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Some evidence suggests that the HPA axis may be dysfunctional in children with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to investigate whether a different pattern of HPA axis activity is found between the inattentive (I) and combined (C) subtypes of ADHD, in comparison with healthy control children. A total of 100 prepubertal subjects [52 children with ADHD combined type (ADHD-C), 23 children with ADHD predominantly inattentive type (ADHD-I), and 25 healthy control subjects] were studied. The effects of stress were studied by comparing cortisol responses to a psychosocial stressor, consisting of a public speaking task. Children with ADHD-I showed an elevated cortisol response to the psychosocial stressor, in contrast to children with ADHD-C who showed a blunted cortisol response to the psychosocial stressor. When a distinction was made between responders and non-responders (a subject was classified as a responder when there was an increase in cortisol reactivity), hyperactivity symptoms were clearly related to a lower cortisol reactivity to stress. The results indicate that a low-cortisol responsivity to stress may be a neurobiological marker for children with ADHD-C, but not for those with ADHD-I. Directions for future research and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Fibromyalgia is a form of non-articular rheumatism characterised by long term (>3 months) and widespread musculoskeletal aching, stiffness and pressure hyperalgesia at characteristic soft tissue sites, called soft tissue tender points. The biophysiology of fibromyalgia, however, has remained elusive and the treatment remains mainly empirical. This article reviews the neuroendocrine-immune pathophysiology of fibromyalgia. There is no major evidence that fibromyalgia is accompanied by activation of the inflammatory response system, by immune activation or by an inflammatory process. There is some evidence that fibromyalgia is accompanied by some signs of immunosuppression, suggesting that immunomodifying drugs could have potential in the treatment of fibromyalgia. Recent trials with cytokines, such as interferon-α, have been undertaken in patients with fibromyalgia. Immunotherapy with these agents, however, may induce symptoms reminiscent of fibromyalgia and depression in a considerable number of patients. Lowered serum activity of prolyl endopeptidase (PEP), a cytosolic endopeptidase that cleaves peptide bonds on the carboxyl side of proline in proteins of relatively small molecular mass, may play a role in the biophysiology of fibromyalgia through diminished inactivation of algesic and depression-related peptides, e.g. substance P. Trials with PEP agonists could be worthwhile in fibromyalgia. The muscle energy depletion hypothesis of fibromyalgia is supported by findings that this condition is accompanied by lowered plasma levels of branched chain amino acids (BCAAs), i.e. valine, leucine and isoleucine. Since there is evidence that BCAA supplementation decreases muscle catabolism and has ergogenic values, a supplemental trial with BCAAs in fibromyalgia appears to be justified. [ABSTRACT FROM AUTHOR]

Background: Little is known about patients with early onset psychosis (EOP) because of the low prevalence and separation of mental health care for adolescents and adults., Aim: To describe characteristics of patients with EOP, their global functioning and their journey concerning healthcare, education, employment status, living situation and wellbeing in the years following onset of psychosis., Method: Data about demography, symptoms, treatment and functioning were collected from electronic patient records for 31 patients with EOP. Fourteen of these patients completed a questionnaire after discharge from inpatient treatment in ZNA University Child and Youth Psychiatry in Antwerp (UKJA) regarding after care, education, work and living conditions and wellbeing., Results: Most patients developed severe psychotic symptoms before the age of 16 that required prolonged intensive psychiatric treatment. They showed multiple risk factors associated with psychosis. Following inpatient treatment most patients received special needs education and a majority transitioned into adult psychiatric care. Parents were the main source of social support for patients., Conclusion: During recovery access to support in different domains of life is needed. If we want to offer adequate care for each patient the organization of mental healthcare and assistance needs to be improved.

Background: Virtual reality (VR) has been on the rise in recent years due to the better quality and accessibility of VR glasses and software. Despite the fact that VR is being used more often in psychiatric care, little is known about the possible applications of VR in forensic psychiatry., Aim: To investigate which possible VR-applications already exist that can also be used in forensic psychiatry and what the possible risks are., Method: Scientific literature was consulted in PubMed, Web of Knowledge, Embase en Cochrane Library to search for immersive VR-applications for aggression, motivation and the most prevalent psychopathologies in forensic psychiatry., Results: Several relevant VR-applications were found that can be used in the diagnosis or treatment of forensic psychiatric patients. Despite the limited number of empirical studies, several authors emphasize the potential benefits of VR for this target group., Conclusion: Due to the low number of studies of good quality on the use of VR in psychiatric care, it is currently not yet possible to draw clear conclusions about efficiency, deployability and specific applications. However, there is enough potential within forensic psychiatry to integrate VR into various parts of the care process, such as treatment, diagnosis and risk assessment.

Background: Multiple and complex needs (MCN) in children and youth jeopardize their development and pose significant challenges to the different professionals they meet. However, there is no agreed-upon definition of this vulnerable population., Objectives: To develop a definition of 'MCN in children and youth' that is meaningful for all professionals involved in care delivery for this population., Method: A cross-sector, multidisciplinary, and geographically spread panel of 47 experts representing mental health, youth care, juvenile justice, and education in Flanders participated in an online Delphi study. Qualitative analysis of answers in the first round yielded four definition possibilities that participants then ranked in the second round. In the last round, participants rated their agreement with the highest ranked definition. An additional survey asked 25 international experts to rate and comment their agreement with the final definition., Results: The final definition was: Children and adolescents with profound and interacting needs in the context of issues on several life domains (family context, functioning and integration in society) as well as psychiatric problems. The extent of their needs exceeds the capacity (expertise and resources) of existing services and sequential interventions lead to discontinuous care delivery. As such, existing services do not adequately meet the needs of these youths and their families. Cross-sector, integrated and assertive care delivery is necessary for safeguarding the wellbeing, development and societal integration of these young people. Response rates to the three Delphi rounds were 76.6, 89.1, and 91.3%. The definition was widely endorsed among Flemish (93.2% agreement) and international experts (88% agreement)., Conclusion: A definition of MCN in children and youth was constructed using the Delphi method and further evaluated for international relevance in an additional survey. Such an agreed-upon definition can be valuable for optimizing care delivery and conducting research.

Background: In participatory action research (par), researchers, practitioners and the community engage in a research process together. This research approach has the potential to assist in bridging the research-practice gap by starting from practice needs and using joint expertise and experiences to enrich scientific knowledge, optimise clinical practice and empower stakeholders from different backgrounds.
AIM: To discuss the potential benefits of par for clients, professionals and researchers in the field of mental healthcare.
METHOD: Starting from the literature on par, fundamental characteristics and benefits of this research approach in the field of mental healthcare are described and illustrated with an example from practice.
RESULTS: par in mental healthcare can contribute to enriching prepositional and practical knowledge, facilitate positive social change in care delivery, empower all stakeholders, and ultimately make a significant contribution to the integration of research and practice.
CONCLUSION: par is valuable for clients, professionals and researchers in a variety of projects in mental healthcare.

This study, as a part of a participatory action research project, reports the development process of an innovative collaboration between child and adolescent psychiatry and child welfare, for adolescent girls with multiple and complex needs. The findings emerge from a qualitative descriptive analysis of four focus groups with 30 professionals closely involved in this project, and describe the evolution of the collaborative efforts and outcomes through time. Participants describe large investments and negative consequences of rapid organizational change in the beginning of the collaboration project, while benefits of the intensive collaboration only appeared later. A shared person-centred vision and enhanced professionals' confidence were pointed out as important contributors in the evolution of the collaboration. Findings were compared to the literature and showed significant analogy with the life cycle model for shared service centres that describe the maturation of collaborations from a management perspective. These findings enrich the knowledge about the development process of collaboration in health and social care. In increasingly collaborative services, child and adolescent psychiatrists and policy makers should be aware that gains from a collaboration will possibly only be achieved in the longer term, and benefit from knowing which factors have an influence on the evolution of a collaboration project.

Background: Methylphenidate (MPH), the first choice medication for attention-deficit hyperactivity disorder (ADHD), is associated with serious adverse effects like arrhythmia. Evidence on the association of ADHD with immune and oxidant-antioxidant imbalances offers potential for antioxidant and/or immunomodulatory nutritional supplements as ADHD therapy. One small randomised trial in ADHD suggests, despite various limitations, therapeutic benefit from Pycnogenol®, a herbal, polyphenol-rich extract., Methods: This phase III trial is a 10-week, randomised, double-blind, placebo and active treatment controlled multicentre trial with three parallel treatment arms to compare the effect of Pycnogenol® to MPH and placebo on the behaviour of 144 paediatric ADHD and attention-deficit disorder (ADD) patients. Evaluations of behaviour (measured by the ADHD-Rating Scale (primary endpoint) and the Social-emotional Questionnaire (SEQ)), immunity (plasma cytokine and antibody levels, white blood cell counts and faecal microbial composition), oxidative stress (erythrocyte glutathione, plasma lipid-soluble vitamins and malondialdehyde and urinary 8-OHdG levels, as well as antioxidant enzyme activity and gene expression), serum zinc and neuropeptide Y level, urinary catecholamines and physical complaints (Physical Complaints Questionnaire) will be performed in week 10 and compared to baseline. Acceptability evaluations will be based on adherence, dropouts and reports of adverse events. Dietary habits will be taken into account., Discussion: This trial takes into account comorbid behavioural and physical symptoms, as well as a broad range of innovative immune and oxidative biomarkers, expected to provide fundamental knowledge on ADHD aetiology and therapy. Research on microbiota in ADHD is novel. Moreover, the active control arm is rather unseen in research on nutritional supplements, but of great importance, as patients and parents are often concerned with the side effects of MPH., Trial Registration: Clinicaltrials.gov number: NCT02700685 . Registered on 18 January 2016. EudraCT 2016-000215-32 . Registered on 4 October 2016.

Background: Very little information is available concerning the prevalence of the use of medication for treatment of individuals with autism spectrum disorder (ASD), particularly in European countries. Earlier studies have shown that a large number of patients with ASD use at least one psychoactive drug and that the numbers are increasing. Even in the nineties, studies suggested that the frequent use of psychoactive medication was widespread, although at the time there were only limited grounds for this assumption., Aim: To assess the prevalence with which psychoactive medication and complementary and alternative medicine (CAM) are being used for treating young people with ASD, and also to investigate relations between medication use and a number of individual characteristics that are included in the Behavioral Model of Health Service Use., Method: The study sample (0-17 years) in the province of Antwerp, Belgium, was recruited by various means. We used a questionnaire that had been previously used in North American studies and that had to be completed by the parents of the young persons involved in the study., Results: We included data from 263 questionnaires. In our sample 42.6% of the young persons used one or more one psychoactive drug. More than 12.2% used more than one drug. The most frequently used psychoactive drugs were ADHD-medication (31.6%) and antipsychotics (16.7%). About 14% used at least one CAM. We found a positive relationship between the use of medication and psychiatric comorbidity and/or epilepsy, the severity of autism and the parents' living conditions., Conclusion: We found a relatively low use of antipsychotics, antidepressants, mood stabilisers and sedatives, the prevalence being lower that that reported in North American studies. Our findings appear to be in accordance with current clinical guidelines.

16p11.2 microduplication is linked with a vulnerability for a range of psychiatric and somatic problems, with variable expression and penetration rate. We discuss the phenotypical expression of this microduplication with the case of a brother and sister. Both subjects went through child psychiatric diagnostics and treatment, where a varying degree of developmental delay and symptoms that match an attention deficit/hyperactivity disorder were observed in combination with short stature and low body mass index.

Background: So far there have been relatively few studies of conduct disorder in girls. It is very important that professionals engaged in preventing and treating this disorder have a sound knowledge of the risk factors involved and of the developmental course of the disorder., Aim: To provide an overview of what is known about the risk factors and about the way in which conduct disorder develops in girls., Method: We searched the Eric, PubMed and Medline databases for articles on conduct disorder in girls. We reviewed 41 studies and we summarised the results., Results: Several risk factors contribute to the development of conduct disorder in girls. Just like boys, girls too can display the life-course-persistent pathway of antisocial behavior. Such girls are often associated with serious risk factors. Those with serious forms of antisocial behaviour have an increased risk of experiencing adjustment problems in later life., Conclusion: Future research in this area will have to concentrate on the creation of adequate prevention and treatment programs.

The aim of this study was to explore motor impairment in male adolescents suffering from psychiatric conditions. Taking into account the heterogeneity of a clinical population, motor profiles of distinctive diagnostic groups were evaluated. Whether or not motor ability discriminates between several diagnostic categories was investigated. The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) was administered to examine a detailed motor profile. The motor abilities of a clinical population (n=144) were compared to those of typically developing peers (n=87), using independent t-tests. To account for differences in intellectual functioning, a one-way ANCOVA was performed. To investigate the extent to which a specific diagnosis contributes to variation in motor scores a stepwise linear regression approach was applied. Results indicated that the clinical group performed significantly worse in comparison to the control group on all BOT-2 scales, even after controlling for IQ. The constructed models indicated that diagnostic categories accounted for a significant amount of the variance in motor ability scores. The results imply that motor ability of adolescents with a psychiatric disorder is in need of attention, regardless of the diagnosis and support the notion that objective motor assessment should be part of routine clinical practice., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Aim: To summarize research regarding the motor abilities of children and adolescents who suffer from a common psychiatric condition., Methods: In order to outline the current knowledge regarding the motor abilities of children and adolescents with autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), disruptive behavior disorders (DBD) and depression, a comprehensive systematic literature search was carried out using PubMed, Medline and ERIC databases. The databases were searched for relevant English language articles published between January 1990 and April 2014. Only studies that conducted a quantitative evaluation of motor ability and concerned individuals aged 0-18 years were included. A separate search was conducted for each disorder (ASD, ADHD, DBD, depression) in conjunction with each of the following keywords: (psycho/perceptuo) motor/movement skill(s), (psycho/perceptuo) motor/movement abilities, (psycho/perceptuo) motor/movement impairment, (psycho/perceptuo) motor/movement problem(s), motor function, motor coordination, motor performance, motor deficit(s). To detect supplementary relevant literature, the reference lists of the retrieved articles were examined., Results: The search strategy yielded 51 studies meeting the inclusion criteria. In total, 28 studies were included that examined the motor abilities of children and adolescents with ASD. All studies indicated that they performed below average on various standardized motor assessment instruments. The overall prevalence rate for impairment in motor abilities ranged from 33% to 100%. Twenty-seven studies examined the motor abilities of children and adolescents with ADHD. Depending on the type of motor assessment tool and the cut-off points used by different researchers, prevalence rates of impairment in motor abilities are highly variable and ranged from 8% to 73%. Remarkably, there is a paucity of research addressing the motor abilities of individuals with DBD or depression. Furthermore, methodological problems, such as measurement and comorbidity issues, complicate the generalization of the findings., Conclusion: Research suggests that motor impairment is highly prevalent in some psychiatric conditions, particularly ASD and ADHD. However, future work is necessary to draw sound conclusions.

The aim of this study was to explore the incidence, type and severity of motor impairment in male adolescents with a disruptive behavior disorder (DBD) and evaluate the role of comorbid ADHD. The Bruininks-Oseretsky test of motor proficiency, Second Edition was administered to examine a detailed motor profile and to compare the motor abilities of individuals with DBD (n = 99) to those of controls (n = 87). Additional subgroup analyses were conducted within the clinical population and encompassed (1) analyzing differences in motor profiles between individuals diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) and (2) comparing the motor profiles of individuals with or without comorbid ADHD. The results indicated that individuals with a DBD showed a mixed motor impairment profile. Even after controlling for IQ, the DBD group obtained significantly lower scores in comparison to controls. The ODD and CD subgroups showed a similar motor profile. Presence of comorbid ADHD did not produce major differences in the motor profile. As approximately 79% of the adolescents with a DBD suffered from motor impairment, motor ability needs to be adequately addressed in research as well as in clinical practice., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The incidence of anorexia nervosa (AN) in adolescents has increased significantly in recent years. In several studies and in the media it has been suggested that AN has recently become more prevalent in the pre-adolescence. In view of the impact that an eating disorder can have on a child, it is important to diagnose and start treating the illness as early as possible., Aim: To review the literature on the characteristics and susceptibilities of patients with eating disorders because this information can be important for early diagnosis, prevention and identification of susceptibilities to early-onset eating disorders., Method: We searched the literature for articles relating to early-onset eating disorders. We based our search on PubMed and on related relevant articles listed in the references. We selected 34 relevant articles published between 1987 and 2014., Results: The literature lists characteristics and susceptibilities at various levels. Many types of factors are involved; examples of 'biological' factors are prior streptococcal infection, previous consultations with GP and a patients medical history; psychological factors include comorbidity, temperament, a particular personality profile, maturation-anxiety; environmental factors such as family history, family functioning and/or stressful events can play a role in the development of eating disorders. CONCLUSION The literature indicates that the early development of AN in children is related to a complex combination of etiological factors. However, there is a need for more research into this group of patients.

Background: The Belgian child and adolescent mental health care system is in the process of being substantially reformed and re-shaped., Aim: To outline recent reforms in Belgian child and adolescent mental health care., Method: To provide an overview of the recent literature on service delivery and on the organisation of the Belgian mental health care system for children and adolescents., Results: On the basis of various studies a National Plan for Child and Adolescent Mental Health was drawn up and recently approved., Conclusion: According to this National Plan additional measures will be taken to help children and young people with mental health problems. Networking will play an increasingly important role in the new organisational configuration of the new mental health policy.

Regular non-medical treatment of a 6-year-old female patient with autism spectrum disorder failed due to comorbid compulsions and hallucinations. Differential diagnosis included obsessive-compulsive disorder and psychosis. The patient's young age complicated accurate diagnosis and management. In this case we opted for a diagnostic follow-up, resulting in treatment with a selective serotonin reuptake inhibitor because of the patient's frequent compulsions. This reduced the symptoms significantly.

Background: Quality youth care and decisions about youth care should ideally be based on a combination of empirical data, the clinical judgment of health professionals and the views and preferences of clients. Additionally, the treatment provided needs to fit in with the client's social and cultural background. Clients' views about their treatment are often collected via satisfaction measurements and particularly via satisfaction questionnaires., Aim: To make a critical analysis of the factors that determine both client satisfaction and the content of the satisfaction questionnaires used as a measurement method in youth care., Method: We made a selective study of the relevant literature., Results: Our results show that client satisfaction is not an indicator of the effectiveness of treatment and that the degree of client satisfaction varies according to the client's outlook and perspective. Apparently, there are many disadvantages of using questionnaires as a measurement method., Conclusion: For the collection of a young person's views, qualitative methods seem to be more effective than questionnaires.