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Tratamiento TOC trastorno obsesivo compulsivo niños y adolescentes

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Trastorno Obsesivo Compulsivo en Niños y Adolescentes Causas, Sintomas, Medicaciones, Manejo Terapia Cognitivo Conductual
Dra. Marle Duque, Residente de Psiquiatría de la Universidad de Antioquia (Colombia).
Revision por residente de psiquiatría sobre Trastorno Obsesivo Compulsivo en Niños y Adolescentes, desarrollada durante la rotacion de psiquiatría infantil en la UdeA.

Published in: Education, Health & Medicine
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Tratamiento TOC trastorno obsesivo compulsivo niños y adolescentes

  1. 1. INTERVENCIÓN TERAPÉUTICA EN EL TRASTORNO OBSESIVO COMPULSIVO EN NIÑOS Y ADOLESCENTES Dra. Marle Duque, Residente de Psiquiatría Universidad de Antioquia (Colombia).
  2. 2. Agenda <ul><li>Algunas generalidades </li></ul><ul><li>Aspectos etiológicos relevantes </li></ul><ul><li>Farmacoterapia </li></ul><ul><li>Terapia Cognitivo Conductual </li></ul><ul><li>Consideraciones especiales y a largo plazo </li></ul>
  3. 3. Importancia <ul><li>Entre la mitad y un tercio de los pacientes adultos iniciaron los síntomas en la infancia con un promedio de inicio a los 13 años de edad (7-18 años) y la gran mayoría sin intervención ni diagnóstico en la niñez </li></ul><ul><li>La prevalencia del TOC en niños está entre el 1% y el 4%, con una proporción de 3 hombres por cada 2 mujeres </li></ul>Behaviour Research and Therapy 45 (2007) 2593–2603 Child Adolesc Psychiatric Clin N Am 20 (2011) 239–254
  4. 5. Aspectos Clínicos
  5. 6. Aspectos Clínicos <ul><li>RITUAL DEL TOC </li></ul><ul><li>Se acompaña de ansiedad </li></ul><ul><li>Su interrupción produce irritabilidad y agresividad </li></ul><ul><li>Tiene consecuencias negativas e interfiere con la vida cotidiana </li></ul><ul><li>Tiene como finalidad disminuir la ansiedad </li></ul><ul><li>Es percibido por los demás como algo patológico </li></ul><ul><li>Continúa en la adolescencia y adultez </li></ul><ul><li>Lavarse, Comprobar, Repetir, no contribuyen al aprendizaje y al desarrollo </li></ul><ul><li>Incapacitante, produce sufrimiento y contribuye al aislamiento social </li></ul><ul><li>RITUAL NORMAL PARA LA EDAD </li></ul><ul><li>Es agradable </li></ul><ul><li>Su interrupción se tolera bien </li></ul><ul><li>No interfiere en la vida cotidiana </li></ul><ul><li>Tiene como finalidad el disfrute </li></ul><ul><li>Es percibido por los demás como normal </li></ul><ul><li>Disminuye a partir de los 8 años </li></ul><ul><li>Contribuye al aprendizaje y al desarrollo del niño </li></ul><ul><li>No es incapacitante, produce placer, puede servir para jugar con otros niños </li></ul>Clinical Psychology Review 28 (2008) 118–130.
  6. 7. Aspectos Clínicos <ul><li>Apter y cols, en una muestra de 861 adolescentes reportaron: </li></ul><ul><li>la prevalencia como relativamente alta a lo largo de la vida de solamente síntomas obsesivos o compulsivos (SOC) </li></ul><ul><li>como imágenes intrusivas (6%) </li></ul><ul><li>pensamientos no placenteros (8%) </li></ul><ul><li>acumulación (29%) </li></ul><ul><li>acciones repetitivas (27%) </li></ul><ul><li>urgencia de repetición (30%) </li></ul><ul><li>rituales (34%) </li></ul><ul><li>orden (49%) y </li></ul><ul><li>limpieza exagerada (72%) </li></ul><ul><li>Hasta el 20% de los individuos con estos síntomas los consideraron absurdos, </li></ul><ul><li>sólo 8% reportó utilizar más de una hora al día en ellos </li></ul><ul><li>únicamente 3.5% los consideró como usualmente o siempre angustiantes. </li></ul>Behaviour Research and Therapy 45 (2007) 2593–2603.
  7. 8. Generalidades <ul><li>El TOC es un trastorno crónico, en una revision de 8 estudios (n=208), se reportó que 50% (23-70%) cumplían criterios en el seguimiento a 7 años (2-22 años). </li></ul><ul><li>La persistencia ha sido relacionada con una aparición temprana y larga duración del trastorno. </li></ul><ul><li>El diagnóstico de TOC es clínico </li></ul><ul><li>Escalas </li></ul><ul><li>Trastornos de Ansiedad versión para Padres y Niños </li></ul><ul><li>La Escala Yale Brown para niños (CY-BOCS) </li></ul><ul><li>El inventario obsesivo comulsivo de Florida de niños (C-FOCI) y </li></ul><ul><li>El inventario revisado Obsesivo – Compulsivo (OCI-R) </li></ul><ul><li>  </li></ul>Journal of Child Psychology and Psychiatry 49:5 (2008), pp 489–498 Paediatrics And Child Health 19:2. 2008.
  8. 9. Aspectos Etiológicos Biológicos <ul><li>Lesiones cerebrales focales </li></ul><ul><li>Genética. </li></ul><ul><li>Las secuelas autoinmunes generadas por infecciones. </li></ul><ul><li>Disfunción fronto – subcortical, específicamente en el circuito cortico –estriado – tálamo – cortical que integra el funcionamiento cognitivo y motor </li></ul><ul><li>Serotonina </li></ul>Behaviour Research and Therapy 45 (2007) 2593–2603 Neuroscience and Biobehavioral Reviews 33 (2009) 818–830
  9. 10. Aspectos Etiológicos Psicológicos Child Adolesc Psychiatric Clin N Am 20 (2011) 239–254. OBSESIONES Pensamientos, impulsos, imágenes recurrentes y persistentes ANSIEDAD/MALESTAR COMPULSIONES Condcutas o actos mentales repetitivos ALIVIO Temporal de la ansiedad Reforzamiento Negativo
  10. 11. GRACIAS
  11. 12. Mas información sobre psiquiatria infantil en: <ul><li>Canal de You Tube “Psiquiatriainfa” </li></ul><ul><li>Buscar por palabras claves otros temas: </li></ul><ul><ul><li>Autismo y Sindrome de Asperger </li></ul></ul><ul><ul><li>Ansiedad </li></ul></ul><ul><ul><li>Depresión </li></ul></ul><ul><ul><li>Sueño, Higiene, parasomnias </li></ul></ul><ul><ul><li>Estrés Postraumático </li></ul></ul><ul><ul><li>Trastorno por Déficit de Atención con Hiperactividad (TDAH) </li></ul></ul><ul><ul><li>Retardo mental (discapacidad cognitiva) </li></ul></ul><ul><ul><li>Trastorno Afectivo Bipolar </li></ul></ul><ul><ul><li>Otros </li></ul></ul>

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