The efficacy of risperidone on the treatment of very-early onset skin picking disorder

Skin picking disorder (SPD) has frequently been reported to start before the age of 10; but "very-early onset" type was not defined before in the literature. Also, research on the treatment of SPD in childhood is limited. We presented a "very-early onset" SPD case whose symptoms have started on the age of 4 and escalated with her comorbid oppositional defiant disorder diagnosis. Patient was successfully treated with low dose (0.25 mg/day) risperidone and proper psychoeducational interventions. Identifying SPD in very early childhood is hard cause; criterion of SPD might not capture all the specific features which very young children manifest and clinicians might overlook their complaints. Efficacy of risperidone might reflect a shared psychopathological etiology between impulse control and SPD, and lead future research on treatment of SPD with atypical anti-psychotics

New aspects of being an adolescent mother: Comparison of psychosocial features between adult and adolescent mothers

Objective: Becoming a mother during the adolescence can cause additional burdens and adversities which might put these individuals at higher risk for psychosocial disturbances. Several studies have reported higher depression rates and worse parenting skills for adolescent mothers but results are contradicting and limited. In accordance with these issues, we aimed to compare perceived social support, selfconfidence in child-bearing, mother-infant bonding profiles and depressive symptoms of adolescent mothers with their counter-parts who got pregnant and gave birth in their medically accepted reproductive stage (between ages of 25 - 30). Methods: Our case group consisted of 47 adolescent mothers who were to our hospital due to pregnancy under the age of 18 and were in the time period of 12 to 18 months after giving birth; whereas control group of the study included total of 53 mothers who got pregnant between ages of 25 - 30 and were in the time period of 12 to 18 months after giving birth. Both groups were evaluated using Beck Depression Inventory (BDI), Multidimensional Scale of Perceived Social Support (MSPSS), Pharis Self-Confidence Scale (PSCS) and Mother to-Infant Bonding Scale (MTIBS) and scores were compared between groups. Results: Adolescent mothers were generally living with family elders (p=0.001), under-educated (p<0.001), unemployed (p<0.001) and mostly didn't receive any physical support for child-bearing (p=0.011). They also had lower MSPSS-Intimate (p<0.001) and MSPSS-Total (p<0.001) scores; whereas adult mothers scored lower on PSCS (p=0.001) and higher on BDI (p<0.001) and MTIBS (p<0.001). There was also a positive correlation between BDI and MTIBS (p<0.001). Furthermore, linear regression models showed that, education level difference was accountable for significant portions of differences in MSPSS-Intimate (p=0.013), MSPSS-Total (p=0.016), MTIBS (p=0.002) and BDI (p=0.003) scores; whereas occupational status was only accountable for significant portion of differences in PSCS scores (p=0.019). Conclusion: Majority of the adolescent mothers was less educated and unemployed; but had better mother-to-infant bonding profiles compared to their counterparts. Regression analyses showed that lower depression scores were accountable for this better mother-to-infant bonding profile among adolescent mothers. In addition, higher educated and employed adult mothers had lower maternal self-confidence in child bearing, worse mother-to-infant bonding profiles and higher depression scores. This might reflect possible protective role of more communal family structure and cultural features as well as negative effect of additional distress which working adult mothers may experience in their daily lives. Further studies with larger sample size and diverse cultural backgrounds are needed to better understand the interaction between various psychosocial features

Negative effects of accompanying psychiatric disturbances on functionality among adolescents with chronic migraine

Background Chronic migraine is a condition with gradually increasing prevalence among adolescents which causes severe headaches resulting in functionality loss. Factors contributing to migraine becoming chronic and negatively affecting quality of life in adolescence are still unclear. Parallel with these, we aimed to examine the effect of psychiatric symptoms on headache severity and functionality loss among adolescents with chronic migraine. Methods We evaluated features of 50 adolescents who were diagnosed with chronic migraine according to International Classification of Headache Disorders-3 for the first time in their lives by an experienced neurologist. Sociodemographic and clinical data were collected and Pediatric Migraine Disability Assessment Score, Visual Analogue Score and DSM-5 Level 1 Cross-Cutting Symptom Measure Scores (CCSM-5) were evaluated. Semi-structured psychiatric interviews were done to those who scored higher than cut-off scores on CCSM-5. Healthy control group was constituted of cases which had similar age and sex distribution to case group. Results Majority of the case group was female (%78). There was a positive correlation between headache severity and computerized tomography history in emergency department. All of the psychiatric symptom scores were significantly higher in case group except for psychotic symptoms; but attention problems and manic symptoms clusters did not have significant difference according to the thresholds of CCSM-5. Receiving a psychiatric diagnosis did not affect frequency, severity or duration of headaches. There were also no relationship between depression/anxiety diagnosis and severity of headache/functionality loss. Conclusion Findings suggest that; more rational treatment methods with lesser functionality loss should be developed by adopting multidisciplinary and prospective approach via psychiatric screening for adolescents with chronic migraine

Is attention deficiency hyperactivity disorder comorbidity not always a negative scenario for specific learning disorder?

Amaç: Özgül Öğrenme Bozukluğu (ÖÖB) başta Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB) olmak üzere sıklıkla diğer psikiyatrik bozukluklarla birlikte görülmektedir. Çalışmamızda ÖÖB tanısı almış olguların komorbid durumları, tedavi ve klinik izlemlerine dair verilerin literatür eşliğinde tartışılması amaçlanmıştır. Yöntemler: Çalışmamıza Ocak 2016 ile Mayıs 2021 tarihleri arasında kliniğimize başvuran, klinik görüşme ve uygulanan psikometrik testler ile birlikte Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı Beşinci Basımı (DSM-5) tanı ölçütlerine göre ÖÖB tanısı konan 18 yaş altı olgular dâhil edilmiştir. Toplam 232 olgunun sosyodemografik verileri, takip süreleri, komorbiditeleri ve aldıkları tedaviler geriye dönük olarak incelenmiştir. Bulgular: Olguların %68,1’ine en az bir psikiyatrik hastalık eşlik ettiği ve en sık birlikte bulunan tanının DEHB olduğu, %58,6’sının ilaç tedavisi kullandığı ve ilaç kullanan olguların en sık DEHB tanısına yönelik tedavi aldıkları saptanmıştır. Ayrıca olguların %71,6’sının 3 ay içinde tekrar polikliniğe başvurusunun olmadığı gözlenmiştir. DEHB komorbiditesi olan veya DEHB tedavisi alan olguların diğer gruplara göre poliklinik takip sürelerinin daha uzun olduğu ve tanı yaşlarının daha ileri olduğu bulunmuştur. Ayrıca DEHB komorbiditesi olan ve herhangi bir psikiyatrik ilaç tedavisi kullanan olguların tedavi terk oranlarının daha düşük olduğu saptanmıştır. Sonuç: ÖÖB ye en sık eşlik eden komorbiditenin DEHB olduğu, DEHB varlığı ve psikiyatrik ilaç tedavisinin olguların klinik takibini etkilediği belirlenmiştir. Sonuçların ÖÖB tanısının tek bir bozukluk olarak düşünülmemesi gerektiği ve komorbiditelerin tanı ve tedavi sürecindeki önemine vurgu yaptığı düşünülmüştür.Aim: Specific Learning Disorder (SLD) is often seen together with other psychiatric disorders, especially Attention Deficit Hyperactivity Disorder (ADHD). This study aimed to discuss the evaluation of comorbid conditions, treatment, and clinical follow-up in cases diagnosed with SLD, in light of the literature findings. Methods: Cases under the age of 18 who applied to our clinic between January 2016 and May 2021 and were diagnosed with SLD according to The Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) diagnostic criteria by clinical interview and applied psychometric tests were included in our study. Sociodemographic features, follow-up duration, comorbidities, and treatments of a total of 232 cases were retrospectively examined. Results: We found that 68,1% of participants had at least one psychiatric comorbidity and the most frequent comorbidity was Attention Deficit Hyperactivity Disorder (ADHD); 58.6% were using some medical treatment and the majority of patients who used medication were under ADHD treatment. Furthermore, 71.6% did not continue follow-ups for more than 3 months (drop-out). Patients who had ADHD comorbidity or were under ADHD treatment had longer follow-up durations and older ages at diagnosis compared to other groups. In addition, drop-out rates were lower in patients who had ADHD comorbidity and were using any psychiatric medication. Conclusion: The most common comorbid condition accompanying SLD is ADHD. It was determined that ADHD and psychiatric drug treatment affected the clinical follow-up of the cases. It was concluded that the results have emphasized that SLD should not be considered as a single disorder and the importance of comorbid conditions in the diagnosis and treatment proces

Comparison of referrals to a university child and adolescent psychiatry out-paiıent unit before and during the Covıd-19 pandemic

AMAÇ: COVID-19 salgınının fiziksel etkilerinin yanında; hem hastalık kavramının hem de alınan tedbirlerin ruh sağlığı kliniklerinde takip edilen çocuklar üzerindeki etkilerinin dikkatle izlenmesi ve ortaya konması çok önemlidir. Çalışmamızda, pandemi öncesi ve pandemi sırası dönemlerdeki çocuk psikiyatrisi poliklinik başvurularının karşılaştırılarak pandeminin hasta profili ve poliklinik pratiğine etkilerinin ortaya konması amaçlanmıştır. GEREÇ VE YÖNTEM: Türkiye’de ilk COVID-19 vakasının bildirildiği 11 Mart 2020 tarihinden önceki (pandemi öncesi [PÖ]) ve sonraki 14 aylık dönem (pandemi sırası [P]) boyunca üniversitemizin çocuk psikiyatrisi polikliniğine yapılan girişlerin tamamı geriye dönük olarak incelenmiştir. P’nin ilk 7 ayı “pandeminin ilk dönemi (PİD)”, son 7 ayı ise “pandeminin son dönemi (PSD)” olarak ayrıca araştırılmıştır. Tüm hastaların yaşları, cinsiyetleri ve psikiyatrik sorunları ayrıntılı olarak kaydedilmiş ve karşılaştırılmıştır. BULGULAR: Toplam poliklinik başvuru sayısı PÖ’ne göre P’de %45,9 azalmış; PİD’ne göre PSD’nde %82,5 artmıştır. Tanılar özelinde başvuru sayıları PÖ’ne göre P’de; dikkat eksikliği ve hiperkativite bozukluğu ve depresif bozukluklar için belirgin azalma, obsesif-kompulsif bozukluk, anksiyete bozuklukları, özgül öğrenme bozukluğu ve kişilik bozuklukları için belirgin artış göstermiştir (her biri için p<0,001). PİD’ne göre PSD’nde ise başvuru sayıları; kişilik bozuklukları için artış, davranım bozukluğu, obsesif-kompulsif bozukluk ve anksiyete bozuklukları için azalma göstermiştir (her biri için p<0,001). SONUÇ: COVID-19 pandemisinin getirdiği psikolojik stresörlere rağmen P’de poliklinik başvurularının azalmış olması bu kişilerin ihtiyaçları olmasına rağmen psikiyatrik desteğe yeterince ulaşamadıklarını göstermektedir. PSD’nde poliklinik başvurularında oldukça keskin bir artış izlenmesi de, uzun dönemde ruh sağlığı desteğine olan talebin artabileceğini vurgulamaktadır. Psikiyatrik sorunların COVID-19 pandemisinden nasıl ve ne ölçüde etkilendiğini tam olarak ortaya koyabilecek gOBJECTIVE: It’s essential to carefully assess and define the effects of illness conception and precautions related to COVID-19 pandemic, in addition to it’s physical effects, on children followed-up in psychiatry clinics. We aimed to define the effects of pandemic on patient profile and clinical practice by comparing child psychiatry out-patient unit referrals before and during the pandemic. MATERIAL AND METHODS: All child psychiatry out-patient referrals during 14-months periods before (before pandemic [BP]) and after (during pandemic [DP]) the official announce of first COVID-19 case in Turkey on 11 March 2020 were retrospectively examined. First (PFP) and second (PSP) 7-months periods of DP were additionally explored. Age, gender and psychiatric problems of all referrals were recorded and compared. RESULTS: Total referrals decreased by 45.9% in DP compared to BP and increased by 82.5% in PSP compared to PFP. For the diagnoses, rates of attention deficit-hyperactivity disorder and depressive disorders significantly decreased; whereas obsessive-compulsive disorder, anxiety disorders, learning disorders and personality disorders significantly increased in DP compared to BP (p<0.001 for each). Rates of personality disorders significantly increased; whereas conduct disorders, obsessive-compulsive disorders and anxiety disorders significantly decreased in PSP compared to PFP (p<0.001 for each). CONCLUSIONS: Despite the psychological stressors came along with COVID-19 pandemic, dropping rates of referrals in DP shows these individuals cannot access psychiatric support even if they need it. Sharp increase in referral rates in PSP might implicate growing demand for psychiatric support in the long run. Further studies with larger samples and longitudinal design are needed in order to fully define how and to what extend psychiatric problems are effected by COVID-19 pandemic

Evaluation of personality features and mental state of keratoconus patients

Objectives: Keratoconus (KCN) is a disorder that usually appears during adolescence and progressively reduces visual acuity. KCN may lead to differences in personality features as a result of vision loss and the numerous clinical examinations and treatment methods used from a young age. The aim of this study was to better understand the psychological characteristics of KCN patients and to define possible correlations between corneal topographic parameters and psychological state. Methods: A total of 59 KCN cases were included in the study group and were compared with 65 age- and sex-matched healthy individuals. All of the participants underwent a routine ophthalmic examination that included corrected distance visual acuity (CDVA), biomicroscopy, and fundoscopy. The KCN patients were evaluated busing Scheimpflug corneal topography. Psychiatric evaluations were performed using the Eysenck Personality Questionnaire Revised-Short Form (EPQ), the Self-Confidence Scale, the Maudsley Obsessive-Compulsive Inventory (MOCI), and the Beck Depression Inventory (BDI). Results: The mean age of the case and control groups was 23.98±5.7 years and 25.82±5.4 years, respectively. The KCN cases had significantly higher EPQ neuroticism subscale scores; higher MOCI subscale scores, with the exception of the doubting subscale; and higher BDI scores. Analysis of the KCN duration revealed a positive correlation with the checking and slowness subscales of the MOCI, however, there was no significant correlation between the psychometric scale scores, corneal topographic parameters, and CDVA. Conclusion: A substantially asymmetrical course and a relatively long period for KCN to result in severe vision loss might explain the lack of correlations between psychological parameters and visual acuity. Nonetheless, the apparent effect of vision loss on emotional distress cannot be disregarded; the day-to-day progressive loss of visual acuity and multiple, costly interventions may initiate or contribute to a depressive mood in KCN patients. A vicious depressive cycle and the exhaustion of long-term coping mechanisms might be underlying factors for the higher neuroticism scores seen among KCN patients. Both the personality traits and mental state of KCN patients demonstrate distinguishing properties; clinicians working with these patients should consider their mental state in addition to other factors in order to achieve better treatment outcome

Hiccups associated with switching from quetiapine to aripiprazole in an adolescent patient

Aripiprazole has a distinct place amongst other antipsychotics with its partial agonist-antagonist effect on dopaminergic and serotonergic receptors. Several case reports are associating aripiprazole to hiccups, but most of them are in the adult age group. The exact pathophysiologic mechanisms underlying this side effect are still fairly unknown and case reports displaying this phenomenon in adolescent patients are scarce. We report an adolescent bipolar patient who developed hiccups right after panic-like symptoms while switching from quetiapine to aripiprazole. Switching from a more potent D2 and 5HT1A antagonist to aripiprazole seems to increase the risk of hiccups as a side-effect. It should be emphasized that clinicians using aripiprazole for the treatment of adolescent patients should be mindful of this rare and fairly unknown phenomenon, especially in the early stages of drug initiation and while increasing the dosage

Hiccups associated with switching from quetiapine to aripiprazole in an adolescent patient

Aripiprazole has a distinct place amongst other antipsychotics with its partial agonist-antagonist effect on dopaminergic and serotonergic receptors. Several case reports are associating aripiprazole to hiccups, but most of them are in the adult age group. The exact pathophysiologic mechanisms underlying this side effect are still fairly unknown and case reports displaying this phenomenon in adolescent patients are scarce. We report an adolescent bipolar patient who developed hiccups right after panic-like symptoms while switching from quetiapine to aripiprazole. Switching from a more potent D2 and 5HT1A antagonist to aripiprazole seems to increase the risk of hiccups as a side-effect. It should be emphasized that clinicians using aripiprazole for the treatment of adolescent patients should be mindful of this rare and fairly unknown phenomenon, especially in the early stages of drug initiation and while increasing the dosage

Psychoeducation Can Ameliorate Somatic and Manic Symptomatology in Youth at High-Risk for Bipolar Disorder: A Randomized-Controlled Study

Background: Given the high hereditary rates for bipolar disorder (BD), offspring of BD patients (high-risk [HR] group) are perfect candidates for research on early detection and prevention strategies. Psychoeducation is a structured and systematic intervention, in which the knowledge of the illness and its treatment is transferred to the patient and/or family in a didactic approach and it is a core component of psychotherapeutical interventions. Several studies which explored the effectiveness of these interventions in HR youth reported positive out-comes; but these were mainly focused on symptomatic HR and none of them were done among asymptomatic HR. Therefore with this study, we aimed to evaluate the effect of psychoeducational intervention on asymptomatic HR youth

Dikkat eksikliği ve hiperaktivite bozukluğu tanılı çocuk ve ergenlerde Akdeniz diyeti alışkanlıkları ve semptomlar üzerine etkileri

Objective: Attention deficit hyperactivity disorder (ADHD); is a common neurodevelopmental disorder with multifactorial etiology. Despite the dominant role of the genetic factors; environmental factors such as diet related features may have effect on ADHD diagnosis and symptomatology. In our study we aimed to compare Mediterranean diet (MD) habits of ADHD group with healthy controls and explore the effect of MD on ADHD symptom severity. Method: All participants were evaluated with semi-structured psychiatric interviews and total of 113 individuals with ADHD and 120 healthy controls were included. Socioeconomic and clinical features of both groups were examined. Adherence to MD was evaluated with Mediterranean Diet Quality Index (KIDMED) and ADHD symptomatology was evaluated with Turgay scale. Results: ADHD group had lower KIDMED scores and worse adherence to MD compared to healthy controls. "Medium adherence" to MD increased the risk of ADHD diagnosis two-folds and "low adherence" to MD increased the risk of ADHD diagnosis five-folds compared to "good adherence". Total KIDMED scores and MD adherence levels were negatively correlated with inattention symptoms. Discussion: Adherence to a healthy diet (MD) seems to be related to lesser inattention problems in addition to lower rates of ADHD diagnosis and this indicates the importance of a "healthy diet" not only in the occurrence of ADHD, but also in the clinical symptomatology. certain dietary habits may play a role in both ADHD development and clinical appearance; but further evaluation is needed to shed light on causality and to determine if dietary manipulation could ameliorate ADHD symptoms