To review the literature on child sexual abuse with emphasis on psychosocial/psychodynamic aspects.

Systematic literature review from the articles indexed in Medline, PSYinfo, Pepsic, Lilacs and Scielo in the last ten years. Terms researched were: child sexual abuse, psychosocial, psychodynamic and psychoanalysis.

Child sexual abuse can have devastating consequences for the psychological functioning of children, possibly interfering with their proper process of development. It can contribute to violent behavior, acts of delinquency and mental disorders in adolescence and adulthood, as well as the development of comorbid post-traumatic stress and self-aggressive behaviors, risk behaviors and teenage pregnancy. Gravity of psychic consequences increase in relation to the frequency of abuse. Aspects of power, seduction and coercion are involved. Inequalities of age and gender are highlighted. Often practiced without the use of physical force, it may be difficult to be proven. A frequent abuser of familiarity with the child creates conditions that foster abuse. The revelation of the abuse may not occur, perpetuating the suffering and helplessness of the child. Sexually abused children may develop identification with the abuser and even become sexual offenders in adulthood. There are difficulties in the conceptual definition of abuse, the establishment of protocols for investigative and therapeutic management of cases and in predicting the immediate consequences along with the medium and long-term consequences.

Studies on the therapeutic practices used for the treatment of abused children and their families can help to construct therapeutic models, minimizing suffering in this terrible situation of violence.

To investigate socio-demographic and clinical trials of 19 sexually abused children.

Statistical analysis with SPSS of data on psychiatric and pediatric care of sexually abused children, aged 2-12 years old, treated at the Pediatric Service of University of Campinas-Brazil Clinical Hospital in 2007.

From a total of 19 children, 2 (10.5%) were boys and 17 (89.5%) girls. The average age group was 7.4 years. Eleven (57.9%) attended regular school, one (5.3%) attended special school, one (5.3%) pre-school and six (31.5%) did not attend any school. Regarding ethnicity, 11 (57.9%) children were white and eight (42.1%) non-white. The abuse was committed with physical threats in nine (47.4%) cases, without threats in two (10.5%). Eight children were unable to define physical threat. The abuse occurred only once in 10 (52.6%) cases and several times in nine (47.4%). Prior psychiatric treatment occurred in two (5.3%) children and psychological treatment in six (31.6%). Twelve (63.2%) children had never attended psychological or psychiatric consultations. Eleven (57.9%) children received a psychiatric diagnosis and referral for treatment. In 13 (68.4%) attendance was diagnosed in the Z-code of the International Classification of Diseases-10. Family and people close to children appear as abusers in 15 cases (78.9%).

Despite the small sample, this study supports the literature in which child sexual abuse appears as a phenomenon more frequent in girls, dysfunctional families, and practiced mainly by family members or close friends of children. The relationship with psychiatric disorders was also highlighted.

We investigated the timing of cigarette, alcohol, and marijuana use initiation in adolescents, focusing on three levels of predictors: (1) individual-, (2) family- and (3) neighborhood characteristics.

A community-representative sample of 440 mother-child dyads was assessed 4 times over 6 years. Children were on average 10 (+ 2) years old at baseline (T1), with equal SES, gender and ethnic representation.

We examined the timing of first alcohol, cigarette, and marijuana use as reported by children on the Youth Risk Behavior Survey (YRBS) at T3 in relation to predictors collected at baseline (T1).

Individual-level predictors at T1 included child gender, race, and child reports of sensation seeking. Family-level predictors included household size, maternal education, family income, and child-reported exposure to home violence. Finally, maternal and child reports regarding gangs and drugs in the neighborhood, and child reports of neighborhood violence were factor-analyzed into a single scale, where higher scores reflected unsafer neighborhoods.

To examine the timing of first cigarette, alcohol, and marijuana use as a function of the above predictors, three separate Cox regression (i.e., survival) models were estimated.

Controlling for all other predictors, neighborhood safety remained significant predictor of substance use initiation among adolescents across all three examined substances. Children living in unsafe neighborhoods started, on average, smoking, drinking, and using marijuana at an earlier age, as indicated by positive and significant regression coefficients.

These results point to the importance of broader contextual influences - such as neighborhoods - on underage substance use initiation.

Impaired facial emotion recognition, especially fear were widely described in adolescents with conduct disorder, and some literature data indicate similar changes in adolescents with ADHD. However, to our best knowledge the relationship between emotion recognition, conduct symptoms and hyperactivity measures in a mixed clinical population were not investigated.

A mixed clinical population of 56 adolescents (19 girls) between age 11-16 (13.4 on average) admitted to the acute department of Vadaskert Child Psychiatry Hospital was taken part in our study. The parental and self-report version of the Strength and Difficulties Questionnaire (SDQ), facial emotion recognition test including six basic emotions (FEEST) and Raven IQ measures were performed.

In the overall population, in 21 cases externalization symptoms, while in 35 cases internalizing symptoms dominated the condition. Fear recognition irrespective to age and IQ were significantly worse in externalizing teens compared to internalizing ones (p< 0.05), while the recognition of other investigated emotions (anger, disgust, happiness, sadness, surprise) did not show significant differences. In the overall population, only fear recognition was significantly related to self reported conduct (R=-0.35, p< 0.01) and hyperactivity problems (R=-0.27, p< 0.05), while overall emotion recognition was related to both self reported hyperactivity (R=-0.33, p< 0.02) and parent reported hyperactivity problems (R=-0.29, p< 0.03).

Our results indicate that hyperactivity symptoms measured by SDQ were specifically related to impairments in fear recognition, and this effect is irrespective from attention problems as no relationship between symptom severity and other emotions were observed.

To assess efficacy and safety of tenoten for children (TC, ultra-low doses of antibodies to S100 protein) in ADHD patients.

In a double-blind placebo-controlled study 50 children (6-12 years) met DSM-IV criteria, mild/moderate CGI-ADHD-Severity and ADHDRS-IV-Parent:Inv > 22 points were enrolled. Patients were randomized to receive either TC (2 tablets BID, n=25) or placebo (n=25) for 12 weeks. ADHD symptoms were assessed by ADHDRS-IV-Parent:Inv, CPRS-R:S and CGI-ADHD-Severity.

According to both parents and investigators assessment TC decreased ADHD symptoms: ADHDRS-IV total score reduced by 13.5 points, hyperactivity by 6.7 points, inattention by 6.8 points (5.4, 2.3 and 3.2 in placebo); CPRS-R:S total score reduced by 12.8 points, hyperactivity by 3.6 points, inattention by 6.1 points (4.8, 1.8 and 1.7 in placebo). ADHD severity reduced in 9 patients received TC and 3 patients received placebo. No adverse effects were reported in both groups.

The study demonstrated good clinical efficacy and safety of TC in children with ADHD.

PMU, Emma Children's Hospital, AMC Amsterdam, tertiary referral centre for children with invalidating functional complaints (at least two present):

1. - impact on their social/family life's

2. - given up their hobbies

3. - school absenteeism

Complaints; long-lasting (> 3 months) and therapy resistant

PMU-approach:

• • integrated approach starting at intake by paediatrician and psychiatrist/psychotherapist; → Explanation; body and mind belong together

• • Validation of complaints by full history and thorough physical examination → Complaints are real, no doubt.

• • Explanation of complaints by models (stress model, brain-gut axis, sensitisation model)

• • Individual treatment (rehabilitation, graded exercise, cognitive behavioural therapy etc.)

:

• • Retrospective observational study (charts) in children with abdominal pain (ap) and headache as primary complaint

• • Measuring persistence of complaints/ invalidation level

• • 66 pt evaluated (42 pt with ap, 24 pt with headache), 43 girls (65.2%) Age at first visit; mean 13.5 yr (range 6-17):

  1. - 34 pt finished treatment

  2. - 19 pt in treatment

  3. - 6 pt one consult planned

  4. - 5 pt no follow-up after intake

  5. - 2 pt no complaints at moment of intake

• • Duration complaints: >2 yrs in 31 pt (47.0%), school absenteeism ≥ 20% in 46 pt (69.7%), 33,3% visited > 5 care providers for complaints.

• • 16 pt (47.1%) treatment < 6 months

• • 25 pt (73,5%) lost/minimized complaints, 22 pt (64.7%) no school absenteeism.

PMU-approach; good results for this serious invalidated patient group with therapy resistant functional complaints. Note; relative small group, not yet long term follow-up.

Anorexia mentalis is a psychiatric disease followed by body deterioration.Goal: The selecting of medicament treatment and psychotherapy, following certain procedures which will lead the patient into the quickest psychosomatics functioning.

During the period from January till December 2007, 15 female patients, age 14-19, were treated. Six of them were treated with Haloperidol, and 9 received Olanzapine treatment.The therapy consists of:A:A “two-way” therapy and “multi-level”therapy”: food intake (high energy supplements and meals) and body mass growth curve, i.e. physical and psychical conditions are simultaneously monitored (horizontal level).B: Pharmacotherapy (neuroleptics and antidepressives)C: Psychotherapy (individual, family, behavioral, psychodynamic) (vertical level A, B)The treatment is pervasive and in stages, with individual corrections by the therapist according to specificity of each patient.

The following parameters were observed: body weight, BMI, hormonal status, regaining menstrual cycle, and psychical status, brain NMR scan, period of hospitalization. Female patients treated with Olanzapine gained 3-4 kg in one month, during that period psychopathology gradually faded: obsessive thoughts about weight loss, disturbed body image. Depressive emotionality lasts longer; therefore the antidepressives are included in therapy. Female patients treated with Haloperidol gained body weight slower, in a period of five months in average, and they also showed slower psychopathological restitution.

Anorexia is very serious psychological disease that can be a death threat to a patients physical health, therefore, an early disease detection, timely reaction and treatment are essential.

The relationship of DRD4exonIII48bp VNTR and executive function were studied in 86 children with Tourette's Syndrome.

86 Han Chinese children with GTS were tested using a set of neuropsychological test(Stroop test, trail making test,modified Wisconsin Card sorting test) and compared with 51 healthy control group to understand the relationship between executive deficits and genetics.

Compared with normal children, The GTS group showed impairment on almost all psychological measures. In some stroop test, combined ADHD group differed from the GTS-alone group. No evidence show significantly difference among DRD4exonIII48bp VNTR and executive function.

GTS patient has executive function deficits,these deficits may have nothing to do with DRD4exonIII48bp VNTR.For comorbid, there is a certain influence in the executive function.

Were violent/non-violent traumatic life events and victimization by/witnessing violence associates of attempted suicide among depressed adolescents who were also less resilient at early adulthood?

The present study examined a subset of mainly depressed, age-and-gender matched, adolescents derived from a representative sample of 2464 students (T1, mean age = 13.7 years) followed-up after one year (T2Q) and reassessed 5 years later (T3, n = 252, mean age = 20.0 years, 73% participation), with a questionnaire, including the Connor-Davidson Resilience Scale and K-SADS-PL psychiatric interviews which also tapped traumatic life events.

Logistic regression analyses revealed that attempters were victims, not witnesses of violence; more depressed and less resilient than non-attempters, and that resilience was a moderator of lifetime violent events and attempted suicide, even in the presence of antecedent depression.

To analyze the different combination of personality pathology associated to variables of psychiatric hospital admissions (number of admissions, total of days spent as psychiatric inpatient, average of days for admission, and number of admissions in a day care hospital).

The ICD-10 and DSM-IV modules of the semi-structured interview IPDE (International Personality Disorders Examination) were administered, in a sample of 107 adolescent psychiatric patients (M=15.8, SD=0.8 years old; age rank 15-17; 79% female).

Personality pathology group identified by the IPDE showed significantly higher number (p< .001) of psychiatric admissions (M=1.48) than no personality pathology group (M=0.57), but not significant higher number of admissions in a day care hospital. Psychotic patients showed the highest rate of admissions (M=2.88). In present sample, between 30% and 38% of all hospital admitted patients showed a Cluster B personality disorder (PD).The users of psychiatric inpatient services with a complex PD (two o more PD from different clusters) presents in average: 2-2.5 admissions, 34-53 total days spent as psychiatric inpatient, and 11-16 days on each admission.

Patients with psychotic disorders or complex PD were the highest users of inpatients services, but not of day care hospital admissions.

The family is one of main factors, which have influence on body and mental health of the children especially in early ages. The aim of study was to explore the family status of the children with behavior disorders.

During 2007-2008 years 112 families were observed with children 10-15 years old with behavior disorders. The research methods were clinical-anamnesistical and clinical-psychological. Also the parents of the children answered on the questionnaire about development of their child in infancy and upbringing.

There are following types of unfortunate families: incomplete family (46,3%), formal family (25%) where parents are at the stage of divorcement and the mutual respect and understanding are absent; family with alcoholic way of life (74,5%), antisocial family (79,8%) with criminal and antisocial mode of life. The prevalent method in upbringing was hypo wardship at the 46, 4% (n = 51. In 43,6% (n = 48) of cases type of upbringing was estimated as child neglect generally it was family where both parents led antisocial way of life. In 10% (n = 11) of families upbringing was made as hyper wardship. In the majority of cases (79 5% (n = 89)) children had the poor conditions of life.

The conducted investigation showed that families where children were bringing up with violations of behaviour could be considered as socially deformed with antisocial mode of upbringing. The findings could be useful for development of complex rehabilitation program for children with behavior disorders.

The results showed that the adolescents were more concerned about their physical appearance (body dissatisfaction and obsession with being thin), by their social environment (interpersonal distrust). The Anorexia (AN) has alarming increase of the disorders of the food conduct in the last two decades. The conception etiopatogénica current is multifactorial: biopsicosocial, where the more important are the sociocultural factors.

To assess the presence of symptoms of cognitive and behavioural symptoms characteristic of eating disorders in adolescents.

Clinical case: four neighbors of the same village, who initiated being adolescents, food restriction. Finally, three of them needed hospitable revenue. In our case, they are athletes, favorite children of the best families and they form part of the regional soccer team. Like a jobby, being children, they competed furtively “to see wich one lost more weight “

Theory Multifactorial postulates that the Anorexia nervosa would be a complex interaction betewing the psychological and family factors that would lead the teenager to rejecting the food; the consistent malnutrition would produce changes hipotalámicos and endocrine that would contribute to the disorders of the corporal image and the fear of the obesity.

Our adolescents with normal weight showed specific factors for developing eating disorders in the future. The sociocultural influences and concretly, “the longing thinness ” constitute the principal factor predisposition of maintenance of these disorders. It seems to be important to anticipate the clinical conditions that they could accompany on the future cases in our young men.

Oxidative stress suposses an imbalance between oxidants and antioxidants molecules. Negative and positive family environment have been related with worse and better outcomes respectively in schizophrenic patients.

Our objetive is to determine antioxidant defense in healthy controls and unaffected relatives of early onset psychosis patients and to asses its relationship with familiar environment.

We included 82 healthy controls (HC) and 14 healthy controls with second degree family history of psychosis (HCWFHP), aged between 9 to 17.

Total antioxidant status and lipid peroxidation test were determined in plasma and antioxidant enzime activities and glutathione levels were determined in erytrocytes.

We used the Global Assesment Functioning scale (GAF) and the Family Environment Scale (FES). The FES is made up of ten subscales: cohesion, expressiveness, conflict, independence, achievement, intellectual-cultural, social, moral, organization and control.

The analyses showed a significant decrease in total antioxidant level in HCWFHP compared with the HC (U Mann Withney = 281.00, p=0.009, effect size= -0.78).

HC and HCWFHP did not differ in the GAF scale, nevertheless the scores of HCWFHP were significantly higher in cohesion and intellectual-cultural dimensions of the FES (p=0.007, p=0.025).

Adjusting by this two FES dimensions, antioxidant status remained significantly different between groups: OR= 10.86, p=0.009.

Although we cannot induce causative relations, we can state that family environment is not playing a role in inducing oxidative stress in these subjects. It could be hypothesized that families with affected relatives protect themselves with positive envionmental factors such as cohesion and intellectual-cultural activities.

This is a comprehensive, non-systematic review of the literature addressing the following issues:

1. a) differentiation normality/presence of the disorder;

2. b) clinical relevance of the age-of-onset of impairment criterion;

3. c) frontiers with Bipolar Disorders (BD);

4. d) guidelines for treatment when the disorder is associated with comorbidities.

Clinical tips are presented to make the diagnosis without significantly increasing the proportion of false positives, as well as to help in both the differential diagnosis with BD and the pharmacological management of the disorder associated to comorbidities.

The precise diagnosis, avoiding very flexible criteria, is crucial in a disorder with a dimensional construct in the population, as well as the adequate use of medication for a highly comorbid disorder.

The Child Behaviour Checklist (CBCL), Teacher Rating Form (TRF), Youth Self Report (YSR) by Achenbach, 1991 and the style of explaining events (measured by Seligman's Attributional Style Questionnaire) were administered to a cohort of ADHD outpatients boys (34) and randomly matched-paired community reference sample of primary school male pupils. The results were statistically proved.

Adolescence of boys with ADHD was overfilled in a characteristic way with pessimism more than in healthy boys. The boys had more externalized and internalized disorders, however, only the externalized disorders indicated direct correlation with pessimistic attribution. The intensification of internalized disorders didn’t change the coloring of adolescence neither among boys with ADHD nor among healthy boys.

Pessimistic way of interpreting the world that is distinctly present among boys with ADHD is closely connected with the intensification of behavior disorders.

This study aimed at assessing the putative association between the fingertip patterns of right and left digits II and intellectual functioning.

The study involves the evaluation of dermatoglyphic patterns on right and left digits II in 342 adolescents (144 talented ones, 102 normal individuals and 96 subjects with learning disabilities) from the Shahrekord city in Iran. Comparisons between the frequencies of fingerprint patterns of each digit were made on the basis of two groups at a time employing Chi-square test.

The most frequent dermatoglyphic pattern was whorl on both fingers in the 3 groups. An observation of right digit II revealed that the normal adolescents in comparison to the talented ones had a greater number of the whorl patterns (P=0.02), while the latter had more ulnar loops than the former (P=0.09). Group comprising those with learning disabilities had more ulnar loops than the group composed of the normal adolescents (P=0.09), and there was a predominance of radial loops among the talented subjects as opposed to those among the individuals with learning disabilities (P=0.002). There was no significant association in the relative frequencies of different finger patterns on left digit II between the groups (P>0.05).

Our results support an association between some dermatoglyphic patterns observed on right digit II with IQ level in adolescents. Further researches, needless to say, especially employing various quantitative dermatoglyphic indices and larger-sized samples are recommended.

Current study aimed to assess the possibility of prediction of continuous performance test in primary school children with attention deficit hyperactivity disorder, with parents and teacher reports of inattention, hyperactivity and oppositional behavior.

Fifteen school aged children with Attention Deficit Hyperactivity Disorder without co-morbid psychiatric disorders were selected from Roozbeh child and adolescent psychiatry clinic. Teachers and parent Conner's questionnaires, Continuous Performance Test and 4 class dictation scores were registered from each subject.

Commission errors were correlated with hyperactivity scale in the parent report (r=-0.50, p< 0.05), and with ADHD score (r=-0.49, p< 0.05). Omission error was correlated with inattention (r=0.66, p< 0.05) and ADHD score (r=0.51, p< 0.05) on teachers report. Reaction time was correlated with oppositional (r=0.51, p< 0.05) subscale in parents Conner's questionnaire. Dictation scores were correlated with inattention on parents report (r=-0.52, p< 0.05) and omission on Continuous Performance Test (r=-0.79, p< 0.05).

Current study reported a significant correlation between neuropsychological tests and questionnaires, in ADHD.

The aim of the current study was to assess the impact of computer games and computer-assisted type instruction on dictation scores of elementary school children with attention deficit - hyperactivity disorder (ADHD).

In this single-blind clinical trial, 37 elementary school children with ADHD, selected by convenience sampling and divided into group I (n=17) and group II (n=20), underwent eight one-hour sessions (3 sessions per week) of intervention by computer games versus computer-assisted type instruction, respectively. 12 school dictation scores were considered: 4 scores preintervention, 4 scores during interventions, and 4 scores post-intervention. Dictation test was taken during each session. Data was analyzed using repeated measure ANOVA.

Two groups were matched for age, gender, school grade, medication, IQ, parent's and teacher's Conners’ scale scores, having computer at home, history of working with computer, and mean dictation scores. There was no significant difference in dictation scores before and after interventions and also between the study groups. The improvement in school dictation scores had no significant correlation with age, gender, Ritalin use, owning a computer at home and past history of computer work, baseline dictation scores, Ritalin dose, educational status, IQ, and the total score of parent's and teacher's Conners’ rating scale.

Absence of significant improvement in dictation scores in study groups may be due to the confounding effect of other variables with known impact on dictation scores. Further studies in this field should also assess the change of attention and memory.