Sex difference in alcohol withdrawal syndrome: a scoping review of clinical studies.

Background: We conducted a review of all studies comparing clinical aspects of alcohol withdrawal syndrome (AWS) between men and women. Methods: Five databases (PubMed, Cochrane, EMBASE, Scopus and Clinical Trials) were searched for clinical studies using the keywords "alcohol withdrawal syndrome" or "delirium tremens" limited to "sex" or "gender" or "sex difference" or "gender difference." The search was conducted on May 19, 2023. Two reviewers selected studies including both male and female patients with AWS, and they compared males and females in type of AWS symptoms, clinical course, complications, and treatment outcome. Results: Thirty-five observational studies were included with a total of 318,730 participants of which 75,346 had AWS. In twenty of the studies, the number of patients presenting with or developing AWS was separated by sex, resulting in a total of 8,159 (12.5%) female patients and a total of 56,928 (87.5%) male patients. Despite inconsistent results, males were more likely than females to develop complicated AWS [delirium tremens (DT) and AW seizures, collective DT in Males vs. females: 1,792 (85.4%) vs. 307 (14.6%), and collective seizures in males vs. females: 294 (78%) vs. 82 (22%)]. The rates of ICU admissions and hospital length of stay did not show sex differences. Although variable across studies, compared to females, males received benzodiazepine treatment at higher frequency and dose. One study reported that the time from first hospitalization for AWS to death was approximately 1.5 years shorter for males and males had higher mortality rate [19.5% (197/1,016)] compared to females [16% (26/163)]. Conclusion: Despite the significant heterogeneity of the studies selected and the lack of a focus on investigating potential sex differences, this review of clinical studies on AWS suggests that men and women exhibit different AWS manifestations. Large-scale studies focusing specifically on investigating sex difference in AWS are needed.

Association of Liver Transplant and Attention-Deficit Hyperactivity Disorder: A Single-Center Experience.

OBJECTIVES: This prospective cohort study aimed to determine the prevalence of attention-deficit hyperactivity disorder and to reveal how the diagnosis of attention-deficit/hyperactivity disorder can be made most accurately in children with liver transplant. MATERIALS AND METHODS: We studied a group of 62 children from 6 and 18 years old who underwent liver transplant at least 1 year previous to our study and who were followed up in the Department of Pediatric Gastroenterology. A child and adolescent psychiatrist evaluated all liver transplant patients for attention- deficit hyperactivity disorder based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The Kiddie Schedule for Affective Disorders and Schizophrenia (in Turkish) was applied to the children. The Kiddie Schedule and the Conners Parent Rating Scale were applied to the children's parents. The Conners Teacher Rating Scale was applied to the children's teachers. RESULTS: The frequency of attention-deficit hyperactivity disorder in the sample was found to be 24.5% according to Kiddie Schedule, 45.9% according to the Conners Parent Rating Scale, and 24% according to the Conners Teacher Rating Scale. However, clinical examination showed that 9.67% of the children had attention-deficit hyperactivity disorder. CONCLUSIONS: We concluded that detailed clinical examination is more important than neuropsychological tests and scales when diagnosing attention-deficit hyperactivity disorder in pediatric liver transplant recipients.

How did the COVID-19 pandemic affect child and adolescent psychiatry outpatient clinic admissions? A single-center, retrospective study.

BACKGROUND: The COVID-19 pandemic and the measures for controlling the pandemic adversely affected child and adolescent mental health; however, studies that examined the effects of the pandemic on child and adolescent mental health services are limited. This study aimed to determine the changes in admission to a child and adolescent psychiatry outpatient clinic (CAPOC) in the first year of the COVID-19 pandemic compared with the previous year. METHODS: In this study, the information regarding admissions to Baskent University Faculty of Medicine's CAPOC between March 2019 and March 2021 was examined. Information including age, sex, admission date, the form of admission (first admission/follow-up), and the diagnosis was obtained from the electronic medical record system and the differences between the pre-pandemic period and the pandemic period were assessed. RESULTS: It was found that during the pandemic, there was a decrease in CAPOC admissions; however, both female admissions and median age increased compared with the previous year. Also, admissions due to obsessive-compulsive disorder and somatic symptom-related disorders increased. CONCLUSIONS: Although there were fewer CAPOC admissions during the pandemic period compared with the pre-pandemic period, there were differences between the age, sex, and diagnosis distributions of the patients between the pandemic and the pre-pandemic period. Understanding the impact of the COVID-19 pandemic on CAPOC admissions will help plan child and adolescent mental health protective measures.

Relation of Anxiety, Depression, and Behavioral Problems With Time Allocated to Television, Computer, and Smartphone in Children Receiving Renal Replacement Therapy.

OBJECTIVES: Children and adolescents with chronic diseases have more screen exposure time compared with their healthy peers. In this study, we investigated screen exposure time of children who received renal replacement therapy, which included kidney transplant and dialysis treatment, versus a healthy control group. MATERIALS AND METHODS: Our study included 55 children and adolescents between the ages of 8 and 18 years. Although 28 participants did not have any chronic disease, 27 had chronic diseases and received renal replacement therapy. Among these patients, 17 had kidney transplant and 10 were receiving dialysis. A sociodemographic information form and the Conners Short-Form Parent Rating Scale were given to parents. Pediatric and adolescent patients completed the Children's Depression Inventory and Spielberger State-Trait Anxiety Scale-2. We analyzed differences between the groups with and without renal replacement therapy and examined relations between continuous variables. RESULTS: Duration of television screen time was significantly higher in children and adolescents receiving renal replacement therapy. Patients in the renal replacement therapy group showed a positive correlation between the Conners Short-Form Parent Rating Scale anxiety subscores and duration of smartphone use. In the kidney transplant recipient group, smartphone and computer durations were positively correlated and television duration was negatively correlated with the Conners Short-Form Parent Rating Scale behavioral problems subscores. CONCLUSIONS: Children on renal replacement therapy may be at risk in terms of excessive television exposure. Children who are on dialysis and have had a kidney transplant may be more prone to the negative effects of screen exposure than healthy peers who do not have chronic illnesses. These children and adolescents should be closely monitored to avoid the negative effects of excessive screen exposure.

Psychiatric Evaluation of Children During the Organ Transplant Process.

OBJECTIVES: Organ transplantation is performed frequently in Turkey. A routine psychiatric examination is performed before all transplant procedures, and psychiatric support is continued during the posttransplant period. In this study, we reviewed the psychiatric consultation records of child and adolescent patients admitted to Baskent University Hospital who underwent or were scheduled to undergo transplant to determine the prevalence of psychiatric disorders in this population. MATERIALS AND METHODS: Fifty-nine transplant patients were seen by the Department of Child and Adolescent Psychiatry between 2012 and 2015 and were evaluated based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. RESULTS: Thirty patients (50.8%) were female, and 29 patients (49.2%) were male. The mean age of the study population was 10.2 ± 4.5 years, and the mean age at transplant was 9.9 ± 4.6 years. In total, 69.5% of participants were diagnosed with a psychiatric disorder. The most common diagnosis was adjustment disorder, with a prevalence of 52.4%. CONCLUSIONS: Our study found that psychiatric disorders are frequently encountered in pediatric transplant patients. This study revealed a higher prevalence of psychiatric disorders during the posttransplant period than during the pretransplant period.

[Relationship between the Psychiatric Symptoms in Expecting Parents and Postpartum Depression and Infantile Colic: A Multicenter Follow up Study]. / Anne ve Baba Adaylarinda Psikiyatrik Belirtiler ile Dogum Sonrasi Depresyon ve Infantil Kolik Arasi Iliski: Çok Merkezli Bir Takip Çalismasi.

OBJECTIVE: The aim of this study is to evaluate the relationship between postpartum depression (PPD), infantile colic (IC) and different psychosocial variables, psychiatric symptoms, attachment style and perceived social support in expecting parents. METHOD: Two hundred forty five expecting mothers and 150 expecting fathers were first interviewed between the 22-34 weeks of pregnancy. Sociodemografic data form, Adult Attachment Style Scale (AASS), State Anxiety Inventory (SAI), Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS) and Brief Symptom Inventory (BSI) were filled out by each expecting parent. Second interview was conducted between the postpartum 4-24 weeks. Data form consisting health, nutrition, sleep and crying problems of the infant and EPDS and SAI were filled out by mothers and SAI by fathers. RESULTS: One in every four mothers had PPD symptoms above the threshold on EPDS. Maternal and paternal insecure attachment style, maternal psychiatric symptoms and postpartum anxiety level were found to be the predictors of PPD. One in every five infants had IC and maternal education level, hostility score and PPD symptoms along with paternal insecure attachment style and psychiatric symptoms were the main predictors of IC. CONCLUSION: Results about PPD and IC regarding maternal variables are consistent with the literature. In addition, paternal insecure attachment style is found to be an important risk factor for both PPD and IC. Fathers should also be included in further studies exploring PPD or IC.

Quality of life and anxiety in Turkish patients with anorectal malformation.

AIM: The aim of this study was to investigate quality of life (QoL) and anxiety level in Turkish children with anorectal malformation as well as the anxiety level of their mothers and the support group effects on anxiety. METHODS: A total of 87 children and their parents were included. They were grouped according to children's age: <8 years (group 1), 8-12 years (group 2) and >12 years (group 3). The anxiety of all mothers and of children in group 3 was assessed by Spielberger's State-Trait Anxiety Index-2. The QoL of children in groups 2 and 3 was evaluated with the Ped-QL 4.0 test by self-report and proxy report. The QoL results in groups 2 and 3 were compared with age-matched controls. RESULTS: Mothers in groups 1 and 3 were more anxious than were those in group 2. Adolescents in group 3 had poorer QoL compared with controls by self- and proxy reports. A significant difference was observed in QoL between the children who did and those who did not soil. The anxiety level was significantly lower in parents who attended more than one meeting. CONCLUSIONS: High anxiety and poor QoL levels in adolescence may have been related to the growing importance of body image. The higher anxiety levels of mothers in group 1 could be explained by an encounter with a baby who was different from the imagined baby and the newness of illness. QoL may have been perceived as being worse than what it was for psychological reasons.

Comparing brain magnetic resonance spectroscopy findings of pediatric treatment-naive obsessive-compulsive disorder patients with healthy controls.

OBJECTIVE: It is believed that biochemical alterations in different brain regions are involved in the pathophysiology of obsessive-compulsive disorder (OCD) in children and adolescents. The aim of this study was to explore possible metabolic variations between pediatric OCD cases and healthy controls in brain regions which were implicated in OCD pathophysiology. METHOD: Children and adolescents between 8 and 16 years of age with OCD (n:15) and case matched healthy controls (n:15) were recruited for the study. After detailed clinical and neuropsychological evaluations, all subjects underwent the multiregional magnetic resonance spectroscopy (MRS) procedure with a long echo time (TE:135). RESULTS: Significantly lower n-acetylaspartate (NAA) ratios in the left inferior frontal gyrus, right occipital grey matter, left anterior cingulate cortex and lower choline (Cho) ratios in right and left anterior cingulate cortex and higher Cho ratio in left lenticular nucleus was observed in the OCD group. Also we found a negative correlation between OCD duration and left insular cortex NAA/Cho ratio. CONCLUSION: We found significant metabolic alterations in the brain regions which were implicated in OCD pathophysiology. Lower NAA and Cho ratios in anterior cingulate cortex and lower NAA ratios in the left inferior fronyal gyrus containing lateral orbitofrontal cortex can be possibly related to higher activation in OCD patients. Also further studies of the occipital lobes and insula should be continued in OCD.