Decreased right hippocampal volumes and neuroprogression markers in adolescents with bipolar disorder.

OBJECTIVES: The aim of the present study was to assess differences and correlations between the hippocampal volumes (HCVs), serum nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) levels in adolescents with bipolar disorder (BP) compared to healthy controls. METHODS: Using structural magnetic resonance imaging, we compared HCVs of 30 patients with euthymic BP who were already enrolled in a naturalistic clinical follow-up. For comparison, we enrolled 23 healthy controls between the ages of 13 and 19. The boundaries of the hippocampus were outlined manually. The BDNF and NGF serum levels were measured with the sandwich ELISA. RESULTS: The groups did not differ in the right or left HCVs or in the NGF or BDNF serum levels. However, negative correlations were found between the right HCVs and the duration of the disorder and medication and positive correlations were found between the duration of the medications and the NGF and BDNF levels in the patient group. Additionally, positive correlations were found between the follow-up period and left normalized HCVs in both the BP and lithium-treated groups. CONCLUSIONS: The right HCVs may vary with illness duration and the medication used to treat BP; NGF and BDNF levels may be affected by long-term usage. Further research is needed to determine whether these variables and their structural correlates are associated with clinical or functional differences between adolescents with BP and healthy controls.

Forensic child and adolescent psychiatry: from field experiences to education standards.

OBJECTIVE: Forensic evaluation of children is one of the most problematic areas of child and adolescent psychiatry. In this study we aimed to examine Turkish Child and adolescent psychiatrists' attitudes and problems in forensic psychiatry. METHOD: Thirty nine (80%) of all practitioners who are on their compulsory medical service programme countrywide were reached and requested to complete a questionnaire. RESULTS: 76.9% of the specialists found their education to be inadequate in dealing with practical issues. The most common reason of this inadequacy was endorsed as not receiving structured forensic evaluation training. The inadequate number or skills of health professionals from other disciplines and excessive workload were the leading factors mentioned as negatively affecting the quality of assessments. Most favoured solutions to solve current problems were reported as reorganising the residency training and curriculum of child and adolescent psychiatrists and establishing education programmes for other disciplines. CONCLUSION: The standardisation of forensic psychiatry education in child and adolescent psychiatry training and the establishment of global standards for forensic evaluation teams and processes should be considered as the first steps in enhancing the global quality of child and adolescent forensic psychiatric evaluations.

Increased hippocampal volumes in lithium treated adolescents with bipolar disorders: a structural MRI study.

BACKGROUND: Structural neuroimaging studies in bipolar disorder (BD) have consistently identified several anatomical abnormalities in many brain areas related to mood regulation. Hippocampus is one of the key components of emotional regulatory networks in the brain. Evidence about hippocampal changes in BD is quite limited and inconsistent particularly for adolescent onset BD. It is aimed to compare hippocampus volumes of euthymic BD-I adolescents with healthy controls using structural MRI. METHODS: Hippocampal volumes of seventeen youths between 13 and 19 age period with DSM-IV BD (seven boys) and twelve healthy comparison subjects (five boys) were compared using structural MRI. Differences in hippocampal volumes between groups were tested. RESULTS: There was no significant difference between the right and left hippocampus volumes of patients with BD and the control group. However boys tended to have significantly larger right hippocampal volumes than girls both in BD and control group. Right hippocampal volumes were enlarged in lithium treated bipolar patients. This enlargement is not related to sex. LIMITATIONS: Future, longitudinal follow-up studies need large enough sample sizes of both sexes and a sex-matched healthy comparison group to sort out developmental, gender and medication influences on brain structures over time in BD. CONCLUSIONS: Lithium treatment in adolescent-onset BD has a significant effect on hippocampus volumes.