Evaluación de la expresión emocional en pacientes diagnosticados de TDAH y en tratamiento con metilfenidato
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2015-03-27
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Rodríguez Lorenzo, T., Monzón Díaz, J., Rubio Morell, B., Girbau-Ronda, J., & Gracia Marco, R. (2015). Evaluación de la expresión emocional en pacientes diagnosticados de TDAH y en tratamiento con metilfenidato. Revista De Psiquiatría Infanto-Juvenil, 32(1), 31–48. Recuperado a partir de https://aepnya.eu/index.php/revistaaepnya/article/view/112
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Palabras clave:
TDAH, expresión emocional, metilfenidatoResumen
Introducción: Aunque la investigación y la experiencia clínica han demostrado que los estimulantes son fármacos eficaces para el tratamiento básico de los síntomas del TDAH, un comúnmente descrito, aunque en gran medida poco estudiado efecto secundario de este tipo de fármacos es el efecto sobre la expresión emocional de los pacientes.
Objetivos: El objetivo de esta investigación es evaluar el impacto del tratamiento farmacológico con Metilfenidato en la expresión afectiva de niños diagnosticados de TDAH.
Material y métodos: Se trata de un estudio descriptivo de series de casos, unicéntrico, de grupo único, donde “n” serán 15 niños diagnosticados de TDAH en el Complejo Hospitalario Universitario de Canarias, que requieran comenzar tratamiento farmacológico con metilfenidato (MPH), con una dosis diaria de al menos de 0,3mg/Kg. Se evaluará, en dicha población, la expresión emocional, por medio de la Escala Infantil de Expresión Emocional (EESC), realizando una comparación entre el momento previo al tratamiento y un mes posterior al comienzo del mismo.
Resultados: La evaluación de la puntuación total de la EESC efectuada por los padres, no mostró diferencias estadísticamente significativas entre el momento previo al tratamiento y tras un mes con el mismo. Los dominios (emociones positivas, aplanamiento emocional y labilidad emocional) tampoco mostraron diferencias entre ambos períodos de tiempo, sin embargo, las emociones positivas mostraron una tendencia al descenso más llamativa que el resto, sin llegar a ser estadísticamente significativo (p=0.0638).
Conclusión: No se han encontrado cambios estadísticamente significativos en la expresión emocional de los niños causada por el tratamiento con metilfenidato. Sin embargo, los datos muestran que existe inclinación hacia a una mejoría en la misma.
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31. Faraone SV, Biederman J, Spencer TJ, Aleardi M. Comparing the efficacy of medications for ADHD using meta-analysis. Med Gen Med 2006; 8 (4): 4.
32. Hosenbocus S, Chahal R. A review of executive function deficits and pharmacological management in children and adolescents. J Can Acad Child Adolesc Psychiatry 2012; 21 (3): 223-9.
33. Castells X, Ramos-Quiroga JA, Rigau D, Bosch R, Nogueira M, Vidal X, Casas M. Efficacy of Methylphenidate for Adults with Attention-Deficit Hyperactivity Disorder. CNS Drugs 2011; 25:157-169
34. American Academy of Child and Adolescent Psychiatry. Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. JAACAP 2002; 41, 26S-49S
35. Kratochvil CJ, Vaughan BS, Harrington MJ, Burke WJ. Atomoxetine: A selective nonadrenaline reuptake inhibitor for the treatment of attentiondeficit/hyperactivity disorder. Expert Opinion on Pharmacotherapy 2003; 4, 1165-1174
36. Doherty SL, Frankenberger W, Fuhrer R. Children’s self-reported effects of stimulant medication. Int J Dis Dev Educ 2000; 47, 39-54
37. Kratochvil CJ, Faries D, Vaughan B, Perwien A, Busner J, Saylor K, Kaplan S, Buermeyer C, Swindle R. Emotional Expression During Attention-Deficit/Hyperactivity Disorders Treatment: Initial Assessment of Treatment Effects. J Child Adolesc Psychopharmacol 2007; 17 (1): 51-62.
38. Buhrmester D, Whalen CK, Henker B, MacDonald V, Hinshaw SP. Prosocial behavior in hyperactive boys: Effects of stimulant medication and comparison with normal boys. J Abnorm Child Psychol 1992; 20, 103-121.
39. Granger DA, Whalen CK, Henker B. Perceptions of methylphenidate effects on hyperactive children’s peer interactions. Journal of Abnormal Child Psychology 1993; 21, 535-549.
40. Whalen CK, Henker B, Granger DA: Ratings of medication effects in hyperactive children: Viable or vulnerable? Behav Assess 1989; 11:179–199.
41. Penza-Clyve, S, Zeman, J, (2002) Initial Validation Of The Emotion Expression Scale For Chilren (EESC), J Clin Child Adolesc Psychol 2002; 31 (4): 540-547.
42. Perwien AR, Kratochvil CJ, Faries D, Vaughan B, Busner J, Saylor KE, Buermeyer CM, Kaplan S, Swindle R. Emotional Expression In Children Treated With ADHD Medication: development of a new measure. J Atten Disord 2008; 11: 568-79.
43. Schacht A, Bürger A, Wehmeier PM, Huss M. Evaluation of Patient- and Parent-Rated Emotional Expression Using the Expression and Emotion Scale for Children (EESC) in an Observational Study of ADHD in Children and Adolescents. The Open Psychiatry Journal 2012; (6):1-12
44. Criado-Alvarez J.J., Romo-Barrientos C. Variabilidad y tendencias en el consumo de metilfenidato en España. Estimación de la prevalencia del trastorno por déficit de atención con hiperactividad. Rev Neurol 2003; 37 (9): 806-810
45. Katic A, Ginsberg L, Jain R, Adeyi B, Dirks B, Babcock T, Scheckner B, Richards C, Lasser R, Turgay A, Findling RL. Clinically relevant changes in emotional expression in children with ADHD treated with lisdexamfetamine dimesylate. J Att Disord 2012; 16 (5): 384-97.
46. Carlson GA, Kelly KL. Stimulant rebound: How common is it and what does it mean? J Child Adolesc Psychopharmacol 2003; 13, 137-142.
47. Swanson JM, Wigal S, Greenhill LL, Browne R, Waslik B, Lerner M, Cantwell DP. Analog classroom assessment of Adderall in children with ADHD. JAACAP 1998; 37, 519-526.
2. Kessler RC et al. Patterns and Predictors of Attention-De?cit/Hyperactivity Disorder Persistence into Adulthood: Results from the National Comorbidity Survey Replication. Biol Psychiatry 2005, 57: 1442-1451.
3. American Psychiatric Association. DSM-IV TR Manual diagnóstico y estadístico de los trastornos mentales-IV. Barcelona: Masson; 2001
4. Barkley RA. Attention deficit hyperactivity disorders: A handbook for diagnosis and treatment. 2 ed. New York: Guilford Press; 1998.
5. Hechtman L. Assessment and diagnosis of attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 2000; 9: 481-98
6. Matza LS, Rentz AM, Secnik K, et al. The link between health related quality of life and clinical symptoms among children with attention-deficit hyperactivity disorder. J Dev Behav Pediatr 2004; 25: 166-74.
7. McClure A, Prasad S, Poole L, et al. Functional outcomes of children with attention deficit hyperactivity disorder in the UK. Arch Dis Child 2005; 90(Suppl II): A48-A50
8. Riley AW, Spiel G, Coghill D. ADORE Study Group. Factors related to health-related quality of life (HRQoL) among children with ADHD in Europe at entry into treatment. Eur Child Adolesc Psychiatry 2006; 15: i38-i45.
9. Albert J, López-Martín S, Fernández-Jaén A, Carretié L. Alteraciones emocionales en el trastorno por déficit de atención/hiperactividad: datos existentes y cuestiones abiertas. Rev Neurol 2008; 47 (1): 39-45
10. Faraone SV and Mick E. Molecular genetics of attention deficit hyperactivity disorder. Psychiatr Clin North Am 2010, 33: 159-180.
11. Gizer IR et al. Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 2009, 126: 51-90.
12. Banerjee TD et al. Environmental risk factors for attention-deficit hyperactivity disorder. Acta Pediatr 2007, 96: 1269-1272.
13. Swanson JM et al. Etiologic subtypes of attentiondeficit/hyperactivity disorder: brain imaging, molecular genetic and environmental factors and the dopamine hypothesis. Neuropsychol Rev 2007, 17: 39-59.
14. Shaywitz BA, Klopper JH, Gordon JW. Methylphenidate in 6-hydroxydopamine-treated developing rat pups. Effects on activity and maze performance. Arch Neurol 1978; 35 (7): 463-9.
15. Arnsten AF. Fundamentals of attention-deficit/hyperactivity disorder: circuits and pathways. J Clin Psychiatry 2006; 67 Suppl 8: 7-12.
16. Biederman J, Gao H, Rogers AK, Spencer TJ. Comparison of parent and teacher reports of attention-deficit/hyperactivity disorder symptoms from two placebo-controlled studies of atomoxetine in children. Biol Psychiatry 2006; 60 (10): 1106-10
17. National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people and adults. Great Britain: The British Psychological Society and The Royal College of Psychiatrist; 2009.
18. Rappley MD. Clinical practice. Attention deficithyperactivity disorder.N Engl J Med 2005, 352: 165-173.
19. Willcutt EG and Pennington BF. Comorbidity of reading disability and attention-deficit/ hyperactivity disorder: differences by gender and subtype. J Learn Disabil 2000, 33: 179-191.
20. Dalsgaard S et al. Conduct problems, gender and adult psychiatric outcome of children with attention-deficit hyperactivity disorder. Br J Psychiatry 2002, 181: 416-421.
21. Biederman J. Impact of comorbidity in adults with attention-deficit/hyperactivity disorder. J Clin Psychiatry 2004, 65 (Suppl 3): 3-7.
22. Castellanos FX et al. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. JAMA 2002, 288: 1740-1748.
23. Valera EM et al. Meta-analysis of structural imaging findings in attention-deficit/hyperactivity disorder. Biol Psychiatry 2007, 61: 1361-1369.
24. Faraone et al. Molecular genetics of attentiondeficit/ hyperactivity disorder. Biol Psychiatry 2005, 57: 1313-1323.
25. Bedard AC et al. Dopamine transporter gene variation modulates activation of striatum in youth with ADHD. Neuroimagen 2010, 53: 935-942.
26. Jensen PS, Hinshaw SP, Swanson JM, et al. Findings from the NIMH multimodal treatment study of ADHD (MTA): implications and applications for primary care providers. J Dev Behav Pediatr 2001; 22: 60-73.
27. Castells X, Ramos-Quiroga JA, Escuder G, Bosch R, Casas M (2004). Los fármacos estimulantes en el tratamiento del TDAH. En: Tomás J, Casas M. TDAH: Hiperactividad. Niñosmovidos e inquietos.Barcelona: Laertes, p. 278-95
28. American Academy of Pediatrics Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder. Clinical practice guideline: Treatment of the school-age child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108, 1033-1044.
29. Conners, C. K., March, J. S., Frances, A., Wells, K. C., & Ross, R. Treatment of attentiondeficit/hyperactivity disorder: Expert consensus guidelines. Journal of Attention Disorders 2001; 4: S7-S34
30. Greenhill, L., Pliszka, S., Dulcan, M. K., Bernet, W., Arnold, V., Beitchman, J., et al. Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults.
JAACAP 2002; 41: 26S-49S
31. Faraone SV, Biederman J, Spencer TJ, Aleardi M. Comparing the efficacy of medications for ADHD using meta-analysis. Med Gen Med 2006; 8 (4): 4.
32. Hosenbocus S, Chahal R. A review of executive function deficits and pharmacological management in children and adolescents. J Can Acad Child Adolesc Psychiatry 2012; 21 (3): 223-9.
33. Castells X, Ramos-Quiroga JA, Rigau D, Bosch R, Nogueira M, Vidal X, Casas M. Efficacy of Methylphenidate for Adults with Attention-Deficit Hyperactivity Disorder. CNS Drugs 2011; 25:157-169
34. American Academy of Child and Adolescent Psychiatry. Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. JAACAP 2002; 41, 26S-49S
35. Kratochvil CJ, Vaughan BS, Harrington MJ, Burke WJ. Atomoxetine: A selective nonadrenaline reuptake inhibitor for the treatment of attentiondeficit/hyperactivity disorder. Expert Opinion on Pharmacotherapy 2003; 4, 1165-1174
36. Doherty SL, Frankenberger W, Fuhrer R. Children’s self-reported effects of stimulant medication. Int J Dis Dev Educ 2000; 47, 39-54
37. Kratochvil CJ, Faries D, Vaughan B, Perwien A, Busner J, Saylor K, Kaplan S, Buermeyer C, Swindle R. Emotional Expression During Attention-Deficit/Hyperactivity Disorders Treatment: Initial Assessment of Treatment Effects. J Child Adolesc Psychopharmacol 2007; 17 (1): 51-62.
38. Buhrmester D, Whalen CK, Henker B, MacDonald V, Hinshaw SP. Prosocial behavior in hyperactive boys: Effects of stimulant medication and comparison with normal boys. J Abnorm Child Psychol 1992; 20, 103-121.
39. Granger DA, Whalen CK, Henker B. Perceptions of methylphenidate effects on hyperactive children’s peer interactions. Journal of Abnormal Child Psychology 1993; 21, 535-549.
40. Whalen CK, Henker B, Granger DA: Ratings of medication effects in hyperactive children: Viable or vulnerable? Behav Assess 1989; 11:179–199.
41. Penza-Clyve, S, Zeman, J, (2002) Initial Validation Of The Emotion Expression Scale For Chilren (EESC), J Clin Child Adolesc Psychol 2002; 31 (4): 540-547.
42. Perwien AR, Kratochvil CJ, Faries D, Vaughan B, Busner J, Saylor KE, Buermeyer CM, Kaplan S, Swindle R. Emotional Expression In Children Treated With ADHD Medication: development of a new measure. J Atten Disord 2008; 11: 568-79.
43. Schacht A, Bürger A, Wehmeier PM, Huss M. Evaluation of Patient- and Parent-Rated Emotional Expression Using the Expression and Emotion Scale for Children (EESC) in an Observational Study of ADHD in Children and Adolescents. The Open Psychiatry Journal 2012; (6):1-12
44. Criado-Alvarez J.J., Romo-Barrientos C. Variabilidad y tendencias en el consumo de metilfenidato en España. Estimación de la prevalencia del trastorno por déficit de atención con hiperactividad. Rev Neurol 2003; 37 (9): 806-810
45. Katic A, Ginsberg L, Jain R, Adeyi B, Dirks B, Babcock T, Scheckner B, Richards C, Lasser R, Turgay A, Findling RL. Clinically relevant changes in emotional expression in children with ADHD treated with lisdexamfetamine dimesylate. J Att Disord 2012; 16 (5): 384-97.
46. Carlson GA, Kelly KL. Stimulant rebound: How common is it and what does it mean? J Child Adolesc Psychopharmacol 2003; 13, 137-142.
47. Swanson JM, Wigal S, Greenhill LL, Browne R, Waslik B, Lerner M, Cantwell DP. Analog classroom assessment of Adderall in children with ADHD. JAACAP 1998; 37, 519-526.
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