Beckwith-Wiedemann syndrome (BWS) is a rare and complex congenital disorder characterized by a spectrum of symptoms and somatic findings. The prevalence of classic BWS is 1:26,000 births in Europe, and is equal in both sexes. The causes of the disorder are complex and are related to alterations in the expression of one or more genes in the region of chromosome 11. The heterogeneity of the clinical picture results in a spectrum of clinical features, the most common of which include: excessive growth of one side or certain parts of the body, macroglossia, abdominal wall deficits such as umbilical hernia, hypoglycemia, enlarged abdominal organs and an increased risk of developing certain types of tumors in adulthood.

The aim of this article is to highlight the importance of an early multidisciplinary approach in the management of children and adolescents with BWS.

Using clinical practice and a review of the existing limited literature, we examined the complexity of the disease and the importance of psychiatric, psychotherapeutic, and psychological interventions in the treatment of children and adolescents with rare diseases such as BWS.

According to our clinical practice, a number of uncertain physical symptoms and possible complications may in some children with BWS lead to psychomotor retardation and lack of self-confidence due to the often impaired physical appearance. Affected children and adolescents are more likely to be exposed to abuse at school, show more behavioral and learning difficulties, difficulties in social adjustment, and resultant emotional difficulties. After initial genetic and pediatric treatment and subsequent regular monitoring, it is necessary to pay additional attention to the development of psychological sequelae in order to involve them and their families in psychotherapeutic treatment, and intervene in a timely manner so that they can achieve or maintain psychological stability and functionality. Many adolescent patients with BWS do not have significant somatic difficulties that would require pediatric intervention, but often present with symptoms of mental illness.

Psychological stress in children and adolescents suffering from rare somatic diseases represents a negative experience of an emotional and social nature, which affects the course of the disease and interferes with the treatment. Due to a number of possible physical manifestations and outcomes of such diseases, extensive psychological support and care by child and adolescent psychiatrists and the entire medical team is required. A multidisciplinary approach is crucial in the treatment of these patients and results in improved functionality and quality of life.

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Emotion dysregulation (ED) is transdiagnostic domain that plays a pivotal role in the emergence and persistence of numerous mental disorders. Examining the extent of ED within non-clinical populations may shed light on whether ED is indeed linked to symptoms as observed in clinical settings. This investigation constitutes a crucial milestone toward the development of preventive strategies.

To investigate the correlations between ED, psychopathological symptoms, risky behaviors, and environmental factors in adolescent students.

A total of N=610 students (16 years; 72% females) completed self-report standardized questionnaires measuring depression, anxiety, impulsivity, childhood trauma, relations with classmates, and family functioning. Lifetime risky-behaviours were recorded using an ad-hoc checklist, and ED through Difficulties in Emotion Regulation Scale (DERS). The sample was then divided into subgroups based on percentiles of DERS Total scores: N=210 low ED, N=187 moderate, N=214 high.

Participants exhibiting high ED displayed higher level of depression, anxiety and impulsivity (Table 1). There was an observable trend linking higher levels of ED with a greater proportion of youths reporting risky behaviors (Table 2). The high ED group reported an increased frequency of childhood traumatic experiences, less favorable relationships with family members and classmates (Table 3).Table 1.

Clinical symptoms by level of ED in students (N=610)

Findings provide robust support for the association between ED and compromised personal functioning, even within a non-clinical sample. The trend observed in the relationship between ED, clinical symptoms and risky behaviors is consistent across all variables. Overall, these results contribute to the growing body of evidence advocating for preventive interventions aimed at addressing ED in adolescents.

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Children with non-syndromic orofacial clefts are at higher risk for developmental difficulties. Speech and language as commonly affected developmental domains in these children.

The aim of the current study was to explore the effects of early interventions for speech and language on later cognitive outcomes in this patient population.

A combined retrospective/prospective-comparative study was carried out at the Department of Pediatrics of the University of Pécs in Hungary. The participants were children between 6 and 16 years of age. The study consisted of a self-designed demographic questionnaire and an IQ test (WISC-IV).

A total of 41 children with non-syndromic orofacial clefts and 44 age-matched controls participated in the study. Children of the cleft group were examined by pedagogical professional services and required special education plans significantly more often than controls (p<0.001 and p=0.02, respectively). Participants of the cleft group who received early speech and language therapy score higher on the Verbal Comprehension Index (p=.005). Full-Scale IQ score was also higher for cleft participants who received therapy, however not significant but borderline (p=0.08).

Early language and speech interventions for children with non-syndromic orofacial clefts may have a positive effect on verbal skills and overall cognitive development. Future longitudinal studies examining baseline cognitive functioning of infants are needed to provide more conclusive evidence on the effects of interventional programs on speech and language development in cleft patients.

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The prevalence of metabolic disorders is rising, diabetes prevalence doubled during 1990-2017. In 2020, 7.8% of US pregnancies were complicated by Gestational Diabetes Mellitus (GDM). Our aim is to assess the impact this increase has on childhood developmental disorders and understand the link between maternal metabolic disorders and neurodevelopmental disorders in children with focus on Autism Spectrum Disorder (ASD) and ADHD.

Our aim is to assess the impact this increase has on childhood developmental disorders and understand the link between maternal metabolic disorders and neurodevelopmental disorders in children with focus on Autism Spectrum Disorder (ASD) and ADHD.

A literature search was conducted using medical subject heading (MeSH) terms in PubMed, database from Jan 1 2014 to Feb 15, 2023. Only large-scale (n>20,000) were reviewed. A total of 3 articles were included in our final qualitative synthesis review.

An increased rate of ASD and ADHD are observed in children of mothers with insulin resistance, demonstrated by Type 2 Diabetes (T2DM) and GDM (Kuan-Ru Chen, et al.). T2DM had the strongest association with ASA and ADHD when looking at other neurodevelopmental disorders (Chen, et al.). GDM severity correlates to increased risk of ADHD (Xiang, et al.). Maternal obesity as a risk factor for ASA and ADHD has confidence intervals in the same ranges as immune dysregulatory disorders including Asthma and Autoimmune disorders (Woolfenden, et al.).

Pathomechanism of neurodevelopmental disorders involves maternal oxidative stress and inflammation. Maternal T2DM and obesity are pro-inflammatory states that can be targeted as modifiable risk factors of ASD and ADHD in children. Preconception metabolic optimization and tight glycemic control in pregnancy are two ways clinicians can start to address the rates of rising ASD and ADHD.

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Anorexia Nervosa (AN) is common in adolescents and has a high mortality and morbidity rate with a lifetime prevalence of 0.5% to 2%.1,2 We aim to review the neurobiology correlation of Anorexia Nervosa in Autism Spectrum Disorder as they are often associated together.

1. Understand the correlation between the neurobiology of Autism Spectrum Disorder (ASD) and Anorexia Nervosa.

2. Assess the association and prevalence of Anorexia nervosa in the ASD population.

3. To focus on the implications for the pathogenesis of Anorexia Nervosa and treatment of this disorder in the ASD population.

We searched PubMed, APA PscyINFO, Embase, CINAHL, and Google scholar databases with the keywords Autism Spectrum Disorder AND Anorexia Nervosa and included 6 relevant human studies out of 187 published in English.

Neilson et al. studied the outcome of ASD in teenage onset AN, and a statistically significant negative dose-response relationship is found in all the 3 Morgan-Russell Outcome Assessment Schedule (MROAS) domains in stable ASD over time, and the results on the subscales ‘mental state,’ ‘psychosexual state’ and ‘socio-economic state, “personal contacts,’ ‘social activities’ and ‘employment record.’3 The outcome of AN onset in adolescence is generally favorable regarding mortality and the persistence of eating disorders in adulthood. A study by Pruccoli et al. noted a high prevalence of ASD traits in a group of young AN patients, predominantly seen in 4 specific EDI-3 subscales and independent of BMI.4 Margari et al. found only AN diagnosis had a statistically significant difference (p = 0.04) in females vs. males when comparing sex differences for comorbidities.5

Morphological changes in brain areas are linked to social cognition and increase the risk of eating disorders in ASD. We recommend future studies with robust study design to explore the full spectrum of pathogenesis and association of AN in ASD.

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Appropriate sleep habits play a pivotal role in the physical and psychological development of children. However, sleep deprivation or sleep problems can have a significant impact on children’s mental health and daily functioning. This study investigates the sleep habits and problems in children aged 7 to 10 who attend the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal.

The primary objective of this study is to assess the sleep habits and problems in children aged 7 to 10, aiming to establish data that can guide the development, implementation, and reevaluation of future interventions tailored to this age group.

This study is observational in nature and involved the participation of 21 patients from the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal, throughout the year 2022. Questionnaires related to sleep habits were administered to this population. Parents were invited to complete the Children’s Sleep Habit Questionnaire (adapted from the Children’s Sleep Habit Questionnaire by Prof. Owens, 2000), while the children (patients) were asked to fill out the Sleep Self Report-PT (adapted from Owens 2000 Research Version) and the Strengths and Difficulties Questionnaire (SDQ-Por, by Robert Goodman, 2005).

As of now, the results of this study are still being processed. The data collected from the questionnaires will be analyzed to gain insights into the sleep habits and issues of children aged 7 to 10 years attending the Child and Adolescent Psychiatry Service in Vila Real, Portugal. Findings will be discussed, and any significant observations or trends will be highlighted.

This research aims to provide valuable insights into the sleep patterns and problems experienced by children in the specified age group. By understanding these issues, we can develop and implement targeted interventions to improve sleep quality and overall mental well-being. The conclusions drawn from this study will contribute to the development of evidence-based strategies for enhancing the sleep health of children in the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal.

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ADHD is a very frequent reason for consultation in child psychiatry. It affects 2.5% of children and 5% of adults. Diagnosis is clinical. Treatment is based on medication combined with psychosocial interventions.

Develop an ADHD guide for caregivers.

We carried out a literature review covering the last 5 years using the google scholar and pubmed search engines, including the key words ADHD, in order to produce a printable guide for caregivers working with children, in particular school teachers and healthcare personnel.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting 5% of school-age children.

It is characterized by abnormally high levels of developmental inattention, hyperactivity and impulsivity, leading to impaired personal, social, academic or occupational functioning. Because of its pervasiveness, ADHD can interfere negatively with general well-being, as well as with social life, academic performance and the development of social skills, which can lead to low self-esteem.

ADHD has multiple etiologies. It is thought to be due to a complex interaction between genes and environment. In fact, genetic vulnerability predisposes to the disorder which, under the influence of an unfavorable environment, expresses itself in clinical symptoms represented by 2 dimensions: inattention, hyperactivity and impulsivity.

Diagnosis is essentially clinical, and treatment is based on medication combined with psychosocial interventions.

ADHD is one of the most frequently encountered disorders in general practice, pediatrics and child psychiatry. Early recognition of the disorder enables appropriate management, while limiting the impact of the disease on the functioning of the young person and his or her family.

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Cyber victimization is a form of violence that is perpetrated through social media, and its victims are primarily adolescents and young adults. This can have a negative impact on their psychosocial well-being.

To investigate the relationship between cyber victimization, depression, and suicide, identifying risk factors, prevention and intervention strategies through an case report.

We report the clinical case of a 16-year-old Tunisian man who developed a depressive disorder after being cyber-victimized. We also conducted a literature review in PubMed database keywords: depression, suicide, cybervictimisation, adolescents to identify risk factors, prevention and intervention strategies.

The adolescent was a member of a youth group called The Gung, which organized climbing challenges that were then broadcast on Facebook. He was the victim of cyberbullying after failing a challenge that was broadcast live. As a result, he was rejected by his group of friends and subjected to death threats and bullying. A clinical examination revealed major depressive disorder, low self-esteem, and low self-assertion. The patient was treated with a combination of medication and psychotherapy, and he had a good outcome with social and educational reintegration.

Several studies have found that cyber victimization is associated with depressive disorders, anxiety disorders, and suicidal behavior among youth. Several risk factors have been identified, including low socioeconomic status, disrupted family dynamics, low self-esteem, and psychiatric disorders. Prevention and intervention strategies involve families, educational institutions, civil society, and health professionals.

The seriousness of cyber victimization among youth is undeniable. Early and personalized intervention is necessary to prevent suicidal behavior and restore the well-being of adolescents.

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This case report elaborates an unconventional approach to the management the use of clozapine, typically used in treatment-resistant Schizophrenia, in a 17-year-old female patient with treatment-resistant Conduct Disorder, Attention Deficit and Hyperactivity Disorder and Intellectual Disability.

The aim is to demonstrate the potential effectiveness and applicability of clozapine in treating severe, treatment-resistant behavioral problems associated with Conduct Disorder, even without the presence of psychosis, by detailing the clinical course, treatment strategy and outcome of this unique case.

A 17-year old female patient was referred to inpatient clinic due to escalating aggression towards her family members and risky sexual behaviors despite undergoing treatments before as risperidone, haloperidole, olanzapine, lithium, clonidin or aripipirazole. She was running away from home repeatedly and under the risk of sexual abuse. After comprehensive clinical and psychopathological assessment, a decision was made to initiate treatment with clozapine, closely monitoring the patient for adverse effects, and assessing its impact on the patient’s aggressiveness and other behavioral problems. During her stay, clozapine dose titrated to 250 mg/day in addition to her current treatment as amisulpiride 800 mg/day and valproic acid 500 mg/day. Atropine solution as mouthwash used for salivary hipersecretion. No other side effects observed. Cognitive and behavioural therapy interventions made for anger management and impulsivity. Also focused on family-based interventions about establishing healthy boundaries.

A significant reduction in aggressive behavior was noted under the treatment of clozapine. The patient’s overall conduct and interaction with family improved remarkably. The treatment was well-tolerated except sialorrhea, leading to a successful integration back into her family and community.

This case highlights the potential of clozapine as a viable treatment option for managing severe, treatment-resistant behavioral problems in patients with conduct disorder, even in the absence of psychosis. A randomized-controlled trial showed that clozapine was more effective than risperidone in conduct externalization factors, delinquency trait and global functioning in children and adolescents(Juárez-Treviño et al. Clin Psychopharmacol Neurosci. 2019;17(1):43-53). While it necessitates careful monitoring due to its side-effect profile, this unconventional use of clozapine may open up new avenues for the management of treatment-resistant conduct disorder, thereby improving patient outcomes and quality of life. Further controlled studies are warranted to ascertain the safety and efficacy of this approach.

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Early-Onset Schizophrenia (EOS) is a rare and severe form of schizophrenia that begins in childhood and it is often associated with genetic risk factors, poorer prognosis, and increased treatment resistance compared to adult-onset schizophrenia (Hatzimanolis et al. Eur Psychiatry 2020;63(1):e44). This case report presents two siblings diagnosed with EOS and treated at the same inpatient clinic in different years.

The aim is offering a perspective on the clinical characteristics, genetic and enviromental implications, and treatment challenges of two siblings with EOS and seeking to enhance understanding of EOS’s complexity, particularly in the context of treatment resistance.

A comprehensive retrospective review of the siblings’ all medical records was conducted, focusing on their psychiatric history, symptoms, treatment trials, and responses of treatment. Both cases’ current clinical situations were evaluated cross-sectionally.

Older sibling: 19 year-old male, was diagnosed with EOS following the onset of symptoms as social withdrawal, negativism and suspiciousness at the age of 14. He referred to the inpatient clinic with the cause of drug intake refusal. Risperidone treatment started but there was no significant response. Risperidone to olanzapine switch made and clinical remission observed. After his discharge, 4 more hospitalisations in 5 years needed due to low socioeconomic status, parental neglect and him having no insight and stopped taking his medications repeatedly. Several depot form antipsychotic injections started to prevent recurrent hospitalisation. Despite that he needed several hospitalisations to adult psychiatry inpatient clinics.Younger sibling: 14 year-old female, were diagnosed with EOS following the symptoms as auditory hallucinations, suspiciousness, disorganised speech and behaviours at the age of 13. She referred to the same inpatient clinic with suicidal risk after 2 years of his brother’s last hospital stay. She responded good to olanzapine treatment like her brother’s, during her first stay. After 2 weeks of her discharge, her psychotic symptoms started again with no specific reason. Second hospitalisation needed due to her homicidal and suicidal risk. Clozapine and aripipirazole treatment started and she discharged in partial remission. She is being followed in outpatient clinic, with low functioning.

Despite trials of multiple antipsychotic medications and adjunctive treatments, both siblings demonstrated significant treatment resistance. These sibling cases underscore the complexity and challenges in managing EOS, particularly when it presents with treatment resistance. The shared familial environment and potential genetic factors demand further investigation to elucidate the pathogenesis of EOS and optimize therapeutic approaches.

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Schizo-obsessive disorder (SOD) is a complex psychiatric condition characterized by exhibiting symptoms of schizophrenia and obsessive-compulsive disorder (OCD)(Schirmbeck et al. Front Pharmacol. 2013 Aug 9;4:99). Some researchers prefer to describe this condition as a spectrum called “schizo-obsessive spectrum” and state that clinical represantations such as OCD with poor insight, OCD with schizotypal personality disorder, schizophrenia with obsessive-compulsive symptoms and schizophrenia with OCD are included in this spectrum(Poyurovsky et al. J Psychiatr Res. 2005 Jul;39(4):399-408). There is limited literature available on early on-set schizo-obsessive disorder in child and adolescent sample.

This case series aimed to describe the clinical characteristics, phenomenology, diagnostic process and treatment response of SOD in a sample of inpatient adolescents and illuminate the intricate symptomatology between schizophrenic and obsessive-compulsive features.

A retrospective review was conducted of 7 adolescent patients who met DSM-V criteria for both schizophrenia and OCD in our inpatient clinic over the past year. Data were collected from medical records, including demographic information, clinical presentation, treatment history and response to treatment. All data were anonymized to maintain patient confidentiality.

The sample consisted of 5 females and 2 males, with a mean age of 15,4 years. All patients presented with a mixed symptomatology of hallucinations, delusions and obsessive-compulsive symptoms. Many common points observed about clinical characteristics and psychiatric history of the patients. In most of the patients, the first psychiatric complaints started with obsessive-compulsive symptoms. It was observed that obsessions evolved into over-valued ideas and delusions in the course of time. Patients responded late and inadequately to pharmacological treatment, multiple drug use was necessary. Hospitalization lasted longer, the average time was 53 days. Most of the patients required augmentation with cognitive-behavioral therapy due to partial response or intolerable side effects. Unfortunately, no patient experienced full remission or returned to premorbid functioning.

This case series underscores the complexity of diagnosing and treating schizo-obsessive disorder in a pediatric population. It appears that a combined approach using both pharmacotherapy and psychotherapy may yield the most beneficial results. However, given the small sample size and retrospective design, these findings need to be interpreted with caution. Further research are crucial to corroborate our findings and refine treatment strategies.

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Antipsychotic use for adolescents (defined here as under 25 year olds) must be done with caution, giving due thought to advantages and potential side effects. Antipsychotics are extremely useful and effective drugs, but have side effects and many of these are problematic.

It has been noted that Risperidone is often used for this age group, despite the UK guidance being cautious about its use.

To assess the extent of Risperidone prescribing in Norfolk/Suffolk for this patient group and to consider the monitoring of this.

Given that bone mass density is set down in teens – mid 20’s, this is a particularly concerning issue when given to this age group. Additionally, distressing side effects and issues with fertility shoudl be considered. If risperidone is used, Maudsley is very clear that this must be monitored: baseline/annual prolactin levels done, and action should be taken if these are elevated and/or the patient symptomatic.

1. 1) Evaluate numbers of adolescents, under 2ndry care Mental health service who have been prescribed Risperidone

2. 2) Consider who prescibed it and the indication

3. 3) to consider if routine monitoring had been completed (specifically, baseline prolactin and then annual prolactin levels)

4. 4) to consider if these patients had developed side effects

Almost 20% of 18-25 years olds, due to be seen in Youth Community Service had been prescribed Risperidone. Of these, only 44% had had prolactin levels done, despite the guidance. This equates to the over half not having prolactin checked. 60% of patients reveiwed had symptoms of hyperprolactinemia. Indications for use included emotional dysregulation/EUPD, psychosis, ADHD, OCD/ASD and depression

Risperidone should be used with extreme caution in this patient group. Medication can be very useful for some young people experiencing distressing symptoms but, as Hippocrates advises, “do no harm” and seek not to cause iatrogenic harm.

Given that many of the young people seen by mental health services are experiencing emotional dysregulation (not necessarily an abnormal state in adolescent, when much is in flux), it is tempting to consider medication as one means of trying to alleviate distress. There is no clear treatment for dysregulated feelings, and most would accept that psychological support is more appropriate.

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Autism spectrum disorders (ASD) is a neurodevelopmental disorder with an estimated lifetime prevalence of at least 1%. Some studies suggest that approximately 60% of children with ASD show emotional dysregulation and 44-86% sleeping disorders.

Studies suggest that cognitive behavioral therapy and animal-assisted therapy AAT can be an intervention strategy to promote emotional and behavioral dysregulation and sleep disturbances.

The purpose of this study was to investigate the effect of a therapy program assisted with dogs (AAT) together with cognitive behavioral therapy (CBT) on behavioral and emotional regulation and sleep disorders in children diagnosed with ASD.

The sample was composed of 24 children between 7 and 10 years old diagnosed with ASD randomized into two groups (CGT group (control group) and AAT + CBT group (experimental group). Inclusion criteria: communication level of simple sentences, mild-moderate difficulties in behavioral and emotional regulation and sleep disturbances. Exclusion criteria: intellectual disability, children with specific dogs phobia. Assessment included ADOS-2, WISC-V, CGAS. dysregulation profile of Achenbach scale and Sleep Disturbance Scale for Children-Bruni. A program of 12 sessions (weekly one-hour sessions) focusing emotional and behavioral regulation and sleep disturbance was designed (Behavior Emotional Sleep Treatment Program. A pre-post evaluation was performed.

Participants were 20 boys and 2 girls (2 participants dropped out), with a mean age of 9. Regarding the socio-demographic and clinical characteristics, no significant differences has been observed between both groups in the global functioning measured with the Children’s Global Assessment scale (CGAS) (p=0.832), nor in the cognitive capacity (QI ) neither in reference to the associated comorbidities (p=0.103) nor in the variable prescription pharmacological treatment (p= 0.142). In emotional self-regulation, a significant improvement in emotional regulation difficulties was observed after treatment in both groups (experimental group: p=0.014; control group: p=0.012). However, the comparison between the pre-post intervention results between groups, regarding the emotional regulation variable, a greater improvement is observed in the experimental group (p=0.013). Significant improvements were also observed in sleep disorders (Bruni scale total score and in the sleep conciliation and maintenance difficulties scale) in both groups.

To conclude, although this is a pilot study with a small sample size and further research is needed, results suggest that a therapy program assisted with therapy dogs and CBT have positive effects on emotional dysregulation and sleep disturbances in children with ASD and offers a possible intervention strategy.

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Nonsuicidal self-injury (NSSI) is a self-damaging behavior with typical onset in early adolescence, and shows greater prevalence in females. NSSI is defined by recurrent episodes of intentional self-inflicted damage to body tissue, without suicidal intent. These recurring self-inflicted injuries are done by the indivuduel to relief oneself from negative feelings, to resolve interpersonal difficulties, or to induce positive feelings.

NSSI in DSM-5. has been included among the conditions in need of further study.

NSSI can be interpreted as a maladaptive coping mechanism that can be regarded as an emotional dysregulation. Adverse childhood experiences including physical abuse, neglect or sexual abuse are the strongest predictors of the NSSI. Research has repetitively found strong associations between NSSI and identity diffusion and/or distorted personality traits.

The aim of our study was to assess the association between childhood traumatization, personality characteristics including stages of identity development, and self-injurious behavior among female adolescents that experience difficulties with emotional regulation.

We compared our results to a Hungarian normative sample. The sample consisted of inpatients adolescents, age between 14 and 18, with a diagnosis consisting of „Emotional disorders with onset specific for childhood” or „Mixed disorders of conduct and emotions” with chronic nonsuicidal self-injurious behavior.

Childhood traumatization was measured with the short version of Childhood Trauma Questionnaire (H-CTQ-SF). Identity development and identity diffusion were measured with the Assessment of Identity Development in Adolescence Questionnaire (AIDA). Temperament and character factors were measured with the Junior Temperament and Character Inventory (JTCI).

Adolescent patients with NSSI reported severe and multiplex childhood traumatization. These patients scored higher on novelty seeking and harm avoidance and scored lower on the persistence, self-directedness, and cooperativeness factors in the JTCI. These results were compared with the Hungarien normative sample. Adolescents scored higher on the Discontinuity and Incoherence scales of the AIDA.

Our preliminary results suggest that childhood traumatization predicts self-injurious behavior in adolescent females. Additionally, we have found associations between signs indicative of personality disorder, including lower level of self-cohesion, self-integration and self-directedness.

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In the year 2021, there was a notable increase in behaviors associated with anxiety, depression, and stress among school-aged children and adolescents, possibly attributed to the pervasive effects of social isolation and confinement measures.

This study conducted a thorough analysis of cases involving students aged 11 to 17 years who exhibited risk factors, anxious and depressive symptoms, and mood disturbances.

This study focused on students aged 11 to 17 years and employed a comprehensive approach to assess the impact of anxiety, depression, and stress. Cases were meticulously analyzed, and key categories were established to characterize the multifaceted challenges faced by the students. These categories included the availability of family support, utilization of psychopharmacological treatment, engagement in psychological therapies, participation in psychopedagogical interventions, and patterns of school absenteeism.

The analysis revealed a concerning prevalence of anxiety, depression, and stress-related symptoms among the student population. Many students exhibited risk factors that warranted immediate attention, including social isolation, disrupted routines, and uncertainty about the future. Furthermore, a significant portion of students displayed anxious and depressive symptoms, often leading to altered mood and behavioral challenges. In the context of family support, it was apparent that students with robust familial backing tended to cope more effectively with the psychological strain induced by the pandemic. However, a noteworthy number of students lacked adequate family support systems, exacerbating their mental health struggles. Students in need of such interventions benefited significantly from their implementation, demonstrating improved emotional well-being and a reduction in symptom severity. Nonetheless, the accessibility of these services remained a concern, with disparities in access evident among different demographic groups. Psychopedagogical interventions played a pivotal role in addressing issues related to school absenteeism and facilitating a smoother transition to remote learning. Students who engaged in these interventions showed positive progress in terms of school attendance and academic performance.

The findings of this study underscore the urgency of a holistic approach to addressing anxiety, depression, and stress in school-aged children and adolescents. It is imperative that consultations with child and adolescent psychiatry specialists be conducted promptly and in a manner that considers the unique contextual factors influencing each student’s mental health. Moreover, efforts should be directed toward enhancing family support, expanding access to psychopharmacological treatment and psychological therapies, and promoting the implementation of psychopedagogical interventions.

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Although the etiological diagnosis of loss of consciousness is essentially based on a careful history and clinical examination, electroencephalography (EEG) remains an important investigative tool.

The aim of this study was to identify the value of EEG in the management of adolescents with recurrent bouts of fainting

This was a retrospective descriptive study conducted from January 2019 to May 2022. We included all adolescents referred to the functional explorations department at Habib Bourguiba hospital, Tunisia for Electroencephalogram (EEG) as part of a workup to explore recurrent episodes of loss of consciousness.

A total of 55 adolescents were included in this study, with a mean age of 15.4±2.3 and a 72.4% female proportion.The delay between the EEG and the onset of the seizure was greater than one week.67.3% of patients were referred by the child psychiatry department.29.1% of the 55 EEG reports were pathological. Epileptiform discharges were noted in 56.3% of adolescents. Slow waves were found in 43.7% of cases. The location of the abnormalities was predominantly frontal. Patients with temporal EEG anomalies had a notion of ascending epigastric pain preceding loss of consciousness in 90% of cases. Adolescents with EEGs containing epileptiform abnormalities had a history of paroxysmal movements in 30% of cases. The sensitivity of the EEG was estimated to be around 25%, and the specificity around 79%.

Although the clinical examination is of great importance in the etiological diagnosis of loss of consciousness, the EEG remains a complementary examination of non-negligible interest in the etiological investigation.

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Behavioral disorders are a frequent reason for consultation in child psychiatry. Children and adolescents with epilepsy are at risk of behavioral disorders that can affect their quality of life.

The aim of this study was to investigate the electroencephalographic aspects of children with behavioral disorders and to determine the prevalence of comorbidity with epilepsy.

This was a retrospective descriptive study conducted from January 2019 to May 2022. We included all children and adolescents referred to the functional explorations department at Habib Bourguiba hospital, Tunisia for Electroencephalogram (EEG) as part of a workup to explore a behavioral disorder.

A total of 117 patients were included in the study. The mean age was 14 ±4.2 years. The sex ratio was 1.29. Agitation was reported in 66.7% of patients. One case of attempted suicide was noted. Among these patients, 29.9% reported audiovisual hallucinations. Concentration difficulties were associated with 59% of cases. Ten patients had a history of epileptic seizures. Of the 117 EEGs performed, 59.8% were pathological. The abnormalities observed were paroxysms in 67.1% of cases and focal slowing in 25.7%. Five patients had a rapid rhythm on the EEG. An absence-type electro-clinical seizure was recorded in one patient. Patients with visual hallucinations had epileptiform abnormalities of occipital location in 41.7% of cases, and slow waves of anterior location in 50% of cases. Patients with auditory hallucinations had parietal epileptiform abnormalities in 89% of cases.

Ictal and interictal manifestations seem to play a part in the genesis of behavioral disorders in children and adolescents. An EEG would therefore be preferable in this age group, for better management.

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Children and adolescents with ASD are more likely to have eating problems compared to the general population of the same age, one of the disorders whose prevalence is increased in people with ASD is avoidant/restrictive eating disorder Food (ARFID) ARFID is characterized by a lack of interest in eating or avoidance of food intake, which in the case of people with ASD is usually related to impaired sensory processing and cognitive rigidity. For this reason, the Autism Day Hospital carries out a specific food intervention program.

To retrospectively evaluate the results of the Food Program of the Autism Day Hospital during the year 2022.

A retrospective analysis of the cases of patients admitted to the Food Program of the Autism Day Hospital during the year 2022 is carried out. Results of the sensory pattern and presence of genetic alterations of each one of the patients are compared. And the results of the intervention are evaluated by quantifying the new foods introduced into the diet at the end of the admission.

The sample is made up of a total of 5 children (4 boys and 1 girl) aged between 7 and 12 years. All of them meet diagnostic criteria for Autism Spectrum Disorder and present comorbidity with ARFID. Of the total sample, 1 of the patients presented in the genetic study a microdeletion S. in 15q13.3, duplication in 2q13 and duplication in 5p12-p11, with the genetic studies in the rest of the patients in the sample being normal. Regarding the results of the sensory pattern (Infant/Toddler Sensory profile test), all the patients presented differences in relation to other children of their age in the oral sensory pattern, this difference being definitive in 3 of the 5 patients in the sample. All the patients included in the program presented a satisfactory evolution, introducing at least 15-20 new foods into their usual diet, including different textures and consistencies.

The therapeutic approach to ARFID in children with ASD carried out from a multidisciplinary perspective; sensory integration, behavioral approach and, if necessary, psychopharmacological, has shown, based on the results obtained from the food program of the ASD Day Hospital, a favorable evolution of the eating disorder. For this reason, we consider the detection of this typical comorbidity of ASD and its referral to specific therapeutic programs to be of special importance.

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Smith-Magenis syndrome (SMS) is a complex genetic disorder characterised by distinctive physical features, developmental delay, cognitive impairment and a typical behavioural phenotype. SMS is caused by interstitial 17p11.2 deletions (90%) involving multiple genes, including the retinoic acid-induced 1 gene (RAI1), or by pathogenic variants in RAI1 itself (10%).

In this case report, we present a case of Smith-Magenis syndrome with Autism Spectrum Disorder with karyotype 46,XX, 17p 11.2 gene deletion confirmed by Autism Spectrum Disorder, who was followed up in a paediatric neurology outpatient clinic with neuromotor developmental delay and whose diagnosis was delayed due to B12 deficiency. We also update scientific developments in Smith-Magenis syndrome.

We describe an 18-month-old male with Smith-Magenis syndrome and Autism Spectrum Disorder who was seen in our paediatric psychiatric outpatient clinic and who received B12 replacement with developmental delay.

The patient was followed up in the paediatric neurology outpatient clinic with delay in neuromotor developmental milestones and this delay was thought to be due to B12 deficiency (B12<100 ng/L). The initial examination revealed delay in neuromotor and behavioural milestones, speech delay, wide and high nasal bridge and hypertelorism. Further physical examination revealed syndactyly of the second and third toes bilaterally and crossed lower teeth. Clinical and psychometric testing (Ankara Developmental Screening Inventory) by 2 consultants and 1 research assistant resulted in a diagnosis of intellectual disability and an additional diagnosis of Autism Spectrum Disorder due to social deficits that could not be explained by intellectual disability.

Smith-Magenis syndrome is a well-known disorder involving the deletion of chromosome 17p11.2, which contains the RAI1 gene. This condition is associated with neuromotor and behavioural delay, as well as distinctive dysmorphic features. Clinicians should consider Smith-Magenis syndrome in the differential diagnosis for patients with delayed neuromotor and behavioural milestones, even in the presence of documented blood parameters (such as B12 deficiency) that may account for the delay.

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Conversive disorder is characterised by the presence of one or more involuntary neurological symptoms that are not due to a clear medical pathology. On the other hand, consciously simulated illnesses fall into two diagnostic categories: factitious disorders and malingering, which are differentiated by both the motivation for the behaviour and the awareness of that motivation. Factitious disorder behaviours are motivated by an unconscious need to assume the sick role, whereas malingering behaviours are consciously driven to achieve external secondary gains.

Study of the differences between conversion disorder and factitious disorder and their repercussions from a case of difficult diagnosis.

Bibliographic review of scientific literature based on a relevant clinical case.

We present the case of a 14-year-old male patient. Adoptive parents. Studying in high school. Social difficulties since childhood. He comes to the emergency department on several occasions referring stereotyped movements and motor tics in the four extremities with left cervical lateralization. Increase of these symptoms in the last month, so it was decided to admit him to the pediatric hospital. After observation and study of the patient’s movements with normal complementary tests he should return home. The following day he returned to the emergency department after an episode of dizziness, mutism and emotional block. It was decided to admit him to Psychiatry for behavioral observation and differential diagnosis.

In the assessment of patients it is essential to make an appropriate diagnosis taking into account the patient’s symptomatology and the patient’s background and life context. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist’s consultation. The first challenge is to detect them, and recent studies have confirmed the importance of “positive” clinical bedside signs based on incoherence and discordance. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.

None Declared