Dimitris Anagnostopoulos

A first assessment of the needs of young refugees arriving in Europe: what mental health professionals need to know

the current situation, (4) underscore the need for structured approaches toward acute and medium-term treatment, and (5) finally encourage us all to professionally deal with the crisis as cooperatively and creatively as we possibly can. We are acutely aware of the fact that an assessment of the current situation is but a snapshot; undoubtedly, it will take time to enable child and adolescent psychiatrists and other mental health professionals throughout Europe to professionally achieve the aforementioned aims. We currently by no means have a sufficient insight into the different challenges that our colleagues face throughout Europe. The respective knowledge will grow regionally and nationally according to specific requirements; it is nevertheless important to bundle this growing information to provide overviews and to thus enable a more rapid, stringent, and targeted progress in the prevention and treatment of mental disorders. Currently, we are well aware of the fact that many questions cannot be answered yet in a satisfactory manner; as a first attempt to deal with such questions, we introduce an ESCAP online forum (http://www.escap.eu/care/organizing-the-knowledge-to-support-mental-health-care-for-refugee-children/) to openly discuss such issues and to allow expert articles to follow-up.

Psychopathology and mental health service utilization by immigrants' children and their families.

To investigate the psychopathology of immigrants’ children and psychiatric service utilization by the immigrant families, data were collected from the files of all 35 immigrant children seen over a 3-year period at the Community Mental Health Centre of the Athens University Psychiatric Department. Immigrant children were matched by age, gender and intake date with 70 Greek children. Data concerned information about the child’s place of birth, current living conditions, parents’ country of origin, social and economic situation, occupations and educational status, social insurance, psychiatric history, referral source, diagnostic and therapeutic services rendered, number of sessions and outcome. Utilization of services was assessed 6 months after intake. No significant differences were found regarding family’s structure and parents’ psychopathology. However, immigrant families had significantly worse economic situations, lower status jobs, worse housing and were usually uninsured. No significant differences were observed regarding service utilization parameters, except concerning ‘cooperation with other services’. No differences were found regarding frequency or type of psychiatric diagnosis. However, 91% of the immigrant group received a psychosocial diagnosis as opposed to 49% of the Greek group. Immigrant children did not present more serious or diverse psycho-pathology than did Greek children. Immigrant families had equal levels of service utilization as Greek families. However, it was apparent that immigrant families did not apply for help as readily as their Greek counterparts.

Treatment compliance and early termination of therapy: a comparative study.

Background: Compliance in therapy appears to be linked to the process of therapeutic alliance. A positive patient–therapist relationship usually leads to successful completion of therapy. The aim of this study was to compare evidence, collected at two time periods in a Community Mental Health Center in Athens, on factors affecting treatment compliance. The hypothesis was that by modifying the therapeutic team’s functioning, noncompliance could be reduced. Methods: Epidemiological data were collected from child and adolescent out-patient files at two time periods: time period A, 1990–1994, n = 455 (sample A) and time period B, 2000–2002, n = 476 (sample B). Variables pertaining to the patient, his family and recommended treatment were examined. Student’s t test and the Pearson χ2 test were used in order to explore the correlation of the variables with treatment completion in each sample. Logistic regression analyses were used to determine whether the effect of each variable on treatment completion differed between the two samples. Results: In sample A, most patients (58.6%) did not comply with therapy. The type of recommended treatment, the number of sessions, season of admission and the type of presented problem were found to correlate with treatment completion. Between the two time periods, certain modifications were implemented in the team’s functioning (less diagnostic sessions, focused psychotherapy techniques, less time interval between referral and first diagnostic appointment). A significant reduction in the early termination rate (45.7%) was noted in sample B. The type of recommended treatment, the number of sessions, the family’s situation, the mother’s educational level and the patient’s gender were related to treatment completion in sample B. The effect of the type of proposed treatment and the mean number of sessions of the completed treatments differed significantly between the two samples. Conclusions:Early termination rates in therapy decreased between two time periods. This decrease may be attributed to modifications in the team’s functioning, aimed at improving the therapeutic relationship. The limitation of this study is that only those factors pertaining to the service’s organization and functioning were investigated.

Depressive Symptomatology in High School Students: The Role of Age, Gender and Academic Pressure

To clarify the prevalence of depressive symptomatology in high school students in Athens and to evaluate risk factors for depressive symptomatology the CES-D scale was administered to 713 students (age 15–18). Demographic, school performance and extracurricular activities data were collected. A high prevalence (26.2%) of depressive symptomatology (CES-D cut-off score >28) was found. Regression analysis showed depressive symptomatology to be associated to gender (girls had higher scores than boys), school record (students with a better record had lower scores) and the interaction of gender and grade (males were found to have higher depressive symptomatology scores as they grew older).

Migration mental health issues in Europe: the case of Greece

The migrations of people of many different cultural, racial and ethnic backgrounds have been a major issue of concern in Greece the last three decades. Since 1989 Greece has been transformed into a host country for immigrants and refugees. The collapse of the former socialist regimes of Eastern Europe and the slow but steady growth of Greek economy, in combination with its location, turned Greece into a major draw for hundreds of thousand immigrants. According to 2001 census, the total immigrant population in Greece was about 800,000 people, of which approximately 60% came from neighboring Albania. It has been estimated that from 1988 to 2004 the number of foreigners living in Greece were more than one million. Research on the mental health among immigrant children in Greece during the past decade showed that this population did not present more serious or diverse psychopathology or worse social adaptation compared to Greek children [1, 2]. Immigrant families had equal levels of service utilization as Greek families. However, it was apparent that immigrant families did not apply for help as readily as their Greek counterparts. Also, immigrant students seemed to perform significantly lower academic achievement and be less engaged in school (possibly in order to protect themselves from academic failure) than their nonimmigrant classmates [3, 4].

European Society of Child and Adolescent Psychiatry: position statement on mental health of child and adolescent refugees

ECAP [1]. Since then, a number of activities have been put in place to organize the knowledge to support mental health care for refugee children and make it available everywhere in Europe. The ESCAP online forum (http://www.escap.eu/care/ position-statement-announcement/escaps-approach/), introduced 6 months ago to openly discuss challenging issues and allow professionals to share their experience, has served as a valuable platform to gather, enrich and Introduction

Identification of endocannabinoids and related N-acylethanolamines in tetrahymena. A new class of compounds for Tetrahymena.

The endocannabinoid system is a lipid signaling system in mammalian cells. We reported that major components of the endocannabinoid system such as fatty acid amide hydrolase and monoacylglycerol lipase, are present in the protist Tetrahymena, with characteristics similar to those in mammals. Tetrahymena is a model organism for molecular and cellular biology studies as its genome sequence is available. Here we report the presence of N-acylethanolamines (AcEs) and their respective 2-acylglycerols (2-AcGs) in Tetrahymena thermophila for the first time; the former is a new lipid class for the protist. Using LC-MS/MS we identified, N y-linolenoyl, N-eicosenoyl, N-linoleoyl, N-palmitoyl, N-stearoyl and N-oleoylethanolamines as well as the corresponding monoacylglycerols. The levels of 2-acylglycerols were much higher than the corresponding N-acylethanolamines, as reported for mammals. To our knowledge, N-gamma-linolenoylethanolamine (GLEA) was found for the first time in nature. Anandamide and 2-AG were present in trace amounts. These results demonstrate the existence of a new lipid class in Tetrahymena, strengthen the conviction that the endocannabinoid system is present in this protist, verifying its importance throughout evolution. Tetrahymena could be used as a model for metabolic studies on the endocannabinoids, as well as for the study of drugs targeted towards biosynthetic and catabolic enzymes of AcEs and 2-AcGs.

Abnormal auditory ERP N100 in children with dyslexia: comparison with their control siblings.

BackgroundRecent research has implicated deficits of the working memory (WM) and attention in dyslexia. The N100 component of event-related potentials (ERP) is thought to reflect attention and working memory operation. However, previous studies showed controversial results concerning the N100 in dyslexia. Variability in this issue may be the result of inappropriate match up of the control sample, which is usually based exclusively on age and gender.MethodsIn order to address this question the present study aimed at investigating the auditory N100 component elicited during a WM test in 38 dyslexic children in comparison to those of 19 unaffected sibling controls. Both groups met the criteria of the International Classification of Diseases (ICD-10). ERP were evoked by two stimuli, a low (500 Hz) and a high (3000 Hz) frequency tone indicating forward and reverse digit span respectively.ResultsAs compared to their sibling controls, dyslexic children exhibited significantly reduced N100 amplitudes induced by both reverse and forward digit span at Fp1, F3, Fp2, Fz, C4, Cz and F4 and at Fp1, F3, C5, C3, Fz, F4, C6, P4 and Fp2 leads respectively. Memory performance of the dyslexics group was not significantly lower than that of the controls. However, enhanced memory performance in the control group is associated with increased N100 amplitude induced by high frequency stimuli at the C5, C3, C6 and P4 leads and increased N100 amplitude induced by low frequency stimuli at the P4 lead.ConclusionThe present findings are in support of the notion of weakened capture of auditory attention in dyslexia, allowing for a possible impairment in the dynamics that link attention with short memory, suggested by the anchoring-deficit hypothesis.

Child health, the refugees crisis, and economic recession in Greece

According to the UN Refugee Agency, roughly 860 000 refugees and migrants without travel documents have entered Greece by sea since 2015, with the Greek islands becoming the main gateway to the European Union. Most refugees (45%) are men, 35% are children, and 20% are women, mostly from Syria, Afghanistan, and Iraq. More than 250 deaths and 149 missing people were recorded in Greek territorial waters in 2015, and almost half of those who have drowned trying to reach Greece were children. Journeys by sea in winter weather are particularly dangerous and children are often soaking wet and extremely cold when they are brought ashore, which leads to a high risk of hypothermia, and in many cases hospital treatment is needed. For refugees who fi nally reach a Greek island, living conditions are poor, especially for young children. The authorities, non-governmental organisations, church charities, and local communities have made a great humanitarian effort to host newly arrived refugees, address their primary needs, and care for young children and pregnant women. Nevertheless, thousands of people continue to arrive each day, leading to a shortage of supplies. Roughly 1800 requests for child services for unaccompanied minors have been made since 2015. Children and adolescent refugees endure considerable physical and mental challenges before and during their journey and experience continued hardship after their arrival, such as exposure to violence, separation from their families, insecurity, inadequate housing, trafficking, and sexual exploitation. Medical examinations and health care, psychosocial support, and housing are being offered free of charge by a network of public services and non-governmental organisations through the national child protection legislation. Unfortunately, this extraordinary infl ux of migrants coincides with the disastrous Greek economic recession. Gross domestic product has fallen by 25% since 2010, the income and employment of both native residents and immigrants have decreased, and the public health sector and welfare sector have been aff ected by austerity measures. Nevertheless, protection of the lives and integrity of child refugees remains a major concern not only for the state, but also for allied health professionals and local communities. Health professionals, in particular, should assess the complex, continuing challenges for the wellbeing of children and adolescents who are refugees, not only with the aim to support them and provide access to effective treatments, but also to act as advocates for refugee rights, anti-discriminatory policies, and social justice.

The psychopathology of parents of children and adolescents with obsessive-compulsive disorder.

Objective: Our purpose was to determine the rates of psychopathology in parents of children and adolescents with obsessive-compulsive disorder (OCD) and compare these with that found in parents of children with learning disorders of reading and written expression. Method: Thirty-one children with OCD, aged 8–15 years, and their parents (n = 62), aged 43–48 years, were studied and compared to 30 children with learning disorders, aged 7–16 years, and their parents (n = 58), aged 40–46 years. In order to investigate the parental psychopathology, the Symptom Checklist-90-R (SCL-90-R), the State and Trait Anxiety Inventory and the Yale-Brown Obsessive-Compulsive Scale were administered. The psychopathology of children was examined through the Schedule for Affective Disorders and Schizophrenia for school-aged children and other instruments. Results: Both fathers and mothers of the probands differed from the controls in a variety of symptoms (i.e. anxiety, depression, obsessions, etc.). Both parents had increased severity of OC symptomatology in comparison to the controls. In addition, the probands’ fathers had severe OC symptomatology at a higher percentage than the mothers and respective controls. Conclusion: The elevated scores of the parents of children with OCD in some SCL-90-R subscales can be perceived as an index of heightened psychopathology. More fathers in the OCD group, compared to mothers and controls, were found to have OC symptoms in the SCL-90-R and increased severity of OC symptoms on the Yale-Brown Obsessive-Compulsive Scale. The last finding requires further study. Parental psychopathology in children with OCD needs to be addressed clinically.