Determination of the relationship between major histocompatibility complex alleles and childhood onset obsessive-compulsive disorder.

BACKGROUND: About half of the cases of obsessive-compulsive disorder (OCD) occurring in childhood/adolescence occur with similar symptoms both in childhood and adulthood. Immunologic stress is claimed to be a risk factor in the etiology of childhood onset OCD. Our aim was to elucidate the relationship between childhood onset OCD risk and MHC complex I and II alleles. METHODS: MHC alleles of 49 OCD children together with 277 healthy children (aged 4-12) were analyzed by PCR. Results were evaluated by using univariate analysis and multivariate logistic regression analysis. RESULTS: A2, A29, C4, DRB3.1, and DRB1*16 alleles were found to increase the risk of OCD. DISCUSSION: The relationship found between DRB locus and OCD in this study was remarkable since there have been studies on different populations reporting similar relationship between DRB locus and rheumatoid arthritis, which is also an AID. MHC class I and class II alleles were found to increase the risk of OCD in our study, which serves as a suitable model for studies suggesting that MHC genes do not work completely independently. Even though the MHC class I and II genes are considered to have different roles in immune response, in fact they tend to work in cooperation. As in previous studies on AIDs, there is a linear relationship between MHC class II alleles and OCD risk.

Role of calcium metabolism in ADHD: The relationship between parathyroid hormone and ADHD symptom severity.

Background: Vitamin D has been found to be associated with the pathogenesis of attention deficit hyperactivity disorder (ADHD). However, the potential role of parathyroid hormone (PTH) is still unclear. Aim: We aimed to investigate the association between calcium metabolism and ADHD symptomatology. Methods: We included 106 participants aged between 7 and 13 years old (51 ADHD patients, mean age: 9.54 ± 1.77, 55 healthy controls mean age: 9.97 ± 0.94) to this study. K-SADS-PL and Conners' Parent/Teacher Rating Scales, Stroop Test were performed. Blood samples to measure serum levels of Vitamin D, PTH, calcium (Ca), magnesium (Mg), phosphorus (P), and alkaline phosphatase (ALP) were collected in the spring (March-April-May) to prevent seasonal variability. Results: PTH, P, and ALP values were significantly lower and Vitamin D, Ca, and Mg values were significantly higher in the ADHD group (P < 0.05, for all). Both groups had Vitamin D deficiency. Control group has lower Vitamin D levels than the ADHD group (respectively; 17.66 ± 9.07, 21.99 ± 10.99, P < 0.05). There was a negative correlation between PTH and CTRS hyperactivity, CGI-RI and CGI-EL sub-scores, CGI-Total, DSM-IV-Inattention, DSM-IV Hyperactivity/Impulsivity, DSM-IV-Total scores (P < 0.05, for all). Conclusions: We found lower PTH levels in ADHD patients and a strong and negative correlation between PTH and symptom severity. Future studies are needed to clarify if these findings are due to the key role of PTH in ADHD pathology or PTH's function in activating vitamin D.

Effect of Impairment on the Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder in a National Survey: Nation-Wide Prevalence and Comorbidities of ADHD.

OBJECTIVE: This study aimed to determine the prevalence and comorbidities of attention-deficit hyperactivity disorder (ADHD) by evaluating a large-scale nation-wide sample of children. METHOD: The inclusion criterion was being enrolled as a 2nd, 3rd, or 4th-grade student. A semi-structured diagnostic interview (K-SADS-PL), DSM-IV-Based Screening Scale for Disruptive Behavior Disorders, and assessment of impairment (by both parents and teachers) were applied to 5,842 participants. RESULTS: The prevalence of ADHD was 19.5% without impairment and 12.4% with impairment. Both ADHD with and without impairment groups had similar psychiatric comorbidity rates except for oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses. Impairment in the ADHD group resulted in significantly higher ODD and CD diagnoses. CONCLUSION: Even when impairment is not described, other psychiatric disorders accompany the diagnosis of ADHD and may cause impairment in the future. Impairment in the diagnosis of ADHD significantly increases the likelihood of ODD and CD.

Evaluation of child marriage in a Turkish sample: 8 years' data.

This study aims to examine 167 adolescents who were referred by courts between 2008 and 2016 to prepare medical-legal reports on their suitability for marriage. Most were illiterate or graduates of primary/secondary school; only 17 (10.2%) were still at high school. A total of 95 girls (56.9%) had a religious marriage without a civil certificate, 63 girls (37.7%) were pregnant, and 15 (9%) had a child. According to medical reports, 91 of the girls were considered unsuitable for marriage; 76 girls who were pregnant and/or had a child were also considered unsuitable, so it was necessary to let the judge decide.

Technological addictions in attention deficit hyperactivity disorder: Are they associated with emotional intelligence?

BACKGROUND: The impaired regulation of emotional responses has significant social consequences for patients with attention deficit hyperactivity disorder (ADHD) and can be thought to increase the risk for technological addictions. AIM: Ditto objective of the present research is to investigate the relationship between technological addictions and trait emotional intelligence (EI) in adolescents with ADHD. METHODS: This cross-sectional study was conducted in 150 treatment-naïve adolescents with ADHD, aged 12-18 years. The sociodemographic information form, the Emotional Quotient-Inventory: Youth Version (EQ-i: YV), Internet Addiction Test, Smartphone Addiction Scale, and Conners' Parent Rating Scales were used for data collection. RESULTS: The findings revealed that ADHD-C and female patients have lower mean stress management scores on EQ-i: YV. Patients who have smartphone addiction (SA)/problematic internet usage have lower total EI and stress management scores. The oppositional, hyperactivity, and DSM-total scores were negatively correlated with stress management scores. Intrapersonal and stress management scores were negatively correlated to SA symptoms. CONCLUSION: The stress management dimension was the strongest factor related to ADHD and technological addictions. In adolescents with ADHD, stress management may be the key factor to cope with daily problems. Therefore, the interventions to develop EI can be a therapeutic option in ADHD and technological addictions.

Mannose-Binding Lectin 2 Gene Polymorphism in PANDAS Patients.

INTRODUCTION: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), a subgroup of obsessive-compulsive disorder (OCD), has received much attention even though the specific underlying mechanisms remain unknown. Mannose-binding lectin (MBL) is a key factor in the innate immune response. The aim of this study was to investigate the role of MBL2 gene polymorphisms in pediatric OCD patients diagnosed as PANDAS, PANDAS-Variant and non-PANDAS. METHODS: The study included 102 pediatric OCD patients (59 [57.8% ] PANDAS, 20 [19.6% ] non-PANDAS, and 23 [22.5% ] PANDAS-Variant) and 60 healthy controls. Polymorphisms at codon 52, 54 and 57 of the MBL2 gene were investigated. RESULTS: Codon 54 polymorphism and any variant of MBL2 gene were significantly more frequent in the OCD group than in the control group (OR=2.97, 95% CI: 1.26-6.97; and OR=2.66, 95% CI: 1.32-5.38, respectively). According to regression analysis, the presence of any variant of MBL2 gene was found in 14.50-fold increased frequency in the PANDAS subgroup compared with the non-PANDAS subgroup (95% CI: 2.49-84.19). CONCLUSIONS: Our findings support an association between MBL2 genotypes and pediatric OCD, particularly PANDAS-OCD.

The Effectiveness of Melatonin in Head Banging: A case report.

Head banging is one of the three typical subtypes of rhythmic movement disorder. It typically involves anteroposterior movements of the head. Rhythmic movement disorder usually resolves in early childhood but less commonly persists into adolescence and adulthood. Although benzodiazepines commonly used, the universal effectiveness of any pharmacologic agent has not been approved. Herein, we present an 8-year-old girl patient suffered from head banging who responded to melatonin after in failure to imipramine treatment. Although nocomplete remission has been obtained, this is the first melatonin trial in a child patient with headbanging.

The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T).

AIM: The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey. METHOD: A nation-wide, randomly selected, representative population of 5830 children (6-13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently. RESULTS: Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring. CONCLUSION: This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group.

Recantation of Sexual Abuse Disclosure Among Child Victims: Accommodation Syndrome.

BACKGROUND: Disclosing the sexual abuse may be related on many individual and/or environmental factors in all age groups. The sociocultural context is the most influential factor of the disclosing process especially for those living in patriarchal cultural values. This study compares the impacts of sexual abuse and other sociodemographic variables between recanting and non-recanting victimized groups in Adana city from Turkey. METHODS: The samples attending our department were divided into two groups: group 1 comprised victims who recanted their first abuse disclosure, and group 2 comprised victims who insisted on the veracity of their first report at further evaluations. The characteristics of the child, family, and abuser were compared between recanting victims and non-recanting victims by retrospective data. RESULTS: Each group included 27 children, for a total of 54 subjects. All adverse social reactions after the sexual abuse, including keeping secrets and a repressive family attitude, were higher among group 1 victims than group 2 victims (p < 0.0001). CONCLUSIONS: Although they are victimized by protecting family integrity, victims may show a tendency to keep secrets and to not immediately disclose an abuse event.

Prevalence of Childhood Affective disorders in Turkey: An epidemiological study.

AIM: To determine the prevalence of affective disorders in Turkey among a representative sample of Turkish population. METHODS: This study was conducted as a part of the "The Epidemiology of Childhood Psychopathology in Turkey" (EPICPAT-T) Study, which was designed by the Turkish Association of Child and Adolescent Mental Health. The inclusion criterion was being a student between the second and fourth grades in the schools assigned as study centers. The assessment tools used were the K-SADS-PL, and a sociodemographic form that was designed by the authors. Impairment was assessed via a 3 point-Likert type scale independently rated by a parent and a teacher. RESULTS: A total of 5842 participants were included in the analyses. The prevalence of affective disorders was 2.5 % without considering impairment and 1.6 % when impairment was taken into account. In our sample, the diagnosis of bipolar disorder was lacking, thus depressive disorders constituted all the cases. Among depressive disorders with impairment, major depressive disorder (MDD) (prevalence of 1.06%) was the most common, followed by dysthymia (prevalence of 0.2%), adjustment disorder with depressive features (prevalence of 0.17%), and depressive disorder-NOS (prevalence of 0.14%). There were no statistically significant gender differences for depression. Maternal psychopathology and paternal physical illness were predictors of affective disorders with pervasive impairment. CONCLUSION: MDD was the most common depressive disorder among Turkish children in this nationwide epidemiological study. This highlights the severe nature of depression and the importance of early interventions. Populations with maternal psychopathology and paternal physical illness may be the most appropriate targets for interventions to prevent and treat depression in children and adolescents.

Six months methylphenidate treatment improves emotion dysregulation in adolescents with attention deficit/hyperactivity disorder: a prospective study.

PURPOSE: Individuals with attention deficit/hyperactivity disorder (ADHD) may suffer from emotional dysregulation (ED), although this symptom is not listed among the diagnostic criteria. Methylphenidate (MPH) is useful in reducing emotional symptoms in ADHD. The aim of the present study was to determine both psychosocial risk factors and presence of ED in adolescents with ADHD before and after MPH treatment. PARTICIPANTS AND METHODS: Eighty-two patients aged 12-18 years with ADHD were included as participants. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime, the Difficulties in Emotion Regulation Scale (DERS), sociodemographic form, and the Inventory of Statements About Self-Injury were administered. Results were compared before and after 6 months MPH treatment. RESULTS: A significant improvement was detected on DERS for impulsivity (15.9±6.8 initial vs 14.2±6.5 final test, p<0.01) and total score (88.4±23.3 initial vs 82.4±2.7 final test, p<0.05) across all patients taking MPH regardless of subtype and sex. Despite treatment, a significant difference remained for impulsivity, strategies, and total score in patients with comorbid oppositional defiant disorder (ODD) compared with those without ODD, but no difference was detected for conduct disorder comorbidity. In patients who self-harm, scores for goals, impulsivity, strategies, clarity, and total score were higher before treatment: furthermore, impulsivity and total score remained high after treatment. In maltreated patients, goals, impulsivity, strategies, and total scores were significantly higher before treatment; however, their symptoms were ameliorated after treatment with MPH. CONCLUSION: Individuals with severe ED may "self-medicate" by smoking and/or self-harming. MPH led to significant improvements in ED possibly owing, in part, to a decrease in impulsivity, so that individuals felt more able to supervise their emotions and engage in goal-directed behaviors. ED should be considered particularly in patients with additional psychosocial factors and ODD comorbidity, and included in the treatment plan.

[Executive Functions in Frontal Lob Syndrome: A Case Report]. / Frontal Lob Sendromunda Yönetici Islevler: Bir Olgu Sunumu.

Prefrontal cortex in frontal lobe (FL) is the center of executive functions (EF). FL damage can lead to executive dysfunction by influencing frontal-subcortical circuits (dorsolateral, orbitofrontal, ventromedial). Damage to the dorsolateral prefrontal cortex (DLPFC) can lead to deterioration in EF, whereas damage to the orbitofrontal cortex (OFC) can lead to personality changes with the characteristic of disinhibition and irritability. In addition, damage to the anterior cingulate cortex/medial prefrontal cortex (ACC/MPFC) can result in decreased spontaneity. Neuropsychological tests are important components in the assessment of EF including goal-directed behavior, decision-making, risk assessment, making plans for the future, setting of priorities and order of our actions. Clinical conditions affecting frontal-subcortical connections outside of the FL can also lead to executive dysfunctions and frontal lobe syndrome (FLS). This case report is about an adolescent patient diagnosed as FLS. The clinical symptoms, assessment and treatment processes of this case are discussed in this report. The case is a 15-year-old boy that was admitted to our clinic with behavioral problems, which began after a car accident three years ago. Magnetic resonance imaging (MRI) of the brain indicated hyperintense signal increase in periventricular deep white matter that is associated with traumatic brain damage. Neuropsychological tests results (Stroop, Wisconsin Card Sorting Test, Serial Digit Learning Test, Line Orientation Test, Verbal Memory Processes Scale) have demonstrated impairment in cognitive flexibility, verbal fluency, setting priority, inappropriate response inhibition, sustained attention, planning, problem solving, organization skills and subcortical memory functions. We thought that cognitive and behavioral symptoms of this case were associated with the dysfunctions of frontal-subcortical circuits, independent of an obvious frontal lesion. FLS for the patients with sudden-onset behavioral and cognitive problems after head traumas should be kept in mind in differential diagnosis, even in the absence of an obvious frontal lesion.

Vitamin D insufficiency in a boy with obsessive-compulsive disorder.

Vitamin D deficiency not only causes low bone mass but also may lead to neuropsychiatric disorders. In the present case, vitamin D supplementation reduced obsessive-compulsive disorder (OCD) symptoms associated with streptococcal infection in a 7-year-old boy. Sudden onset of symptoms, including excessive hand washing and fear of touching anything, had occurred 1 month before presentation. Although there are few studies on a possible causal relationship between vitamin D and neuropsychiatric disorders, the present report; together with previous data, suggest an etiological role of vitamin D-related immune processes.

Vitamin D Deficiency in Obsessive-Compulsive Disorder Patients with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: A Case Control Study.

INTRODUCTION: Previous studies have indicated that vitamin D deficiency is common in psychiatric patients, particularly in those with neuropsychiatric disorders such as autism and schizophrenia. Vitamin D is an important neurosteroid hormone and immunomodulatory agent that also has bone metabolic effects. There has been an increasing interest in immune-related neuropsychiatric symptoms that are triggered by group A beta-hemolytic streptococcal infections. In this study, we aimed to compare the serum levels of vitamin D between obsessive-compulsive disorder (OCD) patients with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and control subjects. METHODS: Thirty-three OCD patients with PANDAS and 20 healthy controls were enrolled in the study. Serum 25-hydroxyvitamin D (25-(OH) D), calcium, phosphorus, alkaline phosphatase, and parathormone levels of the two groups were compared. Serum 25-(OH) D levels of <15 ng/mL were classified as vitamin D deficiency. The children's Yale-Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impression (CGI) were used to assess the severity of OCD symptoms. RESULTS: There was no significant difference in serum 25-(OH) D levels between the patient and control groups. However, vitamin D deficiency was significantly more frequent in the patient group than in the control group (48.5% vs. 20.0%; p=0.038). Moreover, OCD patients with vitamin D deficiency had higher rates of comorbid ADHD than those without vitamin D deficiency (87.5% vs. 52.6%; p=0.027). While serum phosphorus levels were negatively correlated with age as well as alkaline phosphatase and ASO levels, they were positively correlated with the YBOCS total score and global severity score. Serum parathormone levels were positively correlated with the YBOCS total score, compulsion score, obsession score, and global severity score. CONCLUSION: This study supports the hypothesis that an association between vitamin D metabolism and PANDAS-related OCD exists. We suggest that biochemical parameters predicting metabolic bone diseases are more common in PANDAS patients. There is a need for prospective studies to show a clear association between PANDAS and bone metabolic turnover based on autoimmune mechanisms.

Association between pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections disease and tumor necrosis factor-α gene-308 g/a, -850 c/t polymorphisms in 4-12-year-old children in Adana/Turkey.

OBJECTIVES: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a newly defined disease in neuropsychiatry and occurs with an autoimmune mechanism after Group A Beta Hemolytic Streptococcus (GABHS) infection. Tumor necrosis factor (TNF), encoded by TNF-α gene has an important role in the apoptotic mechanisms of autoimmune diseases. Recently, TNF-α polymorphisms and autoimmune/psychiatric disorders have been reported to be related. In this regard, we focused on to investigate a possible relation between the TNF-α gene promoter region-308 G/A and - 850 C/T polymorphisms and PANDAS. MATERIALS AND METHODS: In this study, ages of PANDAS patient and control groups were ranging from 4 years to 12-year-old. Patient group includes childhood onset PANDAS patients (n = 42) and control group includes healthy children (n = 58). Diagnoses have been carried out according to Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) criteria with Affective Disorders and Schizophrenia-Present and Lifetime (KSAD-S-PL) and Children Yale-Brown Obsessive Compulsive Scale Moreover, PANDAS criteria established by the American National Psychiatry Institute have been employed for diagnoses. For identifying polymorphisms; Polymerase Chain Reaction, Restriction Fragment Length Polymorphism and Polyacrylamid Gel Electrophoresis were used. RESULTS AND DISCUSSION: For -308 polymorphism, 37 of 42 PANDAS patients' results and for -850 C/T polymorphism, 38 of 42 PANDAS patients' results were obtained. According to our statistical analysis there is a positive relationship between PANDAS patients for -308 G/A polymorphism but not for -850 C/T polymorphism. There is no positive relationship between -308 G/A polymorphism and antistrep-tolysin O (ASO) titers and no relationship between -850 C/T polymorphism and ASO titers. We found, however, positive relationship between genders of patients (boys) and the disease. According to our results, we propose that the AA polymorphism of -308 G/A polymorphism can be used as a molecular indicator for PANDAS.

Sexual abuse in a classroom of ten male students: a group victimization.

The term "professional perpetrator" is used to describe individuals who commit sexual abuse in the capacity of a position of trust such as a teacher, household member, or employer. There is an increasing body of evidence focusing on educator sexual abuse in the school environment. However, data are limited about this topic. The aim of this paper is to present the rare occurrence of the case of a male teacher in Turkey who sexually abused his students in an elementary school. Although it is unknown which populations are most vulnerable to sexual abuse, in Turkey we think that the indigenous population is at risk. Abuse cases are not logged into the criminal justice system because the majority of abuse allegations are ignored or disbelieved by families.

Aripiprazole Improved Obsessive Compulsive Symptoms in Asperger's Disorder.

There are many comorbid disorders associated with autism spectrum disorders in child and adolescent population. Although obsessive compulsive disorder and autism spectrum disorders (ASD) comorbidity has common in clinical practice, there are few reports about psychopharmacological treatment for obsessive compulsive symptoms in children with ASD in the literacy. We report a successful treatment case with aripiprazole in Asperger's Disorder with obsessive compulsive symptoms. The Yale Brown Obsessive Compulsive Scale was performed to assess symptom variety. This case report supports the effectiveness of aripiprazole in treatment of obsessive compulsive symptoms in Asperger's Disorder or ASDs. Aripiprazole may be beneficial to obsessive compulsive disorder comorbid autism spectrum disorders in child and adolescent age group.

Child sexual abuse: seven years in practice.

The purpose of this study was to determine the socio-demographic characteristics of sexually abused children. The records of 101 cases of child sexual abuse (CSA) were retrospectively evaluated. Socio-demographic characteristics of the victims, type of sexual abuse, and psychiatric diagnosis were studied. Of the victims, 56.4% (n = 57) were female and 43.6% (n = 44) were male. The mean age was 9.57 +/- 3.5, with a range of 4-17 years. Ninety-three (92.1%) of the victims had been admitted as part of the legal process. The majority (66.3%) of the victims had been abused by an acquaintance, while 33.7% had been abused by a stranger. Anal or vaginal penetration was reported in 48.5% of the cases. Post-traumatic stress disorder was the most common (54.5%) psychiatric diagnosis established after sexual abuse. Descriptive data related to the abused children and an understanding of the consequences of CSA will help authorities in planning prevention.

Short-term effects of playing computer games on attention.

OBJECTIVE: The main aim of the present study is to investigate the short-term cognitive effects of computer games in children with different psychiatric disorders and normal controls. METHOD: One hundred one children are recruited for the study (aged between 9 and 12 years). All participants played a motor-racing game on the computer for 1 hour. The TBAG form of the Stroop task was administered to all participants twice, before playing and immediately after playing the game. RESULTS: Participants with improved posttest scores, compared to their pretest scores, used the computer on average 0.67 +/- 1.1 hr/day, while the average administered was measured at 1.6 +/- 1.4 hr/day and 1.3 +/- 0.9 hr/day computer use for participants with worse or unaltered scores, respectively. According to the regression model, male gender, younger ages, duration of daily computer use, and ADHD inattention type were found to be independent risk factors for worsened posttest scores. CONCLUSION: Time spent playing computer games can exert a short-term effect on attention as measured by the Stroop test.