Search

INTRODUCTION Despite the high proportion of children and adolescents living in low- and middle-income countries, 95% of all specialized child and adolescent mental health resources are located in high-income countries. To strengthen child and adolescent mental health services (CAMHS), first it is necessary to complete an assessment of the available services and training programs to determine what is needed, particularly in regions with young populations, such as Southeast Europe, the Far East, and the Middle East. The aim of this article is to compare the status of child and adolescent psychiatry (CAP) training programs and the workforce in CAMHS in three geographical regions, to identify similar problems, highlight success stories, and to make recommendations for future studies. METHODS This study compared CAP training programs and CAMHS workforce using the World Psychiatric Association, CAP Section's regional studies data. RESULTS This study included data from 44 countries: 18 countries in the Far East, 15 countries in the Middle East, and 11 countries in Southeast Europe. There were significant differences both within, and between, the three included regions with regards to availability and infrastructure of CAP training programs. Besides Greece, all included countries reported the need for more child and adolescent psychiatrists and allied child and adolescent mental health professionals. DISCUSSION There is an urgent need for more qualified child and adolescent psychiatrists and allied professionals in a very large group of countries in three different geographic regions with great differences in religion, culture, and economy.

Symptoms of attention deficit hyperactivity disorder (ADHD) in children often persist into adulthood and can lead to severe antisocial behavior. However, to-date it remains unclear whether neuro-functional abnormalities cause ADHD, which in turn can then provide a marker of persistent ADHD. Using event-related functional magnetic resonance imaging (fMRI), we measured blood oxygenation level dependent (BOLD) signal changes in subjects during a reversal learning task in which choice of the correct stimulus led to a probabilistically determined ‘monetary’ reward or punishment. Participants were diagnosed with ADHD during their childhood (N = 32) and were paired with age, gender, and education matched healthy controls (N = 32). Reassessment of the ADHD group as adults resulted in a split between either persistent (persisters, N = 17) or remitted ADHDs (remitters, N = 15). All three groups showed significantly decreased activation in the medial prefrontal cortex (PFC) and the left striatum during punished correct responses, however only remitters and controls presented significant psycho-physiological interaction between these fronto-striatal reward and outcome valence networks. Comparing persisters to remitters and controls showed significantly inverted responses to punishment (P

AIM: Despite the general consensus on the importance of youth mental health, the scarcity of child and adolescent mental health services is prominent all over the world. Child and adolescent psychiatry (CAP) postgraduate training can play a pivotal role in increasing access to youth mental health services. In comparison to Europe and North America, however, little is reported regarding CAP training in the Far East, one of the most dynamic and rapidly developing world regions with a very young population. This paper presents an original study on the current status of academic child and adolescent psychiatry training across the Far East. METHODS: We collected data from 17 countries in the Far East using an internally distributed questionnaire to the Consortium members invited for this study, consisting of leading academic child and adolescent psychiatrists in each country. RESULTS: Based on informants' input, we found an overall underdevelopment of CAP postgraduate training systems despite CAP's recognition as a subspecialty in 12 of 17 of the nations or functionally self-governing areas in the Far East. Paucity of official guidelines for CAP training was also evident. All informants reported a need for additional child and adolescent mental health professionals. CONCLUSION: There seems to be several obstacles to the development of CAP postgraduate training in the Far East, including stigma towards mental health issues and lack of funding. International collaboration is desired to develop evidence-based and culture-tailored CAP training systems. Language: en

Childhood stress and genetic factors like the Val66MET polymorphism of the brain derived neurotrophic factor (BDNF) gene are associated with a higher risk for developing major depressive disorder (MDD) and might also influence hippocampal changes. The aim of this study was to determine which hippocampal dentate gyrus and cornu ammonis subfields are altered in MDD compared to healthy controls and which subfields are affected by the BDNF Val66Met polymorphism and child adversity. Adult patients with MDD and healthy matched controls underwent high-resolution magnetic resonance imaging. Automatic segmentation using the programme FreeSurfer was used to segment the hippocampal subfields dentate gyrus (DG/CA4), CA1 and CA2/3. The history of possible childhood adversity was assessed using the Childhood Trauma Questionnaire and the Val66Met BDNF SNP (rs6265) genotypes were obtained. Patients with MDD had significantly smaller CA4/DG and CA2/3 volumes compared to healthy controls. Furthermore, there was a significant interactive effect of BDNF allele and childhood adversity on CA2/3 and CA4/DG volumes. Met allele carriers without childhood adversity had larger and with childhood adversity smaller CA4/DG and CA2/3 volumes than Val-allele homozygotes. Our results highlight stress by gene interactions as relevant for hippocampal volume reductions, in particular for the subfield CA2/3 and dentate gyrus.

Frodl T, Skokauskas N. Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Objective: About 50–80% of ADHD cases have been found to persist into adulthood, but ADHD symptoms change with age. The aim of this study was to perform a meta-analysis of MRI voxel-based morphometry (VBM) and manual tracing studies to identify the differences between adults and children with ADHD as well as between treated and untreated individuals. Method: Several databases were searched using keywords ‘attention-deficit and MRI’, ‘ADHD and MRI’. Gray matter volumes from VBM studies and caudate volumes from tracing studies of patients and controls were analyzed using signed differential mapping. Results: Meta-analyses detected reduced right globus pallidus and putamen volumes in VBM studies as well as decreased caudate volumes in manual tracing studies in children with ADHD. Adult patients with ADHD showed volume reduction in the anterior cingulate cortex (ACC). A higher percentage of treated participants were associated with less changes. Conclusion: Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure.

Background Previous studies have reported variable and at times opposite findings on comorbid psychiatric problems in children with autistic spectrum disorders (ASD). Aims This study aimed to examine patterns of comorbid psychiatric problems in children with ASD and their parents compared with IQ matched controls and their parents. Methods Behavioural/emotional problems were evaluated in a sample of children with ASD [a diagnosis of ASD was given if they met criteria for ASD on both of the ADI-R (Autism Diagnostic Interview-Revised) and ADOS (Autism Diagnostic Observational Schedule)] and an age and IQ matched control group using the Child Behavior Checklist (CBCL/6–18). Parental psychological distress for both groups was evaluated with the Brief Symptom Inventory (BSI). Results There were 59 (88%) boys and 8 (12%) girls in the ASD group. Similarly, 57 (85%) of the control group were male and 10 (15%) were female. The groups did not differ significantly on mean age, mean IQ scores, gender and parents mean age. Results of the CBCL/6–18 revealed that the majority of parents reported their child with ASD as having either internalising (clinical range: 47.8%; borderline range: 16.4%) or externalising problems (clinical range: 10.4%; borderline range: 20.9%). In the control group more parents reported their children having externalising (clinical range: 46.3%; borderline range: 16.4%) than internalising problems (clinical range: 35.8%; borderline range: 11.9%). Almost a half of the ASD group met CBCL DSM criteria for clinically significant attention deficit hyperactivity disorder (44.78%) and anxiety (46.2%) problems. Based on the Brief Symptom Inventory Global Severity Index 22.4% of fathers and 23.8% of mothers of ASD children produced scores that were indicative of possible psychopathology. Conclusions High rates of clinically significant psychiatric problems were detected in ASD children, with anxiety and attention deficit hyperactivity disorder being the most frequently detected syndromes.