In classical stroop task ADHD children show core deficit in interference control in the condition of the incongruent color word: more errors and slower speed. In previous studies children with emotional disorder were found to show attentional bias in emotional stroop task in which children are asked to name quickly the color of emotional words such as ‘anxious’, ‘worried’, ‘sad’ and ‘disappointed’, while ignoring the meaning of the words. The aim of this study was to evaluate emotional stroop effect between ADHD and emotional disordered children to investigate attentional bias toward emotional stimuli.

The subjects were 22 ADHD children and 14 children who have emotional disorder, including anxiety, tic or depressive disorder. Classical stroop task as well as emotional stroop task, IQ test, State-Trait Anxiety Inventory for Children(STAIC) and Children's Depression Inventory(CDI) were administered individually to all children.

1. 1. Children with emotional disorder obtained higher CDI and STAIC scores than ADHD children.

2. 2. There were no significant group difference in emotional stroop task between children with emotional disorder and ADHD even after controlling IQ.

We could not found that children with emotional disorder show more attentional bias toward anxiety or depression-relevant stimuli than ADHD children. Further research with large subjects and more sophisticated assessment of emotional problem is needed to elucidate emotional stroop effect.

Strength and Difficulties Questionnaire (Goodman et al, 1998) completed from children and their parents. SDQ included 25 items, generating scores for emotional-behavioral problems.

Was completed using SPSS 10.0. Comparisons were made between groups, problems and predictive factors influencing emotional and behavioral problems.

A total of 200 children referred to CAP from 2 - 17 years old were screened, from which 53.1% males and 46.3% females. Mean age was 9.5 ± 4.4 years old. 15.4% were identified being with borderline emotional symptoms and 62.9% were within abnormal range of emotional symptoms. 16.7% of the children were identified with borderline behavioral symptom and 60.6% were within abnormal range of behavioral symptoms. 10.5% were identified with borderline hyperactivity symptoms and 48.7% were within abnormal range of hyperactivity/inattention symptoms. From the total sample resulted that 8% of them had borderline difficulties and other 84.6% of the subjects had experienced abnormal and major overall social, emotional, behavioral difficulties. There was a significant statistical difference between symptoms and gender (p< 0.002).

This study represents a serious approach in identifying problems of emotional and behavioral health for Albanian children/adolescents and the need of further studies in community for the prevention of mental health problems in children/adolescents.

M. is a 12 year old girl, whom since the age of 3 has been increasing the frequency of tics (screeches, closing the eyes, clenching the fists, exposing her teeth, repeating countlessly “I’m kidding!”, “You’re a whore”).

She has a younger sister. Her mother was diagnosed with anxious depression and her father suffers from chronic alcohol abuse.

The complementary diagnostic tests performed (CT, EEG, MRI), requested by the physicians that she consulted previously, were normal.

With sorrow, M. states on her first appointment “I’m hyperactive and I cannot control myself”.

The authors aim to present a short revision of the literature on Tourette syndrome, describing a clinical case, highlighting the therapeutic intervention (psychopharmacological and psychotherapeutic) and the clinical course.

Clinical case presentation and revision of the literature.

Managing patients with Tourette syndrome requires a comprehensive intervention, which includes medication and a psychotherapeutic approach.

In the case described, a psychoeducational intervention was performed with M.’s family and M. teachers (information about the disease and strategies to reduce stress inducers and undervalue the tics), family counseling (exploring the impact of the tics in their lives and how this could be minimized), cognitive-behavioral techniques and administration of a dopamine antagonist agent.

In this particular case, family intervention was paramount to the favorable clinical outcome, since it was a dysfunctional family.

To describe a case of conversion disorder in a pre-school girl, affecting the sensory functions.

The authors revise the specific characteristics of this disorder in pre-school children and highlight its differences from adult's common pictures. With that purpose they describe a case of a 5 year's old girl who attended the ER with sudden blindness complaints. She was admitted for observation and investigation. All possible organic causes where excluded. She was then referred to Child and Adolescent Psychiatry emergency consultation. She was diagnosed with Conversion Disorder triggered by a familiar stressful situation and was medicated with diazepam. Her vision recovered suddenly within a few hours.

Although common among adolescents and older children, conversion disorder is a rare entity among pre-school children. The affected function in this age group is usually the motor function, but in rare cases it can affect the sensory functions causing deafness or blindness. This seems to be associated with stressful events but also has a strong familiar component, where imitation of adult's behaviors and familiar gains take major roles.

Eating disorder becomes a problem in the moment when the changes in the way of food consumption are changing the quality of life.

In the population of secondary school students, 610 students,have been chosen by the method of systematic sampling. The study is prospective, control, clinical-epidemiological, descriptive and analytic. The applied instruments are Eating Attitudes Test and Eating Disorders Inventory by Garner. The respondents who have the score of 20 or higher on the EAT-26 are the experimental group, and control group is consisted of adolescents who did not show high scores on these scales. What is being compared between the groups are the scores of the Eating Disorders Inventory by Garner and EAT-26 scales.

There were(59%) females and males (41%). 56 (9.2%) had a high score on the EAT-26, Salčić S. (2005) found 10.3% of respondents with a high sum on the EAT-26. 67.9% of respondents who are in the group of critical score on the EAT-26 (x2 = 8,049, p = 0005) show a desire for slenderness. Dissatisfaction with their own body shows 91.1% (x2 = 5,638, p = 0018). 53.6% from the experimental group show an interceptive awareness (x2 = 24,207, P = 0000). 42.9% (x2 = 11,602, P = 0001) have an expressed perfectionism.

Changes in the nutrition attitudes are also followed by certain changes in body perception and mood, which is reflected in the development of clinical forms of eating disorders.

Adolescence characterize frequent psychical crisis which are result of biological development, looking for own identity, changes in family relation and many socio-cultural influences. Many of social, economic, other environmental factors make some changes in adolescent population. The main objective was finding how many adolescents had risk behavior and subsequences oftener sexual intercourse and aggressive behavior.

Research has done in Banjaluka's high schools, involved 202 adolescents age 18 (51 male, 151 female) which are separate in two groups. Adolescents who consumed psychoactive substances were in experimental group and control group involve adolescents who don’t use psychoactive substances. In research used risk behavior questionnaire Q-2000 (K.B. Kelly, 2000).

Out of total number of individuals in the study, 35,6% was cigarette smokers, 56,9% consumed alcohol, 20,2% consumed marijuana, and sexual intercourse 21,7% (75% used contraceptive methods). Adolescents which used alcohol oftener had sexual intercourse(27,8%, p= 0,026) than adolescents who don’t drink (13,8%), and 29,5% was aggressive in last year. Similar results was found in groups with marijuana and tobacco. Group which used marijuana 34,1% (p= 0,052) had sexual intercourse than group who don’t smoke cannabis (18,6%) and they were aggressive 41,8%. Group which used tobacco had sexual intercourse 34,7% (p=0,0017) than group nonsmokers (14,6%), and aggressive behavior 30,5%.

Adolescents are prone to abuse of psychoactive substances in developing countries. The consequence is higher risk behavior such as violence and promiscuity. Research will be conducted to develop preventive and educational programs in schools.

Many youth with tics experience distress about having tics and how others may perceive them. Such symptoms are often more impairing and distressing than are the tics and negatively impact self-concept, functioning, and quality of life. Although treatments exist that target the frequency and severity of tics, no intervention has been developed that helps youth with tics cope with their condition and limit associated functional impairment and distress. Given this, we developed a cognitive-behaviorally oriented psychotherapy protocol that promotes adaptive coping and resiliency among youth with tics in addressing varied issues commonly experienced by this population. This poster reports data from the Phase I component of this study.

Phase I concentrated on developing the treatment protocol through expert opinion coupled with focus groups with parents and children with a tic disorder. Based on this, we developed a preliminary manual and piloted it in 6 youth with tics who met relevant inclusion/exclusion criteria. Phase II involves a preliminary test of the protocol in that focuses primarily on feasibility issues. All subjects participated in assessments (Screening, Baseline, Post-treatment) conducted by a blinded independent evaluator.

Only Phase I data will be presented as Phase II is ongoing. Descriptive statistics related to improvement rates; tic severity; child self-esteem and self-efficacy; and child internalizing symptoms will be reported. Qualitative data from the focus groups will also be presented regarding domains of impairment for youth with tics.

This treatment shows early promise of helping youth with tics cope with their condition.

Postpartum depression is a common but yet under diagnosed condition that affects new mothers but has also been linked to psycho-emotional and developmental difficulties in the offspring. Autistic disorder is a severe developmental disorder that has a much better prognosis when diagnosed early. The aim of this study was to examine the possible association between maternal postpartum depression and the presence of autistic traits in the offspring.

We undertook a longitudinal study in Athens, Greece, following a cohort of 291 women with questionnaires for 24 months after delivery. The women filled out the Edinburg Postnatal Depression Scale (EPDS) at six and twelve months postpartum and the Modified Checklist for Autism in Toddlers (M-CHAT) at around 18 months after delivery. Both questionnaires are used as screening tools, using a cut-off of 12/30 for the EPDS and 3/23 for the M-CHAT.

95 women who had filled out both the EPDS at 12 months postpartum as well as the M-CHAT were included in the analyses. Self-reported postpartum depression in the mother at 12 months postpartum was strongly associated with the presence of autistic traits in the offspring at 18 months of age (OR= 5.24, 95% CIs 1.15-23.79).

Maternal postpartum depression was found to be associated with the presence of autistic traits in the offspring at 18 months of age. These findings stress the need for early identification of postpartum depression cases and careful follow up of both mother and offspring.

To evaluate newborn fluoxetine exposure at different period on development and behavior of adult rats.

Male rat pups were randomized to be treated once daily with fluoxetine(s.c.) or saline(s.c.) during postnatal day 1∼7 and postnatal day 8∼21. Recorded the body weight. Starting at 90 days of age, all rats were tested with several experimental facilities, including open field test, elevated-plus maze, novelty- suppressed feeding test and forced swim test.

:

1. 1 Weight gain of rats with fluoxetine exposure during postnatal day 1∼7 were lower than controls (P<0.05).

2. 2 Exploratory behavior decreased and depression anxiety behavior increased in adult rats with neonatal fluoxetine exposure (P<0.05), and more severe with postnatal day 1∼7 exposure (P<0.05).

Newborn fluoxetine exposure may result badness weight gain and depression anxiety behavior in adult rats, and the earlier exposure may accompany the larger risk.

Selective mutism is a psychiatric disorder characterized by consistent failure to speak in specific social situations despite speaking in other occasions.

To demonstrate different therapeutic approaches: Cognitive Behavioral Therapy (CBT)/ CBT besides medication.

The material used comes from the archives of the Child/Adolescent Clinic of the Community Mental Health Center (CMHC) of Katerini, Greece.

Two six-year-old children visited the Child/Adolescent Clinic of the CMHC of Katerini. They both presented reluctance to speak at school while interaction in other activities varied between them. Although they were both initially treated with CBT, the severity of symptoms in one case led to the administration of Fluoxetine in addition to CBT. Fluoxetine was initiated at 4 mg/day and gradually titrated to 20 mg/day. Two years later, both cases show clear improvement. The first one treated only with CBT has begun to speak at school, mainly when asked to do so, and appears more willing and comfortable among strangers. The second one shows signs of progress especially after the initiation of Fluoxetine. The patient interacts with strangers, speaks to children out of school and appears in better mood. Despite the progress, she still mutes at school.

In accordance with other international references, this presentation shows that cases of Selective Mutism respond to variant therapeutic approaches. Although CBT can be proved quite effective, Fluoxetine can be used to provide extra benefit.

Obsessive Compulsive Disorder (OCD) is an anxiety disorder characterized by obsessions and compulsions, actions which disrupt everyday functioning, and is frequently recognized in youth. Selective Serotonin Reuptake Inhibitors (SSRIs) are widely recommended as first-line pharmacotherapy.

The aim of this presentation is to demonstrate Escitalopram monotherapy in juvenile with OCD.

The material used comes from the archives of the Child/Adolescent Clinic of the Community Mental Health Center (CMHC) of Katerini, Greece.

A 9-year-old child was referred to the Child/Adolescent Clinic of the CMHC. The patient presented unwelcome repeated thoughts that induced anxiety symptoms while at the same time he performed several actions (compulsions) to neutralize his obsessions. From his history, a mood disorder episode was described at simultaneously with the onset of OCD. Then, the patient was admitted in a General Hospital (for a month) and was treated with Fluoxetine on and off for several years. Due to relapse of the symptoms, Risperidone was introduced (1mg/day). The scheme was not beneficial enough, so another SSRI (Escitalopram) was initiated while Risperidone was withdrawn gradually. Six months after the initiation of Escitalopram, the patient's situation is stable, the obsessions and compulsions have been restricted and he appears in better mood.

Monotherapy with Escitalopram seems to provide significant levels of symptomatic improvement in cases of OCD in juvenile producing effective results to this young patient.

In 2008 a new support group based on psycho-educational principles, attachment theory and neurodevelopmental practice, began at the Womens and Childrens Hospital (WCH) in South Australia. This group caters for parents, grandparents and other carers, who have children in neonatal intensive care and special care nurseries.

2 years of research have been done to evalaute the parent experience of neonatal intensive care and the support networks available for parents.

Qualitative interviews have been performed with parents who have attended the group. The 1st set taken when their babies were in the nursery and then 5 months post discharge. Interviews with nursing staff who work within the nursery were also completed in 2009. A survey study using the PSS-NICU is underway at present and will conclude in late 2010.

The parent interviews were reviewed with framework analysisand indicated a number of themes. The main theme was the loss of control of the parental relationship and the distress at sharing their child with nursing staff. Nursing staff interviews were analysed with framework analysis and the main theme was of chronic parental distress and difficulties managing the parental grief.

These results indicate that psychological support should be focussed on 1. the attachment relationship in trauma and 2.dealing with grief at deviating from the normal parenting experience. These results were used to provide modifications to our parent group and to structure education and support for nursing staff in the intensive care unit.

Population-based analysis of regional and provincial data has permitted identification of areas for modeling innovative service delivery paradigms. Attention Deficit and Hyperactivity Disorder (ADHD) serves as an example. Within the same catchment region, comparing tertiary service utilization with provincial ADHD rates, we have identified a potential service gap. Potential to improve capacity based on a fiscally neutral model is discussed.

Annual data collected in the regional child and adolescent mental health program information system from 2002-2009 was used to describe characteristics of those referred with a provisional diagnosis of ADHD. Regional population-based utilization rates were compared to the region-adjusted provincial rates of ADHD.

As is typical, receiving a provisionally diagnosis of ADHD was significantly associated with longer wait for service and length of stay, being male and younger, greater comorbidity (e.g., conduct disorder), more behavioral problems and more problems at school. About half of the referrals came from community-based primary care physicians. Many children are diagnosed with ADHD by community physicians and relatively few receive specialized treatment.

Analysis of population-based service rates identify potentially large knowledge gap. Within this gap, the quality of service and fidelity to evidence-based practice in community-based treatment of ADHD are unknown. Community-based primary care practitioners have little specialized mental health training and may require support in delivering evidence-based care. To this end, we describe a model to address the identified service gap for ADHD.

Attachment theory offers both a conceptual framework and an empirical basis for understanding the development of parent-child relationships and their contribution to individual psychosocial adaptation across the life cycle. Although no existing model adequately predicts suicide, family relationship problems are increasingly implicated in the etiology of adolescent suicidal behaviour.

We sought to examine the association between felt attachment security and a history of suicidal behaviour among a group of adolescents in psychiatric treatment.

In this cross-sectional study, we examined the association between felt attachment security and a history of suicidal behaviour among 122 hospitalized adolescents. Felt security (as measured by the validated Adolescent Attachment Questionnaire) has been defined as one's perception of the availability and responsiveness of an attachment figure.

Compared to others, the group coded as both depressed and suicidal had significantly higher scores on the AAQ subscales of ‘perceived unavailability’ and ‘angry distress’, as well as higher comorbidity and lower self-esteem compared to non-suicidal, non-depressed adolescents. The model accounted for approximately 50% of the observed variance.

Attachment theory integrates ethological and psychoanalytic principles in describing the origins and growth of human personality. It provides a coherent framework for understanding adolescent suicidality.

The purpose of this presentation is to describe two cases of teenage addiction to on-line gaming where the subjects required medical attention due to unintentional, self-inflicted injuries to the tongue and upper lip during the course of the game.

Case study of two teenage boys, both aged 15, who attended the Specialized Outpatient Unit for Internet and PC Addiction in our Clinic, due to incessant on-line video-gaming that had a number of detrimental effects to their well-being.

The first teenager had repeatedly bitten his tongue due to stress experienced during gaming while the second had bitten his upper lip. In both cases their injuries required emergency medical assistance and thorough examinations for other possible causes (e.g spasms) for their injuries were negative. The first teenager was diagnosed with Internet Addiction Disorder and separation anxiety - pathological attachment to mother, he scored 78 on WISC-III. A behavioral intervention for separation anxiety and a CBT program for IAD was successful; his on-line gaming was limited to 2 hours/day on follow-up. The second teenager was diagnosed with IAD and co-morbid depressive disorder. Fluoxetine (30mg/day) was initiated and his mood improved while his computer usage time fell from 16 to 4 hours/day. A CBT program was initiated and he's under treatment with good progress.

Teenagers addicted to on-line gaming can experience severe stress which they may instinctively attempt to alleviate with self-inflicted wounds. Co-morbidity with other psychiatric disorders should be carefully assessed. Treatment can be pharmaceutical or psychotherapeutic.

The purpose of the current study was to investigate the influence of therapeutic alliance (TA) as a treatment process variable on outcome in cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). Although CBT for pediatric OCD disorder is considered a first-line treatment, not all youth have positive treatment responses, suggesting the need for investigating factors that enhance or reduce treatment effects.

Twenty-five youth aged 7-17 years (M = 13.16, SD = 2.69) with a principal diagnosis of OCD and parents participated in the study. Using a multiple-informant, multiple-time point design, the current study examined the role of TA in family-based CBT for pediatric OCD.

Findings indicated

1. (1) stronger child-rated, parent-rated, and therapist-rated TAs were predictive of better treatment outcome,

2. (2) larger, more positive early alliance shifts (rated by changes in child-rated TA between sessions 1 and 5) were predictive of better treatment outcome.

TA was a predictor of subsequent change in OCD symptoms in youth treated with CBT. These findings correspond with alliance-outcome research among youth treated with evidence based therapies for behavior disorders.

Obesity and its related disorders are growing epidemic across the world. As some forms of abnormal temperament are considered as subtype of the soft bipolar spectrum, we aimed to evaluate abnormal temperaments in morbid obese patients.

Using a short version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego, we investigated abnormal depressive, cyclothymic, hyperthymic, irritable or anxious temperament in 213 patients with morbid obesity compared to a control group of 90 patients admitted prior to transplantation. Additionally, the Beck-Depression Inventory (BDI) and the Self-Report Manic Inventory (SRMI) were applied to assess the current mood states.

The obese group showed statistically significant more psychiatric comorbidities compared to the control group. Abnormal temperaments were significantly more often observed in patients with morbid obesity rather than in controls. Cyclothymic, irritable and anxious temperaments showed specificity to obesity. Obese patients had significantly higher scores in BDI, while no difference for SRMI scores was registered among the whole groups. All temperaments were positively correlated with BDI and SRMI in the obese group.

Our results need replication but indicate an affective overlap in form of abnormal temperament and depressive symptoms in obese patients, whereas mood swings should be evaluated and early mood stabilization considered for patients with significant weight gain to prevent obesity or to reduce already existing overweight. Studies of mood stabilizers and prospective observations would shed further insight on this complex interface of a major clinical and public health issue.

Description of the patients initially attended by the medical area at Emergencies service that later required psychiatric assessment.

Retrospective review of the clinical histories of the previous three months (July to September) using Hospital Ramon Cajal's history software. Data were analyzed using the SPSS software 15.0 version.

55 patients were assessed, 25 male and 30 females, with an average age of 34 years old. Many of the patients were frequent users of our Emergencies service: almost half of the patients (45%) had already come between 2 and 5 times, and only 11 of them (20%) had never been there before. 74% of these patients were already receiving psychiatric care in their ambulatories.

The most frequent cause of consulting were suicidal attempts (50’9%) and drug abuse (18’2%). Up to 56’4% needed to continue been attended by a psychiatry ambulatory, 20% required hospitalization at the psychiatric unit and only 5’5% of the patients did not need any psychiatric care.

The medical area in our Emergency Service is well trained in recognizing psychiatric symptons, that is the reason why around 95% of the patients of our study needed psychiatric treatment.

Sucidial attempt is the typical case in which it is necessary a close collaboration between different medical areas that work in the Emergency service.

To identify prevalence rates and related patient characteristics associated with depression, alcohol use disorders (AUD), and nicotine dependence among individuals admitted to a university general hospital.

4352 consecutively admitted patients were assessed using the HAD scale and AUDIT. They were also asked on daily cigarette smoking during the previous month. Multivariate logistic regression analyses were performed.

56.6% were male. The average age was 49.3. Prevalence rates of depressive disorder, AUD and nicotine dependence were, respectively, 14%, 9.8% and 16.9%. In the multivariate analysis depression was associated with previous suicide attempt (OR = 8.7), less schooling (3.6), prior use of psychotropic medicines (3.1), cancer (1.7) and pain (1.7). AUD were associated with male sex (OR = 6.3), smoking (3.5), admission for an external cause (2.4), mainly road accidents, and previous suicide attempt (2.3). Nicotine dependence was associated with AUD (OR = 3.4), young adulthood (2.3), widowhood (2.2) and previous suicide attempt (1.8).

This is the largest sample of medical and surgical inpatients surveyed by standardized screening instrument, for 13 months, in a Brazilian general hospital. High prevalence rates of psychiatric disorders and respective patient profiles highlight the need to develop more effective methods for detecting and managing these disorders. Hospital admission should be considered a milestone in a person's life from which a psychiatric disorder is detected and specific treatment strategies are implemented.

Chronic pain disorders have been accepted as one of major comorbid disorder in chronic posttraumatic stress disorder (PTSD). The main purpose of this research was to evaluate subjective processing of the pain in war veterans suffering from chronic PTSD and low back pain.

227 Croatian war veterans participated in this study. Based on their personal history, psychiatric and surgical assessment they were divided in three groups: subjects suffering from PTSD and chronic low back pain (N=88), subjects suffering from chronic low back pain (N=50) and healthy controls (N=89). The following questionnaires were used in assessment of PTSD, depressive disorders and pain: Trauma Symptom Inventory, Hospital Anxiety and Depression Scale and the short-form McGill Pain Questionnaire.

We have shown the significant differences between three groups. The group of PTSD patients experience the higher level of the intensity of pain and have an altered perception of pain complaining more of the affective and sensory pain than the group suffering from the chronic low back pain only. Both groups suffering from pain show depressive pattern rather than the the control group. We have shown that the affective and sensory pain is in the strong positive correlations with the specific PTSD symptoms and depression.

Patients suffering from PTSD seem to have an altered processing of the pain, especially the affective component of pain, probably because of functional pain disorders in many those patients. However, the neurobiological mechanism is needed to thoroughly understand the processing of pain in chronic PTSD.