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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

We consider as serious manifestations in adolescence self harm and suicidal behavior. In clinical practice we meet adolescent patients with various comorbid psychopatology and problems of personality development. Cases need to be assessed individually and adequate treatment should be indicated. Autors deal with autodestructive behavior in adolescence and the message is illustrated by case reports. [ABSTRACT FROM AUTHOR]

Many mental disorders in childhood and adolescence have somatic symptoms in addition to psychological symptoms. In some disorders, the physical symptoms are to be registered first. These are mainly dissociative and somatoform disorders. In neurotic disorders, abdominal pain, nausea and heart palpitations are the most common. Eating disorders have significant somatic consequences. Mental disorders with somatic manifestations typical for childhood are inorganic enuresis, encopresis and tic disorder. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder is a risk for children and adolescents exposed to a serious traumatic event. Both diagnostics and treatment, especially in younger children, are complicated due to the child's immaturity in emotional, cognitive and relationship area. Recently, we differentiate between posttraumatic stress disorder as a result of one sudden unexpected endangering situation, and a complex posttraumatic stress disorder, which is a result of a repeated, long-term traumatization usually in an important interpersonal context. The authors describe types of child trauma as well as characteristics of its clinical consequences and possibilities for treatment. [ABSTRACT FROM AUTHOR]

Anorexia nervosa has a negative impact on the physical and psychosocial development of children and adolescents. Although it occurs most often during adolescence, however, the increasing incidence of disorder at an early age highlights the need to study an early-onset group. Developmental approach should be applied both in the diagnostics and the effective treatment. The authors deal with mental anorexia with early onset and the message is illustrated by case reports. [ABSTRACT FROM AUTHOR]

The authors deal with suicidal behaviour in children and adolescents. They examined 35 patients (6 boys and 29 girls) hospitalized in the Department of Child and Adolescent Psychiatry of the University Hospital Motol after suicidal attempt in 2010. The main focus of their study was to identify the motivation and risk factors for suicidal behaviour. The results indicated that problematic family background, psychopathology including depressive symptoms (63 %), anxiety (31%) and conduct disorders (29%) were common. The problematic personality development (83%) seemed to be extremely important. Drug poisoning was identified as a predominant type of suicidal attempt (89%). [ABSTRACT FROM AUTHOR]

Objective: Orexin A (OXA) is a hypothalamic neuropeptide involved in regulation of food intake and nutritional status. There are multiple disturbances of neuropeptide signaling described in girls with anorexia nervosa (AN), but OXA levels have not been addressed in this population to date. Therefore, we analyzed OXA levels of AN girls in this study., Method: OXA (radioimmunoassay/RIA/method), leptin, insulinlike growth factor-1 (IGF-1), and insulinlike growth factor-1 binding protein-3 (IGFBP-3) levels were measured before and after 8 weeks of realimentation in 36 girls with AN and in 14 healthy controls (control group: CG)., Results: Average weight increased significantly in AN during the study (p < .0001), while plasma levels of OXA decreased (before realimentation: 56.2 ± 2.4 pg/ml; after realimentation: 47.5 ± 1.4 pg/ml; p = .0025). OXA levels before realimentation differed from levels in the CG (47.15 ± 2.6 pg/ml, p = .034), but not afterward. We did not find any correlation between OXA and age, height, weight, BMI; or IGF-1, IGFBP-3, and leptin levels., Discussion: OXA levels in untreated AN patients differ significantly from healthy subjects and decrease during realimentation. These findings indicate that OXA may be involved in the nutritional regulation of malnourished children and adolescents., (Copyright © 2010 Wiley Periodicals, Inc.)

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.

Specific aspects of therapy of eating disorders in pubescent and adolescent girls are related to unfinished biological development in time of severe malnutrition. Namely the issues of 1) exact determination of recommended body weight (target weight, weight for discharge etc.) on the basis of the exact analysis of the weight history, 2) relation between body weight and menstrual cycle (menarche, amenorrhoea and remenorrhoea) and 3) risk of non-realization of the genetic growth potential (status of linear growth and skeletal maturity) are discussed in this article. The article brings the results of the data analysis of 90 inpatients with anorexia nervosa and the tables of the recommended target weight for adolescents with finished linear growth. The authors emphasize the importance of an exact analysis of growth and weight history and of reflection of biological age in girls with eating disorders for successful and reasonable realimentation therapy.

Paper dials with specific characteristics of eating disorders in childhood and in early adolescence. Eating disorders can come in all ages, however, they occur most frequently in adolescents and in young adults. Less frequently they appear in childhood and in adolescence (only about 5% of patients are children below 12 years) but they represent serious challenge to the developmental process both at the biological and psychosocial level. Paper gives characteristic signs of eating disorders in children and specific syndromes, which occur in that developmental stage.

Paper deals with problems of atypical forms of food intake disorder. Such disorders can be divided into three groups. First group included sub-clinical forms of food intake disorders. Patients with signs of thinning are included into the second group; however, their active role in slimming cannot be identified. In the third group the accompanying syndromes prevail, e.g. the syndrome of depression and obsessive-compulsive syndrome. Problems in the diagnostics and therapy of those atypical forms are discussed.