Objective Parameters in Attention Deficit Hyperactivity Disorder: Eye and Head Movements.

OBJECTIVE: We aimed to evaluate eye and head movements, which are objective parameters in ADHD. Method: While the children were watching the course video task, which included the relevant (teacher and smart board) and irrelevant (any regions outside the relevant area) areas of interest, their eye movements were evaluated through eye tracking, and video recordings were made simultaneous. Head position estimation was made using through video recordings. The proportion of total fixation duration on areas of interest (PFDAOI) and saccade count, amplitude, velocity for eye movements, number of total head movements and angular change of head movement in x-y-z axes for head movements were compared. RESULTS: Children with ADHD had lower PFDAOI on the relevant area, and had more saccade and head movements The angular change of head movement in the x-axis was higher in the ADHD group. CONCLUSION: In the assessment of ADHD, the eye and head movements may be particulary useful.

Psychometric Properties of the Turkish Version of the Children's Saving Inventory in a Clinical Sample.

OBJECTIVE: The Children's Saving Inventory (CSI) is a measurement tool developed to assess hoarding behavior in children. This study aims to investigate the psychometric properties of the Turkish version of the CSI in a clinical sample of children and adolescents. MATERIALS AND METHODS: The study sample consisted of 52 children and adolescents diagnosed with obsessive-compulsive disorder in the 8-17 age group and their families. As a structured diagnostic interview, the Development and Well-Being Assessment (DAWBA) was applied to all participants included in the research. Hoarding disorder (HD) diagnosis was made clinically by considering the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria. The Children's Yale-Brown Obsessive- Compulsive Scale Symptom Checklist (CY-BOCS) was administered by an experienced clinician. The parents and children filled out the Obsessive-Compulsive Inventory-Child Version (OCI-CV) and CSI scales independently. RESULTS: The 20-item CSI Turkish version demonstrated good internal consistency. This 4-factor structure of the scale was confirmed by confirmatory factor analysis. Children's Saving Inventory showed convergent and discriminant validity with the OCI-CV and CY-BOCS subscales, and the higher CSI total scores in children and adolescents diagnosed with HD confirmed the construct validity. CONCLUSION: These findings support the use of the CSI Turkish version as a valid and reliable scale to investigate the hoarding behavior of children and adolescents in a clinical sample. In addition, the CSI Turkish version is currently the only validated instrument to evaluate hoarding behavior in children and adolescents, as rated by parents in Türkiye.

Parent rated bedtime resistance and comorbidity may predict levels of attention among Turkish children diagnosed with ADHD in on-line education classes during the COVID-19 outbreak.

OBJECTIVE: This study aimed to compare the attention levels, of Turkish children and adolescents with Attention Deficit/ Hyperactivity Disorder (ADHD) in on-line education classes with healthy controls. METHODS: This study is a cross-sectional, internet-based, case-control study that recruited 6-18 years old patients diagnosed with ADHD and receving treatment and healthy controls from eight centers. The measurements used in the study were prepared in the google survey and delivered to the participants via Whatsapp application. RESULTS: Within the study period, 510 children with ADHD and 893 controls were enrolled. Parent- rated attention decreased significantly in both groups during on-line education classes due to COVID-19 outbreak (p<0.001; for each). Children and adolescents with ADHD had significantly elevated bedtime resistance, problems in family functioning difficulties than control children according to parental reports (p=0.003; p<0.001; p<0.001, respectively). Furthermore, bedtime resistance and comorbidity significantly predicted attention levels in on-line education. CONCLUSION: Our findings may underline the need to augment student engagement in on-line education both for children without attention problems and those with ADHD. Interventions shown to be effective in the management of sleep difficulties in children as well as parent management interventions should continue during on-line education.

Does Modifying the Consent Process Based on the Dominant Intelligence Type Reduce Anxiety During 3rd Molar Operations?

PURPOSE: Third molar surgery is one of the most commonly performed operations, usually associated with high anxiety. The purpose of this study was to determine if patients' anxiety would reduce if consent was modified to match their dominant intelligence type (DIT). METHODS AND MATERIALS: A single center, prospective randomized clinical study was conducted in the Maxillofacial Surgery Clinic of Ordu University on patients admitted for lower third molar removal between October 2020 and June 2021. The participants were randomly assigned to a study group where consent was based on DIT or a control group where consent was obtained in the standard fashion. DIT was determined using the multiple intelligence test and was further categorized as visual/spatial, verbal/linguistic, and bodily/kinesthetic. The consent method was the primary and the type of DIT was the secondary predictor variable. The primary and secondary outcome variables were the salivary cortisol level and Modified Dental Anxiety Scale (MDAS) scores measured before and after the consent, and after the operation. Mann-Whitney U, Friedman, Kruskal Wallis, Pearson correlation, and χ2 tests were conducted for statistical analysis. RESULTS: Eighty patients (55 females and 25 males; mean age 23.5 ± 6.2) were included. No significant difference was observed between the study and control groups for the change in cortisol levels and MDAS scores before-after consent (-11.15 ± 62.64; -6.84 ± 32.9) (P = .389), (-0.6 ± 3.46; -0.7 ± 2.49) (P = .832) and before consent-after operation (-39.80 ± 108.2; -39.72 ± 77.04) (P = .987), (-4.31 ± 5.97; -3 ± 4.34) (P = .867). The change in MDAS scores and cortisol levels was not correlated after consent (P = .587, r = 0.62) and operation (P = .406, r = 0.94). CONCLUSION: Providing consent based on DIT is not statistically different than providing consent in the standard fashion. The role of consent strategy in managing anxiety and lack of correlation between salivary cortisol and MDAS requires further investigation.

Determinants of Leaky Gut and Gut Microbiota Differences in Children With Autism Spectrum Disorder and Their Siblings.

Leaky gut hypothesis is one of the well-known theory which tries to explain etiology of Autism Spectrum Disorder (ASD). Unfortunately there is still a gap of evidence to investigate the corner points of the hypothesis. The aim of this study was to investigate the determinants of leaky gut in children with ASD, their siblings and healthy controls. Intestinal microbiota was found to be similar between ASD and sibling groups. Biological markers of bacterial translocation showed a significant difference in the sibling group, whereas the marker indicating local inflammation was not different between the groups. The findings from this study did not support the role of Gut microbiota or leaky gut on the etiology of autism.

Assessing sustained attention of children with ADHD in a class flow video task.

OBJECTIVE: The aim of the study was to evaluate sustained attention performance of children with ADHD and effect of distractors on sustained attention through an eye-tracking during a class-flow video task. METHOD: Data were collected using an eye-tracking during a class-flow task conducted with 60 children (ADHD and control groups). Two areas of interest were determined in the task, these are relevant (teacher and whiteboard) and irrelevant (any regions outside the relevant area) areas. The task also included distractors in relevant and irrelevant areas, comprising a brief conversation and dropping of a pencil, respectively. Proportion of total fixation duration on areas of interest (PFDAOI) was used to assess sustained attention. RESULTS: Children with ADHD had lower PFDAOI in the relevant area during the whole class than children in the control group. After the relevant area distractor, PFDAOI increased in relevant area in ADHD group, indicating these children may have better attention after the distractor. However, children with ADHD also showed increased PFDAOI in the irrelevant area following the irrelevant area distractor, indicating that it negatively affected them. There was no significant change in the control group following the distractors. CONCLUSION: These findings indicate that children with ADHD have poor sustained attention performance during the whole class. Moreover, distractors in distinct areas could affect children with ADHD differently. Thus, students with ADHD could benefit from increased stimuli in the relevant area and this can be a guide for classroom arrangements to improve the academic functionality of these children.

Prevalence and correlates of hoarding behavior and hoarding disorder in children and adolescents.

Although hoarding symptoms are reported to begin in childhood and adolescence, the true prevalence of the disorder in this age group is unknown. This study aims to estimate the prevalence of hoarding disorder (HD) in children and adolescents. The present study was planned as a two-stage epidemiological research. In the first stage, the Children's Saving Inventory (CSI) and informed consent forms were delivered to a group of students' parents. In the second stage, one-on-one psychiatric interviews with a physician were planned with the families and children who had hoarding behavior (HB), as described by their parents. The DSM-5-based HD interview and the Development and Well-Being Assessment (DAWBA) diagnostic tool were used to detect prevalence of HD and comorbid psychiatric disorders. A total of 3249 children were included in the study, and 318 children and their parents were evaluated in the second stage. As a result of the second assessment, 32 out of 318 children met the HD diagnostic criteria. The estimated prevalence of HD was 0.98% (95% CI 0.7-1.4). Hoarding disorder was found more frequently in females (F/M = 3/1). After a logistic regression analysis, variables such as female sex and the presence of any psychopathology were identified as independent correlates of HD. More than half (56.2%) of the children diagnosed as having HD also had a comorbid psychiatric disorder. In the present study, the two-stage evaluation method was used in a large pediatric sample to determine the estimated prevalence of HD, as well as the factors associated with the disorder and comorbid psychiatric disorders.

The Relationship between Psychopathology, Self-esteem, Body Perception and Serum Sex Steroids in Pubertal Gynecomastia.

OBJECTIVE: The current study aimed to investigate the psychopathology behind gynecomastia and potential associated problems regarding self-esteem and body perception, and the relationships of these variables with sex steroid levels in adolescents with pubertal gynecomastia. METHODS: The study included 50 normal weight male adolescents aged between 11 and 18 years with gynecomastia but without any chronic organic pathology, and 50 healthy pubertal male adolescents matched for age. The adolescents underwent psychopathology assessment by Development and Well-Being Assessment interviews; self-esteem was assessed using the Rosenberg Self-Esteem Scale; body perception was evaluated using the Body Image Perception Scale, and the relationship between these variables and sex steroid levels were explored. RESULTS: The results of the study revealed that the gynecomastia group had significantly greater internalization disorder (X2 = 12.96, p < 0.001), and impairments in self-esteem (z = -1.975, p = 0.024) and body perception (z = -2.286, p = 0.022), and these variables were correlated with the gynecomastia stage. In the study group, cortisol levels were significantly higher (z = -2.330, p = 0.02) in adolescents with internalization disorder compared to those without, and cortisol levels increased in parallel with increased gynecomastia duration (r = 0.386, p = 0.006). CONCLUSION: In our study, we found that gynecomastia, depending on its stage, may lead to internalization disorder and impair self-esteem and body perception. It was found that there was no direct relationship between these parameters and sex steroids in pubertal gynecomastia, except for high cortisol levels in adolescents with internalization disorder.

Mitochondrial DNA copy number may be associated with attention deficit/hyperactivity disorder severity in treatment: a one-year follow-up study.

OBJECTIVE: Studies on etiopathogenesis of attention deficit/hyperactivity disorder (ADHD) are increasingly focussing on mitochondrial dysfunction. Children diagnosed with ADHD who had significantly higher mitochondrial DNA (mtDNA) copy numbers than healthy children in our first study were re-examined in 1-year follow-up to investigate effects of severity and treatment of ADHD on mtDNA. METHODS: Twenty-eight patients who participated in previous study were included in this follow-up study. Patients were equally divided into two groups according to whether they had been receiving treatment. Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, and Conners Parent Rating Scale (CPRS) were used. Polymerase chain reaction was performed. RESULTS: Means of the first and second mtDNA copy were similar in all patients. mtDNA copy numbers did not change between two measurements in treated and non-treated groups. There was a correlation between CPRS ADHD index and inattention scores and mtDNA copy number in treated group. mtDNA copy number did not change in patients with ADHD over a period of 1 year regardless of treatment. CONCLUSIONS: There may be a relationship between decreased ADHD severity with treatment and positive effects of mitochondrial functions. Mitochondrial dysfunction may play a role in pathophysiology of ADHD.KEY POINTSThis was the first study to follow up ADHD patients in order to investigate mitochondrial dysfunction by measuring mtDNA copy numbers 1 year after the initial measurements.mtDNA copy number, one of the best markers of mitochondrial dysfunction, did not change in ADHD patients over a period of 1 year regardless of treatment.Mitochondrial dysfunction may play a role in the pathophysiology of ADHD, where it may be involved with or without treatment.In the treated group, there was an association between decreased ADHD severity and reduced mtDNA copy numbers.There may be a relationship between decreased ADHD severity with treatment and the positive effects of mitochondrial functions.

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

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

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.

Mitochondrial DNA Copy Number is Associated with Attention Deficit Hyperactivity Disorder.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children. Several hypotheses have been proposed to explain its etiology. Mitochondrial dysfunction (MD) is suggested to be one of the causes of Attention Deficit Hyperactivity Disorder. The objective of the study was to evaluate the relationship between MD and ADHD by investigating mitochondrial DNA (mtDNA) levels from peripheral blood leukocytes, one of the best biomarkers of mitochondrial dysfunction. SUBJECTS AND METHODS: This study included 56 children aged 6-16 years who were diagnosed with ADHD for the first time and 56 age- and sex-matched children without ADHD. Real-time PCR was performed to determine the relative mtDNA copy number in each study participant. RESULTS: The mean mtDNA copy number of the case group was 57.623±24.827 and that of the control group was 44.204±18.926 (p=0.002). The mtDNA copy number of the case group was higher than that of the control group. Results of ROC curve analysis provided a mtDNA cutoff value of 45. CONCLUSION: Significantly higher mtDNA copy number in ADHD group may suggest mitochondrial dysfunction in the etiopathogenesis of ADHD.

Nablus Mask-Like Facial Syndrome with Moderate Developmental Delay.

Nablus mask-like facial syndrome (NMLFS) is defined by distinctive craniofacial appearance including tight-appearing glistening facial skin, blepharophimosis, telecanthus, severe arched eyebrows, flat and broad nose, long philtrum, distinctive ears, unusual hair patterns, mild developmental delay and "happy" disposition. We aim to report a 7-year-old boy diagnosed with NMLFS and moderate developmental delay. Literature emphasis that Intellectual Disability is common in this syndrome though it has been diagnosed to only a few people worldwide.

Do we need to re-think on subthreshold childhood psychiatric cases? A follow-up study.

A remarkable number of children all over the world have psychiatric disorders, which cause severe impairments in functionality. In the development of future mental health planning, not only determining epidemiological data is sufficient, but also follow-up studies are needed. This study aimed to determine the course of subthreshold psychiatric disorders in three-year follow-up process, and whether there is a relationship between sociodemographic factors, parental attitudes and SDQ scores and the escalating escalation from SPD to psychopathology or the disappearance of SPD symptoms. This study included fifty-four children with age of 7-9 years. The Development and Well Being Assessment, structured diagnostic interview, was used to evaluate psychiatric disorders. Besides, parents were asked to fill out a socio-demographic form and the Parent Attitude Research Instrument. The mean age of children was 8.2 ± 0.8 years, and 59.3% of them were girls, and 40.7% of them were boys. At the beginning of the study, most common subthreshold psychiatric disorders were Specific Phobia with a prevalence of 3%, followed by Attention Deficit Hyperactivity Disorder 2.2%. After three-year of the follow-up period, 37% of subthreshold cases progress into psychiatric disorders. Living in a city centre in a slum and psychiatric disorder history of the family were independent risk factors for developing psychopathology. Living in a village was an effective protective factor in the disappearance of Subthreshold Psychiatric Disorder symptoms. In this study, besides the factors that may be effective in the development of psychiatric disorders, the factors that may be effective in the disappearance of Subthreshold Psychiatric Disorder symptoms were examined.

Is it possible to recognize children diagnosed with ADHD from their facial anthropometric measures? A case-control study.

The recent main focus of the researches on Attention-deficit Hyperactivity Disorder is on identifying behavioral phenotypes. For this purpose, neuroanatomical factors have recently become a focus. This study aimed to investigate whether the individuals diagnosed with Attention-deficit Hyperactivity Disorder differ from healthy individuals in terms of facial anthropometric measurements. Forty children, diagnosed with Attention-deficit Hyperactivity Disorder, were included in the study as the case group, and forty healthy children were included in the study as the control group. Two photographs were taken from the facial region, and anthropometric measurements were performed using the computer program "Image J" in the computer environment. It was found that a strong relationship between Attention-deficit Hyperactivity Disorder and nasal width, ear length and upper face debt length. The results obtained from the research support the knowledge that there is a close relationship between the forebrain development process and the facial development process during the embryonic development process.

Psychometric Properties of Turkish Version of the Strength and Difficulties Questionnaire for Age 2-4.

INTRODUCTION: Strengths and Difficulties Questionnaire for 2-4 year olds (SDQ 2-4) is one of the best of these scales developed to screen children in early childhood for psychosocial problems. The aim of this study is to investigate the psychometric properties of SDQ 2-4 in Turkish for the age group of 2-4 years. METHODS: The study was conducted with 159 participants. SDQ 2-4 Parent and BITSEA scales were applied to parents. Patients whose scores were detected to be at risk were referred to the hospital and a clinical interview was performed. RESULTS: Chronbach alpha value for total difficulties scale was 0.80. Total difficulties score of the SDQ was positively correlated with the BITSEA/P score, and negatively correlated with the BITSEA/C score. Prosocial Behaviors score of SDQ was positively correlated with BITSEA/C while it was negatively correlated with BITSEA/P. In all scales of SDQ that identified the problem, the scores of the participants with clinical diagnosis were significantly higher than the scores of the participants not diagnosed. The cut-off value for total difficulties scale was calculated as 10 with 80% sensitivity and 88% specificity. CONCLUSION: The SDQ 2-4 scale is valid and reliable in the Turkish language.

The prevalence of childhood mental disorders in different habitations: are we underestimating their prevalence in rural areas?

Background: Recently, the number of epidemiological studies of child psychiatry has increased, but most of these studies focus on children living in city centres. Unfortunately, one-third of the global population lives in rural areas, and various habitations exist in cities, including city centres and slums. Moreover, despite having a high risk for psychopathology development, individuals who have symptoms but fall outside the limits specified for diagnoses due to having fewer symptoms than those mentioned in diagnostic systems and individuals who do not fulfil the impairment criteria listed in diagnostic systems are not addressed in these studies.Aim: The purpose of this study was to understand the prevalence of DSM-IV childhood psychiatric disorders and subthreshold psychiatric problems from middle-class city centres, city centres in slums, towns and village areas of Turkey with a nationally representative sample using a state-of-the-art methodology.Methods: In total, 1080 children were randomly selected from second and third grades for the study's sample. A structured diagnostic interview was applied.Results: The overall prevalence of psychiatric disorders was 8.4% (n = 91); 7.2% (n = 78) of the children were subthreshold cases. The general prevalence of psychiatric disorders was higher among children living in villages with respect to all the other human settlement areas included in the study.Conclusions: Although global urbanisation foregrounds the mental health of children living in cities, children in rural areas may have a greater risk of developing a mental disorder. This study confirmed that an equal amount of children fell outside of the diagnosing limits.

Serum NGF levels may be associated with intrauterine antiepileptic exposure-related developmental problems.

OBJECTIVE: It has been shown that maternal epilepsy and antiepileptic drug use during pregnancy have adverse developmental outcomes in children. The aim of this study was to investigate the developmental outcomes of maternal epilepsy and prenatal antiepileptic exposure. We also looked for the associations between serum levels of glial cell-derived neurotrophic factor (GDNF) and nerve growth factor (NGF) and developmental outcomes. METHODS: This is a retrospective, nonrandomized, case-controlled study. Fifty-three children aged two to six years old with maternal epilepsy were included in the case group. Fifty-three age- and gender-matched children without maternal epilepsy were included in the control group. Developmental assessment was conducted using the Denver II Developmental Screening Test (DDST-II). Serum levels of NGF and GDNF were measured using an enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: Multiple regression analysis revealed that prenatal antiepileptic exposure was significantly associated with lower global developmental scores (B = -7.5, confidence interval (CI): -13.1; -1.9, p = 0.009) while periconceptional folate use was associated with a reduced risk for adverse developmental outcomes (B = 6.6, CI: 0.91; 12.3, p = 0.024). Children with prenatal antiepileptic exposure are at increased risk for global developmental delay (GDD) particularly for language domain (p = 0.018). We found a statistically significant positive correlation between NGF levels and global developmental scores (r = 0.302, p = 0.009). Serum levels of GDNF in children with maternal epilepsy were significantly lower than the children without maternal epilepsy (p = 0.025). CONCLUSIONS: Prenatal antiepileptic exposure was related with the increased risk of GDD while periconceptional folate use was related with lower risk. Clinicians should inform all women in reproductive age with epilepsy about the possible benefits and risks of antiepileptic drug use during a possible pregnancy. Periconceptional folate use has protective effect on child development, and all women on antiepileptic drugs should be encouraged for periconceptional folate use. Serum NGF levels may be a promising biomarker for monitoring global development delay in at-risk population.

The Role of Nerve Growth Factor (NGF) and Glial Cell Line-Derived Neurotrophic Factor (GDNF) in Tic Disorders.

OBJECTIVES: Tic disorders are associated with neurodevelopmental origin, changes in dopaminergic neurons, and the formation of immunoreactivity, it is thought that neurotrophic factors may be crucial in the emergence of tic disorders. In this study, we targeted to explore role of neurotrophic factors in tic disorders. The aim of this study was to investigate serum Glial Cell Line-Derived Neurotrophic Factor (GDNF) and Nerve Growth Factor (NGF) levels in patients with tic disorder and healthy controls. METHODS: Thirty-four children, constituted the case group, were diagnosed with tic disorder. The control group included 34 healthy children. Development and Well-Being Assessment (DAWBA) (structured interview) and Yale Global Tic Severity Rating Scale (YGTSRS) was applied to the patients. NGF and GDNF levels were measured with ELISA kit. RESULTS: In case group, serum NGF and GDNF levels were found to be significantly higher in females than males (p = 0.042, p = 0.031). It was determined that serum NGF and GDNF levels were correlated with each other (r = 0.803, p <0.001) and there were no correlations between other parameters. There was no significant difference in NGF and GDNF in patients with tic disorder, compared to healthy controls. CONCLUSIONS: The absence of this relationship does not exclude the hypothesis that neurotrophic factors may play a role in the etiopathogenesis of tic disorders.

Myasthenia Gravis Attack after Oral Risperidone Treatment: A Case Report.

Myasthenia gravis (MG) is an autoimmune disease, which can be triggered by anticholinergic agents. The 6-year-old female patient was admitted to the outpatient clinic. She was had been previously diagnosed with comorbid attention deficit hyperactivity disorder and conduct disorder and was receiving short-acting methylphenidate and risperidone, as recommended by a child psychiatrist. However, after using the drugs, she stated that she was overly tired during the day and that her eyelids drooped. Hence, the current treatment was stopped. She was hospitalized with a prediagnosis of ocular type MG and pyridostigmine (90 mg/day) treatment was started. The patient recovered and subsequently the treatment was stopped. Since psychiatric symptoms of the patient resurfaced, long-acting methylphenidate treatment was initiated. During this treatment, the symptoms of MG did not return. The Naranjo's scale of adverse drug reaction probability was completed. Consequently, there may be an association between risperidone and MG.