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This article reviews the recent literature on depression in children and adolescents. We describe the current knowledge about clinical presentation, epidemiology, prognosis and risk factors with a focus on the differences from depression in adults.

With regard to internalizing disorders we wanted to describe: 1) a possible change in diagnoses over time; 2) a possible corresponding change in causes for referral; 3) correspondence of hospital diagnosis with causes for referral. For 70 randomly selected records/year (n=560), referral papers were examined and compared with register-data on all 8-13-year-old children examined in the study period (1995-2002). The hospital-based frequency increased for depressive disorders and obsessive-compulsive disorder (OCD) and decreased for anxiety disorders. A corresponding increase occurred for depressive and OCD symptoms as cause for referral. Agreement between referral causes and subsequent clinical diagnoses was modest. In most cases (68%) referred for internalizing symptoms, a clinical diagnosis within the internalizing spectrum was given. The increase in the diagnoses of depressive disorder and OCD seems partly due to an increase in patients referred for these disorders. Referrers identify internalizing disorders reliably but child psychiatric examination leads to more precise diagnoses.

Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder occurring in approximately 3-6% of the population. The high prevalence of the disease and the fact that it has an onset early in life emphasise the importance of adequate treatment. This article focuses on the largest long-term treatment study of ADHD, the Multimodal Treatment study of Attention Deficit Hyperactivity Disorder (MTA), taking into consideration especially the limitations of the design and their impact on the outcome of the study. Primary among these is the fact that outcome was measured 4-6 months after the most intensive phase of behavioural treatment but while medication was still active. This may have had an impact on the study results, especially since the MTA study did not indicate a significant difference between combined and strictly pharmacological treatment.

OCD (obsessive-compulsive disorder) is characterised by the presence of annoying, unwelcome and intrusive obsessions and compulsions. The obsessions appear over and over and the child recognize them as something strange and unwelcome, but at the same time they are clearly a product of his/her own mind and not a hallucination or a thought disorder as seen in psychotic disturbances. Compulsions are imposed actions that the child feels it has to perform, often in a certain pattern. Both children and adults can suffer from OCD. Almost 2/3 of adults with OCD report onset of their OCD symptoms in childhood or early adolescence. Previously, OCD among children and adolescents was considered to be rare, but newer epidemiologic surveys show that 1-1% of children and adolescents suffer from OCD in such a degree that they fulfil the diagnostic criteria. The prevalence varies surprisingly little in various countries regardless of cultural background.

Objective: DSM-IV is the most widely used diagnostic classification system in research, whereas ICD-10 is more widely used clinically. Knowledge of differences is essential when research findings are implemented in daily clinical practice. We examined differences between the two diagnostic systems regarding three major child psychiatric diagnostic categories., Methods: A total of 199 consecutively referred, child psychiatric patients were interviewed with a semistructured diagnostic interview (K-SADS-PL) including questions covering specific ICD-10-DCR criteria, and diagnosed according to both diagnostic systems., Results: Differences were found regarding the diagnoses major depressive disorder/depressive episode and attention deficit hyperactivity disorder/disturbance of activity and attention. In both cases, more children met DSM-IV-TR criteria than ICD-10-DCR criteria. The diagnosis, oppositional defiant disorder, proved interchangeable between the two diagnostic systems., Conclusion: Differences between diagnostic systems must be taken into account when research findings using one diagnostic system are implemented with children diagnosed by another diagnostic system.

Objective: Maternal smoking during pregnancy may increase the risk for behavioral disorders. The aim of this study was to investigate the association between smoking during pregnancy and hyperkinetic and attention-deficit/hyperactivity disorder in the offspring in a large population-based study., Methods: This study was designed as a nested case-control study. Data were obtained from Danish longitudinal registers and included 170 children with hyperkinetic disorder and 3765 population-based control subjects, who were matched by age, gender, and date of birth. Potential confounders, including newborn characteristics, socioeconomic status, and family history of psychiatric illnesses, were evaluated by conditional logistic regression analyses., Results: Women who smoked during pregnancy had a 3-fold increased risk for having offspring with hyperkinetic disorder compared with nonsmokers. Socioeconomic factors and history of mental disorder in the parents or siblings seemed to confound the result to some extent (adjusted relative risk: 1.9; 95% confidence interval: 1.3-2.8). Adjustment for parental age or exclusion of children with low birth weight (<2500 g), preterm delivery (<37 weeks completed gestation), and Apgar scores <7 at 5 minutes revealed no changes in the results. Also, excluding children with conduct disorders or comorbid disorders revealed no change in the results., Conclusions: Our results showed an increased risk for hyperkinetic disorder in children of mothers who smoked during pregnancy. This could not be explained by newborn characteristics, parental socioeconomic status, family history of psychiatric hospitalizations or contact as outpatients, conduct disorders, or comorbidity.

Background: Studies indicate that major depressive disorder (MDD) is frequent in children but that it may be missed. This study determines the incidence of hospital-treated MDD based on the frequency of MDD in child psychiatric patients, and analyses effects of age and gender on depressive symptoms and psychiatric comorbidity., Methods: One hundred ninety-nine consecutive child psychiatric patients were interviewed using a semi-structured diagnostic interview (K-SADS-PL). Comorbidity and symptoms were compared across age and gender., Results: Current or partly remitted MDD was found in 42 children (21%). Thirty-eight (90%) had comorbid psychiatric disorder(s). Onset of the comorbid disorder was prior to onset of depression in 74% of cases. No significant gender-differences were found, but anhedonia, hypersomnia and decreased ability to concentrate were more frequent in the older age group. In contrast, feelings of worthlessness were more frequent in the younger age group. The number of melancholic symptoms was significantly associated with older age., Conclusion: MDD is frequent in child psychiatric patients aged 8-13 years. Age-but not gender-had significant effects on melancholy score and the prevalence of specific symptoms. Results suggest that MDD may be underdiagnosed in clinical samples unless careful examined with diagnostic interview.

Background and Methods: The adverse effects and potential clinical value of risperidone as augmentation to selective serotonin reuptake inhibitor (SSRI) treatment in treatment resistant severe adolescent OCD patients were examined in 17 adolescents (15-19 years old, 8 males and 9 females) in an open label trial of risperidone 1-2 mg daily., Results: After 12 weeks of augmenting treatment, statistically significant improvements were reflected in OCD symptom ratings (mean total Y-BOCS/CY-BOCS scores after treatment with second SSRI 24.2 +/- 2.6 versus 19.9 +/- 2.9, p < 0.001) and global assessment scores (mean CGAS, 69.4 +/- 11.4 versus 74.7 +/- 9.6, p < 0.001). Four patients had moderate improvement of more than 25% reduction in Y-BOCS scores in OCD symptoms. Further 10 patients had a reduction of 10-25% in total score, indicating slight improvement. One patient (6%) dropped from clinical OCD to a subclinical level of OCD (Y-BOCS total score < 15). No patient was found to have worsened during augmentation treatment. Eight cases had weight gain and sedation was reported in four cases., Conclusion: These preliminary findings suggest that augmentation with risperidone in dosages up to 2 mg daily might be efficient in adolescents with treatment resistant OCD.

The Five to Fifteen parent questionnaire (FTF) was developed to offer a neuropsychological dimension to the assessment of children with Attention Deficit/Hyperactivity Disorder and other child psychiatric disorders. The domains included in the FTF were motor skills, executive functions, perception, memory, language, social skills and learning, in addition to a domain for emotional and behavioural problems. The aim of the present study was to test the clinical validity and utility of the FTF with a main focus on discriminant and criterion validity. The clinical sample consisted of 155 clinically diagnosed children (ICD-10 criteria), 102 were tested with WISC-III. The parents rated their children independent of the diagnostic evaluation. The results were presented as profiles. These clinical profiles were compared to those of a Swedish norm sample consisting of 854 children from the age of five to fifteen. Results demonstrated that the profiles for the clinical groups were similar in forms and levels to those of the upper 10 percent of the norm sample (those with most difficulties). Five out of eight FTF domains discriminated significantly between diagnostic groups in the clinical sample. Influence of IQ, gender and age on the results were low. Three out of four relevant FTF domains correlated significantly with corresponding WISC-III indexes/measures. The clinical utility of individual children's profiles were demonstrated. On the whole, the findings supported the clinical validity and utility of the FTF.

Obsessive-compulsive disorder (OCD) is today the fourth most frequent diagnosis issued within psychiatry. OCD can be quite incapacitating for the affected person and often becomes chronic. The purpose of the present study has been to help illuminate the character of the quality of life among the members of the Danish OCD Association. The data was compiled from 406 questionnaires sent out to all those members of the Danish OCD Association who had reported to suffer from OCD. The level of response was 54.4%. Persons with OCD signalled striking influences on their academic, occupational and social functions and thereby a corresponding influence on their quality of life in general. Emerging were significant levels of comorbidity and suicidal tendency. The time interval between symptom onset and the establishment of a correct diagnosis was found to be 13 years in average in this study. There appeared to be a marked tardiness in treatment as a consequence of the latency period between onset of symptoms and the establishment of a diagnosis. This has proven to be of importance in relation to the provision of proper treatment, the developmental course of the OCD condition, and not least in the quality of life for the person with OCD as well as his/her family members.

The objective of this study was to examine whether social risk factors adjusted for gender and some well-known perinatal risk factors were related to parental descriptions of deviant behaviour in 3(1/2)-year-old children. The study was a prospective cohort study of 1345 mothers enrolled during early pregnancy. Parents answered a questionnaire and children's behavioural difficulties were categorized into the following groups; "hyperactive-distractible", "hostile-aggressive" and "anxious-fearful" following a modified Behar scale. The male gender was found to be related to a description of all kinds of deviant behaviour. Having a family member experiencing employment difficulties was the factor most closely related to "hyperactive-distractible" behaviour. Familial stress due to lack of time, experience of divorce and mothers in excess of 35 years at childbirth were found to be related to "hostile-aggressive" behaviour, but male gender was the most closely related. Social disadvantage was not found to be related to "anxious-fearful" behaviour.

Objective: The purpose of this review was to examine the literature assessing the relationship between prenatal exposure to nicotine, alcohol, caffeine, and psychosocial stress during pregnancy to the risk of developing behavioral problems related to attention deficit hyperactivity disorder (ADHD) in childhood., Method: PubMed, MEDLINE, EMBASE, and PsycINFO were searched systematically. Studies using DSM diagnostic criteria and other validated diagnostic or screening instruments for ADHD and those examining ADHD symptoms were included. A narrative approach was used because the studies differed too much in methods and data sources to permit a quantitative meta-analysis., Results: Twenty-four studies on nicotine (tobacco smoking), nine on alcohol, one on caffeine, and five on psychosocial stress were identified. All were published between 1973 and 2002. In spite of inconsistencies, the studies on nicotine indicated a greater risk of ADHD-related disorders among children whose mothers smoked during pregnancy. Contradictory findings were reported in the alcohol studies, and no conclusion could be reached on the basis of the caffeine study. Results from studies on psychological stress during pregnancy were inconsistent but indicated a possible modest contribution to ADHD symptoms in the offspring. Many studies suffered from methodological shortcomings, such as recall bias, crude or inaccurate exposure assessments, low statistical power, and lack of or insufficient control of confounders. A general lack of information on familial psychopathology also limited the interpretations., Conclusions: Exposure to tobacco smoke in utero is suspected to be associated with ADHD and ADHD symptoms in children. Other maternal lifestyle factors during pregnancy may also be associated with these disorders. Further studies are needed to reach conclusions.

The prescription of antidepressants for children and adolescents is a controversial subject, and it has been documented that the practice has increased in the past decade in Denmark, the UK, and the USA. The aim of this study was to survey the indications for and use of antidepressants in child and adolescent psychiatry. Questionnaires were sent to all Danish child and adolescent psychiatric hospitals, out-patient clinics and privately practising psychiatrists treating children and adolescents under the age of 19 years (31 units in all). A 93.5 % response rate for the total of 382 questionnaires in the survey. The antidepressant serotonin selective re-uptake inhibitors (SSRIs) were the most prominently used agents in treating children and adolescents. The extent of their use represents 8 % of the total sample of individuals under the age of 19 years receiving any kind of psychiatric treatment - 0.03 % of the reference population in Denmark. It is only a surprisingly minor group of children and adolescents that are being treated with antidepressants despite the fact that 10 % of youth under the age of 19 are afflicted with diseases like depression, OCD, anxiety disorder and eating disorders.

Elective mutism is a relatively uncommon disorder characterized by consistent failure to speak in specific social settings, such as in school, despite speaking fluently in a variety of other situations. Elective mutism is a very debilitating disorder for the affected child, as well as for their families, with detrimental implications for the development of social skills and learning if not offered appropriate support and treatment. The most promising treatment results have thus by far been achieved through a combination of cognitive behaviour therapy and supportive cooperation between parents, the school, and the treating child psychiatrist, occasionally supplemented with pharmacological treatments such as selective serotonin reuptake inhibitors. The available literature on this disorder is still very limited and consists predominantly of case reports. In recent years, however, there has been a growing focus on the etiology and general understanding of the disorder. While still disputed, it has been suggested that elective mutism might be understood as an emotional disorder on a par with e.g. separation anxiety and social phobia. Studies looking at the long-term course of the disorder are urgently required to elucidate whether children presenting elective mutism will be more likely to suffer from emotional disorders in adulthood, and may also ultimately lead to improved treatments for this disabling psychiatric disorder of childhood.

A subcommittee under the Danish Psychiatric Association and the Child and Adolescent Psychiatric Association in Denmark have recently developed national guidelines for the psychopharmacological treatment with lithium and antiepileptic drugs, and the present translation aims at contributing to the international discussion on the development of proper guidelines for the treatment of bipolar disorder. Among the antiepileptic drugs, the report deals with valproate, carbamazepine and lamotrigine and to a lesser extent with oxcarbazepine, gabapentin and topiramate. The various drugs will be reviewed, outlining the scientific evidence for mood-stabilizing properties and discussing major side effects, the most important interactions with other drugs and practical use. Special considerations during pregnancy and lactation, during treatment of children and adolescents and during treatment of the elderly will also be presented. Antidepressants and antipsychotics are beyond the scope of the report, but due to the mood-stabilizing properties of at least some of the atypical antipsychotics, these agents will be brought into some focus in connection with the overall treatment guidelines for the different phases of bipolar disorder given at the end of this report.

Background: Attention-deficit hyperactivity disorder (ADHD) is a common childhood condition, and is more prevalent in boys. The adult outcome of girls with ADHD has never been studied., Aims: To identify predictors for adult psychiatric outcome of children with ADHD, including gender and comorbidity., Method: Children aged 4-15 years, referred for hyperactivity/inattention and treated with stimulants were included (n=208). The Psychiatric Case Register provided follow-up data on psychiatric admissions in adulthood until a mean age of 31 years., Results: A total of 47 cases (22.6%) had a psychiatric admission in adulthood. Conduct problems in childhood were predictive (hazard ratio HR=2.3; 95% CI 1.22-4.33). Girls had a higher risk compared with boys (HR=2.4; 95% CI 1.1-5.6)., Conclusions: Girls with ADHD had a higher risk of adult psychiatric admission than boys. Conduct problems were also associated with a higher risk. Girls with ADHD with conduct problems had a very high risk of a psychiatric admission in adulthood.

The present review describes the theory of a spectrum of obsessive-compulsive disorders (OCD). This spectrum includes such disorders as trichotillomania, eating disorders, body dysmorphic disorder, and possibly pervasive developmental disorders. OCD with an onset in childhood is presented as a specific subtype, with more boys affected and frequently co-morbid with tics and Tourette's syndrome. Furthermore, it seems to be more genetically determined and have more significant deviations, as measured by neuro-imaging studies, than has OCD with an adult onset. The PANDAS theory (paediatric autoimmune neuropsychiatric disorder associated with streptococcal infections) is described. This subtype of OCD is, still on a speculative basis, connected to infections with beta-haemolytic streptococci. The obsessive-compulsive symptoms are characterised by a sudden onset, "sawtoothed" course with relapses and remissions, and are associated with neurological abnormalities. There are still no clinical consequences in terms of penicillin treatment of this PANDAS subtype of OCD.

Obsessive-compulsive disorder is a far from rare neuropsychiatric disorder in children and adolescents which affects approximately 1-1.5% of the pediatric population. Obsessive-compulsive disorder is defined by the presence of obsessions and/or compulsions. It often takes a chronic course with either persistent, constantly distressing obsessive-compulsive symptoms or a waxing and waning course. The best documented and most efficient treatment is cognitive behavioural therapy and antidepressant medication with serotonin specific agents. In most cases, an improvement rate of 20-50% is reported following medication alone.

We present the case of a 10-year-old boy, Sam, with congenital deafness and Gilles de la Tourette Syndrome (GTS). GTS is characterised by multiple motor tics and one or more vocal tics that wax and wane. Due to his deafness Sam never developed vocal language but instead used sign language from the age of four. His tic disorder rapidly accelerated from the age of seven over a six-month period and soon sign language was incorporated into tics as complex "vocal" tics. Bursting out "words" in sign language would also occur in front of people unfamiliar with sign language and often with an obscene content although this was not evident to someone not trained in sign language. To our knowledge this is the first reported case of a congenital deaf child with GTS. The case presented here supports previously published work that the intentional share of the tics in GTS is very small. This case also questions former theories on which regions and circuits of the brain are involved in GTS.

Objective: The primary purpose of the study was to describe tolerability and effectiveness of citalopram in the treatment of adolescent obsessive-compulsive disorder (OCD)., Method: Thirty nondepressed patients (15 females, 15 males) with a mean age of 13.7 years (range 13-18 years) were treated for their OCD with citalopram in an open-label, flexible-dose study (range of dose 20-70 mg; mean dose 46.5 mg). All patients were referred to Aarhus University Hospital. The patients were monitored for 1 to 2 years. The mean total score on the Yale-Brown Obsessive Compulsive Scale (child or adult version) was 28.7 at base-line, 23.3 after 10 weeks of treatment, 20.0 after 6 months, 18.4 after 1 year, and 17.9 after 2 years (from baseline to 2 years of treatment: t = 11.65; p < .001)., Results: Seventy percent showed a decrease in total Yale-Brown Obsessive Compulsive Scale score in excess of 35% from baseline to 1 year of treatment. Twenty percent still had a score of greater than 20 after 1 year of treatment, indicating that clinically they still had OCD. Side effects were similar to those reported from the use of other selective serotonin reuptake inhibitors (SSRIs). No patient was excluded because of serious side effects during the 1 year of observation., Conclusions: The clinical effectiveness and tolerability of citalopram in the long-term treatment seem to be comparable with the observations of other SSRIs in childhood and adolescent OCD. A further, statistically significant reduction is provided by an extended treatment period of up to 1 year.

The use of stimulants in the treatment of children and adolescents with Attention Deficit Hyperactivity Disorder, ADHD, and Deficit in Attention, Motor Control and Perception, DAMP, is often considered somewhat controversial. It was first used in 1937, and since the 1960s, 3000 published studies and 250 reviews have demonstrated the positive, short-term effect of stimulants on children and adolescents with ADHD/DAMP. More than 160 randomised, controlled trials (RCT) have studied the effect of attention, hyperactivity, and impulsivity. Furthermore, stimulants have proved effective on the social relation of such children, both in their families and in with their peers. Side effects are often mild, transient and dose-related. The short-term effectiveness of stimulants is thus well-documented and their prescription evidence-based, whereas further studies on the long-term effect are needed.

The purpose of this study was to describe a group of 42 refugee- and immigrant children up to 14 years old compared to Danish controls in order to identify groups at risk and describe course, examination, treatment and contact. The investigation was based on case records. The only statistically significant results were higher frequencies of referral than expected regarding children from Lebanon and Somalia. However, the data indicate differences between the foreign and Danish groups as to greater problems of speech and language and less behavioural and emotional problems among the foreigners. No foreign children were offered foster homes. The attitudes of the parents towards referral, examination and treatment are more negative in the foreign group. The need for more research is emphasized.

In the development of the majority of children, ritualistic behaviour may be seen as a normal phenomenon. In some children and adolescents, however, these rituals become time-consuming, interfering, irritating and annoying. The most common obsessions in both children and adults with obsessive-compulsive disorder (OCD) are related to a fear of dirt and contamination, fear of some terrible happening, and the fear of harming a loved one. The most common compulsions are washing fixations, checking behaviour and rituals (including mental rituals). Prevalence studies show that OCD in children and adolescents is far more common than previously thought. It is estimated that up to 2% of this population have symptoms fulfilling OCD criteria. The impact of early OCD onset can be profound, with long-term studies indicating that approximately 50% of these patients will also suffer from OCD in early adulthood. These patients tend to remain socially isolated, to have fewer relationships than their non-OCD peers, and have a tendency to remain within the family home during early adulthood. In addition, childhood OCD is associated with comorbid psychiatric disorders, in particular depression, anxiety and panic disorders, Tourette's syndrome and eating disorders. Treatment strategies for childhood OCD reflect those used in adult psychiatry. The most effective psychotherapeutic approach is based on cognitive-behavioural therapy with exposure and prevention. In contrast to pharmacotherapeutic agents without serotonin activity, the serotonin-specific antidepressants appear to be effective and well-tolerated in the treatment of OCD in children.

Obsessive-compulsive disorder (OCD) in children and adolescents is often a disabling condition, which demands treatment with medication. Research shows that serotonin is involved in the disorder and empirical treatment studies show that antidepressants with serotonin activity are effective. The first choice of treatment in the psychopharmacological approach to OCD in children and adolescents are the SSRI agents, which have been documented as being effective as well as well-tolerated in children and adolescents. The best-documented SSRI to this point is sertraline. However, fluoxetine and fluoxamine have also undergone systematic studies in children and adolescents. Clomipramine has been proven effective, however, side effects caused by this agent would suggest that an SSRI is a better choice. Treatment with an SSRI seems to have effect in approximately 75 % of patients with OCD. There are still no systematic studies analyzing augmenting medication for children and adolescents with OCD. Research indicates that the combination of medication and psychotherapy (cognitive behavioural therapy) is important in most cases. Based on a few long-term follow-up studies on OCD children and adolescents there is not evidence that all children and adolescents suffer a lifetime course of the disease. It is therefore recommended that discontinuation is attempted after 1-1.5 years of successful treatment.

A total of 546 children and adolescents, aged 5 to 15 years, who were admitted as in-patients to psychiatric hospitals throughout Denmark between 1970 and 1973, were followed up regarding to later readmissions and mortality. Approximately one-third of the sample had at least one readmission after the age of 18 years: there was no significant difference between male and female subjects. Probands with three selected diagnoses, namely childhood neurosis, conduct disorder and maladjustment reactions, had a significantly greater general risk of readmission to psychiatric hospital in adulthood than the background population. In total, 24 probands (22 male, and 2 female subjects) died during the study period. Eight subjects had committed suicide. The standard mortality rate was significantly increased.

The adverse effects and potential clinical value of citalopram, a highly selective serotonin reuptake inhibitor, were examined in 23 children and adolescent (9-18 years old, 11 boys) with obsessive-compulsive disorder (OCD) in an open-label trial of citalopram 10-40 mg (modal 40 mg) daily. After 10 weeks of citalopram treatment, statistically significant improvements were reflected in OCD symptom ratings (mean Total Y-BOCS/CY-BOCS scores, 30 +/- 4 vs. 21 +/- 4, p < 0.001) and global assessment scores (mean CGAS, 59 +/- 11 vs. 71 +/- 11, p < 0.001). Over 75% of these youth showed a marked improvement (4 patients had more than 50% reduction in CY-BOCS scores) or moderate improvement (14 patients had 20%-50% reduction) in OCD symptoms. No patient was found to have worsened during citalopram treatment. Adverse effects appeared minor and transient. None of the 23 patients dropped out of the study or had the medication discontinued because of side effects. These open trials of citalopram do not allow for any firm conclusions regarding its effectiveness in the treatment of childhood and adolescent OCD, but these preliminary findings suggest that citalopram might be particularly well-tolerated in children and adolescents with OCD at doses up to 40 mg daily.

3 cases of early onset, severe eating disorder are described. These young children did not present a distorted body image even though they had suffered a great weight loss, were somatically distressed and in all other aspects fulfilled the criteria for anorexia nervosa. The criteria for anorexia nervosa are discussed for this group of young patients.

A total of 546 children and adolescents, aged 5 to 15 years, who were admitted as in-patients to psychiatric hospitals throughout Denmark between 1970 and 1973, were followed up with regard to later readmissions and mortality. Approximately one-third of the sample had at least one readmission after the age of 18 years; there was no significant difference between male and female subjects. Probands with three selected diagnoses, namely childhood neurosis, conduct disorder and maladjustment reactions, did have a significantly greater general risk of readmission to psychiatric hospital in adulthood than the background population. In total, 24 probands (22 male, and 2 female subjects) died during the study period. Eight subjects had committed suicide. The standard mortality rate was significantly increased.

The ICD-8 diagnosis applicable to borderline psychosis in children is psychosis limitaris infantilis (299.02). Results from a register-based study referring to all Danish children admitted between 1970 and 1992 and diagnosed borderline psychosis are presented here. A total of 415 children (332 boys and 83 girls) were admitted with a diagnosis of psychosis limitaris infantilis. At a follow-up examination in the Psychiatric Case Register 70% of those diagnosed with psychosis limitaris infantilis were found to have been re-admitted at least once to a psychiatric hospital. Thirteen percent of the boys and 19% of the girls, admitted more than once, had a diagnosis of schizophrenia after 5 years. This share increased after a 15-year period of observation to 24% in the group of boys, whereas the number of schizophrenic girls remained unchanged. One third of the boys and 17% of the girls were diagnosed with personality disorders, following a 15-year observation period.

The aim of this study was to determine the frequency, demographic characteristics and course of children and adolescents admitted with a diagnosis of schizophrenia before the age of 18 years. The paper describes 312 patients from Denmark who were given a diagnosis of schizophrenia during the period between 1970 and 1993. Schizophrenia with a childhood onset was extremely rare. Only four children under the age of 13 years and 28 children under the age of 15 years had received such a diagnosis. The study showed that a number of adolescents who were diagnosed with schizophrenia at their first admission were not given the same diagnosis at later admissions in adulthood. The most common diagnoses in this group of apparently misdiagnosed cases were personality disorders, primarily borderline and antisocial personality disorder.

The available literature on etiological aspects and treatment of childhood and adolescent obsessive-compulsive disorder is reviewed. Reports regarding the etiological background are still inconsistent, but there is increasing evidence of a biological background with involvement of serotonin neurotransmitter systems. It seems that a combination of medication and behavioral therapy is most effective in the treatment of OCD. Only a few controlled trials of medication in the treatment of OCD in children and adolescents have been published. Such studies, including a considerable number of patients over a considerable period of time, are still needed.

Obsessive-compulsive disorder (OCD) in children and adolescents is apparently a much more common disorder than previously believed. The literature on OCD in children and adolescents is reviewed, and OCD is described as a severe disorder with a poor prognosis for about half of the patients. The clinical picture seems to be the same across different cultures. The most common symptoms are obsessions about dirt and contamination and washing rituals.

Objective: The course of obsessive-compulsive disorder (OCD) in childhood and adolescence was analyzed., Method: Twenty-three (88%) of 26 children and adolescents with OCD, all referred to a county child psychiatric clinic as inpatients or outpatients, were longitudinally evaluated every 6 months for obsessive-compulsive symptomatology. At follow-up, 1 1/2 to 5 years after referral (mean follow-up time 3.2 years, SD 1.1), obsessive-compulsive as well as comorbid symptomatology was assessed and compared with that of an age- and sex-matched child psychiatric control group., Results: Approximately one half of the children and adolescents retained an OCD diagnosis at follow-up. One third of these had an episodic course of the illness, and two thirds had chronic OCD. None in the control group had clinical OCD at follow-up, but three had subclinical obsessive-compulsive symptoms. Thirteen of the probands with OCD received medication (either clomipramine or citalopram) for a period of 1/2 to 2 years (mean 1.4 years). Medication seemed to reduce the severity of OCD in most cases., Conclusions: This short-term but intensive study supported theories of OCD as an illness with fluctuating severity. Previous findings, that OCD seems to be chronic in approximately half of the cases, were supported by this study.

Prediction of the phenomenological course of obsessive-compulsive disorder (OCD) in adulthood was determined in 47 probands referred in childhood for in- or outpatient treatment for OCD. The only factor that predicted a poor outcome, defined as the presence of OCD in adulthood, was severity of OCD in childhood, as measured by the duration of the obsessive-compulsive symptoms. More females than males had an episodic course of OCD. However, just as many females as males had OCD, either chronically or episodically, in adulthood. Age of onset did not predict the phenomenological course of OCD.

The family history of obsessive-compulsive (OCD) and other psychiatric disorders of 20 children and adolescents, consecutively referred for OCD, is described and compared with that of 20 comparison patients, matched for age and gender. OCD, current or past, was found in 3 fathers to OCD patients, and obsessive-compulsive behaviour was found in 5 fathers and 3 mothers to OCD patients but only in 1 mother to a comparison patient. Over half of the patients reported about precipitating events for their obsessive-compulsive symptoms. The type of triggering event seemed to be connected to the obsessive-compulsive symptomatology only in a few cases.

All first-time admissions from 1970 to 1986 with obsessive-compulsive neurosis (OCD) (ICD-8 diagnosis number 300.39) or obsessive-compulsive personality disorder (OCPD) (ICD-8 diagnosis number 301.49) were analyzed based on an extract from the nationwide Psychiatric Case Register in Denmark. All patients with secondary diagnoses other than neurotic disorders or personality disorders (including "neuroses characterogenes") were excluded from the study. A total of 284 patients were first-time admitted with a main diagnosis of OCD during the period. The sex ratio was 0.67 (males/females). A total of 126 were first-time admitted with a diagnosis of OCPD, with a sex ratio of 1.18 (males/females). Seventy-seven percent of the readmitted patients with a first-time diagnosis of OCD kept a diagnosis within the "emotional spectrum" at the last admission. About half kept OCD as a main diagnosis, whereas only 15% shifted to a severe psychiatric diagnosis such as schizophrenia or manic-depressive psychosis. Of the readmitted patients with OCPD, 13% later developed a diagnosis of manic-depressive psychosis.

The present study is an analysis of the sociodemographic background of children and adolescents with OCD and child psychiatric control patients. The case records of 61 children and adolescents with OCD and of 117 control patients aged 8-17 years, admitted to a Danish child psychiatric hospital during a 17-year period, were analyzed with regard to sociodemographic data. The OCD patients differed in many ways from their controls, regarding problems at school and family background. Significantly more parents of OCD patients belonged to the highest social classes, and significantly fewer OCD patients came from broken homes. Parents of OCD patients had fewer admissions to psychiatric hospitals and fewer abuse problems than in the control groups.

Forty-seven people with admissions in childhood for obsessive-compulsive disorder (OCD) and 49 child psychiatric controls were followed up in young adulthood and assessed for DSM-III-R personality disorders with the Structured Clinical Interview for DSM-III-R Personality Disorders. The number of personality disorders in OCD patients did not differ significantly from the number in controls. The most common personality disorder was avoidant personality disorder (significantly more frequent than in controls), whereas obsessive-compulsive personality disorder (OCPD) was not found more often in the OCD group. Subjects with OCD in adulthood seemed to have OCPD more often than childhood OCD patients with no OCD at follow-up. In the whole group, histrionic personality disorders were more common in women than in men and OCPD more common in men than in women, whereas borderline personality disorder was most common among women in the OCD group. The presence of a personality disorder in adulthood could not be correlated with such childhood factors as social background, symptoms or age of onset of OCD.