Resumo Introdução O ritmo biológico está associado ao nível de alerta, desempenho cognitivo e humor dos indivíduos. Sua regularidade é essencial para preservar uma boa saúde e qualidade de vida. Objetivo Apresentar as etapas de construção da escala intitulada Biological Rhythm Interview of Assessment in Neuropsychiatry – Kids (BRIAN-K), criada para medir disrupturas do ritmo biológico em crianças e adolescentes brasileiros. Métodos Os itens foram desenvolvidos seguindo a versão adulta da escala. A análise das características psicométricas da escala se baseou nas respostas de 373 pais/cuidadores de crianças em idade escolar (7 e 8 anos). Resultados Um modelo teórico de 17 itens, com o objetivo de avaliar quatro domínios do ritmo biológico (sono, atividades, ritmo social e padrão alimentar) foi determinado usando análise fatorial exploratória (AFE) e pela identificação de um fator geral. As propriedades psicométricas da BRIAN-K mostraram-se satisfatórias. Conclusão Apenas dois itens precisaram ser reescritos. São necessários mais estudos para investigar a adequação do instrumento a diferentes faixas etárias e evidências adicionais de validade e confiabilidade.

Abstract Introduction Biological rhythm is associated with the level of alertness, cognitive performance and mood of the individuals. Its regularity is essential to preserve good health and quality of life. Objective To present the steps for the construction of the scale entitled Biological Rhythm Interview of Assessment in Neuropsychiatry – Kids (BRIAN-K), designed to measure biological rhythm disruptions in Brazilian children and adolescents. Methods Items were developed following the adult version of the scale. Analysis of the psychometric characteristics of the scale was based on the responses of 373 parents/caregivers of school age children (7 and 8 years old). Results A theoretical model of 17 items with the purpose of evaluating four domains (sleep, activities, social rhythm and eating pattern) was determined using exploratory factor analysis (EFA) and via identification of a general factor. The psychometric properties of the BRIAN-K showed favorable properties. Conclusion Only two items needed to be rewritten. Further studies are needed to investigate the instrument's adequacy to different age groups and additional evidence of validity and reliability.

Objective: To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents, including the treatment of bipolar depression and comorbid attention deficit/hyperactivity disorder (ADHD). Methods: Narrative review of randomized clinical trials and open-label studies published from 2000 to 2012. The PubMed and PsycINFO websites were queried. Case series were included when a higher level of evidence was not available. Results: Published data from randomized controlled trials (RCTs) in acute mania/hypomania with significant responses are available for lithium, topiramate, risperidone, olanzapine, and aripiprazole. Open trials of lithium and lamotrigine show that these drugs may be effective in the treatment of depressive episodes. No trials of selective serotonin reuptake inhibitors (SSRIs) have been conducted. In the treatment of comorbid ADHD, there are encouraging findings with mixed amphetamine salts and atomoxetine; conflicting results are observed with methylphenidate. Conclusions: Published RCTs of traditional mood stabilizers are scarce, but the best available evidence (results from meta-analytic regression) suggests that second-generation antipsychotics (SGAs) as a group are more effective in reducing manic symptoms. Risperidone was the only one included in head-to-head comparisons (vs. lithium and divalproex), showing superiority in terms of efficacy, but with more metabolic side effects, which were also more common in most of the SGAs. There are few studies addressing the treatment of ADHD and depression. Brazilian guidelines for the treatment of pediatric bipolar disorder should also include some SGAs (especially risperidone and aripiprazole) as first-line treatment, and these drugs should be provided by the public health services.

O Stressful Life Events Schedule (SLES) é um instrumento que visa investigar a presença e o impacto de eventos de vida estressantes (EVE) ocorridos nos últimos 12 meses. O objetivo deste trabalho é traduzir e adaptar por equivalência semântica os itens da escala para a língua portuguesa. Seis etapas foram realizadas: (1) Tradução; (2) Retrotradução; (3) Revisão técnica e adaptação semântica; (4) Avaliação e validação do conteúdo e do significado geral considerando o contexto da população; (5) Realização de uma medida de confiabilidade em relação ao construto dependência/independência dos EVE; e (6) Produção da versão final do instrumento. O tempo verbal se manteve na maioria dos itens da escala. Algumas alterações foram necessárias como um acréscimo da variação de alguns termos. A versão adaptada demonstrou ser de fácil aplicação, não tendo sido avaliada como extensa e contemplando um número considerável de EVE.

The Stressful Life Events Schedule (SLES) is an instrument to investigate the presence and impact of stressful life events (SLE) occurred during the latest 12 months. The aim of this study is to translate and adapt, through semantic equivalence, the items from the instrument to the Portuguese language. The process had six steps: (1) Translation; (2) Backtranslation; (3) Technical review and semantic adaptation; (4) Assessment and content validation and overall meaning, considering the context of the population; (5) A measure of reliability was conducted in relation to the dependence/ independence construct; and (6) Production of the final version of the instrument. The verbal conjugation was maintained in most of the scale's items. Some changes were required, such as an addition of the variation of some terms. The adapted version proved to be of easy application, not too extensive and contemplating a considerable number of SLE.

El Stressful Life Events Schedule (SLES) es una escala que objetiva investigar la presencia y el impacto de los acontecimientos vitales estresantes (EVE) en los últimos 12 meses. El objetivo del presente estudio es traducir y adaptar por equivalencia semántica los ítems de la escala para la lengua portuguesa. Las seis etapas realizadas fueron: (1) traducción y (2) retraducción, (3) revisión técnica y adaptación semántica, (4) evaluación y validación del contenido y del significado general teniendo en cuenta el contexto de la población, (5) realización de una medida de fiabilidad para el constructo dependencia / independencia de los EVE, y (6) producción de la versión final del instrumento. El tiempo verbal se mantuvo en la mayoría de los ítems de la escala. Algunas modificaciones fueran necesarias, tales como el aumento de la variación de algunos términos. La versión adaptada se mostró de fácil aplicación, no evaluada como extensa y contemplando un número considerable de EVE.

OBJECTIVES: To assess the role of the Val66Met polymorphism at the brain-derived neurotrophic factor (BDNF) gene on the performance of children and adolescents with bipolar disorder [juvenile bipolar disorder (JBD)] on the Wisconsin Card Sorting Test (WCST). METHODS: Children and adolescents were assessed by the K-SADS-PL and a clinical evaluation for BD and comorbid conditions. Manic and depressive symptoms were assessed with the Young Mania Rating Scale and the Children Depression Rating Scale - Reviewed. The Val66Met polymorphism at the BDNF was genotyped from a blood sample. Patients' IQ and executive functions were assessed by a standard cognitive flexibility test (WCST). RESULTS: Fifty-three subjects were included in the study. No significant difference was observed between the Val/Val and Val/Met+Met/Met groups on any WCST scores in the MANCOVA (F48,5 = .76; p = .59; Perseverative Errors, p = .66; Nonperseverative Errors, p = .58; Categories Completed, p = .34; Attempts to Reach First Category, p=.64; and Percentage of Conceptual Level Responses, p = .99). CONCLUSIONS: Our findings from this sample of children and adolescents with BD do not replicate results from studies of adults and suggest the existence of differences in the neurobiology of this disorder across the life cycle. Investigations of larger samples are necessary to confirm these data.

The identification and treatment of mood disorders in children and adolescents has grown over the last decades. Major depression is one of the most common and debilitating disorders worldwide, imposing a massive burden to the youth population. Bipolar disorder is being increasingly recognized as having its roots early in life, and its presentation during childhood and adolescence has been submitted to extensive research. This review aims to highlight clinical aspects of the current knowledge on mood disorders in the pediatric population, presenting updated information on epidemiology, diagnostic procedures, and management strategies. Limitations of available evidence and future directions of research in the field are also discussed.

OBJETIVOS: Demonstrar a eficácia de uma intervenção psicoterápica em grupo (grupo operativo de reflexão) onde pais e bebês são atendidos concomitantemente. METODOLOGIA: Através do relato de caso de uma menina com quadro de crises de agressividade, são discutidos aspectos da intervenção psicoterápica. RESULTADOS: Houve resolução dos sintomas, e aspectos saudáveis da interação mãe-bebê foram restabelecidos. DISCUSSÃO: No caso apresentado, o grupo operativo de reflexão foi fundamental para a melhora dos problemas apresentados por uma dupla mãe-bebê, auxiliando a mãe e o bebê a modificar aspectos disfuncionais na sua interação. CONCLUSÕES: Apesar dos bons resultados para essa família, mais estudos são necessários para avaliar o efeito do grupo operativo de reflexão.

OBJECTIVES: To demonstrate the efficacy of a psychotherapeutic group intervention (reflective operational group), in which parents and infants are seen concomitantly. METHODS: In a case report of a female infant who presented aggressiveness, aspects of the psychotherapeutic intervention are discussed. RESULTS: There was resolution of symptoms, and healthy aspects of the mother-infant interaction were reestablished. DISCUSSION: In the reported case, the reflective operational group was fundamental to symptom improvement presented by a mother-infant dyad, helping the mother and the baby change dysfunctional aspects of their interaction. CONCLUSIONS: In spite of the good results for this family, further studies are needed to assess the efficacy of the reflective operational group.

OBJETIVOS: Avaliar a presença de história de comportamento inibido e de transtornos de ansiedade na infância em pacientes brasileiros adultos com transtorno do pânico e com transtorno de ansiedade social, comparando-os com um grupo controle. MÉTODOS: Cinqüenta pacientes com transtorno do pânico, 50 com transtorno de ansiedade social e 50 controles participaram do estudo. Para avaliar a presença de história de ansiedade na infância foi utilizada a Escala para Avaliação de Transtornos Afetivos e Esquizofrenia para Crianças em Idade Escolar - Versão Epidemiológica (K-SADS-E) e o Diagnostic Interview for Children and Adolescents-Parent Version (DICA-P). A presença de comportamento inibido na infância foi avaliada através da Escala Auto-Aplicativa de Comportamento Inibido - Versão Retrospectiva (RSRI-30). RESULTADOS: Os pacientes apresentavam uma prevalência significativamente maior de história de transtornos de ansiedade e de comportamento inibido em relação ao grupo controle. Pacientes com transtorno de ansiedade social apresentavam, também, taxas significativamente maiores de transtorno de evitação (46% x 18%, p = 0,005), transtorno de ansiedade social (60% x 26%, p = 0,001), presença de pelo menos um transtorno de ansiedade na infância (82% X 56%, p = 0,009), comportamento inibido global (2,89 ± 0,61 vs. 2,46 ± 0,61, p < 0,05) e comportamento inibido escola/social (3,56 ± 0,91 vs. 2,67 ± 0,82, p < 0.05) na infância em comparação com pacientes com transtorno do pânico. CONCLUSÃO: Nossos dados são similares aos encontrados na literatura e corroboram a teoria da diátese de ansiedade, sugerindo que a história de transtornos de ansiedade na infância é associada com transtornos de ansiedade, principalmente transtorno de ansiedade social, na vida adulta.

PURPOSE: To evaluate the presence of behavioral inhibition and anxiety disorders during childhood in Brazilian adult patients with panic disorder and social anxiety disorder compared to a control group. METHODS: Fifty patients with panic disorder, 50 patients with social anxiety disorder, and 50 control subjects were included in the study. To assess the history of childhood anxiety, the Schedule for Affective Disorders and Schizophrenia for School Age Children, Epidemiologic Version (K-SADS-E), and the Diagnostic Interview for Children and Adolescents-Parent Version (DICA-P) were used. The presence of behavioral inhibition in childhood was assessed by the self-reported scale of Behavioral Inhibition Retrospective Version (RSRI-30). RESULTS: Patients showed significantly higher prevalence of anxiety disorders and behavioral inhibition in childhood compared to the control group. Patients with social anxiety disorder also showed significantly higher rates of avoidance disorder (46% vs. 18%, p = 0.005), social anxiety disorder (60% vs. 26%, p = 0.001), presence of at least one anxiety disorder (82% vs. 56%, p = 0.009) and global behavioral inhibition (2.89 ± 0.61 vs. 2.46 ± 0.61, p < 0.05) and school/social behavioral inhibition (3.56 ± 0.91 vs. 2.67 ± 0.82, p < 0.05) in childhood compared to patients with panic disorder. CONCLUSION: Our data are in accordance to the literature and corroborates the theory of an anxiety diathesis, suggesting that a history of anxiety disorders in childhood is associated with an anxiety disorder diagnosis, mainly social anxiety disorder, in adulthood.