Brain-derived neurotrophic factor in bipolar disorder: Associations with age at onset and illness duration.

Bipolar disorder (BD) is a heterogeneous disorder that contains neurodevelopmental differences. Defining homogeneous subgroups of BD patients by using age at onset (AAO) as a specifier may promote the classification of biomarkers. This study compares peripheral BDNF levels between pediatric and adult BD patients to investigate the associations between BDNF levels, AAO, and illness duration. We enrolled two groups of euthymic patients, those with pediatric BD (n = 39) and those with adult BD (n = 31), as well as a group of healthy controls (HCs) (n = 90). Participants were assessed using clinical measures and BDNF serum levels were obtained using ELISA. We observed that BDNF levels were comparable between adult BD and HCs, but were clearly lower in pediatric BD than in HCs. In adult BD with AAO ≥30 years, BDNF levels were significantly higher than in adult BD with AAO <30 years. In pediatric BD, patients with prepubertal-onset had higher BDNF levels than those with pubertal-onset. BDNF levels demonstrated the accuracy of being able to distinguish pediatric BD from healthy controls in a receiver operating characteristic (ROC) curve analysis (area under the curve [AUC] = 0.792). In adult BD, higher BDNF levels were associated with later disease onset, but this was not the case in pediatric BD. Finally, reduced BDNF levels were associated with illness duration in adult BD. The findings indicate that BDNF levels in BD patients are associated with AAO. BDNF may, therefore, potentially serve as a developmental marker in BD, when AAO is taken into account.

Parental psychological distress associated with COVID-19 outbreak: A large-scale multicenter survey from Turkey.

AIMS: Pandemics can cause substantial psychological distress; however, we do not know the impact of the COVID-19 related lockdown and mental health burden on the parents of school age children. We aimed to comparatively examine the COVID-19 related the stress and psychological burden of the parents with different occupational, locational, and mental health status related backgrounds. METHODS: A large-scale multicenter online survey was completed by the parents (n = 3,278) of children aged 6 to 18 years, parents with different occupational (health care workers-HCW [18.2%] vs. others), geographical (Istanbul [38.2%] vs. others), and psychiatric (child with a mental disorder [37.8%]) backgrounds. RESULTS: Multivariable logistic regression analysis showed that being a HCW parent (odds ratio 1.79, p < .001), a mother (odds ratio 1.67, p < .001), and a younger parent (odds ratio 0.98, p = .012); living with an adult with a chronic physical illness (odds ratio 1.38, p < .001), having an acquaintance diagnosed with COVID-19 (odds ratio 1.22, p = .043), positive psychiatric history (odds ratio 1.29, p < .001), and living with a child with moderate or high emotional distress (odds ratio 1.29, p < .001; vs. odds ratio 2.61, p < .001) were independently associated with significant parental distress. CONCLUSIONS: Parents report significant psychological distress associated with COVID-19 pandemic and further research is needed to investigate its wider impact including on the whole family unit.

Investigation of structure-function correlation among the young offspring of patients with bipolar disorder.

Bipolar disorder (BD) has been associated with impaired executive functioning and integrity of fronto-limbic white matter tracts. The evaluation of these factors in young offspring of patients with BD (BDoff) as a high-risk group offers an opportunity to investigate factors that could predict vulnerability to the disorder. This study aims to examine the correlation between neurocognition and neuroimaging findings to evaluate the potential for these findings as biomarkers for the early recognition of BD. We enrolled BDoff (n = 16) who were aged between 12 and 18. Participants were assessed using clinical and neurocognitive tests. In addition, structural brain magnetic resonance and diffusion tensor imaging data were obtained. Mean fractional anisotropy (FA) and mean diffusivity (MD) values of the superior longitudinal fasciculus (SLF) and cingulum were extracted and correlations with neuropsychological data were analyzed. FA values in the SLF were negatively correlated with Stroop interference, the Wisconsin Card Sorting Test, and the Trail Making Test (B-A) scores. MD values in the cingulum were inversely correlated with the Child and Youth Resilience Measure and positively correlated with higher scores on the Barratt Impulsiveness Scale-Attentional. These findings provide a link between features of the brain and cognitive dysfunction in BDoff.

Genetic imaging study with [Tc-99m] TRODAT-1 SPECT in adolescents with ADHD using OROS-methylphenidate.

AIM: To examine theeffects on the brain of 2-month treatment withamethylphenidate extended-release formulation (OROS-MPH) using [Tc-99m] TRODAT-1SPECT in a sample of treatment-naïve adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). In addition, to assess whether risk alleles (homozygosity for 10-repeat allele at the DAT1 gene were associated with alterations in striatal DAT availability. METHODS: Twenty adolescents with ADHD underwent brain single-photon emission computed tomography (SPECT) scans with [Tc-99m] TRODAT-1 at baseline and two months after starting OROS-MPH treatment with dosages up to 1 mg/kg/day. Severity of illness was estimated using the Clinical Global Impression Scale (CGI-S) and DuPaul ADHD Rating Scale-Clinician version (ARS) before treatment,1 month and 2 months after initiating OROS-MPH treatment. RESULTS: Decreased DAT availability was found in both the right caudate (pretreatment DAT binding: 224.76 ±â€¯33.77, post-treatment DAT binding: 208.86 ±â€¯28.75, p = 0.02) and right putamen (pre-treatment DAT binding: 314.41 ±â€¯55.24, post-treatment DAT binding: 285.66 ±â€¯39.20, p = 0.05) in adolescents with ADHD receiving OROS-MPH treatment. Adolescents with ADHD who showed a robust response to OROS-MPH (n = 7) had significantly greater reduction of DAT density in the right putamen than adolescents who showed less robust response to OROS-MPH (n = 13) (p = 0.02). However, between-group differences by treatment responses were not related with DAT density in the right caudate. Risk alleles (homozygosity for the 10-repeat allele of DAT1 gene) in the DAT1 gene were not associated with alterations in striatal DAT availability. CONCLUSION: Two months of OROS-MPH treatment decreased DAT availability in both the right caudate and putamen. Adolescents with ADHD who showed a robust response to OROS-MPH had greater reduction of DAT density in the right putamen. However,our findings did not support an association between homozygosity for a 10-repeat allele in the DAT1 gene and DAT density, assessedusing[Tc-99m] TRODAT-1SPECT.

Atomoxetine treatment may decrease striatal dopaminergic transporter availability after 8 weeks: pilot SPECT report of three cases.

Attention deficit/hyperactivity disorder is one of the most common neurodevelopmental disorders. The pathophysiology is thought to involve noradrenaline and dopamine. The role of dopamine transporter (DAT) was evaluated in imaging studies using mostly dopamine reuptake inhibitors. Atomoxetine is a selective noradrenaline reuptake inhibitor. Here we report the results of a pilot study conducted to evaluate changes in striatal DAT after 8 weeks of atomoxetine treatment. Our results suggest that 8 weeks of atomoxetine treatment may change striatal DAT bioavailability as measured via SPECT but that change was not correlated with genotype or clinical improvement.

[The validity and reliability of the Social Communication Questionnaire- Turkish form in autistics aged 4-18 years]. / 4-18 Yas Araligindaki Otistik Bireylerde Sosyal Iletisim Ölçegi Türkçe Formunun Geçerlik ve Güvenilirlik Çalismasi.

OBJECTIVE: The Social Communication Questionnaire (SCQ) is a valid and reliable 40- item scale used to assess of pervasive developmental disorders (PDDs). The aim of this study was to determine the validity and reliability of the SCQ-Turkish Form (SCQ-TF). MATERIALS AND METHODS: The study included 100 children and adolescents aged 4-18 years 50 were diagnosed as PDD and 50 were diagnosed with intellectual disability (ID) based on DSM-IV-TR criteria. The consistency, test-retest reliability, content validity, and discriminant validity of SCQ-TF for the groups in the study sample were evaluated. SCQ-TF was compared to the Childhood Autism Rating Scale (CARS), Autism Behavioural Checklist (ABC), and Clinical Global Impression Severity of Illness (CGI-SI). The most appropriate SCQ-TF cut-off point was determined via ROC analysis. RESULTS: The 4-factor structure of SCQ-TF accounted for 43% of the observed total variance. Correlations between the Social Communication Questionnaire -Turkish Form and the other measures were significant. The Cronbach's alpha value for the SCQ-TF total score was 0.80. Intraclass correlation coefficient (ICC) varied between 0.87 and 0.96, and the cut-off point was 15. CONCLUSION: The findings show that SCQ-TF is valid and reliable for use in Turkey in those aged 4-18 years.

Effects of sociodemographic factors and maternal anxiety on preoperative anxiety in children.

OBJECTIVE: To investigate the effects of sociodemographic factors and maternal anxiety levels on behaviour in children undergoing surgery. METHODS: This study included children aged 3-12 years who were scheduled for surgery, and their respective mothers. Each mother completed a questionnaire concerning sociodemographic and economic characteristics. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) form Tx-1, following transfer of the child to the operating room. An anaesthesiologist rated preoperative anxiety in each child using the Frankl Behaviour Rating Scale (FBRS) and Venham Picture Test (VPT). RESULTS: One hundred children (mean ± SD age 7 ± 2.7 years) who received dental (47%), plastic (39%) or urological (14%) surgery, and 100 mothers (mean ± SD age 34 ± 6.6 years) were included. A statistically significant difference between maternal STAI Tx-1 scores and children's VPT scores was revealed. There was no significant difference between maternal STAI Tx-1 scores and children's FBRS scores. Maternal education level and socioeconomic status had no effect on FBRS, VPT and STAI Tx-1 scores. CONCLUSION: Maternal knowledge and experience of anaesthesia, and high levels of maternal anxiety, may be related to increased anxiety in children undergoing surgery.

Increased hippocampal volumes in lithium treated adolescents with bipolar disorders: a structural MRI study.

BACKGROUND: Structural neuroimaging studies in bipolar disorder (BD) have consistently identified several anatomical abnormalities in many brain areas related to mood regulation. Hippocampus is one of the key components of emotional regulatory networks in the brain. Evidence about hippocampal changes in BD is quite limited and inconsistent particularly for adolescent onset BD. It is aimed to compare hippocampus volumes of euthymic BD-I adolescents with healthy controls using structural MRI. METHODS: Hippocampal volumes of seventeen youths between 13 and 19 age period with DSM-IV BD (seven boys) and twelve healthy comparison subjects (five boys) were compared using structural MRI. Differences in hippocampal volumes between groups were tested. RESULTS: There was no significant difference between the right and left hippocampus volumes of patients with BD and the control group. However boys tended to have significantly larger right hippocampal volumes than girls both in BD and control group. Right hippocampal volumes were enlarged in lithium treated bipolar patients. This enlargement is not related to sex. LIMITATIONS: Future, longitudinal follow-up studies need large enough sample sizes of both sexes and a sex-matched healthy comparison group to sort out developmental, gender and medication influences on brain structures over time in BD. CONCLUSIONS: Lithium treatment in adolescent-onset BD has a significant effect on hippocampus volumes.

A case with unexplained bleeding from multiple sites: munchausen syndrome by proxy.

Munchausen syndrome by proxy (MBP) is an extreme form of child abuse where children were unnecessarily treated or investigated for medical conditions that were falsified by their caregivers. Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge, all of which are only witnessed by her mother. Extensive investigation revealed no organic etiologies for bleeding. The diagnosis of MBP was put by a multidisciplinary team. The diagnosis of MBP must be kept in mind in conditions where there is no underlying organic pathology in a bleeding patient.

Maternal reactions to a child with epilepsy: Depression, anxiety, parental attitudes and family functions.

OBJECTIVE: The goal of this study was to investigate how the disease and treatment of epilepsy affected the psychological profile (depression and anxiety) of mothers whose children had epilepsy, as well as these mothers' attitudes towards their children and their family relationships. METHODS: Both the case and control groups consisted of 50 children and their mothers. All mothers were asked to complete the Beck Depression Inventory, State-Trait Anxiety Inventory, Parental Attitude Research Instrument and Family Assessment Device. RESULTS: Mothers whose children had epilepsy scored significantly higher in depression and state anxiety compared to the mothers of the control group. The mothers of children diagnosed with epilepsy also failed to develop supportive and friendly relationships with their children. In addition, these mothers scored significantly higher in the Attitude of Hostility and Rejection, Marital Discordance and Authoritarian Attitude as compared to the mothers of the control group. CONCLUSION: This cross-sectional study demonstrated that, for the mothers of children who had epilepsy, the illness might have an adverse effect on their lives and their family relationships.

Depression and anxiety in children and adolescents with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is the most common autoinflammatory disease which requires a lifelong treatment. The aim of this study was to evaluate the depression and anxiety in pediatric FMF patients. The Children's Depression Inventory and the Screen for Child Anxiety-related Emotional Disorders were the instruments used. Forty-three patients with FMF and 53 healthy controls were compared. Both study and control groups were divided into two age groups, 7-12 and 13-18 years. The depression scores of patients with FMF were significantly higher than their healthy peers (p = 0.001). However, there was no significant difference between patients with FMF and control group regarding the anxiety scores (p = 0.78). The disease duration was not significantly correlated with depression and anxiety scores. There was a significant correlation between depression score and FMF severity score (p = 0.01). The mean depression and anxiety scores of the FMF patients were positively correlated with the number of attacks (p = 0.000 and p = 0.001, respectively).This study suggested that patients with FMF were considerably more depressed than their healthy peers and that the depression scores were negatively affected from disease severity score and number of attacks. Psychosocial assessment of children with FMF has potential clinical implications and individualized counseling and interventions are needed.

Effects of long-term methylphenidate treatment: a pilot follow-up clinical and SPECT study.

BACKGROUND: Although abnormalities in the regional cerebral blood flow (rCBF) responses to methylphenidate (MPH) treatment have been reported in children with attention deficit hyperactivity disorder (ADHD), there are few prospective longitudinal studies assessing the long-term effects of MPH and discontinuation effects after chronic treatment. METHODS: The authors studied ten drug-naive children (2 girls, 8 boys, mean age+/-S.D.=9.60+/-1.96) diagnosed with ADHD by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria, using (99m)Tc-HMPAO-single photon emission computed tomography (SPECT). Patients were studied at baseline (visit 1), after 2 months of MPH treatment (visit 2) and after a drug-free period of 2 months following 12 months of MPH treatment (visit 3) at doses of 1 mg/kg/day. We evaluated SPECT data visually and semi-quantitatively. RESULTS: Two months of chronic MPH treatment resulted in visually detectable improvement in hypoperfusion in the right frontal cortex and all areas of temporal cortex with the exception of left lateral temporal cortex. This improvement was still detectable on visual evaluations of SPECT data after 2 months of treatment discontinuation. The treatment effects that were detected visually were not statistically significant in semi-quantitative analyses. CONCLUSIONS: Treatment effects of chronic MPH treatment may persist long after the discontinuation of the treatment.

Technetium-99m HMPAO brain SPECT in children with attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is a developmental, neurobehavioral syndrome with an onset in childhood. The aim of this study was to investigate the existence of regional perfusion changes in ADHD by means of Tc-99m HMPAO brain SPECT. Thirteen children with a diagnosis of ADHD and 7 healthy, age-matched controls were included in this study. Hypoperfusion was observed on the right temporal cortex in 9, and on the left temporal cortex in 3 children. The distribution of the lesions showed right lateral temporal cortex involvement in 3, right medial temporal cortex in 9 and left medial temporal cortex in 8 children. Asymmetric perfusion was seen on the caudate nucleus in 4, on the thalamus in 3 and on the frontal cortex in 6 children. There was a significant difference between children with ADHD and controls in right medial temporal cortex: cerebellum and right lateral temporal cortex: cerebellum ratios. Hypoperfusion in the right medial temporal cortex was significantly and inversely correlated with Du Paul teachers' questionnaire rating scale (r = -0.71, p = 0.006). It has been postulated that difficulty in self regulating response to stimuli in ADHD is mediated by underfunctioning of the orbital frontal cortex and subsequent connection to the limbic system. Decreased temporal cortex perfusion may dysfunction of the limbic system or the orbito-frontal-limbic axis.