Bodily sensations and quality of life in adolescents with non-cardiac chest pain: a comparative study for the undetermined part of a frequent health problem.

BACKGROUND: Chest pain in adolescents represents a considerable burden for health services and is rarely associated with cardiac disease. Since chest pain could be related to psychosocial factors there is a need for exploring the relationships among stressful situations, drug consumption, suicidal behaviors, accompanying bodily symptoms and health-related quality of life in adolescents with non-cardiac chest pain. METHODS: In this study, we assessed these determinants in 108 adolescents with non-cardiac chest pain (NCCP) and a control group of 77 patients using a structured interview applied to the patients presented to the cardiology outpatient clinics of Tepecik Training and Research Hospital, Izmir, Türkiye, between 30 October 2018 and 30 June 2019. After the interview, the adolescents were given a self-administered pediatric quality of life inventory and the body sensations questionnaire for assessing aspects of fear. RESULTS: Adolescents with NCCP expressed more panic associated bodily symptoms and reported worse subjective physical, academic, and emotional functioning in addition to more suicidal ideation. CONCLUSIONS: NCCP could be accepted as a warning sign of an underlying psychosocial problem and requires a more interdisciplinary collaborative care by pediatricians, psychologists, and psychiatrists.

Adolescents with unexplained chest pain reported depression and impaired emotional and social functioning.

AIM: Chest pain is common in adolescence, but there are no established criteria for managing this problem, which is rarely associated with cardiac disease. This study addressed the gaps in the literature by evaluating psychosocial factors that could be associated with medically unexplained chest pain. METHODS: We consecutively selected 100 patients (68% girls) aged 13-18 who were diagnosed with unexplained chest pain when they presented to the cardiology outpatient clinics of Tepecik Research Hospital, Izmir, Turkey, between 30 September 2015 and 30 June 2018. The controls were 76 age- and sex-matched adolescents (69% girls) aged 13-18 who were undergoing routine cardiology assessments before joining sports clubs. We assessed their health-related quality of life and any depression and physical symptoms. RESULTS: Regression analysis showed some adolescents were a number of times more likely to report chest pain. These included those who reported boredom (4.1 times), felt stressed or anxious (2.2) and those who experienced sleep disturbance (2.6), co-morbid headaches (2.0), back pain (3.1) and impaired social functioning (1.2). CONCLUSION: The results indicated a significant association between unexplained chest pain and physical symptoms, depression and impaired emotional and social functioning. These factors warrant further evaluation.

The relationships between attachment quality, metacognition, and somatization in adolescents: The mediator role of metacognition.

PROBLEM: To investigate the associations between attachment quality, metacognition problems, and somatization. METHODS: One thousand and seven adolescents between the ages of 14-17 were included in the study. They completed the DSM-V Level 2 Somatic Symptoms Scale, the Inventory of Parent and Peer Attachment (short version), the Metacognitions Questionnaire for Children (MCQ-C), and the Strengths and Difficulties Questionnaire. The Spearmen's rank-order correlation test and structural equation modeling were used to analyze the associations between the scales. FINDINGS: Correlation coefficients and structural equation modeling indicated that attachment quality is significantly associated with somatic symptom severity, and MCQ-C scores play a partial mediator role in the relationship between attachment quality and somatization. CONCLUSION: Improving metacognitive skills in adolescents with low attachment quality may increase therapeutic success when addressing somatization.

The relationships between nomophobia, alexithymia and metacognitive problems in an adolescent population.

Yavuz M, Altan B, Bayrak B, Gündüz M, Bolat N. The relationships between nomophobia, alexithymia and metacognitive problems in an adolescent population. Turk J Pediatr 2019; 61: 345-351. Nomophobia refers to an intense anxiety and stress caused by being out of contact with mobile phones (MPs). It is known that excessive engagement with MPs decreases adolescents` psychological well-being, social and academic functioning. The aim of this study was to investigate the associations of nomophobia with alexithymia which is characterized by difficulties in describing and expressing emotions and using empathy, and with the metacognition characteristics which have the function of controlling the cognitions in an adolescent population. The study was conducted on 1817 participants (n = 972, 54% female, n = 835, 46% male). The Nomophobia Questionnaire (NMP-Q), The Twenty-Item Toronto Alexithymia Scale (TAS-20) and The Metacognition Questionnaire for Children and Adolescents (MCQ-C) were administered to participants. A question form for socio-demographic data was also administered to participants and their families. Cathegorical variables were analyzed by chi-square test, and numerical variables were analyzed by independent sample t test. The relationships between the scales` scores were analyzed by the Pearson-product moments correlation test. The predictive effects of alexithymia, metacognition problems and gender were assessed by multiple linear regression analysis. Nomophobia, alexithymia and metacognition problem levels were significantly higher in females than males. There was a significant correlation between NMP-Q and TAS-20 scores and MCQ-C scores. TAS-20, MCQ-C scores and gender significantly predicted the nomophobia when NMP-Q score was a dependent variable. Therapeutic interventions for improving social skills like emphatic thinking and/or increasing emotional expression may be beneficial in the treatment of adolescents with alexithymic traits which experience nomophobia. Moreover, interventions that enhance metacognitive skills which can control negative thoughts triggered by the possibility of losing contact with MPs may increase treatment success.

Oppositional defiant disorder/conduct disorder co-occurrence increases the risk of Internet addiction in adolescents with attention-deficit hyperactivity disorder.

Objectives The aims of this cross-sectional study were to assess the prevalence of Internet addiction (IA) in a clinical sample of adolescents with attention-deficit hyperactivity disorder (ADHD) and to detect the moderating effects of co-occurring oppositional defiant disorder/conduct disorder (ODD/CD) on the association between ADHD and IA. Methods The study group comprised 119 adolescent subjects who were consecutively referred to our outpatient clinic with a diagnosis of ADHD. The Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was completed by parents, and subjects were asked to complete the Internet Addiction Scale (IAS). Results The IAS results indicated that 63.9% of the participants (n = 76) fell into the IA group. Degree of IA was correlated with hyperactivity/impulsivity symptoms but not with inattention symptoms. As compared to the ADHD-only group (without comorbid ODD/CD), ADHD + ODD/CD subjects returned significantly higher scores on the IAS. Conclusions As adolescents with ADHD are at high risk of developing IA, early IA detection and intervention is of great importance for this group. In addition, adolescents with ADHD + ODD/CD may be more vulnerable to IA than those in the ADHD-only group and may need to be more carefully assessed for IA.

The relationships between problematic internet use, alexithymia levels and attachment characteristics in a sample of adolescents in a high school, Turkey.

The aim of this study is to investigate the relationships between attachment characteristics, alexithymia and problematic internet use (PIU) in adolescents. The study was performed on 444 high school students (66% female and 34% male). Internet Addiction Test (IAT), Toronto Alexithymia Scale (TAS-20) and Short Form of the Inventory of Parent and Peer Attachment (s-IPPA) scales were used. The adolescents who scored ≥50 on IAT were considered as the PIU group and <50 were considered as control group. There was a moderate positive relationship between TAS-20 and IAT scores (r = .441), and a moderate negative relationship between TAS-20 and s-IPPA scores (r = -.392), and a negative weak relationship between IAT and s-IPPA scores (r = -.208). S-IPPA scores were significantly lower in the PIU group compared to the controls (p < .001). TAS-20 scores of the PIU group were significantly higher compared to the controls (p < .05). Logistic regression analysis indicated that s-IPPA scores and TAS-20 significantly predict the PIU development (p < .05). The results indicate that alexithymia increases the risk of PIU and higher attachment quality is a protective factor for both alexithymia and PIU. These results suggest that it is important to focus on the insecure attachment patterns and alexithymic characteristics when studying adolescents with PIU.

Factitious Disorder Presenting with Stuttering in Two Adolescents: The Importance of Psychoeducation.

A factitious disorder (FD) is a diagnostic entity in which patients intentionally act physically or mentally ill without obvious benefits and without being consciously aware of a clear underlying motive. Most pediatric FD cases have been reported as Munchausen syndrome by Proxy; however, pediatric disease symptoms can also be intentionally falsified by child and adolescent patients. To our knowledge, in the medical literature, an FD patient presenting with stuttering has not been previously reported. In this case report, we aimed to discuss the diagnosis and treatment process of FDs in children and adolescents by reporting the cases of two FD patients presenting with stuttering according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition. Both patients improved with psychoeducation and early confrontation.

Anxiety, depression, suicidal ideation, and stressful life events in non-cardiac adolescent chest pain: a comparative study about the hidden part of the iceberg.

Chest pain in adolescents is rarely associated with cardiac disease. Adolescents with medically unexplained chest pain usually have high levels of anxiety and depression. Psychological stress may trigger non-cardiac chest pain. This study evaluated risk factors that particularly characterise adolescence, such as major stressful events, in a clinical population. The present study was conducted on 100 adolescents with non-cardiac chest pain and 76 control subjects. Stressful life events were assessed by interviewing patients using a 36-item checklist, along with the Children's Depression Inventory and Spielberger's State-Trait Anxiety Inventory for children, in both groups. Certain stressful life events, suicidal thoughts, depression, and anxiety were more commonly observed in adolescents with non-cardiac chest pain compared with the control group. Moreover, binary logistic regression analysis showed that trouble with bullies, school-related problems, and depression may trigger non-cardiac chest pain in adolescents. Non-cardiac chest pain on the surface may point to the underlying psychosocial health problems such as depression, suicidal ideas, or important life events such as academic difficulties or trouble with bullies. The need for a psychosocial evaluation that includes assessment of negative life events and a better management have been discussed in light of the results.

Maternal and paternal personality profiles of adolescent suicide attempters.

Personality features have been correlated with suicidal behaviors in recent decades. Given its neurobiological background, Cloninger's model of personality, the Temperament and Character Inventory (TCI), may help to identify the maternal and paternal personality dimensions associated with adolescent suicide attempts. The present study is the first that specifically compares the temperament and character profiles of both mothers and fathers of the adolescent suicide attempters with a control group, by considering the influence of demographic and clinical factors. The study group comprised 117 parents of 71 adolescent suicide attempters and 119 parents of 71 age- and gender-matched adolescents without a suicide attempt included as a control group. The TCI and Brief Symptom Inventory (BSI) were applied to the parents in both groups. Logistic regression analysis, which was performed to adjust confounding factors, demonstrated significantly higher scores for harm avoidance among the mothers and lower scores of self-directedness among the fathers of the adolescent suicide attempters. New psychotherapeutic modalities considering the high-risk parental personality traits would be beneficial to support parent-adolescent relationships and may have a preventative effect on adolescent suicide.

Internet addiction, sleep and health-related life quality among obese individuals: a comparison study of the growing problems in adolescent health.

BACKGROUND: The rapid rise in the global prevalence of obesity suggests that environmental factors may be responsible. The increased use of technology is associated with increased rates of obesity due to declines in physical activity and significant sedentary life style. Internet addiction is also a growing health issue associated with diminished physical activity and poor sleep quality as well as various health problems. The purpose of this study was to determine associations between Internet addiction and adolescent obesity-related problems. DESIGN AND METHODS: In this case-control study, 71 adolescents with obesity were recruited from the outpatient clinic at Tepecik Teaching Hospital and Katip Celebi University Hospital, Department of Pediatric Endocrinology in Izmir, Turkey. The control group consisted of 64 non-obese adolescents that were matched with patients in the study group by age and gender. All subjects completed socio-demographic forms, an Internet addiction scale, the Pediatric Quality of Life Inventory, the Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale. RESULTS: Adolescents with obesity were significantly more likely to have Internet addiction (p = 0.002), lower quality of life (p < 0.001), and higher daytime sleepiness (p = 0.008). Moreover, binary regression analysis showed that Internet addiction and less physical activity were associated with increased odds of obesity. CONCLUSION: The results indicated a significant association between Internet addiction and obesity. Health practitioners should take possible Internet addiction, online activities, and physical activities into consideration in follow-up of obese adolescents. In addition to pharmacologic therapies and dietary interventions, providing behavioral therapy targeting healthy Internet use may be promising to reduce the effects of obesity in adolescence.

Parental attitude, depression, anxiety in mothers, family functioning and breath-holding spells: A case control study.

AIM: This study aimed to identify differences in the antenatal stressful life events, parenting style, family functioning, depression and anxiety of mothers who have children with breath-holding spells (BHS) compared with controls. METHODS: This case control study divided 66 children into a group of children with BHS and a control group, with the children's ages ranging between 6 months and 5 years of age. This study explored underlying anxiety and depression in mothers as well as functioning of their families. Socio-demographical data and stressful life events that the mother experienced during pregnancy were analysed. In order to evaluate the effects of family structure, depression and anxiety in mothers on BHS in children, the Family Assessment Device, and both the Parental Attitude Research Instrument and the Beck Depression Inventory as well as the State-Trait Anxiety Inventory were used to assess both groups. RESULTS: Exposure to stressful life events during pregnancy (P < 0.001), depressive traits (P < 0.001), state-trait anxiety (P < 0.001), overprotective maternal characteristics (P = 0.027) and most of the family functioning subscales were found to be significantly different between BHS and control groups. CONCLUSIONS: The association of anxiety, depression, prenatal stressful events and poor family functioning in mothers who have children with BHS is significantly higher than controls. An evaluation of these problems may be beneficial in the management of BHS.

Efficacy of a Brief Psychoeducational Intervention for Mothers of Children with Breath-Holding Spells: A Randomized Controlled Pilot Trial.

Objective Mothers of individuals with breath-holding spells (BHS) suffer more often from anxiety and experience more stressors in their everyday life. The purpose of this study was to examine the efficacy of psychoeducational intervention in reducing BHS and coping with these spells. Participants and Methods Mothers who have children with BHS were randomly assigned to one of the two groups: an intervention group receiving psychoeducational therapy in addition to the routine follow-up (n = 31) and a control group who did not receive psychoeducation in their routine follow-up (n = 28). The data collected at the beginning of the study and at the end of 3rd and 6th months about the frequency of the spells per month, maternal anxiety, and depression levels and mothers' perceived self-knowledge about coping BHS of both groups were compared. Results Mothers in psychoeducation group, compared with controls, improved significantly on state anxiety, depression, perceived anticipation anxiety level for BHS of their children and self-knowledge about coping with the spells. Conclusion The intervention program had a positive effect on anxiety-depression levels of the mothers and the frequency of BHS among the children. The possible link between emotional and autonomic dysregulation in children with BHS and maternal mental health were discussed.

T102C polymorphism of serotonin-2A receptor gene in Turkish schizophrenia patients: Association with cognitive impairment and soft neurological signs.

AIM: Previous studies have shown an association between the T102C polymorphism of the serotonin-2A receptor gene and schizophrenia. In addition, an association of this polymorphism with clinical phenotypes in schizophrenia such as treatment response and cognitive impairment has been observed. MATERIALS AND METHODS: In this case-control study conducted in Turkish Caucasians, we compared T102C polymorphism genotype and allele frequencies in 76 schizophrenic patients and 165 healthy controls. We also investigated interaction of this polymorphism with clinical and cognitive variables in patients. RESULTS: No significant difference was observed in the distribution of the three genotypes (T/T, T/C and C/C) and in the allele frequencies in controls and patients with schizophrenia. No evidence of association was detected at various clinical phenotypes including symptom severity, suicidality, treatment response, age of disease onset, number of hospitalizations and history of violence (in co-dominant, dominant, or recessive models). However, as compared to the C/C genotype, patients with 1 or 2 copies of the T allele were characterized by better stroop test performances and less "motor coordination" soft neurological signs. CONCLUSION: Further research is needed to elucidate the impact of T102C polymorphism on neurocognitive functions in both healthy and patient populations.

Attachment Characteristics and Behavioral Problems in Children and Adolescents with Congenital Blindness.

INTRODUCTION: This study aimed to assess the behavioral problems and the attachment characteristics of children and adolescents with congenital blindness (CB). METHOD: Forty children and adolescents aged 11-14 years with CB were included as the case group. Forty healthy children and adolescents who were matched for age, gender, and socioeconomic status with the case group served as the comparison group. Behavioral problems were assessed by the Child Behavior Checklist for ages 4-18 (CBCL 4/18). Attachment characteristics were assessed via the Short Form of Inventory of Parent and Peer Attachment (s-IPPA). RESULTS: The case group had lower CBCL total problems scores as well as anxiety/depression, withdrawal/depression, and attention problems subscales scores with respect to the comparison group. There were no significant differences between the two groups in s-IPPA scores. CONCLUSION: Children and adolescents with CB did not differ from the comparison group in terms of attachment, whereas, they had lower scores on behavioral problems than the comparison group. Although previous studies indicate that children and adolescents with CB may be at the risk of insecure attachment, our study suggested that adaptive mechanisms of their families together with professional help from specialized teachers and services provided by schools for children and adolescents with CB may play compensatory roles.

Depression and anxiety levels and self-concept characteristics of adolescents with congenital complete visual impairment.

OBJECTIVE: Previous studies have reported that visual impairment can affect the mental health of children and adolescents. The aim of this study is to investigate the depression and anxiety levels and the self-concept characteristics of adolescents with congenital complete visual impairment. METHOD: This is a cross-sectional study. 40 adolescents with congenital complete visual impairment studying in a specialized primary school for visual impairment, and 40 sighted adolescents were included in the study. Both groups were matched in terms of age, gender and socio-economic status. The mean age of the adolescents in both groups was 12.82±1.17. The Children's Depression Inventory, Piers-Harris Children's Self-Concept Scale, Spielberger Trait Anxiety Inventory for Children and sociodemographic form were used in the study. The mean scores of the scales obtained from both groups were compared using the Mann-Whitney U test. RESULTS: The difference between the two groups was not statistically significant either in terms of depression scores or in terms of total scores; the happiness, physical appearance, popularity, behavior and adjustment subscales scores of the Piers-Harris Children's Self-Concept Scale. The intellectual and school-status subscale scores of the adolescents with visual impairment were significantly higher than those of the controls. Anxiety levels of the adolescents with visual impairment were significantly higher when compared with sighted adolescents. CONCLUSION: These results indicate that the depression levels and self-concept characteristics of adolescents with visual impairment are similar to those of sighted adolescents, whereas the anxiety levels of the adolescents with visual impairment are significantly higher than those of the sighted ones.

Childhood trauma and dissociation in schizophrenia.

BACKGROUND: This study is concerned with relationships between childhood trauma history, dissociative experiences, and the clinical phenomenology of chronic schizophrenia. SAMPLING AND METHODS: Seventy patients with a schizophrenic disorder were evaluated using the Structured Clinical Interview for DSM-IV, Dissociative Experiences Scale, Dissociative Disorders Interview Schedule, Positive and Negative Symptoms Scales, and Childhood Trauma Questionnaire. RESULTS: Childhood trauma scores were correlated with dissociation scale scores and dissociative symptom clusters, but not with core symptoms of the schizophrenic disorder. Cluster analysis identified a subgroup of patients with high dissociation and childhood trauma history. The dissociative subgroup was characterized by higher numbers of general psychiatric comorbidities, secondary features of dissociative identity disorder, Schneiderian symptoms, somatic complaints, and extrasensory perceptions. A significant majority of the dissociative subgroup fit the diagnostic criteria of DSM-IV borderline personality disorder concurrently. Among childhood trauma types, only physical abuse and physical neglect predicted dissociation. CONCLUSIONS: A trauma-related dissociative subtype of schizophrenia is supported. Childhood trauma is related to concurrent dissociation among patients with schizophrenic disorder. A duality model based on the interaction of 2 qualitatively distinct psychopathologies and a dimensional approach are proposed as possible explanations for the complex relationship between these 2 psychopathologies and childhood trauma.

Psychological effects of repeated general anesthesia in children.

BACKGROUND: Although methods for reducing preoperative anxiety have been a major interest of pediatric anesthesiologists, there are no reports of the effects of repeated anesthesia on psychological development of children. METHODS: To determine the overall effect of multiple anesthetics on the psychology of children, we undertook to compare the children undergoing repeated anesthesia (Group S) for the treatment of corrosive esophagitis with a control group (Group C) with chronic renal disease and frequent hospital admissions. Psychological tests and diagnosis of children Group S (n = 23) were compared prospectively with Group C (n = 20). All children had been appropriately treated over the previous 5 years and 50% of patients in Group C had general anesthesia once and those in Group S underwent at least 5 GAs. Parents completed a child behavior checklist (CBCL) and Marital Conflict Questionnaire; the children were evaluated by a child psychiatrist using DSM-IV criteria and completed the Child Depression Inventory (CDI). RESULTS: The children in Group S underwent a total of 251 (11 +/- 7) GAs over 4-60 months. The incidence of psychopathology was nine and 10 children in groups S and C, respectively. The CBCL and CDI scores were parallel with a psychiatric diagnosis. Marital conflict scores were higher in Group S. CONCLUSIONS: Both chronic disease states affect psychology of children. Repeated anesthesia in addition to chronic disease does not seem to disturb the child's psychological health further when tentative and precautious approach modalities are undertaken.