood diagnosis, and a smaller group with persistent ADHD. The extent to which childhood-onset and late-onset adult ADHD may reflect different causes has implications for genetic studies and treatment of ADHD.</p