PTSD, depression, and migration-related experiences among Syrian refugees living in camp vs urban settings.

Despite the increased heterogeneity of living conditions of refugees in recent years, there is a lack of robust epidemiological data about the relationship between refugees' mental health and their living contexts. The current study aims to compare frequencies of pre-migration traumatic events and post-migration difficulties between refugees living in camps and those living in cities; and to identify the prevalence of post-traumatic stress disorder (PTSD), depression, and factors associated with them. A field survey was conducted among 1,470 refugees living in camps and urban settings of Turkey. The survey instruments included a socio-demographic form, the Harvard Trauma Questionnaire, the Post-migration Living Difficulties Scale, and the PTSD and depression modules of the Mini-International Neuropsychiatric Interview. Both PTSD and depression were more common in urban settings than in camps. Both disorders were associated with living context and migration-related experiences. Pre-migration traumas were more frequent among refugees living in cities than in those living in camps, while post-migration difficulties were more common in the refugees living in camps. The living context is potentially a critical determinant of refugee mental health. Camp and urban refugees may have different experiences and needs. In particular, refugees living in some urban settings may be at higher risk for having psychological problems.

Factors Associated with Family Belongingness in Children Under Legally Required Health Care.

Introduction: It is known that family dysfunctions increase the risk of abuse, neglect and delinquency in children. On the other hand, family belonging was shown as one of the protective factors against these types of risks. In this study, it was aimed to investigate the relationship between family belonging and various risk factors for children and their families who are being treated in a mental health clinic with the decision of health measure. Method: The study group consisted of 57 adolescents who were treated with a health measure decision, and the control group consisted of 42 adolescents who were treated in the same clinic without any health measure, both groups were over the age of 14. The Parenting Style Scale and The Family Belonging Scale were applied to the participants who took part in the study on a voluntary basis. Data in the sociodemographic information form were updated with the help of parents. Results: Children with health measure decisions had higher rates of grade repetition, exposure to a negative life event, domestic physical and verbal violence, living in a fragmented family system, presence of mental illness in the mother, and a history of delinquency in family members compared to children in the control group. It was found that children's participation in social activities, and the education and income levels of the parents were lower. Additionally, authoritarian and negligent parenting styles were more pronounced and family belonging was lower in the same group. In the regression analysis, it was revealed that the family belonging of children who had been followed up with a health measure desicion, increases with the participation in social activities and decreases with physical violence. Conclusion: Our study supported that in studies targeting children at risk or in need of protection, family-oriented interventions are protective, preventive and curative.

Tic disorders in the differential diagnosis of chronic cough in children in relation to four cases.

Chronic cough is a frequent reason for medical referrals in childhood. In patients who do not have signs or symptoms of an underlying respiratory system disease and who do not respond to experimental treatment, psychogenic cough should be considered. In this paper, four patients who were referred to our department with a prediagnosis of psychogenic cough, found to have tic disorder as a result of the assessments performed and improved with antipsychotic medication are presented. The differantial diagnosis of chronic cough in children should include tic disorders as well as psychogenic cough. Tic disorders can be diagnosed easily with detailed history and their response to medical treatment is rather satisfactory. Recognition of these disorders by pediatricians will minimize erroneous diagnoses and inappropriate therapies in children with a complaint of chronic cough.

The Effect of Sertraline on the Quality of Life for Children and Adolescents with Anxiety Disorder.

INTRODUCTION: In this study, we aimed to determine the changes in quality of life of children/adolescents with anxiety disorders during six months of sertraline treatment, to investigate parent-child/adolescent concordance in perception of quality of life and to examine the effect of treatment on children/adolescents. METHODS: In this study, 30 patients with anxiety disorders according to criteria specified in Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition (DSM-IV) were assigned to sertraline treatment. The patients were evaluated using the Pediatric Quality of Life Inventory (PedsQL), State-Trait Anxiety Inventory for Children, Clinical Global Impression Scale (CGI) and the Children's Global Assessment Scale (CGAS) at 0th, 2nd and 6th months. RESULTS: PedsQL total scores increased significantly with the treatment in children and adolescents (p<.001), however, no differences were observed in parent proxy report (p=.326). The mean CGAS score was 59.85±7.73 at the beginning of treatment and 73.70±7.01 at the end of treatment (p<.001). The average CGI score decreased from 4.68±.96 to 2.27±.84. CONCLUSION: It was observed that perception of quality of life in children and adolescents with anxiety disorders increased with the treatment.

A nationwide study of social-emotional problems in young children in Turkey.

We aimed to assess the prevalence of social-emotional problems of Turkish children in early childhood and to understand their association with various bio-psycho-social risk factors, in order to establish guidelines in planning training programs for parents and professionals. Data from a representative sample of 1507 boys (54.3%) and 1268 girls (45.7%) aged 10-48 months were collected. The primary caregivers (mothers=91.4%) completed the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the Brief Symptom Inventory (BSI) and a form designed to gather information about various bio-psycho-social risk factors. Based on the caregiver terms, a total of 1626 children (60.1%) were reported to experience social-emotional problems. However, based on the BITSEA-problem clinical (1.5 SD) cut-off scores, 9.3% (9.1% of boys; 9.5% of girls) of all children were found to experience social-emotional problems. The variables, that showed a significant association with BITSEA-problem scores in pairwise comparisons, were entered in logistic regression analysis to determine the variables that predict the group with scores of above clinical cut-point. Higher total score of BSI of the primary caregiver, being separated from the mother for more than a month, and lower income of the family were found to be significant predictors of social-emotional problems. Caregiver reports highlight that maternal variables of mothers' psychological well-being, education and access to sources of support are closely related to the social-emotional wellbeing of their off-spring. The findings obtained from this study may be used for detection of prioritized domains in terms of management of preventive mental health services.

Prevelance of mental disorders and associated factors in institutionalized 3-5 year old children.

OBJECTIVE: In this study, we aimed to determine the prevelance and severity of mental disorders in institutionalized children between the ages of 3-5 years, investigate the factors associated with the mental disorders and compare these findings with the data of a community sample composed of children who were raised by their own families. METHOD: Thirty-four children raised in three institutions in Kocaeli were compared with an age- and sex-matched community sample. Children were assessed according to DSM-IV diagnostic criteria. The Socio-demographic information form, and Early Childhood Inventory-4 (ECI-4) parent scale were used for data collection. RESULTS: Children that were reared in institutions had evidence of higher rates of mental disorders. In institution-reared children, symptom severity of attention deficit hyperactivity disorder, reactive attachment disorder, oppositional deficient disorder, and pervasive developmental disorder were higher than the community subjects. Age, time spent with father, duration of institutionalization, number of siblings, number of hospital admissions because of physical symptoms and presence of abuse before institutional care were determined to be predictive factors for psychiatric symptoms. CONCLUSION: These findings revealed that institutionalized children are at risk for mental disorders and protective measures are as important as instutional care for these children. Our results suggest that essential steps should be taken to protect the mental health of children in institutional care.

Posttraumatic stress symptoms in children diagnosed with type 1 diabetes.

BACKGROUND: Studies consistently found remarkable rates of posttraumatic stress symptoms (PTSS) in children with chronic diseases. But, only one study had searched PTSS in children with diabetes, until now. So, the present study aimed to examine incidence rate and predictors of PTSS in children with type 1 diabetes. METHOD: PTSS were evaluated by Child Posttraumatic Stress Reaction Index in fifty four children with diabetes (aged between 8-18 years). This assessment was based on hypoglycaemia as the potential traumatic event. Children were also introduced a brief questionnaire about demographic and disease related information. Some other information was obtained from families, medical stuff and records. Among 54 children, forty two had complete information. Hence, to evaluate possible predictive factors related with PTSS, multiple regression analysis was conducted for 42 children. RESULTS: 18.5% of children were reported PTSS at severe or very severe level, and 51.9% were reported PTSS at moderate level or above. Multiple regression analyses were shown that child PTSS were not significantly related with possible predictive factors other than number of hypoglycaemic attacks for the last month. CONCLUSION: The study results support that posttraumatic stress symptoms are not rarely seen in paediatric patients with diabetes, and even if not severe, hypoglycaemic attacks may be perceived as traumatic by the children with diabetes. But, because of some limitations, the results should be carefully interpreted.

Outcome in early adolescent idiopathic scoliosis after deformity correction: assessed by SRS-22, psychometric and generic health measures.

The purpose of this study was to examine the health status of early adolescent patients with idiopathic scoliosis using depression-anxiety scales, a generic Quality-of-Life Inventory as well as the Scoliosis Research Society-22 (SRS-22) questionnaire to search for the most comprehensive approach for the measurement of outcomes. Thirty-seven early adolescent patients with idiopathic scoliosis were analyzed within 6-12 months of the postoperative time period. There was no statistically significant correlation between the total score of SRS-22 and the total scores of the pediatric quality-of-life inventory. However, the total scores of SRS-22 were positively correlated with the self-esteem level and negatively correlated with the depression level and State-Trait Anxiety Inventory for Children scores. In early adolescents with idiopathic scoliosis deformity correction, SRS-22 may be inadequate in terms of mental health and physical activity parameters to evaluate overall quality of life.

Atomoxetine and methylphenidate treatment in children with ADHD: the efficacy, tolerability and effects on executive functions.

The aim of this study was to compare the safety, efficacy, tolerability, and the effects of atomoxetine and OROS-MPH on executive functions in children with ADHD. This study was an open-label study that only included two medication groups. Children were randomized to open-label atomoxetine or OROS-MPH for 12 weeks. Primary efficacy measures were T-DSM-IV-S, CGI-I and neuropsychological tests battery. Safety assessments included electrocardiogram, adverse events checklist and laboratory tests. According to the endpoint improvement scores of CGI and parents T-DSM-IV-S, treatment responses were not significantly different between the two study groups. OROS-MPH led to a significantly greater reduction in teacher T-DSM-IV-S scale scores. OROS-MPH was more effective than atomoxetine on Stroop-5 time and number of corrections. Significant decrease in the percentage of perseverative errors on WCST in the OROS-MPH group was seen (p = 0.005). The most frequently reported adverse events in the atomoxetine group were anorexia, nausea, nervousness, weight loss, abdominal pain, and somnolence. In the OROS-MPH group, patients most frequently reported anorexia, nervousness, insomnia, headache, nausea, and weight loss. When all these results are considered, although both drugs can be considered effective in ADHD treatment, more remarkable improvement is provided by OROS-MPH based on the rates across informant (i.e., teachers, clinicians) and neuropsychological evaluation.

Priapism associated with methylphenidate: a case report.

Priapism is a persistent unwanted erection that is not associated with sexual desire or sexual stimulation. Immediate diagnosis and treatment are essential for priapism; otherwise, it causes ischemia of cavernous tissues, which will result in erectile dysfunction. In this paper, we report a 14-year-old male patient who presented with priapism after administration of immediate-release methylphenidate. When the usage of immediate-release methylphenidate was terminated, priapism spontaneously disappeared. To our knowledge, this is the first report in the literature of priapism associated with immediate-release methylphenidate use. This issue is significant because in the case of immediate-release methylphenidate prescription to adolescent male patients, the probability of the development of priapism should not be ignored.

Social anxiety level in Turkish adolescents.

Social phobia is a mental disorder characterized by extreme and consistent fear of meeting new people, scrutiny in a variety of performance and/or interactional situations. The aim of this study was to investigate the level of self-reported social anxiety in a community sample of Turkish adolescents and the relationship between social anxiety and some sociodemographic parameters. This study was a school-based cross-sectional study. Students in grades 6-8 (aged 10-16) from 12 schools in Kocaeli/Turkey were screened by the Social Anxiety Scale for Adolescents (SAS-A). The correlations of sociodemographic parameters with the SAS-A scores were examined. Data from a sample of 1,713 students (865 boys 50.4% and 848 girls 49.5%) were analyzed. A significant gender difference in the SAS-A points was found. Boys reported higher SAS-A total and subscale scores (except social avoidance and distress-general subscale score) than did girls. A significant negative correlation was found between socioeconomic status and social anxiety level. SAS-A scores were higher in those with a low socioeconomic level, and who were going to rural schools. The result of this study showed that social phobic symptoms among Turkish adolescents were more severe in boys. Some factors such as low socioeconomic level, and going to a rural school had impact on the SAS-A scores. As the impairment in the school-domain was reported to be quite high, professionals and teachers need to recognize social anxiety in adolescents, so that help can be offered to overcome the difficulties social phobia causes.

The volumetric differences of the fronto-temporal region in young offspring of schizophrenic patients.

The aim of this study is to examine the volumetric differences of the fronto-temporal region in the offspring of schizophrenic patients in comparison to normal. Twenty-six offspring of chronic schizophrenic patients aged between 8 and 15 years and 23 control children were matched with respect to cranial MRI. Chronic schizophrenic patients were reevaluated with SCID-I to confirm their diagnosis. Parents of children in the control group completed SCL-90-R and were evaluated by clinical interview to exclude any psychotic disorder. The diagnoses of psychiatric disorders in all of the children were established by DSM-IV-based clinical interviews with children and parents. They underwent IQ evaluation by WISC-R and evaluated with cranial MRI. Hippocampus, thalamus, amygdala, corpus callosum, frontal, and temporal lobe volumes were measured and compared by using MANCOVA. After covarying whole brain volume, age and gender, statistically significant decrease in the measurements of corpus callosum and hippocampi, and a non-significant trend toward smaller temporal lobes were observed in the high-risk children. The structure of hippocampal formation and corpus callosum were impaired in the children of the schizophrenic patients which suggests a neurodevelopmental abnormality in subjects with genetic high risk for schizophrenia.

[The reliability and validity of the children's negative cognitive errors questionnaire]. / Cocukluktaki Olumsuz Düsünceleri Degerlendirme Olçegi Geçerlik-Güvenilirlik Calismasi.

OBJECTIVE: The Children's Negative Cognitive Errors Questionnaire (CNCEQ) is a self-report scale measuring negative cognitive errors in children. The aim of this study was to examine its reliability and validity, and to obtain its norms for Turkish children. METHOD: The study was carried out at 3 public schools representing 3 different socioeconomic statuses. The sample of 538 children was selected randomly among third-eighth grade elementary school students. The students were evaluated by the CNCEQ, Children Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Coopersmith Self-Esteem Inventory (SEI). For test-retest reliability, the CNCEQ was readministered to the students 7 days after its first administration. RESULTS: In the reliability analysis, the Cronbach's alpha coefficient was calculated as 0.82 and 0.79. Test-retest reliability of the total score was 0.87. In comparing the CNCEQ to CDI, SAIC, TAIC, and SEI, correlations were r = 0.77, r = 0.57, r = 0.50, and r = -0.65, respectively (P < 0.001). Construct validity factors had eiganvalues > 1. These factors were related to catastrophizing, personalizing, and selective abstraction. CONCLUSION: The Turkish version of the CNCEQ has appropriate reliability and validity for assessing negative cognitive errors in Turkish children; however, additional reliability and validity studies should include patient groups with specific disorders.

[The symptoms of PTSD, depression and anxiety in adolescent students three and a half years after the Marmara earthquake]. / Marmara Depreminden Uç Buçuk Yil Sonra Ergenlerde TSSB, Depresyon ve Anksiyete Belirtileri.

OBJECTIVE: To screen the symptoms of posttraumatic stress disorder (PTSD), depression and anxiety in adolescent students three and a half years after the Marmara earthquake in Turkey. METHOD: Overall 334 students were selected from secondary schools located within Kocaeli province in Turkey, three and a half year after a severe earthquake. They were chosen to participate in this cross-sectional study by simple random sampling. The students were evaluated by the Child Posttraumatic Stress Reaction Index (CPTSD-RI), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI). Additionally, an information form was filled out by the students. RESULTS: Of the 334 students we found that 1.8% had very severe, 20.4% had severe, 38.3% had moderate and 30.2% had mild symptoms of PTSD and that 22.2% had probable PTSD and 30.8% had probable depression diagnoses. The frequency and intensity of re-experiencing and hyperarousal symptoms were considerably high on CPTSD-RI. The mean grades of anxiety measures were higher than that of the normal population. A significant correlation was determined between PTSD, depression and anxiety. CONCLUSION: The symptoms of PTSD depression and anxiety may continue for years after natural disasters. Hence, prevention studies and the screening of children and adolescents after disasters are important for the mental health of the community.