Disruptive mood dysregulation disorders (DMDD) is new to DSM-5 and represents children with rage episodes. Medical treatment is critical but few randomized trials. DMDD may be a replacement for the diagnosis of Bipolar Disorder noted in DSM-IV with a heavy use of atypical neuroleptics. DMDD reflects a more moderate treatment of these symptoms.

Telepsychiatry referrals 6–9 year old children randomized into n = 12 = group A (11 males/1 female), n = 13 = group B (11 males/2 females). ANOVA not significant (NS) in age and gender. Group A received guanfacine (GUA) titrated to weight between 3–4 mg. Both groups received behavior support. Group B did not receive medications. Analysis by t-test comparison.

Group A showed significant improvement in frequency but not in intensity of rage episodes (P < 0.05). Major side effects include sedation and gastric irritation. Dropouts from original sample of 22 per group were based on inability to titrate, cost of drug, inability to swallow pills, worsening of symptoms with addition of an atypical neuroleptic.

GUA is a possible treatment for DMDD but there are limitations requiring further study. Group B did show improvement reflecting the utility of behavioral strategies (future studies require control groups) but GUA may provide a useful alternative to neuroleptics. Cardiovascular issues were not a problem and were assessed. Future studies are warranted.

The author has not supplied his declaration of competing interest.

Do we need to work from offices in psychiatry? The clinical interface has been debated particularly in child and adolescent psychiatry with continued beliefs related to the differences in therapeutic alliance when compared to face-to-face practice. That literature clearly shows that telepsychiatry is equal in its therapeutic effects. But not much has been written about the other advantages of telepsychiatry, which may be intuitive but needs to be documented.

The University of Toronto Telepsychiatry Program is the largest in the world with over 60 psychiatrists and 1400 sites. This is an anaectodal review of 25 years of practice using this medium outlining the advantages (ADV) and disadvantages (DADV) to this medium.

ADV: convenience from home, complete access to hospital files, physician safety during sessions, able to see multiple sites and include multisystem professionals including schools, cost effective (when compared to outreach psychiatry), simplicity of connection with minimal interference. DADV: novelty to client, quality of video to pick up very subtle nonverbal information, technical support required, capital cost to set up, mental health biases to technology.

This technology is evolving. It is essential physicians understand the issues whether it be privacy, cost, utility and clinical application. The long-term impact will likely affect future practice and allow resource sensitive care to outlying areas with the ability to impact a country's mental health significantly. Health economic data is required for future research.

The author has not supplied his declaration of competing interest.

WHO.

Health care is to be claimed unlimitedly, making sure you get better, free from symptoms, against any price, something you undergo and releases you from the responsibility to self-manage and recover.

YES WE CAN.

Care appealing to personal strength and possibilities. Care that also demands commitment, not a lack thereof. Care that apart from physical/mental functioning also deals with a spiritual dimension within a personal context. Care that deals with purpose (life goals) for both the patient and the caretaker.

Yes We Can and Positive Health has been very successful:

– perfect climate for recovery: e.g. role models, positive group dynamics, expert experience, no coercion or compulsion, structured healthy program;

– focus on strength hand abilities, coping skills, learn what is important, moral, values;

– system oriented: family therapy is mandatory;

– after-care (helping back to school/work);

– be Aware: old fellows help with prevention by visiting various schools.

Vision of Yes We Can and life story of a fellow.

The author has not supplied his declaration of competing interest.

Addiction at a young age constitute a problem of public health. Adolescence is a period at risk for the addicting conducts.

To establish the characteristics of the addiction and the psychiatric comorbidities.

We led a retrospective descriptive study which concerned 62 teenagers, having addicting conducts, followed in the outpatient clinic of the hospital Razi between January, 2013 and December, 2014.

Tobacco is the most consumed product with 90,3% of users, followed by the alcohol (59.7%).

Fifty percent consumed the cannabis.

Benzodiazepin, Trihexyphenidyl chlorhydrate, buprenorphin with high dosage and the organic solvents were raised respectively to about 14.5%, 22.6%, 12.9% and 14.5% of the patients.

The average age of initiation for tobacco was 12 years.

The most frequent motive for consultation was behaviour disorders (37.1%).

Among our patients, 43.5% had psychiatric family history, 11.3% had undergone sexual abuse during their childhood, 17.7% had histories of suicide attempts.

The found diagnoses were the dependence in a substance (25.8%), followed by the major depressive episode (14.5%), the adjustment disorder with depressed mood (11.3%) and the bipolar disorder (8.1%).

Seventeen percent of them had personality traits who would evoke the borderline personality and 11.3% antisocial personality.

It is essential to diagnose and to take care of the teenagers having addicting conducts, as early as possible, to avoid transition to a chronic state in the adulthood.

The authors have not supplied their declaration of competing interest.

Adolescents with conduct disorders (CD) often associate symptoms of executive dysfunction and developmental history of attention deficit hyperactivity disorder (ADHD). There is high-quality evidence that psychostimulants have a moderate-to-large effect on conduct problems in youth with ADHD. Lisdexanfetamine (LXD) reduces impulsivity and others ADHD symptoms, has better daylong coverage and less abuse potential than others stimulants.

To evaluate the efficacy of lisdexanfetamine associated to psychological and family interventions in these multi-problem cases.

This work presents for discussion the preliminary measures of the effectiveness and security of LXD (range between 50–70 mg, during 6 months), prescribed to seven boys, ages 15 to 17 with ADHD comorbid with severe conduct disorders. All of them were living in a Young Offender Centre, received intensive psychological and psycho-educational treatment during 6 months before and during the use of LXD. Structured clinical assessment, ADHD and Conduct Disorder Scales were performed before the onset and followed 3 and 6 months.

Measures of ADHD, and CD symptoms improved at 3 and 6 months comparing to basal measures. Secondary effects were well tolerated and all patients showed a good adherence to treatment except for one of them who was drop out because of increase of anxiety.

Evidence indicates that LXD can be beneficial and well tolerate for impulsive and aggressive behaviours in teenagers with ADHD and severe CD. Limitations are the small number of cases and those related to the controlled observation method used.

The authors have not supplied their declaration of competing interest.

Persistent encopresis is part of a fairly specific pathologic complex including personality, and familial factors. To a very large extent, interest in encopresis issues has revolved around the mother–child relationship.

In this study, we aimed to assess the psychological profile and the counter attitudes of encopretic children's mothers.

We led a retrospective and descriptive study carrying on 91 medical records of children with encopresis, followed in the outpatient child psychiatry department of the Hédi Chaker university hospital of Sfax over a period of seven years, going from January 1st, 2000 till December 31st, 2006.

In our study, emotional deprivation was noted in 62.2% of cases. Besides, repeated separations from mothers were noted in 26.4% of cases with 2.2% cases of prolonged separations. Our study also revealed that 19.8% of mothers have obsessive personality traits while 14% have rather anxious traits. Furthermore, 6.6% of encopretic children's mothers were found to have anxio-depressive spectrum disorders according to the DSM-IV-TR. Mothers’ intolerance towards encopresis was estimated at 53.3%. This intolerance was mainly reflected in physical punishment, depreciation, blame and humiliation. Toilet training was rigid in more than half of cases (62.2%).

Childhood encopresis can be viewed as a result of a maternal-child conflict. In fact, the mother–child relationship appears to be directly involved in the genesis of encopresis. Nevertheless, the role of the own child neurodevelopmental state in response to the family system should not be ignored.

The authors have not supplied their declaration of competing interest.

Perceived autonomy (PA) can be considered as the key mediating variable in promoting intrinsic motivation. Therefore, an environment that encourages autonomy increases intrinsic motivation and leads to continuance intention.

The main purpose of this study was to assess the social conditions which give rise to autonomous forms of motivation.

We led a transversal study, over four months, from June until September 2016. It included 90 adolescents aged 14–20 years and members of voluntary association in Sfax (Tunisia). PA was assessed using the “perceived autonomy in life domains” (PALD) for the life spheres of leisure, interpersonal relationships, school, and general domains.

The average age of participants was 16 (14 to 20 years). The sample was female-dominated (53%). All participants were secondary school pupils. Almost 70% were from a high socioeconomic level and over 60% had parents’ high level of education.

The mean scores of PA ranged from 117 (SD = 4.5) in general domain to 15 (SD = 4.5) in school domain.

There was a significant correlation between PA and parents’ level of education (P = 0.01), parental relationship (P = 0.01), level of family communication (P = 0.00), giving compliments (P = 0.01) and rights in decision-making (P = 0.05). The other factors that significantly enhance PA were having a good network of friends (P = 0.01) and having sports and extracurricular activities (P = 0.03).

The present findings provide additional support for the synergistic relationship between family dynamics and family relationship perceptions and PA, and emphasize the role of parents to encourage autonomy.

The authors have not supplied their declaration of competing interest.

Stuttering constitutes for children a psychological and social disability, in which the environmental context plays an important role in the installation, stabilization and aggravation or attenuation.

Our study aims to describe the socio-familial characteristics of children with stuttering.

This is a descriptive and analytical-retrospective study carried out on 80 children with stuttering and had been followed-up in the child psychiatry department of UMC Hédi Chaker Sfax (Tunisia) for more than 3 years (January 2012 to 31 December 2013).

In our study, the prevalence of stuttering in child psychiatry consultation department of Sfax is 4%. Most of the patients were either the youngest (36.25% of cases) or seniors (35% of cases).

Personal history of speech disorder had been reported in 8 children (10% of cases). Family history of speech disorder was reported in 33.75% of cases. These disorders had been kind of stuttering in 60.66% of cases, speech delay in 18.52% of cases and sound speech disorder in 7.41% of cases.

The parent–child relationship is marked by a parental rigidity in 18.6% of cases. The existence of triggering factor was noted in 37.5% of cases: traumatic situation (30% of cases), the birth of a younger sibling (22% case).

The emergence and evolution of stuttering depend on predisposing, precipitating and chronicisants factors. Identifying these factors and adopting a favorable parental attitude contribute to the fight against stuttering in children and, at least, avoid aggravation and chronicity of this disorder.

The authors have not supplied their declaration of competing interest.

The depressive states in adolescents have their specificity: they are often poorly understood by the children themselves as reduced mood and can be expressed in the growth of aggressive behaviour, stubbornness, oppositional behavior, care. Even the pre-clinical level of depression can have a significant negative impact on the lives of adolescents.

One hundred and seventy-three visually and 139 hearing impaired students of correctional boarding schools, 7–18 years old.

Children's Depression Inventory (CDI) M. Kovacs, statistical (nonparametric test Mann–Whitney).

At 20.8% the increased and at 3.1% the high risk of depression was identified. For students with visual impairments often were characterized by significantly higher scores on a scale of “anhedonia” and “incompetence”. The girls revealed significantly higher scores for total scale depression, the scale “negative mood”, “interpersonal problems” and “negative self-esteem”.

A comparative analysis of data, obtained by different researchers was held. There were no literature sources, which would have provided data about the level of depression of children with sensory impairments.

Children with sensory impairments have a greater risk of developing depression in comparison with pupils of general education schools. Therefore, a screening of children in this category on the level of depression should be obligatory in addition to clinical examination. The detected data must be taken into account in psychotherapeutic and preventive measures.

The authors have not supplied their declaration of competing interest.

The aim of this study is to present two cases of Silver–Russel Syndrome patients with behavioural problems. The male is diagnosed with ADHD, and the female shows antisocial behaviour.

Russell–Silver syndrome (RSS) is a rare disorder characterized by intrauterine growth retardation and postnatal growth deficiency along with a handful of common physical characteristics and a range of other symptoms.

Clinical observation, tests (EEG, psychological tests – IQ scale, JEPQ, Projective techniques) and interviews with the patients and their parents and foster parents.

S.H. (20 years) – is opponent, aggressive, refuses every kind of cooperation with delayed mental development.

V.M. (10 years) – premature baby (born in the sixth month) in a 40 years old mother (second pregnancy); blind on right eye and very low vision on the left eye; lost both of his parents at the age of 1.6 in a car accident; had several operations and is always under some treatments. V.M. had low school performance. The foster parent noticed that he has an attention deficit. Besides, he is very aggressive verbally and physically, has low frustration tolerance, borderline intelligence.

According to several studies that claims that patients with Silver–Russel syndrome have behavioural problems and among them, the most common are attention deficit problems; our study improves that hypothesis. Both of our patients have attention deficit problems.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

Although catatonia was conceptualized as a subtype of schizophrenia, it is now recognized to occur most commonly in the course of other psychiatric disorders, in drug-induced disorders [1] or neurologic conditions [2]. Catatonia is rarely seen together with OCD and there are a limited number of case reports in the literature [3,4].

We describe the case of a 12 year boy who presented in our clinic with mutism, negativism, immobility, social withdrawn, rigid posture, refusal to eat.

We performed a thorough psychiatric diagnostic assessment of the child as well as laboratory tests and MRI of the brain.

The child's first symptoms appeared 2 years ago: initially the child became socially withdrawn, spent most of time at his room, and became preoccupied with rituals of hand washing, walking back and forth, preoccupations with food contamination, became aggressive if someone would interrupt what he was doing, stopped going at school, and stopped calling his parents “mother” or “father”. Brain MRI showed lateral ventricular asymmetry and suboccipital cyst.

The child was put on therapy with lorazepam and sertraline. His obsessive-compulsive symptoms improved, and the apparent catatonic like features resolved and did not return over follow-up.

Catatonia is not uncommon among children and adolescents, and the relationship between OCD and catatonia is still misunderstood, but it may be an indicator of the severity of the OCD.

The authors have not supplied their declaration of competing interest.

Studying the role of neurophysiological disorders in the formation of behavior disorders in adolescents.

Two hundred and two adolescents aged 11–15 years with behavior disorders were observed. The diagnostic methods included electrophysiological, clinical psychopathological and statistical methods.

In the structure of behavioral disorders, psychopathological syndromes in adolescents have been identified: psychopathic (n = 106), asthenoneurotic (n = 50), asthenoabulic (n = 26) and anxiety-depressive (n = 20).

As a result, it was found that high seizure activity commonly observed in adolescents with anxiety-depressive syndrome (66.67 ± 10.33%); less frequently in adolescents with asthenoneurotic (40.00 ± 6.79%), psychopathic (38.71 ± 4.64%), asthenoabulic (28.57 ± 8.68%) syndromes.

At the same time, diffuse changes with dysregulation of the diencephalic-stem structures were observed in the majority of adolescents with psychopathic (61.29 ± 4.64%), asthenoneurotic (60.00 ± 6.79%), asthenoabulic (57.15 ± 9.51%) syndromes and much less frequently in adolescents with anxiety-depressive symptoms (33.33 ± 10.33%).

Dystonic rheoencephalography type was observed in a third of adolescents with psychopathic (35.48 ± 4.55%), asthenoneurotic (30.00 ± 6.35%) and anxiety-depressive (33.33 ± 10.33%) syndromes, while the hypertensive rheoencephalography type was prevailed in adolescents with astenoabulic symptoms (14.29 ± 6.73%).

Liquor hypertension in adolescents with asthenoneurotic (15.00 ± 4.95%) and psychopathic (9.67 ± 2.81%) syndromes was more common.

The statistical analysis indicated that violations of bioelectric properties of the brain with high seizure activity and dysfunction of the low stem structures and disorders of cerebral hemodynamics by dystonic type are risk factors for the formation of behavioral disorders in adolescents.

Detection of neurophysiological disorders in adolescents is an informative diagnostic method of early signs of behavioral disorders.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Suicide is one of the most leading cause of death for teenagers in the world. Suicide ideation is known risk factor for suicide completion. Suicidal adolescents rarely asked for help. The contact with the health care system is an opportunities to screen for suicidal ideation.

The aim of this study is to examine the prevalence and the risk factors of suicidal ideation among adolescents consulting in emergency.

Our study was a transversal type, descriptive and analytic. It was conducted with 106 adolescents consulting in emergency for somatic complains. Each participant filled out demographic questionnaire and suicidal ideation questionnaire (SIQ). The SIQ is a self-report instrument for suicidal ideation, appropriate for adolescents. The SIQ has 30 items. The respondent is asked to choose from a 7-point continuum (6 = “Almost every day” to 0 = “I never had this thought”) to assess the frequency of that particular thought within the last month. Cut-off score for the SIQ is a sum of 41 and higher, indicating the presence of serious suicidal ideation.

Adolescents were aged between 12 and 19 years with an average age 16.34 ± 2.54 years; 47.2% were boys. According to the SIQ, the prevalence of suicide ideation during the last month were 14.2%.

The risk factors for suicidal ideation among Tunisian adolescents were the female gender, middle school level, low family income, parents’ divorce, parental neglect, family conflicts and previous psychiatric disorder.

General physicians should regularly screen for suicidal thoughts in their adolescent patients with these characteristics.

The authors have not supplied their declaration of competing interest.

Amongst adolescents, depression is a common mental health problem. Adolescent depression is associated with distress, functional impairment and difficulties in relationships with peers and family members. Depressive symptoms, even if sub-threshold to meet diagnostic criteria for a depressive disorder, are also risk factors for these difficulties. Adolescents rarely consult for their psychological distress. Emergency departments, which are often used by adolescents in this context, constitute a privileged place to detect this suffering.

The objective of this study was to estimate the prevalence and correlates of psychological distress among adolescents seen in emergency department.

Our study was a transversal type, descriptive and analytic. It was conducted with 106 adolescents consulting in emergency department. All adolescents completed a sociodemographic data and the Adolescent Depression Rating Scale (ADRS), a screening questionnaire for depression.

The study included 106 adolescents. All of them consult for a somatic complain and none of them goes to the emergency department for a psychiatric reason. The mean age was 16.34 ± 2.54 (12→19 years). Sex ratio (♂/♀) = 0.89. The ADRS score was considered normal (score < 4) for 54.7% of the sample (n = 58) and 45.3% of adolescents (n = 48) had depressive symptoms (score ≥ 4). Depression was significantly correlated to bad school results (P = 10−3), tobacco use (P = 0.014), personal psychiatric history (P = 10−3) and family problems (P = 10−3).

Depressive symptoms are frequent among adolescents. Their consultations within emergency department provide a potential opportunity for their identification and for signposting to appropriate specialist services.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

We report the case of a 19-year-old male who was brought to our psychiatry consultation by his family for behavioural disorders and poor school performance of years of evolution.

We found ourselves before a tall, thin, childish, suspicious, perplex, inhibited and minimizer patient, so we sent him to our hospital for psychiatric admission, where he showed a flowery delirium of mystic, religious and megalomaniac content; complex visual and auditory hallucinatory phenomena; and where he was diagnosed of acute polymorphic psychotic disorder and autism spectrum disorder with marfanoid habit. Therefore, we suspected a Lujan–Fryns syndrome and requested genetic confirmation. Risperidone was prescribed as solo treatment, with a rapid control of the symptoms.

Lujan–Fryns syndrome, first described in 1984, corresponds to a sequence mutation in exon 22 of med12 gene of chromosome X. It is hard to suspect and diagnose before puberty. Those affected have marfanoid habit and also other psychiatric manifestations such as autistic behaviour, mild-moderate mental retardation (there are some reported cases with normal intelligence), language disorders, emotional instability, aggressiveness, hyperactivity, shyness which can be extreme, obsessive-compulsive disorder, isolation, delusions, visual and auditory hallucinations, and there are cases that describe schizophrenia. Its diagnosis requires adequate physical and psychopathological examination, and it is established with clinical suspicion and genetic confirmation. There are very few cases described and there is little bibliography available about Lujan–Fryns syndrome [1].

The authors have not supplied their declaration of competing interest.