Changes in Emotional and Behavioral Problems Between 2000 and 2011 Among 16-Year-Old Polish Children: A Cross-Sectional Study.

Since after the second world war there has been an increasing number of studies investigating secular changes in adolescent mental health. Although no general trends could be outlined, the majority of studies show at least partial deterioration of psychological wellbeing from year 2000 on. Our study adds to this knowledge by exploring changes in self-declared emotional and behavioral problems in Poland, which is a part of post-communist Europe. In this paper, we compared responses on the Youth Self-Report by Polish 16-year-olds from 2000 and those from 2011. Two independent samples consisted of 259 (year 2000) and 185 (year 2011) 16-year-olds of both genders, drawn from randomized, normative, school-based groups. We analyzed linear, ordinal and binary logistic regression models. The results revealed that teenagers from 2011 reported more self-rated internalizing and total problems. Social and thought problems also rose significantly. Gender related time trends hint at a male increase in externalizing, aggressive behaviors and anxiety/depression. Caseness rose significantly in most scales with female gender being an additional risk factor for internalizing and total problems. No reduction in self-reported emotional and behavioral problems was detected.

Genetic tests in major psychiatric disorders-integrating molecular medicine with clinical psychiatry-why is it so difficult?

With the advent of post-genomic era, new technologies create extraordinary possibilities for diagnostics and personalized therapy, transforming todays' medicine. Rooted in both medical genetics and clinical psychiatry, the paper is designed as an integrated source of information of the current and potential future application of emerging genomic technologies as diagnostic tools in psychiatry, moving beyond the classical concept of patient approach. Selected approaches are presented, starting from currently used technologies (next-generation sequencing (NGS) and microarrays), followed by newer options (reverse phenotyping). Next, we describe an old concept in a new light (endophenotypes), subsequently coming up with a sophisticated and complex approach (gene networks) ending by a nascent field (computational psychiatry). The challenges and barriers that exist to translate genomic research to real-world patient assessment are further discussed. We emphasize the view that only a paradigm shift can bring a fundamental change in psychiatric practice, allowing to disentangle the intricacies of mental diseases. All the diagnostic methods, as described, are directed at uncovering the integrity of the system including many types of relations within a complex structure. The integrative system approach offers new opportunity to connect genetic background with specific diseases entities, or concurrently, with symptoms regardless of a diagnosis. To advance the field, we propose concerted cross-disciplinary effort to provide a diagnostic platform operating at the general level of genetic pathogenesis of complex-trait psychiatric disorders rather than at the individual level of a specific disease.

Parent-reported behavioural and emotional problems in Albanian Kosovar children.

AIMS: Because no epidemiological study has been conducted of children's mental health problems in Kosova, which experienced a traumatic war in 1998-99, we conducted the first national epidemiological survey of children's mental health ever undertaken in Kosova. METHODS: Participants were 1374 Kosovar children ages 6-18 recruited through schools (60% from urban areas). Parent-reported behavioural and emotional problems were assessed using the Child Behaviour Checklist (CBCL/6-18). Kosovar findings were compared with findings from five other Central and Eastern European societies (Poland, Romania, Lithuania, Serbia and Croatia), plus the US. RESULTS: Confirmatory factor analysis (CFA) indicated that the CBCL 8-syndrome model manifested good fit to the Kosovar data. Mean item ratings and Cronbach's alphas were very similar to those of the other six societies. Kosova's mean Total Problems score fell in the middle of the range of the seven societies compared. CBCL scores were higher for adolescents (12-18), urban children, and those whose parents had limited education compared with younger (6-11), rural, and more socially advantaged children. CONCLUSIONS: Strong consistency was found between Kosovar findings and those for neighbouring countries with respect to CFA results, mean item ratings, alphas and problem score levels. Results of this epidemiological survey highlight the utility of the CBCL for identifying Kosovar Albanian children with mental health service needs.

Evaluation of the LIM homeobox genes LHX6 and LHX8 as candidates for Tourette syndrome.

The etiology and pathophysiology of Tourette Syndrome (TS) remain poorly understood. Multiple lines of evidence suggest that a complex genetic background and the cortico-striato-thalamo-cortical circuit are involved. The role of Lhx6 and Lhx8 in the development of the striatal interneurons, prompted us to investigate them as novel candidate genes for TS. We performed a comparative study of the expression of Lhx6 and Lhx8 and investigated genetic association with TS using two samples of trios (TSGeneSEE and German sample - 222 families). We show that Lhx6 and Lhx8 expression in the forebrain is evolutionarily conserved, underlining their possible importance in TS-related pathophysiological pathways. Our tagging-single nucleotide polymorphism (tSNP)-based association analysis was negative for association with LHX8. However, we found positive association with LHX6 in the TSGeneSEE sample (corrected P-value = 0.006 for three-site haplotype around SNP rs3808901) but no association in the sample of German families. Interestingly, the SNP allele that was identified to be significantly associated in the TSGeneSEE dataset, showed an opposite trend of transmission in the German dataset. Our analysis of the correlation of the LHX6 region with individual ancestry within Europe, revealed the fact that this particular SNP demonstrates a high degree of population differentiation and is correlated with the North to South axis of European genetic variation. Our results indicate that further study of the LHX6 gene in relation to the TS phenotype is warranted and suggest the intriguing hypothesis that different genetic factors may contribute to the etiology of TS in different populations, even within Europe.

Prevalence of tic disorders among schoolchildren in Warsaw, Poland.

OBJECTIVE: To estimate the prevalence and to describe clinical characteristics of tic disorders in 12-15 year old Warsaw schoolchildren. METHOD: Children attending 24 randomly selected schools were screened by inquiring their parents and teachers. Children indicated as tic-positive by the screening procedure were investigated using semi-structured questionnaires and the Polish version of YGTSS scale. A validity study involved random selection and investigation of 130 non-indicated subjects. RESULTS: Out of 1,579 screened children, 104 met criteria for tic disorders, giving a lifetime prevalence of 9.9% (95% CI 7.1-12.6%) and a point prevalence of 6.7% (4.3-9.1%). Lifetime prevalence of ICD-10 tic disorders was 2.6% (95% CI 1.2-4.1%) for transient tic disorder (TTD); 3.7% (1.9-5.4%) for chronic tic disorder (CTD); 0.6% (0.2-0.9%) for Tourette disorder (TD); and 2.9% (1.2-4.6%) for non-specific tic disorder. Screening procedure had high sensitivity (92%) and low positive predictive value (18%). CONCLUSION: Tic disorders are common among Warsaw schoolchildren, have mild severity and form a continuum. The present study has confirmed numerous problems with studying neurobehavioral disorders in general population not referred to physicians, and stressed out the need to improve education on tic disorders in the general public.

Attitudes of enuretic children towards their illness.

UNLABELLED: The aim of this study was to establish the attitudes of enuretic children towards their illness and to assess the correlation between children's attitudes and biological and medical variables describing the clinical picture and course of enuresis. Fifty children were included (31M, 19F), aged 8-18 y (mean 12.74 y), all with the diagnosis of enuresis. The reference groups consisted of 60 children with asthma and 40 children with chronic heart disease, aged 8-12 y. The Polish version of the Child Attitude Toward Illness Scale (CATIS) was administered to all the children and structured interviews concerning demographic and medical data were conducted with the parents. There were no significant differences in median CATIS scores between the subgroups divided according to age, type of enuresis and family history of enuresis. There was no significant correlation between the CATIS score and frequency of enuresis and number of therapeutic failures. The girls had significantly lower median CATIS scores than the boys (p = 0.03). The difference in median CATIS scores between genders was significant only for the older group aged 14-18 y. The older girls had the lowest CATIS scores. Enuretic children were found to have statistically significantly more negative attitudes towards their illness than children with asthma (p = 0.006) and children with chronic heart disease (p = 0.067). CONCLUSION: Enuretic children had more negative feelings about their illness than children with other chronic conditions. This negative attitude was not related to demographic or clinical data except for gender. The adolescent girls demonstrated the most negative attitude towards enuresis.

Bone mineral density in adolescent girls with anorexia nervosa--a cross-sectional study.

UNLABELLED: The total body and lumbar spine bone mineral density (BMD) were measured in order to determine the prevalence and possible risk factors of decreased BMD in anorexia nervosa (AN). SUBJECTS: Sixty-one in-patient girls with DSM III-R AN: age 14.7+/-2.16 years; duration of AN 12.9+/-15.1 months; percentage of ideal body weight 70+/-8.7%; body mass index score -1.62+/-0.79. METHOD: Total body (in 61 patients) and lumbar spine BMD (in 43 patients), content of lean and fat tissue mass were measured by DXA during the first month of treatment. RESULTS: Low total body BMD was found in 23.7% and low lumbar spine BMD in 36.6% of patients. There was a negative correlation between BMD and age, age of menarche, degree of undernourishment, duration of AN and amenorrhea. A step-wise linear regression analysis revealed that age of menarche was the most important factor related to BMD in this group.

Obsessive-compulsive disorder and acquired toxoplasmosis in two children.

Two children presenting symptoms of obsessive-compulsive disorder (OCD) and with acquired toxoplasmosis are described and the possibility of a previously rarely reported association between OCD and acquired toxoplasmosis is discussed. Case 1 is a 14-year-old boy with Tourette syndrome (TS), attention deficit hyperactivity disorder (ADHD) in partial remission and a three-year history of OCD referred to our department due to an acute deterioration of obsessive-compulsive (OC) symptoms. Case 2 is an 11-year-old boy referred to our department because of a two-year history of OCD. The OC symptoms were observed immediately following an infection. In both cases laboratory tests confirmed the diagnosis of acquired toxoplasmosis. The pharmacological therapy of T.gondi infection without any psychopharmacological treatment caused remission or significant improvement regarding OC symptoms.

Transient dystonias in three patients treated with tiagabine.

PURPOSE: Tiagabine (TGB) is a new antiepileptic drug (AED) with gamma-aminobutyric acid (GABA)ergic mechanism of action. GABAergic compounds may influence the extrapyramidal system, probably via modulation of dopaminergic nigrostriatal neurons. A well-known side effect of TGB is probably dose-related extrapyramidal tremor. To our knowledge, acute dystonias associated with TGB treatment have yet to be described. METHODS: Three patients with transient acute dystonic reactions while taking TGB as add-on therapy with carbamazepine (CBZ) are presented. The focal limb dystonia in one case, an oromandibular dystonia in second, and writer's cramp in third one were observed. RESULTS: In all cases dystonic movements resolved spontaneously without discontinuation of TGB therapy and without any concomitant treatment. CONCLUSIONS: Tiagabine may cause various mild extrapyramidal side effects. All three cases reported were diagnosed with transient possibly drug-related dystonia after increase in TGB dose. It remain unclear whether dystonic movements are specific for patients treated with TGB/CBZ bitherapy.

Bone mineral content and bone mineral density in adolescent girls with anorexia nervosa--a longitudinal study.

OBJECTIVE: Total body and lumbar spine bone mineral density (BMD-TB, BMD-L) and total body bone mineral content (BMC-TB) were measured to establish the course of bone demineralization in anorexia nervosa and the clinical factors influencing BMC-TB and BMD changes during treatment. METHOD: Forty-two girls with DSM III-R anorexia nervosa, age 14.7+/-2.4 years. BMC-TB, BMD-TB and BMD-L were measured in approximately 7-month intervals for 27.8+/-4.1 months using DXA. RESULTS: Despite nutritional improvement, there was an initial decrease of BMD-L, and no change in BMC-TB and BMD-TB. an increase in BMC-TB and BMD was observed after approx. 21 months from the beginning of the study. CONCLUSION: The improvement in BMC-TB and BMD was related to changes in nutritional status and was significantly marked in younger patients, with earlier anorexia onset and before menarche.

[Features of autism, autistic traits, autism: retrospective analysis of clinical symptoms in children treated in the Pediatric Psychiatric Clinic]. / Cechy autyzmu, rysy autystyczne, autyzm: analiza retrospektywna objawów klinicznych u dzieci leczonych w Klinice Psychiatrii Dzieciecej.

All currently accepted definitions of autism include three main criteria which have to be met for a diagnosis to be made. These are: disturbance of reciprocal social interaction, disturbance of communication and restriction of normal variation in behaviour and interests. The criteria used in the ICD-10 include all these domains. On the other hand, the number of mentally handicapping conditions and brain damage syndromes show the same triad of symptoms. Many of patients actually fulfill all currently accepted criteria for autism, but, for some reason do not receive the diagnosis. We analysed retrospectively the clinical picture of all children hospitalised in Department of Child Psychiatry in the last 10 years before the introduction of ICD-10 in Poland (1986-1996) and diagnosed as having autism, autistic traits or features. The group consist of 19 children (0.8% of all children hospitalised in that time). 4 of them had been diagnosed as having autism, 4 as having features of autism and 11 as having autistic traits. Additional diagnoses were: organic brain damage in 2 children, carnitine deficiency and cerebral palsy in 1 child and minimal brain dysfunction in 3 cases. Despite of the diagnosis all children met current ICD-10 criteria for autism or atypical autism, according to age of onset. There were no significant differences in constellation of symptoms included in ICD-10 between groups divided according to the past diagnosis.

[Hyperactivity and behavioral disorders in Sanfilippo A (mucopolysaccharidosis type IIIA)--case report and review of the literature]. / Nadpobudliwosc psychoruchowa i zaburzenia behawioralne w przebiegu choroby Sanfilippo A (mukopolisacharydozy typu IIIA)--opis przypadku i przeglad pismiennictwa.

Sanfilippo syndrome is one of mucopolysaccharidoses. The main symptom of this syndrome is regression of psychomotor development and neurological signs which occur between 2 and 6 years old. Unlike other mucopolysaccharidoses body dysmorfic features are relatively rare. Course of disease is progressive, most of the patients die before 20. The diagnosis is often difficult. In our opinion in each case presenting psychomotor regression of unknown origin metabolic disease should be excluded (e.g. urine analysis for mucopolysaccharides should be indicated). A 6 year old boy has been under psychiatric and psychological control since he was 3 due to psychomotor retardation, hyperactivity, autistic features, and behavioural disorder. In paediatric examination thickened facial features, coarse hair, knock-knees, short neck were noted. Genetic consultation set up the diagnosis of mucopolysaccharidosis type IIIA (Sanfilippo A disease).

[Schizophrenia, schizophrenia-like disorders and delusional disorders in patients with anorexia nervosa: literature review and report of 3 cases]. / Schizofrenia, zaburzenia typu schizofrenii i urojeniowe u pacjentów z rozpoznaniem jadlowstretu psychicznego--przeglad pismiennictwa, prezentacja 3 przypadków.

The authors present the review of literature concerning schizophrenia, schizophrenia type and delusional disorders in patients with a lifetime diagnosis of anorexia nervosa (AN). The authors describe also 3 patients (2 cases of paranoid schizophrenia and 1 case of catatonic syndrome). The clinical features in all patients are discussed. In 1 patient the catatonic symptoms occurred within the context of AN, (perhaps due to metabolic disturbances) and in 2 other cases the psychotic features occurred after recovery from AN. The authors discuss the occurrence of psychotic features in AN, and the possible function of starvation and metabolic disturbances in their aetiology.

Psychogenic seizures in obsessive-compulsive disorder with poor insight: a case report.

Psychogenic seizures or psychogenic nonepileptic seizures occur in various mental disorders. Obsessive-compulsive symptoms can also imitate epileptic partial seizures, but detailed observations of this phenomenon are rare in the literature. A girl of 13 years was referred to the Department of Child Psychiatry because of sudden falls that had occurred during a 1-year period, mainly at school. She had been diagnosed previously as having epilepsy or conversion seizures. After a fall, she demonstrated no response for periods up to 10 minutes, postictal somnolence had occasionally been observed. From the age of 10 years, the patient was reported to have had intrusive recurrent thoughts about dirt and contamination and had also demonstrated some signs of separation anxiety disorder. She was diagnosed as having obsessive-compulsive disorder with poor insight. The chronic falling disappeared completely when behavioral therapy was begun, but the girl still exhibits obsession and separation anxiety.

[Psychotherapeutic methods in the treatment of obsessive-compulsive disorder (OCD) in children and adolescents]. / Metody psychoterapeutyczne stosowane w leczeniu zaburzenia obsesyjno-kompulsyjnego u dzieci i mlodziezy.

The psychiatric and psychological literature was systematically reviewed for studies applying psychotherapeutic principles to young persons with obsessive-compulsive disorder. Abundant clinical and empirical evidence suggest that cognitive-behavioral psychotherapy, alone or in combination with pharmacotherapy, is an effective treatment for OCD in children and adolescents. Thirty-two investigations, most of them single case reports, showed some benefit for such kind of interventions. Graded exposure and response prevention form the core of treatment; anxiety management training and specific family interventions may play an adjunctive role.

[Carbamazepine in the treatment of alcohol withdrawal]. / Karbamazepina w leczeniu alkoholowego zespolu abstynencyjnego.

The authors present a review of literature on the initial rationale and efficacy in clinical trials of carbamazepine (CBZ) in the treatment of alcohol withdrawal, and the pharmacokinetics of carbamazepine in alcoholics as well. Neurophysiological and clinical studies support the kindling hypothesis in the pathophysiology of alcohol withdrawal. The exact physiological action mechanism of CBZ has not been entirely examined. However, the "antikindling effects" are of particular importance in epilepsy and other neurological and psychiatric conditions. Numerous controlled studies were able to demonstrate the effectiveness of carbamazepine in the treatment of alcohol withdrawal symptoms and have compared its properties to other drugs such as clomethiazole and benzodiazepines. Carbamazepine could be a useful alternative to conventional therapeutic approaches, especially in the treatment of mild and moderate alcohol withdrawal symptoms, and alcohol withdrawal with generalized tonic-clonic seizures.

Catatonic syndrome preceded by symptoms of anorexia nervosa in a 14-year-old boy with arachnoid cyst.

This paper reports a case of a 14-year-old boy with arachnoid cyst in the right parietal region, who was referred to the child psychiatry department due to anorexia nervosa. A few days after admission he developed nihilistic and guilt delusions and lapsed into catatonia. The diagnostic problems and relations between his various pathological conditions (anorexia, catatonia, organic brain lesion) are discussed in this paper.