<p>This study investigated a consecutive cohort of 88 youngsters with onset of a psychotic disorder at age 15.7 (sd 1.5) years and followed-up 10.6 (sd 3.6) years after first admission at the age of 26.5 (sd 3.7) years. A subsample of 15 subjects were assessed with the Five Minute Speech Sample for measuring Expressed Emotion and subsequent recording of relapses during a two year period.</p><p>A diagnostic split between schizophrenia spectrum psychosis and affective psychotic disorder was usually stable over time. The main diagnostic shift was an influx to schizophrenia spectrum disorder of subjects with a better premorbid function and less insidious onset as compared to those with a stable schizophrenia diagnosis.</p><p>Early onset schizophrenia spectrum disorder usually had a poor functional outcome. Most subjects needed support in the form of a disability pension. Early onset affective psychotic disorder usually had a good functional outcome. Most subjects worked and enjoyed regular friendships. The functional level before onset of illness was the best predictor of future functional level in psychotic disorders. A family history of non-affective psychosis predicted a worse function in schizophrenia. Frequent episodes and low intelligence predicted a worse function in affective disorders.</p><p>Four men (4.5% of the sample) committed suicide. The risk of suicide was increased about 30 times. Almost a third of subjects attempted suicide. Females made more attempts. Suicide attempts were related to more depressive symptoms but less negative symptoms at first episode, to readmissions and to dependence on nicotine. </p><p>Subjects with schizophrenia spectrum psychoses were less satisfied with life than those with affective psychotic disorder. Subjective satisfaction in schizophrenia was strongly associated to depressive mood while in affective disorders it was associated to degree of employment.</p><p>Adolescents with psychosis in families rated high or borderline high in Expressed Emotion either during first episode or after discharge had an increased risk of relapse.</p>

<p>A total population of 4,479 children (7-15 years of age) attended school in Ludvika & Smedjebacken in 2000. All the school children and their parents were asked to fill in a questionnaire concerning different tics A three-stage procedure was used: tic identification, interview, and clinical assessment.</p><p>Tourette syndrome, according to DSM IV criteria was found in 25 (0.6%) of the children, another 34 (0.8%) suffered from chronic motor tics (CMT), 24 (0.4%) from chronic vocal tics (CVT) and 214 (4.8%) children had had transient tics (TT) during the last year. Altogether 297 (6.6%) children had or had had some tic disorder. </p><p>Twenty-five controls without tics and 25 children with TT of the same age, sex and school as the TS children were randomly chosen. They were together with the 34 children with CMT and the 24 children with CVT examined with use of a broad battery of instruments. </p><p>The mean age of the first symptoms of TS was significantly lower than the onset of chronic motor/vocal tics. A younger age of onset of TS indicated more severe tics. Eighty per cent had a first-degree relative with a psychiatric disorder such as tic disorder, obsessive-compulsive behaviour, attentiondeficit/hyperactivity disorder (ADHD), or depression. A non-significant increase with regard to reduced optimality score in the pre-, peri-, or neonatal periods was found in children with TS compared to controls. No differences were found concerning socio-economic status. Psychiatric comorbid disorders were found in 92% of the children with TS. ADHD was most common. Patterns of psychiatric comorbidity were similar in children with TS and CVT. Children with TS perform poorer than the population in general with respect to cognitive functioning and self-perception.</p><p>The results are discussed as they relate to the need for case identification, diagnosis, intervention, and treatment. </p>

This study investigated a consecutive cohort of 88 youngsters with onset of a psychotic disorder at age 15.7 (sd 1.5) years and followed-up 10.6 (sd 3.6) years after first admission at the age of 26.5 (sd 3.7) years. A subsample of 15 subjects were assessed with the Five Minute Speech Sample for measuring Expressed Emotion and subsequent recording of relapses during a two year period. A diagnostic split between schizophrenia spectrum psychosis and affective psychotic disorder was usually stable over time. The main diagnostic shift was an influx to schizophrenia spectrum disorder of subjects with a better premorbid function and less insidious onset as compared to those with a stable schizophrenia diagnosis. Early onset schizophrenia spectrum disorder usually had a poor functional outcome. Most subjects needed support in the form of a disability pension. Early onset affective psychotic disorder usually had a good functional outcome. Most subjects worked and enjoyed regular friendships. The functional level before onset of illness was the best predictor of future functional level in psychotic disorders. A family history of non-affective psychosis predicted a worse function in schizophrenia. Frequent episodes and low intelligence predicted a worse function in affective disorders. Four men (4.5% of the sample) committed suicide. The risk of suicide was increased about 30 times. Almost a third of subjects attempted suicide. Females made more attempts. Suicide attempts were related to more depressive symptoms but less negative symptoms at first episode, to readmissions and to dependence on nicotine. Subjects with schizophrenia spectrum psychoses were less satisfied with life than those with affective psychotic disorder. Subjective satisfaction in schizophrenia was strongly associated to depressive mood while in affective disorders it was associated to degree of employment. Adolescents with psychosis in families rated high or borderline high in Expressed Emotion either during first episode or after discharge had an increased risk of relapse.

The negative impact of war on child mental health has been repeatedly documented. Still, the majority of children exposed to ethnic and political violence show no signs of clinical disorder. In Western countries of exile, these findings have prompted a variety of attempts to evaluate refugee children, in the hope of identifying and offering support to those children “at risk”. This study critically examines one such attempt. The aims are fourfold: 1. to describe the range and pattern of child trauma-stress exposure and mental health reactions as captured on clinician semi-structured interview; 2. to critically compare clinician assessment with independent parent, child and teacher reports; 3. to identify factors of potential risk or protective import for child mental health; 4. to draw clinical implications: from whom and by what means can children at risk be reasonably identified? The target of our study was the entire population of Bosnian-Serbian-Croatian speaking child refugee families assigned to Umeå and surrounding municipalities during 1994-95. Fifty families, containing 90 children aged one month to 20 years, were included in the study. Assessment occurred in two phases. First, a semi-structured interview was conducted that inquired broadly as to the child’s family background, trauma-stress exposure, emotional-behavioral problems, patterns of family functioning, and future hopes. Second, standardized self-report questionnaires were administered, separately to parent and child, to provide alternative appraisal of the child’s war exposure, mental health symptoms, coping strategies, and social network. Teacher evaluation of child cognitive-social functioning as well as emotional-behavioral problems was also obtained. Clinician semi-structured interview revealed the child’s pre-war period as preponderantly good, and provided richly detailed narratives of child exposure during war and resettlement that clustered into a limited number of type-stories. Independent parent assessment captured the same broad strokes of child war exposure; but both approaches – fixed questionnaire and semi-structured interview – showed specific areas of blindness. Teenage self-report offered a disparate but equally rich account of war exposure, while that of primary school child was significantly less detailed. Nearly half of the study children (48%) were identified on clinician interview with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%), followed by posttraumatic reactions (23%) and anxiety-regressiveness (15%). Independent symptom appraisal by parent and primary school child was largely concordant with that of clinician, while teenagers made similar assessment as to who was in distress, but defined the nature of that distress differently. Teacher report stood apart, identifying fewer inward emotional problems and asserting the cognitive-social competence of the vast majority of study children. Trauma-stress exposure during both war and resettlement presented as an unequivocal risk to mental health, but accounted for only part of outcome variance. Additional factors of strong import related broadly to “living in the present”. Parent impairment of daily routines, child dissatisfaction with school and an ongoing quarrelsome relationship presented as risk factors. Protection was associated with parent maintenance of a warm family climate and of concrete physical-emotional caring, child social ties to physically present others, including teacher; and above all, a family sense of hope for the future. Results support the general robustness of our semi-structured approach. Exploring the child’s present well-being in narrative relation to past and future, our assessment captured and gave meaning to the complexity of child exposure and behavior. At the same time, independent parent and child appraisals provided an additional richness to the retelling and evaluation of child experience. Particularly the apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment.

A total population of 4,479 children (7-15 years of age) attended school in Ludvika &amp; Smedjebacken in 2000. All the school children and their parents were asked to fill in a questionnaire concerning different tics A three-stage procedure was used: tic identification, interview, and clinical assessment. Tourette syndrome, according to DSM IV criteria was found in 25 (0.6%) of the children, another 34 (0.8%) suffered from chronic motor tics (CMT), 24 (0.4%) from chronic vocal tics (CVT) and 214 (4.8%) children had had transient tics (TT) during the last year. Altogether 297 (6.6%) children had or had had some tic disorder. Twenty-five controls without tics and 25 children with TT of the same age, sex and school as the TS children were randomly chosen. They were together with the 34 children with CMT and the 24 children with CVT examined with use of a broad battery of instruments. The mean age of the first symptoms of TS was significantly lower than the onset of chronic motor/vocal tics. A younger age of onset of TS indicated more severe tics. Eighty per cent had a first-degree relative with a psychiatric disorder such as tic disorder, obsessive-compulsive behaviour, attentiondeficit/hyperactivity disorder (ADHD), or depression. A non-significant increase with regard to reduced optimality score in the pre-, peri-, or neonatal periods was found in children with TS compared to controls. No differences were found concerning socio-economic status. Psychiatric comorbid disorders were found in 92% of the children with TS. ADHD was most common. Patterns of psychiatric comorbidity were similar in children with TS and CVT. Children with TS perform poorer than the population in general with respect to cognitive functioning and self-perception. The results are discussed as they relate to the need for case identification, diagnosis, intervention, and treatment.

O grande número de crianças acolhidas institucionalmente no Brasil contemporâneo é uma constante que incomoda a sociedade e pede uma solução urgente do Estado, seja do ponto de vista da assistência social, seja no âmbito da assistência jurídica. Analisar de que modo o direito está contribuindo para a mudança deste quadro é o objetivo do presente trabalho, que retorna às origens da adoção e caminha até o panorama atual das crianças e adolescentes aptos a serem adotados, passando pelo desejo daquelas pessoas que querem adotar, bem como pelos princípios balizadores do Estatuto da Criança e do Adolescente e pela teoria da proteção integral, adotada pelo ordenamento brasileiro, para buscar uma solução juridicamente possível. Neste contexto, busca-se saber se a adoção intutitu personae, a qual não tem previsão expressa no Estatuto da Criança e do Adolescente, ainda assim é viável, a partir das normas e princípios vigentes. Os novos conceitos trazidos pela Lei n. 12.010/2009, como família natural, família extensa e família substituta, bem como o Cadastro de Adotantes são pontos de estudo centrais para a conclusão da presente dissertação de mestrado. / The large number of children living in institutions in contemporary Brazil has been a constant that troubles society and requires an urgent solution from the State, whether from the social or legal assistance point of view. Analyzing how the Law is contributing to change this situation is the purpose of this paper. It returns to the origins of adoption and goes through the current overview of children and adolescents eligible to be adopted, as well as the desire of those people who want to adopt, passing through the guiding principles of the Estatuto da Criança e do Adolescente (Statute of the Child and Adolescent) and the full protection theory adopted by the Brazilian system to seek a legally possible solution. In this context, we try to find out if the intuitu personae adoption, which is not provided by the Estatuto da Criança e do Adolescente, is still feasible based on the rules and principles in force. The new concepts set forth by Law no. 12.010/2009, such as natural family, extended family and surrogate family, as well as the Register of Adopting Parents, are focal points of study for the conclusion of this Masters dissertation.

As redes de proteção à criança e ao adolescente constituem uma política pública recente no contexto nacional. O Conselho Tutelar é uma instituição que aciona o funcionamento das redes, sob a égide jurídica do Estatuto da Criança e do Adolescente (ECA). Nesse campo problemático e complexo, quais os significados e representações da função social do Conselho Tutelar construídas pelos seus atores principais? Esta pesquisa teve como objetivo analisar o funcionamento dessa instituição, a partir das práticas discursivas de seus agentes. Trata-se de um estudo qualitativo, referenciado na Teoria das Representações Sociais, segundo Moscovici e Jodelet. A coleta de dados ocorreu em cinco sessões de grupo focal, análise de documentos, prontuários e observação participante da rotina institucional, num Conselho Tutelar que atua num município de pequeno porte (85 mil habitantes) no interior do país. Os dados foram analisados através da técnica denominada Análise de Conteúdo, que consiste na identificação dos temas recorrentes e emergentes, seja nas regularidades ou singularidades discursivas. As unidades de significado foram organizadas em categorias temáticas que explicitaram os aspectos cognitivos, afetivos e políticos do dispositivo grupal. Enquanto resultados, afirma-se que os discursos indicam posicionamentos defensivos, ambivalentes e paradoxais no que tange ao trabalho do Conselho Tutelar e a Doutrina de Proteção Integral. Os enunciados trazem à tona incompatibilidades entre a esfera pública e a esfera privada. As condições institucionais, concretas e subjetivas, contribuem efetivamente para o sofrimento psíquico dos conselheiros tutelares, com destaque para a impotência e regressão psicofamiliar frente às pressões da sociedade. As representações sociais, objetivadas na prática desses agentes públicos, desvelam que o dispositivo acabou tomando a forma do mal social que visa a combater. Conclui-se, enquanto tese, que o Conselho Tutelar, tal como está estruturado no país, funciona como um dispositivo ideológico e propagandístico, sendo pouco capaz de atender aos anseios sociais por promoção de direitos, inclusão e cidadania. Frente ao julgamento ético e moral, as vítimas tendem a ser culpabilizadas, incorrendo na amenização ou negação dos danos, justificando a violência para fins idealistas na educação exemplar. Diante da condição paradoxal, constatou-se um processo de estereotipia, discriminação e demonização da clientela. / The child and adolescent protection network is a recent public politics in the national context. The Guardianship Council is an institution that actuates the networks functioning, under the legal aegis of the Child and Adolescent Statute (CAS). In this complex field, what are the meanings and representations of the function of the Guardianship Council constituted by its main actors? This study aimed to analyze the functioning of this institution, from its agents discursive practices. Its a qualitative study, having as reference the Theory of the Social Representations, according to Moscovici and Jodelet. The data collection occurred in five sessions of focal group, analysis of documents, records and participating observation of the institutional routine, at a Guardianship Council that acts in a small city (85 thousand inhabitants) in the countrys interior. The data were analyzed through the Content Analyzed, which consists in identifying the recurrent and emerging themes, on the discursive regularity or uniqueness. The meaning units were organized into thematic categories that show the cognitive, affective and political aspects of the group device. While results, its affirmed that the speeches indicated defensive, ambivalent and paradox positions regarding the Guardianship Councils work and the Integral Protective Doctrine, findings revealed an incompatibilities between the public and private spheres. The institutional conditions, concrete and subjective, contribute to the psychic suffering of the guardianship counselors, highlighting the psych familiar impotence and regression. The social representations, objectified at these public agent practices, unveiling that the device, ended taking the shape of the social ill that aims to combat. Its concluded, as thesis, that the Guardianship Council, as it is organized in Brazil, works as an ideological and propagandistic device, it is incapable to attend the social expectations by rights, social inclusion and citizenship. In view of the ethical and moral judgment, the victims tend to be blamed, incurring mitigation or denial of the damage, justifying the violence to idealistic ends at the exemplary education. Concluding, it has been found a process of stereotyping, discrimination and demonizing of the communities.

Bakgrund: I Sverige finns ca 35 000 personer diagnostiserade med schizofreni. Att insjukna i schizofreni innebär en livsomvälvande katastrof både för den som insjuknar och de närstående. Av de barn och ungdomar som drabbas av schizofreni får hälften ett livslångt handikapp. Deras föräldrar får ofta svårigheter med att möta sina barns lidande, bekymmer, att förstå deras förändrade livsvärld och den problematik som den psykiska störningen omfattar. Syfte: Denna litteraturstudies syfte var att beskriva föräldrarnas svårigheter hantera den uppkomna situationen och att förstå sina barns förändrade livsvärld och den problematik som den psykiska störningen innebär. Ett vidare syfte har varit att tydliggöra sjuksköterskans vägledande roll i denna process. Metod: En litteraturstudie med kvalitativ ansats som belyser föräldrarnas upplevelser av att ha ett barn med schizofreni. Resultat: Studiens resultat visar fem framträdande teman; Att inte förstå vad som händer med sitt barn, Moraliska och praktiska dilemman, Skuld och skam, Att som förälder sörja förlusten av det barn man en gång känt samt Vilken form av stöd/information söker föräldrarna? Slutsatser: Allvarlig psykisk störning orsakar ett stort lidande både för barnet som diagnostiserats och dess föräldrar. Det är en komplex situation för hela familjen och det ligger ett stort ansvar på vårdaren att vara öppensinnig i kommunikationen med denna patientgrupp och deras närstående för att kunna hjälpa och stödja.

To align the neuropsychological functioning of our adult euthymic patient group with that reported in previous studies on euthymic bipolar disorder (BD), we used a neuropsychological battery that examined sustained attention (Rapid Visual Information Processing Task), verbal memory (California Verbal Learning Task), executive functioning (Intradimensional-Extradimensional Shift Task, Barrett Impulsivity Task, and Framing Task), and emotion responsiveness/regulation (Positive Affect/Negative Affect Scales, Behavioral Inhibition/Behavioral Activation Scale, and Affective Lability/Affective Intensity Scales) in patients versus healthy volunteers (HV). Our results corroborated existing evidence of reduced sustained attention, impaired verbal memory and executive functioning, and abnormal emotional responsiveness and regulation in euthymic BD relative to healthy controls (Chapter 2). To investigate how abnormal development of brain function in BD leads to deficits in decision-making, motor inhibition, and response flexibility, we examined child and adult BD using a novel risky decision-making task, and used cross-sectional (age x diagnosis) functional magnetic resonance (fMRI) designs to examine neural activation associated with motor inhibition and response flexibility in BD relative to HV. During the risky decision-making task, adult euthymic BD patients were no different from healthy controls in their proportion of risky lottery choices over a range of competing lotteries. This matched behavioral performance was associated with similar prefrontal and striatal brain activation between the patient and control groups during response, anticipation, and outcome phases of decision-making (Chapter 3). These results are different from previous studies that have shown increased risk taking during decision-making in euthymic BD. Similarly, young BD patients were no different from age-matched healthy and patient controls in their pattern of decision making during the risky choice task. This was evidenced by a similar number of risky lottery selections over the range of changing expected values between the young BD group and control groups (Chapter 4). Using a cross-sectional, fMRI analytic design during the stop signal task, we found that child and adult BD showed similar behavioral performance to child and adult HV during motor inhibition. However, this matched behavioral performance was associated with abnormal neural activation in patients relative to controls. Specifically, during unsuccessful motor inhibition, there was an age group x diagnosis interaction, with BD youth showing reduced activity in left and right ACC compared to both age-matched HV and adult BD, and adult BD showing increased activation in left ACC compared to healthy adults. During successful motor inhibition there was a main effect of diagnosis, with HV showing greater activity in left VPFC and right NAc compared to BD (Chapter 5). These neuroimaging data support existing laboratory-based evidence of motor inhibition impairments in BD relative to HV, and indicate brain dysregulation during motor control is important to BD pathophysiology. A previous behavioral study showed impaired response flexibility in young BD patients relative to age-matched controls when using the change task. Here, we used the change task during fMRI to examine response flexibility in child and adult BD compared to child and adult HV. We found that patient and control groups showed similar change signal reaction times in response to change cues. However, this matched behavioral performance was associated with abnormal age group x diagnosis activations in brain regions important in signal detection, response conflict, response inhibition, and sustained attention. Specifically, during successful change trials, child BD participants showed frontal, parietal, and temporal hyperactivation relative to healthy children and adult BD, while adult BD showed hypoactivation in these regions relative to healthy adults. These novel fMRI findings during the change task indicate impaired neural activation during response flexibility may be important to the pathophysiology of BD development.

Background: Orphanhood is a major consequence of the HIV/AIDS epidemic in sub-Saharan Africa. There is little evidence concerning psychological problems for AIDS-orphaned children. This thesis explores the relationship between orphanhood status and mental health. It also examines mediating influences of environmental risk and protective factors, and interactions between factors, on children’s psychological problems. Methods: 1200 isiXhosa-speaking children were interviewed, using standardised questionnaires, in deprived urban settlements of Cape Town. A qualitative stage with 60 AIDS-orphaned children, 42 caregivers and 20 professionals explored participant perceptions of risk and protective factors. A quantitative stage compared 1025 AIDS-orphaned children to control groups of other-orphans and non-orphans. Data were analysed with t-tests, chi-sq, anovas, regression and log-linear analyses. The study took place in collaboration with Cape Town Child Welfare. Results: AIDS-orphaned children reported more depression (p<.001), peer relationship problems (p<.001), post-traumatic stress (p<.001), suicidal ideation (p<.05), delinquency (p<.001) and conduct problems (p<.001) than other-orphans and non-orphans. Anxiety showed no differences. Compared to Western norms, AIDS-orphaned children showed higher levels of internalising problems and delinquency, but lower levels of conduct problems. These differences remained when controlling for socio-demographic factors. A number of factors strongly mediated the relationship between AIDS-orphanhood and mental health. These include poverty-related factors (food, education and social security, p<.001). caregiving-related factors (caregiver illness, p<.001, excessive housework p<.001, being a streetchild, p<.001) and AIDS-related stigma (p<.001). Cumulative effects were also found. Food insecurity and AIDS-related stigma interacted to raise likelihood of disorder from 19% to 83%, and orphanhood status and bullying interacted to raise likelihood from 12% to 76%. Conclusions: This thesis shows clear evidence of heightened psychological problems amongst AIDS-orphaned children. It also indicates mediating factors and points to areas of possible intervention. The South African Ministry of Social Development plans to scale up the study to a national survey of AIDS-orphanhood.