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Purpose:To characterize the perceptions of self, mother and family of prepubertal children and to determine if the perceptions of children with depression and their behavior towards their mothers are different from children with anxiety disorders and nonpsychiatric controls.Methods:Children (aged 7–13 years) with major depressive disorder (n = 30), anxiety disorders (n = 37) and nonpsychiatric controls (n = 32) underwent structured psychiatric evaluations and completed questionnaires on their perceptions of themselves and their relations with their mothers and families. The child–mother dyad was observed during structured interactions.Results:Self-perceptions of depressed children were significantly more negative than those of children with anxiety and controls. Depression severity negatively correlated with the child's self-perception and positively correlated with perceptions of the mother as being more rejecting, controlling, less accepting and less allowing autonomy, and of the family as being less cohesive. Depression severity was also positively associated with the child's hostile attitude towards the mother during the interactions.Conclusion:Our findings of greater negative perceptions of self, mother and family in depressed children compared to children with anxiety disorders and nonpsychiatric children suggest that approaches specifically addressing negative perceptions and targeting familial relationships could be especially effective for treating young children with depression.

Marked gender differences have been identified in cigarette smoking. In this study, we aimed to identify the gender-specific emotional and behavioral disorders among adolescent smokers and their consequent utilization of mental health services. We performed a nationwide survey study of an Israeli representative sample of 906 adolescents and their mothers. Mental disorders were assessed using the Development and Well-Being Assessment (DAWBA) Inventory. Levels of emotional and behavioral difficulties were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Mental health services use and smoking habits were also assessed. Among non-smoker adolescents there were significant gender differences in almost all SDQ scales: emotional problems, pro-social, hyperactivity/inattention and conduct problems, whereas in the smoker group there was a difference only in the SDQ emotional problems scale (both self- and maternal-rated, P < 0.001 and P = 0.002, respectively). Only marginal difference was noted between males and females in help-seeking for emotional or behavioral problems. Over 50% of both male and female smokers in the study had untreated mental disorders (non-significant gender difference). The well-established gender differences in psychiatric symptomatology narrowed markedly in adolescent smokers; the typical gender difference in disruptive behaviors was lost in the adolescent smoking population. The implications of these findings are particularly relevant to developing more effective gender-specific programs to prevent youth smoking, to facilitate quitting and prepare primary care practitioners to identify mental disorders and behavioral problems in adolescents with a smoking history.

BackgroundThe goal of this study was to explore the notion that anomalies of self-experience (ASE) are a core, ‘not-yet-psychotic’ clinical phenotype of emerging schizophrenia and its spectrum.MethodTo accomplish this goal, we examined the relationship between ASE and commonly accepted risk markers in a sample of 87 help-seeking, non-psychotic adolescents (aged 14–18 years). ASE were assessed with the Examination of Anomalous Self-Experience (EASE), subclinical psychotic symptoms were assessed with the Prodromal Questionnaire and the Structured Interview for Prodromal Syndromes, deterioration in psychosocial functioning was assessed with the Social and Role Functioning Scales, and level of distress with the Mood and Anxiety Symptoms Questionnaire.ResultsAbout 82 participants completed the entire EASE interview. The number of participants who reported ASE at a clinically meaningful level (n = 18, 22%) was smaller than that who met diagnostic criteria for a prodromal syndrome (n = 28, 34%). The degree of overlap between the two conditions was moderate but statistically significant (χ2(1) = 7.01, p = 0.008). An exploratory factor analysis revealed that ASE load on a different factor than prodromal symptoms and deterioration in functioning, but that there is a moderate correlation between the three factors.ConclusionsThese results suggest that ASE are prevalent among non-psychotic help-seeking adolescents, yet at a considerably lower rate than prodromal symptoms. In addition, they suggest that ASE and prodromal symptoms constitute distinct but moderately related dimensions of potential risk. Taken together, they provide preliminary support for the clinical usefulness of supplementing and refining the methods of early detection of risk with assessment of ASE.

Family environment has a clear role in suicidal behavior of adolescents. We assessed the relationship between parental bonding and suicidal behavior in suicidal (n = 53) and non-suicidal (n = 47) adolescent inpatients. Two dimensions of parental bonding: care and overprotection, were assessed with the Parental Bonding Instrument. Results showed that adolescents with severe suicidal behavior tended to perceive their mothers as less caring and more overprotective compared to those with mild or no suicidal behavior. A discriminant analysis distinguished significantly between adolescents with high suicidality and those with low suicidality [χ2(5) = 15.54; p = 0.01] in 71% of the cases. The perception of the quality of maternal bonding may be an important correlate of suicidal behavior in adolescence and may guide therapeutic strategies and prevention.

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.

BackgroundDepression and anxiety disorders are among the most common childhood psychiatric disorders. Selective serotonin reuptake inhibitors (SSRIs) are generally considered first-line treatment for both depression and anxiety in this age group. However, it has been reported that 30%–40% of all patients who receive a sufficient dose and duration of treatment fail to respond. Moreover, SSRI use is frequently associated with serious adverse events (SAE), including activation symptoms, manic switch and increased suicidal behavior. These are particularly relevant in pediatric populations because of concerns about the suicide threat of SSRIs, resulting in a black-box warning. Currently there is no way of knowing in advance who of the patients will respond. Identification of biomarkers that would be early predictors of response and of the occurrence of SAE could help to maximize the benefit–risk ratio for the use of SSRIs, and speed up the matching of treatment to patient. The main objective of this project is therefore to identify and validate biomarkers predicting response and SAE in depressed children and adolescents, thus improving treatment, enabling the development of novel diagnostic tests and suggest novel therapeutic targets for future related drug development.MethodsAs a preliminary pilot, we already obtained blood samples from 80 depressed and anxious children and adolescents over the last year before, during and after eight weeks of fluoxetine (FLU) therapy. Genetic and epigenetic samples were collected from all participants. The patients were treated with FLU 20–40 mg/day for 8 weeks. Clinical response was measured with several scales including the Children's Depression Rating Scale–Revised (CDRS-R), the Beck Depression Inventory (BDI) and the Screen for Child Anxiety Related Emotional Disorders (SCARED).ResultsThe participant's age ranged from 6 to 18 (14.12 ± 2.30) years. The overall response rate was 56%. Ten percent responded with SAE. Regarding Pharmacogenetics, The 5-HTTLPR ss genotype was associated with a poorer clinical response with regard to depressive symptoms as well with fewer reports of agitation compared to the ll genotype. Regarding immune measures, we analyzed cytokine levels from 41 children. Plasma concentrations of TNF-α, IL-6 and IL-1β were measured by enzyme linked immunosorbent assays (ELISA) before and after FLU treatment. Antidepressant treatment significantly reduced TNF-α levels (P = 0.037), with no significant changes in the levels of IL-6 and IL-1β. All three pro-inflammatory cytokines were significantly (P < 0.05) higher in SSRI-refractory than SSRI-responsive patients, i.e.: higher levels of TNF-α, IL-6 and IL-1β might predict non-response to fluoxetine treatment in children.Future plansOut of the study sample we selected 13 remitters and 13 non-responders and 10 children with SAE (activation symptoms, manic/hypomanic switch, increased suicidality), and analyzed expression profiles in peripheral blood at admission and after 8 weeks of treatment using illumine Truseq technique. Hopefully, we shall find significant differences in miRNA profiles between the different groups which may serve as biomarkers indicating AD treatment response and SAE. The differentially regulated miRNA's can be studied in depth in the future in animal models in order to support the hypothesis that they may be involved in the AD mechanism.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background Smoking among adolescents is still a major public health problem and a global concern. Early onset and long-term smoking are associated with physical and psychological health problems. Objective To identify risk factors and comorbidities for occasional and daily smoking among European adolescents. Methods In the context of the Europe-wide 'Saving and Empowering Young Lives in Europe” (SEYLE) study we surveyed 12,328 youths at the age of 13 to 17 from 11 countries. We applied questions from the Global School-Based Student Health Survey to determine nicotine consumption as well as other risk behaviors. Psychiatric symptoms were assessed by the Strengths and Difficulties Questionnaire, the Becks Depression Inventory-II, the Zung Self-Rating Anxiety Scale, the Deliberate Self-Harm Inventory and the Paykel Suicide Scale. Results On average 30.9% of adolescents reported daily smoking and the onset of smoking was reported by 35.3% between the age of 12 and 13 already. Multinomial logistic regression model showed significant correlations between adolescent smoking and migration background, living in single parent households, no physical activity, parental smoking and physical fights. Further it revealed significant associations of adolescent smoking with alcohol consumption, illegal drug use, anxiety, conduct problems, hyperactivity, suicidal ideation, self-injury and internet-dependence. Conclusion Our data show that adolescent smoking is associated with psychosocial factors, especially family setting and parental behaviors. Further, smoking and psychiatric problems are highly correlated. Therefore, early preventive measures are necessary and essential not only for adolescents but also for their parents.

SummaryCalcium channel blockers increase the capacity of the urinary bladder. The antienuretic activity of verapamil was examined in young adult enuretics. Eleven drug-free, healthy, sleep-related enuretic males, were treated for two weeks with verapamil (240 mg, per os, at 9 pm). Verapamil failed to display an antienuretic effect.

European Psychiatry - In Press.Proof corrected by the author Available online since samedi 30 octobre 2010

Introduction Truancy negatively affects almost every aspect in the life, including physical, mental health, social and economical conditions. Objectives To implement and evaluate outcomes of three different kinds of intervention against truancy. A mechanistic intervention to stop truancy will be used as control. Aims To reduce truancy among European adolescents improving mental health in European high schools. Methods The WE- STAY intervention carried out in 6 different European Countries. In Italy a sample of 2265 High school students (mean age 15.6 ± 0,6; 64,4% females) was selected. The students were randomized into one of four different intervention arms. Baseline evaluation of students' lifestyle, coping styles, at-risk truancy, self-harm behaviours and mental health issues was collected using a structured questionnaire. Results 6% has been absent from school for 7 days or more without a valid excuse during the past year. 55,0% of the sample has smoked cigarettes; 7,2% drank alcohol 4 or more time during the week (13,9% male and 3,4% female). About the use of drugs, 17,4% of them used drugs at least once in a lifetime. 16% of the students started a fight at least once in a lifetime. Conclusions Truancy is often related to mental health problems and at-risk behaviours. The truancy has been the focus of a different policy initiatives, often ended in failure. Through the implementation of WE-STAY is possible to acquire more data on truancy prevalence and its correlated psycho-social and psychiatric aspects, as well as information on school and parents attitudes toward this phenomenon.

Life events (LEs) contribute to the development of psychiatric disorders such as anxiety and depression. Nevertheless, the power of the stress-affective disorders correlation is relatively low, suggesting the existence of moderating and mediating factors (Liu et al., 2000). Caspi et al. (2003), showed a mediating effect for short allele in the 5-HTTLPR gene to be a vulnerability factor for developing affective reaction towards life events. The present study t aimed to examine the intensity of anxiety, depression and suicidal symptoms within a clinical population as a function of the genetic vulnerability and LEs variables, focusing on adolescents. The sample consisted of 146 adolescents, aged from 11 to 18 years, 54 with main diagnosis of depression, 38 with anxiety disorder and 54 healthy control group. A post-hoc analysis yielded that only for the anxiety group, but not for the depressive group, the correlation between early trauma and the suicidal ideation is dependent on genetic vulnerability. As such, only for those who suffer from anxiety disorder who also have two short alleles (ss), the existence of childhood trauma predicts more suicidality that accompany their affective disorder., while for those with two long alleles, or for those with depression, this linkage does not have significance.

The presentation will attempt to critically assess the various treatment modalities for child and adolescent depression including biological, psychological and social therapies. There will be an emphasis on personalizing treatment both as regards pharmaco-and psycho therapy. An attempt will be made to predict where the next advances will come from

Introduction Peer relationships play a critical role in the development of adolescents, not only for the acquisition of social skills but also for the sense of personal identity and competence. Thus the quality of peer relationships influences actual and future mental health of the adolescent. Objectives SEYLE (Saving and Empowering Young Lives in Europe) is a randomized controlled trial, funded by the EU, evaluating interventions for mental health promotion and suicide prevention. The study comprised 12,395 high-school students from 11 European countries. Aims We investigated the differences on psychological problems between students with poor and good peer relationships. Methods 1,195 adolescents (mean age 15.3 ± 0.6; 68% females) from the Molise region constituted the Italian sample. Adolescents were identified as with poor peer relationships if they never or just sometimes get along with people of their age, feel that peers like having them in the group and feel that peers were kind and helpful. Psychometric measures were used to assess mental health problems such as depression (Beck Depression Inventory II), anxiety (Zung Self-Assessment Anxiety Scale), well-being (WHO-5) and suicidal ideation (Paykel Suicide Scale). Results Adolescents who reported poor peer relationships scored significantly higher (p Conclusions Particularly in adolescence peer relationships may influence psychological well-being and vice versa mental health influences the openness to the others. So promoting mental health and contemporary improve social skills could lead adolescents to a better life.

Studies of suicidal behaviour have provided valuable information about the risk factors associated with these behaviors , yet there is not much information about predictors of transitions from suicidal thoughts to actual suicide behavior.The current study aims to elucidate the mechanisms in which suicidal ideation emerges over time and how suicidal ideation can lead to suicidal actions.We attempt to determine the effects of psychopathology, non-suicidal self-injury (NSSI) and risk behaviors on suicidal behavior. This is examined through our model of youth suicidal behavior based on the theoretical framework of Joiner's Interpersonal Theory of Suicide. Methods The prospective study design included baseline two follow-up assessments within a year. Follow-up sample included a total of 708 adolescents from schools throughout Israel. The students completed self-report questionnairesregarding suicide ideation and attempts, psychopathology, life style, socio-demographic background, non-suicidal self-injury, life events and social support. Results Results indicate that interpersonal distress and internalizing disorders at baseline predicted later levels of suicidal ideation. The effects of interpersonal factors on ideation were partly or fully mediated by internalizing symptoms. We also found that increases in suicidal ideation and in engagement in risk behaviors and NSSI over time were associated with the occurrence of a suicide attempt within the follow up period. Conclusions The model identifies the different phases along the path to suicidal behavior, and risk factors associated with each phase. Hopefully this model will improve our understanding of the short-term course of suicidal behavior among adolescents, which may lead to potential improvements for intervention and prevention.

Background According to previous studies the prevalence of adolescent depression is 4–8% both in the USA and Europe. The aim of the current study was to investigate the prevalence of adolescent depression separately in several European countries. Method Data were drawn from the Saving and Empowering Young Lives in Europe (SEYLE) study, which included 11 countries (Austria, Estonia, France, Germany, Hungary, Ireland, Italy, Israel, Romania, Slovenia and Spain) and Sweden served as the coordinating centre. Depression was measured by the Beck Depression Inventory-II (BDI-II). Adolescents with a score of 20 or greater on the BDI-II were defined as depressed. Multiple imputations were conducted to address missing data. Results Out of 14,115 students who consented to participate, finally 12,395 adolescents (5,568 (44.92%) boys and 6,827 (55.08%) girls) were enrolled into the study. The mean age of the students was 14.81 years (SD = .83). Significant differences were detected in the ratio of non-depressed and depressed adolescents among countries (χ2(20) = 385.352 p = .000). The prevalence of depressed adolescents ranged from 7.1% to 19.4%. The prevalence of depressed adolescents according to country in increasing order is: Hungary: 7.1%, Austria: 7.6%, Romania: 7.6%, Estonia: 7.9%, Ireland: 8.5%, Spain: 8.6%, Italy: 9.2%, Slovenia: 11.4%, Germany: 12.9%, France: 15.4%, Israel: 19.4%. Conclusion Based on a screening tool our data underlines the importance of taking account country specific prevalence rates of adolescent depression.

Objective To assess the impact of lithium treatment alone or combined with other medications on TSH levels and WBC count in hospitalized bipolar and non-bipolar children, adolescents and young adults using data extracted from electronic medical records. Method The study investigated serum TSH and WBC count in lithium treated hospitalized youth, aged 12–24 years. The study included 122 BP (N = 67) or non-BP (N = 55) disorder inpatients treated with lithium for mean duration of 173 days. TSH and WBC values were examined at baseline and at the end of the hospitalization. Subjects were divided into two groups for analysis: group 1 was treated with lithium as monotherapy and group 2 was treated with lithium combined with other psychotropic agents (polypharmacy). Results The mean end-point TSH levels were significantly higher (3.16 ± 2.68 vs 1.52 ± 0.92 mU/L, P 3 cells, P Conclusions Lithium treatment is associated with significant increase in thyrotropin levels and WBC counts in youth. Higher-baseline TSH level is associated with higher TSH levels in lithium-treated subjects. Close monitoring of thyroid functions in lithium treated children and adolescents is recommended.

IntroductionThe study of near fatal suicide attempters may provide insight into the minds of persons who die by suicide. Such attempts are characterized by high suicide intent, together with high medical lethality. The ability to fully understand the specific psychological profiles associated with severe of suicide intent can provide insights for suicide prevention.Objectives & aimsThe objective of the present study was to investigate the relationship of suicide intent to lethality among medically serious suicide attempters. Our aim was to examine specific psychological variables related to the subjective and objective components within suicide intent.Methods102 suicide attempters belonged to one of two groups: 35 subjects who made medically serious suicide attempts were compared with 67 non- medically serious suicide attempters. All were interviewed and completed questionnaires covering mental pain, communication difficulties, and seriousness of the suicide intent.ResultsThe objective component of the suicide intent scale (SIS) was highly correlated the lethality, as well as to communication difficulties, such as self disclosure while the subjective component of the SIS was related to mental pain variables such as depression and hopelessness. A significant interaction between mental pain and communication difficulties was found to predict severity of the objective suicide intent.ConclusionsThe suicidal person whom suffers from depression and hopelessness and cannot signal his pain to others because of communication difficulties can be a risk for a serious suicide attempt - which is more planned, with more precautions against discovery and without communication before or during the attempts.

IntroductionThe literature on suicidal behaviour among immigrants is scarce and little has been written from a comparative perspective.AimsThe aim was to investigate whether suicide attempts are more common among immigrants than among their hosts, to map the differences between different immigrant groupings, and to analyse whether suicidal behaviours among immigrants and the populations of their countries of origin are related.MethodsData on suicide attempts (27,000 person-cases) originated from the WHO/EURO Multicentre Study on Suicidal Behaviour. Suicide attempt rates were calculated for each group. The immigrant groups were compared at each Center and across Centers. The completed-suicide rates of the home countries were compared to attempted-suicide rates in the immigrant groups using rank correlations.ResultsTwenty-seven of the 56 immigrant groups showed significantly higher suicide attempt rates than their hosts. Also, they tended to have similar rates across different Centers. There was a significant correlation between the country-of-origin suicide rate and the immigrant-group suicide attempt rate among those born there. However, Chileans, Iranians, Moroccans and Turks displayed high suicide-attempt rates as immigrants despite low suicide rates in the home countries.ConclusionsThe similarity of the groups’ rates across Centers, and that of the suicidal behaviour in the countries of origin and among immigrants suggests strong continuity, which may be interpreted in cultural or genetic terms. The generally higher rates among immigrants in each Center and across Centers point to the influence of acculturative factors. Additional investigation into the specific characteristics of immigrant suicide attempters is needed.

Objectives:To follow adolescent suicide attempters attending an emergency room in southern Israel through their induction examination for military service and then for the duration of this service.Methods:117 attempters were evaluated after a suicide attempt, and then followed up for up to five years. Outcome was assessed by their achievements on pre-induction psychometric and psychological testing at the induction center and by the quality of their service. Repeated suicidal behavior was also assessed.Results:In general boys had a worse prognosis than girls and suicidal behavior associated with poor educational achievements was particularly associated with a poor psychosocial outcome.Conclusions:Adolescent suicidal behavior in general has a good prognosis but boys with educational difficulties who attempt suicide are at great risk for adjustment problems.