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QT dispersion (QTd) is a measure of interlead variations of the surface 12-lead electrocardiogram (ECG). Increased QTd, found in various cardiac diseases, reflects cardiac instability and risk for lethal cardiac arrhythmias. Research suggests a link between psychotropic treatment, ECG abnormalities (QT prolongation), and increased sudden cardiac mortality rates. Reports of sudden death in children treated with psychotropic drugs have raised concerns about cardiovascular monitoring and risk stratification. QTd analysis has not been investigated in very young children treated with antipsychotic drugs. In the present retrospective chart review study, we calculated QT interval, QTd, and their rate-corrected values in very young children treated with antipsychotics.The charts of 12 children (ages 5.8 +/- 0.98 yr; 4 girls, 8 boys) were examined before initiation of antipsychotic treatment [risperidone (n = 7), clotinapine (n = 1), and propericiazine (n = 4)] and during the maintenance period after achieving a positive clinical response. Three children were concomitantly maintained on methylphenidate. QT interval, QTd, and their rate-corrected values were calculated.QT interval, QTd, and their rate-corrected values were all within normal values both before and after successful drug treatment.This preliminary, naturalistic, small-scale study suggests that antipsychotic treatment, with or without methylphenidate, in very young children is not commonly associated with significant alterations of QT interval and dispersion, suggesting the relative safety of these agents in this unique age group.

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 first 5 years of life, the period called "early childhood", are characterized by a dynamic process of development and maturation of the central nervous system (CNS). This process is manifested by continuous changes in cognitive, motor, speech/language, psychological and sensory modulation skills and consequently, in the behavior of the developing child. It is a period of neuron-plasticity, in which the CNS structure and functioning are very sensitive to environmental influences. These influences could be positive or negative. On the one hand, early protective factors, like secure attachment, increase the resilience of the very young child against stressors and against the development of psychopathology; but on the other hand, there is a high vulnerability to early insults of any kind. It has been demonstrated that a high percentage of psychopathology in adult life has his roots in early childhood, and that early diagnosis, which leads to early therapeutic interventions, decreases morbidity and the later life consequences of the disorders. These findings have promoted the field of early childhood psychiatry during the last decade, to become one of the most promising challenges in the field of mental health. In our review, we present an update on the state of nosology, assessment and diagnosis in early childhood and provide clinical guidelines for the daily work of professionals involved in the mental health care of very young children.

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.