Towards a definitive symptom structure of obsessive-compulsive disorder: a factor and network analysis of 87 distinct symptoms in 1366 individuals.

BACKGROUND: The symptoms of obsessive-compulsive disorder (OCD) are highly heterogeneous and it is unclear what is the optimal way to conceptualize this heterogeneity. This study aimed to establish a comprehensive symptom structure model of OCD across the lifespan using factor and network analytic techniques. METHODS: A large multinational cohort of well-characterized children, adolescents, and adults diagnosed with OCD (N = 1366) participated in the study. All completed the Dimensional Yale-Brown Obsessive-Compulsive Scale, which contains an expanded checklist of 87 distinct OCD symptoms. Exploratory and confirmatory factor analysis were used to outline empirically supported symptom dimensions, and interconnections among the resulting dimensions were established using network analysis. Associations between dimensions and sociodemographic and clinical variables were explored using structural equation modeling (SEM). RESULTS: Thirteen first-order symptom dimensions emerged that could be parsimoniously reduced to eight broad dimensions, which were valid across the lifespan: Disturbing Thoughts, Incompleteness, Contamination, Hoarding, Transformation, Body Focus, Superstition, and Loss/Separation. A general OCD factor could be included in the final factor model without a significant decline in model fit according to most fit indices. Network analysis showed that Incompleteness and Disturbing Thoughts were most central (i.e. had most unique interconnections with other dimensions). SEM showed that the eight broad dimensions were differentially related to sociodemographic and clinical variables. CONCLUSIONS: Future research will need to establish if this expanded hierarchical and multidimensional model can help improve our understanding of the etiology, neurobiology and treatment of OCD.

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.

Electroconvulsive therapy in an adolescent with bipolar disorder, substance use, and body dysmorphic disorder comorbidity: case report.

Our case report is on the use of electroconvulsive treatment (ECT) in an adolescent with Bipolar Disorder (BPD), Substance Use Disorder (SUD) and comorbid Body Dysmorphic Disorder (BDD). In our case, ECT was not considered at the first stage, but we encountered medication noncompliance and treatment resistance. Symptoms of body dysmorphic disorder completely disappeared after ECT, which is consistent with the literature. ECT is a treatment with a low side effect profile in treatment-resistant cases. In addition, it will be useful to increase the knowledge and experience of clinicians on ECT and to provide conditions for ECT in child and adolescent psychiatric clinics.

Factors related to diagnostic persistence of attention deficit/hyperactivity disorder in Turkish children and adolescents.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is one of the most frequently occurring mental disorders in children and adolescents. The purpose of this study was to determine diagnostic persistence three years after the first clinical evaluation and to investigate the factors relating to diagnostic persistence in children and adolescents with ADHD. METHODS: The study included 183 children and adolescents who were evaluated in the first admission. Of 183 children and adolescents, 142 children and adolescents were evaluated in the second admission and only the data of 142 children and adolescents were analysed in the study. Diagnostic persistence was defined as having met the full criteria for ADHD on second evaluation. Symptom severity of ADHD was determined using the Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form (T-DSM-IV-S). Intelligence level was assessed through the Wechsler Intelligence Scale for Children-Revised. RESULTS: Of the children included in the study, 77.5% (n = 110) were determined to have ADHD diagnostic persistence. Low intelligence levels, younger age and higher T-DSM-IV-S inattention and conduct disorder scores were associated with diagnostic persistence. ADHD diagnosis in children and adolescents tends to continue at high rates. CONCLUSIONS: Determination of the risks related to ADHD diagnostic persistence may contribute to improved treatment planning and interventions.

[Quality of life in children with neurofibromatosis type 1, based on their mothers' reports]. / Nörofibromatozis Tip 1 Tanili Çocuklarda Annelerin Degerlendirmesine Göre Yasam Kalitesi.

OBJECTIVE: The aim of this study was to investigate health-related quality of life (HRQoL) in children with neurofibromatosis type 1 (NF1) and to determine the factors affecting HRQoL in these children, with particular emphasis on NF1-specific findings and complications. MATERIALS AND METHODS: The patient group included 60 NF1 patients aged 3-18 years that were evaluated at our pediatric neurology outpatient clinic between January 2001 and January 2011. The control group included 96 age-matched patients without chronic disease and whose mothers had similar levels of education as the mothers of those in the patient group. All the mothers completed the Pediatric Quality of Life Inventory PedsQoL-Parent Form and the PedsQoL scores in the 2 groups were statistically compared. In addition, the effects of sociodemographic variables, as well as NF1-specific findings and complications (skin findings, neurofibromas, Lisch nodules, arterial hypertension and/or cardiac pathology, short stature, macrocephaly, orthopedic problems, hyperintense lesions on cranial MRI, epileptic seizures, psychiatric disease, and cognitive involvement) were statistically analyzed. RESULTS: All PedsQoL domain scores were lower in the patient group than in the control group (P = 0.0001). HRQoL decreased, and the number of NF1-specific findings and complications increased as age increased in the patient group (P = 0.013). Short stature, neurofibromas and/or plexiform neurofibromas, bone lesions, and psychiatric problems were factors specifically related to low-level HRQoL in the NF1 patients. CONCLUSION: NF1 negatively affected HRQoL in the patient group. We think that multidisciplinary evaluation and, in particular, psychiatric management of NF1 patients are necessary to improve patient HRQoL.

Prevelance of mental disorders and associated factors in institutionalized 3-5 year old children.

OBJECTIVE: In this study, we aimed to determine the prevelance and severity of mental disorders in institutionalized children between the ages of 3-5 years, investigate the factors associated with the mental disorders and compare these findings with the data of a community sample composed of children who were raised by their own families. METHOD: Thirty-four children raised in three institutions in Kocaeli were compared with an age- and sex-matched community sample. Children were assessed according to DSM-IV diagnostic criteria. The Socio-demographic information form, and Early Childhood Inventory-4 (ECI-4) parent scale were used for data collection. RESULTS: Children that were reared in institutions had evidence of higher rates of mental disorders. In institution-reared children, symptom severity of attention deficit hyperactivity disorder, reactive attachment disorder, oppositional deficient disorder, and pervasive developmental disorder were higher than the community subjects. Age, time spent with father, duration of institutionalization, number of siblings, number of hospital admissions because of physical symptoms and presence of abuse before institutional care were determined to be predictive factors for psychiatric symptoms. CONCLUSION: These findings revealed that institutionalized children are at risk for mental disorders and protective measures are as important as instutional care for these children. Our results suggest that essential steps should be taken to protect the mental health of children in institutional care.

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.