The aim of this study was to determine whether diabetic patients who were depressed present a decrease of brain serotonergic activity compared to diabetic patients without depression or patients with depression but without diabetes. Determination was made with plasma free fraction of l-tryptophan (FFT) and intensity-dependent auditory-evoked potentials (IDAEPs).

Thirty seven adolescents were studied (20 type 1 diabetic subjects: 9 with depression, 11 without depression), 9 controls and 8 subjects with only depression. FFT, glucose, glycated hemoglobin, free fatty acids, albumin and IDAEPs were determined.

All diabetic patients showed a significant decrease of FFT. The group diabetic subjects with depression presented a steeper slope of the amplitude-intensity function of N1/P2 component, suggesting a higher reactivity of the auditory cortex in comparison to diabetic subjects without depression, subjects with only depression, and controls. This was associated with lower plasma FFT. Diabetic subjects with depression had a deficiency of metabolic control due to poor treatment adherence.

These findings suggest an enhanced deterioration of brain serotonergic neurotransmission in diabetic subjects with depression with abnormal responses of the auditory cortex. The N1/P2 component of IDAEP is proposed as a noninvasive indicator of brain serotonergic tone that differentiates depressed from nondepressed diabetic patients.

Childhood or Early Onset Schizophrenia (EOS), defined as the onset of psychotic symptoms before the thirteenth birthday, represents a rare, clinically severe variant, associated with significant chronic functional impairment and poor response to antipsychotic treatment. Despite of that, in clinical practice, atypical agents have become the treatment of choice in patients with EOS.

To review the different pharmacological strategies, in which an atypical antipsychotic was used in the management of EOS in childhood and adolescence.

We conducted a literature search of articles related to the use of atypical antipsychotics in children and adolescents with EOS in the last 20 years from the Medline database.

Several atypical antipsychotics, such as Risperidone, Olanzapine, Quetiapine, Aripiprazol and Clozapine were consistently found to reduce the severity of psychotic symptoms in EOS when compared to placebo. Although Clozapine has demonstrated to be more efficacious than other atypical and typical antipsychotics, it remains the medication of last resort due to its profile of side effects. Finally, in general, children and adolescent have a higher risk of extrapyramidal symptoms, akathisia, prolactin elevation, sedation and metabolic effects of atypical antipsychotics than adults.

Antipsychotics are the mainstay of treatment of EOS. Randomized controlled trials suggest a trend to superior efficacy for atypical antipsychotics over classic antipsychotic. Children and adolescents trend to be more sensible to antipsychotic side effects. Clinicians should be aware of this problem and be careful when monitoring this type of treatment.

Disturbed eating behaviors are a significant health concern among child and adolescents with type 1 diabetes mellitus (DM1) and are generally related to poor glycemic control, ketoacidosis, hospitalization and microvascular complications. Rates of eating problems among youths with DM1 have been reported to be as high as 38%.

To review clinical characteristics, demographic profiles and risk factors for the development of eating disturbances among child and adolescents with DM1.

We performed a literature research of articles from 1980 until present, in which a Disturbed Eating Behavior appeared comorbid with DM1 in children and adolescents, using Medline database.

Almost all studies selected report a high prevalence of eating disturbances of child and adolescents with DM1 when compared with healthy pairs. This population trend to develop body image discontent and lower self-esteem. They are more likely to diet, skip meals, and omit insulin. All these practices have been associated with worsening diabetic medical complications and poorer psychological outcome.

Due to the high prevalence and severe medical and psychological complications associated with disturbed eating behaviors among pediatric population with DM1, clinicians and school professionals may benefit from specialized training to identify the range of unhealthy weight control behaviors used by youths with DM1. Preventive programs that address disturbed eating behaviors should be provided for adolescents with DM1 in order to reduce the psychological and medical impact of this comorbid situation.

Studies have shown that children with learning difficulties are likely to demonstrate a host of shared behavioral and emotional problems that affect their daily functioning.

The goal of this study was to examine profiles of behavioral and emotional problems in children at risk for Learning Disorders (LD) and Communication Disorders (COMM), without intellectual disabilities.

Data on the Child Behavior Checklist (CBCL) of 52 participants (4–12 years old) at-risk for LD and 52 age- and gender- matched participants at-risk for COMM were obtained from the archival records of a local outpatient child psychiatric clinic. For all CBCL scales, T scores ranging from 65 to 69 are in the borderline clinical range, whereas a T score of 70 and above are in the clinical range. T scores of below 65 are considered as non-clinical. For the purposes of this study, a T score of 65 and above for the CBCL syndromes indicated the problem to be of clinical concern.

A total of 51.9% of these children had at least one problem of clinical concern, with Attention Problems (LD: 36.5% vs. COMM: 17.3%), Social Problems (LD: 21.2% vs. COMM: 30.8%), and Withdrawn/Depressed (LD: 23.1% vs. COMM: 26.9%) syndromes being commonly reported. There were no significant differences between the 2 groups on the CBCL syndromes.

Findings from the study suggest that children with any form of learning difficulties demonstrate high prevalence of behavioral and emotional problems, suggesting possible comorbidities such as Attention Deficit Hyperactivity and Depression.

Pseudologia Fantastica (PF) is an understudied and poorly understood entity, first described by a German psychiatrist in the late 19th century. The terms mythomania and pathological lying are often used interchangeably.

In addition to reviewing the literature around PF and its place nowadays in the current diagnostic system, we report the case of an adolescent female who suffered from PF.

We describe and analyse a clinical case of PF and make a bibliographic review about this disorder.

Typically, PF has its onset during adolescence and the clinical picture is often very uniform. The central features include a marked tendency to lie that is both quantitatively and qualitatively quite distinct from “normal” lying. Instead of being a goal-directed lie, pseudology lacks an obvious motive and is often more associated with internal motives, which can constitute some kind of gratification on their own.

The only diagnosis available in our current diagnosis system that accounts for prominent purposeless deception is the Axis I Factious Disorder diagnosis. Despite this, some Personality Disorders should always be considered as possible comorbidity of PF.

While cases of PF are thought to be quite rare overall, they have been documented all over the world. There is the need for further case studies and reviews to be published on this issue in order to determine whether PF should be better understood on Axis I or Axis II of our diagnostic system. Greater awareness of its medical, social and legal consequences is mandatory.

Early diagnosing of autism is supposed to rely on behavioral patterns that cannot all be manifested in children before older age. It seems that all diagnostic criteria from DSM/IV and ICD/10 do not apply for children under two years of age and are relevant only for children above this age. The aim of our research has been to reveal the timing of occurrence of diagnostically relevant behaviors as noticed by parents of autistic children.

The sample consisted of 105 parents of autistic children. Questionnaire for appraising the behavioral abnormalities of autistic children provided information on the parents estimation at what age their children started to show these abnormalities.

Deficit in social interactions is first to be noticed by parents (at the child's age of 13–37 months). Problems in communication occur later, at age 18.8–49.5 months. Stereotypic behaviors and interests occur at age of 20.2–34.8 months, the most common being: “plays with toys in an unusual way” (90.6%), and “unusual moving of arms” (80%), observed at age of 2–3.

The most common parents concern are language difficulties, never mind findings that social deficits are observed first (13–37 months). Diagnostic criteria in psychiatric manuals such as ICD-10 or DSM-IV pay little attention to early manifestations of the disturbance. It seems that accurate diagnosis of autism only exceptionally can be made before age 3–4, mostly because diagnostically relevant behaviors do not occur before that age.

There is little study about attention deficit hyperactivity Symptoms in children with PDD In the present study we evaluated the co-occurrence rate of ADHD and its subtypes according to DSM-IV-TR in children with high functioning PDD.

Participants were recruited from the consecutive referrals to the child and adolescent psychiatric clinics in Ebne Sina and Sheikh Hospital, Mashhad, Iran. We selected 3–12 year old individuals who had PDD according to DSM IV-TR who had verbal or performance IQ of 70 or higher on WISC-III. The diagnosis was made by a certified child and adolescent psychiatrist. Subjects were divided into two age groups (children aged 3–7 and children aged 8–12). Forty children with the mentioned criteria were included in the sample.

Among 40 subjects 31 children 22 boys and 9 girls (77/5%) met the DSM- IV-TR diagnostic criteria for ADHD. Fifteen children with combined type (37/5%), 11 with predominantly inattentive type (27/5%) and 5 with predominantly hyperactive impulsive type (12/5%). The co occurrence rate of ADHD with PDD subtypes were 69/5 For Autistic Disorder and 51/5 For As /PPD NOS without a statistical significant difference (P = 0/078). The co occurrence rate of ADHD in 2 age groups were 36/3 (20 of 31) for the older group and 66/7 (11 of 31) for the younger group without a statistical Significant difference (P = 0/5). Discussion: The high co occurrence rate of ADHD in children with Autism spectrum disorder found in our study strongly indicates a clinical need to assess AD/HD symptoms in children with PDD.

Aim of the present study was to assess health-related quality of life (HR-QoL) by self and proxy-parent assessment in children and adolescents who survived a first stroke episode.

We investigated HR-QoL in 133 pediatric stroke survivors (71 preschool children (G1) aged 4 to < 8 years and 62 school children/adolescents (G2) aged 8 to 21 years) and in 169 healthy controls aged 4 – 16 years. HR-QoL was assessed with the generic KINDL-R questionnaire exploring overall well-being and 6 sub-dimensions (physical well-being, psychological well-being, self-esteem, family-related well-being, friend-related well-being, and school-related well-being. Proxy-parent reports explored overall well-being and sub-dimensions. Results were compared within groups between cases and controls. In pediatric stroke survivors the neurological long-term outcome was measured with the standardized Pediatric Stroke Outcome Measure.

65% of stroke survivors exhibited at least one motor-sensor/cognitive disability. G1 and G2 stroke survivors reported lower overall well-being compared with healthy controls. In G2 stroke survivors, friend-related well-being was significantly reduced compared with healthy controls, 85.0 vs. 73.0 points, p < 0.001. Parents/proxys of both G1 and G2 stroke survivors rated the overall well-being and all sub-dimensions (except family-related and school-related well-being and in G1 stroke survivors physical functioning) lower compared with parent/proxys of healthy children/adolescents.

Our results suggest that the KINDL-R questionnaire is a useful tool in the assessment of HR-QoL in pediatric stroke survivors. Compared with healthy controls, all pediatric/adolescent stroke survivors are strongly affected regarding their overall well-being and older children/adolescents regarding their well-being with peers.

Childhood depression is a cause of substantial morbidity and mortality in this population. Although antidepressants are used frequently for the treatment of this disorder, there has been recent controversy about their efficacy and safety in this population.

Providing updated information from the scientific point of view on some burning issues in relation to the prescription of antidepressants in childhood depression.

It has been made a review of the recent studies which have been published about the safety and efficacy of antidepressants, and the consequences of the warnings given by Regulatory Agencies on health care professionals to prescribe antidepressants for children.

Impact of Safety Warnings: there has been a decrease in prescribing antidepressants and an increased suicide in this population since the FDA and EMA warnings announced an increased risk of suicide with pediatric antidepressant agents versus placebo. This is not possible to extract it because of causal relations. Effectiveness: nine of the sixteen controlled trials published between 1990 and 2010 provide evidence of effectiveness versus placebo in the treatment of major depressive disorder (MDD) in pediatric population (three for fluoxetine, two for sertraline, one for citalopram, two for escitalopram, and one for venlafaxine).

The antidepressant studies in children and adolescents have significant and methodological limitations that prevent getting conclusive findings. It is required further studies to determine which subgroups of patients and what drugs there have a risk / benefit ratio favorable, because no treatment can lead to serious damage in depressed children and adolescents.

5% of adults with schizophrenia report onset of psychosis before the age of 15. Despite the lack of precise incidence and prevalence rates from childhood or adolescent population-based studies, it is generally agreed that the prevalence of psychotic disorders increases markedly during adolescence.

The aim of this presentation is to demonstrate a case of an adolescent with psychosis and mild mental retardation.

The material used comes from the archives of the Child/Adolescent Clinic of the CMHC.

A 12-year-old boy was referred to the Child/Adolescent Clinic. He presented unwelcome repeated actions, (repeated opening/closing his books, allocating/reallocating things, sitting/re-sitting on the chair). He complained about auditory hallucinations (children talking/laughing ‘in his head’). He also presented self-destructive behavior (‘when I am angry I bang my head against the wall’). He was irritable, aggressive towards other children, with impulsive behavior. He had troubles understanding Greek language since he was from Russian origin.

From his history, both his father and grandfather were referred to suffer from mental disorder.

He was administered WISC and Rorschach tests. His intelligence quotient score was below 70 and the Rorschach test confirmed paranoid schizophrenic symptoms. Hospitalization was suggested but immediately rejected by his mother.

Risperidone was initiated (1 mg/day-1,5 mg/day). Soon, the symptoms began to be restricted. He began to be more concentrated, functional and sociable. 2 years after the initiation of risperidone, the patient's situation is stable (0,5 mg/day), appearing better mood.

Monotherapy with risperidone seems to provide significant levels of symptomatic improvement in young psychotic patients.

Psychiatric disorders occur in a complex context of human relations in its social and psychological aspects. Family functioning is closely related to physical and psychological well-being of family members and its impairment affects the family as a whole.

To evaluate family functioning in two groups of adolescents (13–18 years): cases (with major depressive disorder) and controls (with no DSM-IV psychiatric disorders based on the Brazilian version of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime/K-SADS-PL).

Families of cases (N = 9) and controls (N = 9) were matched by adolescent's age, gender and education, number and age of siblings, parental marital status and occupational activity, and family income. An experienced systemic family therapist applied the Structured Family Interview to each family. Nine dimensions of family functioning were evaluated: communication, rules, roles, leadership, conflict, aggressiveness, affect, individuation and integration. Session transcripts were independently evaluated by two other systemic family therapists blind to the family case-control category.

Raters scored all interview items using a standardized coding system (overall agreement = 83.5%). Cases exhibited lower mean scores in seven family dimensions, specially affect (p = 0.0078). Differences were not found regarding rules and leadership.

Difficulty in expressing affect in parent-child relationships was the main characteristic of families with a depressive adolescent. Improvement of family functioning can contribute to minimize the negative influence of psychosocial and family factors on the reoccurrence, and severity of depressive episodes among depressed adolescents.

To find more effective combinations for resistant and refractory tic disorders and to evaluate scheduled escalation of three drugs including high dose Vitamin B6 in psychiatric patients.

Twenty three adult patients (20 male, 3 female) with resistant Tourette syndrome were enrolled to this trial. They showed non compliance to different previous regimens including classic antipsychotics and newer dopamine/serotonin receptor antagonists. Mean age was 27yrs, global social functioning was impaired in all and substantially in 50%. Major depression and anxiety were encountered in 78 and 69% respectively as studied by way of MCMI-III and Hamilton.

After six weeks, twenty patients improved substantially with 80–90% reduction of abnormal movements as judged by the physician in charge and first degree relatives. Depression and anxiety also improved by at least 60% and global functioning improved much as patients felt better in work, social activities, parties and relation to the opposite sex. Maximal tolerated dose of the three drugs were 12.5, 40 and 400 mg respectively. Three patients exhibited extra pyramidal signs that responded to addition of Biperiden and 10 showed some numbness and dysphoria some times during treatment for which the doses were reduced. Most patients could maintain good functioning at lower doses of 5–7.5, 20 and 240 mg or less respectively.

We conclude that this combination in addition to scheduled escalation is extremely effective with enough compliance. Scheduled escalation causes better patients commitment as the drug increments planned and a necessity of treatment and not merely due to refractory disease.

Autism is a behavioural phenotype of unknown aetiology characterized by social and communication deficits and the presence of restricted interests/repetitive behaviours. The prevalence of epilepsy is increased but variable in children with autism. Epidemiological data suggests that 10–30% of patients with autism have the diagnosis of epilepsy. All seizure types can be associated with autism. There are several different studied risk factors for epilepsy prevalence in patients with autism: age, gender, cognitive level, type of language disorder and co-morbid medical conditions. It is speculated by some authors the possibility of common pathophysiological mechanisms between some clinical and subclinical epilepsy and autism. The diagnosis of seizures in autistic children can be difficult since behavioural abnormalities seen in complex partial and absence seizures can be due to autism itself.

The authors intend to briefly review the association between autism and clinical epilepsy illustrated by 3 clinical vignettes of children followed in a Paediatric Liaison Unit.

Review of clinical files and relevant published literature.

There isn’t sufficient data helping clinicians to predict which children will develop epilepsy. The treatment is not substantially different from other cases of epilepsy, however, doesn’t seem to have a major impact on the autism symptomatology. Although there is controversy in the literature concerning the association between autism and epilepsy (“direct cause and effect” “association” or an “epiphenomenon”), the latter should be routinely screened in autism patients.

The present study investigated the relationship between mother's attitudes towards child rearing practices with child perception of those styles, locus of control and self – concept.

The sample consisted of 388 third grade males in the junior high school students and their literate were selected from five educational districts who completed the Parental Authority Questionnaire, the Parenting Style Survey, the Nowicki – Strickland Locus of Control Scale and Tennessee Self- concept Test. The data were analyzed using Pearson correlation formula and Anova.

The findings of the study are so follow: The relationship between mother's attitude toward child rearing practice and child's perception of those styles was not statistically significant. The relationship between mother's attitude toward child rearing practice, child locus of control and self-concept were not significant, but the relationship between child's perception of their mother's parenting style, child's locus of control and self-concept were statistically significant. The relationship between locus of control and self-concept was also statistically significant.

One of the only few options available for rehabilitation of orphans in eastern societies is orphanage rearing. A lot many factors, however, go into determining the level of cognitive, behavioral and emotional development of children in these institutions.

A study was conducted on four major orphanages located in Srinagar city, to assess the existing differences in available facilities and their impact on the psychological adjustment of these children.

The UCLA loneliness scale was used to assess levels of loneliness, an indicator of psychological distress, among the resident children.

High scores were associated with adverse living conditions, like poor residential setup, rigid timetables, poor recreation facilities, poor nutrition and lack of modern educational facilities.

These facts could prove seminal in planning for better rehabilitation modules for orphans, especially in the wake of their exponential increase in the chronic conflict and disaster affected regions.

ADHD is one of the most prevalent psychiatric disorders in children.

ADHD have co-morbidity with many other psychiatric disorders.

Aim of this study was Comparing of prevalence of three subtypes of ADHD with psychiatric co- morbidity in primary school students of Arak-Iran.

This study was a descriptive analytic, cross- sectional one, which carried on 2000 (960 girls and 1040 boys) primary school students in 1st state of Arak in academic year of 2009–2010, which screened by Intelligence Raiven scale and 48 Canner’s questionnaire (parents and teachers)and if there were existed of any subtypes of ADHD, we have done K-SADS-E questionnaire (Schedule for Affective disorder and Schizophrenia -epidemiological version)for them, data were analyzed by using descriptive- statistical methods and Logistic- regression for obtaining R. R.

2.3, 3.5 and 2.7 percent of children have one of the subtypes of ADHD. The findings showed that prevalence of hyperactivity and attention deficit subtypes decreased while combined type increased by increased age. The prevalence of two subtypes of hyperactivity and attention deficit in boys and girls were not significantly different but combined type was significantly different. Finally, there were differences between ADHD subtypes and co- morbidity of psychiatric disorders such as conduct, depressive, enuresis, schizophrenia, oppositional, obsessive- compulsive, mania and social phobia, but these differences were not significant between girls and boys.

Prevalence of subtypes of ADHD were different between age and gender but there were not significant differences between Co morbidity of ADHD subtypes and psychiatric disorders

ADHD is one of the most prevalent psychiatric disorders in children.

ADHD have co-morbidity with many other psychiatric disorders.

Aim of this study was Comparing of prevalence of three subtypes of ADHD with psychiatric Co- morbidity in primary school students of Arak-Iran.

This study was a descriptive analytic, cross- sectional one, which carried on 2000 (960 girls and 1040 boys)primary school students in 1st state of Arak in academic year of 2009–2010, which screened by Intelligence Raiven scale and 48 Canner’s questionnaire (parents and teachers)and if there were existed of any subtypes of ADHD, we have done K-SADS-E questionnaire(Schedule for Affective disorder and Schizophrenia -epidemiological version)for them, then data were analyzed by using descriptive- statistical methods and Logistic- regression for obtaining R. R.

2.3, 3.5 and 2.7 percent of children have one of the subtypes of ADHD. The findings showed that prevalence of hyperactivity and attention deficit subtypes decreased while combined type increased by increasing age. The prevalence of two subtypes of hyperactivity and attention deficit in boys and girls were not significantly different but combined type was significantly different. Finally, there were differences between ADHD subtypes and Co morbidity of psychiatric disorders such as conduct, depressive,enuresis, tic, schizophrenia, oppositional, obsessive- compulsive, manic and social phobia, but these differences were not significant between girls and boys.

Prevalence of subtypes of the ADHD were different between age and gender but there were not significant differences between Co morbidity of ADHD subtypes and psychiatric disorders.