German psychiatric outpatient clinics have been established to treat the sickest among outpatients. They receive a lump sum per patient and quarter. This reimbursement is currently under scrutiny, because it can act as a disincentive for the care-givers and to the disadvantage of the patients. It was the aim of this study to elucidate the connections between individual aspects and concerns of the patients and the amount of care administered.

Clients of one of the largest health insurers, who visited a preselected outpatient clinic were followed for six months (p=339). All treatment activities were logged individually. Relevant sociodemographic data, the diagnoses, the individual needs and idiosyncracies, the course of the symptoms and case history were noted. Associations between the factors and utilization were tested by ANOVA and multiple linear regression models.

The regression model with the best fit (r²=0,48, p< 0,001) included five variables. Lower utilization is associated with living in nursing home (ß=-0,378; p< 0,001), higher age (ß=-0,273; p< 0,001), legal incapacity (ß=-0,306,p=0,002) and lower social functioning (ß=-0,187; p=0,033); higher utilization with inpatient days prior to outpatient treatment (ß=0,168; p=0,015). Treatment aims, isolated functional deficits, diagnoses and graveness of symptoms did not have a significant influence.

Outpatient clinics should address the needs of younger patients with the aspiration of an independent life despite of a grave psychiatric disorder. Treatments administered to nursing-home inhabitants are much less complex, although these patients are even sicker. A corresponding reallocation of financial resources is suggested.

In over 60 years little has changed in children's mental health and the flag waving continues: It is time for action in the trenches. It is imperative to focus health policy on the need to provide basic mental health succor to children and their families. A failure to alter the situation related to children's mental health will no doubt have catastrophic consequences for our society. We review the level of progress made in reforming regional mental health services since 2002.

Using population-based representation of regional service utilization capacity permits comparison of regional, provincial and national rates of child and adolescent mental disorder.

Regional services in the last 6 years have served at most approximately 1% of the 0-18 year old population annually. This rate represents an increase from about 0.6% in 2002.

Rationing the scant professional resources that exist to serve children's mental health will become increasingly difficult. For example, it is estimated that three percent of 0-18 year-olds are estimated to suffer a debilitating mental problem. Implication for policy are that our results point to service gaps in need of immediate policy development to meet basic needs of children. Several strategies are considered.

Prior to facing the challenges of FM management, an initial diagnosis must be made. To guide general practitioners (GPs) in the early detection of FM in Europe, we developed an easy-to-use screening tool specific to FM.

A European multidisciplinary expert group was constituted with the aim of providing clinical expertise, defining methodology, and identifying key issues around the detection of FM. Three conceptual models describing factors that may contribute to the identification of FM patients were derived from; a) a comprehensive literature review, 2) clinician focus groups (N=6), and 3) face-to-face interviews with German, French, and English-speaking patients (N=29) conducting by psychologists to explore their attitudes and perceptions of the disease. A FM screening tool was developed in all three languages and tested for comprehension and applicability in FM-diagnosed and FM-suspected patients.

The models derived from the literature, clinician focus groups, and FM patient interviews showed high consistency. The resulting FM screening tool is comprised of 14 questions that describe patients’ pain, fatigue, associated symptoms, impact on everyday life, personal history, and attitudes towards their FM.

Based on this qualitative study, the detection of FM is likely to require the assessment of multiple psychological factors in addition to symptoms, including patient reporting of personal history and patient behaviour. The quantitative validation of these findings is currently underway.

To investigate the role of perfectionism in the development of disordered eating behaviours.

382 female university students completed the Hewitt & Flett MPS and the EAT-40 at baseline, one year after (T1) and two years later (T2).

Perfectionism at baseline was significantly associated with long-term abnormal eating attitudes/behaviours. Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) were significant predictors of disordered eating behaviours. SOP at baseline was predictive of diet concerns, at T1 and T2. Baseline SPP was correlated with overall eating disturbance at T1 and T2. Regression analysis revealed that only SPP was a significant predictor of bulimic behaviours and social pressure to eat at T1, but not at T2.

Our findings contribute to a more clear understanding of the association between perfectionism and eating disorders. SOP and SPP were prospectively associated with abnormal eating attitudes/behaviours and SOP was found to be predictive of diet concerns.

The main aim of this study was to analyze the association between a set of neurobiological/clinical factors and impulsivity in patients suffering from bulimia nervosa, as well as the capability of this factors to predict the severity of impulsivity.

The Impulsive Behaviors Scale (IBS), the Diagnostic Interview for Bordeline Patients - Revised (DIB-R), the Beck Depression Inventory (BDI), the Millon Multiaxial Clinical Inventory (MMCI-II) and the Family Environment Scale (FES) were applied to 70 female patients with DSM-IV BN (purging subtype). Twenty-four hour urinary excretion of norepinephrine (NE), 3-methoxy-4-hydroxyphenylglycol (MHPG), serotonin (5-HT), 5-hydroxi-indol-acetic acid (5-HIAA), dopamine (DA), homovallinic acid (HVA), and morning serum cortisol levels before and after the administration of 1 mg of dexamethasone were determined.

Impulsivity was associated to lower levels of urinary 5-HT and 5-HIAA, borderline features, and lower family expressed emotion.

The consideration of impulsivity as a core clinical feature in patients with bulimia nervosa could lead us to identify clinical subtypes of patients, with specific clinical profiles and specific treatment needs.

To examine the natural course of eating disorders (ED) prospectively over 6 years and to examine link between stressful life events (SLEs) and ED relapse among women with personality-disorders (PDs).

Subjects were 132 female patients with bulimia nervosa (N=40) or EDNOS (N=92) in the Collaborative Longitudinal Personality Disorders Study. EDs were assessed with the Structured Clinical Interview for DSM-IV Axis-I, and monitored with the Longitudinal Interval Follow-up Evaluation during follow-up. PDs were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV), and monitored with the Follow-Along version of the DIPD-IV during follow-up. SLEs were assessed with the Life Events Assessment (LEA). Follow-up assessments were conducted at 6- and 12-months and then yearly through 72 months. Proportional hazard regression analyses were performed to examine the link between time-varying levels of SLEs and ED relapse. Cox regressions controlled for the same covariates used in prior work: duration of ED, number of co-morbid psychiatric disorders, and time-varying status of PDs.

Of the 132 patients, 59% had remissions from ED, 68% of whom subsequently relapsed over the course of 6 years (BN and EDNOS did not differ in relapse). Total number of negative SLEs reported by ED patients significantly predicted subsequent ED relapse (HazardRatio=1.5, p< .05). The types of SLEs that predicted ED relapse were elevated work stressors (HazardRatio=3.0, p< .01) and elevated recreation stressors (HazardRatio=3.1, p< .05).

Higher work stress and higher recreation stress represent significant warning signs for triggering relapse for women in remission from BN and EDNOS.

Small number of prestigious scientific journals publishes most of the world's scientific information. Although scientists in developing countries represent 25% of the world's scientific community national journals from this "scientific periphery" are poorly visible: the Science Citation Index (SCI) included less than 2% of these journals in 1995.

A vicious cycle of inadequacy for these journals: small number and poor quality of manuscripts submitted, inadequate review process, and imperfect English prevents them from reaching higher visibility and eventually escaping form anonymity. Key problems seem to be poorly designed and unoriginal research, lack of knowledge of research methods and data presentation.

1. 1. Teaching principles of scientific research in medical schools.

2. 2. Author-friendly editorial policy - a procedure where most of the articles received are pre-reviewed intramurally and improved by providing guidance to the authors, before being sent out for extramural review.

3. 3. Proactive board of editors - who seek interesting research and encourage researchers to communicate their results.

4. 4. Networking regional collaboration.

In the case of Croatian Medical Journal (CMJ) that followed and partly developed the "treatment" described, such policy resulted in significant formal success - inclusion of CMJ in the most selective international indexing databases (MEDLINE, Current Contents and Web of Science), open access status, decent visibility and attention of researches (impact factor 1.2). The original, active and efficacious approach of the editors of CMJ will be analyzed in this presentation.

Although suicide rates are decreasing in most European countries, suicide is still a major health concern. Despite of the fact, that the vast majority of suicidal patients contacted with health care services before the suicidal act, the doctor-patient meeting is a necessary, but sometimes not sufficient way enough to prevent suicide. Most patients, who commit or attempt suicide, are not regarded as being at high immediate risk at their final contact with health care services.

Based on reviewing the relevant literature and on our previous studies we developed a brief, practical, clinical guideline, which may aid general practitioners and primary care professionals to assess suicide risk and also to manage these patients.

We introduce a model for an integrated, regional suicide prevention strategy, which includes recognition, risk assessment and also intervention. The main steps of our model are to recognize warning signs, explore crisis situation and/or psychopathologic symptoms, assess protective and risk factors, estimate suicide risk, plan intervention strategies, and finally manage suicidal patients through the different levels of intervention.

In the management of suicidal behaviour the complex stress-diathesis model has to be adjusted by considering biological markers (mental disorders, personality traits) and psycho-social factors (crisis, negative life events, interpersonal conflicts). Only after the assessment of these factors primary care professionals, as ‘gatekeepers’ can manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic facilities in the recognition, treatment and prevention of suicidal behaviour.

Due to the implementation of the DRGs (Diagnosis Related Groups) in the somatic departments of general hospitals, an elevated demand for psychiatric consultations can be anticipated. It is a moot question whether psychiatric consultation services are adequate for such a surplus load. We investigated whether the proportion of psychiatric consultation requests for patient's capacity to consent and for guardianship is rising.

The DRGs were implemented in the somatic departments of the Ev. Krankenhaus Königin Elisabeth Herzberge (KEH) at the end of 2003. We compared consultation requests with the keywords “capacity to consent”, “capacity to enter contracts” and “need for guardianship” in the year 2002 with 2004.

Significantly more consultations with the keyword “guardianship” were requested in 2004 compared to 2002 (p=0.019). 56% concerned medical questions regarding capacity of consent. There was a slight, but increase in the requests social reasons.

The confirmation of the indication for the appointment of a guardian decreased inversely without statistical significance (80% in 2002 and 64% in 2004; Chi-Square p=0.058).

The increasing demand of the consiliary-liason-service was confirmed in our investigation. It is possible that the implementation of the DRGs plays a role in the increase of psychiatric consultation request. As a trial to ease the growing burden, we developed a form which also enables colleagues from the somatic departments to apply for guardianship of their patients without psychiatric assistance.

The objective of the present study was to find the prevalence of attention deficit hyperactivity (ADH) symptoms in a highly consanguineous community.

A cross sectional study was conducted during October 2006 - January 2007.

A total of 2500 primary school students, aged 6-12 years were randomly selected from the government primary schools and 1869 students (74.8%) gave consent to participate in this study.

Of the students surveyed, 50.7% were boys and 49.3% girls. The data revealed that 158 boys [16.7%; 95%CI (14.4-19.2] and 50 girls [5.4%;95%CI (4.1-7.1)] scored above the cut-off (≥15) for ADH symptoms, thus giving an overall prevalence of [11.1%; 95%CI (9.7-12.6)]. The Children who had higher score for ADH symptoms were in the age group 6-9 years. Children who had higher score for ADH symptoms had school performance poorer than those with lower scores (P=0.002). 200 children (96.2%) with ADH were disobedient, 60.6% noisy and hyperactive, 36.5% very cranky, 37.5% troublesome and 37.9% nervous. The logistic regression identified in our study that socio-economic condition, number of children, school performance and poor relationship between parents were the main contributors for ADH. This shows that the consanguinity has no impact on ADH children.

The study revealed that ADH symptoms are found to be a common problem among the school children in Qatar. A significant difference was found between children with and without ADHD for their behaviour.

The aim of this study was to investigate the association between parental characteristics and parental practices and the trajectories of Disruptive Behaviours (DBs) during early childhood.

Trajectories of DBs - Hyperactivity, Oppositional behaviour and Physical Aggression - were assessed based on annual mother interviews from 17 to 60 months for a Canadian population-representative birth cohort (N=2057).

Frequency of DBs increased from 17 to 41 months and then tended to decline. Parental characteristics and parental practices were both associated with chronic trajectories of DBs.

Early childhood is a critical period to prevent later DBs during school years that leads to psychosocial maladjustment during adolescence and adulthood.

ADHD is a well-established neurodevelopmental disorder affecting a significant population across the lifespan. Driven by the need to provide adequate clinical care, several national and international medical societies have published guidelines on ADHD. Our objectives were to compare the recommendations set out by these guidelines and their methodological quality.

To meet the inclusion criteria the guidelines had to be published by national or international medical societies or governmental bodies and focus on diagnosis or management of ADHD. To assess their methodological quality we used the Appraisal of Guidelines for Research & Evaluation (AGREE) instrument.

We identified 13 guidelines on diagnosis and/or management of ADHD meeting our inclusion criteria. They represented the recommendations from 9 different bodies from 4 different countries and 1 European group. All guidelines made recommendations on both diagnosis and treatment. Seven made recommendations concerning children and adolescents, four are about ADHD in adulthood and two made brief comments on specific aspects of treatment in adulthood. All groups have used DSM-IV criteria but differed on their assessment recommendations to varying degrees. All of them recommended stimulants as the core of pharmacological treatment. Only one (NICE 2008) recommends specifically methylphenidate as the first-line treatment.

Most of the diagnostic and treatment recommendations are consistent across the guidelines with few but important exceptions. This may reflect differences of service provision and target audiences. Convergent recommendation of psychostimulant treatment and differences with respect to psychosocial interventions reflect the strength (and weakness) of underlying evidence.

Many well known studies have defined results and tolerability of stimulants used in school children with ADHD in last period. In our follow-up study from August 2007 to January 2009. will present results of once-daily OROS Methylphenidate therapy including break it for holiday.

We are enrolling 32 children in study, 7-14 years old, and all of them were team-diagnosed according DSM IV/psychiatrist, psychologist, neurologist. Children with ADHD symptoms are treating with OROSMPH (18-54mg), with adjustments based on clinical symptoms, and all ADHD symptoms measures, vital signs, EEG and laboratory results also will be included through our study period.

Effects of OROS MPH therapy will be presented only in children who completed the study, looking for adverse events, clinically significant effects on vital sings, EEG, laboratory test parameters, and also, improvement academic functions, before and after breaking therapy.

Besides our expecting on reduction of ADHD symptoms with minimal effects on vital sings,values on growth, tick, laboratory test, it considers too, better academic functioning, social relationship with continual therapy.