Blood CRP levels are elevated in children and adolescents with functional neurological symptom disorder.

There is accumulating evidence that patients with functional neurological symptom disorder (FND) show activation of multiple components of the stress system-the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and brain regions involved in arousal- and emotion-processing. This study aims to examine whether the immune-inflammatory component of the stress system is also activated. C-reactive protein (CRP) blood titre levels were measured in 79 children and adolescents with FND. CRP values ≥ 2 mg/L suggest low-grade inflammation. CRP values > 10 mg/L suggest a disease process. Sixty-six percent of subjects (n = 52) had CRP titres ≥ 2 mg/L. The upward shift in the distribution of CRP levels suggested low-grade inflammation (median CRP concentration was 4.60 mg/L, with 75th and 90th percentiles of 6.1 and 10.3 mg/L, respectively). Elevated CRP titres were not explained by sex, pubertal status, BMI, or medical factors. Confounder analyses suggested that history of maltreatment (χ2 = 2.802, df = 1, p = 0.094, φ = 0.190; ß = 2.823, p = 0.04) and a diagnosis of anxiety (χ2 = 2.731, df = 1, p = 0.098, φ = 0.187; ß = 4.520, p = 0.061) contributed to elevated CRP levels. Future research will need to identify the origins and locations of immune cell activation and the pathways and systems contributing to their activation and modulation. Because functional activity in neurons and glial cells-the brain's innate effector immune cells-is tightly coupled, our finding of elevated CRP titres suggests activation of the immune-inflammatory component of the brain's stress system. A more direct examination of inflammation-related molecules in the brain will help clarify the role of immune-inflammatory processes in FND.

To go or not to go: School refusal and its clinical correlates.

Problematic school refusal that is child motivated is a serious but common presentation and a child psychiatric emergency. Mental health professionals, paediatricians, educators and parents are often required to work in tandem to alleviate concerns due to this. Prolonged absence from school may lead to immediate (educational backwardness) and far-reaching effects (psycho-social and educational maladjustment). Psychiatric morbidity is high in school-refusing children presenting to secondary and tertiary services and is associated with temperamental, family and environmental adversities. Outcomes can vary according to their age, duration of school refusal and environmental variables.

Do we really know how to treat a child with bipolar disorder or one with severe mood dysregulation? Is there a magic bullet?

Background. Despite controversy, bipolar disorder (BD) is being increasingly diagnosed in under 18s. There is scant information regarding its treatment and uncertainty regarding the status of "severe mood dysregulation (SMD)" and how it overlaps with BD. This article collates available research on treatment of BD in under 18s and explores the status of SMD. Methods. Literature on treatment of BD in under 18s and on SMD were identified using major search engines; these were then collated and reviewed. Results. Some markers have been proposed to differentiate BD from disruptive behaviour disorders (DBD) in children. Pharmacotherapy restricted to short-term trials of mood-stabilizers and atypical-antipsychotics show mixed results. Data on maintenance treatment and non-pharmacological interventions are scant. It is unclear whether SMD is an independent disorder or an early manifestation of another disorder. Conclusions. Valproate, lithium, risperidone, olanzapine, aripiprazole and quetiapine remain first line treatments for acute episodes in the under 18s with BD. Their efficacy in maintenance treatment remains unclear. There is no validated treatment for SMD. It is likely that some children who are currently diagnosed with BD and DBD and possibly most children currently diagnosed with SMD will be subsumed under the proposed category in the DSM V of disruptive mood dysregulation disorder with dysphoria.

Outcome of children with school refusal.

OBJECTIVE: To assess prospectively the psychiatric diagnostic status, psychosocial correlates, and short-term outcome of youngsters with school refusal. METHODS: Thirty-three subjects (8-16 years) presenting with school refusal to a tertiary Child and Adolescent Psychiatry service were evaluated. Instruments administered at baseline and after 3 months (including an outcome measure at 3 months) were: The Missouri Assessment of Genetics Interview for Children (MAGIC) to ascertain psychiatric diagnoses, a modified version of Parent Interview Schedule (PIS), and the Children's Global Assessment Scale (CGAS). RESULTS: Twenty-nine subjects (87.9%) had a psychiatric diagnosis at baseline. Depressive disorder (63.6%) was commonest followed by specific phobias (30.3%). Psycho-social factors influenced school refusal in a majority (87.9%). Twenty of the thirty subjects (66.6%) who could be followed-up had returned to school. Psychiatric diagnosis persisted in 16 subjects. Younger age, being last-born, no or one diagnosis, and good baseline functioning predicted a favorable outcome. CONCLUSIONS: Psychiatric morbidity is high in a clinic population of youngsters with school refusal. It is associated with temperamental, family, and other environmental adversities. Short-term outcome in these children is largely favourable in terms of return to school and global functioning.