Psychopathology, quality of life, and related factors in pediatric liver transplantation candidates and recipients.

BACKGROUND: Liver transplantation (LT) has been accepted as a standard treatment of pediatric liver diseases that can progress to end-stage liver disease or lead to acute liver failure. However, there is a lack of studies clarifying quality of life (QoL) and the characteristics and the prevalence of common psychiatric disorders in children before and/or after LT. Thus, this study aimed to investigate QoL and the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in children and adolescents before and after LT and to compare them with healthy controls. METHODS: The study included 30 children aged 5-18 years who were waiting for LT (pTx group) or had undergone LT (Tx group) as the study groups and 20 children for the control group. The PedsQL was used to evaluate QoL, and SCARED, CDI, and the CPTSD-RI were used to evaluate psychopathology. RESULTS: The QoL scores were higher in the control group compared with the study groups in all or most of the dimensions, depending on the reporter. The mean scores of anxiety, depression, and PTSD of the control group were significantly lower than those of the Tx and pTx groups. A significant positive correlation was found between depression, anxiety, and PTSD scores, and a negative correlation was observed between depression, anxiety, and PTSD scores and QoL. CONCLUSION: Waiting for LT and the transplantation process itself seem to be psychologically traumatic for children. Healthcare providers need to be trained to recognize the symptoms of the main psychiatric disorders.

Can gestation be considered as trauma in adolescent girls: post-traumatic stress disorder in teen pregnancy.

Although post-traumatic stress disorder (PTSD) in adolescent pregnancy has been reported at high rates in the limited research in this area, no studies have evaluated gestation as trauma in teens. This study, aimed to evaluate PTSD in this high risk group. All pregnant adolescents who presented to our obstetrics and gynaecology clinics in a one-year period were invited to participate in the study. Adolescents with a history of domestic or dating violence, rape, and sexual abuse were excluded. PTSD was rated using the Child Post-Traumatic Stress Disorder-Reaction Index. When the pregnant adolescents and control group were compared, various severities of PTSD were observed in nearly two-thirds of the study group. Although there was clinically significant PTSD among 23.3% of the controls, PTSD was more frequently seen in adolescents with pregnancy compared with their healthy peers. Educating adolescents about birth control methods and preventing child marriages will be protective in this respect.Impact statementWhat is already known on this subject? Teen pregnancy has significant psychosocial and economic impacts for adolescents, their offspring, and the community in terms of education and employment, increased risk of abuse and neglect, and the physical and emotional well-being of the offspring. Pregnancy and birth-related risks are also higher than in adults. In this context, pregnancy itself may be accepted as trauma for adolescents.What do the results of this study add? There has been limited research on PTSD in pregnant teens and is mainly associated with traumatic childhood events. This is the first study to examine pregnancy-related PTSD and related conditions in this group.What are the implications of these findings for clinical practice and/or further research? The prevalence of pregnancy related-PTSD in pregnant teens can be considered high and alarming, considering the fact that most of them had never been treated for it at all. Healthcare providers serving this population need to be trained to recognise the core symptoms of PTSD, and should direct adolescents for professional assistance if needed. Strategies such as higher quality sexual health education and greater access to reproductive health services to reduce adolescent pregnancy and marriage are also imperative.

Psychopathology, health-related quality-of-life and parental attitudes in pediatric asthma.

Objective: Considering that unknown psychopathology might play a role in the management of pediatric asthma, this study examines how self-esteem and psychosocial family environment (child-raising attitudes and parental coping strategies) influence the physical and psychosocial well-being of these children. Hence, this paper aims to predict psychosocial factors influencing health-related quality-of-life (HRQL) in children with asthma without a documented history of mental illness. Methods: 32 patients with asthma and 32 controls aged 8-18 years were included in the study. All participants were largely middle-income, Caucasian school-aged children. The child-raising attitudes examined were: dependency, egalitarianism/democratic attitude, rejection of the homemaking role, marital conflict, and strictness/authoritarianism. The parental coping strategies were; social support seeking, problem-solving attitude and avoidance. Results: Psychiatric comorbidity was present in 72% of asthma patients and 22% of the controls. The most common mental illness identified was generalized anxiety disorder; 32% vs 13%, respectively. Dependency was the only parental child-raising attitude that differed significantly between groups (47 ± 8 vs 41 ± 11, respectively. p = 0.035). There was a negative correlation between the PARI dependency subscale and the total HRQL score according to the parents (rp= -0.39, p = 0.027). The most influential factors connected with the total HRQL score in asthma were Rosenberg self-esteem scale score, presence of psychopathology and dependency according to the child. Conclusions: Simple ways to overcome emotional dependency and fortify self-esteem (exercises promoting self-awareness, opportunities cultivating decision-making, and a considerable freedom-of-choice to experience consequences) worth recommending to parents of children with asthma. Patients with suspected mental illness must be referred for psychiatric evaluations.

Post-traumatic stress disorder and health-related quality of life in the siblings of the pediatric bone marrow transplantation survivors and post-traumatic stress disorder in their mothers.

Although BMT is lifesaving in many childhood diseases, it was found to be related to anxiety, depression, and PTSD in parents, and PTSD, anxiety and overall low self-esteem in siblings. Research on siblings' HRQoL is limited. The aim of this study was to investigate PTSD and HRQoL in siblings (donor and non-donor) of pediatric BMT survivors and PTSD in their mothers, compared to the healthy controls. Thirty-five siblings and their mothers and 35 healthy peers and their mothers were recruited as the study group and as the comparison group, respectively. In children, Child PTSD-Reaction Index for PTSD and PedsQL for HRQoL were used. PTSD Checklist-Civilian Version was used for PTSD in mothers. The study group, both children and mothers, obtained significantly higher PTSD rates than the control group. Children in the study group also reported significantly poorer HRQoL than the control group in all scales. As a novel finding, there was a significant negative correlation between siblings' and mothers' PTSD scores and siblings' PedsQL scores, indicating that PTSD symptoms in siblings and mothers significantly led to impairment in siblings' HRQoL or vice versa. Thus, the identification and treatment of siblings and mothers with PTSD seems imperative.

Psychopathology in pediatric bone marrow transplantation survivors and their mothers.

BACKGROUND: Bone marrow transplantation (BMT) is used to treat various hematologic, oncologic and metabolic diseases. While the treatment is lifesaving, it is also associated with anxiety, post-traumatic stress disorder, depression and psychosocial problems both in children and parents. METHODS: The aim of this study was to investigate the psychopathology in pediatric BMT survivors and their mothers compared with healthy controls. All children were interviewed using Kiddie Schedule for Affective Disorders and Schizophrenia to assess lifelong psychopathology. For the mothers, the Symptom Checklist-90-Revised (SCL-90-R) was used. RESULTS: In the BMT group, 17 children (63%) had at least one psychiatric disorder, while 15 (53.6%) did in the control group. Although lifelong prevalence of psychopathology in the BMT group did not differ significantly from the control group generally, anxiety disorders were significantly higher in the BMT group. When the SCL-90-R scores of the mothers were compared, Anxiety, Obsessive-Compulsive, Interpersonal Sensitivity and Phobic Anxiety were significantly higher in the mothers in the BMT group, indicating more difficulty in these areas. CONCLUSIONS: Bone marrow transplantation is a significant stressor, especially for mothers. Clinicians should address the child and family as a whole in assessments and be aware of psychiatric symptoms in mothers and children who have had such a life-threatening condition.

Living with the unknown: Posttraumatic stress disorder in pediatric bone marrow transplantation survivors and their mothers.

Bone marrow transplantation (BMT) is used to treat children with various hematologic, oncologic, and metabolic diseases. Although the treatment can be lifesaving, it is also physically and psychologically demanding for both the child and caregivers. In previous studies, BMT is found to be related with anxiety, posttraumatic stress disorder (PTSD), depression, and psychosocial problems both in children and parents. The aim of this study was to investigate PTSD in pediatric BMT survivors and their mothers compared with the healthy controls. Twenty-seven BMT survivors and their mothers and 28 healthy peers and their mothers were recruited as the study group and as the comparison group, respectively. All children were interviewed using Child Posttraumatic Stress Disorder-Reaction Index (CPTSD-RI) for assessing posttraumatic stress responses. As for mothers, Clinician-Administered PTSD Scale (CAPS) was used. In healthy children and mothers, instead of BMT, the most important traumatic event reported by them was included. All data were analyzed by a neutral statistician from the Department of Biostatistics of the university. The BMT group, both children and mothers, obtained significantly higher PTSD rates than the control group (66.5% and 17.8%, respectively, in children; 57.6% and 7%, respectively, in mothers). However, there was a weak correlation between survivors' and mothers' posttraumatic stress responses. These findings suggest that BMT is a significant stressor for both children and mothers. Clinicians should be aware of psychiatric symptoms of children who underwent such a life-threatening condition. Combination of medical treatment with psychosocial support is imperative.

Attachment styles and psychopathology among adolescent children of parents with bipolar disorder.

BACKGROUND: The aim of this study was to compare attachment styles and psychopathology in adolescent children of parents with bipolar disorder (BD) with a healthy control group. MATERIAL AND METHODS: We studied 25 adolescents who had at least 1 parent with BD (BD group) and 28 adolescents who had no parents with BD (control group). The adolescent participants were between the ages of 12 and 17 years. We used the Adolescent Relationship Scales Questionnaire (A-RSQ) for the adolescents in the BD vs. control groups, and we used the Schedule for Affective Disorders and Schizophrenia for School-age Children - present and lifetime version (K-SADS-PL). We used the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinician Version for each parent of adolescents in the BD and control groups to rule out psychopathologies. RESULTS: Attachment styles of participants were assessed according to A-RSQ, dismissing attachment style scores of adolescents in BD group were found significantly higher compared to the healthy control group (p<0.05). As a result of the assessments, 12 adolescents (48%) out of 25 in the BD group and 5 adolescents (18%) out of 28 in the control group were given DSM-IV Axis I diagnosis, which is a statistically significant result (p<0.05). However, when psychiatric diagnoses were assessed separately, the difference was not statistically significant. CONCLUSIONS: We found that the adolescent children of parents with BD have increased risk of developing mental illnesses, and that these adolescents adopt dismissing attachment styles.

Patients with disorders of sex development undergoing surgical treatment: A psychosocial evaluation in adolescence.

The surgical outcomes of disorders on sex development (DSD) are comparatively well studied in the literature, whereas studies investigating its impacts on mental health are scarce. In this study, we aimed to evaluate psychiatric diagnoses, sex roles, quality of life, and adolescents who were surgically treated because of DSD as well as parental attitudes in their parents. The study group consisted of 19 patients diagnosed with DSD and the control group consisted of 20 age- and gender-matched healthy peers. The Kiddie-Schedule for Affective Disorders and Schizophrenia was performed by a child and adolescent psychiatrist to assess the psychiatric diagnoses. To evaluate quality of life (QoL) and sex roles, The Pediatric Quality of Life Inventory (PedsQL), and the Bem Sex Role Inventory were used, respectively. Mothers completed the PedsQL-Parent Form and the Parental Attitude Research Instrument (PARI). Of 19 children in the patient group, 14 (73.7%) had a past or current history of at least one psychiatric disorder. The most common psychiatric disorder was major depression. There was no significant difference between the two groups in terms of sex roles. A statistically significant difference was found between the study and control groups in four factor scores of the PARI. While there was no significant difference between the groups in terms of the children's QoL scores, parent-proxy reports of psychosocial health scores and total QoL scores of the study group were significantly lower than the controls. This finding shows that parents perceived the QoL of their children with DSD as worse than their healthy peers, probably due to their concerns for the future. In conclusion, it is important to identify and treat the psychiatric disorders concomitant in patients with DSD.

Increased Hyperacusis with Risperidone in an Autistic Child.

Autistic spectrum disorder is a neurodevelopmental disorder characterized by qualitative impairment in social interactions and communication skills. In addition to these core features, sensory processing abnormalities such as auditory hypersensitivity have been frequently reported. Although the cause of auditory hypersensitivity remains unknown, it is thought to be associated with decreased inhibitory processing, possibly resulting from an abnormal sensory gating system or dysfunction of inhibitory interneurons. Its relation to drugs has not been well documented to date. In the literature, there is only one case on hyperacusis that worsened with risperidone in a 5-year-old girl with autism. Here we represent the case of an 11-year-old boy with autism, in whom hyperacusis worsened with risperidone, decreased after the discontinuation of the medication, and re-occurred after the prescription of the drug again. Although auditory hypersensitivity tends to affect the child's daily life negatively and is found to be correlated with behavioral problems in autistic patients, we still know very little about its etiology, treatment, and conditions related to it. There is a great need for conducting further studies in this regard.