Social media addiction, escapism and coping strategies are associated with the problematic internet use of adolescents in Türkiye: a multi-center study.

Introduction: The literature highlighted that problematic internet use can have detrimental consequences on individuals' well-being. Social media addiction, escapism and coping skills are closely related to problematic internet use. However, no study has currently examined the relationship between problematic internet use and social media use, escapism and coping skills. Method: This multicenter cross-sectional designed study evaluated the relationships between problematic internet use and social media addiction, escapism, and coping skills in 508 adolescents (319 female) aged 14-18 years. In order to collect data, sociodemographic data form, Internet Addiction Scale, Social Media Addiction Scale, Escapism Scale and Kidcope Adolescent Version have been used. First, adolescents who scored ≥50 on the Internet Addiction Test were classified as the problematic internet use group; adolescents who scored <50 were classified as the control group. Then, the relationships between problematic internet use and social media addiction, escapism and coping skills were evaluated. Results: The results showed that problematic internet use was associated with duration of social media use, impairment in social media-related functionality, preferring virtual life, and virtual pleasure, escapism, avoidant and negative coping strategies. Conclusion: These findings may provide an empirical basis for problematic internet use prevention and intervention in adolescence.

Emotional Dysregulation and Temperament-Character Traits in Adolescents With Functional Neurological Symptom Disorder (Conversion Disorder).

ABSTRACT: The purpose of this study was to evaluate emotion dysregulation and temperament-character traits in adolescents with functional neurological symptom disorder (FNSD). Forty adolescents with FNSD and 40 healthy adolescents were evaluated by a semiconstructed diagnosis interview, Temperament and Character Inventory (TCI), Difficulties in Emotion Regulation Scale (DERS), Regulation of Emotions Questionnaire (REQ), and Children's Somatization Inventory-24 (CSI-24). The external and internal dysfunctional emotion regulation scores of REQ, all subscales of DERS, except the awareness subscale, and CSI-24 scores were significantly higher in FNSD patients compared with healthy controls. There were significant differences between the groups in terms of harm avoidance and reward dependence subscale scores of TCI. Multiple logistic regression analysis showed that the external dysfunctional emotion regulation strategy, somatization, and reward dependence are significant predictors of FNSD. Our results provide evidence that adolescents with FNSD experience emotional dysregulation and that the differential value of some temperament-character traits in the diagnosis of FNSD.

A NEW ARTIFICIAL INTELLIGENCE-BASED CLINICAL DECISION SUPPORT SYSTEM FOR DIAGNOSIS OF MAJOR PSYCHIATRIC DISEASES BASED ON VOICE ANALYSIS.

BACKGROUND: Speech features are essential components of psychiatric examinations, serving as important markers in the recognition and monitoring of mental illnesses. This study aims to develop a new clinical decision support system based on artificial intelligence, utilizing speech signals to distinguish between bipolar, depressive, anxiety and schizophrenia spectrum disorders. SUBJECTS AND METHODS: A total of 79 patients, who were admitted to the psychiatry clinic between 2020-2021, including 15 with schizophrenia spectrum disorders, 24 with anxiety disorders, 25 with depressive disorders, and 15 with bipolar affective disorder, alongside with 25 healthy individuals were included in the study. The speech signal dataset was created by recording participants' readings of two texts determined by the Russell emotion model. The number of speech samples was increased by using random sampling in speech signals. The sample audio signals were decomposed into time-frequency coefficients using Wavelet Packet Transform (WPT). Feature extraction was performed using each coefficient obtained from both Mel-Frequency Cepstral Coefficients (MFCC) and Gammatone Cepstral Coefficient (GTCC) methods. The disorder classification was carried out using k-Nearest Neighbor (kNN) and Support Vector Machine (SVM) classifiers. RESULTS: The success rate of the developed model in distinguishing the disorders was 96.943%. While the kNN model exhibited the highest performance in diagnosing bipolar disorder, it performed the least effectively in detecting depressive disorders. Whereas, the SVM model demonstrated close and high performance in detecting anxiety and psychosis, but its performance was low in identifying bipolar disorder. The findings support the utilization of speech analysis for distinguishing major psychiatric disorders. In this regard, the future development of artificial intelligence-based systems has the potential to enhance the psychiatric diagnosis process.

Evaluation of cognitive disengagement syndrome in children with obsessive-compulsive disorder: Clinical implications.

Cognitive disengagement syndrome (CDS) has been found to be associated with internalizing symptoms. Yet, no study thus far has focused on whether there is an association between obsessive-compulsive disorder (OCD) and CDS. The purpose of this study is to examine the symptom frequency and clinical implications of CDS in children with OCD. The study included sixty-one children with OCD and sixty-six typically developing children. Children were evaluated by a semi-constructed diagnosis interview, Obsessive-Compulsive Inventory, Barkley Child Attention Scale, and Stroop test. The frequency of elevated symptoms of CDS, and total time, total error, and total correction scores of the Stroop test were significantly higher in the OCD group compared to the controls. Elevated CDS symptoms were significantly associated with higher OCD symptom prevalence and poorer performance on the Stroop Test. Moreover, poor insight, hoarding symptoms, mental compulsions, and ADHD comorbidity were significantly higher in those with elevated CDS symptoms than in those without CDS in the OCD group. The findings of this study provide clinical implications that CDS symptoms may contribute to deficits in attentional orientation, conceptual flexibility, and cognitive processing speed in OCD.

Sociodemographic variables, clinical characteristics, and treatments in children with trichotillomania in terms of age and gender: a multicenter study.

OBJECTIVE: Although trichotillomania (TTM) is a common, typically pediatric-onset disorder, data on the phenomenology of TTM in children, accompanying comorbid psychiatric disorders, and treatment options are extremely limited. In our study, it was aimed to investigate these variables and related factors in patients undergoing psychiatric evaluation and follow-up. METHOD: The study included 79 children and adolescents between the ages of 4 and 17 who were diagnosed with TTM and followed up in four different Child and Adolescent Psychiatry outpatient clinics between 2015 and 2020. The sociodemographic characteristics of these patients, clinical features of the disease, comorbid psychiatric disorders, and treatment approaches have been studied. RESULTS: Our results showed that TTM was more common in girls, hair and eyebrow plucking was the most common, and symptoms and features accompanying TTM changed with age, but not with gender. Again, 79.7% of these children had at least one psychiatric comorbid disorder (most common being anxiety disorders and Attention Deficit/Hyperactivity Disorder), comorbidity was closely related to TTM severity, 93.7% used at least one pharmacotherapeutic agent, and positive response rates to treatment were found to be low. Moreover, TTM severity was found to increase with age and disease duration. CONCLUSION: Study findings support that clinical presentation, disease severity and comorbidity rates may change with age in children and adolescents with TTM, and early intervention is important to prevent clinical progression/worsening and mental health sequela.

Does Involvement in Peer Bullying Invite Self-Injury?: The Association Between Peer Bullying and Self-Injury in a Clinical Sample.

ABSTRACT: Previous studies have linked peer bullying to nonsuicidal self-injury (NSSI). However, the evidence is largely limited to population-based groups. This study examined whether there is a relationship between NSSI and being a victim of peer bullying among adolescents in a clinical sample and how this may be influenced by types of bullying. The sample consisted of 96 outpatients with NSSI and 107 healthy adolescents. The Inventory of Statements About Self-Injury, Peer Bullying Scale, and Rosenberg Self-Esteem Scale were applied. Whereas the scores of each bullying type of adolescents with NSSI were significantly higher, their self-esteem scores were significantly lower. Each victimization score of bullying had a negative correlation with NSSI-onset age and self-esteem scores and a positive correlation with self-injury scores. This study demonstrated that being a victim of any type of bullying is strongly associated with self-injury. It would be advisable to screen adolescents with self-injury for exposure to bullying, and vice versa.

Clinical characteristics according to sex and symptom severity in children with selective mutism: a four-center study.

INTRODUCTION: Clinical information regarding selective mutism (SM), a persistent and debilitating psychiatric disorder, in children is extremely limited. We aimed to examine sociodemographic characteristics and comorbid psychiatric conditions and identify clinical variables associated with sex and SM severity among children with SM. METHODS: We analyzed the medical records of 49 children who received treatment for SM in four different tertiary hospitals in Turkey between 2016 and 2021. Children's charts were reviewed to examine clinical characteristics, comorbidities, and response to treatment. RESULTS: Thirty-one children were female, and 18 were male (female:male ratio is 1.7:1). Most children (73.5%) with SM displayed onset of SM in 3-6 years. However, most children (57.1%) were diagnosed between the ages of 7-11. The mean time from onset to diagnosis was 1.69 ± 1.37 years. Females displayed a later onset of SM (6.42 ± 2.40 vs. 4.89 ± 0.96; p= 0.013) and higher comorbidity rates (71% vs. 38.9%, p= 0.039) than males. The vast majority of children received two or more psychiatric diagnoses. Children in the severe group had a longer duration of illness, higher rates of psychiatric comorbidity, speech delay, and treatment resistance. CONCLUSION: Our study suggests that SM may have different clinical features according to sex and symptom severity of SM. More information about children with SM is needed to understand the development and maintenance of SM.

Could Fetuin-A Be a Biomarker for Autism Spectrum Disorder and Cognitive Developmental Delay?

Early detection of cognitive developmental delay (CDD) and autism spectrum disorder (ASD) is challenging, despite the numerous scientific studies conducted and different therapeutic strategies. Lack of a biomarker for autism is a limiting factor for early diagnosis, which could provide better outcome with early start of therapy. Because of the high serum fetuin-A concentration during intrauterine life, it has been suggested that fetuin-A may have a role in brain development. The current study sought to determine if fetuin-A, a multifunctional glycoprotein thought to have a role in brain development, may be used as a biomarker for the diagnosis of ASD and developmental delay. The study involved 55 children with cognitive developmental delays and 40 healthy children. Two categories of children with cognitive developmental delays were identified. The participants were subjected to a psychiatric assessment as well as developmental testing. Only 54.5% of the 55 individuals had CDD, whereas 45.5% had ASD. Using an ELISA kit, the levels of serum fetuin-A were determined spectrophotometrically. The serum fetuin-A levels in the patients from the test group were found to be significantly lower than in the healthy individuals (p < 0.001). The cutoff value for the serum fetuin-A levels for cognitive developmental delay and autism spectrum disorder was 518 µg/liter, according to the results of ROC analysis (84.6% sensitivity and 91.4% specificity, AUC: 0.95, p < 0.001). The findings suggest that the serum fetuin-A level may be used to diagnose autism spectrum disorder and cognitive developmental delays.

Is Serum Progranulin Level a Biomarker in Autism and Cognitive Development Disorders?

OBJECTIVE: Cognitive developmental delay is a picture of the group of early-onset chronic diseases that affect 1.5-10% of children. Autism spectrum disorders are neurodevelopmental diseases with a genetic basis and abnormal brain development, characterized by disorders in areas that make up interpersonal relationships, such as communication, social cognition, and processing of emotional signals. Immune system dysfunction is thought to play a role in the pathogenesis of some neurological disorders, including autism. Progranulin is thought to be a regulator of the innate immune response. The purpose of this study was to look at plasma levels of progranulin, an anti-inflammatory neurotrophic factor, in children with autism spectrum disorder and cognitive developmental delay. MATERIALS AND METHODS: The study was conducted on 52 children who were patients and 35 healthy children. Of the 52 children of the patient group, 32 were diagnosed with CDD and 20 were diagnosed with cognitive developmental delay-autism spectrum disorder. Serum progranulin concentrations were measured using a human-specific sandwich enzyme-linked immunosorbent assay. RESULTS: Serum progranulin concentration was statistically lower in the patient group (110.746 ± 26.04) than in the healthy control group (137.346 ± 30.02). There was a statistically significant difference between the groups in levels of serum progranulin (P=.000). Receiver operating characteristic analysis was performed to evaluate the potential of progranulin as a biomarker to distinguish patients with cognitive developmental delay-autism spectrum disorder from healthy children. It detected a moderate area under the curve (0.743 ± 0.06) value and a more significant P value for progranulin (P=.000). CONCLUSION: Progranulin deficiency in patients with autism spectrum disorder-cognitive developmental delay may result in decreased neurotrophic support for many years, with cumulative damage associated with unregulated inflammation that may play a role in autism spectrum disorder-cognitive developmental delay. We believe that low progranulin levels could be a biomarker for autism spectrum disorder-cognitive developmental delay.

Estimation of the Development of Depression and PTSD in Children Exposed to Sexual Abuse and Development of Decision Support Systems by Using Artificial Intelligence.

The most common diagnoses after childhood sexual abuse are Post-Traumatic Stress Disorder and depression. The aim of this study is to design a decision support system to help psychiatry physicians in the treatment of childhood sexual abuse. Computer aided decision support system (CADSS) based on ANN, which predicts the development of PTSD and Major Depressive Disorder, using different parameters of the act of abuse and patients was designed. The data of 149 girls and 21 boys who were victims of sexual abuse were included in the study. In the designed CADDS, the gender of the victim, the type of sexual abuse, the age of exposure, the duration until reporting, the time of abuse, the proximity of the abuser to the victim, number of sexual abuse, whether the child is exposed to threats and violence during the abuse, the person who reported the event, and the intelligence level of the victim are used as input parameters. The average accuracy values for all three designed systems were calculated as 99.2%. It has been shown that the system designed by using these data can be used safely in the psychiatric assessment process, in order to differentiate psychiatric diagnoses in the early post-abuse period.

Psychiatric basics of alopecia areata in pediatric patients: Evaluation of emotion dysregulation, somatization, depression, and anxiety levels.

BACKGROUND/OBJECTIVE: Alopecia areata (AA) is a skin disease characterized by sudden-onset hair loss. The relationship between psychiatric status and AA has not been fully elucidated. The aim of this study was to evaluate emotion dysregulation, somatization, depression, and anxiety levels in children and adolescents with AA. METHODS: The study included 27 patients aged 8-18 years diagnosed with AA, and an age and gender-matched control group consisting of 30 cases without a known chronic medical disease. All individuals were screened for existing psychiatric illnesses by a pediatric psychiatrist through the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version (K-SADS-PL). The patients were then evaluated using the Children's Depression Inventory (CDI), Screen for Child Anxiety-Related Emotional Disorders (SCARED), State-Trait Anxiety Inventory for Children (STAI-C), and Children Somatization Inventory (CSI-24). In addition, the patients' parents were asked to complete the Emotion Regulation Checklist-Family Form (ERC). RESULTS: When comparing the scale scores of the AA and control group, there was a statistically significant difference between the groups in terms of the Emotional Lability/Negativity subscale scores on ERC. K-SADSPL ratios denoted features of at least one psychiatric condition in 62.9% and 16.6% of the AA group and control group, respectively. CONCLUSIONS: Our results emphasize the importance of psychiatric evaluation in patients with AA. Our study also reveals the need for further studies with a larger sample of AA patients being evaluated in terms of emotion regulation.

Can Temperament and Character Traits Be Used in the Diagnostic Differentiation of Children With ADHD?

ABSTRACT: In this study, it was aimed to determine the contributions of temperament and character traits to the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Thirty-six patients between the ages of 9 and 14 with a diagnosis of combined type ADHD and 39 healthy children were included in the study. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Version and the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale parent form were used to assess hyperactivity/impulsivity and inattentiveness, and comorbid disorders. The Junior Temperament and Character Inventory-Revised form was used to evaluate temperament-character traits. The classification-based association rules (CBARs) method was used for finding rules predicting ADHD accurately. Low persistence and self-directedness scores, and higher disorderliness and fatigability subgroup scores were found in the ADHD group. In CBARs, the separation of children with ADHD from healthy controls could be made with 0.83 accuracy, 0.80 sensitivity, and 0.86 specificity. The results of our study support the view that temperament-character traits can help clinical diagnosis of ADHD.

Prevalence and predictors of psychological response during immediate COVID-19 pandemic.

AIM: COVID-19 pandemic has created a serious psychological impact worldwide since it has been declared. This study aims to investigate the level of psychological impacts of the COVID-19 pandemic on the Turkish population and to determine related factors. METHODS: The study was carried out by an online questionnaire using the virtual snowball sampling method. The sociodemographic data were collected on the following subjects: participants' experience on any signs of infection within the last month, the history of COVID-19 contact-treatment-quarantine, level of compliance with precautionary measures, the sources of information and level of knowledge about the pandemic process and their belief levels on the knowledge they acquire. Besides, the questions that take place in the Depression, Anxiety and Stress Scale-21 (DASS-21), and Impact of Events Scale-Revised (IES-R) were asked to participants. RESULTS: Of the 3549 participants, anxiety was found in 15.8%, depression in 22.6%, stress in 12.9%, and psychological trauma in 20.29% based on moderate and above levels. Female gender, young age, higher education level, being single, high monthly income, presence of psychiatric illness, a large number of people living together, having any signs of infection, and contact history with COVID-19 infected person or contaminated object are identified as risk factors that may increase psychological impact. Compliance with the rules was found to reduce the risk of psychological response. CONCLUSIONS: The risk factors for the psychological impact of the COVID-19 pandemic, and acknowledging these factors can help to formulate the interventions to reduce the stress levels of the population.

The role of physical activity on mental health and quality of life during COVID-19 outbreak: A cross-sectional study.

INTRODUCTION: The COVID-19 pandemic has placed restrictions on people's physical activities. The aim of this study was to evaluate the physical activity levels of individuals and assess the effects of physical activity on quality of life, depression and anxiety levels during the COVID-19 outbreak. METHODS: This cross-sectional study were included 2301 participants aged 20-75 years. The data were collected through the Google Forms web survey platform by the virtual snowball sampling method. In the multivariate analysis, the independent predictors were analyzed using possible factors identified in previous analyses by multinomial logistic regression analysis. Hosmer-Lemeshow and Omnibus tests were used to evaluate the logistic regression model and coefficients. RESULTS: The mean weekly energy consumption of the participants was 875±1588 MET-min, and only 6.9% were physically active enough to maintain their health. There was a weak positive relationship between physical activity levels and quality of life, while there was a weak negative relationship between physical activity levels, depression and anxiety (p<0.05). In the multinomial logistic regression model established for comparison of physically active and inactive participants, general health status and physical health status variables were statistically significant (p<0.05). However, relationships between psychological status, social relationships and environment scores, Beck Depression and Beck Anxiety Inventory scores were not statistically significant (p>0.05). CONCLUSIONS: Results showed that physical activity programs should be included in guidelines as an integrative approach to pandemic management. During COVID-19 outbreak, community-based rehabilitation programs are needed, and these programs should be carried out in cooperation with community stakeholders.

Can suicide behavior and seasonality of suicide be predicted from inflammatory parameters in adolescents?

According to the 2017 data of World Health organization approximately 800 million individuals commit suicide annually. After understanding that psychiatric disorders start the inflammation process by suppressing the brain, a number of studies using neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and monocyte/lymphocyte ratio have been conducted. Platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio and other hemogram parameters may be a marker in predicting suicide. In addition, the determination of the relationship between these inflammatory markers and the cyclicity/seasonality of suicide can provide a basis for preventive mental health measures. This hypothesis was performed on 193 patients who attempted suicide and the control group consisted of 109 healthy children and adolescents between 2014 and 2019. Data were evaluated by SPSS software version 22 and a value of p < 0.05 was accepted to be significant in all tests. In our study, we found that hemogram parameters showing inflammation were significantly higher in the patients who committed suicide. Another finding of this study is that inflammation is directly related to suicide attempt rather than seasonality in adolescents who commit suicide. Rigorous testing of this medical hypothesis with other research will have major clinical and policy implications for preventive mental health.

Determining the probability of juvenile delinquency by using support vector machines and designing a clinical decision support system.

It is a known fact that individuals who engaged in delinquent behavior in childhood are more probable to carry on similar behavior in adulthood. If the factors that lead children to involve in delinquency are defined, the risk of dragging children into crime can be detected before they are involved in crime and delinquency can be prevented with appropriate preventive rehabilitation programs, in the early period. However, given that delinquent behavior occurs under the influence of multiple conditions and factors rather than a single risk factor; the need for diagnostic tools to evaluate multiple factors together is obvious. Artificial intelligence-based clinical decision support systems have already been used in the field of psychiatry as well as many other fields of medicine. In this study, we assume that thanks to artificial intelligence-based clinical decision support systems, children and adolescents at risk can be detected before the criminal behavior occurs by addressing certain factors. In this way, we anticipate that it can provide psychiatrists and other experts in the field.

Evaluation of temperament and character traits of patients with severe acne.

BACKGROUND: Acne vulgaris (AV) is an inflammatory disease of the pilosebaceous unit. The relationship between personality and acne development has not been fully explained, and to the best of our knowledge, there are a limited number of studies in the literature evaluating temperament and character traits of individuals with acne. AIM: The aim of this study is to evaluate temperament-character traits of individuals with severe acne and to compare them with healthy controls. PATIENTS/METHODS: This study was conducted on 51 patients who admitted to the dermatology outpatient clinic with complaint of acne and were diagnosed with severe AV and 47 healthy individuals, as a control group. All individuals included in the study participated voluntarily. The forms including sociodemographic data, clinical information, and Temperament and Character Inventory (TCI) scores were applied to the patient and control groups. RESULTS: The scores of scales/subscales of exploration (NS1), persistence (P), responsibility (S1), purposefulness (S2), resourcefulness (S3), self-acceptance (S4), enlightened 2nd nature (S5), self-directedness (S), integrated conscience (C5), and cooperativeness (C) were statistically significantly lower, and the scores of scales/subscales of worry and pessimism (HA1), fear of uncertainty (HA2), shyness (HA3), fatiguability (HA4), and harm avoidance (HA) were statistically significantly higher in the patient group, in comparison with the control group. CONCLUSIONS: When we evaluated the patients with severe acne in terms of temperament and character features, we concluded that individuals' feeling of discomfort about their appearance may cause them to be less sociable, more anxious, and to have low resourcefulness and virtues.

Effects of mental and physical performance on attention, anger control and sleep quality.

PURPOSE: This study aimed to determine the effective parameters on individual working performance, daily working order, and even on choosing a vocation. DESIGN AND METHODS: This prospective study was conducted on 288 students from Inönü University Medical School and Physical Education Vocational High School by applying the evaluation form, the Multidimensional Anger Scale, the Wender Utah Attention Rating Scale, the 25-item short form of the Pittsburg Sleep Quality Scale. FINDINGS: In the BESYO students, the ratio of attention disturbances were higher, whereas in medical school students the ratio of sleep disturbances were higher. We also found that the quality of sleep affects daily functionality significantly. PRACTICE IMPLICATIONS: This study demonstrates the importance of regulating intense mental processes in sleep quality and consequently functional regulation.