Sintomas Retrospetivos na Perturbação de Hiperatividade e Défice de Atenção do Adulto: Reflexão sobre a Informação Auto e Hétero Reportada
DOI:
https://doi.org/10.51338/rppsm.479Palavras-chave:
Adulto, Autorrelato, Perturbação de Hiperatividade e Défice de Atenção/diagnósticoResumo
Segundo os critérios do manual de classificação DSM ‑5, para se realizar o diagnóstico de perturbação de hiperatividade e défice de atenção (PHDA), os sintomas têm de estar presentes antes dos 12 anos de idade. Existe ainda a referência de que a informação recolhida junto dos adultos sobre a sua infância tende a não ser confiável, pelo que se aconselha a obtenção de informações complementares. Foi realizada uma revisão da literatura, recorrendo à base de dados de referências bibliográficas, PubMed, como principal ferramenta de pesquisa. A concordância entre adultos e seus informadores face a sintomas retrospetivos na infância pode variar entre 21% e 74%. Existem grupos de investigação que defendem que os adultos tendem a reportar com menor frequência o número e a severidade dos seus sintomas, sendo que outras pessoas poderão dar informações adicionais sobre a sintomatologia. Por outro lado, a exatidão da evocação de sintomas por terceiros relativamente à infância, na PHDA do adulto, é reportada como fraca ou moderada em estudos clínicos e populacionais, diminui ao longo do tempo e a sua validade tende a ser baixa. O autorrelato da sintomatologia encontra ‑se mais correlacionado com a avaliação do clínico do que o relato colateral. O recurso à informação colateral em contextos clínicos poderá ser considerado uma fonte auxiliar, contudo, sujeito ao julgamento clínico. Apesar dos dados conflituosos, alguns grupos de investigação e o DSM ‑5 continuam a encorajar os clínicos a procurar informações de terceiros para corroborarem o diagnóstico de PHDA nos adultos. Tendo em conta a baixa exatidão e a ausência de fatores clínicos úteis que melhorem a validade da informação recordada, os clínicos devem sobretudo caracterizar os sintomas atuais de PHDA, mais do que tentar definir os casos com base em recordações potencialmente imprecisas. No caso de alguém que descreva com precisão os sintomas de PHDA ao longo da vida, dando exemplos associados à sua disfunção, o diagnóstico poderá ser feito. A informação de terceiros é aconselhável quando a recordação da infância e adolescência é inadequada ou quando existem dúvidas quanto à credibilidade da história.Downloads
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