[Clinical characteristics of children with Tourette's Syndrome].

INTRODUCTION: Tourette Syndrome (TS) is a neurodevelopmental disorder presenting with motor and vocal tics. Although TS influences the everyday life of children, we only have fragmented knowledge on the topic of the developmental and comorbidity profile, symptom severity and genetical/environmental background. The aim of this article is to present the demographical characteristics, comorbidity profile and the tic symptom types and severity of patients from the Tourette Syndrome Outpatient Clinic of Vadaskert Child and Adolescent Psychiatry Hospital, Budapest. METHODS: Our sample consists of all the patients (N=137), who visited the Tourette Syndrome Outpatient Clinic between February, 2012, and July, 2013. Patients were in the age range of 3 to 18 years. We recorded demographical and tic-specific data (age, symptom onset, TS in the family, comorbidity, adverse pre-/peri-/postnatal events) of the participants, and administered the Yale Global Tic Severity Scale (YGTSS). RESULTS: The average age at symptom onset was 5.9 years. Average symptom severity (measured by the YGTSS) was 22.4 points. Comorbid Attention Deficit and Hyperactivity Disorder (ADHD) was reported in 31%, Obsessive-Compulsive Disorder (OCD) in 10%, and Autism Spectrum Disorders (ASD) in 10% of the sample. The most common tic types were simple head tics (blinking, shaking of head). Symptom severity correlated positively with age (p <0.05), but not with gender, age at symptom onset, positive family history for TS, or adverse pre-, peri-, and postnatal events. CONCLUSION: The characteristics of our sample does not show any major differences from international reports of similar samples. Comorbidity is an exception: our sample shows lower rates of comorbidities than usually reported.

The association between major depressive disorder in childhood and risk factors for cardiovascular disease in adolescence.

OBJECTIVE: Depression in adults is associated with risk factors for cardiovascular disease (CVD). It is unclear, however, when the association between clinical depression and cardiac risk factors develops or how early in life this association can be detected. METHODS: In an ongoing study of pediatric depression, we compared CVD risk factors including smoking, obesity, physical activity level, sedentary behavior, and parental history of CVD across three samples of adolescents: probands with established histories of childhood-onset major depressive disorder (n = 210), never-depressed siblings of probands (n = 195), and controls with no history of any major psychiatric disorder (n = 161). RESULTS: When assessed during adolescence, 85% of the probands were not in a major depressive episode. Nevertheless, at that assessment, probands had a higher prevalence of regular smoking (odds ratio [OR] = 12.54, 95% confidence interval [CI] = 4.36-36.12) and were less physically active than controls (OR = 0.59, CI = 0.43-0.81) and siblings (OR = 0.70, CI = 0.52-0.94) and had a higher rate of obesity than did controls (OR = 3.67, CI = 1.42-9.52). Parents of probands reported high rates of CVD (significantly higher than did parents of controls), including myocardial infarction and CVD-related hospitalization (ORs = 1.62-4.36, CIs = 1.03-15.40). Differences in CVD risk factors between probands and controls were independent of parental CVD. CONCLUSIONS: Major depression in childhood is associated with an unfavorable CVD risk profile in adolescence, and risks for pediatric depression and CVD may coincide in families. Effective prevention and treatment of childhood depression may be a means to reduce the incidence of adult CVD.

Why are children and adolescents referred for psychiatric assessment without fulfiling diagnostic criteria for any psychiatric disorder?

BACKGROUND: Clinicians often experience that children are referred for psychiatric evaluation without fulfiling the diagnostic criteria of any psychiatric disorders. This study investigates factors that might lead children to psychiatric referral without any psychiatric disorder. METHOD: Children/adolescents who were referred for psychiatric assessment (referred group) (n = 418, mean age = 10.82 years, SD = 3.81) and a control group (n = 48, mean age = 10.38 years, SD = 3.77) were evaluated by the Mini International Neuropsychiatric Interview Kid (MINI Kid) and the Erfassung der Lebensqualität Kindern und Jugendlichen (Measure of Quality of Life for Children and Adolescents). The referred group was further divided into two subgroups: referred subgroup without MINI Kid diagnosis (n = 61) and referred subgroup with MINI Kid diagnosis (n = 357). Subjects less than 18 years old were included and there was no lower age limit. RESULTS: Attention-deficit/hyperactivity disorder (ADHD) symptoms significantly increased the odds for referral as social phobia symptoms significantly decreased the odds for psychiatric referral. Regarding quality of life (QoL), the control group showed significantly less impairment when compared with the referred group; the two referred subgroup with and without diagnosis did not differ significantly. CONCLUSIONS: ADHD symptoms, even in a subthreshold level and impaired QoL represent risk factors for psychiatric referral in children. Secondary prevention of children should target to screen subthreshold ADHD symptoms and QoL.

Gender interactions in the recognition of emotions and conduct symptoms in adolescents.

BACKGROUND: According to literature data, impairment in the recognition of emotions might be related to antisocial developmental pathway. In the present study, the relationship between gender-specific interaction of emotion recognition and conduct symptoms were studied in non-clinical adolescents. METHODS: After informed consent, 29 boys and 24 girls (13-16 years, 14 ± 0.1 years) participated in the study. The parent version of the Strengths and Difficulties Questionnaire was used to assess behavioral problems. The recognition of basic emotions was analyzed according to both the gender of the participants and the gender of the stimulus faces via the "Facial Expressions of Emotion- Stimuli and Tests". RESULTS: Girls were significantly better than boys in the recognition of disgust, irrespective from the gender of the stimulus faces, albeit both genders were significantly better in the recognition of disgust in the case of male stimulus faces compared to female stimulus faces. Both boys and girls were significantly better in the recognition of sadness in the case of female stimulus faces compared to male stimulus faces. There was no gender effect (neither participant nor stimulus faces) in the recognition of other emotions. Conduct scores in boys were inversely correlated with the recognition of fear in male stimulus faces (R=-0.439, p<0.05) and with overall emotion recognition in male stimulus faces (R=-0.558, p<0.01). In girls, conduct scores were shown a tendency for positive correlation with disgust recognition in female stimulus faces (R=0.376, p<0.07). CONCLUSIONS: A gender-specific interaction between the recognition of emotions and antisocial developmentalpathway is suggested.

[Conduct symptoms and emotional decision making in non-clinical adolescents]. / Viselkedészavar tünetek és érzelmi döntéshozatal kapcsolata serdülokben.

BACKGROUND: In adults with antisocial personality disorder, literature data indicate alterations in emotional decision making and in the working of the prefrontal cortex. Similar alterations were described in adolescents with psychopathic traits, however, a dimensional link was not established between behavioral variables and variables associated with decision making. The aim of the present study was to describe the relationship between externalizing symptoms and emotional decision making in non-clinical adolescents. METHODS: Originally 57, 7th-10th grade students between 13-16 years participated in the study after informed consent, but the data of 4 adolescents were not used because of incomplete data-set (N=53; 24 girls and 29 boys; age=14.7 ± 1.0 years, mean ± SD). The parent version of the Strengths and Difficulties Questionnaire (SDQ) was used to assess behavioral problems. The Iowa Gambling Task (IGT) performance and Raven IQ measures were also assessed. RESULTS: The number of summarized risky choices was positively correlated with Conduct Problems Scale of SDQ (r=0.31, p<0.05). While the number of risky choices was not correlated with conduct problems in the first 20 selections (r=0.11, p=n.s.), a marked positive correlation was present in the above measures in the last 20 selections (r=0.28, p<0.05). The number of risky choices did not depend on Raven IQ, age, and other behavioral scales of SDQ. CONCLUSIONS: Even subthreshold conduct symptoms are associated with altered emotional decision making in adolescents, what might be important in the development of antisocial behavior.

[Quality of life of newly diagnosed, treatment naive children and adolescents with attention-deficit hyperactivity disorder]. / Figyelemhiányos-hiperaktivitás zavrral frissen diagnosztizált, kezelésben még nem részesülo gyermekek és serdülok életminosége.

INTRODUCTION: Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent childhood psychiatric disorder, it affects around 3-12% of the children. ADHD is associated with numerous social and emotional impairments. Quality of life (QoL) studies of children with ADHD established low QoL in the most cases. Our aim was to examine QoL of children with ADHD according to the following aspects: age, children's self-report and parentproxy report, and we also would like to compare them with healthy control group along several dimensions of QoL. METHODS: The clinical group consist of a treatmant naive group of children with ADHD, who were just diagnosed in the Vadaskert Hospital. The healthy control group consist of children from elementary schools. The children of control group do not have ADHD and do not stand under psychological or psychiatrical treatment. In our study we applied Mini International Neuropsychiatric Interview Kid and Intervertat Lebensqualitat Kindern und Jugendlichen questionare. RESULTS: Compared children with ADHD to healthy control group they have significantly lower QoL at many areas (school, peer realtions, generally) due their self report. By parent's proxy report children with ADHD have lower QoL according to all of the QoL domains. Parents of children with ADHD reported significantly lower QoL for their children in the most areas (school, family, peer realtion, mental state, generally) then the affected children. Adolescent with ADHD have lower QoL in 3 domains (school, peer relations, generally) than children with ADHD, while children with ADHD have lower QoL in one dimension (being alone) compared with adolescents with ADHD. CONCLUSION: Based on our results children with ADHD compared to healthy control group have lower QoL in many dimensions and there are age-related differences in the assessment of QoL. Additionally, our study draw the attention to the differences of QoL assessment between children and parents.

Conduct symptoms and emotion recognition in adolescent boys with externalization problems.

BACKGROUND: In adults with antisocial personality disorder, marked alterations in the recognition of facial affect were described. Less consistent data are available on the emotion recognition in adolescents with externalization problems. The aim of the present study was to assess the relation between the recognition of emotions and conduct symptoms in adolescent boys with externalization problems. METHODS: Adolescent boys with externalization problems referred to Vadaskert Child Psychiatry Hospital participated in the study after informed consent (N = 114, 11-17 years, mean = 13.4). The conduct problems scale of the strengths and difficulties questionnaire (parent and self-report) was used. The performance in a facial emotion recognition test was assessed. RESULTS: Conduct problems score (parent and self-report) was inversely correlated with the overall emotion recognition. In the self-report, conduct problems score was inversely correlated with the recognition of anger, fear, and sadness. Adolescents with high conduct problems scores were significantly worse in the recognition of fear, sadness, and overall recognition than adolescents with low conduct scores, irrespective of age and IQ. CONCLUSIONS: Our results suggest that impaired emotion recognition is dimensionally related to conduct problems and might have importance in the development of antisocial behavior.

[Aggressive and prosocial behavior in childhood psychopathology]. / Az agressziv es proszociális viselkedés megjelenése a gyermekkori pszichopatológiában.

Aggressive/attacking and helpful/emphatic/prosocial behaviors are extremely important in human relationships. Both high levels of aggression and deficits of prosociality play important role in the development and conservation of mental disorders. We review the measurement options and clinical importance of aggressive and prosocial behavior. The typical developmental pathways and the genetic and environmental background of these behaviors are presented. The clinical tools used in the measurement of aggression and prosociality are summarized in the present paper, with specific attention on questionnaires applied in Hungarian practice. The connections between diagnostic categories (conduct disorder, oppositional-defiant disorder, attention deficit and hyperactive disorder, autism spectrum disorders) and the two behaviors are evaluated. In the end, we present those additional research projects that explore the cognitive-emotional background of aggressive or prosocial behavior with clinical relevance either in the diagnosis or in the treatment of child psychiatric diseases.

The relationship between conduct symptoms and the recognition of emotions in non-clinical adolescents.

BACKGROUND: In adult individuals with antisocial personality disorder, impairment in the recognition of fear seems established. In adolescents with conduct disorder (antecedent of antisocial personality disorder), only sporadic data were assessed, but literature data indicate alterations in the recognition of emotions. The aim of the present study was to assess the relationship between emotion recognition and conduct symptoms in non-clinical adolescents. METHODS: 53 adolescents participated in the study (13-16 years, boys, n=29, age 14.7±0.2 years; girls, n=24, age=14.7±0.2 years) after informed consent. The parent version of the Strengths and Difficulties Questionnaire was used to assess behavioral problems. The recognition of six basic emotions was established by the "Facial expressions of emotion-stimuli and tests", while Raven IQ measures were also performed. RESULTS: Compared to boys, girls showed significantly better performance in the recognition of disgust (p<0.035), while no significant difference occurred in the recognition of other emotions. In boys, Conduct Problems score was inversely correlated with the recognition of fear (Spearman R=-0.40, p<0.031) and overall emotion recognition (Spearman R=-0.44, p<0.015), while similar correlation was not present in girls. CONCLUSIONS: The relationship between the recognition of emotions and conduct problems might indicate an important mechanism in the development of antisocial behavior.

[Validation of the Hungarian version of the Strengths and Difficulties Questionnaire in an adolescent clinical population]. / A Képességek és Nehézségek Kérdoív (SDQ-Magy) validálása serdülokorú klinikai populációban.

INTRODUCTION: The short Strengths and Difficulties Questionnaire (SDQ) available in parent, teacher and self-report versions, is used world-wide for assessing and screening childhood behavior and mental problems, as part of clinical assessments, therapy outcome evaluations, and research tool. The aim of the present study was to extend the use of Hungarian version to a clinical sample, to examine the clinical cut-off values suggested previously on the basis of a normative sample, and to test the questionnaire's sensitivity in differentiating between different psychiatric disorders. METHOD: The parent and self-report versions of the five scale SDQ-Magy questionnaire was filled in by 716 parents and their children admitted to Vadaskert Child Psychiatry and Outpatient Clinic. Clinical (ICD) diagnoses were determined during psychiatric examination. RESULTS: With a few exceptions, internal consistencies of the scales were satisfactory (0,55-0,79), the parent version showing greater reliability compared to the self-report version. Children's age, gender, and parents' level of education had some effect on the scale scores. The questionnaire's Total problem and symptom scale scores were very effective in discriminating between the control and the clinical sample. In the clinical sample, parents rated their children's behavior and mental problems as more severe. Profiles of scale scores distinguished the wider internalizing, externalizing, and co-morbid diagnostic categories, as well as the eight specific diagnoses. Based on the normal-abnormal cut-off values proposed earlier (Turi et al., 2011), the great majority of clinical cases were screened by the questionnaire. CONCLUSIONS: The Hungarian version of the SDQ proved applicable in a clinical sample. Psychometric properties, variances due to age, gender and informant were consistent with international experiences. SDQ profiles related to clinical diagnoses and their difference from the control group show the sensitivity and discriminative power of the questionnaire, while the screening ability based on clinical cut-offs also supports the clinical use of the questionnaire.

[The relationship between reactive/proactive aggression, callous/unemotional traits and behavioural problems in Hungarian adolescents]. / A reaktiv/proaktiv agresszió, a rideg/érzéketlen vonások és a viselkedési problémák kapcsolata magyar serdüloknél.

INTRODUCTION: The relationship between the type of physical aggressive behavior, callous/unemotional traits and behavioral problems was extensively studied in the literature, but no similar data exist in Hungarian adolescents. AIM: In the present study, the type of aggressive behavior was assessed in adolescents on a normative sample to study its relationship with callous/unemotional traits and behavioral problems. SAMPLE: 223 students were participated in the study after informed consent (girls, n=106, age: 14.2±1.5 years; boys, n=117, age: 13.9±1.6 years) from primary and secondary schools in Miskolc and adjacent areas. METHODS: The Reactive/Proactive Aggression Questionnaire was used to assess the level of aggressive behavior, the Inventory of Callous Unemotional Traits was used to measure callous/unemotional traits, while behavioral problems were established by the means of the Strengths and Difficulties Questionnaire. RESULTS: In the present non-clinical sample, the level of reactive aggression was higher than the level of proactive aggressive behavior. In boys, proactive and total aggression measures were significantly higher compared to girls. In both genders, reactive aggression was specifically associated with emotional and peer-related problems. Proactive aggression was correlated positively with callous traits in both genders, while self-reported prosocial behavior had an inverse correlation with proactive aggressive behavior in boys. Self reported conduct- and hyperactivity problems were positively correlated with both types of aggressive behavior in both genders. The strongest positive correlation was observed between self-reported conduct symptoms and both types of aggressive behavior. CONCLUSIONS: Callous/unemotional traits were related with proactive forms of aggression, similar to literature data. Reactive aggressive behavior was related to peer-related and emotional problems, thus our data outlined the importance of the distinction between the two main types of aggression.

[Adulthood -- childhood -- adulthood: long-term therapy in child and adolescent psychiatry]. / Felnottkor -- gyermekkor -- felnottkor: Hosszútávú kezelés a gyermek és felnott pszichiátriában.

The aggregation of psychiatric disorders within families is well-known. The relative role of biological, psychogenic and socialization-related factors varies with the individual case. Another well-known fact is that parents play a very important role in influencing whether their child gets the right treatment when it is necessary. In this paper we highlight the complex links between childhood and adulthood through the presentation of three psychiatric cases. The first story starts with a lactation psychosis of a mother and ends when the daughter who became psychotic at the age of 15 enters adulthood. During these 18 years several psychiatrically relevant episodes happened in the family. During our care, step by step, in relation to emerging psychological problems, the family revealed more and more secrets, explaining past events, and offering a possibility for psychoeducation and psychotherapy. Knowledge concerning the life and psychiatric history of parents, in spite of the fears of the family, largely contributed to evaluating the symptoms of the daughter, reaching a diagnosis, initiating and maintaining therapy and achieving the present balanced state. The next two cases present the stories of two boys with Attention-Deficit/Hyperactivity Disorder (ADHD). One of the children was 6 years old when the family sought professional help, and now he is 11, the other child was 8 years old when the parents sought help and he is 15 now. The two families reacted differently to the offered treatment, but in both cases the family stayed continuously in touch with their child psychiatrists. With these two different stories on ADHD we would like to present several issues and successes which may surface during the long-term treatment of ADHD.

[Comparing the comorbidity of attention-deficit/hyperactivity disorder in childhood and adolescence]. / A gyeremek és serdülkokori Figyelemhiányos-hiperaktivvitás zavar kmorbiditásainak összehasonlitása.

BACKGROUND: International researches found that comorbid psychiatric diagnoses are present in more than two-thirds of attention-deficit/hyperactivity disorder (ADHD) cases, and the patterns of comorbidity are influenced by developmental aspects. The aim of this study is to compare the comorbid diagnoses with ADHD on a Hungarian sample between a children and an adolescents. METHODS: Children and adolescents (under the age of 18) with ADHD according to the Mini International Neuropsychiatric Interview Kid, hospitalized for the first time to Vadaskert Psychiatric Hospital for Children and Adolescents were included in the study. The study sample was divided into two groups: children (3-12 years) and adolescents (13-18 years). Descriptive statistics, Chi-square test and independent sample t-test were applied. RESULTS: The most common comorbid diagnoses with ADHD were oppositional defiant disorder, conduct disorder and suicide behavior in both age-groups, as well as manic episode in the child group and generalized anxiety disorder in the adolescent group. In the adolescent group the number of comorbid diagnoses with ADHD (mean number of diagnoses= 4.30; SD=2.84) was significantly higher than in the child group (mean number of diagnoses=2.61; SD=1.73) (t=-3,726; df=50,202; p<0,001). Comparing the prevalence of comorbid disorders between the two age groups, we did not found any diagnosis which was significantly more common in the child group than in the adolescent group, while major depressive disorder, suicide behavior, dysthymic disorder, alcohol and psychoactive substance dependence, psychotic disorder and generalized anxiety disorder occured significantly more frequently in the adolescent group. CONCLUSION: Our study draws the attention to the importance of the early recognition of ADHD, as well as the importance of the evaluation of comorbid externalizing and internalizing disorders in childhood and adolescence. Our result of the common co-occurrence of suicidal behavior and ADHD in both age-groups is of great clinical relevance. More studies are needed to investigate the frequent comorbidity of ADHD and manic episode in childhood, because of the several overlapping symptoms of these disorders.

[Symptoms of depression in children and adolescents in relation to psychiatric comorbidities]. / A gyermek- és serdulokori depresszio tuneteinek összefuggése a pszichiatriai komorbiditásokkal.

INTRODUCTION: The lifetime prevalence of MDD before adolescence is 4-5%, while the symptoms concern 13-20% of the adolescents. In the development of suicidal behaviour the most important risk factors are the use of psychoactive drugs and smoking. Psychiatric comorbidities are aggravating significantly the major depression. The comorbidities are high among major depression, anxiety and disruptive disorders. SAMPLE AND METHOD: We examined 649 children being in a depressive episode diagnosed by ISCA-D semi-structured interview, 45,9% of them were girls, and 54,1% were boys, the mean age was 11,7 years ( SD=2,00). The participants were enrolled into three groups according to their comorbidities: group with only depression without comorbidities, group with anxiety comorbidity, and group with disruptive comorbidity. We compared the three groups according to the frequency of their depressive symptoms. RESULTS: Anxiety comorbidities increase the incidence of depressive symptoms. Among the criteria symptoms irritability where the most frequent symptom independently from the comorbidities, the depressed mood is the most frequent within the anxiety group, while anhedonia occurred with a moderate frequency in each groups. In the anxiety group the vegetative symptoms, while in the disruptive group the psychomotor agitation and the feeling of worthlessness are the most frequent symptoms. Comorbidities are increasing the incidence of the suicide symptoms. The incidence of impaired decision making was high in each group, the comorbidities didn't influence it's frequency. Among depressed boys irritability and feelings of worthlessness (low self-esteem) increase the presence of externalisation comorbidity. Among depressed girls guilt was significantly more frequent in the anxiety comorbidity group, and concentration problems are the most typical symptoms in the clear MDD group, without comorbidities.

Reactive and proactive aggression in clinical adolescents with attention-deficit/hyperactivity disorder: The moderating role of gender and comorbidities.

Aggression is well-known problem in adolescent with Attention-Deficit/Hyperactivity Disorder (ADHD), but the precise relation of reactive and proactive aggression by gender and comorbidities has not been characterized in this population. The aim of this study was to assess the level of reactive and proactive aggression in adolescents with ADHD and in matched non-ADHD clinical controls. The level of aggression was assessed by the Reactive and Proactive Aggression Questionnaire in 391 adolescents with ADHD and in 391 matched non-ADHD clinical controls. The selection of adolescents with ADHD was representative for a three-year-long period in Vadaskert Child Psychiatry Hospital. General Linear Model was used to assess the difference by ADHD, gender, and comorbidities on the level of reactive and proactive aggression. The presence of ADHD was associated with higher levels of reactive and proactive aggression. In girls, the effect of ADHD on reactive aggression was more profound. The presence of oppositional defiant disorder or conduct disorder in both groups resulted in higher levels of aggression. Our data suggest that adolescents with ADHD have higher level of aggressive behavior, and girls are especially vulnerable in terms of reactive aggressive behavior.

[Investigation of callous/unemotional traits and interpersonal characteristics among Hungarian adolescents--preliminary research results]. / Rideg/érzékelten vonások és interperszonális jellemzok vizsgálata magyar serdüloknél--elso vizsgálati eredmények.

UNLABELLED: In the understanding of aggressive behaviour an important role is contributed to callous/unemotional (C/U) traits (lack of guilty and empathy, grandiose self, manipulation). C/U traits are parts of psychopathy construct. There were a growing amount of researches in last decades connected to the appearance of C/U traits among children. Cognitive, behavioral and emotional features were identified among children with C/U traits which may contribute to the appearance of aggressive behavior. AIM: Aim of this paper is to examine connection between C/U traits and interpersonal characteristics in normative population. This paper is a part of a publication serial taken by the Institution of Psychology at the University of Debrecen and Vadaskert Child Psychiatry Hospital and Outpatient Clinic about callous/unemotional traits. METHODS AND SAMPLE: We studied 223 elementary and secondary school students using the Inventory of Callous Unemotional Traits and the Strenghts and Difficulties Questionnare. RESULTS: In case of moderate appearance of callous/unemotional traits behavior problems, relationship problems and hyperactivity are more typical furthermore presence of prosocial behavior is less typical. CONCLUSION: Results from normal population confirm assumption that C/U traits contribute to the appearance of juvenile aggression and antisocial behavior.

Saving and empowering young lives in Europe (SEYLE): a randomized controlled trial.

BACKGROUND: There have been only a few reports illustrating the moderate effectiveness of suicide-preventive interventions in reducing suicidal behavior, and, in most of those studies, the target populations were primarily adults, whereas few focused on adolescents. Essentially, there have been no randomized controlled studies comparing the efficacy, cost-effectiveness and cultural adaptability of suicide-prevention strategies in schools. There is also a lack of information on whether suicide-preventive interventions can, in addition to preventing suicide, reduce risk behaviors and promote healthier ones as well as improve young people's mental health.The aim of the SEYLE project, which is funded by the European Union under the Seventh Framework Health Program, is to address these issues by collecting baseline and follow-up data on health and well-being among European adolescents and compiling an epidemiological database; testing, in a randomized controlled trial, three different suicide-preventive interventions; evaluating the outcome of each intervention in comparison with a control group from a multidisciplinary perspective; as well as recommending culturally adjusted models for promoting mental health and preventing suicidal behaviors. METHODS AND DESIGN: The study comprises 11,000 adolescents emitted from randomized schools in 11 European countries: Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the scientific coordinating center. Each country performs three active interventions and one minimal intervention as a control group. The active interventions include gatekeeper training (QPR), awareness training on mental health promotion for adolescents, and screening for at-risk adolescents by health professionals. Structured questionnaires are utilized at baseline, 3- and 12-month follow-ups in order to assess changes. DISCUSSION: Although it has been reported that suicide-preventive interventions can be effective in decreasing suicidal behavior, well-documented and randomized studies are lacking. The effects of such interventions in terms of combating unhealthy lifestyles in young people, which often characterize suicidal individuals, have never been reported. We know that unhealthy and risk-taking behaviors are detrimental to individuals' current and future health. It is, therefore, crucial to test well-designed, longitudinal mental health-promoting and suicide-preventive interventions by evaluating the implications of such activities for reducing unhealthy and risk behaviors while concurrently promoting healthy ones. TRIAL REGISTRATION: The German Clinical Trials Register, DRKS00000214.

No evidence of an association between two genes, EDN1 and ACE, and childhood-onset mood disorders.

Recent evidence supports a pathological link between heart disease and depressive symptoms, suggesting that depression is both etiologic and prognostic to heart disease. Thus, biological molecules which are at the interface between heart and mind are plausible candidate genes for depressive disorders. To investigate this line of enquiry we have investigated two genes, Endothelin 1 (EDN1) and Angiotensin-converting enzyme (ACE) in a family-based sample with childhood-onset mood disorders (COMDs). EDN1 is highly expressed in endothelium where it acts as a potent vasoconstrictor, and is also expressed in the brain where it exhibits neurotransmitter characteristics. ACE acts as a potent vasopressor, and interacts with the hypothalamic-pituitary-adrenocortical (HPA) system, which is often dysregulated in mood disorders. Furthermore, ACE has recently been found to be associated with major depression. Polymorphisms were selected to best capture the genetic variation at the two loci, and to replicate previous associations. The markers were genotyped across EDN1 and ACE in a sample comprised of 382 Hungarian nuclear families ascertained through affected probands diagnosed with a mood disorders before the age of 15. We found no evidence of association between either of these genes and COMD. Consequently, we were unable to support our hypothesis that these two genes, which are involved in both vascular and brain functions are contributing to the susceptibility to mood disorders of children/adolescents.

Dyskinesia in Treatment-Naive and Stimulant-Treated Children With ADHD.

Objective: Stimulants are safe and effective medications for the treatment of ADHD. There are a number of case studies that report stimulant-induced dyskinesia. The aim of this study was to compare dyskinesia in a treated and a treatment-naive group of children with ADHD, and a healthy control group. Method: Children aged 6 to 18 years were involved in the study (n = 158). Diagnosis of ADHD was measured with the Mini International Neuropsychiatric Interview Kid (MINI Kid). Dyskinesia was assessed with the Abnormal Involuntary Movement Scale (AIMS). Results: Before methylphenidate administration, the treated ADHD group showed significantly higher AIMS total score than the control group (p = .001) and the treatment-naive ADHD group (p < .001). We found the same pattern 1.5 hr after methylphenidate administration. Conclusion: These results call attention that clinicians should take special care for the possible development of dyskinesia during the treatment of their ADHD patients with methylphenidate.

Further genetic evidence implicates the vasopressin system in childhood-onset mood disorders.

Studies in both animals and humans advocate a role for the vasopressin (AVP) system in the aetiology of depressive symptoms. Attention has particularly focused on the role of AVP in the overactivation of the hypothalamic-pituitary-adrenal (HPA)-axis in mood disorders. Elevated AVP plasma levels have been found in mood disorder patients, which are often positively correlated with the severity of symptoms. We recently reported an association between childhood-onset mood disorders (COMD) and polymorphisms in the receptor responsible for the AVP-mediated activation of the HPA-axis (AVPR1B). As genetic variation in the vasopressinergic system could provide a mechanism to explain the endocrine alterations observed in mood disorders, we investigated other genes in this system. The gene encoding AVP is the strongest candidate, particularly as genetic variation in this gene in rodents is associated with anxiety-related behaviours. Six single-nucleotide polymorphisms (SNPs) were genotyped across the AVP gene in a sample comprised of 586 Hungarian nuclear families ascertained through affected probands with a diagnosis of COMD. In addition, AVP coding and putative regulatory regions were screened for mutations using denaturing high-performance liquid chromatography. One SNP, 3' to the AVP, gene reached significance (P = 0.03), as did the overtransmission of a five-marker haplotype with a frequency of 22% (P = 0.0001). The subsequent mutation screen failed to identify any putative functional polymorphisms. The outcome of this study, combined with our previous association between COMD and AVPR1B, implicates genetic variation in vasopressinergic genes in mediating vulnerability to COMD.