Development of posttraumatic stress disorder and depression after open globe injury in adults.

PURPOSE: To investigate the prevalence of posttraumatic stress disorder (PTSD) and depression after open globe injury in adults. METHODS: A total of 95 participants, 43 adult patients with open globe injury and 52 age-sex similar subjects (control group), were included in this cross-sectional study. Age, gender, education level, occupation, accident history, psychiatric history, trauma type, cause of trauma, and visual acuity were recorded. One to six months after trauma, PTSD and depression symptoms of the participants were evaluated with the Posttraumatic Stress Disorder Questionnaire-Civil Version Scale (PTSD-S) and Beck Depression Inventory (BDI), respectively. RESULTS: Patients with open globe injury had a higher PTSD-S total score than the control group, but not significant (23.67 ± 20.41 vs. 18.56 ± 13.13, p = 0.580). Patients with eye trauma exhibited a much higher prevalence of PTSD compared to the control group (20.9% vs. 3.8%, p = 0.010). Patients with trauma had a significantly higher BDI total score than the control group (12.47 ± 10.08 vs. 7.69 ± 6.10, p = 0.015). Also, patients had a higher rate of depression symptoms than controls (25.6% vs. 7.7%, p = 0.017). A significant positive correlation was observed between PTSD-S and BDI scores in the trauma group (r = 0.720, p < 0.001). CONCLUSION: An increased prevalence of PTSD and depression was observed in adults after open globe injury. The significant relationship between PTSD-S and BDI scores indicates that patients with open globe injuries should be questioned in terms of both symptoms. For patients with open globe trauma, a holistic approach with psychosocial assessment in addition to physical intervention would be beneficial.

Effects of electroconvulsive therapy on nitrosative stress and oxidative DNA damage parameters in patients with a depressive episode.

BACKGROUND: Few studies have investigated the relationship between electroconvulsive therapy (ECT) and markers of nitrosative stress and oxidative DNA damage. OBJECTIVE: The aim of this study is to examine changes in nitrosative stress and oxidative DNA damage in patients with a depressive episode treated with ECT. METHODS: The current study included 48 patients with a depressive episode treated with ECT and 30 healthy control participants. First, the serum nitrosative stress markers of nitric oxide (NO•), nitric oxide synthase (NOS), and peroxynitrite (ONOO-) and the oxidative DNA damage marker 8-hydroxy-2'-deoxyguanosine (8-OHdG) were compared between the study and control groups. These parameters were also compared pre- and post-treatment for the study group. RESULTS: NO•, NOS, and ONOO- levels were significantly higher in patients with depressive disorder (DD) than in the control group. NO• and NOS levels significantly decreased in the ECT group after treatment while 8-OHdG levels significantly increased. CONCLUSIONS: The study findings suggest that ECT may have reduced nitrosative stress levels while increasing oxidative DNA damage. More research is now needed to better understand the issue.KEY POINTSNitrosative stress levels can increase in patients with depressive disorder.Electroconvulsive therapy may reduce nitrosative stress while increasing oxidative DNA damage.These results suggest that nitrosative stress plays an important role in the mechanism of action of electroconvulsive therapy.

Caring for the Most Vulnerable: A Model for Managing Maladaptive Behavior in Children with Mental Special Needs During the COVID-19 Pandemic.

Background: This article presents the results of a comprehensive national model developed for managing maladaptive behaviors (MBs) in children with mental special needs (CMSNs) during the coronavirus disease 2019 (COVID-19) pandemic that combines telehealth-based Applied Behavioral Analyses, psychiatric interventions, and support from local psychosocial teams. This study aims to determine the effectiveness of a system that combined telehealth applications with local psychosocial support teams, allowing services from video calls to emergency interventions. Materials and Methods: The system combines the telehealth applications with the services from local psychosocial intervention teams. In addition to system records covering sociodemographic variables and initial complaints, a telephone survey questioning the effectiveness and satisfaction of the system was used as the main outcome. Results: In total, 347 individuals used the system with mothers constituting the majority of applicants (88.7%, n = 332). The overall satisfaction of the system was 8.8/10. In terms of effectiveness, 63.3% (n = 237) of caregivers reported an improvement in the reason of application. Counselors decided on a need for follow-up visits for 36.6% (n = 137) of applications. A referral to a psychiatrist was asked for 40 patients (10.6%). Discussion: To our best knowledge, this is the first study presenting a model for managing MBs of CMSNs during the COVID-19 outbreak. In general, therefore, it seems that there is a need for unique systems to handle behavioral problems of CMSNs. Conclusions: The findings of this study suggest that it is possible to establish an integrative multistep multidisciplinary telehealth-based approach in a short while.

Efficacy and Safety of Electroconvulsive Therapy in Adolescents: A Retrospective Chart Review Study From Turkey.

OBJECTIVE: The aim of this study was to report the efficacy and safety of electroconvulsive therapy (ECT) in manic, depressed, psychotic, and catatonic adolescent patients. METHODS: Medical records of 78 adolescents who had received ECT in Department of Psychiatry, Gaziantep University Medical Faculty, during 2011 to 2017 were reviewed. Sixty-two subjects in this sample were identified to have complete records and met the study inclusion criteria. RESULTS: The mean ± SD age of subjects was 17.11 ± 1.04 years and female sex was 53.2% (n = 33). Primary the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnoses were bipolar mood disorders (n = 33, 53.2%), major depressive disorder (n = 16, 25.8%), schizophrenia (n = 8, 12.9%), and schizoaffective disorders (n = 5, 8.1%). Electroconvulsive therapy was significantly effective in treating manic, depressive, psychotic, and catatonia symptoms as evidenced by significant differences in pretreatment and posttreatment scores in outcome measures including Hamilton Depression Rating Scale, Young Mania Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression-Severity Scale (P < 0.001). Presence of comorbidity adversely affected treatment response (P = 0.001). However, ECT was also effective in those with comorbid diagnoses (P < 0.001). Depressive symptoms in patients with bipolar depression responded better than those with unipolar depression (P = 0.012). Electroconvulsive therapy was generally safe with subjective memory complaints (85%), headache (69%), and prolonged seizure (8%) as the reported adverse effects possibly related to ECT. Four subjects (6%) developed a manic switch during ECT. CONCLUSIONS: Electroconvulsive therapy is an effective and a safe treatment option in adolescent patients with severe and resistant psychopathology. Although comorbidity may decrease treatment response, ECT seems to be effective even in the presence of multiple psychiatric diagnoses.

The prevalence of childhood mental disorders in different habitations: are we underestimating their prevalence in rural areas?

Background: Recently, the number of epidemiological studies of child psychiatry has increased, but most of these studies focus on children living in city centres. Unfortunately, one-third of the global population lives in rural areas, and various habitations exist in cities, including city centres and slums. Moreover, despite having a high risk for psychopathology development, individuals who have symptoms but fall outside the limits specified for diagnoses due to having fewer symptoms than those mentioned in diagnostic systems and individuals who do not fulfil the impairment criteria listed in diagnostic systems are not addressed in these studies.Aim: The purpose of this study was to understand the prevalence of DSM-IV childhood psychiatric disorders and subthreshold psychiatric problems from middle-class city centres, city centres in slums, towns and village areas of Turkey with a nationally representative sample using a state-of-the-art methodology.Methods: In total, 1080 children were randomly selected from second and third grades for the study's sample. A structured diagnostic interview was applied.Results: The overall prevalence of psychiatric disorders was 8.4% (n = 91); 7.2% (n = 78) of the children were subthreshold cases. The general prevalence of psychiatric disorders was higher among children living in villages with respect to all the other human settlement areas included in the study.Conclusions: Although global urbanisation foregrounds the mental health of children living in cities, children in rural areas may have a greater risk of developing a mental disorder. This study confirmed that an equal amount of children fell outside of the diagnosing limits.

Serum NGF levels may be associated with intrauterine antiepileptic exposure-related developmental problems.

OBJECTIVE: It has been shown that maternal epilepsy and antiepileptic drug use during pregnancy have adverse developmental outcomes in children. The aim of this study was to investigate the developmental outcomes of maternal epilepsy and prenatal antiepileptic exposure. We also looked for the associations between serum levels of glial cell-derived neurotrophic factor (GDNF) and nerve growth factor (NGF) and developmental outcomes. METHODS: This is a retrospective, nonrandomized, case-controlled study. Fifty-three children aged two to six years old with maternal epilepsy were included in the case group. Fifty-three age- and gender-matched children without maternal epilepsy were included in the control group. Developmental assessment was conducted using the Denver II Developmental Screening Test (DDST-II). Serum levels of NGF and GDNF were measured using an enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: Multiple regression analysis revealed that prenatal antiepileptic exposure was significantly associated with lower global developmental scores (B = -7.5, confidence interval (CI): -13.1; -1.9, p = 0.009) while periconceptional folate use was associated with a reduced risk for adverse developmental outcomes (B = 6.6, CI: 0.91; 12.3, p = 0.024). Children with prenatal antiepileptic exposure are at increased risk for global developmental delay (GDD) particularly for language domain (p = 0.018). We found a statistically significant positive correlation between NGF levels and global developmental scores (r = 0.302, p = 0.009). Serum levels of GDNF in children with maternal epilepsy were significantly lower than the children without maternal epilepsy (p = 0.025). CONCLUSIONS: Prenatal antiepileptic exposure was related with the increased risk of GDD while periconceptional folate use was related with lower risk. Clinicians should inform all women in reproductive age with epilepsy about the possible benefits and risks of antiepileptic drug use during a possible pregnancy. Periconceptional folate use has protective effect on child development, and all women on antiepileptic drugs should be encouraged for periconceptional folate use. Serum NGF levels may be a promising biomarker for monitoring global development delay in at-risk population.

Is surgery a risk factor for separation anxiety in children?

OBJECTIVE: Postoperative anxiety symptoms are distressing for both family and child. The aim of this study was to examine the prevalence of postoperative anxiety symptoms in children. METHODS: 60 children aged 6-12 undergoing surgery were included in the study group. The study group was assessed three times in terms of separation anxiety disorder (SAD), at the time of presentation, 1 and 3 months postoperatively. A personal information form and the SAD section of the K-SADS-PL on the basis of DSM-IV diagnostic criteria for screening SAD symptoms were used. RESULTS: Study group consisted of 19 girls (31.7%) and 41 boys (68.3%) (mean age 8.9 ± 2.3). Four (6.6%) of the cases at the time of presentation and 13 (21.6%) in the study group met SAD diagnostic criteria in 1 month and 21 (35.0%) in 3 months. Anxiety disorder symptoms were significantly higher in the study group at 3 months postoperatively (p < 0.05). There is significant correlation between both SAD symptoms and duration of hospitalization. There was also a positive correlation between duration of hospitalization and parental education and SAD symptoms. CONCLUSION: Greater SAD was observed in children undergoing surgical procedures. It will be useful to physicians to consider SAD after surgery in pediatric patients especially when the level of parental education and duration of hospitalization increase. Since SAD may persist long after surgery, it may cause constant fear in personality disorders and lead to psychological problems by significantly lowering quality of life.

The Role of Nerve Growth Factor (NGF) and Glial Cell Line-Derived Neurotrophic Factor (GDNF) in Tic Disorders.

OBJECTIVES: Tic disorders are associated with neurodevelopmental origin, changes in dopaminergic neurons, and the formation of immunoreactivity, it is thought that neurotrophic factors may be crucial in the emergence of tic disorders. In this study, we targeted to explore role of neurotrophic factors in tic disorders. The aim of this study was to investigate serum Glial Cell Line-Derived Neurotrophic Factor (GDNF) and Nerve Growth Factor (NGF) levels in patients with tic disorder and healthy controls. METHODS: Thirty-four children, constituted the case group, were diagnosed with tic disorder. The control group included 34 healthy children. Development and Well-Being Assessment (DAWBA) (structured interview) and Yale Global Tic Severity Rating Scale (YGTSRS) was applied to the patients. NGF and GDNF levels were measured with ELISA kit. RESULTS: In case group, serum NGF and GDNF levels were found to be significantly higher in females than males (p = 0.042, p = 0.031). It was determined that serum NGF and GDNF levels were correlated with each other (r = 0.803, p <0.001) and there were no correlations between other parameters. There was no significant difference in NGF and GDNF in patients with tic disorder, compared to healthy controls. CONCLUSIONS: The absence of this relationship does not exclude the hypothesis that neurotrophic factors may play a role in the etiopathogenesis of tic disorders.

An Investigation of Dissociative Symptoms and Related Factors in Autistic Adolescents.

Despite exposure to trauma and adverse life events being frequently reported in Autism Spectrum Disorder (ASD), few studies have examined the relationship between these factors and dissociative symptoms in the autistic population. The aim of the study is to investigate symptoms of dissociation in autistic adolescents, and to explore factors that could be associated with dissociative symptoms in ASD. This cross-sectional study involved 59 autistic adolescents between 12 and 18 years old, with the mean age of 14.3 ± 1.8. Dissociation, autism characteristics, childhood traumas, peer bullying, and Post-Traumatic Stress Disorder (PTSD) symptoms were assessed using the Adolescent Dissociative Experiences Scale (ADES), the Childhood Autism Rating Scale (CARS), the Childhood Trauma Questionnaire (CTQ), the Nine-Item Child-Adolescent Bullying Screen (CABS-9), and the Child Posttraumatic Stress Reaction Index (CPTS-RI), respectively. Results from the ADES revealed that 12.5% of the participants scored above the threshold for dissociative disorders. In the linear regression model constructed to evaluate factors associated with dissociative symptoms, an increase in dissociative symptoms was statistically significantly associated with an increase in the total CTQ score (p = 0.002) and age (p = 0.006). The findings of the study indicate that dissociative symptoms may occur in autistic adolescents. It is suggested that dissociative symptoms observed in autistic adolescents may particularly be associated with childhood traumas and increasing age. Further research into dissociative symptoms in ASD is warranted, requiring larger sample sizes, specialized measurement scales, and structured interviews.

Increased Hyperactivity with Decreased Parental Perceived Social Support Among Turkish Children with Autism Spectrum Disorder during Coronavirus Disease 2019 Pandemic.

Objective: The aim of the present study is to investigate the change in emotional/behavioral problems of children with autism spectrum disorder (ASD) and the perceived social support of parents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A total of 51 children with ASD aged between 6 and 18 years took part in the study. The Aberrant Behavior Checklist (ABC), the Strengths and Difficulties Questionnaire (SDQ), and the Multidimensional Scale of Perceived Social Support (MSPSS) were used to evaluate ASD symptoms, emotional/behavioral problems, and perceived social support, respectively. The cases were assessed before and 6 months after the pandemic. Results: Our findings indicated that after the onset of the pandemic hyperactivity scores of children with ASD increased, whereas perceived social support of their parents decreased, compared to their pre-pandemic levels (P-value < .05). The increase in hyperactivity and irritability levels among children were positively associated with the presence of a chronic illness in the family and medication discontinuation (P-value < .05). Conclusion: Quarantine in the COVID-19 pandemic may cause or worsen behavioral problems among children with ASD possibly due to problems related to poor medication adherence and lowered perceived social support among their parents. Clinicians working with children with special needs may be pro-active to assess and manage emotional/behavioral problems among this special population particularly during difficult times such as pandemic.

The Role of Sertoli Cell Hormones in Male Preponderance Observed in Autism Spectrum Disorder.

Introduction: There is a significant, but poorly understood, male preponderance in prevalence of autism spectrum disorder (ASD). The aim of this study was to examine the relationship between male preponderance in ASD and Inhibin B (InhB) and Anti-Müllerian hormone (AMH) levels and the 2D/4D finger ratio associated with fetal androgen exposure. Methods: 42 patients with ASD and 42 neurotypical controls between the ages of 5 and 10 were included. ASD diagnosis and severity were determined using K-SADS PL (Kiddie-SADS - Present and Life Time) Version 2016 and the Childhood Autism Rating Scale (CARS). Serum InhB and AMH were measured. The 2D/4D finger length ratio was also calculated for hand anthropometric measurements. Results: Serum InhB levels were higher in children diagnosed with ASD compared to the neurotypical controls (p=0.003). Serum AMH levels were similar in both groups. Positive correlation was determined between AMH and CARS scores (r=0.315, p=0.05). 2D/4D finger ratios in the ASD group were significantly lower than in the control group (p<0.001). Conclusion: The study findings suggest that InhB, AMH, and fetal testosterone may be associated with male preponderance in ASD. More research is now required for a better understanding of this subject.

VEGF, IGF-1 and FGF-2 Serum Levels in Children and Adolescents with Autism Spectrum Disorder with and without Bipolar Disorder.

PURPOSE: To investigate serum levels of VEGF, IGF-1 and FGF-2, and relationships with several clinical characteristics in children and adolescents with autism spectrum disorder (ASD) with and without bipolar disorder (BD). METHOD: 40 subjects with ASD + BD as study group, and 40 subjects with ASD as control group were included. Serum levels of VEGF, IGF-1, and FGF-2 were measured using commercial enzyme-linked immunosorbent assay kits. RESULTS: The study group was significantly higher than the control group in terms of ASD severity, self-harming behavior and sleep disturbance. Serum VEGF and FGF-2 levels were significantly higher in the ASD + BD group than in the control group. There was no significant difference in serum IGF-1 levels between the two groups. There was no correlation between VEGF, IGF-1 and FGF-2 serum levels and ASD severity in the study group. However there was a negative correlation between VEGF levels and age at first diagnosis of BD, and a positive correlation between IGF-1 levels and the number of bipolar episodes in the study group. CONCLUSION: Growth factors like VEGF and FGF-2 may be potential biomarkers of bipolar disorder in young subjects with ASD. Given the difficulty of clinical management of BD in young subjects with ASD, potential biomarkers would help clinicians in the diagnosis and follow up of BD in this special population. Further research is needed whether VEGF and FGF-2 can be potential biomarkers in the clinical management of young subjects with ASD and BD.

Higher Levels of Galectin-1 and Galectin-3 in Young Subjects with Autism Spectrum Disorder Compared to Unaffected Siblings and Healthy Controls.

Objective: : Despite being highly genetic, the etiology of autism spectrum disorder (ASD), has not yet been clarified. Recent research has focused on the role of neuroinflammation and immune system dysfunction in the pathophysiology of neurodevelopmental disorders including ASD. Galectin-1 and galactin-3 are considered among the biomarkers of neuroinflammation and there has been recent reports on the potential role of galectins in the etiology of neurodevelopmental disorders. However, there has been no study examining the relationship between ASD and galectin levels. Methods: : Current study aimed to investigate galectin-1 and galectin-3 serum levels in young subjects with ASD comparing with their unaffected siblings and healthy controls. Results: : We found significantly higher levels of galectin-1 in case group compared to both unaffected siblings and healthy controls, and higher levels of galectin-3 in case group compared to healthy controls. However, there was no significant association between galectin-1 and galectin-3 levels with the severity of ASD. Conclusion: : Findings of our study may support neuroinflammation hypothesis in the etiology of ASD and the potential role of galectin-1 and galectin-3 as biomarkers.

Serum Zonulin and Claudin-5 but not Interferon-Gamma and Interleukin-17A Levels Increased in Children with Specific Learning Disorder: A Case-Control Study.

Background: Gut-blood and blood-brain barrier permeabilty (gut-brain axis) has been attracting increased attention in the etiology of neurodevelopmental disorders. In this study, we aimed to investigate serum levels of zonulin (a biomarker of intestinal permeability), claudin-5 (a biomarker of blood-brain barrier permeability), and interferon-gamma and interleukin-17A in children with specific learning disorder. Methods: Forty-three children with DSM-5 diagnosis of specific learning disorder and 43 healthy children were included in this study. Serum levels of zonulin, claudin-5, interferon-gamma, and interleukin-17A were measured using commercial enzyme-linked immunosorbent assay kits. Results: Serum zonulin and claudin-5 levels of the study group were significantly higher than the control group according to the multivariate analysis of covariance test while controlling for age, gender, and body mass index. However, serum interferon-gamma and interleukin-17A levels were not significantly different between the two groups. There was no correlation either between zonulin and interferon-gamma and interleukin-17A or claudin-5 and interferon-gamma and interleukin-17A. Conclusion: Gut-blood and blood-brain barrier permeability may be disrupted in subjects with special learning disorder. Further research is needed to determine whether zonulin and claudin-5 may be biomarkers, and some dietary interventions or specific agents such as zonulin or claudin-5 inhibitors could be used in the management of neurodevelopmental disorders including special learning disorder.

Fluoxetine Related Urinary Retention in a 15-Year-Old Girl: a Case Report.

Fluoxetine is an effective and safe agent frequently used in the treatment of childhood depression and obsessive-compulsive disorder. Urinary retention is defined as the inability to empty the bladder completely. Drug use is one of the most important factors in the etiology of urinary retention. Urinary retention is an uncommon side-effect of fluoxetine use. We report a case of chronic urinary retention during fluoxetine monotherapy in a 15-year-old girl, resolving following the discontinuation of treatment.

Serum Levels of Brain-Derived Neurotrophic Factor, Nerve Growth Factor, Neurotrophin-3, and Glial-Derived Neurotrophic Factor in Children with Specific Learning Disorder.

Introduction: Specific learning disorder (SLD) is a neurodevelopmental disorder that involves complex interactions of genetic, neurobiological and environmental factors, but the definite mechanisms remain mostly unknown. The possible role of neurotrophins has been implicated in the pathophysiology of various neurodevelopmental disorders. This study aimed to investigate whether serum levels of brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF), and neurotrophin-3 (NT-3) in children with SLD deviate from those of neurotypical brains. Methods: Forty-four patients with SLD and 44 healthy controls aged 7--12 years were included. SLD diagnosis and severity was determined using DSM-5-based interviews and SLD clinical observation battery. Serum neurotrophins were measured using enzyme-linked immunosorbent assay. Results: BDNF (p=0.032), NGF (p=0.029), and NT-3 (p=0.025) serum levels were significantly higher in the SLD group compared to the control group; however, serum levels of GDNF did not show any significant difference between groups. On the other hand, GDNF serum levels were significantly different between mild and severe SLD groups (p=0.007) and were lower in severe SLD subjects than in mild cases. There was also a significant correlation between patients' reading speeds and serum levels of GDNF (p=0.025), and GDNF serum levels were lower in patients with slower reading speeds. Conclusion: These findings suggest that neurotrophins might play a role in the pathophysiology of SLD. Increased serum levels of BDNF, NGF, and NT-3 might reflect compensatory attempts at neuroprotection against neurodevelopmental impairment.

Association between ocular trauma and attention-deficit/hyperactivity disorder in adult patients.

Purpose: To investigate the potential relationship between ocular trauma and attention-deficit/hyperactivity disorder (ADHD)-related clinical outcomes in adults. Methods: This prospective case-control study included 108 ocular trauma patients and 90 age-sex-matched healthy control. The ocular trauma group was separated into the subgroups home accident, outdoor activity, and work related in terms of the reasons for ocular trauma, and as ocular surface problems, blunt trauma-related, and open globe injury in terms of the clinical findings. The ADHD-related clinical outcomes were evaluated using the Wender-Utah Rating Scale (WURS). The outcomes were compared between ocular trauma and control groups, and ocular trauma subgroups. Results: The demographic characteristics of ocular trauma groups and controls were similar (P > 0.05, for all). In comparison to the control group, the ocular trauma group had higher total WURS score and WURS subscale scores, but not significantly (P > 0.05, for all). According to comparisons of the subgroups separated by the reasons, there was significant difference in the mean behavioral problems/impulsivity scores in favor of outdoor activities (P = 0.015). On the other hand, the mean scores for WURS subscales of the subgroups separated by the clinical findings were similar (P > 0.05, for all). Conclusion: WURS scores in ocular trauma patients are similar to control; however, the score in behavioral problems/impulsivity subscales is higher for ocular trauma caused by outdoor activities.