The role of internalizing problems on headache characteristics and pain coping strategies among adolescents diagnosed with episodic migraine.

OBJECTIVES: The aim of this study is to investigate the correlational processes and possible mediation mechanisms between internalizing problems and significant indicators of headache (pain frequency, duration, and intensity) and pain coping strategies among adolescents diagnosed with episodic migraine. METHODS: The study sample included 143 adolescents diagnosed with episodic migraine in compliance with the diagnostic criteria specified in ICHD-3. In collecting data, Sociodemographic Information Form, Headache Questionnaire Form, Pain Coping Questionnaire, Children's Depression Questionnaire, and Screen for Child Anxiety-Related Disorders: Child Form were used. Statistical analyses of the study were carried out using the 'SPSS for Windows Package Program.' RESULTS: The findings of the study indicate that adolescents suffer from a higher headache frequency per month in parallel with higher levels of depression (r=0.28, p<0.05), total anxiety (r=0.19, p<0.05), panic disorder/somatic symptoms (r=0.22, p<0.05), and school avoidance (r=0.21, p<0.05). In addition, the higher the levels of internalizing problems among adolescents are, the more common is the use of coping strategies that give rise to feelings of helplessness in the face of pain (r=0.27, p<0.01). On the other hand, the study findings concerning mediation mechanisms show that the level of depression is a full mediator in correlations between the levels of panic disorders/somatic symptoms and school avoidance and both monthly headache frequency and use of coping strategies that give rise to feelings of helplessness in the face of pain among adolescents. CONCLUSION: The results of the study also offer an insight into the age-related phenotypic variation and chronicity of migraine.

The mediating role of early maladaptive schemas on the relationship between illness perception and pain coping strategies among adolescents diagnosed with migraine.

Objective: This study aimed to examine the mediating role of early maladaptive schemas on the relationship between illness-related perceptions and pain coping strategies among adolescents diagnosed with migraine. Material and methods: A total of 134 adolescents (aged 12-18 years) diagnosed with migraine with and without aura participated in the study. The Illness Perception Questionnaire, the Pain Coping Questionnaire, and the Early Maladaptive Schema Questionnaires Set for Children and Adolescents were used. Results: The intensity of using desperate ways of coping with pain was higher among adolescents who perceive migraine as a chronic disease (ß = 0.199, p < 0.05) even if they have episodic attacks and who have higher levels of coherency in understanding the illness (ß = 0.256, p < 0.01). First, full mediations of over-vigilance/inhibition and impaired autonomy/performance schema domains on these relations were observed. Second, the increases in negative cognitive (ß = 0.199, p < 0.05) and emotional (ß = 0.280, p < 0.01) representations related to the consequences of the illness lead to an increase in the uncontrolled and frequent use of analgesic drugs where the partial mediating role of over-vigilance/inhibition schema domain on this correlation is observed. The perceptions about the negative as well as serious consequences of migraine are related to both the self-active behaviors (ß = 0.181, p < 0.05) and the conscious cognitive attempts (ß = 0.207, p < 0.05) as effective coping strategies, which is an unexpected finding. The disconnection/rejection schema domain had a full mediation role on both relations. Conclusion: The results suggest that early maladaptive schemas are essential factors that affect the migraine coping processes of adolescents.

Corrigendum: The mediating role of early maladaptive schemas on the relationship between illness perception and pain coping strategies among adolescents diagnosed with migraine.

[This corrects the article DOI: 10.3389/fneur.2023.1128965.].

Early maladaptive schemas in episodic and chronic migraine in adolescents.

Introduction: Psychotherapies, such as schema therapy, are receiving increasing attention in the management of pediatric headaches. The purpose of this study was to investigate early maladaptive schemas (EMSs) in adolescents with episodic migraine (EM) and chronic migraine (CM). Methods: This clinic-based, cross-sectional study consisted of 167 adolescents, aged 12-18, who were diagnosed with EM (n = 140) and CM (n = 27). The clinical characteristics of migraine, its accompanying symptoms, EMSs, the interrelationship of EMSs, depression, and anxiety were evaluated. We specifically analyzed psychopathology and abuse history as covariates in this study. Results: Defectiveness/shame, mistrust/abuse, abandonment/instability, enmeshment/undeveloped self, self-sacrifice, and subjugation schemas were more prevalent in the CM group. In terms of schema domains, the CM group scored significantly higher in disconnection/rejection and other orientations. Psychopathology did not affect the EMS scores, but a history of sexual abuse did. In patients with EM, a relationship was found between the variables of anxiety, depression, and five of the EMS domains. On the other hand, the CM group showed a significant relationship with anxiety, hypervigilance/inhibition, disconnection/rejection, and other orientation domains. Discussion: This study highlights the value of EMSs, anxiety, and depression in young people with EM and CM. Schema therapy and schema-based therapeutic interventions should be researched, especially in pediatric migraine, as they may potentially prevent the progression to treatment-resistant migraine.

functional outcome in late adolescence/early adulthood of patients with autism spectrum disorder and its relationships with parental burnout and depression: A preliminary multi-center, cross-sectional study.

The aim of this study is to determine the functioning of adults with autism spectrum disorders (ASDs) diagnosed in childhood and depression and burnout levels among their parents. A total of 261 adults with ASDs and their parents were recruited for the study. Both parents completed the Beck Depression and Maslach Burnout Inventories and reported the functioning of their adult offspring with ASDs. Only 5.4 % of our sample reported "good" or "very good" outcomes. The most common psychiatric comorbidities were intellectual disabilities and attention-deficit/hyperactivity disorder. Maternal burnout and depression scores were significantly elevated compared to those of fathers. There is an undeniable urgent need for more research to identify the needs of adults and families suffering from ASD. Modifications for those with ASD may have to be made for support in workplaces, achieving driving licenses, using public transportation and attendance at tertiary education.

Correlates and predictors of re-incarceration among Turkish adolescent male offenders: A single-center, cross-sectional study.

BACKGROUND: Adolescents involved in the legal system are known to be under elevated risk for repeat offending. There may be many reasons for recidivism. Specifically, we aim to investigate the clinical, socio-demographic, and familial factors and psychopathology among adolescents in a penal institution and to determine risk factors for re-incarceration. METHODS: This single-center cross-sectional survey was conducted at Tarsus Closed Penal Institution for Children and Youth. This institution is for males only, and all male adolescents detained at the center within the study period were evaluated with semi-structured interviews (K-SADS-PL). The adolescents completed Meaning and Purpose of Life Scale, The EPOCH measure of Adolescent Well-being, Family Sense of Belonging Scale, Children's Alexithymia Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory for themselves. Descriptive and inferential analyses were used. P was set at 0.05. RESULTS: Ninety adolescent offenders with a mean age of 16.6 years (S·D = 0.7) were enrolled. Mean age at first offense was 14.6 years (S·D = 2.1). The most common reason for offenses was reported as as being with peers who were offenders, too (57.8%). Most common diagnoses were substance use (36.7%), attention deficit/hyperactivity disorder (33.3%), and conduct disorder (26.7%). Rates of offending and conviction in first-degree relatives were 62.2% and 60.0%, respectively, and most of the adolescents had at least one peer with a criminal record (n = 71, 78.9%). Re-incarcerated adolescents had lower education, committed more violent crimes, and reported elevated use of substances, suicide attempts, and psychopathology. However, in regression analysis, age of onset was the sole predictor of re-incarceration. CONCLUSION: Turkish male adolescents in forensic settings may be screened for externalizing disorders and referred for treatment. Re-incarcerated Turkish youth may be more susceptible to peer influence, substance use and externalizing disorders. It may be prudent to systematically screen offending youth for psychiatric disorders regardless of the individual's request for treatment and refer identified cases to treatment. Integration of child and adolescent psychiatrists with penal institutions serving youth may help in this regard.

Early maladaptive schemas differing according to sex may contribute to migraine among the youth.

OBJECTIVE: Despite many diverse findings from studies about the comorbidity of psychiatric disorders and migraine, there are still unknown points. Schemas, which are the basic structures of cognition, are understudied. This study examined the effects of sex on early maladaptive schemas (EMSs) and the clinical characteristics of migraine in adolescents with migraine. METHODS: The sample comprised 171 adolescents (67.3% females, n = 115) aged 12-18 years. The clinical characteristics of migraine (duration, severity, frequency of headaches, etc.), accompanying symptoms (nausea, vomiting, photophobia, etc.) and EMSs were evaluated depending on sex. Psychopathology and abuse history were analyzed as covariates in this study. RESULTS: The mean age was 15.4 ± 1.9 among the females and 15.2 ± 2.0 among the males (p = 0.65). There was no difference in terms of migraine characteristics, and except for dizziness and pain relief by massage, all other symptoms were similar between the sexes. Female adolescent migraineurs significantly elevated scores for EMS of emotional deprivation, abandonment/instability, defectiveness/shame (disconnection/rejection domain), dependence/incompetence, vulnerability to harm/illness, failure (in impaired autonomy/performance domain) and negativity/pessimism (in hypervigilance/inhibition domain). On the other hand, male migraineurs had significantly elevated scores only in insufficient self-control/self-discipline (in impaired limits domain). Type of migraine and current psychopathology had no significant effect on the EMS domains, while sexual abuse history significantly affected some EMS. CONCLUSION: Our study highlights the importance of screening for EMSs among adolescent patients with migraine. Schema therapy and similar therapeutic interventions may be used in the management of migraine in adolescents. Gender may also be important factor the schema therapy in adolescent migraine patients.

Novel inflammatory targets for immunotherapies in pediatric patients with trichotillomania.

Immune dysregulation may be important in the etiology of obsessive-compulsive and related disordersandbody-focusedrepetitivebehaviors, such as Trichotillomania (TTM). The role of inflammation and inflammatory markers in TTM has received relatively little attention. This study was aimed to determine the expression levels of inflammatory markers (i.e. IL-1ß, IL-1α, IL-4, IL-6, IL-17, TNF-α and TGF-ß) in peripheral blood mononuclear cells of children with TTM and healthy controls and to evaluate their association with clinical variables. Seventy-seven patients with TTM and 107 healthy controls were enrolled in the study. Peripheral blood was collected in standardized conditions. The mean age of patients and controls did not differ significantly (10.8 ± 4.4 and 12.0 ± 3.2 years; respectively). The majority of patients with TTM and controls were females (n = 55, 71.4 % and n = 55, 51.4 %; respectively); with a greater preponderance of females among TTM. Patients with TTM had significantly elevated expression levels of TNF-α, IL-6 and IL-17 compared to controls. However, the expression level of IL-4 was significantly reduced in TTM patients compared to controls. Accordingly, we found a pro-inflammatory state in TTM and those findings may suggest novel treatment options for TTM and further, cross-disciplinary studies focusing on neuro- inflammation in TTM conducted on larger samples are needed.

Oromandibular Dystonia Related to Sertraline Treatment in a Child.

In children, similar to adults, the agents that cause movement disorders are most commonly dopaminergic and antidopaminergic drugs. However, it is also known that selective serotonin reuptake inhibitors (SSRIs), which are frequently prescribed in child psychiatry practice, may rarely lead to tremor, akathisia, dystonia, dyskinesia, and parkinsonism. In this study, we report a rare side effect of SSRIs, namely oromandibular dystonia related to sertraline, in a pediatric patient who was diagnosed with posttraumatic stress disorder.