Assessing the validity and reliability and establishing norm values for a selective attention test in a Turkish sample of 6-14-year-old participants.

Selective attention is a cognitive skill that allows an individual to focus on a particular input for further processing while simultaneously suppressing irrelevant or distracting information. In this study, we have developed a new test to assess selective attention-the Cognitive Skills Assessment of Minerva (CSM) Selective Attention Test-and have established selective attention norm values for Turkish individuals aged 6-14 years. This new online selective attention assessment test includes the flanker task. We employed split-half reliability to prove the reliability of the test. Based on the analysis, there was no significant difference between the groups, indicating that the test is reliable. We used criterion-related validity (congruent validity) analysis to evaluate the CSM Selective Attention Test. The correlation between the results of the new test and the Eriksen Flanker Test showed that the new test is valid. Finally, we conducted a comprehensive norm study with 2,297 participants aged 6-14 years from 12 different regions and schools in Turkey. According to the analysis of variance, age but not gender is a distinguishing factor for selective attention. We subsequently established norm values for each age group. The findings also show that the CSM Selective Attention Test provides reliable results across all samples and populations aged 6-14.

Adolescents' somatic complaints in eight countries: what influence do parental rearing styles have?

Medically unexplained physical symptoms are frequently named by adolescents in both clinical and normative samples. This study analyzed the associations between parental rearing styles and adolescents' body complaints in diverse cultural contexts. In a cross-cultural study of 2415 adolescents from eight countries (Argentina, France, Germany, Greece, Pakistan, Peru, Poland, and Turkey), the associations of maternal and paternal support, psychological control, and an anxious parental monitoring style with youth body complaints were tested. Girls reported more somatic complaints than boys, the level of complaints differed between countries, and gender differences varied significantly between countries. Hierarchic multilevel models revealed that the expression of distress via body complaints, after controlling for country, gender, and sociodemographic status, was significantly associated with parental rearing styles. The negative impact of mothers' psychological control on body complaints generalize across countries. In addition, mothers' anxious monitoring had a negative impact on the offspring's health, whereas higher levels of paternal support and lower levels of paternal psychological control contributed to lower levels of somatic complaints. Sociodemographic variables such as family structure, standard of living, and employment status of the parents, did not turn out as significant in the final model. The findings point to the different roles of fathers and mothers play in adolescents' health and their complex interplay.

Voices of adolescent incest victims: A qualitative study on feelings about trauma and expectations of recovery.

BACKGROUND: Incest, is a serious social problem facing society and children/adolescents themselves. The purpose of this study is to explore the ways adolescents talk about and give meaning to their experiences of incest concerning cultural, ethnic factors relevant to southeastern of Turkey. METHOD: We focused on in-depth interviews of five incest victims (14-16 years girls, from low socioeconomic status in southeastern of Turkey). RESULTS: Four key themes were constructed from the qualitative analysis: 1. Unable to understand/Delayed meaning-making: Adolescents provided definitive information about the first abuse memory but they were also unable to understand what they had experienced so they delayed meaning making. 2. Dysfunctional coping style with the incest: Adolescents told that they threatened the perpetrators in various phases of incest. 3. Avoidance of eye contact by the perpetrator: We recognized that perpetrators avoided social contact with the victim. This theme evokes dehumanizing of women during incest. 4. The urge to destroy happy memories: This theme presents data on the adolescents' expectations about recovery. CONCLUSION: According to the themes, two fundamental therapeutic precepts could guide the treatment process for adolescent girl incest survivors: 1. Exploration of the delayed meaning making: Therapist could address dysfunctional family functioning and explain that it is normal for a child to be delayed in meaning making. 2. Recovery of the adolescent's lost self after semantic dehumanization in abuses: Therapist should help her to dispute irrational beliefs about worthlessness and to gain control of her body.

Hyperfocusing as a dimension of adult attention deficit hyperactivity disorder.

Patients with Attention Deficit Hyperactivity Disorder (ADHD) suffer not only from inability to focus but also from inability to shift attention for events that trigger their interests. This phenomenon is called "hyperfocusing". Previous literature about hyperfocusing is scarce and relies mainly on case reports. The study aimed to investigate and compare the severity of hyperfocusing in adult ADHD with and without psycho-stimulant use. ADHD (DSM-IV-TR) patients either psycho-stimulant naive (n=53) or on psycho-stimulants (n=79) from two ADHD clinics were recruited. The control group (n=65) consisted of healthy university students. A socio-demographic form, the Beck Depression Inventory, the Wender-Utah Rating Scale, the Adult ADHD Self- Report Scale and the Hyperfocusing Scale were applied to the participants. There was no difference between total Hyperfocusing Scale and Adult ADHD Self- Report Scale scores of two patient groups, but both have higher scores than controls (p<0.001). Hyperfocusing is higher in adult ADHD and there was no difference between stimulant-naive patients or patients on stimulants. Hyperfocusing can be defined as a separate dimension of adult ADHD.

A Cross-Cultural Investigation of Suicidal Disclosures and Attitudes in Austrian and Turkish University Students.

The prevalence of suicidal behavior and the nature of attitudes toward suicide differ in Austria and Turkey. To see if there were differences in disclosure, 351 Turkish and 310 Austrian students answered questions about disclosing suicidal thoughts. More Austrian than Turkish students reported suicidal ideation and believed that suicidal people disclose their plans, but suicidal disclosures were equally common in the two groups. Compared to Austria, suicidal disclosures in Turkey met with more positive social reactions that may facilitate a successful social support process. These findings imply that prevention efforts should reduce the stigma around suicidal disclosures.

Lamotrigine for attention deficit-hyperactivity disorder comorbid with mood disorders: a case series.

Attention deficit-hyperactivity disorder (ADHD) is frequently comorbid with mood disorders in both children and adults. Comorbidity is shown to have negative consequences and it needs to be treated effectively. Lamotrigine, an anticonvulsant indicated for the maintenance treatment of bipolar depression is reported to be effective in adult ADHD comorbid with bipolar II disorder. We conducted a retrospective chart review to identify patients with adult ADHD and comorbid mood disorders on lamotrigine, along with ADHD medications, and/or antidepressants and antipsychotics. We identified 40 patients (17 women, 42.5%; age range 16 - 55 yrs), 50% with bipolar II and 50% with recurrent depression. Their treatment response was evaluated by Clinical Global Impression scales. We found that 31 patients (77.5%) improved with lamotrigine, there was no change in 7 patients (17.5%) and 2 patients got worse, with a mean lamotrigine dose of 125.6 ± 47.8 mg (25 - 250 mg). To our knowledge, this is the first study to report that lamotrigine might be a safe and effective treatment option for adult ADHD comorbid with bipolar and recurrent depression.

Temperamental characteristics in adults with attention-deficit hyperactivity disorder: a comparison with bipolar disorder and healthy control groups.

OBJECTIVE: To date, the affective temperamental characteristics of adults with attention-deficit hyperactivity disorder (ADHD) have not been studied. The aim of this study is to explore those temperamental characteristics for adults diagnosed with ADHD as measured by the TEMPS-A and then to compare those results with results for individuals diagnosed with bipolar disorder (BD) and with healthy controls. METHODS: Forty adults with ADHD, 40 patients with BD, and 40 healthy controls were enrolled in this study. The groups were matched by age and gender. All patients were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I), the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Young Mania Rating Scale and the Wender Utah Rating Scale. Subjects' temperamental characteristics were examined using the Turkish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire (TEMPS-A). RESULTS: Ten subjects (25%) in the ADHD group and 15 subjects (30%) in the bipolar group had at least one dominant temperament. There was no identifiable dominant temperament in the control group. Compared to the control group, the ADHD group scored higher than other groups on all domains of the TEMPS-A: depressive cyclothymic, irritable and anxious. However, the hyperthymic domain was not higher for this group. Adults with ADHD scored higher on the irritable temperament scale as compared to the BD group. The ADHD and BD groups had similar mean scores for each of the other four temperaments. CONCLUSION: The adults diagnosed with ADHD in this study had different temperamental characteristics from the control group, and these temperamental characteristics were similar to those of the bipolar patients. Recognizing the role of temperamental characteristics in adults with ADHD may increase our understanding of ADHD.

Association among SNAP-25 gene DdeI and MnlI polymorphisms and hemodynamic changes during methylphenidate use: a functional near-infrared spectroscopy study.

OBJECTIVE: To investigate the interaction of treatment-related hemodynamic changes with genotype status for Synaptosomal associated protein 25 (SNAP-25) gene in participants with attention deficit hyperactivity disorder (ADHD) on and off single dose short-acting methylphenidate treatment with functional near-infrared spectroscopy (fNIRS). METHOD: A total of 15 right-handed adults and 16 right-handed children with DSM-IV diagnosis of ADHD were evaluated. Ten milligrams of short-acting methylphenidate was administered in a crossover design. RESULTS: Participants with SNAP-25 DdeI T/T genotype had decreased right deoxyhemoglobin ([HHb]) with treatment. SNAP-25 MnlI genotype was also associated with right deoxyhemoglobin ([HbO2]) and [HHb] changes as well as left [HHb] change. When the combinations of these genotypes were taken into account, the participants with [DdeI C/C or T/C and MnlI G/G or T/G] genotype had increased right [HHb] with MPH use whereas the participants with [DdeI T/T and MnlI T/T] or [DdeI T/T and MnlI G/G or T/G] genotypes had decreased right prefrontal [HHb]. CONCLUSIONS: These results suggested that SNAP-25 polymorphism might be associated with methylphenidate induced brain hemodynamic changes in ADHD participants.

Attitudes of medical students, general practitioners, teachers, and police officers toward suicide in a Turkish sample.

Since attitudes predict future behavior and are important in suicide prevention, we aimed to determine the attitudes of professional groups with potential importance in suicide and suicide prevention. A total sample of 205 medical students, general practitioners, secondary school guidance teachers, and police officers from Ankara completed the Attitudes Toward Suicide Scale (ATSS). Principal components analysis revealed a nine factor model for the scale. Participants from different professions held different attitudes toward suicide. Medical students and general practitioners had the most permissive attitudes. General practitioners' attitude scores about preparedness to prevent suicide were lower compared to other groups, which points out the importance of continuing medical education and implementation of suicide prevention programs in primary care.

Psychometric properties and cut-off scores of the Beck Depression Inventory-II in Turkish adolescents.

The current study examined the psychometric properties and cut-off scores of the Beck Depression Inventory II in Turkish adolescents. A total of 503 non-clinical and 166 clinical adolescents participated in the study. Test-retest (r = .89) and internal consistency (alpha = .90) reliabilities, convergent validity (r = .81) and discriminant validities (r = .39, r = .49 and r = .42) were satisfactory. Exploratory factor analyses yielded two factors. The cut-off score for mild depression in Turkish adolescents was lower than that reported previously for adults. The findings are discussed in relation to those of previous studies conducted in other countries.

The effect of tianeptine in the prevention of radiation-induced neurocognitive impairment.

Radiation-induced neurocognitive impairment is an undesirable radiation-induced toxicity and a common health problem in patients with primary or metastatic brain tumor. It greatly impairs quality of life for long-term brain tumor survivors. Hippocampus is the most important brain structure for neurocognitive functions. It has been shown that radiation affects the hippocampal neurogenesis due to either induce the apoptosis or reduce the precursor cell proliferation in the hippocampus. Radiation-induced microglial inflammatory response is also negative regulator of neurogenesis. Tianeptine is a clinically effective antidepressant that induces neurogenesis. It has also been shown that tianeptine is able to reduce apoptosis and cytoprotective against the effects of proinflammatory cytokines in the hippocampus. Given the putative role of impaired hippocampal neurogenesis in radiation-induced neurocognitive impairment we think that tianeptine can be effective for preventing radiation-induced neurocognitive impairment by increasing hippocampal neurogenesis.

Impaired verbal memory and otherwise spared cognition in remitted bipolar patients on monotherapy with lithium or valproate.

OBJECTIVES: Patients with bipolar disorder have been reported to have neurocognitive deficits; however, it is not known whether the cognitive dysfunctions are state-dependent or a stable trait. Lithium and valproate, 2 of the most widely used mood stabilizers in the treatment of bipolar disorder, have also been associated with cognitive impairment. However, the degree and pattern of neurocognitive impairment in euthymic bipolar patients on either monotherapy with lithium or valproate have not been compared before in depth. METHODS: We compared 17 euthymic outpatients with bipolar disorder (BD) on lithium monotherapy to 11 euthymic outpatients with BD on valproate monotherapy and 29 comparison subjects using tests measuring immediate verbal memory and executive functions in addition to 3 subtests of the Wechsler Adult Intelligence Scale Revised. The groups were similar in terms of level of education, duration and severity of illness, and gender distribution. Patients on lithium monotherapy were older than patients on valproate and healthy controls. Mood symptoms as assessed by standardized scales were mild to non-existent in both patient groups. RESULTS: Immediate verbal memory was impaired in both patient groups compared to controls, where the main effect of age was not significant. No significant differences could be found on the other cognitive measures. CONCLUSIONS: Both lithium and valproate may be associated with immediate verbal memory impairment, sparing other cognitive functions. Presence of a similar verbal memory deficit in the lithium and valproate groups suggests that this deficit might be intrinsic to BD or that the 2 medications influence immediate verbal memory similarly. Larger samples of remitted bipolar patients on monotherapy should be studied for more precise conclusions.

Depression scores and associated factors in pregnant and non-pregnant women: a community-based study in Turkey.

The aims of this study were to evaluate and compare the depression scores of pregnant and non-pregnant women, and to identify the factors associated with depression scores in the two groups. This community-based study was conducted in a primary health care center catchment area in Ankara (population: 17,838) in January 2003. At the beginning of the study, the trimesters of all pregnant women (n = 66) were determined and as a control group (n = 138), two non-pregnant women matched for age and parity characteristics living in the same area were selected for each pregnant woman. Each participant completed a questionnaire and the Beck Depression Inventory (BDI). One-way ANOVA, univariate correlation, and multiple linear regression analyses were used in statistical evaluation. Depression scores of pregnant and non-pregnant women, and women at different trimesters of pregnancy were similar. Using a cut-off score > or = 18 on the BDI, 26.5% of non-pregnant women, 27.3% of pregnant women, 25.0% of pregnant women in their first and second trimester, and 30.0% of third trimester pregnant women were found to be depressive. According to multiple linear regression analysis, age, age at marriage, and the number of people living in the home were associated with depression in both groups. Depression scores were similar in pregnant women and non-pregnant controls. There were different associations between depression score and the study groups' characteristics.

[Validity and reliability of the Turkish version of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults]. / Wender-Utah Derecelendirme Olçegi Türkçe formunun eriskin dikkat eksikligi ve hiperaktivite bozuklugu'nda geçerlik ve güvenilirlik çalismasi.

OBJECTIVE: To determine reliability and validity of Turkish form of the 25 item Wender Utah Rating Scale (WURS), which is designed as an aid for diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. METHOD: The scale was administered to 59 patients who were diagnosed as having ADHD according to DSM-IV criteria after comprehensive psychiatric and neuropsychological assessments in outpatient clinics of University of Ankara Medical School, Department of Psychiatry. Control groups consisted of 59 patients with depression, 44 patients with bipolar affective disorder in remission, and 145 healthy controls. Subjects who were illiterate and younger than 18 years of age were excluded from the study. WURS was readministered to 63 of the healthy controls after 4 weeks. RESULTS: Principal components analysis revealed 5 factors explaining 61.3% of the variance. The factors were labeled as Irritability, Depression, School Problems, Behavioral Problems/Impulsivity and Attentional Deficits. Mean factor scores of ADHD group was higher than all groups except Depression factor. Turkish form of WURS demonstrated excellent internal consistency (Cronbach's alpha= 0.93), and the test-retest coefficient for the WURS (total score) was 0.81. Item-total score correlations varied between 0.31-0.75. A cut off score of 36 or higher identified 82.5% of the adults with ADHD (sensitivity), 90.8% of the healthy controls (specificity), 66% of patients with depression, and 64.3% of patients with bipolar affective disorder correctly. CONCLUSION: Turkish form of the WURS is a reliable and valid scale in assessing childhood symptoms in adults for ADHD. However overlapping mood disorder items lowers specificity of the scale.

Symptoms defined by parents' and teachers' ratings in attention-deficit hyperactivity disorder: changes with age.

OBJECTIVE: To determine whether Child Behavior Checklist/4-18 (CBCL) and Teacher Report Form (TRF) scores of children and adolescents with a first-time diagnosis of attention-deficit hyperactivity disorder (ADHD) are different and whether there is a similar difference in normal control subjects. METHOD: We analyzed the CBCL and TRF scores of 146 patients (124 boys and 22 girls, aged 6 to 18 years; mean age 11.0 years, SD 3.6). We analyzed the same scores for 274 age and sex-matched control subjects recruited from a nationally representative sample. RESULTS: Subjects with ADHD had significantly higher CBCL and TRF scores than control subjects. Age was significantly correlated with scores on the CBCL and TRF subscales Social Withdrawal, Somatic Complaints, and Internalization Problems; with scores on the CBCL subscale Attention Problems; and with scores on the TRF subscale Anxiety-Depression. In the group with ADHD, age was negatively correlated with scores on the CBCL and TRF subscale Externalizing Problems and with scores on the TRF subscale Aggressive Behavior. In the control group, the only significant correlation was between age and the CBCL subscale Somatic Complaints score. CONCLUSIONS: These results indicate that underdiagnosis of ADHD in childhood may cause the emergence of greater internalization problems in adolescence.

[Neuropsychological findings in adults with attention deficit hyperactivity disorder]. / Dikkat Eksikligi ve Hiperaktivite Bozuklugu olan eriskinlerde nöropsikolojik bulgular.

OBJECTIVE: Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder with childhood onset and persistence into adulthood. Role of neuropsychological testing is becoming an important clinical measure in the assessment and diagnosis of adults with ADHD. The aim of this study was to assess neuropsychological functions of adults with ADHD compared to healthy controls. METHOD: Neuropsychological functions of 16 adults with DSM-IV diagnosis of ADHD and 16 healthy controls were assessed. Control grup was matched in age, gender and years of education. Benton Visual Retention Test, Wisconsin Card Sorting Test (WCST), Wechsler Memory Scale and Stroop Color and Word Test were used for neuropsychological assessment. RESULTS: 13 of the ADHD patients were male and 3 were female. Mean age was 29.5+/-8.1, and mean education year was 13.4+/-2.2. In Stroop Color and Word Test, adults with ADHD completed word and color word subtests in a longer time than normal controls, made more mistakes in color reading subtest, made more corrections in word subtest, and had higher interferance scores compared to healthy controls (p.05). Adults with ADHD also showed poorer performance in Wechsler Memory Scale's logical memory subtest (p<.05). Patients' and healthy controls' performances were similar in Wisconsin Card Sorting Test and Benton Visual Retention Test. CONCLUSION: Although ADHD adults' perfomance in traditional measures of executive functioning (WCST) were similar to normal controls, they showed poor performance in tests measuring selective attention, distractibility and response inhibition (Stroop Test) indicating that attention problems do not remit with age and persist in adulthood.

Which GP deals better with depressed patients in primary care in Kastamonu, Turkey: the impacts of 'interest in psychiatry' and 'continuous medical education'.

BACKGROUND: Little is known about the reasons behind Turkish GPs' limited ability to diagnose and treat major depression. OBJECTIVE: The aim of this preliminary study is to evaluate the impact of a GP's level of interest in psychiatry and participation in previous continuous medical education (CME) on their ability to recognize and treat major depression. METHODS: Thirty-eight GPs from an underdeveloped city in Turkey participated in the study. A survey consisting of questions about their demographic characteristics, self-reported capacity for recognition and antidepressant management of depression, presence of previous CMEs and self-ratings of their interest in psychiatry was given to all GPs. Comparisons were made using hierarchical multiple regression analyses and SPSS software. RESULTS: Almost half of the GPs had participated previously in at least one CME course on depression, and these were significantly more involved with the treatment of depressed patients (P = 0.02). Hierarchical multiple regression analysis indicated that 'interest in psychiatry' was an important factor in predicting the GPs' confidence in recognizing and treating depression even after controlling for other variables such as age, gender (P = 0.01) and participation in previous CME (P = 0.05). CONCLUSION: Our findings suggest that personal characteristics, including a GP's interest in psychiatry, should be considered when planning education and other interventions to improve the detection and treatment of depression in primary care.