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Na pitanje mijenja li se psihopatologija kod djece i mladih veliki broj stručnjaka za mentalno zdravlje, roditelja i nastavnika odgovorio bi pozitivno, ali uz različita objašnjenja. Najčešći razlozi, prema brojnim ispitivanjima su: promjena obiteljskih odnosa, sve veći utjecaj okruženja i medija, povećani pritisak i očekivanja od mladih uz izostanak odgovarajuće podrške, kvalitetnija dijagnostika koja omogućuje profesionalcima bolji uvid u etiologiju problema i dr.Ispitivanja usmjerena na prevalenciju pojedinih oblika ponašanja ukazuju na porast kako anksioznih tako i depresivnih poremećaja, ali u odnosu na temeljnu edukaciju procjenitelja naglasak se daje na različite etiološke faktore. Brojna ispitivanja usmjerena prema etiologiji psihotičnih poremećaja ukazuju na različitosti vezane u odnosu na procjenitelje. Analiza postojećih klasifikacija ukazuje na promjene u pristupu. Veliki broj istraživača smatra da DSM ranije nije bio usmjeren na etiologiju, dok se prema prijedlogu DSM 5 mijenjaju kriteriji dijagnosticiranja što se reflektira i na procjene pojedinih dijagnostičkih skupina i terapijskih pristupa. Posebice se naglasak daje na deficit u kognitivnom kapacitetu koji počinje u razvojnom razdoblju, a smatra se da ima bitni utjecaj na razvoj mentalnih poremećaja. Promjena kliničke slike temeljem brojnih istraživanja ukazuju na nove spoznaje etiologije, posebice vezane uz funkcioniranje SŽS-a i povezanosti bioloških i psiholoških čimbenika, ali i promijenjenom dinamikom u obiteljskim odnosima te načinima školovanja što sve zahtijeva multidisciplinski pristup u dijagnostičkim procesima kao i daljnja istraživanja te povezanost kliničara i istraživača.

Association between the polymorphisms of the selected genes encoding dopaminergic system with ADHD and autism Attention-deficit hyperactivity disorder (ADHD) and autism are heritable, polygenic neurodevelopmental disorders with similar symptoms, onset in childhood, and more frequent occurrence in boys than in girls (Muhle et al., 2004;Wallis, 2010).The study evaluated the association of ADHD and/or autism with dopamine receptor D4 exon 3 variable number of tandem repeats (DRD4 VNTR) polymorphism, catechol-o-methyltransferase (COMT Val108/158Met; rs4680), dopamine-beta-hydroxylase (DBH -1021C/T; rs1611115) and monoamine oxidase type B (MAO-B intron 13; rs1799836) polymorphisms in ethnically homogenous non-related Caucasian male subjects of European (Croatian) ancestry: 102 medication-free children (9.2 72.5 years old) who met DSM-IV criteria for ADHD, 80 subjects (18.2 710.3 years old) who met DSM-IV criteria for autism, and had 43.27 8.9 Childhood Autism Rating Scale scores, and 128 healthy control subjects (16.9 79.0 years old). Genotyping of DRD4 VNTR was done using polymerase chain reaction and 2% agarose gel electrophoresis, and individuals were categorized into DRD4 long (L) allele carriers (possessing at least one copy of 7 or more repeats allele) and short (SS) homozygotes (possessing 2 copies of 2-6 repeats allele).Genotyping of rs4680, rs1611115 and rs1799836 was done using a Taqman-based allele-specific polymerase chain reaction assays (Applied Biosystems, Foster City, CA). Subjects were categorized into COMT Met/Met homozygous genotype vs. Val carriers, DBH CC genotype vs. T carriers, and MAO-B A or G carriers. Results (Table 1) were evaluated with two tailed χ 2 test, standardized residuals (RZ 2.00), odds ratio (OR), 95% CI, z and Cramer's C or V statistics. Pr 0.0125 was considered significant after Bonferroni correction for multiple comparisons.Genotype frequencies in DRD4 VNTR in autism and healthy controls, and in the DBH -1021C/T in ADHD (Po 0.05) deviated from Hardy-Weinberg equilibrium (HWE), while other genotype frequencies were in the expected HWE (P>0.05). DRD4 L allele carriers in ADHD and autistic groups and COMT Met/Met genotype in healthy subjects contributed to the significant χ 2 statistics.There were less DRD4 L allele carriers than SS genotype carriers in autistic subjects compared to ADHD (z ¼3.324; P ¼0.001; OR¼2.4; 95% CI¼1.022-5.548) or control groups, confirming the role of L allele in attention, and supporting the hypothesis (Grady et al., 2005) Table 1 The frequencies of the DBH -1021C/T, MAO-B intron 13, DRD4 VNTR and COMT Val108/158Met genotypes and the additive genetic effects of DRD4 and COMT risk genotypes in healthy control subjects and in subjects with ADHD or autism. Healthy subjectsSubjects with ADHD Subjects with autism R¼ standardized residuals (RZ 2.00 indicated that these genotypes contributed to significant differences in χ 2 test); Φc¼ effect size calculated using Cramer's C or V statistics.Due to Bonferroni correction, Pr 0.0125 was considered significant.

Disocijativni poremećaji mogu se definirati kao raskol u obično cjelovitim funkcijama svijesti, pamćenju, identitetu i opažanju, dakle disocijativni poremećaj karakterizira prekid normalne integracije svijesti. Kada se govori o djeci i adolescentima, najčešći su konverzivni poremećaji kao i poremećaji identiteta koji uključuju značajan diskontinuitet doživljaja selfa uz promjene afekta i ponašanja što se najčešće opaža kao poremećaj pamćenja, koncentracije i privrženosti, što dovodi do značajnog oštećenja u socijalnom, radnom i drugim važnim područjima funkcioniranja. Uzroci se nalaze u traumatskim događajima zlostavljanja, ali i brojnim drugim traumatskim iskustvima, kao što su hospitalizacije, preseljenja, gubitak važnih osoba i sl. Neurobiološka istraživanja traumatizirane djece pokazuju abnormalnosti (funkcijske i strukturne) u razvoju limbičkog sustava, kao i kortikalne promjene. Van der Kolk u svojim istraživanjima navodi da povećana razina emocionalne pobuđenosti dovodi do promjena u hipokampusu koji je odgovoran za neadekvatno evaluiranje senzornih informacija. Važno je naglasiti da djeca normalno pokazuje fantaziju i maštanje u ponašanju što je teškoća u dijagnostičkom procesu u odnosu na patološku disocijaciju. Poseban su problem diferencijalna dijagnoza, kao i komorbidne bolesti. / Dissociative disorders can be defined as disruptions in the usually complete functions of consciousness, memory, identity and perception, therefore characterized by the disruption of normal consciousness integration. When talking about children and adolescents, the most common are conversion disorders as well as identity disorders, which include a significant discontinuity of self-experience with changes in affect and behaviour, most commonly observed as memory disorder, concentration and attachment disorder, leading to significant impairment in social, work and other important areas of functioning. Causes are found in traumatic events of abuse, but also in many other traumatic experiences, such as hospitalization, relocation, loss of important persons, etc. Neurobiological studies of traumatized children show abnormalities (functional and structural) in the development of the lymphatic system as well as cortical changes. In his research, Van der Kolk states that an increased level of emotional upheaval leads to changes in the hippocampus responsible for inadequate evaluation of sensory information. It is important to emphasize that children normally exhibit fantasy and imagination in behaviour, which presents difficulties in the diagnostic process in relation to pathological dissociation. A special problem is differential diagnosis, as well as comorbid diseases.

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