Theory of Mind Abilities May Predict Treatment Outcomes in Adolescents With Obsessive-Compulsive Disorder: A Follow-Up Study.

AIMS: Researchers report varying levels of cognitive flexibility and theory of mind (ToM) deficiencies in adolescents with obsessive-compulsive disorder (OCD). This research set out to investigate the impact of these variables on the disorder's outcomes. METHOD: The study involved 39 adolescents with OCD and 40 healthy controls. We assessed the case group at the initial visit to the outpatient clinic and again at the end of the first year of treatment. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was applied to assess OCD symptom distribution and severity. The Reading the Mind in the Eyes of Children Test (RME-CT) was applied to evaluate ToM skills, and the Cognitive Flexibility Scale (CFS) was employed to evaluate cognitive flexibility levels. RESULTS: Baseline RME-CT and CFS scores were significantly lower in adolescents with OCD compared to the control group (p = 0.002 p = 0.001, respectively). At the end of the 1-year follow-up, RME-CT and CFS scores increased significantly in the adolescents with OCD (p < 0.001, p = 0.003, respectively). A significant negative correlation was observed between the initial RME-CT scores and the Y-BOCS scores at the end of the 1-year follow-up (p < 0.001). The initial RME-CT score had a significant negative predictive effect on the subsequent severity of OCD (ß = -0.711, p < 0.001). CONCLUSIONS: The research revealed poorer long-term prognoses for OCD in adolescents who exhibit low ToM skills. In conclusion, the results indicate that ToM skills may serve as a predictive factor for long-term treatment outcomes among adolescents diagnosed with OCD.

The relationship between digit ratio (2D:4D) and intelligence levels in specific learning disorders.

BACKGROUND: Higher prenatal testosterone exposure regulates brain development and affects learning and intelligence directly. The digit ratio (2D:4D) is regarded as an indicator of prenatal testosterone exposure. This study aims to investigate the 2D:4D ratios and intelligence levels in individuals with specific learning disorders (SLD) and compare the ratios with healthy subjects. METHODS: The study included a total of 117 patients diagnosed with SLD and 67 healthy controls. We measured the 2D:4D ratios and administered the Wechsler-Intelligence Scale for Children-Revised to assess intelligence quotient (IQ) scores in the SLD group. Sociodemographic data was obtained for both patients and healthy subjects and compared in both groups, as well as 2D:4D ratios. RESULTS: Compared to healthy controls, both-hand 2D:4D ratios were found to be lower in the SLD group. In addition, male and female participants with SLD showed lower 2D:4D ratios in both hands than controls. The total scores on the WISC-R were found to decrease as the right-hand 2D:4D ratios and the age increased in the SLD group. CONCLUSION: Our findings add to the literature examining the influence of prenatal testosterone exposure on learning and intelligence in the SLD sample. Further research in this domain may yield valuable insights into the underlying mechanisms and potential clinical implications for the management of SLDs examining additional variables that could potentially impact alongside the impact of sex hormones on brain development.

Maternal perception of spousal support in raising children with developmental disability in the context of family and child variables.

OBJECTIVE: The purpose of this study was to examine the relationship between the variables of mental, physical, and emotional problems in children with developmental disabilities (DDs) and the spousal support perceived by the mothers of those children. METHODS: One hundred forty-three children diagnosed with autism spectrum disorder (ASD, n:43), intellectual disability (ID, n:28), cerebral palsy (CP, n:47), or Down syndrome (DS, n:25) were included in this study. The support that mothers received from their spouses was evaluated using the Spousal Support Scale (SSS). Aggressive behavior in the children was evaluated using the anger-aggression subscale of the Social Competence and Behavior Evaluation Scale (SCBE-30). The data obtained were then subjected to statistical comparisons. RESULTS: Multiple comparisons revealed no significant difference between the DD diagnosis groups (ID, CP, ASD, and DS) in terms of spousal support or spousal support sub-dimension scores (p > 0.05). Significant negative correlation was found between anger-aggression subscale scores and SSS sub-parameters (emotional support r = -0.315 p < 0.001, financial and informational support r = -0.285 p < 0.001, appreciation r = -0.299 p < 0.001, social support r = -0.381 p < 0.001, and spouse support score r = -0.389 p < 0.001). CONCLUSION: Children's anger-aggression levels were adversely affected by a lack of spousal support for their mothers.

Nursing personality and features in children with autism spectrum disorder aged 0-2: an exploratory case-control study.

AIM: Although studies have investigated relationships between autism spectrum disorder (ASD) and breastfeeding duration, information concerning these children's nursing styles is limited. This study investigated nursing personality and features and ASD. METHOD: One hundred forty-one children aged 24-72 months diagnosed with ASD and 128 healthy children were included. Information concerning the family's sociodemographic characteristics and the child's developmental stages was obtained through forms prepared by the authors and from hospital records. The Childhood Autism Rating Scale (CARS) was used to determine symptom severity in ASD. Development levels of children with ASD were determined using the Denver Developmental Screening Test 2nd Edition (DDST II). RESULTS: Mothers of children with ASD reported higher rates of unintended pregnancies (p = 0.029) [2.380*(1.093-5.182)]. Children with ASD exhibited less nursing strike (NS) behavior (p = 0.042) [0.388(0.156-0.967)] and less eye contact during breastfeeding (ECDB) (p = 0.009) [2.300(1.236-4.282)]. NS reduced the risk of ASD 2.6-fold, while absence of ECDB increased the risk 2.3-fold, and unintended pregnancy increased the risk 2.4-fold. Higher CARS scores were determined in children with ASD with vaginal delivery histories (p = 0.041) and histories of incubation (p = 0.025). Lack of ECDB was associated with decreased social and gross motor scores at DDST-II (p = 0.005). CONCLUSION: Babies with ASD began breastfeeding at least as early as typically developing peers and for similar lengths of time. However, babies with ASD exhibited less NS behavior and less eye contact during breastfeeding. Babies with ASD perceive no emotional cues even in the first months, and may therefore not exhibit NS behavior.

Emotional and behavioral problems in children and adolescents with hearing loss and their effects on quality of life.

PURPOSE: Determination of mental functions in children with hearing loss is important in improving the quality of life of the child. Many scales have been developed for this purpose. In this study, it was aimed to determine the emotional and behavioral effects of both the child with hearing loss and the parent in the hearing loss and device process, and to investigate the effect of this situation on the quality of life. METHODS: Forty-five children aged 7-17 years with sensorineural hearing loss with audiometric methods and 32 healthy controls without hearing problem were included in the study. All children received a Powers-Weakness Questionnaire-Self-Reporting Scale, Strengths and Difficulties Questionnaire, Child Anxiety and Depression Scale, and Kid-KINDL Quality of Life Scale. In all parents, the Parental Statement of Powers-Weaknesses Questionnaire and the Kid-KINDL Quality of Life Scale parental form questionnaires were applied. RESULTS: In the patient group, both mother (p = 0.001) and father (p = 0.027) education levels were significantly lower than the control group. The success rate of the sick children was lower than that of healthy children (p = 0.013). According to the surveys, the quality of life scale and all subscales were significantly lower in the patient group than in the control group (p < 0.05 for each). Child depression inventory score was also significantly higher in the patient group (p = 0.005). CONCLUSIONS: Data obtained in the study indicate that children with hearing disabilities should be closely monitored and undergo a better rehabilitation process in terms of both anxiety and depression and their quality of life. According to our findings, since the parents of hearing-impaired children are observed to have a low level of education, it is seen that these families should be educated more closely in approaching children and improving their quality of life.

Foveal avascular zone and vessel density in children with attention deficit hyperactivity disorder.

PURPOSE: To compare the retinal and choroidal microvasculature quantitatively via optical coherence angiography (OCTA) in children with attention deficit hyperactivity disorder (ADHD) who were under methylphenidate (MFD) treatment or newly diagnosed as ADHD and were not taking any medication. METHODS: This was a cross-sectional, comparative, and observational study. The children who were between 6 and 17 years old and previously diagnosed as ADHD and were under MFD treatment or who were newly diagnosed as ADHD were included in the study. Optical coherence tomography angiography imaging was performed via OCT RT XR Avanti with AngioVue software (Optivue Inc, Freemont, CA). The main outcome measure of the study was OCTA parameters of the children with ADHD. RESULTS: A total of 186 eyes of 186 patients were included in the study. There were 80 eyes in the control group (newly diagnosed) and 106 eyes in the treatment group (under MFD treatment). The mean duration of methylphenidate use in the treatment group was 33.9 ± 20.1 months (between 6 and 84 months). The choriocapillary flow area (p = 0.03), superficial parafoveal thickness (p = 0.01), and deep parafoveal thickness (p = 0.01) were statistically greater in the treatment group than the control group. CONCLUSION: Most of the important OCTA parameters especially foveal avascular zone (FAZ) area and FAZ perimeter were similar in the two groups. There was a significant difference between the two groups in parafoveal thickness values which might point to a slight effect of MFD on retinal circulation.

Gardner-Diamond Syndrome in an Adolescent With Suicidal Ideation: A Case Report.

Gardner-Diamond syndrome (GDS) is a rare disease often seen in young women involving painful localized inflammation and ecchymosis. Ecchymosis usually develops spontaneously after emotional stress. The pathophysiology of the disease is not fully understood, and little is known about management modalities for this syndrome. The primary approach of health professionals in the evaluation of this rare condition should involve identification of cases and investigation of potential accompanying psychiatric pathologies. The case presented here highlights the importance of assessing for GDS and reviews descriptions of GDS in the context of the existing literature.

Pediatric patients with psoriasis and psychiatric disorders: premorbidity and comorbidity in a case-control study.

BACKGROUND: Psychiatric disorders are thought to play an important role in the onset, exacerbation and course of several chronic dermatological diseases. We aimed to investigate psychiatric diagnoses in children with psoriasis before and during the disease and to examine potentially related factors. METHODS: A total of 108 children aged 8-16 years, 54 with a diagnosis of psoriasis and 54 healthy individuals, were included in the study. Participants were evaluated using The Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version (K-SADS PL), Children's Dermatology Life Quality Index (CDLQI), Screen for Child Anxiety Related Emotional Disorders (SCARED) and Children's Depression Inventory (CDI), and the results were compared using statistical techniques. RESULTS: At least one psychiatric diagnosis was present in 70.3% of children with psoriasis and in 27.7% of the control group, the difference being significant (p = .0001). It was seen that 73.6% of children with a psychiatric diagnosis were psychiatric diagnoses in the premorbid period. Children with psoriasis were determined to have 9.21-fold greater risk of anxiety (p = .0001) and a 6.65-fold greater risk of depression (p = .0019) compared with the control group. CONCLUSIONS: A statistically significant increase in psychiatric disorders occurs in disease periods in cases of pediatric psoriasis. Moreover, a high prevalence of psychiatric disorders was detected in the premorbid process. We think that it is important for these to be considered in the management of the disease and in controlling exacerbation, and for the mechanisms involved to be elucidated.

The role of psychiatric status on pediatric extremity fractures: a prospective analysis.

PURPOSE: The aim of the study was to investigate the relationship between attention deficit and hyperactivity disorder (ADHD), anxiety, and depression with pediatric extremity fractures. METHODS: Between November 2014 and November 2016, consecutive 138 patients with pediatric extremity fractures were prospectively investigated in terms of the tendency to anxiety, depression, or ADHD in the study group. Consecutive 168 non-trauma patients who were admitted to general pediatrics outpatient clinic were included the control group. Patients were performed with Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form (T-DSM-IV S), The Screen for Child Anxiety-Related Emotional Disorders (SCARED), and The Children's Depression Inventory (CDI). RESULTS: There were not any significant differences between study and control groups regarding the age, gender distribution, economical level, or previous psychiatric admission rates (p > 0.05). In the study group, the previous ADHD history and previous fracture history were significantly higher than the control group (p < 0.05). In the study group, the severity of depressive signs and anxiety were significantly higher than the control group (p = 0.000 and p = 0.019; respectively). Regarding the previous fracture history, conduct disorder and tendency to depression were significantly higher in the study group (p = 0.001 and p = 0.011; respectively). CONCLUSIONS: The signs of ADHD, anxiety, and depression were determined to be higher in children with extremity fractures compared with the non-traumatic population. In patients with especially behavioral problems and depressive signs, directing to the child and adolescent psychiatrists will be protective to prevent re-fractures and high-energy traumas.

Effects of Long-Term Use of Prescription Methylphenidate on Myocardial Performance in Children with Attention-Deficit/Hyperactivity Disorder: A Tissue Doppler Imaging Study.

OBJECTIVE: Many children diagnosed with attention-deficit/hyperactivity disorder are treated with methylphenidate (MPH). The purpose of this study was to evaluate the relationship between long-term use of osmotic-release oral system methylphenidate (OROS MPH) and cardiac functions. METHODS: The study involved 116 subjects 6-18 years of age. Fifty-eight of these were in the case group and were using OROS MPH (extended-release capsules). Fifty-eight children not receiving treatment were included in the control group. Participants were also assessed using 12-channel electrocardiography (ECG), transthoracic 2D echocardiography, Doppler echocardiography, and tissue Doppler imaging (TDI). The findings obtained were compared using statistical methods. RESULTS: No significant differences were determined between the case and control groups in terms of systolic blood pressure and diastolic blood pressure or 12-channel ECG findings. There was also no difference in 2D and M-mode measurements among the echocardiography findings. Of the TDI parameters obtained, only E' septal values differed significantly between the case and control groups. However, this was not at such a level as to indicate cardiac function impairment. CONCLUSIONS: The study data showed that the echocardiographic parameters we measured resulted in no clinical difference between the children using MPH and the healthy controls. We conclude that MPH use in children does not impair cardiovascular functions at short-term follow-up.

Interactions between Posttraumatic Stress Disorder and Alopecia Areata in Child with Trauma Exposure: Two Case Reports.

Alopecia areata (AA) is a dermatologic disease that can be seen in all age groups with nonscarring hair loss. While the causes of AA are suggested to be the role of genetic, psychological stresses, cellular and humoral immunity, and endocrine and neural factors, the underlying cause is not fully known. Psychiatric diseases are frequently reported in many studies in patients with AA. In this report, children with AA and psychiatric evaluation of them and the prominence of psychiatric evaluation in AA were discussed; AA and posttraumatic stress disorder were reviewed in the light of the relevant literature.

Is growth hormone deficiency associated with anxiety disorder and depressive symptoms in children and adolescents?: A case-control study.

AIM: Children with growth hormone deficiency (GHD) are reported to experience failure in psychological maturation, and to have a lack of self-confidence in social life, and depressive symptoms. The purpose of this study was to investigate the relation between GHD and anxiety disorders and depression in children and adolescents. METHOD: 122 children and adolescents aged 7-17, 87 receiving GHD therapy and 35 before treatment, and 122 healthy volunteers were included in the study. All participants were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version-Turkish Version (K-SADS-PL-T). Diagnoses falling outside this semi-structured interview were made with clinical evaluation based on DSM-V diagnostic criteria. Participants were also assessed using an information form, the State-Trait Anxiety Inventory for Children (STAI-C), the Social Anxiety Scale for Children-Revised (SASC-R), and the Children's Depression Inventory (CDI), and the results were subjected to statistical analysis. RESULTS: Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD) were significantly more common in children with GHD compared to the control group (p ≤0.001 and p = 0.033, respectively). Receipt of treatment significantly reduced GAD and SAD rates in the group diagnosed with GHD (p = 0.012, and p = 0.014). Being in receipt of GH therapy also caused a significant decrease in STAIC (State) (p ≤0.001), STAIC (Trait) (p ≤0.001), SASC-R (p ≤0.001), and CDI (p ≤0.001) scale scores. Untreated subjects had more adverse scale scores than treated subjects, and treated subjects had more adverse scale scores than the control group. An increase was observed in all scale scores in the form of control group < treated group < pre-treatment group. IGF and GH-PEAK exhibited moderate negative correlation with STAIC-TRAIT, STAIC-STATE, and SASC-R, and weak negative, significant correlation with CDI (Spearman's rho p ≤0.05). CONCLUSION: Having GHD and being in receipt of treatment resulted in lower scale scores. Children with GHD had higher GAD and SAD burdens compared to the healthy controls. The etiology of these children's existing psychiatric diseased now requires identification using more variables in psychosocial and hormonal terms.

The effect of deformity correction on psychiatric condition of the adolescent with adolescent idiopathic scoliosis.

PURPOSE: The purpose of this prospective study was to evaluate the effects of deformity correction on body image, quality of life, self-esteem, depression and anxiety in patients with adolescent idiopathic scoliosis (AIS) who underwent surgery. METHODS: Between June 2014 and July 2015, 41 consecutive patients who underwent surgery for AIS were compared with the control group of 52 healthy patients regarding the changes in the pre- and postoperative quality of life and psychiatric status of patients with deformity correction. Body Cathexis Scale (BCS), Pediatric Quality of Life Inventory (PedsQL), Children's Depression Inventory (CDI), Piers-Harris self-esteem questionnaire (PH-SEQ) and state-trait Anxiety Inventory for Children were used to evaluate the patients. RESULTS: There was a significant decrease in postoperative first-year Cobb angle and trunkal shift imbalance compared with the preoperative values (p = 0.0001 and p = 0.0001). Postoperative first-year thoracic kyphosis angle and body height showed a significant increase according to preoperative values (p = 0.0001 and p = 0.0001). Postoperative PH-SEQ score and PedsQL total score showed a significant increase in the study group compared to the preoperative level, but no significant difference was found between the control group. Postoperative CDI score, BCS score, STAI-state and STAI-trait scores decreased significantly in the study group compared with preoperative scores. CONCLUSIONS: Surgical correction of deformity in AIS provided significant improvements regarding quality of life and psychiatric condition. Spinal surgeons should be aware of the possible psychological problems of AIS patients and should keep in mind that deformity correction not only improves physical health but also improves mental health. These slides can be retrieved under Electronic Supplementary Material.

Seroprevalance Anti-Toxoplasma gondii antibodies in children and adolescents with tourette syndrome/chronic motor or vocal tic disorder: A case-control study.

Toxoplasma gondii infection may be associated with psychiatric disorders due to its neurological effects. The purpose of this study was to investigate the relation between tic disorders in children and adolescents and Anti-Toxoplasma IgG. 43 children diagnosed with Tourette's syndrome(TS) and 87 with chronic motor or vocal tic disorder(CMVTD), and 130 healthy volunteers, all aged 7-18, were enrolled. Anti-Toxoplasma IgG antibody levels obtained from blood specimens were investigated. Toxoplasma IgG positivity was determined in 16(37.2%) of the patients with TS, in 27(31%) of those with CMVTD and in 12(9.2%) members of the control group. Anti-Toxoplasma gondii antibody positivity was 5.827-fold higher in subjects with TS and 4.425-fold higher in subjects with CMVTD compared to the control group. Correlation was determined between a diagnosis of TS or CMVTD and Anti-Toxoplasma gondii antibodies. We think that it will be useful for the neuropsychiatric process associated with Anti-Toxoplasma gondii antibodies to be clarified.

An Investigation of SDF1/CXCR4 Gene Polymorphisms in Autism Spectrum Disorder: A Family-Based Study.

OBJECTIVE: Autism spectrum disorders (ASD) have a complex pathophysiology including genetic, inflammatory and neurodevelopmental components. We aim to investigate the relationship between ASD and gene polymorphisms of stromal cell-derived factor-1 (SDF-1) and its receptor CXC chemokine receptor-4 (CXCR4), which may affect inflammatory and neurodevelopmental processes. METHODS: 101 children diagnosed with ASD aged 2-18 and their biological parents were included in the study. All participants were assessed using an information form and the Children were assessed using Childhood Autism Rating Scale (CARS). SDF-1 G801→A and CXCR4 C13→T polymorphisms were detected by genetic techniques. The results were evaluated using the transmission disequilibrium test (TDT) and haplotype relative risk (HRR). RESULTS: Following TDT evaluation for CXCR4, the assumption of equality was not rejected (χ2=1.385, p=0.239). HRR for the C allele was 1.037 [HRR (95%CI)=0.937 (0.450-2.387), χ2=0.007, p=0.933] and HRR for the T allele was 0.965 [HRR (95%CI)=0.965 (0.419- 2.221), χ2=1.219, p=0.270], but the findings were statistically insignificant. Based on TDT evaluation for SDF1, the assumption of equality cannot be rejected (χ2=0, p=0.999). HRR for the A allele was 0.701 [HRR (95%CI)=0.701 (0.372-1.319), χ2=1.219, p=0.270] and HRR for the G allele was 1.427 [HRR (95%CI)=1.427 (0.758-2.686), χ2=1.219, p=0.270], but the findings were statistically insignificant. CONCLUSION: The genetic screening of blood samples from mother, father and child trios could not show a significant association between SDF1/CXCR4 genes and ASD on the basis of TDT and HRR tests. More extensive genetic studies are now needed to investigate the relationship between SDF1/CXCR4 gene polymorphisms and ASD.

Newly Developed Skin Picking After Methylphenidate Treatment in Attention Deficit Hyperactivity Disorder: Possible Mechanisms.

Dermatillomania is characterized by excessive and repeated skin picking sufficient to damage cutaneous tissue, but with no underlying dermatological disease. The condition appears as an independent diagnosis in the Obsessive-Compulsive and Related Disorders category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A psychiatric pathology is generally reported to accompany this symptom. Attention deficit hyperactivity disorder (ADHD) is a potentially lifelong condition involving inattentiveness, hyperactivity, and impulsiveness. Attention deficit hyperactivity disorder is one of the most common childhood psychiatric disorders. Treatment includes medication, psychotherapy, and psychosocial therapies. Psychostimulants constitute the basis of treatment of children with ADHD worldwide. We describe a case of skin picking developing after methylphenidate therapy for ADHD. Possible explanations of methylphenidate and skin picking are reviewed in the light of the current literature.

The relationship between Toxoplasma gondii IgG antibodies and generalized anxiety disorder and obsessive-compulsive disorder in children and adolescents: a new approach.

AIM: Toxoplasma gondii may play a role in the development of psychiatric diseases by affecting the brain. The purpose of this study was to examine the relation between serum toxoplasma IgG positivity and obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD) in children and adolescents. METHOD: Sixty patients diagnosed with OCD and 60 patients with GAD presenting to the pediatric psychiatry clinic, together with 60 control group subjects with no psychiatric diagnosis, were included in the study. The patients were administered the State-Trait Anxiety Inventory for Children and the Children's Yale-Brown Obsessive Compulsive Scale. Serum toxoplasma IgG levels were determined from blood specimens collected from the study and control groups. The results were then compared using statistical methods. RESULTS: State and trait anxiety levels were significantly higher in the OCD and GAD patients than in the control group (p = .0001/.0001). Serum toxoplasma IgG levels were positive in 21 (35%) of the OCD patients, 19 (31.7%) of the GAD patients and 6 (10%) of the control group. A significant relation was determined between IgG positivity and GAD (p = .003). IgG-positive individuals were determined to have a 4.171-fold greater risk of GAD compared to those without positivity (4.171[1.529-11.378]) (p = .005). A significant relation was also determined between IgG positivity and OCD (p = .001). IgG-positive individuals were determined to have a 4.846-fold greater risk of OCD compared to those without positivity (4.846[1.789-13.126]) (p = .002). CONCLUSION: This study shows that serum toxoplasma IgG positivity indicating previous toxoplasma infection increased the risk of GAD 4.171-fold and the risk of OCD 4.846-fold in children and adolescents. Further studies are now needed to investigate the relation between T. gondii infection and GAD/OCD and to determine the pathophysiology involved.