CHRONIC ILLNESS, HOSPITALIZATION AND CHILD

Duygusal sorunlar, kronik hastalığa sahip çocuk ve ergenler ve ailelerde evrensel anlam taşımamalarına karşın, araştırmalardan gelen kanıtlar; kronik pediatrik hastalıkların psikolojik bozukluklar için esas bir risk etkeni oluşturduğunu göstermiştir. Kronik hastalıklarla beraber olan psikolojik sorunlarla sıklıkla ruh sağlığı konsultanları yüzleşirler. Bunları tanımlamak için bir yapıya ihtiyaç vardır. Hasta değerlendirilirken, klinisyenler, en azından teorik olarak, psikosomatik komponentin kronik hastalıkların her fazında var olacağını mutlaka hatırlamalıdırlar. Kronik hastalığa tepki, bireysel, gelişimsel ve çevresel etmenlerden etkilenir. Etkin psikiyatrik konsultasyon ve psikolojik yardım kronik hastalıkların tedavisi sırasında daha iyi prognoz ve uyuma yol açabilir. Although emotional disturbances do not mean universal in chronically ill children and adolescents and their families, the evidence from studies indicated that the chronic pediatric illness constitutes a substantial risk factor for psychological disorder. Psychological problems associated with chronic illness frequently confront the mental health consultant, and a framework for conceptualizing them is required. In evaluating a patient, the clinicians must remember that a psychosomatic component is at least theoretical possible in every phase of all chronic disorders. Reacting to the chronic illness is influenced by individual, developmental and environmental factors The effective psychiatric consultation and psychological support can lead to better prognosis and compliance during the treatment of chronic illness

Serum Brain-derived Neurotrophic Factor Levels among Euthymic Adolescents with Bipolar Disorder Type I

INTRODUCTION: Bipolar disorder (BD) has been increasingly associated with abnormalities in neuroplasticity and cellular resilience in brain regions that are involved in mood and that affect regulation. Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family that regulates neuroplasticity. The aims of the current study were to compare serum BDNF levels in euthymic adolescents with BD type I with those in controls and to investigate the relationship between clinical variables and serum BDNF levels in adolescents with BD type I. METHODS: Twenty-five adolescents diagnosed with BD type I and 17 healthy control subjects within the age range of 15–19 years were recruited. Diagnoses were made by two experienced research clinicians using the Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version and the affective module of Washington University in St. Louis Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia-Present State and Lifetime. Blood samples were taken during euthymia, which was defined as Young Mania Rating Scale and Hamilton Depression Rating Scale scores below 7. RESULTS: The comparison of BDNF serum levels between the case and healthy control groups revealed no significant differences. In the case group, BDNF levels were significantly lower in patients being currently treated with lithium. CONCLUSION: Similar to normal BDNF levels in adult patients with BD, the normal BDNF serum levels that we found in the euthymic state in adolescents and early adulthood may be related to the developmental brain stage in our study group. It may also show a common neurobiological basis of pediatric and adult BD. Further investigations evaluating BDNF levels in different mood states could help identify the role of BDNF in the underlying pathophysiology of BD

The validity and reliability of the social communication questionnaire-Turkish form in autistics aged 4-18 years

Objective: The Social Communication Questionnaire (SCQ) is a valid and reliable 40-item scale used to assess pervasive developmental disorders (PDDs). The aim of this study was to determine the validity and reliability of the SCQ-Turkish Form (SCQ-TF). Materials and Methods: The study included 100 children and adolescents aged 4-18 years; 50 were diagnosed as PDD and 50 were diagnosed with intellectual disability (ID) based on DSM-IV-TR criteria. The consistency, test-retest reliability, content validity, and discriminant validity of SCQTF for the groups in the study sample were evaluated. SCQ-TF was compared to the Childhood Autism Rating Scale (CARS), Autism Behavioural Checklist (ABC), and Clinical Global Impression-Severity of Illness (CGI-SI). The most appropriate SCQ-TF cut-off point was determined via ROC analysis. Results: The 4-factor structure of SCQ-TF accounted for 43.0% of the observed total variance. Correlations between SCQ-TF and the other measures were significant. The Cronbach's alpha value for the SCQ-TF total score was 0.80. The intraclass correlation coefficient (ICC) varied between 0.87 and 0.96, and the cut-off point was 15. Conclusion: The findings show that SCQ-TF is valid and reliable for use in Turkey in those aged 4-18 years

The Validity and Reliability of the Turkish Version of the Social Communication Questionnaire

OBJECTIVE: The Social Communication Questionnaire (SCQ) is a valid and reliable 40-item scale used to assess pervasive developmental disorders (PDDs). The aim of this study was to determine the validity and reliability of the SCQ-Turkish Form (SCQ-TF). MATERIALS AND METHODS: The study included 100 children and adolescents aged 4-18 years; 50 were diagnosed as PDD and 50 were diagnosed with intellectual disability (ID) based on DSM-IV-TR criteria. The consistency, test-retest reliability, content validity, and discriminant validity of SCQ-TF for the groups in the study sample were evaluated. SCQ-TF was compared to the Childhood Autism Rating Scale (CARS), Autism Behavioural Checklist (ABC), and Clinical Global Impression-Severity of Illness (CGI-SI). The most appropriate SCQ-TF cut-off point was determined via ROC analysis. RESULTS: The 4-factor structure of SCQ-TF accounted for 43.0% of the observed total variance. Correlations between SCQ-TF and the other measures were significant. The Cronbach's alpha value for the SCQ-TF total score was 0.80. The intraclass correlation coefficient (ICC) varied between 0.87 and 0.96, and the cut-off point was 15. CONCLUSION: The findings show that SCQ-TF is valid and reliable for use in Turkey in those aged 4-18 years

The Evaluation of Amygdala Volumes in Adolescents with Bipolar Disorder Type I

Amaç: Bipolar bozukluk (BB) tip I tanılı ergenlerde beyin görüntüleme tekniklerinden manyetik rezonans görüntüleme (MRG) kullanarak hastalıkla ilgili değişkenlerin amigdala hacimlerine etkisini araştırmak ve amigdala hacim farklılıklarını sağlıklı ergenlerle karşılaştırmaktır. Gereç ve Yöntem: Olgu grubunu, Dokuz Eylül Üniversitesi Tıp Fakültesi Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Anabilim Dalı’nda Ruhsal Bozuklukların Tanısal ve İstatistiksel El Kitabı IV (DSM-IV) tanı ölçütlerine göre BB tip I tanısı ile izlenmekte olan ve Mayıs 2008 ile Kasım 2008 tarihleri arasında Dokuz Eylül Üniversitesi Tıp Fakültesi Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Anabilim Dalı’na başvurup DSM-IV tanı ölçütlerine göre BB tip I tanısı alan 13-19 yaş arası 17 olgu oluşturmuştur. Kontrol grubunu, psikiyatrik değerlendirme sonucunda herhangi bir psikiyatrik tanı almayan 13-19 yaş arasındaki 12 ergen oluşturmuştur. Tüm hastaların beyin MRG incelemeleri 1,5 Tesla (Gyroscan Intero, Philips, Netherland) MRG cihazı ile standart kafa koili kullanılarak yapılmıştır. Olgular ötimik fazda MRG çekimine alınmıştır. Ötimik fazda olma ölçütü, Young Mani Derecelendirme Ölçeği ve Hamilton Depresyon Ölçeği ile değerlendirilmiştir. Bulgular: Olgu grubu ve kontrol grubu arasında sağ ve sol amigdala hacimlerinin karşılaştırılması sonucunda her iki grup arasında anlamlı bir fark bulunamamıştır. Olgu grubunda hastalık süresi ile sağ ve sol amigdala hacimlerinin ise negatif korele (sağ amigdala p=0,026; sol amigdala p=0,031) olduğu bulunmuştur. Sonuç: Ergen ve erişkin BB örneklemlerinde yapısal MRG ile saptanan amigdala hacim farkları erken başlangıçlı BB ile geç başlangıçlı BB arasındaki altta yatan patofizyoloji farklarını gösteriyor olabilir.Objectives: The aim of the present study is to investigate whether the variables of the disorder affect amygdala volumes in the adolescents with Bipolar Disorder (BD) type I and to compare the possible amygdala volume changes with healthy adolescents. Materials and Methods: Seventeen adolescents aged between 13 and 19 years, who had BD type I according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria that was either already been followed up or got the diagnosis after their admission to Dokuz Eylül University Faculty of Medicine, Department of Child and Adolescent Psychiatry between May 2008 and October 2008, were included in the study. Twelve adolescents between 13 and 19 years old and without any psychiatric diagnosis were included in the healthy control group. The magnetic resonance imaging (MRI) scans of all participants were performed by using an MRI machine with 1.5 Tesla power (Gyroscan Intero, Philips, Netherlands) and standard head coils. The MRI scans of the cases were made during euthymic phase. The phase of euthymia was defined according to Young Mania Rating Scale and Hamilton Depression Rating Scale. Results: The evaluation and comparison of both right and left amygdala volumes between the patient and the control group revealed no significant difference. However, in the patient group, negative correlation was found between right and left amygdala volumes and the duration of the disorder (for the right amygdala p=0.026; for the left amygdala p=0.031). Conclusion: The differences detected in amygdala volumes by structural MRI scans in adolescent and adult BD samples may reflect underlying pathophysiologic differences between the early onset and the late onset of the disorde

Allele frequencies of dopamine D4 receptor gene (DRD4) and Catechol-O-methyltransferase (COMT) Val158Met polymorphism are associated with methylphenidate response in adolescents with attention deficit/hyperactivity disorder: a case control preliminary study

OBJECTIVES: In this study, it was aimed to analyse the relationship between clinical improvement in adolescents with attention deficit/hyperactivity disorder (ADHD) and the presence of allele frequencies of dopamine D4 receptor (DRD4), and Val158Met polymorphism of catechol-O-methyltransferase (COMT) genes. METHODS: Thirty-four adolescents (age range, 13–18 years) with ADHD participated in this study. Thirty-two patients were males and two were females. Du Paul ADHD Rating Scale-Clinician version (ARS) and Clinical Global Impression-severity of impairment (CGI-S) were used for the evaluation of symptom severity. Fifty healthy age-matched adolescents were recruited as controls. RESULTS: When the groups with (n = 9) and without (n = 25) 7-repeat alleles for DRD4 were considered, there was a statistically significant decrease of DuPaul ARS total and hyperactivity scores in those treated with OROS-methylphenidate. When the Val/Met allele-positive group for COMT gene (n = 17) was compared with the Val/Val allele-positive group (n = 13) and Met/Met allele-positive group (n = 4), there was a statistically significant decrease of ARS total scores, ARS attention scores, and CGI scores in adolescents with ADHD treated with OROS-MPH. CONCLUSIONS: Specific data from further studies with a larger sample sizes would provide more insights to replicate the current findings

Executive functions and impulsivity in suicide attempter adolescents with major depressive disorder

OBJECTIVE: The aim of this study was to examine the relationship between executive functions and suicidality in terms of impulsivity and depression severity. METHODS: Depressed adolescents who have made a suicide attempt in the last year (n = 32), depressed adolescents without a suicide attempt (n = 30), and healthy controls (n = 30) participated in the study in Dokuz Eylul University Faculty of Medicine, Department of Child and Adolescent Psychiatry. Clinical diagnoses were made according to the DSM-IV by applying Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL). Data were collected by using a sociodemographic data form, the Beck Depression Inventory (BDI), Barratt Impulsiveness Scale, and the Children’s Depression Rating Scale – Revised (CDRS-R). To evaluate all participants’ intelligence scores, the Wechsler Intelligence Scale for Children (WISC-R) was applied for adolescents aged under 16 years, and the Wechsler Adult Intelligence Scale (WAIS) was applied to adolescents aged 16–18 years. To determine the performance-based executive functions, Wisconsin Card Sorting Test and Stroop Test were applied to all participants. RESULTS: In this study, the participants who had made a suicide attempt displayed lower performance in the Stroop Test, especially in part 1 and part 4 compared with the controls (p = .04 and p = .011). Depressive patients also exhibited lower performance in the Stroop Test in part 3 compared with the controls (p = .049). Impulsivity was found more severe in depressive patients compared with controls (p < .001). There were no statistically significant differences between depressive patients with or without suicide attempt in terms of depression severity. CONCLUSION: Executive dysfunction appears to be associated with suicidal behaviour in adolescents with the major depressive disorder. This findings need to be replicated with a larger sample size in the future