Os manuais diagnósticos de psiquiatria e as classificações internacionais de doenças vêm apontando o transtorno de conduta como um dos principais distúrbios que afetam crianças e adolescentes que vivem em meio urbano pobre. Esse trabalho investiga como a emergência e o avanço dessa categoria diagnóstica vem de encontro às transformações engendradas no cenário cultural pelo capitalismo, como a falta de empregos, aumento dos índices de violência e o constante sentimento de insegurança social. Busca se conhecer como essa categoria diagnóstica surge como uma forma de estigma e controle na sociedade contemporânea dos jovens diagnosticados, pois este transtorno é apontado como uma das explicações para causa da violência praticada por jovens. Esse estudo se deu no contexto de um ambulatório de saúde mental, num bairro pobre da cidade do Rio de janeiro, com adolescentes diagnosticados com o transtorno de conduta. Como metodologia, foi utilizada a análise do discurso dos profissionais de um ambulatório público de saúde em relação aos jovens diagnosticados. Foi feita também análise das condutas terapêuticas dos profissionais dirigidas aos jovens. Este trabalho aponta para farta prescrição de medicamentos no tratamento desses jovens diagnosticados no cotidiano, apesar das poucas evidências científicas de sua eficácia. / The diagnostics manuals of psychiatry and the international classifications of disorders are showing the derangement of the behavior like one of the most commons disorders that affect children and teenagers who live in a poor and urban environment. This work investigate how the emergency and the development of this area emerge form the transformations on the cultural scenario by the capitalism, like the lack of jobs, increase of the violence and the constant feeling of social insecurity. Search to know how this category appear like a shape of stigma and control in the contemporaneous society of those list young people, because this derangement are point like one of the explanations for the violence that those kids commit. This work was done in a context of a mental health ambulatory, on a poor neighborhood, in Rio e Janeiro, with teenagers who were diagnostic with those disorders. As methodology, were used the review of the discourse of the professionals who work in a public health ambulatory in relation to the young people who were diagnostic. At the same time we done the review of the therapeutic conduct of the professionals thought those teenagers. This work shows the extreme use of medications in the treatment of those young people, spite a few scientific evidence being really prove.

Os manuais diagnósticos de psiquiatria e as classificações internacionais de doenças vêm apontando o transtorno de conduta como um dos principais distúrbios que afetam crianças e adolescentes que vivem em meio urbano pobre. Esse trabalho investiga como a emergência e o avanço dessa categoria diagnóstica vem de encontro às transformações engendradas no cenário cultural pelo capitalismo, como a falta de empregos, aumento dos índices de violência e o constante sentimento de insegurança social. Busca se conhecer como essa categoria diagnóstica surge como uma forma de estigma e controle na sociedade contemporânea dos jovens diagnosticados, pois este transtorno é apontado como uma das explicações para causa da violência praticada por jovens. Esse estudo se deu no contexto de um ambulatório de saúde mental, num bairro pobre da cidade do Rio de janeiro, com adolescentes diagnosticados com o transtorno de conduta. Como metodologia, foi utilizada a análise do discurso dos profissionais de um ambulatório público de saúde em relação aos jovens diagnosticados. Foi feita também análise das condutas terapêuticas dos profissionais dirigidas aos jovens. Este trabalho aponta para farta prescrição de medicamentos no tratamento desses jovens diagnosticados no cotidiano, apesar das poucas evidências científicas de sua eficácia. / The diagnostics manuals of psychiatry and the international classifications of disorders are showing the derangement of the behavior like one of the most commons disorders that affect children and teenagers who live in a poor and urban environment. This work investigate how the emergency and the development of this area emerge form the transformations on the cultural scenario by the capitalism, like the lack of jobs, increase of the violence and the constant feeling of social insecurity. Search to know how this category appear like a shape of stigma and control in the contemporaneous society of those list young people, because this derangement are point like one of the explanations for the violence that those kids commit. This work was done in a context of a mental health ambulatory, on a poor neighborhood, in Rio e Janeiro, with teenagers who were diagnostic with those disorders. As methodology, were used the review of the discourse of the professionals who work in a public health ambulatory in relation to the young people who were diagnostic. At the same time we done the review of the therapeutic conduct of the professionals thought those teenagers. This work shows the extreme use of medications in the treatment of those young people, spite a few scientific evidence being really prove.

Nossa Dissertação teve sua origem no contato com as idéias e com o trabalho clínico de Michael Wernet, nosso professor na Universidade de Freiburg-Alemanha e supervisor dos estágios que realizamos na instituição na qual é o psicólogo responsável. A apresentação do referencial teórico que embasa nosso trabalho inicia-se com a abordagem gestaltista de Wernet acerca do desenvolvimento do ato de perceber (Affolter, apud Wernet), o que implicou a exposição de conceitos básicos da Teoria da Gestalt (Wertheimer, Köhler, e comentadores como Castilho-Cabral, Engelmann, Ramozzi-Chiarottino). Tal perspectiva foi complementada com a apresentação da abordagem de Ayres acerca da Integração Sensorial e com o estabelecimento de relações entre o desenvolvimento do ato de perceber, segundo Affolter, e a construção do real segundo Piaget. O método utilizado em nossa dissertação foi o “estudo de caso”. Analisamos comportamentos de cinco sujeitos (entre 22 e 44 anos), todos com transtornos severos do comportamento e danos no funcionamento cerebral. Nosso objetivo foi mostrar o sentido dos atos dos sujeitos, que compreendemos ser expressão da lei da pregnância de Max Wertheimer, e a tentativa de reorganizá-los visando a socialização dos sujeitos. A partir dessa compreensão, a intervenção que pudemos produzir tornou-se conseqüentemente pregnante, uma vez que cada etapa foi “requerida” pela anterior, representando uma mudança qualitativa em nossa relação com os sujeitos em questão. Os resultados mostram o sucesso de nosso intento: de um modo geral, constatamos uma diminuição na freqüência de surtos, uma substituição de comportamentos com seqüelas negativas para o sujeito por condutas alternativas sem as seqüelas anteriores, bem como uma melhoria na possibilidade de interação com o outro. / Our dissertation sprung from the contact with the ideas and the clinical work of Michael Wernet, our Professor in the University of Freiburg – Germany, and supervisor of the courses which we attended in the institution where he is the psychologist in charge. The theoretical basis of our work is compounded by the gestaltic approach of Wernet to the development of the act of perceiving (Affolter, apud Wernet), which led us to the basic concepts of the Theory of the Gestalt and latter commentaries on it (Wertheimer, Köhler, Castillo-Cabral, Engelmann, Ramozzi-Chiarottino). Such point of view was complemented by the approach of Ayres concerning the Sensorial Integration as well as by the establishment of connections between the development of the act of perceiving, according to Affolter, and the construction of the reality, according to Piaget. The methodology of our work is based on five case-studies. We examined the behaviour of five subjects (between 22 and 44 years-old), all of them with severe prejudices of behaviour and damaged cerebral functions. Our purpose was to show that their actions had a constructive meaning, which we believe to be the expression of the “law of pregnancy” of Max Wertheimer. It was also our objective to try to reorganize the subjects, aiming at their further socialization. Following this point of view, the result was that our intervention became pregnant, since each stage was demanded by the previous one. That represented a change of quality in our relationship with the subjects. The results point to the achievement of our goal: generally speaking, we obtained a decrease in the frequency of break-downs as well as a substitution of the so called “self aggressive behaviour” for other ways of response without negative sequels. Another result was the improvement of the possibility of the subjects to interact with other people.

Twin and family studies have shown that genetic factors play a role in the development of conduct disorder (CD). The purpose of this study was to identify genetic variants associated with CD using a family-based association study. We used 4,720 single nucleotide polymorphisms (SNPs) from the Illumina Panel and 11,120 SNPs from the Affymetrix 10K GeneChips genotyped in 155 Caucasian nuclear families from Genetic Analysis Workshop (GAW) 14, a subset from the Collaborative Study on the Genetics of Alcoholism (COGA). 20 SNPs had suggestive associations with CD (p∈<∈10-3), nine of which were located in known genes, including ADAM10 (rs383902, p=0.00036) and CAMK2A (rs2053053, p=0.00098). Our results were verified using the International Multi-Center ADHD Genetics Project (IMAGE) dataset. In conclusion, we identified several loci associated with CD. Especially, the two genes (ADAM10 and CAMK2A) have been reported to be associated with Alzheimer's disease, bipolar disorder and depression. These findings may serve as a resource for replication in other populations.

This research study compared perceptions of family functioning among preadolescent children with behavior difficulties and their primary caregivers. Participants consisted of 29 caregiver-child dyads as well as each child's classroom teacher. Eligibility for the study was based on the child's placement within a self-contained Emotionally Handicapped (EH) or Severely Emotionally Disturbed (SED) classroom in one of three elementary schools within two west coast Florida counties. Data collection included teacher rating scales pertaining to the severity of each child's behavior and the presence of Callus Unemotional (CU) traits in addition to caregiver and child interviews tapping perceptions of family functioning. Results indicated that caregivers consistently viewed their families as more adaptive and cohesive than did children with a disruptive behavior disorder. These findings are consistent with previous research showing a similar pattern among older adolescents with a disruptive behavior disorder. No relationship was not found between the child's perception of family functioning and CU traits, although it was noted that there was considerable restriction of range on CU traits. Overall, the results of this study contributes to the existing literature by demonstrating that preadolescents, like their older counterparts, also view their families as less adaptive and cohesive than do their caregivers. Limitations and directions for future research are discussed.

The purpose of the current study was to examine the treatment acceptability ratings of teachers of adolescents on three different types of commonly used interventions: (a) positive verbal praise, (b) token economy with response cost and extinction, and (c) psychotropic medication. Ratings of treatment acceptability were also assessed according to type of disorder (i.e., externalizing or internalizing). The participants were 101 teachers of adolescents recruited from a midwestern public school district. Participants were asked to read two case studies presented in a counterbalanced format. One case study focused on a youth who displayed symptoms related to an internalizing disorder (Major Depressive Disorder), while the other focused on a youth who displayed symptoms of an externalizing disorder (Conduct Disorder). After each case study, participants were asked to read three treatment vignettes. Each treatment vignette described one of the three previously mentioned interventions. The participants then rated the treatment acceptability of each intervention using a modified Abbreviated Acceptability Rating Profile. A 2 x 3 repeated measures ANOVA was used to analyze the data from the measures. Statistically significant differences were found among level of intervention intrusiveness, type of disorder, as well as interaction effects between the two main variables of interest. Overall, teachers indicated they found less intrusive interventions as more acceptable than the more intrusive interventions; interventions for externalizing disorders were also rated as more acceptable than interventions targeting internalizing disorders. A noteworthy exception was the most intrusive intervention, psychotropic medication, as equally acceptable for both disorders. The current study is unique in that previous researchers have not investigated treatment acceptability of internalizing disorders or among teachers of adolescents as a population. The findings of this study may be useful for teachers of adolescents experiencing classroom difficulties with youth displaying symptoms of either Conduct Disorder or Major Depressive Disorder. Recommendations for future research are discussed as well.

No description available.

This work addresses issues in the study of gene-environment interaction (GxE) through research of conduct disorder (CD) among adolescents and extends the recent report of significant GxE and subsequent replication studies. A sub-sample of 1,299 individual participants/649 twin pairs and their parents from the Virginia Twin Study of Adolescent and Behavioral Development was used for whom Monoamine Oxidase A (MAOA) genotype, diagnosis of CD, maternal antisocial personality symptoms, and household neglect were obtained. This dissertation (1) tested for GxE by gender using MAOA and childhood adversity using multiple approaches to CD measurement and model assessment, (2) determined whether other mechanisms would explain differences in GxE by gender and (3) identified and assessed other genes and environments related to the interaction MAOA and childhood adversity. Using a multiple regression approach, a main effect of the low/low MAOA genotype remained after controlling other risk factors in females. However, the effects of GxE were modest and were removed by transforming the environmental measures. In contrast, there was no significant effect of the low activity MAOA allele in males although significant GxE was detected and remained after transformation. The sign of the interaction for males was opposite from females, indicating genetic sensitivity to childhood adversity may differ by gender. Upon further investigation, gender differences in GxE were due to genotype-sex interaction and may involve MAOA. A Markov Chain Monte Carlo approach including a genetic Item Response Theory modeled CD as a trait with continuous liability, since false detection of GxE may result from measurement. In males and females, the inclusion of GxE while controlling for the other covariates was appropriate, but was little improvement in model fit and effect sizes of GxE were small. Other candidate genes functioning in the serotonin and dopamine neurotransmitter systems were tested for interaction with MAOA to affect risk for CD. Main genetic effects of dopamine transporter genotype and MAOA in the presence of comorbidity were detected. No epistatic effects were detected. The use of random forests systematically assessed the environment and produced several interesting environments that will require more thoughtful consideration before incorporation into a model testing GxE.

Grâce à une démarche ethnographique et à l’appui théorique de la sociologie interactionniste et de la sociologie de l’expérience, nous proposons une étude de la stigmatisation sociale, de la ségrégation scolaire et de la réaction des individus ainsi socialement traités à partir du cas des jeunes diagnostiqués comme souffrants de troubles du comportement et orientés en Institut Thérapeutique, Educatif et Pédagogique (I.T.E.P.). Nous commençons par déconstruire le processus amenant à l’étiquetage de certains élèves au comportement déviant et à l’échec scolaire évident, déviances qui sont traduites en trouble mental et en handicap. Cela permet de saisir les enjeux socio-politiques qui expliquent comment les acteurs parviennent à légitimer la mise à l’écart des élèves présentant des troubles du comportement. L’I.T.E.P. développe une stratégie de normalisation du comportement combinant deux logiques : celle du nécessaire soulagement de la souffrance psychique tenue pour responsable des troubles du comportement chez ces jeunes, et celle qui relève davantage de l’« orthopédie sociale » consistant en une rééducation et une resocialisation. Cette prise en charge totale prend le risque de leur isolement social et de leur glissement dans une situation de liminalité dont il sera difficile, par la suite, de sortir. A cette stratégie, et malgré les étiquettes et la prise en charge disqualifiantes auxquelles ils sont confrontés, les jeunes répondent par la mise en place de tactiques qui consistent, d’une part, à mettre à distance les stigmates qu’ils subissent et, d’autre part, en un travail de « normification » de leur personnalité et à travers elle, de leurs comportements. Leurs objectifs est de convaincre, dans un premier temps, qu’une telle orientation est illégitime dans leur cas et, dans un second temps, qu’ils sont prêts à retourner dans un cursus de formation ordinaire. / Through an ethnographic approach and based on the theory of sociological interactionism as well as the sociology of experience, we offer a study of social stigmatisation and segregation in school. We also study the reactions of individuals that fall victim to them. We base our work on young people diagnosed as suffering from behaviour disorder and who are admitted in Institut Thérapeutique, Educatif et Pédagogique (Therapeutic, Educational and Pedagogical Institute). We start by unravelling the process that leads to the stigmatisation of some pupils as well as their deviant behaviour and the obvious difficulties they face in school. These deviances are described as mental disorders and disability. Thus we can understand the socio-political issues that explain how the setting aside of students with behaviour disorder is justified by those involved. I.T.E.P. develops a strategy of behaviour normalisation based one two ideas: the necessary relief of psychological suffering responsible for the behaviour disorders these young people suffer from, and “social orthopaedics” as a way to re-educate and re-socialise them. This comprehensive approach to care puts them at risk of social isolation and might see them slip into a situation of liminality that can prove to be difficult to do away with. Despite the labelling and the discrediting care they have to deal with, these young people answer by resorting to tactics that aim at shrugging off the stigma they suffer from and embark on a process of « normification » of their own personality and therefore of their behaviour. They aim is first to convince that this kind of care is not justifiable in their case and secondly that they are ready to go back to an ordinary training structure.

<p>Individuals afflicted with childhood and adolescent mental disorders have an increased risk for poor outcome in adulthood. The progression of psychopathology from childhood to adult life may be influenced by a multitude of interacting variables, both biological and psychosocial. There is limited information on the relationships between child psychopathology and adult personality and personality disorders. The main aim of this thesis was therefore to gain better knowledge concerning adult personality outcome in patients with early onset of mental disorders. </p><p>Former child psychiatric patients as compared to controls had a significantly higher prevalence of all DSM-IV personality disorders (38.0 vs. 10.9 percent, p<0.001) and also a considerably higher personality disorder co-morbidity. They also had more psychosocial and environmental problems. This was exaggerated in those diagnosed with a personality disorder. Major depression, disruptive disorders and substance use disorders at a young age were strong predictors for adult personality disorder.</p><p>Patients with an early onset major depression had more personality disorders and more deviant personality traits than those with a late onset. </p><p>Forensic psychiatric male patients diagnosed with a previous conduct disorder as compared to those without had more cluster B personality disorders, and more repeated violent criminality and mixed abuse. They also exhibited more deviant personality traits and higher psychopathy scores.</p><p>The instrument "Child and Adolescent Psychiatric Screening Inventory-Retrospect" had acceptable sensitivity and specificity for assessment of child psychiatric disorders. Subscales demonstrated good internal reliability (Crohnbach´s alpha = 0.76-0.93).</p><p>The results suggest that adult personality disturbances are prevalent in individuals affected with mental problems at young ages. A better understanding of the transition of psychopathology from childhood to adulthood and a better identification of those at risk will be of help in attempts to prevent permanent impact on the adult personality.</p>