Thalassemia patients in transfussion dependent period and after hematopoietic stem cell transplantation: how are the psychiatric status and life quality of these patients?

Although hematopoietic stem cell transplantation (HSCT) has been widely used to treat patients with beta-thalassemia major, evidence showing whether this treatment improves mental health, self esteem and health-related quality of life (HRQoL) is limited. We aimed to describe psychiatric problems, HRQoL and self-esteem scores of patients who have thalassemia and compared with patients who underwent HSCT in the current study. A total of 24 patients with thalassemia major and 13 patients who underwent HSCT at least 2 years ago aged between 7-37 years were included. We used The Children's Depression Inventory, The Spielberger State-Trait Anxiety Inventory, and Pediatric Quality of LifeTM (PedsQL™) for assesment of children and Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) for assessment of adults. We also used Piers Harris Self Concept Scale for children and adults. Psychopathologies are common in both groups (50% in Thalassemia group and 69.2% in HSCT group). Popularity scores in Piers Haris scale of patients in HSCT group were significantly higher compared to thalassemia group (p = 0.03). Additionally, HSCT group had higher scores in physical health subscales of HRQoL in both children and parents'(p = 0.02, p = 0.03 respectively). Our findings suggest improved HRQoL and self-esteem in thalassemia patients after HSCT. However, due to the high prevalence of mental disorders in both groups, we would like to emphasize that clinicians should examine not only the physical but also the psychological state of the patients with thalessemia during the their treatment and follow-up period after HSCT.

The relationship between dissociation symptoms, sleep disturbances, problematic internet use and online gaming in adolescents.

Some adolescents admitted to the child and adolescent psychiatry outpatient clinic experience dissociative symptoms, such as hearing strange sounds, temporary blackouts, seeing images, changes in body parts, and looking at themselves from outside themselves. Some may also have sleep disturbances and a history of spending a long time on the internet. This study investigated the relationship between dissociative symptoms and sleep disorders, problematic internet usage (PIU),aggression and digital game addiction in adolescents. Participants completed the State-Trait Anger Expression Inventory (STAXI), Problematic Internet Usage Scale (PIUS), Digital Game Addiction Scale (DGAS-7), Children's Depression Inventory (CDI), Adolescent Dissociative Experiences Scale (A-DES), Pittsburgh Sleep Quality Index (PSQI), Screen for Child Anxiety Related Emotional Disorders Child Version (SCARED), and a sociodemographic form. Regression analyses were performed to identify associations. The sample consisted of 244 adolescents between 14 and 18 years of age (M = 15.93, SD = 0.90), of which 171 (70.1%) were girls and 73 (29.9%) were boys. Fifty-two (21.3%) were classified as having problematic online gaming (POG+), whereas 192 (78.7%) were classified as not having problematic online gaming (POG-). There was a difference between the two groups in all sub-dimensions of the PIUS, STAXI, CDI, and A-DES. Adolescents who had higher scores on the A-DES had a higher risk of sleep disorders and had higher scores on the PIU, CDI, and SCARED. The POG+ group dissociation scores were considerably higher than POG- group scores. Adolescents with high A-DES scores also had higher anger scores and weaker anger control skills. Consequently, sleep disorders, PIU, and POG may increase dissociative symptoms.

Executive Functions and Theory of Mind Skills of Sexually Abused Female Adolescents and Their Externalizing and the Internalizing Behavioral Problems.

Sexually abused children (SAC) often experience acute and chronic adverse psychological and physiological effects later in life. This study aims to evaluate psychiatric diagnoses, Executive Functions (EF) and Theory of Mind (ToM) skills deficiencies in sexually abused female adolescents and examine the relation of these deficiencies with externalizing and internalizing behavioral problems. The patient group comprised 42 female adolescents aged 14-18 years (mean = 16.42, standard deviation = 1.01). The Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, Dokuz Eylül ToM Index and Reading the Mind in the Eyes test were applied. The Behavior Rating Inventory of Executive Function, Strengths and Difficulties Questionnaire, and Kiddo-KINDL were completed by the participants and their families. A total of 57.2% (n = 24) were classified as SAC with internalizing behavior problems (SAC+I), whereas 66.7% (n = 28) comprised the SAC with externalizing behavior problems (SAC+A) subgroup. SAC+I showed deficits in EF and TOM. Some EF skills were found to be statistically weaker in SAC+A. There was no difference between SAC+A and SAC-A in the TOM tests. The results highlight the need to explore whether these deficiencies are due to psychiatric diseases or whether those who have disabilities in this field carry a higher risk of psychiatric disorder.

Determinants of Posttraumatic Stress Disorder (PTSD) among children and adolescents in the subacute stage of Kahramanmaras earthquake, Turkey.

BACKGROUND: Earthquakes are potentially traumatic natural disasters due to their destructive nature, and huge impacts, producing scenes of horror, undesirable and uncontrollable results. Children are affected mainly by earthquakes not only physically but also psychologically. We aimed to evaluate the rates of probable PTSD and related factors in children and adolescents after the February 6 Kahramanmaras earthquake. METHODS: In this cross-sectional study, 246 children and adolescents were included. The research was conducted in Hatay, one of the most affected provinces, between 06/07/2023-06/08/2023. Sociodemographic form, Children's Depression Inventory, Children's Posttraumatic Response Reaction Index, Screen for Child Anxiety Related Emotional Disorders, Child and Youth Resilience Measure and Social Support Appraisals Scale for Children were applied by face-to-face survey method. RESULTS: The median age of the participants was 12 (8-18). 133 (54%) of the participants were girls. Probable depression rate was 98%, and probable anxiety disorder rate was 63%. Probable mild, moderate, severe and very severe PTSD rates were 18%, 29%, 43% and 8%, respectively. The probable severe PTSD rate was higher in children who were injured in the earthquake (p = 0.032), who received outpatient treatment (p = 0.016), and who saw people trapped under the collapse (p = 0.012). Also, the children whose sleep routines have changed post-earthquake were found to have more probable severe PTSD (p < 0.001). Access time to the potable water supply (p = 0.045), toilet facilities (p = 0.045), shelter facilities (p = 0.004), heating facilities (p = 0.001), clothing supply (p < 0.001) and healthcare services (p = 0.009) were found to be associated with probable severe PTSD right after the earthquake. In the fifth month of the earthquake, inadequate meeting of clothing needs (p = 0.018), educational services (p = 0.028) and social activity opportunities (p < 0.001) were significantly associated with probable severe PTSD. In the multivariate analysis, the risk of probable severe PTSD was increased 2.9 times in those with post-earthquake sleep changes (p = 0.001) and 11.1 times in those with probable anxiety disorders (p < 0.001). Also, it has been shown that each unit increase in the APP-family score reduces probable severe PTSD risk by 2% (p = 0.002). CONCLUSION: In the current study, the rates of probable PTSD, depression and anxiety disorders were considerably high. Probable anxiety disorder and sleep disturbance were significant predictors of probable severe PTSD. On the other hand, social support from family was found to be a significant protective factor for severe PTSD risk. We conclude that the lack of meeting needs that increase the risk of probable severe PTSD differs in the acute and subacute phases.

Myths Regarding Gender Differences in Eating Disorders in Adolescents. / Ergenlerde Yeme Bozukluklari ile ilgili Cinsiyet Farkliklari Temelinde Bilinmeyenler.

OBJECTIVE: Factors predicting eating disorder (ED) may vary among genders. This study investigated the gender specific influence of adolescents' social media use, body perception, depression and anxiety symptoms on eating disorder risk. METHOD: The sample consisted of 183 adolescents aged 14 to 18 years (mean: 15.65±0.89). Sociodemographic information and data from the, Children's Depression Inventory (CDI), Social Media Attitude Scale (SMAS), Eating Disorder Examination Scale (EDES), Eating Attitudes Test (EAT), Screen for Child Anxiety Related Emotional Disorders Child Version (SCARED), and Body Cathexis Scale (BCS) were collected. RESULTS: In this study, women have higher scores in SCARED (p<0.001), and lower scores in social competence subscale of SMAS (p=0.008) in comparison to men. Adolescents at risk for eating attitudes had higher scores in the CDI, the BCS, and the SMAS-Social Competence subscale, while adolescents at risk for eating disorder had higher scores in all scales except the SMAS-Relationship with Teachers subscale. Although depression and body perception influence women's' eating attitudes directly, social media revealed its effect on ED by the mediation of depressive symptoms. In men, social isolation, anxiety, and depression directly predicts ED, while social media enhanced the risk of ED by aggravating anxiety. CONCLUSION: It is important to know the factors that influence the risk of ED in terms of gender, and effectively address adolescence's psychological and medical burden.

Living on with autism after a devastating earthquake: experiences of children and adolescents in Turkey.

Introduction: The current study aimed to investigate the psychological impact of the Turkey 2023 earthquakes on children with autism spectrum disorder (ASD) and their parents residing in Hatay, Sanliurfa, and Ankara provinces, encompassing the periods both before and after the Turkey 2023 earthquakes. Method: This cross-sectional, multicenter study included 103 children and adolescents with ASD aged between 6 and 18. Participants were evaluated based on their residence in Ankara, Hatay, and Sanliurfa, three cities affected differently by the earthquake. Parent-report questionnaires were utilized to assess the children's autism symptoms and behavioural problems. The Childhood Autism Rating Scale was used to determine autism severity. The psychiatric problems of mothers were also assessed with self-report scales. Results: Significantly increased levels of core autism symptoms, irritability, and hyperactivity were found in Hatay and Sanliurfa participants after the earthquakes compared to before, while no differences were detected in children from the Ankara group. Scale score increases in the Hatay group, which had to take a more extended break from special education, were higher than in the Sanliurfa group. Participants with late-diagnosed ASD exhibited a more significant increase in their scale scores after the earthquake. Depression, stress and hopelessness scores were the highest, and the life satisfaction levels were the lowest in mothers of the Hatay and Sanliurfa groups. More pronounced increases were observed in aberrant behaviours among children of mothers with low educational levels following the earthquake. Discussion: Our findings demonstrate that the exacerbation of core ASD symptoms and behavioural deterioration after the earthquakes are associated with disruptions in specialized education services, exposure to earthquake-related trauma, and the educational level of mothers.

Effect of perceived social support, comorbid psychiatric disorders, and pregnancy complications on adaptation to pregnancy in adolescents: A comparison study from southeastern Turkey.

OBJECTIVE: Adolescent pregnancies are categorized as high risk due to their adverse obstetric and neonatal outcomes. The aim of our study was to investigate the well-being of pregnant adolescents by assessing pregnancy complications, depression, anxiety, social support, and adaptation to pregnancy. METHODS: Pregnant adolescents who presented to the Obstetrics and Gynecology Outpatient Clinic of Hatay Training and Research Hospital between July 2022 and January 2023 were included in the study. Pregnant adults were also included as a control group during the same period. All participants were assessed using the Beck Depression Inventory, Multidimensional Scale of Perceived Social Support, Perinatal Anxiety Screening Scale, and Prenatal Self-Evaluation Questionnaire. RESULTS: A total of 61 pregnant adolescents were enrolled in the study and were compared with 116 adults. Our findings indicate that pregnant adolescents tend to exhibit a higher rate of pregnancy complications in comparison with pregnant adults, with complication rates of 14.8 % and 6.1 %, respectively (p = 0.057). The presence of complications had a negative impact on the acceptance of pregnancy in adolescents unlike in adults (p = 0.022). The relationship of pregnant adolescents with their partners was negatively affected by pregnancy complications (p = 0.046). Perceived social support (especially that of a partner) significantly reduced depression and anxiety scores in pregnant adolescents during the prenatal period (p = 0.002) CONCLUSION: Adolescent pregnancies have negative psychiatric consequences even in traditional societies where child marriage is accepted. Future studies should consider variables that may reduce the impact of sociocultural factors on adolescent pregnancy.

Executive function, behavioral problems, and insulin resistance in adolescents with obesity.

OBJECTIVES: In this study, we examined executive function (EF) abilities, behavioral and emotional (BE) issues, and overall quality of life (QoL) of adolescents with obesity and compared them with a control group and also aimed to investigate whether the presence of insulin resistance (IR) is associated with these problems. METHODS: This cross-sectional study included a sample of 50 adolescents aged 11-18 years with obesity and age- and gender-matched 50 normal weight adolescents who had attended and were treated at the pediatric outpatient clinic. Sociodemographic data were collected through personal interviews with the adolescents and their parents. Measurements of the height and weight, fasting blood glucose, and insulin levels of all adolescents were assessed. In addition, the participants and their parents completed the Kiddo-KINDL, the Strengths and Difficulties Questionnaire, and the Behavior Rating Inventory Scale from Executive Function. RESULTS: Of the 50 adolescents with obesity, 27 (54.0 %) were girls, and 23 (46.0 %) were boys, with a mean age of 14.06 ± 1.83 years. Adolescents with obesity have more EF deficiencies, BE difficulties, more problems in peer relationships and lower QoL scores than those without obesity. The QoL was worse in girls, adolescents with obesity, and those with IR. Adolescents with obesity and those with and without IR did not differ about EF deficiencies and BE problems. CONCLUSIONS: Addressing these EF deficits and BE problems in interventions for adolescents who have difficulty adapting to lifestyle changes, an essential part of obesity treatment in clinical practice, may contribute to treatment success.

Sensory profiles, behavioral problems, and auditory findings in children with autism spectrum disorder.

Objective: This study examined the relationship between sensory processing (SP) differences and behavioral problems in children with autism spectrum disorder (ASD). We also investigated whether audiological test results could objectively detect auditory processing differences. Method: Forty-six children with ASD, ages 3-9 years, were enrolled in the study. Problematic behaviors and sensory processing of children were assessed using scales. The otolaryngologist performed a detailed head and neck examination and a formal audiological examination was performed by an audiologist. Results: Stereotypy, hyperactivity, and irritability were related to sensation seeking. Stereotypy was also associated with visual processing. Touch processing differences was related to irritability and inappropriate speech. Lethargy was associated with auditory processing. There were no differences in SP and behavior problems in the children whose audiological profiles could be measured between those who passed or failed the test. Conclusion: There was an association between SP differences and behavioral problems in children with ASD, supporting previous studies. Audiological test results did not reveal the SP differences documented in the parent forms.

Childhood Non-verbal Communication Scale (CNCS): Turkish Adaptation and Psychometric Properties.

Introduction: Nonverbal communication (NC) skills develop dramatically during the first year of life. Especially in children with Autism Spectrum Disorder (ASD), inadequacies in these skills in the early period negatively affect language development later. Therefore, early recognition of ASD symptoms is the first step in the diagnosis. The test to screen ASD at the earliest age is the Modified Checklist for Autism in Young Children/M-CHAT in Turkey. However, this test can be used for 18 months or later. In the present study, we aimed to adapt the Childhood Nonverbal Communication Scale (CNCS) to Turkish, which was developed in Iran to evaluate NC skills in children from birth to 18 months and determine psychometric properties. Methods: This cross-sectional and methodological study was conducted in 3 provinces and included 323 parents of children who are normally hearing and 3-18 months old. Sociodemographic form, Ankara Development Screening Inventory, CNCS-Turkish form, and LittleEARS Auditory Questionnaire were applied. Results: CNCS Turkish form consisting of 37 questions shows a two-factor structure. The reliability coefficient of the 37-item scale is highly reliable (KR-20=0.937). It also had good convergent validity based on a significant correlation between total scores and LittleEARS results (r=0.804, P<0.001). According to the normative curve plotted by the CNCS total score for age, NC skills progressed with a steep slope from 3 to 12 months and then progressed gradually until 18 months. Conclusions: Childhood Nonverbal Communication Scale (CNCS) is a promising tool showing good validity and reliability in Turkish.

Surgical treatment of a calcified amorphous tumor originating from left atrium.

Calcified amorphous tumor is a non-neoplastic tumor or intracavitary cardiac mass which is rarely seen in heart. It is frequently associated with left ventricle and mitral valve. Clinical symptoms varies from asymptomatic status to serious neurological and cardiopulmonary symptoms. Imaging studies such as echocardiography, computed tomography, or magnetic resonance imaging can reveal the mass preoperatively, although the exact diagnosis is done by pathological inspection of the specimen. Follow-up is recommended by echocardiography after surgical treatment due to its recurrence potential. Herein, we present a mass attached to the mitral valve posterior leaflet causing rather silent symptoms such as dyspnea and fatigue on exertion.

Invasive papillary breast carcinoma, solid variant with neuroendocrine differentiation.

Invasive papillary carcinoma, solid variant is a rarely observed breast tumor. It is encountered in patients of advanced ages and has a good prognosis. After the physical examination, mammography, and ultrasonography examinations, modified radical mastectomy were applied to the 72-year-old patient, who came to our hospital complaining of a mass in the left breast. During the macroscopic analysis, a well-limited, necrotic, and bleeding tumor with a diameter of 7 cm was found in the left breast, covering almost the whole area. The case was diagnosed as invasive papillary carcinoma, solid variant with neuroendocrine differentiation, which has been reported in the literature as a result of the histopathological and immunohistochemical analysis.