Project Extension for Community Health Outcomes (ECHO) Autism: A Successful Model to Increase Capacity in Community-Based Care.

Individuals with autism spectrum disorder (ASD) struggle to access high-quality health care due to the shortage of trained providers. ECHO (Extension for Community Healthcare Outcomes) Autism is a unique educational program that allows ASD experts to provide knowledge and skills to professionals in local communities to deliver evidence-based care to children with ASD and their families. The model teaches clinicians how to screen and diagnose ASD, as well as manage common co-occurring medical and mental health issues. ECHO Autism is particularly useful for addressing the complex needs of children with ASD and reducing disparities often present in rural and underserved communities. The model can be disseminated globally due to its flexibility in accommodating local and regional differences in social norms and constructs. This article provides an overview of the format of the ECHO Autism model, data supporting the model's efficacy, and discusses future research directions.

Orthorexia nervosa - a separate clinical entity, a part of eating disorder spectrum or another manifestation of obsessive-compulsive disorder? / Ortoreksja ­ oddzielna jednostka chorobowa, spektrum zaburzen odzywiania czy wariant zaburzen obsesyjno-kompulsywnych?

OBJECTIVES: The aim of the study was to determine the prevalence of orthorexia nervosa in the population of adolescents and young adults, as well as to determine whether orthorexia is a separate clinical entity, a part of eating disorder or another manifestation of obsessivecompulsive disorder. METHODS: The study group consisted of 864 subjects (599 females and 265 males). The mean age of female participants was 20.21±3.27 years, and of male participants 18.93±3.67 years. As a part of the study, we used a proprietary questionnaire to collect patient data, as well as following diagnostic questionnaires: ORTO-15 by Donini et al. (Polish version validated by Janas-Kozik et al.), EAT-26 by Garner and Garfinkel, and MOCI (Maudsley Obsessive Compulsive Inventory) by Hodgson and Rachman. The results were analysed statistically. RESULTS: 27% of subjects were found to be at risk of orthorexia nervosa (score of 35 was considered a cut-off point). These subjects achieved significantly higher scores in the EAT-26. There were no statistically significant differences in the MOCI scores. The highest risk of orthorexia was observed in subjects aged 13-16 years old (junior secondary school) and the lowest in 16-19-year-olds (senior secondary school). Individuals with suspected orthorexia tended to have significantly higher BMI. Specific analysis of environmental features will be exposed in the next issue. CONCLUSIONS: Orthorexia nervosa is not a separate clinical entity. It does not belong to the OCD spectrum, but meets the criteria of eating disorder spectrum.

The prevalence and risk factors of orthorexia nervosa among school-age youth of Pomeranian and Warmian-Masurian voivodeships. / Rozpowszechnienie i czynniki ryzyka ortoreksji wsród uczacej sie mlodziezy województwa pomorskiego i warminsko-mazurskiego.

OBJECTIVES: The aim of the study was to determine the prevalence of orthorexia nervosa among school-age youth from Pomeranian and Warmian-Masurian voivodeships, as well as search for factors which enhance the risk of orthorexia nervosa. An attempt was made to find differences in occurrence of orthorexia nervosa among youth from big cities and small towns. METHODS: The study group consisted of 864 subjects (599 females and 265 males). The mean age of female participants was 20.21+/-3.27 years, and of male participants - 18.93+/-3.67 years. In the study, we used a proprietary questionnaire to collect patient data, as well as following diagnostic questionnaires: ORTO-15 by Donini et al. (Polish version validated by Stochel, Janas-Kozik et al.), EAT-26 by Garner and Garfinkel, MOCI (Maudsley Obsessive-Compulsive Inventory) by Hodgson and Rachman, and BDI-II (Beck Depression Inventory II) by Beck. The results were statistically analyzed. RESULTS: 27% of subjects were found to be at risk of orthorexia nervosa (score of 35 was consideredas cut-off point). The highest score of risk was observed in the group of students of junior secondary school, the lowest in the group of students of senior secondary school. There were no statistically significant differences in the risk of orthorexia in groups from big city and small town. Studied social factors did not show impact on the risk of orthorexia. Individuals with suspected orthorexia have notably higher BMI. There were no statistically significant differences in occurrence and severity of depression in the study group. Depression occurred in 25% of the subjects;the link between depression and orthorexia was not confirmed. CONCLUSIONS: On the basis of the study, it was indicated that the group of the highest risk are students of junior secondary school, probably because of the great interest in physical attractiveness in this period of life, as well as individuals with higher BMI. We believe that for more effective diagnosis it would be advisable to adopt a cut-off point for orthorexia in the ORTO-15 at the level of 35 points, as postulated by Stochel, Janas-Kozik et al. The 40-point threshold is associated with considerable overdiagnosis of the phenomenon.

Emotional expression in psychiatric conditions: New technology for clinicians.

AIM: Emotional expressions are one of the most widely studied topics in neuroscience, from both clinical and non-clinical perspectives. Atypical emotional expressions are seen in various psychiatric conditions, including schizophrenia, depression, and autism spectrum conditions. Understanding the basics of emotional expressions and recognition can be crucial for diagnostic and therapeutic procedures. Emotions can be expressed in the face, gesture, posture, voice, and behavior and affect physiological parameters, such as the heart rate or body temperature. With modern technology, clinicians can use a variety of tools ranging from sophisticated laboratory equipment to smartphones and web cameras. The aim of this paper is to review the currently used tools using modern technology and discuss their usefulness as well as possible future directions in emotional expression research and treatment strategies. METHODS: The authors conducted a literature review in the PubMed, EBSCO, and SCOPUS databases, using the following key words: 'emotions,' 'emotional expression,' 'affective computing,' and 'autism.' The most relevant and up-to-date publications were identified and discussed. Search results were supplemented by the authors' own research in the field of emotional expression. RESULTS: We present a critical review of the currently available technical diagnostic and therapeutic methods. The most important studies are summarized in a table. CONCLUSION: Most of the currently available methods have not been adequately validated in clinical settings. They may be a great help in everyday practice; however, they need further testing. Future directions in this field include more virtual-reality-based and interactive interventions, as well as development and improvement of humanoid robots.

Autism spectrum disorder (ASD) in girls. Co-occurring psychopathology. Sex differences in clinical manifestation. / Zaburzenia ze spektrum autyzmu (ASD) u dziewczat. Wspólwystepujace zespoly psychopatologiczne. Róznice miedzyplciowe w obrazie klinicznym.

OBJECTIVES: The study aims to define the differences in clinical manifestation among adolescent girls and boys with autism spectrum disorder (ASD). METHODS: The study group consisted of 15 adolescent girls and 16 adolescent boys with diagnosis of autismor Asperger syndrome and their parents. Adolescents were assessed with ADOS (Autism Diagnostic Observation Schedule, Polish adaptation of the assessment), algorithms of ADOS and ADOS-2 (revised version) were compared. Structured interview was conducted with parents, they fulfilled AQ (Autism Quotient), ASAS (Australian Scale for Asperger Syndrome), GQ-ASC (Girls' Questionnaire for Autism Spectrum Conditions). Medical records were analyzed. Results were analyzed using statistical methods. RESULTS: Patients were assessed with ADOS Module 4. Results indicated statistically significant differences between ASD girls and ASD boys in communication section, both verbal and gestures. The mean scores of AQ for ASD girls and ASD boys were M = 33.0 and M=30.9, and of ASAS M =57% and M =61% respectively. ASD girls had more psychiatric hospitalisations than ASD boys (60% vs. 31%), and they were more often treated with antidepressants (67% vs. 31%), anxiolytics (20% vs. 6%), mood stabilizers (40% vs. 19%). ASD boys were more often treated with psychotropic medications (50% vs. 47%) and stimulants (44% vs. 20%) than ASD girls. CONCLUSIONS: ASD girls are at risk of receiving non-spectrum classification in ADOS or ADOS-2 while their developmental history and clinical manifestation confirm ASD. Clinical data suggests that ASD girls present more abnormalities in sensory profile. ASD girls are at greater risk for developing anxiety, depression, suicidal ideation, and for psychiatric hospitalization. ASD boys appear to be at greater risk for co-occurring ADHD, OCD and tics.

[Pedophilia--a review of literature, casuistics, doubts]. / Pedofilia--przeglad literatury, ilustracja kazuistyczna, dylematy.

The main purpose of this article is presentation of several basic issues related to the phenomenon of child sexual molesters and recognition of pedophilia as a significant social problem. The article, supplemented by casuistic illustration showing adolescents with sexual behavior disorders is giving rise to the following question: do they progress in their inappropriate behaviors to grow into adult molesters or do they stop anywhere along the way of their development? Casuistry, in the intention of the authors, is the background for discussion about prevention of child sexual abuse. This article presents also a review of the current knowledge about child sexual molesters. The topics include: the definition of pedophilia itself, which varies in the literature depending on the types of activities, kinds of victims and the circumstances in which the perpetrator acts, through to the recognition of symptoms of pedophilia as well as its consequences. It includes both intra-familial and extra-familial child sexual abuse and their offenders. The more, that the history of child sexual abuse is associated with numerous long-term physical, psychological, behavioral, interpersonal and social effects on the victim. The examinations made among pedophilic molesters have shown structural and functional temporal-limbic abnormalities, including abnormalities in the amygdala and it is possible that the pedophilic inclinations are secondary to neurodevelopmental perturbations and other neuropsychiatric syndromes.

Autistic traits in male and female students and individuals with high functioning autism spectrum disorders measured by the Polish version of the Autism-Spectrum Quotient.

So far no standardized screening instrument for autism spectrum disorders for adults has been developed in Poland. The main aim of the study was to explore the properties of the Polish version of the Autism-Spectrum Quotient (AQ), especially its reliability and discriminating power. The second purpose was to establish whether the pattern of sex and area of study differences in the amount of autistic traits found in other countries also exist in Poland. The groups in the study included students (n = 2819), adults with ASD (n = 60) and a non-clinical sample (n = 60) matched with the ASD group for age, sex, education and place of residence. The Polish version of AQ proved to be reliable, although--as in studies conducted in other countries--the internal consistency coefficients for subscales (with exception for social skill) were low. ASD diagnosis was the most powerful determinant of AQ scores. Sex differences in autistic traits and a relationship between autistic traits and area of study were found.

[Iatrogenic influence of testosterone therapy among persons with Klinefelter Syndrome]. / Jatrogenne skutki suplementacji testosteronu u osób z Zespolem Klinefeltera.

The purpose of this work is a presentation of cases of persons with Klinefelter Syndrome where, most probably--as a result of testosterone supplementation therapy, some aggressive behaviours occurred requiring implementation of pharmacotherapy and psychiatric hospitalisation. The authors contemplate adequacy of standard hormone treatment where the main purpose is to improve the quality of life of the karyotype 47, XXY patients described. The article has been enhanced by a theoretical introduction into the basic subject which is the Klinefelter Syndrome.

[Transsexualism or internalized homophobia--case study]. / Transseksualizm czy zinternalizowana homofobia--studium przypadku.

The objective of the paper is the presentation of ideas on human sexuality development, disorders concerning this area, particularly transsexualism, homosexualism and social stigmatization of homosexuals with its consequences. Symptoms reported and identified by adolescents such as sexual identity disorder, can masque a different problem, for instance lack of self-acceptance of homosexual orientation in a person from a conservative environment. The presented case study illustrates this problem.

[Anxiety disorders in children suffering from anorexia nervosa]. / Zaburzenia lekowe u dzieci wspólwystepujace z jadlowstretem psychicznym.

AIM: The basic aim of the study was the estimation of comorbidity of anxiety disorders (including obsessive-compulsive disorders) and anorexia nervosa. The next aim was to make out whether and what kind of influence is exerted on them by environmental (especially the family's) and children's own conditioning. A group of 30 children (the average age - 13.5 years), 27 girls and 3 boys treated for the first episode of anorexia nervosa was considered. METHOD: Structured interview from patients as well as their parents, clinical observation, psychiatric and psychological investigation with the use of The Depression Rating Scale for Children (Elva o. Poznansky and comp.), The Hamilton Depression Rating Scale and The Children's Yale-Brown Obsessive-Compulsive Scale. Results were worked out with the help of statistical methods. RESULTS: The comorbidity of anxiety disorders, OCD and anorexia nervosa in the considered group was frequently observed. Anxiety disorders were observed in the group of 16.7% patients in which 6.7% suffered from generalized anxiety disorders and 10% - from social phobia. According to the anamnesis - 40% of the investigated children, suffered from separation anxiety in the past, 13% - manifested social phobia and 10% - experienced generalized anxiety disorders. Together, during the whole life of those studied, anxiety disorders were observed in 40% of the children. Statistically, in the examined group, depression was significantly frequent amongst children suffering from anxiety disorders and anorexia nervosa (p<0.01). The comorbidity of OCD and anorexia nervosa appeared in 13.3% of the cases. As for intensity--in one case it was extremely severe, in another one--moderate and in two other cases--mild. In the investigated group of children OCD appeared in the restricting subtype of anorexia nervosa. All children with OCD and anorexia nervosa suffered from severe depression syndromes. CONCLUSIONS: In the considered group of children suffering from anorexia nervosa the number of biological as well as psychological events which could predispose to anxiety disorders (including OCD) was found.

[Psychopathological syndromes and the problem of youth sexual orientation]. / Zespoly psychopatologiczne a problem orientacji seksualnej u mlodziezy.

AIM: The objective of the paper is to present of ideas on relationships between sexual orientation and sanity of individuals. METHOD: The authors present a review of scientific news published by researchers, enhanced with case studies and formation of crucial factors leading to the evolution of psychiatric perturbations of the described cases. RESULTS: Analysis of the papers and self made research lead to the conclusion, that the most important risk factor for psychopathologic syndrome evolution in homosexuals and bisexuals is their social stigmatisation.

[Depression syndromes in patients suffering from anorexia nervosa]. / Zaburzenia depresyjne wspólwystepujace z jadlowstretem psychicznym.

AIM: The purpose of the study was the estimation of comorbidity of depressive syndromes and anorexia nervosa (based on criteria of ICD-10 and DSM-IV). A group of 30 children (average age--13.5), 27 girls and 3 boys suffering from a first episode of anorexia nervosa was considered. METHOD: Anamnesis from patients and their parents, clinical observation, the psychiatric investigation with use of The Depression Rating Scale for Children (Elva o. Poznanski and comp.) and the Hamilton Depression Rating Scale. RESULTS: The comorbidity of depressive syndromes and anorexia nervosa was frequently observed. 73.3% children suffered from depressive syndromes in the course of anorexia nervosa. As for intensity--in 33% it was moderate, in 20%--severe, and in 20%--mild depression. In the investigated group of children depressive syndromes appeared in the bulimic subtype of anorexia nervosa in 88.8% cases and in the restricting subtype in 72.2%. Statistically, in the considered group, the depression was significantly frequent in the first and the second degree relatives. CONCLUSIONS: In the examined group, the number of biological as well as psychological events which could predispose to depression was found. However, the children were not suffering from depression until they were sick from anorexia nervosa and their bodies were not cachectic.

[Characteristics of the forming personality in children suffering from anorexia nervosa]. / Cechy ksztaltujacej sie osobowosci u dzieci chorujacych na jadlowstret psychiczny.

AIM: The evaluation of forming personality in 30 children (27 girls and 3 boys) suffering from anorexia nervosa (average age--13.5). METHOD: Anamnesis from patients and their parents, clinical observation, psychiatric investigation, psychological investigation with use of following methods: The Thematic Apperception Test, Colorful Pyramids Test, The House-The Tree-The Man Test. RESULTS: After the conducted investigation and observation, the characteristics of the forming incorrect personality were observed in 80% of examined children. According to DSM IV classification, in 50%--from the cluster C, and in 30% cases--the cluster B. According to ICD-10 classification: 26.6% attributes of dependent personality, 16.6%--histrionic personality, 13.3% avoiding personality, 10%--anancastic personality, 6.7% borderline personality and 6.7% antisocial personality. CONCLUSIONS: There is predominating opinion in literature, connecting restrictive type of psychical anorexia, with disorders of personality of anxiety type--the cluster C, and the figure bulimic--with personality the cluster B. Those results were confirmed with statistical significance in the conducted examinations.

[An attempt to evaluate the health condition and social functioning of anorectic females--a follow-up study]. / Próba oceny stanu zdrowia i funkcjonowania spolecznego pacjentek z zaburzeniami jedzenia--badanie katamnestyczne.

AIM: An attempt to evaluate, on the basis of follow-up data, the health condition and social functioning in patients with anorexia nervosa, four years after hospitalisation. METHOD: Anamnesis from 20 young females (aged 17-24, average 21.7) hospitalised for the treatment of anorexia nervosa in The Department of Developmental, Psychotic and Geriatric Psychiatry, Medical University in Gdansk. RESULTS AND CONCLUSIONS: 50% of those studied suffer protractedly, with periods of remission or intensity of symptoms. 80% of women have achieved normalisation of weight (30% of them seemed to be healthy and well functioning; 50% of them is in partial remission), 20% still fulfill DSM-IV criteria for anorexia nervosa. Currently 60% menstruate (10% of them without hormonal treatment). In the examined group, 50% appear to have an abnormal manner of nutrition. Abnormal behaviour caused weight loss in 70% of those studied. Most of the females (55%) consider themselves overweight, 75% have weight-gain phobia.

[Prodromal symptoms of schizophrenics syndrome in children and adolescent]. / Objawy prodromalne zespolów schizofrenicznych u dzieci i mlodziezy.

This presentation concentrates on modality and frequency analysis of prodromal schizophrenic symptoms of the children and adolescent. A sample (n-50) of children between 8 and 19 years was tested by structural interview. There were observed the signs resembling following symptoms: negative symptoms (74%), anxiety disorders (42%) and obsessive-compulsive disorders (20%).