Most children experience some degree of fear during their development. Excessive fears can create serious obstacles to children. The aim of this study was to identify the most common fears in a sample of children and adolescents and examine the socio-demographic correlates of fears.

This cross-sectional study was conducted during the period July 2010 to February 2012 at Public and Private Schools of the Ministry of Education and Higher Education, in Qatar. Out of 2188 students approached, 1703 students agreed to participate in this study, with a response rate of 77.8%. The questionnaire includes socio-demographic information, academic performance, behaviour at home and various fears.

More than half of the children experienced fears (56.7%). Most of them were in the intermediate level, 12–15 years old (46.1%). Overall, reported fears were significantly more frequent in girls (62.6%) than boys (37.4%) (P < 0.001). A significant difference was observed between girls and boys who experienced fears in their age group (P < 0.001), education of mother (P = 0.04), household income (P = 0.008) and academic performance (P < 0.001). The most frequent reported fears were fear of someone dying in the family (85.2%), parents getting divorced (84.5%), breaking religious law (82%), being kidnapped (78.2%), family members ill (78%) and dying (76.7%).

The study findings revealed that fears were highly prevalent in Arab children and adolescents in Qatar. Girls reported more fears than boys. There was a significant difference observed between girls and boys in their age group and academic performance for the reported fears.

The author has not supplied his/her declaration of competing interest.

As this is a time of great change in Romanian psychiatry we considered it was useful to analyze the availability of various types of psychotherapy and the commitment of psychiatry residents to psychotherapy training, comparing with data from 1998.

Same protocol study like in 1998 was used. The data from National Centre for Medical Training were analyzed. We examined the total number of residents undergoing psychotherapy training, year of residency and the type of psychotherapy they chose.

In 2009, there are 726 psychiatry residents in Romania (180 in 1998) distributed in 11 (6 in 1998) university training centres. We registered a response rate of 81.8% (77.7% in 1998), and only 30.13% residents are involved/ in a specific psychotherapy training comparing with 48.5% in 1998. The types of psychotherapy were: cognitive behavioural therapy, positive psychotherapy, transactional analysis, psychoanalysis, psychodrama, hypnosis, existential psychotherapy.

Even though training in psychotherapy is included in curricula like compulsory topic since 2007, the availability of psychotherapeutic training for residents is still restricted, due to high costs, the need to self-finance the training, organizational difficulties and low number of training centres and trainers.

A considerable proportion of patients with morbid obesity require treatment with antidepressants.

The aim of this study is to determine the incidence of patients who are in antidepressant treatment and identify risk factors for the need of this treatment in patients with morbid obesity.

Retrospective cohort study of 292 patients with morbid obesity who underwent bariatric surgery at Hospital del Mar from January 2010 to November 2015. The incidence of antidepressant treatment was analyzed, and also its possible relationship with the following variables: age, sex, BMI, tobacco smoking, alcohol consumption and age of onset of obesity. Chi2 test for categorical variables and Student t-test for quantitative variables were applied. Afterwards, a multivariate analysis was performed using logistic regression.

The mean age is 43.1 years. Most of the patients (76.4%) are women. Seventy-seven patients (26.4%) are receiving treatment with antidepressants. There is a statistically significant relationship between age and the need of treatment with antidepressants (P < 0.001). This relationship is still present when the variables are analyzed using logistic regression (P < 0.005, OR 1.049). We have not found any significant relationship with the rest of the variables.

Despite the large number of patients in the study, there are limitations, such as being a retrospective study and not being adjusted for confounding factors. From all the variables that have been analyzed we have found that as the age of the patients increase, there is a higher number of patients that receive treatment with antidepressants.

The authors have not supplied their declaration of competing interest.

The 5HTTLPR polymorphism of the serotonin transporter gene has been found to be significantly associated with suicide and it has also been described that suicidality is associated with increased impulsiveness, aggression and hopelessness. The aim of our study was to investigate the possible association of affective temperaments, hopelessness, aggression, impulsiveness and the 5HTTLPR s allele in a psychiatrically healthy population who have never attempted suicide.

135 psychiatrically healthy women participated in the study. All participants completed the Buss-Durkee Hostility Inventory (BDHI), the Barratt Impulsiveness Scale (BIS-11), the Beck Hopelessness Scale and the Temperament Evaluation of Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A). 5HTTLPR genotypes were determined by PCR. Results were analysed using Analysis of Covariance and forward stepwise regression.

We found a strong association between the presence of the s allele and the studied characteristics. ANCOVA indicated that there is a strong relationship between Hopelessness and aggressiveness, impulsiveness and affective temperaments. Forward stepwise regression indicated a significant role for depressive temperament, anxious temperament, irritable temperament, hostility and motor impulsiveness in predicting hopelessness. Adjusted whole model R2 was 37.61%.

Our study indicates a strong association between the s allele and factors related to increased risk of suicide. Our results show that depressive, anxious and irritable affective temperaments, hostility and motor impulsiveness influence Hopelessness, which has an important predictive role in the emergence of suicidal behaviours. Our results have implication for the recognition and prevention of possible emergence of suicidal behaviours within the healthy, non-depressed population.

ADHD has long been considered to affect males more than females. It has been suggested that this difference is not as marked in the adult population. Differences in prevalence in adolescents may be contributed to by underdiagnosis in females. While these differences have been explored in children, there are limited data for the adult population with ADHD. Our study looked at a community sample of adults with ADHD and we examined differences in varying areas of comorbidity between males and females.

We looked at a sample of 50 patients in the adult ADHD clinic. On the basis of gender, differences were recorded in a variety of areas including alcohol and illicit drug use (including cannabis), forensic history, age of diagnosis of ADHD, family history and psychiatric comorbidity.

The full results are pending. Preliminary findings suggest an increased prevalence of substance misuse amongst males. Male patients were more likely to have a forensic history. Female patients are more likely to suffer with comordid anxiety and depression while male patients have a higher prevalence of autistic spectrum disorders and learning difficulties.

Service provision for adult ADHD has to be structured according to the needs of the population served rather than focussing on provison of prescribing services alone. The treatment approach for females with ADHD may diiffer from that for males. The use of psychotherapy in this population is particularly benficial. Comorbidity amongst females may complicate treatment with stimulants as this may worsen features of anxiety and depression.

The aim of this study was to investigate the efficacy of blue light emitting diode units in suppression of melatonin secretion and to evaluate whether a single exposure can improve well being in healthy males and females (20/30) and in 15 women with premenstrual syndrome.

All study participants were of morning-type with a regular sleep schedule. On control day 1, the subjects were kept under dim illumination (< 10 lx) from 19:00 to 22:30. On day 2, after 1.5h in dim light, the subjects were exposed for 60 min to blue light (12.15 μM/cm², TurboLite, Germany) following by 30 min dim light. Blood samples were collected every 30 min for melatonin assay. Zerssen's complaints scale was used to assess mental und physical well-being at 19:00 (pre-test) and at 22:30 (post-test) after dim illumination or blue light exposure. In addition a visual analogue scale (VAS) for sleepiness was applied.

Overall, blue light improved significantly mental and physical complaints from pre-test to post-test (reduction in sum score of the Zerssen's complaints scale by in average 30%) and reduced sleepiness, as measured by the VAS. There were gender-related differences, as well as differences related to the menstrual phase in females. Blue light reduced but not suppressed the gradual increase of melatonin in plasma with time mostly pronounced in the follicular phase.

A single exposition with blue light of low radiant flux density, as applied in our study, seems to be helpful in reducing mental and physical distress.

Ketamine is a phenylcyclohexylamine derivative comprising a racemic mixture of S- and R-ketamine that possesses anesthetic, analgesic, anti-inflammatory, and antidepressant activity. Oral (including extended release [PO]), intravenous (IV) sublingual (SL), transmucosal (TM), intranasal (IN), intramuscular (IM), rectal (PR), and subcutaneous (SC) formulations have been developed since its commercialization in 1970.

To review and understand the impact of different forms and formulations on the pharmacokinetics of ketamine.

The extant literature on ketamine metabolism and formulations was reviewed and discussed.

IV (racemic) ketamine (KET) has been shown to improve depressed mood within 4 hours with maximal effect at 24 hours. KET is a chiral molecule with two optimal isomers, R- and S-KET. KET is stereoselectively metabolized by CYP2B6 and CYP3A4 initially via nitrogen demethylation to active metabolite, norketamine (NK); there is no interconversion between R- and S-KET. NK is further metabolized to hydroxynorketamine (HNK) by CYP3A4 and CYP3A5; and dehydronorketamine (DHNK) by CYP2B6. Additional metabolic pathways exist including a direct enantioselective hydroxylation of KET to 6-hydroxyketamine (HK). Bioavailablity is greatest (100%) with the IV racemic KET formulation, but as low as 8% for oral S-KET due to extensive first-pass metabolism; the KET: NK ratio is a measure of first pass metabolism. NK plasma levels are higher with oral S-KET than KET as a result of local intestinal metabolism effects. Additionally, greater plasma concentrations are noted with IV bolus doses of S-KET vs. racemic KET or R-KET. S-KET possesses a longer elimination half-life than racemic KET due to inhibition by R-KET. KET is primarily renally eliminated and twice as fast in children vs. adults.

Complex interactions are reported between ketamine form (racemic/enantiomer), formulation, dose, and route of administration that impact on clinical variables and thus, outcome.

None Declared

To determine the efficacy, acceptability, and tolerability of second-generation antipsychotic drugs (SGAs) in anorexia nervosa.

We covered all randomized controlled trials (RCTs) comparing a pharmacotherapy with SGAs to placebo or no treatment in anorexia nervosa. Primary outcome was weight gain assessed by mean change in body mass index (BMI). Secondary outcomes were change of anorectic symptoms assessed by the Yale–Brown–Cornell Eating Disorders Scale (YBC-EDS) score and the Eating Disorders Inventory (EDI) score, and premature discontinuation of treatment. Using the random-effects model of Der-Simonian and Laired standardized mean differences based on Hedges's g and risk ratios were calculated.

Seven RCTs investigating olanzapine (N=4), quetiapine (N=2), and risperidone (N=1) with 201 subjects were included. There was no significant between-group difference in mean BMI change when comparing the pooled group of SGA drugs with the pooled control group (N=6, n=152; Hedges's g=0.17, 95% CI: -0.14-0.48; p=0.28). None of the examined single SGAs was significantly superior to placebo/no treatment in achieving BMI gain. We found no significant between-group differences for all secondary outcomes with the exception of the EDI total score which decreased statistically significant more in the pooled control group. The antipsychotic medication was well tolerated.

Because of lacking evidence SGAs cannot be generally recommended in anorexia nervosa although some individuals or subgroups of patients might respond to an antipsychotic medication. Further research is needed to identify which anorectic patients could probably benefit from treatment with antipsychotic drugs. The medication with SGAs was well accepted and tolerated in anorectic patients.

Mounting evidence has suggested a pivotal role of immune dysfunction in the pathophysiology of autism spectrum disorders (ASD). In this study, levels of inflammatory cytokines were measured intrauterinely in amniotic fluid (AF) samples and postnatally in dried blood spots samples (DBSS) of children diagnosed later in life with ASD and their controls.

Study population was retrieved from a historic birth cohort (HBC) kept at Statens Serum Institute (SSI) in Copenhagen, Denmark. The HBC comprises AF and maternal serum samples collected during antenatal screening/diagnostic tests since 1980. All singleton ASD cases who had a corresponding AF sample in the HBC and born 1982–2000 were identified utilizing Danish nation-wide health registers. Controls were selected from the HBC and frequency-matched to cases on gender and year of birth. Corresponding DBSS were indentified in the Danish Newborn Screening Biobank. Levels of selected inflammatory cytokines in AF samples and DBSS were analyzed at SSI using Luminex xMAP technology. Case-control differences were assessed as categories (logistic regression) or continuous measures (tobit regression).

Total of 414 cases and 820 controls were included in the study. Measurements performed on AF showed elevated levels of TNF, IL-4, and IL-10 in ASD. Discrepant pattern was seen in DBSS with elevated levels of IL-8 and sIL-6rα. While findings in this study show that immune dysfunction in ASD starts intrauterinly, the discrepant intrauterine/neonatal patterns are of a special interest. Finally, further studies to examine the specificity of these findings to ASD are necessary.

The outbreak of the SARS-CoV-2 epidemic forced a change in the functioning of health care systems across the globe, requiring rapid adaptation to new conditions for the safe provision of services within all medical fields. General disruption has also affected the traditional program of a postgraduate training, which has been so far fixed with temporary solutions, but not given a proper evaluation in the times of big expectations and pressures from both patients and healthcare workers.

Outbreak of the COVID-19 put psychiatry trainees and Early Career Psychiatrists in an unprecedented position of responsibility for treatment of a variety of comorbidities they had no prior experience with due to closure of specialized hospital departments and limited access to regular diagnostic tools. In addition to changes in clinical practice and deployment to unfamiliar ground, rescheduling of different components of regular training, transferring most of the educational activities to distance learning, limiting professional growth by canceling most courses and conferences only strengthened the feeling of uncertainty caused by constant adjustments of the final examinations’ conditions.

The Speciality Training Section of the Polish Psychiatric Association decided to review changes forced by the COVID-19 outbreak in a traditional postgraduate training program in psychiatry.

Identified shortcomings pose questions about the necessity of a solid revision of the training in order to cope with more demanding working conditions.

Presented recommendations may be the starting point for a discussion on the programs’ evaluation across the entire region.

No significant relationships.

The use of coercive measures within forensic psychiatry has generated much debate across public, professional and academic domains. the use of restraint, seclusion and rapid tranquillisation challenge the key principles of healthcare as well as individual human rights.

To conduct a systematic review of the literature between the years 1980–2010, examining empirical research studies into the use of coercive measures within forensic psychiatry

To examine current literature; frequencies and variations of coercive measures used within forensic psychiatry

A systematic literature search was conducted using the electronic databases ASSIA, BHI, CINAHL, EMBASE, MEDLINE, PAIS, PsycINFO and Sociological Abstracts.

Twenty-five empirical papers were elicited from the literature search. Younger patients or those newly admitted were restrained and/or secluded most often. Findings relating to gender and diagnoses were ambiguous. Interestingly, no significant differences were found between patient ethnicity and use of restraint and/or seclusion. Limited studies related to staff and patient experiences. Both staff and patients were documented as feeling anxious and angry surrounding coercive experiences. Staff perceptions, roles and responsibilities were suggested to influence decision-making and practice in the use of coercive measures.

Whilst the use of coercive measures remains a controversial method of practice, variations have been found in the use of coercive measures. Differences in ward atmosphere, staffing and patients have all been suggested as contributing factors. More research is required however, into how these varying factors might interact and contribute towards reducing coercive practice.

The author declares that he has no competing interest.

To evaluate patient and physician satisfaction with risperidone long-acting injection (RLAI) in patients with schizophrenia enrolled in the electronic Schizophrenia Treatment Adherence Registry (e-STAR) in Belgium.

e-STAR is an ongoing, international, prospective, observational study of patients with schizophrenia who start RLAI during their routine clinical management. Treatment satisfaction was assessed by the patient and physician on a 5-point scale from ‘very good’ to ‘very bad’.

135 patients with mean age 40.9±14 years and duration of illness 9.5±9.2 years initiated treatment with RLAI, followed-up for at least 18 months were included in this analysis. At baseline, only 29.2% of patients expressed “good” or “very good” satisfaction while 21.1% of them expressed “bad” or “very bad” with their previous treatment. Similarly at baseline, 38.2% of physicians reported “good” or “very good” level of satisfaction and 14.6% rated their satisfaction as “bad” or “very bad” at that time. After initiation of RLAI, both patient and physician satisfaction with treatment improved dramatically. At 18 months, 76.5% of patients were satisfied (‘good’ or ‘very good’) with RLAI treatment and only 2.4% felt ‘bad’ and none reported ‘very bad’. Physicians also expressed satisfaction with RLAI with 82.1% of them rated it as ‘good’ or ‘very good’. Only one physician reported satisfaction below ‘moderate’.

The low levels of patient and physician satisfaction with treatment prior to RLAI are likely to be a key decision driver to change therapy. After starting treatment with RLAI, both patient and physician satisfaction with the treatment substantially improved.

Analizing connection between risk factors in family and behavioral disturbances in children whose parents have had symptoms of posttraumatic stress disorder (PTSD).

We analyzed a group of 100 children of school age (10 -15 years) in two randomly choused schools. Those children are from complete families and their parents agreed to participate in psychometric testing. We divided those children in two groups: Experimental group (N=50)- those parents show symptoms of PTSD, and Control group (N=50) those whose parents do not show symptoms of PTSD. The assessment to PTSD symptoms and level of dramatization in parents was done with Harvard Trauma Questionnaire- Bosnia and Herzegovina version), and behavior disturbances by using Child Behavior Check List (CBCL for parents, Achenbach 1991). According to gender and participation of parents the sample was homogeneous. Data were processed with descriptive statistics.

Children of parents with PTSD symptoms show higher correlation of family size, number of children in family, (p< 0.05), the level of parents education, social and economic state of family and symptoms of behavior disturbances (p< 0.01). Regarding expression of Internalization as behavior characteristic is in higher correlation with family size (p< 0.01) and Externalization is in higher correlation with family size, socio- economic state of family and education of parents (p< 0.05).

Children whose parents have symptoms of PTSD show significantly higher correlation of risk factors in family and behavior problems. The highest correlation is associated with family size, number of children in family, education of parents and economic circumstances.