Evaluation of subclinical cardiovascular risk in drug-naive pediatric patients with anxiety disorders.

OBJECTIVE: This study examined subclinical atherosclerosis in drug-naïve children with anxiety disorders using non-invasive measures to investigate the clinical features associated with subclinical atherosclerosis. METHOD: A total of 37 drug-naive children and adolescents with anxiety disorders and 37 healthy controls were included in the study. The Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory (STAI-T and STAI-S) were used to assess children's depression and anxiety levels. Carotid artery intima-media (cIMT), epicardial adipose tissue (EAT), and periaortic adipose tissue (PAT) thicknesses, which are indicators of subclinical atherosclerosis, were obtained by echocardiographic measurements. RESULTS: Multivariate analysis of covariance (MANCOVA) revealed a significant main effect on cIMT, EAT thickness, and PAT thickness, independent of confounding factors such as age, sex, body mass index, mean blood pressure, and family income (Pillai's Trace V = .76, F (1, 72) = 35.60, P < .001, ηp2 = .76). Analysis of covariance (ANCOVA) showed that cIMT, EAT thickness, and PAT thickness values were significantly higher in the anxiety disorder group compared to the the control group (P < .001). In partial correlation analysis, a positive correlation was observed between STAI-T and cIMT and EAT thickness. In linear regression analyses, age and STAI-T were significantly correlated with cIMT and EAT thickness levels. CONCLUSIONS: These results suggest that subclinical cardiovascular risk is significantly increased in children and adolescents with anxiety disorders.

Case of twin achondroplasia and autism coexistence and literature review.

Achondroplasia and autism spectrum disorder (ASD) are two genetically based disorders. The coexistence of autism with chromosomal abnormalities such as Down syndrome, monogenic syndromes such as tuberous sclerosis, Fragile X, and Rett syndrome, and microdeletion syndromes such as Phelan-McDermid syndrome helps to shed light on the genetic basis of autism spectrum disorder. The association between ASD and achondroplasia has been reported twice in the literature. In this article, we report Turkish patients who were born as identical twins from IVF pregnancy of 34 and 36-year-old parents, clinically and molecularly diagnosed with achondroplasia, and diagnosed with ASD at the age of 39 months. Our case is the first twin patient with the coexistence of achondroplasia and autism. We discuss environmental and genetic factors contributing to the development of ASD.

Cardiovascular Disease Risk in Children and Adolescents with Attention Deficit/Hyperactivity Disorder.

Objective: The aim of this case-controlled study is to evaluate chronic inflammation, subclinical atherosclerosis and cardiovascular disease risk in children and adolescents with ADHD. Methods: A total of 51 medication-free children and adolescents with ADHD and 51 healthy controls were included in this study. K-SADS-PL was used to determine the diagnosis of ADHD and other psychiatric disorders. Conners' Parent Rating Scale-Revised Short Form and the Conners' Teacher Rating Scale-Revised Short Form severity of ADHD was used to evaluate severity of ADHD. In order to evaluate subclinical atherosclerosis, common carotid intima media thickness (IMT), epicardial adipose tissue thickness (EAT), and periaortic adipose tissue thickness (PAT) were assessed as well as clinical parameters. Results: The IMT (0.037 ± 0.005 cm vs. 0.026 ± 0.003 cm), EAT (0.472 ± 0.076 cm vs. 0.355 ± 0.051 cm), and PAT (0.135 ± 0.016 cm vs. 0.118 ± 0.009 cm) measurements were significantly higher in the ADHD group than in the control group. Additionally, partial correlation analyses revealed that a positive correlation was observed between IMT and EAT, and PAT measurements separately. Multivariate linear regression analysis revealed that, body mass index (BMI) positively predicted IMT. Also, age and BMI positively predicted the EAT levels of the subjects with ADHD. Conclusion: Our results suggest that children and adolescents with ADHD have a risk for cardiovascular disease. For this reason, subclinical atherosclerosis should be taken into consideration in the follow-up and treatment of ADHD for cardiovascular disease risk.

Oxytocin and Vasopressin Levels and Related Factors in Adolescents with Social Phobia and Other Anxiety Disorders.

Objective: This study aimed to determine whether a difference exists in plasma oxytocin and vasopressin levels among social anxiety disorder, other anxiety disorders, and healthy control groups in adolescents. The relationship between several psychiatric variables (i.e., state and trait anxiety, social anxiety, childhood trauma, and behavioral inhibition) and oxytocin or vasopressin levels were also investigated in adolescents with anxiety disorders. Methods: The study included three groups of adolescents: social anxiety disorder (n = 29), those with other anxiety disorders (n = 27), and the control group (n = 28). The participants filled out self-report scales to determine various psychological variables. Oxytocin and vasopressin levels were determined from the blood samples of the participants. Results: The oxytocin levels did not show a significant difference between the social anxiety disorder group and the other anxiety disorders group. However, the oxytocin levels were significantly higher in the social anxiety disorder and other anxiety disorders groups than in the control group. The vasopressin levels did not show a significant difference among the groups. According to the hierarchical regression analysis, the state and trait anxiety levels predicted oxytocin in opposite directions. Oxytocin showed positive and negative relationship with trait and state anxiety respectively. No predictive factors were found for the vasopressin levels. Conclusion: We found that the oxytocin levels of adolescents with social anxiety disorder were not different from those of adolescents with other anxiety disorders. Further studies can improve our knowledge of the relationship among anxiety disorders and oxytocin or vasopressin.

The validity and reliability of the Stress and Anxiety to Viral Epidemics-9 items Scale in Turkish health care professionals.

There is a need for a valid and reliable measurement tool that will detect the psychological symptoms of health care workers in the epidemic and pandemic periods that have been effective worldwide in recent years. This study has aimed to investigate the validity and reliability of the Stress and Anxiety to Viral Epidemics-9 items Scale (SAVE-9) in Turkish health care professionals. The study was carried out with 150 health care professionals. All participants were asked to complete the SAVE-9, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Brief Resilience Scale (BRS). The Cronbach's α coefficient was calculated. Also, exploratory and confirmatory factor analyses were used to evaluate the factor structure. The SAVE-9 scores positively correlated with the PHQ-9, GAD-7, and negatively correlated with the BRS. The exploratory and confirmatory factor analyses supported two-factor structure similar to the original scale. The first factor consists of five items (1, 2, 3, 4, 5, 8), and the second factor consists of three items (6, 7, 9). The Cronbach's α coefficient was found as 0.77. The Turkish version of SAVE-9 is a valid and reliable tool for Turkish health care professionals.

Neutrophil-lymphocyte and Platelet-lymphocyte Ratios among Adolescents with Substance Use Disorder: A Preliminary Study.

OBJECTIVE: Substance use disorder (SUD) is a serious public health problem affecting both the individual and the society, and substance use-related deaths and disability have been shown to increase gradually. Recent etiologic studies have reported that there is a relation between inflammatory parameters and psychiatric disorders. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) used as an indicator of inflammation have been shown to be increased in various psychiatric disorders. In this study, we aimed to investigate the NLR and PLR in adolescents with SUD. METHODS: This study was conducted by retrospectively examining the records of 55 male adolescents who were followed up with SUD in a child and adolescent psychiatry outpatient clinic between November 2019-June 2020. Patients who had comorbid psychiatric disorder were included, and those who received any psychotropic medication were excluded. A total of 61 healthy male adolescents in the same age range without any psychiatric disorders were recruited as a control group. Neutrophil-lymphocyte-platelet counts were noted retrospectively from complete blood tests, and NLR-PLR were calculated. RESULTS: The NLR and PLR of adolescents with SUD were significantly higher than the healthy adolescents (p < 0.01, p < 0.01, respectively). In addition, conduct disorder, depression, and attention deficit/hyperactivity disorder, which were determined as the most common comorbid psychiatric disorders had no effects on NLR (p = 0.513, p = 0.584, p = 0.394, respectively) and PLR (p = 0.210, p = 0.346, p = 0.359, respectively). CONCLUSION: The results of current study indicate that inflammatory processes may have a key role in the pathophysiology of SUD.

Evaluation of hematological inflammatory markers in children and adolescents with attention deficit/hyperactivity disorder.

AIM: This study aims to investigate whether there is a relationship between attention-deficit/hyperactivity disorder (ADHD) and inflammation, using hematologic inflammatory parameters in a large sample of children and adolescents. METHOD: This retrospective study comprises 347 children and adolescents with ADHD between 6 and 17 years of age who met the inclusion criteria as well as 205 healthy children and adolescents in the control group. Serum parameters such as white blood cell (WBC), neutrophil, lymphocyte, platelet, monocyte, eosinophil and basophil counts, mean platelet volume (MPV), and platelet distribution width (PDW) were recorded from complete blood count tests at the time of admission, while neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and other ratios were calculated based on these counts. RESULTS: NLR, PLR, MPV, PDW, WBC and neutrophil counts were significantly higher in children and adolescents with ADHD than in the control group. In the ADHD group, NLR, WBC and neutrophil counts were significantly higher in girls than in boys. CONCLUSIONS: The results of this study support the hypothesis that inflammation plays an important role in the complex pathophysiology of ADHD. In addition, our data confirm that easily obtainable and reliable hematological parameters can be used when investigating the role of inflammation in ADHD etiology (Tab. 4, Ref. 44).

Hemogram parameters in childhood anxiety disorders: Could anxiety disorders be related with inflammation?

In the etiology of anxiety disorders, immune system and inflammation are suggested to play a role. This study hypothesized that there is a relationship between anxiety disorders and inflammation. This retrospective study included 131 children and adolescents between the ages 6-17 who were diagnosed with anxiety disorders. Control group consisted of 131 healthy children with no history of psychiatric disorders or chronic inflammatory conditions. White blood cell (WBC), neutrophil (NEU), lymphocyte, monocyte, basophil, eosinophil values and other hematological markers were noted. From those values, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and other ratios were calculated. WBC and NEU values were significantly higher in children and adolescents with anxiety disorder compared to the control group. In addition, NLR, MLR and PLR values were significantly higher than the control group. Other measured parameters and calculated values did not differ between study groups. No statistically significant difference was found between Generalized Anxiety Disorder (GAD) group, Social Anxiety Disorder group and Not Otherwise Specified Anxiety Disorders (AD-NOS) group in terms of hematological markers except RDW-CV. Only RDW-CV was found statistically significantly higher in AD-NOS group compared to GAD. These results show that there is an association between inflammation and anxiety disorders. Also, it is postulated that hematological parameters can be used as a useful marker in the follow-up of patients with anxiety disorders.

Methylphenidate-Induced Enuresis: 3 Case Reports.

ABSTRACT: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Methylphenidate (MPH) is one of the most widely used drugs in the treatment of ADHD. Enuresis can occur comorbidly with ADHD. However, enuresis is sometimes seen in patients with ADHD as an adverse effect of MPH treatment. In contrast, in some cases, MPH reportedly improves enuresis in patients with ADHD comorbid with enuresis. The literature is contradictory with regard to the relationship between MPH and enuresis. This report presents the cases of 3 children with ADHD who displayed enuresis during MPH treatment.

Sertraline for Trypophobia: Report of an Adolescent Case.

Trypophobia is a clinical entity that is characterized by unpleasant feelings related to or an aversion to irregular patterns of small holes or bumps. There are insufficient data about the etiological factors underlying trypophobia. It has been associated with anxiety disorders because it shows comorbidity and symptom similarity with anxiety disorders. Literature on the treatment strategies of trypophobia is somewhat limited. In this case report, we present an adolescent girl with trypophobia that is successfully treated with sertraline.

Treatment of Isolated Cataplexy With Low-dose Aripiprazole in an Adolescent Patient.

BACKGROUND: Cataplexy is a clinical entity that is characterized by transient muscle tone loss that mostly occurring as a part of narcolepsy. On the other hand, isolated cataplexy (IC) (hereditary cataplexy) is defined as loss of muscle tone that is not accompanied by narcolepsy. Emotional reactions may trigger IC episodes. Additionally, human leukocyte antigen (HLA) DQB1 alleles were shown to be related to IC. Various antidepressants are useful in the treatment of IC; however, there is limited knowledge on the use of antipsychotics in the treatment of IC. CASE REPORT: A 16-year-old adolescent girl was consulted child and adolescent psychiatry outpatient clinic with complaint of sudden episodes of loss of muscle tone. Her HLA typing showed HLA DQB1*03 haplotype. She was diagnosed with IC and was prescribed aripiprazole 2.5 mg/d and her IC symptoms disappeared and never recurred over 6 months of follow-up. CONCLUSIONS: In this case report, we present an adolescent girl with IC that is successfully treated with aripiprazole, an antipsychotic. This case report suggests that aripiprazole may be safely used in some adolescents who diagnosed with IC.

Low-dose Aripiprazole Induced Enuresis Continuum in a Child.

Aripiprazole is an atypical antipsychotic commonly used in the treatment of childhood disorders, such as bipolar disorder, psychosis, and irritability associated with autism spectrum disorder. Common side effects of its use include extrapyramidal side effects, somnolence, tremor, fatigue, nausea, and akathisia. Enuresis is an additional and rare side effect of aripiprazole use. There is limited data on the subject of enuresis induced as a result of treatment with aripiprazole. To our knowledge, there are no reports in the literature on aripiprazole-induced enuresis continuum in children. In this report, we present the case of a 9-year-old boy who developed enuresis continuum after the initiation of a low dose of aripiprazole and describe his rapid improvement when administration of the drug was ended.

Orexin A in adolescents with anxiety disorders.

Objectives: The relationships between orexins and stress-related conditions have been well documented in animal studies. However, human studies confirming this relationship are limited. The aim of this study was to investigate the association between orexin-A and anxiety disorders in adolescents. Additionally, we aimed to examine the relationship between orexin-A and cortisol levels in those with anxiety disorders.Methods: A total of 56 medication-free adolescents diagnosed with any anxiety disorder, except for specific phobias, and 32 healthy controls were included in this study. Depression, state and trait anxiety levels of the participants were measured using self-report scales. Orexin-A and cortisol levels were measured by an enzyme-linked immunosorbent assay (ELISA).Results: Analysis of covariance (ANCOVA) indicated that serum orexin-A levels were significantly higher in the anxiety disorder group than in the control group while controlling for age, sex and depression levels. After controlling for age and sex, orexin-A levels were positively and negatively correlated to depression and cortisol levels, respectively. In addition, a positive correlation trend between trait anxiety and orexin-A was found.Conclusions: Orexin-A levels are higher in adolescents with anxiety disorder; however, depressive symptoms should be considered when investigating this relationship.