The analysis of child abuse and neglect cases assessed by a multidisciplinary study group between 2005-2008.

This study aimed to evaluate the diagnosis, treatment and follow-up of child abuse and neglect (CAN) cases. Subjects were 102 cases that were clinically assessed by the multidisciplinary hospital team. Early and late childhood cases (according to the age at first abuse) were compared by means of characteristics of abuse. Among the 102 subjects, 64 were female and 38 were male (mean age: 8.68 years). Being abused by someone within the family was found to be significantly higher in preschool children compared to children in late childhood. 27.5% (n: 28) of the cases concomitantly had low socioeconomic and educational level and high parental psychological problems and 64.8% had psychiatric problems. A limited number of studies have compared characteristics of early and late childhood abuse considering the age of onset of maltreatment. Consistent with the literature, our study showed that early age of onset of maltreatment is a poor prognostic factor in many ways.

Adjustment to life with metastatic cancer through psychodrama group therapy: A qualitative study in Turkey.

PURPOSE: This study describes the experiences of patients with metastatic cancer participating in psychodrama group therapy. DESIGN AND METHODS: This study was carried out at the cancer hospital of the university, Turkey. The sample consisted of patients with metastatic cancer who participated in 16 weekly psychodrama sessions of 3 h each. The study was analyzed using the NVivo 11 software, the sessions which summarize and code the interviews. FINDINGS: Five main themes were identified: Anxiety of death, coping strategies, psychological resilience, relieving suffering, and the meaning of life. PRACTICE IMPLICATIONS: Psychodrama can be used in patients diagnosed with metastatic and other types of cancer to cope with their psychosocial difficulties. Psychiatric nurses can play a leading role in this area.

Atopic features in early childhood autism.

BACKGROUND: Autism is a developmental disorder of unknown etiology. Sensitivity to dietary and environmental antigens has been considered in its pathogenesis. AIM: To examine immediate hypersensitivity in early childhood autism. METHODS: We investigated 30 autistic children (23 boys, seven girls 2-4 years old) for atopic history, serum IgG, IgA, IgM, IgE levels, and skin prick tests (SPT) with 12 common antigens. RESULTS: Nine/30 autistic children (30%) and 1/39 (2.5%) age-matched neurological controls from the same hospital had a family history suggestive of atopy (p<0.005). No patient in the autism and 28% in control group had symptoms of respiratory allergy (wheezing or asthma) (p<0.005), and 6/30 (20%) autistic vs. 7/39 (17%) control children had history suggesting other allergic disorders (p=ns). Eleven/23 (47.8%) autistic children had at least one positive skin test, similar to age-matched population controls. Serum IgG, IgA, and IgM levels were within age-appropriate limits. Serum IgE was elevated in four patients (13.3%). Specific IgE levels were negative in four cases with multiple SPT positivity. CONCLUSIONS: This study suggests allergic features based on history, skin tests, and serum IgE levels are not frequent in young autistic children despite family history. This discrepancy between predisposition and manifestation might imply immunological factors or environmental conditions.

[Psychopathology in the children of parents with bipolar mood disorder]. / Bipolar duygudurum bozuklugu olan anne babalarin çocuklarinda psikopatoloji.

OBJECTIVE: The aims of this study were to determine the rate of psychopathology in the children of parents with bipolar disorder and to examine the relationship between the psychopathology in these children and the characteristics of bipolar disorder in their parents. METHOD: The study included 36 children of 28 bipolar I parents and 33 children of 28 control parents, all between the ages of 6 and 17 years. The bipolar parents and all of the children were screened using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) and the Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (K-SADS-PL), respectively. The spouses of bipolar parents completed the Symptom Checklist-90-Revised (SCL-90-R) and the children completed the Parenting Style Scale (PSS). RESULTS: The rate of psychopathology was higher in the children of bipolar parents than in those of the control parents. Affective disorders and disruptive behavior disorders were observed with significantly greater frequency in the children of the bipolar parents. Attitudes in study group parents were related to the presence of psychopathology in their children. CONCLUSION: The results of this study suggest that children of bipolar parents have an increased risk of developing psychiatric disorders, especially affective disorders and disruptive behavior disorders. The children of bipolar patients need to be screened for psychiatric symptoms and referred for psychiatric assistance when necessary.

Demographic and clinical features of child abuse and neglect cases.

The aim of this study was to present child abuse and neglect (CAN) cases of the Child and Adolescent Psychiatry Department of Hacettepe University Faculty of Medicine. The charts of all the patients seen at the Child and Adolescent Psychiatry Clinic between 2000 and 2004 were screened regarding the presence of CAN. The mean age of the children was 10.9 years. The offender was generally an extra-familial acquaintance (40.7%). The most common type of abuse was sexual (77.8%) and the most common associated types of abuse were physical and sexual (7.4%). Attention deficit hyperactivity disorder (ADHD) was observed as the most common psychiatric diagnosis (22.2%). Abuse types in relation to age and gender of abused child, risk factors and associated psychopathologies are discussed. Issues related to legislative process and ecology of the abuse experience are mentioned as restrictions for the prevention and treatment of CAN.

The Behavior Rating Inventory of Executive Function and Continuous Performance Test in Preschoolers with Attention Deficit Hyperactivity Disorder.

OBJECTIVE: The aim of this study is to examine performance-based measures and behavioral ratings of executive functions (EF) as a component of preschool attention deficit hyperactivity disorder (ADHD). METHODS: Twenty-one 4-to-6-year-old children with ADHD and 52 children with no psychopathology, matched on age, gender, socioeconomic status, and parental education, were enrolled. Parents were interviewed with the use of The Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version. The Conners' Kiddie Continuous Performance Test (K-CPT) was administered to the children, and the Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and the Conners' Parent Rating Scale-Revised/Short Form (CPRS-R/S) were filled out by the parents. RESULTS: All BRIEF-P and CPRS-R/S scores, the K-CPT measures of inattention and impulsivity were higher in the ADHD group. The CPRS-R/S ADHD index was strongly correlated with inhibition and related indexes in the BRIEF-P and was moderately correlated with inattention measures in the K-CPT. CONCLUSION: The current study is one of the few to investigate the features of preschool ADHD with the use of behavioral ratings of EF and a performance-based measure. Our results suggest that the BRIEF-P was able to identify behavioral difficulties in inhibition and working memory and that the K-CPT identified difficulties indicating inattention. The findings of this study support the use of a combination of methods for a complete evaluation of preschoolers with inattentive and hyperactive/impulsive behavior, the application of rating scales for screening ADHD symptoms, and the measurement of behavioral correlates of EF, along with performance-based measures.

Developing and evaluating professionalism.

Professional behaviour, being one of the domains of professionalism, is an area of medical education that has long been of concern to medical educators. At Hacettepe University, our main goal is to have students become conscious of professional identity, values, responsibilities and the physician-patient relationship. We welcome our new students with an opening ceremony on their first day and two months later, the students start the course called "Health-Illness Concepts and Medical Professional Identity". Students are expected to discuss the subjects given to them as scenarios or arguments. The aim of our study is to determine whether the course leads to a positive change in students' attitudes, indicating the attainment of those attributes that reflect professionalism. On the first and the last days of the course, a questionnaire was delivered to the students. Any positive change in preferences between the two questionnaires is identified as an achievement of that attribute. As a result we found that in all of the seven attributes there were positive changes in the students' attitudes. Positive changes varied from 48% to 84% and all were statistically significant. Using more interactive techniques helped the students to make larger percentage changes in their awareness of these professional attributes.

[A case of Munchausen Syndrome by proxy in the context of folie a famille]. / Paylasilmis ailesel psikoz kapsamindabir "bakim verenin yapay bozuklugu" olgusu.

The occurrence of similar psychotic symptoms in two or more people is called shared paranoid disorder. In this disease, the person who exhibits psychotic symptoms first is the "primary patient". The symptoms are contracted by the other people through persuasion. This disorder is seen among people who share the same house or are emotionally bound. In some cases, shared paranoid disorder may include other diagnoses, such as Munchausen Syndrome. This report discusses the case of a six-year-old, sexually abused boy who, when admitted to the hospital at the age of 10, claimed to have been repeatedly sexually harassed by several different people. His family's frequent changes in hospitals, negative perceptions of and accusations against medical staff, and improper methods of responding to harassment led clinicians to a diagnosis of Munchausen by proxy syndrome. In addition, both parents believed the abuse story, suggesting a potential diagnosis of shared psychotic disorder. In the literature, Munchausen by proxy has rarely been reported with symptoms of sexual abuse. The psychotic symptoms were shared by the family, complicating the case. This report emphasizes that psychodynamic evaluations of Munchausen by proxy and shared psychotic disorder may be helpful in understanding underlying factors.

Establishment of interdisciplinary child protection teams in Turkey 2002-2006: identifying the strongest link can make a difference!

OBJECTIVES: The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS: A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS: Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS: A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS: Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.