Neural correlates of distorted body images in adolescent girls with anorexia nervosa: How is it different from major depressive disorder?

Body image disturbance is closely linked to eating disorders including anorexia nervosa (AN). Distorted body image perception, dissatisfaction and preoccupation with weight and shape are often key factors in the development and maintenance of these disorders. Although the pathophysiological mechanism of body image disorder is not yet fully understood, aberrant biological processes may interfere with perceptive, cognitive and emotional aspects of body image. This study focuses on the neurobiological aspects of body image disturbance. The sample consisted of 12 adolescent girls diagnosed with AN, nine girls with major depressive disorder (MDD) and 10 without psychiatric diagnoses (HC, the healthy control group). We applied a block-design task in functional magnetic resonance imaging using participants' original and distorted overweight and underweight images. After imaging, the participants scored the images for resemblance, satisfaction and anxiety levels. The findings of this study demonstrate that overweight images elicited dissatisfaction and increased occipitotemporal activations across all participants. However, no difference was found between the groups. Furthermore, the MDD and HC groups showed increased activations in the prefrontal cortex and insula in response to underweight images compared to their original counterparts, whereas the AN group exhibited increased activations in the parietal cortex, cingulate gyrus and parahippocampal cortex in response to the same stimuli.

Child and adolescent psychiatry training and services in the Middle East region: a current status assessment.

Mental health is a key component of health, yet appropriate care is limited. Evidence concerning child and adolescent mental health has predominantly come from western countries, while the Middle East region, with a large youth population, has reported very little on it. This original, cross-sectional study of child and adolescent psychiatry in the Middle East provides an assessment of current postgraduate programs, services and what is needed to build workforce capacity. Academic psychiatrists from 16 Middle East countries were invited to form a Consortium to map current postgraduate training as one of the determinants of available child and adolescent psychiatry services, identify gaps in the distribution of child and adolescent psychiatrists, and propose potential steps to improve access to child and adolescent mental health care. The study collected data from 15 of the 16 countries invited (no data provided from Yemen). The study revealed underdeveloped child and adolescent psychiatry academic systems throughout the region. Despite recognition of the specialty in a majority of the countries (11/15), only six countries had established a designated child and adolescent psychiatry training program. The overall shortage of child and adolescent mental health specialists varied, yet all Consortium members reported a need for additional child and adolescent psychiatry specialists and allied professionals. Lack of child and adolescent psychiatry specialized programs in place throughout the region has evidently contributed to the shortage of qualified child and adolescent mental health workforce in the Middle East.

[Reliability and Validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T)]. / Okul Çagi Çocuklari için Duygulanim Bozukluklari ve Sizofreni Görüsme Çizelgesi–Simdi ve Yasam Boyu Sekli–DSM–5 Kasim 2016 –Türkçe Uyarlamasinin (ÇDSG–SY–DSM–5–T) Geçerlik ve Güvenirligi.

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the Schedule for Affective Disorders and Schizophrenia for School-Age ChildrenPresent and Lifetime Version, DSM-5 November 2016 -Turkish Adaptation (K-SADS-PL-DSM-5-T).  METHOD: A total of 150 children and adolescents between 6 and 17 years of age were assessed with K-SADS-PL-DSM-5-T. The degree of agreement between the DSM-5 criteria diagnoses and the K-SADS-PL-DSM-5-T diagnoses were considered as the measure of consensus validity. In addition, concurrent validity was examined by analyzing the correlation between the diagnoses on K-SADS-PL-DSM-5-T and relevant scales. Interrater reliabilities were assessed on randomly selected 20 participants. Likewise, randomly selected 20 other participants were interviewed with K-SADS-PL-DSM-5-T three weeks after the first interview to evaluate test-retest reliability.  RESULTS: The consistency of diagnoses was almost perfect for eating disorders, selective mutism and autism spectrum disorder (κ=0.92-1.0), substantial for elimination disorders, obsessive-compulsive disorder, oppositional defiant disorder, generalized anxiety disorder, social anxiety disorder, depressive disorders, disruptive mood dysregulation disorder and attention deficit hyperactivity disorder (κ=0.67-0.80). Interrater reliability was perfect for selective mutism (κ=1.0), substantial for oppositional defiant disorder, disruptive mood dysregulation disorder, attention deficit hyperactivity disorder, depressive disorders and social anxiety disorder (κ=0.63-0.73). Test-retest reliability was almost perfect for autism spectrum disorder (κ=0.82), substantial for attention deficit hyperactivity disorder, oppositional defiant disorder, disruptive mood dysregulation disorder, depressive disorders and generalized anxiety disorder (κ=0.62-0.78).  CONCLUSION: The results of this study show that the K-SADS-PL-DSM-5-T is an effective instrument for diagnosing major childhood psychiatric disorders including selective mutism, disruptive mood dysregulation disorder and autism spectrum disorder which have recently been added to the schedule.

Refugees in Europe: national overviews from key countries with a special focus on child and adolescent mental health.

Many European countries are becoming multicultural at a previously unseen rate. The number of immigrants including refugees has considerably increased since 2008, and especially after the beginning of the war in Syria. In 2015, 88,300 unaccompanied minors sought asylum in the Member States of the European Union (EU) and most came from Syria, Afghanistan, Iran, Iraq, Somalia and Eritrea. As a reaction to increased immigration, governments in many countries including Germany, Sweden and Norway implemented more restrictive immigration policy. A requirement for all countries, however, is the protection and welfare provision for all arriving children, regardless of their nationality, ensured by international and national legal frameworks. This paper provides an overview of the post 2015 immigration crisis in key European countries with a special focus on current demographics, refugee children, mental health studies, policies and practical support available for refugees.

Tumor necrosis factor alpha-308 gene polymorphism in patients with anorexia nervosa.

Tumor necrosis factor alpha (TNF-alpha) is a principal cytokine that may induce weight loss. TNF-alpha -308 G to A polymorphism increases transcription of TNF-alpha in vitro. The aim of this study was to investigate whether TNF-alpha gene promoter polymorphism at position -308 (G to A substitution) is one of the factors playing a role in the development of anorexia nervosa (AN). Sixteen patients with AN, aged 11-20 years, were included in this study, and 5/16 (31%) patients had TNF-alpha -308 G/A genotype. In the control group, 12/174 (7%) had -308 G/A genotype. There was a significant statistical difference between the patient and control groups (p=0.007). The minimum body mass index (BMI) values ever recorded for each patient during the course of the disease were significantly higher in the five patients with TNF-alpha -308 G to A polymorphism (p= 0.003). TNF-alpha gene promoter polymorphism at position -308 might be associated with a predisposition to AN and initiate the disease. The protective mechanisms that affect clinical manifestation of the disease may be related with other anti-inflammatory cytokines or immunologic mechanisms.