To compare mental health at 5 years in children born extremely preterm and at term and assess associations between functional abilities and mental health within the preterm group.

In a national Norwegian cohort with gestational age (GA) 22–27 weeks or birthweight 500–999g mental health was assessed with The Strengths and Difficulties Questionnaire (SDQ), cognitive function with WPPSI-R, motor function with ABC movement test and severity of cerebral palsy (CP) with the Gross Motor Function Classification for CP (GMFCS).

Neurodevelopmental disabilities (NDD) were described as mild and moderate/severe. SDQ of the preterm children was compared with that of a non-selected reference group born at term. SDQ sub-scores ≥90th percentile were defined as a mental health problem and a total difficulty score ≥90th percentile (TDS90) as suggestive of psychiatric disorder.

Of 361 eligible preterm children parents completed SDQ for 255 (71 %). 28 (11 %) had TDS90 compared to 10 of 758 (1 %) of the reference group (OR: 8.4, 95% CI 4.0 to 17.0).

For the preterms the rate of TDS90 was higher for those with moderate/severe NDD (12/37 vs. 6/116, OR: 9. 3.0;26.0), but not for those with mild NDD (10/102 vs. 6/116) compared with those with no NDD. For preterms with no NDD TDS90 was more common than for the term reference group (6/116 vs. 10/758, OR:3.7, 1.3;10.0), and the most distinguishing features were emotional and peer problems.

Extreme prematurity is associated with increased risk of later mental health problems, particularly if they have other functional impairments.

Major depression and sleep disturbances are closely related and often occur concomitantly. Many of the observed changes of sleep characteristics in depression are also present in healthy aging, which led to the premise that sleep in depression resembles premature aging.

Here, we aimed at quantifying the homeostatic and circadian sleep-wake regulatory components in young women suffering from major depression disorder and healthy young and older control women during 40 hours of sustained wakefulness.

After an 8-h baseline night 9 depressed women, 8 healthy young and 8 healthy older women underwent a 40-hour sustained wakefulness protocol followed by a recovery night under constant routine conditions. Polysomnographic recordings were carried out continuously. Sleep parameters as well as the time course of EEG slow-wave activity (SWA) (EEG spectra range: 0.75-4.5 Hz), as a marker of homeostatic sleep pressure, was analyzed during the recovery night.

Young depressed women exhibited higher absolute mean SWA levels and a stronger response to sleep deprivation compared to healthy young and healthy older women, particularly in frontal brain regions. In contrast, healthy older women exhibited attenuated SWA values compared to the other two groups and an absence of the frontal predominance of mean SWA during the recovery night.

Our data clearly show that homeostatic sleep regulation as well as sleep architecture in young depressed women is not equal to premature aging. Moreover, our findings demonstrate that young depressed women live on an elevated level of homeostatic sleep pressure.

Body Image Distortion (BID) is a key symptom of Anorexia Nervosa (AN). Behavioural research consider such symptom a multidimensional construct. However the majority of the Neuroimaging Studies (NS) conceptualize body image as unidimensional.

To provide a review of the literature about the NS on BID in AN and to classify the NS according to a multidimensional model of the BID as composed by the three widely accepted components: perceptive, affective and cognitive.

We used the Pubmed and Medline databases to search for relevant articles. We used “body image” or “body image distortion”, “magnetic resonance” or “SPECT” or “PET” or “voxel based morphometry”, and “anorexia” as keywords. We classified the degree of the involvement of the three components of BID as primary, secondary and no involvement on the basis of the fMRI tasks used.

Using our three-component model, we found:

1. 1) A high consistency among the NS findings in testing the perceptive component: principal alterations involved the precuneus and the Inferior Parietal Lobe (IPL);

2. 2) A weak consistency among the NS findings in testing the affective component: principal alterations involved the insula, the prefrontal and the parietal cortex;

3. 3) A moderate consistency among the NS findings in testing the cognitive component: principal alterations involved the amygdala and the IPL.

The NS can be useful to better understand the construct of the BID, Our speculative multidimensional model could be used by the NS to define more consistent protocols and tasks to investigate the BID in eating disorders.

The heterogeneity in the manifestation of PSTD symptomatology has never been described in a developmental period spanning from middle childhood through adolescence. The examination of developmental influences on PTSD symptomatic expression is a high priority for DSM-V and could inform research on the etiology and treatment of PTSD.

To examine the symptom structure of PTSD across different age, gender, and exposure groups, and in association with impairment and other disorders.

To identify homogeneous latent classes of PTSD symptoms in children and adolescents.

Latent class analysis (LCA) was applied to 6,733 New York City students (4th–12th grades) exposed to 9/11-related potentially traumatic events. LCA was first applied to PTSD symptoms only, stratified by age, gender and empirically defined exposure groups, and then in combination with impairment indicators. The resultant classes were studied in association with other disorders.

LCA identified 4 classes that vary in severity and symptom configuration. Only the most severe profile, qualitatively characterized by the presence of traumatic memories in combination with avoidance and sleep-related problems, showed high levels of impairment and high rates of other disorders. Girls after puberty and subjects indirectly exposed to 9/11 are at increased risk of severe disturbance.

The 4-class model describes quantitative and qualitative differences in the structure of PTSD across age, gender and exposure. These findings support the inclusion of developmental considerations into DSM-V PTSD diagnostic criteria and suggest that also gender and the nature of traumatic exposure inflence PTSD phenomenology in children and adolescents.

Studies of PTSD among Malaysians are virtually unavailable. Three years after the 2004 tsunami, PTSD symptoms among Malays directly exposed to this disaster were examined.

To examine the potential predictive factors of PTSD symptoms.

To determine PTSD prevalence, severity, and number of lifetime traumas. To examine if sociodemographic characteristics can be significant predictive factors of PTSD severity.

Cross-sectional survey was conducted interviewing 250 Malays from the most severely affected villages. Measurements include socio-demographic characteristics and number of lifetime traumas. The Posttraumatic Stress Diagnostic Scale (PDS)(Foa, 1996)was also included to measure DSM-IV PTSD symptoms.

In total, 18.8% (47) of participants met DSM-IV PTSD criteria, with 14.8% having mild symptoms, 36.1% having moderate symptoms, 42.5% having moderate to severe symptoms, and 6.3% having severe symptoms. The highest reported symptom among all participants was criterion A: intense fear, helplessness and horror. Analysis of lifetime prevalence shows 4.4% never having traumatic experience, 48% having one exposure, 28.4% having two exposures, 12.8% having between 3–4 exposures, and 6.4% having more than 5 exposures to traumatic events in their lifetime. Ordinal logistic regression analysis was additionally conducted to determine the relationship between PTSD level of severity and its socio-demographic predictors.

The prevalence of PTSD remained high with many participants still exhibiting severe symptoms. Findings in this study highlight that an immediate community intervention program is urgently needed.

Decision-making impairment has been found associated with several neuropsychiatric disorders. This cognitive function has been found under influence of genetics factors, but very few are known on how development of decision-making process may be modulated by early environmental factors.

Childhood sexual abuse has also been linked with numerous psychiatric disorders mainly through persistent changes in corticotrophin-releasing factor neurotransmission and sustains alteration of the HPA axis.

We explored the link between decision-making abilities in adulthood and sexual childhood abuse. We hypotheses than childhood sexual abuse may be associated with a lower decision making abilities. We have also hypotheses than this association may be modulated by some genotype critical in modulation of stress response.

The Iowa Gambling Task was used to assess decision-making in 217 patients with a personal history of attempted suicide. The Childhood Trauma Questionnaire was used to examine traumatic childhood experiences. Patients were genotyped for 8 single-nucleotide polymorphisms on four genes related to stress: CRHR1, CRHR2, FKPB5 and AVP.

There was a trend of association between IGT total score and sexual abuse showing that sexually abused subjects had lower scores than non-sexually abused one. This association became significant in the last part of the game (61–80). There was a significant interaction between rs1396862, rs878886 and rs242948 within CRHR1 and childhood sexual abuse in IGT total scores.

Decision making abilities in adulthood may be influenced by the interaction between childhood sexual abuse and functional polymorphism in the CRHR1 gene.

A literature research was performed for acamprosate, bupropion, buprenorphine, clomethiazole, disulfiram, methadone, naltrexone, and varenicline. A rating scale including 22 items, divided in five categories (efficacy, toxicity, pharmacokinetics, patient characteristics and cost effectiveness) was established for evaluation and related to the amount of evidenced based literature. For comparison, three reference substances with established TDM were similarly assessed: clozapine, lithium, and nortriptyline.

The three reference substances, lithium, clozapine and nortriptyline, achieved scores of 12, 15 and 14 points, respectively. Methadone (17 points), bupropion (9 points), buprenorphine (11 points), disulfiram (10) and naltrexone (10 points in the indication opioid-dependency and 9 points in the indication alcohol dependency) achieved more than 30% of the reachable points, while acamprosate (7), clomethiazole (6), and varenicline (3) had fewer points especially in the main characteristics in favor of TDM.

These results suggest this rating scale is sensitive to the drug items pharmacokinetic, efficancy, toxicity and especially to patients characteristics scored by evidence based literature and is also sensitive to detect the appropriateness of TDM for drugs used in addiction treatment. The results will be discussed with respect to the new TDM - AGNP expert group recommendations of 2011.

Polycystic ovary syndrome (PCOS) is characterized by androgen excess, chronic oligoanovulation and polycystic ovaries on ultrasound. Its etiology remains largely unknown however several studies suggested that prenatal androgen exposure might contribute to development of PCOS. An association between androgen dysfunction and attention deficit hyperactivity sendrome (ADHD) is established. The aim of this study was to investigate the ADHD symptoms in women with PCOS.

Forty females who had a clinical diagnosis of PCOS based on Rotterdam diagnostic criteria were recruited for the study group. For comparison, regularly cycling healthy controls who agreed to participate in the study (n = 40) were recruited in control groups. A physical examination was performed by the same physician on all women in Gynecology Department. All participants were then invited to complete the Wender Utah Rating Scale (WURS - 25) and the Adult ADHD Self-Report Scale (ASRS-v1.1).

There were no significant differences in age, education, and BMI between groups. Total WURS and ASRS scores were statistically higher in females with PCOS. Hyperactivity subscore of ASRS and Irritability, School Problems and Behavioral Problems/Impulsivity subscores of WURS were significantly higher in females with PCOS than controls.

Our results showed that ADHD symptoms are higher in women with PCOS than healthy controls. These findings suggest that prenatal exposure to high levels of androgen influences some ADHD symptoms and that hormonal factors may be involved in ADHD.

Although clinicians are faced with the problem of somatisation throughout the lifespan, little research has concentrated on somatoform disorders and Medically Unexplained Symptoms (MUS) in older people.

1. 1. To estimate the prevalence of somatoform disorders and MUS in later life.

2. 2. To examine geriatric and psychiatric morbidity in older persons referred for medically unexplained symptoms.

First, a systematic literature search was performed on the prevalence of somatoform disorder and MUS. Subsequently, a consecutive case series of 37 patients referred for MUS to a multidisciplinary outpatient clinic at a secondary care mental health center in the Netherlands.

A total of 7 studies were found that specifically addressed prevalence rates for somatoform disorders among older persons. Younger (< 50 years) and middle aged (50–65 years) patients had similar, and older patients substantially lower prevalence rates of somatoform disorders. Prevalence rates for MUS showed wider ranges within each age strata due to use of different definitions and instruments.In our convenience sample of 37 elderly patients with MUS, 32 did have a somatoform disorder. These 32 patients had high levels of psychiatric comorbidity, i.e. depressive disorders (n = 18, 56%), anxiety disorders (n = 10, 31%), and substance use (n = 6, 19%).

Although somatoform disorders are common in later life, reported prevalence rates decline with age. This might be an artifact due to diagnostic difficulties due to increased rates of somatic comorbidity with increasing age. This diagnostic complexity and the high prevalence of psychiatric morbidity argues for a multidisciplinary approach in later life.

To study gender differences in mortality among patients with schizophrenia over a period of 27 years.

A longitudinal psychiatric admission register in Northern Norway linked to the National Norwegian Cause of Death Register.

1111 patients with schizophrenia admitted from 1980 – 2006.

Weconfirm the persisting mortality gap between patients with schizophrenia and the general population over a period of 27 years, with a tendency of increasing standardized mortality rates. Male and female schizophrenic patients had 3.5 (95% CI: 3.1 to 4.1) and 2.6 (95% CI: 2.1 to 3.2) times higher mortality, respectively (p = 0.01 for the difference between the genders). Age-adjusted mortality rates in female schizophrenic patients admitted for the first time after 1992 was 70% higher than for those admitted previously, and female patients admitted for the first time after 1992 had significantly higher SMRs (4.6, 95% CI: 2.9 to 7.2) than women who were admitted earlier (SMR = 2.4, 95% CI: 1.9 to 2.9) (p = 0.009). Thus, the absolute mortality also increased. The SMRs for women admitted after 1992 are higher than for men. Men who had always been admitted voluntarily had non-significantly lower mortality than women in the same situation, while for women there was a linear, statistically significant trend towards higher SMRs for women with less use of coercion.

There is a persisting mortality gap between patients with schizophrenia and the general population over a period of 27 years.

This study examines the clinical and familial correlates of bipolar disorder (BPD) when it occurs with and without autism spectrum disorders (ASD) comorbidity in a well characterized research referred population of youth with BPD. We hypothesized that in youth with BPD the clinical and familial correlates of BPD will be comparable irrespective of the comorbidity with ASD.

Clinical correlates and familial risk was assessed using data from a large family study of youth with bipolar I disorder (BPD-I; probands N = 157; relatives N = 487). Findings in BPD-I youth were compared with those of youth with ADHD without BPD-I (probands N = 162; relatives N = 511) and age and sex matched controls without BPD-I or ADHD (probands N = 136; relatives N = 411). All subjects were comprehensively assessed using structured diagnostic interviews and a wide range of non overlapping measures assessing multiple dimensions of functioning.

Thirty percent (47/155) of the BPD-I probands met criteria for ASD. The age at onset of BPD was significantly earlier in the presence of ASD comorbidity (4.7±2.9 vs. 6.3±3.7 years; p = 0.01). The phenotypic and familial correlates of BPD were similar in youth with and without ASD comorbidity.

A clinically significant minority of youth with BPD-I suffers from comorbid ASD. Phenotypic and familial correlates of BPD were typical of the disorder in the presence of ASD comorbidity. BPD-I comorbidity with ASD represents a very severe psychopathologic state in youth.

The physiological changes in peripartum may affect symptoms of depression and impact diagnostic judgments in the peripartum. The sharp fall in cortisol and CRH after childbirth suggests that the HPA axis characteristics of postpartum depression are different from melancholic depression, the latter being characterized by high cortisol levels.

A modified version of the SCID was used to assess symptoms of depression and melancholic and atypical subtypes in pregnancy and the postpartum period. Secondly, we investigated the diurnal output of saliva cortisol in women with and without symptoms of depression at 7.5 weeks postpartum, and non perinatal controls.

The antenatal symptom pattern (n = 892 women) was different from the postnatal. The sensitivity of the symptoms ranged from 0.7% to 51.6%, and specificity from 61.3% to 99.1%. The best discriminating symptoms were motor retardation/agitation and concentration antenatally, and motor retardation/agitation, concentration and fatigue postnatally. In a subgroup of this sample (n = 449) 17% of the cohort met SCID criteria for a depression at least once in pregnancy: melancholic depression (2.4%), atypical depression (4.4%), and non specified depression (10.2%). Mood reactivity, distinct quality of mood and sleep pattern discriminated between the two groups. There was no increase in cortisol over the day, however a significant difference in diurnal pattern of cortisol between postnatally depressed and non-depressed women.

These findings suggest that perinatal depression has different associated symptoms from depression at other times. The cortisol pattern in the postnatally depressed women is similar to that reported for PTSD and atypical depression.

Craving in negative emotional situations (negative craving) is commonly associated with relapse and heavy alcohol use. Elevated dynorphin levels were associated with negative emotions, while variations in the OPRK1 and PDYN genes encoding OPRK1 receptor and dynorphins were associated with alcohol dependence.

To investigate potential overlap in the genetic factors underlying, negative craving and alcohol dependence.

Examine the association of the negative craving and genetic variation in the OPRK1 and PDYN genes.

13 PDYN and 10 OPRK1 Single Nucleotide Polymorphisms (SNPs), including those previously reported to be associated with alcohol dependence were genotyped in 196 alcohol dependent subjects. The raw scores of the negative subscale of Inventory of Drug Taking Situations (IDTS) were utilized as a quantitative measure of negative craving. Logistic regression models were used to test for associations after controlling for age and gender.

Gene-level haplotype testing demonstrated significant association of negative craving with variation in PDYN (p < 0.05) but not OPRK1 gene. The rs2281285 - rs199794 haplotype showed significant association (p = 0.0236) with negative craving, while rs2235749 - rs10485703 haplotype showed marginally significant association (p = 0.055). This replicates previous findings of association between these haplotypes and alcohol dependence. Negative craving was also associated with PDYN rs2281285 variant (p = 0.012) with estimated effect size of 6.95 (SE = 2.75). This new association finding was not significant after correction for multiple testing (p = 0.18).

Our findings support association of PDYN sequence variation with negative craving in alcohol dependent subjects. Future studies should investigate functional mechanisms of this association.

ADHD is one of the most frequent developmental disorders in childhood. Adults also suffer from symptoms of attention-deficit/hyperactivity disorder. Prevalence estimates of ADHD in adult community samples (5%) are based on American and West-European studies. Most of research though is concentrated on early ADHD symptoms. There are no sufficient data on clinical manifestation and scale of this problem in Poland.

To assess prevalence (life and 12-month), access to psychiatric care and other clinical and sociodemographic aspects of ADHD in adult population in Poland (both contemporary and retrospective). The first Polish nationwide survey, Epidemiology of Mental Disorders and Access to Care (EZOP, Poland)” was included in the WHO's WMH.

The aim of this paper is to present collected data on ADHD in community sample.

Composite International Diagnostic Interview (cidi capi v.3.1) was administered in random sample of Poles aged 18–65 (n = 10000). Data was collected from November 2010 to March 2011 by trained Millward Brown SMG/KRC interviewers.

Response rate is 50.4%. Prevalence estimated on the basis of retrospective reports in Screening Section is 2.2% for attention-deficit symptoms (2.5% for men and 1.9% for women) and 2.8% for hyperactivity symptoms (respectively 3.2% and 2.8%). Further analysis are in progress and detailed results will be known till December 2011.

Presented study will allow to introduce data on relation between intensity of early ADHD symptoms and it's later clinical manifestation. The identification of demographic factors influencing the course of the disorder and patterns of treatment will be possible.

Dysfunctional neuroplasticity contributes to the pathogenesis of Alzheimer's disease, schizophrenia and depression. However, the underlying molecular mechanisms are not fully understood. Previous studies report neuromodulatory properties of the serotonin-1A (5-HT1A) receptor, which is also altered in these disorders. This suggests 5-HT1A mediated neuroplasticity as potential pathogenic factor.

The aim of this study was to demonstrate 5-HT1A mediated neuroplasticity in vivo.

We used positron emission tomography to quantify 5-HT1A receptor binding (BPND) together with structural magnetic resonance imaging in 35 healthy subjects (mean 26.6 ±6.8 years; 17 women). Voxel-wise regression analysis was performed with gray matter volume (GMV) as dependent and 5-HT1A BPND as independent variable. Additionally, regression analysis was calculated with whole brain GMV as dependent variable and 5-HT1A BPND of the dorsal raphe nucleus (DRN) as independent variable. Control variables were age, sex and total GMV, respectively.

5-HT1A receptor density predicted GMV of the hippocampus, medial temporal cortex, inferior temporal cortex, medial occipital cortex and the pericalcarine region in each hemisphere (p < 0.05 false discovery rate corrected, R2: 0.308–0.503). These associations were independent from local numbers of neurons. Furthermore, 5−HT1A receptor levels in the DRN predicted GMV of the anterior cingulate cortex (p = 0.001, R2=0.656, uncorrected).

These results demonstrate 5-HT1A receptor mediated morphogenetic mechanisms in healthy human subjects' brains, which occur not only locally but also at the macro-network level. Finally, morphogenetic signaling investigated with multimodal neuroimaging could contribute to better understanding and diagnostic identification of gray matter loss in neuropsychiatric disorders.

Frowning expresses negative emotions like anger, fear, and sadness. According to the facial feedback hypothesis, suppression of frowning will also diminish the corresponding negative emotions. Hence, mood improvement has been observed in patients who underwent treatment of glabellar frown lines with botulinum neurotoxin. This observation suggests the possibility that the intervention may be employed for the management of psychiatric disorders associated with negative emotions. Preliminary data from an open case series indicate that the intervention might improve the symptoms of depression.

To test whether an onabotulinumtoxinA injection into the glabellar region is benefical as an adjunctive treatment of major depression within a clinical trial.

We used a randomized, double-blinded, placebo-controlled study design (n = 30; ClinicalTrials.gov, number, NCT00934687).

We show that a single onabotulinumtoxinA treatment shortly leads to a strong and sustained improvement in partly chronic major depression that did not respond sufficiently to previous treatment. As for the primary end-point, Hamilton Depression Rating Scale (HAM-D17) six weeks after treatment compared to baseline, scores of onabotulinumtoxinA recipients showed 37.9% (8.34 points) more improvement than those of placebo-treated participants (F = 12.30, p = 0.002, η2 = 0.31, d = 1.28).

Our findings support the concept that the facial musculature not only expresses, but also regulates, mood states. As it stands, treatment of glabellar frown lines with botulinum neurotoxin can be considered for depressed patients with the objective of inducing mood-lifting effects.

A substantial proportion of patients with schizophrenia has co-morbid psychoactive substance abuse, which can influence their cognitive functions. The aim of the study is an assessment of cognitive functioning in abstinent schizophrenia patients with various previous pattern of psychoactive substance abuse.

The study was performed on a group of 80 schizophrenia patients (74 male, 6 female), aged 18–40 (mean 25) years, of whom in 40, a co-morbid psychoactive substance abuse was diagnosed. The latter group was subdivided, based on their predominant type of substance (opioid, amphetamine, or cannabis). All patients were examined during clinical improvement, and patients with comorbid substance abuse, after a six-week period of detoxification in a therapeutic community. A battery of neuropsychiatric tests was used, which included subtests of Trail Making Test, Stroop test and Verbal Fluency Test.

No significant differences in clinical factors and cognitive functioning between two examined groups were found. However, when the patients were divided according to their pattern of substance addiction, it turned out that the group of patients with cannabis, despite the shortest duration of disease and that of addiction, and highest percentage of using atypical antipsychotics, performed worse on all cognitive tests, significantly so on Stroop's and Fluency tests, compared to the groups with predominant opioid or amphetamine abuse.

Abstinent schizophrenic patients who previously abused cannabis have worse cognitive functioning compared to other schizophrenic patients with comorbid substance abuse. A possible role of previous cannabis use or cannabis withdrawal in this phenomenon is discussed.