Factors associated with suicide attempt risk in adolescent inpatient psychiatric care: toward a practical model

Suicide is an important social and medical problem, particularly among children and adolescents. The aim of the study was to determine the association of the psychiatric diagnosis and selected psychosocial factors with the risk of suicide attempts among patients of an adolescent psychiatric unit. A retrospective analysis was performed on a database of consecutive N = 1311 patients aged 13-18 years of the adolescent psychiatric ward. A hierarchical logistic regression analysis was performed to assess the predictive value of the main psychiatric diagnosis, for factors selected from the database to determine their influence on the relative risk of a suicide attempt. Primary diagnoses of mood disorders and emotional and behavioral disorders were associated with an increased risk of a current admission after a suicidal attempt, a history of past suicidal attempts and non-suicidal self-harm (NSSI). History of NSSI was associated with a fourfold increase probability of a suicide attempt. Truancy, sexual abuse, heartbreak and frequent conflicts were related to a rise in suicidal attempt risk. Learning difficulties were found to be linked to increased probability of suicidal attempt, but only among women. The current study confirms that the primary diagnosis, NSSI and well-recognized psychosocial factors (including family- and school-related factors) may prove useful in the assessment of suicidal risk among adolescents admitted to a psychiatric ward.

Increase in Search Interest for "Suicide" and "Depression" for Particular Days of the Week and Times of Day: Analysis Based on Google Trends

Depression is the most common disorder in people who attempt suicide or die by suicide. Research review indicate that therapy of depression (including psychoeducation) is one of the main factors in the prevention of suicidal behavior. In this paper we examine the intensification of search interest for the terms "depression" and "suicide" in Google search engine with regard to the time of day and day of the week in Poland, Germany, Great Britain and Italy. The goal of the study was to determine if there are any days of the week or hours when search for "suicide" and "depression" particularly increases. Numerous studies focusing not only on the seasonality of suicidal behavior, but also on the days of the week and hours, indicate that it is most often undertaken on Mondays in the night and early morning hours. The results of the research being the basis of this paper show a certain time coincidence: first, the increase in search interest for "suicide" and "depression" and then undertaking suicidal behavior (suicide and suicide attempts). Searching for terms "suicide" and "depression" usually took place (except in Italy) at weekends and most often in the late evening hours and at night. The conclusions from the research can be used in suicide prevention activities, for example in determining the hours of operation of individual helpline numbers.

Are Children Harmed by Being Locked up at Home? The Impact of Isolation during the COVID-19 Pandemic on the Phenomenon of Domestic Violence

The phenomenon of violence against children is a very complex one. There are many types of child abuse, and they are culturally dependent to a significant degree. Although studies show that children generally only suffer from mild COVID-19 infection, some social restrictions introduced during the pandemic, such as home isolation, may have many severe consequences on the population's mental health. Studies on this topic suggest that violence against children increased during lockdown due to the COVID-10 pandemic. This narrative review summarizes this available literature on the subject and discusses the different forms of violence against children, their cultural aspects, the impact of the COVID-19 pandemic on the phenomenon of violence, the long-term consequences of the above, and forms of assistance for abused minors.

Comparison of thyroid-stimulating hormone levels in adolescents with schizophrenia, bipolar disorder, unipolar depression, conduct disorders, and hyperkinetic disorders

The aim of this study was to retrospectively compare values of thyroid-stimulating hormone (TSH) in adolescent patients diagnosed with schizophrenia, bipolar disorder, unipolar depression (UNI-DEP), conduct disorders (CD), and hyperkinetic disorders.The research involved 1122 patients (718 women, 64%); aged 12 to 18 hospitalized in the Department of Adolescent Psychiatry, Medical University of Lodz. We analyzed TSH levels in the whole study population and compared it between the above-mentioned subgroups of diagnoses.Mean serum TSH concentration in the studied population (n = 1122) was 2.06 μIU/mL. The values of percentiles were as follows: 2.5th - 0.53 μIU/mL, 10th - 0.89 μIU/mL, 25th - 1.31 μIU/mL, 50th - 1.9 μIU/mL, 75th - 2.6 μIU/mL, 90th - 3.43 μIU/mL, 97.5th - 4.72 μIU/mL. TSH values were negatively correlated with patients' age (P = .00001). Patients with bipolar depression had higher TSH levels than patients with CD (P = .002). Also, when male and female groups were examined separately we found that female patients with UNI-DEP and bipolar disorder had higher TSH levels than female patients with CD (P = .001; P = .001).Our results confirm that there may be a higher prevalence of thyroid dysfunctions in bipolar and UNI-DEP subgroups among adolescents and that it is worthy to consider some kind of interventions regarding thyroid function in depressed individuals.

Psychometric Properties of the Suicide Acceptance Questionnaire

Only a few questionnaires are available for measuring attitude towards suicide as a unidimensional construct, i.e. emphasizing acceptance or disapproval of the suicidal act under a set of difficult life circumstances. The aim of this study was to develop the Suicide Acceptance Questionnaire (SAQ) and examine its psychometric properties. A group of 177 Psychology, Medicine and Law students completed the SAQ, Attitudes Towards Suicide questionnaire and a demographic survey. Exploratory factor analysis found the SAQ to have a single factor structure, explaining 55.49% of variance, with high goodness of fit. Owing to the nature of explicit attitudes, the SAQ may have limited power in predicting behavior. The findings indicate that the SAQ demonstrates appropriate reliability and concurrent validity for measuring the acceptance of suicide act. Future research with use of confirmatory factor analysis is needed for determining whether the proposed construct fits data.

Implementation of the national register of suicide attempts as a preliminary strategy for the prevention of suicides in Poland

Studies show that suicide attempts are a major independent predictor of suicide. Only in some countries of the world, there are national registers of these behaviors. Poland is among the countries where suicide prevention is at the stage of implementation of these strategies. One is the initial diagnosis of the prevalence of suicidal behavior (SB) in selected populations. The aim of the study was to assess the prevalence of SB in Poland on the basis of available databases, including data such as age, sex and mental disorders and the analysis of differentiation of selected indicators of SB.

Material and methods

We analyzed available registers of completed suicides (CS) and suicide attempts (SA), carried out under reporting of the central statistical office (CSO, in the general population, based on death certificates), Police Headquarters (PH, the number of reported SB in the country) and the Institute of Psychiatry and Neurology in Warsaw (IPiN, the number of SB in all psychiatric institutions) and the department of adolescent psychiatry in Łódź (SB among hospitalized youth).

Results and conclusions

Reported data on dissemination of SB in Poland are incomplete, which may affect the reliability of the assessment of the effectiveness of implemented strategies for the prevention of suicides. The aim should be to create a central register of SB, which will not only gather a well-defined data but also monitor how it is obtained.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Treatment of generalized anxiety disorder in terms of cognitive behavioral]

Risk of generalized anxiety disorder (GAD) within life is estimated at 2.6-5.1%. Amongst etiological factors that affect the development of the disorder are: biological and psychological problems, including cognitive models. There are known several cognitive models: metacognitive, Borkovec'c model and the model developed in Quebec. Key cognitive contents that occur with generalized anxiety disorder are focused on two aspects: metacognitive beliefs and intolerance of uncertainty. A primary purpose of cognitive-behavioural therapy (CBT) is the modification of dysfunctional beliefs about worry. Cognitive behavioural therapy is effective in reducing anxiety, makes it easier to operate in the professional sphere and improves the quality of life.

Supplementation of Antipsychotic Treatment with the Amino Acid Sarcosine Influences Proton Magnetic Resonance Spectroscopy Parameters in Left Frontal White Matter in Patients with Schizophrenia

Dysfunction of the glutamatergic system, the main stimulating system in the brain, has a major role in pathogenesis of schizophrenia. The frontal white matter (WM) is partially composed of axons from glutamatergic pyramidal neurons and glia with glutamatergic receptors. The natural amino acid sarcosine, a component of a normal diet, inhibits the glycine type 1 transporter, increasing the glycine level. Thus, it modulates glutamatergic transmission through the glutamatergic ionotropic NMDA (N-methyl-d-aspartate) receptor, which requires glycine as a co-agonist. To evaluate the concentrations of brain metabolites (NAA, N-acetylaspartate; Glx, complex of glutamate, glutamine, and γ-aminobutyric acid (GABA); mI, myo-inositol; Cr, creatine; Cho, choline) in the left frontal WM, Proton Nuclear Magnetic Resonance (¹H-NMR) spectroscopy was used. Twenty-five patients randomly chosen from a group of fifty with stable schizophrenia (DSM-IV-TR) and dominant negative symptoms, who were receiving antipsychotic therapy, were administered 2 g of sarcosine daily for six months. The remaining 25 patients received placebo. Assignment was double blinded. ¹H-NMR spectroscopy (1.5 T) was performed twice: before and after the intervention. NAA, Glx and mI were evaluated as Cr and Cho ratios. All patients were also assessed twice with the Positive and Negative Syndrome Scale (PANSS). Results were compared between groups and in two time points in each group. The sarcosine group demonstrated a significant decrease in WM Glx/Cr and Glx/Cho ratios compared to controls after six months of therapy. In the experimental group, the final NAA/Cr ratio significantly increased and Glx/Cr ratio significantly decreased compared to baseline values. Improvement in the PANSS scores was significant only in the sarcosine group. In patients with schizophrenia, sarcosine augmentation can reverse the negative effect of glutamatergic system overstimulation, with a simultaneous beneficial increase of NAA/Cr ratio in the WM of the left frontal lobe. Our results further support the glutamatergic hypothesis of schizophrenia.

Adding Sarcosine to Antipsychotic Treatment in Patients with Stable Schizophrenia Changes the Concentrations of Neuronal and Glial Metabolites in the Left Dorsolateral Prefrontal Cortex

The glutamatergic system is a key point in pathogenesis of schizophrenia. Sarcosine (N-methylglycine) is an exogenous amino acid that acts as a glycine transporter inhibitor. It modulates glutamatergic transmission by increasing glycine concentration around NMDA (N-methyl-d-aspartate) receptors. In patients with schizophrenia, the function of the glutamatergic system in the prefrontal cortex is impaired, which may promote negative and cognitive symptoms. Proton nuclear magnetic resonance (¹H-NMR) spectroscopy is a non-invasive imaging method enabling the evaluation of brain metabolite concentration, which can be applied to assess pharmacologically induced changes. The aim of the study was to evaluate the influence of a six-month course of sarcosine therapy on the concentration of metabolites (NAA, N-acetylaspartate; Glx, complex of glutamate, glutamine and γ-aminobutyric acid (GABA); mI, myo-inositol; Cr, creatine; Cho, choline) in the left dorso-lateral prefrontal cortex (DLPFC) in patients with stable schizophrenia. Fifty patients with schizophrenia, treated with constant antipsychotics doses, in stable clinical condition were randomly assigned to administration of sarcosine (25 patients) or placebo (25 patients) for six months. Metabolite concentrations in DLPFC were assessed with 1.5 Tesla ¹H-NMR spectroscopy. Clinical symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS). The first spectroscopy revealed no differences in metabolite concentrations between groups. After six months, NAA/Cho, mI/Cr and mI/Cho ratios in the left DLPFC were significantly higher in the sarcosine than the placebo group. In the sarcosine group, NAA/Cr, NAA/Cho, mI/Cr, mI/Cho ratios also significantly increased compared to baseline values. In the placebo group, only the NAA/Cr ratio increased. The addition of sarcosine to antipsychotic therapy for six months increased markers of neurons viability (NAA) and neurogilal activity (mI) with simultaneous improvement of clinical symptoms. Sarcosine, two grams administered daily, seems to be an effective adjuvant in the pharmacotherapy of schizophrenia.

Supplementation of antipsychotic treatment with sarcosine – GlyT1 inhibitor – causes changes of glutamatergic (1)NMR spectroscopy parameters in the left hippocampus in patients with stable schizophrenia

Glutamatergic system, the main stimulating system of the brain, plays an important role in the pathogenesis of schizophrenia. Hippocampus, a structure crucial for memory and cognitive functions and rich in glutamatergic neurons, is a natural object of interest in studies on psychoses. Sarcosine, a glycine transporter (GlyT-1) inhibitor influences the function of NMDA receptor and glutamate-dependent transmission. The aim of the study was to assess the effects of sarcosine on metabolism parameters in the left hippocampus in patients with schizophrenia. Assessments were performed using proton nuclear magnetic resonance ((1)H NMR) spectroscopy (1.5T). Fifty patients diagnosed with schizophrenia (DSM-IV-TR), with dominant negative symptoms, in stable clinical condition and stable antipsychotics doses were treated either with sarcosine (n=25) or placebo (n=25). Spectroscopic parameters were evaluated within groups and between two groups before and after 6-month intervention. All patients were also assessed with the Positive and Negative Syndrome Scale (PANSS). In the sarcosine group, after 6-month treatment, we found significant decrease in hippocampal Glx/Cr (Glx-complex of glutamate, glutamine and GABA, Cr-creatine) and Glx/Cho (Cho-choline), while N-acetylaspartate (NAA), myo-inositol (mI), Cr and Cho parameters remained stable along the study and also did not differ significantly between both groups. This is the first study showing that a pharmacological intervention in schizophrenia, particularly augmentation of the antypsychotic treatment with sarcosine, may reverse the pathological increase in glutamatergic transmission in the hippocampus. The results confirm involvement of glutamatergic system in the pathogenesis of schizophrenia and demonstrate beneficial effects of GlyT-1 inhibitor on the metabolism in the hippocampus and symptoms of schizophrenia.

[The relation of selected psychiatric disorders to occurrence of suicide attempts among teenage psychiatrically hospitalized patients]

Suicide is the third cause of death globally in the age group 10-19. Multiple risk factors (genetic, psychiatric, psychological, familial, social) increased number of suicide attempts.

AIM

The aim of this study was to explore whether mental disorders are associated with the number of suicide attempts among psychiatric hospitalized adolescents.

MATERIALS AND METHODS

Retrospective, chart-based analysis of 119 patients, aged 13-18, treated in 2013-2014 in the Department of Adolescent Psychiatry in Łódź. Inclusion criteria was diagnosis of schizophrenia, schizotypal and delusional disorders, mood disorders, neurotic, stress-related and somatoform disorders, behavioral and emotional disorders according to ICD 10. Exclusion criteria were other psychiatric diagnosis, incomplete information about intention of self-harm behaviors. For statistical analysis used Statistica 9.1.

RESULTS

Among psychiatricaly hospitalized patients, 51.2% of people attempted suicide. No relationship was found (p > 0.05) between psychiatric diagnosis and frequency of suicide attempts in adolescents, but the most common suicide attempts related to people with a diagnosis of mood disorders (59.3%) and neurotic disorders (54.6%), and least frequently in patients with a diagnosis of schizophrenia , schizotypal and delusional disorders (40%) and behavioral and emotional disorders (44.4%).

CONCLUSIONS

There is no relation between the occurrence of suicide attempts and the type of mental disorders among psychiatrically hospitalized adolescents.

Cutaneous deliberate self-harm in Polish school teenagers - an inter-disciplinary challenge

Self-harm of the skin is a complex problem encountered mainly in adolescents and young adults. The aim of the study was to assess the prevalence of deliberate cutaneous self-harm without suicidal intent among secondary school teenagers of the Lodz region. A self-administered specially designed anonymous questionnaire was delivered to 1,448 secondary school teenagers, aged 12-19 years. The lifetime prevalence of self-reported deliberate self-harm was 19.5%, out of which 14.4% confirmed isolated cutaneous self-injury (self-cutting in the vast majority of cases), 1.7% ingested a substance or drug in excessive amounts and 3.5% declared both behaviours. Our results indicate that skin is the organ most commonly involved in deliberate self-harm. Dermatologists, especially those focussed on dermatosurgery and aesthetic dermatology, should understand the special issues relating to such patients before taking decisions concerning performing any procedures on these individuals, since deliberate self-harm has been recognised as one of the main risk factors of suicide.

Neuropsychiatric symptoms and celiac disease

BACKGROUND

Neuropsychiatric symptoms may represent an atypical manifestation of celiac disease that occur before a gastroenterological diagnosis is made. Some studies suggest that a gluten-free diet is effective in treating the depression, anxiety, and neurological complications associated with celiac disease.

METHOD

The article describes the case of a patient suffering from chronic, treatment-resistant symptoms of depression and anxiety. The diagnosis of celiac disease and introduction of an elimination diet caused a significant improvement in mental state and everyday functioning in the presenting patient.

CONCLUSION

The presence of persistent anxiety and depressive symptoms, with a poor reaction to pharmacological treatment, indicates a need to identify somatic reasons for the underlying condition. It is important to remember that celiac disease can occur at any age, not only in childhood. The presence of this somatic cause of persistent depressive and anxiety symptoms should be considered in the diagnostic process in adults.

Efficacy of metabolic and psychological screening for mood disorders among children with type 1 diabetes

OBJECTIVE

To compare the diagnostic accuracy and time expenditure of screening models based on glycated hemoglobin (HbA(1c)) level and psychometric measures for mood disorder (MD) among children with type 1 diabetes.

RESEARCH DESIGN AND METHODS

With semistructured clinical interviews (Schedule for Affective Disorders and Schizophrenia for Children-Present and Lifetime version, 120 min/patient) as a reference for diagnosing MD, including major depressive disorder (MDD), we tested 163 subjects, aged 8 to 18 years, with type 1 diabetes. We evaluated four screening approaches: 1) Children's Depression Inventory (CDI) at 30 min/patient, 2) HbA(1c) level, 3) HbA(1c) level plus CDI, and 4) HbA(1c) level plus Children's Depression Rating Scale (CDRS) at 40 min/patient. These tests were conducted with all participants, and the total time expenditure for all four approaches was calculated as the total time needed to implement successfully the screening for MD or MDD in the center.

RESULTS

HbA(1c) performed on par with individual psychometric tests in diagnosing MD or MDD. The HbA(1c) plus CDRS model was the best screening procedure for both MD and MDD, with diagnostic thresholds for HbA(1c) established at 8.7% and 9.0%, respectively. Cutoff points for CDRS assessed after filtering by HbA(1c) were 26 (MD) and 30 (MDD) points. Center-wide application of this procedure would result in an 83% reduction of the examination time necessary for the psychiatrist for MD screening and a 91% reduction for MDD screening, as compared with standard screening with CDI.

CONCLUSIONS

Use of HbA(1c) level followed by CDRS is a time-efficient procedure to screen for MD in children with type 1 diabetes.

[The evaluation of the stress coping styles and emotional intelligence in psychiatrically treated adolescent patients with deliberate self-harm in relation to chosen clinical features]

AIM

The primary goal of the study was an evaluation of the dominating stress coping styles in adolescent patients with self-harm records, who were psychiatrically treated, taking into account the level of their emotional intelligence vs. the psychiatric diagnosis, the type of motives and decision involved in self-harming and the presence of suicidal attempts (SA) in the past. The secondary goal included an analysis of the correlations between particular stress coping skills and the level of emotional intelligence.

METHOD

The reported studies involved self-harming patients aged of 13-18 years during their psychiatric hospitalisation (n=31). The applied tools included the Coping Inventory for Stressful Situations (CISS) and the Two-Dimensional Inventory of Emotional Intelligence (DINEMO).

RESULTS

An evaluation of the correlation between stress coping styles and the levels of emotional intelligence in the studied group and the types of mental disorders did not reveal any significant differences between the evaluated subgroups. Patients, who confirmed an instrumental motive, obtained statistically significantly higher scores on the task-oriented scale vs. those who performed the acts of DSH for reactive or pathological reasons. Taking into consideration the type of decision, involved in self-harming acts, did not show any differences in the stress coping styles of the patients, however, those patients, who had planned an act of DSH, achieved statistically significantly higher scores in the OTHERS scale of the DINEMO. Patients with DSH and with SA in the past (77% studied group), achieved similar results in CISS and DINEMO vs. the self-harming patients without SA in the past. In the study group, one statistically significant correlation was demonstrated between CISS--the avoidance-oriented style--and the I in DINEMO.

CONCLUSIONS

1. Patients with DSH records and without SA constitute a fairly uniform group with regards to stress coping styles, taking into account the type of psychic disorders and the urgency of self-harm decision. 2. Their use of the task-oriented style may be associated with instrumental auto-aggression. 3. DSH may be a non-verbal form of communicating other problems to others. 4. Adolescents, who perform the acts of self-harm, are endangered by suicidal attempts, regardless of their stress coping styles or the level of their emotional intelligence. 5. A development of constructive stress coping skills against strong emotional reactions is a recommended method in the therapy of patients with DSH.

Sweet sins: frequency and psychiatric motivation for theft among adolescents with type 1 diabetes

BACKGROUND

Behavioral problems are an issue among adolescents with type 1 diabetes (T1D). The authors hypothesize that theft, possibly because of an underlying psychiatric morbidity, may be a way of procuring sweets leading to worse glycemic control.

OBJECTIVE

To evaluate psychiatric morbidity and the association of theft and metabolic control among children and adolescents with T1D, using data from an interim analysis of an ongoing quality-of-life and psychiatric comorbidity study.

METHODS

One hundred and nine consecutively hospitalized individuals aged 8-18 years with T1D were asked about incidents of theft. The data on psychiatric morbidity were taken from an ongoing longitudinal study using semi-structured diagnostic interview (KSADS-PL).

RESULTS

Overall, 10 children (9%) reported that they had committed theft. Primary motivation for theft was reported as either direct or indirect gain of sweets. Patients who admitted to theft were more likely to have worse metabolic control expressed by glycated hemoglobin (HbA1c) [10.4% (interquartile range 9.8-11.8) vs. 7.7% (6.9-8.8); p < 0.0001] and higher odds of having psychiatric morbidity (odds ratio 8.2; 95% confidence interval 1.9-34.2) than their peers. In the subgroup analysis of patients with psychiatric morbidity, HbA1c was significantly higher if having committed a theft was reported [10.2% (9.4-11.9) vs. 8.1% (7.2-9.2); p < 0.001]. No significant differences in socioeconomic status, clinical factors, or rates of complications were found.

CONCLUSIONS

Theft may be a factor negatively affecting metabolic control in children with T1D and underlying psychiatric co-morbidity. Psychiatric morbidity is more frequent among patients with T1D and a history of theft.

FC27-02 - Psychiatric co-morbidity predicts acute hospitalization among adolescents with type 1 diabetes mellitus

Introduction

During the 90's, there was a dramatic increase (more than 200%) of the incidence of type 1 diabetes in the Polish pediatric population. During the first decade of onset of the disease, 48% of the prospectively monitored children developed psychiatric disorders.

Objectives

To determine the influence of psychiatric co-morbidity on hospitalization for complications among children and adolescents with type 1 diabetes (T1DM).

Methods

One hundred seventy patients (age range: 8-18 years) with T1DM were evaluated using semi-structured diagnostic interview (K-SADS-PL). Current and past episodes of psychopathology were assessed according to DSM-IV criteria. The effect of psychiatric symptoms for number and times of hospitalizations due to medical complications per year was assessed by using General Linear Model. The mean time of observation was 4,0 ± 2,0 years.

Results

The median number of days per year of acute hospitalizations was 4,0 (Interquartile Range 0.0-6.8) for group with co-morbidity and 2.6 (0.0–4.6) for group without; also the median of average number of hospitalizations was 0.4 (0.0–0.8) and 0.3 (0.0–0.5) respectively. Psychiatric co-morbidity was associated with number (beta = 0.19; p < 0.05) and duration of hospitalizations (beta = 0.16; p < 0.05) per year.

Conclusions

Young people with type 1 diabetes and psychiatric co-morbidity are at increased risk of hospitalization for disease complications. Interventions aimed at routine psychiatric screening followed by treatment may decrease the number of acute hospitalizations.

Symptom clusters in obsessive-compulsive disorder (OCD): influence of age and age of onset

Obsessive-compulsive disorder (OCD) is an ailment of heterogeneous nature. It is believed that the age of onset determines the subtype of juvenile OCD. The objective of our study was to evaluate the rates of symptoms' contents and the age of manifestation of the various OCD symptoms in adolescents and adults with early and late onset of disorder. Both authors independently reviewed the medical charts of patients treated for OCD between 1999 and 2007 in a psychiatric university hospital. Patients were evaluated using the Yale-Brown obsessive-compulsive scale check list (Y-BOCS). The patients were grouped as adolescents (group 1), adults with late onset (group 2) and adults with early onset (group 3). Chi2 was used for nominal variables and the non-parametric Kruskal-Wallis ANOVA for continuous comparisons due to deviations from normality of distribution. A total of 132 patients were enrolled in the study (44 group 1, 43 group 2 and 45 group 3). There were no differences in gender distribution. Religious, sexual and miscellaneous obsessions were more frequent and somatic less frequent in group 1 than in group 2. Contamination compulsions were most seldom found in group 1. Cleaning obsessions were more frequent in group 3 than in group 1. Checking were the rarest and miscellaneous, the most often compulsion among adolescents in comparison to other groups. The symptoms' content in adolescents differed from those observed in adult, both with early and later onset of the disease. The age at onset influences the rates of adult patients' compulsions.

[Self-harm done by young patients during their psychiatric hospitalization in relation to the presence of specific mental disorders and chosen environmental factors]

AIM

The objective of the study was to assess the relation between the occurrence of deliberate self-harm (DSH) in young patients during their psychiatric treatment and the presence of specific mental disorders, or the history of suicide attempts, the exposure to abuse and their family situation.

METHOD

The studied group consisted of 187 in-patients aged 13-19 years, hospitalized at the Adolescent Ward of the Central Clinical Hospital, Medical University of Łódź, during the 2 quarters on the turn of 2005 and 2006. All patients were examined psychiatrically, and on discharge they were also assessed with the "Questionnaire for the Assessment of Self-Harm" designed for the purpose of this study.

RESULTS

Forty-seven percent of the psychiatrically treated in-patients had performed DSH acts. A strong relationship (p < 0.001) was found between the occurrence of SH and the previous history of suicidal attempts, the presence of an alcohol problem in the family, the exposure to sexual and physical abuse and the lack of support from close family members.

CONCLUSIONS

There was no relation between the occurrence of deliberate self-harm in young in-patients and the presence of a specific psychiatric disorder.

Gender influence in suicidal behaviour of Polish adolescents

OBJECTIVE

The aim of the study was to assess the prevalence and possible suicide attempts and ideation predictors in the school population of girls and boys in the city of Lódź.

METHOD

A self-administered anonymous questionnaire was distributed to a representative (random) sample of 1663 students, aged 14-21. Boys and girls reporting no suicidal behaviour (NSB) constitute the control groups; the characteristics of these groups were compared to those of the groups with suicidal behaviour (SB), with focus on the associations between different variables and gender, separately for suicidal ideation (SI) and suicide attempts (SA).

RESULTS

About 37% of girls and 25% of boys reported suicidal ideation and about 11% and 5%, respectively, suicide attempts. Boys were more likely to make multiple suicide attempts. The relation between SB and the history of psychiatric treatment was the same for both sexes. Boys with SB were significantly more often fascinated with death, and girls were significantly more often exposed to difficult family situations.

Suicidal ideation and suicide attempt in Polish adolescents: is it a suicidal process?

The objective of our study was to assess the prevalence and possible predictors of suicide attempts and ideation in the school population of adolescents in the city of Lodz.

METHOD

A self-administered anonymous questionnaire was distributed to a representative (random) sample of 1,663 students, aged 14 to 21 years. Adolescents reporting no suicide behaviour constitute the control group; characteristics of this group were compared to those of the group concerned, with exploration of the correlation between different variables in terms of relative risk, separately for suicidal ideation and suicide attempts.

RESULTS

About 31% of students reported suicidal ideation (SSI), and 8%--suicide attempts (SSA). Among the factors related to the highest relative risk of suicide attempts in the examined students and differentiated SSA and SSI, the most significant factor appeared to be previous psychiatric treatment and/or psychotherapy (OR = 9), run away from home (OR = 7), suicidal deaths among relatives and friends (OR = 6), drug abuse (OR = 5), and "fascination with death" (OR = 4).

CONCLUSIONS

There are separate predictors of suicide attempt and suicidal ideation in Polish adolescents. Suicidal ideation as a common phenomenon (occurring in every third pupil) probably should be included into the specificity of the puberty process and considered as a separate phenomenon from suicide attempt. The presence of previous psychiatric diagnosis is most strongly related to the occurrence of suicide attempts (including those repeated), but is not related to suicidal ideation.

[The prevalence od social phobia in representative group of adolescents from Lodz]

AIM

Recent epidemiological studies have produced a remarkable variation in the estimated life-time prevalence of social phobia, ranking from 0.5% to 22.6%. About 95% of social phobia occurs prior to the age of 20, approximately 40% prior to the age of 10. Studies of mainly patient samples report a mean age of onset of 14.6 to 20 years.

METHOD

In co-operation with GUS, the year 2000 we assessed with a specially prepared questionnaire including DSM-IV criteria for social phobia and CIDI, the prevalence of specific and generalised type of social phobia in a representative group of adolescent population from Łódź. Subjects of the study (n = 1929) were chosen from 36450 adolescents.

RESULTS

We found, that generalised social phobia was present in 7% of subjects, specific subtype in 17% of subjects, more frequently in women than in men (p < 0.05), with the same prevalence in adolescents from various type of schools. 15% of adolescents with social phobia were alcohol or psychoactive drug abusers, 5% attempted suicide.

CONCLUSION

Only 1/4th of adolescents with social phobia was in psychological or psychiatric therapy. Subjects with social phobia have a high risk of other comorbid psychiatric disorders and significant worsening of social functioning.

[Dysfunction of the hypothalamic-pituitary-adrenal axis in adolescents after a suicide attempt]

The subject of the research were two populations: 84 adolescents aged 14-21, after sui cidal attempts (ASA--drug overdose), never treated psychiatrically, and 30 adolescents after accidental intoxication (ACI). The objective of this research was to find whether there is a relation between the observed suicidal behaviors, psychic disorders and dysfunction of the hypothalamo--pituitary--adrenal axis. In each patient the plasma levels of cortisol and ACTH were assessed, and also the Dexamethasone Suppression Test (DST) was made. It was found that most patients in the ASA group were females. Additionally, in this group statistically higher levels of cortisol after DST were found, comparing to the ACI group. Considering the sex of patients, the differences of serum cortisol levels were significant only in females. We found that higher cortisol levels in ASA were related to diagnosed depressive disorders (mostly in females), presence of psychosocial and environmental problems, and elevated risk level of repeated suicidal attempt.

Obstetric complications and Apgar score in early-onset schizophrenic patients with prominent positive and prominent negative symptoms

The objective of the study was to find associations between obstetric complications (OCs) history and schizophrenia course and symptoms. We analysed the obstetric and psychiatric history of 50 DSM IV schizophrenic subjects who experienced their first schizophrenia episode in adolescence, and 30 healthy controls. Obstetrical data and Apgar scores were obtained from medical records and evaluated with the Lewis and Murray Scale. Based on patients' documentation [including longitudinal evaluation with Positive and Negative Syndrome Scale (PANSS)] the symptom profile and the course of schizophrenia were determined.

RESULTS

we distinguished two major groups of patients: with prominent negative and prominent positive symptoms. Schizophrenics with prominent negative symptoms and a chronic schizophrenia course had significantly more definite OCs and lower Apgar scores than patients with prominent positive symptoms and controls. Subjects who had a positive OCs history were more than four times likely to develop schizophrenia in adolescence than those without such a history (OR=4.64; 95% CI=1.29-17.51) with the likelihood of developing schizophrenia with prominent negative symptoms especially high (OR=7.31; 95% CI=1.80-29.65). An Apgar score of between 0 and 3 after birth was associated with an increased risk for developing schizophrenia (OR=2.25; 95% CI=0.56-9.12), especially with prominent negative symptoms (OR=3.71; 95% CI=0.84-16.32). The findings support the hypothesis of a role of OCs in developing early-onset schizophrenia and suggest the associations of the OCs history with a specific symptoms profile (prominent negative symptoms) and a chronic course of schizophrenia.

[Clinical picture and duration of prodromal period of schizophrenia in adolescents]

The aim of study was retrospective estimation of clinical picture and duration of prodromal period in 150 adolescents with the first episode of schizophrenia.

[Psychoeducation of families of adolescent patients]

The paper presents the preliminary observations concerning the attitudes manifested by the families of adolescents diagnosed as psychotic and admitted to psychoeducation group. The above group was characterized by the high level of expressed emotion and, what is even more important, by the attempt to deny the presence of the illness and by the fear of stigmatization. The last two factors proved particularly relevant for realization of the therapeutic programme, and were often instrumental in individual decisions to leave the group. In the course of psychoeducation of adolescents' families the therapeutic programme should be geared to the actual needs of the group.

[Developmental disorders in the fourth edition of the American classification: diagnostic and statistical manual of mental disorders (DSM IV -- optional book)]

In 1991 the American Psychiatric Association proposed a draft version of the IV edition of the Diagnostic and Statistical Manual of Mental Disorders--the DSM IV Options Book. Authors of this version wanted to increase clarity of the criteria sets and to provide compatibility with the Tenth Edition of the International Classification of Diseases (ICD - 10). The purpose of this Options Book is to propose some changes in wording, diagnostic divisions and to discuss various options concerning the placement of sections and disorders within the classification. The "Disorders of Infancy, Childhood or Adolescence" section was renamed "Disorders Usually First Evident in Infancy, Childhood or Adolescence" and moved to the front of the classification and also was expended to 11 groups of disorders. Several suggestions have been made about including new diagnostic groupings such as: Rett's Disorder, Eating Disorders and Voice Disorder. The Options Book introduces a superior category for Attention Deficit Disorders (with and without hyperactivity) and for Conduct Disorder/Oppositional Defiant Disorder. Several options are proposed regarding The Anxiety Disorders of Childhood or Adolescence. There is no evidence for a distinction in this category according to the age criterion. One option would be to move these disorders into the adult anxiety section (similarly as in the Mood Disorders and Schizophrenia). In the new version the title "Specific Developmental Disorders" is omitted. The suggestion is to include Phonological Disorder (Articulation Disorders) and Elective Mutism into Speech and Language Disorders section.