Separation Individuation and Transitional Object Use in Daily Smoker Adolescents.

BACKGROUND: Smoking is an important problem in adolescence. Early developmental trajectories are also associated with cigarette smoking. OBJECTIVES: The present study aims to evaluate the separation-individuation process and use of transitional objects in daily smoker adolescents. METHOD: The research included 97 adolescents who were daily smokers and 210 adolescents who were nonsmokers. Transitional object assessment questionnaire, strength and difficulties questionnaire- adolescent form(SDQ), children's depression inventory(CDI) and state-trait anxiety inventory for children(STAI-C), separation and individuation test of adolescence(SITA) were applied. RESULTS: SITA subscales scores of engulfment anxiety, need denial, and rejection expectancy was higher and separation anxiety, teacher enmeshment, nurturance seeking scores were statistically significantly lower in smoker adolescents than nonsmokers. In logistic regression analysis, separation anxiety(odds ratio [OR] 0.93; 95% confidence interval[CI] 0.87-0.98), teacher enmeshment(OR 0.93; 95% CI 0.88-0.98), practicing mirroring(OR 1.05; 95% CI 1.02,1.08) and rejection expectancy (OR 1.06 95% CI 1.02,1.11) were found to be predictors of daily smoking. The use of a childhood transitional object for feeling tired and the use of an adolescent transitional object for feeling anxious and tired was found to be significantly higher in smokers. CONCLUSIONS: There are some differences in the process of separation-individuation and the use of transitional objects in the smoker group. This suggests that early developmental characteristics may be associated with smoking. Further studies are needed to better understand the causal relationship between smoking and the separation-individuation process and transitional object use.

The association between separation individuation process and binge eating disorder in adolescents aged 12-18.

PURPOSE: To evaluate the associations between separation individuation (SI) process and binge eating disorder (BED) in adolescence aged 12-18 years old, as most challenges related to SI process and eating disorders (EDs) tend to arise in this age group. METHODS: This is a cross-sectional study of 30 adolescents diagnosed with BED and 332 healthy adolescents as a control group. All adolescents diagnosed with BED underwent clinical interviews and all adolescents in the study filled in self-reported questionnaires. RESULTS: Our results highlighted higher levels of need denial (p = 0.014) and rejection expectancy (p = 0.008) of SI difficulties in adolescents with BED as compared to the ones without BED. CONCLUSION: This is the first study of its nature providing good evidence for the association between SI process and BED in adolescents. Although these difficulties in SI process by themselves are not evidence of causative link, these results can contribute to the understanding of the causative factors in BED and underpin further research. The correlation can be used as a consideration in the prevention and treatment of BED. LEVEL OF EVIDENCE: Level III, case-control analytic study.

The Relationship of Disordered Eating Attitudes with Stress Level, Bone Turnover Markers, and Bone Mineral Density in Obese Adolescents.

OBJECTIVE: To investigate the effect of stress caused by disordered eating attitudes on bone health in obese adolescents. METHODS: A cross-sectional study comprising 80 obese adolescents was performed from November 2013 to September 2014. Twenty-four-hour urinary free cortisol levels were measured as a biological marker of stress. Bone turnover was evaluated using bone-specific alkaline phosphatase, serum osteocalcin, and urinary N-telopeptide concentrations. Bone mineral density was measured using dual-energy X-ray absorptiometry. The Eating Disorder Examination Questionnaire, Dutch Eating Behavior Questionnaire, Children's Depression Inventory, and the State-Trait Anxiety Inventory for Children were used to assess eating disorders, depression, and anxiety. Psychiatric examinations were performed for binge eating disorders. RESULTS: In the Pearson's correlation test, a positive correlation was found between the 24-hour urinary cortisol level and Dutch Eating Behavior Questionnaire total and restrained eating subscale scores (p<0.05 for both). In linear regression analyses, the Dutch Eating Behavior Questionnaire total and restrained eating subscale scores were found to be significant contributors for urinary cortisol level (ß=1.008, p=0.035; ß=2.296, p=0.014, respectively). The femoral neck areal bone mineral density was found to be significantly higher in subjects who had binge eating disorder compared with those without binge eating disorder (p=0.049). CONCLUSION: Despite the lack of apparent effects on bone turnover and bone mineral density in our obese adolescents at the time of the study, our results suggest that disordered eating attitudes, and especially restrained eating attitudes, might be a source of stress. Therefore, studies in this area should continue.

The impact of migration and culture on suicide attempts of children and adolescents living in Istanbul.

BACKGROUND: Suicidal attempts are steadily increasing in societies with rapid urbanisation and dramatic social changes in places like Istanbul. Stress related to internal migration may increase suicidal behaviour. AIM: We investigated the impact of internal migration and culture on suicide attempts among youth in Istanbul. METHODS: We retrospectively analysed the records of 210 children and adolescents, aged 6-18 years, who presented at the Emergency Outpatient Clinic of the Department of Pediatrics at Cerrahpasa Medical School in Istanbul because of suicide attempts between January 2008 and December 2010. RESULTS: The majority of patients (78.95%, N = 165) had a background of internal migration, mostly (65%, N = 136) originating from regions with large cultural differences compared with that of Istanbul. Noticeably, more migrants than non-migrants (18.8% vs. 6.8%) and more patients originating from regions with large cultural differences chose high-risk methods for suicide attempts (20.7% vs. 8.1%). CONCLUSION: Internal migration can be considered a serious risk factor for suicidal behaviour. Furthermore, the degree of cultural differences between the area of origin and the new environment can be of vital importance. Healthcare measures should, therefore, focus on internal migration as a risk factor for youth suicidal behaviour and provide assistance for appropriate resettlement and integration in countries with increased mobility.

Psychiatric disorders and their association with burn-related factors in children with burn injury.

BACKGROUND: The aim of this study was to assess psychiatric disorders and their association with burn-related factors in a population of Turkish children with burns. METHODS: Thirty-one children admitted to the Cerrahpasa Medical Faculty Burn Unit between January 2013 and August 2013 were first assessed by the plastic surgeon, and then those with psychological symptoms were referred to a child psychiatrist, and the records were analyzed retrospectively. RESULTS: The percentage of burned area to Total Body Surface Area (TBSA) ranged between 2-60% (mean, 17.3%). Nineteen patients (61.3%) had a psychiatric diagnosis, which included acute stress disorder (ASD) (n=15), depression (n=3), posttraumatic stress disorder (n=2, comorbid with depression), and delirium (n=1). The percentage of burned area to TBSA was associated with the presence of psychopathology and ASD. Further, psychopathology was associated with the number of burned major body regions. CONCLUSION: Pediatric burn patients are at risk of developing psychopathology. The children with a greater percentage of burned area to TBSA and more burned body regions have the greatest risk of psychopathology. Surgeons have an important role in patient referral for psychiatric interventions, so that psychiatric disorders can be prevented as early as possible.

Recognition of emotional facial expressions and broad autism phenotype in parents of children diagnosed with autistic spectrum disorder.

OBJECTIVE: Research findings debate about features of broad autism phenotype. In this study, we tested whether parents of children with autism have problems recognizing emotional facial expression and the contribution of such an impairment to the broad phenotype of autism. METHOD: Seventy-two parents of children with autistic spectrum disorder and 38 parents of control group participated in the study. Broad autism features was measured with Autism Quotient (AQ). Recognition of Emotional Face Expression Test was assessed with the Emotion Recognition Test, consisting a set of photographs from Ekman & Friesen's. RESULTS: In a two-tailed analysis of variance of AQ, there was a significant difference for social skills (F(1, 106)=6.095; p<.05). Analyses of variance revealed significant difference in the recognition of happy, surprised and neutral expressions (F(1, 106)=4.068, p=.046; F(1, 106)=4.068, p=.046; F(1, 106)=6.064, p=.016). CONCLUSION: According to our findings, social impairment could be considered a characteristic feature of BAP. ASD parents had difficulty recognizing neutral expressions, suggesting that ASD parents may have impaired recognition of ambiguous expressions as do autistic children.

Attachment Characteristics and Behavioral Problems in Children and Adolescents with Congenital Blindness.

INTRODUCTION: This study aimed to assess the behavioral problems and the attachment characteristics of children and adolescents with congenital blindness (CB). METHOD: Forty children and adolescents aged 11-14 years with CB were included as the case group. Forty healthy children and adolescents who were matched for age, gender, and socioeconomic status with the case group served as the comparison group. Behavioral problems were assessed by the Child Behavior Checklist for ages 4-18 (CBCL 4/18). Attachment characteristics were assessed via the Short Form of Inventory of Parent and Peer Attachment (s-IPPA). RESULTS: The case group had lower CBCL total problems scores as well as anxiety/depression, withdrawal/depression, and attention problems subscales scores with respect to the comparison group. There were no significant differences between the two groups in s-IPPA scores. CONCLUSION: Children and adolescents with CB did not differ from the comparison group in terms of attachment, whereas, they had lower scores on behavioral problems than the comparison group. Although previous studies indicate that children and adolescents with CB may be at the risk of insecure attachment, our study suggested that adaptive mechanisms of their families together with professional help from specialized teachers and services provided by schools for children and adolescents with CB may play compensatory roles.

[The effect of circumcision on the mental health of children: a review]. / Sünnetin Çocuk Ruh Sagligi Üzerine Etkisi: Gözden Geçirme Çalismasi.

Circumcision is one of the oldest and most frequently performed surgical procedures in the world. It is thought that the beginning of the male circumcision dates back to the earliest times of history. Approximately 13.3 million boys and 2 million girls undergo circumcision each year. In western societies, circumcision is usually performed in infancy while in other parts of the world, it is performed at different developmental stages. Each year in Turkey, especially during the summer months, thousands of children undergo circumcision. The motivations for circumcision include medical-therapeutic, preventive-hygienic and cultural reasons. Numerous publications have suggested that circumcision has serious traumatic effects on children's mental health. Studies conducted in Turkey draw attention to the positive meanings attributed to the circumcision in the community and emphasize that social effects limit the negative effects of circumcision. Although there are many publications in foreign literature about the mental effects of the circumcision on children's mental health, there are only a few studies in Turkey about the mental effects of the one of the most frequently performed surgical procedures in our country. The aim of this study is to review this issue. The articles related to circumcision were searched by keywords in Pubmed, Medline, EBSCHOHost, PsycINFO, Turkish Medline, Cukurova Index Database and in Google Scholar and those appropriate for this review were used by authors.

Serotonin-2A receptor and catechol-O-methyltransferase polymorphisms in panic disorder.

Catechol-O-methyltransferase (COMT) and serotonin receptor 2A (5HTR2A) polymorphisms have been investigated for their possible role in panic disorder (PD). The aim of this study was to investigate the genotype distribution of the COMT val158met and 5HTR2A 102T/C polymorphisms in PD. COMT val158met is a polymorphism at codon 158 that results in variations in COMT enzymatic activity with high- (H) and low-activity (L) alleles. The 5HTR2A 102T/C polymorphism comprises a T-to-C mutation at position 102. The effects of symptom severity, gender, and age of onset were also investigated. The participants were 105 outpatients with PD and 130 controls. The severity of the symptoms of PD was assessed by the Panic and Agoraphobia Scale (PAS). Polymorphisms of the 5HTR2A and COMT genes were identified using polymerase chain reaction and restriction fragment length polymorphism analysis. A significant relationship was found between the COMT Val158Met polymorphism and PD. No significant differences were found in genotype distributions or allele frequencies of the 5HTR2A polymorphisms between the PD and control groups. There were no significant relationships between the COMT and 5HTR2A polymorphisms and age of onset, gender, presence of agoraphobia, or PAS scores in the PD group (p>0.05).

Psychiatric assessment of children with nonsyndromic cleft lip and palate.

OBJECTIVE: The aim of the study was to determine whether children with nonsyndromic cleft lip and palate (NSCLP) are more likely to be diagnosed with psychiatric disorders and whether cleft-related factors are related to psychopathology. METHOD: Twenty children from 6 to 16 years of age with NSCLP, attending the Plastic, Reconstructive and Aesthetic Surgery Department of Cerrahpasa Medical Faculty between January and October 2010, were included as the case group. Forty healthy children who were matched on age and sex with the case group served as controls. Children were assessed by psychiatric interviews and scales. RESULTS: Social anxiety disorder (SAD) (P=.003) and major depressive disorder (MDD) (P=.010) were more prevalent in children with NSCLP. The severity of dentofacial (P=.035) and cleft lip nose deformities (P=.002), appearance and competence of the lip (P=.008), dental alignment (P=.002), feeding (P=.044) and articulation problems (P<.001) were associated with clinical global functioning. CONCLUSIONS: Children with NSCLP are at risk of developing psychopathology, especially SAD and MDD. The above cleft-related factors and articulation problems may be the target of interventions to prevent and treat psychiatric disorders in these children.

Maternal psychopathology and psychomotor development of children with GERD.

OBJECTIVES: The relation between gastroesophageal reflux disease (GERD) and maternal psychopathology as well as the role of impairments in mother-child interactions in the perpetuation of feeding problems in children with GERD was previously implicated but not confirmed. The present study aimed to study the relation between maternal psychopathology and feeding problems in children with GERD and the effects of GERD on the psychomotor development of children. SUBJECTS AND METHODS: The case group included 39 children with GERD and their mothers and the comparison group included 39 healthy children and their mothers. The groups were matched for age, gestational age, socioeconomic status, and sex. Scales used for the psychiatric assessment of mothers were the Beck Anxiety Inventory, Hamilton Rating Scale for Depression, Eating Attitudes Test, and Experiences in Close Relationships-Revised. The children's developmental levels were assessed by the Brunet-Lezine Revised test. RESULTS: Maternal Beck Anxiety Inventory, Hamilton Rating Scale for Depression, Eating Attitudes Test, and Experiences in Close Relationships-Revised scores were significantly higher in the case group. Forced feeding and maternal thoughts of the child's feeding as insufficient were associated with a high level of maternal attachment-related anxiety and avoidance. Children with GERD had significantly lower Brunet-Lezine-Revised scores. CONCLUSIONS: Maternal psychopathology, especially insecure attachment, may play a role in the feeding problems in children with GERD. Children with GERD should be examined for maternal psychopathology and feeding problems so that maladaptive feeding behaviors can receive appropriate intervention before the development of negative reinforcement to feeding. The psychomotor development of children should be kept in mind.

Depression and anxiety levels and self-concept characteristics of adolescents with congenital complete visual impairment.

OBJECTIVE: Previous studies have reported that visual impairment can affect the mental health of children and adolescents. The aim of this study is to investigate the depression and anxiety levels and the self-concept characteristics of adolescents with congenital complete visual impairment. METHOD: This is a cross-sectional study. 40 adolescents with congenital complete visual impairment studying in a specialized primary school for visual impairment, and 40 sighted adolescents were included in the study. Both groups were matched in terms of age, gender and socio-economic status. The mean age of the adolescents in both groups was 12.82±1.17. The Children's Depression Inventory, Piers-Harris Children's Self-Concept Scale, Spielberger Trait Anxiety Inventory for Children and sociodemographic form were used in the study. The mean scores of the scales obtained from both groups were compared using the Mann-Whitney U test. RESULTS: The difference between the two groups was not statistically significant either in terms of depression scores or in terms of total scores; the happiness, physical appearance, popularity, behavior and adjustment subscales scores of the Piers-Harris Children's Self-Concept Scale. The intellectual and school-status subscale scores of the adolescents with visual impairment were significantly higher than those of the controls. Anxiety levels of the adolescents with visual impairment were significantly higher when compared with sighted adolescents. CONCLUSION: These results indicate that the depression levels and self-concept characteristics of adolescents with visual impairment are similar to those of sighted adolescents, whereas the anxiety levels of the adolescents with visual impairment are significantly higher than those of the sighted ones.

Epidemiology of depression in an urban population of Turkish children and adolescents.

BACKGROUND: In Turkey, studies of childhood depression have been limited to those using only scales. METHODS: This is a two-stage cross-sectional epidemiological study. Three schools in Fatih, Istanbul, Turkey were selected by cluster sampling. The study included 1482 students between the fourth and eighth grades. The Child Depression Inventory (CDI) was used for screening in the first stage. According to test results, 320 children were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Depressive disorders were diagnosed in 62 students, constituting the case group. The control group was matched to the case group on school, grade, age, gender, and socioeconomic status (SES). RESULTS: The prevalence rate was 4.2% for some form of depressive disorder, 1.55% for major depressive disorder, 1.75% for dysthymic disorder, 0.26% for double depression, and 0.60% for depressive disorder-not otherwise specified. According to the logistic regression analysis, increasing age, having a working mother and low maternal education were all positively associated with CDI score. Low SES, perception of paternal health and relations with father as negatively, low popularity and behavior subscales of the Piers-Harris self-concept scale, and high trait anxiety were associated with the presence of a depressive disorder. LIMITATIONS: Parents were not included in the diagnostic interviews. CONCLUSIONS: Dysthymic disorder was the most common depressive disorder. Low maternal education, low SES, dysfunctional interaction with the father, anxiety, and low self-esteem, which were all associated with depression, may be the target of interventions for prevention and treatment of depression.

Some clinical characteristics of children who survived the Marmara earthquakes.

The Marmara earthquakes occurred in the Marmara Region (North West) of Turkey in 1999 and resulted in a death toll of approximately 20,000. This paper investigates the relationships between diagnoses and certain variables in children who developed emotional and/or behavioral disturbances in the aftermath of the Marmara earthquakes and were subsequently seen at a child psychiatry outpatient clinic. The variables evaluated are gender, age, the location where the earthquake was experienced, and the degree of losses, bodily injuries, and damage to the residence. Medical records of 321 children and adolescents ranging in age from 2 to 15 years who presented at the clinic due to problems associated with the earthquake between August 1999 and February 2000 were reviewed. Of the patients, 25.5% were diagnosed with post-traumatic stress disorder (PTSD), 16.5% with acute stress disorder (ASD) and 38% with adjustment disorder. No relationship is found between gender and diagnosis. Younger age groups tended to be diagnosed with adjustment disorder. Those who had lost relatives, friends or neighbors were more frequently diagnosed with ASD or PTSD. The same was true for children whose residence was heavily damaged. Children and adolescents constitute the age group that is most severely affected by natural disasters and display significant emotional-behavioral disturbances. The frequency of ASD and PTSD found in our study is considerably high. Although rarely mentioned in the literature, adjustment disorder appears to be one of the most common reactions of children to trauma.

Clinical effectiveness of quetiapine in children and adolescents with Tourette's syndrome : a retrospective case-note survey.

BACKGROUND AND OBJECTIVE: Tourette's syndrome is a relatively common biological genetic disorder with a broad spectrum of neurobehavioural manifestations. Unfortunately, treatment of the condition is often unsatisfactory and all available drugs are associated with potential adverse effects. We therefore aimed to investigate the efficacy of quetiapine, a newer atypical antipsychotic, in the treatment of children and adolescents with Tourette's syndrome. METHODS: This was a retrospective study carried out in outpatient clinics. Twelve patients aged 8-18 years with Tourette's syndrome (diagnosed according to Diagnostic and Statistical Manual IV criteria) who were receiving quetiapine therapy and had no diagnosis of epilepsy, major depression or psychotic disorder, were included in the study. The main outcome measure was the Yale Global Tic Severity Scale (YGTSS) score. RESULTS: The initial dose of quetiapine was 25 mg/day, but the mean dose was increased to 114.6 +/- 51.6 mg/day and 175.0 +/- 116.8 mg/day at the fourth and eighth weeks of treatment, respectively. The YGTSS score, which was 21.6 +/- 4.0 at baseline, showed significant decreases at 4 and 8 weeks (reducing to 7.5 +/- 7.4 and 5.6 +/- 8.1, respectively; p < 0.003). Routine laboratory parameters and serum prolactin level were all normal and did not change throughout treatment. Mild but significant increases in both bodyweight and body mass index at 4 and 8 weeks compared with baseline were observed. CONCLUSION: Other than causing mild weight gain, quetiapine appears to be an effective, safe and well tolerated drug in children and adolescents with Tourette's syndrome.

Hematological and biochemical changes in volatile substance abusing street children in Istanbul.

The aim of the study is to assess the hematological and biochemical changes of inhalant abusing adolescences in Istanbul, Turkey. The study subjects comprised 24 street children. Demographic characteristics, hematological markers, complete blood count tests and white blood cell differential and liver function tests (alanine transaminase, aspartate transaminase, alkaline phosphatase) were evaluated. The blood cell counts and studied biochemical parameters were within normal range for age and sex matched adolescences. Anemia was observed in only one girl who had hypermenorea. The duration and the amount of substance abuse were investigated for a correlation with the blood parameters, only the amount showed the possibility of a trend associated with Hb and Hct (p<0.05). There was no significant relationship between the parameters except for the age. Although volatile abuse has been supposed to be related with anemia or other hematological abnormalities, we found no significant relation between volatile abuse and hematological or studied biochemical parameters. Alkaline phosphatase was the parameter found to be most affected, though being in normal range.

Juvenile offences among hospitalized adolescent inhalant users in Istanbul: a comparison regarding place of residence.

In this research, juvenile offenses and associated behaviors among adolescent inhalant users in Istanbul were investigated and inhalant users living in the street were compared to inhalant users living with their families. An interview questionnaire developed by the researchers was administered to 200 male adolescent inhalant users who were hospitalized during 2002-2003. More than half of the sample had committed juvenile offenses at least once in their lifetime, 16.3% had entered a house of corrections, 91.5% had friends who committed juvenile offenses, and the majority had been taken to a police station at least once in their lifetime. The rates for juvenile offenses, being taken to the police station, committing crimes to obtain money to buy drugs, and obtaining income through illegal activities were higher among adolescents living in the street than adolescents living with their families. Although the juvenile offense rate was higher among adolescents living in the street, it can be suggested that both groups live in subcultures that have a tendency towards crime, and inhalant use is part of these subcultures. Juvenile offense interventions can be useful for all inhalant users.

Single-voxel proton MR spectroscopy in toluene abuse.

Inhalation of toluene, which is an organic solvent, causes toxic encephalopathy characterized by cognitive impairment, cerebellar and extra-pyramidal symptoms. We studied cranial MR images and single-voxel MR spectroscopy of 22 toluene abusers and age-matched control subjects. The mean age of the abusers and mean duration of abuse were 18,1 years and 47 months, respectively. We got three MR spectra from the centrum semiovale, cerebellum and thalamus by using STEAM sequence with a TE value of 30 ms. N-acetyl aspartate (NAA)/Creatine (Cr), Choline (Cho)/Cr, myo-inositol (mI)/Cr peak integral ratios were calculated. NAA/Cr in the cerebellum and centrum semiovale of the abusers were significantly lower than those of the control subjects. mI/Cr in centrum semiovale and cerebellum were higher in toluene abusers. No significant difference was found in the metabolite ratios of the thalami. The association of NAA/Cr and mI/Cr ratios in cerebellum and centrum semiovale with the duration of abuse was significant. Normal level of NAA in thalamus, which was a neuron rich gray matter structure, might imply that toluene inhalation did not cause direct neuronal injury. Selective reduction of NAA and increased level of mI in white matter supported the theory of that axonopathy and gliosis were the main mechanisms of pathophysiology in chronic toluene encepholopathy. Insignificance of elevation of Cho/Cr ratios demonstrated that toluene inhalation did not cause active demyelination.