The role of adverse childhood experience and social support type in postpartum depression in Turkey.

BACKGROUND: Improved knowledge of causal and protective factors is crucial for Postpartum depression (PPD) prevention and management. AIMS: To investigate the relationship between adverse childhood experience (ACE), perceived social support and PPD in a middle-income non-Western country, and to investigate which type of ACE and which sources of social support were associated with PPD. METHODS: The study was cross-sectional study and conducted in a one center from Turkey during March-June 2019. Women up to 1-week postpartum were included in the study. The Edinburgh Postpartum Depression Scale (EPDS), a validated ACE questionnaire, and the Multidimensional Scale of Perceived Social Support were completed. RESULTS: Nine hundred women took part in the study. The proportion identified with PPD and ACE were 10% and 8.8%, respectively. In bivariate analysis, having previous PPD, unwanted pregnancy, insufficient antenatal care, low family income, history of ACE, and perception of low social support were associated with PPD (p < 0.05). Family support was perceived as beneficial, in both women with no history or ≥2 instances of ACE. However, perceived support from friends and/or a special person was lowest in the ≥2 ACE group (p < 0.05). In logistic regression, unwanted pregnancy, emotional abuse, and neglect, incarceration of a household member, and poor special person support were factors significantly associated with developing PPD (p = 0.005). CONCLUSIONS: Emotional abuse, neglect, household dysfunction, and perceived poor support from a special person were risk factors for PPD. A history of maternal childhood trauma and poor social support might indicate the need for early PPD interventions.

Steroid-induced psychosis in an adolescent: treatment and prophylaxis with risperidone.

Steroid-induced psychotic disorder is one of the serious adverse effects of corticosteroid therapy and is characterized by hallucinations and delusions. While the mechanism is unclear, treatment of steroid psychosis involves dosage reduction or discontinuation of prednisone. In cases where this cannot be done, typical treatment involves an antipsychotic medication. Although it is a well-known complication in adulthood, literature about steroid-induced psychotic disorder in children and adolescents is lacking. Here we report a 12-year-old case of steroid-induced psychotic disorder who was treated with an atypical antipsychotic, risperidone, and in whom the antipsychotic therapy was maintained because of continuation of her corticosteroid treatment for nephrotic syndrome. Pediatricians should be aware of this rare problem when prescribing corticosteroids in this age group. To our knowledge, this is the first reported case of steroid-induced psychosis successfully treated with risperidone in an adolescent with nephrotic syndrome.

Childhood idiopathic nephrotic syndrome in Turkey.

BACKGROUND: It has been reported that there are racial and regional differences in peak incidence age, histopathological features and response to steroid therapy in childhood idiopathic nephrotic syndrome. METHODS: One hundred and thirty-eight patients with a diagnosis of idiopathic nephrotic syndrome, followed up in 1994-2000, were assessed retrospectively. The aim of this study was to assess the patients' response pattern to steroid therapy, to determine whether the duration of the initial steroid therapy alters the steroid response pattern of the disease and to assess renal biopsy results. RESULTS: One hundred and fourteen patients who initially received only steroid therapy and were followed up regularly were classified according to response pattern. Of the 114 patients, 30 children had an initial response, 25 children had infrequent relapse, 19 had frequent relapse, 25 had steroid dependence and 15 children had steroid resistance. The 99 patients with steroid responsive nephrotic syndrome were divided into two groups with respect to duration of the initial steroid therapy. There was no statistically significant difference between standard and short therapy groups with respect to the steroid response patterns. Percutaneous renal biopsy was performed in 43 of the 138 patients. Mesengioproliferative glomerulonephritis was the most common histopathological lesion, followed by membranoproliferative glomerulonephritis. The proportions of membranous glomerulonephritis, focal segmental glomerulosclerosis and minimal change nephrotic syndrome were low in our group. CONCLUSIONS: Our study group is similar to one reported from Saudi Arabia with respect to the steroid response pattern and to Saudi Arabian and Nigerian reports with respect to the histopathology. Although it has been reported that short initial steroid therapy was followed by a higher rate of relapses, there was no statistically significant difference between standard and short therapy groups with respect to the relapse rate in our study group.