[Reliability and Validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T)]. / Okul Çagi Çocuklari için Duygulanim Bozukluklari ve Sizofreni Görüsme Çizelgesi–Simdi ve Yasam Boyu Sekli–DSM–5 Kasim 2016 –Türkçe Uyarlamasinin (ÇDSG–SY–DSM–5–T) Geçerlik ve Güvenirligi.

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the Schedule for Affective Disorders and Schizophrenia for School-Age ChildrenPresent and Lifetime Version, DSM-5 November 2016 -Turkish Adaptation (K-SADS-PL-DSM-5-T).  METHOD: A total of 150 children and adolescents between 6 and 17 years of age were assessed with K-SADS-PL-DSM-5-T. The degree of agreement between the DSM-5 criteria diagnoses and the K-SADS-PL-DSM-5-T diagnoses were considered as the measure of consensus validity. In addition, concurrent validity was examined by analyzing the correlation between the diagnoses on K-SADS-PL-DSM-5-T and relevant scales. Interrater reliabilities were assessed on randomly selected 20 participants. Likewise, randomly selected 20 other participants were interviewed with K-SADS-PL-DSM-5-T three weeks after the first interview to evaluate test-retest reliability.  RESULTS: The consistency of diagnoses was almost perfect for eating disorders, selective mutism and autism spectrum disorder (κ=0.92-1.0), substantial for elimination disorders, obsessive-compulsive disorder, oppositional defiant disorder, generalized anxiety disorder, social anxiety disorder, depressive disorders, disruptive mood dysregulation disorder and attention deficit hyperactivity disorder (κ=0.67-0.80). Interrater reliability was perfect for selective mutism (κ=1.0), substantial for oppositional defiant disorder, disruptive mood dysregulation disorder, attention deficit hyperactivity disorder, depressive disorders and social anxiety disorder (κ=0.63-0.73). Test-retest reliability was almost perfect for autism spectrum disorder (κ=0.82), substantial for attention deficit hyperactivity disorder, oppositional defiant disorder, disruptive mood dysregulation disorder, depressive disorders and generalized anxiety disorder (κ=0.62-0.78).  CONCLUSION: The results of this study show that the K-SADS-PL-DSM-5-T is an effective instrument for diagnosing major childhood psychiatric disorders including selective mutism, disruptive mood dysregulation disorder and autism spectrum disorder which have recently been added to the schedule.

Cognitive and behavioral impairment in mild hyperphenylalaninemia.

Evinç SG, Pektas E, Foto-Özdemir D, Yildiz Y, Karaboncuk Y, Bilginer-Gürbüz B, Dursun A, Tokatli A, Coskun T, Öktem F, Sivri HS. Cognitive and behavioral impairment in mild hyperphenylalaninemia. Turk J Pediatr 2018; 60: 617-624. As elevated phenylalanine (Phe) is detrimental to brain functions, determining a safe upper limit of blood Phe is important for initiation of treatment plans and setting Phe targets in hyperphenlalaninemic patients. It is accepted that Phe levels below 360 µmol/L does not impair brain function and hence does not require treatment. Therefore, we aimed to compare cognitive functions and attention-related problems among healthy children and untreated patients with hyperphenylalaninemia (HPA). This study included 41 hyperphenylalaninemic patients (`all HPA group`) aged 6-16 years with untreated blood Phe between 240 and 600 µmol/L and 29 healthy controls. `All HPA group` was further divided into 2 subgroups according to their lifetime median blood Phe levels as `Phe 360-600 µmol/L` and `Phe 240-360 µmol/L` groups. Wechsler Intelligence Scale for Children-IV (WISC-IV), Conners` Continuous Performance Test (CPT), Strength and Difficulties Questionnaire (SDQ) and Schedule for Affective Disorders and Schizophrenia for School-Age Children: Present and Lifetime Version (K-SADS-PL) were performed as a comprehensive neurocognitive, attention and behavioral assessment. The study illustrated that `all HPA` patients had significantly lower scores on all WISC-IV indexes compared to controls, except for Working Memory. Both `Phe 360-600 µmol/L` and `Phe 240-360 µmol/L` subgroups had lower Full Scale intelligence quotient (IQ) and Verbal Comprehension scores compared to controls. `All HPA` patients also had longer reaction times and more peer problems than controls, indicating attention deficits and behavioral problems. Since the results demonstrated that children with untreated Phe levels between 240-360 µmol/L are at higher risk for cognitive and attention-related problems, lowering the `safe` upper Phe level should be considered.

The Behavior Rating Inventory of Executive Function and Continuous Performance Test in Preschoolers with Attention Deficit Hyperactivity Disorder.

OBJECTIVE: The aim of this study is to examine performance-based measures and behavioral ratings of executive functions (EF) as a component of preschool attention deficit hyperactivity disorder (ADHD). METHODS: Twenty-one 4-to-6-year-old children with ADHD and 52 children with no psychopathology, matched on age, gender, socioeconomic status, and parental education, were enrolled. Parents were interviewed with the use of The Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version. The Conners' Kiddie Continuous Performance Test (K-CPT) was administered to the children, and the Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and the Conners' Parent Rating Scale-Revised/Short Form (CPRS-R/S) were filled out by the parents. RESULTS: All BRIEF-P and CPRS-R/S scores, the K-CPT measures of inattention and impulsivity were higher in the ADHD group. The CPRS-R/S ADHD index was strongly correlated with inhibition and related indexes in the BRIEF-P and was moderately correlated with inattention measures in the K-CPT. CONCLUSION: The current study is one of the few to investigate the features of preschool ADHD with the use of behavioral ratings of EF and a performance-based measure. Our results suggest that the BRIEF-P was able to identify behavioral difficulties in inhibition and working memory and that the K-CPT identified difficulties indicating inattention. The findings of this study support the use of a combination of methods for a complete evaluation of preschoolers with inattentive and hyperactive/impulsive behavior, the application of rating scales for screening ADHD symptoms, and the measurement of behavioral correlates of EF, along with performance-based measures.

The effects of conscious sedation with nitrous oxide/oxygen on cognitive functions.

BACKGROUND/AIM: The aim of this study was to investigate the effects of conscious sedation with 40% nitrous oxide/oxygen (N2O/O2) on cognitive functions. MATERIALS AND METHODS: Forty dental patients referred to the sedation unit at Gazi University Faculty of Dentistry Department of Oral and Maxillofacial Surgery received a combination of 40% N2O/O2 inhalation for conscious sedation. Psychometric tests were applied three times: before sedation, during sedation, and at the end of the recovery, for assessing cognitive functions. RESULTS: The results of this study showed that the 40% N2O/O2 combination impaired cognitive functions during the conscious sedation. Recovery of most of the cognitive functions occurred 15 min after sedation. However, in addition to the persistence of 'hypnotic effects' and 'sensations of isolation' during the recovery period, 'motor loss value' showed more cognitive impairment 15 min after sedation than before the sedation period, and, thus, the ability to execute fine motor skills was not totally recovered by then. CONCLUSION: The results of this study could be crucial for informing patients about avoiding attentive activities soon after conscious sedation via 40% N2O/O2.

Theory of Mind in Schizophrenia and Asperger's Syndrome: Relationship with Negative Symptoms.

OBJECTIVE: Although previous studies have shown that the theory of mind (ToM) ability is impaired in Asperger's Syndrome (AS) and in schizophrenia, few controlled studies compared the ToM performance between the two disorders. Besides, the relationship between the degree of ToM impairment and symptom dimensions is unclear, and presence of ToM impairment in remitted patients with schizophrenia is controversial. Here, we tested the hypothesis that schizophrenia patients with prominent negative symptoms were closer to AS patients and different than schizophrenia patients without prominent negative symptoms and healthy controls in terms of ToM functioning. METHOD: Fourteen patients with AS, 20 with schizophrenia and 20 healthy controls, matched by age, educational level and IQ scores were enrolled. AS was diagnosed according to the DSM-IV criteria and independently confirmed by two psychiatrists. Schizophrenia patients were diagnosed by the Turkish version of Structured Clinical Interview for DSM-IV Diagnosis (SCID-I) and symptom severity was evaluated with the Scale for the Assessment of Negative and Positive Symptoms. Schizophrenia group consisted of clinically stable patients. The ToM battery included stories to assess first and second order false belief tasks (ToM1 and ToM2). The full-scale IQ, Verbal Comprehension, Freedom from Distractibility and Perceptual Organization scores were assessed by Weschler Adult Intelligence Scale-Revised (WAIS-R). Non-parametric tests were used to compare the neuropsychological performances of the three groups. In order to investigate whether schizophrenia patients with prominent negative symptoms were similar to AS patients, schizophrenia patients were divided into high (Sch-HN) and low (Sch-LN) negative-symptom subgroups by median split. For these four groups (AS, Sch-HN, Sch-LN, and controls) between group comparisons were performed. Correlations between the clinical measures and ToM performance were assessed by Spearman correlation test. RESULTS: AS and schizophrenia patients performed significantly worse than controls in the ToM2 task, while the AS group had worse ToM1 performance than both schizophrenia patients and healthy controls. The Sch-HN subgroup had significantly lower ToM2 scores than the Sch-LN patients, and worse ToM1 functioning than the controls. CONCLUSIONS: These results suggest that clinically stable schizophrenia patients have ToM impairments. Sch-HN group performed comparably poorly as the AS group, while the Sch-LN group was relatively spared. The most profoundly impaired patients with schizophrenia in terms of ToM functioning were represented by those with high negative symptoms (Sch-HN). Similar to AS, as a neurodevelopmental impairment, these patients may not have developed ToM ability, or they may have lost their ToM capacity as a result of a neurodegenerative process during the illness. Supplementary studies using other methods (e.g., neuroimaging, neurophysiology) may highlight the brain regions that are affected differentially in AS and schizophrenia, the relationship of ToM impairments and negative symptoms, and the role of ToM impairments in the neurodevelopmental or neurodegenerative hypothesis of schizophrenia.

[Proton magnetic resonance spectroscopy in Asperger's syndrome: correlations with neuropsychological test scores]. / Asperger Sendromunda Proton Manyetik Rezonans Spektroskopi: Nöropsikolojik Testlerle Iliskisi.

OBJECTIVES: It has been shown that autistic spectrum patients have impaired theory of mind (ToM) performance; however, no study has investigated the relationship between ToM performance and brain neurochemistry in these patients. The present study aimed to investigate the correlations between dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) N-acetyl-aspartate (NAA)/choline (Cho), NAA/creatine (Cr), and Cho/Cr values based on 1H magnetic resonance spectroscopy and ToM tests. METHOD: The study sample included 13 adult, right-handed, Caucasian males with Asperger's syndrome (AS) (age range: 17-37 years) and 20 controls matched by age, gender, handedness, and Wechsler Adult Intelligence Scale, Revised (WAIS-R) full-scale IQ scores. RESULTS: AS cases had significantly lower ToM performance. DLPFC NAA/Cho levels were inversely correlated to ToM scores (r = -0.738, P = 0.004). On the other hand, ToM performance improved as DLPFC Cho/Cr increased (r = 0.656, P = 0.015). ACC MRS variables were not significantly correlated with ToM performance in the AS group. No significant correlation was observed between ACC or DLPFC MRS variables and ToM performance in the control group. DISCUSSION: Because NAA/Cho was inversely correlated with ToM performance and Cho/Cr was correlated with ToM performance, it can be suggested that the Cho level was related to better ToM test performance in the AS group. An increase in the Cho peak was associated with an increase in membrane breakdown or turnover. The Cho peak was also thought to reflect cellular density and astrocytosis. It is suggested that membrane turnover and astrocytosis might affect cognitive functioning.

Atopic features in early childhood autism.

BACKGROUND: Autism is a developmental disorder of unknown etiology. Sensitivity to dietary and environmental antigens has been considered in its pathogenesis. AIM: To examine immediate hypersensitivity in early childhood autism. METHODS: We investigated 30 autistic children (23 boys, seven girls 2-4 years old) for atopic history, serum IgG, IgA, IgM, IgE levels, and skin prick tests (SPT) with 12 common antigens. RESULTS: Nine/30 autistic children (30%) and 1/39 (2.5%) age-matched neurological controls from the same hospital had a family history suggestive of atopy (p<0.005). No patient in the autism and 28% in control group had symptoms of respiratory allergy (wheezing or asthma) (p<0.005), and 6/30 (20%) autistic vs. 7/39 (17%) control children had history suggesting other allergic disorders (p=ns). Eleven/23 (47.8%) autistic children had at least one positive skin test, similar to age-matched population controls. Serum IgG, IgA, and IgM levels were within age-appropriate limits. Serum IgE was elevated in four patients (13.3%). Specific IgE levels were negative in four cases with multiple SPT positivity. CONCLUSIONS: This study suggests allergic features based on history, skin tests, and serum IgE levels are not frequent in young autistic children despite family history. This discrepancy between predisposition and manifestation might imply immunological factors or environmental conditions.