Elevated Serum Galectin-1 and Galectin-3 Levels in Children With Specific Learning Disorder: A Case Control Study.

OBJECTIVE: Specific learning disorder (SLD) is a neurodevelopmental disorder in which underlying pathogenesis and etiological factors are not fully understood. Neuroinflammatory response (measured with serum levels of galectin-1 and galectin-3), which is associated with learning and memory, may play an important role in the etiopathogenesis of SLD. Aim of the present study is to examine whether serum galectin-1 and galectin-3 levels are related to SLD. METHODS: The current study consisted of 42 treatment-naive children with SLD and 42 control subjects. All of the subjects were assessed using semi-structured psychiatric examination to diagnose SLD and exclude attention-deficit hyperactivity disorder. Serum galectin-1 and galectin-3 levels were measured via venous blood samples. RESULTS: The SLD and control group did not differ significantly in terms of age, sex, and body mass index (BMI). The SLD group had significantly higher serum levels of galectin-1 (8.78±2.97 vs. 7.40±2.03, p=0.019) and galectin-3 (1.86±0.93 vs. 1.32±0.69, p=0.003) than the control group when controlled for age, sex, and BMI. CONCLUSION: Higher serum levels of galectin-1 and galectin-3 in children with SLD may indicate the role of neuroinflammatory response in the pathogenesis of SLD. Other mechanisms involving galectin-1 and galectin-3 related to learning may play a part in the etiology of SLD.

Oxytocin Levels in Children with Separation Anxiety and Their Mothers before and after Treatment.

Objective: The purpose of this study was to compare the plasma oxytocin levels of children with separation anxiety disorder (SAD) and their mothers with those of healthy controls and to examine the relationship between oxytocin levels and changes in anxiety three months after treatment. Methods: Thirty children aged 6-12 years with SAD, 30 healthy children, and mothers of both groups were included in the study. All cases were evaluated with semi-structured interview and Clinical Global Impression Scale. All cases and mothers of both groups filled out scales to determine various psychological variables (anxiety, depression, and attachment). The patient group children were re-evaluated with their mothers after three months, following treatment. Plasma oxytocin levels were evaluated from both groups and their mothers before and after treatment. Results: The plasma oxytocin levels of mothers of children with SAD were significantly lower than those of the controls and increased significantly three months after their children were treated. No difference was found between the plasma oxytocin levels of children with SAD and the control group, and these children's levels decreased significantly after treatment. A positive correlation was found between changes in the plasma oxytocin levels of children with SAD and the change in anxiety scores. Conclusion: Our results show that the change in plasma oxytocin levels in both children and mothers after treatment suggests that oxytocin may be important in the etiology of SAD.

Serum Levels of Brain-Derived Neurotrophic Factor, Nerve Growth Factor, Neurotrophin-3, and Glial-Derived Neurotrophic Factor in Children with Specific Learning Disorder.

Introduction: Specific learning disorder (SLD) is a neurodevelopmental disorder that involves complex interactions of genetic, neurobiological and environmental factors, but the definite mechanisms remain mostly unknown. The possible role of neurotrophins has been implicated in the pathophysiology of various neurodevelopmental disorders. This study aimed to investigate whether serum levels of brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF), and neurotrophin-3 (NT-3) in children with SLD deviate from those of neurotypical brains. Methods: Forty-four patients with SLD and 44 healthy controls aged 7--12 years were included. SLD diagnosis and severity was determined using DSM-5-based interviews and SLD clinical observation battery. Serum neurotrophins were measured using enzyme-linked immunosorbent assay. Results: BDNF (p=0.032), NGF (p=0.029), and NT-3 (p=0.025) serum levels were significantly higher in the SLD group compared to the control group; however, serum levels of GDNF did not show any significant difference between groups. On the other hand, GDNF serum levels were significantly different between mild and severe SLD groups (p=0.007) and were lower in severe SLD subjects than in mild cases. There was also a significant correlation between patients' reading speeds and serum levels of GDNF (p=0.025), and GDNF serum levels were lower in patients with slower reading speeds. Conclusion: These findings suggest that neurotrophins might play a role in the pathophysiology of SLD. Increased serum levels of BDNF, NGF, and NT-3 might reflect compensatory attempts at neuroprotection against neurodevelopmental impairment.

The role of adverse childhood experiences and attachment styles in social anxiety disorder in adolescents.

BACKGROUND: Social Anxiety Disorder (SAD) is one of the most common disorders of adolescence and results in marked impairments in social and academic/occupational activities that likely to persist into adulthood. Multiple etiological factors contribute to the development of social anxiety disorder. Two critical factors in presenting with a primary diagnosis of SAD might be adverse childhood experiences (ACEs) and attachment styles. The current study examined how ACEs and attachment styles may be related to SAD in adolescents. METHODS: 60 participants with ages ranging from 11 to 18 (M = 14.6; female = 36), who have a primary diagnosis of SAD and 60 control group adolescents (M = 14.6; female = 30) were included in the study. Both groups completed the Liebowitz Social Anxiety Scale (LSAS), the Childhood Trauma Questionnaire (CTQ), and the Adolescent Relationship Scales Questionnaire (A-RSQ). RESULTS: After controlling adolescent gender and parental education levels, childhood emotional neglect and income significantly predicted an increased risk for adolescents' SAD diagnosis. Attachment styles did not significantly contribute to predicting adolescents' SAD diagnosis after controlling childhood emotional neglect. CONCLUSION: The high predictive value of emotional neglect in childhood emphasizes its importance as a risk factor of SAD in adolescence.

Peer Victimization in Preadolescent Children With ADHD in Turkey.

The present study aims to investigate peer victimization and its relationship with comorbid psychiatric diagnoses and quality of life (QoL) among children with attention deficit hyperactivity disorder (ADHD). Study sample consisted of 66 children with ADHD (mean age = 8.6 ± 1.1 years) and age- and gender-matched 66 controls (mean age = 8.5 ± 1.3 years). In self-reports, the ADHD group reported significantly higher rates of victimization and bullying than the non-ADHD group. Verbal and physical forms of victimization and bullying were the most prevalent forms in both groups; however, exclusion from peer groups, which is named as relational bullying, was the most significantly differing type between two groups. QoL parameters did not significantly differ between the children involved in bullying and those not involved, except for the lower physical QoL in victimized children in the control group. In conclusion, peer victimization was significantly more prevalent in the ADHD group than the non-ADHD group. Preventive measures are needed for peer victimization, especially for children with ADHD.

Caring for the Most Vulnerable: A Model for Managing Maladaptive Behavior in Children with Mental Special Needs During the COVID-19 Pandemic.

Background: This article presents the results of a comprehensive national model developed for managing maladaptive behaviors (MBs) in children with mental special needs (CMSNs) during the coronavirus disease 2019 (COVID-19) pandemic that combines telehealth-based Applied Behavioral Analyses, psychiatric interventions, and support from local psychosocial teams. This study aims to determine the effectiveness of a system that combined telehealth applications with local psychosocial support teams, allowing services from video calls to emergency interventions. Materials and Methods: The system combines the telehealth applications with the services from local psychosocial intervention teams. In addition to system records covering sociodemographic variables and initial complaints, a telephone survey questioning the effectiveness and satisfaction of the system was used as the main outcome. Results: In total, 347 individuals used the system with mothers constituting the majority of applicants (88.7%, n = 332). The overall satisfaction of the system was 8.8/10. In terms of effectiveness, 63.3% (n = 237) of caregivers reported an improvement in the reason of application. Counselors decided on a need for follow-up visits for 36.6% (n = 137) of applications. A referral to a psychiatrist was asked for 40 patients (10.6%). Discussion: To our best knowledge, this is the first study presenting a model for managing MBs of CMSNs during the COVID-19 outbreak. In general, therefore, it seems that there is a need for unique systems to handle behavioral problems of CMSNs. Conclusions: The findings of this study suggest that it is possible to establish an integrative multistep multidisciplinary telehealth-based approach in a short while.

The Relationship between Online Sexual Solicitation and Internet Addiction in Adolescents.

The purpose of this study is to investigate the association between online sexual solicitation (OSS) and internet accessibility, usage, and addiction in adolescents. The study was conducted with 48 adolescents who had been exposed to OSS and 48 age- and sex-matched adolescents who had not been exposed to OSS. Internet addiction (IA) was determined by the Young Internet Addiction Scale. The groups were compared in terms of socio-demographic characteristics, internet access facilities, internet use characteristics, psychiatric disorders, and IA. The results showed that the duration of daily internet use, the purpose of internet use, and the rate of IA were significantly higher in the OSS-exposed group than in the control group. Depressive disorder and post-traumatic stress disorder were more common in the OSS group than in the control group. Results revealed that the association between OSS and IA is independent of psychiatric disorders. In conclusion, the evaluation of adolescents exposed to OSS, in terms of IA and the measures and interventions to be taken in this regard, will contribute to the prevention of new exposures. Additionally, considering that OSS may be among the possible negative consequences of IA, evaluating adolescents with IA in terms of OSS will provide significant benefits.

[Adaptation of Internet Gaming Disorder Questionnaire to Turkish:Reliability and Validity Study]. / Internet Oyun Oynama Bozuklugu Ölçeginin Türkçe Uyarlama,Geçerlik ve Güvenilirlik Çalismasi.

OBJECTIVE: This study aims to investigate the validity and reliability of the Turkish version of Internet Gaming Disorder Questionnaire. METHOD: The Experimental Sample of this study included 1161 students aged between 10 and 18 from four different schools. Language equivalence study of the questionnaire was conducted by two experts one of whose native language was English and fluent in Turkish, and the other, vice versa. Reliability of the questionnaire was evaluated by Test-retest method and Cronbach's alpha internal consistency analysis. Construct validity of the questionnaire was examined by confirmatory factor analysis. SPSS and -MPLUS 6.1- softwares were used for statistical analyses. RESULTS: Cronbach's alpha coefficient for internal consistency was 0.86. Total score correlations varied between 0.23 and 0.70 (p<0.01). Test-retest score averages did not differ for both the total and subgroup scores. Test-retest correlation was calculated as 0.865 (p<0.01). Confirmatory factor analyses for construct validity showed that factor loadings of items varied between 0.165 and 0.785. Cut-off score of the questionnaire was determined as 69 after Cluster analyses and ROC analyses. CONCLUSION: This study concluded that the validity and reliability of the Turkish version of Internet Gaming Disorder Questionnaire developed by Pontes et al. were satisfactory.

Online sexual solicitation in adolescents; socio-demographic risk factors and association with psychiatric disorders, especially posttraumatic stress disorder.

Technological developments and increased use of the internet created some risks for adolescents, such as online sexual solicitation (OSS). The aim of this study is to examine the sociodemographic risk factors of OSS and the association between OSS and psychiatric disorders in a psychiatric clinical sample. The study was conducted with 189 adolescents. The psychiatric evaluation was performed with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) based psychiatric interviews and the Strengths and Difficulties Questionnaire was used. OSS was defined by questions that are used in previous studies and that predict exposure to OSS. The participants were divided into two groups and compared. In addition, the Child Post-Traumatic Stress Disorder Reaction Index was answered by the participants who exposed to OSS. The prevalence of OSS was determined as 21.1%. Depressive disorder, borderline personality disorder, and secondary psychiatric diagnosis are significantly higher in adolescents who exposed to OSS. The rate of post-traumatic stress disorder (PTSD) development after exposure to OSS was determined as 57.8%. These results indicate that OSS is a severe trauma that occurs at a high rate, and it is associated with psychiatric problems, especially PTSD.

Management of Hepatotoxicity Induced by the Use of Olanzapine.

Numerous drugs cause hepatotoxicity clinically or biologically. Neuropsychiatric drugs constitute 16% of these drugs. The occurrence of hepatotoxicity induced by the use of olanzapine is expressed by the researchers. In such cases, generally the dose of olanzapine is reduced or the drug is completely discontinued and the treatment of the patient fails. The aim of this study is to report the case for whom elevated liver enzymes were observed but the process was managed without changing treatment dose and drug and to discuss this case with literature information. The present study has characteristics of being the first in the literature concerning management of the process.

Effects of attention-deficit/hyperactivity disorder on child abuse and neglect.

It is known that children with mental and developmental problems are at risk of abuse and neglect. Attention-deficit/hyperactivity disorder is one of the most frequent neurodevelopmental disorders in children and adolescents. The purpose of this study is to examine whether children diagnosed with ADHD are under more risk in terms of child abuse and neglect compared to controls. In this case-control study, 104 children, who applied to Child and Adolescent Psychiatry Unit of Bursa Yuksek Ihtisas Training and Research Hospital between January and June 2015, were diagnosed with ADHD, and had no other psychiatric comorbidity except for disruptive behavior disorders, and 104 healthy children were compared. Abuse Assessment Questionnaire was applied to children after approval of the families was received. It was determined that the children diagnosed with ADHD were exposed to more physical (96.2%) and emotional abuse (87.5%) in a statistically significant way compared to controls (46.2%; 34.6%), they were exposed to physical and emotional neglect (5.8%) at a lower rate compared to healthy children (24.0%), and there was no difference between them and healthy children in terms of witnessing family violence (56.7%; 47.1%) and being exposed to sexual abuse (5.8%; 1.9%). The children diagnosed with ADHD were exposed to physical and emotional abuse at a higher rate; further studies should emphasize the role of parents in this topic and how parental education and treatment programs change the results.

Gender Differences in Sexually Abused Children and Adolescents: A Multicenter Study in Turkey.

The purpose of this study was to examine gender-based differences in abuse-related characteristics and post-abuse psychiatric disorders among sexually abused children and adolescents. The researchers retrospectively examined files, judicial reports, and social examination reports of 1,250 sexually abused youth cases. Results showed that boys were more often victimized by penetration, force, and physical violence. Incidence of sexual abuse by family members, familiar persons, and multiple persons was higher among girls. In addition, a higher rate of major depressive disorder as well as alcohol consumption and cigarette smoking were found in sexually abused girls. No difference was observed between boys and girls in terms of post-traumatic stress disorder, conduct disorder, and other mental disorders. Intellectual disability was more frequent in boys.

Factors related with unintentional injuries in children with newly diagnosed attention-deficit/ hyperactivity disorder.

The aim of the present study was to investigate the factors associated with unintentional injury in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). One thousand four hundred and thirty children between the ages of 6 and 18 who were diagnosed with ADHD for the first time in child psychiatry outpatient clinics were included in the present study. The socio-demographic information of the children, their developmental histories, chronic physical health conditions, comorbid psychiatric disorders, and information obtained via the Turgay DSM-IV-based Child and Adolescent Disorders Screening and Rating Scale were examined retrospectively. It was determined that 12.8% of the children (n D 183) experienced unintentional injury. It was established that age, male gender, disruptive behavioural problems, and low education levels among mothers were predictive of unintentional injuries. The results of the present study suggest that behavioural problems accompanying ADHD and comorbid psychiatric disorders are important in terms of unintentional injuries.

Developmental delays in preschool children with adenotonsillar hypertrophy.

OBJECTIVES: This study aims to investigate the effects of adenotonsillar hypertrophy on general development, as well as fine and gross motor capabilities, social communication, and language development in children with adenotonsillar hypertrophy by applying the Denver Developmental Screening Test-II. PATIENTS AND METHODS: The study included 30 patients (12 boys, 18 girls; mean age 53.3±12.2 months; range 32 to 72 months) who were indicated for adenotonsillectomy due to adenotonsillar hypertrophy between February 2013 and July 2013. The control group comprised 30 children participants (12 boys, 18 girls; mean age 53.1±12.8 months; range 32 to 72 months) with no adenotonsillectomy indication. All participants included in the study were performed routine physical examination, flexible fiberoptic nasopharyngoscopy, and tympanometry. Brodsky scale and fiberendoscopic findings were used to categorize tonsil and adenoid sizes, respectively. Following ear, nose, and throat evaluation, a psychologist conducted Denver Developmental Screening Test-II in all participants blindly. RESULTS: Adenotonsillar hypertrophy patients had higher abnormal levels of general development (c2=7.13, p=0.028). Although patients and controls had similar levels of fine motor, gross motor, and personal-social development levels, there was a statistically borderline difference between them in terms of language development (t=1.82, p=0.074). CONCLUSION: The possibility of adenotonsillar hypertrophy should definitely be considered in children with delayed general and language developments.

Problematic Internet use was more common in Turkish adolescents with major depressive disorders than controls.

AIM: This study compared problematic Internet use (PIU) rates in 12- to 18-year-olds with major depressive disorder (MDD) and healthy controls and explored potential links between PIU and suicide among patients with MDD. METHODS: The study sample consisted of 120 patients with MDD (62.5% girls) and 100 controls (58% girls) with a mean age of 15. Suicide ideation and suicide attempts were evaluated, and sociodemographic data were collected. In addition, the Children's Depression Inventory, Young Internet Addiction Test and Suicide Probability Scale were applied. RESULTS: The results showed that PIU rates were significantly higher in the MDD cases than the controls (p < 0.001). The analysis of covariance results showed that there was no relationship between potential suicide and the Young Internet Addiction Test score in MDD cases. However, the hopelessness subscale scores of the MDD patients with PIU were significantly higher than the scores of those without PIU. CONCLUSION: Our results show that PIU was higher in adolescents with MDD and hopelessness was more prevalent among MDD patients with PIU, but no links with potential suicide were found. As this study was a cross-sectional one, it did not allow us to infer a causality relationship between PIU and MDD.

Factors related with unintentional injuries in children with newly diagnosed attention-deficit/hyperactivity disorder.

The aim of the present study was to investigate the factors associated with unintentional injury in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). One thousand four hundred and thirty children between the ages of 6 and 18 who were diagnosed with ADHD for the first time in child psychiatry outpatient clinics were included in the present study. The socio-demographic information of the children, their developmental histories, chronic physical health conditions, comorbid psychiatric disorders, and information obtained via the Turgay DSM-IV-based Child and Adolescent Disorders Screening and Rating Scale were examined retrospectively. It was determined that 12.8% of the children (n = 183) experienced unintentional injury. It was established that age, male gender, disruptive behavioural problems, and low education levels among mothers were predictive of unintentional injuries. The results of the present study suggest that behavioural problems accompanying ADHD and comorbid psychiatric disorders are important in terms of unintentional injuries.

Disordered eating attitudes, alexithymia and suicide probability among Turkish high school girls.

We aimed to examine association between disordered eating attitudes (DEAs), alexithymia and suicide probability among adolescent females and to explore potential link between alexithymia and suicide probability in subjects with DEAs. 381 female students completed Eating Attitude Test (EAT-26), Toronto Alexithymia Scale (TAS-20) and Suicide Probability Scale (SPS). It was found that 13.2% (n=52) of the subjects have DEAs. Results indicated that total TAS-20 score and scores of Difficulty in Identifying Feelings (DIF) and Difficulty in Describing Feelings (DDF) subscales were significantly higher in DEAs group than in those non DEAs group (p<0.05). Additionally, total SPS score (p<0.001), Hopelessness (p=0.001), Suicide Ideation (p<0.001) and Hostility (p=0.003) subscales scores of SPS were significantly higher in the alexithymic DEAs than the non-alexithymic DEAs group. In order to control potential effect of depression, SPS subscales were used as covariate factors in ANCOVA. Negative Self-Evaluation subscale yielded a statistically significant difference between groups, other subscales did not. Results point out these; DEAs are relatively frequent phenomenon among female students in Turkey and presence of alexithymia was associated with an increased suicide probability in adolescents with DEAs. The results should be evaluated taking into account that depressive symptomatology was not assessed using a depression scale.

Importance of insulin immunoassays in the diagnosis of factitious hypoglycemia.

We report two cases emphasizing the importance of insulin assays for evaluation of hypoglycemia in diabetic patients. Case 1 was a 96/12-year-old female patient with type 1 diabetes mellitus and case 2 was a 1010/12-year-old male patient with DIDMOAD. Both patients were on a basal-bolus insulin regimen. Both were admitted because of persistent hypoglycemia. Analyses of serum samples obtained at the time of hypoglycemia initially showed low insulin and C-peptide levels. Recurrent episodes of unexplained hypoglycemia necessitated measurement of insulin levels by using different insulin assays, which revealed hyperinsulinemic hypoglycemia with low C-peptide levels, findings which confirmed a diagnosis of factitious hypoglycemia. Surreptitious administration of insulin should not be excluded in diabetic patients with hypoglycemia without taking into account the rate of cross-reactivity of insulin analogues with the insulin assay used.

Early-married and sexually abused girls differ in their psychiatric outcomes.

Early marriage and sexual abuse are the two of the most frequent types of childhood abuse. Although early marriage is also a type of sexual abuse, it is associated with different physical, social, and mental outcomes than sexual abuse alone. The purpose of this study was to compare early-married girls and sexually abused girls who were referred for forensic evaluation in Turkey in terms of their sociodemographic characteristics, mental disorder rates, and mental symptom severity. We included 63 adolescent girls for whom a judicial report had been demanded and who were under 15 years old when they were married but were not yet 18 years old during the evaluation (15.51±0.78) and 72 sexually abused adolescent girls between 14 and 18 years old (15.80±1.10) in this study. Following a psychiatric evaluation, the study participants completed the Child Posttraumatic Stress Disorder Reaction Index (CPTS-RI) and the Brief Symptom Inventory (BSI). We used the Windows SPSS 16.0 software program to assess the results. At least one psychiatric disorder was determined in 44.4% of the early-married and 77.8% of the sexually abused cases (p<0.001). A diagnosis of PTSD or ASD was observed in 11.1% of the early-married cases and in 54.2% of the sexually abused victims (p<0.001). MDD was determined in 33.3% of the early-married cases and 56.9% of the sexually abused cases (p=0.006). The CPTS-RI scores of the sexually abused victims were higher than those of the early-married cases (p<0.001). All of the subscale scores of the BSI were higher in the sexually abused adolescents than in the early-married cases (p<0.001). Although early marriage has severe physical, social and mental outcomes, it is not as severe as sexual abuse in terms of psychiatric disorder rates and the psychiatric symptom severity it causes.

Medication persistence in Turkish children and adolescents with attention-deficit/hyperactivity disorder.

OBJECTIVE: The aim of this study was to investigate medication persistence in Turkish children and adolescents with attention-deficit/hyperactivity disorder (ADHD). The effects of sociodemographic characteristics, symptom severity of ADHD, comorbidity, and treatment-related factors influencing medication persistence in children diagnosed with ADHD were studied. METHODS: Medication persistence over a continuous 12 month period was evaluated for 877 children and adolescents between 6 and 18 years of age, who were diagnosed with ADHD for the first time and started to receive medication. Medication persistence was determined according to whether or not taking the prescribed medication continued for 12 months after the initiation of treatment. Whereas the symptom severity of ADHD was assessed by using the Turgay Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV)-based Child and Adolescent Behaviour Disorders Screening and Rating Scale-Parents Form (T-DSM-IV-S), perceived medication efficacy after the first treatment was evaluated by the Clinical Global Impressions-Improvement Scale (CGI-I). RESULTS: In this study, medication persistence over a continuous 12 month period occurred at a rate of 30.2% (n=265) in the subjects studied. The hierarchical regression analysis conducted in this research revealed that younger age, higher hyperactivity/impulsivity symptom severity, use of long-acting methylphenidate, addition of another ADHD medication, addition of other psychotropic medications, absence of side effects, and perceived medication efficacy were associated with successful medication persistence over a continuous 12 month period. CONCLUSIONS: Understanding the factors that affect medication persistence in ADHD may improve treatment efficacy and symptom control, while minimizing future risks.