Milica Pejovic-Milovancevic

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.

Common schizophrenia alleles are enriched in mutation-intolerant genes and in regions under strong background selection

Schizophrenia is a debilitating psychiatric condition often associated with poor quality of life and decreased life expectancy. Lack of progress in improving treatment outcomes has been attributed to limited knowledge of the underlying biology, although large-scale genomic studies have begun to provide insights. We report a new genome-wide association study of schizophrenia (11,260 cases and 24,542 controls), and through meta-analysis with existing data we identify 50 novel associated loci and 145 loci in total. Through integrating genomic fine-mapping with brain expression and chromosome conformation data, we identify candidate causal genes within 33 loci. We also show for the first time that the common variant association signal is highly enriched among genes that are under strong selective pressures. These findings provide new insights into the biology and genetic architecture of schizophrenia, highlight the importance of mutation-intolerant genes and suggest a mechanism by which common risk variants persist in the population.A new GWAS of schizophrenia (11,260 cases and 24,542 controls) and meta-analysis identifies 50 new associated loci and 145 loci in total. The common variant association signal is highly enriched in mutation-intolerant genes and in regions under strong background selection.

Sex Differences in Autism Spectrum Disorders: Does Sex Moderate the Pathway from Clinical Symptoms to Adaptive Behavior?

We explored sex differences in diagnostic categories, clinical symptoms and adaptive behavior of persons with autism spectrum disorders, as well as sex-specific correlations of clinical and adaptive caracteristics. The study involved 108 patients (83 males, 6.73 ± 4.33 years old) diagnosed with autism spectrum disorders (ASD). Assessment included ADI-R and Vineland Adaptive Behavior Scale II. Males were more often diagnosed with typical autism. There were no sex differences in the autistic symptoms, while females showed better functioning in Daily living skills, without reaching statistically significant difference (p = 0.062). We have found different associations of autistic symptoms with different aspects of adaptive behavior in males and females. Social reciprocity in females correlated with social domain of adaptive behavior, in a positive direction. Our findings have shown that although there are no sex differences in autistic symptoms, females tend to be somewhat more functional, and are also less frequently diagnosed with typical autism. Our results have also shown that sex might moderate the way clinical symptoms are expressed in adaptive behavior. Social reciprocity might be the core feature regarding sex differences in ASD. Our findings might have diagnostic and therapeutical implications, pointing out to the need for individualized, sex-specific treatment in this group of disorders.

Coping strategies in civilians during air attacks

Abstract.Background: Coping strategies may influence the psychological outcome after a stressful event, both as coping at the time of the event and as strategies of dealing with its consequences after the event. The aim of the study was to investigate coping strategies used by civilians during the air attacks in Yugoslavia in 1999, and their association with the level of exposure, gender and psychological symptoms 1 year later. Method: The sample is a non-selective group of 139 medical students from the University of Belgrade, Yugoslavia. Open questions and content analysis were used to assess coping strategies. Symptoms of intrusion and avoidance were assessed, as well as general psychological symptoms. Results: Content analysis of answers to open questions revealed nine categories of coping strategies (sport and walks, leisure activities, talking and gathering, humor, avoidance, philosophical approach, getting information, work, and substance abuse). A cluster analysis identified three groups of students with different styles of coping. Students that used dominantly ‘talking and gathering’ had the highest, and the ones that mostly used ‘leisure activities’ the lowest scores on intrusion. There were significant gender differences in how coping strategies were associated with intrusive symptoms. Conclusion: The type of coping strategies used during the air attacks may contribute to the level of intrusive symptoms 1 year after the event. Different coping strategies might be effective in men and women to reduce intrusive symptoms. Longitudinal and prospective studies are needed to draw definite conclusions on causal relationships between coping strategies and levels of posttraumatic stress.

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

Personality Characteristics of Psychiatric Trainees

Personality Characteristics of Psychiatric Trainees Dusica Lecic-Tosevski a, Milica Pejovic-Milovancevic a, Lazar Tenjovicb, Saveta Draganic-Gajic a, George N. Christodoulou c a Institute of Mental Health, School of Medicine and bDepartment of Psychology, School of Philosophy, University of Belgrade, Belgrade, Serbia & Montenegro; c Department of Psychiatry, Eginition Hospital, University of Athens, Athens, Greece

Attitudes of psychiatry residents toward mental illness

INTRODUCTION Attitudes of lay people and physicians towards mentally ill patients are frequently highly biased. The aim of this study was to investigate differences in attitudes of psychiatry and internal medicine residents toward mental illness and to establish the relationship between their attitudes and their personal characteristics. MATERIAL AND METHODS The sample consisted of 45 psychiatry and 36 internal medicine residents. The attitudes toward mental illness were assessed using Opinions about Mental Illness Questionnaire (OMI) and personality traits were examined using the Eysenck Personality Questionnaire (EPQ). RESULTS Our findings showed that in regard to internal medicine residents, psychiatry residents do not consider mentally ill patients to be inferior and dangerous. Psychiatry residents have a benevolent attitude toward the mentally ill. Personality traits of psychiatry residents were not related to their opinions about mental illness. DISCUSSION The results suggest that there is a need to develop strategies that would bring about changes in the curriculum of training programs for medical residents, including proper training in mental health issues. Such strategies should help in destigmatization of persons with mental disorders and increase the competence of physicians to deal with mentally ill.

Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder

Research on sex-related differences in Autism Spectrum Disorder (ASD) has been impeded by small samples. We pooled 28 datasets from 18 sites across nine European countries to examine sex differences in the ASD phenotype on the ADI-R (376 females, 1763 males) and ADOS (233 females, 1187 males). On the ADI-R, early childhood restricted and repetitive behaviours were lower in females than males, alongside comparable levels of social interaction and communication difficulties in females and males. Current ADI-R and ADOS scores showed no sex differences for ASD severity. There were lower socio-communicative symptoms in older compared to younger individuals. This large European ASD sample adds to the literature on sex and age variations of ASD symptomatology.

Glutathione S-Transferase Deletion Polymorphisms in Early-Onset Psychotic and Bipolar Disorders: A Case-Control Study

OBJECTIVE To examine glutathione S-transferase (GST) deletion polymorphisms in development of early-onset severe mental disorders, with the hypothesis that patients with GSTM1-null and GSTT1-null genotypes will develop psychotic disorders at a younger age. METHODS We identified GSTM1 and GSTT1 deletion polymorphisms by multiplex polymerase chain reaction (PCR) in 93 patients with early onset severe mental disorders and 278 control individuals. The diagnoses were confirmed by Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and Schedule for Affective Disorders and Schizophrenia-Life-Time Version (K-SADS-PL) interviews. RESULTS Individuals with the GSTM1-null genotype were at 3.36-fold higher risk of developing early-onset severe mental disorders than carriers of a corresponding active genotype. The risk of those disorders was increased by 6.59-fold in patients with GSTM1-null/GSTT1-active genotype. Patients with the GSTM1-null genotype were at approximately 2-fold increased risk for developing early-onset schizophrenia-spectrum disorder (EOS), early-onset bipolar disorder (EOBD) with psychotic symptoms, or early-onset first-episode psychosis (EOFEP), compared with patients with the GSTM1-active genotype. CONCLUSION The GSTM1-null genotype might be associated with higher risk for early onset severe mental disorders.

ESCAP for mental health of child and adolescent refugees: facing the challenge together, reducing risk, and promoting healthy development

Humanitarian emergencies such as war and armed conflict can have a direct impact on the psychosocial well-being and mental health of children and adults, along with the physical, environmental, and financial burden. Child refugees face intense psychological trauma, before, during, and after their flight, as a result of fleeing their homelands and entering into states of uncertainty, physical danger, and distress. They have experienced and witnessed violence, lost loved ones, faced deprivation, and been separated from their families. ESCAP has taken a clear position in the refugee crisis, standing up for the mental health and well-being of refugee children, adolescents, and their families. A Task Group initiated by board members within ESCAP has started to collect relevant knowledge and experience to support mental health workers involved with the care for refugee children and post on a dedicated website. The aim of the project “ESCAP for mental health of child and adolescent refugees” is to make available the necessary knowledge everywhere in Europe, where professionals and volunteers are helping these children and their families. All 33 National Associations of Child and Adolescent Psychiatry, as ESCAP members, were called to defend the mental health of young refugees and to present the ESCAP position statement to their governments. The project members take the position of promoting the healthy adaptation of young refugees and their families to the new living circumstances and to lower the risk of developing mental health problems. Using our expertise and showing leadership in this