Pedophilia: Clinical Features, Etiology and Treatment

There is a growing recognition that child sexual abuse is a critical public health problem. Child sexual abusement is not a medical diagnosis and is not necessarily a term synonymous with pedophilia. According to DSM-IV, a pedophile is an individual who fantasizes about, is sexually aroused by, or experiences sexual urges toward prepubescent children (generally <13 years) for a period of at least 6 months. It is difficult to estimate the true prevalence of pedophilia because few pedophiles voluntarily seek treatment. Most of the available data are based on individuals who have become involved with the legal system. Most individuals who engage in pedophilia are male. When compared with other sex offenders, pedophiles are in the older adult age range (age, 40-70 years). Pedophiles may engage in a wide range of sexual acts with children. These activities includes exposing themselves to children, looking at naked children, masturbating in the presence of children, physical contact, rubbing, fondling a child, engaging in oral sex, or penetration of the mouth, anus, and/or vagina. Generally, pedophiles do not use force to have children engage in these activities but instead rely on various forms of psychic manipulation and desensitization. People with pedophilia use internet to be a vehicle capable of meeting their needs: obtaining information, monitoring and contacting victims, developing fantasy, overcoming inhibitions, avoiding apprehension, and communicating with other offenders. The compulsive-aggressive trait is more pronounced in people with pedophilia. Generally they plan the sexual offending with the intention of relieving internal pressures or urges. Pedophiles generally experience feelings of inferiority, isolation or loneliness, low self-esteem, internal dysphoria, and emotional immaturity. There are likely multiple factors and multiple pathways involved in the development of pedophilia. Since there has been no treatment method that can alter the pedophile’s sexual orientation toward children, much of the focus of pedophilic treatment is on stopping further offenses against children. The combination of pharmacologic and behavioral treatment coupled with close legal supervision appears to help reduce the risk of repeated offense. Currently chemical castration; testosterone suppression by antiandrogenic therapy is a popular treatment option. Effective prevention is most effective means to manage the sexual abusement of children. For primary prevention and treatment, it is necessary to know the characteristics of pedophilia and understand the factors that lead to the development of the pedophilic tendencies

Treatment of Pediatric Bipolar Disorder

Although once pediatric bipolar disorder had been perceived as a very rarely seen psychiatric disorder, studies conducted within the last two decades revealed that this disorder is more often than assumed. Childhood and adolescent onset bipolar disorder causes and leads serious familial and academic disturbances, more frequent subtance use, precarios sexual intercourses, adolescent pregnancy and tendency to delinquency. Lifelong functionality is worse than adult onset. It could be more difficult to be diagnosed and could take longer time period for the diagnosis than adult onset. Difficulties of compliance to treatment can be seen more frequently because of the behavioural age characteristics of this group. Diagnostic controversies about the pediatric bipolar disorder also led disagreement about the treatment. In this review treatment approaches in the child and adolescent onset bipolar disorder have been discussed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000): 92-106

Genetic Basis of Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric disorders of childhood. Due to studies reporting that the effects of ADHD diagnosis on functioning may last throughout life, this disorder, which has great importance for child and adolescent psychiatry, started to attract greater attention recently in terms of adult psychiatry. A review, evaluating the results of studies conducted on the genetic basis of ADHD, which started to attract increasing attention both in our country and the world, was thought to help clinicians working in this field. PubMed and Turkish Psychiatry Index online search engines were screened using “attention deficit hyperactivity disorder”, “ADHD”, “genetics” as key words. The data obtained were combined with information gleaned from several textbooks. Based on previous studies, it could easily be concluded that ADHD is one of the most common heritable psychiatric disorder with distinguished genetic features. Despite its importance for diagnosis and treatment, the etiology of ADHD is still not clear and the disorder seems to be a complex problem arising from the effects of both genetic and environmental factors. Although previous studies revealed that ADHD displayed familial and hereditary transmission, stable patterns of Mendelian inheritance could not be discriminated by evaluation of pedigrees. Therefore, many studies have been conducted on the molecular genetic basis of ADHD recently. The previous studies did not report consistent results in identification of the genes responsible for ADHD which has been partially linked to heterogeneity of the disorder. Grouping relevant patients according to comorbidities and persistence in adolescence rather than DSM-IV subtypes could be an important alternative method for overcoming this limitation in the research studies

Neurobiological, Psychosocial and Environmental Causes of Violence and Aggression

In psychiatric practice psychotic disorders, mania, substance and alcohol related disorders, antisocial and borderline personality disorders, attention deficit hyperactivity disorder, conduct disorder, mental retardation, organic brain syndrome, delirium, stereotypical movement disorders, trichotillomania, eating disorders and other obsessive-compulsive spectrum disorders, pervasive developmental disorders, major depressive disorder, mixt episodes are closely related with agression towards surrounding and other people and towards self. Although as in suicide agression and violence are not always related to prominent psychopatology, violence and agression are closely associated with crime. In some societies, especially ritualistic agressive behaviours towards self are perceived as culturally normative. Sex, temperamental and cognitive patterns, medical factors also neurobiological and neuropsychiatric causes like neurotransmitters and hormonal factors and their metabolism, glucocorticoid and cholesterol metabolism, genetic factors and also ecological, toxical, nutritional factors, psychosocial and psychodynamic factors can be related with development and severity of agression and violence towards surrounding, other people and towards self. Although it is accepted that there isn&#146;t single explanation of the individual differences about the tendency to violence, there are contradicting points of view among researchers about the most significant risc factor. Probably development or alleveation of violent behavior is influenced by the reciprocal interaction between psychosocial, psychodynamic, temperamental, neuropsychiatric, enviromental, genetic factors, parenting styles, quality of nurturition and education and school mental health interventions. Positive psychosocial, familial, educational factors, psychiatric interventions, protective mental health quality and positive government political attitudes can restorate negative genetic, neurobiological individual tendencies to crime. In this review all these factors related with violence and agression above and possibly related psychological, genetic and neurobiological factors with suicide and agression towards self will be reviewed

The recognition and management of psychological problems among child and adolescent with chronic and fatal disease

WOS: 000263263200009The child with a serious medical illness is at greater risk for developing emotional problems. Unlike a child with a temporary sickness, the child with a chronic illness must cope with knowing that the disease is here to stay and may even get worse. The children are hurt emotionally by the uncertainity about illness and treatment. Chronic illness also affects psychological health of their parents. Hence, in addition to the physical aspects it is necessary also, to focus on the psychological health of the child and their parents in order to ensure compliance and thus treat the child comprehensively. It is important to develop a supportive communication with the child and his family for the sake of treatment and effective interventions. To meet children's needs for information and support in health care settings, it is necessary to understand the children's level of understanding about the illness, hospitalization process, and death. The purpose of this paper was to review the information on the recognition and management of the psychological problems that accompany chronic physical illnesses in children and adolescents. Also in this paper the information of children's level of understanding about the illness, hospitalization process and death are reviewed. (Anatolian Journal of Psychiatry 2008; 9:244-252

Epidemiology in Pediatric Bipolar Disorder

Childhood and adolescent bipolar disorder diagnosis has been increasing recently. Since studies evaluating attempted suicide rates in children and adolescents have shown bipolarity to be a significant risk factor, diagnosis and treatment of bipolarity has become a very important issue. Since there is a lack of specific diagnostic criteria for especially preadolescent samples and evaluations are made mostly symptomatically, suspicions about false true diagnosis and increased prevalence rates have emerged. This situation leads to controversial data about the prevalence rates of bipolar disorder in children and adolescents. The aim of this article is to review the prevalence of childhood and adolescent bipolar disorder in community, inpatient and outpatient based samples in literature

Evaluation of Gender Role Perceptions in Adolescents According to Sociodemographic Factors

WOS: 000441304600009Objective: The main focus of the study is to evaluate the relationship between the development of gender role perception during the adolescence and the social demographic backgrounds such as sex; age; educational level, financial situation and working status of the parents. Methods: One hundred individuals aged between 12 and 17 were chosen as a study group. To analyze the sociodemographic backgrounds of the participants, a semi-structured questionnaire designed by the researcher was applied to all subjects. To describe the sexual role and gender role perceptions of each individual, two existing measures are used: "BEM sex role inventory" (BSRI) and "gender roles attitude scale" (GRAS). Results: The subcategories of "gender roles attitude scale" (GRAS) (egalitarian gender roles, female gender roles, marriage gender roles, traditional gender roles and male gender roles) were significantly different according to different age and gender groups. Similar results were obtained for the subgroups of "BEM sex role inventory" (femininity, masculinity, and neutral) as well. Furthermore, the novel finding of this study was the significant relationship between the educational and financial situation of the parents and the gender role perception in their children. While children of the families with low education and low income were more prone to have traditional view; the children with highly educated parents, working mother and high income tended to have more egalitarian view. Conclusion: Results of the present study clearly suggest that certain sociodemographic backgrounds of adolescents are significantly associated with certain aspects of their gender role perceptions

Olanzapine associated peripheral edema: a case report

Peripheral edema is most commonly associated with multiple medical etiologies and drugs including nonsteroidal anti-inflamatory, antihypertensives, steroids, and immunosuppresive agents. The atypical antipsychotic olanzapine is rarely related with peripheral edema. However relationship of olanzapine and edema remains as a hypothesis. In this case report a peripheral edema developing shortly after initiation of treatment in a patient with schizophrenia is reported and theoretical explanations of this phenomenon are discussed