Understanding priorities and needs for child and adolescent mental health in Greece from multiple informants: an open resource dataset

The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [ https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard ]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.

Specificity of phonological representations in school-age high-functioning ASD children

PURPOSE

Well-specified phonological representations are important for the development of spoken and written language. This study investigates the types of speech errors and the quality of phonological representations in Greek-speaking school-age children with high-functioning autism spectrum disorder (HF-ASD), as well as the relationship between stored phonological representations and speech output in this sample, according to Stackhouse and Wells' (1997) model.

METHOD

All participants completed a phonological and a naming test, and a non-word repetition task. A receptive phonological task was administered to a subgroup of HF-ASD and typically developing (TD) participants. According to performance in the phonological test, the HF-ASD children were categorised as ASD with Speech Sound Disorder (SSD) or ASD without SSD.

RESULT

The HF-ASD children made significantly more speech errors and showed significant difficulties in the repetition of non-words and the stored phonological representations compared to the TD group but had the same naming abilities with their TD peers. The ASD children with SSD and without SSD performed alike in the receptive task, indicating that both groups had unspecified phonological representations.

CONCLUSION

These results support the hypothesis of distinct phonological representations for speech input and output and highlight the need of using receptive tasks to evaluate underlying phonological knowledge, a process which could allow clinicians to identify the level of speech breakdown.

Qualitative analysis of verbal fluency in school-age children with high-functioning autism spectrum disorders. Associations with age and IQ

This study analyzes performance on both a Semantic and a Letter verbal fluency (VF) task in school-age children with high-functioning autism spectrum disorder (HF-ASD) (n = 20) and without ASD (n = 20) and investigates the relationship between VF indicators and age, verbal and non-verbal IQ, ASD severity, and attention deficit hyperactivity disorder (ADHD) symptomatology. Furthermore, the Poor Lexical-Semantic Structure Model and the Slow-Retrieval Model are tested if they could account for semantic retrieval difficulties in children with HF-ASD. The HF-ASD group generated significantly fewer correct responses in both VF tasks in comparison to the control group. The type of task significantly affected performance and both groups showed higher word generativity on the Semantic task. The groups did not differ in clustering, switching, and errors. Age significantly correlated with the VF indicators in the ASD group, but in the control group, there was a significant negative correlation with the number of errors. Non-verbal and verbal IQ did not correlate with any VF indicators in both groups, while ASD severity and ADHD symptomatology correlated positively and significantly with error responses in the ASD group. The Slow-Retrieval Model explains VF difficulties in the HF-ASD group indicating that poorer word generativity can be attributed to slower retrieval of words from the semantic network.

The science of child and adolescent mental health in Greece: a nationwide systematic review

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

Virtual Reality Training of Social Skills in Adults with Autism Spectrum Disorder: An Examination of Acceptability, Usability, User Experience, Social Skills, and Executive Functions

Poor social skills in autism spectrum disorder (ASD) are associated with reduced independence in daily life. Current interventions for improving the social skills of individuals with ASD fail to represent the complexity of real-life social settings and situations. Virtual reality (VR) may facilitate social skills training in social environments and situations similar to those in real life; however, more research is needed to elucidate aspects such as the acceptability, usability, and user experience of VR systems in ASD. Twenty-five participants with ASD attended a neuropsychological evaluation and three sessions of VR social skills training, which incorporated five social scenarios with three difficulty levels. Participants reported high acceptability, system usability, and user experience. Significant correlations were observed between performance in social scenarios, self-reports, and executive functions. Working memory and planning ability were significant predictors of the functionality level in ASD and the VR system's perceived usability, respectively. Yet, performance in social scenarios was the best predictor of usability, acceptability, and functionality level. Planning ability substantially predicted performance in social scenarios, suggesting an implication in social skills. Immersive VR social skills training in individuals with ASD appears to be an appropriate service, but an errorless approach that is adaptive to the individual's needs should be preferred.

Theophrastus's "Anaisthetos" ("The Obtuse Man"): the oldest "phenomenological" description of neurodevelopmental disorders in an adult

Theophrastus (381-278 B.C.), was the first to adopt the term character for the description of distinct inner psychological and moral features of an individual. In his classic book 'Characters' in a simple style wording he analyses some of his contemporary individuals. The character "Αναίσθητος" (Anaisthetos) has been translated in English as "The Obtuse Man" and in Modern Greek both as "Αναίσθητος", meaning lack of appreciation and "Βραδύνους", meaning slowness of mind. Theophrastus' description of this particular character is compatible with the co-occurrence in an adult of two Neurodevelopmental Disorders: the Attention-Deficit Hyperactivity Disorder (ADHD) and the Social Pragmatic Communication Disorder (SPCD), according to the 5th Diagnostic and Statistical Manual of Mental Disorders. Ten out of the twelve statements support the possible occurrence of ADHD while five of them the occurrence of SPCD. The description does not justify a diagnosis of an intellectual disability; therefore, we consider that in the Modern Greek vocabulary the original term «Αναίσθητος» ("Anaisthetos"), meaning lack of appreciation, is more accurately corresponding to this particular Theophrastus's character than "Βραδύνους" ("Obtuse"), which indicates the presence of low intellectual capacities. Also the lack of repetitive and restrictive interests and behaviours excludes Autism Spectrum Disorder as a possible diagnosis. Minor psychiatric disorders and traits according to the Peripatic School were attributed to the lack of rational control over appetites and behavior. Accordingly, «Αναίσθητος» is a phenomenological description of a stigmatizing inappropriate social behavior and the only help that might give is in increasing self-awareness. In our contemporary clinical practice, though, the early recognition and appropriate treatment of Neurodevelopmental Disorders in affected individuals, leads to a better clinical care and may diminish stigmatization. The co-existence of these two disorders in a character in such a different historical context reinforces their validity as diagnostic constructs and provides an example of co-occurrence of Neurodevelopmental Disorders.

Strategic decision making and prediction differences in autism

Background

Several theories in autism posit that common aspects of the autism phenotype may be manifestations of an underlying differentiation in predictive abilities. The present study investigates this hypothesis in the context of strategic decision making in autistic participants compared to a control group.

Method

Autistic individuals (43 adults, 35 male) and a comparison group (42 adults, 35 male) of age and gender matched individuals, played a modified version of the prisoner's dilemma (PD) task where they were asked, if capable, to predict their opponents' move. The predictive performance of the two groups was assessed.

Results

Overall, participants in the autism group had a significantly lower number of correct predictions. Moreover, autistic participants stated, significantly more frequently than the comparison group, that they were unable to make a prediction. When attempting a prediction however, the success ratio did not differ between the two groups.

Conclusions

These findings indicate that there is a difference in prediction performance between the two groups. Although our task design does not allow us to identify whether this difference is due to difficulty to form a prediction or a reluctance in registering one, these findings could justify a role for prediction in strategic decision making during the PD task.

mPD: Introduction of a single player prisoner's dilemma application for medical experiments

BACKGROUND

Prisoner's dilemma is one of the most popular concepts among scientific literature. In medical literature the majority of prisoner's dilemma experiments with human participants implement computerized means. Despite this, there is no shared validated tool for prisoner's dilemma tasks.

METHODS

The application is developed in Javascript programming language and makes use of the pixijs library for WebGL rendering. To create a custom trial, a set of variables have to be set. These refer to the linguistics, user controls, available choices, computer strategy, interaction flow (simultaneous or sequential), opponent's choice prediction requirement, noise induction, human opponent behavior simulation, the way resulted data will be handled and more. Results are in JSON format and include time interval data.

RESULTS

We have developed an application which, given the various parameters experimenter can modify, is able to simulate a large number of single player prisoner's dilemma versions. It is open source with no installation requirement, executable by any modern internet browser remotely or locally with the ability to post data results either locally or remotely. Experimenter only has to modify certain starting values in order to create his design of choice. Two examples are included, with initial settings and results, to demonstrate the use and validity of the application.

CONCLUSIONS

Our aim is to assist future researchers in their methodological designs. In this scope, our application, has the minimum requirements, can be served either locally or remotely, has a wide range of modifiable parameters and takes care of the resulted data. In the long term, a shared and validated tool would contribute to increasing methodologies' credibility and mitigating cross-validation discrepancies.

Parenting Children with Autism Spectrum Disorder during Crises: Differential Responses between the Financial and the COVID-19 Pandemic Crisis

Parenting a child with autism can be particularly stressful and challenging, especially during periods of crises. This study focuses on parenting children with autism during the COVID-19 pandemic in comparison to the economic crisis, six years ago. We administered the same set of questionnaires (CES-D, F-COPES, PSI-SF, and WHOQoL-BREF), along with a demographic characteristic and a COVID-19-related questionnaire to the same group of parents of children with autism as we did six years ago. Results indicated that during the COVID-19 crisis, the level of parenting stress and the distress due to personal factors related to demands of parenting, were significantly lower compared to the economic crisis, while the environment facet of quality of life was significantly higher. The depressive symptomatology was elevated during both periods. Finally, when addressing the pandemic crisis, parents were more likely to passively accept problematic issues, less able to obtain social support, and less able to acquire and accept help from others. In our sample, findings differentiate the genre of crises through the parents’ responses regarding the sense of competence in their parental role, their quality of life, and the coping strategies they implemented. The study implies that each crisis must be confronted with particular responses to particular needs.

Factors of influence in prisoner's dilemma task: a review of medical literature

The Prisoner's Dilemma (PD) is one of the most popular concepts amongst the scientific literature. The task is used in order to study different types of social interactions by giving participants the choice to defect or cooperate in a specific social setting/dilemma. This review focuses on the technical characteristics of the PD task as it is used in medical literature and describes how the different PD settings could influence the players' behaviour. We identify all the studies that have used the PD task in medical research with human participants and distinguish, following a heuristic approach, seven parameters that can differentiate a PD task, namely (a) the opponent parties' composition; (b) the type of the opponent as perceived by the players; (c) the interaction flow of the game; (d) the number of rounds; (e) the instructions narrative and options that are given to players; (f) the strategy and (g) the reward matrix and payoffs of the game. We describe how each parameter could influence the final outcome of the PD task and highlight the great variability concerning the settings of these parameters in medical research. Our aim is to point out the heterogeneity of such methods in the past literature and to assist future researchers with their methodology design.

P–261 The human embryo following biopsy on day5 vs day3: Implantation, cytoskeleton, ultrastructure and effects of endometrial damage/inflammation on receptivity as revealed by scanning electron microscopy

Study question

Are there any differences in implantation, cytoskeleton and ultrastructure of embryos biopsied on day5 vs day3 and how endometrial damage/inflammation may affect receptivity and implantation?

Summary answer

No differences are observed in implantation rates but vitrification following day5 biopsy led to more cytoskeletal/ultrastructural anomalies. Infections and epithelial damage severely affected endometrial receptivity.

What is known already

Successful implantation is dependent on the correct synchronization of the window of implantantation with the transfer of chromosomally/genetically normal embryos, in a well prepared receptive endometrium. This is the first study to examine the effects of day5 vs day3 embryo biopsy by comparing implantation/pregnancy rates and by analysing cytoskeleton using Confocal Laser Scanning Microscopy (CLSM), and ultrastructure by Transmission Electron Microscopy (TEM). In addition, Scanning Electron Microscopy (SEM) was used on endometrial biopsies to assess possible uterine pathologies/inflammation that may be responsible for the failed implantation after PGT-A/M and if subsequent treatment can increase implantation/pregnancy rates in succeeding PGT-A/M cycles.

Study design, size, duration

470 embryos were biopsied on day5 for PGT-A (n = 152–37 cycles) or on day3 for PGT-A (n = 162–29 cycles) and PGT-M (n = 156–22 cycles). Following transfer of normal embryos, spare embryos, rejected for transfer following day5 or day3 biopsy were processed for Cytoskeletal analysis (n = 30 fresh day3 biopsied, n = 30 day5 biopsied/vitrified) or TEM (n = 20 fresh day3 biopsied, n = 20 day5 biopsied/vitrified). Also, patients with a –ve hCG test, underwent endometrial biopsy to detect infection/inflammation and assess receptivity.

Participants/materials, setting, methods

Cytoskeletal analysis was performed by embryo immunostaining with α-tubulin, γ-tubulin, acetylated-tubulin antibodies and DAPI or/ PI to visualise DNA. TEM analysis was carried out following embryo fixation in gluteraldehyde, incubation in osmium, aqueous uranyl acetate, dehydration through ethanol series, and immersion in Epon. Endometrial biopsies were fixed in gluteraldehyde solution and processed for SEM using standard methods. The study was conducted in an academic hospital with an IVF/PGD laboratory and 3 private IVF Units.

Main results and the role of chance

162 embryos were biopsied on day 3 for PGT-A (29 cycles), 10 cycles had no normal embryos for transfer, 30 normal embryos were transferred in 19 cycles leading to 12/19 (63.2%) +vehCG/ET and 11/19 (57.9%) Ongoing pregnancy rate/ET. 156 embryos were biopsied on day 3 for PGT-M (22 cycles), 2 cycles had no normal embryos for transfer, 34 normal or carrier embryos were transferred in 20 cycles leading to 15/20 (75.0%) +vehCG/ET and 13/20 Ongoing pregnancy rate/ET (65.0%). 152 embryos were biopsied on day 5 for PGT-A (37 cycles), 8 cycles had no normal embryos for transfer, 34 normal embryos were transferred in 29 cycles leading to 18/29 (62.1%) +vehCG/ET and 16/29 (55.2%) Ongoing pregnancy rate /ET. Analysis of endometrial biopsies with SEM revealed bacterial infections, inflammation and epithelial damage. So far, 33.3% of patients who received intracavitary infusions-antibiotic treatment per os achieved a +vehCG/ET in their next PGT-A/M cycle. Cytoskeletal analysis showed that the majority of spindles examined in both day3 and day5 biopsied embryos were normal (85/114(74.6%) and 87/137(63.5). However vitrification following day5 biopsy led to more cytoskeletal/ultrastructural anomalies which included multipolar/abnormally shaped spindles, chromosome-bridging, chromosome-lagging and more vacuoles, lipofuscins. and distension of mitochondria.

Limitations, reasons for caution

Patients undergoing PGT-A have various aetiologies (heterogeneous group). The embryos used for cytoskeletal and ultrastructural analysis in this study were all diagnosed with either chromosomal abnormalities or single gene defects following PGT-A or PGT-M.

Wider implications of the findings: This is the first study to compare implantation/pregnancy rates, cytoskeleton and ultrastructure of day5 vs day3 biopsied embryos. The similarities observed in implantation/pregnancy rates, and the limited ultrastuctural and cytoskeletal anomalies identified confirm the procedures’ safety and indicate in certain cases endometrial factors/inflammation responsible for failed implantation following PGT-A/M.

Trial registration number

Not applicable

Metabolic profile of patients with isolated systolic hypertension

PURPOSE/OBJECTIVE

While hypertension is an important contributor to cardiovascular disease (CVD) and its treatment has well-established mortality benefits, there is uncertainty as regards the management of isolated systolic hypertension (ISH). Furthermore, the association of ISH with CVD and mortality has been established, but the metabolic characteristics of the affected population have not as yet been adequately described. The aim of this study was to describe the metabolic profiles of patients with ISH.

METHODS

An observational study of patients attending the Hypertension Unit of the University Hospital of Heraklion, Crete, Greece, was performed.

RESULTS

In total, 809 hypertensive patients not on any antihypertensive treatment were identified. Among them, 44.7% were men, aged 55.6 ± 12.5 years, while 29.7% of both men and women were smokers. Systolic blood pressure was 161.3 ± 15.8 mmHg and diastolic blood pressure was 96.1 ± 11.3 mmHg. Body mass index (BMI) was 31 ± 5.3 kg/m², while 9.6% had type 2 diabetes (T2D). A comparison of patients with ISH with those with hypertension, but not ISH, revealed that patients with ISH were older and had lower SBP and higher pulse pressure, while they also had lower total cholesterol and LDL and were more likely to have T2D, albeit they had a slightly lower BMI. On the other hand, they did not have any difference in terms of gender, smoking status, HDL, triglycerides, liver biochemistry, uric acid, or prevalence of impaired fasting glucose.

CONCLUSION

Patients with ISH were older, with lower SBP, total cholesterol, and LDL and higher pulse pressure and higher prevalence of diabetes.

Validation of the Empathy Quotient (EQ) - Greek version

The original English language Empathy Quotient (EQ) is a self-reporting questionnaire that measures the construct of empathy in adults of normal intelligence. The EQ is sensitive to gender, and neurodevelopmental disorders. The EQ has been translated to many languages all over the world. The EQ - Greek version may be available through open access from www.autismresearchcentre.com. Aim of the present study was to validate the EQ- Greek version.The study took place in the 1st and 2nd Departments of Psychiatry of the National and Kapodistrian University of Athens (NKUA), "Eginition" and "Attikon" Hospitals respectively, and in the Korydallos Prison Psychiatric Clinic in Athens. Two groups completed the original 60 items version. One group consisted of general population and volunteer students from post graduate training programs (normal control group, N= 127) and the other group of patients recruited from the Adult Neurodevelopmental Disorders Unit of the 1st Department of Psychiatry of NKUA, the outpatients' clinic of the 2nd Department of Psychiatry of NKUA and the Korydallos Prison Psychiatric Clinic (patient group, N=196). Three versions of the EQ were examined: the EQ-40, EQ-28 and EQ-15. All versions showed very good internal validity: Cronbach's a value was 0.902, 0.892 and 0.793 respectively. They all showed good test-retest variability: the Intraclass Correlation Coefficient was 0.928, 0.924 and 0.855 respectively. Concurrent validity examined by the correlation analysis with the Interpersonal Reactivity Index (IRI) showed non-significant correlations between the EQ and the IRI. Exploratory Factor Analysis (EFA) indicated a one-factor structure for the three versions. Confirmatory Factor Analysis (CFA) for the one-factor structure showed a good fit for all the three versions. CFA for the three-factor structures (Cognitive Empathy, Emotional Empathy, Social Skills) showed also a good fit for EQ-28 and the EQ-15. When the EQ-40 was used as a measure of empathy in a single dimension in adults, the EQ discriminated the normal control group from the patients' group. The mean EQ score for the total sample was 35.84 with the lowest scoring being among Autism Spectrum Disorder (ASD) patients. As expected, females scored higher than males (p<0.001). To conclude, the Greek version of EQ showed good psychometric properties and could serve as a useful tool for clinicians to assess empathy in clinical populations and especially in subjects with ASD and other neurodevelopmental disorders.

Trait-Based Dimensions Discriminating Adults with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and, Co-occurring ADHD/ASD

This study assessed the co-occurrence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in newly diagnosed adults of normal intelligence and the contribution of trait-based dimensions deriving from the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), the Autism-Spectrum Quotient (AQ), and the Empathy Quotient (EQ) to the differentiation of patients with ADHD, ASD, and ADHD/ASD. A total of 16.1% of patients with ADHD received a co-occurring ASD diagnosis, while 33.3% of patients with ASD received an ADHD diagnosis. Subjects with ADHD or ADHD/ASD had higher scores in all ADHD traits compared to ASD subjects. Compared to the ADHD group, the ASD group had AQ scores that were significantly greater, except for attention to detail. ADHD/ASD co-occurrence significantly increased the score of attention to detail. The total EQ score was greater in the ADHD group. In the stepwise logistic regression analyses, past hyperactivity, current inattention and impulsivity, attention switching, communication, imagination, and total EQ score discriminated ADHD patients from ASD patients. Attention to detail, imagination, and total EQ score discriminated ADHD cases from ADHD/ASD cases, while past hyperactivity and current impulsivity discriminated ASD subjects from ADHD/ASD subjects. Our findings highlight the importance of particular trait-based dimensions when discriminating adults with ADHD, ASD, and co-occurring ADHD/ASD.

The Emotion of Disgust among Medical and Psychology Students

The emotion of disgust evolved as a way to protect oneself from illness and is associated with aspects of disease avoidance. Disgust Scale–Revised (DS-R) (Olatunji et al., 2008) measures the disgust propensity of three kinds of disgust (core, animal reminder, contamination). Contextual factors, such as academic background, might influence DS-R scoring, especially among medical students, where the notion of disease is central. We examined DS-R scoring and the choice of postgraduate studies in medical (n = 94) and psychology (n = 97) students. In an anonymous web-based survey, participants completed the DS-R and a questionnaire including plans for postgraduate studies. Females outnumbered males and scored higher in total DS-R score (p = 0.003). Psychology students scored higher in all three kinds of disgust (p < 0.001 for core disgust and animal reminder, p = 0.069 for contamination disgust), indicating a higher level of disease avoidance. Medical students willing to follow Internal Medicine scored higher in core disgust (p < 0.05), while psychology students willing to study Experimental Psychology scored lower in the animal reminder subscale (p = 0.019 and p < 0.001 for the association between these subscales and the orientation of Medical and Psychology Students, respectively). In conclusion, disgust propensity as rated by DS-R is related to academic background and orientation preferences in postgraduate studies.

Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD)

BACKGROUND

Co-occurring psychiatric disorders in adults with Attention Deficit Hyperactivity Disorder (ADHD) and/or Autism Spectrum Disorder (ASD) contribute to the burden of the healthcare and possibly to the delay of diagnosis. Aim of the study was to clinically assess the prevalence and compare lifetime co-occurring psychopathology in a sample of newly diagnosed ADHD and/or ASD adults and discuss the diagnostic challenges they pose.

METHODS

The lifetime prevalence rates of ten of the most frequently co-occurring psychiatric diagnoses was registered in 336 adults of normal intelligence who underwent a thorough clinical evaluation for the diagnosis of ADHD and/or ASD for the first time in their lives. Four study groups were formed: the ADHD (n = 151), the ASD (n = 58), the ADHD+ASD (n = 28) and the nonADHD/nonASD (NN) (n = 88) group.

RESULTS

At least one co-occurring psychopathology was found in 72.8% of the ADHD group, in 50% of the ASD group, in 72.4% of the ADHD+ASD group and in 76.1% of the NN group (p = 0.004). In all groups the most frequent psychiatric disorder was depressive disorder. The only significant difference regarding the patterns of psychiatric co-occurrence between the ADHD and the nonADHD groups (ASD and NN groups) was found for SUD (p = 0.001). Also, the proportion of subjects with Bipolar Disorder was significantly greater in the NN group as compared to those with ASD (p = 0.025).

CONCLUSIONS

Our results support the high prevalence of co-occurring psychiatric disorders in adults with ADHD and/or ASD with the ASD group presenting the lowest rate. The most marked difference between the ADHD and the nonADHD groups was found for SUD. Moreover, our findings highlight the need for a thorough clinical assessment of all referred patients both in the presence and absence of ADHD and/or ASD.

Mothers' parenting stress is associated with salivary cortisol profiles in children with attention deficit hyperactivity disorder

The aim of this study was to explore the relation between mothers' parenting stress and the functioning of the hypothalamic-pituitary-adrenal axis (HPAA), as expressed by daily salivary cortisol concentrations, in their children diagnosed with attention deficit hyperactivity disorder (ADHD). Seventy-five children aged 6-11 years diagnosed with ADHD predominant hyperactive-impulsive/combined (ADHD-HI/C, N = 49) and inattentive symptoms (ADHD-I, N = 26) and 45 healthy peers and their mothers participated in the study. Μothers completed measures assessing their children's ADHD status, perceived parenting stress (Parenting Stress Index - Short Form, PSI-SF), mothers' symptoms of psychopathology, social support and socioeconomic status. Children's salivary cortisol samples were collected at six different time points on a single day. Mothers of children with ADHD-HI/C reported higher levels of parenting stress than mothers of children with ADHD-I and controls. All PSI-SF subscales showed significant associations with children's cortisol awakening response (CAR) in both ADHD groups, with the exception of the parental distress subscale in the ADHD-I group. In both ADHD groups, the parent-child dysfunctional interaction subscale, the difficult child subscale and the PSI total score were significantly associated with children's CAR. An interrelation is revealed between mothers' high levels of parenting stress and HPAA functioning in children with ADHD. In this population, CAR has been identified as a sensitive peripheral measure of HPAA functioning in children. Lay summaryThis study showed that in families of children diagnosed with ADHD, there is a complex relation between the mothers' high levels of parenting stress and children's atypical hypothalamic-pituitary-adrenal axis functioning.

Internalizing and externalizing problems in obese children and adolescents: associations with daily salivary cortisol concentrations

OBJECTIVE

Pediatric obesity commonly co-exists with emotional and behavioral disorders, while disturbed cortisol concentrations have been reported in both obese and chronically stressed individuals with anxiety and/or depression. We investigated the prevalence of internalizing and externalizing problems, reported by both parents and children, in a clinical population of obese children (OC) compared to normal-weight children. We examined the role of cortisol as a potential mediator between obesity and such problems.

DESIGN

We compared 110 obese with 31 normal-weight children. The Greek version of the child behavior checklist (CBCL) and the youth self-report (YSR) were used and salivary cortisol was determined serially five times a day.

RESULTS

T-scores of internalizing problems (anxiety/depression, social withdrawal, somatic complains) reported by both children (49.3±12.3 vs. 43.2±9.1) and mothers (60.6±11.3 vs. 50.6±10.4) were significantly higher (p=0.03 and p<0.001, respectively) in the obese than in the lean children. Externalizing problems (delinquency, rule-breaking behaviors) reported only by mothers were significantly higher in the OC (57.2 ±10.5 vs. 48.2±13.3, p=0.003). The cortisol area under the curve (AUC) was significantly smaller (p=0.03) in the OC than in the controls; however, a cortisol correlation with internalizing/externalizing symptoms was not observed.

CONCLUSIONS

There is a high prevalence of internalizing and externalizing problems in a clinical population of OC. A mediation effect of cortisol in the relation between internalizing/externalizing problems and obesity could not be supported.

35-Year Follow-Up of a Case of Ring Chromosome 2: Array-CGH Analysis and Literature Review of the Ring Syndrome

Côté et al. [1981] suggested that ring chromosomes with or without deletions share a common pattern of phenotypic anomalies, regardless of which chromosome is involved. The phenotype of this 'general ring syndrome' consists of growth failure without malformations, few or no minor anomalies, and mild to moderate mental retardation. We reconsidered the ring chromosome 2 case previously published by Côté et al. [1981], and we characterized it by array CGH, polymorphic markers as well as subtelomere MLPA and FISH analysis. A terminal deletion (q37.3qter) of maternal origin of the long arm of the ring chromosome 2 was detected and confirmed by all the above-mentioned methods. Ring chromosome 2 cases are exceedingly rare. Only 18 cases, including the present one, have been published so far, and our patient is the longest reported survivor, with a 35-year follow-up, and the third case characterized by array-CGH analysis.

New Interview and Observation Measures of the Broader Autism Phenotype: Description of Strategy and Reliability Findings for the Interview Measures

Clinical genetic studies confirm the broader autism phenotype (BAP) in some relatives of individuals with autism, but there are few standardized assessment measures. We developed three BAP measures (informant interview, self-report interview, and impression of interviewee observational scale) and describe the development strategy and findings from the interviews. International Molecular Genetic Study of Autism Consortium data were collected from families containing at least two individuals with autism. Comparison of the informant and self-report interviews was restricted to samples in which the interviews were undertaken by different researchers from that site (251 UK informants, 119 from the Netherlands). Researchers produced vignettes that were rated blind by others. Retest reliability was assessed in 45 participants. Agreement between live scoring and vignette ratings was very high. Retest stability for the interviews was high. Factor analysis indicated a first factor comprising social-communication items and rigidity (but not other repetitive domain items), and a second factor comprised mainly of reading and spelling impairments. Whole scale Cronbach's alphas were high for both interviews. The correlation between interviews for factor 1 was moderate (adult items 0.50; childhood items 0.43); Kappa values for between-interview agreement on individual items were mainly low. The correlations between individual items and total score were moderate. The inclusion of several factor 2 items lowered the overall Cronbach's alpha for the total set. Both interview measures showed good reliability and substantial stability over time, but the findings were better for factor 1 than factor 2. We recommend factor 1 scores be used for characterising the BAP.

Comorbid attention-deficit/hyperactivity disorder in adult psychiatric outpatients with depressive or anxiety disorders

BACKGROUND

There are very few studies reporting on the prevalence and the contribution of not previously diagnosed ADHD in the clinical picture of other psychiatric disorders. The aim of our study is to determine the prevalence and clinical correlates of comorbid attention deficit/hyperactivity disorder (ADHD) in adult psychiatric outpatients with depressive or anxiety disorders.

METHODS

During a 6-month period, 114 outpatients with depressive or anxiety disorders were evaluated for ADHD diagnosis. Assessment included interviews with both patient and relatives/friends and the use of a daily diary. Moreover, the patients completed the self-report scales Beck Depression Inventory (BDI), Spielberger's Anxiety Inventory (STAI), and the Symptom Checklist-90-R Rating Scale (SCL-90-R).

RESULTS

A total of 22 out of 114 patients (19.3%) received an ADHD diagnosis for the first time in their life. Comorbid ADHD compared to non ADHD patients scored significantly higher (p < 0.05) for depression (BDI), state and trait anxiety (STAI) and in the following SCL-90-R factors: Positive Symptoms Distressing Index, Positive Symptoms Index, Somatization, Obsessive Compulsive, Depression, Anxiety, and Hostility.

CONCLUSIONS

ADHD might go unrecognized among psychiatric outpatients. Patients with depressive or anxiety disorder reporting more severe symptomatology should be carefully screened for possible comorbid adult ADHD.

Parental readiness to implement life-style behaviour changes in relation to children's excess weight

AIM

The aim if this study is to evaluate parental readiness to implement changes in specific life-style behaviours for preventing or reducing obesity in children.

METHODS

Eighty-seven parents of overweight or obese children participated in this cross-sectional study. Parents completed a questionnaire for the assessment of their perceptions about their children's weight and their readiness to take action in general, as well as in relation to ten obesogenic life-style behaviours. The transtheoretical model with the five stages of change (precontemplation, contemplation, preparation, action and maintenance) was used for this assessment. A total readiness score was calculated for the 10 behaviours.

RESULTS

A total of 4.6% of parents were in the precontemplation-contemplation stage for overall weight management. However, this percentage was greater for particular behaviours, such as allowing children to self-regulate their food intake, having family meals, reducing screen time and increasing physical activity. Child's body mass index, paternal education level and parental perception about child's excessive weight being attributed to over-consumption of sweets and salty snacks were significantly associated with total readiness score.

CONCLUSIONS

The results of the present study indicate that the high readiness for general action reported by parents of overweight/obese children does not necessarily imply their readiness to engage in changes in specific life-style behaviours.

Circadian cortisol profiles, anxiety and depressive symptomatology, and body mass index in a clinical population of obese children

Obesity is highly co-morbid with anxiety and/or depression in children, conditions that may further worsen the metabolic and cardiovascular risks for obese individuals. Dysregulation of the hypothalamic-pituitary-adrenal axis is involved in the pathophysiology of anxiety disorders, depression, and obesity, and diverse cortisol concentrations may be found in obese children, depending on their degree of psychological distress. The aim of this study was to examine cortisol profiles among obese children with or without symptoms of anxiety and depression. A group of 128 children (53% females; mean age ± SD: 11.2 ± 2.2 years) derived from a pediatric obesity clinic were studied. Anxiety and depressive symptomatology were assessed with appropriate instruments. Morning serum and five diurnal salivary cortisol concentrations were measured. Obese children were 3.1/2.3 times more likely to report state and trait anxiety, respectively, and 3.6 times more likely to report depressive symptoms than children of the same age group, from a contemporary Greek sample. Trait anxiety and noon salivary cortisol concentrations were significantly positively correlated (p = 0.002). Overall, salivary cortisol concentrations were increased in children with anxiety or depression symptomatology compared to obese children without any affective morbidity (p = 0.02) and to those with anxiety and depression co-morbidity (p = 0.02). In conclusion, in obese children, emotional distress expressed by symptoms of anxiety and/or depression is associated with circadian cortisol profiles reflecting a potential pathway for further morbidity. Longitudinal studies may reveal a role of cortisol in linking obesity, anxiety, and depression to the development of further psychological and physical morbidity.

Use of a Relaxation Technique by Mothers of Children with Autism: A Case-Series Study

Mothers of children with autism are subject to considerable stress by having to adjust to the disorder and to cope with practical and social issues. Evidence on the effects of relaxation training on stress of these mothers is scarce. The purpose of this pilot case-series study was to examine the role of a simple 6-week daily stress management technique on mothers of children with autism. Mothers' stress measurements and children's functionality were assessed using validated instruments. Participants were 11 mothers of children with autism seen consecutively in the autism clinic of a children's hospital. Statistically significant median reductions of perceived and parental stress were noted after the 6-week intervention. Median stress scores were lower by 37.1% and 33% from the baseline values of the perceived stress scale and parental stress index, respectively. Stress was not significantly correlated with children's functioning. Stress management seems to have benefits for mothers of children with autism.

Individual common variants exert weak effects on the risk for autism spectrum disorders

While it is apparent that rare variation can play an important role in the genetic architecture of autism spectrum disorders (ASDs), the contribution of common variation to the risk of developing ASD is less clear. To produce a more comprehensive picture, we report Stage 2 of the Autism Genome Project genome-wide association study, adding 1301 ASD families and bringing the total to 2705 families analysed (Stages 1 and 2). In addition to evaluating the association of individual single nucleotide polymorphisms (SNPs), we also sought evidence that common variants, en masse, might affect the risk. Despite genotyping over a million SNPs covering the genome, no single SNP shows significant association with ASD or selected phenotypes at a genome-wide level. The SNP that achieves the smallest P-value from secondary analyses is rs1718101. It falls in CNTNAP2, a gene previously implicated in susceptibility for ASD. This SNP also shows modest association with age of word/phrase acquisition in ASD subjects, of interest because features of language development are also associated with other variation in CNTNAP2. In contrast, allele scores derived from the transmission of common alleles to Stage 1 cases significantly predict case status in the independent Stage 2 sample. Despite being significant, the variance explained by these allele scores was small (Vm< 1%). Based on results from individual SNPs and their en masse effect on risk, as inferred from the allele score results, it is reasonable to conclude that common variants affect the risk for ASD but their individual effects are modest.

A novel approach of homozygous haplotype sharing identifies candidate genes in autism spectrum disorder

Autism spectrum disorder (ASD) is a highly heritable disorder of complex and heterogeneous aetiology. It is primarily characterized by altered cognitive ability including impaired language and communication skills and fundamental deficits in social reciprocity. Despite some notable successes in neuropsychiatric genetics, overall, the high heritability of ASD (~90%) remains poorly explained by common genetic risk variants. However, recent studies suggest that rare genomic variation, in particular copy number variation, may account for a significant proportion of the genetic basis of ASD. We present a large scale analysis to identify candidate genes which may contain low-frequency recessive variation contributing to ASD while taking into account the potential contribution of population differences to the genetic heterogeneity of ASD. Our strategy, homozygous haplotype (HH) mapping, aims to detect homozygous segments of identical haplotype structure that are shared at a higher frequency amongst ASD patients compared to parental controls. The analysis was performed on 1,402 Autism Genome Project trios genotyped for 1 million single nucleotide polymorphisms (SNPs). We identified 25 known and 1,218 novel ASD candidate genes in the discovery analysis including CADM2, ABHD14A, CHRFAM7A, GRIK2, GRM3, EPHA3, FGF10, KCND2, PDZK1, IMMP2L and FOXP2. Furthermore, 10 of the previously reported ASD genes and 300 of the novel candidates identified in the discovery analysis were replicated in an independent sample of 1,182 trios. Our results demonstrate that regions of HH are significantly enriched for previously reported ASD candidate genes and the observed association is independent of gene size (odds ratio 2.10). Our findings highlight the applicability of HH mapping in complex disorders such as ASD and offer an alternative approach to the analysis of genome-wide association data.

Grazing behavior of the greek breed of sheep »Serres« in lowland and mountainous pastures

Abstract. The grazing activities of indigenous sheep of the greek breed »Serres« was investigated in a typical lowland, and in a mountainous pasture in northern Greece during the vegetative period (April–October) of 2008. Grazing time, resting and ruminating time, distance travel and air temperature in relation to pasturing month and altitude were examined. It was remarked significant effect (P<0.001) of the pasturing month on grazing time, and resting time of sheep. Mean grazing time was greater in the lowland (315.71 min/day ±4.57) than in the mountainous pasture (283.57 min/day ±4.79). On the contrary, the resting time and the distance travel of sheep were shorter in the lowland pasture. The resting time had significant (P<0.01) positive relationship to air temperature (r=0.777).

P01-330-Case report of an adolescent psychotic patient

Introduction

5% of adults with schizophrenia report onset of psychosis before the age of 15. Despite the lack of precise incidence and prevalence rates from childhood or adolescent population-based studies, it is generally agreed that the prevalence of psychotic disorders increases markedly during adolescence.

The aim of this presentation is to demonstrate a case of an adolescent with psychosis and mild mental retardation.

Method/material

The material used comes from the archives of the Child/Adolescent Clinic of the CMHC.

Discussion/results

A 12-year-old boy was referred to the Child/Adolescent Clinic. He presented unwelcome repeated actions, (repeated opening/closing his books, allocating/reallocating things, sitting/re-sitting on the chair). He complained about auditory hallucinations (children talking/laughing ‘in his head’). He also presented self-destructive behavior (‘when I am angry I bang my head against the wall’). He was irritable, aggressive towards other children, with impulsive behavior. He had troubles understanding Greek language since he was from Russian origin.

From his history, both his father and grandfather were referred to suffer from mental disorder.

He was administered WISC and Rorschach tests. His intelligence quotient score was below 70 and the Rorschach test confirmed paranoid schizophrenic symptoms. Hospitalization was suggested but immediately rejected by his mother.

Risperidone was initiated (1 mg/day-1,5 mg/day). Soon, the symptoms began to be restricted. He began to be more concentrated, functional and sociable. 2 years after the initiation of risperidone, the patient's situation is stable (0,5 mg/day), appearing better mood.

Conclusion

Monotherapy with risperidone seems to provide significant levels of symptomatic improvement in young psychotic patients.

The impact of a tragic accident on mental health professionals

Objective

To investigate the psychological impact of the tragic accident in Tempi which cost of 21 students’ life (2003), on mental health professionals (MHP).

Material

BDI and Impact of Event Scale-Revised (IES-R) scores of PHPO MHP (psychiatrists/child-psychiatrist/psychologies/social workers) who offered support to victims’families/teachers/rest of the students.

Method/results

The personnel were deployed to the area exposed to witnessing experiences/impressions of the accident. Participants responded to BDI 10 days and IES-R 9–10 months past-accident. There was an IES-R retest 7 years later. The response rate was 100%. All achieved mild depression scores. As for IES-R, common qualities of conscious experience were found among them, though with different personality styles. Two major response sets, intrusion (unbidden thoughts/troubled dreams/waves of feelings/repetitive behavior) and avoidance (denial of the meanings of the event/behavioral inhibition/counterphobic activity/emotional numbness) were abstracted from evaluation.

No sex differences were mentioned as there was only one male in the group.

A correlation of 0.42 (p > 0.0002) between intrusion and avoidance subscale scores indicated that the two subsets were associated, though not measuring identical dimensions.

7 years later the mean score of the personnel on IES-R was 23: Impact Event: may be affected. All achieved a quite high score on the response ‘any reminder brought back feelings about it’.

Conclusion

MHP face additional emotional strain often over extended periods of time. There is a need to develop strategies such as insight oriented training. Research is imperative and an ethical requirement to find ways to protect the health of the carers and so their patients.

Are greeks SAD?

Introduction

Seasonal Affective Disorder (SAD) is thought to be related to a lack of serotonin, or according to other theories, the primary cause is melatonin produced in the pineal gland, since there are direct connections between the retina and the pineal gland.

Objective

To demonstrate cases of SAD treated in the CMHC of Katerini(northern Greece), in 2009.

Material

Archives of the adult-clinic of the CMHC in 2009.

Method/results

The CMHC accepted 3294 people (1517:males/1777:females) in 2009. 280 were diagnosed with depression (48:males/232:females). 96 were newcomers (22: males/74:females) seeking for session the fall-spring period, complaining about mood swings as daylight hours began to dwindle.

In September: 72 depression cases were reported (63:women/9:men). In December: 92 (73:women/19:men). The references were amazingly high: 84 (71:females/13:males) in March. More than ¾ of all sufferers were women,most in their 40s, correlating with international literature. The majority complained about decreased levels of energy/difficulty concentrating/fatigue/increased desire to be alone/increased need for sleep (unlike typical depression). They also mentioned interference with their relationships and work productivity. 1/3 of them received antidepressant medication, whereas Cognitive Behavior Therapy (CBT) was applied to the total of them. Although light therapy is widely recommended, there aren’t the means to be applied in the CMHC.

Conclusion

Though SAD is prevalent in most of the Nordic countries and mid-latitude places, our patients followed the SAD pattern with an onset of depressive symptoms in the fall, continuation of symptoms throughout winter and remission of them in the spring according to other international references.

A genome-wide scan for common alleles affecting risk for autism

Although autism spectrum disorders (ASDs) have a substantial genetic basis, most of the known genetic risk has been traced to rare variants, principally copy number variants (CNVs). To identify common risk variation, the Autism Genome Project (AGP) Consortium genotyped 1558 rigorously defined ASD families for 1 million single-nucleotide polymorphisms (SNPs) and analyzed these SNP genotypes for association with ASD. In one of four primary association analyses, the association signal for marker rs4141463, located within MACROD2, crossed the genome-wide association significance threshold of P < 5 × 10⁻⁸. When a smaller replication sample was analyzed, the risk allele at rs4141463 was again over-transmitted; yet, consistent with the winner's curse, its effect size in the replication sample was much smaller; and, for the combined samples, the association signal barely fell below the P < 5 × 10⁻⁸ threshold. Exploratory analyses of phenotypic subtypes yielded no significant associations after correction for multiple testing. They did, however, yield strong signals within several genes, KIAA0564, PLD5, POU6F2, ST8SIA2 and TAF1C.

Functional impact of global rare copy number variation in autism spectrum disorders

The autism spectrum disorders (ASDs) are a group of conditions characterized by impairments in reciprocal social interaction and communication, and the presence of restricted and repetitive behaviours. Individuals with an ASD vary greatly in cognitive development, which can range from above average to intellectual disability. Although ASDs are known to be highly heritable ( approximately 90%), the underlying genetic determinants are still largely unknown. Here we analysed the genome-wide characteristics of rare (<1% frequency) copy number variation in ASD using dense genotyping arrays. When comparing 996 ASD individuals of European ancestry to 1,287 matched controls, cases were found to carry a higher global burden of rare, genic copy number variants (CNVs) (1.19 fold, P = 0.012), especially so for loci previously implicated in either ASD and/or intellectual disability (1.69 fold, P = 3.4 x 10(-4)). Among the CNVs there were numerous de novo and inherited events, sometimes in combination in a given family, implicating many novel ASD genes such as SHANK2, SYNGAP1, DLGAP2 and the X-linked DDX53-PTCHD1 locus. We also discovered an enrichment of CNVs disrupting functional gene sets involved in cellular proliferation, projection and motility, and GTPase/Ras signalling. Our results reveal many new genetic and functional targets in ASD that may lead to final connected pathways.

Parental involvement does not augment the effectiveness of an intense behavioral program for the treatment of childhood obesity

OBJECTIVE

To evaluate the effectiveness of active parental involvement in a lifestyle intervention for the management of childhood obesity.

DESIGN

Forty-two overweight children (32 girls and 10 boys), aged 9.2 +/- 0.2 years and with percent overweight 39.8 +/- 2.7%, were randomly allocated either to a child-and-parent group (N = 23) or a child-alone group (N = 19). Both groups attended a 3-month multidisciplinary program extended by booster sessions during follow-up, which involved many cognitive behavioral therapy principles and assigned high self-regulation to the children, but differed in parental involvement. Percent overweight was evaluated at baseline, and at 3, 6, and 18 months thereafter.

RESULTS

There was no significant interaction between time and group or a significant difference between groups. Percent overweight decreased by 4.9 +/- 1.4 at 18 months (p < 0.001); the reduction occurred during the active phase of the treatment (0-3 months) and was maintained thereafter.

CONCLUSION

In the setting of the present study, the active parental involvement did not significantly modify the results of lifestyle interventions for children's overweight management.

Acquired competence in cognitive therapy following a two level course

The objective of this study was to examine the predictive value of trainees' previous experience and performance at an introductory course in Cognitive Therapy for their subsequent success in an advanced course. From 203 completers of an introductory course during seven consecutive years 32 participated in an advanced course. In a linear regression analysis previous clinical and psychotherapeutic experience as well as performance at the introductory course were studied as predictors for trainees' success in the advanced course. Performance at the introductory course was the only significant predictor of trainees' successful completion of the advanced course. An introductory course might help to select those trainees who have the desired qualities to succeed in a formal psychotherapeutic training program.

Wandering in Brief Psychotic Disorders: A Case Study

Wandering is a symptom present in a variety of psychiatric disorders.

A case of a patient manifesting wandering in the scope of a brief psychotic disorder is described in this presentation.

A 28-year-old male patient was transferred in the Acute Ward of the Psychiatric Hospital of Petra Olympus from the emergency ward of the General Hospital of Katerini.

He was exhausted, filthy, and full of scratches, mentioning that while being with his girlfriend in a remote area, they were verbally attacked by strangers. Panicked, he ran away (this being the last thing he could clearly recall). from that point on, he was wandering in the forest disorientated and feeling threatened. He accidentally approached his village and sought for help.

Upon his admission he had a good self, place orientation but he was disorientated in time and couldn't define the time period he had been wandering. (His relatives mentioned that he was missing for three days, confirming the incident he described). He presented persecutory ideas, auditory hallucinations and he was extremely anxious since he strongly believed that his life was in danger.

He was free of psychiatric history, being functional till the day of the incident. His lab results were normal as well as his neurological examination, EEG and brain-CT. the test for substance use was also negative. He received medication with risperidone (3mg/day) and diazepam (15mg/day). Few days upon his admission he was free of symptoms and was dismissed within 10 days with diagnosis: Brief Psychotic Disorder on risperidone (2mg/day).

Grieving Process in Children and Adults Using Services of the Psychiatric Hospital of Petra Olympus, Katerini, Greece. Similarities - Differences

Objective:

The demonstration of differences in grieving process between children mourning for the parent and adults grieving for their spouse.

Method:

Sub-structured clinical interviews were given to 10 adults and 10 children using the services of the Psychiatric Hospital of Petra Olympus to evaluate their reactions and grieving process.

Discussion:

2 of the evaluated children had outbursts of cries during the sessions. This behavior was the same at home.

8 played the role of the ‘supportive adult’ to the grieving parent, not allowing themselves to express feelings of anger, grief, guilt, and fears. They didn't ask for support, in fear of becoming a burden to the rest of the family.

Their parents noticed changes in sleep patterns, eating habits, and behavior.

One child wasn't well-informed about the loss and didn't fully understand what had happened to the deceased.

As for parents, 8 asked and received medical support and medication,

whilst 2 started consuming alcohol. 6 were avoiding talking to their children and sharing their feelings, whereas 3 mentioned incapability to go on with their life.

Conclusions:

Children mourn in a different way from adults. Their grief may not be easily detected.

The proper way of informing the child, the encouragement to the expression of feelings, the living memories of their late parent and the participation in the family grieving process (both for children and adults) are not causes of further stress and anxiety but lead to a better way of resolving the grieving process, offering comfort and relief.

Association between family divorce and children's BMI and meal patterns: the GENDAI Study

The aim of this work was to explore the associations between family factors, including divorce, and children's overweight as well as eating and physical activity patterns in a population-based sample of healthy school-aged children. In this cross-sectional study, 1,138 children (53% girls; age: 11.2 +/- 0.7 years) from elementary schools in the Attica region participated. Their parents provided sociodemographic information, including their marital status. Overweight status classification was based on weight and height measurements and BMI evaluation. Children completed a physical activity checklist and a questionnaire on meal patterns and eating behaviors. The Eating Style score was calculated: the higher the score, the more frequent a child was engaged in less-structured feeding practices promoting food intake for reasons other than hunger. Analysis revealed significant association between family divorce and children's overweight: compared with children of married parents, those of divorced had significantly higher BMI levels (20.0 +/- 3.6 kg/m(2) vs. 21.3 +/- 3.4 kg/m(2), respectively, P = 0.007). Controlling for socioeconomic and physical activity factors, divorce remains a significant predictor of a higher BMI, along with older age, higher father's and mother's BMI, less children in the family, and more minutes of daily screen time. Children who had experienced a divorce in their family also reported higher Eating Style score, even after adjusting for potential confounders. In conclusion, in this sample of fifth and sixth graders, unfavorable family circumstances have been associated with children's overweight, as well as with aspects of their eating behavior, namely eating style in relation to conditions around food consumption and hunger, independent of other socioeconomic factors.

Mapping autism risk loci using genetic linkage and chromosomal rearrangements

Autism spectrum disorders (ASDs) are common, heritable neurodevelopmental conditions. The genetic architecture of ASDs is complex, requiring large samples to overcome heterogeneity. Here we broaden coverage and sample size relative to other studies of ASDs by using Affymetrix 10K SNP arrays and 1,181 [corrected] families with at least two affected individuals, performing the largest linkage scan to date while also analyzing copy number variation in these families. Linkage and copy number variation analyses implicate chromosome 11p12-p13 and neurexins, respectively, among other candidate loci. Neurexins team with previously implicated neuroligins for glutamatergic synaptogenesis, highlighting glutamate-related genes as promising candidates for contributing to ASDs.