The Assessment of the Relationship Between ADHD and Posttraumatic Stress Disorder in Child and Adolescent Patients.

OBJECTIVE: This study examined ADHD comorbidity in child and adolescent patients who diagnosed with posttraumatic stress disorder (PTSD) or obsessive compulsive disorder (OCD). METHOD: Sixty-eight child and adolescent patients with PTSD and 42 child and adolescent patients with OCD were evaluated for ADHD. The sample included 110 patients who were administered structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). RESULTS: Results showed that 22.05% patients with PTSD and 59.52% patients with OCD met criteria for ADHD. CONCLUSION: The results of our study indicate that no meaningful differences were detected in comparisons between PTSD and OCD groups, in having ADHD as comorbidity.

Diabulimia, a Type I diabetes mellitus-specific eating disorder.

Type I diabetes mellitus is the most common endocrinologic disorder affecting pediatric patients. Diet regimen adaptations in patients with diabetes may result in focusing on only diet and weight control, which causes eating disorders more often in these patients. Diabulimia is an eating disorder specific to patients with diabetes characterized by limiting and/or skipping insulin dosing. It is well observed that diet management and insulin treatment are withheld for body appearence and social acceptance issues, especially in patients whose disease is diagnosed during adolescence. We hereby present a patient who was diagnosed as having diabetes at the age of 12 years and skipped insulin doses in order to control weight and was subsequently diagnosed as having diabulimia.

Effect of eye trauma on mental health and quality of life in children and adolescents.

The purpose of this study is to evaluate the effects of eye traumas on mental health and quality of life of children, adolescents, and their parents. Medical records of 20 children and adolescents presented with blunt and open eye injuries between June 2009 and May 2014 were reviewed. Demographics of patients, timing and type of trauma, findings of initial examination, and medical and surgical interventions applied were recorded. To detect mental health, "Affect disorders and schizophrenia interview chart for school children, now and lifelong" (AFSIC-NL) and "Child Post-Traumatic Stress Reaction Index (CPTSD-RI)" were used. "Pediatric scale of quality of life" (PedsQL) was used to assess quality of life for both parents and children. According to AFSIC-NL, 9 patients were diagnosed with mental disorders including posttraumatic stress disorder (n = 3, 15 % patients), generalized anxiety disorder (n = 3, 15 % patients), and major depression (n = 3, 15 % patients). The PedsQL values of both children's and parents' were at their lowest in school and physical health domains for children and in physical health domain for parents. A reverse correlation was detected between the number of surgeries and PedsQL-child physical functionality, school functionality, psychosocial functionality, and total scale point. There was a statistically significant relationship between initial visual acuity or lens damage and PedsQL-parent emotional functionality scale. Regarding CPTSD-RI, the parents of these patients have a mild posttraumatic stress disorder. Eye injuries can lead development of psychopathology in children. Therefore, psychiatric support must be provided in follow-up period for these patients.

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.

Psychiatric and Neurocognitive Evaluation Focused on Frontal Lobe Functions in Rolandic Epilepsy.

INTRODUCTION: In this study, we aimed to assess the behavioral problems, psychiatric disorders and neurocognitive functions focusing on frontal lobe functions in children with rolandic epilepsy (RE) and compare them with a control group. METHOD: 31 children with RE, aged between 8 and 13,5 years were compared with a control group matched for age, sex and socioeconomic status. Behavioral problems were assessed by the Child Behavior Checklist (CBCL) and psychiatric diagnoses were established by using the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version. The Wechsler Intelligence Scale for Children-Revised (WISC-R), Wisconsin Card Sorting Test (WCST) and the Stroop Color and Word Test (SCWT) were applied in both groups of children. RESULT: The RE group presented more psychiatric disorders than the control group. Verbal and total IQ scores in the RE group were lower than in the control group. Although the groups did not differ from each other in WCST scores, children with RE displayed lower performance in SCWT. The RE group had a higher externalizing score and higher total scores in CBCL. CONCLUSION: It was concluded that RE did not affect basic frontal lobe functions significantly, had negative effects on attention and IQ performance and increased behavioral problems and psychiatric disorders.

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 validity and reliability of the Turkish Pediatric Quality of Life Inventory for children 13-18 years old]. / Cocuklar Için Yasam Kalitesi Olçeginin 13-18 Yas Ergen Formunun Geçerlik ve Güvenilirligi.

OBJECTIVE: The Pediatric Quality of Life Inventory (PedsQL) is a modular instrument that measures health related quality of life, and investigates the physical and psychosocial functioning, unrelated to health, of children 2-18 years old. In this study, the objective was to evaluate the validity and reliability of the Turkish PedsQL in adolescents 13-18 years old. METHOD: The study included 230 adolescents and 230 parents. The subjects were separated into 3 groups: 1. Healthy; 2. Has an acute disease; 3. Has a chronic disease. The reliability and the validity of PedsQL were computed. RESULTS: The internal consistency of the scale (Cronbach's alpha coefficient) was 0.82 for the child self-report and 0.87 for the parent proxy report. The PedsQL scores of both the child self-report and parent proxy report showed a statistically significant low to medium level of inversely proportional correlation with many indicators of morbidity and illness burden. There was a statistically significant and direct proportional correlation between the child self-report and parent proxy report scores. CONCLUSION: The PedsQL is valid and reliable for evaluating the quality of life of Turkish adolescents 13-18 years old.

[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.

Evaluation of the effect of methylphenidate by computed tomography, electroencephalography, neuropsychological tests, and clinical symptoms in children with attention-deficit/hyperactivity disorder: A prospective cohort study.

BACKGROUND: Stimulant drugs are the most commonly used treatments for attention-deficit/hyperactivity disorder (ADHD), although the mechanism of action of these drugs is still not entirely understood. OBJECTIVE: The aim of this study was to investigate the effects of the psychostimulant drug methylphenidate (MPH) on regional cerebral blood flow (rCBF), electrical activity of the brain, and clinical symptoms in children with ADHD using single-photon emission computed tomography (SPECT), electroencephalography (EEG), and neuropsychological tests. METHODS: In this prospective cohort study, pediatric outpatients received MPH for 3 months at a mean dose of 1 mg/kg · d (range, 0.5-1.5 mg/kg · d). They were then administered the Wechsler Intelligence Scale for Children-Revised, the Bender Visual-Motor Gestalt Test (BGT), EEG, and SPECT of the brain. The parents and/or teacher of each child were asked to complete the Conners' Parent Rating Scale (CPRS), the Conners' Teacher Rating Scale (CTRS), and the Turgay Diagnostic and Statistical Manual of Mental Disorders Fourth Edition-based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S). All of the evaluations were performed at baseline and after 3 months of MPH treatment. Each child underwent a Stroop test as an activation method 15 minutes before the SPECT procedure. RESULTS: Sixty patients were assessed for inclusion. Twenty-one children (18 boys [85.7%], 3 girls [14.3%]; mean [SD] age, 9.7 [1.7] years; range, 8-13 years) with a diagnosis of ADHD were included in and completed the study. Mean (SD) BGT scores before MPH treatment compared with after MPH treatment were significantly decreased (9.8 [4.2] vs 6.3 [3.4]; Z = -3.27; P = 0.001). After treatment with MPH, the visual SPECT results suggested that low rCBF was normalized in the right frontotemporal areas in 10 children with ADHD. After treatment, 12 patients (57.1%) had no change in EEG activity, 5 (23.8%) had improvement, and 4 (19.0%) had worsening activity. Patients who had improvement or no worsening on EEG after MPH treatment were associated with significant improvement after MPH treatment compared with before treatment in mean (SD) CTRS scores (25.9 [14.3] vs 35.0 [14.4]; P = 0.003), teachers' T-DSM-IV-S total score (25.1 [14.2] vs 38.4 [18.7]; P = 0.005), and CPRS scores (mothers scores: 29.7 [16.6] vs 42.6 [17.2], P = 0.002; fathers' scores: 29.4 [16.8] vs 41.9 [23.7], P = 0.004). No significant difference was found in these scores in the patients whose EEG findings showed deterioration after MPH treatment. The quantitative values for SPECT observed before treatment compared with those observed after 3 months of MPH treatment were not found to be significantly different in any areas of the brain. CONCLUSIONS: MPH use over 3 months was associated with improvement from baseline in visual-motor function and behavioral disorders in these children and adolescents with ADHD. However, no significant difference in rCBF or electrical activity in the brain was observed in this small study.

Psychiatric approach in the treatment of reflex sympathetic dystrophy in an adolescent girl: a case report.

Reflex sympathetic dystrophy (RSD) is an unusual diagnosis in the pediatric age group. It is a syndrome characterized by pain in one or more extremities with a significant morbidity in childhood. Patients with RSD have frequently undergone many unnecessary investigations such that the diagnosis and treatment may be considerably delayed. The pathophysiology remains unclear; however, a number of psychological problems were frequently suggested to play a role in this disorder. We describe a 13-year-old girl diagnosed as pediatric RSD who was admitted to a child and adolescent psychiatry unit with a history of severe pain in the right hand, increasing disability and symptoms of nervousness and withdrawal from social activities. In this report, we discuss psychogenic factors underlying the disorder of an adolescent girl and psychiatric approach as a part of a multimodal treatment of pediatric RSD.

Psychological consequences of the 1999 earthquake in Turkey.

We explored the prevalence of posttraumatic stress disorder (PTSD) and its relation to demographic characteristics and other risk factors for developing PTSD in a large sample (N = 910) of earthquake survivors living in tent city. Twenty-five percent of the sample met DSM-IV criteria for PTSD assessed with the Posttraumatic Stress Disorder Self Test (PTSD-S). Peritraumatic factors explained the most variance when the risk factors were grouped as demographics, pretraumatic, peritraumatic, and posttraumatic. The study emphasized that PTSD among the earthquake victims was as prevalent in Turkey as after disasters in other developing countries but higher than usually found after disasters in developed countries, and there was a relation between some factors-mostly peritraumatic-and PTSD.

Acrocyanosis as a side effect of tricyclic antidepressants: a case report.

Acrocyanosis is probably the most unusual side effect of tricyclic antidepressant drugs. In this paper, we report a 10-year-old boy with primary enuresis nocturna and attention deficit hyperactivity disorder who developed two episodes of acrocyanosis, the first of which was after imipramine treatment and the second after desipramine usage. We also review the possible pathogenesis of acrocyanosis. We suggest that physicians should be aware of this rare side effect of tricyclic antidepressants.