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The World Association for Infant Mental Health (WAIMH) decided to compose a position paper on infants' rights in wartime, as there is still a general lack of attention paid to the impact of war-related traumas on infants' development and psychological health. Though there are numerous areas of violent conflicts around the globe, there have been few published studies that relate specifically to infants. Consequently, humanitarian aid programs tend to overlook infants' psychological needs and to pay more attention to those of older children. This position paper first reviews the studies identified through a literature search, about the impact of war-related traumas during pregnancy and postnatal periods, then describes the existing recommendations that have been added to the Children Rights Convention and their implications for infant mental health clinicians.

Unfortunately, terrorism, violence and other acute adverse life events have become a world-wide problem. There is no country today that is protected from these phenomena and people can no longer feel safe anywhere. This new situation has increased both the scientific interest in post-traumatic stress disorder (PTSD) and the amount of research conducted on this issue.

Pregnancy is one of the most vulnerable periods of life, both physically and emotionally. The effects of stress and trauma have a potential impact on a pregnant woman, as well as on her fetus and future child. Indeed, an increasing number of animal and human studies on the influences of stress on the developing fetal brain have produced evidence that prenatal maternal stress may have a long-term impact on a child’s mental health. Post-traumatic stress disorder during pregnancy, whatever its origin, has a direct impact not only on a woman’s mental health (such as anxiety, depression, and suicidal behavior) but also on pregnancy outcomes, especially premature birth and spontaneous abortion. It may also have a significant impact on the early mother-infant relationship, which, in turn, is decisive in establishing the child’s personality and socio-emotional functioning. Still, one needs to carefully differentiate between stressful events of different types and level of severity. In this chapter, we will review the impact of different types of trauma during pregnancy, including situations of intimate partner violence (IPV), war-related rape, other war-related conditions, pregnancy following a previous traumatic delivery, and natural catastrophes. We will show how variables, such as the timing, nature, and chronicity of the stressful and/or traumatic event, moderate the impact of stress on pregnancy outcomes.

Out-of-home care (OoHC) refers to young people removed from their families by the state because of abuse, neglect or other adversities. Many of the young people experience poor mental health and social function before, during and after leaving care. Rigorously evaluated interventions are urgently required. This publication describes the protocol for the Ripple project and notes early findings from a controlled trial demonstrating the feasibility of the work. The Ripple project is implementing and evaluating a complex mental health intervention that aims to strengthen the therapeutic capacities of carers and case managers of young people (12-17 years) in OoHC. The study is conducted in partnership with mental health, substance abuse and social services in Melbourne, with young people as participants. It has three parts: 1. Needs assessment and implementation of a complex mental health intervention; 2. A 3-year controlled trial of the mental health, social and economic outcomes; and 3. Nested process evaluation of the intervention. Early findings characterising the young people, their carers and case managers and implementing the intervention are available. The trial Wave 1 includes interviews with 176 young people, 52% of those eligible in the study population, 104 carers and 79 case managers. Implementing and researching an affordable service system intervention appears feasible and likely to be applicable in other places and countries. Success of the intervention will potentially contribute to reducing mental ill-health among these young people, including suicide attempts, self-harm and substance abuse, as well as reducing homelessness, social isolation and contact with the criminal justice system. Australian New Zealand Clinical Trials Registry ACTRN12615000501549 . Retrospectively registered 19 May 2015.

To examine how relational behavior and maternal representations are manifested before and after parent-infant psychotherapy, mothers’ and infants’ behaviors and maternal narratives were assessed in 45 clinic-referred dyads who participated in psychodynamically informed parent-infant psychotherapy. Pretreatment and posttreatment assessments included observations of mothers’ and infants’ behaviors (CIB; Feldman, 1998) and assessment of maternal representations (PDI; Aber, Slade, Berger, Bresgi, & Kaplan, 1985). Parent-infant psychotherapy consisted of weekly child-mother, child-father, and two parents’ sessions. Following psychotherapy, maternal sensitivity and child engagement showed a significant increase. An increase was also evidenced in the richness of maternal narratives regarding the mother-infant relations. During the pretreatment assessment, maternal intrusiveness was associated with restricted narratives, lack of joyful descriptions, and reduced coherence and child engagement was associated with m...

Introduction Psychiatric disorders can start at a very young age, though prevalence of specific disorders change over time. Consequently, any study of continuities and discontinuities should start in infancy, and core concepts of developmental psychopathology are useful for understanding the data. Violence is a major societal problem, while the most effective intervention is to prevent the developmental, normative aggression in very early childhood, from turning into conduct disorders and antisocial personality disorders later in life. The aims of this study were to apply the core concepts of developmental psychopathology to the understanding of the data about how developmental aggression in infancy may turn into pathological violence and conduct disorders in childhood and then into psychopathology in adulthood. Methods Selective computerized review of the literature examining longitudinal studies of aggression and violence from infancy to adulthood was conducted. Results Pathways of continuity and discontinuity of aggression and violence were identified from infancy into adulthood. Early care-giving quality is a major contributor to the outcomes, but additional risk and protective factors are in a dynamic and complex interplay. The longer a pathway is pursued, the more difficult change becomes. Discussion Intervention programs aimed at reducing violence among individuals and societies should target risk and protective factors, at least as much as the symptoms.

ObjectiveBoth adolescent suicide and attention deficit hyperactivity disorder (ADHD) are troubling phenomena with high comorbidity, including impulsivity, depression and personality disorders (PD). Studies on the association between these two phenomena are relatively rare. This pilot study's aim was to estimate the rate of ADHD in adolescents attempting suicide.MethodSubjects constituted consecutive admissions to the psychiatric emergency room (ER) who were admitted as a result of attempting suicide. Assessment included the use of the Kiddie-SADS, Strengths and Difficulties Questionnaire (SDQ) and the Conners’ Rating Scale (CRS). Those diagnosed as suffering from ADHD were assessed by a standardized Continuous Performance Test (Test of Variables of Attention [TOVA]) that included methylphenidate (MPH) challenge. Twenty-three (23) adolescents completed the study. M:F ratio was 5:18, respectively.ResultsOf the 23 participants who completed the study, 65% were diagnosed with ADHD, 43.5% with depression and 39% with cluster B PD. ADD/ADHD ratio was 66%:34%. Only five of the patients were formerly diagnosed as ADHD, only three had been medicated and 14 out of 15 adolescents responded well to MPH challenge.ConclusionThese preliminary results suggest a significant association between ADHD and suicidal behavior in adolescents. Further study is needed to establish this association and assess the causality.

The main objective of this study was to examine neuropsychological mechanisms mediating the association between tryptophan hydroxylase 2 (TPH2) and attention deficit hyperactivity disorder (ADHD). A continuous performance test (T.O.V.A.) was administered to 344 participants diagnosed with DSM IV ADHD who were also genotyped for eight TPH2 intronic SNPs. Association between TPH2 (single SNPs and haplotypes), ADHD, and performance on the T.O.V.A. were tested using robust family-based association tests as implemented in two statistical genetic programs: UNPHASED and PBAT. Association was only observed between an eight locus haplotype and ADHD DSM IV combined type III (global P = 0.036). Robust association was observed between TPH2 single SNPs (and haplotypes) and performance on the T.O.V.A., especially Errors of Omission (eight locus haplotypes, global P = 0.038). Significant associations were also observed between TPH2 and improvement (before–after scores) in T.O.V.A. Total Response Variability scores following acute methylphenidate challenge (eight locus haplotypes, global P = 0.009). Using the MFBAT program, significant multivariate association was observed between single SNPs and haplotypes [eight locus haplotypes and all four T.O.V.A. variables (PBAT-GEE P = 0.013)]. The two most common TPH2 eight locus haplotypes were in a Yin Yang configuration and the Yang haplotype was the risk haplotype for both DSM IV ADHD and deficits in neuropsychological performance. The current investigation shows that risk for ADHD conferred by TPH2 variants is partially mediated by serotonergic mechanisms impacting some facets of executive function. Importantly, improvement in T.O.V.A. performance, especially on Response Time Variability, following methylphenidate was also associated with TPH2. © 2008 Wiley-Liss, Inc.

Background: Child and adolescent mental health problems are prevalent and require adequate interventions. Despite several evidence-based interventions for these problems described in the literature, few studies addressed strategies to diffuse efficacious interventions for child mental disorders especially in developing countries. Methods: An extensive but not systematic review of the literature was performed aiming to identify evidence-based interventions for children and adolescents with mental disorders, professionals to target in disseminating these interventions, and the available strategies to diffuse information. Results: Substantial evidence-based information is available to guide preventive, psychosocial and psychopharmacological interventions. The effectiveness of treatments in real-world settings and the cost-effectiveness of interventions are rarely tested. Professionals at different levels (teachers, school counselors, social workers, general practitioners, pediatricians, child psychologists and psychiatrists) should be targeted in diffusing efficacious interventions for child mental health problems worldwide. Telepsychiatry and the internet seem to be the most promising strategies to diffuse knowledge with lower costs. Conclusions: Medical and allied professionals must incorporate child and adolescent mental health issues in their under- and postgraduate curricula, and be better prepared to critically evaluate available information. Professionals need to disseminate evidence-based programs to guide parents and teachers in developing countries to deal with child and adolescent difficulties. Countries need to explore internet solutions for dissemination of medical information.

Parenting is, in its essence, the domain where adult mental health and infant's mental and physical health meet in a complex and dynamic interplay. Becoming a parent is a developmental challenge in itself, and often exacerbates an existing mental illness, and in turn, maladaptive parenting impinges on the early parent-infant relationship, and on the infant's socio-emotional development and later functioning. The capacity for mentalization is brought as a bridging concept between adult and infant psychiatry. A few clinical vignettes illustrate the dynamic interplay between very young children's vulnerabilities and needs and their parents' strengths and weaknesses, leading to a complex interaction and often to symptoms in both child and parent. In the light of the compelling data about the impact of parental psychopathology on parenting behaviors and children outcomes, there is an imperative need for a working alliance and on-going communication between child and adult psychiatrists.

In this study we aimed to examine the outcome of children's severe psychiatric disorders from preschool into later childhood and adolescence.Forty preschool children (28 boys and 12 girls) treated in a tertiary referral mental health center, evaluated at admission and 5.5 ± 1.2 years thereafter.Seven (58.3%) children diagnosed with internalizing disorders at baseline were free of any psychiatric diagnosis at follow-up (p=0.02). Conversely, only one child (8.3%) diagnosed with comorbid disruptive-internalizing disorders at baseline was free of any psychiatric disorder at follow-up (p=1.0). Seven (43.7%) children diagnosed with disruptive disorders at baseline were free of psychiatric diagnoses at follow-up (p=0.02).The small sample size and naturalistic nature of the study.The trajectories of severe psychiatric disorders at preschool years are similar to those reported in community samples and differ according to the baseline diagnosis. Children with internalizing disorders show a much better recovery rate than those with comorbid disruptive and internalizing disorders.

The evolution of the concept of depression in infancy (0-3 years) is relatively new and follows a path similar to the history of depression in adolescence, then in childhood, and in preschool years. It started with Spitz observation of a depressive clinical syndrome, named anaclitic depression, followed by Bowlby's description of three phases in the development of infants who have been separated from their caregiver. Kreisler linked life-threatening feeding disorders with depression in infancy. This article reviews the different causes of depression in infancy. Clinical vignettes illustrate some of them. The main unanswered question is whether depression in infancy can be primary. Diagnostic criteria, differential diagnoses and prognoses are reviewed, as well as therapeutic concerns specific to infancy.

La theorie de l’attachement represente un cadre theorique general a la comprehension de l’organisation des relations humaines tout au long de la vie et en particulier lors de l’adaptation aux situations de separation. Si les premiers types de relations se reproduisent de maniere generale au cours de la vie et dans les relations de couple en particulier, les experiences continuelles avec un conjoint - caracterise par son propre type d’attachement - devenu une figure d’attachement importante, provoque la reactualisation du reseau de representation interne (schemas internes actifs). Le type d’attachement de chaque partenaire influence donc le caractere de la relation de couple. Cet article decrit les differents types d’attachement d’individus et de couples et tente, d’une part, d’apprehender ce qui relie deux personnes, les attentes d’une relation, la capacite a creer une relation de proximite et d’intimite, et, d’autre part, de cerner les elements qui eveillent les conflits, ceux susceptibles de briser la relation et ceux qui caracterisent le processus de separation.

Objective To examine mother and child's touch patterns in infant feeding disorders within a transactional framework. Method Infants (aged 9–34 months) referred to a community-based clinic were diagnosed with feeding disorders ( n = 20) or other primary disorder ( n = 27) and were case matched with nonreferred controls ( n = 47). Mother–child play and feeding were observed and the home environment was assessed. Microcoding detected touch patterns, response to partner's touch, and proximity at play. Relational behaviors were coded during feeding. Results Compared with infants with other primary disorder and case-matched controls, less maternal affectionate, proprioceptive, and unintentional touch was observed in those with feeding disorders. Children with feeding disorders displayed less affectionate touch, more negative touch, and more rejection of the mother's touch. More practical and rejecting maternal responses to the child's touch were observed, and children were positioned more often out of reach of the mothers' arms. Children with feeding disorders exhibited more withdrawal during feeding and the home environment was less optimal. Feeding efficacy was predicted by mother–child touch, reduced maternal depression and intrusiveness, easy infant temperament, and less child withdrawal, controlling for group membership. Conclusions Proximity and touch are especially disturbed in feeding disorders, suggesting fundamental relationship difficulties. Mothers provide less touch that supports growth, and children demonstrate signs of touch aversion. Touch patterns may serve as risk indicators of potential growth failure.

Dans un premier temps, nous passons en revue les etudes qui ont examine les influences pathogenes des troubles psychiatriques parentaux sur le jeune enfant en general, et du trouble obsessionnel compulsif (TOC) en particulier. Puis nous presentons le cas d’un garcon de 2 ans et demi qui nous fut adresse, avec un diagnostic d’autisme et d’hyperactivite. La description du deroulement chronologique des seances therapeutiques mere-enfant-pere montre qu’il s’agissait en fait d’une depression clinique de l’enfant provoquee par les consequences d’un TOC grave et chronique maternel, reste secret jusque-la. Nous concluons par une reflexion sur l’entree en constellation maternelle comme facteur d’aggravation de troubles mentaux preexistants d’un cote, et de motivation de demande de soins par ailleurs.

Some studies have suggested possible association of the dopamine receptor subtype 4 (DRD4) gene exon III 48 bp repeat polymorphism with novelty seeking behavior. As suicidal behavior in adolescents is linked to risk taking behavior, we evaluated the association of suicidality with DRD4 polymorphism in Israeli inpatient suicidal adolescents. Sixty-nine inpatient adolescents who recently attempted suicide were assessed by structured interview and rating scales for detailed clinical history, diagnoses, suicide intent and risk, impulsivity, violence, and depression. The frequency of DRD4 alleles was compared between the suicidal inpatients and 167 healthy control subjects. No significant association between the DRD4 polymorphism and suicidal behavior was found. Analysis of the suicide-related measures demonstrated a significant difference in depression severity between suicidal inpatients homozygote and heterozygote for the DRD4 alleles (p=0.003). The relevance of this finding to increased depression severity in suicidal adolescents, if replicated, is as yet unclear.

Item does not contain fulltext Researchers and clinicians worldwide share concerns that many youngsters with attention-deficit/hyperactivity disorder (ADHD) and/or disruptive behaviour disorders (DBDs) do not receive appropriate treatment despite availability of effective therapies. At the request of Johnson and Johnson (sponsor), 11 international experts in child and adolescent psychiatry were selected by Professor Stan Kutcher (chair) to address these concerns. This paper describes the experts' consensus conclusions, including treatment practice suggestions for physicians involved in the early treatment of youngsters with ADHD (or hyperkinetic disorder, in countries preferring this classification) and/or DBDs internationally: suggested first-line treatment for ADHD without comorbidity is psychostimulant medication aided by psychosocial intervention. For ADHD with comorbid conduct disorder (CD), psychosocial intervention combined with pharmacotherapy is suggested. For primary CD, suggested first-line treatment is psychosocial intervention, with pharmacotherapy considered as an 'add-on' when aggression/impulsivity is marked and persistent. Pharmacotherapy requires careful titration; full-day coverage is the suggested goal. Regular long-term follow-up is recommended.

The use of typical antipsychotics is limited in children with schizophrenia, owing to the high rate of response failure and early appearance of extrapyramidal syndromes as well as tardive and withdrawal dyskinesia. The aim of the present study was to examine the effectiveness of the atypical antipsychotic olanzapine in the treatment of childhood-onset schizophrenia. The study sample included nine children hospitalized for schizophrenia who had proven refractory to treatment with at least two antipsychotic drugs. Olanzapine was administered after a 2-week washout period in gradually increasing doses to a maximum of 5 mg/day on day 5 and 10 mg/day in week 3; six patients received up to 20 mg/day as of week 5. The duration of the study was 12 weeks. Patient psychiatric status was measured with three scales at onset of therapy and thereafter once weekly. Patients also underwent regular blood, laboratory, and liver function tests, and we also monitored their blood pressure and weight and performed electrocardiography and electroencephalography. A reduction in all psychopathology scores was obtained at 12 weeks from baseline. All extrapyramidal symptoms of previous medications resolved, and there were no new incidents. Side effects were mild. There were no adverse changes in blood chemistry, hematological tests, or electrocardiography parameters, but the treatment was associated with a significant weight gain (6.10 +/- 3.25 kg). At 1-year follow-up, the improvement in psychiatric symptoms was sustained in eight children. We conclude that olanzapine may have potential as a first-line drug in the treatment of drug-resistant childhood-onset schizophrenia. Large-scale, double-blind, placebo-controlled comparative studies are needed to clarify the role of the various atypical antipsychotics in both treatment-resistant and treatment-naïve populations with psychotic symptoms/disorders.

L'experience clinique et l'experience de recherche avec la classification DC: 0-3 dans une Unite de Sante Mentale Infantile sont presentees dans cet article. L'utilisation clinique des diagnostics DC: 0-3 est decrite dans le contexte de notre processus routinier d'evaluation et de notre approche theorique de base. Les raisons pour lesquelles les enfants ont ete envoyes a l'Unite et la distribution des diagnostics DC 0-3 de 414 bebes et leurs parents, evalues dans l'Unite entre 1996 et 2000, sont donnees. 25% n'avaient aucun diagnostic sur aucun des 4 axes, 29,5% des bebes avaient a la fois un diagnostic primaire et un diagnostic relationnel, et seuls 5,6% avaient un diagnostic sur chacun des 4 axes. Moins de la moitie (45%) des bebes recurent une diagnostic primaire, et 52% avaient un diagnostic relationnel. Des explications possibles sont offertes, et les problemes auxquels nous avons fait face avec l'utilisation de la classification sont decrits. L'utilisation de la classification DC 0-3 en matiere de recherche est illustree a travers un d'une etude sur les diagnostics et les interactions lors de seances de jeu et de prise de nourriture de bebes qui nous avaient ete envoyes et de bebes qui ne nous avaient pas ete recommandes. Ces resultats de recherche eurent des implications importantes pour notre travail clinique, comme par exemple la validation de la formation que nous avions donnee aux infirmieres de la communaute et l'utilite de la routine combinee a l'utilisation d'outils categoriques et dimensionnels dans un cadre clinique.

Depressive symptoms and suicidality were assessed in 114 children 6-12 years old, of whom 41 had been physically abused, 38 neglected, and 35 neither abused nor neglected. The physically abused children manifested significantly higher levels of depressive symptomatology and suicidality than did the other two groups. Implications for research and clinical practice are discussed.

The hippocampus, a medial temporal lobe structure, is often considered to play an important role in the pathophysiology of schizophrenia. Recent developments of neuroimaging and molecular postmortem techniques have significantly increased our ability to study the role of discrete brain regions in the pathophysiology of schizophrenia. This article describes animal models, structural, histological, molecular biology, and neuropsychological evidence for the involvement of the hippocampus in the pathophysiology of schizophrenia. The major findings in schizophrenic patients are decreased volumes, hypometabolism, and cytoarchitectural abnormalities which are more robust on the left hippocampus, as well as verbal memory impairment. It is yet to be determined whether these changes are neurodevelopmental or neurodegenerative in nature. Overall, these findings indicate that there are subtle changes in the hippocampus of schizophrenic patients. More comprehensive and focused hippocampal research in schizophrenia is required to elucidate the contribution of this intriguing brain structure to the pathophysiology of schizophrenia.

Legends serve as an important means of expressing fears, wishes, and fantasies. One of the best known and beloved legends worldwide is the nineteenth-century tale of Pinocchio, the wooden puppet who becomes a "real boy," or, as eventually becomes apparent, the boy enclosed in a wooden shell. This protective shell is an extremely interesting symbol and may be the reason the story holds a special place in the human experience. This paper discusses the significance of the wooden shell in the early protection of the developing psyche against invasive stimuli. In cases of normal development, this rigid enclosure is eventually discarded as the psyche matures. However, in pathological situations, it may remain a static, inhibitive shield. We describe the case of O., whose shell prevented his healthy interaction with the environment, and discuss how his problem was managed in the context of the legend. We also discuss related theories of the envelope of the ego.

Psychoses are increasingly being traced to biological aetiologies, and the distinction between organic and nonorganic psychoses is becoming vague. This review covers recent ‘biological’ findings that indicate that psychosis may be the end point for a range of brain disorders. Hence, the term organic

Objective To investigate the relationship between components of death concept (preoccupation with death, death as a pleasant state, and death as final) and suicidal behavior in adolescents. Method The death concepts of 51 suicidal inpatients, 102 nonsuicidal inpatients, 36 emergency room suicidal subjects, and 81 normal controls were compared using Pfeffer's Child Suicide Potential Scale. In addition, the IQ level as well as emotions that potentially influence the death concept were measured. Results Both groups of suicidal adolescents evaluated death as more pleasant than the nonsuicidal groups. All the study groups equally perceived death as a final state. Suicidal inpatients were more preoccupied with death than nonsuicidal inpatients, but surprisingly among all study groups, including normal controls, the emergency room suicidal subjects were the least preoccupied with death. Partialing out depression, anxiety, and aggression specifically augmented the association between preoccupation with death and suicidality. Thus the relationship between death concept and suicidality appears to be a direct one. No correlation was found between suicidality and intelligence level. Conclusions Elements of death concept distinguish suicidal from nonsuicidal as well as between hospitalized versus nonhospitalized suicidal adolescents. Thus the death concept evaluation is potentially valuable in the assessment of adolescents with a high risk for suicide.

Objective To determine the relative importance of aggression and depression in adolescent suicide within different diagnostic categories. Method One hundred sixty-three consecutive admissions to an adolescent psychiatric inpatient unit were assessed using a semistructured diagnostic instrument, the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Scores for depression, suicidal behaviors, and violent behaviors were calculated from this assessment. Results Anorexia nervosa and conduct disorder patients had the highest suicidal behavior scores. In addition, patients with conduct disorder were significantly more violent than patients with major depressive disorder, and scores on the Violent Behavior Scale correlated with suicidal symptoms but not with depressive symptoms. Conclusion: Aggression may be as important in some kinds of suicidal behaviors as is depression. Thus it seems that there are hypothetically at least two types of suicidal behaviors during adolescence: a wish to die (depression) and a wish not to be here for a time (impulse control). The first type of suicidal behavior characterizes that seen in disorders with prominent depression such as major depressive disorder and anorexia nervosa, and the second characterizes disorders of impulse control such as conduct disorder. J. Am. Acad. Child Adolesc. Psychiatry , 1995, 34, 7:912–918.

Psychiatrists, health care organizations working in the psychiatric field and psychiatric associations often have multiple relationships with the pharmaceutical industry in areas including patient care, research, and education. Some of these relationships arise from contact with pharmaceutical representatives who market products, while others derive from industry-sponsored educational activities or research studies. For health care organizations and psychiatric associations, relationships encompass activities conducted within the organizational framework (e.g., teaching and research) as well as those based on the financial relationships of organizational leadership or the organization itself with industry (e.g., stock ownership, licensure of patents). Many benefits can flow from such relationships, including the opportunity for psychiatrists to have input into product development and organizational access to increased resources that can be devoted to the entity’s primary missions. However, there is also the possibility that financial and other benefits for psychiatrists, health care organizations working in the psychiatric field and psychiatric associations may negatively affect fidelity to patients, research subjects, and trainees. As has been widely recognized, attention must be given to protecting the role of the physician and the missions of medical organizations from being adversely impacted by these relationships. The following recommendations are offered in that spirit.

In this chapter, we propose a strategy for increasing the likelihood of identifying youth who are experiencing serious emotional difficulties, which would place them at risk for suicide. Admittedly, current knowledge of the multiple causes of youth suicide remains incomplete, and the scant, currently available mental health resources to address this problem are generally woefully inadequate to meet the need. The situation is even worse in under-resourced environments throughout the world, where there is an acute lack of all mental health services for youth. New efforts are called for. Raising awareness of children’s mental health among important youth stakeholders, parents, teachers, and youth themselves, and increasing help and treatment-seeking behaviours, holds out the potential to help reduce unnecessary deaths by suicide in youth.

The blood levels of several “stress indicators” (prolactin [PRL], growth hormone [hGH], total catecholamines, and adenosine 3’, 5’-cyclic monophosphate [cAMP]) were measured in men during the first 2 weeks of uncomplicated acute myocardial infarction (AMI) and during a 3-month follow-up period. PRL levels were significantly elevated during the first day, and hGH was elevated during the week after the AMI. The levels returned to the control baseline values thereafter. The levels of the total catecholamines and cAMP in blood remained normal throughout the study period. Sexual function during the 3-month follow-up was measured in 29 patients, using a specially designed questionnaire. Impotence was found in five patients and decreased libido in four. No correlation was noted between PRL values, the other stress indicators, and sexual dysfunction. A trend toward increased incidence of sexual dysfunction was found among patients with recurrent AMI.

Serum thyroid stimulating hormone (TSH), prolactin (PRL), and growth hormone (GH) levels were measured before and after stimulation with 200 μg of thyrotropin releasing hormone (TRH) in 10 patients with obsessive-compulsive disorder (OCD) and in 10 control subjects. There were significantly more blunted TSH responses among OCD patients than control subjects. PRL and GH responses to TRH challenge did not differ between OCD patients and controls. These results may indicate dysregulation of the hypothalamic-pituitary-thyroid axis in OCD.

[3H]PK 11195 binding to platelet membranes and plasma stress hormones were studied in soldiers at the beginning of a parachute training course, following 6 days of preparatory exercises, and after the fourth actual parachute jump. A slight reduction (15%; NS) in the number of peripheral benzodiazepine receptors (PBR) was detected at the end of the exercise period, prior to the first jump. Reduced (26%; P less than 0.05) density of PBR was observed immediately after the repeated actual jumps. Equilibrium dissociation constants were not affected by the stressful situation. Plasma cortisol and prolactin levels remained unaltered during the entire study period.

Subjective improvement-assessment in attention deficit/hyperactivity disorder (ADHD), following a single dose of methylphenidate (MPH) was compared to performance on the Test-of-Variables-of-Attention (TOVA). Self-perception was assessed with the clinical-global-impression-of-change (CGI-C). Participants included 165 ADHD subjects (M:F ratio 67%:33%) aged 5-18 (11.09 +/- 3.43) years. TOVA was administered before and after MPH challenge (0.3 mg/kg). Self-perception CGI-C scores were compared to the TOVA scores. An inverse correlation was found only between CGI-C and the TOVA-Commission-scores (r = -0.326, p < 0.001). We thus conclude that subjective reports are too unreliable to be used in order to assess MPH benefit in ADHD pediatric populations.

Biological and environmental factors have been related to the persistence of psychopathology in preschool children. The objective of the study was to identify the factors predicting the clinical outcome in preschool inpatients with emotional and behavioral disorders.Twenty-eight children aged 3 to 6.5 years attending a therapeutic nursery were evaluated. Clinical data were collected from the children's charts, including: biological parameters, developmental milestones, intelligence level, socioeconomic status, and stressful life events. Severity of symptoms at follow-up was assessed using the Clinical Global Impression Scale.Low socioeconomic status, excess stressful life events, and female gender were associated with poor clinical outcome. Biological factors such as pregnancy and birth complications and genetic factors were not significant predictors.The study was limited by its retrospective design and small sample size.More effort in social interventions and supportive family therapy may improve the outcome of young children with emotional and behavioral problems.

This study investigates the impact of temperament and parenting styles on attachment patterns in children with ADHD. The study included 65 children aged 7-15 and their parents. Children diagnosed as Combined or Predominantly Hyperactive Impulsive Type had significantly higher scores than those diagnosed as Predominantly Inattentive Type in anxious and avoidant attachment, emotionality, and activity dimensions of temperament, and their parents reported higher levels of controlling styles. Hierarchic regressions indicated that parental promotion of autonomy with children with temperamental emotionality predicted anxious attachment, while parental restriction of autonomy with children with high levels of temperamental activity predicted avoidant attachment.

Iron plays a role in the regulation of dopaminergic activity. In the present study, nonanemic children with attention deficit hyperactivity disorder (ADHD) were evaluated with regard to heme and nonheme iron metabolism and the effect of short-term iron administration on behavior. The study group consisted of 14 boys aged 7-11 years. All first underwent testing to rule out other psychiatric and medical problems. The severity of the ADHD symptoms was determined by parent and teacher scores on the Connors Rating Scale. Thereafter, each patient received an iron preparation (Ferrocal), 5 mg/kg/day for 30 days. Blood samples were taken before and after drug administration. Results showed a significant increase in serum ferritin levels (from 25.9 +/- 9.2 to 44.6 +/- 18 ng/ml) and a significant decrease on the parents' Connors Rating Scale scores (from 17.6 +/- 4.5 to 12.7 +/- 5.4). There were no changes in other blood parameters or in the teachers' scores on the rating scale. The effect of iron supplementation on the behavioral and cognitive symptoms in noniron-deficient ADHD children merits further investigation using a placebo-controlled study.

Suicidal behavior runs in families and is partially genetically determined. Since greater serotonin 5-HT(2A) receptor binding has been reported in postmortem brain and platelets of suicide victims, the 5-HT(2A) receptor gene polymorphism T102C became one of the candidate sites in the study of suicide and impulsive-aggressive traits. However, studies that examined the association of this polymorphism with suicidality have contradictory results. This study used a family-based method and one homogenous ethnic group to overcome ethnic stratification in order to test this association. METHODS: Thirty families of inpatient adolescents from Jewish Ashkenazi origin, with a recent suicide attempt, were genotyped. All subjects were interviewed for clinical diagnosis, depressive and impulsive-aggressive traits and demographic data. Allele frequencies were assessed using the Haplotype Relative Risk method for trios. RESULTS: No difference was found in allelic distribution between transmitted and non-transmitted alleles. There was no significant association of genotype with any of the clinical traits CONCLUSIONS: These preliminary results suggest that the 5-HT(2A) T102C polymorphism is unlikely to be associated with suicidal behavior and related traits in adolescent suicide attempters. Language: en

Many children are referred to the psychiatrist with the title of the "difficult child". Behind that popular and nonscientific description hide several major psychiatric syndromes, such as attention-deficit hyperactivity disorder, disruptive behavior disorders, mood disorders and posttraumatic stress disorder. This article reviews the different clinical faces of these disorders, their differential diagnoses, comorbidity and prognosis. These disorders are very prevalent and have long-term consequences on the process of development of the child. Acquaintance with the disorders, early diagnosis and treatment can prevent complications and improve the prognosis.

Studies of schizophrenia in twins have historically influenced the psychiatric world in shifting the focus of the etiology of psychiatric disorders from a psychodynamic to a genetic one. Although twinning is as frequent a phenomenon as schizophrenia, clinical issues relating to the development of twins and treatment of psychiatrically sick twins are relatively infrequent in the literature. This article presents the treatment of adolescent schizophrenic twins, and focuses on specific developmental, educational and therapeutic issues that must be considered when treating twins. The recent treatment of identical schizophrenic twins has allowed us to review the literature and revisit some of these issues.

The aim of this presentation is to provide an account of a relatively new therapeutic approach, so that those who are unfamiliar with it will be encouraged to investigate its possibilities further. In this state of the art lecture I aim to provide an account of the development of cognitive behaviour therapy from both behavioural and psychoanalytic approaches. I shall summarise the main issues relating to evidence for effectiveness in comparison to other forms of treatment. I shall then discuss the prospects for the use of this form of psychotherapy in the future.