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Corporal punishment (CP) is a widely spread disciplining practice among parents and caregivers globally. Our paper aimed to explore the relationship between the parental attitudes towards CP, expected outcomes of CP, and parenting practices on one hand, with the reported dysfunctions of their children, on the other. Additionally, we aimed to explore the relationship between the use of CP and the reported academic, developmental, and psychological–emotional dysfunctions of their children. The present study involved a nationally representative sample of 1186 parents in Serbia, who had at least one child aged 0–18 years at the moment of interviewing. The parents filled out a series of questionnaires on their attitudes towards CP, expectations of CP outcomes, and their parental practices. Findings indicate that parents that report having a child with dysfunctions have positive attitudes towards CP and expect positive outcomes of CP. These parents also report using more CP as a disciplining method, as well as other harsh disciplining practices. We also identified parental positive expectations of CP, use of physical assault, psychological aggression, neglect as significant predictors of reported child dysfunctions severity. Having all the results in mind, we can assume that children with health-related and school-related issues might be at potential risk of further maltreatment. This is the peer reviewed version of the paper:Grujicic, R., Toskovic, O., Lazarević, L. B., Mandic-Maravic, V., Mitkovic-Voncina, M., Radanović, A., Radosavljev-Kircanski, J., Videnović, M., Pekmezovic, T., & Pejovic Milovancevic, M. (2022). How are parental practices and attitudes towards corporal punishment related to child academic, developmental, or psychological–emotional dysfunctioning? European Child & Adolescent Psychiatry. [https://doi.org/10.1007/s00787-022-02061-z]

Background/Aim. Attachment and emotion regulation skills are recognized as important factors in the development of depression, but their specifics have rarely been discussed in clinical adolescent population. The aim of our study was to investigate attachment and emotion regulation strategies in adolescents with depression. Methods. The sample consisted of 101 adolescents, age 16 to 24, divided into three groups: 1) 41 adolescents with the diagnosis of depressive disorder; 2) 30 adolescents with the diagnosis of anxiety disorder; 3) 30 health adolescents (without psychiatric diagnosis). The assessment was done by the following instruments: the Socio-demographic questionnaire; the Semistructured clinical interview (SCID-I) for the Diagnostic and Stratistical Manual of Mental Disorders, Fourth Edition (DSM-IV); the Beck Depression Inventory (BDI); the Inventory of Parent and Peer Attachment (IPPA) and Emotional Regulation Questionnaire (ERQ). Data were analyzed using MANCOVA and partial correlation, with gender, age and birth order as covariates. Results. The adolescents with depressive disorders had less secure attachment to mother and peers than the health adolescents and less secure attachment to father comparing to other two groups (MANCOVA F = 4.571; p = 0.000). The adolescents with anxiety disorder had less secure attachment to father and peers compared to the healthy adolescents group (p < 0.05). The depressed adolescents used the strategy of cognitive reappraisal less often than both control groups (MANCOVA F = 5.200; p = 0.001). Subjective experience of depressive symptoms was related to insecure attachments to both parents and peers (r = -0.457; -0.436; -0.349; p = 0.000), as well as to lower use of cognitive reappraisal (r = -0.446; p = 0.000). Conclusion. Our findings related the adolescent depression to insecure attachment in all domains, with the specific weakness in emotion regulation (weak cognitive reappraisal). The findings could have practical implications for preventive and therapeutic interventions.

Although a number of children and adolescents has a diagnosable mental disorder, only a small portion of them receives treatment early enough. One of the ways to enhance the availability of treatment is the application of cognitive-behavioral therapy (CBT), a therapeutic modality with shown efficacy in various internalizing and externalizing child and adolescent disorders, in school settings. School environment represents a useful therapeutic setting since, on one hand, it reduces the stigma of psychiatric treatment and increases the availability of intervention to young people, and on the other hand, it provides a possibility of specific information integration and mastering the acquired skills. This paper briefly summarizes some of the CBT principles, indications and techniques most important for working with youth in school environment. With education of school professionals, CBT in school settings may represent a structured, practical and adherable way to help the challenges young people face growing up.

Transforming growth factor beta (TGF-β), which has a role as a regulatory cytokine, has not been widely investigated in patients with major depressive disorder (MDD) who experienced childhood trauma. The aim of our study was to investigate the differences in circulating TGF-β levels between the patients with major depressive disorder (MDD) with and without child maltreatment (CM) history, and to compare them to the corresponding control subjects' groups (with or without CM). Blood samples were obtained from 55 patients, fulfilling DSM-IV-R criteria for a current MDD episode without psychotic symptoms, and 45 healthy controls, matched for age and gender. Participants were administered the Childhood Trauma Questionnaire (CTQ). Serum TGF-β concentration was determined by enzyme-linked immunosorbent assay. The concentration of TGF-β was significantly higher in patients with MDD with CM history, compared to MDD patients with no CM, as well as both control groups. Furthermore, we have shown that the combined effect of CM history and MDD affected TGF-β levels in adulthood, which was not observed in the control group with CM. These results indicate that MDD patients with the experience of CM have altered immune-regulatory response, and they may constitute a specific subtype within this heterogenic disorder (ecophenotype).

The fixed dystonia phenotype was originally established as a prototype of functional dystonia. Nevertheless, in recent reports different functional dystonia phenotypes have been recognized with dystonic movement comprising phasic instead of tonic contraction. To examine clinical characteristic in all patients with dystonia who fulfilled the criteria for functional movement disorders irrespective of phenotype in an attempt to determine parameters of clinical presentations that might impact the disease progression pattern and outcome. Patients presented with dystonia features incompatible with organic disease without other features required for the diagnosis of functional movement disorders were analyzed and prospectively followed-up. The two-step cluster analysis was performed to obtain the subgroups of dystonia phenotypes. The two-step cluster analysis extracted two subgroup of patients. Patients of the first cluster (68.8%) presented with “mobile” dystonia (84.9%), of cranial/neck/trunk localization (90.9%), fluctuated clinical course (69.7%), with frequent additional movement or other functional neurological disorders (63.6%) during follow-up. In the second cluster (31.2%) all of the patients presented with “fixed” dystonia of extremities, and the clinical course was characterized by either the disease progression (60%), or continuous without improvement (26.7%), and rare occurrence of additional functional neurological disorders (13.3%). In terms of clinical and demographic features as well as pattern of disease progression there are two clinical phenotypes in patients with functional dystonia. Distinctive features of incongruence and inconstancy are characteristic for “mobile” functional dystonia subgroup of patients.

Objective The aim of this cross-sectional study was to identify if there was a specific difference between patients with functional dystonia (DysF) and those with adult-onset, isolated idiopathic (“primary”) dystonia (DysP) in terms of psychiatric disorders, psychological stressor, dissociation correlates, and personality traits. Methods Thirty-nine clinically definite DysF and 30 DysP patients matched by age, gender and dystonia distribution underwent psychiatric interview based on DSM-5 criteria and additional testings for global cognitive and psychiatric functions (Mini-Mental State Examination, Hamilton Depression and Hamilton Anxiety Rating Scale, Apathy Scale, Somatoform Dissociation Questionnaire-20, Dissociative Experiences Scale II, and the five-dimensional Revised Neuroticism-Extroversion-Openness Personality Inventory). Results Almost half of our DysF patients had prior psychiatric treatment, which was significantly more frequent when compared to DysP. Patients with DysF in comparison to DysP also had considerably more frequent preceding stress, higher apathy, dissociative and somatoform scores, as well as significantly higher rate of la belle indifference sign. This sign, stress before dystonia and prior psychiatric disorder independently predicted having DysF. Some of psychiatric disorders (i.e. substance-related disorders, schizophrenia, adjustment disorder, borderline personality disorder, post-traumatic stress disorder, psychotic depression, delusional disorder) were exclusively present among DysF patients. DysF compared to DysP patients had lower scores for both extroversion and openness to experiences. Conclusion Our data found different pattern of psychiatric comorbidity and personality traits between DysF and DysP patients, including a higher prevalence of psychological stressor and dissociative correlates, indicating at least a partial role of psychological mechanisms in the pathogenesis of DysF.

Adolescence is a period between childhood and adulthood, characterized by specific physical and psychological development. It is a transitional developmental period, rather than a single snapshot in time. Traditional neurobiological and cognitive explanations of adolescent development of behavior have failed to account for the changes in behavior observed during adolescence. Magnetic resonance imaging studies have discovered that myelinogenesis continues from childhood to adulthood in the brain's region-specific neurocircuitry, which remains structurally and functionally vulnerable to impulsive habits. The maturation of the adolescent brain is influenced by heredity, environment, and sex, and they play a crucial role in myelination. Furthermore, one of the measures extracted out of MRI studies is also the thickness of cerebral cortex, a part that harbors synapses. It is the complexity of these synapses that allows humans to generate and understand complex thoughts and feelings in the real world, including the ability to solve analogies. And it is the complexity of those connections, remaining under construction during adolescence, that may be responsible for immature and impulsive behavior and neurobehavioral excitement during the adolescent life.

Background Despite relatively consistent findings regarding the number of personality pathology domains, differences in domain structure remain. Recently the proposed ICD-11 domains were partially validated in a sample of patients with major depression producing five domains: Detached, Anankastic, Negative Emotional, Antisocial and Borderline. The aim of our study was to attempt to cross-validate these findings in a sample of patients primarily diagnosed with personality disorder (PD). Subjects and methods All subjects were assessed by Structured Clinical Interview for the DSM-IV Axis II PD. Exploratory factor analysis (EFA) was applied on fifty seven DSM PD symptoms selected to represent the five proposed domains. Results SCID II data were collected from a total of 223 subjects. The EFA extracted five factors. The first factor labeled as borderline-internalizing constituted of borderline together with avoidant and dependent items, the second, labeled as disinhibited/ borderline externalizing, incorporated narcissistic and histrionic items. The other three separate factors in our study labeled as antisocial, anankastic and detached, were less robust. Conclusions In our study five personality pathology domains were partly replicated. The most robust findings support the existence of the two factors, borderline-internalizing and disinhibited/borderline externalizing. However, the EFA was performed on a relatively low prevalence symptoms distribution, particularly for antisocial and schizoid factors.

Autism spectrum disorders (ASD) are a group of complex psychiatric disorders, with a proposed gene-environment interaction in their etiology. One mechanism that could explain both the genetic and environmental component is oxidative stress. The aim of our study was to investigate the potential role of common polymorphisms in genes for glutathione transferase A1, M1, T1 and P1 in susceptibility to ASD. We also aimed to explore the possible oxidative stress - specific gene-environment interaction, regarding GST polymorphisms, maternal smoking tobacco during pregnancy (TSDP) and the risk of ASD. This case-control study included 113 children with ASD and 114 age and sex-matched controls. The diagnosis was made based on ICD-10 criteria and verified by Autism Diagnostic Interview – Revised (ADI-R). We investigated GSTA1, GSTM1, GSTP1 and GSTT1 genotypes and explored their individual and combined effects in individuals with ASD. Individual effect of GST genotypes was shown for GSTM1 active genotype decreasing the risk of ASD (OR = 0.554, 95%CI: 0.313–0.983, p = 0.044), and for GSTA1 CC genotype, increasing susceptibility to ASD (OR = 4.132, 95%CI: 1.219–14.012, p = 0.023); the significance was lost when genotype-genotype interactions were added into the logistic regression model. The combination of GSTM1 active and GSTT1 active genotype decreased the risk of ASD (OR = 0.126, 95%CI: 0.029–0.547, p = 0.006), as well as combination of GSTT1 active and GSTP1 llelle (OR = 0.170, 95%CI: 0.029–0.992, p = 0.049). Increased risk of ASD was observed if combination of GSTM1 active and GSTP1 llelle was present (OR = 11.088, 95%CI: 1.745–70.456, p = 0.011). The effect of TSDP was not significant for the risk of ASD, neither individually, nor in interaction with specific GST genotypes. Specific combination of GST genotypes might be associated with susceptibility to ASD, while it appears that maternal smoking during pregnancy does not increase the risk of ASD.

Objectives: Autism spectrum disorders (ASD) are characterized by qualitative impairment of social interactions, impairment of verbal and nonverbal communication, as well as restricted interests and repetitive behavior. ASD represent a group of complex psychiatric disorders, with both genetic and environmental factors implicated in their etiology. Recent neuroanatomical and epidemiological studies point out to prenatal and early postnatal genesis of ASD. Aim: In this review, we present recent studies that explored the effect of environmental, prenatal and perinatal risk factors on development of ASD. Also, we point out those factors that have been proven to have the strongest association with ASD, and emphasize a very complex interaction of individual factors that might eventually lead to manifestation of this group of disorders. Conclusion: A precise defining of risk factors might provide more insight not only into etiology of ASD, but might also give us a possibility for early recognition and possible prevention of autism spectrum disorders, especially in susceptible individuals. It is also a first step in defining the basis of the gene-environment interaction mechanism, which might enable the development of an individualized therapeutic approach for this group of disorders.

Autism spectrum disorders (ASD) significantly impact lives of affected individuals and their families. They confront daunting challenges and multiple demands in their daily life, when compared to parents of children with other disabilities or parents of typically developing children.Participants completed The Caregiver Needs Survey, the survey intended for parents or primary caregivers of children with a diagnosis of ASD. During the study, 231 parents were interviewed; 167 mothers and 64 fathers. Parents were recruited from the patient database comprised of families from the two largest cities in Serbia. All of them were contacted before the study, either via phone or at the child's regular check-in visit.Over 90 percent of the parents reported that additional support at schools, home, and improved relationships with service providers are necessary and important. The most important challenges related to care were child's communication difficulties, social interaction difficulties, and problems with daily living skills. The significant predictors of lower overall satisfaction were parent's higher education, having a first concern related to problems of the child's interaction with others or playing alone, and parent frustration with accessing services in the past 12 months. Greater overall satisfaction, on the other hand, was related to having an in-school tutor training or assistance in managing child's needs or implementing treatments, and having primary care doctor or pediatrician as a source of information on autism.Future efforts to develop ASD-related policies and services should also take the following into consideration: the low level of awareness among caregivers and health care providers about the early signs of autism; disparities in access to services; educational problems and significant levels of dissatisfaction with the overall care and stigma.

There is an ongoing debate on the relationship between depression and anxiety, but data on similarities and differences in their predictor profiles are scarce. The aim of our study was to compare family and personality predictors of these disorders among 220 "emerging adults." As such, two clinical groups with noncomorbid depressive and anxiety disorders, and one healthy control group were assessed by sociodemographic questionnaires, Structured Clinical Interview for DSM-IV Disorders and NEO Personality Inventory, Revised. We found significant overlap in family and personality risk profiles, with increasing effect size for predictors common to anxiety and depression when the categories "no disorder-anxiety disorder-depressive disorder" were considered as existing along a continuum. Among the contributing factors we assessed, family psychiatric history, family structure and conflicts with parents were more significant than personality traits. Our study indicates that emerging adults may be more vulnerable to depression than anxiety in the presence of family and personality risk factors.

Access to medical information is important as lifelong scientific learning is in close relation with a better career satisfaction in psychiatry. This survey aimed to investigate how medical information sources are being used among members of the European Federation of Psychiatric Trainees. Eighty-three psychiatric trainees completed our questionnaire. A significant variation was found, and information availability levels were associated with training duration and average income. The most available sources were books and websites, but the most preferred ones were scientific journals. Our findings suggest that further steps should be taken to provide an equal access to medical information across Europe. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

This review aims to provide a brief description of the complex etiology of autism spectrum disorders (ASD), with special emphasis on the recent findings of impaired redox control in ASD, and to suggest a possible model of oxidative stress-specific gene-environment interaction in this group of disorders. Recent findings point out to the significance of environmental, prenatal, and perinatal factors in ASD but, at the same time, are in favor of the potentially significant oxidative stress-specific gene-environment interaction in ASD. Available evidence suggests an association between both the identified environmental factors and genetic susceptibility related to the increased risk of ASD and the oxidative stress pathway. There might be a potentially significant specific gene-environment interaction in ASD, which is associated with oxidative stress. Revealing novel susceptibility genes (including those encoding for antioxidant enzymes), or environmental factors that might increase susceptibility to ASD in carriers of a specific genotype, might enable the stratification of individuals more prone to developing ASD and, eventually, the possibility of applying preventive therapeutic actions.

Still obscure mechanisms of intergenerational child maltreatment (ITCM) have been investigated partially, from various psychological and biological perspectives and from various time perspectives. This review is aimed at integrating the findings on different temporal ITCM pathways, emphasizing the mind–brain–body interplay. Psychological mediators of ITCM involve attachment, mentalization, dissociation, social information processing, personality traits, and psychiatric disorders. Neurobiological findings mostly refer to the neural correlates of caregiving and attachment behaviors, affected by several physiological systems (stress-response, immune, oxytocin), which also affect physical health. The latest research clusters around the epigenetic pathways of ITCM, suggesting the additional, prenatal, and preconception forms of transmission. Data suggest that ITCM needs to be conceptualized as a longitudinal process, with various interrelated psychological, neurodevelopmental, and somatic paths. Future research and prevention should take into account both, each path and each phase of ITCM, in an integrative way.

Background:There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country.Methods:Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration.Results:A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have ‘ever’ considered to move to a different country in their future, 53.5% were considering it ‘now’, at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (2500€) incomes, personal reasons were paramount (44.5%).Conclusions:A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities.

The independent roles of each childhood maltreatment type on child abuse potential in adults have been insufficiently explored and are inconsistent, with dissociation as one of the possible suggested mediators of intergenerational child abuse. We investigated these effects among 164 non-clinical adult parents, who filled in general questionnaires: Childhood Trauma Questionnaire (CTQ), Child Abuse Potential Inventory (CAPI) and Dissociative Experience Scale (DES). Among all maltreatment types (emotional, physical and sexual abuse, emotional and physical neglect), emotional abuse was the only independent predictor in the regression model of child abuse potential. The relationship between emotional abuse history and child abuse potential was partially mediated by dissociation. The findings could speak in favor of the potentially unique detrimental role of emotional abuse in intergenerational maltreatment, with dissociation as one of the possible mechanisms.

The dynamics of adolescence require adjustments in psychiatric treatment because of the challenges of this developmental stage in life. This column describes the Day Hospital for Adolescents (DHA) of the Institute of Mental Health in Belgrade, Serbia, which was established in December 2007. The DHA is a holistic program for the treatment of youths ages 15–25 with emotional disorders. The multicomponent therapeutic program includes individual treatment, several group therapeutic activities, and work with patients’ families and the school system. An evaluation of data obtained for 102 patients indicated that DHA treatment was associated with significant reductions in depression symptom severity and improved functioning. The adolescents reported a high level of treatment satisfaction. The results suggest that a multicomponent day hospital is an effective treatment modality for adolescents with emotional disorders.

Objective: To examine glutathione S-transferase (GST) deletion polymorphisms in development of early-onset severe mental disorders, with the hypothesis that patients with GSTM1-null and GSTT1-null genotypes will develop psychotic disorders at a younger age. Methods: We identified GSTM1 and GSTT1 deletion polymorphisms by multiplex polymerase chain reaction (PCR) in 93 patients with early onset severe mental disorders and 278 control individuals. The diagnoses were confirmed by Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and Schedule for Affective Disorders and Schizophrenia–Life-Time Version (K-SADS-PL) interviews. Results: Individuals with the GSTM1-null genotype were at 3.36-fold higher risk of developing early-onset severe mental disorders than carriers of a corresponding active genotype. The risk of those disorders was increased by 6.59-fold in patients with GSTM1-null/GSTT1-active genotype. Patients with the GSTM1-null genotype were at approximately 2-fold increased risk for developing early-onset schizophrenia-spectrum disorder (EOS), early-onset bipolar disorder (EOBD) with psychotic symptoms, or early-onset first-episode psychosis (EOFEP), compared with patients with the GSTM1-active genotype. Conclusion: The GSTM1-null genotype might be associated with higher risk for early onset severe mental disorders. * Abbreviations : EOS : early-onset schizophrenia EOFEP : early-onset first-episode psychosis EOBPs : early-onset bipolar disorders GSH : glutathione GST : glutathione S-transferase ROSs : reactive oxygen species MAPEG : membrane-associated proteins in eicosanoid and glutathione metabolism K-SADS-PL : Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version ICD-10 : International Classification of Diseases, Revision 10 DSM-IV : Diagnostic and Statistical Manual of Mental Disorders , 4th Edition DSM-III-R : Diagnostic and Statistical Manual of Mental Disorders , 3rd Edition–Revised SADS-L : Schedule for Affective Disorders and Schizophrenia Lifetime PCR : polymerase chain reaction ORs : odds ratios CIs : confidence intervals CNV : copy number variation NA : not applicable

We explored sex differences in diagnostic categories, clinical symptoms and adaptive behavior of persons with autism spectrum disorders, as well as sex-specific correlations of clinical and adaptive caracteristics. The study involved 108 patients (83 males, 6.73 ± 4.33 years old) diagnosed with autism spectrum disorders (ASD). Assessment included ADI-R and Vineland Adaptive Behavior Scale II. Males were more often diagnosed with typical autism. There were no sex differences in the autistic symptoms, while females showed better functioning in Daily living skills, without reaching statistically significant difference (p = 0.062). We have found different associations of autistic symptoms with different aspects of adaptive behavior in males and females. Social reciprocity in females correlated with social domain of adaptive behavior, in a positive direction. Our findings have shown that although there are no sex differences in autistic symptoms, females tend to be somewhat more functional and are also less frequently diagnosed with typical autism. Our results have also shown that sex might moderate the way clinical symptoms are expressed in adaptive behavior. Social reciprocity might be the core feature regarding sex differences in ASD. Our findings might have diagnostic and therapeutical implications, pointing out to the need for individualized, sex-specific treatment in this group of disorders.

IntroductionAutism spectrum disorders (ASD) are complex psychiatric disorders, with both genetic and environmental factors implicated in their etiology. Recent studies suggest the prenatal and early postnatal genesis of ASD, therefore, understanding the effect of environmental risk factors could be important for prevention and treatment of ASD.AimsThe aim of this study was to determine the association of prenatal factors and perinatal complications with ASD.MethodsOur study included 102 subjects with ASD (80% boys) aged 9.35 ± 5.85, and 107 age and sex matched healthy controls (77% boys). For the diagnosis of ASD, we used the ICD-10 criteria and Autism Diagnostic Interview-Revised (ADI-R). A questionnaire regarding prenatal and perinatal factors/complications was administered to all subjects.ResultsLogistic regression model of having autism vs. being a control subject included gender, age, maternal and paternal age at birth, pregnancy order, smoking in pregnancy, number of medication during pregnancy (mostly tocolytics, antihypertensives, antiarrhythmics), and early postnatal complications (mostly prematurity, low birth weight, hyperbilirubinaemia). The model was significant, explaining about the third of variance, with number of medication during pregnancy and having an early postnatal complication as significant predictors.ConclusionsOur study has shown a significant association of specific prenatal and perinatal factors and ASD, even after controlling for other potential confounding variables. Identifying specific risk factors is important for prevention of ASD. It is also the first step in defining basis of the gene–environment interaction mechanism, which might enable development of an individualised therapeutic approach for this group of disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.