Comparison of mothers of adolescents diagnosed with type 1 diabetes mellitus and mothers of healthy adolescents in terms of difficulty in emotion regulation, depression and anxiety levels and clinical variables.

BACKGROUND: The aim of our study was to evaluate the difficulty in emotion regulation, depression and anxiety levels of mothers with a child diagnosed with type 1 diabetes mellitus (T1DM) compared to mothers of the non- T1DM control group. METHODS: Our study included 72 adolescents followed up with T1DM and 72 healthy adolescents and their mothers. Psychiatric evaluation of children was performed according to DSM-IV diagnostic criteria. All mothers were administered the `Difficulties in Emotion Regulation Scale-Brief Form (DERS-16)` and the `Hospital Anxiety-Depression Scale (HAD)`. RESULTS: The most common psychiatric diagnoses in the T1DM group were attention deficit and hyperactivity disorder and anxiety disorders. The total and subscale scores of the DERS-16 and HAD scales of the mothers in the T1DM group were significantly higher than the control group. There was a statistically significant positive correlation between the DERS-16 total score and the HAD total and subscale scores of the mothers in the T1DM group. In the multivariate model found to be significant (p < 0.001), only HbA1c levels an indicator of metabolic control, had significant and negative effects on emotion regulation, anxiety and depression (p < 0.05), while sociodemographic characteristics did not have a significant effect (p > 0.05) Conclusions. Difficulty in emotion regulation and depression-anxiety levels were found to be higher in mothers of adolescents with T1DM compared to the control group. Difficulties in emotion regulation, depression and anxiety symptoms in the parent may reduce the treatment compliance of the adolescent with T1DM, which may result in worse metabolic control. Therefore, both adolescents and their parents should be evaluated in terms of psychiatric symptoms and necessary guidance should be given.

Childhood Non-verbal Communication Scale (CNCS): Turkish Adaptation and Psychometric Properties.

Introduction: Nonverbal communication (NC) skills develop dramatically during the first year of life. Especially in children with Autism Spectrum Disorder (ASD), inadequacies in these skills in the early period negatively affect language development later. Therefore, early recognition of ASD symptoms is the first step in the diagnosis. The test to screen ASD at the earliest age is the Modified Checklist for Autism in Young Children/M-CHAT in Turkey. However, this test can be used for 18 months or later. In the present study, we aimed to adapt the Childhood Nonverbal Communication Scale (CNCS) to Turkish, which was developed in Iran to evaluate NC skills in children from birth to 18 months and determine psychometric properties. Methods: This cross-sectional and methodological study was conducted in 3 provinces and included 323 parents of children who are normally hearing and 3-18 months old. Sociodemographic form, Ankara Development Screening Inventory, CNCS-Turkish form, and LittleEARS Auditory Questionnaire were applied. Results: CNCS Turkish form consisting of 37 questions shows a two-factor structure. The reliability coefficient of the 37-item scale is highly reliable (KR-20=0.937). It also had good convergent validity based on a significant correlation between total scores and LittleEARS results (r=0.804, P<0.001). According to the normative curve plotted by the CNCS total score for age, NC skills progressed with a steep slope from 3 to 12 months and then progressed gradually until 18 months. Conclusions: Childhood Nonverbal Communication Scale (CNCS) is a promising tool showing good validity and reliability in Turkish.

Relationship between insight level and clinical and familial features in pediatric obsessive-compulsive disorder.

OBJECTIVE: The aim of this study was to explore the relationship between insight level and clinical and familial psychiatric features of children with obsessive-compulsive disorder (OCD). METHODS: Children's Yale-Brown Obsessive-Compulsive Scale-Symptom Checklist, 11th item of the Children's Yale-Brown Obsessive-Compulsive Scale, Wechsler Intelligence Scale for Children Revised Form, Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version 1.0, and Structured Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders-IV Axis I Disorders were applied to 92 pediatric OCD patients. RESULTS: In this study, the prevalence of OCD in the first children of the family was high (41.3%), and low insight was significantly related with concomitant intellectual disability (p=0.003). The level of insight was high in patients with comorbid OCD spectrum disorders (p<0.001). Attention deficit and hyperactivity disorder (ADHD) was the most common psychiatric diagnosis accompanying OCD (19.5%). Among the obsession-compulsion subscales, the symmetry/hoarding was higher in males (p=0.046). OCD patients with a family history of major depressive disorder (MDD) had high ADHD comorbidity rates (p=0.038). In OCD patients, whose family had psychiatric disorders besides MDD and anxiety disorders, the diagnosis rate of intellectual disability was higher than other diagnoses (p<0.001). CONCLUSION: The sociodemographic, clinical, and familial features of pediatric OCD patients cannot be adequately clarified if the patient has limited insight. Therefore, the insight of children with OCD should be considered a range or continuity.

The Effect of Drug Use, Body Mass Index and Blood Pressure on Oxidative Stress Levels in Children and Adolescents with Attention Deficit and Hyperactivity Disorder.

Objective: The aim of this study was to determine the correlation between clinical variables such as body mass index, blood pressure, drug use and oxidative stress level in children and adolescents with attention deficit and hyperactivity disorder (ADHD). Methods: Total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), malondialdehyde (MDA) and superoxide dismutase (SOD) activity were measured in the serum of 51 patients (38 male, 13 female) diagnosed with ADHD according to DSM-5 diagnostic criteria and 32 control subjects (12 male, 20 female). The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version was applied to all participants. Results: The mean TOS, OSI, MDA values were determined to be significantly higher (p < 0.001) and the mean SOD value was lower in the ADHD group (p < 0.001). Multivariate regression analysis indicated significantly lower SOD and diastolic blood pressure values and significantly higher MDA in the ADHD group compared to the control group (p < 0.01). Low SOD (sensitivity 90.2%, specificity 78.0%) and high MDA (sensitivity 86.3%, specificity 81.2%) were determined to be predictive parameters for diagnosing ADHD. In univariate analysis, the mean TOS, OSI and SOD values were higher in ADHD patients under medication, while the mean TAS was higher in patients not using medication (p < 0.01). Only TOS was significant in multivariate logistic regression analysis (p < 0.01). Conclusion: The results of this study demonstrate that impaired oxidative balance may play a role in the etiology of ADHD.

An Evaluation of Anxiety Disorder and Emotion Regulation Difficulty in Children and Adolescents with Alopecia Areata.

Context: The relationship between alopecia areata (AA) and emotion regulation difficulty has not yet been fully explained. Aims: The aim of the study was to investigate the levels of anxiety and emotion regulation difficulty in children diagnosed with AA. Settings and Design: This case-control study was done in the university setting. Methods: Behavioral tests measuring anxiety and emotion regulation difficulties, and the measures assessing AA severity were applied to 32 AA patients consulted at Dermatology Clinic of Yozgat Bozok University. A control group was formed of 36 healthy children. Statistical Analysis Used: Kolmogorov-Smirnov normality test, Mann-Whitney U test and Pearson's and Fisher's Chi-square tests and Spearman's correlation test. Results: Evaluation was made of a total of 68 subjects (32 patients, 36 healthy subjects). The Difficulties in Emotion Regulation Scale (DERS)-total score and the DERS-clarity subscore were statistically significantly higher in the control group than in the patient group (P = 0.021, P = 0.003, respectively). No significant difference was determined between the two groups in respect of anxiety levels. No correlation was determined between disease severity and the scales. It was determined that as disease duration increased, so the DERS-non-acceptance subscale score increased, and with an increase in age, the SAI score of the AA patients increased. The DERS-impulse subscale score was seen to be statistically significantly higher in the boys with AA than in girls (P = 0.030). Conclusions: The results of this study showed that a visible, chronic, recurrent disease such as AA is not always seen with high psychiatric comorbidity and that together with the presence of the disease, patient age and disease duration are also important. It can be considered that AA may have been affected by the location, time and conditions of the study.

Relationship between sleep problems and chronotypes of children and adolescents with attention deficit and hyperactivity disorder and serum GABA, glutamate and homocysteine levels.

In this study, we aimed to determine the relationship between chronotype, sleep problems and serum levels of GABA (gamma amminobutyric acid), glutamate and homocysteine in children and adolescents diagnosed with attention deficit and hyperactivity disorder (ADHD) as well as factors affecting this relationship. Sleep problems of 46 children and adolescents aged 7-18 years diagnosed with ADHD and 30 healthy volunteers aged 7-18 years were evaluated with Children's Sleep Habits Questionnaire (CSHQ) while chronotypes were evaluated with Children's Chronotype Questionnaire (CCQ). Serum glutamate, GABA and homocysteine levels were measured using immunosorbent test (ELISA) kits. Sleep problems were significantly more common in the ADHD group compared to the control group (p < .001). Serum GABA, glutamate and homocysteine levels were found to be predictor biomarkers for ADHD, independent of total sleep problem score. When the homocysteine levels were above the cut-off point of 9.445 µmol/L, the sensitivity in early diagnosis of ADHD was 84.8% and the specificity was 70.0%. Although ADHD is a disorder in which sleep problems are common, increased serum GABA, glutamate and homocysteine are important in diagnosing ADHD independent of ADHD-related sleep problems. Homocysteine levels may be an important predictor for the presence of ADHD.

Psychiatric morbidity in children and adolescents with dermatological disorders.

BACKGROUND: Understanding the existence of a cycle, where psychological disturbances cause skin diseases and in turn, skin diseases cause psychological disorders, provides the basis for good dermatological practice. OBJECTIVE: The aim of this case-control study is to examine the psychiatric morbidity of dermatological disorders in children and adolescents with no history of psychiatric disorders. METHOD: In this study, 502 participants (251 patients and 251 healthy individuals) were evaluated according to DSM-IV criteria. All participants were interviewed and evaluated using the Turkish version of the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (K-SADS-PL) and the State-Trait Anxiety Inventory for Children (STAI-1 and STAI-2), the Childhood Depression Inventory (CDI), adolescent and parent forms of the Strengths and Difficulties Questionnaire (SDQ-A and SDQ-P) and a questionnaire evaluating child's level of school success. RESULTS: Our results indicated that the rates of general psychiatric comorbidity, mood disorders, anxiety disorders, and adjustment disorders were significantly higher in the study group compared to the control group. The CDI, STAI-1, STAI-2, and SDQ (and subscales) scores were significantly higher in the study group. Moreover, psychiatric comorbidity was higher in inflammatory and allergic dermatoses compared to other dermatological subgroups. Having a dermatological disease restricts physical activity thus increasing the risk of psychiatric comorbidity. CONCLUSIONS: Investigating the education, attitudes, and awareness of dermatologists about psychocutaneous disorders might contribute to the development of new educational strategies and elicit appropriate biopsychosocial approaches.

Decreased brain-derived neurotrophic factor levels may predict early perioperative neurocognitive disorder in patients undergoing coronary artery bypass surgery: A prospective observational pilot study.

STUDY OBJECTIVE: To determine the prognostic value of the change in intraoperative BDNF (Brain-derived neurotrophic factor) levels during cardiac surgery with cardiopulmonary bypass (CPB) on early perioperative neurocognitive disorder (PND). DESIGN: Prospective observational pilot study. SETTING: The study was performed in the Medical Faculty Hospital, from January 2020 to August 2020. PATIENTS: 45 adult patients undergoing elective coronary artery bypass surgery (CABG) with CPB. INTERVENTIONS: None. MEASUREMENTS: Cognitive function was evaluated 1 day before and 4 days after the surgery. Serum BDNF levels were measured at four time points (T1: after induction; T2: with aortic cross-clamp; T3: without aortic cross-clamp; T4: 4 days after surgery) by enzyme-linked immunosorbent assay. MAIN RESULTS: The incidence of PND was 37.8% four days after surgery. Serum BDNF (T2 and T4) levels were significantly lower in PND group compared to non- PND group (p = 0.003 and p = 0.016, respectively). Moreover, lactate, rSO2 (regional cerebral oxygen saturation), aortic cross-clamp time, CPB duration, and the amount of blood transfusion differed between the groups. Logistic regression analysis identified serum BDNF-T2, age, cross-clamp time, and rSO2-T2 as independent risk factors for PND. Based on the ROC analysis, the area under curve (AUC) of BDNF-T2 concentration for prediction of PND was 0.759 with sensitivity of 71.4% and specificity of 64.7% (p < 0.01). CONCLUSION: Intraoperative BDNF serum levels may be a useful biomarker in predicting PND in patients undergoing CABG surgery. More comprehensive studies is needed in order to confirm the effect of decreasing intraoperative BDNF serum levels on the development of PND. TRIAL REGISTRATION NUMBER: NCT04250935 www.clinicaltrials.gov.

Sleep quality in children and adolescents with obsessive-compulsive disorders.

BACKGROUND: Although the effect of obsessive-compulsive disorder (OCD) on sleep is not well-known, recent studies suggest an association between OCD and sleep quality. AIMS: We aimed to assess sleep quality in children and adolescents with OCD and to seek its association with OCD symptoms and OCD severity. METHODS: All of the subjects were assessed using DSM 5 and affective disorders and schizophrenia for school-age children - present and lifetime version, which is based on DSM-IV. The Yale-Brown obsessive-compulsive scale and children's Yale-Brown obsessive-compulsive scale were applied to the subjects with OCD. Pittsburgh sleep quality index (PSQI) was used to assess sleep quality, and the Wechsler intelligence scale for children-revised (WISC-R) was used to measure their intelligence levels. RESULTS: PSQI total score was significantly higher in patients with OCD (p < 0.001), suggesting that patients with OCD have a significantly worse sleep quality. The presence of somatic disorders was also associated with worse sleep quality (p = 0.040). Sleep quality was not significantly associated with OCD severity (p = 0.152). Among patients with extreme OCD, the 'sleep duration' component of the PSQI was higher than those with moderate or severe OCD (p = 0.019). The patients with 'contamination/cleaning' symptom group had a lower total PSQI score compared with 'symmetry/hoarding' symptom group (p = 0.014). CONCLUSIONS: The findings of the present study indicate that the sleep quality of children and adolescents with OCD is influenced, and there may be an association between sleep quality and OCD symptoms and severity in these patients.

The relationship between prenatal testosterone and developmental stuttering in boys.

Dönmez YE, Özcan Ö, Bilgiç A, Miniksar DY. The relationship between prenatal testosterone and developmental stuttering in boys. Turk J Pediatr 2019; 61: 193-199. Stuttering is a multi-factorial speech disorder characterized by various dysfluencies in the beginning and/or smooth flow of speech. Its incidence is about 1% in the general population, with 80% of stuttering cases seen in children aged three to eight years. The etiology of developmental stuttering has not been precisely explained. Several researchers report that neurological factors, especially atypical lateralization of the speech and language processes, play an important role in the etiology of stuttering. Various hypotheses suggest that prenatal testosterone causes atypical hemispheric lateralization. The aim of this study was to investigate the role of prenatal testosterone in the etiology of developmental stuttering by the use of the ratio of secondand fourth-digit lengths (2D:4D). Totally 133 boys (49 boys who stutter and 84 boys who do not stutter) were included in the study. The age range of children participating in the study was determined as 2-12 years. In the comparative evaluation conducted between the stuttering group and the control group in terms of their right 2D:4D and left 2D:4D ratios, it was found that the left 2D:4D ratio of the patients was significantly higher than that of the control group. We are of the opinion that prenatal testosterone may play a role in the etiology of developmental stuttering. The present study is the first study in the literature to reveal a relationship between prenatal testosterone and developmental stuttering.