Illness-related outcomes of illicit substance use disorder in adolescents with early onset schizophrenia: a multicenter study.

OBJECTIVES: Lifetime co-occurring substance use disorders are common at the time of presentation for the treatment of primary psychosis. Our aim was to investigate the clinical characteristics of adolescents with early-onset schizophrenia/schizoaffective disorder (EOS), categorized as either with (EOS + SUD) or without SUD (non-SUD/EOS), in a multi-center sample. METHODS: Between 2016 and 2022, 255 patients were evaluated across three tertiary-care inpatient units. Diagnoses were confirmed by the treating physician according to the DSM-5 during the hospital stay. The severity of symptoms was measured using the Positive and Negative Syndrome Scale (PANSS). RESULTS: The EOS + SUD group exhibited a higher illness onset, fewer years of education, longer duration of untreated psychosis (DUP), a higher frequency of male gender, more frequent hospitalizations, increased use of clozapine and zuclopenthixol LAI, along with higher rates of post-traumatic stress disorder and conduct disorder. Notably, differences in DUP, clozapine use, and the number of hospitalizations did not persist in the multivariate logistic regression model. CONCLUSIONS: Our findings support the notion of SUD playing a role in modifying the course of illness in EOS. Future studies should emphasize exploring treatment responses to medications and interventions among youth with dual diagnoses.

functional outcome in late adolescence/early adulthood of patients with autism spectrum disorder and its relationships with parental burnout and depression: A preliminary multi-center, cross-sectional study.

The aim of this study is to determine the functioning of adults with autism spectrum disorders (ASDs) diagnosed in childhood and depression and burnout levels among their parents. A total of 261 adults with ASDs and their parents were recruited for the study. Both parents completed the Beck Depression and Maslach Burnout Inventories and reported the functioning of their adult offspring with ASDs. Only 5.4 % of our sample reported "good" or "very good" outcomes. The most common psychiatric comorbidities were intellectual disabilities and attention-deficit/hyperactivity disorder. Maternal burnout and depression scores were significantly elevated compared to those of fathers. There is an undeniable urgent need for more research to identify the needs of adults and families suffering from ASD. Modifications for those with ASD may have to be made for support in workplaces, achieving driving licenses, using public transportation and attendance at tertiary education.

Turkish adaptation and validation of the Short-UPPS-P in adolescents and examination of different facets of impulsivity in adolescents with ADHD.

The short form of the Impulsive Behavior scale (S-UPPS-P) is a widely used scale to measure multiple impulsive personality traits; although it has been translated into many languages, no Turkish translation has been studied to date. Our study had two aims. First, we tested the validity and reliability of the Turkish version of the S-UPPS-P for adolescents. Second, we examined impulsive trait characteristics exhibited by adolescents with ADHD, compared to a community sample. We evaluated the psychometric properties of the Turkish S-UPPS-P scale in 384 adolescents aged 11-18 and tested correlations with ADHD symptoms by assessing 41 adolescents diagnosed with ADHD. Our results showed that with a few slight modifications the Turkish translation of the S-UPPS-P scale can validly assess impulsive trait characteristics for Turkish adolescents. The subscales of lack of premeditation, positive urgency, and negative urgency efficiently distinguished between adolescents with ADHD and control subjects. This is the first scale to evaluate the multidimensional nature of impulsivity in Turkish adolescents. This scale is capable of screening various facets of impulsivity in typically developing adolescents as well as those with ADHD, enabling us to enhance our understanding of possible risks for comorbid diseases in the latter group.

Psychomotor agitation and irritability in adolescents with manic episode: Clinical data from three inpatient units.

OBJECTIVES: We aimed to investigate the characteristics of adolescents with Bipolar disorder-I with irritability and agitation (Mania+IA) compared to those without irritability and agitation (Mania-IA) in a multi-center representative sample. METHODS: Data of 145 patients from three tertiary-care inpatient units between 2016 and 2021 were obtained. Psychomotor agitation was defined as a score of ≥3 on the YMRS "Increased Motor Activity--Energy" item, irritability as a score of ≥4 on the YMRS 'irritability' item, and severity anchors of speech and thought disturbance on the YMRS '6 and 7' items. RESULTS: Previous manic episodes (p = 0.013), involuntary hospitalization (p = 0.006), psychotic features (p = 0.001), formal thought disorder (p = 0.010) and aggressive/disruptive behavior (p = 0.021) were more frequent in the Mania+IA group. Conversely, depressive episodes (p = 0.006) and family history of depression (p = 0.024) were more frequent in the Mania-IA group. The Mania+IA had poorer functioning at the time of discharge. CONCLUSIONS: Irritability and agitation were closely related to complications, psychotic symptoms and thought disorder. Assessment and monitoring of psychomotor agitation and irritability may help child and adolescent psychiatrists to predict clinical difficulties and appropriate interventions.

Psychometric Properties of The Clinician Affective Reactivity Index for Assessment of Irritability in a Clinical Sample of Turkish Children and Adolescents.

Background: No clinician-oriented scale exists to assess irritability in Turkey. This pilot study aimed to evaluate the psychometric properties of the Turkish version of The Clinician Affective Reactivity Index (CL-ARI). Method: A total of 116 children and adolescents aged between 10 to 17 years (14.1 ± 2.1 years) were recruited from the psychiatric outpatient clinics. The participants completed a set of scales (Strengths and Difficulties Questionnaire [SDQ], Affective Reactivity Index [ARI], Revised Child Anxiety and Depression Scale, Swanson, Nolan, and Pelham, Version IV Scale). Diagnostic interviews were administered to confirm psychiatric diagnoses. Cronbach's alpha was calculated to assess internal consistency. Discriminant validity was further tested using independent sample t-test and Receiver Operating Characteristic curves. Interrater reliability was tested using intraclass correlation coefficients (ICC). Convergent validity was also tested using Pearson's correlation. Results: Cronbach's alpha values of CL-ARI were 0.919 total score, 0.842 for the temper outbursts score, 0.861 for the irritable mood score, and 0.840 for the impairment score. ICC values for interrater reliability were high for the temper outbursts (r = 0.993), the irritable mood (r = 0.993), the impairment (r = 0.917), and the total score (r = 0.991). In the sample, there was a high level of correlation between the self-report ARI-child/parent form and the CL-ARI total and subscale scores. Likewise, moderate-high level of correlations were found between the behavioral SDQ child/parent forms and the CL-ARI total and subscale scores. Conclusions: This is the Turkish validation of the CL-ARI, a dedicated interview and rating scale to assess irritability in the clinical sample. The results of this study suggest that the Turkish version of CL-ARI has adequate internal consistency and interrater reliability, and sufficient convergent and discriminant validity to be used in research settings.

Index depressive episode and antidepressant exposure were associated with illness characteristics of pediatric bipolar disorder.

OBJECTIVE: Pediatric bipolar disorder (PBD) is a serious, recurrent disorder leading to severe functional impairment. As a first mood episode, index episode could affect the long-term course of the illness. This study aimed to investigate the clinical characteristics of youth with PBD from our multicenter, nationwide, naturalistic follow-up samples and to identify (i) the effects of index mood episode and (ii) the effect of previous antidepressant treatments on the age at mania onset of PBD. METHOD: The study sample consisted of 271 youth with BD-I followed by the child and adolescent psychiatry clinics of seven different university hospitals and three research state hospitals, representing six geographic regions across Turkey. All diagnoses were made according to structured interviews, and all data were retrospectively obtained from clinical records by the clinicians. RESULTS: When patients with index depressive/mixed episodes (IDE, n=129) and patients with index (hypo)manic episodes (IME, n=142) were compared, the total number of mood episodes and rapid cycling feature were significantly higher in the IDE group than in the IME group. The Cox regression analysis adjusted for sociodemographic and illness characteristics revealed female adolescents in the IDE group treated with antidepressants were more likely to have an earlier onset of mania (hazard ratio=2.03, 95% confidence interval=1.31-3.12, p=0.001). CONCLUSION: This is the first large-scale nationwide follow-up study in Turkey that indicated prior antidepressant treatments were associated with an earlier onset of mania in youth, particularly in adolescent females. Larger prospective studies are needed to identify neurodevelopmental processes underlying PBD and initiate prevention approaches.

Childhood Masturbation: Sleep Habits of Children, Maternal Psychopathology, and Other Risk Factors-A Controlled Study.

The current study aimed to explore sleep habits, maternal psychological symptoms, and other risk factors in children with childhood masturbation (CM). The study was conducted with 80 children with CM and 44 children as a control group. Sleep habits were assessed with the Children's Sleep Habits Questionnaire and mothers' psychiatric symptoms were screened using the Symptom Checklist-90. In the CM group, sleeping in the same room with parents, history of unplanned pregnancy, and not playing with the child every day were more common than in the control group. Sleep problems (in particular, night waking) are associated with increased incidence of CM. The simple act of parents playing with their children every day may protect against children engaging in CM. Maternal psychiatric symptoms were more common among children with CM than in the control group. By expanding our knowledge about potential risk factors associated with CM, clinicians can distinguish between desirable and undesirable behavior and intervene in pathological cases. [Journal of Psychosocial Nursing and Mental Health Services, 60(1), 38-47.].

Evaluation of the resilience of the girls with central precocious puberty treated with gonadotropin-releasing hormone analog.

OBJECTIVES: The aim of this study was to evaluate the resilience of girls with central precocious puberty (CPP) during treatment with a gonadotropin-releasing hormone agonist (GnRHa) and compare these results with their healthy peers. METHODS: The Connor-Davidson Resilience Scale (CD-RISC) is a self-report scale used to quantify resilience, which is divided into seven subgroups (hardiness, coping, flexibility, purpose, optimism, regulation of emotion and cognition (REC), and self-efficacy). Fifty-one girls with CPP receiving GnRHa treatment and 51 healthy controls were involved in the study. Anthropometric measurements were evaluated and CD-RISC was performed at least six months after the initiation of GnRHa treatment. RESULTS: There was no statistically significant difference between the anthropometric evaluations of girls with CPP and the control group. Similarly, the total score and subgroup scores of patients with CPP and the control group showed no statistically significant difference. In the correlation analysis, there was a weak negative correlation between height and flexibility (r=-0.314 p=0.025), height SDS and flexibility (r=-0.254 p=0.092), height SDS, and purpose (r=-0.285 p=0.058). Also, there was a weak negative correlation between REC and weight (r=-0.435 p=0.003), REC and weight SDS (r=-0.461 p=0.002), REC and height (r=-0.269 p=0.077), REC and height SDS (r=-0.322 p=0.033), REC and BMI (r=-0.289 p=0.058), and REC and BMI SDS (r=-0.353 p=0.019). CONCLUSIONS: The resilience of girls with CPP treated with GnRHa was found to be similar to their healthy peers. The early diagnosis of the disease and adequate treatment may decrease the discrepancy of somatic changes between girls with CPP and their peers, which may help them to overcome the stress of CPP and long-term treatment.

Psychological Well-Being Among Internally Displaced Adolescents and the Effect of Psychopathology on PTSD Scores Depends on Gender.

The purpose of this cross-sectional study was to investigate the post-traumatic symptoms and psychological well-being among internally displaced (ID) adolescents in the early phase of the conflict in the southeast part of Turkey and clarify the effect of psychopathology on PTSD scores depends on gender. With the help of the results of our study, we aimed to enhance our understanding of adolescent mental health. Our study was completed with 102 ID adolescents (42 boys, 60 girls). Our results showed that ID adolescents flee from conflict had significantly higher levels of mental disorders and PTSD. Girls show higher rates of PTSD symptoms than boys and there was no significant interactive effect of gender and emotional, behavioral and peer problems on PTSD. However, boys with ADHD seem to be more prone to develop PTSD than girls. We aimed to highlight the challenges facing adolescents forced to flee from conflict zones who were temporarily relocated. These results may help us to enlighten our understanding of ID adolescents and may suggest more studies to provide beneficial gender-specific intervention program.

Perceived Family Climate and Self-Esteem in Adolescents With ADHD: A Study With a Control Group.

Objective: In this study, our objective is to assess the perception of family environments by adolescents with ADHD based on perceived expressed emotion (EE) and the self-esteem of the adolescents. Method: Uludag University Medical Faculty Hospital completed this study with 41 adolescents with ADHD and 35 control group participants who were matched based on age and gender. Results: The total scores of perceived EE, described as a lack of emotional support, irritability, and intrusiveness, were significantly higher in ADHD group than in the control group. The group with ADHD also showed significantly lower self-esteem. There was a negative correlation between self-esteem scores and total perceived EE scores in the ADHD group and the control group. Conclusion: This study showed that the adolescents with ADHD perceive less emotional support and higher levels of intrusiveness, with patients also describing their families as more irritating. Other results in this study show that adolescents with less emotional support possess lower self-esteem, as do adolescents with more irritable parents.

Big Data in Adolescent Psychiatry: Do Patients Share Their Psychiatric Symptoms on Social Networking Sites?

BACKGROUND: Fascinating developments in big data technologies and unprecedented diffusion of social networking sites (SNSs) generate unseen opportunities for scientific fields, including psychiatry. This study focuses on the use of SNSs by adolescent psychiatric patients and the potential use of SNS-generated data to help medical practitioners diagnose and treat patients' mental health. Our objective is to understand and measure the psychiatric and individual conditions in which symptom-sharing occurs on SNSs and the frequency of these conditions. Based on literature, we hypothesized that the perceived value of social network sites positively affects adolescents' sharing of symptoms on these sites. SUBJECTS AND METHODS: An empirical test of this hypothesis was conducted with a survey of 224 adolescents admitted to a psychiatry clinic in Turkey. The hypothesis was tested using a hierarchical multiple regression analysis. RESULTS: The perceived value of SNSs explained an additional 37.8% of variation in symptom sharing on SNSs above and beyond the control variables, which are gender, age, type of disorder, and amount of internet and SNS use. The findings suggested that adolescents share symptoms on SNSs only if they attribute value to the SNSs that they use. We also found that 72% of adolescents in our sample shared their symptoms on SNSs. CONCLUSIONS: There is an attractive opportunity for information technology companies to develop, together with health professionals; data analytics that are able to detect symptoms to support psychiatric diagnoses and pave the way for big-data enabled personalized medicine.

Perceived Expressed Emotion, Emotional and Behavioral Problems and Self-Esteem in Obese Adolescents: A Case-Control Study

Objective: Obesity is a chronic disease which leads to medical and psychiatric complications. Family climate is a critical factor in the treatment of obesity and comorbid psychiatric disorders. In our study, perceived expressed emotion (EE), psychopathology, self-esteem and emotional and behavioural problems (BP) among obese adolescents were investigated and compared with their non-obese peers. Methods: The subjects were 49 obese adolescents and 47 non-obese adolescents served as the control group. All participants were requested to fill out the Socio-demographic Data Form, Shortened Level of Expressed Emotion Scale, Rosenberg Self-Esteem Scale, Strength and Difficulties Questionnaire-Adolescent Form. Results: In our study, obese adolescents showed a significant difference in perceived EE (p<0.001). Subscales of EE, such as Lack of Emotional Support (p<0.001), intrusiveness (p<0.001), irritability (p<0.001), self-esteem (p<0.001), emotional and BP (p<0.001), attention deficit-hyperactivity disorder (p<0.001), problems in peer relationships (p<0.001) and social skills (p<0.001) were significantly worse when compared with the control group. There was a strong relationship between EE and emotional and BP and self-esteem. Conclusion: The higher rate of perceived EE, psychopathology and low self-esteem among obese adolescents showed that obesity prevention and treatment are also crucial for good mental health in adolescents. The important role of the family in mental health of obese adolescents was emphasized. It was shown that identification of risk factors in childhood that promote obesity should be done so that targeted intervention and prevention programs can be developed.

Effectiveness of autism training programme: An example from Van, Turkey.

OBJECTIVE: To determine the knowledge and attitudes of family practitioners before and after their participation in a training programme. METHODS: The study was conducted at Van Training and Research Hospital, Van, Turkey, from December 1to 15, 2016, and comprised family practitioners. Before the training, the practitioners were asked to fill out a questionnaire that was prepared by the researchers. Subsequently, the training course was presented by the child and adolescent psychiatrists. After the training, participants were asked to fill out the same questionnaire again. The results of survey were compared before and after training. Data was evaluated using SPSS 22.Descriptive analyses were used and baseline characteristics were compared between groups using McNemar's test and paired t-test. RESULTS: Of the 79 family practitioners who filled out the questionnaire,75(94.9%) were included. The mean age of the practitioners was 28.2±11.63, with 40(53%) being females. Moreover,26(34.7%) participants thought that they had sufficient information regarding autism spectrum disorder before training, and this number increased to 66(88%) after training. There was a significant difference between pre-training and post-training scores of the questionnaire (p<0.001). CONCLUSIONS: There was a deficiency in knowledge about autism symptoms, aetiology, prevalence and treatment among family practitioners. .

School going adolescents' perception of family climate and mental problems: Results from Kocaeli, Turkey.

OBJECTIVE: To investigate the association between the perception of expressed emotion and psychopathology of school-going adolescents in a non-clinical sample. METHODS: The cross-sectional field study was conducted in Kocaeli, Turkey, and comprised high-school students during the 2014-15 school years. Data was collected using the Information Collection Form, Strengths and Difficulties Questionnaire and Shortened Level of Expressed Emotion Scale. SPSS 21 was used for data analysis. RESULTS: Of the 487 subjects, 295(60.57%) were girls and 192(39.43%) were boys. The overall median age was 16 (inter-quartile range: 15-17 years). There were significant positive relationships between the scales in terms of emotional problems (p<0.001), behavioural problems (p<0.001), Attention-deficit/hyperactivity disorder (p<0.001), and peer relationship problems (p<0.001). There was also a negative significant relationship between pro-social behaviours and expressed emotion (p<0.001). CONCLUSIONS: The concept of perceived expressed emotion in non-clinical adolescents is useful in alarming clinicians and preventing mental disorders.

The Relationship Between Perceived Family Climate and Glycemic Control in Type 1 Diabetes Mellitus Adolescent Patients.

OBJECTIVE: Type 1 diabetes mellitus (T1DM) is a chronic disease which ranks third in children under age 16 years. Expressed emotion (EE) is a term that indicates a specific family climate including lack of emotional support (LES), irritability, and emotional over-involvement. It is known that the family environment is highly important for glycemic control in diabetic adolescents. In this study, the relationship between perceived EE and glycemic control in adolescents diagnosed with T1DM not accompanied by psychopathology were investigated. METHODS: The study included 49 adolescents with T1DM and 50 adolescents as a control group. Adolescents with psychopathology and intellectual disability were excluded from the study. Perceived EE was measured by the Shortened Level of Expressed Emotion Scale (SLEES) and blood sugar regulation was assessed by HbA1c levels. RESULTS: The adolescents with T1DM showed a significant difference in perceived EE (p=0.020) and LES (p=0.014) when compared with the control group. When diabetic adolescents were compared among themselves, the diabetic adolescents with poor glycemic control perceived greater EE (p=0.033) and less emotional support (p=0.049). In regression analyses, the predictive power of mother's educational level, the employment status of mothers and the subscale "LES" of SLEES combined to explain HbA1c level was determined to be 37.8%. CONCLUSION: The strong relationship between perceived EE and glycemic control showed us that perceived EE can hinder treatment compliance without causing psychopathology. For this reason, it is recommended that not only patients with psychopathology, but all diabetic adolescents receive psychosocial support and family interventions.