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Iva Dudova, Jana Kocourkova, Jiri Koutek Department of Child Psychiatry, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic Abstract: Eating disorders frequently occur in conjunction with autism spectrum disorders, posing diagnostic and therapeutic difficulties. The comorbidity of anorexia nervosa and Asperger syndrome is a significant clinical complication and has been associated with a poorer prognosis. The authors are presenting the cases of an eleven-year-old girl and a five-and-a-half-year-old girl with comorbid eating disorders and Asperger syndrome. Keywords: eating disorders, early-onset anorexia nervosa, autism spectrum disorders, Asperger syndrome, diagnostics, therapy

Jana Kocourkova, Iva Dudova, Jiri Koutek Department of Child Psychiatry, Charles University Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic Abstract: Asperger syndrome hinders adaptation to developmental challenges during childhood and adolescence, particularly with regard to interpersonal relationships. Individuals with Asperger syndrome display lack of empathy and limited ability to understand social and emotional exchanges with other people. Individuals with Asperger syndrome are significantly exposed to the risk of suicidal behavior, especially during adolescence. The authors describe cases of suicidal behavior in two adolescent boys with Asperger syndrome. Keywords: Asperger syndrome, suicidal behavior, adolescence

Before 1990, abortions were highly prevalent in Eastern Europe, including Czechoslovakia. After 1990, the Czech and Slovak populations experienced a significant decrease in the abortion rate. Because both states have complete statistics on abortion and identical histories of abortion legislation, trends in abortion rates between 1988 and 2008 can be compared in detail using standard and decomposition methods. Binary logistic regression with odds ratios and 95% confidence intervals were used to identify the variables associated with changes in attitudes toward abortion between 1991 and 2008. First, a convergence in abortion rates was confirmed, although a higher abortion rate among unmarried Czech women remained in 2008. In contrast, a divergence in contraceptive practices was found; Slovaks have significantly lagged behind Czechs in the use of modern contraceptives. Differentials in attitudes toward abortion significantly increased (p < .001). Additionally, although a decline in the abortion rate was achieved without legal restrictions to access to abortions, various factors were responsible for this outcome. In the Czech Republic, improvements in family planning and increasing awareness of reproductive health have played key roles in promoting responsible sexual behavior, whereas in Slovakia, the stronger influence of the Catholic Church has contributed to the prevention of abortions.

Background: Delayed childbearing in European countries has resulted in an increase in the number of women having children later in life. Thus more women face the problem of age-related infertility and cannot achieve their desired number of children. Childbearing postponement is one of the main reasons for the increasing use of assisted reproductive technology (ART) and conversely, the latter may be one of the factors contributing to the rise in female childbearing age. The research goal of our article is to evaluate the demographic importance of ART increased use and to examine its impact on both the fertility rate and birth timing., Methods: Comparative analysis based on demographic and ART data collected by the European IVF-monitoring (EIM) Consortium for the European Society of Human Reproduction and Embryology (ESHRE)., Results: Most countries with a higher total fertility rate (TFR) also registered a higher number of treatment cycles per 1 million women of reproductive age. Despite the positive relationship between the postponement rate and the demand for ART among women aged 35 and older, the highest share of children born after ART was not found in countries characterized by a "delayed" fertility schedule. Instead, the highest proportion of ART births was found in countries with fertility schedules concentrated on women aged between 25 and 34. Accordingly, the effective use of ART can be expected in populations with a less advanced postponement rate., Conclusions: ART can have a demographic relevancy when women take advantage of it earlier rather than later in life. Furthermore it is suggested that the use of ART at a younger age increases women's chance of achieving their reproductive goals and reduces the risk of age-related infertility and failed ART. Based on a demographic approach, reproductive health policy may become an integral part of policies supporting early childbearing: it may keep women from delaying too long having children and increase the chance of diagnosing potential reproductive health problems requiring a timely ART application.

Eating disorders represent significant psychopathological spectrum, particularly in adolescent girls. One of the risk factors associated with eating disorders is a strong emphasis of western visual-oriented culture on physical appearance and slimness. However, sensory handicap leading to disability to see one's own body and bodies of others does not mean that eating disorder cannot develop in blind people. The authors believe that body image is a mental construct that is not dependent on sensory perception only. They present the case of an adolescent patient, blind from early childhood, who shows symptoms of mental anorexia, depression, suicidal behavior and self-harming.

Objectives: The aim of this study was to identify risk factors and possible predictors of severity of suicidal behavior of children and adolescents., Methods: Seventy-seven patients (15 boys and 62 girls) aged 15.5+/-1.6 years on average, hospitalized due to a suicidal attempt in the department of pediatric psychiatry, were examined. Structured interviews with patients and their parents were used to clinically assess circumstances of suicidal behavior, relevant risk factors and severity of suicidal behavior., Results: The results indicated that patients with any previous traumatic experience tended to have somatically less severe suicidal attempts (p=0.050). Intensity of suicidal intent was associated with a history of depression (p=0.014) and anxiety disorders (p=0.004), and the current stress from a mental disorder (p=0.014). Somatic severity of suicidal behavior was significantly associated with intensity of suicidal intent (p=0.014). A history of any trauma (previous traumatic experience predicted less severe suicidal behavior, p=0.053) and the current stress from sexual problems (p=0.067) were identified as predictors of somatic severity of suicidality. These two predictors showed only a trend level of significance. The only significant predictor of intensity of suicidal intent was the current stress from a mental illness (p=0.017)., Conclusions: Several risk factors of somatic severity of suicidal behavior and intensity of suicidal intent were described. The most important finding of the study was the association between a history of psychological trauma and a tendency to have less somatically severe suicidal behavior.

Self-harm represents a serious and pathological behavior that occurs most notably during adolescent years and currently seems to be a problem that is on the increase. Self-harm is a self destructive behavior which most frequently takes the form of cutting and burning. Relative to suicidal behavior, self-harm, in and of itself, is not intended to be lethal and tends to be repeated and addictive. However, in cases of self-harm the risk of suicidal behavior cannot be ignored. This presentation is a case study of a girl who engaged in an unusual form of self-harm, by swallowing needles.

Objective: The aim of the study was to evaluate the importance of increased use of assisted reproduction technologies (ART) for the fertility trends in the Czech Republic., Data and Methods: Comparative analysis based on demographic and ART data was used. Demographic data have been published by EUROSTAT and the Czech Statistical Office. ART data have collected by ESHRE., Findings: In the 1990s a trend towards later childbearing contributed greatly to the decline in total fertility rate (TFR) in the Czech Republic. Recently, recuperation of delayed births has resulted in the increase of TFR to 1.5 children per woman which is considered to be a critical minimum level. The highest increase in fertility rates occurred in the age group of 35-39, in which the contribution of ART treatments usually is greatest. Moreover, a substantial increase of multiple births has been registered. In 2005 the estimated share of children born after ART in the Czech Republic (3%) was close to countries with the highest share (Nordic countries, Belgium or Slovenia). However, the Czech Republic registered only half the number of ART cycles per million inhabitants than in those countries. Contrary to Nordic countries the Czech Republic faced an extremely low TFR of 1.28 children per woman. As the estimation of average number of cycles suggests, the need for fertility treatment has not been met in the Czech Republic yet. Moreover, due to the continuous postponement of childbearing to higher women s age, demand for ART treatment will be even higher in the near future and will probably result in the need of more than 2 500 cycles per million inhabitants in the Czech Republic., Conclusions: Spreading of ART is particularly relevant in the countries caught in the low fertility trap as higher impact on fertility trends could be expected. In the Czech Republic there is a chance to get over the critical level of TFR if comprehensive population policy including the improved access to ART based on well-considered strategy with explicit aim to optimize the quality of health care was accepted. However, from the demographic perspective the risk of further delay of childbearing encouraged by ART treatment should be taken into account while making these decisions.