The problem of interaction between physicians and parents is very acute for child psychiatrists in Russia (Semenova S, Iakovleva I., 2012, Kupriyanova T, Koren E., 2013). The risk of stigmatization is one of the main reasons of treatment refuse.

To identify the reasons for resorting to a psychiatrist, agreement with the diagnosis and methods of treatment.

80 parents of mental disease's children were examined by special questionnaire.

We found that the 28 parents (35%) took their children to psychiatrist by their own initiative, some other professionals (pediatrician, neurologist or psychologist) encouraged applying to a psychiatrist in 44 cases (55%), 8 parents (10%) asked for advice after strong recommendations from teachers. Examination of the child by psychiatrist and an explanation of symptoms persuaded 20 parents (25%) only. 53 parents (66,3%) were convinced that a doctor for a diagnosis of mental disorder had to examine the child several times, 21 (26,2%) agreed with the diagnosis after several evaluations of different mental health professionals. 72 parents (90%) were not satisfied with the medical information about the child's illness that was provided and were needed to supplement that.

All of those factors hamper the effective interaction between the doctor and the parents of patients, which leads to delays in providing necessary assistance and negatively affects the health of children.

The authors present the outcomes of a new disability assessment paradigm, which ran for three years and concerns patients with autism.

Introduction of a new paradigm for assessing the state of health, decrease in the working capacity, and disability in patients with mental and behavioural disorders.

The evaluation reflected functional health state assessment and working incapacity in relation to the International Classification of Diseases and the International Classification of Functional Abilities, and principles of personalised medicine. Assessment of a patient's ability to undergo work rehabilitation is also part of personalised medicine.

In 2009, there were 28 741 of acknowledged cases of disability due to mental illnesses, out of which, 1 262 were cases of autism. In 2012, there were 32 326 cases of disability due to mental illnesses, with autism patients representing 1 866 cases. There was an increase in the number of acknowledgements of the degree of disability due to autism by 47% from 1 262 cases in 2009 to 1 866 cases in 2012; the proportion of persons with disability due to mental disorders increased between 2009 and 2012 by 12.4%.

The new paradigm of disability assessment represents a personalised evaluation of patients’ ability with special emphasis on their social integration. The increase in the number of disabilities due to autism significantly outweighs the total increase of disabilities caused by a mental illness.

Reward and punishment alterations are observed in depressed patients (Taylor Tavares et al., Neuroimage, 2008). Reward hyposensitivity and punishment hyper-sensitivity can be studied in humans and animals using operant tasks, such as the probabilistic reversal learning (PRL) task (Ineichen et al., Neuropharmacology, 2012).

To determine the effects of the new antidepressant agomelatine (AGO), a MT1/MT2 melatonergic receptor agonist and 5-HT2C receptor antagonist on reward and punishment processing as well as to evaluate its mechanism of action.

Mice learned spatial discrimination for sucrose-pellet reward in an operant apparatus. In the PRL task, mice were assessed on rewardstay, negative feedback sensitivity (NFS) and reversals completed. Using latin-square designs, agomelatine (AGO 10 or 25 mg/kg), melatonin (MT 10 or 25 mg/kg), the 5-HT2C antagonist S 32006 (2.5 or 5 mg/kg) or vehicle (VEH) were administered acutely i.p. An additional group of mice was treated acutely i.p. with the MT1/2 antagonist S 22153 (20 mg/kg) + VEH or S 22153 (20 mg/kg) + AGO (25 mg/kg).

Data underwent a median-split (high vs low performers) according to PRL behaviour under VEH. In low-performing mice specifically, AGO at 25 mg/kg increased reward-stay, decreased NFS and increased reversals completed, relative to VEH. There were no effects of MT or S 32006. Agomelatine effects were counteracted by prior administration of the MT1/2 antagonist S 22153.

Agomelatine acutely is able to increase reward sensitivity and decrease punishment sensitivity in mice. The results suggest a potential synergy between its melatonergic agonist and 5-HT2C antagonist properties.

To date 56 reciprocal microdeletion/microduplication syndromes have been described. Due to intensive application of microarray technologies new submicroscopic rearrangements are being published. The reciprocal rearrangements are particularly valuable, since they allow to determine the dosage-sensitive pathogenic genes.

To improve ID diagnostics.

To identify novel candidate loci of ID.

We performed the genome-wide analysis for 79 patients with idiopathic ID using CGH Microarray Kits 4×44K and 8×60K (Agilent Technologies, USA). Pathogenically significant cases were confirmed by qPCR.

We present two patients with microdeletion (369 kb) and microduplication (766 kb) at 3p26.3 containing the only gene - CNTN6. The microduplication was inherited from apparently healthy father. The child with microdeletion was an orphan. Recently, the microduplication in 3p26.3 (containing CNTN6) has been shown to be associated with autism spectrum disorders (ASDs). Contactin 6 is also suggested to play a neuroprotective role in ischemic injury and contribute to granule cell maturation and/or synaptic formation in the developing cerebellum.

Considering the experiments with mice we found myotonic syndrome, late development of sit and walk ability in the anamnesis, current fine motor skills impairment and dysarthria in patient with dup3p26.3. His IQ is 47. Dysarthria was also observed in the patient with del3p26.3 (IQ 55).

Obviously, CNTN6 can be a novel pathogenic gene associated with ASDs, ID, and motor functions impairment. This study was supported by EU Seventh Framework Program, CHERISH project no. 223692 and by Federal Program of Ministry of Education and Science of Russian Federation no. 8727.

Major symptoms evidenced by patients with Attention Deficit Hyperactivity Disorder (ADHD) have been linked to deficiencies in cognitive control, especially when conflicts in information processing occur.

We wanted to define neural correlates of impairments in conflict monitoring in ADHD using the ERP technique. Unlike previous ERP studies that focused on brain potentials following incorrect responses in ADHD, we investigated a brain potential, the N2, which reflects conflict monitoring before a correct response.

Participants were 33 adult ADHD subjects, and 29 matched healthy controls. We recorded 128-channel EEGs for ERP responses during a Go/NoGo Task with a prepotent GO response, where subjects had to withhold response to repeated stimuli.

Using age and gender as covariates in the analyses, subjects with ADHD evidenced significantly larger N2 amplitudes than healthy controls. The extent of N2 enhancement showed a significant association with the number of errors in the incongruent condition of the Stroop Task. With regard to scalp topography, the differences were manifested over the frontal areas, with the most pronounced difference appearing at the midline areas.

Patients with ADHD evidence a marked enhancement in N2 amplitude in a Go/NoGo task with prepotent response tendency. The fact that N2 enhancement is directly related to incongruent errors in the Stroop task suggests that behavioral deficits in conflict processing in ADHD may be underlied, at least partially, by the ‘hyperreactivity’ of neurobiological processes that generate this brain potential.

Supported by the Hungarian Scientific Research Fund (OTKA), Grant NN103325

Emerging evidence suggests that disturbances in emotional processing in ADHD may interfere with executive functioning, and account for impairments in life functioning.

To investigate whether patients with ADHD evidence deficits in processing emotionally-valenced inputs, and to delineate the neurobiological correlates of these deficits.

Using event-related potentials from 128-channels, we tested 33 adult ADHD subjects and 29 individually-matched healthy controls (HC) in a cognitive control task of response inhibition. The task was performed by presenting valenced pictures (positive/negative/neutral) of the International Affective Picture System. The pictures were shown in random sequence, and repeated occasionally. Participants were asked to respond to each stimulus, and to withhold response for the repetition.

With regard to behavioral measures, ADHD subjects showed more commission and omission errors. In terms of ERPs, both groups displayed a pronounced P300 component for all emotional valences in the frontal regions in the NoGo vs. the Go condition (‘NoGo P300’). However, compared to HC's, ADHD subjects showed a significant P300 reduction for negative, but no reduction for positive, or neutral stimuli.

Regarding the frontal NoGo P300, HC's were able to overcome the intrusion of negative emotion, and showed the same waveform when presented with negative as they showed with positive or neutral stimuli. By contrast, while ADHD subjects did not differ from HC's regarding positive and neutral inputs, they exhibited a pronounced P300 reduction for negative pictures, which may constitute a neurobiological correlate of emotional dysregulation.

Supported by the Hungarian Scientific Research Fund (OTKA), Grant NN103325

Schizophrenia is generally a lifelong condition. Despite high mortality, most survive into old age. Few prospective longitudinal studies have analysed trajectories from early-mid adulthood into old age.

Systematically review longitudinal studies of the progression of schizophrenia into old age, focusing on cognition, functioning, co-morbidity, mortality and quality of life.

Advance understanding of the course of schizophrenia and highlight interventions that improve outcomes and even achieve a state of wellbeing in later life.

Electronic search of PubMed, PsychINFO and Scopus. Search terms: (ageing OR ‘older adult’ OR elderly OR geriatric OR ‘late life’) AND (schizophrenia OR schizoaffective OR schizophreniform’). Articles and books searched manually.

The course in later life is variable. Many remain symptomatic and mortality and somatic comorbidity increase. Higher rates of decline in cognitive functioning affect ability to function independently. However, many individuals have a favourable clinical course and may stop receiving treatment altogether. 18–27% achieve recovery in old age. Growing evidence base for interventions that alleviate symptoms, improve social and cognitive functioning and quality of life. Inequalities remain in the quality and range of treatment interventions available to older people with schizophrenia.

Early introduction of regular psychiatric and somatic assessments and prompt and adequate treatment of symptoms and comorbidities throughout the life course are essential. Cases of remission/recovery are often excluded in clinical research. This risks presenting a biased, somewhat pessimistic description of the illness course into later life. Evidence base for interventions needs improvement and future trials must include older participants.

In spite of good development of laboratory and instrumental methods of diagnostics of brain and mental disorders, there remains an insufficiency of methods for etiology differentiation, especially clinical-psychopathological in psychiatry.

is to evaluate the differential diagnostic's opportunities in estimation of clinical phenomena's complexity for identification of neurotic, organic or endogenous genesis of disorders.

expert estimation, statistical.

As the experts 7 certified specialists (psychiatrists, psychologists and others) were involved.

In the research the academically definitions and the clinical case descriptions of the following clinical phenomena were estimated:

1. - Conversion, obsession, neurasthenia, phobia, derealisation/depersonalization, anxiety (partly specific for neurotic, stress-related and somatoform disorders);

2. - True hallucinations, confusion, amnesia, fixation hypomnesia, anecphoria (partly specific for organic mental disorders);

3. - Pseudo hallucinations, delusion of control, automatism, paralogia, emotional withdrawal, autism, ambivalence (common symptoms of schizophrenia);

4. - Inability to feel, sadness, lassitude, euphoria, excitement as the signs of endogenous affective disorders.

5. - Mainly non-specific phenomenon - persecutory delusions.

Thus were obtained 14 estimates for each item on a 100-point scale.

Dispersion of majority ranges was too high to get significant differences. But 6 from 7 experts significantly (p<0.05) and 1 tendentionally (p<0.01) rated 3 symptoms (autism, conversion and paralogia) as relatively more complex as compared with 7 more simplex phenomena (anxiety, confusion, euphoria, excitement, neurasthenia, phobia and sadness) by U-Wilcoxon-Mann-Whitney criteria.

established ranges of psychopathological phenomena's complexity reveal non-linear relations to etiology but in some cases they can be useful instrument of differential diagnostics of mental disorders.

Most patients (70%) discontinuing tobacco smoking will relapse within 6 months. A major challenge is the understanding of the processes involved in relapse. High cigarette craving has been proposed as a predictor of relapse. A recent study suggests that low inhibitory control capacities (low ability to inhibit prepotent responses) were correlated with high nicotine dependence. In this study, we focused on the link between inhibition capacity, craving, tobacco dependence and relapse.

134 smokers willing to quit smoking were consecutively included and followed prospectively. Tobacco dependence was assessed with the Fagerstorm test. We used the Hayling task to measure their inhibitory capacity and a specific questionnaire to measure tobacco craving (TCQ 12). Assessments were performed at baseline, 1, 3 and 6 months after smoking cessation. Any relapse in smoking during the follow-up was evaluated.

There was an association between lower inhibition capacities and higher dependance level at baseline. Low inhibition capacities were an independent predictor of relapse at 6 months (logit R 2 = .08, F (2,134) = 10.851, p <. 004). In contrast, although level of tobacco dependence and craving predicted relapse in the short term (first month), they did not predict relapse at 6 months.

These results suggest that inhibition capacities may predict smoking relapse in the long term (6 months) better than usual measures of craving. In clinical practice, an inhibition test, which is short and feasible, could be of interest to identify smokers at higher risk of relapse.

The case group consisted of 29 CAH girls and 11 CAH boys. The typically developing group consisted of 35 girls and 25 boys. K-SADS was used to screen the children for co-morbid psychiatric diseases. Progressive Coloured Matricies was used to determine their IQs. The play activity questionnaire to study their sex-typed play. Hormonal profile (testosterones, progesterone and delta 4 androgens) was done for the cases.

we hypothesized that elevated prenatal exposure to testosterones will cause masculinization of behavior and play in girls with CAH but will not affect boys.

Girls exposed to high levels of androgen prenatally, because of the genetic disorder congenital adrenal hyperplasia, show increased male-typical play. They preferred to play with masculine object items (cars and trucks), rough-and-tumble play and war play. They were less interested in pretend play than the typically developing girls. No differences were seem in the active and adventurous play. CAH girls showed preference for boys as playmates.

CAH boys showed the same pattern of behavior as the typically developing group but with restricted (less) interest in most of the play items.

All cases were on glucocorticoid treatment so the hormonal levels were within range.

Depressive disorders have the highest inpatient utilization rates in German health care. The aim of this study was to evaluate response, remission and non-response rates as well as predictors of response in depressive inpatients.

Consecutively admitted inpatients with a depressive episode (F32.0-2, F33.0-2) were assessed at admission and at discharge for depression (Beck depression inventory II, BDI-II) and general psychopathology (Brief Symptom Inventory, BSI). Most frequent cause for admission was nonresponse to prior outpatient treatment.

A total of 2323 inpatients with depression (M=48.02 years, SD=11.79) was included. 46.7% of patients received concomitant antidepressants. Mean duration of inpatient treatment was 53.16 days (SD=23.31). For completers, BDI-II decreased from 29.36 (SD=9.36) at admission to 14.00 (SD=10.96) at discharge (Effect size: 1.64). Response rates were 75.5% (BDI-II) and 68.7% (BSI) and remission rates 62.2% (BDI-II) and 40.8% (BSI). Non-response rates, also including minor responders, varied between 23.4% (BDI-II) and 27.4% (BSI). A comparison between patients with and without concomitant antidepressants showed a significant time and group effect, but no significant interaction effect.

Responders showed significantly higher depressive symptoms (BDI-II) and higher scores on the scales anxiety and phobic anxiety (BSI) at admission. They had fewer inpatient pretreatments before index admission. Furthermore, therapy motivation was identified as predictor for response.

The results demonstrate that about two thirds of depressive patients show response after a multimodal inpatient treatment. Future studies should focus on early identification of non-responders as well as on the development of treatment strategies for these patients.

To study the pragmatic language deficit in ADHD children.

This study included 62 consecutive newly diagnosed ADHD children according to Diagnostic and Statistical Manual of mental disorders IV-TR criteria, their age ranged from 6–8 year. Then they were referred to the Phoniatric unit, Kasr Al-Aini for pragmatic assessment. Forty four normal control children (age and sex matched), were included in the study. The included samples were subjected to the protocol of language and pragmatic assessment applied in Kasr Al-Aini. Twenty-four children with ADHD were excluded as they had history of delayed language development. Four control children were also excluded because of phonetic errors. The 38 ADHD children and 40 controls were subjected to the following psychiatric assessment: Semi-structured interview to confirm that the patients have ADHD, Wechsler Intelligence scale for children (WISC), and Conner's’ Parent Rating Scale-Revised: long version (CPRS-R: L).

ADHD children got less significant scores in intention, narrative, conversation and total pragmatic scores than controls. There was significant negative correlation between inattention Conners’ subscale with intention and narrative pragmatic subscales. Also, significant negative correlation between social problems Conners’ subscale and intention and conversation.

ADHD children have pragmatic deficits than controls

Neurocognitive deficit (executive functions, verbal and spatial learning and memory, visual processing and attention) is a core feature of schizophrenia.

The main objective of this study is to identify the cognitive deficit in adolescents with early onset psychosis (EOP - schizophrenia, schizoaffective disorder, depression with psychotic features). The secondary objective is to examine if the cognitive deficits are global or specific.

This study is longitudinal, during a period of one year and a half. Twenty-eight adolescents at first psychotic episode (15 with EOP and 13 with other psychotic disorders) agreed to participate to this study and were assessed during their hospitalization in a university clinic for child and adolescent psychiatry, in Cluj-Napoca, Romania. The age of patients ranged from 10 to 17 years. The diagnosis was based on DSM-IV criteria. 32 healthy adolescents, volunteers, formed the control group and were matched by age and gender. All the patients and the adolescents from control group were assessed for intelligence level using Raven Test and those with mental retardation were excluded. The neurocognitive functioning was assessed with Trail Making A and B, verbal fluency tasks, Wisconsin Card Sorting Test and Rey Auditory Verbal Learning Test.

Adolescents with EOP at first psychotic episode had signicant neurocognitive dysfunction as compared to healthy adolescents from the control group.

Our results are consistent with those of previous studies and it is clear that many adolescents with early onset schizophrenia show substantial impairment across multiple domains of neurocognition.

Legal drugs are changing the standards of drug consumption. These substances, labelled ‘not for human consumption’ are sold as incense, bath salts or pills, tricking sanitary authorities and Food and Drug Administration. Despite the absence of clinical trials, they grant a feeling of safety by being freely sold over the internet and smart-shops, and by ending the fear of control, since medical analyzes do not detect them. This makes them appealing and their popularity is steadily growing.

The authors aim to describe the results of analysis made to several legal drugs samples available online and its potential implications.

Review of PubMed’ studies between 2010 e 2012, using as key-words: ‘legal drugs’ and ‘purchase online legal highs’.

Studies of substance labeling found a lack of information, since 81,9% of the analyzed products did not report side effects and 86,3% did not specify medical interactions. A study done six months after mephedrone's prohibition in the U.K., showed that 62,5% of products still presented this substance, as well as unlisted components. Three subsequent studies revealed that the majority of the drugs listed the active principle on the label, but a significant percentage also showed unlisted substances.

In addition to the dangerous effects and interactions of the unlisted substances, consumers and sellers, misled by the nomenclature ‘legal’, may be committing an illegality when buying these drugs. Despite governmental efforts, the gap between the identification of a potentially harmful substance and its prohibition, makes difficult to prevent this potential flagellum.

In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their premorbid adjustment.

In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganized, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9- month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analyzed.

During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 45% to 25%. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.

A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are executed.

GXR, a selective α2A-adrenergic agonist, is a non-stimulant ADHD treatment approved in the USA for children and adolescents, and in Canada for children.

To evaluate long-term maintenance of efficacy of GXR in children and adolescents with ADHD who respond to an initial open-label, short-term trial.

To determine if there is a higher rate of treatment failure for placebo vs GXR during the double-blind randomised-withdrawal phase (RWP) (NCT01081145).

Patients (6–17 years) meeting DSM-IV-TR criteria for ADHD, baseline ADHD Rating Scale-IV (ADHD-RS-IV) ≥32 and Clinical Global Impressions-Severity (CGI-S) ratings ≥4 were enrolled. Following 7-week dose optimization and 6-week maintenance periods on open-label GXR (1–7 mg/day), eligible patients entered a 26-week, double-blind, RWP with GXR or placebo. The primary endpoint was rate of treatment failure (≥50% increase in ADHD-RS-IV total score and ≥2-point increase in CGI-S at two consecutive visits, compared to the RWP baseline). The key secondary endpoint was time-to-treatment failure. Safety assessments included treatment-emergent adverse events (TEAEs), electrocardiograms and vital signs.

Of 528 patients enrolled, 316 (60.0%) entered the RWP. At study end, 49.3% (GXR) and 64.9% (placebo) (95%CI; −26.6, −4.5, p<0.01) of patients had relapsed (Figure). Time-to-treatment failure was 56 days (placebo) versus 218 days (GXR), p=0.003. During the RWP, the most common GXR TEAEs (≥5% patients) were headache, somnolence and nasopharyngitis.

GXR demonstrated long-term maintenance of efficacy versus placebo in children and adolescents with ADHD.