Delayed-Onset Toxicity in an Adolescent Case Following Attempted Suicide with an Overdose of Paliperidone Intake.

Paliperidone is a relatively novel atypical antipsychotic drug that is currently used to treat schizophrenia in adolescents and adults. The drug was generated by combining the active metabolite of risperidone, 9-hydroxyrisperidone, with osmotic controlled-release oral administration system (OROS) technology. Due to its specific design, the drug has been identified as a different form, albeit an active metabolite of risperidone. Such distinction mainly manifests itself during pharmacokinetic processes, because paliperidone is not affected by CYP2D6 metabolism. On the other hand, this drug is regularly released for a period of 24 hours. Even though it is possible to reach relevant literature on the efficacy and safety of paliperidone use in detail, limited data regarding its toxicity exists. A review of the literature in that sense, has revealed a scarce number of case reports and a retrospective study existing. Bearing in mind the specific form and design of the drug, we have hypothesized its toxicity might cause diverse clinical presentations, in the face of overdose or poisoning. This might in turn, prompt us to switch our usual evaluation and intervention practices. With this case report, we have aimed to discuss delayed onset toxicity with paliperidone overdose in an adolescent case, due to a suicide attempt with excessive intake of the medication.

DSM-5 Level 2 Sleep Disorders Scale Validity and Reliability of Turkish Form (Form for Children Aged 11-17 Years and Parent Form for Children Aged 6-17 Years).

INTRODUCTION: This study aimed to assess the validity and reliability of Turkish version of DSM-5 Level 2 Sleep Disorders Scale. METHOD: The scale was prepared by translation and back translation of DSM-5 Level 2 Sleep Disorders Scale. Study groups consisted of a clinical sample that contained cases that had sleep related problems and treated in a child and adolescent psychiatry unit and also a community sample. In the assessment process, child and parent forms of DSM-5 Level 2 Sleep Disorders Scale and also Children's Sleep Habits Questionnaire-Turkish version (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) were used. As for reliability analyses, internal consistency coefficient and item-total score correlation analysis, test-retest reliability; and for validity analyses, explanatory factor analysis and for concurrent validity, correlation analyses with Children's Sleep Habits Questionnaire-Turkish version (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) were made. RESULTS: In reliability analyses, Cronbach's alpha internal consistency coefficient values were found to be very highly reliable regarding child and parent forms. Item-total score correlation coefficients were high for child form while medium and high for parent form; indicating a statistical significance. As for construct validity, two factors were maintained that would count for 74.1% of the variance in child form and 66.9% of the variance in parent form. It was seen that positive and negative statements weighed on two different factors. As for concurrent validity, child and parent form of the scale showed significant correlation with Children's Sleep Habits Questionnaire-Turkish version (CSHQ) and Pittsburgh Sleep Quality Index (PSQI). CONCLUSION: It was found that Turkish version of DSM-5 Level 2 Sleep Disorders Scale could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

Validity and Reliability of the Turkish Version of DSM-5 Level 2 Anxiety Scale (Child Form for 11-17 Years and Parent Form for 6-17 Years).

INTRODUCTION: This study aimed to assess the validity and reliability of the Turkish Version of DSM-5 Level 2 Anxiety Scale's child and parent forms. METHODS: The scale was constructed by carrying out the translation and back translation of DSM-5 Level 2 Anxiety Scale. The study group consisted of a community and clinical sample. The scale was applied to 148 parents and 189 adolescents that represented the clinical and community sample. During the assessment process, Screen for Childhood Anxiety Related Emotional Disorders and Strengths and Difficulties Questionnaire - Parent Form were also used. RESULTS: Reliability analyses indicated a high internal consistency regarding Level 2 Anxiety Scales, both for child and parent forms (0.915/0.933). In the meantime, it was shown that child form for Level 2 Anxiety Scale was significantly correlated with Screen for Childhood Anxiety Related Emotional Disorders (r=0.758, p<0.0001) while the parent form was significantly correlated with Strengths and Difficulties Questionnaire - Parent Form (r=0.717, p<0.0001). As for the content validity, one factor was obtained for both forms, and it was observed to be consistent with the original construct of the scale. CONCLUSION: It was concluded that Turkish version of DSM-5 Level 2 Anxiety Scale was a valid and reliable tool to be utilized both for clinical practice, and research purposes.

Genetic imaging study with [Tc-99m] TRODAT-1 SPECT in adolescents with ADHD using OROS-methylphenidate.

AIM: To examine theeffects on the brain of 2-month treatment withamethylphenidate extended-release formulation (OROS-MPH) using [Tc-99m] TRODAT-1SPECT in a sample of treatment-naïve adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). In addition, to assess whether risk alleles (homozygosity for 10-repeat allele at the DAT1 gene were associated with alterations in striatal DAT availability. METHODS: Twenty adolescents with ADHD underwent brain single-photon emission computed tomography (SPECT) scans with [Tc-99m] TRODAT-1 at baseline and two months after starting OROS-MPH treatment with dosages up to 1 mg/kg/day. Severity of illness was estimated using the Clinical Global Impression Scale (CGI-S) and DuPaul ADHD Rating Scale-Clinician version (ARS) before treatment,1 month and 2 months after initiating OROS-MPH treatment. RESULTS: Decreased DAT availability was found in both the right caudate (pretreatment DAT binding: 224.76 ±â€¯33.77, post-treatment DAT binding: 208.86 ±â€¯28.75, p = 0.02) and right putamen (pre-treatment DAT binding: 314.41 ±â€¯55.24, post-treatment DAT binding: 285.66 ±â€¯39.20, p = 0.05) in adolescents with ADHD receiving OROS-MPH treatment. Adolescents with ADHD who showed a robust response to OROS-MPH (n = 7) had significantly greater reduction of DAT density in the right putamen than adolescents who showed less robust response to OROS-MPH (n = 13) (p = 0.02). However, between-group differences by treatment responses were not related with DAT density in the right caudate. Risk alleles (homozygosity for the 10-repeat allele of DAT1 gene) in the DAT1 gene were not associated with alterations in striatal DAT availability. CONCLUSION: Two months of OROS-MPH treatment decreased DAT availability in both the right caudate and putamen. Adolescents with ADHD who showed a robust response to OROS-MPH had greater reduction of DAT density in the right putamen. However,our findings did not support an association between homozygosity for a 10-repeat allele in the DAT1 gene and DAT density, assessedusing[Tc-99m] TRODAT-1SPECT.

Serum brain-derived neurotrophic factor levels in treatment-naïve boys with attention-deficit/hyperactivity disorder treated with methylphenidate: an 8-week, observational pretest-posttest study.

Brain-derived neurotrophic factor (BDNF) is an important neurotrophin in the brain that modulates dopaminergic neurons. In this study, we aimed to investigate the changes in serum BDNF levels of children with attention-deficit/hyperactivity disorder (ADHD) in response to OROS methylphenidate treatment. We also aimed to determine whether there were any pre-post-differences between ADHD subtypes and comorbid psychiatric disorders in serum BDNF levels. Fifty male children with ADHD and 50 male healthy controls within the age range of 6-12 years were recruited to the study. The psychiatric diagnoses were determined by applying a structured interview with Kiddie schedule for affective disorders and schizophrenia for school-age children-present and lifetime version. The symptom severity of ADHD was measured using the Clinical Global Impression ADHD Severity Scale (CGI-S). Physicians completed Du Paul ADHD questionnaires. The levels of serum BDNF were assessed before and after 8 weeks of treatment with effective dosages of OROS methylphenidate. In the present study, the mean serum BDNF levels of boys with ADHD and of the healthy controls were 2626.33 ± 1528.05 and 2989.11 ± 1420.08 pg/mL, respectively. Although there were no statistically significant difference between the ADHD group and healthy controls at baseline (p = 0.22), the increase of serum BDNF was statistically significant from baseline to endpoint in the ADHD group (p = 0.04). The mean serum BDNF levels at baseline and endpoint of the ADHD group were 2626.33 ± 1528.05 and 3255.80 ± 1908.79 pg/mL, respectively. The serum BDNF levels of ADHD-inattentive subtype were significantly lower at baseline (p = 0.02), whereas BDNF levels post-treatment showed no significant difference. The increase of serum BDNF levels with methylphenidate treatment after 8 weeks was significantly higher in the inattentive group (p = 0.005). The increase of serum BDNF levels with methylphenidate treatment after 8 weeks in boys with ADHD may support the potential role of BDNF in the pathophysiology of ADHD. The role of BDNF in ADHD subtypes in particular should be evaluated with further, larger studies.

Treating an Adolescent with Long QT Syndrome for Bipolar Disorder: A Case Presentation.

OBJECTIVES: Long QT syndrome (LQTS) is described as the development of sudden syncope attacks or death as a result of ventricular tachycardia (VT) episodes that might be observed as elongated QT interval in electrocardiography (ECG). Implantable Cardioverter Defibrillator (ICD) is recommended as first-line treatment for the condition in guidelines. We aimed to present an adolescent recently diagnosed with Bipolar Disorder (BD) who had LQTS that was treated with ICD, discussing her follow up and treatment along with relevant literature. METHODS: Psychiatric assessment of the case that applied to our child psychiatry unit due to manic symptoms were carried out by using Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) criteria. Symptom severity was monitored via Young Mania Rating Scale scores (YMRSS). RESULTS: The case met criteria for Bipolar Disorder Type I (BD-I). She had improvement in her mood symptoms with treatment regimen as risperidone 3 mg/day, valproate 1000 mg/day and lorazepam 1 mg/dayi after her 2-week follow up as well as no reported ICD activity, reflecting fine cardiac functions and rhythm. CONCLUSIONS: LQTS is a serious health issue for children and adolescents diagnosed with BD. This condition should be kept in mind especially in cases where familial risk factors are present and precautions need to be maintained upon required assessments. These cases need to be closely monitored due to risk factors related to both BD and LQTS, in a multidisciplinary fashion, involving both psychiatry and cardiology divisions.