Prevalence and Factors Affecting the Use of Antipsychotics and Antipsychotic Polypharmacy in a Child and Adolescent Psychiatry Inpatient Service.

Objective: We aimed to examine the antipsychotics used by patients hospitalized in the child and youth inpatient service providing tertiary care to investigate whether there is a difference between admission and discharge, polypharmacy, which antipsychotics are used, and which psychotropics are used concomitant with antipsychotics. Methods: Research data were collected retrospectively from all children and adolescents hospitalized in a child and adolescent psychiatry inpatient service in a university hospital in a 4-year period (2015-2019). The sociodemographic and clinical characteristics of the patients, the antipsychotics they used at admission and discharge, the other psychotropics concomitantly used with antipsychotics, and the side effects associated with antipsychotics during hospitalization were collected from the files of the 363 patients. Results: Patients on antipsychotics increased 12.1% from hospitalization to discharge. Antipsychotic polypharmacy increased from 16.2% at admission to 30.7% at discharge. Logistic regression analysis was performed to investigate the factors affecting antipsychotic and antipsychotic polypharmacy. Self-harm, aggression/violence, and extended hospitalization were factors associated with increased antipsychotic use. Psychotic symptoms, psychotic disorder, and extended hospitalization were factors associated with an increase in antipsychotic polypharmacy. Conclusions: Understanding the factors that may cause antipsychotic use and polypharmacy in inpatient services in children and adolescents may prevent unnecessary drug use and long-term side effects that may occur due to these drugs.

The Prevalence and Comorbidity Rates of ADHD Among School-Age Children in Turkey.

Objective: The aim of the present study was to explore the prevalence and comorbidity rates of ADHD in a community sample of school-age children. Method: Participants were 1,508 children aged 6 to 14 years. Parents and teachers of each child completed the Turgay Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S). Screen-positive cases were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Diagnoses were based on DSM-IV criteria. Results: The prevalence rate of ADHD was 8%. Children from extended families had extremely high rates (46.4%) of ADHD. Sixty percent of children with ADHD had one or more comorbid diagnoses. The most common comorbidities were learning disorders (35.7%) and oppositional defiant disorder (22.6%). Conclusion: The prevalence and comorbidity rates of ADHD in school-age children in Turkey are similar to those found in previous studies in other countries.

Altered levels of brain-derived neurotrophic factor, proBDNF and tissue plasminogen activator in children with posttraumatic stress disorder.

The current study aims to compare the serum brain-derived neurotrophic factor (BDNF), proBDNF and tissue plasminogen activator (tPA) levels in cases that have developed posttraumatic stress disorder (PTSD) in consequence of sexual abuse with those in healthy control subjects. Thirty-one female patients between 8 and 18 years of age who have been diagnosed with PTSD due to sexual abuse and thirty-one healthy female volunteer controls were included in the study. Frequency, intensity and severity of PTSD symptoms were assessed on the basis of Clinician-Administered Post-Traumatic Stress Disorder Scale for Children and Adolescents (CAPS-CA). Serum BDNF, proBDNF and tPA levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA) method. Results of the present study revealed that serum levels of BDNF and proBDNF in PTSD group were significantly lower but tPA level was significantly higher as compared to healthy control subjects. There were no correlations between CAPS-CA scores and BDNF, proBDNF and tPA levels. Decreased levels of BDNF, as suggested to have a role in the etiopathogenesis of PTSD, appear to be a result of the reduction in proBDNF production. The increased tPA levels in such cases, on the other hand, can be a compensatory mechanism serving to increase the BDNF levels.

Effects of perpetrator identity on suicidality and nonsuicidal self-injury in sexually victimized female adolescents.

PURPOSE: Child sexual abuse and sexual dating violence victimization are common problems that are known to have long-term negative consequences. This study aimed to compare the sociodemographic, abuse-related, and clinical features of female adolescents who were sexually abused by different perpetrators, and identify the factors associated with suicidality and nonsuicidal self-injury (NSSI) in these cases. PATIENTS AND METHODS: Data of 254 sexually abused female adolescents between the ages of 12-18 years were evaluated. The cases were classified into three groups, namely "sexual dating violence", "incest", and "other child sexual abuse", according to the identity of the perpetrator. The three groups were compared in terms of sociodemographic, abuse-related, and clinical features. RESULTS: Major depressive disorder was the most common psychiatric diagnosis, which was present in 44.9% of the cases. Among all victims, 25.6% had attempted suicide, 52.0% had suicidal ideation, and 23.6% had NSSI during the postabuse period. A logistic regression analysis revealed that attempted suicide was predicted by dating violence victimization (adjusted odds ratio [AOR] =3.053; 95% confidence interval [CI] =1.473, 6.330) and depression (AOR =2.238; 95% CI =1.226, 4.086). Dating violence victimization was also the strongest predictor of subsequent suicidal ideation (AOR =3.500; 95% CI =1.817, 6.741). In addition, revictimization was determined to be an important risk factor for both suicidal ideation (AOR =2.897; 95% CI =1.276, 6.574) and NSSI (AOR =3.847; 95% CI =1.899, 7.794). CONCLUSION: Perpetrator identity and revictimization are associated with negative mental health outcomes in sexually victimized female adolescents. Increased risk of suicidality and NSSI should be borne in mind while assessing cases with dating violence and revictimization histories, in particular.

Topiramate: A Novel Therapeutic Candidate for Diabetes and Aggression? Positron Emission Tomography (PET) Findings.

BACKGROUND: There is still limited knowledge regarding the role of impaired brain glucose metabolism in the generation of aggression during diabetes. Additionally, there are rapidly replicating piece of evidence suggesting that topiramate may exert significant mood stabilizing effect. In this respect, we aimed to evaluate the neurometabolic correlates of the therapeutic effect of topiramate in a patient with diabetes and Intermittent explosive disorder (IED). METHODS: We measured regional cerebral glucose metabolism using 2-[18F]-fluoro-2-deoxy-D-glucose and positron emission tomography (FDG-PET) in a diabetic patient with aggressive outbursts before and after treatment with topiramate. In order to reveal a defined information underlying the improvement of the aggressive symptoms we also combined the PET with Modified Overt Aggression Scale. RESULTS: We have found that topiramate leads to the improvement in Modified Overt Aggression Scale that was well correlated with the increase in cortical brain metabolism. DISCUSSION: The therapeutic role of topiramate may not only suggest secondary deficits due to diminished functions of the cortical part of emotional circuits but also indicate that diabetic individuals may be vulnerable to lower cerebral glucose metabolism in cortical regions. Further clinical trials that include well-conducted randomized controlled trials and cohort studies by using other methods (i.e., magnetic resonance spectroscopy and quantitative EEG analysis) are necessary to confirm our preliminary findings.

Increased urinary 6-hydroxymelatoninsulfate levels in attention deficit hyperactivity disorder diagnosed children and adolescent.

There are some studies in attention deficit hyperactivity disorder (ADHD) which note altered circadian rhythms, suggesting abnormalities in melatonin physiology. In order to better characterize the possible melatonin alteration in ADHD, in this study we aimed to detect daytime, nighttime and 24 h levels of 6-hydroxymelatoninsulfate (6-OH MS) in the patients diagnosed with ADHD. Twenty-seven patients between 6 and 16 years-old, who had been diagnosed initially with ADHD, but without other physical and psychiatric disease history and who had not taken psychotropic pharmacotherapy for six months, plus 28 healthy volunteer controls, were included in the study. Urine samples were collected during the whole 24 h cycle, daytime and nighttime separately to assess the time-dependent excretion of the 6-OH MS, which is the main urine metabolite of melatonin. The Enzyme-Linked Immunosorbent Assay (ELISA) method was used for measuring the urine 6-OH MS level. Daytime (15.4 (8.9-24.8) ng/ml vs 6.9 (2.5-15.9) ng/ml, p=0.002), nighttime (102.9 (65.3-197.7) ng/ml vs 61.5 (37.2-114.4) ng/ml, p=0.012) and 24 h (54.1 (34.6-83.9) ng/ml vs 27.3 (14.3-48.9) ng/ml, p=0.000) 6-OH MS levels median (25p-75p) were found to be significantly higher in the ADHD group. After adjustment for age and sex, there was a statistically significant difference between the ADHD group (59.8 ± 4.9) and control group (33.8 ± 4.8) in 24-h 6-OH MS levels (F(1, 51)=13.673, p=.001, partial η2=.211). There was no relationship between 6-OH MS levels and Conners Parent Rating Scale short form subscale scores for the ADHD group. These findings indicate that melatonin production is increased in ADHD cases. Further research is needed to determine and thereby understand the mechanisms underlying the higher melatonin production, to assess the impact of altered melatonin on the pathophysiology of ADHD.

Knowledge, attitude and behaviour of boys and parents about circumcision.

AIM: To determine the knowledge, attitude and behaviour of parents and previously circumcised early adolescent boys about circumcision. METHODS: Half of the boys attending the sixth class of the primary school in our city centre and their parents were included in this cross-sectional, descriptive study. Questionnaires were prepared by the authors, which include 38 questions for parents and 25 questions for boys. RESULTS: Sixty-six per cent of the students were circumcised at the age of 7 years and above, 26% between three and 6 years and 8% below 3 years of age. Forty-two per cent of boys were circumcised by a traditional circumciser and 64% were circumcised at home. Main reasons of circumcision for parents were religious purposes (79%) and health issues (51%). When the boys were asked about their thoughts during circumcision, they mostly stated that 'it was necessary to become a man' (58%) and 'it would hurt much' (50%). Thirty-eight per cent of boys were frightened during circumcision and 46% were worried. Boys circumcised in the 7 years and above age group were most content about their age of circumcision. CONCLUSIONS: We consider that it is reasonable to wait up to an age at which the child could understand and participate in the decision of the concept and timing of circumcision.

Developmental characteristics of children aged 1-6 years with food refusal.

OBJECTIVE: The aim of this study was to compare the sociodemographic and developmental characteristics of children with food refusal and children with no history of feeding problems. DESIGN: Cross-sectional case-control study. SAMPLE: 30 children aged 1-6 years who were seen in the outpatient clinics for food refusal formed the case group, and 30 healthy children matched for age, sex, and socioeconomic status formed the control group. METHODS: Anthropometric indices and early developmental characteristics of all the children in the study were evaluated and also their developmental levels were determined using the Ankara Developmental Screening Inventory. RESULTS: The mean age of children with food refusal was 42.4+/-17.6 months, and the male/female ratio was 12/18. Children with food refusal had shorter mean breastfeeding durations and lower mean birth weights, body mass index, percentage height for age, and percentage weight for height values than those of the controls. There were no significant differences between the 2 groups in developmental delays. CONCLUSIONS: These results suggest that food refusal may be related to lower birth weight and shorter breastfeeding duration. Further research with larger samples is needed to clarify these relationships and the effects of feeding problems on the growth and development of children.

[Family functioning, personality disorders, and depressive and anxiety symptoms in the mothers of children with food refusal]. / Yeme Reddi Olan Cocuklarin Annelerinde Kisilik Bozukluklari, Depresyon ve Anksiyete Belirtileri ve Aile Islevleri.

OBJECTIVE: A review of the literature reveals that feeding problems during early childhood can be related to maternal psychiatric disorders. We aimed to evaluate the personality disorders, levels of depression and anxiety symptoms in the mothers of children with food refusal in addition to family functioning. METHOD: Thirty children aged between 1 and 6 years admitted to the clinic for food refusal and their mothers were included in the study. The control group consisted of 30 healthy children and their mothers. The Beck Depression Inventory, State-Trait Anxiety Inventory, McMaster Family Assessment Device and Structured Clinical Interview for DSM-III-R Personality Disorders were performed in mothers, and the presence of any personality disorders was evaluated with the SCID-II Interview. RESULTS: The depression and anxiety scores of the mothers of patients were higher than those of the controls. Perceived family functioning by mothers of patients was more problematic than that of the controls. Rates of maternal personality disorders were not significantly different between the two groups. CONCLUSION: Food refusal is not only related to characteristics of the child or his/her mother, but also to problems in family functioning. An integrative approach which evaluates the whole family is helpful to assess and treat children with food refusal.