Social withdrawal is a potential signals of distress and mental illness such as psychosis, mood disorders, anxiety (Kirkcaldy & Siefen, 2012). The term 'hikikomori” defines a particular form of social withdrawal recognized in Japan at the end of the last century (Saito, 1998). At the moment in all the west world (United States, France, United Kingdom, Spain, Italy) there is an increasing frequency of adolescents and young people who show symptoms of hikikomori like a life style centered on the own home and refusal of the school.

Requests to take care of social withdrawal teenagers (hikikomori) are increasing. This work describes two cases in treatment of early adolescents.

Authors analyse the terapeutic steps of the clinical treatment of two very young teenegers arrived to the Public Health Service because their extreme social withdrawal. The work focusses the attention on the relationship with the patients, the families and the social context.

The two cases show that the treatment of hikikomori sindrome is complex. A single type of approach (e.g. individual psychoterapy or family therapy) is not sufficient. Combining different patterns it is possible to create a network of treatments able to promote the resources of subject and of his/her familiar and social context.

Results underline the necessity of increasing the clinical knowledges on the social withdrawal sindrome and creating new protocols useful for the treatment.

The Japanese Saito coined the term “hikikomori” to define an extreme form of social withdrawal, particularly present in Japan (1998). In the West there is an increasing frequency of adolescents hikikomori.

The UFSMIA Arezzo has received a number of requests to take care of adolescents bearing strong similarities to hikikomori teenagers or “on the way of the social withdrawal”. These admissions have led to an epidemiological study in order to quantify these behaviors among very young teenagers in a Italian town.

The research used a questionnaire addressed to the coordinator teachers of the middle schools of Arezzo (2694 students). The questionnaire collected information on the single student absent from school for more than 40 days asking reasons for the absence.

Absents from school for more than 40 days not for an illness were 27. The average age was 14,5 years, 59,3% males, 40,7% females. The 66,6% of the students repeated one or more times a year of school. The teachers do not know the reasons for the absences for 29,6% of students but for 51,9% they indicate psychological problems as the main reason of the absences. The 40,7% of students showed difficulty waking up, leaving home, coming to school, difficulty in relating to others and low self-esteem. These signs could bring to identify hikikomori subjects.

The research shows that the school is not able to recognize a student hikikomori, but it can provide valuable informations to identify a teenager with social withdrawal.

The Dynamic-Maturational Model (DMM) (Crittenden, 2008) considers attachment as a selection process of external informations, especially from care givers, made by CNS. In the DMM, the variability of information processing is caused by the integration of cognitive and affective informations. This kind of integration leads to secure attachment; instead, a prevailing mode will lead to an avoidant attachment (“cognitive”) or ambivalent (“affective”), with potential clinical implications. CARE-Index analyses the interactions between children and adults before the structuring of attachment and the “dyadic sensitivity” (a dyadic construct composed of any behaviour pattern which pleases the child, increases his/her well-being and focus and reduces his/her discomfort and disengagement).

The aim of this study is to investigate the extent to which stressor life events of care givers can influence/change dyadic sensitivity and thus the structure of children attachment.

We will use a modified version of Social Readjustment Rating Scale (Holmes, 1967), which will be administered to 40 parents whose relationship with the child was assessed by CARE-Index. The changes made to the scale classify life events by type (Family, Personal, School) and age group in which the event occurred.

We expect to find a correlation between stressful life events and specific patterns of attachment.

If this kind of correlation is detected, risk situations can be recognised and treated at an early stage.

In child and adolescent psychiatry antipsychotics are used in large and increasing quantities for a wide range of disorders and psychopathology, including psychotic, mood and disruptive behaviour disorders.

The European Medicines Agency (EMA) has approved Paliperidone for the treatment of schizophrenia in adolescents from 15 years old.

To present our clinical experience with Paliperidone in the treatment of psychotic symptoms and other psychopathological disorders in adolescents.

To describe with data from clinical practice the potential usefulness of Paliperidone in adolescent disorders beyond Schizophrenia.

Five patients from an outpatient child and adolescent mental health service, on treatment with Paliperidone during 2014, were selected as clinical illustration. Case reports describe personal and family history, clinical presentation, management and treatment, course and outcome, with especial focus in treatment tolerance.

We present 3 males and 2 females, age between 15 and 17 years. Diagnoses were: autism, borderline personality disorder, schizotypal personality disorder, personality disorder not otherwise specified and schizophrenia. Prescribed dose was 3-9 mg/day, and actual mean time of treatment duration is 5,8 months. In 4 cases Paliperidone was initiated as a change from other antipsychotic. There were no adverse effects that required discontinuation and in all cases symptoms improved.

Our clinical experience evidences that Paliperidone is a valuable therapeutic option on behalf of its effectiveness and tolerance.

In our practice the symptoms that respond better to Paliperidone are: hallucinations, reference ideation, irritability, aggression, disorganized behaviour and stereotypies.

Lurasidone has demonstrated efficacy for schizophrenia and bipolar depression in adults.

To identify a tolerated dose range of lurasidone for pediatric studies.

To characterize PK and tolerability profiles of lurasidone in a pediatric population.

Patients aged 6 to 17 years diagnosed with ADHD and conduct disorder/disruptive behavior disorder, bipolar disorder, schizophrenia, Tourette syndrome, or autism spectrum disorder were assigned to 1 of 5 open-label lurasidone dosing cohorts (20, 40, 80, 120, or 160 mg/d). If a dose level was tolerated, the next dose cohort was initiated. In the single-dose phase, blood was collected predose and for 48 hours postdose. In the multiple-dose phase, patients received once-daily lurasidone for 7 to 9 days; blood was collected before and for 24 hours after the final dose. Lurasidone PK parameters, including maximum serum concentration and area under the concentration-time curve, were calculated.

In 105 patients, the observed lurasidone PK were consistent with a PK model of adult exposure at steady state. The most common AEs were somnolence (42%), sedation (18%), and nausea (17%); incidence of AEs was generally dose-dependent across the 20-160 mg/d dose range. All 6- to 9-year-old patients experienced somnolence at 120 mg/d. Two serious AEs (parkinsonism, dystonia) were reported, both at 80 mg/d.

The PK and AE profiles of lurasidone in this heterogeneous pediatric population were consistent with data observed in adult populations. Based on this study, doses of lurasidone 20-80 mg/d are selected for evaluation in pediatric clinical trials.

Sunovion Pharmaceuticals Inc.

There is a great concern amongst the CAP Trainees and the Early Career CAP Specialists regarding a patient's transition from the Child & Adolescent Psychiatrist to the Adult Psychiatrist after the 18th year of age.

The main objective was to explore the views of the European CAP Trainees and Early Career CAP Specialists in order to create a framework and then present it to the UEMS CAP Section for further discussion.

The central aim is to educate future specialists to handle the transition in an optimal manner. This will guarantee the patient's good care according to a balanced opinion of the patient, family and the clinicians.

In a multicenter cross-sectional study, data was collected from 33 countries, using an on-line survey method.

The results that will be presented involve the views of the CAP trainees and Early Career CAP Specialists regarding the variable current conditions in every country and the general viewpoints of the participants. There were various issues that have been raised such as the timing of the transition, the professional respect across the boundary, the ethical preparation of the patient for the transition and the continuity of care.

The views of the European CAP Trainees and the Early Career CAP Specialists regarding transition from CAP to Adult Psychiatrist Services will be essential for drafting a framework within the UEMS CAP Section in order to promote the best quality of care for the patients.

Children and adolescents with autism spectrumdisorder (ASD) have deficits in social interaction and communication, and restricted, repetitive patterns of behavior, interests, or activities. Because of these features they may seem odd, being marginalized and victimized.

The aimof this paper is to present the case of a childwith a diagnosis of ASDvictim of bullying. Methods: We followed in the outpatient child andadolescent psychiatry department of the Hospital Magalhães Lemos, a child of 7 years referencedby his family physician for bullying. We did a brief theoreticalreview.

The child of sevenyears, was characterized by a peculiar socialbehavior, with little ocular contact, little social-emotional reciprocity, telegraphic answersto most questions and, extensive monologuesabout his topic of primary interest, video games. Thechild says he has no friendsat school and prefers play alone. Accordingto the mother, he was never invitedto a birthday party, and theother kids call him “J thesmelly”, they don´t want to play withhim and they taunt him. Bullying appearsto be only the façade of more global social difficulties related to ASD.

According to literature children with ASP are moreoften victims of bullying. In fact they exhibit significant riskfactors related to their difficulties insocialization, and theory of mind. Moreover theabsence of protective factors, such as having friends and supportivepeers also contribute to victimization. Childrenwith ASP also appear as perpetratorsespecially, those with co-morbid hyperactivity and aggressive behaviors.

One of the most serious forms of abuse is sexual abuse (SA), especially when the victims are children. Questions still remain: what actual long-term consequences of child sexual abuse effect the mental health of children.

Examined-68 people (22 boys, 46 girls) having detected by physicians fact of SA, and recognized as victims in legal status. The group was split by age (3-6 years), and by the type of SA: family abuse and extrafamilial abuse. Group of 38 children – catamnesis study over a 5-year period.

To reveal long-term mental health consequences of child SA taking into accountd the type (family and extrafamilial).

All the children were examined repeatedly during the follow-up period, clinically and paraclinically by psychiatrist (clinical observation, dialog with the child and parents), by neurologist and clinical psychologist (projective techniques and standardized personality questionnaires).

Psychopathologic consequences of SA are divided into acute (reaction to stress), subacute (6 months after the trauma) and remote (observation during 5 years). In acute and subacute period the disorders are qualified as acute reaction to stress and PTSD.

In long-term period clinical characteristics were defined as conduct disorder (personality development disorder), primarily of mixed type. In the structure of remote psychopathologic presentations, especially as the consequences of family SA are – hyperemotivity, neuroticism (trichologia, onychophagia, enuresis and encopresis, asthenic syndrome and subdepressive syndrome, obsessive fears, dysmorphophobia and others).

In prepubertal period-runaways, promiscuity, early alcoholization, taking drugs, behavior as a victim, sex-role identification disorder.

The prevalence of substance use is among adolescents is on rise. In India, inhalant is one of the common drugs of use and acts as a gateway for illicit substance use. The mainstay of treatment for inhalant use among this population is psychosocial interventions. In India, we largely rely on western models to guide intervention programs, however, there is a need to develop and test the psychosocial interventions which are culturally relevant and effective.

The present study aims to highlight the culture specific psychopathological factors associated with inhalant use among adolescents. The paper aims at studying the effectiveness of a psychosocial intervention in reducing the frequency and quantity of inhalant use among adolescent clinic population.

Four adolescents reporting to the Adolescent Clinic at the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi were recruited for the study. A single-case design was adopted. The pre-, and post- intervention assessment were carried out.

There was a significant reduction in frequency and quantity of inhalant use in the cases. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research. The psychpathological factors and challenges to intervention are discussed.

Autism spectrum disorders (ASD) is characterized by deficits in three functional domains: language and communication, social reciprocity, and the presence of restricted interests/repetitive behaviours. There are also deficits in social cognition. When having a face-to-face conversation, a listener not only hears what a speaker is saying, but also sees the articulatory gestures. Speech signals needs then a multisensory processing. Impairments in multisensory perceptual binding given that hallmark features of the disorder include difficulties in speech, communication, and social interactions.

We suggest that atypical multisensory processing in ASD may have an impact on speech perception and social processing.

Therefore we could observe differences in a delayed free recall, between an unisensorial and multisensoral stimulus.

Our pilot study measures free recall scores in 3 lists of words presentation after 30 minutes. In the first condition (CI) words are only listened to, in the second (CII) associated with the picture of a man's face and in the third (CIII) associated with the man speaking in video. Participants were 7- to 13-year-olds typically developing children (TD) (N = 19) and ASD children (N = 19).

Our findings show that words recall is higher in CIII for TD children whereas ASD children recall more CI words.

Findings shows that multimodal information brings improvement in long term recall for TD children. In ASD group a better recall is observed with unimodale information. We suggest that multisensory integration deficits in ASD can impact learning of socials information and then social cognition.

With one in ten young people being affected by ill mental health and stigma regularly cited as a factor affecting access to early intervention services, focussing resources on school based stigma reduction strategies seems prudent. ‘Headucate’, a student society, designed a 50 minute workshop which aims to increase mental health literacy and decrease stigma.

Repeated, cross sectional surveys were carried out at three time points; 1) immediately before (n=77), 2) Immediately after (n=81) and 3) three months post workshop (n=73). The surveys were paper based versions of the Reported Intended Behaviours Score (RIBS) and Mental Health Knowledge Scale (MAKS) utilising a social distance scale.

Four year 10 classed (pupils aged 14-15) were recruited. Post hoc t-tests were carried out when one-way ANOVAS were significant.

Disorder knowledge (from MAKS) and intended contact (from RIBS) significantly increased between time points one and two (p<0.01 and <0.004 respectively) but then decreased.

Analysis of the question pertaining to knowing where to access help showed a statistically significant increase (p<0.001) between time points one and two and then a decrease at time three, albeit to a higher value than at time point one (3.45 compared to 3.13, P=0.088).

Headucate workshops offer a low resource option which is well accepted by students. Like other school based stigma reduction strategies, a dramatic increase was seen between immediately before and after indicating that the workshop resonates with the pupils, but there was little sustained change in attitudes.

Although the terminology of Asperger’s Syndrome has been subsumed within high functioning autism in the last edition of the DSM, the absence of a clear consensus concerning the relevance of the distinction between HFA and AS persists among researchers and clinicians. Besides, the frequent convergence of clinical signs between AS and intellectual high potential encourages to investigate the existence of parallels and their nature. The current situation contributes to maintain confusion at the diagnostically level and by extension to hamper the care system.

Explore and better define three atypical neurocognitive profiles: HFA, AS and intellectual high potential, in order to refine the criteria for a more accurate identification.

Data will be collected from 5 groups of children: 'typical HFA”, 'typical AS”, 'typical gifted children”, 'atypical” (ambiguous diagnosis) and control. These groups will be compared to each other at multiple level: cognition, language, social cognition, psychomotor assessment. Evaluations will be completed by questionnaires and by a clinical interview process (anamnestic data).

'Typical” gifted children, even when they exhibit social issues, don’t have constitutional deficit in the area of social cognition and perform normally or above average in such tasks. Children with heterogeneous psychometric profiles show neuropsychological and/or psychopathological disorders. AS group performs better in language dimension and verbal comprehension (vocabulary, verbal abstraction) than HFA group. In addition, AS children might present motor coordination difficulties and undetermined lateralization more frequently than HFA children.

Despite these differences, these children exhibit atypical developmental trajectories characterized by heterochrony.

This study covers 368 adolescents: male 170, female 198, aged 12-17, with equal urban and rural distribution. The research tool used was Q 2004 (K.B. Kelly 2000). EPI info was used for statistical analyses. Research is epidemiological and was done in urban and rural areas of Sarajevo Canton

Out of total number of individuals involved in the study 25.8% was found to be cigarette smokers, 39.4% consumed alcohol, and 2.2% consumed marijuana. Alcohol abuse is more present in urban rather than in rural types of communities. (56.6%; 43.4%; p=0, 0001).

Of all age groups examined, alcohol abuse is most frequent in males (53.1%; 46.9%)

and high school age group, 69.0%; 31.0%). Passive parental support to alcohol consumers is surprisingly high, > 50%.

It is determined that parents (particularly father) use tobacco and alcohol, and support passively similar behavior their children.

Home Treatment is a relatively new concept in adolescentpsychiatry. A shortage of beds in the UK, as well as the high cost of admission, has driven service innovation. Bedfordshire, which has no local inpatient unit, has developed a county wide Home Treatment Team to keep young people at home asmuch as possible. Engagement with service users is key to the aims of theservice. Understanding the young person in their context is vital in thisprocess.

To show that Home Treatment is clinically and cost effective. To show how engagement is achieved.

All young people presenting as high risk, or in crisis atA&E or other venues are seen by the team. An audit of estimated reductionof hospital admissions was done, combined with a naturalistic study of youngpeople’s and their families’ appreciation and understanding of the process. Anoutline of the teams understanding of engagement is given.

In-patient admissions were reduced, at considerable costsaving. Young people and their families found the service helpful, and werevery happy with the level of support.

Home Treatment is a safe and effective way of dealing withyoung people otherwise likely to need inpatient care. Engagement must includefamily or other carers, and close liaison with education and social services isessential.