Today, the general interpretation of the etiology of various psychopathological symptoms in adolescence does not talk about causes, but the risk factors.

We tried to determine whether traumatic experiences among adolescents represent a risk factor for suicide.

The study was conducted at the University Department for Child and Adolescent Psychiatry, University Hospital Osijek in 2006. and 2007. years.

In the study period we included 100 patients, the experimental group consisted of 50 patients who were admitted to the department for attempted suicide in the order of admission to hospital treatment, the control group consisted of 50 patients admitted to the department for other psychiatric disorders, also in the order of admission to treatment / diagnosed according to DSM IV/.

Age range of 13–18 years. There was no statistically significant difference between the two groups of subjects according to age (χ2 = 5289, df = 5, p = .382) and according to sex (χ2 = .694, df = 1, p = .405). In the suicidal group 38 patients (76%) reported traumatic experiences /most in family context/ while in nonsuicidal group 27 patients (54%) what is statistical difference (χ2 = 5319, df = 1, p = .021).

In daily psychiatric work we must focus on adolescents who have experienced traumatic experiences and is therefore extremely important in anamnesis always ask for the lived traumatic experience. Family practitioners, specialists in educational institutions, parents and adolescents themselves have a role in early recognition of these risk factors.

Serotonin is implicated in impaired impulse control, aggression and suicidal behaviour. Low cerebrospinal fluid (CSF) concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) have been found in violent suicide attempters, suicide victims and in violent offenders. CSF 5-HIAA concentrations have both genetic and environmental determinants. Childhood trauma may have an effect on central monoamine function as an adult.

The aim of this study was to assess the relationship of CSF 5-HIAA and the exposure to and the expression of violence in childhood and during adult life measured with the Karolinska Interpersonal Violence Scale (KIVS).

42 medication free suicide attempters underwent lumbar puncture and were assessed with the Karolinska Interpersonal Violence Scale (KIVS) to assess history of childhood exposure to violence and lifetime expressed violent behaviour.

In women CSF 5-HIAA showed a significant negative correlation to exposure to violence during childhood. Furthermore, suicide attempters with low CSF 5-HIAA were more prone to commit violent acts as an adult if exposed to violence as a child compared to suicide attempters with high CSF 5-HIAA. In the non-traumatized group, CSF 5-HIAA showed a significant negative correlation to expressed violent behaviour in childhood.

Although central serotonergic function has important genetic determinants, exposure to childhood trauma may also affect serotonergic function. Low serotonergic function may facilitate aggression dyscontrol in traumatized suicide attempters.

Each psychiatric patient is potentially suicidal. However, the mentally illness people who pronounced security measure of compulsory psychiatric treatment are the particular risk group. In their current psychopathology has the greatest importance in the development of suicidal tendencies. On the other hand, many provocative external factors affect the emergence of suicidality.

The paper discusses the influence of several variables on the occurrence of suicidal tendencies: type of mental disorder, kind of crime, length of hospitalization, stigmatization and social and family acceptance.

The retrospective study included 160 patients diagnosed with schizophrenia, paranoid psychosis and mood disorders in the period since 2005 to 2009. The research is related to the relationship of “social isolation” of these patients and suicidal tendencies.

The results showed that patients diagnosed with schizophrenia exhibit the highest degree of suicidality 67, 5%. Criminal offense into the family, long hospitalization, the stigmatization of patients and not accepting of the social environment, particularly of the family are the factors that contribute to suicidality.

Misunderstanding and avoidance of the patients from the social environment and especially from the family is a common characteristic of these patients. This causes the feeling of worthlessness, rejection and helplessness. The sense of further life for them doesn’t exist. If we look at suicide as a revenge and punishment of others, than suicidality of this group of mental illness people is a good example of that.

Media reports and the official statistics published after the war in Kosova demonstrate a rising trend of suicide in general population. In the past in our clinic have been little interest in whether suicidal risk and behavior has been documented and whether these signs of risk and suicide behavior is associated with Mental disorder and PTSD.

134 offenders hospitalized in period time 2007–2009 were included. We used DSM-IV criteria, SBQ-R and assessed risk of suicide factors.

31,9% were diagnosed with personality disorder, 21,3% were psychotic, 8,5% were drug abusers, 21,3 were depressed with PTSD signs of trauma war, and 17% of them without diagnosis. Risk factors such are abnormal behavior, isolation, hopelessness, depression or other mental disorder, family problems or personal loss and drug or alcohol intoxication were important risk factors for suicidal behavior in 73% of them.12,8 % reported attempt of suicide, 14,9% of them reported that have had a plan to kill themselves, 40% reported that have told someone that are going to commit suicide, and 23,4% reported that they are likely to attempt suicide someday. Suicidal thoughts and attempts were commoner in forensic setting than in general population and were significantly associated with Personality disorder, Psychosis and PTSD.

Suicide behavior and its significant association with mental disorder play an important role and should include training programs in recognition of offenders at high risk behavior and preventive programme management in forensic settings in our country.

In this presentation Michael Fitzgerald will investigate the evidence for the clinical, genetic, and other evidence for the overlap between Autism and Attention Deficit Hyperactivity Disorder.

He will examine the questions of a similar underlying pathophysiological process and alternately a number of pathologies leading to the same clinical presentation. He will examine clinical and epidemiological overlap, overlap mechanisms, deficits in social interaction in Attention Deficit Hyperactivity Disorder, and genome wide gains in Attention Deficit Hyperactivity Disorder and Autism, candidate gene studies as well as neurochemical and treatment issues.

The issue of overlap between ADHD and Autism is being increasingly recognised.

In a child psychiatric clinic for Autism Spectrum Disorders (ASD) a long waiting list and outplacement difficulties were a substantial problem in the past years. This problem has been tackled by going back to the main focus of our treatment, ensuring that children are able to go back home to their parents after clinical treatment.

By redefining the main goal of clinical treatment in return to the family this problem has been overcome. In the search of tools to empower child and parents we adjusted the principles of Pivotal Response Treatment to our clinical setting.

To empower child and parents in order to make a return to the family possible.

The aim was to improve the learning environment in the clinical treatment groups and at home in order to increase child initiatives.

An Applied Behavior Analysis (ABA) training package was developed for the staff in order to increase learning situations in the clinic. Elements within the package are a two-day training workshop in ABA techniques, live feedback and video feedback during three months after training. For parents an ABA parent group training was developed in order to increase learning situations at home. In the training parents were introduced with ABA techniques and received video feedback. Parents participated in eight group sessions and two individual sessions.

At the time of writing this study is still in progress. At the Congress the first preliminary results will be discussed and the first conclusions will be drawn.

The traditional mental status examination, used universally in psychiatry, does not provide flexibility to accommodate the developmental perspective necessary for the examination of patients with Autism Spectrum Disorder (ASD). The Grodberg Autism Mental Status Examination (GAMSE), developed at the Seaver Autism Center for Research and Treatment, prompts the observation and recording of social, communicative and behavioral functioning in patients with ASD. The GAMSE contains 8 items, which produce a total score ranging from 0 to 16.

1. To determine the validity of the GAMSE in accurately predicting diagnostic classification based on a gold standard observational assessment.

2. To establish inter-rater reliability.

Eighty consecutive patients receiving autism diagnostic evaluations at the Seaver Autism Center were administered the GAMSE and the Autism Diagnostic Observation Schedule (ADOS) as part of standard intake procedures. The classification accuracy of the GAMSE was assessed using the ADOS as the gold standard. Inter-rater reliability on the GAMSE was also examined (n = 44).

A receiver-operating characteristic (ROC) curve analysis was used to determine a cut-off score based on the 8 items of the GAMSE. The most effective cut-off score of greater than or equal to 5 predicted outcome on the ADOS with a sensitivity of 0.94 and a specificity of 0.81. Co-rating of 44 participants on the AMSE resulted in an average measures intra-class correlation of 0.85.

Preliminary results indicate excellent classification accuracy and suggest that the GAMSE may act as a useful standardized autism assessment tool for clinical and research endeavors.

There is increasing evidence that many of the core behavioral impairments in autism spectrum disorders (ASD) emerge from disconnectivity of networks that are important for social communication. It is less clear, which specific fiber tracts are involved and how possible alterations of white matter are associated with clinical symptomatology and neuropsychololgical characteristics in ASD.

18 children with ASD and 18 carefully matched typically developing controls aged 6–12 years were examined using diffusion tensor imaging (DTI) and voxel-based morphometry (VBM). Fractional anisotropy (FA) values were correlated with symptom severity as indexed by the children's scores on the Autisms Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) and results from the Childrens Embedded Figures Test (CEFT).

Decreased FA values were identified for the fornix (FO), the superior longitudinal fasciculus (SLF) the corpus callosum and the uncinate fasciculus (UF) in the ASD group compared to controls, with most prominent differences in the UF bilaterally and the right SLF. FA values of affected fiber tracts were negatively associated with clinical measures of autistic smypotmatology and response time of the CEFT. Additionally, we observed decreased grey matter concentration in the left supramarginal gyrus.

Our findings support the hypothesis of abnormal white matter microstructure of fronto-temporal cortical networks in ASD, which are associated with core symptoms of the disorder.

Behavioral intervention is an evidence-based treatment for children with autism but there still exists some disagreement regarding how intensive the treatment needs to be. Little previous research has directly compared the effects of high to low-intensity behavioral intervention.

To compare the effects of high versus low-intensity behavioral intervention.

Compare outcomes in the area of diagnostic classification, intellectual functioning, executive functions, challenging behavior, language, socialization, and independent living skills after two years of treatment.

60 children with autism, under five years old, comprised two groups who received behavioral intervention services. The high-intensity group received 25–35 hours per week for two years and the low-intensity group received 8–15 hours per week of treatment. For all participants, a comprehensive battery of assessments was conducted prior to treatment and at annual intervals.

The high-intensity group outperformed the low-intensity group on all measures after two years of treatment.

This study provides further evidence that high intensity behavioral intervention produces greater gains than low-intensity treatment and the results suggest that children with autism under the age of five years should receive access to high-intensity treatment

The existence of mentally retarded children in the family caused despair, frustration and isolation of individual and family are and their push for diversity issues on individual family members and parents as a marital unit and the total family system as a family show.

This study compared the amount of stress parents feel mentally retarded children with parents is normal.

The study after the event (Ali - a comparison) is.The sample of 120 parents of retarded children and 120 parents of normal children using a sampling Chndmrhlh chosen. To check the source of feeling stress questionnaire stress (QRS) was used and analysis of data by independent t tests May Pearson.

Results showed that parental stress in two groups of mentally retarded children and parents have significantly different normal and feeling stress parents of mentally retarded children than parents were normal. Between mothers and fathers of mentally retarded children in terms of Nshdv significant difference in stress levels stress parents of mentally retarded children were the same.the child's gender had no impact on parent stress levels, but between the retarded child's age and parental stress there was a significant relationship, whatever the case retarded child's age increased parental stress will increase. Similarly, parental education and children backward stress there was no significant difference whatever the parents are more educated than parents with lower education have less stress.

The results show parents of mentally retarded children than normal children, parents significantly more stress they endure.

To investigate the effect of cognitive and emotional response to disease and treatment on diabetes self-management behavior. To study the effect of psychosocial factors as self-esteem, body image, different coping strategies and family factors on diabetes self-management behavior and subsequent glycemic control in diabetic adolescents.

Cross-sectional study which includes 37 controlled and 30 uncontrolled diabetic adolescents recruited from Abou El-Rich Hospital, All participants were subjected to Semi structured interview, Personal Models of Diabetes Questionnaire, Body Image Scale, Coopersmith Self Esteem Inventory, Taxonomy of Children's Coping Strategies and assessment of Glycosylated Hemoglobin.

Perceived seriousness of diabetes is higher in the group of uncontrolled diabetes (p < 0.001). Higher self-esteem in the group of controlled diabetes (14.91 ± 3.43) compared to the group of uncontrolled diabetes (10.33 ± 4.74). There was highly statistical significant difference regarding Coopersmith Self- Esteem Inventory (p < 0.001).

Lower self-esteem was more prevalent among uncontrolled diabetic adolescents. In the group of uncontrolled diabetes early age of onset, and longer duration of illness were associated significantly with lower self-esteem.

In a baseline study among 7–8 year old children with auditory vocal hallucinations (AVH), only limited functional impact of AVH was observed.

To assess AVH 5-year course and its predictors, as well as AVH 5-year incidence and its risk factors.

A sample of 337 12- and 13-year-old children were reassessed on AVH after a mean follow-up period of 5.1 years. Parents completed the Child Behaviour Checklist (CBCL). School performance was assessed.

The AVH 5-year persistence and incidence rates were 24% and 9% respectively, more new cases arising in urban areas. Both persistent and incident AVH were associated with problem behaviour in the (CBCL) clinical range, particularly at follow-up, as well as with other psychosis-like symptoms, particularly at baseline. AVH persistence was predicted by baseline AVH severity, notably in terms of external attribution of voices and hearing multiple voices, and was associated with worse primary school test scores and lower level secondary school.

First-onset AVH in middle childhood is neither rare nor neutral in terms of psychopathological and behavioural comorbidity. Persistence of AVH in early childhood similarly is not rare and associated with psychopathological, behavioural and cognitive alterations.

26.5% of psychiatric patients in Germany have minor children. More than half of these children have specific needs, which are seldom met.

To examine problems, needs and used interventions for families with a mentally ill parent in the federal state of Saxony, Germany. The study focused on outpatients and included mothers and fathers and all psychiatric disorders.

We asked all psychiatrists in the federal state of Saxony to take part in our study. All patients with minor children who came to one of the 58 participating psychiatrist's practices at an appointed date were asked to fill out a detailed questionnaire including sociodemographic data, the Strengths and Difficulties Questionnaire (SDQ), specific needs, used interventions and reasons for not using interventions. The questionnaire was developed using data from 26 expert interviews.

128 psychiatric outpatients took part in our study (78% female). The most common diagnoses were depression and anxiety disorders. More than 40% of the patients rated their children in the SDQ in an abnormal or borderline range. 22% of the children have been treated because of emotional or behavioural problems. Reasons not to use interventions were missing knowledge and fear of stigmatisation.

HELP-S for children is the first study which examines the situation of children with a mentally ill parent in an outpatient setting. Therefore, our results are an improvement in research in the field of families with a mentally ill parent and heading towards the improvement of care.

Children and adolescents experience significant emotional disorders and the prevalence of these conditions is notable. In 1999, the U.S. Surgeon General's report on children's mental health listed the following prevalence data: Anxiety disorders 13.0%; Mood disorders 6.2%; Disruptive disorders 10.3%; Substance use disorders 2%; Any Disorder: 20.9%* (*Children age 9–17 with mental or addictive disorders, combined MECA sample, 6-month prevalence.) However, there is an acknowledged dearth of pediatric mental health care professionals in the U.S. and among those professionals available, geographic and reimbursement limitations restrict access to the care available for many children and adolescents.

Primary health care providers are being encouraged to provide some of the identification and care management to offset this access problem.

Expand clinical skills of providers, develop tools for planning at state and local level, educate public about importance of early screening and diagnosis.

In 2005, the American Academy of Pediatrics convened a Task Force of members and consultants to develop recommendations and paradigms for melding physical health care and mental/behavioral care in the primary practice medical home for children and adolescents.

This project concluded in 2010 with six published papers and appendices detailing increased identification of pediatric mental health conditions, methods for primary care providers working collaboratively with families and mental health specialists, algorithms for decisions and actions, and payment mechanisms supporting parity between mental and physical care in the US third party payer system.

Paper presents the major recommendations and outcomes from this 5 year project.

Unwillingness is a fairly common misinterpretation of a child who does not know what is expected from him, does not know any better or who is incapable to perform. Behaviour to communicate distress can get overlooked and a communicative element can get over-rated. Recursive reciprocal dysfunctional interactions can ensue when the behaviour remains misinterpreted.

To illustrate a few groups of misinterpretations from conversations with children.

Any child with behaviour difficulties is assessed on his view of behaviour (ongoing assessment).

For the assessment drawings, diagrams, projective, open and hypothetical questions.Role play is also used to help the child identify with the situation.

83 children, including children with a learning disability and autism, age range6-16 years displayed opposition, challenging behaviour and self-harm. 52 had autism, one additional one was examined by Mum. 28 children had a diagnosis of ADHD All 7 children with oppositional behaviour had autism. Only 4 self-harmers were examined. 8 children with autism articulated problems respecting rules. All other children except for one young person with deliberate self-harm (+autism) explained their behaviour as a offloading and communicative. 6 described their behaviour solely as stress relief’. Adolescents without autism articulated their need to anger their parents for letting them down’. 16 articulated specific learning problems.

Behaviour problems can be a substitute for expressing emotions communicatively in children who have insufficient emotional language repertoire. The offloading behaviour does not necessary have a communicative element. Their behaviour can be a result of deficient skills.

Cognitive impairment is recognized as an important feature of psychosis in its early stages and is a determinant of prognosis and management of these disorders.

To test the cognitive functions in first psychotic episode in patients with disorders of schizophrenia, schizoaffective disorder, bipolar disorder and depression with psychotic disorder and to compare them to controls.

The study included 254 patients diagnosed according to Diagnostic and Statistical criteria of Mental disorders, 4th edition (91 schizophrenics, 21 with schizoaffective disorder, 107 with bipolar disorder and 31 with psychotic depression) and experiencing their first psychotic episode. Seventy healthy volunteers matched as regards age and sex with patients were used as controls. All are subjected to cognitive evaluation by Trail Making Test, part B, Wisconsin card sorting test 128, Benton Visual Retention Test and Wechsler Adult Intelligence Test.

All patients showed significant cognitive deterioration in all tests compared to control group. On comparing patients to each other, there was no significant difference between schizophrenics and patients with bipolar disorder, but both showed marked deterioration in comparison to depressive group.

Cognitive impairments are present in early stages of psychosis and need careful assessment and management.

Surface based MRI methods are a promising approach for the identification of cerebral shape alterations in schizophrenia [1]. In particular, investigating gyrification might offer important evidence for disturbed neurodevelopmental mechanisms in schizophrenia.

The present study is the first to compare on a vertex - wise basis mean curvature as a sensitive parameter for the identification of local gyrification changes in first episode schizophrenia.

54 patients with first-episode schizophrenia and 54 healthy control subjects underwent high-resolution T1-weighted MRI scans. Surface extraction and mean curvature calculation was performed using the Freesurfer Software package. Statistical cortical maps were created to estimate gyrification differences between groups.

A significantly increased gyrification was detected in patients relative to controls in a large right parahippocampal-lingual cortex area. A further analysis of cortical thickness of this cluster revealed concurrent significant reduced cortical thickness in patients.

This is the first study to reveal an aberrant gyrification of the medial surface in first episode schizophrenia on basis of a vertex - wise analysis of local gyrification changes of the entire cortex. Both affected areas, the parahippocampal and the lingual cortex, are of high pathophysiological relevance for schizophrenia. Thus, our data provided new in vivo evidence for an early maturational deficit of these cortical areas in schizophrenia [2].

Minor motor and sensory deficits or neurological soft signs (NSS) are frequently found in individuals suffering from schizophrenia at any stage of their illness. The basal ganglia and the thalamus are accepted as being important for both motor control and integration of sensory input. However, whether NSS are related to structural alterations of these brain regions remains controversial.

20 patients with a first-episode psychosis were investigated using high-resolution magnetic resonance imaging (MRI) at 3 Tesla. NSS were examined on the Heidelberg Scale after remission of acute symptoms and correlated with volume and shape of striatum, pallidum and thalamus by using sophisticated MRI analyses, namely VBM-DARTEL (volume) and FSL-FIRST (shape).

Results NSS scores in patients with schizophrenia were significantly associated with volumetric changes and surface alterations in all investigated areas. Associations remained significant when controlling for age, gender, education, medication and intracranial volume.

Our findings lend further support for an involvement of the basal ganglia and the thalamus in NSS.