Religion would be a missing link in the case formulation of adolescents with conduct problems: an eclectic approach.

Psychiatry is concerned with mental health. Cognition is one of the key mental functions and manifests itself primarily as behavior. A behavior exhibited in response to a stimulus is influenced by biological (inherited), psychological (individual), and social (environmental) factors. During consolidation of an exhibited behavior, the factors affecting the individual's cognitive structure and personality play crucial roles. Underlying factors for a problematic behavior, and their weakness/strength levels are determined via the Biopsychosocial model. Empirically effective current practices to intervene the problematic behaviors do not always result in success. One of the reasons may be other elements that were omitted during the case formulation process. This article aims to stress the idea that whatever the underlying factor of a problematic behavior is, the most crucial determinant and/or pre-emptive factor in developing or maintaining that behavior might actually be the religion as a governing and directive philosophy on how to conduct oneself. In this instance, the key is in the hands of the parents or caregivers.

Evaluation of chronic cough etiology, quality of life, and anxiety level in children.

Introduction: To evaluate the quality of life and anxiety level of school-age children with chronic cough, and changes with treatment. Materials and Methods: Patients aged between 6-18 years with a chronic cough were included in this study. A control group was designed, and the scale scores were compared with each other. Result: The mean age of the 82 patients was 10.9 ± 3.8 years, 62 (75.6%) had at least one specific cough marker. Forty patients (48.8%) were diagnosed with asthma. At their first visit, the psychosocial health scores and the total scale scores (sum of physical and psychosocial total scores) were lower than the control group for both patients and parents. After the resolution of cough, their scores increased to the same level with the control group. It was also found that the level of anxiety was significantly higher than in the control group both before treatment and after the resolution period (p<0.001 and =0.008, respectively). Conclusions: Asthma was the leading cause of chronic cough. Quality of life is impaired in children with chronic cough. Anxiety level in these patients increases and after symptoms improve, continues to be higher than that of healthy children.

Loneliness, internalizing symptoms, and inflammatory markers in adolescent COVID-19 survivors.

BACKGROUND: Concerns about the psychiatric sequelae after COVID-19 infection have increased as the pandemic spreads worldwide. The increase in self-isolation during this pandemic period has also revealed the importance of feelings of loneliness. This study aimed to examine the relationship between baseline inflammation levels, internalizing symptoms, and feelings of loneliness in adolescent COVID-19 survivors in the long term. METHODS: A total of 74 adolescents (41 girls, 55.4%, mean age 14.88) and their parents were included in the study. This cross-sectional study assessed internalizing symptoms via Revised Children's Anxiety and Depression Scale (RCADS) and feelings of loneliness using the UCLA-loneliness scale. Baseline inflammatory markers at COVID-19 diagnosis were collected. Logistic regression analysis was used to determine predictors for depression in adolescents. RESULTS: The most common disorder was Major Depressive Disorder (MDD) (25.7%), and 33.8% of the adolescents were in the clinical range in at least one internalizing domain. Baseline C-Reactive Protein (CRP) levels correlated weakly with MDD scores. Loneliness scores correlated with all internalizing symptoms, strong association with MDD scores. Loneliness, anxiety, and parental anxiety were associated with an increased likelihood of MDD. Baseline CRP positivity did not predict MDD in adolescent COVID-19 survivors. CONCLUSIONS: This study indicates that anxiety, loneliness, and parental anxiety play an important role in adolescents' experience of depressive symptoms after COVID-19 infection. Thus, screening parental psychopathology and loneliness in COVID-19 survivors seems to be preventive for adolescent mental health problems.

Psychiatric symptoms in children with COVID-19, mothers` psychological resilience and related factors: pandemic hospital inpatient experiences.

BACKGROUND: Information on psychological problems and affecting factors in children hospitalized with the suspicion or diagnosis of COVID-19 is limited. We aimed to screen the psychiatric symptoms of children hospitalized with COVID-19 in Ankara City Children`s Hospital and evaluate the caregivers` depression, anxiety, stress, and resilience levels during hospitalization. METHODS: Among the children and adolescents hospitalized in Ankara City Children`s Hospital between 1 May 2020 and 31 May 2020 due to the diagnosis of COVID-19, those who agreed to participate in the study were included. The Strengths and Difficulties Questionnaire (SDQ), the Depression Anxiety Stress Scale-21 (DASS- 21) scale, and the Brief Resilience Scale (BRS) were used to determine the symptoms. RESULTS: The mean age of study group (n = 49) was 8.7 ± 5.0 years, 59.2% (n = 29) were girls. The mean children`s SDQ-externalizing problems scores were higher in the COVID-19 positive mothers group than the COVID-19 negative mothers` group. The SDQ-total score was positively and strongly correlated with the DASS total score, DASS-depression score, and DASS-anxiety score. BRS scale scores were negatively correlated with the SDQtotal, externalizing, and DASS-21scale scores. CONCLUSIONS: COVID-19 positivity in mothers could be associated with externalizing problems in children. The high resilience of caregivers of inpatients seems to be related to less psychopathology in children. During hospitalization, caregivers` psychological evaluation and psychosocial support may be important for preventive child mental health.

Finding underlying genetic mechanisms of two patients with autism spectrum disorder carrying familial apparently balanced chromosomal translocations.

BACKGROUND: Genetic etiologies of autism spectrum disorders (ASD) are complex, and the genetic factors identified so far are very diverse. In complex genetic diseases such as ASD, de novo or inherited chromosomal abnormalities are valuable findings for researchers with respect to identifying the underlying genetic risk factors. With gene mapping studies on these chromosomal abnormalities, dozens of genes have been associated with ASD and other neurodevelopmental genetic diseases. In the present study, we aimed to idenitfy the causative genetic factors in patients with ASD who have an apparently balanced chromosomal translocation in their karyotypes. METHODS: For mapping the broken genes as a result of chromosomal translocations, we performed whole genome DNA sequencing. Chromosomal breakpoints and large DNA copy number variations (CNV) were determined after genome alignment. Identified CNVs and single nucleotide variations (SNV) were evaluated with VCF-BED intersect and Gemini tools, respectively. A targeted resequencing approach was performed on the JMJD1C gene in all of the ASD cohorts (220 patients). For molecular modeling, we used a homology modeling approach via the SWISS-MODEL. RESULTS: We found that there was no contribution of the broken genes or regulator DNA sequences to ASD, whereas the SNVs on the JMJD1C, CNKSR2 and DDX11 genes were the most convincing genetic risk factors for underlying ASD phenotypes. CONCLUSIONS: Genetic etiologies of ASD should be analyzed comprehensively by taking into account of the all chromosomal structural abnormalities and de novo or inherited CNV/SNVs with all possible inheritance patterns.

Serum Brain-Derived Neurotrophic Factor (BDNF) Level in Children with Specific Learning Disabilities. / Özgül Ögrenme Bozuklugu Olan Çocuklarda Serum Beyin Kaynakli Nörotrofik Faktör (BKNF) Düzeyi.

OBJECTIVE: Specific learning disorder (SLD) is a neurodevelopmental disorder frequently seen in childhood with deficits in many areas of functioning. Although the etiology of SLD is known to be multifactorial, research findings are limited. In this study, we aimed to compare the serum levels of brain-derived neurotrophic factor (BDNF) in children with SLD to healthy children to find out whether BDNF has a role in the pathophysiology of SLD. METHOD: The study included 30 children between the ages of 7-12, diagnosed with SLD and 30 age and gender matched healthy controls. The groups were tested on the Affective Disorders and Schizophrenia Interview Schedule for School-age Children-Now and Lifetime Form (K-SADS-PL), the Wechsler Intelligence Scale for Children-revised form (WISC-R), the Teacher Information Form (TIF) and the Specific Learning Difficulty Battery (SLDB). RESULTS: No difference the serum BDNF levels in children with SLD and the healthy controls. BDNF levels did not correlate with the WISC-R scores and reading rate in the SLD group. CONCLUSION: An association was not determined between SLD and and serum BDNF levels. Our study was the first to investigate this relationship and provided preliminary data on this topic. There is a need for further studies with large patient groups of phenotypic homogeneity.

Seizures in children with epilepsy and attention-deficit/hyperactivity disorder.

BACKGROUND: Epilepsy is an important disorder that is sometimes accompanied by inattention problems. This study explored the features of seizures in children with epilepsy, with or without attention-deficit/hyperactivity disorder (ADHD). METHODS: Between January 2017 and January 2018, data records of children with epilepsy aged 5-18 years admitted to hospital were retrospectively collected. SPSS 17.0 was used for analyses and P < 0.05 was accepted as significant. RESULTS: Of 301 patients with epilepsy, 32 of them had ADHD. Median age at diagnosis of epilepsy in the epilepsy + ADHD group was lower than in the epilepsy alone group (6 vs 8 years; z = -2.989, P = 0.003). The two groups were similar in terms of duration of epilepsy, seizure types and features of complicated versus non-complicated epilepsy, number of anti-epileptic drugs (AED) used (for all, P > 0.05). The epilepsy + ADHD group had a significantly higher prevalence of intellectual disability (31.3% vs 12.6%; χ2 (1) = 7.9, P = 0.014) and specific learning disorder (12.5% vs 1.9%; χ2 (1) = 11.1, P = 0.009) than the epilepsy alone group (χ2 (1) = 11.1, P = 0.009). ADHD medication use was identified in 68.8% of children in the epilepsy + ADHD group. CONCLUSION: Attention-deficit-hyperactivity disorder was identified in 11.8% of 5-18-year-old children (32/301) with epilepsy in a 1 year period. ADHD is more frequent in children with epilepsy in childhood (5-11 years of age). Epilepsy diagnosis is more frequent in younger children with ADHD. Children with epilepsy and ADHD, also have a significantly higher prevalence of intellectual disability and specific learning disorder. Younger children diagnosed with epilepsy should be carefully monitored for ADHD.

Pictures portrayed by children with migraine with aura: a Turkish case series.

BACKGROUND: Migraine is one of the most debilitating disorders with its chronic nature seen in childhood characterized by episodic bilateral or unilateral throbbing pain on the head that strikes at any time. It is divided into two categories as with or without aura and is diagnosed according to the 2013 International Headache Society criteria. AIM AND METHOD: This study aims to present the pictures depicted by adolescents aged 14-18 who were diagnosed with migraine with visual aura by Ankara Training and Research Hospital Child Neurology Department. RESULTS: They were told to draw their visual auras as a picture that they depict or as a draft via changing another picture. In this article, five adolescents with migraine and their pictures related to their visual aura were presented. CONCLUSION: The diagnosis of migraine with visual aura in patients under 18 years of age would be supported by picturing of their visual images. Thus, pediatric patients could better express themselves and the clinician would better manage the process both in diagnosis and follow-up of the migraine with aura.

Neuropeptide Y Levels in Children and Adolescents with Attention Deficit Hyperactivity Disorder.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in adolescence, however, the etiology has not been described. Neuropeptide Y (NPY) is one potential factor that may be involved in the etiology of ADHD. The goal of this study was to evaluate NPY levels in children with ADHD and compare the findings to healthy controls. METHODS: Forty-eight ADHD patients and 40 healthy controls were included in this study. The age range of ADHD patients was 6 to 16 years. All patients were diagnosed according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). RESULTS: The NPY levels of children with ADHD were compared to healthy controls but were not significantly different (t (86)= -0.887,  p= 0.378). NPY levels were similar (F= 0.191, p= 0.826) between ADHD presentations, and included 8 children with predominantly hyperactive-impulsive type (14.3%), 14 children with predominantly inattentive type (30.4%), and 26 children with a combined type (55.4%). There was also no difference between ADHD patients using medical treatment, ADHD patients not using medical treatment, and control subjects in terms of NPY levels (F= 0.572, p= 0.566). There was a significant positive correlation between age and NPY levels in the ADHD group (r= 0.349, p= 0.015). CONCLUSION: This study demonstrated that the NPY levels of ADHD subjects were not different than those of controls. Future studies with homogeneous phenotypes and a larger sample population are needed.

The assessment of serum lipid profiles of children with attention deficit hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in children and the pathophysiology remains obscure. Some studies show that lipid imbalances are associated with ADHD etiology. We studied the association of serum total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride (TG) levels in ADHD. We examined 88 children aged 8-12 years who were diagnosed with ADHD and 88 healthy children. The exclusion criteria were as follows: obesity, any psychotropic use in the last 3 months, presence of a chronic disease and/or malignancy, history of medically treated lipid metabolism disease in family members, intelligence quotient (IQ) < 70, and comorbidities, with the exception of oppositional defiant disorder. The sample was evaluated using a semi-structured clinical assessment interview and Conners' rating scales. Despite controlling for age, sex, and body mass index (BMI) variables, the total cholesterol and LDL levels were significantly higher in the ADHD group than the levels of healthy controls, whereas the TG and HDL cholesterol levels were similar among groups. Conners' rating scales, reflecting symptom severity, and total cholesterol, TG, HDL, and LDL levels of the ADHD group were not correlated. The study results support the difference in serum lipid and lipoprotein profiles of children with ADHD compared with healthy controls. This difference is thought to be related with changes in oxidant/antioxidant balance states in ADHD.

Increased levels of serum neopterin in attention deficit/hyperactivity disorder (ADHD).

Attention deficit/hyperactivity disorder (ADHD) is the most frequently occurring neuropsychiatric disorder in childhood with an etiology that is not fully understood. A number of reviews that have addressed the neurobiology of ADHD have focused on imaging and genetics. Relatively little attention has been given to factors/mechanisms involved in the brain dysfunction. We suggest that changes in cellular immunity may be involved. Neopterin is a good indicator of cellular immunity, and we evaluated serum levels of neopterin in patients with ADHD. The study group consisted of 49 patients with ADHD. An age- and gender-matched control group was composed of 31 healthy subjects. Venous blood samples were collected, and the levels of neopterin were measured. The levels of neopterin were significantly higher in ADHD than in the comparison subjects. Cellular immunity may have a role in the etiopathogenesis of ADHD.

Lipid peroxidation markers in children with anxiety disorders and their diagnostic implications.

OBJECTIVE: Numerous factors, including genetic, neurobiological, neurochemical, and psychological factors, are thought to be involved in the development of anxiety disorders. The latest findings show that the pathophysiology of anxiety disorders might be associated with oxidative stress and lipid peroxidation; however, no studies have so far investigated lipid peroxidation markers in children with anxiety disorders. Serum levels of lipid hydroperoxide (LOOH) are a reliable marker of lipid peroxidation. Paraoxonase and arylesterase are two enzymes that protect against such peroxidation, and might also be diagnostic markers. In this study, we investigated whether there are associations between anxiety disorders and lipid peroxidation markers in children, and assessed the diagnostic performance of these markers. METHODS: The study group consisted of 37 patients (children and adolescents) with anxiety disorders. A control group, matched for age and gender, was composed of 36 healthy subjects. Venous blood samples were collected, and LOOH levels and paraoxonase and arylesterase activity were measured. RESULTS: LOOH levels were significantly higher in the anxiety disorders group than in the control group. There were no significant differences in paraoxonase or arylesterase activities between the patient and the control groups. DISCUSSION: Lipid peroxidation or oxidative damage might play a role in the aetiopathogenesis of anxiety disorders. LOOH may be a potential biological marker for anxiety disorders in children.

Oxidative stress in children and adolescents with anxiety disorders.

BACKGROUND: Anxiety disorders are common in children and adolescents, and they can significantly impair quality of life. Genetic, neurobiological, neurochemical, and psychological factors are believed to play a role in the etiopathogenesis of anxiety disorders. Recent evidence suggests that the pathophysiology of anxiety disorders may be associated with oxidative stress. In this study, we investigated whether there are associations between children with anxiety disorders and total oxidant/antioxidant status. METHODS: The experimental group consisted of 40 patients (children and adolescents) with anxiety disorders. An age- and gender-matched control group composed of 35 healthy subjects was also assessed. Venous blood samples were collected and total antioxidative status (TAS), total oxidative status (TOS), and the oxidative stress index (OSI) were determined. RESULTS: Both the TOS and the OSI of the experimental group were significantly higher than those of the control group. There were no significant differences in TAS between the experimental and control groups. LIMITATIONS: The main limitation of our study was the small sample size. CONCLUSIONS: This study suggests that oxidative balance is impaired in children with anxiety disorders. Oxidative stress may play a role in the etiopathogenesis of anxiety disorders, and TOS may be a useful diagnostic tool in this context.

Serum nerve growth factor (NGF) levels in children with attention deficit/hyperactivity disorder (ADHD).

Attention deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioral disorder of childhood. The etiopathogeny of ADHD has not been totally defined. Recent reports have suggested a pathophysiological role of neurotrophins in ADHD. In this study, we evaluated serum levels of nerve growth factor (NGF) in patients with ADHD. The sample population consisted of 44 child or adolescent patients diagnosed with ADHD according to DSM-IV criteria; 36 healthy subjects were included in the study as controls. Venous blood samples were collected, and NGF levels were measured. The mean serum NGF levels of the ADHD patients were significantly higher than those of the controls. Age and gender of the patients were not correlated with serum NGF levels. There were no significant differences in NGF levels among the combined and predominantly inattentive subtypes of ADHD. Our study suggests that there are higher levels of serum NGF in drug naive ADHD patients, and that increased levels of NGF might have an important role in the pathophysiology of ADHD.

Complementary and alternative medicine use in Turkish children with epilepsy.

We aimed to determine the prevalence, pattern of use, parental sources of information and adverse effects of complementary and alternative medicine (CAM) in children with epilepsy. Parents of children with epilepsy (n=305; mean age: 8.3±4.3 years) were interviewed with structured open and close-ended questionnaire. Patients were divided in two groups, CAM and non-CAM and compared using statistical tests. The use of CAM was detected in 22.6% of the patients (n=69). Prayer was the most commonly used therapy in 91.3% of children (n=63). Gender (p=0.032, [OR]: 0.5, 95%CI: 0.287-0.945) and resistance to antiepileptic drugs (p=0.005, [OR]: 3.4, 95%CI: 1.459-8.148) were found to be associated with CAM use. Parental use of CAMs to treat their children with epilepsy is not common in the Eastern Blacksea Region of Turkey. The research findings have demonstrated that patients' parents trust in their doctors. However, male sex and the presence of resistance of anti epileptics are potentially CAM predictors.