Mental Health, and Eating Disorders in Patients After Roux-en-Y Gastric Bypass Surgery (RYGB).

<b>Introduction:</b> Obesity, as one of the main health problems worldwide, is associated with an increased risk of developing mental and eating disorders and negative eating habits. Bariatric surgery allows for rapid weight loss and alleviates the symptoms of concomitant diseases in obese patients.<b>Aim:</b> Pre- and postoperative estimation of mental disorders and eating behaviors in patients after Roux-en-Y Gastric Bypass (RYGB).<b>Material and methods:</b> Analysis of data from up to 5 years of follow-up including clinical examination and questionnaires.<b>Results:</b> Following parameters decreased after RYGB: anxiety and hyperactivity from 32.81% to 21.88%, mood disorders - 31.25% to 20.31%, substance abuse - 40.63% to 28.13%, emotional eating - 76.56% to 29.69%, binge eating - 50% to 6.25%, night eating - 87.5% to 20.31%. Postoperative rates of: negative eating habits, daily intake of calories and sweetened beverages, flatulence, constipation, and abdominal pain decreased, while the rate of food intolerance and emesis increased.<b>Conclusions:</b> In our patients, the occurrence of: mental and eating disorders, negative eating habits, daily calories, sweetened beverages, coffee intake decreased after weight loss (as a result of RYGB), but water, vegetables and fruit consumption increased. Lower rate of flatulence, constipation, and abdominal pain, but higher of food intolerance and emesis were also confirmed after RYGB.

Factors associated with suicide attempt risk in adolescent inpatient psychiatric care: toward a practical model.

Suicide is an important social and medical problem, particularly among children and adolescents. The aim of the study was to determine the association of the psychiatric diagnosis and selected psychosocial factors with the risk of suicide attempts among patients of an adolescent psychiatric unit. A retrospective analysis was performed on a database of consecutive N = 1311 patients aged 13-18 years of the adolescent psychiatric ward. A hierarchical logistic regression analysis was performed to assess the predictive value of the main psychiatric diagnosis, for factors selected from the database to determine their influence on the relative risk of a suicide attempt. Primary diagnoses of mood disorders and emotional and behavioral disorders were associated with an increased risk of a current admission after a suicidal attempt, a history of past suicidal attempts and non-suicidal self-harm (NSSI). History of NSSI was associated with a fourfold increase probability of a suicide attempt. Truancy, sexual abuse, heartbreak and frequent conflicts were related to a rise in suicidal attempt risk. Learning difficulties were found to be linked to increased probability of suicidal attempt, but only among women. The current study confirms that the primary diagnosis, NSSI and well-recognized psychosocial factors (including family- and school-related factors) may prove useful in the assessment of suicidal risk among adolescents admitted to a psychiatric ward.

How to Make the Unpredictable Foreseeable? Effective Forms of Assistance for Children with Autism Spectrum Disorder (ASD) during the COVID-19 Pandemic.

Symptomatology in patients with the diagnosis of autism spectrum disorder (ASD) is very heterogeneous. The symptoms they present include communication difficulties, behavior problems, upbringing problems from their parents, and comorbidities (e.g., epilepsy, intellectual disability). A predictable and stable environment and the continuity of therapeutic interactions are crucial in this population. The COVID-19 pandemic has created much concern, and the need for home isolation to limit the spread of the virus has disrupted the functioning routine of children/adolescents with ASD. Are there effective diagnostic and therapeutic alternatives to limit the consequences of disturbing the daily routine of young patients during the unpredictable times of the pandemic? Modern technology and telemedicine have come to the rescue. This narrative review aims to present a change in the impact profile in the era of isolation and assess the directions of changes that specialists may choose when dealing with patients with ASD.

Are Children Harmed by Being Locked up at Home? The Impact of Isolation during the COVID-19 Pandemic on the Phenomenon of Domestic Violence.

The phenomenon of violence against children is a very complex one. There are many types of child abuse, and they are culturally dependent to a significant degree. Although studies show that children generally only suffer from mild COVID-19 infection, some social restrictions introduced during the pandemic, such as home isolation, may have many severe consequences on the population's mental health. Studies on this topic suggest that violence against children increased during lockdown due to the COVID-10 pandemic. This narrative review summarizes this available literature on the subject and discusses the different forms of violence against children, their cultural aspects, the impact of the COVID-19 pandemic on the phenomenon of violence, the long-term consequences of the above, and forms of assistance for abused minors.

Increase in Search Interest for "Suicide" and "Depression" for Particular Days of the Week and Times of Day: Analysis Based on Google Trends.

Depression is the most common disorder in people who attempt suicide or die by suicide. Research review indicate that therapy of depression (including psychoeducation) is one of the main factors in the prevention of suicidal behavior. In this paper we examine the intensification of search interest for the terms "depression" and "suicide" in Google search engine with regard to the time of day and day of the week in Poland, Germany, Great Britain and Italy. The goal of the study was to determine if there are any days of the week or hours when search for "suicide" and "depression" particularly increases. Numerous studies focusing not only on the seasonality of suicidal behavior, but also on the days of the week and hours, indicate that it is most often undertaken on Mondays in the night and early morning hours. The results of the research being the basis of this paper show a certain time coincidence: first, the increase in search interest for "suicide" and "depression" and then undertaking suicidal behavior (suicide and suicide attempts). Searching for terms "suicide" and "depression" usually took place (except in Italy) at weekends and most often in the late evening hours and at night. The conclusions from the research can be used in suicide prevention activities, for example in determining the hours of operation of individual helpline numbers.

Comparison of thyroid-stimulating hormone levels in adolescents with schizophrenia, bipolar disorder, unipolar depression, conduct disorders, and hyperkinetic disorders.

ABSTRACT: The aim of this study was to retrospectively compare values of thyroid-stimulating hormone (TSH) in adolescent patients diagnosed with schizophrenia, bipolar disorder, unipolar depression (UNI-DEP), conduct disorders (CD), and hyperkinetic disorders.The research involved 1122 patients (718 women, 64%); aged 12 to 18 hospitalized in the Department of Adolescent Psychiatry, Medical University of Lodz. We analyzed TSH levels in the whole study population and compared it between the above-mentioned subgroups of diagnoses.Mean serum TSH concentration in the studied population (n = 1122) was 2.06 µIU/mL. The values of percentiles were as follows: 2.5th - 0.53 µIU/mL, 10th - 0.89 µIU/mL, 25th - 1.31 µIU/mL, 50th - 1.9 µIU/mL, 75th - 2.6 µIU/mL, 90th - 3.43 µIU/mL, 97.5th - 4.72 µIU/mL. TSH values were negatively correlated with patients' age (P = .00001). Patients with bipolar depression had higher TSH levels than patients with CD (P = .002). Also, when male and female groups were examined separately we found that female patients with UNI-DEP and bipolar disorder had higher TSH levels than female patients with CD (P = .001; P = .001).Our results confirm that there may be a higher prevalence of thyroid dysfunctions in bipolar and UNI-DEP subgroups among adolescents and that it is worthy to consider some kind of interventions regarding thyroid function in depressed individuals.

Psychometric Properties of the Suicide Acceptance Questionnaire.

Only a few questionnaires are available for measuring attitude towards suicide as a unidimensional construct, i.e. emphasizing acceptance or disapproval of the suicidal act under a set of difficult life circumstances. The aim of this study was to develop the Suicide Acceptance Questionnaire (SAQ) and examine its psychometric properties. A group of 177 Psychology, Medicine and Law students completed the SAQ, Attitudes Towards Suicide questionnaire and a demographic survey. Exploratory factor analysis found the SAQ to have a single factor structure, explaining 55.49% of variance, with high goodness of fit. Owing to the nature of explicit attitudes, the SAQ may have limited power in predicting behavior. The findings indicate that the SAQ demonstrates appropriate reliability and concurrent validity for measuring the acceptance of suicide act. Future research with use of confirmatory factor analysis is needed for determining whether the proposed construct fits data.

[Treatment of generalized anxiety disorder in terms of cognitive behavioral]. / Terapia zaburzen lekowych uogólnionych w ujeciu poznawczobehawioralnym.

Risk of generalized anxiety disorder (GAD) within life is estimated at 2.6-5.1%. Amongst etiological factors that affect the development of the disorder are: biological and psychological problems, including cognitive models. There are known several cognitive models: metacognitive, Borkovec'c model and the model developed in Quebec. Key cognitive contents that occur with generalized anxiety disorder are focused on two aspects: metacognitive beliefs and intolerance of uncertainty. A primary purpose of cognitive-behavioural therapy (CBT) is the modification of dysfunctional beliefs about worry. Cognitive behavioural therapy is effective in reducing anxiety, makes it easier to operate in the professional sphere and improves the quality of life.

Psychiatric Disorders and Health-Related Quality of Life in Children With Type 1 Diabetes Mellitus.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is a chronic condition with major effect on health-related quality of life (HRQoL) and mental health. In 1990s, high rates of psychiatric disorders were reported among children with T1DM. Little is known, however, about current prevalence of psychiatric disorders in children with T1DM and the relation between psychiatric diagnosis and HRQoL. OBJECTIVE: The aim of the study was to determine the prevalence of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) psychiatric disorders and the association between psychiatric comorbidity and HRQoL in the pediatric population with T1DM. METHODS: We conducted a cross-sectional study of 207 children, aged 8-18 years, diagnosed with T1DM. The presence of psychiatric disorders has been assessed by the standard diagnostic interview according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria. HRQoL was measured by the general and diabetes mellitus-specific modules of the Paediatric Quality of Life Inventory. RESULTS: Of the evaluated patients, 26.6% (N = 55) met the criteria for psychiatric disorders at the time of evaluation. The most common diagnoses were anxiety (N = 32; 15.5%) and mood disorders (N = 8; 3.9%). One-third of the patients (N = 66, 31.9%) met the criteria for at least 1 psychiatric diagnosis in their lifetime. The presence of psychiatric disorders was related to an elevated hemoglobin A1c level (8.6% vs 7.6%) and a lowered HRQoL level in the general pediatric quality of life inventory. In the diabetes mellitus-specific pediatric quality of life inventory, children with psychiatric disorders revealed more symptoms of diabetes mellitus, treatment barriers, and lower adherence than children without psychiatric disorders. CONCLUSIONS: T1DM in children is associated with a very high prevalence of psychiatric comorbidity, which is related to elevated hemoglobin A1c and lower HRQoL levels.

Supplementation of Antipsychotic Treatment with the Amino Acid Sarcosine Influences Proton Magnetic Resonance Spectroscopy Parameters in Left Frontal White Matter in Patients with Schizophrenia.

Dysfunction of the glutamatergic system, the main stimulating system in the brain, has a major role in pathogenesis of schizophrenia. The frontal white matter (WM) is partially composed of axons from glutamatergic pyramidal neurons and glia with glutamatergic receptors. The natural amino acid sarcosine, a component of a normal diet, inhibits the glycine type 1 transporter, increasing the glycine level. Thus, it modulates glutamatergic transmission through the glutamatergic ionotropic NMDA (N-methyl-d-aspartate) receptor, which requires glycine as a co-agonist. To evaluate the concentrations of brain metabolites (NAA, N-acetylaspartate; Glx, complex of glutamate, glutamine, and γ-aminobutyric acid (GABA); mI, myo-inositol; Cr, creatine; Cho, choline) in the left frontal WM, Proton Nuclear Magnetic Resonance (¹H-NMR) spectroscopy was used. Twenty-five patients randomly chosen from a group of fifty with stable schizophrenia (DSM-IV-TR) and dominant negative symptoms, who were receiving antipsychotic therapy, were administered 2 g of sarcosine daily for six months. The remaining 25 patients received placebo. Assignment was double blinded. ¹H-NMR spectroscopy (1.5 T) was performed twice: before and after the intervention. NAA, Glx and mI were evaluated as Cr and Cho ratios. All patients were also assessed twice with the Positive and Negative Syndrome Scale (PANSS). Results were compared between groups and in two time points in each group. The sarcosine group demonstrated a significant decrease in WM Glx/Cr and Glx/Cho ratios compared to controls after six months of therapy. In the experimental group, the final NAA/Cr ratio significantly increased and Glx/Cr ratio significantly decreased compared to baseline values. Improvement in the PANSS scores was significant only in the sarcosine group. In patients with schizophrenia, sarcosine augmentation can reverse the negative effect of glutamatergic system overstimulation, with a simultaneous beneficial increase of NAA/Cr ratio in the WM of the left frontal lobe. Our results further support the glutamatergic hypothesis of schizophrenia.

Comparison of Metabolite Concentrations in the Left Dorsolateral Prefrontal Cortex, the Left Frontal White Matter, and the Left Hippocampus in Patients in Stable Schizophrenia Treated with Antipsychotics with or without Antidepressants. ¹H-NMR Spectroscopy Study.

Managing affective, negative, and cognitive symptoms remains the most difficult therapeutic problem in stable phase of schizophrenia. Efforts include administration of antidepressants. Drugs effects on brain metabolic parameters can be evaluated by means of proton nuclear magnetic resonance (¹H-NMR) spectroscopy. We compared spectroscopic parameters in the left prefrontal cortex (DLPFC), the left frontal white matter (WM) and the left hippocampus and assessed the relationship between treatment and the spectroscopic parameters in both groups. We recruited 25 patients diagnosed with schizophrenia (DSM-IV-TR), with dominant negative symptoms and in stable clinical condition, who were treated with antipsychotic and antidepressive medication for minimum of three months. A group of 25 patients with schizophrenia, who were taking antipsychotic drugs but not antidepressants, was matched. We compared metabolic parameters (N-acetylaspartate (NAA), myo-inositol (mI), glutamatergic parameters (Glx), choline (Cho), and creatine (Cr)) between the two groups. All patients were also assessed with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS). In patients receiving antidepressants we observed significantly higher NAA/Cr and NAA/Cho ratios within the DLPFC, as well as significantly higher mI/Cr within the frontal WM. Moreover, we noted significantly lower values of parameters associated with the glutamatergic transmission--Glx/Cr and Glx/Cho in the hippocampus. Doses of antipsychotic drugs in the group treated with antidepressants were also significantly lower in the patients showing similar severity of psychopathology.

Adding Sarcosine to Antipsychotic Treatment in Patients with Stable Schizophrenia Changes the Concentrations of Neuronal and Glial Metabolites in the Left Dorsolateral Prefrontal Cortex.

The glutamatergic system is a key point in pathogenesis of schizophrenia. Sarcosine (N-methylglycine) is an exogenous amino acid that acts as a glycine transporter inhibitor. It modulates glutamatergic transmission by increasing glycine concentration around NMDA (N-methyl-d-aspartate) receptors. In patients with schizophrenia, the function of the glutamatergic system in the prefrontal cortex is impaired, which may promote negative and cognitive symptoms. Proton nuclear magnetic resonance (¹H-NMR) spectroscopy is a non-invasive imaging method enabling the evaluation of brain metabolite concentration, which can be applied to assess pharmacologically induced changes. The aim of the study was to evaluate the influence of a six-month course of sarcosine therapy on the concentration of metabolites (NAA, N-acetylaspartate; Glx, complex of glutamate, glutamine and γ-aminobutyric acid (GABA); mI, myo-inositol; Cr, creatine; Cho, choline) in the left dorso-lateral prefrontal cortex (DLPFC) in patients with stable schizophrenia. Fifty patients with schizophrenia, treated with constant antipsychotics doses, in stable clinical condition were randomly assigned to administration of sarcosine (25 patients) or placebo (25 patients) for six months. Metabolite concentrations in DLPFC were assessed with 1.5 Tesla ¹H-NMR spectroscopy. Clinical symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS). The first spectroscopy revealed no differences in metabolite concentrations between groups. After six months, NAA/Cho, mI/Cr and mI/Cho ratios in the left DLPFC were significantly higher in the sarcosine than the placebo group. In the sarcosine group, NAA/Cr, NAA/Cho, mI/Cr, mI/Cho ratios also significantly increased compared to baseline values. In the placebo group, only the NAA/Cr ratio increased. The addition of sarcosine to antipsychotic therapy for six months increased markers of neurons viability (NAA) and neurogilal activity (mI) with simultaneous improvement of clinical symptoms. Sarcosine, two grams administered daily, seems to be an effective adjuvant in the pharmacotherapy of schizophrenia.

Supplementation of antipsychotic treatment with sarcosine ­ GlyT1 inhibitor ­ causes changes of glutamatergic (1)NMR spectroscopy parameters in the left hippocampus in patients with stable schizophrenia.

Glutamatergic system, the main stimulating system of the brain, plays an important role in the pathogenesis of schizophrenia. Hippocampus, a structure crucial for memory and cognitive functions and rich in glutamatergic neurons, is a natural object of interest in studies on psychoses. Sarcosine, a glycine transporter (GlyT-1) inhibitor influences the function of NMDA receptor and glutamate-dependent transmission. The aim of the study was to assess the effects of sarcosine on metabolism parameters in the left hippocampus in patients with schizophrenia. Assessments were performed using proton nuclear magnetic resonance ((1)H NMR) spectroscopy (1.5T). Fifty patients diagnosed with schizophrenia (DSM-IV-TR), with dominant negative symptoms, in stable clinical condition and stable antipsychotics doses were treated either with sarcosine (n=25) or placebo (n=25). Spectroscopic parameters were evaluated within groups and between two groups before and after 6-month intervention. All patients were also assessed with the Positive and Negative Syndrome Scale (PANSS). In the sarcosine group, after 6-month treatment, we found significant decrease in hippocampal Glx/Cr (Glx-complex of glutamate, glutamine and GABA, Cr-creatine) and Glx/Cho (Cho-choline), while N-acetylaspartate (NAA), myo-inositol (mI), Cr and Cho parameters remained stable along the study and also did not differ significantly between both groups. This is the first study showing that a pharmacological intervention in schizophrenia, particularly augmentation of the antypsychotic treatment with sarcosine, may reverse the pathological increase in glutamatergic transmission in the hippocampus. The results confirm involvement of glutamatergic system in the pathogenesis of schizophrenia and demonstrate beneficial effects of GlyT-1 inhibitor on the metabolism in the hippocampus and symptoms of schizophrenia.

[The relation of selected psychiatric disorders to occurrence of suicide attempts among teenage psychiatrically hospitalized patients]. / Zwiazek wybranych zaburzen psychicznych z wystepowaniem prób samobójczych wsród nastoletnich pacjentów hospitalizowanych psychiatrycznie.

UNLABELLED: Suicide is the third cause of death globally in the age group 10-19. Multiple risk factors (genetic, psychiatric, psychological, familial, social) increased number of suicide attempts. AIM: The aim of this study was to explore whether mental disorders are associated with the number of suicide attempts among psychiatric hospitalized adolescents. MATERIALS AND METHODS: Retrospective, chart-based analysis of 119 patients, aged 13-18, treated in 2013-2014 in the Department of Adolescent Psychiatry in Lódz. Inclusion criteria was diagnosis of schizophrenia, schizotypal and delusional disorders, mood disorders, neurotic, stress-related and somatoform disorders, behavioral and emotional disorders according to ICD 10. Exclusion criteria were other psychiatric diagnosis, incomplete information about intention of self-harm behaviors. For statistical analysis used Statistica 9.1. RESULTS: Among psychiatricaly hospitalized patients, 51.2% of people attempted suicide. No relationship was found (p > 0.05) between psychiatric diagnosis and frequency of suicide attempts in adolescents, but the most common suicide attempts related to people with a diagnosis of mood disorders (59.3%) and neurotic disorders (54.6%), and least frequently in patients with a diagnosis of schizophrenia , schizotypal and delusional disorders (40%) and behavioral and emotional disorders (44.4%). CONCLUSIONS: There is no relation between the occurrence of suicide attempts and the type of mental disorders among psychiatrically hospitalized adolescents.

Neuropsychiatric symptoms and celiac disease.

BACKGROUND: Neuropsychiatric symptoms may represent an atypical manifestation of celiac disease that occur before a gastroenterological diagnosis is made. Some studies suggest that a gluten-free diet is effective in treating the depression, anxiety, and neurological complications associated with celiac disease. METHOD: The article describes the case of a patient suffering from chronic, treatment-resistant symptoms of depression and anxiety. The diagnosis of celiac disease and introduction of an elimination diet caused a significant improvement in mental state and everyday functioning in the presenting patient. CONCLUSION: The presence of persistent anxiety and depressive symptoms, with a poor reaction to pharmacological treatment, indicates a need to identify somatic reasons for the underlying condition. It is important to remember that celiac disease can occur at any age, not only in childhood. The presence of this somatic cause of persistent depressive and anxiety symptoms should be considered in the diagnostic process in adults.

Cutaneous deliberate self-harm in Polish school teenagers - an inter-disciplinary challenge.

Self-harm of the skin is a complex problem encountered mainly in adolescents and young adults. The aim of the study was to assess the prevalence of deliberate cutaneous self-harm without suicidal intent among secondary school teenagers of the Lodz region. A self-administered specially designed anonymous questionnaire was delivered to 1,448 secondary school teenagers, aged 12-19 years. The lifetime prevalence of self-reported deliberate self-harm was 19.5%, out of which 14.4% confirmed isolated cutaneous self-injury (self-cutting in the vast majority of cases), 1.7% ingested a substance or drug in excessive amounts and 3.5% declared both behaviours. Our results indicate that skin is the organ most commonly involved in deliberate self-harm. Dermatologists, especially those focussed on dermatosurgery and aesthetic dermatology, should understand the special issues relating to such patients before taking decisions concerning performing any procedures on these individuals, since deliberate self-harm has been recognised as one of the main risk factors of suicide.

[The evaluation of the stress coping styles and emotional intelligence in psychiatrically treated adolescent patients with deliberate self-harm in relation to chosen clinical features]. / Ocena stylów radzenia sobie ze stresem i inteligencji emocjonalnej u samouszkadzajacej sie mlodziezy leczonej psychiatrycznie w zaleznosci od wybranych czynników klinicznych.

AIM: The primary goal of the study was an evaluation of the dominating stress coping styles in adolescent patients with self-harm records, who were psychiatrically treated, taking into account the level of their emotional intelligence vs. the psychiatric diagnosis, the type of motives and decision involved in self-harming and the presence of suicidal attempts (SA) in the past. The secondary goal included an analysis of the correlations between particular stress coping skills and the level of emotional intelligence. METHOD: The reported studies involved self-harming patients aged of 13-18 years during their psychiatric hospitalisation (n=31). The applied tools included the Coping Inventory for Stressful Situations (CISS) and the Two-Dimensional Inventory of Emotional Intelligence (DINEMO). RESULTS: An evaluation of the correlation between stress coping styles and the levels of emotional intelligence in the studied group and the types of mental disorders did not reveal any significant differences between the evaluated subgroups. Patients, who confirmed an instrumental motive, obtained statistically significantly higher scores on the task-oriented scale vs. those who performed the acts of DSH for reactive or pathological reasons. Taking into consideration the type of decision, involved in self-harming acts, did not show any differences in the stress coping styles of the patients, however, those patients, who had planned an act of DSH, achieved statistically significantly higher scores in the OTHERS scale of the DINEMO. Patients with DSH and with SA in the past (77% studied group), achieved similar results in CISS and DINEMO vs. the self-harming patients without SA in the past. In the study group, one statistically significant correlation was demonstrated between CISS--the avoidance-oriented style--and the I in DINEMO. CONCLUSIONS: 1. Patients with DSH records and without SA constitute a fairly uniform group with regards to stress coping styles, taking into account the type of psychic disorders and the urgency of self-harm decision. 2. Their use of the task-oriented style may be associated with instrumental auto-aggression. 3. DSH may be a non-verbal form of communicating other problems to others. 4. Adolescents, who perform the acts of self-harm, are endangered by suicidal attempts, regardless of their stress coping styles or the level of their emotional intelligence. 5. A development of constructive stress coping skills against strong emotional reactions is a recommended method in the therapy of patients with DSH.

Efficacy of metabolic and psychological screening for mood disorders among children with type 1 diabetes.

OBJECTIVE: To compare the diagnostic accuracy and time expenditure of screening models based on glycated hemoglobin (HbA(1c)) level and psychometric measures for mood disorder (MD) among children with type 1 diabetes. RESEARCH DESIGN AND METHODS: With semistructured clinical interviews (Schedule for Affective Disorders and Schizophrenia for Children-Present and Lifetime version, 120 min/patient) as a reference for diagnosing MD, including major depressive disorder (MDD), we tested 163 subjects, aged 8 to 18 years, with type 1 diabetes. We evaluated four screening approaches: 1) Children's Depression Inventory (CDI) at 30 min/patient, 2) HbA(1c) level, 3) HbA(1c) level plus CDI, and 4) HbA(1c) level plus Children's Depression Rating Scale (CDRS) at 40 min/patient. These tests were conducted with all participants, and the total time expenditure for all four approaches was calculated as the total time needed to implement successfully the screening for MD or MDD in the center. RESULTS: HbA(1c) performed on par with individual psychometric tests in diagnosing MD or MDD. The HbA(1c) plus CDRS model was the best screening procedure for both MD and MDD, with diagnostic thresholds for HbA(1c) established at 8.7% and 9.0%, respectively. Cutoff points for CDRS assessed after filtering by HbA(1c) were 26 (MD) and 30 (MDD) points. Center-wide application of this procedure would result in an 83% reduction of the examination time necessary for the psychiatrist for MD screening and a 91% reduction for MDD screening, as compared with standard screening with CDI. CONCLUSIONS: Use of HbA(1c) level followed by CDRS is a time-efficient procedure to screen for MD in children with type 1 diabetes.

Sweet sins: frequency and psychiatric motivation for theft among adolescents with type 1 diabetes.

BACKGROUND: Behavioral problems are an issue among adolescents with type 1 diabetes (T1D). The authors hypothesize that theft, possibly because of an underlying psychiatric morbidity, may be a way of procuring sweets leading to worse glycemic control. OBJECTIVE: To evaluate psychiatric morbidity and the association of theft and metabolic control among children and adolescents with T1D, using data from an interim analysis of an ongoing quality-of-life and psychiatric comorbidity study. METHODS: One hundred and nine consecutively hospitalized individuals aged 8-18 years with T1D were asked about incidents of theft. The data on psychiatric morbidity were taken from an ongoing longitudinal study using semi-structured diagnostic interview (KSADS-PL). RESULTS: Overall, 10 children (9%) reported that they had committed theft. Primary motivation for theft was reported as either direct or indirect gain of sweets. Patients who admitted to theft were more likely to have worse metabolic control expressed by glycated hemoglobin (HbA1c) [10.4% (interquartile range 9.8-11.8) vs. 7.7% (6.9-8.8); p < 0.0001] and higher odds of having psychiatric morbidity (odds ratio 8.2; 95% confidence interval 1.9-34.2) than their peers. In the subgroup analysis of patients with psychiatric morbidity, HbA1c was significantly higher if having committed a theft was reported [10.2% (9.4-11.9) vs. 8.1% (7.2-9.2); p < 0.001]. No significant differences in socioeconomic status, clinical factors, or rates of complications were found. CONCLUSIONS: Theft may be a factor negatively affecting metabolic control in children with T1D and underlying psychiatric co-morbidity. Psychiatric morbidity is more frequent among patients with T1D and a history of theft.