Socio-legal consequences of Tourette Syndrome and its comorbidities: A case study and review of the literature.

Tourette Syndrome is a neurodevelopmental disorder that is associated with the presence of multiple motor and one or more verbal tics. In this case report, we present a 16 years old Tourette syndrome patient who was diagnosed with comorbid Attention Deficit Hyperactivity Disorder. The patient was evaluated for legal responsibility after she made untrue allegations saying that a bus driver had sexually harassed her. We summarize the case and review the current literature to assess the socio-legal aspects of Tourette syndrome.

New Formulations of Stimulants: An Update for Clinicians.

In the last 15 years, there has been a marked increase in the number of available stimulant formulations with the emphasis on long-acting formulations, and the introduction of several novel delivery systems such as orally dissolving tablets, chewable tablets, extended-release liquid formulations, transdermal patches, and novel "beaded" technology. All of these formulations involve changes to the pharmaceutical delivery systems of the two existing compounds most commonly employed to treat attention-deficit/hyperactivity disorder (ADHD), amphetamine (AMP) and methylphenidate (MPH). In addition to these new formulations, our knowledge about the individual differences in response has advanced and contributes to a more nuanced approach to treatment. The clinician can now make increasingly informed choices about these formulations and more effectively individualize treatment in a way that had not been possible before. In the absence of reliable biomarkers that can predict individualized response to ADHD treatment, clinical knowledge about differences in MPH and AMP pharmacodynamics, pharmacokinetics, and metabolism can be utilized to personalize treatment and optimize response. Different properties of these new formulations (delivery modality, onset of action, duration of response, safety, and tolerability) will most likely weigh heavily into the clinician's choice of formulation. To manage the broad range of options that are now available, clinicians should familiarize themselves in each of these categories for both stimulant compounds. This review is meant to serve as an update and a guide to newer stimulant formulations and includes a brief review of ADHD and stimulant properties.

Social communication disorder: a narrative review on current insights.

Social communication disorder (SCD) is a novel diagnosis listed under the rubric of communication disorders within the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) and it is reported to be characterized by impairment in use of verbal and nonverbal communication for social aims. This review attempts to summarize the current understanding of the SCD concept along with its evolution and presents data from previous studies conducted. Suggestions for further research are also delineated. As listed in DSM-5, the criteria for this novel diagnosis are vague, display elevated comorbidity with other neurodevelopmental disorders and other childhood psychopathologies, and show partial overlap with autistic spectrum disorders both in terms of genetics and family histories. Data on cross-cultural presentations and temporal stability are also limited. The social communication model proposed by Catani and Bambini may help integrate the neurobiological findings pertaining to SCD. Valid and reliable assessment methods need to be developed for SCD. This may involve either development of novel instruments capturing the DSM-5 criteria or application of statistical methods such as item response theory to existing instruments. The relationships between broad autism phenotype, pragmatic language impairment, nonverbal learning disorder, learning disorders, autistic spectrum disorders, and SCD should be evaluated with further studies.

Understanding the associations between psychosocial factors and severity of crime in juvenile delinquency: a cross-sectional study.

PURPOSE: Juvenile delinquency is a serious and common problem. To date, several studies have focused on possible psychosocial risk factors for delinquency among youths and on the implications of childhood mental illness on child criminality. However, the literature on prevalence of psychopathology and predictors of crime severity among delinquent youths in Turkey is sparse. Therefore, the aim of this study was to show the associations between crime severity and psychosocial factors such as gender, age, criminal history, concomitant attention deficit hyperactivity disorder (ADHD) and other comorbid psychiatric conditions, along with behavioral problem domains of Child Behavior Checklist (CBCL). PARTICIPANTS AND METHODS: This analytical cross-sectional study sample consisted of 52 individuals (30 females and 22 males) who were sent to a pilot detention facility in Istanbul, Turkey. The participants' age ranged from 8 to 18 years (M =13.4; SD =2.9). Self-rating scales were administered in an interview format, and the crime severity information was provided by participants' admission documents. RESULTS: No differences were found in terms of gender, age, children's past history of crime and substance abuse. However, family crime history was significantly higher in the high severity crime group (P=0.026). Having one or more comorbid psychiatric disorder was associated with high crime severity (P=0.018). The most common psychiatric disorders were found to be ADHD, oppositional defiant disorder, conduct disorder (CD) and anxiety disorder. CONCLUSION: Findings suggest that a family history of crime comes across as a very strong predictor of severity of crime. Among psychiatric factors, ADHD and CD were associated with commitment of more severe crimes in delinquent youths in our sample. Anxious/depressed traits as depicted by CBCL are found to be associated with less severe crimes.

Factors predicting treatment adherence in patients with adult attention-deficit/hyperactivity disorder: a preliminary study.

This study aimed to elicit patient- and treatment-related factors that can potentially predict treatment adherence in adult ADHD. Subjects who were over 18 and received a diagnosis of ADHD were included in the study. Chart review data of 102 subjects regarding demographics, medications, comorbidities, concomitant medications and domains of functional impairment were collected, and predictors were assessed using a binominal logistical regression model. One hundred and two patients (78.4 % male) with a mean age of 28.8 (SD = 9.8, range = 18-55) years were enrolled in the study. Childhood diagnosis of ADHD, agents used for treatment (MPH or atomoxetine), individual domains of dysfunction and use of additional psychotropic drugs were not found to be related to treatment adherence. Patients with a university education and those referred for family history of ADHD were more likely to adhere to treatment (p = 0.05 and 0.03, respectively). On the other hand, reasons for referral other than ADHD were significantly more frequently related to non-adherence (p = 0.02). Treatment noncompliance remains a significant problem despite therapeutic effects of medications. Identification of predictors of non-adherence can lead to heightened awareness of special populations at risk. We have found that prior awareness on ADHD (via past history/media/friends) leading to self/clinician referral to rule out ADHD and pervasiveness of symptoms across functional domains led to better compliance in our sample. Future research with prospective design utilizing objective tools for adherence is required.

Sociodemographic and Clinical Features of Disruptive Mood Dysregulation Disorder: A Chart Review.

OBJECTIVE: Disruptive mood dysregulation disorder (DMDD) is a novel diagnosis listed in Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) to encompass chronic and impairing irritability in youth, and to help its differentiation from bipolar disorders. Because it is a new entity, treatment guidelines, as well as its sociodemographic and clinical features among diverse populations, are still not elucidated. Here, DMDD cases from three centers in Turkey are reported and the implications are discussed. METHODS: The study was conducted at the Abant Izzet Baysal University Medical Faculty Department of Child and Adolescent Psychiatry (Bolu), and American Hospital and Bengi Semerci Institute (Istanbul) between August 2014 and October 2014. Records of patients were reviewed and features of patients who fulfilled criteria for DMDD were recorded. Data were analyzed with SPS Version 17.0 for Windows. Descriptive analyses, χ(2) test, and Mann-Whitney U test were used for analyses. Diagnostic consensus was determined via Cohen's κ constants. p was set at 0.01. RESULTS: Thirty-six patients (77.8 % male) fulfilled criteria for DMDD. κ value for consensus between clinicians was 0.68 (p = 0.00). Mean age of patients was 9.0 years (S.D. = 2.5) whereas the mean age of onset for DMDD symptoms was 4.9 years (S.D. = 2.2). Irritability, temper tantrums, verbal rages, and physical aggression toward family members were the most common presenting complaints. CONCLUSIONS: Diagnostic consensus could not be reached for almost one fourth of cases. Most common reasons for lack of consensus were problems in clarification of moods of patients in between episodes, problems in differentiation of normality and pathology (i.e., symptoms mainly reported in one setting vs. pervasiveness), and inability to fulfill frequency criterion for tantrums.

The comorbidity of reduplicative paramnesia, intermetamorphosis, reverse-intermetamorphosis, misidentification of reflection, and capgras syndrome in an adolescent patient.

Delusional misidentification syndromes may be superimposed on neurological or psychiatric disorders and include delusional beliefs that the people, objects, or places around the patient change or are made to change with one another. In this paper, an adolescent patient displaying Capgras syndrome, metamorphosis, reverse-intermetamorphosis, misidentification of reflection, and reduplicative paramnesia was presented. The findings that our patient struggled with visuospatial tests applied in the acute phase as well as the observation that she refused to meet her family face-to-face while accepting to speak on the phone may support the role of right hemisphere and visuospatial functions in the development of those syndromes. Further studies or case series evaluated more extensively are needed to reveal the relationship between right hemisphere functions and delusional misidentification syndromes.

DNA-binding ability of NF-kappaB is affected differently by ERalpha and ERbeta and its activation results in inhibition of estrogen responsiveness.

Estrogenic effects involve interactions between estrogen receptors (ERs), response elements, and nuclear proteins. It is hypothesized that interaction between ER and NF-kappa B may affect the regulation of responsive genes. Electrophoretic mobility shift assay (EMSA) was performed to assess if the interaction of ERs and NF- kappaB affect their respective DNA-binding activities, and alkaline phosphatase assay was done to evaluate estrogenic activity. EMSA revealed that ERs inhibit DNA-binding of p50 and p65, whereas p50 did not impair ER alpha binding. Stimulation with estradiol inhibited DNA binding of NF-kappaB in ERalpha-transfected endometrial stromal cells (ESCs). Moreover, activation of NF-kappaB significantly decreased estrogen responsiveness of Ishikawa cells and ERalpha-transfected ESC. Our results suggest that ERs downregulate NF-kappaB-dependent gene activation by directly preventing DNA binding. However, NF-kappaB-mediated inhibition of ER-dependent gene activation may be carried out indirectly rather than through a direct inhibition of ER-DNA binding. These findings offer new insight into the specific role of ERalpha and could eventually help in developing therapeutics for endometriosis.

Riluzole augmentation in treatment-resistant obsessive-compulsive disorder: an open-label trial.

BACKGROUND: Most patients with obsessive-compulsive disorder (OCD) show only partial reduction of symptoms with standard therapy. Recent imaging data suggests glutamatergic dysfunction in the corticostriatal pathway in OCD. We investigated the efficacy of augmentation therapy with riluzole, a glutamate-modulating agent, in treatment-resistant OCD. METHODS: Thirteen patients aged between 18 and 65 years with a primary diagnosis of OCD that had proven resistant to standard treatment were treated with the addition of riluzole to their existing pharmacotherapy. Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression Inventory (HAM-D), and Hamilton Anxiety Inventory (HAM-A) scores were obtained weekly. RESULTS: Thirteen treatment-resistant OCD patients received riluzole 50 mg twice a day. Y-BOCS scores improved significantly over time. Of 13 patients, 7 (54%) demonstrated a >35% reduction in Y-BOCS scores, and 5 (39%) were categorized as treatment responders. HAM-D and HAM-A scores for the group also significantly improved over time. Riluzole was well tolerated with no serious adverse effects noted. CONCLUSIONS: Riluzole appears to have significant antiobsessional, antidepressant, and antianxiety properties. The addition of this agent may be of practical clinical benefit in patients with OCD.