The prevalence and risk factors for overweight/obesity among Turkish children with neurodevelopmental disorders.

OBJECTIVE: To compare the prevalence and correlates of overweight (OW) and obesity (OB) between autism spectrum disorder (ASD), intellectual disability (ID), and attention deficit-hyperactivity disorder (ADHD) and to investigate which variables significantly contribute to OW/OB in each group. METHODS: Of 267 cases (96 with ASD, 80 with ID, and 91 with ADHD) aged 2-18 years, body mass index (BMI) percentiles, birth weight, food reward usage, weekly screen and physical activity time, and psychotropics used were recorded. RESULTS: OB (OB + OW) prevalence was 22.9 % (36.4 %) in ASD; 22.5 % (40 %) in ID; and 17.6 % (27.5 %) in ADHD. Although the ADHD group had the highest rate of stimulant usage (χ2 = 69.605, p < 0.001), physical activity attendance (χ2 = 49.751, p < 0.001), and the lowest anti-psychotic (χ2 = 69.142, p < 0.001), and anti-depressant usage (χ2 = 7.219, p < 0.001) than ID/DD or ASD, BMI percentile of the participants did not differ between the groups (H(2) = 1.652, p = 0.43). In hierarchical logistic regression analysis, in ASD, food reward (OR = 4.65, 95 %Cl = 1.25-17.19) and the number of psychotropics used (OR = 2.168, 95 %Cl = 1.07-4.36) were significantly related to the risk of OW/OB. In ADHD, each drugs administered and a 1-kilogram elevation in birth weight was associated with a 4.09 and 2.82 increased risk for OW/OB. CONCLUSION: OW/OB is prevalent in children with neurodevelopmental disorders regardless of their diagnosis. Our findings showed that food rewards put a higher risk for OW/OB in ASD than administering a psychotropic. It could be better to use other positive reinforcements other than edible ones to prevent OW/OB in these children.

Psychological burden of pediatric primary immunodeficiency.

BACKGROUND: Primary immunodeficiency disorder (PID), being a chronic disorder, may increase the prevalence of psychopathologies, but there are few studies on the effect of disease-related factors on psychopathology in this population. The aim of this study was therefore to assess and compare three groups: children with PID who receive i.v. immunoglobulin treatment; children with juvenile idiopathic arthritis (JIA); and healthy controls with respect to their mental health status. METHODS: Forty-four children with PID, 32 children with JIA and 30 healthy controls, underwent psychiatric evaluation. The Childhood Depression Inventory and the screen for child anxiety-related emotional disorders questionnaire were completed by the participants. The child behavior checklist was completed by the mothers of the participants. In addition, disease-related factors were identified. RESULTS: The frequency of mood disorders between the three groups differed. There was no difference between the PID and JIA groups with respect to the prevalence of mood disorders and other psychopathologies. The disease-related factors were associated with the frequency of mood disorder in PID patients. CONCLUSION: The rate of psychopathology was similar in patients with PID and JIA and higher than the controls. Some of the disease-related factors were associated with the frequency of mood disorders in the PID patients.

Early Onset Schizophrenia Associated With Obsessive-Compulsive Disorder: Clinical Features and Correlates.

OBJECTIVES: Obsessive-compulsive disorder (OCD) is notably a comorbid disorder in patients with schizophrenia. This study aimed to evaluate clinical features and correlates of early onset patients with schizophrenia with OCD. METHODS: In the present study, we included 10 patients with both schizophrenia and OCD and 19 patients with schizophrenia without OCD. The mean antipsychotic doses the patients needed for treatment are standardized as chlorpromazine equivalent dose. RESULTS: The mean antipsychotic doses at first episode were 491 ± 376 mg/d in schizophrenia comorbid OCD group and 290 ± 209 mg/d in the schizophrenia without OCD group (P = 0.018). This significant difference was also found for the mean doses at the assessment for the study (512.40 ± 336.22 mg/d in schizophrenia comorbid OCD and 296.05 ± 147.25 mg/d in patients with schizophrenia without OCD, P = 0.012). There was no statistical difference in the mean scores of Clinical Global Impression and Positive and Negative Syndrome Scale between schizophrenia with and without OCD group, respectively. (Clinical Global Impression: 5 ± 0.66 vs 4.36 ± 0.83, P = 0.094; Positive and Negative Syndrome Scale: 67.60 ± 11.84 vs 69.84 ± 14.62, P = 0.573). CONCLUSIONS: Adolescents with schizophrenia and OCD needed more antipsychotic doses for acute exacerbation and the maintenance of reduction of psychosis severity than adolescents with only schizophrenia. We could suggest that OCD comorbidity in schizophrenia is more treatment resistant, although the severity of the schizophrenia was similar between study groups. There was no correlation between OCD and schizophrenia symptoms either.

The Psychometric Properties of Turkish Version of Autism Spectrum Screening Questionnaire in Children aged 6-18 years.

OBJECTIVE: The objective of this study is to determine the psychometric properties of the Turkish version of the Autism Spectrum Screening Questionnaire (ASSQ-TR) and to find the best cutoff score for Pervasive Developmental Disorder (PDD) cases. METHOD: Children between 6 to 18 years old with diagnoses of PDD, Obsessive Compulsive Disorder (OCD), and Attention Deficit Hyperactivity Disorder (ADHD) were included. The healthy control (HC) group was recruited from children who did not have any psychiatric complaints or history. Furthermore, parents of 268 children filled the ASSQ-TR. Of the children, 51 were PDD, 67 were ADHD, 50 were OCD, and 100 were HC. In order to show the reliability of the ASSQ-TR, Cronbach's alpha values and test-retest were evaluated. ROC analyses was carried out to show concurrent validity and to determine the cutoff score. RESULTS: The Cronbach's alpha of ASSQ-TR is 0,86, while the test-retest reliability is r: 0,98. Total ASSQ-TR scores of children with PDD (27,96±9,5) were significantly higher than other groups (p<0,001). ROC analysis of ASSQ-TR showed the area under curve to be 0,97 with a cutoff of 16, having the maximum sensitivity (94,1%), specificity (89,0%), and 90,7% diagnostic accuracy of PDD versus HC scores. CONCLUSIONS: Our pilot data showed that ASSQ-TR is a reliable instrument that successfully differentiates clinically diagnosed PDD from HC. This instrument might therefore be useful for the screening of PDD in school-aged children in Turkish populations.

Childhood sexual abuse and supportive factors.

BACKGROUND: Childhood sexual abuse (CSA) can be a devastating life experience and is associated with a higher incidence of mental disorders and suicide attempts. The aim of this study was therefore to identify predictors of mental disorder and suicide attempt in children and adolescents with a history of CSA. METHODS: A total of 181 Turkish children and adolescents with a history of CSA were evaluated for age, gender, suicide attempts, family relationships and educational background. Abuse involving the insertion of an organ or foreign object into the individual's body was designated as "qualified sexual abuse" (QSA); other forms of sexual abuse were designated "basic sexual abuse" (BSA). RESULTS: Suicide attempts were significantly higher in adolescent girls in the QSA subgroup; age, gender, family integrity, and school attendance were not associated with risk of mental disorders in this group. Among BSA patients, family integrity was significantly associated with suicide attempts. Suicide attempts were approximately 10-fold higher (OR, 10.154; 95% CI: 2.020-51.051; P = 0.005) in children from broken families. Family integrity and school attendance were also noted as weak protective factors against mental disorders in BSA patients. The incidence of mental disorders was 3.5-fold higher in children who had not been attending school (OR, 3.564; 95% CI: 1.379-9.211; P = 0.009). CONCLUSION: Family integrity and school attendance were weakly related with psychopathology (e.g. mental disorders or suicide attempts) in BSA survivors but not in QSA survivors. Female gender and puberty also increased the likelihood of suicide attempt in QSA survivors.

[Evaluation of a Neuropsychiatric Disorder: From PANDAS to PANS and CANS]. / Nöropsikiyatrik Bir Hastaligin Evrimi: PANDAS'tan PANS ve CANS'a.

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) syndrome is a disorder seen before adolescence that possesses an abrupt onset of obsessive-compulsive disorder symptoms and/or tics. Swedo and colleagues defined this disorder in 1998 as a syndrome related to Group A streptoccoccus (GAS) infection with neurological issues, such as motor hyperactivation and choreiform movements. The progress of the disorder may be described as wax-and-waning, apart from abrupt onset, and this relapse and remission course is associated with exacerbating infections, according to the creators of PANDAS syndrome. Ruling out of Rheumatoid Fever and Sydenham's Chorea was a necessity for making a proper diagnosis. Since the recognition of this syndrome, clinicians encountered many children who could not fulfill all 5 criteria, which must be met for PANDAS diagnosis. In addition, due to literature showing failure and lack of strong evidence of a major role of GAS, the newly-defined categories PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and CANS (Childhood Acute Neuropsychiatric Syndrome) were created to encompass those of "almost met" non-PANDAS cases. PANS and CANS include concurrent significant psychiatric symptoms with abrupt onset of OCD symptoms and/or tics but do not require identification of any infection agent, immune dysfunction, or enviromental precipitants. In this paper, we aimed to discuss PANS/ CANS, alterations of PANDAS, and diagnoses in which "almost met" PANDAS patients should be classified on the basis of a case who developed an abrupt onset of anxiety, obsessions, and vocal tics.

Risperidone, quetiapine and chlorpromazine may have induced priapism in an adolescent.

Priapism is the prolonged, painful erection of penile tissue not accompanied by sexual arousal. Priapism has been established as a rare adverse drug reaction to drugs such as antipsychotics, psychostimulants, antidepressants, and mood stabilizers. Immediate intervention is needed to prevent destructive and irreversible complications, such as erectile dysfunction, disfigurement, inability of the penis to stay erect, and related social/emotional problems. Antipsychotic-induced priapism may result from the alpha receptor occupancy property of those drugs. We report the case of a 13-year-old suffering from attention deficit-hyperactivity disorder plus conduct disorder with priapism related to antipsychotics. Episodes occurred with risperidone plus methylphenidate, quetiapine plus methylphenidate, and chlorpromazine alone.

Determination of school-related problems in children treated for cancer.

This descriptive and case-control study was carried out in a pediatric oncology outpatient clinic to determine the school-related physical, social, and psychological problems and problems experienced in academic achievement of children treated for cancer. The sample of the study consisted of 56 Turkish patients with cancer, aged 7-18 years, who were in remission and attending school as well as their parents, a control group of patients who did not have cancer, and their teachers. A Child Information Form, a Child Health Questionnaire Parent's Form of 50 questions, a Behavior Evaluation Scale for Children, and Young People and a Teacher's Report Form were used as data collection tools in the study. Of the children, 30.3% experienced various physical difficulties stemming from cancer therapy that affected their school life. The number of late enrollments, the number of children repeating a grade, and the rates of school absenteeism were also found to be higher in the survivors than in the controls.

Broader autistic phenotype in parents of children with autism: Autism Spectrum Quotient-Turkish version.

AIMS: The Autism Spectrum Quotient (AQ) is a self-assessment screening instrument for measuring the degree to which an individual of normal intelligence shows autistic traits. Genetic factors could be responsible for the relatives of individuals with autism exhibiting higher than normal rates of autism-related impairments, referred to as the 'broader autism phenotype' (BAP). The aim of this study was to test whether there is a difference between the parents of autistic and those of typically developing children (TDC) on AQ scores in a Turkish sample. METHOD: The AQ total and subscale scores of the 100 parents (47 fathers, 53 mothers) of children with autistic disorder (AD) were compared with the 100 parents (48 fathers, 52 mothers) of TDC. RESULTS: The parents of AD children scored significantly higher than the TDC parents on total AQ score, and two of five subscale scores; social skills, and communication. The other three subscales (attention to detail, attention switching, imagination) did not differentiate groups. There was no significant difference between mothers and fathers on any AQ scores, neither in the AD nor TDC group. The group × gender interaction was not significant on the total or the five subscale scores of AQ. CONCLUSION: Social skill and communication subscales differentiate AD parents more successfully, and are more sensitive, as reported in other studies. The present findings confirm that social skill and communication impairments in parents of children with autism spectrum disorders are indicators of BAP.

Psychiatric approaches for disorders of sex development: experience of a multidisciplinary team.

OBJECTIVE: Disorders of sex development (DSD) are a group of congenital medical conditions that affect life as a whole. In this study, we aimed to reflect the experience of a multidisciplinary team in the clinical/psychiatric follow-up of a group of children and adolescents with DSD. METHODS: The study group consisted of 51 patients diagnosed with DSD. The Kiddie-Schedule for Affective Disorders and Schizophrenia, Wechsler Intelligence Scale for Children-Revised, Draw a Person Test and Children's Apperception Test, and the Clinical Global Impression Scale (CGIS) were used for psychiatric evaluations. RESULTS: The mean age of the patients was 7.8 years (median: 7.8; min: 1.0; max: 18.0). Genetic evaluation showed 46,XX configuration in 15 patients (29.4%) and 46,XY in 35 (68.6%). One patient (2.0%) was diagnosed to have a sex chromosome disorder. Forty patients (78.4%) had no problems with their given gender identity and gender role. Thirty-four (66.7%) patients had normal intellectual capacity. Twenty-eight (54.9%) patients did not have any psychiatric problem. Depression, anxiety disorders, attention deficit/hyperactivity disorder, and adjustment disorders were the common diagnoses. The mean score of symptom severity on CGIS-severity-baseline was 6.15±0.68 and after one year, it was 1.46±0.51 (Z=-3.236 p=0.001). The mean score of CGI-Improvement was 1.23±0.44. CONCLUSION: It is important to identify and treat the psychiatric disorders encountered in patients with DSD. A psychiatrist needs to be included in the professional team following these patients. Examination and observation results need to be shared by holding periodic team meetings to establish a wholesome point of view for every unique child.

Depression and anxiety levels of the mothers of children and adolescents with left ventricular assist devices.

VADs have been used to provide treatment for end-stage heart failure. Parents may feel overwhelmed with the VAD regimes responsibility and be affected from this process beside children. In this study, we aimed to evaluate the depressive and anxiety symptoms of mothers of the first eight children equipped with a VAD in Turkey. The mothers of eight pediatric patients living with VADs were filled BDI and STAI at first month of VAD implantation (E.I) and secondly six months after their first evaluation (E.II). In E.I, the BDI mean score of mothers was 20.87, in E.II 14.37. STAI-S mean score was 53.37 in E.I and 43.62 in E.II. The Wilcoxon nonparametric-paired t-test revealed significant difference between baseline and end-point STAI-S scores (Z: -2.035; p: 0.042), and for BDI scores (Z, -1.965; p, 0.049). Prolonged usage of VAD may increase distress in parents. Psychiatric evaluation and support of the primary caregiver is important for the well-being of the pediatric patients.

Psychiatric evaluation of children and adolescents with left ventricular assist devices.

OBJECTIVES: To evaluate the psychiatric symptoms of children equipped with a ventricular assist device (VAD) and follow them up for 6 months. With the shortage of donor hearts available for the treatment of end-stage heart failure, VADs have been used to provide temporary treatment until a heart becomes available. VADs provide external sources of power for mechanical circulatory support and are capable of sustaining life over weeks and months. This study provides preliminary details about the psychiatric symptoms and disorders of the first eight children equipped with a VAD in Turkey. METHODS: Eight pediatric patients who recently underwent VAD implantation, aged 1 to 16 years, were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia, Child Behavior Checklist, Children's Depression Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory for Children and followed up for 6 months. RESULTS: In the first evaluation, five participants had a psychiatric disorder diagnosis. Two patients had adjustment disorder with depressive and anxiety symptoms; one had anxiety disorder, not otherwise specified; and two had major depressive disorder. The anxiety and depressive symptom levels in questionnaires were consistent with psychiatric diagnoses. Two patients had heart transplantation during the follow-up period. CONCLUSIONS: To determine and treat psychiatric symptoms and disorders at an earlier stage, it is important for children and adolescents with a VAD and those who have undergone heart transplantation to be evaluated by a multidisciplinary consultation liaison team including psychiatrists, psychologists, consultant nurses, and counselors.

Clinical overview of children with mucopolysaccharidosis type III A and effect of Risperidone treatment on children and their mothers psychological status.

Mucopolysaccharidosis IIIA (MPS IIIA) is a lysosomal storage disorder characterized by progressive mental deterioration and severe behavioral problems. We conducted an open-label, crossover study of the efficacy and safety of Risperidone on behavioral disorder in children with MPS IIIA. A total of 12 patients (5.5+/-2.2 years) with enzymatic diagnosis of MPS IIIA were randomly assigned to receive Risperidone (0.125-2mg/d) for 6 months. The hyperactivity and disruptive behavior level of children before and after treatment was evaluated regarding the scores from Turgay DSM IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S). Clinic Global Impression Scale - Severity (CGIS-S) was used for all cases for determining the psychiatric disorder severity. The anxiety and depression levels of mothers before and after treatment were evaluated using Hamilton Anxiety Scale (HAM-A) and Beck Depression Inventory (BDI). The adverse effects were evaluated by monitoring weight, serum prolactin, glucose and lipid levels. The response to the treatment was measured by decrease in values of CGI-S (from 6+/-1.12 to 2.91+/-0.66, p=0.001). According to T-DSM-IV-S scores the best improvement was observed in hyperactivity scores (16.25+/-8.57/11.58+/-7.26, p=0.001), followed by opposition/defiance (6.66+/-5.92/5.08+/-4.88, p=0.032), and conduct disorder scores (1.00+/-1.85/0.41+/-.99, p=0.67). No clinically relevant elevations in weight and serum prolactin, glucose or lipid levels have been documented (p>0.05). There was a significant decrease in anxiety and depression scores of mothers (HAM-A: 20.33+/-8.28/17.91+/-6.89, BDI: 23.58+/-7.14/20.5+/-5.93, p<0.001). To our knowledge, research on the pharmacological treatment of MPS IIIA with Risperidone has not been reported. According to our data, Risperidone appeared to be safe and effective in MPS IIIA patients.

[Temperamental characteristics of mothers of preschool children with separation anxiety disorder]. / Ayrilma Anksiyetesi Bozuklugu Olan Okul Oncesi Yas Grubu Cocuklarin Annelerinin Mizaç Ozellikleri.

OBJECTIVE: It is reported that there are many risk factors for the development of separation anxiety disorder (SAD) in children and adolescents. One of the most important factors is the mother-child relationship. It is thought that the temperamental characteristics of the mother have an important role to play in the quality of this relationship. The present study aimed to determine the temperamental characteristics of mothers whose preschool children were diagnosed with separation anxiety disorder. METHOD: The study included 60 mothers of children with separation anxiety disorder (diagnosed between 4 and 7 years of age) and 60 mothers of healthy children who were matched by sociodemographic factors with children with SAD. All cases were evaluated with a sociodemographic form, the Child Behavior Check List (CBCL) and The Temperament Evaluation of Memphis, Pisa, Paris and San-Diego Auto questionnaire (TEMPS-A). RESULTS: Mean age of the children (32 female, 28 male) was 5.12+/-.0.85 years. The children with an anxiety disorder had higher behavioral problem CBCL scores than the control group. The mothers of the children with anxiety disorders had higher depressive, cyclothymic, irritabl and anxious temperament scores than the control group mothers. CONCLUSION: The mothers of the children with separation anxiety disorder had higher scores on depressive, cyclothymic, irritability and anxious temperament scores than the control group mothers. We think that this study can be used to inform future community based, prospective studies.

Theory of mind and verbal working memory deficits in parents of autistic children.

The objective of this study was to investigate the potential values of executive function and social cognition deficits as endophenotypes of autism. While theory of mind (ToM) is generally accepted as a unitary concept, some have suggested that ToM may be separated into two components (mental state reasoning and decoding). In this study, both aspects of ToM and verbal working memory abilities were investigated with relatively demanding tasks. The authors used a neurocognitive battery to compare the executive function and social cognition skills of 76 parents of autistic probands with 41 parents of healthy children. Both groups were matched for IQ, age and gender. Index parents had verbal working memory deficits. They had also low performance on a mental state reasoning task. Index parents had difficulties in reasoning about others' emotions. In contrast to findings in the control group, low performance of mental state reasoning ability was not associated with working memory deficit in index parents. Social cognition and working memory impairments may represent potential endophenotypes, related to an underlying vulnerability for autistic spectrum disorders.

Social and emotional outcomes of child sexual abuse: a clinical sample in Turkey.

Childhood sexual abuse is a traumatic life event that may cause psychiatric disorders such as posttraumatic stress disorder and depression. During 2003-2004, 20 sexually abused children were referred to the Child and Adolescent Psychiatry Clinic of Ege University in Izmir, Turkey. Two years later, the psychological adjustment of these children (M age = 9.4 years, SD = 3.63 years, range = 5 to 16 years) is evaluated. Semistructured interviews, a form for the sociodemographic characteristics, are used for evaluations by a child psychiatrist who is blind to the first evaluation. It is determined that sexually abused children have more psychiatric disorders within the first year than 2 years later. However, some behavior problems occur at both short-term and long-term follow-ups.

[Sexual behavior and sources of information about sex among male adolescents: An 8-year follow-up]. / Erkek ergenlerde cinsel davranis ve cinsel bilgi kaynaklari: Sekiz yil arayla degerlendirme.

OBJECTIVE: This study aimed to determine the changes over time in sexual attitude and behavior among adolescents, and to measure the effect of sources information about sex on these changes. METHOD: This study was conducted in 2 stages, the first in 1996 and the second in 2004. In all, 392 male tenth grade students (150 in the first stage and 242 in the second stage) were evaluated. A personal information questionnaire developed by the authors was used to collect sociodemographic data, including sexual behavior, sexual attitude, and sources of information about sex. RESULTS: The findings show that there was a significant increase in intercourse and flirting behavior from 1996 to 2004, although no significant difference in masturbation was observed. Additionally, the number of male adolescents that reported family and pornographic films as their sources of information about sex increased 1.6-fold and 2.9-fold, respectively. A significant relationship between watching pornographic films and engaging in sexual intercourse was noted. CONCLUSION: The number of male adolescents age mean 16, engaging in sexual intercourse increased between 1996 and 2004. Pornographic films were observed to be the most common source of information about sex and also predicted the probability of adolescents having sex. Findings that indicate the need for better and more accurate sources of information about sex. The availability of good quality information about sex is critical to the development of the sexual identity and mental health of male adolescents.