The main aim of this study was to analyze the association between a set of neurobiological/clinical factors and impulsivity in patients suffering from bulimia nervosa, as well as the capability of this factors to predict the severity of impulsivity.

The Impulsive Behaviors Scale (IBS), the Diagnostic Interview for Bordeline Patients - Revised (DIB-R), the Beck Depression Inventory (BDI), the Millon Multiaxial Clinical Inventory (MMCI-II) and the Family Environment Scale (FES) were applied to 70 female patients with DSM-IV BN (purging subtype). Twenty-four hour urinary excretion of norepinephrine (NE), 3-methoxy-4-hydroxyphenylglycol (MHPG), serotonin (5-HT), 5-hydroxi-indol-acetic acid (5-HIAA), dopamine (DA), homovallinic acid (HVA), and morning serum cortisol levels before and after the administration of 1 mg of dexamethasone were determined.

Impulsivity was associated to lower levels of urinary 5-HT and 5-HIAA, borderline features, and lower family expressed emotion.

The consideration of impulsivity as a core clinical feature in patients with bulimia nervosa could lead us to identify clinical subtypes of patients, with specific clinical profiles and specific treatment needs.

To examine the natural course of eating disorders (ED) prospectively over 6 years and to examine link between stressful life events (SLEs) and ED relapse among women with personality-disorders (PDs).

Subjects were 132 female patients with bulimia nervosa (N=40) or EDNOS (N=92) in the Collaborative Longitudinal Personality Disorders Study. EDs were assessed with the Structured Clinical Interview for DSM-IV Axis-I, and monitored with the Longitudinal Interval Follow-up Evaluation during follow-up. PDs were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV), and monitored with the Follow-Along version of the DIPD-IV during follow-up. SLEs were assessed with the Life Events Assessment (LEA). Follow-up assessments were conducted at 6- and 12-months and then yearly through 72 months. Proportional hazard regression analyses were performed to examine the link between time-varying levels of SLEs and ED relapse. Cox regressions controlled for the same covariates used in prior work: duration of ED, number of co-morbid psychiatric disorders, and time-varying status of PDs.

Of the 132 patients, 59% had remissions from ED, 68% of whom subsequently relapsed over the course of 6 years (BN and EDNOS did not differ in relapse). Total number of negative SLEs reported by ED patients significantly predicted subsequent ED relapse (HazardRatio=1.5, p< .05). The types of SLEs that predicted ED relapse were elevated work stressors (HazardRatio=3.0, p< .01) and elevated recreation stressors (HazardRatio=3.1, p< .05).

Higher work stress and higher recreation stress represent significant warning signs for triggering relapse for women in remission from BN and EDNOS.

Small number of prestigious scientific journals publishes most of the world's scientific information. Although scientists in developing countries represent 25% of the world's scientific community national journals from this "scientific periphery" are poorly visible: the Science Citation Index (SCI) included less than 2% of these journals in 1995.

A vicious cycle of inadequacy for these journals: small number and poor quality of manuscripts submitted, inadequate review process, and imperfect English prevents them from reaching higher visibility and eventually escaping form anonymity. Key problems seem to be poorly designed and unoriginal research, lack of knowledge of research methods and data presentation.

1. 1. Teaching principles of scientific research in medical schools.

2. 2. Author-friendly editorial policy - a procedure where most of the articles received are pre-reviewed intramurally and improved by providing guidance to the authors, before being sent out for extramural review.

3. 3. Proactive board of editors - who seek interesting research and encourage researchers to communicate their results.

4. 4. Networking regional collaboration.

In the case of Croatian Medical Journal (CMJ) that followed and partly developed the "treatment" described, such policy resulted in significant formal success - inclusion of CMJ in the most selective international indexing databases (MEDLINE, Current Contents and Web of Science), open access status, decent visibility and attention of researches (impact factor 1.2). The original, active and efficacious approach of the editors of CMJ will be analyzed in this presentation.

Although suicide rates are decreasing in most European countries, suicide is still a major health concern. Despite of the fact, that the vast majority of suicidal patients contacted with health care services before the suicidal act, the doctor-patient meeting is a necessary, but sometimes not sufficient way enough to prevent suicide. Most patients, who commit or attempt suicide, are not regarded as being at high immediate risk at their final contact with health care services.

Based on reviewing the relevant literature and on our previous studies we developed a brief, practical, clinical guideline, which may aid general practitioners and primary care professionals to assess suicide risk and also to manage these patients.

We introduce a model for an integrated, regional suicide prevention strategy, which includes recognition, risk assessment and also intervention. The main steps of our model are to recognize warning signs, explore crisis situation and/or psychopathologic symptoms, assess protective and risk factors, estimate suicide risk, plan intervention strategies, and finally manage suicidal patients through the different levels of intervention.

In the management of suicidal behaviour the complex stress-diathesis model has to be adjusted by considering biological markers (mental disorders, personality traits) and psycho-social factors (crisis, negative life events, interpersonal conflicts). Only after the assessment of these factors primary care professionals, as ‘gatekeepers’ can manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic facilities in the recognition, treatment and prevention of suicidal behaviour.

Due to the implementation of the DRGs (Diagnosis Related Groups) in the somatic departments of general hospitals, an elevated demand for psychiatric consultations can be anticipated. It is a moot question whether psychiatric consultation services are adequate for such a surplus load. We investigated whether the proportion of psychiatric consultation requests for patient's capacity to consent and for guardianship is rising.

The DRGs were implemented in the somatic departments of the Ev. Krankenhaus Königin Elisabeth Herzberge (KEH) at the end of 2003. We compared consultation requests with the keywords “capacity to consent”, “capacity to enter contracts” and “need for guardianship” in the year 2002 with 2004.

Significantly more consultations with the keyword “guardianship” were requested in 2004 compared to 2002 (p=0.019). 56% concerned medical questions regarding capacity of consent. There was a slight, but increase in the requests social reasons.

The confirmation of the indication for the appointment of a guardian decreased inversely without statistical significance (80% in 2002 and 64% in 2004; Chi-Square p=0.058).

The increasing demand of the consiliary-liason-service was confirmed in our investigation. It is possible that the implementation of the DRGs plays a role in the increase of psychiatric consultation request. As a trial to ease the growing burden, we developed a form which also enables colleagues from the somatic departments to apply for guardianship of their patients without psychiatric assistance.

The objective of the present study was to find the prevalence of attention deficit hyperactivity (ADH) symptoms in a highly consanguineous community.

A cross sectional study was conducted during October 2006 - January 2007.

A total of 2500 primary school students, aged 6-12 years were randomly selected from the government primary schools and 1869 students (74.8%) gave consent to participate in this study.

Of the students surveyed, 50.7% were boys and 49.3% girls. The data revealed that 158 boys [16.7%; 95%CI (14.4-19.2] and 50 girls [5.4%;95%CI (4.1-7.1)] scored above the cut-off (≥15) for ADH symptoms, thus giving an overall prevalence of [11.1%; 95%CI (9.7-12.6)]. The Children who had higher score for ADH symptoms were in the age group 6-9 years. Children who had higher score for ADH symptoms had school performance poorer than those with lower scores (P=0.002). 200 children (96.2%) with ADH were disobedient, 60.6% noisy and hyperactive, 36.5% very cranky, 37.5% troublesome and 37.9% nervous. The logistic regression identified in our study that socio-economic condition, number of children, school performance and poor relationship between parents were the main contributors for ADH. This shows that the consanguinity has no impact on ADH children.

The study revealed that ADH symptoms are found to be a common problem among the school children in Qatar. A significant difference was found between children with and without ADHD for their behaviour.

The aim of this study was to investigate the association between parental characteristics and parental practices and the trajectories of Disruptive Behaviours (DBs) during early childhood.

Trajectories of DBs - Hyperactivity, Oppositional behaviour and Physical Aggression - were assessed based on annual mother interviews from 17 to 60 months for a Canadian population-representative birth cohort (N=2057).

Frequency of DBs increased from 17 to 41 months and then tended to decline. Parental characteristics and parental practices were both associated with chronic trajectories of DBs.

Early childhood is a critical period to prevent later DBs during school years that leads to psychosocial maladjustment during adolescence and adulthood.

ADHD is a well-established neurodevelopmental disorder affecting a significant population across the lifespan. Driven by the need to provide adequate clinical care, several national and international medical societies have published guidelines on ADHD. Our objectives were to compare the recommendations set out by these guidelines and their methodological quality.

To meet the inclusion criteria the guidelines had to be published by national or international medical societies or governmental bodies and focus on diagnosis or management of ADHD. To assess their methodological quality we used the Appraisal of Guidelines for Research & Evaluation (AGREE) instrument.

We identified 13 guidelines on diagnosis and/or management of ADHD meeting our inclusion criteria. They represented the recommendations from 9 different bodies from 4 different countries and 1 European group. All guidelines made recommendations on both diagnosis and treatment. Seven made recommendations concerning children and adolescents, four are about ADHD in adulthood and two made brief comments on specific aspects of treatment in adulthood. All groups have used DSM-IV criteria but differed on their assessment recommendations to varying degrees. All of them recommended stimulants as the core of pharmacological treatment. Only one (NICE 2008) recommends specifically methylphenidate as the first-line treatment.

Most of the diagnostic and treatment recommendations are consistent across the guidelines with few but important exceptions. This may reflect differences of service provision and target audiences. Convergent recommendation of psychostimulant treatment and differences with respect to psychosocial interventions reflect the strength (and weakness) of underlying evidence.

Many well known studies have defined results and tolerability of stimulants used in school children with ADHD in last period. In our follow-up study from August 2007 to January 2009. will present results of once-daily OROS Methylphenidate therapy including break it for holiday.

We are enrolling 32 children in study, 7-14 years old, and all of them were team-diagnosed according DSM IV/psychiatrist, psychologist, neurologist. Children with ADHD symptoms are treating with OROSMPH (18-54mg), with adjustments based on clinical symptoms, and all ADHD symptoms measures, vital signs, EEG and laboratory results also will be included through our study period.

Effects of OROS MPH therapy will be presented only in children who completed the study, looking for adverse events, clinically significant effects on vital sings, EEG, laboratory test parameters, and also, improvement academic functions, before and after breaking therapy.

Besides our expecting on reduction of ADHD symptoms with minimal effects on vital sings,values on growth, tick, laboratory test, it considers too, better academic functioning, social relationship with continual therapy.

75 children (55 male) fulfilled the criteria for ADHD: 35 of inattentive type, 28 of combined type and 12 hyperactive/impulsive. In addition, 33 (44%) of the children had comorbities. Children with higher scores for hyperactivity and impulsivity showed low performance in these working memory measures than those with other types. In the Conners’ Continuous Performance Test (CPT), a higher rate of omissions was found in the inattentive group. Children with comorbidity of oppositional desafiant disorder presented lower ISI and Hit RT scores in addition to higher rates of omission.

This study suggests that neuropsychological profile in children with ADHD is associated to specific differences in working memory performance and also in specific measures of the CPT. In addition, better defined tests, involving not only attention and motor planning may determine different neuropsychological profiles and, consequently, different approaches in cognitive rehabilitation.

To describe the development of a service addressing the needs of adults with ADHD, and to survey the caseload of this service.

This review describes the process of setting up a new service for adults with ADHD. This includes drawing up a service plan to look at the resources required, and arranging shared-care agreements with general practitioners. The service was developed in two phases, with the initial phase accepting transitional patients with an established diagnosis of ADHD, and phase two looking at the assessment of individuals without a previous diagnosis. All referrals to the service were surveyed, and information was collated on age, gender, diagnosis, co-morbidity, medication and employment.

The service was set up in November 2007, and over a period of 10 months, 32 referrals were accepted, having met the criteria for assessment. Cases were accepted on the basis that they had a previous diagnosis of ADHD, the majority originating from Child and Adolescent services.

The caseload review revealed high levels of comorbidity. The majority of patients were treated with stimulant medication. The ratio of male to females was higher, as expected. The incidence of substance misuse and conduct disorder was consistent with other studies.

The demand for a service addressing the needs of adults with ADHD has been high, as evidenced by the volume of referrals received. ADHD persists into adulthood in approximately 50% of children with the diagnosis so follow up into adulthood is crucial.

A recent cross sectional study has shown an association between the HOME score and the severity of ADHD symptoms, especially hyperactivity, in children with ADHD. This study will ascertain if the association between symptoms of hyperactivity and the HOME score is present in children with non-ADHD clinical disorders as well as children with ADHD.

Parents of children aged < 10 years attending the Child Guidance Unit, Mater Misericordiae Hospital from 2006 onwards were invited to partake in the study. The HOME was administered to 100 participants and the child's symptoms of inattention and hyperactivity were assessed by administering the Conners’ Parent Rating scale.

A correlational bivariate analysis was performed on parent ratings of inattention and hyperactivity with the total Home score and each subscale. For each set of symptoms, there was a significant and negative correlation with total HOME score: Pearsons's r = -.22, p = .028 for hyperactivity and Pearson's r = -.33, p = .001 for inattention.

Higher scores of hyperactivity and inattention are associated with a lower total HOME score; therefore there is an association between symptoms of hyperactivity and the home environment in children with non-ADHD clinical disorders as well as children with ADHD.