The course of sleep habits in newly diagnosed epilepsy in children: A prospective study.

BACKGROUND: Epilepsy and sleep have a close, complex, and reciprocal relationship. Sleep may also be adversely affected by epilepsy and anti-seizure medication (ASM). This study sought to determine sleep-related problems before and after six months of treatment with ASMs follow-up in children with epilepsy, to reveal changes in sleep habits, and to determine the effect of ASMs on sleep in different types of epilepsy. METHODS: This is a prospective study that included 61 children, aged 4-18 years with newly diagnosed epilepsy, who regularly had follow-up checks and used ASM for six months, and completed the Children's Sleep Habits Questionnaire (CSHQ). Children's Sleep Habits Questionnaire was completed before and after six months of ASM, allowing for assessments based on treatment group and type of epilepsy. RESULTS: The mean ages of 61 children were 10.6 ± 3.9 years. The participants' post-treatment total scores on the CSHQ decreased by 2.9 ± 7.8 units on average compared to their pretreatment scores (p = 0.008; p < 0.01). In the levetiracetam group, post-treatment CSHQ subscale scores showed a mean decrease for bedtime resistance (p = 0.001), sleep duration (p = 0.005), sleep anxiety (p = 0.030), and total scores (p = 0.012) (p < 0.05). In the valproic acid group, post-treatment CSHQ subscale scores showed a mean decrease in sleep duration (p = 0.007) and a mean increase in daytime sleepiness (p = 0.03) (p < 0.05). CONCLUSION: Our study found that children diagnosed with epilepsy had significantly higher rates of pretreatment sleep problems, which significantly decreased in patients who regularly attended follow-up examinations and received treatment. Except for the daytime sleepiness factor, our study found that sleep-related problems improved with treatment. It was observed that the initiation of epilepsy treatment had a positive effect on the patient's sleep, regardless of the type of treatment or epilepsy.

Assessment of Plasma-Endogenous Opioid Neuropeptide Levels and Psychometric Properties of Non-Suicidal Self-Injury in Adolescents.

OBJECTIVE: Non-suicidal self-injury (NSSI) is one of the most common mental health problems and growing public-health issues, coupled with a significant population-level burden among adolescents in both developed and developing countries. We aimed to assess the role of endogenous opioid system-emotion regulation circuitry in NSSI through measurement of plasma beta-endorphin (ß-EP), met-enkephalin (MENK) levels, and determination of psychometric features of Turkish adolescent subjects. METHOD: In this research, we measured plasma ß-EP and MENK levels of 49 adolescents with NSSI and 39 control subjects without NSSI between the ages of 12-18 years. All adolescent subjects were observed in the outpatient clinic, and their clinical and sociodemographic characteristics were examined. All subjects were assessed using the Brief Symptom Inventory (BSI) and Inventory of Statements About Self Injury (ISAS). RESULTS: Plasma ß-EP levels were statistically lower in adolescents with NSSI than control group, whereas there was no statistically significant difference in MENK levels. ß-EP levels showed a negative correlation with depression severity. The data obtained from BSI and ISAS were not found to be associated with both ß-EP and MENK levels, while subscale scores exhibited versatile correlations. CONCLUSION: Our findings supported the salient role of ß-EP in NSSI behavior. Also, decreased plasma ß-EP could be assessed as a reliable indicator for NSSI. However, it is possible that measurement of basal plasma levels of neuropeptides might also bring many confounders and could cause bias. Therefore, repeated measurements of plasma-endogenous opioid neuropeptides in a time-dependent manner-concomitant to engage of NSSI behavior-might give more reliable results.

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.

Is it possible to determine the level of functional impairment that distinguishes the patients with ADHD from those without ADHD?

INTRODUCTION: Functional impairment in attention deficit hyperactivity disorder (ADHD) can occur in many areas such as in family, social activities, and problems related to school and may also persist during adulthood. The Weiss Functional Impairment Rating Scale-Parent Form (WFIRS-P) is designed to measure the functional impairment related to ADHD symptoms. The aim of this study was to determine the level of functional impairment that distinguishes the patients with ADHD who were diagnosed through semi-structured interviews from those without ADHD. METHOD: This study consists of ADHD patients who were diagnosed through semi-structured interview aged 5-18 years (n = 250) and same age gender-matched healthy controls (n = 250). A receiver operating characteristic (ROC) curve was constructed by calculating the sensitivity and specificity of the scale cut-off values. RESULTS: An area under the curve (AUC) of 0.974 (95% CI 0.956-0.986) was found in this study. For WFIRS-P subdomains, AUC curves, which range from 0.76 to 0.95, were also having strong power for differentiation between groups. The optimal cut-off value for WFIRS-P using Youden's J Index is 0.32. There is no significant gender and age group differences in AUC for either the total or subdomain scores. CONCLUSION: Our findings provide that Turkish version of WFIRS-P could be a reliable way of distinguishing the level of functional impairment in ADHD from controls.

[Relationship between the Psychiatric Symptoms in Expecting Parents and Postpartum Depression and Infantile Colic: A Multicenter Follow up Study]. / Anne ve Baba Adaylarinda Psikiyatrik Belirtiler ile Dogum Sonrasi Depresyon ve Infantil Kolik Arasi Iliski: Çok Merkezli Bir Takip Çalismasi.

OBJECTIVE: The aim of this study is to evaluate the relationship between postpartum depression (PPD), infantile colic (IC) and different psychosocial variables, psychiatric symptoms, attachment style and perceived social support in expecting parents. METHOD: Two hundred forty five expecting mothers and 150 expecting fathers were first interviewed between the 22-34 weeks of pregnancy. Sociodemografic data form, Adult Attachment Style Scale (AASS), State Anxiety Inventory (SAI), Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS) and Brief Symptom Inventory (BSI) were filled out by each expecting parent. Second interview was conducted between the postpartum 4-24 weeks. Data form consisting health, nutrition, sleep and crying problems of the infant and EPDS and SAI were filled out by mothers and SAI by fathers. RESULTS: One in every four mothers had PPD symptoms above the threshold on EPDS. Maternal and paternal insecure attachment style, maternal psychiatric symptoms and postpartum anxiety level were found to be the predictors of PPD. One in every five infants had IC and maternal education level, hostility score and PPD symptoms along with paternal insecure attachment style and psychiatric symptoms were the main predictors of IC. CONCLUSION: Results about PPD and IC regarding maternal variables are consistent with the literature. In addition, paternal insecure attachment style is found to be an important risk factor for both PPD and IC. Fathers should also be included in further studies exploring PPD or IC.

Anxiety Disorders Comorbidity in Children and Adolescents with Attention Deficit Hyperactivity Disorder.

INTRODUCTION: Our aim is to investigate the prevalence of comorbidity of anxiety disorders (AD) among patients newly diagnosed with attention deficit hyperactivity disorder (ADHD) and to compare symptom severity of ADHD and sociodemographic parameters between patients with and without AD. METHODS: Among 1683 children and adolescents admitted to Kocaeli University Medical Faculty, Child and Adolescent Mental Health Outpatient Clinic, 447 children and adolescents, who were preliminarily diagnosed as ADHD by clinical interview based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), were invited to participate in the second phase of the study. Kiddie Schedule for Affective Disorder and Schizophrenia, Present and Lifetime-Turkish Version were applied to children and adolescents with ADHD and one of their parents to support the diagnoses of both ADHD and AD. Mothers, fathers, and teachers of the children were asked to complete DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale. RESULTS: Our study group comprised 170 children and adolescents diagnosed with ADHD of whom 19.4% were girls and 80.6% were boys; 27.6% of patients diagnosed with ADHD showed AD comorbidity. Age of the parents at birth of the patients with AD was significantly lower than that of patients without AD. CONCLUSION: In line with the previous studies, the comorbidity rate of AD was found to be higher among patients with ADHD than general population and clinical sample without ADHD. The possibility of comorbidity of AD in patients with ADHD should be considered because higher rates of AD are observed in ADHD and comorbidities of AD.

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.

Frequency and correlates of psychiatric disorders in early childhood: a study of population and clinical samples in Turkey.

Behavioral and emotional problems experienced in early childhood may have a major impact on the development and functioning of a child, leading to a number of psychiatric problems at a later age. The purpose of this study was to determine the incidence of psychiatric disorders in 3-5-year-old children presenting to the Outpatients Department and in the general population, and the relationship between psychiatric disorders and the sociodemographic characteristics of the children. This was a cross-sectional study carried out in Kocaeli, Turkey. Data were collected from two different groups, one representing the general population and the other based on children presenting to the Pediatric Psychiatry Outpatients Department at Kocaeli University Faculty of Medicine. Of the 309 children in the study, 187 (60.5%) were boys and 122 (39.5%) were girls. Children aged 3-5 years (n = 81) were assessed by clinical examination. The mean age of the children was 3.94 +/- 0.81 years. No significant difference was observed between the groups in terms of parents' age groups, presence of consanguineous marriage, family structure, and siblings. The mothers were assessed in terms of regular visits to their physicians, major medical conditions, medication use, alcohol or tobacco consumption, and stress factors during their pregnancies. No significant difference was found between the study samples. The presence of a medical problem after birth was significantly more common in the clinical sample. Of the children in the clinical sample, 79% had at least one psychiatric problem, while the ratio for the general population sample was 41.7%.

Parents' perception of the quality of life of children with intellectual disabilities.

There has been limited research conducted on the quality of life (QoL) of children with intellectual disabilities (IDs). We investigated the QoL in children aged 5-18 years with ID and compared the results with healthy children of the same age in this study. The results indicated that the scores of students with ID were lower on all scales and also that children with ID should be supported in all QoL dimensions (physical, social, emotional, and school functioning). Associations between QoL and factors such as the educational level of the mothers, income level of the family, age at diagnosis, age group, and level of ID were examined in the ID group. A diagnosis of ID before the age of 2 was found to have a statistically significant positive effect on QoL scores. Our findings highlight that early diagnosis is the most important measure to improve the QoL of people with ID.

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 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.

[Smoking and schizophrenia: where is the biological connection?]. / Sizofreni ve Sigara Içimi: Biyolojik Baglanti Nerede?

OBJECTIVE: Patients with psychiatric disorders have a higher incidence of smoking than the general population. In particular, the rate of smoking among patients with schizophrenia has been found to be between two and three times in the general population in western countries. This paper reviews the biological factors that might be contributing to the high rate of smoking among patients with schizophrenia and examines the interaction between nicotine and neurobiological disturbances observed in schizophrenia. METHOD: Papers assessing the possible biological causes of smoking in patients with schizophrenia and the physiological effects of nicotine were reviewed by using the key words "nicotine, schizophrenia, smoking and cigarette" in Pubmed, Turk Medline, and the Turkish Psychiatric Index. RESULTS: Studies conducted in humans and animals show that nicotine can directly increase dopaminergic transmission in the central nervous system, enhance cognitive performance and improve sensory gating deficits observed in patients with schizophrenia. Moreover, smoking diminishes the efficacy of most antipsychotic drugs via an increased hepatic metabolism. CONCLUSION: Studies suggest a link between the physiological effects of nicotine and the neurobiological disturbances in schizophrenia. Disturbances in the cholinergic transmission may be responsible for some symptoms of schizophrenia. The harmful effects of smoking vastly outweigh any possible benefits, but, nevertheless, further investigation may lead to important insights regarding the etiology of schizophrenia at a molecular level.