Depression and post-traumatic stress disorder in child victims of sexual abuse: perceived social support as a protection factor.

Background Social support has been shown to play a protective role against the development of post-traumatic stress disorder (PTSD) and depression in individuals exposed to trauma. Aims The purpose of this study was to investigate the effect of perceived social support on depression and PTSD in child victims of sexual abuse and to determine the relationship between them. Method In total 182 victims of sexual abuse aged 6-18 at time of interview were assessed. Clinical interviews, the Children's Depression Inventory (CDI) and the Child Posttraumatic Stress Reaction Index (CPTS-RI) were used to assess children's psychological status, while the Perceived Social Support Scale-Revised (PSSS-R) was used to measure social support. Results Girls had significantly higher median CDI and CPTS-RI scores than boys, while no significant difference was determined between boys and girls in terms of PSSS-R scores. A statistically significant negative correlation was determined between CDI and PSSS-R scores, CPTS-RI scores and PSSS-R scores in girls, while no significant correlation was identified in male victims. Conclusions In conclusion, we think that social support networks for victims of sexual abuse need to be broadened and increased, and that importance should be attached to protective approaches in that context.

Decreased dehydroepiandrosterone sulphate levels in adolescents with post-traumatic stress disorder after single sexual trauma.

BACKGROUND: Recent evidence shows that the hypothalamic-pituitary-adrenal (HPA) axis can be dysregulated in chronic sexual abuse victims with post-traumatic stress disorder (PTSD). We hypothesized that PTSD in adolescents exposed to a single sexual trauma may function as a chronic stressor leading to HPA-axis dysregulation. AIMS: The objective of this study was to assess dehydroepiandrosterone sulphate (DHEA-S) and cortisol levels in female adolescents |with single sexual trauma-related PTSD compared to healthy controls. METHOD: We assessed 20 female adolescent (age 12-18) single sexual trauma victims with PTSD from the Ondokuz Mayis University Department of Child and Adolescent Psychiatry between December 2013 and December 2014. PTSD symptoms were assessed using the Child Depression Inventory (CDI) and Child Posttraumatic Stress Reaction Index (CPSRI). Blood cortisol and DHEA-S were measured in 20 female adolescent sexual abuse victims with PTSD and 20 healthy adolescents after 12-h fasting using the chemiluminescence method. RESULTS: Compared to age-matched controls, female adolescent sexual abuse victims with PTSD had significantly lower DHEA-S levels (U = 70.00, Z = - 3.517, p = 0.01, r = 0.55). There was also a significant negative correlation between DHEA-S and CDI scores (Spearman r = - 0.522, p < 0.01). CONCLUSIONS: Decreased DHEA-S levels and correlation with depressive symptoms are evidence for a dysregulated HPA-axis in female adolescent single sexual trauma victims with PTSD. Further research is now recommended with large patient groups in order to maximize generalizations.

Neuropsychological weaknesses in adult ADHD; cognitive functions as core deficit and roles of them in persistence to adulthood.

Prior investigations have shown that individuals with attention deficit hyperactivity disorder (ADHD) have impaired neuropsychological functions. This study had two aims, first to investigate weakened cognitive functions in adult ADHD (aADHD), and second, to investigate difference between persisters (those having persistently ongoing ADHD diagnosis in adulthood), and remitters (those having ADHD diagnosis only in childhood and not in adulthood), in terms of cognitive deficits. We evaluated performance on a comprehensive neuropsychological battery in three groups including 34 persisters, 35 remitters, and 35 healthy control group (absence of childhood and adulthood ADHD diagnosis). Our findings showed that adults with ADHD have inefficient attention, interference control and set-shifting functions, which may be revealed on neuropsychological tests that require greater cognitive demand. Given the finding that interference control deficit exists across the lifespan in people with ADHD, we suggest that interference control-associated functional weakness may be a core deficit for ADHD. (JINS, 2012, 18, 1-8).

Traumatic dental injuries in children with attention deficit/hyperactivity disorder.

The aim of this study was to assess the frequency and distribution of traumatic injuries in 247 children with attention deficit/hyperactivity disorder (ADHD) who were 7-16 years old and attended the Ondokuz Mayis University Medical Faculty (Department of Child Psychiatry, Samsun, Turkey). Each psychiatric diagnosis was based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th edn, Washington, DC: American Psychiatric Association, 1994). Traumatic dental injuries were recorded using the classification of the World Health Organization, which was slightly modified by Andreasen and Andreasen (Textbook and color atlas of traumatic injuries, 3rd edn. Copenhagen, Denmark: Munksgaard; 1994. p. 151). Thirty-two percent (78/247) of the ADHD children presented 103 traumatized teeth. The frequency of dental injuries peaked in children who were 10-12 years of age, and showed no significant difference between subtypes of ADHD or gender. The maxillary central incisors were the most vulnerable to injury, and there were no differences between the right and the left sides in terms of susceptibility. Uncomplicated crown fracture (52.4%) and complicated crown fracture (16.6%) were the most commonly encountered types of injury. The main causes of dental injury were falls, collisions with objects, violence, and traffic accidents, and there was no difference in the frequencies of these causes between subtypes of ADHD, age, or gender. Only 5.1% (4/78) of the ADHD children sought treatment within the first 24 h of the injury. In conclusion, children with ADHD experience dental injuries more frequently than was previously described.

The Clinical Features of Comorbid Pediatric Bipolar Disorder in Children with Autism Spectrum Disorder.

The aim of this study was to describe clinical features of PBD comorbidity in children with ASD. Forty children with ASD and PBD aged 6-18 years, and 40 age- and sex-matched ASD subjects with no affective episodes were included in the study. Autism Behavior CheckList, Abberant Behavior CheckList, and Young Mania Rating Scale-Parent Version were completed. This study shows that PBD comorbidity in children with ASD involves a highly episodic course, with manic episodes, subsyndromal symptoms and interepisodic periods commonly being described in the manic symptom profile of these children. These findings need to be repeated with large samples, together with controlled studies concerning therapeutic interventions directed toward PBD comorbidity in children with ASD.

Quantitative analysis of the amygdala, thalamus and hippocampus on magnetic resonance images in paediatric bipolar disorders and compared with the children of bipolar parents and healthy control.

MR imaging studies in paediatric bipolar disorder have particularly focused on the amygdala and hippocampus, subcortical structures, and to a lesser extent on the thalamus. The purpose of this study was to perform structural analysis of the regions of interest (ROI) associated with mood regulation. In this study 18 children (between the ages of 12-18) were matched according to their age and sex and were divided into three groups. These were: a paediatric bipolar disorder group, risk group and a healthy control group. The structured diagnostic interviews were performed with children and their parents. T1 weighted MR images in the sagittal plane with a thickness of 1mm were taken from the subjects. Automatic structural brain analysis was performed, and the volume and volume fraction (VF) of the ROIs were obtained. Brain size in the patients with paediatric bipolar disorder (742.4 ± 110.1cm3) was significantly smaller than the healthy control group (880.7 ± 73.8cm3) (p≤0.05). MRI analysis between the paediatric bipolar disorder, risk group and healthy control group revealed no difference between them in terms of amygdala, thalamus or hippocampal volumes. In this study, there was no difference between the volumes of amygdala, thalamus or hippocampus.

Increased Ghrelin Levels and Unchanged Adipocytokine Levels in Major Depressive Disorder.

OBJECTIVE: One of the hypotheses of the pathophysiology of major depressive disorder (MDD) proposes that there is a relationship between adipocytokine and ghrelin levels and depression. METHODS: Patients with major depression with a BMI ≤25 kg/m2 between the ages of 11 and 18 years (n = 30) were compared with a healthy control group (n = 30). Both groups were evaluated across a pretreatment period (MD-PT) and an improved period (MD-I). We measured serum leptin, adiponectin, resistin, and ghrelin levels and other parameters related to metabolic syndrome, such as glucose, insulin, insulin resistance (homeostasis model assessment [HOMA]), triglycerides (TG), and total cholesterol (TCHOL). RESULTS: Leptin, adiponectin, and resistin levels did not differ across groups; however, ghrelin levels were increased in the MD-I group compared with the control and MD-PT groups (p < 0.05). HOMA levels were also higher in the MD-PT group than in the control group (p < 0.05). After treatment, there was no difference in this measurement. CONCLUSIONS: The relationship between adipocytokines and major depression may be dependent on ghrelin levels as a result of antidepressant treatment and subsequent obesity.

Abuse Characteristics and Psychiatric Consequences Associated with Online Sexual Abuse.

The current study examined the rate and psychiatric correlates of sexual abuse involving the use of digital technologies by the offender in a wide sample of juvenile victims. Sociodemographic, abuse, and psychiatric characteristics of 662 sexually abused children and adolescents were evaluated. Of these, 93 reported that digital devices were used by the offender in several ways to facilitate the sexual abuse. The offender-victim relationship was initiated through the Internet in 39 victims. Involvement of digital technologies in sexual abuse was significantly associated with penetrative and recurrent form of sexual abuse commited by multiple offenders with coexisting violence. Additionally, victims of sexual abuse with a digital component were 4.21 times more likely to develop any psychopathology, 3.77 times more likely to have depression, and 2.14 times more likely to have post-traumatic stress disorder as a result of sexual abuse. These results indicated that the offender's use of digital technology may aid the initiation and facilitation of the sexual abuse of youths and may relate to more severe outcomes. This study revealed the importance of raising the awareness of professionals and the community about the potential risks associated with digital technologies and sexual abuse. Mental health professionals should consider this additional form of victimization, especially when dealing with sexual abuse victims.

Child sexual abuse in Turkey: an analysis of 1002 cases.

This study investigated the characteristics of abuse suffered by children, the dimensions of the psychiatric effects associated with abuse, and the factors affecting these. One thousand two cases aged under 18, exposed to sexual abuse, and referred over a 7-year period were assessed. Girls represented 80.8% of cases, and the numbers rose with age. The aggressors were all male, and 88.2% were known to their victim. Approximately half the children were exposed to sexual abuse involving penetration. Psychological pathology was identified in 62.1%. Female gender, the presence of penetration, physical violence, and incest significantly increased the development of psychological pathology. Levels of awareness in people close to and trusted by the child must be raised to minimize the adverse effects of trauma in the long term, preventive measures must be taken, and medical and social support units from which victims can receive assistance need to be established.

Self-esteem and psychiatric features of Turkish adolescents with psychogenic non-epileptic seizures: a comparative study with epilepsy and healthy control groups.

OBJECTIVE: Children and adolescents with psychogenic non-epileptic seizures (PNES) and epilepsy are known to have psychosocial problems. The aim of the present study was to compare the psychosocial difficulties, history of stressful life events/abuse, psychiatric diagnosis, and self-esteem of adolescents with PNES to the ones with epilepsy and healthy controls at a tertiary care center in Turkey. METHOD: Thirty-four adolescents with PNES diagnosed by video-EEG were compared with 23 adolescents that have epilepsy and 35 healthy volunteers. Comorbid psychiatric diagnoses of participants were examined by semi-structured interviews using Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (KSADS-PL). Self-esteem of adolescents was evaluated by Rosenberg Self Esteem Scale (RSES). RESULTS: No differences in sociodemographic features were observed between the groups. The PNES group showed significantly higher rates of parental conflicts, difficulties in relationship with siblings/peers, school under-achievement, and history of stressful events/abuse. The rates of comorbid psychiatric disorders were 64.7% in PNES and 47.8% in epilepsy group. The most common disorders in both groups were attention deficit hyperactivity disorder (ADHD) and depressive disorder. The rate of posttraumatic stress disorder (PTSD) was significantly increased in the PNES group. Additionally, adolescents with PNES displayed significantly lower levels of self-esteem than the other groups. CONCLUSION: It could be concluded that both disorders involved a high risk for developing psychiatric disorders; additionally, adolescents with PNES have higher rates of stressors and lower levels of self-esteem. Findings from this investigation point to the importance of psychiatric interventions in pediatric PNES and also epilepsy.

Increased Laterality of the Thalamus in Children and Adolescents with Asperger's Disorder: An MRI and Proton Spectroscopy Study.

OBJECTIVE: Thalamic abnormalities have been reported in people with pervasive developmental disorders (PDD) including Asperger's Disorder (ASP). The aim of the present study was to compare the volume and volume fraction of the thalamus and the metabolite concentrations in children and adolescents with ASP using the magnetic resonance imaging and proton magnetic resonance spectroscopy. Additionally, the relationships between thalamic abnormalities and clinical features were examined. METHODS: Volume and volume fractional and metabolic measurements of bilateral thalamus were collected from 15 boys with ASP with a total IQ over 70 (age range 7-18 years, mean age 11.6±3.79 years), and 15 healthy controls matching age, sex and IQ. The thalamic volumes, hemisphere volumes and total brain volumes (TBV) were estimated using the stereological methods on magnetic resonance images. Chemical metabolites of thalamus were evaluated by (1)H spectroscopy. RESULTS: No differences in thalamic volumes, volume fractions and metabolites were observed between the groups. There were significant correlation between thalamic volume and total brain volume in both groups. The ASP group showed a significant left-minus-right thalamus difference as well as a significantly greater laterality index. In addition, a significant correlation between the laterality index and Autism Behavior Checklist language scores was observed. CONCLUSION: Findings from this investigation point to a significant increase in laterality of the thalamus and a relationship with language problems in individuals with ASP. Our findings suggest that thalamic abnormalities may be related to mild language problems observed in ASP.

The relationship between the presence of ADHD and certain candidate gene polymorphisms in a Turkish sample.

Due to the high heritability of attention-deficit hyperactivity disorder (ADHD), parents of children with ADHD appear to represent a good sample group for investigating the genetics of the disorder. The aim of this study was to investigate the association between ADHD and six polymorphisms in five candidate genes [5-HT2A (rs6311), NET1 (rs2242447), COMT (rs4818), NTF3 (rs6332), SNAP-25 (rs3746544) and (rs1051312)]. We included 228 parents of children diagnosed with ADHD and 109 healthy parents as the control group. The polymorphisms were genotyped using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) assays and analyzed using the chi-square test and the multinomial logit model. SNAP-25 (rs3746544) polymorphism was associated with loading for ADHD, while 5-HT2A (rs6311) and NET1 (rs2242447) polymorphisms were associated with ADHD. On the other hand, there was no significant association between the SNAP-25 (rs1051312), NTF3 (rs6332), or COMT (rs4818) gene polymorphisms and ADHD. In addition, we found that even if variation in the SNAP-25 gene alone does not affect the phenotype, it may nevertheless lead to the emergence of a clinical ADHD picture in the presence of other genetic factors. Our findings suggest that a combination of NET1 (rs2242447) and SNAP-25 (rs3746544) is a risk factor for ADHD. Problems associated with the noradrenergic and serotonergic systems and SNAP-25 may play a role, both alone and in interaction with one another, in the pathophysiological mechanisms of ADHD.

Functional disability of children with spina bifida: its impact on parents' psychological status and family functioning.

OBJECTIVE: To evaluate the impact of functional disability of Turkish children with spina bifida (SB) on parents' psychological status and family functioning. METHODS: Fifty-four children with SB and parents were included. The Functional Measure for Children (WeeFIM), Beck Depression Inventory (BDI), and Family Assessment Device (FAD) were used. RESULTS: Mothers' BDI scores were significantly higher than fathers' (p < 0.001). No significant effects of the knowledge of having children with SB before birth and the number of children in families on BDI scores and FAD sub-scores were found (p > 0.05). According to multiple regression analysis; significant correlations with fathers' BDI were problem-solving (p = 0.012) and general functioning (p = 0.037) and with mothers' BDI was roles (p = 0.018). Only childrens age was found to be an influential variable on WeeFIM scores (p < 0.001). CONCLUSION: Spina bifida healthcare should include psychological support to parents of these children and this support should be independent from disability level of children.

The clinical validity and reliability of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

This study investigates the construct validity and reliability of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in a psychiatric clinical sample of toddlers. The sample consisted of a psychiatric clinical sample (N=112) (male, n=79; female, n=33) of toddlers (12- to 42-months old). Both mothers and fathers completed the BITSEA and mothers completed the Child Behavior Checklist 2/3 (CBCL). Children and their parents were administered a comprehensive psychiatric evaluation. Parents were also given the Autistic Behavior Checklist (AuBC) and the Aberrant Behavior Checklist-Community (ABC). The internal consistency of BITSEA scores was good to excellent for both parents. The BITSEA/Problem (P) scores were significantly correlated with Internalizing, Externalizing and Total Problem scores of the CBCL, all subscores of ABC and total score of AuBC. The BITSEA/Competence (C) scores were significantly inversely correlated with ABC total and AuBC lethargy scores. With respect to a community sample, BITSEA/P scores were significantly higher in the disruptive behavior disorder (DBD) and anxiety/depression (Anx/Dep) groups and BITSEA/C scores were significantly lower in the autism group. These results support the reliability and validity of the BITSEA as a screening tool that may be employed in primary health care services and in psychiatric clinical settings for assessing social-emotional/behavioral problems and delays in competence in infants and toddlers.

The reliability and validity of the Turkish version of the brief infant-toddler social emotional assessment (BITSEA).

In this study the reliability and validity of the Turkish version of the brief infant-toddler social emotional assessment (BITSEA) were investigated in a community sample. The sample consisted of 462 children (mean age: 24.60+/-7.93 [12-42] months) who had applied to Turkish health centers for immunization. Both parents completed the BITSEA; mothers completed the child behavior checklist 2/3 (CBCL). Internal consistencies of the BITSEA-problem (P) and competence (C) scales were good to excellent (Cronbach's alpha=0.82 and 0.72, respectively). Interrater reliability between parents and test-retest reliability were good. BITSEA/P scores were significantly correlated with CBCL internalizing, externalizing and total problem scores (p<0.001). Maternal BITSEA/P cutpoint scores revealed that 30.6% of male toddlers and 28.6% of females were in the subclinical range and 13.1% of males and 17.6% of females were in clinical range. Results reveal that the Turkish version of BITSEA is a reliable, valid and simply applicable instrument for screening social, emotional and behavioral problems among toddlers. Clinical validation of the BITSEA/C and BITSEA/P is warranted.

Establishment of interdisciplinary child protection teams in Turkey 2002-2006: identifying the strongest link can make a difference!

OBJECTIVES: The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS: A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS: Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS: A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS: Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Post-traumatic stress symptoms in adolescents after two murders in a school: a controlled follow-up study.

OBJECTIVES: Two students were murdered by gunshot by another student. Among the classmates and the students in another school, we aimed to investigate the factors on the fifth day of trauma to be predictive of higher post-traumatic stress symptoms (PTSS) scores five months later. METHODS: The adolescents attending the school (School A: acute phase n:41; second phase n:57; follow-up group n:35) where the event had occurred, and the adolescents attending a school (School B: acute phase n:98; second phase n:57) of similar statue were included. They had completed "Trauma Questionnaire" (TQ), "Childhood Post Traumatic Stress Disorder-Reaction Index" (CPTSD-RI), "Beck Depression Inventory" (BDI), and "State-Trait Anxiety Inventory" (STAI) both 5 days and 5 months after the event. RESULTS: Both 5 days and 5 months after the trauma, students in school A, and the girls in both schools had significantly higher CPTSD-RI scores. Nine students (25.7%) in the follow-up group were found to have CPTSD-RI scores higher than 39, indicating severe PTSD symptoms. The CPTSD-RI scores of this group 5 months after the trauma were significantly correlated with the several scores of the acute term (CPTSD-RI [r: .76,p < .001]; BDI [r: .56, p: .001]; STAI-state [r:. 49, p: .004]). CONCLUSION: Results reveal that a murder of a peer triggers post-traumatic stress symptoms in a vast majority of the 16-year-old adolescents even without directly witnessing the event. The severity of PTSS significantly increases as the adolescent is in closer relationship with the victim. The concomitant depression and/or anxiety with acute stress symptoms 5 days after the trauma, female gender, and worse school performance were found to be significantly related to the development of more severe PTSS 5 months later.