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Background: ADHD is a common neurodevelopmental disorder frequently diagnosed between the ages 7 and 10 years. We measured ADHD symptomatology in a representative sample of the Czech population. Material and Methods: Data collection was performed in January 2019 through the European National Panel. The respondents completed a demographic questionnaire focusing on ADHD history and a standardized questionnaire, the Adult ADHD Self-Report Scale (ASRS) screener for ADHD symptomatology in adulthood. Results: From the sample of 1,518 respondents, 3% of the respondents reported having been diagnosed with ADHD/hyperkinetic disorder in their lifetime. According to ASRS scoring, 119 respondents were classified as suspected ADHD. Overall, more males than females reported ADHD symptomatology. Age was also significantly associated with ASRS. Education status yielded no significant results. Conclusion: Our study documents that the prevalence of ADHD symptomatology in adults is comparable with that in Western countries despite the different historical and health care backgrounds.

BACKGROUND\ud There is a high prevalence of cognitive and socioemotional dysfunction in very low birth weight (VLBW

Reports of subjective sleep impairments have been replicated in adults with bipolar disorder (BD), young BD patients, and even children of parents with BD. Furthermore, circadian rhythm alterations are a core feature of BD. Despite the impairment in circadian rhythms and altered sleep included in various heuristic developmental models of BD, thus far, biomarkers have not been sufficiently objectively validated. Thus, here, we assessed the rest-activity circadian rhythmicity and sleep macrostructure using actigraphy in a sample of unaffected child and adolescent offspring of bipolar parents (BO; n = 43; 21 females; 11.0 ± 3.2 years) and controls (n = 42; 17 females; 11.1 ± 3.4 years) comparable in sex (

A survey among medical students of all medical schools in the Czech Republic was conducted to investigate attitudes and views of psychiatry and career choice of psychiatry. A Czech version of the Attitudes to Psychiatry Scale (APS) and a questionnaire surveying demographic characteristics and choices of future specialty were distributed to all medical students of eight medical schools in the Czech Republic via the schools’ internal communication systems in the form of an anonymous online questionnaire. Out of a total of 10,147 medical students in the Czech Republic (academic year 2019/2020), 2418 students participated in the survey (response rate 23.8%). Psychiatry as a non-exclusive career choice was considered by 31.3% respondents; child and adolescent psychiatry was considered by 15.4% respondents. Psychiatry as the only choice was considered by 1.6%, and child and adolescent psychiatry was not considered at all. The interest in both specialties was declining since the first year of study. The status of psychiatry among other medical specialties was perceived as low; students were rather discouraged from entering psychiatry by their families. They did not feel encouraged by their teachers to pursue career in psychiatry despite the fact that they were interested in psychiatry. They also felt uncomfortable with patients with mental illness. Despite high enthusiasm for psychiatry in the first year of medical school, only a small proportion of medical students consider to choose psychiatry, and especially child and adolescent psychiatry, as a career at the end of medical school.

V soucasnosti roste pocet žen, ktere musi v obdobi gravidity pravidelně uživat psychofarmaka z důvodu dusevniho onemocněni. Větsina psychofarmak přechazi přes placentu do oběhu plodu, a tak mohou ovlivňovat jeho vývoj. Nicmeně i nelecene dusevni onemocněni v těhotenstvi představuje rizikový faktor pro naruseni průběhu gravidity, vývoje plodu a horsi poporodni adaptaci novorozence. V přehledu shrnujeme aktualni publikovane udaje o efektu nelecene bipolarni afektivni poruchy a uživani stabilizatorů nalady i nelecených uzkostných poruch a uživani anxiolytik na průběh těhotenstvi, vývoj plodu a casnou poporodni adaptaci novorozence. Dle dostupných studii maji některe stabilizatory nalady jasně prokazaný teratogenni efekt a neměly by být v těhotenstvi předepisovany. Avsak napřiklad u lithia byl nazor na jeho negativni efekt na plod revidovan. Rizika pro plod, ktera s sebou nese nelecena bipolarni afektivni porucha v graviditě, se zdaji být vysoka. Osetřujici psychiatr by měl po dobu těhotenstvi pacientku lecit pomoci lithia ci některých nových (atypických) antipsychotik. Anxiolytika jako skupina nemaji jasně prokazaný teratogenni efekt a jejich uživani v těhotenstvi je relativně bezpecne, ale rizika pro plod se zvysuji s rostouci uživanou davkou. Uživani benzodiazepinů v třetim trimestru gravidity s sebou nese zvýsene riziko pro komplikace casne poporodni adaptace ditěte. Farmakoterapie je namistě u těžkých připadů, kde rizika neleceneho onemocněni pro naruseni vývoje plodu a hladkeho průběhu těhotenstvi převysuji rizika spojena s expozici lekům.

To determine current and lifetime psychopathology and assess quality of life (QoL) in offspring of a parent with bipolar disorder (BD).We investigated 43 offspring of bipolar parents (high-risk offspring [HRO]) (mean age 12.5 ± 3.1; range 6.7-17.9 years) and 43 comparison offspring matched for sex, age, and IQ of healthy parents. Lifetime and current presence of Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) diagnoses were assessed using Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). We administered parent and self-report versions of General Behavior Inventory and the Screen for Child Anxiety-Related Emotional Disorders (SCARED). QoL was evaluated using the self-report questionnaire KIDSCREN-52.Thirty-seven HRO (86%) and 18 controls (42%) met DSM-5 criteria for at least one lifetime psychiatric diagnosis (adjusted OR = 7.20; 95% CI 2.27-22.81). Compared to controls, HRO had higher lifetime frequency of any mood disorder (33% vs. 2%, p 0.001), anxiety disorder (60% vs. 14%, p 0.001), and attention-deficit/hyperactivity disorder (26% vs. 5%, p = 0.01). After adjustment for confounders, only mood (OR = 13.05; 95% CI 1.41-120.60) and anxiety (OR = 9.69; 95% CI 2.75-34.31) disorders remained significantly more frequent in the HRO group. In comparison with controls, HRO scored lower in the following domains: QoL, social support and relationship with peers (p = 0.003; Cohen's d = 0.91), parent relationships and home life (p = 0.008; d = 0.67), as well as self-perception (p = 0.04; d = 0.55).In agreement with other studies, we found a higher rate of lifetime anxiety and mood disorders in children and adolescents at confirmed familial risk for BD. Reduction in QoL was already evident across a number of domains. Adult psychiatrists should incorporate into their assessment procedures targeted questions on the presence of psychopathology in offspring of their adult patients with severe mental disorders and child services should bridge with adult services providing accessible services to children of affected parents.

Děti narozene předcasně jsou ve zvýsenem riziku psychiatrických poruch, předevsim neurovývojových a behavioralnich. Pozornost věnovana teto zdravotni oblasti je vsak výrazně mensi v porovnani se somatickou strankou. Cilem tohoto clanku je shrnout nejvýznamnějsi poznatky studii zaměřených na dusevnich zdravi teto rizikove skupiny, informovat o probihajicim výzkumnem projektu u sledovane populace děti s velmi nizkou porodni hmotnosti a nacrtnout koncept psychologicko-psychiatricke pece o děti s těžkou perinatalni zatěži vychazejici z komplexniho uchopeni problematiky ditěte a rodiny.

Objective: We examined the presence of cerebellar symptoms in ADHD and their association with behavioral markers of this disorder. Method: Sixty-two children with ADHD and 62 typically developing (TD) children were examined for cerebellar symptoms using the ataxia rating scale and tested using Conners’ Continuous Performance Test. Results: Children with ADHD had significantly more cerebellar symptoms compared with the TD children. Cerebellar symptom scores decreased with age in the ADHD group; in the TD group remained stable. In both groups, cerebellar symptoms were associated with parent-rated hyperactive/impulsive symptoms, variability of response time standard error (RT-SE) and increase of RT-SE as the test progresses. More variables were associated with cerebellar symptoms in the ADHD group including omission errors, overall RT-SE and its increase for prolonged interstimulus intervals. Conclusion: Our results highlight the importance of research into motor functions in children with ADHD and indicate a role for cerebellar impairment in this disorder.

Michal Goetz,1 Tomas Novak,2 Marie Vesela,1 Zdenek Hlavka,3 Martin Brunovsky,2 Michal Povazan,4 Radek Ptacek,5 Antonin Sebela21Department of Child Psychiatry, Second Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic; 2National Institute of Mental Health, Klecany and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; 3Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic; 4Children’s Department, Bohnice Psychiatric Hospital, Prague, Czech Republic; 5Department of Psychiatry, First Faculty of Medicine, General Teaching Hospital, Charles University in Prague, Czech RepublicBackground: Approximately 30%–60% of adults diagnosed with bipolar disorder (BD) report onset between the ages 15 and 19 years; however, a correct diagnosis is often delayed by several years. Therefore, investigations of the early features of BD are important for adequately understanding the prodromal stages of the illness.Methods: A complete review of the medical records of 46 children and adolescents who were hospitalized for BD at two psychiatric teaching centers in Prague, Czech Republic was performed. Frequency of BD in all inpatients, age of symptom onset, phenomenology of mood episodes, lifetime psychiatric comorbidity, differences between very-early-onset (

Simon Weissenberger,1,2 Radek Ptacek,1,2 Martina Vnukova,1,2 Jiri Raboch,1 Martina Klicperova-Baker,3 Lucie Domkarova,1 Michal Goetz4 1Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, 2Department of Psychology, University of New York in Prague, Prague, 3Institute of Psychology, Czech Academy of Sciences, Prague, 4Department of Paediatric Psychiatry, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic Background: Adult attention-deficit/hyperactivity disorder (ADHD) has been added as a diagnosis to the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM5) in 2013, thus making ADHD, which has been classically known as a childhood disorder, a lifelong disorder. Those suffering from the condition show very specific behavioral traits, which manifest as lifestyle habits; they also show comorbidities that can be the symptoms and/or consequences of certain lifestyles.Materials and methods: The targeted population was adults aged 18–65 years. The total sample was 1,012 (507 males and 505 females). The Adult ADHD Self-Report Scale (ASRS V. 1.1) was administered to evaluate the current symptoms of ADHD and a questionnaire regarding lifestyles that are pertinent to ADHD, exercise, drug use, and diet.Results: An ASRS score of 4–6 points was found in 11.4% of the male population and 9.7% of the female population (5–6 points indicate very high-intensity symptoms). A score of 6, the highest intensity of symptomatology, was found in 1.18% of males and 0.99% of females. Gender differences in scores were not statistically significant. In terms of self-reported lifestyles, we calculated an ordered logistic regression and the odds ratios of those with ASRS scores >4. Those with higher ASRS scores had higher rates of self-reported unhealthy lifestyles and poor diets with high consumption of sweets. We also ascertained a paradoxical finding that is not in line with the current literature on the disorder – lower rates of cigarette smoking among people with higher ADHD symptomatology.Conclusion: Several specific lifestyles were found to be associated with higher ADHD symptoms such as poor diet and cannabis use. Other factors classically associated with the disorder such as cocaine addiction and nicotinism were either insignificant or surprisingly less prominent among the Czech sample. However, ADHD-prone respondents reported to be more physically active, which fits the clinical picture of hyperactivity but contrasts with literature that reports sedentary ADHD lifestyle. Keywords: ADHD, lifestyle, diet, adulthood, ASRS, obesity&nbsp

In this chapter, we discuss contemporary knowledge concerning the manifestations, development, risk factors, prodromes, and neuropsychological findings of bipolar disorder (BP) in children and adolescents. Because this topic has been widely discussed, we have attempted to review the available literature critically and evaluate contradictory findings. Major controversies include the relationship between BP and attention-deficit hyperactivity disorder, the prevalence of mania in childhood, and diagnostic challenges, the problem of irritability, and the diagnosis of disruptive mood dysregulation disorder. The latter condition emerged as a reaction to the trend in the United States of diagnosing BP excessively in children. We have not included a section about treatment because of methodological weaknesses in most available studies.

The review examines Attention Deficit Hyperactivity Disorder (ADHD in its Child and Adult form) and its various presentations (Hyperactive Impulsive, Inattentive, and Combined) with a particular focus on environmental (incl. social factors), lifestyles and comorbidities. It is argued that ADHD is best understood in a holistic and interactive context and a vast empirical literature is presented to illustrate the point: Environmental factors include stress in general as well as exposure to toxins (phthalates, bisphenol A). Social factors are illustrated by effects of social deprivation and seduction to unhealthy lifestyles. Maternal lifestyle during pregnancy is pointed out (particularly her exposure to nicotine, alcohol, caffeine, and drugs, even seemingly benign medications like acetaminophen), which all tend to be related to ADHD. Family environment is discussed with respect to protective effect of (mainly authoritative and autocratic) parenting styles. Societal factors include mainly economic and political issues: income inequality and poverty (low SES is an ADHD risk factor) and a growing moral dilemma between a humanistic effort to globally spread the knowledge of ADHD and the medicalization and commercialization of the disorder. The second part of the review is devoted to ADHD related lifestyles and resulting comorbidities (e.g., food addiction and obesity, substance abuse, electronic media dependencies and conduct and personality disorders). Although ADHD is a neurodevelopmental disorder, its assessment and treatment are also linked to environmental, behavioral and social factors and their interactions.

Background: Attention deficit hyperactivity disorder (ADHD) is a neurological/behavioral disorder characterized by inatten - tion or hyperactivity and impulsivity, or combined symptomatology. Children with ADHD are predisposed to irregular and/or impulsive eating patterns often leading to compromised physical condition. The goal of the present study was to statistically evaluate parental scoring of patterned eating behaviors and associated life- styles within a cohort of 100 boys diagnosed with ADHD in comparison to age-matched male controls. Material/Methods: The study population consisted of 100 boys aged 6-10 years diagnosed with mixed type ADHD by DSM-IV cri- teria and 100 aged-matched healthy male control subjects. Patterns of eating behaviors and associated life- styles were scored by structured parental interviews using a nominal rating scale. Results: Interview scores indicated statistically significant differences in patterned eating behaviors in subjects with ADHD in comparison to healthy controls. Notably, subjects diagnosed with ADHD exhibited markedly dimin- ished adherence to a traditional breakfast, lunch, and dinner schedule, which was linked to a significantly higher frequency (>5/day) of irregular eating times. In the ADHD cohort, disruptive patterns of eating behaviors were associated with diminished nutritional value of ingested food (expressed as lowered content of fruits and veg- etables) and increased consumption of sweetened beverages. Conclusions: Disruptive patterns of eating behaviors, metabolically unfavorable nutritional status, and diminished physical activities of male children diagnosed with ADHD are linked to compromised growth and development and ap- pearance of metabolic diseases in adulthood.

The creation in DSM-5 of a new category ‘unspecified catatonia’ aspires to improve diagnosis and treatment of catatonia in patients of all ages without diagnosable major psychotic, affective or medical disorders. Unspecified catatonia may be particularly beneficial in boosting recognition and treatment of pediatric catatonia that often occurs outside these disorders. Until now, pediatric catatonia has been poorly recognized. Benzodiazepines and electroconvulsive therapy are underutilized in pediatric catatonia, yet are safe and effective treatments without the risk of worsening catatonia or precipitating neuroleptic malignant syndrome. Unspecified catatonia should be considered when catatonic symptoms are present in children and adolescents with autistic and other developmental disorders, autoimmune encephalitides, tic disorders (with or without self-injury) and Tourette’s syndrome, Kleine–Levin syndrome, post-traumatic reactions, pervasive refusal syndrome and other disorders. The aspirations of the ‘unspecified catatonia’ category to reduce morbidity and mortality and to increase further research are bound to be tested in the field of pediatric catatonia over the next few years. Changes in DSM-5 regarding the classification of catatonia are reviewed. Case reports are presented to illustrate the use of the new category, unspecified catatonia, in children and adolescents.

Catatonia is a unique motor dysregulation syndrome characterized by identifiable signs such as immobility, sometimes alternating with excessive motor activity, that is apparently purposeless and not influenced by external stimuli, extreme negativism or muteness, peculiarities of voluntary movement, echolalia, or echopraxia (Fink and Taylor 2009). Catatonia accompanies a number of general medical and neurologic conditions (Dhossche and Wachtel 2010), with acute or insidious onset. In its most severe forms, catatonia may become life threatening, especially when aggravated by autonomic dysfunction and fever. Although previously considered to be rare in children and adolescents (Cohen et al. 1999), recent reports suggest that the prevalence of catatonic symptoms in these age groups is in fact similar to that reported in adults (Ghaziuddin et al. 2012). Overwhelming stress and trauma may trigger catatonia in children and adolescents (Dhossche et al. 2012). Benzodiazepines and electroconvulsive therapy (ECT) are considered first-line treatments (Weiss et al. 2012); however, the literature offers little guidance in cases that do not respond or that respond slowly to a course of these primary treatments. We present an adolescent case with close temporal relationship between onset of catatonia and cyber-bullying, a severe but common stressor nowadays for many adolescents, which resolved with daily ECT and adjunctive amantadine. We did not find any prior published accounts of these features in adolescents.

Michal Goetz,1 Jaroslava Paulasova Schwabova,2 Zdenek Hlavka,3 Radek Ptacek,4 Craig BH Surman5 1Department of Child Psychiatry, Second Faculty of Medicine, Motol University Hospital, 2Department of Neurology, 3Department of Statistics, 4Department of Psychiatry, Charles University, Prague, Czech Republic; 5Department of Psychiatry, Harvard Medical School, Boston, MA, USA Background: Attention-deficit hyperactivity disorder (ADHD) is linked to the presence of motor deficiencies, including balance deficits. The cerebellum serves as an integrative structure for balance control and is also involved in cognition, including timing and anticipatory regulation. Cerebellar development may be delayed in children and adolescents with ADHD, and inconsistent reaction time is commonly seen in ADHD. We hypothesized that dynamic balance deficits would be present in children with ADHD and they would correlate with attention and cerebellar functions. Methods: Sixty-two children with ADHD and no other neurological conditions and 62 typically developing (TD) children were examined with five trials of the Phyaction Balance Board, an electronic balancing platform. Cerebellar clinical symptoms were evaluated using an international ataxia rating scale. Conners’ Continuous Performance Test was used to evaluate patterns of reaction. Results: Children with ADHD had poorer performance on balancing tasks, compared to TD children (P

S Weissenberger,1 M Klicperova-Baker,2 P Zimbardo,3 K Schonova,1 D Akotia,1 J Kostal,2 M Goetz,4 J Raboch,1 R Ptacek1 1First Medical Faculty, Charles University, 2Institute of Psychology, Academy of Sciences of the Czech Republic, Praha, Czech Republic; 3Department of Psychology, Stanford University, Stanford, CA, USA; 4Second Faculty of Medicine, Department of Child Psychiatry, Charles University, Motol University Hospital, Praha, Czech RepublicAbstract: The article draws primarily from the behavioral findings (mainly psychiatric and psychological observations) and points out the important relationships between attention-deficit/hyperactivity disorder (ADHD) symptoms and time orientation. Specifically, the authors argue that there is a significant overlap between the symptoms of ADHD and Present Hedonism. Present Hedonism is defined by Zimbardo’s time perspective theory and assessed by Zimbardo Time Perspective Inventory. Developmental data on Present Hedonism of males and females in the Czech population sample (N=2201) are also presented. The hypothesis of relationship between ADHD and Present Hedonism is mainly derived from the prevalence of addictive behavior (mainly excessive Internet use, alcohol abuse, craving for sweets, fatty foods, and fast foods), deficits in social learning, and increased aggressiveness both in ADHD and in the population high on Present Hedonism. We conclude that Zimbardo’s time perspective offers both: 1) a potential diagnostic tool – the Zimbardo Time Perspective Inventory, particularly its Present Hedonism scale, and 2) a promising preventive and/or therapeutic approach by the Time Perspective Therapy. Time Perspective Therapy has so far been used mainly to treat past negative trauma (most notably, posttraumatic stress disorder); however, it also has value as a potential therapeutic tool for possible behavioral compensation of ADHD.Keywords: ADHD, time perspective, ZTPI, Zimbardo, addiction, alcoholism, delinquency, video games, problematic internet use

Catatonia challenges the validity of modern classification systems by cutting across its proposed boundaries. Contrary to earlier claims that catatonia is restricted to schizophrenia, and soon to be extinct, there is current evidence showing that catatonia is diagnosable in 7 to 17% of acute psychiatric inpatients. A similar proportion of autistic adolescents and adults also meet criteria for catatonia. Sedative treatment and electroconvulsive therapy, the treatments that have historically proven to be effective in catatonia, remain the therapeutic mainstay for catatonia. Evaluation and treatment algorithms that should be helpful when assessing and treating these challenging patients are presented, as well as a GABA-deficit theory of catatonia for guidance of future studies into this syndrome’s biochemical correlates. Further studies are needed to optimize the recognition and treatment of catatonia in a wide range of medical and psychiatric patients of different ages.

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed childhood psychiatric disorders. It is manifested in every part of an affected child's behavior, with multiple symptomatology and heterogenous etiology. Published studies report that ADHD children may show changes in growth and development. Most of the studies on ADHD have been focused on connections between medication and growth changes and describe growth delays associated with medication. However, recent research results point to the low significance of the changes accompanying pharmacological treatment. Changes in growth may not only be a secondary effect of the treatment, but may also be specific characteristics of ADHD.

Objectives: This prospective, observational, non-randomized study aimed to describe the relationship between treatment regimen prescribed and the quality of life (QoL) of ADHD patients in countries of Central and Eastern Europe (CEE) and Eastern Asia over 12 months. Methods: 977 Male and female patients aged 6-17 years seeking treatment for symptoms of ADHD were assessed using the Child and Adolescent Symptom Inventory-4 Parent Checklists, and the Clinical Global Impressions-ADHD-Severity scale. QoL was assessed using the Child Health and Illness Profile-Child Edition parent report form. Patients were grouped according to whether they were prescribed psycho-and/or pharmacotherapy (treatment) or not (no/'other' treatment). Results: No statistically significant differences were observed between cohorts (treatment vs. no/'other' treatment) in terms of change in QoL, although there was improvement over 12 months, with a greater improvement experienced by patients in the treatment cohort in both study regions (CEE and Eastern Asia). Psychoeducation/counselling and methylphenidate were the predominant ADHD treatments prescribed. Conclusions: Although both treatment and no/'other' treatment cohorts showed improvements in mean QoL over 12 months, the difference was small and not statistically significant. A major limitation was the higher than anticipated number of patients switching treatments, predominantly from the no/'other' treatment cohort. (J. of Att. Dis. 2012; 16(1) 44-59)

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists in adulthood. It is defined by inattention and/or hyperactivity–impulsivity. ADHD is associated with many comorbidities, including eating disorders (EDs). In the last decade, studies have reported that ADHD is linked with binge EDs, bulimia nervosa, and anorexia nervosa. Many postulates have been proposed to explain the association: 1) impulsive behavior in ADHD patients leads to disordered eating behavior; 2) other psychologic comorbidities present in ADHD patients account for eating behavior; 3) poor eating habits and resulting nutritional deficiencies contribute to ADHD symptoms; and 4) other risk factors common to both ADHD and EDs contribute to the coincidence of both diseases. Additionally, sex differences become a significant issue in the discussion of EDs and ADHD because of the higher incidence of bulimia nervosa and anorexia nervosa in females and the ability of females to mask the symptoms of ADHD. Interestingly, both EDs and ADHD rely on a common neural substrate, namely, dopaminergic signaling. Dopaminergic signaling is critical for motor activity and emotion, the latter enabling the former into a combined motivated movement like eating. This linkage aids in explaining the many comorbidities associated with ADHD. The interconnection of ADHD and EDs is discussed from both a historical perspective and the one based on the revealing nature of its comorbidities.