Cognitive functioning of adolescents using Methamphetamine: The impact of inflammatory and oxidative processes.

BACKGROUND: Methamphetamine is a substance that causes neurotoxicity and its use is increasing in recent years. Literature highlights cognitive impairment resulting from Methamphetamine use. The aim of the present study is to evaluate the relationship between cognitive impairment and inflammatory processes in adolescents with Methamphetamine use disorder. METHODS: The study included 69 adolescents aged 15-19 years, comprising 37 participants with Methamphetamine Use Disorder and 32 healthy controls. Central Nervous System Vital Signs was used to detect cognitive impairment. Childhood Trauma Questionnaire-33 and The Children's Depression Inventory scales were used. In addition, venous blood was collected from the volunteers. Biochemical parameters (IL-1beta, IL-6, TNF-a, BDNF, FAM19A5, TAS, TOS) were analyzed. RESULTS: Our study showed that (I) IL-6 and TNF-a levels of Methamphetamine users were lower than the healthy group; (II) BDNF levels of Methamphetamine users were higher than the healthy group; (III) mean Neurocognitive Index in cognitive tests of Methamphetamine using adolescents was negatively correlated with duration of Methamphetamine use and BDNF levels. CONCLUSIONS: Our study suggests that Methamphetamine use may have a negative effect on cognitive functions.

The association between cognitive disengagement syndrome and specific learning disorder in children and adolescents with ADHD.

This study aimed to examine the associations between Cognitive Disengagement Syndrome (CDS) and Specific Learning Disorder (SLD) in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). We included sixty "ADHD-only" cases and eighty-two "ADHD + SLD" cases with an IQ score of 80 and above, aged 8-15. We applied both a structured psychiatric interview and a mental status examination. Parents completed the ADHD-Rating Scale IV, Barkley Child Attention Scale, and Specific Learning Disorder-Evaluation Scale. The sample consisted of 94 boys and 48 girls. The mean age of the cases was 10,90 ± 2,32. The "ADHD + SLD" group had a higher proportion of cases with CDS than the "ADHD-only" group (47,6% vs 15%). The "ADHD + SLD" group had significantly higher CDS-total, CDS-sluggish, and CDS-daydreaming scores than the "ADHD-only" group. SLD score was positively associated with CDS-total, CDS-sluggish, and CDS-daydreaming scores. Even when controlled for inattentive symptoms, IQ, drug treatment duration, socioeconomic level, and parental education level, CDS-daydreaming scores but not CDS-sluggish scores were associated with higher SLD scores. The findings indicate a prominent association between CDS and SLD. CDS symptoms -mainly- CDS-daydreaming symptoms are essentially associated with SLD even when controlled for inattentive symptoms, IQ, drug treatment duration, and relevant demographic factors. Therefore, clinicians should pay attention to a possible coexistence of CDS while evaluating cases with SLD.

Should pediatric cardiologists refer all patients with unexplained chest pain to a psychiatrist?

OBJECTIVE: The present study aimed to investigate the relationship between unexplained chest pain in children with parents' mental problems, parental attitudes, family functionality, and the child's mental problems. MATERIAL AND METHOD: A total of 433 children (between 11 and 18 years of age) applied to the Pediatric Cardiology Outpatient Clinic due to chest pain in the last year. A clinical interview was conducted by a child psychiatrist with 43 patients and 33 controls included in the study due to unexplained chest pain. RESULTS: Family history of physical illness was significantly higher in the chest pain group. When evaluated in terms of psychosocial risk factors, life events causing difficulties, derangement in the family, loss of a close person, and exposure to violence were statistically significantly higher in the group with chest pain. Mental disorders were observed in 67.4% of the children in the chest pain group as a result of the clinical interview. The total score of the DSM-5 somatic symptoms scale, which evaluates other somatic complaints in the chest pain group, was also significantly higher. When the family functions of both groups were evaluated, communication, emotional response, behaviour control, and general functions sub-dimensions were statistically significantly higher in families in the chest pain group. CONCLUSION: We recommend that psychiatric evaluation be included in diagnostic research to prevent unnecessary medical diagnostic procedures in children describing unexplained chest pain, as well as to prevent the potential for diagnosing mental disorders in both children and adults.

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.

Clinical Practices and Experiences about Screen Time: From the Perspective of Child and Adolescent Psychiatrists in Turkey - An Online Survey.

Background: Both mental and physical preventable health problems related to screen time (ST) in children and adolescents are increasing. It is important that psychiatrists have awareness to prevent problems in this area. Objective: The aim of our study was to evaluate the child psychiatrists' awareness about ST, their interventions for ST, and to what extent the recommendations of the associations are implemented. Method: All child and adolescent psychiatrists in the country who could be reached via smartphone were invited to participate in the study. Child and adolescent psychiatrists were included regardless of whether they had attended any ST courses/panels. Data were collected through an online questionnaire. A total of 302 physicians volunteered for the study. Results: It was determined that very few child and adolescent psychiatrists had attended an ST course/training in the past or followed any guidelines. A statistically significant difference was found between physicians who received training/courses and those who did not in terms of informing patients and offering interventions (p<0.05). Similarly, a significant difference was found between those who followed the guidelines and those who did not. Conclusion: Raising awareness, increasing psychiatrist participation in trainings, and following guidelines can increase the effectiveness of ST interventions, in order to achieve good results.

Which factors affect internalized stigmatization in adolescents with mental disorders?

PURPOSE: The aim of this descriptive study was to determine the factors affecting internalized stigmatization of adolescents with mental disorders. METHOD: The study data were collected in a university hospital between August 1, 2020 and July 30, 2021 (n = 123), using a Personal information form and the Internalized Stigmatization of Mental Illness-Adolescent Form (ISMI-AF). RESULTS: Gender and the number of hospitalizations were determined to be independent variables with explanatory power in the ISMI-AF, and in the model created with these variables, it was determined that these variables explained 18% of the change in the total points of the ISMI-AF. CONCLUSIONS: It could be recommended that psychosocial programs are developed with the aim of decreasing internalized stigmatization and increasing the psychological resilience of adolescents.

Perceptions and Experiences of Adolescents with Mental Disorders and Their Parents about Psychotropic Medications in Turkey: A Qualitative Study.

This descriptive phenomenological study aimed to evaluate the perception and experiences of adolescents with mental disorders and their parents about the use of and adherence to psychotropic medications. A total of 12 semi-structured interviews with adolescents between the ages of 12 to 18 who were attending an outpatient psychiatric clinic for children and adolescents and 12 interviews with parents were conducted between October 2021 and January 2022 in Manisa, Turkey. Colaizzi's phenomenological interpretation method was used for the analysis of the participants' statements. Our study highlights the main positive effects of psychotropic medication and barriers to medication intake and adherence. Positive effects included symptom management and health improvement. Barriers varied from those directly linked to medication effects (e.g., negative side effects or lack of perceived effect) to personal barriers (e.g., forgetting to take medication or feelings of not being oneself due to medication intake) and societal barriers. In general, the barriers were reflected in concerns related to long-term consequences, such as medication dependence, and in concerns about diminished life prospects. Possible recommendations to improve the use of and adherence to psychotropic medication among adolescents include educating adolescents and parents not only about treatment options but also about mental disorders.

Analysis of Substance Use and Mental Disorder Diagnoses in Adolescents with a History of Delinquency: a Cross-sectional Study.

This study aimed to evaluate substance use and comorbid mental disorders in delinquent adolescents presenting to a child and adolescent psychiatry outpatient clinic. This study included 47 adolescents aged 15-18 years and had a history of delinquency. Data were collected using the Addiction Profile Index Adolescent Form (API-A) and an information form. Results indicated that the adolescents' mean age is 16.11 ± 1.05 years, 78.7% had committed crimes against property and 34.0% against the person, and 34.0% were also victims of crime. Mean API-A total scores indicated that their level of substance use was low. In addition, mean API-A total scores showed significant differences according to the adolescents' migration status, age, economic status, school attendance, mental disorder diagnosis, duration of mental disorder, and type of offense (p < 0.05). The benefit provided by timely and appropriate psychosocial interventions may have a key role in solving this problem for adolescents and improving their future as adults.

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.

Effect of Impairment on the Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder in a National Survey: Nation-Wide Prevalence and Comorbidities of ADHD.

OBJECTIVE: This study aimed to determine the prevalence and comorbidities of attention-deficit hyperactivity disorder (ADHD) by evaluating a large-scale nation-wide sample of children. METHOD: The inclusion criterion was being enrolled as a 2nd, 3rd, or 4th-grade student. A semi-structured diagnostic interview (K-SADS-PL), DSM-IV-Based Screening Scale for Disruptive Behavior Disorders, and assessment of impairment (by both parents and teachers) were applied to 5,842 participants. RESULTS: The prevalence of ADHD was 19.5% without impairment and 12.4% with impairment. Both ADHD with and without impairment groups had similar psychiatric comorbidity rates except for oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses. Impairment in the ADHD group resulted in significantly higher ODD and CD diagnoses. CONCLUSION: Even when impairment is not described, other psychiatric disorders accompany the diagnosis of ADHD and may cause impairment in the future. Impairment in the diagnosis of ADHD significantly increases the likelihood of ODD and CD.

Validity and Reliability of the Turkish Version of the Weiss Functional Impairment Rating Scale- Self Report Form (WFIRSS- TR). / Weiss Islevsellikte Bozulma Ölçegi-Özbildirim Formu Türkçe Güvenilirligi ve Geçerliligi.

OBJECTIVE: The aim of this study was to demonstrate the validity and reliability of the WFIRS-S-TR, Turkish version of the Weiss Functional Impairment Rating Scale-Self Report form. METHOD: The study comprised two groups of participants of 15-18 years of age, one consisting of 35 children diagnosed with attention deficit and hyperativity disorder (ADHD) based on the DSM-IV criteria and the other, 510 healthy volunteers attending high school. Apart from the WFIRS-S-TR, the Health Questionnaire for Children and Adolescents (KIDSCREEN-10 Index) which is a general quality of life and functionality measurement instrument, was used to check the concurrent validity of the WFIRS-S-TR. RESULTS: The Cronbach's alpha coefficient for the total scale was 0.939. The test-retest reliability assessed by repeated measurements two weeks apart gave a high correlation between the results (r=0.804, p<0.0001). Total mean score of the WFIRS-S-TR showed significant correlation with the KIDSCREEN-10 Index total mean score (r= -0.467, p<0.0001). Confirmatory factor analysis was carried out for the construct validity of the WFIRS-S-TR. The RMSEA and the CFI values were found to be 0.065 and 0.68, respectively. CONCLUSION: The WFIRS-S-TR can be used as a valid and reliable tool both in clinical practice and for research purposes.

[Maternal Attitudes, Irritability, Problem Solving Skills and Decision Making in Adolescents with Substance Use: Case-control Study]. / Madde Kullanan Ergenlerin Problem Çözme, Karar Verme Becerileri, Duygusal Tepkisellik Düzeyleri ve Anne Tutumlarinin Degerlendirilmesi: Olgu-Kontrol Çalismasi.

OBJECTIVE: Multiple risk factors affect the emergence of substance use disorders among adolescents and their families. To the best of our knowledge, the effects of irritability, problem solving, decision making skills and maternal attitudes on the severity of the substance use have not been evaluated on the same population. We aimed to evaluate the presence and the effects all of these variables on the severity of substance dependence. METHOD: The study included 40 adolescents, between 14 and 17 years of age, consulting the Child and Adolescent Mental Health and Diseases outpatient clinics with complaints of substance use and 40 age and gender matched healthy controls. The diagnoses were based on the DSM-5 diagnostic criteria. Both groups completed a sociodemographic questionnaire, the Parent Attitude Research Instrument (PARI), the Adolescent Decision Making Questionnaire (ADMQ), the ProblemSolving Inventory (PSI) and the DSM-5 Level 2 Irritability Scale. The patient group were also tested on the Addiction Profile Index for Adolescents (API-AF). RESULTS: Problem solving skills scores of the patients were lower and the scores on the irritability scale completed by the patients and their parents were higher as compared to the control group. Complacency (indifference) in decision-making predicted the severity of the addiction. As the complacency in decision-making increased, the severity of addiction also increased. CONCLUSION: Our results indicated that problem solving and decisionmaking skills and irritability levels of the adolescents together with the family attitudes, affect substance use disorder in adolescence. These variables should be considered in preventive and therapeutic approaches.

Who predict ADHD with better diagnostic accuracy?: Parents or teachers?

OBJECTIVE: The objectives of the study were to determine which parents or teachers predict attention-deficit/hyperactivity disorder (ADHD) better in children and adolescents, and to detect both diagnostical and symptomatological agreement levels across informant reports. METHOD: A total of 417 cases aged 6-14 from a non-referred community sample were assessed by a semi-structured interview, parent- and teacher-rated ADHD Rating Scale-IV. Also, impairment criteria were taken into account to ensure the gold standard diagnosis for ADHD. The measures of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated in each categorical sample. Besides, the agreement between parent and teacher reports of ADHD was investigated. RESULTS: Parents and teachers had similar diagnostic accuracy for predicting ADHD. Both parents and teachers predicted ADHD in similar accuracy in both boys and girls, separately. However, girls were found to be more predictable by both parents and teachers compared to boys. Parents with lower education levels had worse diagnostic accuracy than both parents with higher education levels and teachers. Low to moderate agreement and correlations between parent and teacher ADHD reports were detected. CONCLUSION: In general, parents and teachers seem to predict ADHD in similar accuracy. Nevertheless, child gender and parental education level may alter the predictability power for ADHD. The findings can guide for clinicians that how to evaluate observation reports of parents and teachers to make accurate ADHD diagnosis in patients.

Validity and reliability of the internalized stigma of Mental Illness Scale-Adolescent Form.

PURPOSE: The goal of this study was to assess the validity and reliability of the Turkish version of the Internalized Stigma of Mental Illness Scale-Adolescent Form (ISMI-AF). METHODS: A total of 145 adolescents (12-18 years of age) who were diagnosed with at least one mental disorder according to DSM-5-TR participated in the study. Data were collected at a mental health hospital between October 2017 and 2019 using a sociodemographic information form, the ISMI-AF, and Beliefs towards Mental Illness (BMI) Scale. Reliability (Cronbach's alpha, Split-Half, Spearman-Brown, Hotelling T2 test) and validity analyses of the ISMI-AF were performed. SPSS 26.0 and LISREL 8.80 software were used for statistical analyses. RESULTS: The Cronbach's alpha coefficient for total score was .88, Split-Half score was .84, and the Spearman-Brown factor score was .85. Confirmatory factor analysis showed that the scale confirmed to the five-factor structure in adolescents, but factor loadings and reliability coefficients were low in the "stigma resistance" subscale. There was a positive and weak correlation between ISMI-AF and BMI (r = .37, p = .00). CONCLUSION: The ISMI-AF is a valid and reliable measurement tool that can be used in adolescents. This scale can help psychiatric nurses who work in this field identify and address internalized stigma, which is one of the key factors affecting adherence to treatment, especially in adolescents.

The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T).

AIM: The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey. METHOD: A nation-wide, randomly selected, representative population of 5830 children (6-13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently. RESULTS: Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring. CONCLUSION: This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group.

DSM-5 Level 2 Sleep Disorders Scale Validity and Reliability of Turkish Form (Form for Children Aged 11-17 Years and Parent Form for Children Aged 6-17 Years).

INTRODUCTION: This study aimed to assess the validity and reliability of Turkish version of DSM-5 Level 2 Sleep Disorders Scale. METHOD: The scale was prepared by translation and back translation of DSM-5 Level 2 Sleep Disorders Scale. Study groups consisted of a clinical sample that contained cases that had sleep related problems and treated in a child and adolescent psychiatry unit and also a community sample. In the assessment process, child and parent forms of DSM-5 Level 2 Sleep Disorders Scale and also Children's Sleep Habits Questionnaire-Turkish version (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) were used. As for reliability analyses, internal consistency coefficient and item-total score correlation analysis, test-retest reliability; and for validity analyses, explanatory factor analysis and for concurrent validity, correlation analyses with Children's Sleep Habits Questionnaire-Turkish version (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) were made. RESULTS: In reliability analyses, Cronbach's alpha internal consistency coefficient values were found to be very highly reliable regarding child and parent forms. Item-total score correlation coefficients were high for child form while medium and high for parent form; indicating a statistical significance. As for construct validity, two factors were maintained that would count for 74.1% of the variance in child form and 66.9% of the variance in parent form. It was seen that positive and negative statements weighed on two different factors. As for concurrent validity, child and parent form of the scale showed significant correlation with Children's Sleep Habits Questionnaire-Turkish version (CSHQ) and Pittsburgh Sleep Quality Index (PSQI). CONCLUSION: It was found that Turkish version of DSM-5 Level 2 Sleep Disorders Scale could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

Prevalence of Childhood Affective disorders in Turkey: An epidemiological study.

AIM: To determine the prevalence of affective disorders in Turkey among a representative sample of Turkish population. METHODS: This study was conducted as a part of the "The Epidemiology of Childhood Psychopathology in Turkey" (EPICPAT-T) Study, which was designed by the Turkish Association of Child and Adolescent Mental Health. The inclusion criterion was being a student between the second and fourth grades in the schools assigned as study centers. The assessment tools used were the K-SADS-PL, and a sociodemographic form that was designed by the authors. Impairment was assessed via a 3 point-Likert type scale independently rated by a parent and a teacher. RESULTS: A total of 5842 participants were included in the analyses. The prevalence of affective disorders was 2.5 % without considering impairment and 1.6 % when impairment was taken into account. In our sample, the diagnosis of bipolar disorder was lacking, thus depressive disorders constituted all the cases. Among depressive disorders with impairment, major depressive disorder (MDD) (prevalence of 1.06%) was the most common, followed by dysthymia (prevalence of 0.2%), adjustment disorder with depressive features (prevalence of 0.17%), and depressive disorder-NOS (prevalence of 0.14%). There were no statistically significant gender differences for depression. Maternal psychopathology and paternal physical illness were predictors of affective disorders with pervasive impairment. CONCLUSION: MDD was the most common depressive disorder among Turkish children in this nationwide epidemiological study. This highlights the severe nature of depression and the importance of early interventions. Populations with maternal psychopathology and paternal physical illness may be the most appropriate targets for interventions to prevent and treat depression in children and adolescents.

Validity of proposed DSM-5 ADHD impulsivity symptoms in children.

The American Psychiatric Association (APA) working group on Attention-Deficit/Hyperactivity Disorder (ADHD) proposed the inclusion of four new impulsivity symptoms. However, they were not included in DSM-5 due to the lack of sufficient evidence. The aim of this study is to investigate the performance of the proposed four ADHD impulsivity symptoms with respect to: (a) ADHD factor structure; (b) performance in predicting clinical impairment; (c) specificity for ADHD diagnosis and (d) best symptomatic threshold to predict clinical impairment. The sample comprised 416 children (31 ADHD subjects according to both DSM-IV and proposed DSM-5, 20 ADHD subjects according to just one diagnostic system and 365 controls) from 12 schools. Diagnoses were derived using semi-structured interviews and ADHD rating scales. Results from confirmatory factor analysis indicate that addition of the four new impulsivity items provided a slightly better factor structure if compared to models including only 18 items. Regression analyses showed that only one of the new impulsivity symptoms (impatient) was part of the list of best predictors of impairment. None of the four new impulsivity items was specifically associated with ADHD diagnosis. The best cutoff point in the hyperactivity/impulsivity dimension for predicting impairment did not change significantly. Overall, our findings suggest that the determination on how to best capture impulsivity dimension as part of the ADHD construct needs more investigation and that there is not enough evidence to include these four assessed impulsivity symptoms as part of the ADHD criteria.